The Truth About the Affordable Care Act and Workers’ Compensation

The Truth About the Affordable Care Act and Workers’ Compensation

Denver Workers Compensation
The Affordable Care Act (ACA) presented changes in healthcare coverage that often became controversial. Knee-jerk reactions from insurance companies and human resources organizations believed the ACA would either reduce care quality in workers’ compensation or encourage fraud.

Independent non-partisan studies showed these fears were unfounded. In fact, the ACA did more to help workers’ compensation claims and reduce fraud. These are the myths often stated about the ACA and workers’ compensation and the truth of these issues.

Myth: The ACA will crowd out Denver workers’ compensation patients as demand for primary care increases.

Truth: Studies show that the increased demand has not affected access and quality of care for workers’ compensation patients.

The ACA increased health insurance coverage which created a run on primary care. Doctors received more patient files and that was expected to decrease the quality of care for those receiving treatment under a workers’ compensation policy.

A comprehensive report by the National Council on Compensation Insurance, Inc. (NCCI), concluded that there was no significant impact to care access. Medicine has always been a demanding field and that did not change with the ACA. Clinics and hospitals adapted to the new demand for primary care. Patients received better treatment overall for all their needs, including any workers’ compensation claims.

The same report showed that 68 percent of primary care services occurred during the first 10 days of a workers’ compensation claim. Basically, these claims start off as being demanding on healthcare providers but eventually taper down to become manageable. That allows the issue to even out across the board as providers adapt to patients’ needs.

Myth: The ACA increases the possibility of workers’ compensation fraud.

Truth: Due to increased access, there are fewer reasons to file a workers’ compensation claim and that will likely reduce fraud.

Workers’ compensation coverage can be a result of cost-shifting. When a worker is underinsured, doctors may classify the injury or illness as a workplace injury. This allows the claim to become a workers’ compensation matter that reduces costs to the worker.

Cost shifting was most common with pre-existing conditions. When insurance companies were allowed to deny coverage for those injuries or illnesses, it created a desperate situation where fraud became preferable to declining treatment.

Now, pre-existing conditions are covered and that reduces the need to classify a condition as a workplace claim to guarantee coverage. Two reports, the NCCI one and another independent study by Cognizant, indicate overall claims and fraud decreased since the passage of the ACA.

Myth: Doctors are more likely to label a condition as a workplace injury because they receive more for reimbursement.

Truth: While the insurance industry feared this development, it never played out.

This is related to the crowding-out concern. As doctors face higher case loads, they may be concerned about being paid for all these patients. ACA policies do not pay out as much as workers’ compensation ones so doctors become more willing to believe fraudulent claims and push for workers’ compensation rather than a routine healthcare claim.

However, this has not played out. Workers’ compensation claims decreased overall with no evidence of fraud becoming more widespread. As stated earlier, workers are not as dependent on the workers’ compensation to receive healthcare. The same incentive for fraudulent claims does not exist anymore.

Myth: The ACA will raise workers’ compensation medical costs.

Truth: The support of preventative care reduces claims and also medical costs.

Cognizant reported that in Massachusetts, workers’ compensation claims reduced by 16.7 percent and workers’ compensation hospital costs decreased between five and 10 percent. The ACA reduced costs from the supply side and that affects all healthcare, even that covered by workers’ compensation. This is especially true in states that adopted a Medicaid expansion and increased coverage to more people.

Preventative care played a role as well. For example, obesity prevention programs reduced workers’ compensation costs by three to four percent.

The areas of workers’ compensation and healthcare are complex and that often leads to misunderstanding and rumors. These myths can lead to uninformed decisions and mishandling of your claim. Contact our Denver Workers’ Compensation Attorneys today to get help with or a review of your Colorado workers’ compensation case.

Workers’ Compensation Fraud: 4 Stories of Those Who Were Caught

Workers’ Compensation Fraud: 4 Stories of Those Who Were Caught

Denver Workers Compensation

Workers’ compensation fraud is a problem, due to propaganda, most think the fraud is perpetuated by the workers; however, employers also commit fraud by intentionally misclassify employees to widespread insurance schemes. These schemes cost the system money and detrimentally impact injured workers who rightfully deserve workers’ comp benefits.

