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FL - Bill to Force PEOs to Cover More Workers Filed Ahead of Session's Start

By William Rabb (Reporter)
03/01/2021 | 252 | 0 | 29 min read

The Florida Legislature convenes Tuesday and the workers' compensation bill that seems to be gaining the most attention is one that would force employee leasing companies to cover workers they may not know are on the job. The National Association of Professional Employer Organizations “is very concerned with this legislation,” said Michael Kreiter, senior director of state government affairs for NAPEO. Others said the bill, SB 820, would make professional employer organizations do what they should have been doing all along — accounting for and insuring all their workers... Read More

DC - Court Upholds Calculation of Carpenter's AWW

03/01/2021 | 75 | 0 | 44 min read

The District of Columbia Court of Appeals upheld the calculation of a journeyman carpenter’s average weekly wage based on his total earnings over the 26 weeks before his injury. Case: Hawk v. Department of Employment Services, No. 19-AA-1014, 01/22/2021, published. Facts: Richard Hawk was a journeyman carpenter who did not regularly work for a particular employer. He would instead receive notice of specific jobs through his union. Hourly salaries for union carpenters are set by a collective bargaining agreement, and the number of hours available to work depends on the job. Journeyman ... Read More

LA - Court Dismisses 3rd-Party Demands in Case Involving Worker With Electric Shock Injuries

03/01/2021 | 89 | 0 | 17 min read

A Louisiana appellate court issued three decisions granting summary judgment resolving issues in a complex, multi-party case arising from a worker’s accident during a hotel construction project. Case: Maroulis v. Entergy Louisiana LLC, Nos. 20-C-226, 20-C-241 and 20-C-246, 02/10/2021, published. Facts and procedural history: Hotel Investors LLC hired Sigur Construction and Castleman, Donlea, and Associates LLC to serve as the general contractors for the renovation of the Hampton Inn located in Metairie. Castleman hired Sunbelt Rentals Scaffold Services LLC as a subcontractor. Ioannis... Read More

CA - SCIF Dismisses Complaint Against CDI, Insurance Commissioner

03/01/2021 | 339 | 0 | 29 min read

State Compensation Insurance Fund on Friday dismissed a lawsuit filed in federal court accusing the California Department of Insurance and Insurance Commissioner Ricardo Lara of violating terms of a settlement agreement. The voluntary dismissal notice filed with the U.S. District Court for Central California says State Fund is dismissing the complaint because the Insurance Department vacated its order in a decision regarding Sessions Payroll Management that gave preclusive effect to an order issued in an administrative case involving A-Brite Blind & Drapery Cleaning. Former Insurance Com... Read More

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Press - Innovative Medical Management Acquires TPC Recovery

02/23/2021 | 113 | 0

      Innovative Medical Management Acquires TPC Recovery, Strengthening its Specialization in Revenue-Cycle Management for California Anaheim, CA (February 1, 2021) - Innovative Medical Management, Inc. (IMM), a revenue-cycle management company specializing in complex claims management for California's healthcare providers for over 30 years, has acquired T... Read More

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Industry Insights

NATL. - Paduda: Payers, Hold On to Your Purses and Wallets

By Joe Paduda
03/01/2021 | 100 | 1

Two news items hit the virtual desk: Hospitals will lose more than $50 billion this year, and consolidation among hospitals and health systems is continuing, isn’t improving quality, and is increasing health systems’ leverage over payers. The bad, awful financial picture for hospitals comes after a pretty bad 2020, a year in which operating margins were slashed in half. Of course, financial problems are the main driver behind consolidation as health systems with stronger balance sheets take over struggling competitors. Physician practices ha... Read More

CA - DWC Submits Final MLFS Proposal for Approval

03/01/2021 | 319 | 1 | 16 min read

The California Division of Workers’ Compensation posted a copy of final proposed Medical-Legal Fee Schedule changes it plans to adopt effective April 1. The proposed fee schedule would pay $2,015 for a comprehensive medical-legal evaluation, including the review of up to 200 pages of records. Reimbursement for reviewing additional records would be $3 per page. Payment for a follow-up evaluation would be $1,316.25, under the DWC’s proposal. The follow-up fee would cover the review of 200 pages of records that weren’t reviewed as part of the initial evaluation. Reimbursement ... Read More

CA - WCIRB Submits Sept. 1 Regulatory Filing

03/01/2021 | 141 | 0 | 32 min read

The Workers’ Compensation Insurance Rating Bureau of California on Friday submitted a proposed Sept. 1 regulatory filing that would, among other things, lower the experience rating threshold. The WCIRB is proposing that the insurance commissioner reduce the experience rating eligibility threshold to $9,500 from $9,900 to reflect wage inflation and proposed expected loss rates. Proposed changes to the California Workers’ Compensation Uniform Statistical Reporting Plan would improve clarity and consistency, the WCIRB said. Amendments to the Miscellaneous Regulations for the Recordi... Read More

