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FCN Investigates: $1.9 Million Paid to Attorneys Challenging City Workers' Comp Cases

9:36 AM, Mar 12, 2011   |    comments
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JACKSONVILLE, Fla. -- More heart-related workers' compensation claims filed with the city are denied than accepted, the city says, and records show taxpayers have at times footed thousands for the ensuing court cases.

The city was unable to provide answers concerning specific cases because of HIPAA regulations.

Jacksonville Mayor John Peyton's Chief of Staff Adam Hollingsworth said the 441 claims filed under the Heart/Lung bill, in the last five years, were all carefully reviewed. 

The claims are protected by the Heart/Lung Bill. If a police officer or firefighter is diagnosed with heart disease or high blood pressure, the law says it is presumed the condition is related to their stressful job, unless the city can provide evidence to show it is not work related.

One thing the city says it knows for sure is, "More heart claims are denied than accepted."

"It's important that we determine whether or not a person's claim of heart disease or hypertension is in fact related to the course of their employment, not a lifestyle issue," said Hollingsworth.

He said he is aware that police and firefighters are not happy with how many of those cases were denied.

However, there is no pattern of denial, he said. "There is not.  The facts won't support the assertion."

In December, the city's numbers show the amount of heart and lung cases denied jumped over the last five years, from 30 percent in 2006 to 72 percent in 2010.

Over a five-year period, more than 65 percent were rejected. "The city's pattern is to make sure that injured employees, employees who developed a condition as a result of their employment, get the medical care they need...," said Hollingsworth.

The city said it doesn't have a tracking system in place to follow all the cases. But Hollingsworth is confident the city accepted 90 percent of all workers' comp claims in the last five years.

And in the 10 percent denied and challenged at the local court level, he said, "In 80 percent of the cases, the trial court.....makes a determination that the city has made the correct decision. When those cases are appealed to the 1st District Court of Appeals, the city prevails in 75 percent of those cases."

In two separate interviews Hollingsworth stood by those numbers.

However, in December, the city told us it fought six heart and lung cases on the appellate court level, winning three and losing three.

Last week, numbers obtained from the city showed a total of six appellate cases for all workers' comp claims. The document showed the city won four and lost two.

When asked about the discrepancy, the city said there were actually 11 appeals for all workers comp claims. It won four cases, lost five and settled two.

The reason for the different numbers is because of confusion over separating heart and lung claims and all workers comp cases, according to the city.

"We saved money for the taxpayer," said Hollingsworth.

"In 2007, we spent about $26 million on the city's workers' comp program. Last year, we spent $16 million. So, over the last three years, the city of Jacksonville has saved more than $10 million.   Over the last three years, the city of Jacksonville has saved $10 million in it's total workman's comp program." 

Hollingsworth's savings comes from the total spent in risk management.

In 2006, it was $20 million. That number jumped to $26 million in 2007, then went back down to $20 million in 2008.  It went up to $21 million in 2009 and down to $16 million in 2010.

The $10 million savings is from comparing 2007 to 2010.

The numbers of claims filed, accepted and denied were basically identical during those two years.  The types of injuries were unclear because of HIPAA regulations.

"We saved money for the taxpayer by making sure that we pay employees and provide medical care to those who are injured, in the course of their employment, and by not compensating employees who aren't injured," said Hollingsworth.

After months of waiting, the city finally turned over its numbers on how much attorneys have been paid, challenging the city's decisions.

The numbers show in the last five years, lawyers representing injured workers were paid $1.9 million because the city lost or settled.

Hollingsworth defended the expense. "$10 million is a lot of money. The city has saved $10 million in its workers' compensation program over the last three years. We are proud of that record."

More than $831,000 has been spent on the investigation of workers' comp claims in the last five years.

Two weeks ago, Peyton said, "I can promise you that we have caught fraud in our efforts over time."

But the city did not have numbers of fraud cases, said Hollingsworth.

"We have employees in our city who every day file, on a good- faith basis....," he said. "In fact, what we know is in more than 90 percent of these cases an employee who files a claim seeking compensation or medical care for their injury, the city finds it's in fact an appropriate claim."

Hollingsworth said the number of times the city finds the worker was not injured on the job is "less than 10 percent."

But Hollingsworth said the $831,000 the city spent in fees for  less than 10 percent is a lot of money. "No, $10 million is a lot of money and the city of Jacksonville has saved $10 million in the last three years."

Only a court can decide whether a claim is fraudulent, he said. The city's risk management department does not pursue charges against those who are found to not actually be injured.

He said the decision on whether to pursue a case against a city employee is left up to State Attorney's Office.

You can hear what Hollingsworth had to say about why employees are being sent out of county to see doctors, why surveillance is used on employees, and why the city accepts claims then denies coverage later next week on First Coast News. 

Firrst Coast News

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