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NATL. - New PT Evaluation Codes Being Watched Closely in Comp

By Elaine Goodman (medical/business Reporter)
07/25/2017 | 332 | 0 | 0 min read

A new set of codes for physical therapy evaluations implemented for Medicare on Jan. 1 is starting to make its way into workers’ compensation claims. The Centers for Medicare and Medicaid Services rolled out the new codes for physical therapy evaluations on Jan. 1. Rather than one current procedural terminology, or CPT, code for evaluations, there are now three codes to choose from, depending on whether the evaluation was of low, moderate or high complexity. CMS replaced physical therapy evaluation code 97001 with codes 97161, 97162 and 97163. The code for a reevaluation, 97002, has be. Read More

IN - WC Board Set to Enforce 'Nominal' Penalties for Late Payments and Reports

By J. Todd Foster (Reporter)
07/25/2017 | 130 | 0 | 0 min read

Six years after lawmakers amended the Indiana Code to access civil penalties against noncompliant carriers, the Workers’ Compensation Board announced on Monday that it “is set to formally begin its enforcement protocol” for late filing of forms and payment of benefits. Even defense attorneys concede the penalties are “nominal,” but welcomed them even though they said the board’s timing was a mystery. “I suppose the chairman would not have taken this step if she did not think that claims practices by whomever had gotten to a point where this part. Read More

CO - Uninsured Employers Get Break on Penalties as DWC Implements New Law

By Greg Jones (Deputy Editor)
07/25/2017 | 109 | 0 | 0 min read

Colorado’s top workers’ compensation regulator said he’s already used a new law to cut a break for a handful of employers hit with six-figure fines for operating without insurance under a mandatory penalty structure put in place more than 10 years ago. State lawmakers in 2005 passed a bill setting a minimum fine of $250 per day for operating without coverage, and a maximum fine of $500 per day for second and subsequent violations. Concerns about mandatory minimum penalties surfaced last year as media outlets reported employer complaints about what they said were unfairly la. Read More

NATL. - 9th Circuit Says DBA's 'Zone of Special Danger' Can Exist for Foreign Nationals

By Sherri Okamoto (Legal Reporter)
07/25/2017 | 144 | 0 | 0 min read

The U.S. 9th Circuit Court of Appeals on Friday ruled that a government contractor’s employee was entitled to benefits for the partial loss of his leg after he developed a maggot-infested infection from a cut he sustained during his off-duty hours while fishing off a coral reef in a remote island where he had been stationed. Edwin Jentil had hurt himself while working on Gagan Island – an uninhabited speck of land that’s part of the Kwajalein Atoll, approximately 2,400 miles southwest of Honolulu. The island is accessible only by boat or helicopter, with the permission of Ch. Read More

ME - High Court Says Employer Can't Relitigate Extent of Worker's Impairment After He Got PPD Award

By WorkCompCentral
07/25/2017 | 90 | 0 | 0 min read

The Supreme Judicial Court of Maine ruled that the doctrine of res judicata prevents a party from seeking to change the permanent impairment level associated with an employee’s work-related injury after that level has been established by a prior decree. Case: Bailey v. City of Lewiston, No. WCB-16-204, 07/20/2017, published. Facts and Procedural History: Michael Bailey began working as a firefighter for the City of Lewiston in 1975. In 2011, his doctor diagnosed him with reactive airways deficiency syndrome. The Workers’ Compensation Board awarded Bailey partial incapacity benef. Read More


IL - What's Up With 'Loss of Trade' in Settling/Reserving WC Claims?

By Eugene Keefe
07/25/2017 | 77 | 0 | min read

We were asked by a reader about the concept of “loss of trade” and how to reserve/settle Illinois workers’ compensation claims using it. We wanted to provide a couple of thoughts. Eugene Keefe “Loss of trade” as a permanency concept in Illinois was first used to provide large amounts of permanent partial disability to police officers and firefighters who would receive line-of-duty disability pensions under the Pension Code. When a police officer or firefighter can no longer do his job due to life-changing injuries, he can’t simultaneously receive both th. Read More

OH - Supreme Court Upholds PTD Award for Worker's Depression

By WorkCompCentral
07/25/2017 | 111 | 0 | 0 min read

The Ohio Supreme Court upheld an award of permanent total disability benefits for a worker’s psychological condition, finding the report of his psychologist was enough to support the award, even though the opinions of his other medical providers were deemed unreliable. Case: State ex rel. R&L Carriers Shared Services v. Industrial Commission, No. 2017-OHIO-5833, 07/19/2017, published. Facts and Procedural History: Terry Phillips suffered a workplace injury in 2011. The Bureau of Workers’ Compensation accepted his claim for a traumatic right biceps tendon tear, complex regiona. Read More

Sulivan On Comp

NE - Supreme Court Upholds Dismissal of Claims' Administrator's Suit for Want of Jurisdiction

