How Workers’ Compensation Carriers in Colorado Prey On Injured Workers

Denver Workers Compensation

How do attorneys tend to pitch their services…they tell potential clients that insurance carriers will take advantage of their knowledge of the system and the injured workers’ lack of knowing the system. There is no truer example of this than the following:

In CO, when an injured worker is assigned a psychological impairment that results from a work-related injury, their compensation benefits, typically, are limited to 12 weeks of the injured worker’s weekly wage loss benefits. For example, an injured worker who receives $500 per week in wage loss benefits and receives a 5% psych. impairment that equates to $15,000 in compensation benefits; is typically limited to $6000 [$500 x 12 weeks]. HOWEVER, THERE ARE 2 EXCEPTIONS TO THE RULE LIMITING THE INJURED WORKER’S COMPENSATION BENEFITS in this context.  One, which I will discuss herein, is that IF the psych. impairment results from a “crime of violence”, the limitation DOES NOT apply.  In other words, if the injured worker was assaulted at work, their compensation is not limited to 12 weeks.

So why do I feel compelled to write all of this? It certainly in dry and boring, but here is my point.  I had a client of mine who was assaulted at work.  The worker’s compensation carrier KNOWING THAT MY CLIENT WAS ASSAULTED limited her benefits to 12 weeks.  Because we are experts in workers’ compensation, we “corrected” the carrier’s lack of understanding (a kind way of stating that we didn’t let the carrier screw our client) and forced them to admit for the correct amount of benefits which yielded an additional $11,000.  Without our assistance, our client would never have known that they were getting taken advantage of and being stripped of the benefits they were entitled. THIS TYPE OF STUFF HAPPENS ALL OF THE TIME.  WHETHER YOU CONSIDER THIS A PITCH OR CONSIDER THIS A SERVICE ANNOUNCEMENT TO THE COMMUNITY,  KNOWLEDGE IS POWER; USE IT!

What to Do if Your Workers’ Compensation Case in Colorado is Denied

Denver Workers Compensation

In some cases, getting compensated in the aftermath of an injury might not be as easy as you initially anticipated. In the vast majority of circumstances, workplace injuries are covered by employers with worker’s compensation insurance. This doesn’t mean your claim will be accepted. If your case is denied, there are still some options and you have the power to appeal to the denial and try to reverse the outcome of the situation. Appeals happen through the state’s board of workers compensation – but before trying that route, it is important to understand why your particular case has been denied. To cover every possible scenario and to gain a better perspective of the situation, as well as your own rights, it might be wise to hire an attorney to consult and assist you through the process.

Specific regulations will vary from state to state, but there are many reasons why your worker’s comp claim could have been denied.

Perhaps, you did not report your injury on time. If you wait too long before reporting an injury, you might not receive any compensation. Some workers try to hide their injury, or ignore it, trying to soldier through it to avoid losing working hours and income. On the other hand, failing to attend an injury and rest might actually worsen the situation, and it might come back and haunt you at a later date. Some people experience symptoms of an injury only days after an accident, and if the event has not been reported promptly, they might risk not receiving anything. Even if it doesn’t seem serious at first, always report your injury and file your claim in a timely manner.

Some injuries, on the other hand, are simply not eligible for compensation. This is often the case of stress-related injuries, since the exact root of the problem is often very difficult to prove with transparency.

In certain cases, your comp claim could have been denied because your employer disputed the claim. Perhaps, claiming that the injury did not indeed happen at the work place, or that it was caused by horseplay on the injured part.

This article barely scratches the surfaces: there are many reasons why a comp claim could be denied, and if you think the decision is unfair in your case, consult an attorney and appeal for a chance of reversal.

What is the IWP and What Does it Do?

Denver Workers Compensation

IWP is an organization that focuses on delivering medicinals at the homes of injuries individuals. This is not exactly like your average mail-order pharmacy, as IWP’s service is particularly geared towards people who have experienced recent injuries. Read on to learn more about some of IWP’s most distinctive marks and perks.

