Significant
Arbitration Decisions
1. John Hardison v. Federal Companies (02 WC 48359; 04 MR 1316)
Petitioner alleged a work
injury as a result of his normal job duties as a mover, including
loading and unloading household goods weighing
between 50 and 120 pounds. Petitioner testified that he felt a sharp
pain down his back into the groin while stacking boxes on the moving
van. He testified that he continued working the rest of the day,
despite leg weakness and groin pain, and he testified that he left
a message on the respondent's answering machine later that night
since he was unable to report the accident in person, as he returned
after normal business hours when no one was there. After cross-examination
regarding the specifics of the accident, petitioner testified on
re-direct that he initially felt a sharp pain in his lower back while
stacking boxes in the van and then later felt similar pain inside
the customer's home after leaning over a table to complete paperwork.
Petitioner eventually underwent surgery and was released to return
to work, although he could no longer work as a mover, which had been
his job since 1985. Following a successful cross-examination impeaching
the petitioner's credibility regarding the circumstances surrounding
the alleged accident, the arbitrator denied compensation and the
Workers' Compensation Commission affirmed on review by a 2 to 1 vote.
Petitioner appealed to the Circuit Court of Lake County, where the
denial of compensation was again affirmed. Finally, petitioner appealed
to the Second Judicial District of the Appellate Court of Illinois,
where the court affirmed the Circuit Court decision in a 4 to 1 vote.
The court concluded that the petitioner's failure to testify in a
manner consistent with the medical records could have reasonably
raised concerns regarding the credibility of his claim. The court
further noted that the Commission did not conclude that the acts
of bending over or completing paperwork were non-compensable. Instead,
the court noted that the Commission merely determined that the petitioner's
story was inconsistent and, thus, not credible. The dissenting opinion
indicated that it is not speculation that petitioner's injury began
while loading the truck and culminated while leaning over a table
to deal with work related paperwork. Regardless, we were able to
preserve the "zero" award initially issued by the arbitrator
and subsequently affirmed at the Commission level, Circuit Court
level and finally Appellate Court level.
2. Amy Brys v. Jewel Food Stores (98 WC 40199)
The petitioner alleged
injury as a result of lifting heavy boxes and pulling crates at
work, and first underwent a lumbar microdiscectomy,
followed by a laminectomy at L5-S1, with a bone graft and fusion,
approximately 2 years following the first surgery. The petitioner
testified that she reported the accident to her supervisor, and then
completed accident/off work reports claiming a work related accident.
At trial, petitioner claimed entitlement to 74-1/7 weeks of TTD benefits,
$80,734.60 in medical benefits, and Section 8(d)1 wage differential
benefits as a result of permanent work restrictions following the
two surgical procedures. Following a successful cross-examination
impeaching the petitioner’s credibility regarding the circumstances
surrounding the alleged accident, the Industrial Commission found
petitioner failed to establish her burden of proof. Although the
respondent’s exposure for medical and TTD benefits alone exceeded
$150,000.00, the Industrial Commission issued a “zero” award.
3. James Reichard v. Yellow Freight (98 WC 65437)
The petitioner was involved
in a motor vehicle accident when his truck was blown off the road
and skidded into a steep incline as
a result of windy, icy conditions. The petitioner testified that
he was thrown against the left side of the cab during the accident,
striking his left shoulder and the left side of his face. Approximately
three to four hours after the accident, petitioner stated that he
began complaining of chest pain radiating to the left arm, as well
as shortness of breath. Three days after the accident, petitioner
underwent a triple coronary bypass surgery, which his surgeon causally
related to the motor vehicle accident. The respondent’s IME
physician, a board certified cardiologist, opined that petitioner’s
motor vehicle accident did not cause or contribute to his coronary
artery dissection, and concluded that petitioner’s abnormalities
were simply a progression of his underlying coronary artery disease.
The Industrial Commission found petitioner’s rotator cuff tear,
impingement, and adhesive capsulitis related to the motor vehicle
accident, but found petitioner’s heart condition unrelated.
The Industrial Commission was persuaded by the fact that there was
no evidence of any other cardiac or vascular abnormalities (i.e.,
no evidence of an aortic dissection, no enzyme release suggestive
of myocardial contusion), and determined that petitioner’s
heart condition was simply a progression of his underlying disease
state and unrelated to the motor vehicle accident. Additionally,
the Industrial Commission noted the causative link between smoking
and coronary heart disease, and made specific mention of the fact
that the petitioner admitted on cross-examination that he had been
smoking one pack of cigarettes per day since the age of 7. In conclusion,
the Industrial Commission found petitioner’s heart condition
had progressed to a point where any stress could have caused pain
(including 90% blockage, making him fragile and susceptible to any
normal stress) and the resulting need for bypass surgery. The Industrial
Commission determined petitioner’s pre-existing heart condition
and his longstanding smoking habit were the most likely causative
factors of his heart problems, rather than the motor vehicle accident.
