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WCLA MCLE 12-1-11
bull 2011 Year End CLE Wrap Up amp Reviewbull Thursday December 1 2011bull 1200 noon to 100 pm bull James R Thompson Center Auditorium
Chicago ILbull 10 Hour General MCLE Credit
2012 WCLA MCLE SCHEDULE
bull One Hour Lunch Time Programs January 31 2012 February 29 2012 March 29 2012 April 17 2012 May 16 2012 June 21 2012 July 10 2012 August 8 2012 September 13 20102 October 2 2012 November 7 2012 December 6 2012
bull 2012 WCLA Medical Seminar in Septemberbull 2012 Appellate Court Luncheonbull Two 3 hour ETHICS amp PROFESSIONALISM
Bootcamps
Traveling EmployeesJanuary 2011
bull Cox v IWCC 406 IllApp3d 541 (2010) Appellate Court reverses IWCC decision that Petitioner was not in the course of his employment traveling employee in company vehicle had re-entered course of his employment even if personal trip to bank was deviation
bull Johnson v IWCC No 2-10-0148WC 8-15-2011 Appellate Court says Will County sheriff was back ldquoin the course of his employmentrdquo when he was responding to dispatch in his patrol car after leaving county to perform personal errand (Commission had denied benefits 2-1 for personal deviation) DE NOVO
Medical BillsFebruary 2011
bull Tower Automotive v IWCC 407 IllApp3d 427 (2011) ldquoremand this matter to the Commission with directions to award the claimant the amount actually paid to the providers of medical services rendered to him as a result of his injuries of June 30 2005rdquo
bull ELVIS RIDGEWAY v TLC INC 11 IWCC 920 This award is not subject to the fee schedule based on the Appellate Courts recent holding in Tower Automotive v IWCC hellipthe Court held that the amendatory change to sect 8(a) giving rise to the fee schedule (ie PA 94-0277) applies to claims for accidents occurring on or after February 1 2006 Petitioners accident occurred before February 1 2006
bull CAROLYN OCCHUIZZO v JOLIET PUBLIC SCHOOL DISTRICT 86 11 IWCC 0190 The Commission notes that a very recent decision by the Appellate Court supports Respondents conclusion that it should only be held liable for the amount paid by Medicare for Petitioners treatment Tower Automotive hellipThe Commission notes that the Court limited this decision to workers compensation cases arising from accidents that occurred prior to the implementation of the fee schedule Because the case at hand involves an accident that occurred on January 31 2001 the Commission finds that Respondent is only required to pay the $ 3851162 paid by Medicare to Petitioners medical providers
Medical BillsFebruary 2011
bull Award for More than Negotiated Rate No DONNA J THORPE v PALOS COMMUNITY HOSPITAL 11 IWCC 1041 Following Arbitratorrsquos finding AFFIRMED ldquoThe charges for the second opinion appointment with Dr Schlenker on June 5 2008 (PX5) the charges for the surgery at Palos Community Hospital on July 7 2008 and the charges from Palos Anesthesia Associates and Associated Cardiovascular were incurred and paid at the negotiated rate by the Petitioners husbands group medical insurance (BCBS of Illinois) in the amount of $ 1025057 No objections were made with regard to the amounts paid The Arbitrator finds that the Petitioner has sustained her burden of proof that these medical charges constitute reasonable necessary and causally related to the accident of August 21 2007 and notes that the treatment dates on the account statement correspond to the medical records for treatment provided by Dr Schlenker Moreover the hospital and related surgical charges correspond to the surgery that Dr Chow performed Accordingly the Arbitrator concludes that these amounts paid at the negotiated rate and submitted at arbitration as Petitioners Exhibit 7 constitute reasonable and necessary medical treatment pursuant to Section 8(a) of the Actrdquo
Arising Out Of March 2011
bull MWRD v IWCC 407 Ill App 3d 1010 (2011) ldquoUnder the street risk doctrine where the evidence establishes that the claimantrsquos job requires that she be on the street to perform the duties of her employment the risks of the street become one of risks of the employment and an injury sustained while performing that duty has a causal relation to her employment Potenzohellip In such a circumstance it is presumed that the claimant is exposed to risks of accidents in the street to a greater degree than if she had not been employed in such a capacity and the claimant will be entitled to benefits under the Act
bull STANISLAWA MIYNARCZTK v SOPHIE OBROCHTA 11 IWCC 0747 Potenzo cited by Commission fall by traveling cleaning lady in her driveway returning to company vehicle after lunch break not compensable
48 Hour RuleApril 2011
bull Mulligan v IWCC 408 IllApp3d 205 (2011) Respondentrsquos evidence (Dr Kornblatt records review amp Dr Hopkinson IME) barred as violating 48 hour rule of Section 12 because Respondent failed to turn over reports prior to ldquoset for hearingrdquo (bifurcated over 2 years)
bull Sandra Lindsey v American Liberty School Bus 11 IWCC 0993 With respect to the issue of EVIDENCE the Arbitrator concludes that Petitioners objection to the second report of respondents examining physician and any testimony related to that report must be upheld Petitioners attorney stated that he never received a copy of Dr Troys second report prior to the deposition Respondents attorney appeared for her partner at the last minute due to serious illness and could not provide proof that the report had been tendered to Petitioners attorney 48 hours prior to the deposition The Arbitrator must therefore sustain Petitioners objection pursuant to Section 12 of the Act as recently discussed in MulliganhellipThe Arbitrator notes that despite Petitioners attorneys objection he nevertheless questioned both Petitioner and Dr Silver about the second examination The Arbitrator finds it difficult to believe there could be any prejudice or surprise to Petitioner after reading Dr Troys initial examination report
