Recently in Workers' Compensation Claims Category

Filing a Missouri workers' comp claim: What injured employees need to know

885334_healthcare_upclose.jpgAs personal injury lawyers, we know that the Missouri workers' compensation system can be confusing and intimidating for injured employees and their loved ones. In this post, we address a few questions we commonly hear from our clients.

Q: When do I need to file a workers' compensation claim?
A: First, it's important to note that reporting your injury to your employer is not the same thing as filing a workers' comp claim. If you're injured on the job, you must report the injury to your employer (in writing) immediately - and if you fail to do so within 30 days following the injury, you may lose your right to pursue compensation. After you notify your employer, your employer must then file a Report of Injury with the Missouri Division of Workers' Compensation.

In contrast, a workers' compensation claim must be submitted directly to the Missouri Division of Workers' Compensation. Injured workers may wish to file a claim if they feel they have not been fully compensated for their damages and losses. Claims must be filed within two years following the date of injury, or the date the last payment was made on account of the injury (unless the employer failed to submit a Report of Injury in a timely manner, in which case the employee has three years from those dates to file a claim).

Q: Will I lose my job if I file a claim?
A: Under Missouri law, employers are prohibited from firing an employee solely because the employee is pursuing his or her workers' comp rights. If you believe you were fired, demoted, suspended or disciplined by your employer solely because you filed a workers' comp claim, you should speak with an attorney concerning your legal rights. Depending on the circumstances, you may have grounds for a wrongful termination lawsuit.

Q: What if my injury prevents me from returning to work?
A: Injured employees who are unable to return to work in any capacity may qualify for permanent total disability benefits. If your injury limits your ability to perform certain tasks, but you are still able to work in some capacity, you may be entitled to permanent partial disability benefits. Other benefits available may include temporary total disability benefits (if you are temporarily unable to return to work while recovering from your injury) and temporary partial disability benefits (if you return to work on restricted or modified duty at less than full pay).

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Missouri Supreme Court decision extends legal protections for injured workers

gavel-3-1409593-m.jpgThis week, the Missouri Supreme Court overturned 30 years of precedent in a ruling that strengthens legal protection for workers who are fired after suffering on-the-job injuries.

It has always been illegal for Missouri employers to retaliate against employees who file workers' compensation claims. Section 287.780 of Missouri Workers' Compensation Law states: "No employer or agent shall discharge or in any way discriminate against any employee for exercising any of his rights under this chapter." The law also stipulates that any worker who has been either fired or retaliated against in any way has grounds for a lawsuit against his employer. In 1984, the Supreme Court adopted an "exclusive-cause standard," meaning employees had to prove that filing a workers' comp claim was the sole reason for their dismissal in order to take legal action against an employer.

Now, the Supreme Court has ruled that employees "no longer have to prove that workers' compensation claims [are] the exclusive cause for their dismissal in order to win lawsuits alleging retaliation. Instead...employees must show only that workers' compensation claims were a contributing factor in the subsequent dismissal from their job." (emphasis added)

Sadly, some Missouri employees are reluctant to file a workers' comp claim for this very reason: they fear retaliation from their employers. The Court's ruling works to protect the interests of injured workers who find themselves in this situation. "Discrimination against an employee for exercising his or her rights under the workers' compensation law is just as illegal, insidious and reprehensible as discrimination under the [Missouri Human Rights Act]," wrote Judge George Draper II.

Other forms of employer retaliation

In addition to termination, employer or manager retaliation may show up in any of the following types of discrimination or harassment:

• Unwarranted poor performance review
• Scheduling issues
• Isolation or intimidation
• Demotion, reassignment, reclassification or transfer
• Threatened adverse wage action
• Interference with or dispute of a legitimate workers' compensation claim
• Unreasonable increase or decrease in job duties
• Unjustified disciplinary action

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Managing medical treatment issues as a Missouri workers' compensation claimant

65906_iv_bag.jpgAccording to Missouri's Workers' Compensation Law, your employer has the right to choose the injured employee's health care provider. Most employers will then delegate that responsibility to their insurance carrier. However, this does not mean that an injured worker's medical care is in under the control of the insurance company. Medical treatment is always under the control of the treating physician selected by the employer or insurer. Problems can arise, however, because insurance companies are responsible for authorizing and directing care--which means that there are situations where reasonable care is not provided.