 Fast turnaround and prompt assistance for people of all walks of life.

 When affected by injuries, immediate care is absolutely essential. This is the reason why IWP pledges to deliver prescriptions with an extremely fast turnaround. Normally, the service is able to deliver prescription meds within the span of 7 to 14 days, which is absolutely remarkable. At a small additional overcharge, customers can even request convenient next-day delivery, when immediate delivery is essential.

With locations spread throughout Massachusetts, Arizona and the state of California, IWP has a growing and effective infrastructure to cater to people throughout the country. IWP is committed to serving customers efficiently, regardless of their background. For this reason, the actually offer flexible language services through a dedicated customer services that can answer to requests in English, Spanish, Italian, Polish and many other languages and dialects. This way, IWP can ensure clarity and user-friendliness when serving customers of different cultural heritages – boasting the same excellent high standards for everyone.

Ultimately, this service is particularly perfect for people looking for prompt assistance and for a truly understanding relationship with a pharmacy.

For additional information, resources and know-how, please visit IWP’s official website:

www.iwpharmacy.com

How Your Work Injury Can Affect Your Home Life

Denver Workers Compensation

Getting injured could become the gateway to a wide range of issues, and the aftermath of an accident should never be taken lightly.

Injuries are scary to deal with. In some cases, the effects of an accident could have lasting impacts on your daily routine. Some people are stuck with post-injury symptoms that they need to deal with for the rest of their lives, including chronic pain, arthritis and more. In some cases, pain can be managed with the help of physical therapy, painkillers or alternative solutions such as acupuncture. On the other hand, certain injuries could deeply affect the lifestyle of an individual’s home life. In some unfortunate scenarios, people affected by injuries might no longer continue with their works – this is particularly common in fields such as athletics, where people who get injured might sometime be unable to keep pursing their sport professionally.

The aftermath of an accident, particularly when it debilitates people and impairs their ability to work and provide for themselves, could cause a wide variety of collateral mental symptoms, such as stress, depression or anxiety. In a vicious circle of irony and damage, such mental issues, could in turn cause yet another layer of physical ailments, including high blood pressure and cardiac problems. An injury should not be taken likely, as it can be a gateway to a wide variety of problems that might affect you in ways you can’t even imagine. It’s a great idea to stay positive and promptly focus on recovering, but it is also important to fight for a compensation, when possible. Hiring an attorney could help your voice be heard and give you a better chance of a fair treatment.

Gerard Smith Q/A – Dealing with the Aftermaths of a Sporting Injury

Denver Workers Compensation

Many athletes throughout the world struggle to deal with the aftermath of a sporting injury. Not only is recovery daunting for an athlete, but it might pose an entire career at risk. In addition to that, getting compensated for an injury might be quite difficult in certain circumstances. In order to learn more about the process, please read on to learn about Gerard Smith, an athlete who agreed to talk to us provided we altered his name (yes, Gerard Smith is indeed an alias) and avoid to disclose the true nature of his sportsmanship and athletic affiliation.

Gerard took the time to answer a few of our questions and let us known about his stories, feelings and thought related to an injury he experienced some time ago. For legal reasons, Gerard is not really at liberty to discuss his case or divulge actual personal information, but his answers certainly shed some light on some issues that many athletes across the world can easily relate to. Please read on to find out more.

Q: You recently fell victim of a sporting injury. What was the most challenging aspect of the aftermath of that particular event?

 A: One of the most challenging aspects of the injury was the uncertainty that came after it. To this day, I still don’t know when, and whether I will recover fully. The situation is causing me financial loss, as well as other personal issues such as low morale. To make things worse, getting the right compensation for my injury, which was due to a third party’s negligence, was actually harder than I had anticipated.

Q: How did your injury affect your career?

A: As i mentioned earlier, the injury put a lot of uncertainty on my career. it is scary to think you might need to stop doing what you do for a long time, or worse of all, that you might never fully recover.