City of ChicagoBaumgardnerMay 2011
bull City of Chicago v IWCC 409 IllApp3d 258 (2011) ldquoThe employer maintains that the Act prohibits two permanency awards for the same current condition of ill-being even if that current condition of ill-being is the result of two separate industrial accidents The employer presents a question of statutory interpretation which is reviewed de novohellipBased upon the foregoing we find that the claimant is not entitled to an award under both section 8(d)(1) and section 8(d)(2) for the same condition of ill-beingrdquo
bull Baumgardner v IWCC 409 IllApp3d 274 (2011) Petitioner ldquocontends that the Act does not preclude a scheduled PPD award where wage-differential benefits have been granted under section 8(d)(1) based on a second aggravating injury to the same body part prior to the arbitration hearing on both claimshellipWe note that the claimant asserts that because the facts presented are undisputed the Commissions finding with regard to permanency presents a question of law subject to de novo review We disagreehellipWe cannot say that the Commissions denial of a scheduled PPD award under section 8(e) for the April 1996 injury is against the manifest weight of the evidencerdquo
HB 1698June 2011
bull PA97-0018 effective 6-28-11 but know your applicability dates (eg TPD gross 6-28-11 But AMA Guides 9-1-11)
bull Know your new zones (Cook County Wheaton Zones 1-5) But be aware that 19(b)rsquos will follow Arbitrator not venue
bull Check the web site regularly wwwiwccilgovbull Join the group email news service Register at
httpwwwiwccilgovnewshtm
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
2012 WCLA MCLE SCHEDULE
bull One Hour Lunch Time Programs January 31 2012 February 29 2012 March 29 2012 April 17 2012 May 16 2012 June 21 2012 July 10 2012 August 8 2012 September 13 20102 October 2 2012 November 7 2012 December 6 2012
bull 2012 WCLA Medical Seminar in Septemberbull 2012 Appellate Court Luncheonbull Two 3 hour ETHICS amp PROFESSIONALISM
Bootcamps
Traveling EmployeesJanuary 2011
bull Cox v IWCC 406 IllApp3d 541 (2010) Appellate Court reverses IWCC decision that Petitioner was not in the course of his employment traveling employee in company vehicle had re-entered course of his employment even if personal trip to bank was deviation
bull Johnson v IWCC No 2-10-0148WC 8-15-2011 Appellate Court says Will County sheriff was back ldquoin the course of his employmentrdquo when he was responding to dispatch in his patrol car after leaving county to perform personal errand (Commission had denied benefits 2-1 for personal deviation) DE NOVO
Medical BillsFebruary 2011
bull Tower Automotive v IWCC 407 IllApp3d 427 (2011) ldquoremand this matter to the Commission with directions to award the claimant the amount actually paid to the providers of medical services rendered to him as a result of his injuries of June 30 2005rdquo
bull ELVIS RIDGEWAY v TLC INC 11 IWCC 920 This award is not subject to the fee schedule based on the Appellate Courts recent holding in Tower Automotive v IWCC hellipthe Court held that the amendatory change to sect 8(a) giving rise to the fee schedule (ie PA 94-0277) applies to claims for accidents occurring on or after February 1 2006 Petitioners accident occurred before February 1 2006
bull CAROLYN OCCHUIZZO v JOLIET PUBLIC SCHOOL DISTRICT 86 11 IWCC 0190 The Commission notes that a very recent decision by the Appellate Court supports Respondents conclusion that it should only be held liable for the amount paid by Medicare for Petitioners treatment Tower Automotive hellipThe Commission notes that the Court limited this decision to workers compensation cases arising from accidents that occurred prior to the implementation of the fee schedule Because the case at hand involves an accident that occurred on January 31 2001 the Commission finds that Respondent is only required to pay the $ 3851162 paid by Medicare to Petitioners medical providers
Medical BillsFebruary 2011
bull Award for More than Negotiated Rate No DONNA J THORPE v PALOS COMMUNITY HOSPITAL 11 IWCC 1041 Following Arbitratorrsquos finding AFFIRMED ldquoThe charges for the second opinion appointment with Dr Schlenker on June 5 2008 (PX5) the charges for the surgery at Palos Community Hospital on July 7 2008 and the charges from Palos Anesthesia Associates and Associated Cardiovascular were incurred and paid at the negotiated rate by the Petitioners husbands group medical insurance (BCBS of Illinois) in the amount of $ 1025057 No objections were made with regard to the amounts paid The Arbitrator finds that the Petitioner has sustained her burden of proof that these medical charges constitute reasonable necessary and causally related to the accident of August 21 2007 and notes that the treatment dates on the account statement correspond to the medical records for treatment provided by Dr Schlenker Moreover the hospital and related surgical charges correspond to the surgery that Dr Chow performed Accordingly the Arbitrator concludes that these amounts paid at the negotiated rate and submitted at arbitration as Petitioners Exhibit 7 constitute reasonable and necessary medical treatment pursuant to Section 8(a) of the Actrdquo
Arising Out Of March 2011
bull MWRD v IWCC 407 Ill App 3d 1010 (2011) ldquoUnder the street risk doctrine where the evidence establishes that the claimantrsquos job requires that she be on the street to perform the duties of her employment the risks of the street become one of risks of the employment and an injury sustained while performing that duty has a causal relation to her employment Potenzohellip In such a circumstance it is presumed that the claimant is exposed to risks of accidents in the street to a greater degree than if she had not been employed in such a capacity and the claimant will be entitled to benefits under the Act
