Spring 2009

   The Official Publication of the Arizona Workers’ Compensation Claims Association

                                        By Jim Gill, AWCCA President

In a recent decision from Division One of the            his symptoms as including “stiffness and pain in
Arizona Court of Appeals, the appellate judges           his neck and lower back [and] tingling in [his]
upheld a Maricopa County Superior Court verdict          fingers, arms and legs”.
that found an IME physician in a workers'
compensation claim partially liable for a claimant's     The Paula adjuster asked Dr. Krasner to conduct
death by overdose four years after the IME was           the examination and to reply to the following:
                                                             1. Please describe the findings, diagnosis,
Dr. Scott Krasner had appealed a jury's decision                prognosis and their relationship to the
that he committed medical malpractice and that he               injury of 4/11/00
was partially liable for the death of Jeremy Ritchie,
a workers' compensation claimant whom he had                 2. Do you feel Mr. Ritchie's current
seen in an IME he did for Paula Insurance. In its               symptoms exacerbated a pre-existing back
ruling, the appellate court held that, even in the              condition? If so, do you feel he is now at
absence of a formal doctor-patient relationship, a              a pre-injury status?
doctor conducting an IME owes a duty of
reasonable care to his or her patient.                       3. If not, to what extent do you feel his
                                                                current symptomatology is attributable to
According to the Court of Appeals published                     the 4/11/00 industrial incident, and what
decision, the case began in April of 2000 when                  treatment do you recommend?
Jeremy Ritchie suffered a bruised spinal cord
while at work. The injury caused swelling and                4. Do you feel he is capable of regular work?
compression of the cervical section of the spinal               If not, can he perform light work? Please
cord which resulted in Ritchie's complaints of pain             list the restrictions.
and numbness when he first sought medical
treatment two days post accident.                        Dr. Krasner examined Ritchie and, after ordering
                                                         an MRI of his lumbar spine, he said that Ritchie's
Ritchie initially reported his symptoms to Dr.           injury was stationary without the need for
Robinson at HealthSouth Occupational Medicine.           supportive care and that there was “no indication
When he disagreed with Dr. Robinson's diagnosis,         for any work restrictions”.
Ritchie went to Emergency Chiropractic where Dr.
Howe, one of the chiropractors, recommended that         Based on Dr. Krasner's report, Paula terminated
Paula Insurance refer him to a specialist for further    Ritchie's workers' compensation benefits. The
evaluation. Paula Insurance then sent Ritchie to         Court of Appeals decision gives no indication that
see Dr. Krasner for an IME, describing his injury        Ritchie ever protested Paula's closure of his claim.
as being “a cervical and lumbar strain as a result of    In an affidavit, Ritchie stated: “I was advised that
[a workplace] accident.” Paula further described                                     (Continued on Page 14)
Page 2

                 The Official Publication of the Arizona Workers’ Compensation Claims Association

The Examiner is published quarterly by the Arizona
Workers' Compensation Claims Association, P.O. Box                  AWCCA Mission Statement:
44941, Phoenix AZ , 85064-4941. All articles appearing in
                                                                  The purpose and objective of this association
this publication contain the opinions of the authors and not
necessarily the opinions of the AWCCA, its officers or            shall be to promote the general welfare of its
editors. The AWCCA encourages the submission of new ads           members by developing close relationships
and articles, subject to editing. Signed letters to the editor
                                                                  among those engaged in the handling of
are welcome. AWCCA seeks to provide a forum for the free
exchange of ideas and opinions.                                   workers' compensation claims; to promote

                                                                  cooperation    by   mutual     exchange    of

                                                                  experiences and information and discussions

                                           thereon and, to educate its members.

 If you're looking for news about AWCCA membership,
     upcoming events, past issues of The Examiner,
 information on AWCCA sponsors or contact information
         for AWCCA Executive Committee Members,
            be sure to visit
                                                                        NEW AWCCA
         Please remember to save i
                                                                         P.O. BOX #
           n your Internet Explorer “bookmarks”!                 The AWCCA has a new mailing address.
                                                                 Effective immediately, all mail correspondence
                                                                 including checks, membership applications,
                                                                 Letters to the Editor of The Examiner and other
                                                                 items addressed to the organization or its
      Rebecca Lollich MA, CRC                                    officers should be sent to:
      Vocational Consultant
      Labor Market Expert

      office 480-451-5228                                                          AWCCA
      fax 480-515-1576
      e-mail                                                   P.O. Box 44941
      10115 E. Bell Road
      Ste. 107, Box 505
      Scottsdale, AZ 85260
                                                                                  Phoenix AZ
                                                                                                                             Page 3

                       RETURN TO WORK AFTER
                      FOOT AND ANKLE INJURIES
                                              By Aprajita Nakra, DPM, FACFAS
                                     Board Certified Reconstructive Foot and Ankle Surgeon
                                                    Advanced Ankle & Foot
The spectrum of work related injuries is enormous.                 layer of confusion to this picture. Medical literature
Foot and ankle injuries account for nearly 10% of total            has reiterated that subspecialists should see industrial
workplace injuries. The medical aspects of these                   injury patients - a generalist may miss subtle cues to
problems are often challenging and complex. More                   the pathology of lateral hindfoot pain and talus
challenging than the foot and ankle pathology,                     pathology, whereas a foot and ankle specialist might
however, is the patients' timely return to work. For               be better able to clarify the elements of injury causing
many patients, the pain and difficulties with returning            pain. This stage of diagnosis is often where return-to-
to an occupation which is demanding on the lower                   work failure begins. Many times the injured worker
extremity can be difficult to impossible.                          has spent weeks and sometimes months without a
                                                                   specific diagnosis and without appropriate treatment,
However, there are a percentage of patients who are                resulting in failed attempts to return to work before
able to resume work albeit of a lesser capacity, but are           seeing the subspecialist. This process may give the
not willing to do so. Motivation, chronic pain and                 mistaken impression to the insurance company and the
secondary gain are all factors which the clinician must            employer that the injured worker is malingering and
take into consideration. Medical literature has provided           does not want to return to work.
evidence that if the injured worker is not returned to
work following a calcaneal (heel) fracture within one              It is important for the physician to set the stage for
year, the likelihood of them ever obtaining and                    return to work at the initial contact with the patient,
maintaining gainful employment is markedly reduced.                reinforcing the idea that the outcome of the treatment
In addition, post traumatic arthritis may develop, hence           plan is a return to work and to daily activities as
precluding the ability to rapidly return to work.                  quickly as possible. For some foot and ankle injuries,
                                                                   it may be important to set target dates for return to
The injured worker is a unique patient. Instead of                 work that are reevaluated at follow-up appointments.
experiencing the classic patient / physician dynamic,              These target dates should be based on the physical
multiple parties are involved in the care of this patient.         examination, input from the physical therapist and the
Return to work is critical to all parties involved but the         case manager's input regarding the availability of
potential for miscommunication or inadequate                       modified duty. The case manager is a pivotal member
communication is high because of the involvement of                of the team as he/she is in contact with all the parties
several parties. In addition, foot and ankle patients              involved with the injured worker's claim.
often seek care from generalists, which adds a further                                            (Continued on Page 12)

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                                z   6WDW GLFWDWLRQV XSRQ UHTXHVW        Dallas, Texas                   Mobile (602) 319-0025
                                                                        Referral Line: (800) 922-4994   Home Office (623) 362-4094
Page 4

           AWCCA BOARD
   Donell Hewett was elected as the AWCCA's new Vice-President and,
   Helen Olson was re-elected as AWCCA Treasurer at the Association's
   final dinner meeting of the 2008-09 year on May 12th. Both Donell
   and Helen are Sr. Claims Examiners for Republic Indemnity. Donell
   served as an Executive Committee Member-at-Large during the past
   meeting year.
                                                                           Incoming AWCCA President Jim Gill presents a
                                                                           plaque to outgoing President Cheryl Altman at the
   The AWCCA Bylaws were revised in May of 2008 to reflect that the        May dinner meeting in appreciation of Cheryl's
                                                                           leadership of the 2008-09 Executive Board.
   member who was elected as Vice President would serve in that position
   for one year and then, assume the position of AWCCA President the
   following year. Last year's Bylaws amendments also included a
   provision that the position of AWCCA Treasurer would be up for          The Bylaws amendments were approved
   election during odd-numbered years and, the position of AWCCA           last year in an effort to provide
   Secretary would be up for election during even-numbered years.          continuity on the AWCCA's Executive
   Under those provisions, last year's Vice President, Jim Gill, assumes   Committee from year to year so that
   the position of President for the 09-10 meeting year and last year's    there won't ever be a situation in which
   AWCCA Secretary Tara Shields retains her position for another year.     the entire Board is new.