Fortunately, most big money scams are eventually uncovered. Here are some stories of workers’ comp fraud over the years that made headlines when the perpetrators were caught.

Massive Medical Insurance Scam

An alleged California medical insurance scam racked up nearly $100,000 in false workers’ compensation medical claims. The fraudulent money-making scheme involved seven people, and was apparently spearheaded by a chiropractor. Several clinics treated injured workers and submitted inflated bills for exaggerated injuries and more. The businesses brought in more than $12 million in payments with their scam. Penalties for the charges they face can include up to 97 years in prison.  


FedEx Delivered Fraud in Multiple States

Well-known package-delivery company FedEx found themselves in hot water last year to the tune of $240 million! This proposed settlement was the result of a common scheme some employers use to avoid paying workers’ compensation and other employee-related costs and benefits. It involved fraudulently classifying employee as independent contractors, and dates back to litigation that began in 2005. The settlement was approved for $227,000 earlier this year. About 12,000 drivers in 19 states will receive payments of various amounts from the total.


Fake and Fraudulent Florida Construction Company


In this recent case, Leon Jimenez, the owner of a construction company, ran a widescale workers’ compensation scam. The company didn’t even perform any construction work. Instead, Jimenez was selling workers’ compensation certificates to subcontractors for profit. The subcontractors got their bogus certificates and the employees were left exposed to the risk of uncovered work injuries. Jimenez was arrested for workers’ compensation fraud, false documentation, grand theft, and various other charges that may carry up to 30 years in prison.


If you’ve been injured on the job and you believe that your employer or his insurer is behaving unfairly or illegally, contact an experienced workers’ compensation attorney like Kaplan Morrell to protect your rights.


How Trump May Affect Workers’ Compensation In Colorado

How Trump May Affect Workers’ Compensation In Colorado

Denver Disability Denver Workers Compensation Workers Compensation Blog

The new Trump administration has ushered in some changes that many Americans weren’t quite prepared for, and much of the impact is not yet fully known. After all, he’s only been in office for a little over four months, and many changes are yet to come. With respect to workers’ compensation (work comp) benefits, the potential effect has not been fully realized. However, it appears that the greatest potential impact will come from the repeal of the Affordable Care Act (ACA) and budget cuts.

Healthcare Reform

In Colorado and many other states, the ACA, more popularly called Obamacare, has generated a favorable trend in work comp claims. Claim rates and costs have been dropping, and this movement is very likely due to increased worker access to healthcare. In its 2016 report, the Upjohn Institute for Employment Research identified a strong correlation between the decreased work comp claims and costs and the uptick in health insurance coverage.

Joe Paduda of Health Strategy Associates delves even deeper into the link between Obamacare and work comp claims. He alleges that workers who are hurt on the job have less reason to pursue care through their employer’s work comp insurance if they have their own health insurance.

Further, other health issues that may impact their work injury can be covered by the worker’s insurance, rather than work comp. For example, an employee with high blood pressure would need additional treatment for his hypertension before he could undergo a necessary work-related surgical procedure. However, when the worker has health insurance, his coverage would bear the additional cost, rather than work comp.

The proposed repeal and replacement efforts of Trump and the Republican-led House has thrown millions into uncertainty with respect to healthcare coverage. The most recent version of the new TrumpCare coverage, the AHCA, has the potential to take away health insurance from 14 million Americans by next year, according to the Congressional Budget Office (CBO) estimates. And the number of insured is expected to continue increasing over the next 9 years.

These dire projections could spell big trouble for work comp. Uninsured workers would likely once again turn to work comp for as much medical coverage as possible. These changes would also disproportionally affect older employees, workers in higher risk jobs and many who currently receive coverage through Medicaid. These issues will equate to increased claims and higher costs.

Budget Cuts and Safety Issues

Trump has also proposed budget cuts and safety reform rollbacks that will have adverse effects on the work comp system. While the Obama administration was moving towards establishing minimum workers’ compensation benefit standards on the state level, the Trump administration has expressed no interest in pursuing these reforms.