What if the injured employee disagrees with the diagnosis, or is unhappy with the health provider chosen for him/her?

Missouri law allows employees to select their own doctor, surgeon, or other medical provider, but the employee must pay for that treatment themselves. This happens infrequently, because of the high cost of medical treatment. Even if the injured party has medical insurance, many policies will not cover an injury sustained in the work[lace.

Sometimes it might be necessary to travel to see a physician: for example, when an injured worker needs a specialist, and there are none in the immediate area; or when an accident happens in a small town or rural location, without access to the medical services needed. If you are required to travel outside the local metropolitan area of the employer's location, then the employer is required to pay your travel costs: these are considered necessary and reasonable expenses. If you cannot travel, or believe that the travel is making your condition worse, speak to your employer/insurer about the situation. If nothing satisfactory can be worked out, at this point you can request a conference with an administrative law judge (ALJ) to discuss the situation. It might also be helpful to consult a Missouri Workers' Compensation Attorney.

If an injured worker is unhappy with the medical treatment he is receiving, or believes he needs a specialist, more tests, or a different type of treatment, these situations need to be handled carefully. First, discuss the issue with the insurance company. If this approach doesn't provide a solution, a workers' comp attorney can formally dispute the employer's treatment plan. On the other hand, if the insurer or employer disagrees with a doctor's diagnosis, they then have the qualified right to authorize a change of physician.

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Injured on the job? 5 FAQs answered for Missouri workers

January 24, 2014

orthopedic-leg-brace-1232546-m.jpgThe aftermath of a workplace injury can be a confusing, overwhelming time for victims and their loved ones. In this post, our Missouri workers' compensation lawyers answer five questions we often hear from injured employees.

1. How do I know if I'm covered by the Missouri workers' compensation system?

Under state law, the majority of Missouri employers are required to carry workers' compensation insurance to cover their employees. If a business employs five or more workers, the employer must carry workers' comp insurance. Businesses in the construction industry must carry insurance if they employ one or more workers. (To find out more about what kind of businesses are considered part of the construction industry, click here.) Missouri law does provide exemptions for farm laborers, domestic servants and occasional laborers in private residences, real estate agents and direct sellers, certain inmates, certain volunteers, and certain individuals who serve amateur youth programs.

2. I've been injured at work: what are the first steps I should take?

First and foremost, be sure to report your injury to your employer (in writing) as soon as possible. Failing to report an injury within 30 days following its occurrence can jeopardize your right to workers' compensation benefits. You'll need to include the following information: your name and address; where the injury occurred; the date it occurred; and the nature of the injury. Keep a dated copy for your own records. It's also paramount that you seek immediate medical attention so your injuries can be assessed and documented by a physician.

3. How long do I have to file a workers' compensation claim?

First, please note that filing a workers' comp claim is completely different than reporting the injury to your employer. If you wish to file a claim, you must do so directly with the Missouri Division of Workers' Compensation. Claims must be filed within two years of the date of your injury, or, if you received workers' comp benefits following your injury, within two years following the date of the last payment you received. (If your employer failed to report your injury to the division in a "timely fashion," the time period is extended to three years.)

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Mold in the workplace: What Missouri employees need to know

September 27, 2013

mold-on-the-steps-986716-m.jpgWhen most people hear about a workers' compensation claim, they often think of accidents resulting in physical injuries like broken bones, back or neck injuries, or permanent disability. However, a workers' comp claim can also be connected to an occupational disease, which is defined as "a condition or illness caused by occupational exposure in the workplace." According to the Missouri Department of Labor, occupational diseases recognized by Missouri law include injuries caused by repetitive motion, loss of hearing due to workplace noise, and radiation disability. They may also include respiratory diseases caused by repeated exposure to certain workplace contaminants, including mold.