Q: What would you say to fellow athletes who might go through the same thing you had to endure, and what advice would you give them?

A: First and foremost, stay strong and set your priority straight. Seek legal help as soon as you can and have a clear view of your options. Your physical recovery is obviously going to be your first priority, but if you deserve compensation, don’t let it slide and even if you think the scales would tip in your favor, always hire an attorney, if only for peace of mind.

Thank you for your time and your thoughtful answers. We wish you all the best with your recovery and we’re sure you’ll be up and ready to hit the game soon!

You Won’t Believe the Unusual Injuries Covered by Workers’ Comp

You Won’t Believe the Unusual Injuries Covered by Workers’ Comp

Denver Disability Denver Workers Compensation

Workers Compensation is an important employee benefit and right. It’s designed to pay for treatment associated with injuries and illnesses that occur as you perform duties associated with your job. However, it can cover eight unusual injuries you may have never considered before now.

Company Events

At the company picnic, you trip while playing volleyball and sprain your ankle. Your injuries could be covered by Workers Comp. File a claim if you’re injured or become ill during a company-sponsored picnic or party, business meeting held off-site, corporate ballgame or any special event you attend because of work.

Lunch Breaks

You walk into the lunch room for your break, slip on the wet floor and break your elbow. Your injuries could be covered by Workers Comp. You could also consider filing a claim if you’re injured while picking up lunch at the corner deli for your boss since technically you are working, but your injuries won’t be covered if you are injured while grabbing lunch for yourself or a co-worker.

Travel

You’re rear-ended while driving to work and suffer whiplash. If you’re in your personal car, you can’t file a Workers Comp claim, but if that same accident happens while you drive a company car, you could be eligible for Workers Comp. It can also cover injuries that occur as you travel to business meetings, to meet clients or while visiting potential and current customers.

Diseases and Illnesses

Your company decides to remodel the offices, and you work on the same floor as the repairs. Because of the asbestos in the old ceiling tiles, you develop black lung disease. File a Workers Comp claim for this and other diseases or illnesses that occur because of your work.

Hearing Loss

After working in a noisy environment for a few year, you notice that you can’t hear as well as you used to. File a Worker Comp claim, talk to your Denver disability attorney and receive compensation for your impairment if you can prove that the hearing loss happened while you were on the job.

Mental Health Conditions

Your boss micromanages every project and places so much pressure on you that you can’t even go to work. Consider filing a Workers Comp claim if you become chronically stressed, depressed or traumatized on the job. Be prepared to prove that your condition is caused 100 percent by your work, and ask a medical professional to help you prove your case.

Pre-existing Conditions

The ruptured disc in your back was repaired years ago and hasn’t bothered you until you started performing repetitive lifting tasks for your job. Now, you may be able to file a Workers Comp claim because your job aggravated your preexisting condition.

Misconduct

While showing off your muscles for a cute co-worker, you lift a chair and promptly drop it on your foot. Your injury could be covered by Workers Comp since it can cover injuries even if they occur as you break a company safety rule or perform a criminal act. Before you decide to embrace misconduct, though, remember that it does not usually cover self-inflicted injures and you give up your right to sue your employer if you file a Workers Comp claim.

These eight areas are unusual but could fall under Workers Comp. As with any Workers Compensation claim, you must prove that the illness or injury was caused by your job and is work-related. Contact your Denver workers compensation attorney today to learn more. We’re here to help you figure out if you can file a claim, and we’ll work with you to get you the benefits you deserve.

The Importance of Securing a Comprehensive Workers’ Compensation Settlement

The Importance of Securing a Comprehensive Workers’ Compensation Settlement

Denver Workers Compensation Greeley Workers Compensation Lawyer

If you are eligible for workers’ compensation benefits due to a work injury, the payments and medical care you receive are typically finite. Once your treating physician okays your ability to return to work, your benefits end. This is the situation in temporary disability cases. But what if you suffer a permanent disability?