                                         Not All FCEs Are Created Equal Series….
                                                                       FACT 3/3

  The Functional Capacity Evaluation quantifies safe functional abilities and is a
  pivotal resource for:

     •   Return-to-work and job-placement decisions
     •   Disability evaluation
     •   Determination of how non-work-related illness and injuries impact work
     •   Determination of function in non-occupational settings
     •   Intervention and treatment planning
     •   Case management and case closure

                      Physicians Physical Therapy Service (10 Locations Valley Wide)
                        To Schedule-contact Sanford Goldstein, PT, CDMS, CLCP
                              Director of Industrial Rehabilitation Division
              Phone: 602-320-2452 Fax: 866-583-7567 E-Mail:
                                                                                                                 Page 5

                                           By Jim Gill, AWCCA President
If you're in the insurance industry, whether it's handling   have to work long past his originally planned retirement
workers' compensation, liability or group health claims,     age because his 401K is now worth pennies on the
you've almost certainly heard the buzz about mandatory       dollar). Because Uncle Bernie was hurt on the job, he'll
Medicare reporting. If you're a manager or supervisor,       qualify for workers' compensation. But, he's also on
you've probably been involved in hours and hours of          Medicare because he's eligible at age 65. In addition,
meetings and teleconferences with your IT people,            Uncle Bernie may have had some auto medpay or other
trying to figure out how your staff can comply with          no-fault auto coverage not to mention a group health
government guidelines that are lengthy, complex, filled      insurance policy from his employer. And, the driver who
with an alphabet soup of acronyms and, subject to                                           (Continued on Page 20)
frequent revisions. If you're an adjuster, you've probably
seen your managers and supervisors walk out of those
closed-door meetings, mumbling to themselves with
looks of confusion, frustration and dejection on their

So, what exactly is all this Medicare stuff you've been
hearing about?

On December 30, 2007, President George W. Bush
signed the Medicare, Medicaid and SCHIP Extension
Act of 2007. The legislation took all of 11 days to go
from introduction in Congress to signature by the
President. Why the hurry? Simple: Congress believed it        Arizona Vocational Consulting & Forensic
                                                              Services, Inc. is a full service vocational
could generate billions of dollars of new federal revenue
                                                              consulting firm with over 20 years combined
without having to raise taxes. The source of all that new     experience, specializing in the evaluation of the
money? Insurance companies, self-insureds and injured         impact of workforce displacement due to injury,
claimants.                                                    illness, or other factors on a person’s ability to
                                                              participate in open and competitive work force.
After years of being an issue that was largely ignored by
our nation's lawmakers, the inevitability of red Medicare     Services offered to the Workers’ Compensation
ink finally got the attention of Congress. In 2007, the       Community include labor market research, loss of
                                                              earning capacity recommendations, employer
Medicare program had 44 million beneficiaries for
                                                              consultation,    job     analyses,   return-to-
whom it paid out about $432 billion in benefits.              work/reasonable accommodation evaluation, job
Medicare trustees had been warning Congress that              placement, vocational rehabilitation and labor
payments continued to increase at a rate greater than         market expert witness testimony before the
revenues would support and that sooner or later, the          Industrial Commission of Arizona.
system would simply go broke. Congress needed a quick
fix and their solution was closing some loopholes that                     Lisa Clapp, MA, CRC, CEA
had, for years, cost the Medicare system millions of              Vocational Consultant/Manager/President
dollars in payments that probably should have come
                                                                   Arizona Vocational Consulting & Forensic
from other sources.                                                                            Services, Inc.
                                                                      3120 W. Carefree Highway, #1-150
One of the problems that was draining the Medicare                            Phoenix, AZ 85086
system comes from situations like this: Your 65-year old                    PH:    (623) 742-7269
Uncle Bernie gets rear-ended in a car accident while in                     FAX: (623) 742-7270
the course of employment. (Uncle Bernie will probably              
Page 6

                By Michael A. Nathe, Certified Surveillance Expert, President, Nathe & Nathe Investigations

    Last issue we matched your car style to your                 BEIGE/TAN: The standard production color of
    lifestyle, so this issue we'll see what the color of your    coupes and sedans, both imports and domestics, and
    vehicle reveals about your inner demons.                     ahead of white in popularity. Owners tend to feel
                                                                 that their vehicle is more of a tool than a fashion
    As more and more cars begin to resemble the body             statement, and this lack of “frivolous accessories” is
    styles of their competitors, vehicle colors have             reflected in their personal lifestyle of basic and
    intentionally become more dynamic in the                     simple tastes. These drivers are down-to-earth, no-
    manufacturers' attempts to catch the eye of their            nonsense, and pragmatic.
    prospective buyers. The following “basic” car colors
    reflect a lot about their owner's attitudes and              BLACK: POWER! This is the first pick of the post-
    outlooks. See how you stack up if the car you drive          grad school buyers, hands down (as well as the top
    is the color…                                                pick of car thieves, who also like to hit red). This
                                                                 color is very hard to keep clean or cool but the owner
    RED: You're assertive (or aggressive) and want to be         enjoys the elegance and image of empowerment.
    noticed, which you will be with all the newly                This is the basic color of limousines and large
    installed photo radar “cash” cameras. A vibrant red          domestic sedans (I'm not sure how this applies to
    reflects dynamic high energy.                                hearses, however). Because a shiny black vehicle
                                                                 looks mirror slick, it is the color of most cars in both
    YELLOW: It's an even bigger “I don't care what you           television and print ads.
    think” color than red, so it’s not really seen on family
    sedans or vans. It's the color of sports cars, tricked       GREEN/BLUE (LIGHT OR MEDIUM): These
    out pickup trucks, and customized sport utility              drivers see themselves as calm, quiet, middle of the
    vehicles. It's also a favorite of the middle-aged            road, and trustworthy.
    crazies-men (bright yellow), and women with nice
    divorce settlements who lean towards the sunshine            GREEN/BLUE (DARK): You want to convey
    yellows.                                                     credibility and confidence but still stand apart from
                                                                 the above noted more pastel colors. The darker
    SILVER: It's the second-most popular color in                colors, however, don't seem to have the eye appeal of
    America, and the first color of choice internationally.      the lighter hues and are more common on domestic
    It represents both strength and success. Silver is the       sports utility vehicle than sedans.
    main choice of baby boomers aged 35-55 and, it
    passed white in popularity in 2001. Silver vehicle           ORANGE/PURPLE: “Fun loving,” “trendy,”
    owners love this modern, clean look and are willing          “creative,” and “original” have been used to describe
    to pay for it.                                               these owners; however, I honestly don't know a
                                                                 single person who has a purple car and, does Detroit
    WHITE: Historically the favorite and therefore the           even have this color in their spray guns?
    “go to” color of rental vehicles for good reason.
    People under 55 years old in a white car like to blend       So, how'd you do? Is it time to “change up” and get
    in and see themselves as both practical and                  the vehicle you've always wanted? It's a fantastic
    fastidious, which they actually are in our hot Arizona       time to buy and, if you just want to switch color, I
    summers.                                                     hear Earl Scheib is still in business. Have a great
                                                                                                                      Page 7

                                PRESIDENT'S MESSAGE
Our 2008-09 meeting year has come to an end and I want        handling of workers' compensation claims. We brought
to thank all our regular and associate members who            back The Examiner, introduced the Vendor-of the Month at
participated and showed up at the monthly meetings and        our regular dinner meetings, continued our longstanding
annual events.                                                tradition of fund-raising for extremely worthwhile local
                                                              charities and made multiple behind-the-scenes changes that
Thanks to all the speakers who donated their expertise and    we believe strengthened the organization for the future.
time. A huge thanks again to the AWCCA board, committee
chairpersons and committee members who all worked as a        As we continue to move forward, I want to send out a
team to bring you our big events. Our last meeting at which   challenge for all adjusters next year. The Executive Board,
the annual Fred Brick Rehabilitants of the Year were          with its officers selected from among our regular members,
honored was once again a wonderful event. Seeing the          cannot continue without new blood. We need you to get
award recipients and hearing their stories continues to       involved so AWCCA will thrive and provide the work
remind us that we can overcome serious injury and             comp community a place to be heard. Without your
continue to be productive members of society.                 involvement and support, this great association which has
Congratulations to all the recipients and the hard-working    been in existence for over 25 years will cease to exist. I am
medical and vocational professionals who provided these       very proud and honored to have served this great group as
injured workers with the care and assistance they needed to   President this year and I look forward to staying involved
succeed.                                                      with the AWCCA and the Executive Board as Immediate
                                                              Past President throughout the next year.
My first President's Message talked about change. Your
AWCCA Executive Board was made up of all Past                 Have a wonderful summer and I'll see you all in the fall.
Presidents and, we worked very hard to provide you with
speakers and topics that would benefit your everyday          Cheryl Altman, President

