IL - Department Pitches Rules for When Insurers Deny Medical Bills
09/17/2019 | 224 | 0 | 15 min read
Almost a year after the Illinois General Assembly overrode the Republican governor's veto on Senate Bill 904, regulators proposed rules required by the law allowing physicians to sue insurers that don't pay their bills.
SB 904, which doctors around the state had requested for years, requires insurers to respond to workers' compensation doctors' medical bills within 30 days. If the bill is denied, the carrier or employer must explain why, and the proposed rules from the Illinois Workers' Compensation Commission detail what type of information is required, down to the medica...
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A dramatic increase in the number of employee concussions is catching the attention of the workers’ comp industry, prompting some to act in response to the trend.
In Minnesota, the number of indemnity claims involving concussions hit 533 last year, the highest ever reported in the state. The number is more than twice the roughly 250 concussion claims from five years earlier, and the 2018 figure could rise even higher as claims develop.
When concussion indemnity claims are expressed per 100,000 full-time equivalent workers, the rate in Minnesota grew from four in 2009 to 19.6 in 20...
The Court of Appeal for the 6th District of California has ordered publication of its decision finding that an injured worker was not entitled to temporary disability benefits for time she lost from work to attend medical appointments.
The court’s decision in Skelton v. WCAB was originally released on Sept. 5 as an unpublished opinion. Unpublished opinions are not binding precedent in California.
Renee Skelton’s employer and State Compensation Insurance Fund last week asked the court to release the decision as a published opinion. The court complied Monday.
Skelton wor...
The Iowa Court of Appeals upheld an award of permanent impairment benefits to a worker for a cardiac condition linked to his slip-and-fall accident.
Case: A-Tec Recycling v. Wood, No. 18-2182, 09/11/2019, published.
Facts: Charles Wood worked for A-Tec Recycling Inc. He slipped and fell from the back of a truck while at work. Wood had significant bruising on his right side, and his condition worsened with time.
Doctors diagnosed him with atrial fibrillation, pneumonia and pleural effusion.
Procedural history: A-Tec and its workers’ compensation carrier, the Emcasco Insurance Co....
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Workers' comp combined ratio remained a hot topic from last year. Last week, at the NCCI Virginia State Advisory Conference, the workers' comp combined ratio stunned the audience, and even the NCCI presenters.
Last year, the level was at 89%. Many pundits and actuaries thought the combined ratio was bottoming out to the lowest point or bottom of the trough. I received quite a few questions on how the workers' comp combined ratio equals a healthy market.
One must remember the workers' comp combined ratio level pegs a national statistic...
A New York appellate court ruled that trial judge properly allowed a worker to amend his complaint to add a Labor Law claim.
Case: Clarke v. Acadia-Washington Square Tower, No. 2018-04749, 09/11/2019, published.
Facts: Omroy Clarke fell from a ramp while walking backwards and pulling a loaded pallet jack at a construction site in Brooklyn.
Procedural history: Clarke filed suit against multiple defendants with connections to the construction site, including the City of New York. He asserted claims for negligence and violations of the statutory duty provide a safe workplace.
Clarke late...
The Nevada Supreme Court ruled that an injured worker had to reopen his claim in order to request vocational rehabilitation services from his former employer.
Case: Stevens v. Associated Risk Management, No. 76917, 09/12/2019, unpublished.
Facts: Bruce Stevens suffered a back injury and established a workers’ compensation claim against his employer. His claim was handled by Associated Risk Management Inc.
Several years after his claim closed, Stevens experienced worsening back pain and reopened his claim.
After Stevens’ physician released him back to work, ARM closed the c...
San Diego City Attorney Mara Elliott has sued grocery delivery company Instacart for allegedly misclassifying its workers as independent contractors.
Elliott said in a news release on Friday that Instacart’s shoppers don’t meet any of the three criteria for classifying a worker as an independent contractor spelled out in a California Supreme Court decision last year.
In the Dynamex decision, the high court said that in order to be considered an independent contractor, a worker must be free from the control and direction of the employer in performing the work.
