Posts Tagged ‘case law’

Blowing Smoke in Montana

Thursday, June 3rd, 2010

As a service for Insider readers who do not follow the Flathead Beacon, we bring you the western Montana saga of Brock Hopkins, who either was or was not an employee of Great Bear Adventures when he had a great bear adventure of his own, much to his detriment. Hopkins, 23 at the time, appears to have been an occasional worker at the seasonal attraction. On November 2, 2007, he showed up at the park, took a few hits on his marijuana pipe (not prescribed by a doctor) and checked in with the park owner, Russell Kilpatrick, who was on the phone at the time.
Kilpatrick wanted Hopkins to repair a gate. After completing the task, Hopkins went to ask Kilpatrick if there was anything else that needed doing, but Kilpatrick was asleep (hibernating?). So Hopkins, after carefully placing his marijuana pipe on a storage shed outside the bear pen, mixed up some feed and entered the pen. He was attacked by a bear and sustained severe injuries to his legs. He barely managed to crawl out of the pen.
Contract of Hire
In subsequent court proceedings, Kilpatrick argued that Hopkins was a volunteer at the park. While he denies asking Hopkins to feed the bears, he admits that he did ask him to adjust the gate. And, yes, he did slip him $300 shortly after he was released from the hospital.
Judge James Jeremiah Shea, of the Montana Workers’ Compensation Court, disagreed with Kilpatrick. In his written decision, Judge Shea managed to reference the (marijuana stoked) comedy, “Harold & Kumar Go to White Castle:”
“It is not as if this attack occurred when Hopkins inexplicably wandered into the grizzly pen while searching for the nearest White Castle. Hopkins was attacked while performing a job Kilpatrick had paid him to do – feeding grizzly bears.”
Kilpatrick denies asking Hopkins to feed bears, who may or may not have needed feeding. And one might be inclined to raise the issue of the marijuana impeding Hopkins’s judgment. Judge Shea took these factors into account and concluded that there was contradictory testimony on the issue of feeding the bears and most important, even though Hopkins smoked marijuana on the job, his being stoned was not a significant contributory factor in the injury. (If Hopkins could fix a gate while stoned, he could presumably feed the bears.)
Management’s Burden
Kilpatrick is appealing the ruling. He has a high mountain to climb if he wants to prove that Hopkins was not an employee. I’m not sure he is helping his cause when he indignantly stated the following:

“I became very very angry because I then knew what had happened. In my opinion Brock could not resist one last time of harassing the bears with his habit of blowing smoke in their faces for God only knows what reason and in direct defiance of my telling him NOT to disturb them!!!”

Alas, Kilpatrick is learning a tough lesson in management: you are responsible for the (stupid) actions of people who perform work-related tasks for you, whether or not you formally hired them – and in this case, whether or not you specifically asked them to perform a given task. (If a supervisor is napping, employees are pretty much on their own.)
The fact that Hopkins was prone to blowing smoke at the bears and Kilpatrick still allowed him on the property weakens his case considerably. (As Hopkins left his pipe on the shed prior to entering the pen, it is unlikely that he provoked the bear in this particular manner on that fateful day.)
Meanwhile, the youthful Hopkins has knee problems and possibly permanent muscle damage. He may want to find himself a medical practitioner to write him a script for marijuana, which is available legally in Montana. Blowing smoke can ease the pain, as long as you don’t direct it into the face of a sleepy or hungry bear.

