NATL. - Air Ambulance Business Could Be Flying Into Storm Clouds
| 10 min read
As any high school economics class will explain, more competition in the marketplace is supposed to lead to lower prices.
The Airline Deregulation Act of 1978, in fact, was designed to foster competition and help lower costs for the flying public. But for air ambulance service, the law that prohibits states from regulating routes and fares seems to have had a strange effect, insurers and industry analysts suggest.
Air services have proliferated and more than medical 1,100 helicopters are now buzzing around the country, double the number from 15 years ago. But prices for their servi...
TX - Physician Dispensing Bills Spark Fears of 'Backslide' in Comp Results
| 8 min read
After seeing good results from the workers’ compensation drug formulary and physician dispensing restrictions in Texas, some say legislation that would allow widespread doctor dispensing of drugs is a move in the wrong direction.
“We really think it would be backsliding,” said Fred Bosse, southwest region vice president of state affairs for the American Property Casualty Insurance Association.
Joe Paduda, principal of Health Strategy Associates and a longtime critic of physician dispensing, called the legislation “a terrible idea.”
“There is simply no evi...
IL - Supreme Court Asked to Determine Whether Creditors Can Take Worker's Settlement
| 17 min read
The Illinois Supreme Court is being asked to determine whether the proceeds of a workers' compensation settlement are off-limits to creditor claims by the providers who treated a woman before she declared bankruptcy.
In December 2016, Elena Hernandez filed a Chapter 7 bankruptcy petition in the Northern District of Illinois.
Prior to her declaration of bankruptcy, Hernandez had suffered work-related injuries. She received treatment from the Ambulatory Surgical Care Facility, Marque Medicos Fullerton, and Medicos Pain and Surgical Specialists.
In her bankruptcy petition, Hernandez report...
NY - Worker Gets Summary Judgment for Fall From Defective Ladder
| 4 min read
A New York appellate court ruled that a worker was entitled to summary judgment on his Labor Law claim for a fall from a defective ladder.
Case: Gomez v. Kitchen & Bath by Linda Burkhardt, No. 2017-01092, 03/20/2019, published.
Facts: Ivan Gomez worked for Edgar Duchi as a painter. Kitchen & Bath by Linda Burkhardt hired Duchi as a subcontractor for a renovation project.
Gomez suffered injuries while working on the project when an A-frame ladder collapsed under him.
According to Gomez, the ladder had a broken lock, and that in order to hold the ladder open, his supervisor inse...
NATL. - Gunn: Real or Fake? Revealing Workers' Compensation Fraud
Security cameras in a company cafeteria recently captured a brazen attempt to fake a workers’ compensation injury.
The video shows that the man dumped a cup of ice onto the floor, disposed of the cup and then lay down on the floor as though he slipped on the ice. Prosecutors have charged the man with insurance fraud and theft by deception.
In this case, the fraud was well documented. Most employers do not have cameras in their lunchrooms or other areas of their workplaces. It can be very difficult to prove someone has faked an injury in the workplace without cameras catch...
NC - No Benefits for Widow of Worker Killed in Car Wreck
| 38 min read
The North Carolina Court of Appeal upheld the dismissal of a widow’s claim for benefits for her husband’s fatal car accident.
Case: Wright v. Alltech Wiring & Controls, No. COA18-833, 03/19/2019, published.
Facts: Christopher Wright worked for Alltech Wiring & Controls. His job required him to visit client job sites to prepare estimates for the installation of security systems.
Most days, Wright would leave home in the morning and travel to the office before heading to a client job site. Wright’s normal practice was also to return to the office before going home at...
NV - Substantial Evidence Did Not Support Finding That Worker Rejected Vocational Training
| 3 min read
The Nevada Court of Appeals ruled that substantial evidence did not support a finding that an injured worker had rejected a suitable vocational rehabilitation program.
Case: Ruiz v. Sears Holding Corp., No. 75035-COA, 03/18/2019, published.
Facts and procedural history: Raudel M. Ruiz suffered injuries while working for the Sears Holding Corp. He filed a workers’ compensation claim, which Sedgwick CMS adjusted.
Sedgwick offered Ruiz a nine-month vocational rehabilitation program in order to return him to work as an administrative assistant.
After Ruiz's attorney expressed concern...
LA - Defendant in Worker's Tort Case Can Depose Treatment Provider
| 1 min read
A Louisiana appellate court ruled that a defendant in a civil action was entitled to depose the doctor who had provided treatment to the plaintiff in connection with a workers’ compensation claim.
Case: Menendez-Ramos v. Garcia Roofing, No. 18-C-713, 03/15/2019, published.
Facts: Jacob Menendez-Ramos was allegedly struck in the head by a large metal object while working for a painting subcontractor on the construction of a home. He claimed the object was dropped or thrown by an employee of the roofing subcontractor, Garcia Roofing.
Menendez-Ramos received workers' c...
CA - Cal/OSHA Cites Contractor After Worker Fatally Crushed
| 10 min read
A Bay Area contractor has been cited for serious safety violations after a worker was fatally crushed at a San Rafael construction site on Sept. 18.