Basic facts about mold in the workplace:

• The Occupational Safety and Health Administration (OSHA) reports that mold is a type of fungi that can be found both outdoors and indoors throughout the year. There are thousands of different species of mold.

• Every species of mold shares a common attribute: it can grow with only a spore ("a viable seed"), a nutrient source, moisture, and a suitable temperature. It does not need sunlight, which is why mold is most common in dark, damp areas.

• Mold can create and release millions of spores that pose a threat to human health. It can also produce toxic agents called mycotoxins, which is also known to have adverse effects on the human body.

• Most mold found indoors comes from outdoor sources. However, mold commonly grows - and becomes a health threat - in indoor spaces where water damage, high humidity and/or dampness is present.

• Symptoms of mold exposure vary dramatically, depending on the person. OSHA officials say the people most at risk are children and the elderly, along with those who suffer from allergies, asthma, sinusitis, and other respiratory conditions. People who have weakened immune systems are also at high risk for mold-related illnesses.

How Missouri workers can protect themselves from mold-related illnesses:

• If you are concerned that you're developing health problems associated with mold exposure in your work environment, you should report those concerns to your supervisor as soon as possible. Employers are required by law to provide a safe, healthy working environment for their employees.

Officials at the National Institute for Occupational Safety and Health (NIOSH) strongly advise that you seek immediate treatment from a medical professional, who can diagnose and evaluate your symptoms and determine whether you should be medically restricted from your work environment.

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How do other kinds of benefits impact Missouri workers' compensation claims?

weldingworker.jpgOur Missouri workers' compensation attorneys know that many seemingly simple workers' comp cases can become much more complex when other government benefits and agencies are involved. If you are receiving other kinds of benefits at the time you suffer a Missouri work-related injury, your claim might become extremely complicated too. In this post, we discuss some other benefits or situations which might complicate your workers' compensation claim.

• Unemployment benefits: Employees are disqualified from receiving workers' comp disability benefits if they are receiving unemployment compensation. If you do somehow receive workers' comp checks while you are collecting unemployment benefits, be aware that you will be required to pay back the workers' comp disability benefits.

• Medicare: If the injured employee is covered by Medicare at the time of the accident, or will be eligible for Medicare within thirty days from the date of the accident, the Centers for Medicare & Medicaid Services (CMS), a federal agency, must be notified. There are a lot of factors involved which can delay or hinder a claim once Medicare is involved. Try to get CMS involved as soon as possible to avoid long delays.

• Social Security Disability: If you believe you will not be able to return to work for more than a year, or if you have become permanently disabled as a result of your on-the-job injury, then you need to apply for Social Security Disability benefits immediately. This system is completely different than the Missouri workers' compensation system, and it can take two to three years to start receiving benefits. In addition, each government agency requires has a different burden of proof that must be met in order for the agency to approve your claim. In other words, just because you qualify for workers' compensation doesn't mean you will also qualify for SSD benefits. Furthermore, any disability money you receive from your workers' comp claim might lower the amount of SSD benefits you're eligible for. Under these circumstances, it's often beneficial to retain a workers' comp attorney who is familiar with this type of case.

• MO HealthNet Payments: Following your workplace injury, if you receive any medical care that is paid for by MO HealthNet, you may have to reimburse them once you receive your workers' comp settlement award. Bear this in mind, and discuss it with your employer's insurance carrier so you will understand exactly how to handle this situation.

• Child Support: If you are paying court-mandated child support, a work injury does not excuse you from making the legally required payments. Instead, the insurance company is required by Missouri law to give a portion of your benefits to whomever the child support is owed.

