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Archive | 2013

Ladder Safety Tips to Prevent Fall Injuries

Fall injuries are reportedly the number one cause of workers’ compensation claims in the U.S., as each year more than 9 million American workers seek hospital treatment after sustaining a fall accident. While many of these fall accidents occur due to slips or trips that cause people to take a tumble without falling from some […]

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New Website Address for Electonic Filings

In an e-mail sent by the Colorado Division of Workers’ Compensation on Friday, November 22, 2013, the DWC announced that is working with the Governor’s Office of Information Technology to upgrade and migrate the EDI (electronic filing) website. The decision to migrate the system was influenced by the number of recent outages experienced. This migration […]

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CMS Publishes New WCMSA Reference Guide

The Centers for Medicare and Medicaid Services (CMS) has updated its Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide to document the current WCMSA review process and provide more detailed information on the actions performed by the Workers’ Compensation Recovery Contractor (WCRC).  The updated Reference guide can be found here. The following sections of the […]

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The Affordable Care Act (a/k/a Obamacare) affects Workers’ Compensation Medicare Set-Aside Arrangements

Due to the passage of the Patient Protection and Affordable Care Act (Obamacare), effective January 1, 2014, all restrictions on barbiturate indications will be lifted and any medically accepted indication will have coverage under the Medicare Part D Benefit. Therefore, CMS will begin allocating barbiturates for all medically accepted indications within WCMSAs (barbiturates currently are […]

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An Overview of Whole Person Ratings

When you are injured while working and sustain some type of permanent disability or impairment as a result of this injury: You will be entitled to workers’ compensation benefits. Compensation for your permanent impairment will be based on either an extremity rating or a whole person rating. While extremity ratings are generally used in cases […]

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The Respondents May Bear the Burden of Proving Previously-Admitted Maintenance Medical Treatment No Longer Reasonable and Necessary

It long has been settled law that where the respondents file a final admission admitting for maintenance medical benefits, the respondents are not precluded from later contesting their liability for a particular treatment. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo. App. 1997). Moreover, when the respondents contest liability for a particular medical […]

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An Order Denying an Attempt to Overcome a Division IME Physician’s Findings on MMI Only is not an Appealable Order

As documented in a previous post, the Industrial Claim Appeals Office again dismissed an appeal for lack of a final order where the Administrative Law Judge made found that the respondents failed to overcome the Division IME physician’s opinion on Maximum Medical Improvement but did not enter an order requiring the respondents to pay a […]

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DIME Physician’s Opinion on Causal Relationship May Have No Presumptive Weight in Hearing on Permanent Total Disability Benefits

It long has been settled law that the Division IME physician’s opinion concerning the cause of a particular component of a claimant’s overall impairment must be overcome by clear and convincing evidence. The Industrial Claim Appeals Office appears to have departed from that rule of law in a recent decision which stated that the determination […]

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Workers’ Compensation Fraud (Part 2)

As a continuation of Workers’ Compensation Fraud (Part 1), the following provides some further information regarding illegal workers’ compensation claims. While Part 1 of this blog provided a comprehensive definition of what constitutes workers’ compensation fraud, here in Part 2, we will focus on the criminal penalties for those who are charged with and convicted […]

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An Administrative Law Judge May Deny a Penalty on the Merits for Failure to Plead Specific Grounds for Penalty

In Lovett v. Stroup Insurance Services, Inc., W. C. No. 4-808-092 (August 30, 2013), the Industrial Claim Appeals Office recently held that an Administrative Law Judge’s denial of a penalty for failure to plead the specific grounds for the penalty allegation in the merits was a denial of the penalty on the merits, rather than […]

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An Order Denying “Compensability” Only is Not an Appealable Order

In a decision that stretches the bounds of legal reasoning, the Industrial Claim Appeals Office recently issued an opinion holding an Administrative Law Judge’s order finding a claim not compensable did not deny the claimant a benefit. Abenth v. Northside Christian Church, W. C. No. 4-893-024 (September 12, 2013). The court recognized that the statute […]

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Workers’ Compensation Fraud (Part 1)

While fraud generally refers to the criminal act of intentionally deceiving some entity in order to further one’s personal financial gain, workers’ compensation fraud is specifically defined as the act of intentionally making false statements or representations to the Division of Workers’ Compensation in Colorado in order to secure payments or any type of benefit […]

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Updated CMS Regional Contacts – Revised