                                                                                                    Catastrophic &
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                                                                                            ZoneCare Transportation
                                                                                                       & Translation

Page 8
                                                                                                                      Page 9

                                                                                          5333 N. 7th Street, Suite
                                                                                                     Phoenix, AZ
                                                                                               Fax 602-222-8776

                          Got a problem? Let CMC help!! No matter how large or small we are here
                          to serve YOU!!! We know that each case is unique and that’s why at CMC
                          we strive to provide you with individual service to accommodate all your
                          • Workers Compensation                          • Panels
                          • Auto/Liability                                • Fit for Duties
                          • Short/Long Term Disability                    • File/Record Reviews
                          • Independent Medical Exams

                          CMC offers A La Carte services without a full IME. Here’s another way we
                          can accommodate your needs:
                          • Purpose Letter                        • Chronology of Medical Records
                          • Obtaining Diagnostics                 • Travel - Air, Taxi, Hotel

                                  “Not Just Another Opinion…A Solution”

                                         The 17th Annual AWCCA Golf Charity Tournament
                                         was another huge success. Held on May 8, 2009 at the
                                         Camelback Golf Club in Scottsdale, the event hosted
                                         140 golfers and raised $22,666 for the two designated
                                         charities: Kids' Chance of Arizona and Arizona
                                         Adoption & Foster Care.

AWCCA Golf Tournament Committee Outgoing Golf Tournament Committee Chairperson          Incoming AWCCA Golf Tournament
                                Bernie Cook was extremely pleased with the support
Chairperson Bernie Cook celebrates                                                      Chairperson Sam Lloyd presents a
her last hour as event organizer along                                                  check for $10,000 to Marcia Reck of
with incoming Golf Tournament   the event enjoyed from the workers' compensation        Arizona Adoption & Foster Care at
Committee Chairperson Sam Lloyd community. “I really want to thank the AWCCA for        the May 12th dinner meeting.
and AWCCA President Cheryl Altman.
                                allowing me to coordinate this wonderful event for the
   past eight years” said Cook. “I know Sam Lloyd will do a great job taking over as Golf Tournament Committee
   Chairperson in the future”.

   Supporters and organizers of this year's tournament included 30 team sponsors, 11 tournament co-sponsors,
   11 specialty hole sponsors and 25 volunteers.

   Including golfers, volunteers and guests at the tournament awards luncheon, there were a total of 240 attendees
   at this year's event.
Page 10

               WORKERS' COMP: IT'S TIME TO
                 DICTATE A NEW REALITY
                                      By Tanya Reinhardt, Spooner Physical Therapy

    Injured workers and employers alike are facing tough         her goal. I am a huge supporter of the ASTYM
    economic realities. Achieving a healthy bottom line          treatment to get my patients better faster.”
    is more difficult than ever. But yet, you still have
    some workers with repetitive stress injuries or              This evidence-based process was developed by a
    cumulative trauma disorders that don't improve.              team of clinicians and scientists led by Thomas L.
    Plagued by chronic pain and decreased mobility, they         Sevier, MD, a physician with expertise in rehab and
    seek medical attention, but fail the standard courses        musculoskeletal injuries. The ASTYM treatment has
    of treatment (ice, splints, rehab, anti-inflammatories,      proven      most    effective     for    degenerative
    injections, and surgery). Simply put, you need far           tendonopathies and post-op/post-injury scarring, and
    better results. It's time to dictate a new reality for you   can only be provided by certified ASTYM clinicians.
    and for your injured workers. What's the solution?           Only physical therapists, physical therapist
    An effective protocol-driven rehab process that              assistants, occupational therapists, certified
    produces rapid, cost-effective results, and helps close      occupational therapist assistants, and athletic trainers
    cases quickly.                                               are eligible to become certified ASTYM providers.

    ASTYM (A'-stim) treatment stimulates the patient's           Patients with the following diagnoses have
    body to heal, resulting in remodeling/resorption of          demonstrated excellent clinical results when treated
    tissue and regeneration of degenerated tendons. It           with the ASTYM system:
    has positively changed reality for workers' comp                 • Lateral epicondylosis
    patients, physicians, rehab professionals, and                   • Medial epicondylosis
    employers. Nationwide, ASTYM outcome data                        • Wrist sprain
    reveals that 87.5% of workers' comp cases show                   • Carpal tunnel syndrome
    improved/much improved function within 4-5 weeks.                • Rotator cuff impingement/tendonosis
    In most cases, workers remain on their job - and                 • DeQuervain's tenosynovitis
    productive - during therapy, or get back to work                 • Trigger finger
    faster without restrictions. Another plus, because               • Trochanteric bursitis
    workers are encouraged to stay on the job, the                   • Plantar fasciopathy/heel pain
    patient's body adapts to the stresses of the job,                • Achilles tendinosis
    reducing the chances for recurrence. See ASTYM                   • Patellar tendinosis
    Workers'      Comp       Outcome     Report      at                                      (Continued on Page 11)

    “A recent workers' comp patient of mine with a one
    year      history    of     elbow       pain…lateral
    epicondylitis…hadn't gotten any better with
    conventional therapy,” stated Jennifer Jones, OTR/L,
    CHT, an ASTYM-certified provider at Spooner
    Estrella Physical Therapy. “With ASTYM, she was
    able to be discharged in only 4 weeks, return to
    regular duty, and avoid a cortisone shot, which was
                                                                                                           Page 11

WORKERS’ COMP (cont'd from page 10)
ASTYM providers say that getting patients healed         economy, everyone involved is interested in a fewer
and back to work faster is one of the distinct           number of visits for the patient. Jane Harting, RN,
advantages of the ASTYM treatment. “A patient            Manager of Medical Department at Explorer Van
with trochanteric bursitis was referred directly to me   Company put it this way, “Employers should
by a physician specifically for ASTYM,” stated           seriously consider the ASTYM system as a part of
Spooner Estrella's Clinic Co-owner, Aaron                treatment for repetitive motion disorders. It has had
Reinhardt, PT, MPT. “The patient was having              an important, beneficial effect on course duration,
trouble getting back to full duty work after 6 weeks     lost time, and cost of these claims for our company.”
of ‘traditional’ physical therapy with only minimal
benefits. Within 6 ASTYM sessions, the patient           If you have questions or want to learn more about
reported a 70% improvement in her hip symptoms           ASTYM, contact Aaron Reinhardt or Jennifer Jones
and was able to return to full duty within the month.    at Spooner Estrella Physical Therapy in Phoenix,
Adding ASTYM to her treatment plan was exactly           Arizona at 623.889.0411 (phone), 623.889.0410
what was needed. ASTYM is a very beneficial              (fax), or Or if
addition to my treatment arsenal. It has changed the     you would like to locate an ASTYM certified
way I treat patients.”                                   provider in your area, or desire information about
                                                         how you can become an ASTYM provider, contact
Another notable advantage of the ASTYM treatment         Performance Dynamics, Inc. at 800.333.0244,
is its impact on the bottom line. In this tough, or
Page 12

      Return to Work after Foot and Ankle Injury (cont'd from page 3)
     A return to work is clearly beneficial in terms of overall    workplace. If the patient is unable to meet the
     workers' compensation costs. One study of patients            requirements of the job after these strategies have been
     being treated for chronic pain found that those patients      used, it may be necessary for vocational services to be
     who were directed to return to work during the treatment      recommended.
     program had fewer compensation benefits and received
     less additional treatment for their pain. The drive to        When the patient does not seem to progress as expected,
     return to work is much more than a simple need for the        an independent medical examination may help clarify
     employer (or the insurance company) to limit paid time        the issues. These independent medical examinations
     off. Statistics confirm that prolonged time away from         can be of mixed benefit because they may be performed
     the workplace can be detrimental to the patient's             by a physician who is not trained in foot and ankle
     recovery. The Work-Loss Data Institute's “Official            pathology and hence may miss the subtle diagnostic
     Disability Guidelines” note that the longer a worker is       signs.
     off work, the less likely he or she will ever return to
     work. For those off work 3 months or less, 75% return         Caring for injured workers is complicated by many
     to work. For workers off the job for 6 months, 25%            issues. Understanding some basic return-to-work
     return and for those off work over 12 months, only 5%         strategies allows the foot and ankle specialist to get the
     return to work.                                               worker back to his/her occupation sooner. These
                                                                   strategies are most effective through early intervention
     For scenarios in which the ability of the patient to return   with diagnosis and treatment; early discussion and plans
     to pre-work injury job requirements are uncertain, such       for return to work; active rehabilitation in conjunction
     as bilateral calcaneal fractures in a landscaper, a           with modified duty, and finally, prompt communication
     functional capacity evaluation might help determine           with the treatment team, especially the case manager, to
     whether the patient can meet the demands of the               help ensure the best result for all involved.

