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A series of articles emphasizing practical
knowledge you can't find in practice guides
and interviews with experts who share
their techniques for effective and efficient
case management
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Articles emphasizing practical knowledge you
can't find in practice guides
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Profiles of people who changed workers’
compensation law.
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• Warren
Schneider
• Marjory Harris
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HARRIS:
You are well known for your
ability to find Subsequent Injuries Fund
cases. I've also heard that you are known
for taking these cases to trial. Could you
share some of your techniques for finding
and developing SIF cases?
TREASTER:
I take a detailed medical
history from the client in a face to face
interview. I ask about military service
and/or military disability ratings. I look for
hearing aids and check into learning
disabilities.
I ask about childhood illnesses and/or
birth defects, such as polio, post-polio
syndrome, and autism.
I check with the WCAB (just as the
insurance companies do) for pre-existing
workers' compensation cases.
Social Security earnings records (which
go back 20 years) may indicate pre-existing
disability.
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Labor
Code §4751
If an employee who is permanently partially disabled
receives a subsequent compensable injury resulting in
additional permanent partial disability so that the
degree of disability caused by the combination of both
disabilities is greater than that which would have resulted
from the subsequent injury alone, and the combined effect
of the last injury and the previous disability or impairment
is a permanent disability equal to 70 percent or more
of total, he shall be paid in addition to the compensation
due under this code for the permanent partial disability
caused by the last injury compensation for the remainder
of the combined permanent disability existing after
the last injury as provided in this article; provided,
that either (a) the previous disability or impairment
affected a hand, an arm, a foot, a leg, or an eye, and
the permanent disability resulting from the subsequent
injury affects the opposite and corresponding member,
and such latter permanent disability, when considered
alone and without regard to, or adjustment for, the
occupation or age of the employee, is equal to 5 percent
or more of total, or (b) the permanent disability resulting
from the subsequent injury, when considered alone and
without regard to or adjustment for the occupation or
the age of the employee, is equal to 35 percent or more
of total.
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HARRIS:
SIF requires that a pre-existing
condition actually be labor-disabling
before the occurrence of the subsequent
work injury. Does SB 899’s change to
Labor Code §4663 and the Escobedo
decision have much impact on SIF cases,
or is the real problem that the AMA
Guides-based ratings are so low that SIF
cases may become extinct?
TREASTER: The
new law allows
apportionment to non-disabling conditions.
Subsequent Injury Fund legislation
requires actual pre-existing disability.
And the AMA Guides make it difficult to reach the threshold
for Subsequent
Injuries Fund liability, with their low WPI
for backs and other orthopedic injuries. |
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In the en banc decision, Escobedo
v. Marshalls, 70 CCC 604 (2005), the Board found
that under SB 899, "apportionment now can be based
on non-industrial pathology, if it can be demonstrated
by substantial medical evidence that the non-industrial
pathology has caused permanent disability" (page
16) and summarized the interplay between Labor Code
4751 and 4663: "Applicant asserts that because
SB 899 did not amend section 4751, relating to benefits
payable by the Subsequent Injuries Benefits Trust Fund
(“SIF”), this reflects a legislative intent
that pathology is not one of the “other factors”
upon which apportionment to non-industrial causes can
be based. In essence, applicant asserts that if apportionment
based on pathology were allowed, this would cause a
flood of SIF benefit claims to be filed under section
4751. This is because, in applicant’s view, apportionment
to pathology would decrease the percentage of disability
for which the employer is responsible, while the overall
level of disability would remain unchanged, leaving
the SIF responsible for the difference. We disagree."
(at page 17)
"…if an applicant’s non-industrial
pathology causes apportionable permanent disability
under section 4663 or 4664(a), then SIF benefits will
not be payable under section 4751 unless the applicant
demonstrates that the pathology was causing permanent
disability prior to the subsequent industrial injury.
Although this may mean that, in some cases, an injured
employee will not get either permanent disability benefits
or SIF benefits for the apportioned disability, this
is not a major change from pre-SB 899 law, which held
that an injured employee was not entitled to SIF benefits
based on an asymptomatic disease process that was not
labor disabling prior to the industrial injury. [citations
omitted] In any event, it is an issue within the Legislature’s
domain, not ours." (at pages 18-19)
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HARRIS: Will SIF allow ratings
based on
diminished future earning capacity
(DFEC) in lieu of those based on the AMA
Guides and new Permanent Disability
Rating Schedule? Any plans to litigate
this issue?
TREASTER: Interesting
question. I'm sure someone will litigate this.
For
Mr. Treaster’s resume, click here
Eugene C. Treaster, Esq.
3838 Watt Avenue, Bldg F-600
Sacramento, CA 95821
(916) 444-2622
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To learn more about diminished
future earning capacity (DFEC) as an alternative rating
method, click
here.
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