By WorkCompCentral
07/25/2017 | 91 | 0 | 0 min read

The Nebraska Supreme Court ruled that a workers’ compensation administrator’s claims against an out-of-state corporation were subject to dismissal for want of jurisdiction. Case: Applied Underwriters v. S.E.B. Services of New York, No. S-16-496, 07/21/2017, published. Facts and Procedural History: Applied Underwriters is an Omaha-based corporation that markets and administers workers’ compensation insurance programs nationwide. In 2014, an insurance broker contacted Applied to discuss obtaining workers’ compensation coverage for S.E.B. Services, a New York-based provi. Read More

NJ - Court Upholds $230K Award To City Attorney Who Resisted Waiving Comp Lien

07/25/2017 | 155 | 0 | 0 min read

A New Jersey appeals court has upheld a roughly $230,000 award to a former city attorney who was fired after he resisted waiving a workers' compensation lien against a city employee, New Jersey Law Journal reports. John McGovern, a former assistant attorney for the city of Orange, alleged he was fired after complaining about a manager's order to write a letter waiving $100,000 in workers' compensation liens against the city's former clerk. The clerk had been injured in a car accident and received a settlement in a lawsuit against the other driver. McGovern initially refused t. Read More

CA - Clothing Retailer Pleads Guilty to Comp, Tax Fraud

07/25/2017 | 411 | 0 | 0 min read

A clothing retailer has six months to pay $7.6 million in restitution or he’ll be sentenced to 17 years in state prison after pleading guilty to workers’ compensation fraud and tax evasion, the California Department of Tax and Fee Administration announced. Jeong Hwan Kim, 59, pleaded guilty to four counts of sales tax evasion, filing false state tax returns, failure to pay payroll taxes and workers’ compensation fraud. Prosecutors said Kim, who owned more than 50 clothing stores in Los Angeles, Orange, San Diego and Ventura counties, failed to report more than $29 million i. Read More

CA - Pretrial Hearing Wednesday for Janitorial Firm Owner Accused of Payroll Fraud

07/25/2017 | 316 | 0 | 0 min read

The owner of a Bay Area janitorial firm accused of swindling insurance carriers out of $32 million by underreporting payroll will head to court Wednesday for a pretrial hearing. California Department of Insurance detectives arrested Gina Marie Gregori, 55, on 19 felony counts in June. The department said Gregori defrauded carriers out of $32 million by failing to accurately report payroll data for companies she owned, including GMG Janitorial, GMG Billing Services Plus and Apex Janitorial Solutions. The department said its investigation found Gregori was using a payroll processing . Read More

NATL. - Jopari Urges Adoption of Electronic Attachment Standard

07/25/2017 | 146 | 0 | 0 min read

Jopari Solutions, along with representatives from industry organizations, technology vendors, payers and providers, urged the Centers for Medicaid and Medicare Services this month to establish standards for electronic claims attachments. Jopari made a presentation to CMS’ Division of National Standards on July 18. Attachment standards have been planned since 1996 as part of regulations related to the Health Insurance Portability and Accountability Act, or HIPAA, but have yet to be released. Jopari has testified previously in support of attachment standards during hearings of the . Read More

OH - Legislation Includes Provision that Cuts in Half the Date to File Claims

07/25/2017 | 124 | 0 | 0 min read

Beginning in early October, workers will have one year instead of the longstanding two years to file injury or death claims with the Ohio Bureau of Workers’ Compensation. House Bill 27, the biennial workers’ compensation budget bill, revises Sec. 4123.84 to say that “in all cases of injury or death, claims for compensation or benefits for the specific part or parts of the body injured shall be forever barred unless, within one year after the injury or death,” the claimant files in writing with the BWC or state Industrial Commission. The law does not include occupation. Read More

NATL. - Judge Dismisses NFL Painkiller Lawsuit Claims On Exclusive Remedy Grounds

07/25/2017 | 183 | 0 | 0 min read

A federal judge has dismissed on exclusive remedy grounds the remaining claims in a lawsuit accusing the National Football League of excessively dispensing pain medications, the Washington Post reports. U.S. District Judge William Alsup dismissed almost all of the claims connected with the suit in May, saying the players largely failed to show that their health problems were connected to drugs they received in the league.  He dismissed the remaining claims on Friday because the players involved had filed workers' compensation claims.  The players argued that the clai. Read More

NM - WCA Executive Deputy Director to Resign

07/25/2017 | 102 | 0 | 0 min read

The New Mexico Workers’ Compensation Administration announced Thomas Dow, executive deputy director, will resign Friday. Dow accepted a position as compliance director for the New Mexico Board of Nursing, where he starts July 31, the WCA said. Dow was named executive deputy director of the WCA in November 2011. Before that he served as an assistant district attorney in Clovis and Santa Fe. He was also a senior trial attorney and managing attorney in the Roswell Office of the Public Defender Department, and worked as a legislative analyst for the New Mexico Legislature prior to jo. Read More