                                                                                       Physical Therapy
                                                                                       Athletic Training Services
                                                                                      Occupational Therapy
                                                                                      Physical/ Occupational Therapist
                                                                                     Certified / Licensed Athletic Trainers
                                                                                     Certified Strength and Conditioning Specialist
                                                                                    Sport & Orthopedic Therapy
                                                                                    Specialized Fitness Training
                                                                                    Hand Therapy
                                                                                    Work Injury Rehabilitation
                                                                                    Functional Capacity Evaluations
                                                                                    Ergonomic Consultations
                                                                                    Auto Injuries
                                                                                     Knee Pain? Back/ Neck Pain? Shoulder Pain?

                                                                                                          Physical Therapy and Rehab

                                                                                        Call any of our valley-wide locations:

                                                                                     or go to:
                                                                                       We accept most insurance plans and Medicare.
                                                                                                             Page 13

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                                  Group Evaluations
                                 Medical File Reviews
                          Basec Medical Consult Services, Inc.
Schedules and Coordinates Independent Medical Evaluations for the Insurance Claims Professional.
 • Impairment Ratings                                         • Treatment Plan
 • Second Opinions                                            • AOE/COE
 • Supportive Care Award                                      • Work Status
 Our scheduling staff makes it a point to provide you with the best and most thorough service available.

 We have the experience and flexibility to meet your needs.

                       You can be worry free with a
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                           Website: email:

 AWCCA Job Referral Program Can Work for You!
Are you a claim manager searching for that ideal,         professional looking for a new employment
experienced lost-time claims examiner? Are you an         opportunity, or if you're a manager for an insurance
adjuster looking for a change of professional scenery     carrier, TPA or other professional organization
in the work comp industry? Has your business grown        hoping to attract that perfect candidate to your staff,
to the point where you need to add a new case             contact AWCCA Job Referral Coordinator Joe
manager to your staff? Or, are you a vocational           Strange via e-mail at or,
rehabilitation expert who just moved to Arizona           by phone at 480-483-4323.
wondering how to find a job in the workers'
compensation industry? If you answered “yes” to
any of these questions, Joe Strange, the AWCCA's
Job Referral Coordinator, is waiting to help.

The AWCCA offers an excellent, cost-free way to
match up qualified employees with job opportunities
in the Arizona workers' compensation industry. So, if
you're an adjuster, nurse case manager, voc rehab
specialist, private investigator or other industry
Page 14

    Court Upholds IME Doctor's Liability... (cont'd from page 1)
    my condition was stable, that I did not need further      Notably, Dr. Solomon, the neurologist who had
    medical treatment, and that I could go back to work       prescribed many of the various medications on
    without restriction…”                                     which Ritchie had overdosed, was not originally
                                                              named as a defendant in the lawsuit brought by
    When Ritchie's condition began to worsen, he tried        Ritchie's family. She was added to the suit later, only
    to seek further treatment. He did not initially qualify   after other co-defendants in the case had listed her as
    for AHCCCS benefits because he reportedly made            being a non-party-at-fault. Had she remained as a
    too much money. When he eventually did obtain             non-party-at-fault, the other co-defendants could
    AHCCCS coverage, Ritchie was seen by Dr.                  have argued in trial that she was responsible for
    Solomon, a neurologist, who diagnosed him with a          Ritchie's death but, if a jury found her culpable, the
    “cervical spinal cord compression” and who ordered        plaintiffs could not have collected any money from
    immediate spinal cord surgery. Records indicate that,     her since she would not have been a party to their
    although the surgery halted further deterioration of      lawsuit. Accordingly, the plaintiffs added Dr.
    the spinal cord, “during the eight months before          Solomon to the suit. However, by their lawyer's own
    Jeremy Ritchie's spinal cord decompression surgery,       admission, they did so only reluctantly. When the
    the undiagnosed spinal cord compression contributed       case eventually went to trial, the plaintiffs' attorney
    to an increasing and ongoing injury to Mr. Ritchie's      even told the jury “I think on the verdict form, you
    spinal cord,” causing part of the cord to “die”.          should put a zero next to her name” because he didn't
                                                              believe that her prescribing the assortment of drugs
    Ritchie was eventually diagnosed with “central pain       that eventually killed Ritchie fell below the standard
    syndrome”. Dr. Solomon prescribed Oxycontin and           of care.
    Oxycodone in addition to medications to aid sleep
    and to reduce nerve and muscles spasms.                   Eventually, the jury returned a $5 million verdict and
                                                              found Dr. Krasner to be 28.5 percent liable for that
    In April of 2004, approximately four years after his      amount, even though Krasner had only seen Ritchie
    IME with Dr. Krasner, Ritchie died of an accidental       in a single IME four years prior to his overdose and
    drug overdose characterized as “the synergistic           even though Krasner had never provided any of
    effects of the various medications he was taking for      Ritchie's medical care or prescribed any of the drugs
    his cervical spinal cord injury”.                         that killed him. The jury also found Emergency

    In 2002, long before his death, Ritchie had filed a       Chiropractic to be 37 percent at fault, Dr. Howe to be
    medical malpractice complaint against Dr. Robinson,       28.5 percent at fault and Dr. Robinson to be 6 percent
    HealthSouth, Emergency Chiropractic and Dr.               at fault. The jury attributed no comparative fault to
    Howe, Dr. Krasner and several other entities. After       Jeremy Ritchie, even though he was the one who had
    his death, Ritchie's parents and child amended that       “accidentally overdosed” on his medications.
    lawsuit to include a wrongful death action.                                             (Continued on Page 15)
                                                                                                          Page 15

Court Upholds IME Doctor's Liability... (cont'd from page 14)
Facing a judgment of $1,425,000 for having               Accordingly, Dr. Krasner not only argued that he had
performed a single IME, Dr. Krasner appealed the         no duty to Jeremy Ritchie, but that Ritchie, himself,
jury's award.                                            had acknowledged as much.

In his appeal, one of the main arguments that Dr.        Dr. Krasner further argued that, because he had no
Krasner's attorneys made to the court was that           doctor/patient relationship with Jeremy Ritchie, he
Ritchie had clearly acknowledged, in writing, that he    had no duty to Ritchie. In its decision, the Court
had no “doctor/patient relationship” with Dr.            noted that, in order to maintain a negligence claim,
Krasner. In its 39-page ruling, the Court of Appeals     plaintiffs such as Ritchie's survivors had to prove
noted that when Dr. Krasner examined Jeremy              four elements: (1) that there was a duty requiring
Ritchie, Ritchie signed a document that stated:          defendants such as Dr. Krasner to conform to a
                                                         certain standard of care; (2) that there was a breach
    “It is very important that you realize that no       of that duty by the defendants; (3) that there was a
    doctor/patient relationship exists between you       causal relationship between the breach of duty and
    and Dr. Krasner…This is done to insure that all
    findings will be neutral, and that the evaluators    the damages suffered by the plaintiffs; and (4) that
    are completely independent and not involved          there were actual damages. Krasner's attorneys
    in your disability claim or source.”                 argued that the plaintiffs had not meet all of these
                                                         four requirements and that therefore, they could not
Unfortunately for Dr. Krasner, the trial judge refused   make a negligence claim against him.
to allow the jury to view this document, forming part
of the basis of Krasner's appeal.                                                    (Continued on Page 17)
Page 16

                    AWCCA CONTINUES TO SUPPORT
                      KIDS' CHANCE OF ARIZONA
                                                                                  For many years, Kids' Chance of Arizona has been one

     C          ook
                                                                                  of AWCCA's designated charities. AWCCA members

      R                      ehabilitation                                        are encouraged to continue supporting this worthwhile

       S                                  pecialists, Inc.                        program at the upcoming Kids' Chance Annual Awards
                      Bernie Cook •MS, CDMS
                   Vocational Specialist-Consultant                               Kids' Chance is a scholarship program that benefits
                                                                                  children of individuals who have sustained serious
           Phone 602.971.2202 • Fax 602.971.0943
        3511 E. Campo Bello Dr. •Phoenix, Arizona 85032
                                                                                  workplace injuries or, who have died as a result of a
                                                                                  work-related condition or accident. Scholarship
                                                                                  applications are accepted throughout the year. To
                                                                                  qualify for assistance, the applicant must be between
                                                   Toll Free: 1-888-748-7575
                                                      407-330-9113 ext. 1046
                                                                                  the ages of 16 and 25, maintain a 'C' average or better,
                                                              Fax: 407-585-2021   and take at least 12 credit hours per semester. The
    Transportation & Language Services         
                                                                                  parent's work-related injury or death must have also led
                                                                                  to a substantial decline in family income. As long as
                               Dawn Murphy                                        the applicant maintains financial need and acceptable
                           Regional Sales Executive                               grades, the scholarship may be renewed each semester.