bull STANISLAWA MIYNARCZTK v SOPHIE OBROCHTA 11 IWCC 0747 Potenzo cited by Commission fall by traveling cleaning lady in her driveway returning to company vehicle after lunch break not compensable
48 Hour RuleApril 2011
bull Mulligan v IWCC 408 IllApp3d 205 (2011) Respondentrsquos evidence (Dr Kornblatt records review amp Dr Hopkinson IME) barred as violating 48 hour rule of Section 12 because Respondent failed to turn over reports prior to ldquoset for hearingrdquo (bifurcated over 2 years)
bull Sandra Lindsey v American Liberty School Bus 11 IWCC 0993 With respect to the issue of EVIDENCE the Arbitrator concludes that Petitioners objection to the second report of respondents examining physician and any testimony related to that report must be upheld Petitioners attorney stated that he never received a copy of Dr Troys second report prior to the deposition Respondents attorney appeared for her partner at the last minute due to serious illness and could not provide proof that the report had been tendered to Petitioners attorney 48 hours prior to the deposition The Arbitrator must therefore sustain Petitioners objection pursuant to Section 12 of the Act as recently discussed in MulliganhellipThe Arbitrator notes that despite Petitioners attorneys objection he nevertheless questioned both Petitioner and Dr Silver about the second examination The Arbitrator finds it difficult to believe there could be any prejudice or surprise to Petitioner after reading Dr Troys initial examination report
City of ChicagoBaumgardnerMay 2011
bull City of Chicago v IWCC 409 IllApp3d 258 (2011) ldquoThe employer maintains that the Act prohibits two permanency awards for the same current condition of ill-being even if that current condition of ill-being is the result of two separate industrial accidents The employer presents a question of statutory interpretation which is reviewed de novohellipBased upon the foregoing we find that the claimant is not entitled to an award under both section 8(d)(1) and section 8(d)(2) for the same condition of ill-beingrdquo
bull Baumgardner v IWCC 409 IllApp3d 274 (2011) Petitioner ldquocontends that the Act does not preclude a scheduled PPD award where wage-differential benefits have been granted under section 8(d)(1) based on a second aggravating injury to the same body part prior to the arbitration hearing on both claimshellipWe note that the claimant asserts that because the facts presented are undisputed the Commissions finding with regard to permanency presents a question of law subject to de novo review We disagreehellipWe cannot say that the Commissions denial of a scheduled PPD award under section 8(e) for the April 1996 injury is against the manifest weight of the evidencerdquo
HB 1698June 2011
bull PA97-0018 effective 6-28-11 but know your applicability dates (eg TPD gross 6-28-11 But AMA Guides 9-1-11)
bull Know your new zones (Cook County Wheaton Zones 1-5) But be aware that 19(b)rsquos will follow Arbitrator not venue
bull Check the web site regularly wwwiwccilgovbull Join the group email news service Register at
httpwwwiwccilgovnewshtm
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
Traveling EmployeesJanuary 2011
bull Cox v IWCC 406 IllApp3d 541 (2010) Appellate Court reverses IWCC decision that Petitioner was not in the course of his employment traveling employee in company vehicle had re-entered course of his employment even if personal trip to bank was deviation
bull Johnson v IWCC No 2-10-0148WC 8-15-2011 Appellate Court says Will County sheriff was back ldquoin the course of his employmentrdquo when he was responding to dispatch in his patrol car after leaving county to perform personal errand (Commission had denied benefits 2-1 for personal deviation) DE NOVO
Medical BillsFebruary 2011
bull Tower Automotive v IWCC 407 IllApp3d 427 (2011) ldquoremand this matter to the Commission with directions to award the claimant the amount actually paid to the providers of medical services rendered to him as a result of his injuries of June 30 2005rdquo
bull ELVIS RIDGEWAY v TLC INC 11 IWCC 920 This award is not subject to the fee schedule based on the Appellate Courts recent holding in Tower Automotive v IWCC hellipthe Court held that the amendatory change to sect 8(a) giving rise to the fee schedule (ie PA 94-0277) applies to claims for accidents occurring on or after February 1 2006 Petitioners accident occurred before February 1 2006
bull CAROLYN OCCHUIZZO v JOLIET PUBLIC SCHOOL DISTRICT 86 11 IWCC 0190 The Commission notes that a very recent decision by the Appellate Court supports Respondents conclusion that it should only be held liable for the amount paid by Medicare for Petitioners treatment Tower Automotive hellipThe Commission notes that the Court limited this decision to workers compensation cases arising from accidents that occurred prior to the implementation of the fee schedule Because the case at hand involves an accident that occurred on January 31 2001 the Commission finds that Respondent is only required to pay the $ 3851162 paid by Medicare to Petitioners medical providers
Medical BillsFebruary 2011