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Missouri workers must prove injuries arose "out of and in the course of employment" to collect workers' comp

January 12, 2013

Thumbnail image for file0001675328029.jpgUnder Missouri law, an employee must demonstrate that a workplace injury "[arose] out of and in the course of employment" to be eligible for workers' comp benefits. It might seem black and white: either you were injured on the job, or you weren't. However, a 2012 Missouri Supreme Court decision (Johme v. St. John's Mercy Healthcare) suggests that this issue could present complications to future claimants.

The employee & the injury
Sandy Johme worked as a billing representative at St. John's Mercy Healthcare at the time of her injury. The incident happened in an office kitchen that included a coffee station for all employees, and it was standard practice for the employee who took the last cup of coffee to make a fresh pot for others in the office. Johme was doing just that when she turned and stepped on the edge of her sandal, twisting her ankle and causing her foot to fall out of the shoe. She then fell backwards and landed on the floor.
Subsequently, Johme was transported to the emergency room by ambulance. where she complained of low back pain and left leg pain. An X-ray of her hips and pelvis revealed a fracture. While she did not have surgery to address the fracture, she was admitted to the hospital for pain management and physical therapy.

The claim
Johme filed a claim for workers' comp benefits, but after a hearing, an administrative law judge (ALJ) denied her claim, ruling that Johme's activity - making coffee - did not fall within the scope of her workplace responsibilities. "[Johme] was not performing her [work] duties at the time of her fall at work," the ALJ wrote. "[She] just fell and she would have been exposed to the same hazard or risk in her normal [nonemployment] life."

Johme then appealed to the Labor and Industrial Relations Commission, which reversed the ALJ's decision and awarded benefits to Johme. In its decision, the Commission specifically discussed personal comfort doctrine, which allows employees to collect benefits if they are injured while tending to basic human needs (such as hunger and thirst).

Further, the Commission reviewed the question of whether or not Johme's injury "arose out of and in the course of the worker's employment." Section 287.020.3(2) of Missouri workers' compensation law was amended in 2005 to read as follows:

"An injury shall be deemed to arise out of and in the course of the employment only if:

• (a) It is reasonably apparent, upon consideration of all the circumstances, that the accident is the prevailing factor in causing the injury; and

• (b) It does not come from a hazard or risk unrelated to the employment to which workers would have been equally exposed outside of and unrelated to the employment in normal nonemployment life."

In considering the issue, the Commission referenced a 2010 case, Pile v. Lake Regional Health System, which outlined a standard for applying Section 287.020.3(2):

"The first step is to determine whether the hazard or risk is related or unrelated to the employment...Only if the hazard or risk is unrelated to the employment does the second step of the analysis apply. In that event, it is necessary to determine whether the claimant is equally exposed to this hazard or risk in normal, non-employment life."

The Commission found that making coffee was in fact "incidental to and related to [Johme's] employment," and thus did not consider whether or not she would have been "equally exposed" to the circumstances that caused her injury outside of the workplace. Johme was awarded temporary total disability payments, permanent partial disability payments, and past medical expenses. St. John's then appealed the Commission's ruling, and the Missouri Supreme Court ultimately decided the issue.

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Missouri Court of Appeals affirms award to employee injured in workplace fall

November 8, 2012

1289968_up.jpgRecently, the Missouri Court of Appeals, Eastern District, upheld a decision awarding workers' compensation benefits to a Missouri employee injured in a workplace fall.

The claimant, Jason Pope, was injured while working as an entry-level technician for Gateway to the West Harley Davidson. Pope's on-the-job duties included inspecting, washing and test driving motorcycles. He was also responsible for driving motorcycles into interior showrooms for overnight storage.

On March 17, 2010, Pope had just finished moving motorcycles into an upper-level showroom and was descending a staircase when he fell and fractured his ankle. The injury required surgery followed by seven months of medical treatment and physical therapy. He was unable to work for a period of nine weeks, and he incurred nearly $21,000 in medical expenses.