                                                                                  Kids' Chance is supported in large part by fundraising
                                                                                  events throughout the year. AWCCA supports and helps
   3210 Lake Emma Road, Suite 3090 Lake Mary, Florida 32746
                                                                                  sponsor many of these events. On June 20th, many
                                                                                  AWCCA members took to the alleys to participate in
                                                                                  the 11th Annual Kids' Chance of Arizona Bowlathon,
                                                                                  with 100% of the net proceeds going to benefit the
             LETTERS                                                              organization's scholarship fund.

          TO THE EDITOR                                                           On Friday, July 31st, Kids' Chance of Arizona will host
                                                                                  its second Annual Awards Banquet, starting at 6:00 PM
                                                                                  at the Sheraton Phoenix Downtown Hotel, located at
   Do you have an idea for an Examiner article? Wanna
                                                                                  340 N. Third Street. Sponsored by SCF Arizona, the
   suggest a speaker or topic for our monthly dinner                              program will include speakers from the national Kids'
   meetings or for our seminar? Do you have                                       Chance organization as well as recognition of
   suggestions on how we can improve the AWCCA?                                   scholarship recipients and major Kids' Chance
   The Examiner welcomes Letters to the Editor!                                   contributors. Seating for this inspirational event is
                                                                                  limited. For further information, please contact Julian
   Please direct letters via e-mail to Jim Gill at:                               Huerta of APEX Investigations at 602-722-2971 or via or mail them to: Editor: The                             e-mail at:
   Examiner, c/o AWCCA, P.O. Box 44941, Phoenix,
   AZ 85064-4941. Please include your name.                                       For more information on the Kids' Chance program, or
                                                                                  to obtain a scholarship application, please visit
   Anonymous letters will not be published.
                                                                         or leave a message at 602-253-
                                                                                  4360 or 1-877-253-4360 and a member of the Kids'
                                                                                  Chance scholarship team will return your call.
                                                                                                              Page 17

Court Upholds IME Doctor's Liability... (cont'd from page 15)
 Dr. Krasner also argued that the medical opinions he      plaintiffs' claim was barred by the two-year medical
 rendered in regard to Jeremy Ritchie's medical            malpractice statute of limitations since his original
 condition in 2000 were not proximate, contributing        suit was filed in December of 2002, approximately
 cause of Ritchie's accidental overdose four years         two and a half years after Dr. Krasner's IME.
 later and, that several intervening/superseding events
 actually caused his death. Further, Krasner's             Finally, Krasner's attorneys argued that the actions of
 attorneys contended that it was “not foreseeable that     the plaintiffs' attorney during closing arguments
 Mr. Ritchie would die of a drug overdose four years”      should have caused the court to grant a new trial
 after Dr. Krasner's IME. Krasner's lawyers argued         based on that attorney's urging the jury to find no
 that the drugs Ritchie was later given by other           liability on the part of Dr. Solomon even though he
 physicians were the intervening causes that actually      had named her as a defendant in his clients' lawsuit.
 resulted in his overdose and death. They further          From the appellate summary of the case it appears Dr.
 argued that Dr. Krasner should be relieved of liability   Krasner's attorneys argued that it was inconsistent
 for Ritchie's 2004 death because those intervening        and inappropriate for the plaintiffs' attorney to have
 acts were unforeseeable by a reasonable person in         named Dr. Solomon in their lawsuit and to then urge
 Dr. Krasner's position at the time of the IME in 2000.    a jury not to render any award against her.

 Krasner's attorneys made additional, technical            In its decision, the appellate judges went to great
 arguments to the court. Most significant of these         lengths to resolve every issue in favor of the
 arguments was their contention that the trial judge       plaintiffs and against Dr. Krasner. Foremost in their
 had erred in not granting Dr. Krasner's request for       analysis was the judges' determination that a “duty”
 specific jury instructions that would have more           may arise even in the absence of a formal
 clearly explained the issue of what constituted an        relationship between two parties. In its ruling the
 intervening/superseding cause that would have             court cited heavily from the case of Stanley v.
 relieved Dr. Krasner of liability.                        McCarver, in which a physician, Dr. McCarver,
                                                           conducted a pre-employment tuberculosis screening
 Among the other arguments that Dr. Krasner's              of the plaintiff at the request of the plaintiff's
 attorneys made was their contention that the jury's       prospective employer. Because McCarver failed to
 verdict and apportionment of fault was inappropriate      report several abnormalities he discovered in the
 and excessive and, that the disproportionately large      plaintiff's chest, the plaintiff sued him when he was
 verdict was the direct result of errors on the part of    diagnosed with lung cancer ten months later. In
 the trial judge. Additionally, they argued that the       Stanley, the Arizona Supreme Court ruled that Dr.
 trial judge had erred in not allowing the jury to hear    McCarver had “placed himself in a unique position
 evidence about Jeremy Ritchie's drug use,                 to prevent future harm to Mr. Stanley”, even though
 alcoholism or incarceration and further, that the         he did not have a formal duty to Stanley as a patient.
 judge erred in allowing the jury to be prejudiced by
 hearing evidence about Ritchie's financial condition      Using the Stanley rationale, the appellate court found
 and the loss of his workers' compensation benefits-       that Dr. Krasner had a duty “to conform to the legal
 conditions that reportedly prevented Ritchie from         standard of reasonable conduct in light of the
 continuing to seek medical care for his back injury
 after Paula closed his work comp claim based on Dr.       apparent risk” to Jeremy Ritchie. They stated that Dr.
 Krasner's IME findings.                                   Krasner “assumed a duty to conform to the legal
                                                           standard of care for one with his skill, training and
 Dr. Krasner's attorneys further argued that his IME of    knowledge” and that it was appropriate for the trial
 Jeremy Ritchie was essentially “witness testimony”        court jury to therefore decide whether or not Dr.
 and that therefore, he had immunity from civil            Krasner had breached that duty.
 liability. Krasner's attorneys also argued that the                                    (Continued on Page 18)
Page 18

    Court Upholds IME Doctor's Liability... (cont'd from page 17)
    The obvious concern, of course, is that the appellate       'trickle' ”. The judges gave no further indication as to
    court's decision on the “duty” issue will provide a         how an IME physician being governed by ethical
    strong disincentive for doctors to perform IMEs. What       standards would eliminate their serious concerns about
    doctor is going to be willing to see a claimant in a        a seven-figure wrongful death verdict four years after
    single IME if he or she can then be found liable, to the    a single IME and, they made no inference that any of
    tune of $1,425,000, when another doctor's                   Dr. Krasner's actions in the Ritchie case were alleged
    prescriptions result in the claimant's death by overdose    to be unethical. The judges did say that they “do not
    four years later?                                           hold that every IME physician has a duty of care in
                                                                every situation”. However, IME doctors will likely be
    Interestingly, in its ruling, the appellate court spent a   hard pressed to come up with a situation in which a
    single paragraph acknowledging and quickly                  court wouldn't hold them to an extremely far-reaching
    dismissing this exact concern. In the court's analysis,     “duty of care” based on the facts of the Ritchie case
    the judges stated: “we recognize the very real concern      and, based on the appellate court's doggedly
    that imposing a duty on Krasner to practice reasonable      determined imposition of such a duty on Dr. Krasner.
    care under the circumstances might create a chilling
    effect within the IME community”. However, quoting          Consistent with their decision on the “duty” issue, the
    language from the Stanley case, the judges offered a        appellate court dismissed Dr. Krasner's arguments that
    somewhat cryptic explanation that because “ethical          the trial judge should have at least allowed his attorney
    standards govern physicians”, those standards would         to show the jury the document that Jeremy Ritchie
    “likely limit 'the threatened flood of litigation' to a                                    (Continued on Page 19)
                                                                                                                   Page 19