WA - Senate Passes COVID Presumption Measure for Health Care Workers

03/01/2021 | 69 | 0 | 16 min read

The Washington state Senate passed a bill that would create a presumption of compensability for health care workers who contract a contagious disease that is the subject of a public health emergency. The Senate on Thursday voted 34-15 to pass SB 5190, by Sen. Jeff Holy, R-Spokane. The bill would create a presumption covering health care workers at any type of facility who have direct contact with a person who has been exposed to or tested positive for a disease that is the subject of a health emergency. Employers could rebut the presumption with clear and convincing evidence that exposure o... Read More

NATL. - Average Incurred Cost on TBI Claims Double, NCCI Reports

03/01/2021 | 121 | 0 | 9 min read

The average total incurred cost for a claim with a traumatic brain injury was more than double the average of all lost-time claims between 2013 and 2018, according to a new report from the National Council on Compensation Insurance. Average incurred costs per traumatic brain injury during the five-year study period were about $136,000, compared to an average of $51,000 for all lost-time claims. NCCI reports about 2.5% of TBI claims exceed $1 million. NCCI said its research on megaclaims found brain and head injuries accounted for 17% of claims costing between $3 million and $5 million, and 3... Read More

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Press - NIOSH Director Dr. John Howard to Discuss Future of Work, COVID-19, and Worker Safety at WCRI Conference

02/24/2021 | 59 | 0

  1200px-John_Howard_of_NIOSH.jpgCambridge, MA, Feb. 24, 2021 - The National Institute for Occupational Safety and Health (NIOSH) Director John Howard will deliver a keynote on the future of work, COVID-19, and worker safety at the end of the second day of theWorkers Compensation Research Institute's (WCRI) 37th Annual Issues & Research Conference, held virtually March 23 and 24, 2021.    ... Read More

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OH - BWC Announces 7.1% Rate Reduction

03/01/2021 | 70 | 0 | 62 min read

The Ohio Bureau of Workers’ Compensation on Friday announced that its board of directors approved a net 7.1% reduction in employer rates and assessments that takes effect at the start of the 2021 policy year on July 1. The 7.1% rate cut represents an average statewide change in premiums, the BWC said in a statement. The actual cost of coverage will vary for individual employers based on expected future claim costs in their industry, their recent claims history and their participation in various BWC programs. Combined, the BWC said the state’s employers will pay $71.5 million ... Read More

VA - Commission's Conference Will Be Virtual, Sept. 14-16

03/01/2021 | 72 | 0 | 16 min read

The Virginia Workers' Compensation Commission will hold its education conference online Sept. 14-16, the commission announced Friday. The web-based event is sponsored by the International Workers' Compensation Foundation and will delve into recent changes in the state's compensation system. Education credits will be offered. “The goal of this conference is to educate all who participate in the Virginia workers' compensation system regarding current rules, procedures, policies and forms, and to provide an opportunity for dialogue among these participants,&rdquo... Read More

NATL. - Tower MSA Sets Free Conditional Payment Webinar

03/01/2021 | 105 | 0 | 19 min read

Tower MSA Partners is holding a free webinar on March 18 to discuss Medicare conditional payments. Dan Anders, chief compliance officer for Tower, will cover topics including how and when to communicate with the Commercial Repayment Center and when to communicate with the Benefits Coordination and Recovery Center. Anders will also discuss requesting and responding to Medicare conditional payment recovery correspondence. Other topics that will be explored include how to dispute and appeal conditional payments and how to resolve Treasury Department debt recovery actions. The webinar... Read More

TX - DWC Offers Easier Search Tool on Medical Fee Disputes

03/01/2021 | 111 | 0 | 17 min read

Decisions on medical fee disputes can now be searched more easily and quickly, thanks to a beefed-up search tool, the Texas Division of Workers' Compensation announced. As soon as users begin typing in the search bar on the DWC's web page, results show up. “The tool has a more user-friendly option for searching decisions based on decision number, date received, requestor, and respondent and gives users the ability to export and print their search results,” the DWC noted. The database includes more than 15,300 cases since 2014, with the agency's decision, summary of f... Read More

FL - Loss Data Still Needed When Carrier Goes Bust, Bill Says

By William Rabb (Reporter)
02/26/2021 | 309 | 0 | 53 min read

The legacy of Patriot National, parent company of one of the largest Florida workers' compensation carriers to become insolvent as its CEO was accused of spending millions on a yacht and other non-business items, continues with state officials hoping a bill in the Legislature will help avoid ratemaking complications that could result from future bankruptcies. “If a major carrier becomes insolvent, it could really have an impact on the data that's considered for ratemaking,” said Tom Streukens, executive director of the Florida Workers' Compensation Insurance Guaranty A... Read More

