* It’s hard to argue with the guy…

The head of the Illinois prison system told a legislative subcommittee that he believes millions of dollars paid out in workers’ compensation claims to Menard guards who claimed injury from turning keys involved “fraud.”

Tony Godinez, director of the Illinois Department of Corrections, alleged fraud in response to a question from Rep. Dwight Kay, R-Glen Carbon, during an April 18 session of the Appropriations-Public Safety Committee.

“I am not surprised nor am I taken aback too often in this job, but that was one time I was,” said Kay.

That was Kay’s reaction when Godinez, drawing on his long experience working in the state’s prison system, told the committee, “I think there’s fraud.” This was in reference to more than $10 million paid to guards and Menard Correctional Center employees for repetitive trauma injuries, usually carpal tunnel syndrome of the wrist or cubital tunnel syndrome of the elbow. […]

“I think there’s fraud. I’m sorry to say that but I’ve been working in this business a long time and was (warden) at Stateville for 12 years, some 12 very hard years, and I never saw claims like I’ve seen since I’ve been back,” Godinez said.

In answer to another question from Kay as to why the maximum security Menard prison, and to a lesser extent the medium security Pinckneyville Correctional Center, would be the only two prisons to have numerous repetitive trauma claims, Godinez said, “In my professional opinion, on a personal side, if you’re running a maximum security facility and your claim is using the keys too much, you’re not using them much in a maximum security facility. They’re not coming out a lot. So, I don’t understand why (Menard) as opposed to other facilities where the inmates in minimum and medium are coming out more and the keys are turned more.”

* Part of the problem here is that state agencies no longer have to pay workers’ comp claims. CMS now does that. So the agencies, like Corrections, have no incentive to either stop the fraud (since the cost is coming out of somebody else’s pocket) or fix the problem that’s causing the injuries (since that would cost the agency money and not fixing it would be somebody else’s problem).

Attorney General Lisa Madigan explained this situation in a recent letter to legislative leaders…

Prior to the Blagojevich Administration, some of the largest State agencies – IDOT, IDOC, DHS and ISP – each administered their own workers’ compensation claims, using their own funds. As a result, those agencies had a direct financial interest in improving the workplace to avoid or minimize workers’ compensation claims, defending against workers’ compensation claims and ensuring that injured workers could return to work as soon as possible to reduce the cost of TDD [Temporary Total Disability] payments.

Under the consolidated system for workers’ compensation claims, however, the employing agencies do not experience any impact to their budgets when their employees file claims or remain off of work and on TTD for an extended period of time, providing those agencies with no financial incentive to determine the cause of the increase in claims and take steps to eliminate it. The agencies also have little incentive to accommodate employees whenever possible (including with light duty work) to allow them to return to work quickly.

* Madigan also related this workers’ comp horror story from the private sector…

In 2009, the Second District Appellate Court reinstated benefits to an employee who was injured when he threw himself up against a vending machine in an attempt to dislodge a bag of Fritos that had become stuck after a co-worker attempted to purchase them. Circuit City Stores, Inc. v. IIC, 391 Ill. App. 3d 913 (2d Dist. 2009). The IWCC had awarded benefits to the employee by finding that the personal comfort doctrine applied and that because the employee’s use of physical force to shake the machine to dislodge a bag of chips was neither unusual nor outrageous, the employer was liable for workers’ compensation benefits.2 The Circuit Court reversed, finding that the personal comfort doctrine did not apply. The Appellate Court then reversed and reinstated the benefits.

Some doofus flings himself at a vending machine and that’s covered under workers’ comp? How the heck is that possible? From Madigan…

While acknowledging that the personal comfort doctrine did not apply, the Appellate Court found the claim was nevertheless compensable under the “Good Samaritan” doctrine. The Appellate Court noted that prior cases applying the Good Samaritan doctrine involved an employee providing aide to someone in urgent need (such as rescuing someone who fell into a lake, protecting a young child from physical harm or providing transportation to a stranded motorist and her children). The Appellate Court, however, extended the doctrine to cover an injured worker’s attempt to rescue a co-worker’s stranded bag of chips because the Court found that it was reasonably foreseeable to the employer that this may occur. In addressing the “arising out of’” employment analysis, the Appellate Court concluded that a reasonable trier of fact could find that the “injury originated in a risk incidental to [the employee’s] employment” because (1) the employer provided the vending machine for the convenience of its employees, (2) the machine was defective and (3) the defect “creat[ed] a need for action to dislodge the bag of Fritos.” Circuit City Stores, Inc. 391 Ill. App. 3d at 990-91.

The Illinois Supreme Court has made it clear that Illinois employers are not liable for accidents or injuries solely because they occur at work. The IWCC and the lower courts, however, have increasingly applied an expansive approach to determining whether an accident or injury arose out of and in the course of employment. These decisions have created significant challenges for employers in defending claims on the issue of compensability.

Sheesh.