bull Award for More than Negotiated Rate No DONNA J THORPE v PALOS COMMUNITY HOSPITAL 11 IWCC 1041 Following Arbitratorrsquos finding AFFIRMED ldquoThe charges for the second opinion appointment with Dr Schlenker on June 5 2008 (PX5) the charges for the surgery at Palos Community Hospital on July 7 2008 and the charges from Palos Anesthesia Associates and Associated Cardiovascular were incurred and paid at the negotiated rate by the Petitioners husbands group medical insurance (BCBS of Illinois) in the amount of $ 1025057 No objections were made with regard to the amounts paid The Arbitrator finds that the Petitioner has sustained her burden of proof that these medical charges constitute reasonable necessary and causally related to the accident of August 21 2007 and notes that the treatment dates on the account statement correspond to the medical records for treatment provided by Dr Schlenker Moreover the hospital and related surgical charges correspond to the surgery that Dr Chow performed Accordingly the Arbitrator concludes that these amounts paid at the negotiated rate and submitted at arbitration as Petitioners Exhibit 7 constitute reasonable and necessary medical treatment pursuant to Section 8(a) of the Actrdquo
Arising Out Of March 2011
bull MWRD v IWCC 407 Ill App 3d 1010 (2011) ldquoUnder the street risk doctrine where the evidence establishes that the claimantrsquos job requires that she be on the street to perform the duties of her employment the risks of the street become one of risks of the employment and an injury sustained while performing that duty has a causal relation to her employment Potenzohellip In such a circumstance it is presumed that the claimant is exposed to risks of accidents in the street to a greater degree than if she had not been employed in such a capacity and the claimant will be entitled to benefits under the Act
bull STANISLAWA MIYNARCZTK v SOPHIE OBROCHTA 11 IWCC 0747 Potenzo cited by Commission fall by traveling cleaning lady in her driveway returning to company vehicle after lunch break not compensable
48 Hour RuleApril 2011
bull Mulligan v IWCC 408 IllApp3d 205 (2011) Respondentrsquos evidence (Dr Kornblatt records review amp Dr Hopkinson IME) barred as violating 48 hour rule of Section 12 because Respondent failed to turn over reports prior to ldquoset for hearingrdquo (bifurcated over 2 years)
bull Sandra Lindsey v American Liberty School Bus 11 IWCC 0993 With respect to the issue of EVIDENCE the Arbitrator concludes that Petitioners objection to the second report of respondents examining physician and any testimony related to that report must be upheld Petitioners attorney stated that he never received a copy of Dr Troys second report prior to the deposition Respondents attorney appeared for her partner at the last minute due to serious illness and could not provide proof that the report had been tendered to Petitioners attorney 48 hours prior to the deposition The Arbitrator must therefore sustain Petitioners objection pursuant to Section 12 of the Act as recently discussed in MulliganhellipThe Arbitrator notes that despite Petitioners attorneys objection he nevertheless questioned both Petitioner and Dr Silver about the second examination The Arbitrator finds it difficult to believe there could be any prejudice or surprise to Petitioner after reading Dr Troys initial examination report
City of ChicagoBaumgardnerMay 2011
bull City of Chicago v IWCC 409 IllApp3d 258 (2011) ldquoThe employer maintains that the Act prohibits two permanency awards for the same current condition of ill-being even if that current condition of ill-being is the result of two separate industrial accidents The employer presents a question of statutory interpretation which is reviewed de novohellipBased upon the foregoing we find that the claimant is not entitled to an award under both section 8(d)(1) and section 8(d)(2) for the same condition of ill-beingrdquo
bull Baumgardner v IWCC 409 IllApp3d 274 (2011) Petitioner ldquocontends that the Act does not preclude a scheduled PPD award where wage-differential benefits have been granted under section 8(d)(1) based on a second aggravating injury to the same body part prior to the arbitration hearing on both claimshellipWe note that the claimant asserts that because the facts presented are undisputed the Commissions finding with regard to permanency presents a question of law subject to de novo review We disagreehellipWe cannot say that the Commissions denial of a scheduled PPD award under section 8(e) for the April 1996 injury is against the manifest weight of the evidencerdquo
HB 1698June 2011
bull PA97-0018 effective 6-28-11 but know your applicability dates (eg TPD gross 6-28-11 But AMA Guides 9-1-11)
bull Know your new zones (Cook County Wheaton Zones 1-5) But be aware that 19(b)rsquos will follow Arbitrator not venue
bull Check the web site regularly wwwiwccilgovbull Join the group email news service Register at
httpwwwiwccilgovnewshtm
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
Medical BillsFebruary 2011
bull Tower Automotive v IWCC 407 IllApp3d 427 (2011) ldquoremand this matter to the Commission with directions to award the claimant the amount actually paid to the providers of medical services rendered to him as a result of his injuries of June 30 2005rdquo
bull ELVIS RIDGEWAY v TLC INC 11 IWCC 920 This award is not subject to the fee schedule based on the Appellate Courts recent holding in Tower Automotive v IWCC hellipthe Court held that the amendatory change to sect 8(a) giving rise to the fee schedule (ie PA 94-0277) applies to claims for accidents occurring on or after February 1 2006 Petitioners accident occurred before February 1 2006
bull CAROLYN OCCHUIZZO v JOLIET PUBLIC SCHOOL DISTRICT 86 11 IWCC 0190 The Commission notes that a very recent decision by the Appellate Court supports Respondents conclusion that it should only be held liable for the amount paid by Medicare for Petitioners treatment Tower Automotive hellipThe Commission notes that the Court limited this decision to workers compensation cases arising from accidents that occurred prior to the implementation of the fee schedule Because the case at hand involves an accident that occurred on January 31 2001 the Commission finds that Respondent is only required to pay the $ 3851162 paid by Medicare to Petitioners medical providers
Medical BillsFebruary 2011
