Category Archives: Nebraska

Somebody get me a doctor: Nebraska rules against P.A reports in workers’ compensation

Somebody get me a shot! (Sorry no appropriate Diamond Dave images to go with this post)

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

The Nebraska Supreme Court held recently that a written reports from a Physician’s Assistant or P.A. are inadmissible into evidence under the Rule 10 of the Nebraska Workers’ Compensation Act.

The decision resolves what amounted to a “circuit split” among the seven judges of the Nebraka Workers’ Compensation Court as to whether P.A. reports were admissible into evidence.

The decision didn’t come as a shock to me or any of the other lawyers at this firm. The decision shouldn’t impact how we or any other lawyers develop evidence in Nebraska workers’ compensation cases.

But I believe the decision harms workers in rural areas whose only access to medical care is often a P.A. The decision also harms workers without health insurance whose only treatment for a work injury might be treating with a P.A. at an urgent care clinic. If an employer denies compensability, the only medical evidence that employee may have would be a report from a P.A.

Most lawyers “fix” P.A. reports by having the supervising doctor sign the report. I’ve had P.As take offense at that request. I’ve also had defense lawyers attack medical opinions on hearsay grounds by getting a medical doctor to admit that the P.A. is the one with first-hand knowledge about the injured worker.

Lawyers are stuck with two options if a P.A report is the sole source of expert opinion from a treating provider: 1) Call the P.A. live as a witness in the same manner as in a civil trial or 2) retain an examiner.

Neither of those is a great option. The best fix would be for the Legislature or the Nebraska Workers’ Compensation Court to amend Rule 10 to allow P.A reports into evidence.

Irregular shifts complicate workers’ compensation claims

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

Irregular work hours, driven increasingly by automated scheduling, have lead San Francisco and Seattle to pass municipal ordinances to regulate the practice because irregular schedules make child care, transportation and working multiple jobs increasingly difficult for low wage workers.

Irregular hours also increase the risk of work injury and they can complicate the claims of injured workers.  Here are a few ways irregular working hours can impact a workers’ compensation claim:

Benefit rates

Workers compensation disability benefits are paid based on a workers’ average weekly earnings or their average weekly wage – AWW for short. But when you work 40 hours one week and eight the next, what’s your average work week? Mathematically, in this scenario the average week would be 24 weeks. An insurance company would likely use a simple average.

But under Nebraska law a court is supposed to exclude abnormally low weeks from the calculation of average weekly wage. In other words if the case is pushed into court, a Judge will exclude abnormally low weeks which would lead to a higher benefit rate.

Many employers also pay shift differential where night and weekend shifts get a higher hourly wage. Effective hourly wages can vary from week to week for employees who work irregular shifts that include night and weekend shifts.

Nebraska excludes overtime premium in general from AWW, but shift differential still counts. Sometimes insurance companies will exclude shift differentials from their calculations of average weekly wage. This is particularly true when insurers are calculating permanent disability benefits.

It is also common for workers who work irregular shifts to work less than 40 hours a week. For the sake of permanent disability benefits, Nebraska assumes a minimum of a 40-hour work week . Insurers will often not follow this rule. Irregular shift workers are not the only workers who are subjected to this practice, but when you combine exclusions of shift differential along with not using a 40-hour week, irregular shift workers can get substantially underpaid when it comes to workers compensation.

Our firm, like most other firms, represents injured workers on a contingent fee basis. The problem with that arrangement is that while an under payment of benefits may be a meaningful amount of money to an injured worker, it may not be enough for an attorney to justify taking on an underpayment claim on a contingent fee basis. Most state and federal wage and hour laws allow for fee awards that can be many times the unpaid wages. The reason for attorney fee awards in this case is the important public purpose of these laws.

Workers compensation has the same general purpose of as wage and hour laws, but in Nebraska it is difficult to get attorney fees in a disputed workers compensation case because an award of penalties requries a lack of a reasonable controversy. Conventional wisdom is that employees must show a lack of reasonable controversy to win attorney fees. However, some case law seems to distinguish the standard for winning a penalty versus winning an attorney fee.

Medical appointments

Irregular shifts also make it difficult to schedule medical appointments. This is particularly true of specialists who would be treating a more serious work injury. Missing appointments can be a red flag for judges, doctors and insurers if not explained. A good attorney can help an injured worker explain how an irregular work schedule prevented them or interfere with the. from attending medical appointments.