Court Upholds IME Doctor's Liability... (cont'd from page 18)
signed acknowledging the lack of a “doctor/patient”          The appellate judges further decided that plaintiffs'
relationship. The appellate court found this to be a         claims were not barred by the two-year statute of
moot issue in light of their rationale that a “duty” did,    limitations, even though Jeremy Ritchie's original
in fact, exist between Krasner and Ritchie, regardless       medical malpractice claim against Dr. Krasner was not
of any signed documents that argued to the contrary.         filed until 30 months after his IME and, even though
                                                             the original suit was not amended by his survivors to
On the issue of whether an intervening act caused            include wrongful death allegations until four years
Jeremy Ritchie's death, the appellate court provided         after the IME. The court first ruled that Dr. Krasner's
over four pages of explanation to justify their              attorneys did not raise the statute of limitations issue
conclusion that this issue was a matter for the jury to      prior to the original judgment and that, even if that
decide and, that in their opinion, the jury “had             defense had been raised, it would have been moot,
substantial evidence from which to determine that            since Jeremy Ritchie did not possess the “minimum
Krasner's act [his IME determination] was the                knowledge” needed to recognize that “a wrong
proximate cause of Jeremy's injury”. The court spent         occurred and caused injury” within two years of his
another three pages justifying its conclusion that the       IME with Dr. Krasner.
trial judge did not err by refusing to provide specific
jury instructions to explain the issue of intervening or     The court also ruled that Dr. Krasner could not be
superseding causes. Even though this argument was            shielded from liability through witness immunity by
the one of Dr. Krasner's main defenses at trial, the         claiming that his IME of Jeremy Ritchie was
appellate court believed that the trial judge's issuance     performed in his capacity as a “witness” in Ritchie's
of standard medical malpractice instructions were            workers' compensation case.
adequate and that special “intervening act” jury
instructions were not needed.                                Finally, the court found nothing inconsistent or
                                                             inappropriate about the fact that the plaintiffs' attorney
The court continued its findings by stating that, based      had sued Dr. Solomon but then, asked the jury in
on the evidence presented, the jury was well within the      closing arguments not to award any damages against
realm of reason in awarding $5 million to Jeremy             her. The court found no evidence that the plaintiffs'
Ritchie's survivors and, in finding Dr. Krasner 28.5         litigation against Dr. Solomon was a “sham”, although
percent liable for that amount. The court found nothing      it offered no conceivable rationale as to why a plaintiff
excessive about either figure.                               attorney who was presumably seeking as much
                                                             compensation as possible for his clients would ask a
The court also stated that the trial judge's preclusion of   jury not to award damages against a defendant. The
evidence of Jeremy Ritchie's alcoholism, drug                court made no mention as to whether or not an
addiction and criminal history was appropriate since         undisclosed side agreement had been made between
that evidence would have been prejudicial to the jury.       the plaintiffs and Dr. Solomon, even though such an
Further, the court ruled that it was appropriate and not     agreement would provide one possible explanation as
prejudicial to Dr. Krasner, for the trial judge to have      to why the plaintiffs' attorney urged the jury to heap
allowed the jury to hear evidence of how Jeremy              liability on Dr. Krasner and the other defendants while
Ritchie's financial condition precluded him from             sparing Dr. Solomon from an adverse judgment.
seeking continued medical care for his back injury
once his workers' compensation claim was closed.             Dr. Krasner's attorneys have indicated that an appeal to
This delay in care allegedly caused the continuation of      the Arizona Supreme Court is pending and, several
his back complaints which, in turn, allegedly led to his     “friend of the court” (amicus) briefs are likely to be
use of the prescription drugs on which he overdosed          filed in support of Krasner's position by various
four years later.                                            insurers and self-insureds as well as by members of the
                                                             medical community.
Page 20

    What's All This Medicare Stuff... (cont'd from page 5)
    rear-ended Uncle Bernie also has liability insurance        mistakenly made any payments for injury care that
    coverage that would pay for Uncle Bernie's medical          should have been paid by another source. And, it will
    bills if they were submitted. So, there may be as many      help CMS confirm that a party injured in an accident
    as five other insurance plans of some type that would       has made arrangements to reimburse CMS for any
    cover the medical bills from Uncle Bernie's injuries.       payments that Medicare has already made. It will also
                                                                help CMS make sure that future payments for
    In a perfect world, representatives from all five           accident-related medical care are made by other
    insurance plans would meet for coffee and decide who        responsible insurance providers so that Medicare
    would pay what so that there would be no overlap. In        becomes the last source of payment and not the first
    that scenario, Medicare should be the insurer of last       source of payment as it often has been.
    choice. But, of course, Uncle Bernie forgets to tell one
    doctor that he was injured on the job so, those bills       Medicare payments to folks like Uncle Bernie are
    never make it to the workers' compensation carrier.         considered to be “conditional payments”, meaning that
    Most doctors don't want to wait until Bernie settles his    Medicare has paid for treatment because a “primary
    liability claim with the other driver's insurance           payer” with an obligation to pay has not done so.
    company so, that insurer never makes a direct payment       Under federal law, workers' compensation, group
    to any of Uncle Bernie's medical providers. And,            health, liability and no-fault insurance coverage area
    because Uncle Bernie's prior bills at another doctor's      all primary to Medicare, meaning they are supposed to
    office were previously paid by Medicare, that doctor's      pay first. When Medicare makes a conditional payment
    staff simply submits his new bills to Medicare once         because of non-payment by a primary payer, it actually
    again, instead of asking if Uncle Bernie has auto           has the legal authority to recover twice the amount of
    medpay, workers' compensation or a group health plan        the payment plus interest.
    that will cover his medical expenses. So, Medicare-
    aka, the American taxpayers-end up paying Uncle
    Bernie's bills even though there are four other             In theory, the CMS's enforcement of the Medicare,
    insurance sources that should actually be paying all of     Medicaid and SCHIP Extension Act of 2007 will save
    his accident-related medical expenses. That's because       money for the Medicare system and for the American
    none of those insurance providers are communicating         taxpayers and, it will force insurers and self-insureds to
    with one another and certainly, they're not                 make payments on claims that they should have been
    communicating with Medicare. It's those kinds of            paying all along. Unfortunately, the devil is in the
    situations that Congress believed were bankrupting the      details of how the insurance industry and CMS can
    Medicare system and those kinds of loopholes that           coordinate the massive process of reporting millions of
    they hoped to close by enacting more stringent              injury claims and sorting out who is responsible for
    Medicare second-payer enforcement laws in 2007.             paying what.

    The new law requires that all workers' compensation,        The process starts out in relatively simple fashion.
    liability and no-fault insurers and self-insurers           Each insurance company or self insured entity in the
    determine if anyone making a claim against them is an       country has to register with CMS as a “Responsible
    eligible Medicare recipient and, if so, to report certain   Reporting Entity” (“RRE”) by September 30, 2009
    payment information to the Centers for Medicare and         (the date was recently pushed back from June 30,
    Medicaid Services (CMS). Triggers for reporting             2009). The registration guidelines specify that an
    include a decision to honor a claim for benefits and/or,    employee or director of the actual insurance company
    the issuance of a check to pay a settlement, judgment       or self-insured entity has to complete the registration
    or award. Once that information is received by CMS,         process-an agent or TPA cannot complete the
    it will have a comprehensive list showing any               registration. Each RRE will be assigned a CMS
    Medicare beneficiaries who are also receiving benefits      reporting number. The RRE can then designate a
    from other insurance or self-insurance sources for an       reporting agent which, in turn, is then responsible for
    injury claim. This will help CMS determine if it has                                      (Continued on Page 21)
                                                                                                                  Page 21