Annals of Compensability: Mountain Dew, Mountain Don’t

Tuesday, March 9th, 2010

Henri Cyr was a part-time mechanic for McDermott’s, a Vermont company that transports milk from dairies to processing plants. A co-worker offered Cyr a bottle of Mountain Dew. As he was not thirsty at the time, he put the bottle in the workplace fridge. About a week later the fridge was cleaned out, so Cyr took the bottle home.
Some time later, Cyr came home after a workday, drank a couple of beers and then, feeling thirsty, he opened the bottle of Mountain Dew and took a deep swallow. Alas, the bottle contained toxic cleaning fluid. Cyr felt a severe burning sensation in his mouth, throat and stomach. He was rushed to the hospital, where blood work and urinalysis revealed that his blood alcohol level was .16, well above the legal limit for driving.
So here is the question for workers comp aficionados: is Cyr’s (severe) injury compensable under workers comp?
The initial claim was denied by the Vermont Department of Labor because Cyr was intoxicated and intoxication is an “absolute bar” to benefits – even though, we might add, the intoxication did not in any way contribute to the injury.
Now the Vermont Supreme Court has ruled that Cyr may indeed have a compensable claim. They have remanded the case back for consideration as to whether the injury arose out of “the course and scope of employment.” The majority wrote:

Here, we find that claimant’s injury arose out of his employment when he accepted the bottle containing the caustic chemicals. That act put the mechanism of injury in motion. This is not to suggest that his injury was inevitable once he received the bottle or that no superseding, intervening factor–such as intoxication–could have prevented his injury or altered its mechanism. However, no one suggests he was intoxicated at that time. …His injury would not have occurred had not his employment created the dangerous condition.

In his dissent, Justice Reiber returns to the language of the statute that precludes compensability for any injury “caused by or during intoxication [emphasis added]” He believes that compromising this absolute language in the statute runs contrary to legislative intent.
Whether he was technically drunk or sober, poor Henri Cyr was the victim of horrifying circumstances when he took a swig from the bottle mislabled “Mountain Dew.” He would have been better off if he had resorted to the beverage transported by his employer, wholesome milk.
The lingering mystery in this sad tale is how the toxic chemicals got into the Mountain Dew bottle: who did it and why? Such questions may be beyond the technical issue of compensability, but surely they are the questions most in need of answers.

(Uncompensable) Nightmare at Work

Tuesday, February 23rd, 2010

In December we blogged the horrendous case of Carla Nash, a lovely woman who was mauled by a chimpanzee owned by Sandra Herold, a friend. The 200 pound chimp literally ripped her face apart. Nash, who lacks health insurance, has been hospitalized for over a year at the Cleveland Clinic. The attack destroyed her vision and rendered her face unrecognizable (and unviewable). Doctors have determined that she is not ready for a facial transplant. She has sued Herold for $50 million. Her medical bills will easily run to 7 figures; who will pay has yet to be determined.In our prior blog, we noted that Herold was trying to limit the exposure to her workers comp policy.
A little lost in Nash’s tragedy is the fate of Frank Chiafari, the Stamford, Connecticut police officer who came to Nash’s aid. The raging, blood-covered chimp approached Chiafari’s cruiser, tore off the mirror, ripped open the door and tried to attack the policeman. Chiafari shot and killed the chimp.
In the weeks and months following the incident, Chiafari suffered from post-traumatic stress disorder (PTSD); he experienced anxiety, flashbacks, mood swings and nightmares. He underwent counseling. (It’s not clear how much time, if any, he was away from work.) Chiafari’s workers comp claim was denied: under Connecticut law, public safety officers are eligible for PTSD benefits only when they shoot people – not animals.
Compensating for the Uncompensated
The good news is that Stamford has been covering Chiafari’s medical bills, although they did require him to switch to a therapist of the city’s choosing. The even better news is that Chiafari has literally been working his way through this work-related nightmare. He is still on the job.
There is movement in the Connecticut legislature to amend the workers comp statute so that public safety officers are covered for PTSD resulting from the use of deadly force involving animals. As is so often the case, the law will be adjusted long after the incident that exposed the gap in coverage. Fortunately for officer Chiafari, the city, despite the comp denial, recognized the legitimacy of his claim and paid for the needed counseling. They did the right thing for an officer who did the right thing. Nothing will erase the horrible images from that fateful day last February. But life for Chiafari can go on in all its ordinary splendor – more than we can say, alas, for the ill-fated Carla Nash.