Pope filed a workers' compensation claim, but it was initially denied. An administrative law judge (ALJ) ruled that Pope had not proven that his injury arose "out of and in the course of his employment," which is a requirement of Missouri workers' compensation law. Even though he was wearing his work boots and carrying his helmet when he fell, the ALJ determined that Pope would have been equally exposed to the same risk of injury in his non-employment life.

However, the Missouri Labor and Industrial Commission disagreed, overturning the ALJ's ruling and granting benefits to Pope. The Commission found that Pope's injury occurred while he was acting in the scope of his employment: i.e. walking down the stairs while wearing boots and carrying a helmet. Thus, there was a direct, causal connection between the injury and Pope's employment.

Gateway to the West Harley Davidson and its insurer, the Missouri Automobile Dealers Association Services Corporation, appealed the Commission's decision. The appeal cited two recent decisions made by the Missouri Supreme Court:

Johme vs. St. John's Mercy Healthcare. The Supreme Court denied workers' comp benefits to a St. John's employee after she tripped on her shoe and fell, fracturing her hip and pelvis, while making coffee in a workplace kitchen.

Miller vs. Missouri Highway and Transportation Commission. The Court denied benefits to a road construction worker who suffered a knee injury as he walked briskly to his truck.

However, the Court of Appeals denied the appeal, affirming the Commission's decision to award Pope benefits. The Court noted a key difference between Pope's claim and the claims involving Johme and Miller: "Because the service department was on the first floor, Pope was required to descend the staircase connecting the upper and lower showrooms," the ruling said. "Pope was wearing his work boots and carrying his work-required helmet as he descended the stairs. Unlike Miller and Johme, these facts support a finding that Pope was injured because he was at work, not simply while he was at work."

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OK appeals panel upholds decision granting workers' comp benefits to state representative

October 18, 2012

file000495587744.jpgAn Oklahoma appeals panel has upheld a ruling that awarded workers' compensation benefits to a state representative who was injured in a car crash. According to The Oklahoman, the panel determined that Rep. Mike Christian is entitled to benefits for his injuries, but reduced the award from $61,560 to $51,300.

In 2009, Christian was involved in a collision with a truck as he commuted to the State Capitol in a private vehicle. The incident left him with injuries to his neck and spine, but more than a year passed before he filed a workers' comp claim for the accident.

Ordinarily, Oklahoma employees - like Missouri employees - are unable to collect workers' comp benefits for injuries they sustain when commuting to and from work. However, Oklahoma state law identifies a few exceptions - including, notably, when an employer reimburses an employee for travel costs. Oklahoma legislators are entitled to travel expenses for one round trip to the Capitol per week, so Christian maintained that that exception applied to him, even though he waived reimbursement.

Lawyers for the state's insurance company, Comp Source Oklahoma, argued that Christian was not on the job at the time of the accident, and he was therefore ineligible for workers' comp benefits. In court, they pointed out that Christian's wife was in the vehicle with him at the time of the crash. "Because claimant was commuting with his wife, who was to continue on to her place of employment in their personal vehicle, he could not have claimed mileage for the trip even if he had not waived his right since the trip did not serve a public purpose," attorney Kristi Bynum Russell said at the hearing.

In July, a trial judge agreed with Christian, finding that the accident caused an 18% permanent partial disability to Christian's cervical spine and an 18% permanent partial disability to his lumbar spine. The judge ordered Comp Source Oklahoma to pay Christian $342.00 every week for 180 weeks, for a total award of $61,560.

On Friday, an appeals panel comprised of three judges upheld the award. The ruling did not include a comment on the decision itself, or on the panel's reduction of the award amount. Comp Source Oklahoma is expected to continue the appeals process to the Oklahoma Supreme Court.

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Missouri workplace injuries must arise "out of and in the course of employment" to be compensable

file000790174640.jpgA California appeals court has ruled that the state is not liable for a crash caused by a state employee who was driving to work after a medical appointment for a work-related injury.

