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WCLA MCLE 10-8-13 A Case at Every Level: Recent Supreme Court, Appellate Court, Circuit Court, Commission & Arbitration Decisions Tuesday October 8, 2013.

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Presentation on theme: "WCLA MCLE 10-8-13 A Case at Every Level: Recent Supreme Court, Appellate Court, Circuit Court, Commission & Arbitration Decisions Tuesday October 8, 2013."— Presentation transcript:

1 WCLA MCLE 10-8-13 A Case at Every Level: Recent Supreme Court, Appellate Court, Circuit Court, Commission & Arbitration Decisions Tuesday October 8, 2013 12:00 pm to 1:00 pm James R. Thompson Center, Chicago, IL 1 Hour General MCLE Credit

2 Gruszeczka v. IWCC 2012 ILL App (2d) 101049WC 4-20-09: Commission decision affirming Arbitrator’s denial of benefits received by Petitioner’s attorney 5-4-09: Petitioner’s lawyer mailed Review to Clerk of Circuit Court of DeKalb County according to affidavit (14 days) 5-14-09: Review file-stamped (24 days) Respondent files Motion to Dismiss for late filing and to change venue Motion to dismiss denied and motion to change venue granted (McHenry) McHenry denies reconsideration of Motion to Dismiss and confirms Commission’s denial of benefits Parties cross appeal to Appellate Court

3 Gruszeczka v. IWCC 2012 ILL App (2d) 101049WC Section 19(f)(1) of the Act provides that a proceeding for judicial review of a Commission decision “shall be commenced within 20 days of the receipt of notice of the decision.” … jurisdictional requirements which must be strictly adhered to to vest subject-matter jurisdiction Petitioner urges the adoption of a “mailbox rule” applicable to the commencement of an action in the circuit court for judicial review under section 19(f)(1) of the Act, asserting that the time of the mailing of the documents necessary to prosecute such action is the time of filing for jurisdictional purposes We believe, however, that the reliance upon Harrisburg-Raleigh Airport Authority is misplaced, and we decline to follow Norris for the following reasons…If a mailbox rule were to be engrafted upon the 20-day commencement period mandated in section 19(f)(1), it is the legislature that must do so, not the judiciary under guise of statutory interpretation To commence means to begin or to start (Webster’s Third New International Dictionary 456 (1981))..cannot understand how one can begin or start any action in the circuit court before the necessary documentation is presented to the clerk of the court…we vacate the judgment of the circuit court as having been entered in the absence of subject-matter jurisdiction and we dismiss the claimant’s appeal STEWART & HOLDRIDGE, dissenting: agree with the claimant and would hold that the mailbox rule applies to the filing of appeals from the Commission to the circuit court. Therefore, I respectfully dissent…Guidance in previous decisions which hold the mailbox rule applicable to the filing of jurisdictional documents in appeals. In doing so, I note that the mailbox rule has been applied to the filing of a petition for review from an arbitrator to the Commission…Ambiguity should be resolved in favor of mailbox rule

4 Gruszeczka v. IWCC 2012 ILL App (2d) 101049WC What about general mailbox rule? (5 ILCS 70/1.25): Unless An Act otherwise specifically provides, any writing of any kind or description required or authorized to be filed with, and any payment of any kind or description required or authorized to be paid to, the State or any political subdivision thereof, by the laws of this State: (1) if transmitted through the United States mail, shall be deemed filed with or received by the State or political subdivision on the date shown by the post office cancellation mark What about other instances of mailbox rule in WC rules? At least 6 instances? For example, 7040.10(d)(2)(B), authenticated transcript; 7040.70(e)(2), statement of exceptions (both 2 days mailing time) Venue? 19(f)(1) says “the county where any of the parties defendant may be found” Petition for Leave to Appeal GRANTED by Supreme Court 9-26-12