In Search of a Good Cup of Joe

Wednesday, January 20th, 2010

We recently blogged a “to and fro” case involving a meandering motorcycle ride back to work from a conference. The cycle crashed and the employee filed for workers comp. The court in Wyoming determined that the accident took place during a deviation from the direct route home and thus was not compensable. Some readers commented that the employee was following his supervisor’s lead, so the injury should have been compensable. “To and fro” often raises issues in the gray zone. Here’s another gray area: coffee breaks.
Jesse Cooper, master plumber and foreman, needed to consult with someone at the union hall in Winslow Township, New Jersey. His contact was teaching a class, so Jesse decided to take a coffee break. He preferred the coffee at a deli some five miles down the road. On his way to a good cuppa, he was involved in a serious accident, breaking his arm and both legs.
Personal Comfort or Personal Errand?
Cooper’s employer, Bernickel Enterprises, argued that the coffee break was a personal errand. Workers comp judge Bradley Henson determined that a coffee break was part of the working day and that Cooper was under the “coming and going” rule while on his way to a somewhat distant cup of joe*. He found the injuries to be compensable.
Henson describes Winslow Township as a “rural area”, so the options for coffee are somewhat limited. In his summary of the case, New Jersey comp guru John Geaney notes that there were other coffee options closer than the deli; the judge, however, “accepted as credible that petitioner knew the deli had good coffee.”
This ruling certainly stretches the parameters of the “personal comfort” doctrine to its outer limits. One wonders when that hypothetical line between work and personal might actually be crossed: if I have a sudden craving for a Caramel Brulee Latte (not likely, mind you) and the nearest Starbuck’s is 15 miles out of the way, am I still “working” when I head in that direction?
The Driving Hazard
These two cases share one important characteristic: both involve accidents while driving, statistically the most dangerous part of the working day. As risk managers contemplate enhancements to safety programs, they would do well to put safe driving near the top of the list.
* Why do they call it a “cup of Joe”? Check this link for a possible if not entirely plausible answer involving a former Secretary of the Navy.

To and a Meandering Fro

Tuesday, January 12th, 2010

Richard Selest worked for the state of Wyoming Department of Transportation. He was asked to attend a training session 100 miles away from his office. Given the nice June weather, Richard, his supervisor and a co-worker decided to ride their motorcycles. (This surely would not have been an option in January!) On the way back to the home office, they discussed taking a scenic route, but no final decision was made. When they arrived at the intersection for the scenic road, the supervisor, riding in front, turned off. Richard and the co-worker followed. In the course of the ride, Richard lost control of his motorcycle and suffered serious injuries. Compensable under comp?
Richard’s claim was initially denied on the theory that the scenic route – 50 miles longer – was a deviation from the road back to the office and thus not compensable. Richard countered that his supervisor approved the deviation and that he was not on any specific “personal errand.” He merely was going back to his office, albeit in a meandering fashion.
The case, like the scenic road, wended up to the Wyoming Supreme Court, where Richard once again lost. The court found that the choice of a scenic road was purely personal and a clear deviation from the “course and scope” of employment. Even though Richard had no specific goal in taking the longer road, and even though he was in fact heading back to the office, the deviation in route was substantial, thus taking him outside of comp’s protective umbrella.
One justice dissented, but I think the majority acted appropriately. Despite the fact that Richard was paid for the entire trip (which took one hour longer than the direct road) and despite the fact that he followed his supervisor’s lead, the deviation had nothing whatsoever to do with work. As all good claims adjusters know, this is a matter of reading a map: the presumptive route to the office is a (relatively) straight line. Richard and his co-workers were seduced by the curvy call of nature, for which poor Richard has had to pay a very steep price.