CA - Despite Off-the-Job Infections, Employers Still Burdened by COVID-19, Experts Say

By Mark Powell (Reporter)
02/26/2021 | 538 | 1 | 31 min read

California employers are saddled with COVID-19 claims and struggling to keep up with changing pandemic guidelines, despite evidence that many workers are catching the virus while they’re off the clock, a panel of workers’ compensation experts said. “There have been so many changes for everyone, including employers,” said Dr. Chang Na, chief of service for Kaiser Permanente Occupational and Environmental Health and president of the Kern County Medical Society. Employers have wrestled with how to respond to a new COVID-related presumption, which could funnel some no... Read More

CA - Contractor Can't Get Fee Award for Successful Defense to Coverage Claim

02/26/2021 | 417 | 0 | 156 min read

A California appellate court upheld a finding that a contractor had workers’ compensation insurance but was not entitled to attorney fees for defending against claims that he lacked coverage. Case: Fernandez v. Escutia, Nos. H046529 and H047015, 02/24/2021, unpublished. Facts: Gonzalo and Gloria Fernandez hired licensed general contractor Lucino Escutia to build their home. Escutia was a friend of the Fernandezes, but their relationship soured and they fired him before he finished the job. Procedural history: The Fernandezes sued Escutia, alleging multiple causes of act... Read More

NH - Supreme Court Upholds Reduction in Injured Nurse's Benefits

02/26/2021 | 125 | 0 | 19 min read

The Supreme Court of New Hampshire ruled that a nurse’s benefits were properly reduced because she was capable of returning to work in a sedentary capacity. Case: In re Hoff, No. 2019-0622, 02/24/2021, unpublished. Facts: JoAnn Hoff worked as a nurse for Valley Regional Hospital Inc. In October 2017, she reported back pain and numbness in her legs. A magnetic resonance scan revealed a lumbar disc protrusion, and the hospital began paying her temporary disability benefits. A surgeon who operated on Hoff in December 2017 reported the leg symptoms had resolved by early 2018, but her back... Read More

PA - Supreme Court to Rule on Whether Fee Awards Issue Only if Employer Unreasonably Contests Claim

02/26/2021 | 118 | 0 | 23 min read

The Pennsylvania Supreme Court will be weighing in on whether an employer's unreasonable contest of a claim is a prerequisite to a fee award under Section 440 of the Workers’ Compensation Act. In its decision in Lorino v. WCAB (Commonwealth) last August, the Commonwealth Court said it has always interpreted Section 440 to mean that fees cannot be awarded if the record establishes the employer’s contest was reasonably based, even though the statute provides only that the exception "may" apply in such circumstances. The Supreme Court said it would grant... Read More

OR - OSHA: Restaurant Cited for Exposing Workers to COVID-19 After Inspectors Are Threatened

02/26/2021 | 154 | 0 | 24 min read

Oregon’s Department of Occupational Safety and Health has fined a Florence restaurant more than $17,000 after its owners ignored workplace safety rules and exposed workers to COVID-19, the agency said in a news release. OSHA said the New Blue Hen willfully exposed its staff to the virus despite knowing it was violating health orders that called for limited indoor-dining capacity in areas considered “extreme risk” for contracting COVID-19. Inspectors visited the restaurant in January after receiving multiple complaints, OSHA said. OSHA said it was eventually able ... Read More

CA - Ethics Committee Reports Two Violations From 2019

02/26/2021 | 599 | 0 | 32 min read

The Workers’ Compensation Ethics Advisory Committee identified two violations among the 26 complaints of misconduct filed against administrative judges that were resolved in 2019, according to a report that the California Division of Workers’ Compensation posted Thursday. In two cases, the committee found judges failed to be patient, dignified and courteous and recommended the chief judge pursue further action that’s not described in the report. In one complaint, a defense attorney said a judge acted unprofessionally during a trial in October 2018. According to the complain... Read More

VA - Res Judicata, Independent Contractor Evidence Bills Headed to Governor

02/26/2021 | 147 | 0 | 166 min read

Two bills affecting workers' compensation claims are on their way to the governor after approval by the Virginia legislature on Wednesday. The House of Delegates voted in favor of SB 1351, which would allow injuries or conditions to be added to a claim after adjudication. The bill, introduced by Sen. Lynwood Lewis, D-Accomac, was endorsed by the Senate last month. If signed by Gov. Ralph Northam, the measure would essentially preclude the legal doctrine of res judicata in some comp cases. The issue stems from a 2011 case in which the Virginia Court of Appeals held that res judicata ... Read More