5 Gruszeczka v. IWCC 2013 IL 11412, filed 8/01/2013 Holding: Where a workers’ compensation claimant’s request for circuit court review of an Industrial Commission decision was mailed within the 20days called for by statute, but was not received by the clerk of circuit court until the twenty-fourth day, the statute’s ambiguity was resolved by applying the “mailbox” rule to hold that the filing was timely and that subject matter jurisdiction in the circuit court was not lacking; if this construction is not what the legislature intended, it needs to clearly so set forth. The interpretation of a statute is a question of law that we review de novo. Unlike the appellate court, we do not believe that this question can be answered merely by consulting a dictionary. Alliance argues that Kelly and Wilkins apply here because circuit court review of a Commission decision is a “new action” with a “20-day statute of limitations.” We disagree with this characterization and find that the Kelly/Wilkins test leads inescapably to the conclusion that the date of mailing should control when a party seeks judicial review of a Commission decision. Clearly, when a party seeks review of a Commission decision in the circuit court, the party is not instituting an entirely new cause of action.

6 Tiburzi Chiropractic v. David Kline & Rovey Seed 2013 IL App (4 th ) 121113, filed 9/16/2013 Petitioner settles case: “whereby third-party defendant agreed to satisfy, pursuant to the fee schedule, all medical bills for medically causally related treatment received on or before June 10, 2010.” In May 2011, plaintiff, Tiburzi Chiropractic, filed a small-claims complaint against defendant, David Kline, to collect the balance of fees charged following the performance of chiropractic services. In November 2012, the trial court found in favor of plaintiff and ordered defendant to pay $2,155. In July 2012, the trial court entered an order on defendant's section 19(g) petition. The court found third-party defendant had made full payment pursuant to the terms of the settlement contract lump-sum petition and order, including payment pursuant to the fee schedule and section 8 of the Act of "all medical bills for medically causally related treatment, including, but not limited to, any bills for medical treatment provided by [plaintiff]."

7 Tiburzi Chiropractic v. David Kline & Rovey Seed 2013 IL App (4 th ) 121113, filed 9/16/2013 Pursuant to the Act, the employer must adjust the medical bills to conform to the fee schedule found in section 8.2. 820 ILCS 305/8.2 (West 2010). "Except as provided under subsections (e-5), (e-10), (e-15), and (e-20), a provider shall not bill or otherwise attempt to recover from the employee the difference between the provider's charge and the amount paid by the employer or the insurer on a compensable injury." 820 ILCS 305/8.2(e) (West 2010). In the case sub judice, plaintiff relies on the exception in subsection (e-20) (820 ILCS 305/8.2(e-20) (West 2010)), which states as follows: "Upon a final award or judgment by an Arbitrator or the Commission, or a settlement agreed to by the employer and the employee, a provider may resume any and all efforts to collect payment from the employee for the services rendered to the employee and the employee shall be responsible for payment of any outstanding bills… We agree with defendant that plaintiff's compensable services under the Act are not recoverable…Contrary to plaintiff's argument, it did not treat defendant as a private-pay patient. Instead, plaintiff submitted its bill to defendant's workers' compensation insurance carrier. Accordingly, the trial court erred in awarding plaintiff a monetary judgment in the amount of $2,010.Although we find subsection (e-20) does not allow plaintiff to recover for compensable services in excess of the fee schedule, we find it does allow plaintiff to recover for services not compensable…Here, the workers‘ compensation insurer paid nothing for the 20 cold packs, each billed in the amount of $10. Thus, plaintiff is entitled to judgment in the amount of $200, plus costs.

8 Julia Garcia v. Magid Glove 12 L 50560, Judge Robert Lopez Cepero, 9/23/2013 The motion for a full 20% attorneys’ fee is hereby granted No connection between Section 16a and Section 8(d)1 Set of prerequisite conditions not present in Section 8(d)1 Matter of law and statutory construction Section 16a does not apply to 8(d)1 Section 16a: “However, except as hereinafter provided in this Section, in death cases, total disability cases and partial disability cases, the amount of an attorney's fees shall not exceed 20% of the sum which would be due under this Act for 364 weeks of permanent total disability based upon the employee's average gross weekly wage prior to the date of the accident…”