The arbitrator awarded 35% loss of use of the right arm shoulder
as a result of the torn rotator cuff, impingement, and secondary
adhesive capsulitis, and limited the respondent’s liability
for medical bills to treatment petitioner received to his right shoulder.
4. Ken Bons v. Yellow Transportation (00 WC 19938)
Petitioner was involved in a compensable work-related accident on
February 21, 2000, and as a result, he was released to return to
work with permanent restrictions. It is undisputed that the permanent
work restrictions prevent him from returning to his pre-accident
job as a truck driver for the respondent. A vocational rehabilitation
program was initiated by the respondent to assist petitioner in his
return to work. Thereafter, respondent filed a motion for leave to
suspend benefits claiming petitioner failed to put forth a good faith
effort in the respondent's vocational rehabilitation program. The
motion requested the suspension of both the vocational rehabilitation
program and petitioner's maintenance benefits as a result of his
non-compliance. At trial, petitioner and his vocational expert were
both successfully impeached on cross-examination on a number of issues.
The arbitrator found petitioner lacking credibility and granted respondent's
motion to terminate benefits. Prior to arbitration, the respondent
paid out $130,612.59 in indemnity benefits and $84,660.00 in medical
benefits. Additionally, based upon petitioner's permanent work restrictions,
respondent likely faced Section 8(d)1 wage differential exposure
in the area of $20,000.00 per year, following liability for further
vocational rehabilitation and maintenance benefits. The future cash
value of petitioner's Section 8(d)1 wage differential was approximately
$700,000.00. However, following the favorable trial award terminating
respondent's liability for vocational rehabilitation and maintenance
benefits, the parties reached an agreement to settle all issues with
a release and resignation agreement.
5. Daniel Hicks v. Parsons Engineering (96 WC 43332)
The petitioner sought
vocational rehabilitation and TTD/maintenance benefits, claiming
that the respondent failed to provide an appropriate
vocational rehabilitation program and improperly terminated petitioner’s
TTD/maintenance benefits. The Industrial Commission found that the
respondent complied with §8(a) by locating an employment position
within the petitioner's permanent work restrictions as outlined in
a functional capacity evaluation, and further determined that the
petitioner failed to make a good faith effort in the job placement
program by refusing to attempt the job located by the respondent.
The Industrial Commission determined that the petitioner's lack of
good faith in cooperating with the respondent’s vocational
rehabilitation efforts justified the respondent's termination of
both the vocational rehabilitation program and TTD/maintenance benefits.
6. Gloria Gemenez v. Jewel Food Stores (00 WC 43356)
Petitioner was involved in a compensable work-related accident on
March 18, 2000 when a box fell on top of her. Thereafter, petitioner
sought medical treatment with several different physicians who took
her off work and eventually recommended continued pain management.
She incurred $66,883.80 in medical expenses as a result of her lumbar
radiculopathy and multiple levels of disc bulging, and was off work
for more than one year. Respondent's IME physician diagnosed petitioner
with a work-related lumbosacral strain with mild residual findings
and released her to return to full duty work. After we were able to
successfully impeach petitioner's credibility at trial, the arbitrator
awarded 11-2/7 weeks of TTD benefits rather than the 53-4/7 weeks petitioner
was seeking, $3,516.00 in medical expenses instead of the $66,883.80
sought by petitioner, and 7.5% loss of the man as a whole. The arbitrator
essentially adopted the respondent's argument in totality by cutting
off liability for medical and TTD beyond June 18, 2000, corresponding
to the date that respondent's IME physician indicated petitioner achieved
maximum medical improvement. In so doing, respondent avoided liability
for medical totaling $63,367.80 as well as 42-27 weeks of TTD benefits.
7. Augustina Zamudio v. Marriott (90 WC 53393)
The petitioner filed a petition to reinstate following an order
for dismissal for want of prosecution of her case, claiming she never
received notice of the case dismissal. Additionally, the petitioner
alleged that even if notice was received, she failed to understand
or read English. The arbitrator denied the reinstatement, and the
Industrial Commission affirmed on review. The Industrial Commission's
decision was based upon the cross-examination of the petitioner,
which established that she was stable in her residency and had resources
available to her to translate or interpret any information that she
received that she did not understand regarding her case.