The blog post dated July 22, 2013, published the updated Centers for Medicare and Medicaid Services regional contact list for Workers’ Compensation Medicare Set-aside Accounts. CMS recently revised the regional contact information. The regional contacts for Colorado now are listed as Ian Fraser, Annie Lam, and Sandee Olson, who can be reaced at (415) 744-4907. The revised list […]

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New Social Security Administration Release of Information Form

In July 2013, the Social Security Administration revised the Consent for Release of Information form, used to obtain information regarding an individual’s receipt of Social Security disability income benefits, Supplemental Security Income benefits, or Medicare benefits.  The fillable form can be found here. Please note that this form is not the authorization required by the […]

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Traumatic Brain Injury Facts and Statistics (Part 2)

Continuing from Traumatic Brain Injury Facts and Statistics (Part 1), here is some additional important information for workers who may have sustained a mild to moderate TBI on the job. While Part 1 of this blog focused on defining what traumatic brain injury is, how it can happen at work and what the symptoms of […]

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Clay Thornton, Esq., Leaving Picardi Law Firm

After almost five years with the firm, Clay Thornton, Esq., is leaving Picardi Law Firm on July 31, 2013.  Clay is leaving to take a position with the Colorado Attorney General’s office, where he will be helping to build a new workers’ compensation unit. We wish Clay the best of luck at his new position. […]

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Updated CMS Regional Contacts

The Centers for Medicare and Medicaid Services has updated its list of regional contacts for Workers’ Compensation Medicare Set-aside Accounts. The regional contacts for Colorado are listed as: Tom Bosserman (415) 744-4907 Ian Fraser (415) 744-3665 Tina Lim (415) 744-3673 Irene Cheng (415) 744-3582 The full list of regional contacts for each state can be […]

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All Authorized Treating Physicians Must Refuse to Treat in Order for the Right of Selection to Pass to the Injured Worker

Under §8-43-404(5)(a), C.R.S., the respondent is afforded the right in the first instance to select a physician to attend the claimant. However, the statute implicitly contemplates that the respondent will designate a physician who is willing to provide treatment. Therefore, if the physician selected by the respondent refuses to treat the claimant for non-medical reasons, […]

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Traumatic Brain Injury Facts and Statistics (Part 1)

Traumatic brain injury (TBI) refers to any condition in which a temporary or permanent brain dysfunction arises due to a violent blow to the head or some object penetrating the skull. While a number of events can result in traumatic brain injuries, when TBIs occur on the job, the following factors or incidents may be […]

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Division of Workers’ Compensation Proposed Changes to Procedural Rules 16 and 18

The Division of Workers’ Compensation will be holding a public hearing to discuss proposed changes to two Workers’ Compensation Rules of Procedure: Rule 16 (Utilization Standards), and Rule 18 (Medical Fee Schedule).  The hearing is scheduled for August 6, 2013, at 9:00 a.m. The hearing will be held in the 2nd Floor Conference Room at […]

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2013 Amendments to Colorado Workers’ Compensation Act

As always, there are several amendments to the Act this year. The Division has posted an advisory memorandum that can be found at the following link. Senate Bill 13-157 clarifies the definition of statutory-employer as it applies to injuries occurring on the premises of a “buyer of goods.” As discussed in a separate posting to […]

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Statutory Changes to the Division IME Procedure

The Division IME statute has been amended to include a new timeframe and procedure for responding to a DIME report. The Division has posted an instructive memo that can be found here. In a nutshell, a respondent’s time to respond to a Division IME report no longer is based upon the date the physician mails […]

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Very Little Required to Avoid Closure Pursuant to Final Admission

Posted by: Clay Thornton, Esq. Date: June 26, 2013 In Crigger v. Denver Health, W.C. No. 4-770-747 (ICAO, May 6, 2013), the respondent filed a final admission of liability admitting for Permanent Partial Disability benefits based upon the Division IME’s findings. Within the statutory period for objecting, the claimant filed an application for hearing listing […]

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Workers’ Compensation Medicare Set-aside Account Submission Errors

The Centers for Medicare and Medicaid Compliance (CMS) has issued a document titled WCMSA Top Submission Errors and Helpful Hints which lists the most frequent errors contained in WCMSA proposals as well as tips/hints to increase the likelihood of a speedy approval of a WCMSA. The document can be found by clicking here.