Donning and Doffing Quashed

Monday, January 4th, 2010

Way back in November 2005 we blogged the interesting issue of donning and doffing: whether the time meatpackers spend at the beginning of work putting on protective gear and taking it off at the end of the shift is time on task and compensable. The 2005 ruling of the U.S. Supreme Court went in favor of the workers, but other courts have split on the issue. Now 4th U.S. Circuit Court of Appeals in Richmond has once again ruled against the workers.
The court held that putting on and taking off the gear is “changing clothes” and thus is not necessarily compensable under the Federal Labor Standards Act.
“This sort of fact-intensive determination has classically been grist for the mill of collective bargaining, and Congress ensured that employers and unions could keep it that way by enacting Section 203 (o),” Judge J. Harvie Wilkinson III wrote for the three-judge panel. We assume that the salaried Judge Wilkinson was amply paid during the time he donned his robes to issue the ruling.
Clothes Make the Man
The district court has a rather expansive view of what comprises clothing: workers, members of United Food & Commercial Workers Local 27, each must wear steel-toe shoes, a smock, a plastic apron, safety glasses, ear plugs, a “bump cap,” a hair net, rubber gloves, mesh sleeves and arm shields to do the work, which includes the hanging, eviscerating and de-boning of chickens.
“Because many work clothes are protective to some extent, the distinction urged upon us by the employees would be difficult, if not impossible, for courts to administer in a consistent and coherent manner,” the judge wrote, before also rejecting the plaintiffs’ argument about the definition of “changing.”
What is at stake here is fifteen minutes of pay twice each shift, presumably at or near minimum wage. Call it four bucks per shift per worker. With 250 workers involved in the class action suit, that’s a total of about $1,000 per workforce shift. Having lost the suit, the workers will be paid only for their gruesome “time on task.”
As most of the workers are non-English speaking, the union stewards will have to translate the court’s ruling into their native tongue(s). I trust that the workers will be dressed for the occasion in street clothes: it’s pretty difficult to understand the court’s subtle distinctions when you are encased in steel-toe shoes, a smock, a plastic apron, safety glasses, ear plugs, a “bump cap,” a hair net, rubber gloves, mesh sleeves and arm shields. Then again, perhaps their attorney should have made his case in court while dressed in full slaughterhouse regalia: the visual evidence distinguishing ordinary clothing from personal protective equipment might have been compelling enough for even a judge to understand.

“No, Edith, There is No Sanity Clause”

Tuesday, December 22nd, 2009

You probably never heard of Gilby, North Dakota, population 226. Edith Johnson, 56, worked as a teller in the town’s bank, which, somewhat surprisingly, has been robbed three times. Edith was in the bank during two of the robberies. The last one was especially traumatic: she was handcuffed and placed face down on the floor with a sawed off shotgun pressed against her head. After this incident, she became too afraid to return to her job. Diagnosed with post-traumatic stress syndrome, she filed for workers comp. The claim was denied. North Dakota, like many other states, will pay a “mental” claim only if it is precipitated by a physical injury.
Edith has an attorney and is appealing the denial of her claim. Given the way the law is written, she is unlikely to prevail.
The irony, of course, is that with just a bit of coaching at the time of the incident, it would have been easy for Edith to collect comp. All she would have had to do is complain about a pain in her wrist and shoulder, caused by the handcuffs and the awkward position on the floor. Even without objective medical evidence, these physical complaints would have opened the door to her claim of post-traumatic stress.
Coming from a small town and working as a bank teller, Edith is undoubtedly the soul of rectitude. She is not about to tell a lie. Unfortunately, she is up against the letter of the law, which, in North Dakota, is very clear. Workers Safety and Insurance director Bryan Klipfel explains the denial: “A post-traumatic stress disorder that is directly related to a physical workplace injury may be compensable if it can be shown that it was primarily caused by the physical work injury, as opposed to all other contributing causes.”
Letter and Spirit
Edith’s dilemma reminds me of the scene in the immortal Marx Brothers movie, “A Night at the Opera.” Groucho (Otis. B. Driftwood) and Chico (Fiorello) are discussing the proposed language of a contract. Every time Chico objects, Groucho tears the page from the contract.
Fiorello: Hey, wait, wait. What does this say here, this thing here?
Driftwood: Oh, that? Oh, that’s the usual clause that’s in every contract. That just says, uh, it says, uh, if any of the parties participating in this contract are shown not to be in their right mind, the entire agreement is automatically nullified.
Fiorello: Well, I don’t know…
Driftwood: It’s all right. That’s, that’s in every contract. That’s, that’s what they call a sanity clause.
Fiorello: Ha-ha-ha-ha-ha! You can’t fool me. There ain’t no Sanity Clause!

