The Las Vegas Shooting and Why Police Officers Were Denied Workers’ Comp

Acting in the face of imminent death merits a huge deal of honor, but as several courts in California have shown, it doesn’t obligate a county to supply workers’ compensation benefits.

The story

On October 1st, a lone gunman fired rounds of ammunition into the crowd of a festival with tens of thousands of attendees. This was the deadliest mass shooting conducted by an individual in the United States at the writing of this article.

The Las Vegas police who responded to the scene were quickly joined by off duty Los Angeles police officers who were attending the festival. Along with hundreds of others, some of these L.A. police officers incurred injuries from the shooter.

Returning to Los Angeles, the officers—having responded and been injured in the action—filed for workers’ compensation benefits. A few days later, their requests were denied.

Grounds for Denial

California law says that to get work comp benefits, the injury must be the result of and must occur in the course of the employment. In this situation, it does not meet either test. It doesn’t arise out of the officers’ employment because they were on vacation. It did not occur in the course of the employment because they weren’t scheduled to be working.

RateFast’s own Phil Walker mentions one more tricky rule in workers’ compensation that may be considered: if an employer brings the employee ‘within the zone of injury’ and a ‘freak accident’ occurs, the employee can receive benefits. For example, if an office worker’s building is next to a chemical plant which explodes, burning the office worker, he can still receive workers’ comp benefits.

In the case of the police officers injured in the Las Vegas shooting, none of these things occurred.

So, according to the books, since the officers were not on vacation, and were not scheduled to work, and were nowhere near their place of employment, their claims were denied.

Different Counties Under the Same Statewide System

It was the decision of the courts of Orange County to deny the first round of police officers benefits for their injuries. Officers in Los Angeles and San Bernadino counties in California have also filed work comp claims for injuries sustained.

Likely, their claims will also be denied based on the same grounds. This will not stop the officers from seeking benefits for their injuries. After all, treatment for the injuries from this disaster are very expensive.

One can make the strong argument that responding to the event was heroic, and the right thing to do. In the same breath, one could make the argument that it is not the responsibility of the taxpayers to pay the benefits of police who act on their own accord.  Their treatments may last years, and even decades. In this case, California law supersedes any ethical argument that would muddle the decision of the county courts.

Conclusion

The systems in place for workers’ compensation, and healthcare at large, complicates matters such as mass shootings for victims long after the event has passed.

It doesn’t seem likely that any of the off-duty California officers who assisted the Las Vegas police stopped to consider whether their benefits would cover the shooting if they got injured, and this is a testament to the virtue of those who decided to act.

At present, there are talks of litigation following the decision of the courts to not allow workers’ compensation benefits to the injured off-duty police officers.

And though in this unique case for the courts, virtue does not pay for wages lost from work, perhaps lawmakers might see that virtue could be worth a little compensation in the future.

Common Objections to Workers’ Comp Reports: Apportionment

This article is part of a series on the top reasons why insurance carriers object to a workers’ compensation report and return it to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as claims adjusters.

Welcome to the final in our series of posts about red flags in impairment reports, and how to ensure that your reports are not objected to by an insurance company. In our previous posts, we have covered incomplete history of symptoms, unchecked Activities of Daily Living (ADLs), accounting for prior injuries, incomplete examination, and complications with diagnostic tests.

In a perfect world, the long road of a workers’ compensation claim would end in a healthy patient with a 0% WPI, an fairly compensated primary treating physician, a satisfied claims adjuster, and no involvement with an attorney. But it’s rarely this simple.

Apportionment is an attempt to objectify something that cannot be measured with tools, which opens up the possibility for disagreement. As we’ve learned from our other blog posts in this series, disagreements between PTPs and the employers’ insurance can cause slowed claims, delayed treatment, and could result in the need for an attorney.
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Institutional Bias and What You Can Do to Prevent It

People have the tendency to cut corners sometimes. This might come as a surprise to some, but in some cases doctors are no exception.

That said, cutting corners doesn’t necessarily mean that the job is done lazily. For a doctor this can happen because they are pressed for time, they are making an inference based off of prior experience, even outside forces could be pressuring them to fill in a number here and there.