9 Lourdes Oliver v. Posen-Robbins School District 13 IWCC 0297, 12 WC 017743 IWCC unanimously affirms and adopts decision of the Arbitrator, 3/19/2013 Lourdes Oliver ("Petitioner") testified that on February 23, 2012, she was employed by the Posen- Robbins School District # 143.5 ("Respondent") as a second grade teacher at Gordon Elementary School. Petitioner testified that she had been working for the Respondent for about sixteen (16) years. Petitioner testified that on the morning of February 23, 2012, she finished making copies in the office and was walking from the north entrance of the school, down the hallway to pick up her class from the gym. Petitioner further testified that she was carrying a book in her hands and wearing red pants with flat, rubber-soled boots. Petitioner stated that Ms. Doris Sams was also present in the hallway, leaning against the wall near classroom 19. Petitioner testified that the floor in the hallway was grey with black stripes and while walking down the hallway, she noticed something shiny on the floor; about 30 feet ahead of her, which she described as a liquid. Petitioner testified that she did not notice any color to the liquid and did not see it again after she initially saw it from 30 feet away. Petitioner testified that she attempted to walk around the alleged spill when slipped and fell in the area where she saw the substance, between classrooms 18 and 19, falling on her right shoulder and knee, having pain in her neck. She testified that when she slipped, she was laying on the liquid. She testified that she reported a spill on the floor to the principal and others while laying on the floor after her fall.

10 Lourdes Oliver v. Posen-Robbins School District 13 IWCC 0297, 12 WC 017743 Petitioner also testified that later that night she noticed that her knee was skinned and that she had a small spot on her pants that smelled like coffee. She brought the pants to the arbitration hearing and a dime-sized white spot was apparent on the right knee. Although Petitioner testified that her pants smelled like coffee, she denied drinking coffee or noticing brown discoloration in the area of the hallway where she saw the liquid. The Arbitrator takes judicial notice that the pants displayed by petitioner do not have any stains on them except a dime sized mark on the right pant by the knee area. Ms. Sams testified that on the morning of February 23, 2012, she was acting as a hall monitor and witnessed Petitioner's accident. Ms. Sams stated that she remembered the accident clearly. Ms Sams also testified that she was not reading anything at the time of Petitioner's fall and that she was able to observe the hallway from where she stood. Ms. Sams stated that the hallway was very clear and well lit and that she had been looking at the area where Petitioner fell for about three to five (3-5) minutes before the accident as she was approximately five (5) to ten (10) steps away from the spot and did not observe anything or any discoloration on the light gray floor. Ms. Sams testified that the hallway was clear. Ms. Sams stated that she was standing by the wall near classroom 19 when she directly saw Petitioner slip and fall, approximately ten (10) feet from where she was standing. She testified that Petitioner just fell and that Petitioner did not make mention of any substance on the floor during the fifteen to twenty (15-20) minutes that it took for the ambulance to come. Ms. Sams further testified that she hurried to Petitioner's assistance and that there was no liquid spilled on the floor.

11 Lourdes Oliver v. Posen-Robbins School District 13 IWCC 0297, 12 WC 017743 It is generally accepted by Illinois courts that a fall originating from an unknown, neutral source is "unexplained." Builder's Square, 339 Ill. App. 3d 1006, 1010 (2003). An unexplained fall will not be compensable where the claimant fails to present factual evidence at the arbitration hearing, upon which the Commission could draw a reasonable inference that the employment conditions contributed to the fall. Illinois courts have consistently rejected the positional risk doctrine, and, as such, a claimant alleging an unexplained fall has the burden of proving a reasonable inference that the fall arose out of the employment. Id. Illinois courts have made it clear that an inference alone is not enough to establish the compensability of an unexplained fall. Rather, the claimant must prove that the inference was reasonable…In Builders Square, an employee's husband brought a workers' compensation claim after his wife fell at work and died. The decedent was working for the Respondent in the lawn and garden department, when she fell while opening boxes of merchandise. In his witness testimony, the decedent's coworker and friend stated that he saw her straighten up, then stagger two or three steps backward, collapsing on the floor. The Illinois Appellate Court determined that the decedent's fall at work was not compensable because her husband failed to offer reasonable inferences to explain the fall.Builder's Square, 339 Ill. App. 3d 1006, 1010 (2003).