With that impeccable logic, the Insider wishes the beleagured Edith and the citizens of Gilby all the best and we bid our readers a splendid holiday. Every week we try to invoke the “sanity clause” in risk management and workers comp. It’s not always easy. We sincerely hope that Santa – whether or not he exists – rewards you for all the good that you have done this year.

MA Supremes: teacher chaperoning ski trip due workers comp

Tuesday, December 15th, 2009

In a recent decision that shouldn’t be too surprising to those who follow workers’ comp compensability issues, the Massachusetts Supreme Court recently upheld a decision by the Department of Industrial Accidents to grant workers compensation benefits to Karen Sikorksi, a Peabody teacher injured while chaperoning high school kids on a 2004 ski trip. The City of Peabody had contested the award on the basis that she was a volunteer engaged in a recreational activity.
We’ve seen many of these cases and the decision often hinges on the voluntary nature of the activity. In this case, the city of Peabody probably thought they were well within the law in denying benefits. According to Insurance Journal, the Massachusetts legislature added a little twist to the workers’ comp statue in 1985, when it excluded “… any injury resulting from an employee’s purely voluntary participation in any recreational activity, including but not limited to athletic events, parties, and picnics, even though the employer pays some or all of the cost thereof.”
Note the adjective “purely.”
When is a volunteer really not a volunteer? Usually, when an employer encourages the employees to participate in said activity. (Everybody who has ever been an employee is likely familiar with the concept of so-called voluntary recreational activities – non-participation can be a career-limiting option.) According to reports, the Peabody school administration has historically expected teachers to become involved with the school’s extracurricular activities and, in this particular case, the school principal and the ski club adviser solicited teachers to serve as chaperones. In Sikorski’s case, the Supreme Court justices unanimously found that she was “acting in the course of her employment” and not in a recreational activity as described in the law. The court found that her responsibilities as chaperone were “…essentially the same ones teachers must exercise while working in the school building during school hours.” Chaperones were expected to supervise students both in the lodge and on the slopes.
Another common criteria that courts use is in determining whether an activity is “voluntary” is how beneficial it is to the employer and whether it furthers the employer’s interests. In this case, the court found that it did: “…the ski club’s trips benefited the city by furthering the school’s educational mission.”
Of course, nothing is ever simple with workers’ comp – there are 50 different flavors, so every state law may have its own particular nooks and crannies related to these issues. Andrew G. Simpson has an excellent article on ‘Forced Fun’ and related workers’ compensation problems, in which he discusses variations in state laws.
Other posts related to the issue of “mandatory fun”:

