Claims News Archive

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First Responder at Pulse Nightclub Cannot Claim PTSD on Workers’ Compensation


On June 12, 2016, the Pulse nightclub in Orlando gained international attention as the scene of the deadliest mass shooting by a single gunman in U.S. history, and the deadliest terrorist attack on U.S. soil since Sept. 11, 2001. Forty-nine people were killed and 53 were injured.

First responders swarmed to the scene.

One, 12-year veteran Orlando police officer Gerry Realin, told the Orlando Sentinel that his small hazmat team normally handled operations such as drug bust clean ups rather than moving bodies, but that he and six other officers worked for hours after the massacre handling victims “with dignity.”

His work in those hours led to a diagnosis of PTSD. However, he cannot receive workers’ compensation benefits. Florida’s law on injuries to first responders does not cover wounds that are only psychological.

The New York Daily News has the story.


Never Run Out of Time: Avoiding Treasury Collections in Injury-Related Cases



The main function of an effective Medicare compliance program is to reduce future exposures and liabilities. An emerging trend in this area is the avoidance of conditional payment recovery referrals to the U.S. Treasury Department. These occur when formal collection processes fail to either identify or resolve conditional payment matters in personal injury and workers’ compensation claims. Now is the time for attorneys and claims professionals to review their compliance programs and prevent future...

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Pennsylvania Supreme Court to Review Franchisor as Possible Statutory Employer


When is an employer not an employer? Ah, perhaps in the world of franchises.

The Pennsylvania Supreme Court has agreed to hear a workers' compensation case to decide if a franchisor is liable as a statutory employer for injuries sustained by a franchisee employee.

Frank Gaudioso worked at a Saladworks restaurant. On March 14, 2011, he walked out of the back of the store to throw away a box, and slipped and twisted both of his knees. On May 26, 2011, he petitioned for benefits against Saladworks. The company did not have workers’ compensation coverage, and on Sept. 7, 2011, Gaudioso filed a separate claim petition against the Uninsured Employers Guaranty Fund.

Then the guaranty fund filed a petition to keep out of it, and Saladworks filed a petition saying it had “no relationship” with Gaudioso.

Penn Record has the story and current status. 


Limited Exposure: Making the Most of the Relationship With Your Excess Carrier



Your excess workers’ compensation carrier can be a huge ally when it comes to management. The primary role of an excess carrier is to reimburse insureds for workers’ compensation benefits paid above a self-insured retention (SIR). Many do not realize, though, that their carriers also can help minimize claims exposures in large cases.

On the Same Team Excess workers’ compensation carriers possess a unique expertise in the industry and have many...

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Mass Shooters and Workers’ Compensation Claims



On March 27, 1981, in Washington, D.C., six bullets were fired in 1.7 seconds as President Ronald Reagan and his entourage left the Washington Hilton. The first bullet struck White House Press Secretary James Brady. The second struck District of Columbia policeman Thomas Delahanty. The third struck no one. The fourth bullet hit Secret Service agent Tim McCarthy, and the fifth bullet bounced off the waiting limo landing on the concrete walkway. The final bullet fired in...

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Advocacy Expanded: Empirical Studies and Practical Solutions



Advocacy is rooted in the notion of putting the injured employee’s needs first and making information and resources readily available to improve the overall claims experience. Undoubtedly, the workers’ compensation system has become more complex throughout the years, and many injured employees are left feeling overwhelmed, confused, and frustrated by the process. Ensuring timely and appropriate medical care, providing immediate answers and accurate information, and fostering maximum recovery and a return to productivity...

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Medical Canvassing: 6 Things Every Claims Organization Should Know



In today’s climate, the need for claims organizations to develop and maintain a strong medical canvass program—traditionally viewed as an à la cart service—borders on a best practice. This is most evident at a time in our society when data integrity and security are at an all-time high.

Additionally, the need for third-party data integration with various claims platforms continues to define how companies communicate efficiently while maintaining...

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Contractor That Funded CCIP Has ‘Principal Employer’ Immunity


A contractor that funded a project Contractor Controlled Insurance Program (CCIP) is off the hook for an injured worker’s tort claims, says the Connecticut Supreme Court.

