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Posts Tagged ‘workers compensation’

At the Intersection of FMLA and Workers Compensation: Ramji v. Hospital Housekeeping Systems, Inc.

Posted on: May 11th, 2021

By: Tia Combs

The Eleventh Circuit recently weighed in on how the Family Medical Leave Act (“FMLA”) and state law workers compensation schemes interact in Ramji v. Hospital Housekeeping Systems, LLC, No. 19-13461, 2021 WL 1257247 (11th Cir. April 6, 2021). In doing so, the Court reinforced that workers compensation is not a substitute for FMLA.

The Plaintiff, Ramji, was a housekeeper at a hospital in Snellville, Georgia for over eleven years. In 2013, her job was subsumed by Hospital Housekeeping when it took over cleaning responsibilities at her hospital.

In late 2016, Ramji suffered a knee injury when she tripped as she was getting ready to clock out for her shift. Hospital Housekeeping handled the injury as a workers compensation issue. Ramji received some treatment, including a cortisone shot just over a week after the accident and a recommendation for physical therapy. Eight days after the accident, Ramji was released to light duty and accepted a light duty position with Hospital Housekeeping.

However, before Ramji could start her light duty assignment, she was forced to complete a fitness for duty test (the Essential Skills Test or “EST”). As Ramji was attempting the EST, she complained that her knee was beginning to hurt and that she could not complete the test. She requested to use sick time to fully recover and retake the test at a later date. Her request was denied and, after Hospital Housekeeping docked her for a couple of old infractions in addition to the failure of the EST, Ramji was fired. Now out of a job and unable to get needed treatment, Ramji sought out a workers compensation attorney.  Her case settled for further medical treatment and reinstatement.

Ramji then filed this case for interference with her FMLA rights. While Hospital Housekeeping did win summary judgment at the district court, the Eleventh Circuit has reversed that holding and, in the process, given employers some helpful insights on how workers compensation and FMLA interact.

Initially, the Eleventh Circuit held that while Ramji had not expressly requested FMLA leave, she still had given notice to Hospital Housekeeping that she needed it.  The Court pointed to the oversight of the workers’ compensation program by Hospital Housekeeping which mandated that Ramji’s supervisor accompany her to medical treatment appointments, the company’s receipt of her workers compensation forms detailing her injury, and the company’s notice of her time off work for the injury.

Then, the Court turned its attention to whether Ramji had been denied a benefit due under FMLA. The Court noted that Hospital Housekeeping should have had notice of Ramji’s possible entitlement to FMLA benefits when the company received her workers compensation forms and provided her with eligibility notice at that time. Hospital Housekeeping attempted to argue that Ramji was not entitled to notice of her FMLA rights as the matter was handled through workers compensation and Ramji accepted a light duty assignment. The Eleventh Circuit was not impressed with these arguments. The Court pointed out that FMLA itself gives employers the option of running FMLA and workers compensation concurrently; clearly demonstrating that workers compensation benefits do not preclude FMLA. The Eleventh Circuit similarly noted that FMLA also states that a job with reasonable accommodations does not preclude FMLA entitlement. The Court held that Hospital Housekeeping’s arguments were squarely contradicted by the FMLA.

Finally, Hospital Housekeeping argued that Ramji was not harmed by a denial of FMLA leave as her full treatment record showed that she did not reach full recovery within the twelve weeks she could have received under the Act. However, the Court noted that if Ramji had received a full and uninterrupted twelve weeks of recovery, she might have had a quicker recovery and been ready to return to work in twelve weeks or less. The Court held this was an issue of material fact preventing Hospital Housekeeping from preserving its district court summary judgment.

So, what lessons can employers glean from this case:

  1. No amount of workers compensation benefits are a substitute for FMLA leave. Even employees who qualify and receive workers compensation benefits must be offered FMLA if circumstances otherwise dictate this is appropriate.
  2. The same principal is true for light duty. Even an employee who agrees to a light duty assignment, must be offered benefits under FMLA if he or she is otherwise entitled to it.

For more information about this topic, please contact Tia Combs at [email protected].

Phony Fakes Fall (Allegedly)

Posted on: February 15th, 2019

By: Kevin Stone

The fictional Mike Moffitt famously called Jerry Seinfeld a phony. The reasons remain unknown. A non-fictional New Jersey man, however, appears to be a bona fide phony. Surveillance video of a company breakroom appears to capture the man throwing ice on the floor and then gently laying down next to it. He then filed an insurance claim for the ambulance ride and hospital treatment that followed the “fall.” Unlike the fall, the filing of the claim may actually harm him, as he was arrested for filing a false claim.

This incident is a great reminder to maintain surveillance cameras where appropriate. Cases often come down to the credibility of the plaintiff. But cameras don’t lie.

If you have any questions or would like more information, please contact Kevin Stone at (770) 303-8643 or [email protected].

