CA - Medical Payments Climb 5.5% to $1.9B for 2021
09/26/2022 | 0
After falling to $1.8 billion in calendar year 2020, aggregate medical payments rebounded in 2021 and increased about 5.5% to $1.9 billion, according to a new report by the Workers’ Compensation Insurance Rating Bureau of California.
The WCIRB attributed the increase in aggregate payments to increases in average payments per transaction last year. And the increase in payments per transaction “was largely because of the 2021 fee schedule updates to medical-legal and evaluation and management services.”
While the approximately 559,000 claim total in 2021 was unchang...
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The West Virginia Supreme Court unanimously upheld a denial of benefits to a state worker for his alleged repetitive trauma injury.
Case: Ketterman v. West Virginia Division of Highways, No. 21-0429, 09/19/2022, published.
Facts: Keith Ketterman worked for the West Virginia Division of Highways. He allegedly injured his left upper extremity due to repetitive work in November 2019.
In December 2019, Ketterman sought treatment at South Branch Hospitalist & Internal Medicine. Ketterman reported left shoulder pain, decreased range of motion, occasional weakness, tingling and occasional...
The Illinois Appellate Court upheld an award of benefits to a worker after a prior remand order had directed the Workers’ Compensation Commission to revisit its adverse finding as to his credibility.
Case: F.E. Moran Fire Protection Co. v. IWCC, No. 1-21-1280WC, 09/16/2022, unpublished.
Facts and procedural history: Frank Mioni worked for the F.E. Moran Fire Protection Co. He filed a claim for workers’ compensation benefits for an alleged shoulder injury.
An arbitrator found in favor of Mioni, but the Workers' Compensation Commission reversed. The Appellate Court revers...
The Iowa Court of Appeals ruled that a worker was not entitled to alternate care even though he missed his surgery date because his employer failed to provide him with transportation for a pre-screening.
Case: Denemark v. Archer Daniels Midland Co., No. 21-1851, 09/21/2022, published.
Facts: Brian Denemark injured his left arm while working for Archer Daniels Midland Co. He was diagnosed with a longitudinal tear of the triangular fibrocartilage complex.
ADM authorized Denemark to receive treatment from Dr. Meiying Kuo at Physician's Clinic of Iowa. Kuo provided two injections, then reco...
In addition to paying for medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, independent medical exam (IME) fees, expert fees, functional capacity evaluation charges, rehabilitation benefits, physician advisor fees, behavioral health or social worker support service fees, third-party vendor costs, nurse case management fees, workers’ compensation case attorneys’ fees and th...
An El Dorado County judge dismissed premium fraud charges against three California business owners after county prosecutors said evidence showing they were acting on the advice of a professional insurance agency torpedoed the case, according to a report by the Sacramento Bee.
The Insurance Department in May announced that Troy Williams, John Allison and Nanci Morman were accused of conspiring to illegally reduce work comp premiums owed by Archer Building Co. by more than $125,000.
Williams owned and operated the framing business. Allison created a carpentry business called Allison Developmen...
The Washington State Department of Labor and Industries cited two roofing companies on its “severe violators” list for more than $1 million combined for not providing fall protection to employees working on top of homes.
L&I said it issued two citations to Allways Roofing with total penalties of $788,000. The agency said it has cited the contractor 11 times in the past three years and assessed nearly $2.5 million in penalties over the past 15 months, including a $1.2 million fine in May 2021.
“Many of the violations for which L&I inspectors have cited the company ar...
In separate enforcement actions, the Oregon Occupational Safety and Health Division announced fines totaling more than $144,000 for two contractors accused of repeatedly violating fall protection rules.
The separate citations issued to Corvallis, Oregon-based Iron Head Roofing LLC and Canby, Oregon-based JMJ Construction LLC included the same violation of implementing adequate fall protection systems — such as a personal fall restraint system or other measures — where workers are exposed to falling 6 feet or more to a lower level.
For Iron Head Roofing, which was fined $78,0...
Members of the Commission on Health and Safety and Workers’ Compensation will discuss the procedures for contracting with research organizations to undertake studies of issues relating to California’s comp system during an Oct. 6 meeting.
Commissioners in August criticized the lack of input from injured workers on a Rand Corp. study of the effects of the COVID-19 presumptions created by SB 1159. Although Rand said the presumptions appear to have served the goal of encouraging high-risk workers to seek comp benefits for COVID-19, it said it was ultimately unable to conclude whether...
The U.S. Senate read through legislation that would expand the federal occupational illness program for energy workers.
S. 4928, by Sen. Patty Murray, D-Washington, which was referred to the Committee on Health, Education, Labor and Pensions on Thursday, would amend the Energy Employees Occupational Illness Compensation Program Act of 2000 to expand the ways beryllium sensitivity can be established for purposes of compensation.
Murray said in a statement that current law requires workers to have one abnormal result on a blood test to qualify for benefits for occupational exposure to ber...
A divided West Virginia Supreme Court upheld a denial of additional benefits and treatment for a steelworker with a history of shoulder injuries.
Raymond Hatfield was a steelworker for Huntington Alloys Corp. He injured his left shoulder at work in January 2019.
Hatfield had a long history of left shoulder injuries and surgeries predating this incident.
A magnetic resonance imaging scan from 2012 showed a posterior superior labrum tear with a paralabral cyst extending into the spinoglenoid notch, likely causing denervation and decreased signal to the teres minor muscle.
Another MRI from 20...
The Illinois Appellate Court upheld a determination that a retail worker injured in a robbery was not entitled to prospective surgery or maintenance benefits.
Case: Currey v. IWCC, No. 1-21-0829WC, 09/16/2022, unpublished.
Facts: Kimberly Currey worked for New Ashley Stewart Inc., a retail clothing store. Her job duties included making daily bank deposits.
On June 29, 2012, Currey left her employer’s premises to make a bank deposit. On her way out the door, an assailant attacked her from behind and snatched her purse from her right shoulder, running off with the store's money.
Wh...
The North Carolina Court of Appeals ruled that a truck driver’s death following his loss of control over the vehicle was presumptively compensable.
Case: Frye v. Hamrock LLC, No. COA22-188, 09/20/2022, published.
Facts: Toney A. Frye worked for Hamrock LLC. On July 18, 2017, he was driving a dump truck southbound on a winding stretch of U.S. Highway 226 in Marion when he crossed the double yellow lines and collided head-on with an oncoming vehicle. The dump truck then crashed into an embankment before coming to rest on its side, and Frye was found in the cab dead.
Witne...
The Connecticut Division of Criminal Justice announced that a state corrections worker was arrested on fraud charges for allegedly working as a real estate agent and a reserve police officer in Massachusetts while receiving workers’ compensation benefits in the Constitution State.
Matthew Hubbard, 54, was injured in August 2020 while working for the Connecticut Department of Correction and started collecting temporary total disability benefits.
Between May 6, 2021, and July 5, 2022, he collected more than $74,000 in wage-replacement benefits and another $12,500 for transportation costs...