Denied workers’ compensation and health insurance for a work injury? You might have a counter

Ohio State lines up to run a QB counter against Nebraska

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

My colleagues Paul McAndrew from Iowa and Bernard Nomberg from Alabama have blogged about the tragic but common situation of an employee who puts a work injury on private health insurance only to have health insurance deny payment because they discover the injury is work-related.

It is another example of injured workers getting squeezed. But in the right circumstances an injured worker can squeeze back— a counter-squeeze if you will.

In Nebraska health insurance benefits are considered wages. Nebraska allows employees to receive attorney fees when they sue for unpaid wages under what is called the Nebraska Wage Payment and Collection Act.  So an employer who is denying medical benefits under workers’ compensation, should not be able to deny payment of those bills under private health insurance.

Nebraska also prohibits employers from retaliating against employees for claiming workers’ compensation benefits. Retaliation is an adverse action related to the terms and conditions of employment. Denying payment of wages, in the form of health insurance, because the employee has filed a workers’ compensation claim should be retaliation.

So employers denying workers’ compensation and health insurance benefits can find themselves facing a wage and hour and retaliation case.  Of course, these types of cases are a lot more complicated than described in the last two paragraphs.

In order for the counter-squeeze to work, it is best to have an employer who is at a minimum self-insured for the purposes of health insurance and ideally self-insured for health insurance and workers’ compensation. Tyson, Crete Carrier and Werner Enterprises are large Nebraska employers who fit into the latter category. Self-insurance is important because it allows the employee to link the decision to deny benefits to the employer. In theory you can still make a counter-squeeze work when outside insurance companies are involved, but that turns the case into a civil conspiracy case that can be more costly and difficult to prove.

Wage and hour cases also require detailed proof of medical bills and existence of a valid contract for payment of benefits. If an employee appears to have misrepresented how an injury happened, an employer may be able to fire an employee regardless of any retaliatory motive on their part. But the employee who at first blush may have “screwed up their case” by paying for their workers’ compensation injury with their private health insurance, may be able to salvage a good outcome in their work injury case.

“They have a mosque in small town Nebraska?”

Islamic Center of Omaha

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

I spent a lot of time in rural Nebraska, so I have enjoyed following Chris Arnade’s tour of the forgotten parts of rural America. His tweets are a highlight of a Twitter feed filled with self-promotion and nasty bickering.

On July 3rd, Arnade made it to Nebraska and stopped in a place I know fairly well, Lexington, Nebraska.

Lexington is home to Tyson beef packing plant that employees roughly 3500. I have been travelling to Lexington since 2006 to represent clients who have been hurt at Tyson and other employers. My father Rod, has been doing the same thing since about 1990.

Like many other outside observers of Lexington, Arnade’s attention was drawn to the presence of a large Somali community in Lexington Arnade and other commenters immediately drew the connection between the Tyson plant and the Somali population. Comments about the Somali population in Lexington broke down into three categories:

  1. Vile racist alt-right comments.
  2. Comments from “locals” like me that amounted to “This isn’t news to us” but that were sympathetic towards immigrants.
  3. Comments that were generally sympathetic to the immigrant population made by commenters from coastal and urban areas.

The first group of comments doesn’t deserve a response. The more sympathetic comments from urban areas do deserve a response. Underlying the well-intentioned sympathy for immigrant meat packing workers in rural areas is an assumption that these immigrants are doing work that native-born workers refuse to do.

This assumption is not true. I can argue this anecdotally because I have represented several native-born Americans in meat packing cases over the years. But there are other explanations of why meat packing plants in rural areas hire a substantial number of immigrants.

The first reason is population. Rural areas have a difficult time finding employees to fill highly-paid professional jobs. Meat packing doesn’t pay particularly well and is notorious for being hazardous. A combination of dangerous work and a small population base makes even good paying jobs difficult to fill. As an example, Nebraska placed a maximum security prison in rural Tecumseh, Nebraska in 2001. The combination of dangerous work and the lack of nearby workers has contributed to chronic staff shortages at Tecumseh. Large meat packing plants in rural areas need more labor than those rural areas can provide on their own. Immigrants help fill the need.

