Date: 08/04/2009

WC Process from Claimant and Defense Attorney


Votes: View--> Action Taken:

11:04 AM -- A Discussion of the Workers Compensation Process, by Claimant and Defense Attorneys

Ms. Shelley Dodge, an attorney representing claimants, and Mr. Bernard Woessner, a defense attorney spoke about the workers' compensation process from the legal side. Mr. Woessner introduced himself and his firm and explained their responsibility in the process. He walked through a powerpoint presentation on the respondents' perspective (Attachment B), giving the attorney's viewpoint, and recommended that the committee also consider interviewing a workers compensation claims adjuster. He explained that with the no-fault system, the exclusive remedy is through the workers' compensation process, and that this process has replaced the injured workers' right to sue. He noted that law specifies benefits to workers who are injured in amounts that are likely smaller than personal injury benefits (no pain and suffering).

Attachment B.pdf

Mr. Woessner continued with the definition of "compensable injury" and gave details on how this type of injury can take place. He further explained the complications of causation with compensable injuries. He discussed the workers' compensation benefits in regard to medical treatment, temporary disability, and permanent disability. He further explained that medical treatment, and thus claims, can go on for many years. He offered examples and statistics.

11:21 AM

Ms. Dodge introduced herself and summarized her background. She responded to questions raised earlier in the day, discussing the Industrial Claim Appeals Panel (ICAP), Administrative Law Judges, and the strict nature of appeals. She explained the Subsequent Injury Fund that started in 1919, and also discussed occupational diseases based on prolonged exposure to particular elements. She noted that Pinnacol's financial success has eliminated its governmental immunity and now allows for the filing of bad faith claims by injured workers. Ms. Dodge explained the workers' compensation claim process and noted Pinnacol's response time to claims. She explained medical care is the most disputed part. She explained the process once the claimant is classified as Maximum Medical Improvement. She noted the timeline that claimants go through. Ms.Dodge provided information on the maximum benefits, and the offsets from having social security benefits. She described what she considers flaws of the system and complications that arise, as well as some potential solutions. She commented on some of Pinnacol's medical providers and discussed non-medical issues that sometimes arise, such as employees not receiving benefits in a timely manner, disputes on the manner of calculating impairments, and other issues.

11:40 AM

Senator Mitchell asked about the potential causes of Ms. Dodge's concerns, including miscalculations, improper practices, the statutory framework for workers' compensation, and inherent friction that exists in any adversarial process. Dr. Parry asked about the role of the Administrative Law Judge. Mr. Woessner stated the judge is the fact-finder, and if there is a contest, the factual finding has to have substantial backing or evidence to support it. Ms. Dodge suggested there are two stands of measuring facts or disputes.

Mr. Meersman asked about legal fees. Mr. Woessner stated there are two different mechanisms. Ms. Dodge noted there is a specific workers' compensation law that sets forth attorney fees.

Representative Miklosi asked about bad faith. Ms. Dodge explained that there is a 'bar' set at a particular level, and that Pinnacol has reached that bar due to their profit margin.

Representative Gerou asked about the history of workers' compensation in Colorado and the notion that some states have turned to workers' compensation funds for budget fixes.

Commissioner Marcy Morrison asked the panel about injured worker light duty assignments and questioned the role of the attorney, the claimant, and the employer. Ms. Dodge stated if the claimant has light duty, and the employer does not have a light duty job, the claimant does not work and remains classified as Temporary Total Disability. Mr. Woessner further explained the determination of a claimant working light duty.

Senator Mitchell noted to Representative Gerou some issues with other states using workers' compensation funds for budget fixes. He also discussed issues in regard to Pinnacol's financial stability.

Representative Ryden asked for ideas on how statutes should be changed, in their opinion. Mr. Woessner gave examples of how the system doesn't work, and other issues with the claimant, the employer, and the law. Ms. Dodge stated her belief that oversight is needed of the physicians and benefits.

Representative Pace asked the panel about the profitability of Pinnacol and the relation of benefits given, and questioned how that affects the profit margin. Ms. Dodge discussed represented versus non-represented claimants.