Repeal of an Obama-era OSHA safety regulation could have a detrimental impact on injured workers, as well. The “Volks” rule requires dangerous industry employers to keep health and safety incident records for five-and-a-half years. But Congress changed that to just six months, and Trump signed off. This minimum record-keeping requirement may prevent identification of frequent and repeated safety issues with many companies, and make it much more difficult for their employees to obtain work comp benefits when injured.

If a disabled worker is receiving both Social Security Disability Insurance (SSDI) and work comp benefits, the total may not exceed 80 percent of the average earnings that the worker was receiving before he became disabled. It they do, the SSDI benefits are reduced to offset the overage. In 15 states, this works in the reverse. Instead, it is the work comp benefits that are offset. On May 23, Trump released information on his most recent budget plan with proposed cuts. The Workers’ Compensation Reverse Offset faces elimination in 15 states, of which Colorado is one. With this change, work comp will need to make up the shortfall that the government has been covering via SSDI, hence, raising costs.

Overall, it appears that the Trump administration will be bad news for work comp in Colorado, and throughout the nation. And that’s only addressing what we know so far. If you have questions about these pending changes, or other workers’ compensation issues, please contact us for answers.




Kalin: Obamacare has had an impact on workers’ compensation claims in Colorado

AHCA, CBO, and Workers’ Comp

Four Ways the New Administration Will Influence Workers’ Comp

Choose with Care: Executive Fiscal Conservation and Public Projects

Choose with Care: Executive Fiscal Conservation and Public Projects

Denver Workers Compensation Workers Compensation Blog

When a worker is injured on the job in Colorado, his or her disability lawyer can file a claim for lost wages. That means if an accident causes you to miss work and the accident occurs on a worksite or is not your fault, you are likely entitled to compensation from the state based on your wages. The law in Colorado allows for these benefits but not all states are the same. Though different states work on compensation claims differently, the direction different states take with their compensation laws can be telling of general trends or where compensation laws go in our states.

In Illinois, for example, Governor Bruce Rauner demands the makers of the law agree to what he calls a “Turnaround Agenda.” This agenda is classic political posturing, good branding, and a catchy title intended to do a lot of things that directly affect injured workers. Among other questions addressed in this agenda, it plans to limit settlements juries and judges can award in lawsuits and restrict workers’ compensation protection. In addition, he plans to get rid of prevailing wage laws.

Greeley workers’ compensation attorneys certainly work to find workers’ compensation coverage in an injured worker’s case, if at first an insurance company denies coverage for any number of reasons. For Illinois, a restriction of protection for injured workers could mean anything from restricting the kinds of injuries that are covered to limiting which workers can receive benefits. For example, usually someone has to work full time as an employee of a company to receive compensation benefits. Already, plenty of workers who are injured are denied compensation based on these requirements. Gov. Rauner proposes to restrict compensation benefits even more, making more work for workers’ compensation attorneys in Illinois.

RELATED: 5 Things the Insurance Company Does Not Want You To Know About Workers Comp

Prevailing wage laws, or PWLs, are a requirement for local governments to pay the prevailing county wage on public projects. Those public projects are actually funded by taxpayers, so on paper this makes sense. Certainly, you wouldn’t want to over-pay workers on public projects because the extra money comes directly from the taxpayer’s pocket. The question of paying low wages on things people use every day as part of their lives (highways, for example) is another thing entirely. PWLs answer this question as well. By paying a standard wage based on county, builders can insure workers make a fair wage. It’s not astronomical but it’ll help people get by, which is all workers can honestly hope for in many situations.

Think of PWLs as an emergency low, just in case a company contracted to work on a public project wants to lower wages for any reason. Taxpayer dollars are intended to create a minimum standard or comfort in an area. Governor Rauner wants to cut government spending and it seems like a good place to start is with PWLs. Studies, on the other hand, suggest PWLs do not present a significant cost to taxpayers and should not be pointed at when governments seek to cut government spending.

