Here is a link to the Alabama Workers' Compensation Act. Remember that decisions of the Alabama Supreme Court and Alabama Court of Civil Appeals interpret and apply the Act every week, so reading the language of the Act itself isn't the end of the story.
Senate Removes Louisiana Judge
By JENNIFER STEINHAUER
The Senate on Wednesday found Judge G. Thomas Porteous Jr. of Federal District Court in Louisiana guilty on four articles of impeachment, the first time the Senate has removed a federal judge from the bench in more than two decades.
Judge Porteous was impeached by the House in March on four articles stemming from charges that he received cash and favors from lawyers who had dealings in his court, used a false name to elude creditors and lied to the Federal Bureau of Investigation during his confirmation. The behavior amounted to a “pattern of conduct incompatible with the trust and confidence placed in him,” according to the articles against him.
Mr. Porteous, the eighth federal judge to be convicted and removed from office through impeachment in the history of the Senate, got an early indication that things would not go his way when all 96 Senators present voted “guilty” on the first article against him. One of his lawyers then reached over to touch his arm, as if in consolation.
Mr. Porteous, 64, was appointed to the federal bench by President Bill Clinton in 1994 and has been suspended with pay since 2008; as part of his removal, which begins immediately, he will not receive his federal pension.
Northeastern University Law School Dean Emily A. Spieler recently testified before Congress (Subcommittee on Workforce Protections Committee on Education and Labor) concerning the American Medical Association’s (AMA) Guides to Permanent Impairment.
Doctors in workers' compensation cases often use the AMA Guides to determine whether an injured worker has an impairment rating after a job-related accident. As Dean Spieler noted, The AMA Guides have been in effect since 1971 and are now in widespread use. Some states even require workers’ compensation programs to use the latest edition of the Guides. The Guides were originally designed to be used by physicians in making a scientific assessment of a worker’s level of impairment---or loss of function---due to a work-related injury. The determination of whether a worker is permanently disabled and entitled to workers compensation is based upon his or her impairment rating, which is then applied to the specific case of a given worker. For example, a worker who loses a hand may not suffer permanent disability if he or she is a teacher, but that same worker would be permanently disabled if he or she works in construction. In 2007, the AMA published the 6th edition of the Guides, and witnesses today will describe how this new edition has dramatically reduced impairment ratings for many types of conditions, without apparent medical evidence, and transparency. The 6th edition has become so controversial that many states, including Iowa, Kentucky and Vermont have decided not to adopt them. It also appears that the 6th edition was developed in near secrecy, without the transparency and consensus which should necessarily accompany the development of standards that will have widespread use by state governments. In addition, it appears that the physicians who developed this latest edition may have ties to insurance companies, and are making a profit training doctors on the use of the 6th edition, which is complicated and very difficult to apply. The National Technology Transfer Advancement Act of 1996 sets forth minimum criteria for the development of voluntary consensus standards: openness; balance of interests; due process protections; and consensus. The process used for developing the 6th edition appears to significantly deviate from these standards and is a focus of testimony before us today. Workers who are wholly dependent on this ‘grand bargain’ when they are injured on the job, are the ones paying the price. The subcommittee invited the AMA to testify today, but unfortunately, it declined.
Liberty Mutual and other insurance companies that provide workers' compensation insurance coverage are taking a new approach in their attempt to make injured workers get frustrated and give up: it's called "utilization review." Don't Fall For It!
What they are saying is this: "We will pick the doctor we want to treat you. But if the doctor we pick to treat you wants to do something to treat you that we don't want to pay for, we'll get another doctor to overrule the doctor we told you to treat with."
Here's how their scheme works: let's say you are authorized to treat with Dr. Smith for your work-related injury. Dr. Smith thinks you need an MRI or physical therapy or an epidural injection or whatever it is. The Liberty Mutuals of the world (there are lots of them by various names) will hire a "utilization review" in which another doctor will be asked if Dr. Smith's recommendation is "reasonably necessary." Picture the "reviewing" doctor is out in Las Vegas in his pajamas. It's probably not too far from the truth. The reviewing doctor will review some records, but many times not all the records. The reviewing doctor might try to call Dr. Smith but not necessarily. The reviewing doctor will never see you the injured worker. Then not surprisingly Dr. Pajamas will reach the conclusion that Dr. Smith's recommendation is not reasonably necessary and the treatment will be denied by Liberty Mutual or one of the other usual suspects.
A recent case I heard about involved the recommendation of a board-certified neurosurgeon overruled by a utilization review conducted by a dentist! This is ridiculous!
So what do you do? Do you give up? That's what Liberty Mutual and the others are hoping you'll do. DON'T GIVE THEM THE SATISFACTION! The law is on your side! I handled a case that established the precedent for you. It's called Ex parte Southeast Alabama Medical Center, and it can be viewed here: http://caselaw.findlaw.com/al-court-of-civil-appeals/1180416.html.
The gist of it is this: You can ignore the utilization review. You aren't bound by it! You can have a court order Liberty Mutual or whoever it is to provide you with the treatment that the workers' compensation doctor says you need.
As a lawyer who represents injured people for a living, I see this tactic over and over. It takes a little work and time, but I win these fights for my clients because the law is on your side in this regard.
Just remember: Don't give up! If you need treatment, you can prevail.
Tracy W. Cary
This is off topic of workers' compensation law but I have to share this with you. Last month, my daughter and I were part of a team of 14 from our church (Covenant United Methodist) that participated in a mission trip to Tinyari, Peru. We worked with the first through sixth grade children of the school on four areas: English, crafts, Bible and recreation. We had an incredible trip and were amazed at the beauty of the country and how hard working the people are.