8. Mary Handy v. John H. Harland Co. (99 WC 15767)
Petitioner filed
an Application for Adjustment of Claim alleging a repetitive trauma
injury to her left foot. Although petitioner’s treating physician
repeatedly stated that she should not return to her employment
position with the respondent, and specifically provided information
to assist in her vocational rehabilitation efforts, the respondent
maintained this claim on a denial posture pursuant to a causation
dispute. The arbitrator granted the respondent’s motion to
dismiss prior to trial, relying upon the respondent’s argument
that petitioner could not establish her threshold burden of proof.
Petitioner’s attorney filed a motion to vacate the dismissal,
but the Industrial Commission affirmed the arbitrator’s dismissal
order.
Presentations
1997
February 20, 1997 Overview
of the Illinois Workers' Compensation Act, analysis of "arising
out of" and "in the course of" - Presented to
Marriott claims staff.
1998
February 3, 1998 Overview
of the Illinois Workers' Compensation Act, analysis of "arising
out of" and "in the course of" - Presented to
Universal Underwriters claims staff.
1999
February 22, 1999 Fatal
Cases: An Analysis of Dependency under Section 7 – Presented
to Chubb Insurance claims staff.
2000
February 17, 2000 The
Application of the Petrillo Doctrine in Workers’ Compensation
Cases - Presented to representatives of Argonaut, EMC, IIGF,
Kemper, and Martin Boyer.
September 14, 2000 Mock
Trial/Trial Techniques - Presented to workers’ compensation staff
at Chubb Insurance.
2002
June 25, 2002 Mock Trial/Trial
Techniques/Accident Investigation and Recorded Statements - Presented
at OSI Risk Management Conference.
2003
April
16, 2003 Baggett & The Standard of Proof
for Heart Attack Claims: An Analysis of Mental Stress Cases
at the Industrial Commission – Presented at Workers’ Compensation
Claims Association / Chicago Chapter Meeting.
2004
May
20, 2004 Continuation of Benefits Pursuant
to Sections 8(e)19 and 8(h) of the Act Following Non-Work
Related Death: When Do They Pass On? - Presented to representatives
of Risk Enterprise Management and Westfield Insurance Companies
2005
September
29, 2005 Overview
of Amendments to the Illinois Workers’ Compensation Act
enacted on July 20, 2005 – Analysis of Medical Fee Schedule,
Advisory Board, Utilization Review Programs, and TPD Benefits – Presented
to Yellow/Roadway Transportation in Kansas City, Missouri
2006
February
20, 2006 Overview
of Amendments to the Illinois Workers’ Compensation
Act enacted on July 20, 2005 – Analysis of Medical Fee Schedule,
Advisory Board, Utilization Review Programs, and TPD Benefits – Presented
to Gallagher Bassett Services claims staff in Schaumburg, IL.
February
24, 2006 Overview
of Amendments to the Illinois Workers’ Compensation
Act enacted on July 20, 2005 – Analysis of Medical Fee Schedule,
Advisory Board, Utilization Review Programs, and TPD Benefits – Presented
to representatives of Amcomp, American Re-Insurance Company, Amerisafe,
Aon Risk Service, AT&T Services, Broadspire, Captive Resources,
Chubb, CNA, Concentra, Electrical Contractors' Association, EMC, ESIS,
Factual Photo, Frank Gates, G.W. Thiel, Inc., Gallagher Bassett, Gates
McDonald, Georgia-Pacific Corporation, Gillette Company, Hendrickson
Bumper & Truck Suspension Systems, Interlake, Komatsu, Liberty
Mutual, Marriott Midwest Claims, Matrix, McNellis Insurance Agency,
McWilliams Electric, Midwest, Plano Molding, Plumbing & Mechanical
Contractors Assoc., RCEC, RCI Enterprises, Rollprint Packaging Products,
RR Donnelly, Ryerson, Safeco, SBIC, Sedgwick, Society Insurance, Standard
Parking Corp., The Boler Company, The Fairmont of Chicago, The Horton
Group, Tokio Marine, Transguard, Transilwrap, United Airlines, United
Heartland, Wausau Insurance, Westfield Group, and Zenith, in Schaumburg,
IL.
April 5,
2006 Overview
of Amendments to the Illinois Workers’ Compensation
Act enacted on July 20, 2005 – Analysis of Medical Fee Schedule,
Advisory Board, Utilization Review Programs, and TPD Benefits – Presented
to ESIS claims staff in Chicago, IL.
April 25,
2006 Overview
of Amendments to the Illinois Workers’ Compensation
Act enacted on July 20, 2005 – Analysis of Medical Fee Schedule,
Advisory Board, Utilization Review Programs, and TPD Benefits – Presented
to Society Insurance in Fond Du Lac, WI.
2007
April
20,
2007 Analysis of Aliens under the Illinois
Workers' Compensation Act; Noncompliance - The Impact of Petitioner's
Failure to Cooperate - Presented to Society Insurance in Fond
Du Lac, WI.
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