THE OKLAHOMA THE OKLAHOMA WORKERS’ WORKERS’

COMPENSATION CODECOMPENSATION CODE

THE NUTS AND BOLTS OF THE NUTS AND BOLTS OF AVOIDING AND AVOIDING AND

MITIGATING CLAIMSMITIGATING CLAIMS

Madalene WitterholtMadalene WitterholtChristina F. ToonChristina F. ToonCROWE & DUNLEVYCROWE & DUNLEVY918-592-9800918-592-9800christina.toon@crowedunlevy.christina.toon@crowedunlevy.comcom

PREVENTION OF CLAIMSPREVENTION OF CLAIMSCOVERING YOUR BASESCOVERING YOUR BASES

• PRE-EMPLOYMENT PHYSICAL

• CREATION OF A SAFE WORK PLACE-PROPER TRAINING

RESPONDING TO REPORTED RESPONDING TO REPORTED INJURYINJURY

• EMPLOYER’S FIRST NOTICE OF INJURY

• PROMPT MEDICAL ATTENTION– Actual knowledge– 7 days unless

emergency– Not an admission

of compensability– Selection of

treating physician

FACTS TO DETERMINE AND FACTS TO DETERMINE AND EVALUATE CLAIMEVALUATE CLAIM

• VERIFY EMPLOYMENT• COVERAGE• JURISDICTION• ON-SITE INVESTIGATION (basic facts,

medical treatment, employee interview, witness interview)

• WAGES-RATE DETERMINATION• ADMIT OR DENY

COMPENSABLE INJURIESCOMPENSABLE INJURIES

• Arising out of and in the course and scope of employment

• Major cause now defined as “more than 50%” the fault of employment

• Single event vs. cumulative trauma injuries and the Statute of Limitations

• Consequential injury

DEFENSESDEFENSES

• 30 days notice• The drug defense• Preexisting condition• Intentional injuries• Horseplay• Recreational

activities• Cumulative trauma-

90 day rule• Injuries not physical

in nature

PROVIDING MEDICAL PROVIDING MEDICAL CARECARE

• Official Disability Guidelines “ODG”• Physician’s Advisory Committee for

spine and pain management• 25% penalty for non-payment

TEMPORARY TOTAL DISABILITY TEMPORARY TOTAL DISABILITY BENEFITSBENEFITS

• TTD-time during which the injured worker is fully unable to work in any capacity

• Soft Tissue• Light Duty Restrictions• MMI-Maximum Medical

Improvement• Termination of

Benefits-Prefiling• Payment not an

admission• Employee notice

PERMANENT PARTIAL PERMANENT PARTIAL IMPAIRMENTIMPAIRMENT

• Release at MMI• Scheduled vs. non-scheduled

members• AMA Guides• No treatment, no impairment• Apportionment • Unrepresented Settlement

AND NOW WE’RE IN ACTION-AND NOW WE’RE IN ACTION-MITIGATING THROUGH THE LEGAL MITIGATING THROUGH THE LEGAL

PROCESSPROCESS

• 10-Judges• Employees First

Notice of Accidental Injury

• Pretrial Answer and Stipulation

• Motion for Prehearing Conference

TTD BENEFITS-LITIGATED TTD BENEFITS-LITIGATED CLAIMCLAIM

• 10 days or 15% penalty

• 156 weeks with additional 52

• 7 and 21 day timeline

• Unemployment and short term disability

• Treating physician or CIME

• Non-compliance

THE LEGAL PROCESS THE LEGAL PROCESS CONTINUEDCONTINUED

• Request for change of physician/CWMP

• Termination of TTD benefits/MMI

• Trial Motion• PPI Trial• Appeal

CONTINUING MEDICAL CONTINUING MEDICAL MAINTENANCEMAINTENANCE

• Treating physician or IME• Physicians Advisory Committee• Duration

PERMANENT TOTAL PERMANENT TOTAL DISABILITYDISABILITY

• Vocational evaluation• Loss of hands, feet, legs, eyes, or any

combination of two• PPD and PPI• PTD and TTD• Court review• Suspension of benefits

VOCATIONAL VOCATIONAL RETRAININGRETRAINING

• Permanent restrictions and return to work

• Limited to 52 weeks but may be extended

CLAIM CLOSURE-GET CLAIM CLOSURE-GET CLAIMS OFF YOUR BOOKS!CLAIMS OFF YOUR BOOKS!

• Reopen for Reopen for change of change of condition Medical condition Medical maintenancemaintenance

• The Compromise The Compromise SettlementSettlement

• Agreed OrderAgreed Order• Voluntary Voluntary

MediationMediation• Medicare Medicare

ConcernsConcerns

RECENT CODE UPDATES-RECENT CODE UPDATES-STAY ON TOP OF THE STAY ON TOP OF THE

CHANGECHANGE

• Mileage• Heart claims• MRI testing units/Ownership interest• Missed medical appointments• Mediations• Fees for uncontested death cases• Client funds for political contributions• Coming and going rule

THANK YOU FOR THANK YOU FOR LISTENING!LISTENING!

This presentation is provided by Crowe & Dunlevy for educational and/or informational purposes only and does not constitute legal advice.  No attorney-client relationship is established by viewing this presentation. Copyright © 2012 Crowe & Dunlevy, P.C.