The case involved Linda Gadbois, who was a cook employed by the California prison system. In April 2008, she was injured on the job at Avenal State Prison (AVP) and sought medical treatment through the prison's workers' compensation network. However, Gadbois was not happy with her original doctor, so she selected a different provider from a list supplied by AVP. On the morning of May 28, 2008, Gadbois was scheduled to work, but she was authorized to take time off to attend an appointment with her new doctor. After the appointment, she called AVP and told her supervisor she was on her way to work. She died in a fatal car crash soon afterward.

Kenneth Fields, the other driver involved, was seriously injured in the collision. Ultimately, Fields filed a personal injury lawsuit against Gadbois's estate and the state of California. The suit argued that Gadbois was "acting within the scope of her employment" when she caused the crash, and thus the state was also liable for his injuries. This kind of argument is known as respondeat superior, which is a common-law doctrine "that holds an employer or principal legally responsible for the wrongful acts of an employee or agent, if such acts occur within the scope of the employment or agency."

Normally, employees are normally considered outside the scope of their employment when they're commuting to or from work: thus, injuries sustained during these commutes this concept is known as the "coming and going rule." But Fields' argued that Gadbois, in driving to work from a medical appointment for a work-related injury, was actually acting within the scope of her employment.

However, the appeals court disagreed. After reviewing the case, the court concluded that Gadbois's employer was not liable for Fields' injuries. The ruling points out that Gadbois requested the appointment of her own accord; that AVP did not require her to drive to the appointment; and that driving was not connected to her regular job duties.

Here in Missouri, an employee must prove that an injury "[arose] out of and in the course of employment" to receive workers' comp benefits. In 2005, section 287.020.3(2) of Missouri law was amended to read as follows:

"An injury shall be deemed to arise out of and in the course of the employment only if:

• (a) It is reasonably apparent, upon consideration of all the circumstances, that the accident is the prevailing factor in causing the injury; and

• (b) It does not come from a hazard or risk unrelated to the employment to which workers would have been equally exposed outside of and unrelated to the employment in normal nonemployment life."


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Missouri employees & mental injuries: Your rights under the law

815492_computer_frustration.jpgMost Missouri workers' compensation claims are connected to workplace accidents that cause physical injuries, or to occupational diseases caused by workplace environments. However, there is another separate category of injury that can pose a threat to employees: that of mental or psychological injuries.

You might be surprised to hear that the American Psychological Association ranks mental injuries "among the top ten work-related injuries and illnesses in the nation," and are rapidly on the rise. They offer various theories as to why this might be so.

• Society as a whole has become more educated about mental illnesses and their effects on an individual's health. This increased knowledge has led to heightened awareness of job-related stress disorders that can manifest as mental illnesses.

• Similarly, more employers now understand that mental health directly contributes to productivity. Several states have adjusted their workers' compensation statutes to allow employees to collect benefits for job-related mental health issues.

• A large percentage of today's jobs require more mental than physical effort, increasing the possibility of developing a mental injury.

• Given concerns about the economy and current unemployment rates, the nature of today's workplace is more competitive, fast-paced and stressful than it has ever been. When employees suffer psychological injuries at work, those injuries are often connected to stress.

Here are a couple of real-life examples of mental injuries sustained in the workplace:

• On August 4, 2001, a bank teller in Canton, Ohio was robbed at gunpoint. She was unable to return to her job, and she was subsequently diagnosed with post-traumatic stress disorder (PTSD). But here's the catch: unlike a broken bone, torn retina or mesothelioma, mental injuries are much harder to prove in court, and thus much harder to win a claim for. In this case, the teller was actually denied benefits because there was no corresponding physical injury, not even a minor one, which was a requirement of Ohio law at that time. She took her claim all the way to the Ohio Supreme Court, but lost.