Racketeering and Comp: When the Denial of an Injury is an Injury

Wednesday, December 9th, 2009

Imagine you work as a commercial driver for a long-established trucking firm that self-insures for workers comp. You are injured on the job. You seek benefits under the comp statute. The TPA handling the claim refers you to a company doctor. The doctor determines that the injury is not work related. The adjuster for the TPA denies the claim. End of story?
Not quite. What if you shared your story with five other employees, all of whom filed comp claims, all of whom saw the same doctor (a family practitioner), with the same result: claim denied by the same adjuster at the TPA? A coincidence or a conspiracy?
Five employees of Cassens Transport in Michigan concluded that there was a conspiracy to deny their claims. They filed suit in federal court, alleging a violation of the Racketeer Influenced and Corrupt Organizations Act (“RICO”). A district court dismissed their claims, finding that their individual claims did not constitute a “pattern” of activity and that invocation of the RICO statute would violate the McCarren-Ferguson Act by interfering with state regulation of insurance.
The U.S. Court of Appeals for the 6th Circuit reviewed the case and overturned the district court’s ruling. Now the U.S. Supreme Court, by declining to get involved, has upheld the Appeals Court. The Appeals ruling is a fascinating document which explores the nature and definition of racketeering, the relationship of workers comp benefits to insurance and the roles of state and federal governments. It’s required reading for attorneys and highly recommended for all others.
Criminal Acts?
The district court has been ordered to reconsider the allegations. The five Cassens drivers allege that Cassens, their self-insured employer, Tina Litwiller, a claims adjuster for the TPA Crawford and Co., and Dr. Saul Margules conspired to deny their comp claims. (While you might expect Dr. Margules to be board certified in occupational medicine, he appears to be a family practitioner.) The Appeals Court does not address the substance of the allegations: it simply rules that denial of the workers comp claims might involve a violation of the RICO statute and thus is appropriate fodder for the federal courts.
Some folks are alarmed that the feds are getting involved in what is usually a state issue. That might be a problem, but let’s not lose sight of the delicious prospect before us. During the course of the new hearings, plaintiff attorneys will seek access to some fascinating communication records: between Cassen and Crawford, detailing the status of individual claims; Ms. Litwiller’s claim notes; and communications between Crawford and Dr. Margules, who had so much difficulty finding a connection between a given injury and work. As much as I enjoyed the Appeals Court’s discussion, I am really looking forward to the nitty-gritty details of the proceedings in the district court. (You don’t suppose that some of the written and electronic communications have disappeared, do you?)
At heart, this is a very serious matter. The five employees allege that they have been unlawfully denied the protection of Michigan’s workers comp law through a conspiracy of company, TPA and doctor. If the allegations are proven, if the accused violated the RICO statute, they will face the consequences of a criminal conspiracy. In the Insider’s burgeoning annals of fraud – employee, employer, attorney, doctor, agent, insurer – this case will surely offer one of the more compelling narratives.

Compensable Shampoo?

Friday, November 6th, 2009

Ginger Wilson works as a librarian in Montgomery County, Virginia. One day she arrived at work, got out of her car and headed for the library entrance. Then she remembered that she had a hair appointment at noon, so she returned to the car and opened the door to fetch a bottle of shampoo. A gust of wind caught the door, which slammed against her. She fell, breaking her wrist.
Compensable under workers comp? Not likely, as the return to the car was a definitive deviation from her work routine – she had already exited the car and was headed toward the library. The fetching of shampoo was a personal errand, having nothing to do with work.
Ah, but this is Montgomery County, home of the $32 million comp problem. Ginger was awarded $5,500 in comp benefits, covering her medical costs and six weeks of lost time.
Associate County Attorney Susan Chagrin (who immediately earns a place on my All Name team for attorneys) has sued Ginger for repayment, asserting that the injury had nothing to do with employment. I’m with Chagrin, but to our mutual chagrin, the county is unlikely to prevail. There is nothing fraudulant in Ginger’s filing a claim. She apparently was completely candid about the circumstances of the injury. The claim was accepted by the adjuster. Getting money back on this one is likely to be as difficult as the proverbial putting toothpaste back into the tube.
I have a few random questions for Montgomery County and for Ginger:
1. Why does a librarian with a broken wrist have to miss 6 weeks of work? Library work is about as light duty as it gets.
2. If Ginger returned to her car for the specific purpose of fetching the shampoo, why is she still in “the course and scope of employment”?
3. According to her testimony, Ginger planned to “eat my lunch while I was getting my hair done.” Excuse me and with all due respect, that is a truly revolting example of multi-tasking.
4. Finally – admittedly a bit off point – why does Ginger have to provide her own shampoo for a hair appointment?
As is so often the case, the best opportunity for controlling the outcome of questionable claims is at the beginning. If compensability is in doubt, adjusters should take aggressive action at the outset. Given the particulars of Ginger’s situation (at least as this article presents them), there was enough evidence to deny the claim when it was first filed. Once accepted as compensable, however, it’s unlikely that the decision could be reversed. Ms. Chagrin, in all likelihood, will remain, well, chagrinned.