When cutting corners like this becomes routine, we get institutional bias.

Our interview with Dr. John Alchemy covers institutional bias, why it happens, and what doctors could do to avoid dragging out their claims by letting their bias get the better of them. Listen to the podcast on iTunes here.

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RateFast Podcast: Came for surgery, left with some antidepressants?

After they ask themselves the 3 questions before referring a patient to a spine specialist, your provider may follow through, and when a primary treating physician refers an injured worker to the specialist for diagnostic tests, the worker might suspect that there is surgery ahead. This is not always the case.

In fact, there’s a chance that they might even leave the specialist’s office with a prescription for antidepressants, among other possibly unexpected treatments.

RateFast’s own Dr. John Alchemy and Claire Williams interview orthopedic surgeon Dr. Athanassious about the circumstances surrounding complications with spinal injuries in injured workers, and where the primary treating physician may direct them when more specific care is needed. Click here to listen to the podcast on iTunes.

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How to Accept an Invitation and Create Your RateFast User Account

This blog post is for new RateFast users who need to set up a new user account.

If you have been invited to access an organization’s RateFast account, then you will first need to set up your username and profile.
This article describes the process of receiving an invitation, setting up your account, and keeping it secure.
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RateFast Podcast: Understanding the RFA

In workers’ comp, providers must fill out a Request for Authorization form (RFA) when requesting a service, treatment, or tests for a patient. The RFA must be filled out correctly in order to receive approval from the employer’s insurance.

This excerpt from our podcast on How To Submit an RFA features RateFast’s founder Dr. John Alchemy in conversation with Arun Croll and Claire Williams about the intricacies and limitations of the Request for Authorization process.

There are certain steps that providers can take to make an RFA likely to be accepted, such as making sure that appropriate ICD-10 codes are included on the form. Insurance carriers may deny an RFA for all kinds of reasons, so it’s imperative to be as thorough as possible.

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What are The Chances? Probability and RateFast

An educated prediction is a critical element in decision-making when face to face with the future. This is because the future is always uncertain.

Whether you’re making bets, conducting a weather forecast, or working in medicine, knowing the probability that something will or will not happen can have a huge impact on which action to take next.

Making observations to measure the probability of an event happening involves collecting data from past events in order to compare them to the expected outcome. This is why we can have a sense of confidence as to when we should bring an umbrella, buy buy buy, or sell sell sell.

Check out our podcast titled Probability in Workers’ Compensation with RateFast intern Marten Thompson, where we discuss probabilities, Sherlock Holmes, and more.

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Greater Than or Equal To: Percentiles and RateFast

A percentile is a value below which a percentage of data falls.

This means that if you are in a group of 10 people, and you are the 9th tallest at 6 foot 5 inches, then 6′ 5″ is the 80th percentile height in your group. Note that the value falls below your point in the data set.

It is difficult to dispute the numbers when they are on paper, but what happens when there is a dispute about how that data is organized?
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Common Objections to Workers’ Comp Reports: Examination

This article is part of a series on the top reasons why insurance carriers object to a workers’ compensation report and return it to the medical practice unpaid. This article is intended for medical providers, administrative staff, office managers, as well as insurance claims adjusters.

This is now the fourth in our series of Common Objections to Workers’ Comp Reports. If you haven’t already, read the previous articles on History of Symptoms, Activities of Daily Living (ADLs), and Prior Injuries.

Not everybody can do the splits, but your injured worker used to be able to get pretty close. Maybe they can’t go as far now because their range of motion in their left hip has been limited due to an injury at work. In fact, the key to measuring how much they can do the splits now lies in how far the injured leg moves from the hip as compared to the uninjured leg. This gives a crude idea of the examination in workers’ comp.

Failing to perform the examination according to the rules laid down in the AMA Guides 5th Edition gives the insurance carrier a great reason to object to your report, and the impairment rating that’s based on. Even if the insurance carrier accepts a report with an incomplete exam, the impairment rating is likely to be either too high or too low, which is bad news for at least one of the stakeholders.

Failure to document an exam correct on the report is setting yourself up to have a QME called. Take it from us: it’s better for everybody if the primary treating physician gets the exam right the first time.

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