The Federal Highway Administration, a Colorado analysis of highway construction projects, and Pennsylvania’s Keystone Research center have all shown PWLs have zero negative impact on government costs. Just the opposite is true, according to Frank Manzo IV, the policy director of the Midwest Economic Policy Institute. A PWL makes sure the workforce that takes on a project is qualified and able to get the job done correctly, which is so important with public projects like highways specifically because, as mentioned, we all use those services daily to do everything from get to work to see family.

It seems like Governor Rauner’s plan for Illinois is based on cutting funding by reducing programs on which ordinary people rely. While all of us probably agree that fiscal responsibility is important, lawmakers and particularly executives have to pick their battles with the public good in mind.

Workers’ Compensation can be difficult, confusing, and very complex. Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve. Contact our Denver Disability Attorneys Here or call us at(866) 356-9898 for your free consultation.


Roadside Manners: Work Zones and Tragedy

Roadside Manners: Work Zones and Tragedy

Denver Disability Denver Workers Compensation Social Security Blog Workers Compensation Blog


Almost everyone who drives to work knows the major annoyance that follows. Imagine you are driving to work along a familiar route when suddenly construction appears, almost as if from the pavement, and suddenly the commute that usually takes you twenty minutes takes thirty or more. Most working people who have to be at work by a certain time are hyper aware, sometimes to the minute, of the exact amount of time a commute takes. Denver disability lawyers are no different. Unless you have the great good fortune of having been born a morning person, this familiar struggle is a real issue for working adults. So much so that often when we see those road work signs, if circumstances are right—ie: running late to work, having a rough morning already, in desperate need of that latte—we are tempted to speed through the work area at our usual pace, positive the road workers are trained and prepared for this inevitable eventuality.

In Colorado in 2013, there were eleven crashes in work-zones, which resulted in 14 deaths. In 2014, there were nine crashes, resulting in 10 deaths. Clearly, work zone signs generally encourage us to be more careful around people. After all, those who work on roads or in outdoor construction have very little protection from the elements and especially vehicles. Officially, 85 percent of deaths that occur around construction zones involve drivers and their passengers, leaving just 15 percent of those deaths to include the actual road workers. On a national level, more than 600 people are killed and almost 40,000 injured in work-zone crashes annually. Disability attorneys can help those who are injured and the families of those killed but caution is the best measure we can take when rushing to work or home in work zones.

RELATED: Roadside Accident Had Worker Suffering for 5 years and Counting

Workers who help construct roads are, of course, aware of the inherent risks of their job. And Denver disability lawyers would be the first to point out that almost any injury suffered in this situation would likely qualify for workers’ compensation, but bereaved families receive little consolation from this fact. Looking at the statistics, on average, about seven drivers and one highway worker are killed in any workweek. For many families, the dangers of road work and the importance of caution are not simply encouraged or understood to be important in a vague way, they are the cornerstone of visceral family tragedy.

Eladio Lopez, father of Frank Lopez, was fixing potholes on I25 by 84th avenue on June 4th of 2004 when April Garcia crashed into Lopez and Paul Forster, his co-worker. The crash and complications from it killed both men. April Garcia’s blood-alcohol level was twice the legal limit for driving when she crashed her car. When she was sentenced in 2005, road crews from the Colorado Department of Transportation came into the courtroom wearing their bright vests in a show of sympathy, as if to say “this could be any of us. This affects all of us.” Garcia’s sentence was the maximum: 24 years for two counts of vehicular homicide.

Frank Lopez has kept his father’s memory alive by visiting the headquarters of the Colorado Department of Transportation to remember the 59 road workers, including his father, killed in work zones on state and interstate highways in Colorado. The Colorado Department of Transportation has begun to hold an annual Remembrance Day in honor of those workers who lost their lives, at the same time observing National Work Zone Awareness Week. The names of the fallen workers are highlighted every year and people are reminded to stay aware of work zones and the people who risk their lives to make our morning, afternoon, or evening commute a little easier every day.


Workers’ Compensation can be difficult, confusing, and very complex. Kaplan Morrell has helped thousands of injured workers get the benefits they deserve. Contact our Denver and Greeley Workers’ Compensation Attorneys at (866) 356-9898 for your free consultation.