• In 2010, a Missouri mental health care worker was awarded permanent and total disability benefits for a mental injury sustained at work. The worker has been diagnosed with PTSD after traveling to New York to assist postal workers following the September 11 attack on the Twin Towers. He reported difficulty concentrating, anxiety and nightmares, but he initially returned to work. However, within a year, his condition escalated: after threatening to shoot his coworkers, he was also diagnosed with major affective disorder, and he was never able to return to his job. The Workers' Comp Commission affirmed the award of benefits from the Second Injury Fund.

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Nail salons and chemical overexposure: The risks facing Missouri workers

55175_nails.jpgThe summer months bring increased business to beauty salons across the United States. Summertime reigns as the busiest season for nail technicians in the U.S., with more than 375,000 people working in salons daily. However, many of these workers are not aware of the hazardous chemicals they are exposed to every day and the health risks they pose. Chemicals from nail polishes, glues, removers, and salon products can be detrimental to technicians' health. Without taking certain safety steps, nail technicians could face long term health risks from workplace exposure.

The Occupational Safety and Health Administration (OSHA) provides a list of hazardous chemicals commonly used in nail salons, which notes that employees are exposed to many chemicals, including methacrylic acids and acetates. Chemicals present in salons pose potent hazards and when mixed together, they can become even more dangerous. Employers must work to prevent chemical exposure by properly ventilating the salon and keeping potential dust or chemicals away from breathing zones. Employers can remove dangerous chemicals from breathing zones by using fans and other technologies that provide air circulation. The good news is that workplace illnesses connected to nail salons are largely preventable, provided the appropriate safety precautions are taken.

Also, nail salon owners are urged to reduce usage of products that contain certain hazardous chemicals, and seek out products that are acid free and "3-free" (those made without the "toxic trio": toluene, formaldehyde, and dibutyl phthalate). Reducing the number of chemicals present in the salon automatically decreases the risk of exposure. Another way to protect employees from overexposure is to diligently schedule breaks and allow appropriate time off from all types of chemical exposure. Lastly, always handle chemicals with care. Remember to keep bottles tightly sealed when not in use, and properly dispose of all chemicals.

Chemical overexposure can cause serious health-related consequences for nail technicians. Some studies have linked musculoskeletal disorders, skin problems, respiratory irritation, and headaches to work-related chemical exposure in nail salons. There are more than 10,000 nail products regularly used that do not have EPA safety approval, so the risks of future health problems are high.

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Bill Preventing Co-Worker Lawsuits Passes Missouri General Assembly: Occupational Diseases & Second Injury Fund Left in Limbo

1221952_to_sign_a_contract_3.jpgOn Tuesday afternoon, the Missouri General Assembly passed a bill that will prohibit employees from suing their co-workers for on-the-job injuries. The legislation would only allow employees to sue co-workers when "the accident was the result of gross negligence or an intentional act of harm," says the Springfield News-Leader. The bill was passed in the Missouri House by a vote of 122 - 29, and the Senate unanimously approved it within the same day. Now, it awaits Governor Nixon's approval.

However, the bill does not address two pressing issues that directly affect the Missouri workers' compensation system: (1) the struggling Second Injury Fund; and (2) the process for treating deadly work-related diseases. It appears that these issues will not be addressed until next year.

Earlier this year, Governor Nixon vetoed legislation that addressed all three subjects. In his veto letter, Nixon said his primary concern is connected to occupational diseases, and his worry that the workers' compensation system cannot "adequately compensate workers for debilitating diseases that will eventually take their lives, and [that] such cases should be handled by civil courts, as they now are," according to Columbia Daily Tribune. Occupational diseases are chronic ailments contracted through the workplace, such as mesothelioma and lead poisoning.

After vetoing the proposed bill, however, Nixon sent a letter to Senate Majority Leader Tom Dempsey and Minority Leader Victor Callahan. In the letter, Nixon agreed to sign new workers' comp legislation, provided that those who suffer from occupational diseases would be awarded "enhanced benefits" - meaning they would receive larger weekly payments than injured workers.

