Case Studies

DWRF Benefits for Formerly Self-Insured Manufacturer

In 1978, our client became self-insured, but it reverted to the state fund in 2000 due to numerous workforce reductions. One month later, the Bureau of Workers’ Compensation (BWC) began billing them for benefits paid pursuant to the Disabled Workers Relief Fund (DWRF) in claims where permanent total disability had been awarded. All but two or those claims arose prior to 1978, when the company was state-funded. It paid more than $300,000 in DWRF reimbursements to the BWC before our workers' compensation lawyers were engaged to examine these payments and determined that the company was not liable for DWRF benefits paid in the state-fund claims. Our client requested that the BWC reimburse prior payments and cease future billings. The Bureau denied the request and we sued the BWC in common pleas court for reimbursement and a permanent injunction against future billings. Before the trial, the Bureau agreed to stop assessing the company for DWRF payments in the state-fund claims, saving our client more than $80,000 dollars a year in assessments (currently over $500,000 in savings).

Managing Successor Liability for BWC Premium Increases

Our client purchased the goodwill (i.e. customer lists, phone numbers and advertising) of a small paving company that was going out of business. No property or equipment was purchased by the company and no employees changed hands. The BWC combined the risks of the two companies, which increased our client's premiums by approximately $40,000 and, due to the impact on the company’s bond rating resulting from its altered experience modifier, threatened to reduce the company’s bid qualifications causing it to lose more than $1.5 million a year in revenue. Kegler Brown was retained following the Adjudicating Committee’s decision upholding the risk combination. On appeal, our lawyers convinced the Administrator’s Designee that the combination was improper, which saved our client both premium dollars and potentially significant loss of revenue.

Slip and Fall Claim for Group-Rated Homecare Company

In this case, the claimant slipped and fell on ice in our client's parking lot while walking from her car to the workplace. She suffered a fractured lumbar vertebra, which was complicated by long-standing pre-existing conditions. This combination rendered the claimant potentially permanently and totally disabled and, thus, the company faced substantial liability. Kegler Brown defended the claim utilizing the “going and coming rule,” which precludes compensation for injuries sustained while traveling to or from work. Our attorneys developed the evidence to demonstrate that claimant was not in the “zone of employment” at the time of her fall as the company did not own or maintain control over the lot in which she was injured. The Commission denied the claim and the claimant appealed into court where Kegler Brown assisted the company in obtaining summary judgment and avoiding a significant increase in its premiums.

Jury Trial for Large Self-Insured Nursing Home Company

A 45-year-old nurse's aid had injured her back at work. Her employer certified the claim for a lower back sprain and we successfully defended our client against her motion to the Industrial Commission that her claim be expanded to include both a degenerative disc and a psychological condition. The claimant filed a court appeal and demanded a jury trial. If successful, she likely would be found permanently and totally disabled, a condition that would give her lifetime benefits. Through exhaustive preparation of a slew of expert witnesses and effective cross-examination of the claimant's witnesses, our lawyers successfully convinced a jury, after a three-day trial during the week of Christmas, that her requests were meritless.

Catastrophic Claim Allowance for Group-Rated Financial Services Company

A young employee fell while at work in an office setting and suffered a broken neck, which required extensive treatment. His ensuing claim for workers' comp, if allowed, would result in our client's disqualification from a group rating program, costing the company thousands of dollars each year in premiums. Our attorneys thoroughly investigated the claim and determined that the employee's fall resulted from dehydration caused by binge drinking. We then developed the evidence to prove that he hit only the floor when he fell, making the claim non-compensable. The Industrial Commission agreed with our findings and the potentially disastrous claim was disallowed in its entirety.

Letter of Credit Appeal for Religious Institution

Our attorneys appealed an Ohio BWC requirement that our client provide a $7.3 million letter of credit (LOC) as a condition of self-insured status renewal. Through financial and legal reasoning, we convinced the BWC's Self-Insured Review Panel both that its assessment of the institution as "high-risk" and its understanding of our client's infrastructure were inaccurate. When properly understood, the Panel determined that no LOC was required.