Dual Recovery in Catastrophic Injury Cases: Recent Appellate Decision Expands Liability for Illinois Respondents

September 2024

Ashley L. Krenz

In the case of The American Coal Co. v. Illinois Workers’ Compensation, the Fifth District Appellate Court of Illinois determined that claimants may recover under both sections 8(e)(18) and 8(d)(2) of the Illinois Workers' Compensation Act in catastrophic accidents. This ruling could lead to increased liability for respondents when recovery is awarded under both sections.

The petitioner, a longwall shear operator, was severely injured in a work accident in which he was crushed between a 20-ton piece of steel equipment and a coal block, causing him to lose consciousness. He was airlifted to the hospital and underwent multiple surgeries, including a colon resection requiring a temporary colostomy bag. The petitioner also permanently lost his vision due to optic nerve damage. After weeks in rehabilitation, he continued to suffer from various health issues, including severe pain in his lumbar spine, left hip, and a permanent lack of abdominal muscle control due to the extensive surgeries.

Osman Case Analysis: Powers of the Commission, Manifest-Weight Standard and Causation Review at the Appellate Level

September 2024

Christian K. Kotila

In the recent case of Scott Osman v. The Illinois Workers’ Compensation Commission, et al., 2024 IL App (2d) 230180WC ("Osman"), the Illinois Appellate Court addressed critical issues regarding the Commission’s powers, the legal standard of review, and the causal connection between a claimant’s injury and subsequent medical conditions.

The Claimant was a shipping and receiving clerk and fireman for a school district who fell from a ladder when he was trying to pull orders for shipping and receiving. From the Claimant’s testimony, it was uncovered that he caught his foot between a wall and two pallets and injured his right ankle when he fell back, injuring his right ankle. He underwent ligament reconstruction, physical therapy, and received a custom orthotic, which allegedly caused him to walk with his right foot “splayed” to the right, resulting in a changed gait and pain to his knees and hips. The Claimant’s hip pain manifested five years after the date of the work accident, which he attributed to the altered gait from his ankle injury. The Illinois Workers’ Compensation Commission initially awarded Osman 41.75 weeks of permanent partial disability for his right ankle injury but denied awarding permanent partial disability for the Claimant’s subsequent hip condition and denied associated medical costs.

Principal-Agent Theory Fails Against Shipping Company

May 2024

Jeffrey F. Clement

In Cornejo v. Dakota Lines, Inc., 2023 IL App (1st) 220633, the First District Court of Appeals declined to impose vicarious liability on a shipping broker because the broker exercised very little control over the driver or transportation company involved in a trucking accident. Without an adequate showing of such control, there was no evidence to support the jury’s finding of a principal-agent relationship.

The Exclusive Remedy Provision and “Purely Personal” Workplace Fights

May 2024

Emma L. Knowles

In Price v. Lunan Roberts Inc., Arby’s Restaurant Group, et al, the Illinois Appellate Court opined on the application of the “Exclusive Remedy” provision of the Illinois Workers’ Compensation Act when an injury or death in the workplace stems from a fight. There is a general exception to the “Exclusive Remedy” provision, allowing Plaintiffs to file civil claims against employers, if the fight stemmed from a “purely personal” issue, although the basis for imposing liability on the employer under such circumstances would remain weak. Here, however, the Court clarified the rule and held that any evidence of whether an issue is “purely personal” cannot be speculative.

This case stems from a murder that occurred at an Arby’s fast-food restaurant in Hickory Hills, IL. Decedent John Price was working as an employee at the Arby’s restaurant, when he was stabbed and killed by a co-worker, Irvin Thomas. The stabbing, in which Thomas stabbed Irwin approximately twenty-seven times, occurred shortly after Thomas began his evening shift. A surveillance recording served as evidence of the stabbing, but had no sound, so it was unknown what the two men said to each other leading up to the murder. The murder investigation showed that the two men had some type of association outside the workplace, but the exact nature and depth of the relationship was unclear.

Back to Basics: Workers’ Compensation Fraud in Missouri

March 2024

Amanda J. Richert

The Missouri Division of Workers’ Compensation (DWC) is responsible for overseeing benefits available to employees who become injured or ill on the job during the course of work-related activities. The benefits include payment of medical expenses along with compensation for lost wages and temporary or permanent disabilities. As we all know, these expenses are not insignificant. And, while most claims do involve legitimate accidents and injuries, the few that are fraudulent can negatively impact employers and insurers in a multitude of ways. As such, there must be a method for combatting the illegitimate claims.

In Missouri, the body that investigates allegations of fraudulent workers’ compensation claims is The Fraud and Noncompliance Unit (FNU). The FNU was created in 1993 by the General Assembly to investigate fraud and noncompliance of the Missouri Workers’ Compensation Act, Chapter 287 RSMo. (The Act). As of the writing of this article, the FNU is comprised of eight investigators, two supervisors, one support staff and one manager. The FNU is based in Jefferson City, Missouri, with three investigators assigned to the Kansas City area, two dedicated to St. Louis, two for Columbia and one investigator apiece dedicated to Cape Girardeau and Springfield.

Back to Basics: Workers’ Compensation Fraud in Illinois

March 2024

Noah P. Hamann

Whether you are new to the industry or a seasoned pro, chances are a file has come across your desk that has left you wondering whether a claim qualifies as fraud. In those situations, how do you distinguish when someone is malingering or symptom magnifying versus committing real fraud?

First, consider the problem as a whole. It is estimated that nationally only 1% to 2% of all workers’ compensation cases are fraudulent (¹). While that percentage is arguably small, the dollar value is high. Workers’ compensation fraud results in $34 billion in losses, divided between claimants, medical providers, and premiums (²).

Fraud is a misrepresentation or concealment with reference to some fact material to a transaction that is made with knowledge of its falsity or in reckless disregard of its truth or falsity and with the intent to deceive another and that is reasonably relied on by the other who is injured thereby (³). Proving that the fraud was committed intentionally is a very high bar and can make these cases challenging.