On April 3rd, 2014, in Lonnie Smith vs. Tippah Electric Power Ass’n, NO. 2012-CT-00502-SCT, the Mississippi Supreme Court reversed several lower court rulings that employee Lonnie Smith had intentionally injured himself in an attempt to commit suicide rather than go to prison for murder…and in so doing, the Court awarded Lonnie workers’ compensation benefits for his “accidental injury”. Some might say that this ruling is a stunning upset of an appropriate denial of Smith’s workers’ compensation claim…but is it? Should this result have been anticipated? Was any effort made to settle the case, and if so, did such an effort realistically consider the exposures in light of traditional workers’ compensation doctrine?
Last Thursday, the Mississippi Supreme Court ruled that a man serving a 12-year prison sentence for manslaughter will receive workers compensation benefits for injuries suffered when he was shocked by a power line at his former job, even though the employer argued that he intentionally hurt himself. Here are the salient facts: Continue Reading
Kevin Quinley via LinkedIn (link opens in new window)
Kevin Quinley’s poignant inquiry in the Linked-In group discussion raised the issue of whether or not an “exotic” dancer’s injury, while engaged her occupation of choice, was compensable. For various unrelated reasons, the commentary that followed became quite controversial and it was difficult to keep the analysis “on point”, despite Kevin’s artful attempts to do to. It seems to me that this experience serves as a constant reminder of how such important compensability questions are routinely influenced by, and might be decided, based upon personal bias or sense of morality, whether one is an exotic dancer or a firefighter.
Compare the two occupations: Both occupations are constantly plagued by the issues of “employment status” and “earnings” in controversies over compensability and/or earnings; yet one occupation is routinely ostracized, while the other has, in many cases, been vested with near “worship” status.
2012 was a good year for one self-insured Florida municipality. It not only avoided more than $5 Million in future self-insured workers’ compensation exposures by successfully securing acceptance of a serious injury claim by its excess carrier, it also recovered in excess of $3 Million in prior payments from other excess carriers. What makes these results so significant? The claims had been either denied or rights-reserved due to delayed or poor excess claims management. Fortunately, quick action and sound legal arguments prevailed.
Over the past 20 years I have had the opportunity to conduct reserve adequacy reviews on literally thousands of ‘self-insured’ workers’ compensation claim files. These claims were, and still are, being managed by carriers, third party administrators, and self-insured self-administered entities. While the quality of handling and reserving is all-over-the-board, from very good to very bad, one of the most consistent findings had been the lack of timely and appropriate management of claims with excess exposures…and the consequences have been the loss of tens, if not hundreds, of millions of dollars in excess recovery.
Fortunately, this can be fixed; and it doesn’t take a lot of money or time to do so. It just takes appropriate action… Continue Reading