Maximum Medical Improvement

At some stage during your care, you will reach a point where your recovery is at an endpoint. This means that you are not likely to continue improving, even if you are not back to your pre-injury state. If your injury was severe, it’s possible that you may not be physically able to return to the workforce. When this is the case, you may continue receiving weekly benefits through worker’s compensation or request a lump sum, subject to a 4% per annum reduction. Some permanently injured workers may want to consider a settlement that covers future financial and medical needs.

Normally, in a settlement arrangement, the employer and insurer pay a certain sum of money to the injured worker to settle all past, present and future financial obligations. In return for these settlement funds, the employee gives up any and all future demands and claims against them. Therefore, a workers’ compensation settlement must be very carefully negotiated to ensure that that all your current and future needs will continue to be met.

When you sign a settlement agreement, you give up the following rights under the workers’ compensation benefits system:

Temporary disability benefits
Permanent disability benefits
Permanent total disability benefits
Future medical treatment
Disfigurement compensation
Penalty fees against the insurance company and/or your employer
The right to reopen your case
The right to make any claims for additional benefits for unknown injuries
Your attorney should be able to negotiate these expenses, claims, and potentialities into your settlement agreement, because you only get one shot at this. Barring very minute exceptions, once you sign your settlement agreement, you are stuck with the consequences.

Reopening Your Settlement

In Colorado, when you enter into a settlement agreement, you give up the right to reopen your workers’ compensation case due to a mistake or if your condition worsens. It may be possible to reopen the settlement agreement, but only if you can prove fraud or that a mutual mistake of material fact occurred.

Mutual Mistake of Material Fact

This is a high bar to meet. The mistake must be one made by both sides of the agreement, and it must be an error that has essential bearing on your case. Higher unanticipated bills or additional medical treatment requirements do not constitute a mutual mistake of material fact. Discovering a new medical problem may not qualify either, even if you discover that this previously unknown medical issue was the result of your settled work injury. Fortunately for Victor England, this wasn’t the case.

England v. Amerigas Propane

This case is an example of the stringent requirement for reopening a workers’ compensation settlement agreement. The Colorado Supreme Court decided the case on September 30, 2017. Truck driver England was injured in 2012, and he entered into a settlement agreement governed by the Colorado Worker’s Compensation Act. In 2013, England’s doctor discovered a previously undiagnosed stress fracture to his scapula. The settlement form used included a paragraph prohibiting a reopening of the settlement unless there was fraud or mutual mistake of material fact. England petitioned the ALJ to reopen his settlement and won, but the employer appealed, and the Court of Appeals ruled against the employee. England appealed to the Colorado Supreme Court, which finally agreed that this issue demonstrated a mutual mistake of material fact. His case was reversed and remanded.

Turn to an experienced and knowledgeable Colorado workers’ compensation lawyer to help you determine the best approach when you have been seriously injured at work. If a settlement agreement is your best option, your attorney can skillfully negotiate terms that will ensure your continued care and financial stability in the wake of your injury. Get a free review of your workers’ compensation case with our expert Denver area workers’ compensation attorneys now.

What a Difference An “AND” Makes In Colorado Work Injuries

What a Difference An “AND” Makes In Colorado Work Injuries

Denver Disability Denver Workers Compensation Greeley Workers Compensation Lawyer

THE Industrial Claims Appeals Office (ICAO) HIGHLIGHTS A MAJOR LIMITATION ON MAINTENANCE MEDICAL CARE

Intersection between a law with a later statute creates a major distinction for injured workers’ medical care rights.

Lola Chism injured her left shoulder in July 2009 in an admitted work injury.  Following what was described as “considerable” physical therapy, and two surgical procedures her treating physician placed her at Maximum Medical Improvement(MMI) in January 2011.  The treating physician recommended, and the insurance carrier admitted for, future maintenance medical benefits.