West Coast Land and Development Inc. did not follow regulations when it stacked plywood vertically without securing it, according to the California Division of Occupational Safety and Health, or Cal/OSHA, which issued the citations.
The accident occurred when two employees of the Concord company were framing and installing a shear wall on the third floor of a house under construction. One worker went to get a sheet of plywood from a stack of 26 ...
Press - ReEmployAbility Secures a Spot for Second Year on Seminole 100 List
Tampa, FL (March 13, 2019) – After being recognized for its remarkable growth in 2018 on the Inc. 5000 list for the fifth consecutive year, ReEmployAbility is proud to announce it was also ranked number 59 on Florida State University’s Seminole 100 list during a ceremony at FSU’s University Center Club in Doak Campbell Stadium.
Presented by the Jim Moran Institute for Global Entrepreneurship at FSU’s College of Business, in partnership with the FSU Alumni Association and EY, a multinational financial services firm, the Seminole 100 recognizes the 100 fastest-grow...
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TX - DWC Offers Webinars on Comp System for Health Care Providers
| 37 min read
The Texas Division of Workers' Compensation is offering fee webinars this year for health care providers and staff, to explain the ins and outs of medical care for injured workers.
The webinars will cover most aspects of the system, including utilization review, verification of coverage, medical bill processing, bill disputes, maximum medical improvement, impairment ratings and health care networks, the DWC announced in a bulletin.
The webinars begin at noon and are an hour long. Registration for each session is available on the agency's website.
Some of the upcoming webinars includ...
OR - WCD Announces Corrected Fee Schedule Amounts, Hospital Ratios
| 41 min read
Oregon’s Workers’ Compensation Division corrected the maximum allowable payment amounts for four codes in its Physician Fee Schedule.
At the same time, the division updated the cost-to-charge ratios used to calculate reimbursement owed to in-state hospitals.
The division announced the correct maximum payment for the following current procedural terminology codes:
CPT 72141, $848.33.
CPT 72148, $854.28.
CPT 73221. $897.71.
CPT 73721, $916.87.
The corrected Appendix B to OAR 436-009 has been posted to the division’s website, here.
The division also published a revise...
CA - WCIRB Announces Committee Election Results
| 14 min read
Four carriers were elected to serve three-year terms on two Workers’ Compensation Insurance Rating Bureau committees at the ratemaker’s 103rd annual meeting.
The WCIRB held its annual meeting Wednesday to elect new insurer members to its Governing Committee and Classification and Rating Committee.
Hartford Accident and Indemnity Co. and Preferred Employers Insurance Co. were elected to the Governing Committee for terms that expire at WCIRB’s 2022 annual meeting.
Insurance Co. of the West and National Union Fire Insurance Co. of Pittsburgh were elected to the Classification...
MT - Bill Would Clarify Term Limits for MSF Board Members
| 32 min read
Term limits for Montana State Fund board members would be four years regardless of whether replacements are named, under a bill introduced Friday.
The seven MSF board members are appointed by the governor to four-year terms, but they continue to hold office after the term expires until a successor is appointed and qualified.
Senate Bill 351, introduced Friday by Sen. Jason W. Ellsworth, R-Hamilton, would declare board members shall hold office until the end of their four-year terms.
The bill would also require that board members begin their term on Feb. 1 of odd-numbered years. Terms wo...
SC - Commission Approves New Reimbursement Manual and Fees
| 26 min read
The South Carolina Workers' Compensation Commission has approved changes to its medical services provider reimbursement manual, effective April 1.
The 2019 manual includes a conversion factor of $50; current procedural terminology codes approved by the Centers for Medicare and Medicaid Services for 2019; a maximum allowable payment of $30 per 15-minute unit for anesthesia service; and policy changes, according to a bulletin from the commission.
The policy changes are available here, and the updated manual may be purchased here.
NATL. - Employers Holdings Names John de Figueiredo to Board of Directors
| 10 min read
Employers Holdings Inc. has appointed John M. de Figueiredo to the company’s board of directors, effective April 1.
De Figueiredo is the Russell M. Robinson II Professor of Law, Strategy and Economics at the Duke University Law School and Fuqua School of Business.
Before joining Duke, de Figueiredo held faculty positions at the UCLA Anderson School of Management, UCLA Law School and MIT Sloan School of Management. His research focuses on business and innovation strategies in regulated industries.
De Figueiredo has also served as a strategic management consultant at Monit...
NATL. - WCRI, NIOSH to Present Webinar on Opioid Issues
| 5 min read
The Workers Compensation Research Institute and the National Institute for Occupational Safety and Health are teaming up to offer a free webinar on opioid issues.
The one-hour webinar is scheduled for 1 p.m. Eastern time April 18.
WCRI will discuss the findings from a recent study that identifies characteristics of injured workers and their employers that are associated with differences in opioid dispensing rates. WCRI received funding from NIOSH for the study.
NIOSH will highlight the steps it is taking to help workers and employers facing opioid misuse issues, and ways to protect first re...