What's All This Medicare Stuff... (cont'd from page 20)
providing CMS with initial data about all bodily injury     modifying claim systems for CMS compatibility. Many
claims that have been accepted and/or, that are being       managers are likely scratching their heads on how to
paid. This includes workers' compensation claims,           modify workflow processes to accommodate CMS
liability claims, uninsured and underinsured motorists      reporting requirements. Unfortunately, many questions
claims and medpay claims (in addition to group health       remain unanswered. CMS issued a 180-page “User
insurance claims, although the health insurance             Guide” on March 16th of this year but, it's clear that the
industry's reporting requirements and deadlines are         original requirements are still being modified. More
being addressed separately by CMS).                         changes are likely between now and the time the
                                                            system is supposed to be implemented.
Due to the enormous amount of electronic claim data
that has to be collected and submitted to CMS in an         One thing is for certain, however: CMS has the
acceptable electronic format, and due, in part, to          authority to deal severely with non-compliant RREs.
confusion on the part of insurers and self-insureds on      The fine for non-compliance with the law is $1,000 per
how to comply with many of CMS's frequently                 day, per claim. With stakes that high, insurers, self
changing (or heretofore unspecified) guidelines,            insureds and TPAs have no choice but to “get it right”,
reporting requirements that were originally scheduled       in spite of the volume and complexity of the CMS
for enforcement beginning in July of this year were         reporting and enforcement process.
recently extended until the second quarter of 2010.
Testing for input and submission of claim data collected    For further information on the Medicare, Medicaid and
by insurance companies and self-insureds has been           SCHIP Extension Act of 2007, go to the Center for
postponed until January 1, 2010.                            Medicare and Medicaid Services website at:
Initially, insurance carriers and self-insureds will have
to report five pieces of claimant information to CMS,
including a claimant's first name, last name, date of
birth, Social Security number and gender. CMS will
then run that data through their system and generate a
report, telling the RRE or its agent which claimants
are Medicare eligible. Additional information on those
individuals' injuries and medical payments will then                Jardine Baker Hickman Houston
need to be provided to CMS to ensure that Medicare is                          Attorneys
not paying (and does not pay in the future) medical
bills that should be reimbursed by other sources.                      3300 N. Central Ave., Suite 2600
                                                                             Phoenix, AZ 85012
Insurance companies, self-insureds and TPAs are all                        FAX: (602) 200-9114
scrambling to determine how they will comply with
the new CMS reporting guidelines, both from a                              Steven C. Baker, Attorney
process standpoint and, from a technological                                    (602) 532-5233
standpoint. Some larger companies with greater                     
resources are taking on the responsibility of electronic
CMS reporting by modifying their claims systems to                        Scott H. Houston, Attorney
provide CMS with data in an acceptable format. Other                            (602) 532-5237
companies are outsourcing this process to vendors                
such as Insurance Services Office (ISO), Crowe
Paradis or others.                                                          K. Casey Kurth, Attorney
                                                                                (602) 776-3039
IT staffers at insurance companies and TPAs all across              
the country are undoubtedly burning the midnight oil
Page 22

                                                By Lisa Clapp, MA, CRC, CEA
   The Fred Brick Memorial Rehabilitant of the Year is an       honorable mentions. Following is a brief outline of the
   annual award given to worthy individuals who have            2009 recipients:
   been injured on the job in Arizona. The nomination of
   injured workers and administration of awards are             1) FERN POWELL
   monitored by the Fred Brick Memorial Foundation                 Mesa, AZ
   Board of Directors. The Board is comprised of various           Nominated by Sarah Homan and Joyce Whitney
   professionals in the workers' compensation community,           of Rehab Without Walls
   and for 2008-2009 it included Lisa Clapp, Mark Hyland,
   Debbie Hill, Helen Olson and Julie Palko.                    Ms. Powell is a 59-year-old woman who sustained a
                                                                traumatic brain injury and significant orthopedic
   Each spring, the local workers' compensation                 injuries while working as a security supervisor at an
   community nominates qualified candidates. Recently,          auto auction. Ms. Powell was struck by an automobile
   efforts have been made to increase public awareness          while walking across the lot in January of 2008. She
   and community involvement in this worthy cause.              suffered a right epidural hematoma, subdural and
   Through the selection process, Arizona injured               subarachnoid hemorrhages, an occipital hematoma and
   workers are nominated and their accomplishments              a skull fracture. She required surgical evacuations of
   considered by a panel of Arizona workers'                    the hematomas and was placed in a thoraco-lumbo-
   compensation professionals. The panel is assembled           sacral-orthosis brace for an L2 compression fracture. In
   each year and consists of case managers, claims and          February 2008, she began her comprehensive
   employer representatives, medical providers, attorneys       rehabilitation program at Rehab Without Walls
   and rehabilitation counselors.                               Residential Program. She gradually transitioned to
                                                                home as she demonstrated progress and gained
   The 2009 panel included Kirk Barberich of Klein,             independence. Ms. Powell returned to light-duty work
   Lundmark, Barberich and Lamont, Erin Welsh, MA,              in late October of 2008 with the assistance of the
   CRC, of Arizona Vocational Consulting & Forensic             Vocational       Rehabilitation     Specialist      and
   Services, Inc., Jessica Lee of Pinnacle Risk                 Neuropsychological services. By January 2009, Ms.
   Management, Jan Hazelton, RN of Orchard Medical              Powell had returned to work full time as a security
   Consulting, Viki Galante, PT, MOMT of STI Physical           supervisor and was discharged from Rehab Without
   Therapy & Rehab Inc., and Anthony Lee, MD, PMR of            Walls.
   Southwest Spine and Sports. One Rehabilitant of the
   Year winner is chosen from the nominees based on             Obstacles Ms. Powell faced included left hemi paresis
   their efforts and outcomes in the rehabilitation process.    with left-sided neglect. She required 24-hour
   The award ceremony was held May 12th, 2009 at the            supervision/assistance for all mobility and activities of
   Arizona Workers' Compensation Claims Association             daily living. She had limited working memory and
   monthly dinner meeting before the summer break.              attention, reduced cognitive processing speed and
                                                                problem-solving and mental flexibility deficits. Ms.
   All nominees are winners and each is recognized for          Powell worked extremely hard in her rehabilitative
   their achievement. This year's response yielded 10           process to regain mobility, endurance and strength to
   nominees and therefore, the top three were honored,          achieve independence in her activities of daily living.
   and the remaining 7 were acknowledged as very                She regained skills in the home for cooking and doing
                                                                                               (Continued on Page 23)
                                                                                                                  Page 23

 The Fred Brick Memorial Awards (cont'd from page 22)
laundry. Ms. Powell was an excellent example to other        wound care due to the depths of the wounds. Mr. Powe
survivors of neurological injuries as she remained           had pain control issues, which he overcame with each
positive and highly motivated through intense physical       surgery. During hospitalization, he required infectious
and cognitive rehabilitation.                                disease specialists to minimize the great infection risk
                                                             of the numerous wounds.
Ms. Powell not only overcame many physical and
cognitive barriers, she suffered bouts of anxiety related    Mr. Powe was not expected to return to work as a deputy
to returning to the jobsite. She overcame the challenges     sheriff but his will and determination to continue in his
of resuming the responsibilities of her job and her          life's work in law enforcement gave him the courage and
supervisor's perceptions around her return to work.          tenacity to work through his pain, actively participate in
Despite all, she remained positive and determined to         his recovery and return to the SWAT team.
succeed. She has resumed all her duties, demonstrating
her commitment and hard work in utilizing learned            Mr. Powe's willingness to work hard, “see the light at
compensatory strategies in her work place. She faced         the end of the tunnel” allowed him during his darkest
all of this with a great attitude, winning over the hearts   moments, to acknowledge that although he had
of her coworkers and supervisor.                             significant injuries, his goal was to recover and return
                                                             as a member of the Maricopa County Sheriff's
2.) Glen Powe                                                Department. Without assistance, he tapered himself off
    Goodyear, AZ                                             pain medications after each surgery, reaching his goal
    Nominated by Gerri Hether of                             of a medication-free return to work. Mr. Powe
    Orchard Medical Consulting                               encouraged his providers to “think outside of the box”
                                                             in determining his treatment. He requested to be
Mr. Powe was injured in October of 2006 while                released to full duty when his active treatment was
working as a deputy sheriff. He suffered numerous            completed, having already met the physical agility and
gunshot wounds to his abdomen, back and left hand.           firearm requirements that document his ability to return
These life-threatening injuries required several weeks       to his pre-injury position.
of hospitalization. Mr. Powe returned to work with the
SWAT team in early 2007 on a modified-duty basis.            Mr. Powe was recognized by the Maricopa County
Despite numerous surgeries, he returned to modified          Sheriff's Department for his talents and abilities that
duty shortly after each surgery. He has actively             kept him assigned to the SWAT team following his
participated in his postoperative treatment, including       injury. His wife, Diane and children supported him
therapy to his hand during his recovery and while            emotionally throughout his recovery, encouraging him
working. Mr. Powe's treatment required several               when he hit those bumps in the road that occur during
specialties including a hand surgeon, general surgeon,       recovery from multiple injuries.
wound care specialist, infectious disease and physical
medicine doctors and rehabilitation professionals. He        3.) Nancy Kramer
was deemed MMI from all injuries as of July 2008.                Tempe, AZ
                                                                 Nominated by Diane Hendrix of
The obstacles Mr. Powe has overcome include the                  Rehab Without Walls
devastating hand injury with immediate amputation of
the little finger. Multiple hand surgeries were needed to    Ms. Kramer suffered significant physical and brain
gain as much function to the left hand as possible.          injury following a fall from a horse in the course of her
He underwent immediate abdominal surgery with a              employment. She has experienced a complicated,
colostomy for the initial wound. When the colostomy          extensive rehabilitation process at Rehab Without
was later reversed, Mr. Powe then developed hernias          Walls over the last two years. She demonstrates her
requiring repair for the weakened muscles from the           determination every day by working hard to regain
gunshot injury. The bullet wounds to his back required       physical and cognitive endurance, fine motor dexterity,
immediate surgical debridement, skin grafting and                                           (Continued on Page 24)
Page 24