Injured Colorado workers are entitled to medical benefits following an on-the-job injury “to cure and relieve effects of the injury.”  CRS §8-42-101(1)(a).  In 1988 the Colorado Supreme Court interpreted that law as requiring Colorado Workers Compensation Insurance carriers to pay for all medical care “to relieve the worker from the effects of the industrial injury” based upon the rationale that it “is an obvious fact of industrial life, however, that an injured worker can reach maximum medical improvement from an injury and yet require periodic medical care to prevent further deterioration in his or her physical condition.”  Grover v. Industrial Commission, 759 P.2d 705, 710 (Colo. 1988).

However the Colorado Legislature added a formal, statuotry definition of MMI as the “point when any physical impairment is stable and “no further treatment is reasonably expected to improve the condition.” That definition excluded from ‘further treatment’ any “future medical maintenance.”  CRS § 8-40-201 (11.5).

Ms. Chism continued to have ongoing physical therapy for her shoulder after MMI as maintenance care.  In December of 2015 the treating physician referred her to a surgeon who recommended a reverse total arthroplasty   The employer challenged the proposed treatment, however an ALJ ruled that the surgery should be approved, finding it reasonable and necessary to “cure and relieve” the effects of the injury. The employer appealed.

The ICAO determined the obligation to “cure” the effects of the injury ends at MMI because of the later 1991 statutory definition of MMI that declares “no further treatment is reasonably expected to improve” the injured worker’s condition.  Thus, ICAO reasons, only treatment that will relieve but not cure the work injury can qualify as maintenance care.

The ICAO remanded the case back to the Administrative Law Judge for further consideration if the proposed treatment would just “relieve” the injury, noting that there was no “bright line” test to distinguish between those treatments.  Because six years had passed after the injury, Ms. Chism cannot reopen her work injury claim, she is limited to maintenance care.  If this surgery is curative – it has to be denied under the ICAO’s parsing of the statute.

 

CITE:  Chism v. Walmart, WC No. 4-809-103-03, (January 9, 2017).

Appeals Office Shifts the Burden to Injured Workers in Responsible for Termination Claims

Appeals Office Shifts the Burden to Injured Workers in Responsible for Termination Claims

Denver Disability Denver Workers Compensation Greeley Workers Compensation Lawyer

Injured Workers must now be ready to provide evidence explaining that work absences weren’t their fault.

Injured workers who lose their job while treating for a work injury are entitled to lost wage benefits, called Temporary Total Disability.  However the Colorado Legislature changed the law allowing employers to avoid paying lost wages to injured workers when they are “responsible” for their termination.

Until now, the burden to prove this allegation has rested squarely upon the employer.  The employer must not only prove that the injured worker did – or failed to do – something that led to his or her termination – but that that it is was volitional on the part of the injured worker.  For example if a worker is fired for being late to work three times in one week, the employee could show that the absences were caused by circumstances outside his or her control.

Nicholas Coleman worked as a housekeeper and suffered a low back injury in late 2014.  However in February 2015 he was incarcerated for violating his parole and as a result stopped coming to work and was terminated.  After his release in August 2015 he sought lost wage benefits.  The employer denied claiming that Mr. Coleman was responsible for his termination.

At hearing, although the employer did introduce evidence that Mr. Coleman stopped coming to work, and that Mr. Coleman had been incarcerated for violating his parole – there apparently was no evidence why or how Mr. Coleman violated his parole.  Reasoning that the employer had failed to show proof as to whether the parole violation was volitional, the Administrative Law Judge was unwilling to assume that it was and awarded benefits.

The Industrial Claims Appeals Office (ICAO) remanded the case back for a further hearing and testimony.  The ICAO imposed the burden not on the employer, but the injured worker.  “Typically, when an employer introduces evidence that a claimant has failed to show up for work when scheduled, this amounts to a prima facie case satisfying the employer’s burden of demonstrating the claimant was at fault for the job separation. See Lucero v. Industrial Claim Appeals Office, 812 P.2d 1191 (Colo. App. 1991)(employer’s initial burden to show claimant was discharged for disqualifying reasons). The claimant must then introduce exculpatory evidence or evidence showing that his failure to show up for work when scheduled was non-volitional. See Gonzales v. Industrial Commission, supra (disqualification for failure to meet defined standards, unless the claimant is not at fault in the circumstances).”