Schools and the Importance of Open, Honest Communication

Schools and the Importance of Open, Honest Communication

Denver Disability Denver Workers Compensation

This winter, Casey Middle School in Boulder reportedly moved classes from classrooms to the library because of sewer gas smells. As any Denver disability lawyer could say, bad smells are often not the only detriment of smelling sewer gas, but the school’s principal indicated complete lack of awareness of the smell and the movement of classes. In January, Pete Rast  (a father of one of the students at the middle school) exchanged emails with the principal, Justin McMillan. Rast asked McMillan to confirm the movement of classes, the potential updating of parents, and what the hydrogen sulfide monitors were.

The email exchange was important. Disability attorneys often prefer to have statements in writing because it holds parties accountable to what was said, as opposed to simple phone conversations. However, the emails revealed not only did the principal of the middle school not know the readings of hazardous chemicals in his school, he had until that point been unaware classes had been moved due to sewer smells at all. When he was asked what the real reason was, since the sewer smells excuse was what the children had told their parents, McMillan did not have a response.

The superintendent of the school district has repeatedly said the middle school is safe and believes the issue with the sewer gas is less a safety issue and more an image issue at this point. Attorneys luckily did not need to get involved because the children and teachers were all safe. However, open and honest communication is vital in matters related to health and wellness, particularly where children and school safety is concerned.

Hopefully, the lessons taught at Boulder’s Casey Middle School will last and serve as a teaching example of how to handle rumored relocation of classrooms.

Workers’ Compensation can be difficult, confusing, and very complex. Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve. Contact our Denver Disability Attorneys Office here or call us at (866) 356-9898 for your free consultation.


Source: article-14213-differences-of- opinion-on-safety-remain-for- casey-school.html


Worker’s Comp News: Passenger Killed in Auto Accident Involving RTD Transport

Worker’s Comp News: Passenger Killed in Auto Accident Involving RTD Transport

Denver Disability Denver Workers Compensation

A few weeks ago, a passenger in a crash was ejected and killed on I-225 in Colorado. Denver disability attorneys help clients who were injured or disabled in accidents but crashes, particularly fatal ones, are a different type of law. However, if an accident happens while on the way to work or during the course of one’s duties, disability lawyers might be able to make an argument that the crash was work-related, as long as the correlation between driving and working can be proven.

At about 4:45, Denver police responded to a rollover accident in I-225 and 6th avenue. The passenger was thrown from the driver’s car and neither were on the RTD bus. Both the passenger and the driver were taken to the hospital. While the passenger died, the driver has non-fatal or life-threatening injuries. The driver lost control of his car and neither the driver nor the passenger was wearing a seatbelt.

Related: Roadside Accident Had Worker Suffering for 5 years and Counting

Denver disability attorneys often receive questions about personal injury cases and how a person ought to receive care upon incident. Of course, the system is very complicated but extremely related to workmen’s compensation if the incident occurs during the course of an individual’s workplace duties. Once an accident occurs, insurance companies ought to be alerted as often, insurance will cover medical treatment and provide some compensation for lost wages. This system can be very difficult to navigate if a person is unfamiliar with the nebulous web of injury law. As in any case, it is best to defer to experienced experts in the field to resolve a question to the benefit of the injured party.

Workers’ Compensation can be difficult, confusing, and very complex. Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve. Contact our Denver Disability attorneys here or call us at (866) 356-9898 for your free consultation.



Prosthetic Limbs, Disability & Workers’ Compensation- How Things Factor In

Prosthetic Limbs, Disability & Workers’ Compensation- How Things Factor In

Denver Disability Denver Workers Compensation Social Security Blog Workers Compensation Blog

Hugh Herr lost both his legs to amputation following a mountain climbing injury when he was just 17 years old. Thanks to the marvels of modern technology, Herr now walks with prosthetic limbs and has been quoted saying the idea of physical disability will either be completely eliminated or changed beyond recognition within the next few decades. This is good news for disability lawyers who work hard to meet their clients’ needs when a person is disabled and seek help to receive the reimbursement to which he or she is entitled.