bull Award for More than Negotiated Rate No DONNA J THORPE v PALOS COMMUNITY HOSPITAL 11 IWCC 1041 Following Arbitratorrsquos finding AFFIRMED ldquoThe charges for the second opinion appointment with Dr Schlenker on June 5 2008 (PX5) the charges for the surgery at Palos Community Hospital on July 7 2008 and the charges from Palos Anesthesia Associates and Associated Cardiovascular were incurred and paid at the negotiated rate by the Petitioners husbands group medical insurance (BCBS of Illinois) in the amount of $ 1025057 No objections were made with regard to the amounts paid The Arbitrator finds that the Petitioner has sustained her burden of proof that these medical charges constitute reasonable necessary and causally related to the accident of August 21 2007 and notes that the treatment dates on the account statement correspond to the medical records for treatment provided by Dr Schlenker Moreover the hospital and related surgical charges correspond to the surgery that Dr Chow performed Accordingly the Arbitrator concludes that these amounts paid at the negotiated rate and submitted at arbitration as Petitioners Exhibit 7 constitute reasonable and necessary medical treatment pursuant to Section 8(a) of the Actrdquo
Arising Out Of March 2011
bull MWRD v IWCC 407 Ill App 3d 1010 (2011) ldquoUnder the street risk doctrine where the evidence establishes that the claimantrsquos job requires that she be on the street to perform the duties of her employment the risks of the street become one of risks of the employment and an injury sustained while performing that duty has a causal relation to her employment Potenzohellip In such a circumstance it is presumed that the claimant is exposed to risks of accidents in the street to a greater degree than if she had not been employed in such a capacity and the claimant will be entitled to benefits under the Act
bull STANISLAWA MIYNARCZTK v SOPHIE OBROCHTA 11 IWCC 0747 Potenzo cited by Commission fall by traveling cleaning lady in her driveway returning to company vehicle after lunch break not compensable
48 Hour RuleApril 2011
bull Mulligan v IWCC 408 IllApp3d 205 (2011) Respondentrsquos evidence (Dr Kornblatt records review amp Dr Hopkinson IME) barred as violating 48 hour rule of Section 12 because Respondent failed to turn over reports prior to ldquoset for hearingrdquo (bifurcated over 2 years)
bull Sandra Lindsey v American Liberty School Bus 11 IWCC 0993 With respect to the issue of EVIDENCE the Arbitrator concludes that Petitioners objection to the second report of respondents examining physician and any testimony related to that report must be upheld Petitioners attorney stated that he never received a copy of Dr Troys second report prior to the deposition Respondents attorney appeared for her partner at the last minute due to serious illness and could not provide proof that the report had been tendered to Petitioners attorney 48 hours prior to the deposition The Arbitrator must therefore sustain Petitioners objection pursuant to Section 12 of the Act as recently discussed in MulliganhellipThe Arbitrator notes that despite Petitioners attorneys objection he nevertheless questioned both Petitioner and Dr Silver about the second examination The Arbitrator finds it difficult to believe there could be any prejudice or surprise to Petitioner after reading Dr Troys initial examination report
City of ChicagoBaumgardnerMay 2011
bull City of Chicago v IWCC 409 IllApp3d 258 (2011) ldquoThe employer maintains that the Act prohibits two permanency awards for the same current condition of ill-being even if that current condition of ill-being is the result of two separate industrial accidents The employer presents a question of statutory interpretation which is reviewed de novohellipBased upon the foregoing we find that the claimant is not entitled to an award under both section 8(d)(1) and section 8(d)(2) for the same condition of ill-beingrdquo
bull Baumgardner v IWCC 409 IllApp3d 274 (2011) Petitioner ldquocontends that the Act does not preclude a scheduled PPD award where wage-differential benefits have been granted under section 8(d)(1) based on a second aggravating injury to the same body part prior to the arbitration hearing on both claimshellipWe note that the claimant asserts that because the facts presented are undisputed the Commissions finding with regard to permanency presents a question of law subject to de novo review We disagreehellipWe cannot say that the Commissions denial of a scheduled PPD award under section 8(e) for the April 1996 injury is against the manifest weight of the evidencerdquo
HB 1698June 2011
bull PA97-0018 effective 6-28-11 but know your applicability dates (eg TPD gross 6-28-11 But AMA Guides 9-1-11)
bull Know your new zones (Cook County Wheaton Zones 1-5) But be aware that 19(b)rsquos will follow Arbitrator not venue
bull Check the web site regularly wwwiwccilgovbull Join the group email news service Register at
httpwwwiwccilgovnewshtm
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
Medical BillsFebruary 2011
bull Award for More than Negotiated Rate No DONNA J THORPE v PALOS COMMUNITY HOSPITAL 11 IWCC 1041 Following Arbitratorrsquos finding AFFIRMED ldquoThe charges for the second opinion appointment with Dr Schlenker on June 5 2008 (PX5) the charges for the surgery at Palos Community Hospital on July 7 2008 and the charges from Palos Anesthesia Associates and Associated Cardiovascular were incurred and paid at the negotiated rate by the Petitioners husbands group medical insurance (BCBS of Illinois) in the amount of $ 1025057 No objections were made with regard to the amounts paid The Arbitrator finds that the Petitioner has sustained her burden of proof that these medical charges constitute reasonable necessary and causally related to the accident of August 21 2007 and notes that the treatment dates on the account statement correspond to the medical records for treatment provided by Dr Schlenker Moreover the hospital and related surgical charges correspond to the surgery that Dr Chow performed Accordingly the Arbitrator concludes that these amounts paid at the negotiated rate and submitted at arbitration as Petitioners Exhibit 7 constitute reasonable and necessary medical treatment pursuant to Section 8(a) of the Actrdquo