This burden-shifting is a major departure from traditional litigation when a a party must prove each and every statutory requirement.  Now, employers may simply be able show that a worker was fired in accordance to policy without showing that the worker acted volitionally.  Then if the employee doesn’t provide an explanation, the employer will win.  This case highlights another reason why injured workers need experienced and dedicated attorneys.  Workers Compensation Law Changes weekly and you or your loved one needs an attorney who keeps up with these changes.

 

Source Citation:  Coleman v. Starmark Holdings, WC No. 4-969-560-02, (January 9, 2017)

 

Federal Workers Question Whether OWC Choice of Referee Physicians is Truly Impartial

Denver Workers Compensation Greeley Workers Compensation Lawyer

A group of former federal workers have called into question the impartiality of the Office of Workers Compensation (OWC) when choosing referee doctors. Seven former government employees, led by Blake Brown, filed a lawsuit under the Freedom of Information Act (FOIA) in an attempt to uncover bias in the actions of the OWC. The suit seeks the past 10 years of statistics for Colorado orthopedic doctors who were selected as referees in contested workers’ compensation claims.

Referee Doctors

Under the Federal Employees’ Compensation Act (FECA), injured federal workers must provide proof of their injury via a doctor’s opinion. Many workers opt for treatment by their own physician or a doctor of their choosing. The worker must also submit to examination by a doctor designated by the OWC. When these two physicians cannot agree on the injury or cause, the OWC must resolve the dispute with impartiality. This is meant to be accomplished with a “randomly” chosen referee physician.

The OWC uses software that searches for doctors within 25 miles of the zip code of the injured employee. If the doctors on the generated list are unable or unwilling to provide the needed service, the software then expands the search radius to include physicians in an ever increasing geographical area until a willing and available physician is located. In theory, this method should tap a revolving panel of doctors with no bias in selection. Brown and his fellow plaintiffs believe that this system has been compromised.

Suspected Bias

Brown, et al. suspect that the OWC has actually been referring the same small pool of referee doctors over and over on purpose. They allege that by using this “select pool” of physicians, these doctors become financially reliant upon the assignments. This then influences their decisions in favor of the OWC. The federal workers cite a specific orthopedic doctor that has been used in a referee capacity for the OWC repeatedly. They argue that this physician has weighed in on numerous workers’ compensation cases where the zip codes of the injured employees have been far outside of the initial 25-mile radius, despite the presence of other orthopedic doctors within a closer range.

FOIA Request

The federal workers requested OWC records for the referee selection process under FOIA, to investigate their suspicions. The focus was predominantly on orthopedice doctors and the previous 10-year period. They also specifically asked for screenshots of the scheduling software menus. They received redacted records in response, obliterating physician names and addresses, and no screenshots.

The missing information led to the filing of a suit to received partially un-redacted records. Brown, et al. don’t challenge redacting of employee information. They simply challenge removal of the physician info. The district court denied their requests, and they appealed.

Tenth Circuit Court of Appeals Ruling

The 10th Circuit Court has now weighed in on the case. They disagreed with the lower court and reversed that court’s decision on August 29, 2016. Because some of the redacted data at issue are the physicians’ business addresses, the expectation of personal privacy is impacted. They remanded the case for additional proceedings.

With this turn of events, it’s likely that the plaintiffs in this case may finally receive the information they need to truly investigate their claims, and determine if there is a showing of bias in the OWC’s selection of orthopedic doctors. If this is the case, the situation will likely become far more complicated.

If your rights have been violated in a Colorado Workers’ Compensation claim, don’t hesitate to contact Kaplan Morrell for skilled legal guidance. We have been championing the rights of injured Colorado workers for nearly two decades. Call (866) 356-9898 to schedule a free consultation.