But Ellio...
Concerns about a case backlog may prompt legislation in Guam to use an administrative law judge rather than a Workers’ Compensation Commission, according to a news report.
The backlog of seven cases isn’t a huge number, but some of the cases are “very complicated,” Guam Department of Labor Director David Dell’Isola told the Guam Daily Post.
Sen. Regine Biscoe Lee said one issue is the commission’s ability to achieve a quorum. Lee introduced Bill 201-35 on Sept. 5 to add two general-public positions to the commission and allow member...
The California Division of Workers’ Compensation on Monday announced that the temporary total disability rate will increase 3.8% next year, not more than 6% as the agency announced last week.
The maximum TTD rate will increase to $1,299.43 per week from $1,251.38. The minimum TTD rate will increase to $194.91 from $187.71.
California law requires that TTD benefits be increased by an amount equal to the percentage in the state’s average weekly wage. The average weekly wage for the 12-month period ending March 31 was $1,325, 3.8% more than the previous wage of $1,276, the DWC said ...
The Texas Division of Workers' Compensation has raised the maximum level for weekly benefits, after the average wage in the state increased by almost 4%.
The maximum for temporary total disability, set by law at 100% of the state's average weekly wage, will climb from $938 to $971 starting Oct. 1, the division said in a bulletin posted Monday.
The increase is higher than in recent years. Last year, the average weekly wage and maximum benefit increased by less than 3%, and did not rise at all from 2017 to 2018.
For fiscal 2020, starting Oct. 1, other maximum benefit levels ...
The New Jersey Compensation Rating and Inspection Bureau on Monday announced it is seeking a 3.8% decrease in the overall premium and rate level for 2020.
The proposed revision for 2020 is based on the most recent experience and an annual review of classification relativity.
If approved, the recommendation would mark the fourth consecutive year that rates decreased and the fifth year in a row without an increase, the bureau said.
The bureau said it anticipates that revised rates will be issued in time for 2020 renewals. As a result, it said, member companies should wait to issue new policie...
The U.S. Department of Transportation has announced the 13 members of a new air ambulance advisory committee, which includes a workers’ comp representative.
Ray Pickup, president and chief executive officer of WCF Mutual Insurance Co., will represent the workers’ comp insurance industry on the Air Ambulance and Patient Billing Advisory Committee.
North Dakota Insurance Commissioner Jon Godfread will serve on the committee as representative of state insurance regulators.
The AAPB Advisory Committee is established pursuant to the FAA Reauthorization Act of 2018. The committee will...
The streak of profitability for the workers’ comp insurance line will eventually end, according to insurance company executives, including some who see a potential opportunity when the tide turns.
Jack Roche, chief executive officer of The Hanover, said workers’ comp has benefited from the strong economy and declining loss trends, as some loss content has moved permanently out of the system. Roche’s comments came during the Keefe, Bruyette & Woods insurance conference in New York City this month.
But Roche said it’s hard to imagine that current loss trends can...
When the Pennsylvania General Assembly returns for its fall session Tuesday, one of the first items lawmakers will consider is a bill that would make post-traumatic stress disorder a compensable condition for first responders.
Rep. Stephen Barrar, a Republican and chairman of the House Veterans Affairs and Emergency Preparedness Committee, drafted House Bill 432 and plans on bringing it up for a vote as soon as Sept. 23, according to a legislative staff member and municipal association officials.
“He wants to run with it pretty soon, from what we hear, and it seems to have a lot of...
Retired physician Faustino Bernadett agreed to pay the federal government $1 million as part of a plea deal for helping conceal kickbacks providers were paid to refer patients to Pacific Hospital of Long Beach while he held a majority interest in the facility.
The plea agreement signed in June and accepted by the U.S. District Court for Central California in August says Bernadett purchased Pacific Hospital from Michael D. Drobot in 2005, and held a majority ownership interest from 2005 to October 2010 when he sold it back to Drobot.
Bernadett was not initially involved in operations and was ...