Meatpacking plants also draw in native born workers for urban areas. I recently represented a man from Denver whose wife was from New York City who worked at a packinghouse in rural Nebraska. His family didn’t want to move to an urban area because of crime and a higher cost of living. My client is representative of many former urbanites who have moved out of cities into urban areas. Much attention has been drawn recently to the drastic decline of the African-American population in Chicago. The decline is attributed to crime, the cost of living and lack of jobs in Chicago. Again, anecdotally, I have represented several transplanted Chicago residents in Nebraska workers compensation claims over the years. Former Chicago residents are making their home in rural Nebraska for the same reasons that immigrants are: lower cost of living and the availability of jobs

Despite the overwhelming evidence that native born employees are willing to work in meatpacking, the myth that only immigrants work in meatpacking is persistent. The persistence of this myth rests on several assumptions. The first assumption is based on a romantic notion about manual labor, usually spread by people who never had to support themselves by manual labor. Nebraska Senator Ben Sasse is a prominent proponent of this myth. The myth is something along the lines of people are is soft “too soft” and some hard work will just toughen you up. This myth can deflect legitimate concerns about workplace safety into wimpy and politically correct griping.

An even more insidious basis for the myth that native born Americans won’t work in meatpacking is scientific racism. Scientific racism is the belief that certain ethnic groups are better at some tasks than others. When urban liberals state “Immigrants do the jobs that natives won’t do” they probably don’t mean that there is something inherent in the DNA of Latinos and east Africans that allows them to not to get bi-lateral carpal tunnel and epicondylitis from trimming 3000 briskets over an 8 hour shift. But there is an assumption that immigrants are willing to tough it out while native born workers can’t. This isn’t true. Lots of immigrants can’t handle the physical demands of meatpacking working, but some can. The same goes for native born workers.

Another reason for the myth that native born workers won’t work in meatpacking is the subtle bias of those who report on working conditions in the meatpacking industry. Much of what America knows about meatpacking in rural America is reported by urban journalists like Arande or Fast Food Nation author Eric Schlosser. You almost get the impression that when journalists like Arande see an east African restaurant paired with a Hispanic clothing store in rural Nebraska they feel some intense wave of nostalgia for some idealized crime free but non-gentrified urban neighborhood free of hipsters and artisan cheese shops.  The shock when a journalist happens upon a mosque and African restaurant in rural Nebraska overwhelms the larger story about the impact of meatpacking on the labor force in rural America.

Arnade has gone out of way his way to be fair to rural residents. However not all writers share Arnade’s fair-minded attitude towards rural Americans. In December, liberal commentator Markos Moulitsas wrote that people should be glad that coal miners who voted for Donald Trump were going to lose their health insurance. Coal mining is probably as hazardous a job as meatpacking. But to an urban liberal audience, immigrant meat packers deserve sympathy for working in a dangerous job, but Trump-supporting native born coal miners who work in an equally hazardous job deserve contempt.

The ugly sentiments expressed by Moulitsas found a more hideous expression from New York Times columnist Bret Stephens. The toxic Tory “joked” that the U.S. should deport native born working class people, but that nobody would want them. Stephens “ironic” comments draw an eerie parallel with the ironic racists of the alt-right. it’s disturbing that a so-called liberal publication would give this jerk a bi-weekly forum.

The ugliness of Bret Stephens class prejudice follows from well-meaning assumptions that native born Americans will not work in industries like meatpacking. There is a shared assumption that immigrants have particular virtues and native-born Americans have particular vices and defects. These misconceptions fuel resentments and backlash that opportunists can exploit.  A better understanding of the workforce in rural areas will help honest-minded people overcome views that help perpetuate anger that works to undercut rights and benefits of all workers regardless of race or citizenship status.

Proposed changes to Iowa workers compensation cruelly target elderly employees

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

Anti-worker changes could be coming to Iowa workers compensation. To me the cruelest reform would be the proposal to end permanent total disability benefits at age 67 and limit workers who are over 67 who become permanently and totally disabled to 150 weeks of benefits. One memorable client of mine demonstrates the callousness of the proposed Iowa reforms.

My client Doris Newkirk was 83 years old when she was injured working as a hostess at Lone Star Steakhouse in west Omaha in June 2006. She was near a bathroom door when a large male co-worker came barreling into the bathroom and caused Doris to fall back and injure multiple parts of her body. Like many retirees, Doris worked because she needed the money. After her injury she was unable to work. Fortunately Doris was able to receive permanent total disability benefits to make up for the income she lost because she wasn’t able to work. Those permanent benefits started in September 2007 and continued for five years and 10 ½ months until her death on July 21, 2013.