Arising Out Of March 2011
bull MWRD v IWCC 407 Ill App 3d 1010 (2011) ldquoUnder the street risk doctrine where the evidence establishes that the claimantrsquos job requires that she be on the street to perform the duties of her employment the risks of the street become one of risks of the employment and an injury sustained while performing that duty has a causal relation to her employment Potenzohellip In such a circumstance it is presumed that the claimant is exposed to risks of accidents in the street to a greater degree than if she had not been employed in such a capacity and the claimant will be entitled to benefits under the Act
bull STANISLAWA MIYNARCZTK v SOPHIE OBROCHTA 11 IWCC 0747 Potenzo cited by Commission fall by traveling cleaning lady in her driveway returning to company vehicle after lunch break not compensable
48 Hour RuleApril 2011
bull Mulligan v IWCC 408 IllApp3d 205 (2011) Respondentrsquos evidence (Dr Kornblatt records review amp Dr Hopkinson IME) barred as violating 48 hour rule of Section 12 because Respondent failed to turn over reports prior to ldquoset for hearingrdquo (bifurcated over 2 years)
bull Sandra Lindsey v American Liberty School Bus 11 IWCC 0993 With respect to the issue of EVIDENCE the Arbitrator concludes that Petitioners objection to the second report of respondents examining physician and any testimony related to that report must be upheld Petitioners attorney stated that he never received a copy of Dr Troys second report prior to the deposition Respondents attorney appeared for her partner at the last minute due to serious illness and could not provide proof that the report had been tendered to Petitioners attorney 48 hours prior to the deposition The Arbitrator must therefore sustain Petitioners objection pursuant to Section 12 of the Act as recently discussed in MulliganhellipThe Arbitrator notes that despite Petitioners attorneys objection he nevertheless questioned both Petitioner and Dr Silver about the second examination The Arbitrator finds it difficult to believe there could be any prejudice or surprise to Petitioner after reading Dr Troys initial examination report
City of ChicagoBaumgardnerMay 2011
bull City of Chicago v IWCC 409 IllApp3d 258 (2011) ldquoThe employer maintains that the Act prohibits two permanency awards for the same current condition of ill-being even if that current condition of ill-being is the result of two separate industrial accidents The employer presents a question of statutory interpretation which is reviewed de novohellipBased upon the foregoing we find that the claimant is not entitled to an award under both section 8(d)(1) and section 8(d)(2) for the same condition of ill-beingrdquo
bull Baumgardner v IWCC 409 IllApp3d 274 (2011) Petitioner ldquocontends that the Act does not preclude a scheduled PPD award where wage-differential benefits have been granted under section 8(d)(1) based on a second aggravating injury to the same body part prior to the arbitration hearing on both claimshellipWe note that the claimant asserts that because the facts presented are undisputed the Commissions finding with regard to permanency presents a question of law subject to de novo review We disagreehellipWe cannot say that the Commissions denial of a scheduled PPD award under section 8(e) for the April 1996 injury is against the manifest weight of the evidencerdquo
HB 1698June 2011
bull PA97-0018 effective 6-28-11 but know your applicability dates (eg TPD gross 6-28-11 But AMA Guides 9-1-11)
bull Know your new zones (Cook County Wheaton Zones 1-5) But be aware that 19(b)rsquos will follow Arbitrator not venue
bull Check the web site regularly wwwiwccilgovbull Join the group email news service Register at
httpwwwiwccilgovnewshtm
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
Arising Out Of March 2011
bull MWRD v IWCC 407 Ill App 3d 1010 (2011) ldquoUnder the street risk doctrine where the evidence establishes that the claimantrsquos job requires that she be on the street to perform the duties of her employment the risks of the street become one of risks of the employment and an injury sustained while performing that duty has a causal relation to her employment Potenzohellip In such a circumstance it is presumed that the claimant is exposed to risks of accidents in the street to a greater degree than if she had not been employed in such a capacity and the claimant will be entitled to benefits under the Act
bull STANISLAWA MIYNARCZTK v SOPHIE OBROCHTA 11 IWCC 0747 Potenzo cited by Commission fall by traveling cleaning lady in her driveway returning to company vehicle after lunch break not compensable
48 Hour RuleApril 2011
bull Mulligan v IWCC 408 IllApp3d 205 (2011) Respondentrsquos evidence (Dr Kornblatt records review amp Dr Hopkinson IME) barred as violating 48 hour rule of Section 12 because Respondent failed to turn over reports prior to ldquoset for hearingrdquo (bifurcated over 2 years)
bull Sandra Lindsey v American Liberty School Bus 11 IWCC 0993 With respect to the issue of EVIDENCE the Arbitrator concludes that Petitioners objection to the second report of respondents examining physician and any testimony related to that report must be upheld Petitioners attorney stated that he never received a copy of Dr Troys second report prior to the deposition Respondents attorney appeared for her partner at the last minute due to serious illness and could not provide proof that the report had been tendered to Petitioners attorney 48 hours prior to the deposition The Arbitrator must therefore sustain Petitioners objection pursuant to Section 12 of the Act as recently discussed in MulliganhellipThe Arbitrator notes that despite Petitioners attorneys objection he nevertheless questioned both Petitioner and Dr Silver about the second examination The Arbitrator finds it difficult to believe there could be any prejudice or surprise to Petitioner after reading Dr Troys initial examination report