However, prosthetic limbs present a thorny problem for those same disability attorneys. If a prosthetic limb is damaged, is it considered a personal injury or an injury to property? The best prosthetics mimic limbs in a number of interesting and functional ways. People who had limbs amputated can move a prosthetic as easily and naturally as they could a natural limb. Microprocessors receive instructions from electrical signals from muscles above the prosthetic. Newer prosthetics will allow for both mental direction of the prosthetic and provide sensory feedback to the user the same way those with natural limbs receive sensory feedback.

Related: Pre-existing Condition and Job Loss

Early cases that have to do with this issue would hint that precedence provides that prosthetics are considered property. Denver disability lawyers may beg to differ with the advances in technology. After all, if a prosthetic limb provides the same kind of sensation as a natural limb, how can injury to the prosthetic be considered anything but a personal injury? There is some hope in the case law, however, as earlier rulings have thrown out prosthetics to qualify for workers’ compensation because the prosthetics are static and inanimate objects. There may be hope yet for users of prosthetic limbs filing workers’ compensation claims in the future.

Workers’ Compensation can be difficult, confusing, and very complex. Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve. Contact our Denver & Greeley Workers’ Compensation Attorneys here or call us at (866) 356-9898 for your free consultation.




How the Pain Diagram Can Help (Or Sink) Your Work Injury

How the Pain Diagram Can Help (Or Sink) Your Work Injury

Denver Disability Denver Workers Compensation Social Security Blog Workers Compensation Blog

Don’t underestimate the power of a “Pain Diagram”. At the very least, a Pain Diagram should be completed every time you see the primary care physician. Ideally, a Pain Diagram should be completed any time a physician or therapist examines you.

A Pain Diagram can be helpful in a couple of different ways.

First, the diagram can help the physician track the progression of injured workers’ symptoms in relation to the treatment modalities being provided.

Second, the diagram can help the physician keep track of the areas of the body that are injured/symptomatic. It is not unusual for treatment for a Colorado work injury to be concentrated on one part of the body at a time. As long as the Pain Diagram continues to document the original injuries/symptoms, the relatedness of the symptoms to the original work related injury should be much easier to prove.

As always, how this or any other issue we discuss in this blog would apply to your case depends on many more factors. We urge you to call us to see if you are entitled to workers’ compensation benefits. Workers Compensation is difficult, confusing, and very complex. Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve. Contact Denver Workers Compensation Attorneys or call us at (866) 356-9898 for your FREE CONSULTATION.

Work Safety: Why Aren’t Plants Doing A Better Job Minimizing Risk & Work Related Injuries?

Work Safety: Why Aren’t Plants Doing A Better Job Minimizing Risk & Work Related Injuries?

Denver Workers Compensation Social Security Blog Workers Compensation Blog

Ralph Horner, 54, was killed on the job on June 10th at a JBS Greeley, Colorado meat-packing plant. He was working by a conveyer belt which caught his hair and arm, pulling the man into the machine and killing him.

The Occupational Safety and Health Administration fined JBS $45,500 for one repeated and one serious violation of work safety law. For Ralph Horner and his loved ones, however, the citation cannot come close to setting the incident right.

OSHA has looked at JBS’s safety record before. In 2010, the company was slapped with citations for repeated work injury exposure. Workers have suffered crushed hands and fingers, amputation, and blindness as a direct result of unguarded or improperly guarded machines.

Read More About OSHA And The Lessons Workers Should Learn From A Superhero Movie

There are ways to work in these sorts of plants that minimize risk and exposure to work-related injuries. However, it is too soon to tell if this tragedy will catalyze systematic change in favor of work safety at JBS.

Workers’ Compensation can be difficult, confusing, and very complex. It’s important that an injured worker has an experienced attorney working on their side- the insurance companies have experienced lawyers on their side too- don’t forget that!  If you or a loved one has experienced a work injury, get a FREE consultation from our experienced Colorado workers compensation attorneys. We can help you get the benefits you’re entitled to by law. Call us at (866) 356-9898.