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An ALJ Cannot Order Reimbursement Between Carriers on a Closed Claim

Posted by: Clay Thornton, Esq. In Tennapel v. Bowie Resources, W.C. Nos. 4-779-040 & 4-844-545 (ICAO, April 5, 2013), the claimant suffered an industrial injury with the first employer, and that claim became closed pursuant to final admission. Subsequently, the claimant suffered a similar injury with a subsequent employer. At this point, an IME opined […]

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Statutory Cap Does Not Apply Until the Act Permits Respondent to Terminate Temporary Disability Benefits

Posted by: Clay Thornton, Esq. In United Airlines v. Industrial Claim Appeals Office , 2013 COA 48, 12CA1443 (COCA) (March 28, 2013), the claimant suffered an admitted injury and the employer admitted for temporary disability benefits. Temporary disability benefits were ended when the claimant was released to return to work. At this point in time, […]

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Benzodiazepines and Barbiturates Now Included in WCMSAs

Effective June 1, 2013, the Centers for Medicare and Medicaid Services (CMS) will require all Workers’ Compensation Medicare Set-aside Agreements (WCMSAs) include the cost of a claimant’s benzodiazepine and barbiturate prescription medications. This change is likely to increase the cost of WCMSAs significantly, since there are many drugs falling under the benzodiazepine or barbiturate classes […]

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Proposed Legislation Changing Time to Respond to Division IME Report

Section 8-43-203(2) currently requires respondents to either file an admission of liability consistent with a Division IME physician’s opinion or request a hearing challenging that opinion within thirty days of the date of mailing of the report from the Division IME physician. However, the deadline for respondents to take action has been made uncertain due […]

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Penalties for Failure to Reimburse Claimant for Medical Treatment

Posted by: Clay Thornton, Esq. Date: March 26, 2013 In Ringler v. King Soopers, W.C. No. 4-121-888-11 (ICAO, March 13, 2013), the ICAO affirmed an Order of the ALJ which granted a penatly of 8% of the amount of a medical bill for which the claimant sought reimbursement, and denied the claimant’s request for a […]

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Employer Required to Tender Designated Provider List Even When Employee Declines Medical Treatment

Section 8-43-404(5)(a) affords the employer or insurer the right in the first instance to select a physician to treat the injury. The statute requires the employer or insurer to “provide a list of at least two physicians, … in the first instance, from which list an injured employee may select the physician who attends said […]

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Request for Re-evaluation of Medicare Set-aside Arrangements

The Centers for Medicare and Medicaid Services (CMS) has announced that it will re-evaluate an approved Medicare Set-aside Arrangement if the claimant or the submitter believes that the CMS determination (1) contains obvious mistakes, such as mathematical errors or a failure to recognize that medical records already submitted show a surgery CMS priced already has […]

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Division Repeals Requirement for Final Payment Notice

In what is sure to be relief to almost everyone, the Division of Workers’ Compensation has repealed W.C.R.P. 5-11(B), which required adjusters to file a Final Payment Notice within 60 days after the claim has closed. Therefore, effective April 1, 2013, Final Payment Notices no longer are required to be filed.

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Colorado House Bill Seeks to Prevent Employers from Requiring Employees to Release Passwords to Social Networking Sites

Posted by: Steven J. Picardi, Esq. Date: February 11, 2013 The Colorado House of Representatives has introduced a bill which would prohibit an employer from requiring an employee or applicant for employment to disclose a user name, password, or other means for accessing a personal account or service through an electronic communications device (the bill […]

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Bill Proposes Amendment to Liability of Statutory Employer

In an effort to expand workers’ compensation coverage to employees of uninsured subcontractors or lessees injured while performing services for an insured general contractor, § 8-41-401(1)(a)(I) of the Workers’ Compensation Act of Colorado provides that any person, company or corporation which conducts any business by leasing or contracting out any part of its work to […]

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Penalties for Failure to Contest or Pay Medical Bills Timely

Many insurers and third-party administrators utilize the services of third-party vendors to process payment or denial of medical bills. A recent Industrial Claim Appeals Office case awarding penalties against a self-insured employer for failure of the third-party vendor to process payment or denial of medical bills within the deadlines imposed by the Workers’ Compensation Rules […]

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CMS to Utilize Updated Life Tables for Life Expectancy on MSAs

The Centers for Medicare and Medicaid Services (CMS) has announced that effective January 19, 2013, it will begin referencing the Centers for Disease Control (CDC) Table 1: Life table for the total population: United States, 2008, for Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) life expectancy calculations. This means that for any newly submitted WCMSA proposal […]

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Mileage Rate for 2013

Just a reminder that the Medical Fee Schedule (W.C.R.P. 18) increased the reimbursement rate for mileage to $.052 per mile, effective for travel on or after January 1, 2013.

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