City of ChicagoBaumgardnerMay 2011
bull City of Chicago v IWCC 409 IllApp3d 258 (2011) ldquoThe employer maintains that the Act prohibits two permanency awards for the same current condition of ill-being even if that current condition of ill-being is the result of two separate industrial accidents The employer presents a question of statutory interpretation which is reviewed de novohellipBased upon the foregoing we find that the claimant is not entitled to an award under both section 8(d)(1) and section 8(d)(2) for the same condition of ill-beingrdquo
bull Baumgardner v IWCC 409 IllApp3d 274 (2011) Petitioner ldquocontends that the Act does not preclude a scheduled PPD award where wage-differential benefits have been granted under section 8(d)(1) based on a second aggravating injury to the same body part prior to the arbitration hearing on both claimshellipWe note that the claimant asserts that because the facts presented are undisputed the Commissions finding with regard to permanency presents a question of law subject to de novo review We disagreehellipWe cannot say that the Commissions denial of a scheduled PPD award under section 8(e) for the April 1996 injury is against the manifest weight of the evidencerdquo
HB 1698June 2011
bull PA97-0018 effective 6-28-11 but know your applicability dates (eg TPD gross 6-28-11 But AMA Guides 9-1-11)
bull Know your new zones (Cook County Wheaton Zones 1-5) But be aware that 19(b)rsquos will follow Arbitrator not venue
bull Check the web site regularly wwwiwccilgovbull Join the group email news service Register at
httpwwwiwccilgovnewshtm
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
48 Hour RuleApril 2011
bull Mulligan v IWCC 408 IllApp3d 205 (2011) Respondentrsquos evidence (Dr Kornblatt records review amp Dr Hopkinson IME) barred as violating 48 hour rule of Section 12 because Respondent failed to turn over reports prior to ldquoset for hearingrdquo (bifurcated over 2 years)
bull Sandra Lindsey v American Liberty School Bus 11 IWCC 0993 With respect to the issue of EVIDENCE the Arbitrator concludes that Petitioners objection to the second report of respondents examining physician and any testimony related to that report must be upheld Petitioners attorney stated that he never received a copy of Dr Troys second report prior to the deposition Respondents attorney appeared for her partner at the last minute due to serious illness and could not provide proof that the report had been tendered to Petitioners attorney 48 hours prior to the deposition The Arbitrator must therefore sustain Petitioners objection pursuant to Section 12 of the Act as recently discussed in MulliganhellipThe Arbitrator notes that despite Petitioners attorneys objection he nevertheless questioned both Petitioner and Dr Silver about the second examination The Arbitrator finds it difficult to believe there could be any prejudice or surprise to Petitioner after reading Dr Troys initial examination report
City of ChicagoBaumgardnerMay 2011
bull City of Chicago v IWCC 409 IllApp3d 258 (2011) ldquoThe employer maintains that the Act prohibits two permanency awards for the same current condition of ill-being even if that current condition of ill-being is the result of two separate industrial accidents The employer presents a question of statutory interpretation which is reviewed de novohellipBased upon the foregoing we find that the claimant is not entitled to an award under both section 8(d)(1) and section 8(d)(2) for the same condition of ill-beingrdquo
bull Baumgardner v IWCC 409 IllApp3d 274 (2011) Petitioner ldquocontends that the Act does not preclude a scheduled PPD award where wage-differential benefits have been granted under section 8(d)(1) based on a second aggravating injury to the same body part prior to the arbitration hearing on both claimshellipWe note that the claimant asserts that because the facts presented are undisputed the Commissions finding with regard to permanency presents a question of law subject to de novo review We disagreehellipWe cannot say that the Commissions denial of a scheduled PPD award under section 8(e) for the April 1996 injury is against the manifest weight of the evidencerdquo
HB 1698June 2011
bull PA97-0018 effective 6-28-11 but know your applicability dates (eg TPD gross 6-28-11 But AMA Guides 9-1-11)
bull Know your new zones (Cook County Wheaton Zones 1-5) But be aware that 19(b)rsquos will follow Arbitrator not venue
bull Check the web site regularly wwwiwccilgovbull Join the group email news service Register at
httpwwwiwccilgovnewshtm
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
City of ChicagoBaumgardnerMay 2011
bull City of Chicago v IWCC 409 IllApp3d 258 (2011) ldquoThe employer maintains that the Act prohibits two permanency awards for the same current condition of ill-being even if that current condition of ill-being is the result of two separate industrial accidents The employer presents a question of statutory interpretation which is reviewed de novohellipBased upon the foregoing we find that the claimant is not entitled to an award under both section 8(d)(1) and section 8(d)(2) for the same condition of ill-beingrdquo