    The Fred Brick Memorial Awards (cont'd from page 23)
   and to resume everyday tasks such as paying her bills                    determination, good work ethic and a great attitude.
   and mowing the lawn. Ms. Kramer utilizes                                 Her current supervisors state she is an excellent asset to
   compensation strategies she has learned to assist with                   the company and they love having her there. She has
   limited organization and memory.                                         developed a good relationship with her co-workers, and
                                                                            loves the population she serves. Ms. Kramer talks
   Despite the daily cognitive obstacles, Ms. Kramer was                    enthusiastically about the individuals she serves and
   determined to return to competitive employment. To                       how they banter and joke with her. She genuinely
   that end, she fully engaged in a volunteer opportunity                   seems to enjoy working with the elderly and they
   working at St. Vincent de Paul. In this volunteer                        respond well to her positive attitude and great sense of
   setting, she so impressed the staff with her work ethic                  humor which could brighten a room.
   that they offered her employment on several occasions.
   However Ms. Kramer was moving to Tempe and                               Ms. Kramer's personal triumph over physical and
   decided to find employment close to her home. She                        cognitive disabilities over the past two years is an
   sought out employment at a nursing/assisted living                       accomplishment worthy of recognition. Accolades
   facility, working up to 20 hours per week.                               have been given to her for her volunteer work. She is a
                                                                            committed individual who truly has the well being of
   Ms. Kramer has gained confidence both socially and in                    others at heart.
   her work responsibilities. She demonstrates                                                            (Continued on Page 25)

                                                  3550 North Central Avenue, Suite 915
                                                        Phoenix, Arizona 85012
                                                Phone: 602-287-8722 FAX: 602-222-6649

                                         CorVel Provides The Following Services
               Enterprise Comp is CorVel’s Workers’ Compensation                       MedCheck – Medical Bill Review Services
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               CorCase – Patient Management Services                                       •   Wide Range of Medical Specialties
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                                                                                       CareIQ – Ancillary Services
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                        providers                                                          •   Discounted Pharmacies
                                                                                                               Page 25

 The Fred Brick Memorial Awards (cont'd from page 24)
The Fred Brick Memorial Foundation received seven          Arizona injured workers and their plight to achieve the
VERY Honorable mentions:                                   highest rehabilitation potential available given their
                                                           circumstances”, explains Lisa Clapp a vocational
1.) Brian Love                                             rehabilitation counselor and Chair of the Fred Brick
    Tempe, AZ                                              Memorial (FBM) Foundation. “This is such a
    Nominated by Shanna Estes of Genex Services            meaningful award that recognizes not only the
2.) Eddie Serna                                            prevailing injured workers, but also the professionals
    Phoenix, AZ                                            who play an integral role in their road to recovery.
    Nominated by Shanna Estes of Genex Services            There are so many folks who might be part of the
3.) Shawn Walls                                            process. To name just a few we see doctors, therapists
    Tucson, AZ                                             (physical, speech, occupational and more), employer
    Nominated by Joan Larkin of Orchard Medical            representatives, adjustors, case managers, vocational
    Consulting                                             specialists, and even attorneys!” says Clapp.
4.) James Yielding
    Scottsdale, AZ                                         “We hear so many negatives about the workers'
    Nominated by Sandy Whitlatch of Health Services        compensation system and people who abuse it. This
    International                                          award celebrates the institution and the people in it and
5.) Sandy Hudson                                           that is refreshing,” states Mark Hyland, occupational
    Apache Junction, AZ                                    and certified hand therapist also a committee member
    Nominated by Amy Beth Baron of Orchard Medical         of the FBM Foundation.
6.) George Morris                                          “We are very excited to expand the scope of the FBM
    Phoenix, AZ                                            award,” explains Julie Palko, local nurse case manager
    Nominated by Donna Pagel of Encore Unlimited           and FBM committee member. “Case managers in the
7.) Dan Blier                                              workers compensation arena see many heroes who
    Mesa, AZ                                               struggle with the recovery process. It brings such joy to
    Nominated by Kathy Bullock of Encore Unlimited         recognize the great effort and perseverance of the
                                                           exceptional injured worker who traveled their road to
(For a comprehensive outline regarding the more            recovery”.
information concerning all of our nominees injuries,
rehabilitation, winning attitudes, and outstanding         FBM nominees are now being accepted for the 2009-10
rehabilitation outcomes, please send an email request to   Rehabilitant of the Year Award. If you know of a                                         worthy candidate, please consider nominating them for
                                                           this wonderful recognition of their efforts.
Fred Brick was a special member of the vocational
rehabilitation community. His spirit and tenacity for      In order to support the FBM Rehabilitant of the Year
helping and recognizing the injured worker lives on        award the FBM Foundation needs your help. The
through this memorial. He was a leader, mentor and         organization is a non-profit entity and requires funding
innovator, and respected on a local and national level.    in order to operationalize its worthy mission each year.
Fred was a member of the AWCCA, Arizona Insurance          Generous sponsors from the workers' compensation
Claims Association, Arizona Self Insurers Association,     community continue to support the Foundation. This
and National Association of Rehabilitation                 year's major sponsorship came from the AWCCA, as
Professionals (now the International Association of        well as from many individuals and from money raised
rehabilitation Professionals).                             from donated raffle items. Each year fundraising
                                                           activities are held in conjunction with AWCCA events.
“By further publicizing this award, we are                 Please join us next year in fundraising for a worthy
memorializing Fred's outstanding contributions. At the     award ceremony that spotlights individuals who have
same time we recognize the incredible achievement of       incredibly overcome daunting odds.
Page 26

   The AWCCA Executive Committee is seeking                    Currently, the new AWCCA Executive Committee
   nominees to fill up to three openings for Regular           officers have selected Grace Nolan of MES Solutions,
   Members At Large for the upcoming 2009-10 meeting           Bernie Cook of Liberty Mutual and Debbie Hill of STI
   year.                                                       Physical Therapy and Rehab as Associate Members At
                                                               Large. The Executive Committee will select a fourth
   In accordance with the AWCCA Bylaws as revised in           Associate Member At Large at its next meeting on June
   the spring of 2008, the Executive Committee consists        29th.
   of officers elected by the regular members in addition
   to Regular and Associate Members At Large.                  However, the AWCCA is seeking up to three Regular
                                                               Members who are interested in serving on the
   Elected officers include: President, Past President, Vice   Executive Committee. The Committee meets monthly
   President, Secretary and Treasurer. Additionally, the       in order to plan and coordinate upcoming association
   Executive Committee can include up to three Regular         events and activities and to make decisions about
   Members At Large and up to four Associate Members           AWCCA finances and other issues.
   at Large.
                                                               Participation in the Executive Committee is a great
   Regular AWCCA Members include personnel of                  way to support the AWCCA and to become more
   insurance companies, self-insureds, independent             actively involved in our industry. If you are interested
   adjusters and third-party administrators who handle         in joining the Executive Committee as a Member At
   workers' compensation claims. Associate AWCCA               Large, contact any of the current Executive Committee
   Members include individuals providing ancillary             members via phone or e-mail. Contact information for
   services within the workers' compensation industry.         each of the Executive Committee members is available
                                                               under the “Board Members” tab on the AWCCA
   Regular Members At Large and Associate Members At           website at
   Large are added to the Executive Committee annually
   by a vote of the elected officers.

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