If Nebraska law limited those injured over the age of 67 to 150 weeks of permanent total disability benefits, Doris wouldn’t have been paid anything for the last three years of her life. To her credit, Doris travelled from Omaha to Lincoln in her late 80s to testify against similar legislation when it was proposed in Nebraska. According the Business and Labor committee clerk at the time, the state Senator who introduced the bill at the behest of insurance interests made a motion to kill the bill after listening to her testimony.

Workers compensation is a cost of business. But according to CNBC, Iowa has the second lowest cost of doing business in the country. Iowa, like Nebraska, generally ranks well in national surveys of business climate. Iowa’s weakest area when it comes to business climate,  according to CNBC, is quality of workforce. Unlike Nebraska, Iowa lacks vocational rehabilitation for injured workers. If Iowa is looking to reform its workers compensation system, they should consider investing in vocational rehabilitation so injured workers can fully regain their ability to contribute to the economy in Iowa.

What’s the Connection Between Worker Safety, Employer Profit, and Voting?

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

A recent newspaper article about a Nebraska lawyer fighting against imposing OSHA regulations on small businesses and farms that handle grain illustrates an age-old conflict between Worker (human) safety and Business (corporate) profit. The lawyer argued OSHA compliance is too expensive for small businesses and farms.

I couldn’t disagree more. From my point of view, worker safety is immeasurably more valuable to society than business profit. Human beings are the most important component of any activity, including business. Viewing safety as a cost ignores the cost to the human beings who are burned and maimed by grain explosions, whether they happen at a small business/farm or a huge corporate grain facility.

Farms in Nebraska and Iowa are not required to provide workers’ compensation for their employees. This is justified on the grounds that farms can’t survive such government intervention. I find this an interesting argument from businesses that have long received subsidies from the government. It seems that farm profits are more important than the human beings who do the work to earn those profits.

Our society needs more laws to protect human beings from injury and to compensate them if injured for the profit of others. Candidates for public office need to be asked what matters more to them: Is it human beings or profits that matter more?

Justice Louis Brandeis of the U.S. Supreme Court wrote long ago: “We must make our choice. We may have democracy, or we may have wealth concentrated in the hands of a few, but we can’t have both.”  

If we keep electing representatives who favor the concentrated wealth, then human beings will likely be protected less. These are scary times as the divide between the “haves” and “have nots” continues to grow. Ballots are the only way to tell our representatives that the health and welfare of human beings is paramount. Voting is essential, or we will see more and more concern for profit and less and less concern for human beings.

What Medical Expenses Are Covered In A Workers’ Compensation Case?

Today’s post comes from guest author Roger Moore, from Rehm, Bennett & Moore.

In Nebraska and Iowa, as is the general rule, an employer is liable for all reasonable medical services incurred as a result of a work injury. This is interpreted fairly broadly to include plastic or reconstructive surgery, prosthetic devices, and medicines, among other treatments. As long as the treatment is designed to relieve pain or promote and hasten the employee’s restoration to health and employment, the employer is liable. When a treatment meets these conditions, an injured worker should not be responsible for any portion of the medical bill.

The main difference is in Nebraska, as long as the worker elects a prior treating doctor to treat their injury (for example, the worker’s family doctor), that doctor can dictate the medical care and refer them to others for treatment. If no election is made, then like in Iowa, the employer can choose the doctor to treat a work injury as long as the employer accepts compensability for that injury. However, in Iowa, if the worker can establish that the medical care furnished is unreasonable, then the worker can choose another medical provider.  In both states, if a claim for a work injury is denied, the worker can choose their own doctors to treat with.

If no Petition is filed in Nebraska, an employer continues to be responsible for medical care as long as there is less than a two-year gap in the payment of a medical bill by the employer or insurance company or the payment of temporary or permanent benefits to the injured worker. Also, if the Court enters an order finding the injured worker entitled to future medical care, there is technically no time limit for seeking medical care.

In Iowa, medical benefits cannot be used to extend the deadline to file a claim for benefits. There is no time limitation in seeking medical care relating to an injury either before or after an Award for benefits.

However, in practical terms, large gaps in treatment will likely be met with skepticism from the employer – and possibly the Court – concerning the relationship between the work injury and the medical care. We recommend you seek consistent medical care where there is a need for it to avoid such issues.