The claims arose from an explosion at the Kleen energy plant in Middletown, Conn., in February 2010. The plaintiffs were employees of subcontractors of O&G, the prime contractor.

Stan Martin writes at Lexology: “The project had a CCIP established by O&G. As the CCIP ‘sponsor,’ O&G paid the premiums for workers’ compensation coverage under the CCIP, and each subcontractor’s price was reduced by the amount of insurance costs designated by the subcontractors in their bids.”

The subcontractors took issue with the “paid the premiums” scenario and its accompanying immunity after an explosion, and sought to have the immunity negated. No, said the Supreme Court.


Firefighter Can Press Workers’ Compensation PTSD Claim


A Homewood, Ill., firefighter is getting a do-over in his workers’ compensation PTSD claim.

Moran, a 25-year veteran of the department, says that his PTSD can be traced to a house fire that took place on March 30, 2010, when another firefighter died. The National Institute for Occupational Safety and Health looked into factors leading to the death, and concluded that the commanding officer and crew that responded to the scene did noy follow some key guidelines for fighting fires. Moran was that commanding officer.

The Cook County Record has the story on his pending claim.


Women Sue Coast Guard Over Husbands’ Murders



The wives of two men killed by a disgruntled colleague at the U.S. Coast Guard Communications Station on Kodiak Island claim bosses put their husbands in harm's way by allowing a dangerous man to work there. The complaint, filed Friday in U.S. District Court for Alaska by Nicola Belisle, surviving wife of Richard Belisle, and Deborah Hopkins, surviving wife of James Hopkins, seeks over $1 million in damages.

Belisle and Hopkins...

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Feds Allowed to Fortify Bulletproof-Vest Claims



Hoping to patch its claims over defective bulletproof vests, the U.S. government secured permission to amend its federal complaint against Honeywell International.

At the crux of the 8-year-old case is Z Shield, a bulletproof fortified with panels of a synthetic polymer material called Zylon. Uncle Sam claims that Honeywell knew that Z Shield had degradation problems inconsistent with its marketing when it sold the product to Armor Holdings, which in turn sold the...

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Surprise Home Makeover for Injured Worker


Don’t tell the parents!

A 20-year-old in Michigan and his friends—and even strangers—were part of a real reality show when they gave a surprise repair makeover to the young man’s family home.

His father, Scott Musson, suffered an injury when a 1,200-pound beam fell on him in 2013 as he worked at a crane company.

Musson says the accident damaged two of his vertebrae and he suffered tears in his shoulder. He no longer can work due to the non-stop nerve pain. He's been having additional problems, fighting Accident Fund insurance regarding his claim.

“It has been a really rough road for all of us,” said his wife, Tonya Musson.

So, when the parents were away, the son and others went to work, repairing, repainting, and relandscaping.

The faither's fight with his workers' compensation claim, however, still needs some work.

WXYZ has the story and video.


Bamboozled: Dad Fights for Injured Son’s Medical Care


An New Jersey dad is in a fight for the life of his son.

In 2006, Wesley Perez, a 24-year-old electrician, was nearly killed by a high-voltage shock as he worked on a job at a bank under construction in West Windsor, N.J.

He emerged from a 29-day coma completely disabled.

His father, Gerardo Perez, says that Wesley can't speak, dress or bathe himself, and he uses a wheelchair. reports that. “After the injury, the elder Perez said, all of Wesley's medical and home health aide bills were paid by Ohio Casualty, the insurance company that covered Wesley's employer, Best Way Electric of Jersey City, in Wesley's workers' compensation claim. But in November 2014, all those payments stopped.”



Another ‘Popcorn Lung’ Workers’ Compensation Claim


Michael K. Durbin retired in 2003 at the age of 48, having worked for Archer Daniels Midland in Illinois for approximately 30 years. He had been a “pumper loader operator,” and his job involved close contact with a butter flavoring ingredient that contained the chemical diacetyl.