12 Lourdes Oliver v. Posen-Robbins School District 13 IWCC 0297, 12 WC 017743 Similar to the decedent's spouse in Builder's Square, the Petitioner only offered conjecture as to what caused her to fall, failing to offer evidence or information allowing the Arbitrator to form a reasonable inference to explain the accident. Petitioner's claim that she slipped and fell due to a coffee spill is based solely upon the smell of coffee on her pants later that night and her assertion that she noticed liquid on the floor from thirty (30) feet away. During her testimony, Petitioner admitted that she saw no brown discoloration on a floor where she slipped, despite the light colored flooring. Further, Petitioner testified that she did not notice any liquid around her when she was on the floor. She testified that she saw liquid on the floor from 30 feet away; and tried to avoid it as she walked closer to it. Ms. Doris Sams also testified that she had been watching the area of the hallway where the accident happened for approximately three to five (3-5) minutes and remembered that the area was clear, with no defects on the ground or liquid spilled. The Arbitrator finds the testimony of Ms. Sams to be credible. The testimony of Ms. Sams parallels the testimony of the coworker in Builder's Square. The coworker was a friend of the decedent and had no reason to have bias against her. Similarly, Ms. Sams testified that the Petitioner was well-respected at the school, indicating that Ms. Sams had no bias or reason to testify in an untruthful manner as to the conditions surrounding the Petitioner's fall. During her entirely testimony, Ms. Sams had no doubt that the area where Petitioner fell was clear and that there were no defects on the floor contributing to the accident. Based upon the testimony of Doris Sams, it is unlikely that the accident occurred in the way the claimant testified that it happened. Petitioner's testimony contradicts the testimony of Ms. Sams as Ms. Sams saw nothing spilled on the floor and Petitioner also admitted that she did not notice any discoloration on the floor. Petitioner did not allege that she slipped on coffee until the arbitration hearing, and she presented no evidence to link the coffee smell to the fall. The Arbitrator finds that the Petitioner has not proven, by a preponderance of the evidence, that she sustained an accidental injury arising out of and in the course of her employment.

13 Nicholas Duncan v. Federal Whalen Moving 12WC034355 (9-4-13; Erbacci) DA 6/16/2012 39 yo mover driver Left knee arthroscopy & chondroplasty femoral condyle by Dr. Sumerville (i) Dr. John Cherf; 1% LEI =1% WPI; “impairment does not equate to PPD;” PE grade modifier is zero; did not consider SX report (ii) “Arbitrator notes is medium to heavy work… more adversely affected…greater amount of PPD” (iii) “Younger individual…PPD will be more extensive …live with PPD longer” (iv) “Appears to be diminished…RTW with restrictions …difficulty working as a mover…presently works spotting trucks” (v) “Credibly testified…pain…corroborated…diagnosis…necessity of subsequent surgery…precedent pursuant to Section 19(e)” Award: 25% loss of use of the Left leg (9-4-13) Status: Arbitration Decision Rendered

14 Steven Miller v. ConWay Freight 12WC041880 (7-17-13; Thompson-Smith) DA 9/14/2011 49 yo sales rep/driver Dr. Westin performs arthroscopic repair partially torn rotator cuff, acromioplasty, distal clavicle resection (i) Dr. Westin “by request of the Respondent;” 7% UEI; 4% WPI; “QuickDash…physical exam” (ii) “Judicial notice…medium to heavy work…PPPD will be larger than…lighter work” (iii) “Petitioner is 51…older individual…PPD may be more extensive …than younger individual” (iv) No evidence that FEC is diminished: RTW in full duty capacity (v) “Surgery…pain noted…loss of range of motion…loss of strength” Award: 12% whole person (60 weeks=23.72% arm) Status: Respondent Review filed

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