bull Baumgardner v IWCC 409 IllApp3d 274 (2011) Petitioner ldquocontends that the Act does not preclude a scheduled PPD award where wage-differential benefits have been granted under section 8(d)(1) based on a second aggravating injury to the same body part prior to the arbitration hearing on both claimshellipWe note that the claimant asserts that because the facts presented are undisputed the Commissions finding with regard to permanency presents a question of law subject to de novo review We disagreehellipWe cannot say that the Commissions denial of a scheduled PPD award under section 8(e) for the April 1996 injury is against the manifest weight of the evidencerdquo
HB 1698June 2011
bull PA97-0018 effective 6-28-11 but know your applicability dates (eg TPD gross 6-28-11 But AMA Guides 9-1-11)
bull Know your new zones (Cook County Wheaton Zones 1-5) But be aware that 19(b)rsquos will follow Arbitrator not venue
bull Check the web site regularly wwwiwccilgovbull Join the group email news service Register at
httpwwwiwccilgovnewshtm
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
HB 1698June 2011
bull PA97-0018 effective 6-28-11 but know your applicability dates (eg TPD gross 6-28-11 But AMA Guides 9-1-11)
bull Know your new zones (Cook County Wheaton Zones 1-5) But be aware that 19(b)rsquos will follow Arbitrator not venue
bull Check the web site regularly wwwiwccilgovbull Join the group email news service Register at
httpwwwiwccilgovnewshtm
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
AMA GuidesAugust amp September 2011
bull Sec 81b Determination of permanent partial disability For accidental injuries that occur on or after September 1 2011 permanent partial disability shall be established using the following criteria
bull (a) A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that include but are not limited to loss of range of motion loss of strength measured atrophy of tissue mass consistent with the injury and any other measurements that establish the nature and extent of the impairment The most current edition of the American Medical Associations Guides to the Evaluation of Permanent Impairment shall be used by the physician in determining the level of impairment
bull (b) In determining the level of permanent partial disability the Commission shall base its determination on the following factors (i) the reported level of impairment pursuant to subsection (a) (ii) the occupation of the injured employee (iii) the age of the employee at the time of the injury (iv) the employees future earning capacity and (v) evidence of disability corroborated by the treating medical records No single enumerated factor shall be the sole determinant of disability In determining the level of disability the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
AMA GuidesAugust amp September 2011
bull Impairment DOES NOT EQUAL disability ldquoThe relationship between disability and impairment remains both complex and difficult if not impossible to predictrdquo AMA Guides pg 5
bull ldquoAlthough treating physicians may perform impairment ratings on their patients it is recognized that these are not independenthelliprdquo AMA Guides pg 23
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
AMA GuidesAugust amp September 2011
bull Is AMA Impairment Rating MANDATORY Petitionerrsquos BOPbull What does ldquoshallrdquo mean Mandatory or directory Nelson v
IWCC 194 IllApp3d 10 (1990) OrsquoBrien v White 219 Ill2d 86 (2006) mandatory-directory dichotomy concerns the consequences of failure to fulfill an obligation legislaturersquos intention to make provision mandatory is judged primarily by whether there is an explicit specific penalty attached to not fulfilling obligation
bull Who should do AMA Impairment ratingndash Respondent beware You wanted itndash Petitioner beware Better to fight with ldquo(v) evidence of disabilityrdquo
bull Does Section 12 apply 48 hour rule Hearsay Yes to all
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
Medical TreatmentOctober 2011
bull Workers Compensation Preferred Provider Program Administrator List Approved Companies No Companies have been approved at this time httpinsuranceillinoisgovConsumerapprovedWCPPPListpdf
bull PPP Notices IWCC-Approved PPP Notification Form (required) General Notification Form (optional) Workplace Notice (required)
bull SHANNA CHRISTENSEN v THE ANIMAL HOSPITAL OF GURNEE 11 IWCC 1023 Petitioner exceeds two choices What is emergency treatment ldquoDoes not count as Petitioners second choice of provider In so finding we note that Petitioner was still in the acute phase of her work injury She sought emergency treatment at Lake Forest Hospital only four days after her accident for sharp pain in her left elbowrdquo some treatment found to be ldquounreasonablerdquo Does this trigger NONPAYMENT of Sec 82(e) ldquoexcessive or unnecessaryrdquo Applicability
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
Utilization ReviewNovember 2011
bull ROBERT URBAN v DOMINICKlsquoS 11 IWCC 1025 We find the opinions of Dr Nam and Dr Malek to be more reliable than the opinions of Dr Wehner or Dr Casterjons utilization reviewshellipWe find Petitioner credibly testified that his shoulder symptoms improved rather nicely and speedily after he underwent trigger point injections and physical therapyhellipThe treatment records from Dr Nam and Dr Malek similarly demonstrate that Petitioner had ongoing symptoms that did not respond to the brief course of treatment at Concentra but resolved with injections and physical therapy as recommended by both Dr Nam and Dr MalekhellipWe are similarly unpersuaded by Dr Castrejons utilization review because he did not review all of Petitioners treatment records
![WCLA 3-27-14.pptx [Read-Only] CLE/WCLA_3... · 2016-12-02 · WCLA 3-27-14 • The Five Factors of Section 8.1b • Thursday March 27, 2014 • 12:00 pm to 1:00 pm • James R. Thompson](https://img.pdfslide.net/doc/110x75/5f397c7167df047dfe28db98/wcla-3-27-14pptx-read-only-clewcla3-2016-12-02-wcla-3-27-14-a-the.jpg)