That chemical caused injury to his lungs in the form of chronic obstructive pulmonary disease (COPD), Durbin said in making a workers’ compensation claim. Specifically, Durbin claimed to have a disease that’s been called “popcorn worker's lung” because it was first seen in former workers of a microwave popcorn factory in Missouri.

The Sangamonsum Sun has more background and the current status of the case.


Former Ski Ambassador Frozen Out of Workers’ Compensation Claim


It’s been an uphill battle for Thomas Kibbie, a former ski ambassador for Vermont’s Killington Resort, and his workers’ compensation claim.

Kibbie claims he was injured in 2008 when he fell and hit his head so hard his helmet cracked one January evening while doing a final sweep of the ski area. Kibbie was ultimately diagnosed with a traumatic brain injury, and the resort began paying workers’ compensation benefits.

In 2010, Kibbie and the resort signed a settlement agreement that gave him $50,000. The resort also agreed to pay ongoing costs “for the treatment of his cognitive or other head injury including neurological, psychological, ophthalmological, TBI care and treatment.”

Kibbie says the resort later reneged on the agreement.
The Barre Montpelier Times Argus has the story.


Former NFL Safety Sues Lloyd’s Over Injury Claim



Former Carolina Panther Safety Hakuri Nakamura sued Lloyd's of London claiming it subjected him to "virtually impossible" procedures to prove his claim that he suffered a career-ending injury.

In a complaint filed in the Mecklenburg County Superior Court in North Carolina, Kakamura claims that Lloyd's buried him in duplicative and unnecessary paperwork, which led to extensive delays in processing his claims. He also claims the doctor hired by Lloyd's of London...

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Workers’ Compensation Icy Sidewalk ‘Slip and Fall’ Claim Compensable


A decision by an Oklahoma Workers’ Compensation Commission administrative law judge went slip slidin’ away when it reached the state’s Supreme Court.

According to Insurance Journal, Oklahoma State University employee Annette Legarde-Bober claimed that she slipped and fell on the curb of an icy sidewalk next to the parking lot on school premises, where she was assigned a parking space.

OSU/OKC initially determined that Legarde-Bober was in the course and scope of her employment when she fell, and therefore provided treatment and temporary total disability benefits.

When Legarde-Bober applied for additional benefits, however, the university denied the claim, saying her injury did not arise out of her duties on the job. The ALJ agreed with the school. The Supreme Court did not.


Ex-Wrestlers Sue WWE Over Brain Injuries



Dozens of retired World Wrestling Entertainment Inc. wrestlers are suing Vince McMahon and his company over the concussions they claim to have suffered from decades of bumps in the ring.

Jimmy "Superfly" Snuka, Joe "Road Warrior Animal" Laurinaitis and 51 other performers sued their former employer in Connecticut Federal Court on Monday for racketeering, misclassifying them as independent contractors, and hiding the hazards of their job. They claimed to suffer Chronic Traumatic Encephalopathy (CTE)...

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Snake Bite Prompts Workers’ Compensation Claim


Forget about mailmen and dog bites. In Virginia, it’s office workers and snake bites.

In Chesterfield, Va., 29-year-old Ke’Vonia Cousins says she was on her break and was about to go outside when she felt a shooting pain and something wet on her foot.

“I felt a ting on my big toe and wetness, like hurting pain. I looked up to see if the ceiling was leaking and I need to tell my manager and I looked down and the snake was on my big toe,” she says shaking at the memory.

Cousins was bit by a baby copperhead.

Her employer says it’s not a workers’ compensation claim under Virginia law.

NBC12 has the story.


#WCI2016: Breakout for Adjusters, Program One


For a number of years, the annual Workers’ Compensation Educational Conference has featured a live surgery.

This year, the 9th Annual Orlando Orthopaedic Center Live Surgery Event on Tuesday, August 23, from 8:45 - 9:45 am, offers a unique interactive look into an operating room as Travis B. Van Dyke, M.D., performs a knee meniscectomy procedure live from the Orlando Orthopaedic Center Outpatient Surgery Center. With the help of moderator Lawrence S. Halperin, M.D., Dr. Van Dyke,...

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