In response, Dempsey reportedly proposed that those workers be paid 200% of the state's average weekly wage for 200 weeks, which would equate to a settlement around $300,000. Nixon's offer, according to Dempsey, would have paid closer to $700,000 to employees who suffer from occupational diseases. "The governor's number was too high, so there you are," Dempsey said. Since a compromise couldn't be reached, it's likely that the issue will have to wait until the next legislative session.

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Former St. Louis Rams Linebacker Files Lawsuit Connected to Missouri Workers' Compensation Claim

585059_football_1.jpgJamie Duncan, former linebacker for the St. Louis Rams, has filed a lawsuit in City Court against his former attorney, Mark L. Floyd of the Floyd Law Firm. The lawsuit is connected to a Missouri workers' compensation claim filed on Duncan's behalf: 5 years ago, Duncan alleges, Floyd advised him to sign a $1,000 settlement that included a waiver for any future medical benefits. Duncan's complaint argues that doing so ultimately cost him $255,000, reports the Courthouse News Service.

In 2007, when Duncan's initial claim was made, the Rams had offices in both St. Louis and Los Angeles, and Duncan's settlement was filed in the Missouri Division of Workers' Compensation. In the years that followed, Duncan sought to collect benefits on new claims for cumulative orthopedic and closed head trauma. In that pursuit, he was represented by California attorney Ron Mix.

By March of 2011, the complaint says, "Mix had negotiated a tentative settlement wherein the St. Louis Rams would settle all pending workers' compensation claims of Jamie Duncan, plus a buy-out of future medical benefits for the sum of Three Hundred Thousand Dollars ($300,000)."

Then, in May 2011, the Rams contacted Mix to inform him that Duncan had waived all future medical claims by agreeing to the Missouri settlement in 2007. Thus, the Rams "declined to offer any compensation to the plaintiff," the complaint continues. Mix was eventually able to settle Duncan's California claims for $45,000: since the Rams organization initially offered $300,000, Duncan is suing to recover the difference.

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High-Priced Prescription Drugs Contribute $2.1 Billion to Workers' Compensation Costs in Missouri & Nationwide

file0002115296013.jpgBetween treatment, rehabilitation and medication costs, recovering from a workplace injury can become very expensive very quickly. In particular, the expense associated with certain prescription drugs cost the workers' compensation system billions of dollars in wasted pharmacy-related funds last year, according to the 2011 Express Scripts Workers' Compensation Drug Trend Report.

The report indicates that the use of expensive medication (instead of lower-costing, therapeutically equivalent drugs) accounted for approximately $2.1 billion in wasted funds. In addition, the workers' comp industry saw $107 million wasted due to the use of out-of-network pharmacies and third party billing; and $40 million wasted through the use of "higher-cost" delivery channels (like retail pharmacies) for long-term medication.

• 76.2% of total drug spending in 2011 was associated with the top six "therapy classes," which include narcotic analgesics, anticonvulsants, anti-inflammatory drugs, and dermatological medication.

• Narcotic analgesics have the highest annual cost per user ($508). This therapy class also accounts for approximately 38% of total drug spending and 34% of total utilization.

• 10% of total drug spending in 2011 was associated with the powerful painkiller Oxycontin. This drug also had the highest cost per user.

• The biggest spike in costs was associated with dermatological medication, which rose 7.4% in 2011.

According to Express Scripts' official press release,

"Behaviors such as habit or lack of awareness can lead some physicians to continue to choose branded medications over more clinically equivalent, lower-cost generic alternatives. Injured workers may also request the more expensive medication. These behaviors drive up the cost of the workers' compensation pharmacy benefit."

The report also indicates that about 125 million U.S. employees are currently eligible for workers' compensation coverage. Approximately 4.2 million of these employees suffer work-related injuries and illnesses every year.

Continue reading "High-Priced Prescription Drugs Contribute $2.1 Billion to Workers' Compensation Costs in Missouri & Nationwide" »