Trends and the Economic Impact Involving Workplace Injuries

Posted on: December 6th, 2017

By: Jac O’Delle E. Wright

Employers, agents, brokers and insurers have every reason to keep up-to-date regarding trends and the economic impact involving workplace injuries.  Because of frequent changes, including those involving workers’ compensation legislation and case law, safety management programs and training, as well as indemnity and medical costs, it is important to consider the inclusion of reliable, actuarily-based reports into business plan models.

In California, the premier provider of this information is the Workers’ Compensation Insurance Rating Bureau (WCIRB) that tracks, among other things, projected loss and expense ratios, benefit rates, duration and nature of claims, renewal percentages, retrospective rating plans, hazard group severity multipliers, average returns on net worth, cost exposure pertaining to prescription medications and liens, and comparisons with other states.

The WCIRB is also tracking the long-term impact of State Senate Bill 863 reforms that primarily resulted from negotiations between employers and labor unions, with several provisions effective January 1, 2013 and beyond. Some of the objectives and impact of California’s legislation were to increase benefits for injured workers and, contemporaneously, address and/or limit the rising costs of medical treatment and related costs to employers in part, through the implementation of a Medical Provider Network program and a Utilization Review appeal process.

Similar information to that provided by the WCIRB for other states can also be viewed, including for the following locations:

Florida-National Council on Compensation Insurance (NCCI Holdings, Inc.);

Georgia -National Council on Compensation Insurance (NCCI Holdings, Inc.);

New York Compensation Insurance Rating Board;

New Jersey Compensation Rating & Inspection Bureau;

North Carolina Rate Bureau;

Pennsylvania Compensation Rating Bureau (PCRB)

It is of primary importance to correlate these industry costs and trends with the practical and legal implications as applicable to each individual employment circumstance. For further information, contact our local counsel at Freeman Mathis & Gary LLP, and, for California, contact Jac O’Delle E. Wright at [email protected].

A National “Safe Harbor” to Reduce the Cost of Defensive Medicine?

Posted on: June 18th, 2013

By: Michael Eshman 

The Center for American Progress recently proposed a “safe harbor” in medical malpractice litigation to reduce the cost of defensive medicine.  The essential component of the “safe harbor” plan is the creation of clinical-practice guidelines on a national level, ideally through physician organizations – such as the American College of Obstetrics and Gynecologists.  Under this system, the national guidelines would be presumed to establish the legal standard of care and create a “safe harbor” from medical malpractice for physicians who can show that they followed the guidelines.  The idea being that, with national guidelines that establish the presumptive legal standard of care, physicians hoping to avoid suit will follow the national guidelines rather than practicing defensive medicine – the ordering of excessive and unnecessary medical tests, procedures, or further consultations.

Though the proposal cites an Oregon study that estimated the implementation of a “safe harbor” could save 5% in medical liability costs in Oregon and could resolve 10% of claims more quickly, the value of a national “safe harbor” as a means of reducing the cost of medical malpractice liability is unclear.  A claimant could still support a medical malpractice claim with evidence that the guidelines are not applicable to the specific situation or that a physician did not actually follow the guidelines.

Other proposals to reduce the cost of medical malpractice liability include capping the amount of damages that may be awarded in medical malpractice suits, which has been found unconstitutional in Georgia, and the adoption of the worker’s compensation model for medical malpractice claims.  Either the capping of damages or the adoption of a worker’s compensation model would likely go further in reducing medical malpractice liability costs for medical providers.  However, both methods raise significant legal and constitutional questions.

What are your thoughts on the Center for American Progress proposal and other possible methods of reducing the cost of medical malpractice claims and reducing the cost of defensive medicine?

 

Workers Compensation Model to Replace Georgia’s Medical Malpractice System?

Posted on: August 1st, 2012

By: Scott Rees

A recent study of 330 Georgia physicians indicated Georgia physicians are overwhelmingly in favor of proposed legislation to make such a change.  Instead of the current legal system in place, the workers compensation model would allow a patient to file a claim for review by a panel.  If the panel found “avoidable harm” had taken place, the claim would then be forwarded to a compensation board to award damages.  Those in favor of the system believe this model would allow for predictable settlements in faster time, patients know their claim would be heard, and doctors could avoid the burden of being brought to court over a frivolous claim.  The study was commissioned by Patients for Fair Compensation, and had an error rate of plus or minus 5.5%.  Patients for Fair Compensation claims to be a nonpartisan Section 501(c)(4) organization dedicated to educating and engaging citizens and policymakers on the negative impact on patient care due to defensive medicine – defined as the practice of ordering medical tests, procedures or consultations of doubtful clinical value in order to protect the prescribing physician from malpractice lawsuits.

A few interesting numbers of note taken from the study:

  • 96% of the surveyed physicians said that this system would reduce healthcare costs;
  • 95% of the surveyed physicians said they would support legislation that would provide for this model;
  • 90% of the surveyed physicians said patient care quality and safety would improve under this model;
  • 82% of the surveyed physicians said they currently practice defensive medicine; and
  • 74% of the surveyed physicians said defensive medicine impacts patient care.

Let me know your thoughts on the study and whether you feel such a change would be good for the state, physicians, and patients.