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Top Stories

NATL. - Health Care Workers Drove Increase in Psych Claims During Pandemic, Data Shows

By Mark Powell (Reporter)
05/07/2021 | 0

Mental health claims increased 2.4% last year, and the rise was driven almost exclusively by an unusually sharp uptick in health care workers filing claims for anxiety and depression-related conditions during the COVID-19 pandemic, according to data released by claims management company Sedgwick. Health care workers in 2020 filed nearly 43% more mental health claims than in 2019, by far the biggest increase in any industry that researchers analyzed, said Andy Berg, associate vice president of workforce absence at Sedgwick. “That’s an unprecedented increase and obviously a major c... Read More

CA - CWCI Warns of Unintended Consequences With SB 335

05/07/2021 | 1

Halving the length of time available for employers to accept claims and increasing employers’ liability for medical benefits while assessing liability could have unintended consequences, the California Workers’ Compensation Institute said Thursday. Senate Bill 335, by Sen. Dan Cortese, D-San Jose, would require employers to accept or deny most claims within 45 days instead of the 90 days that they have now. Employers would have 30 days to accept claims from first responders for conditions that are presumed compensable under Labor Code sections 3212 through 3213.2, such as hea... Read More

IA - No PTD Benefits for Airline Worker With Finger Injuries, Psychological Sequala

05/07/2021 | 0

The Iowa Court of Appeals ruled that an airline employee was not entitled to permanent total disability benefits for injuries to her fingers and psychological sequala. Case: Drahozal v. Envoy Air Inc., No. 20-0027, 04/28/2021, published. Facts: Rukhsana Drahozal worked for American Airlines at the Eastern Iowa Airport in Cedar Rapids. On Jan. 4, 2015, while Drahozal was de-icing planes, seepage from the de-icing solution soaked through her gloves onto her hands. Because her hands were already cold and partially numb, she did not realize the damage that had occurred. Over the next few days,... Read More

LA - Welder Gets Award Despite Late Report of Work Causation

05/07/2021 | 0

A Louisiana appellate court ruled that a welder was entitled to benefits for an injury that he belatedly reported to his employer, but he was not entitled to penalties and attorney fees. Case: Headley v. Textron Systems, No. 2020 CA 1174, 04/26/2021, published. Facts: Textron Systems hired Jackson Headley as a welder in June 2015. Toward the end of his shift on Friday, Sept. 8, 2017, Headley allegedly experienced a sharp, burning pain in his lower back as he stood up after completing a weld. Headley did not report the incident to anyone at Textron and did not seek medical attention over the... Read More

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05/04/2021 | 0

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Industry Insights

NATL. - Moore: The Value of Field Case Managers

By James Moore
05/07/2021 | 0

Thursday was National Nurses Day. In celebration, I wanted to bring up a subject that I have seen overlooked in quite a few workers' comp files: field case managers. I like to call them rehab nurses. A field case manager does not have to be an RN or LPN, but most seem to have a nursing background.   I have written a few articles on field case managers where I called them rehab nurses.  They are great risk management assets who greatly assist the employees in recovery.  Field case managers are assigned by a workers'... Read More

DE - Injured Worker Can Seek Punitive Damages in Bad-Faith Suit

05/07/2021 | 0

The Delaware Superior Court ruled that an injured worker provided enough evidence of willful or wanton misconduct by his employer’s insurance carrier to pursue punitive damages on his bad-faith claim. Case: Moyer v. American Zurich Insurance Co., No. K19C-09-026 JJC, 04/28/2021, published. Facts: Michael Moyer worked for CBRE. He suffered an electric shock while troubleshooting a heat pump on March 5, 2019. CBRE submitted a claim to its workers’ compensation insurance carrier, the American Zurich Insurance Co., on the day of the accident. Zurich sent a letter to Moyer the next d... Read More

CA - Owner of Construction Company Accused of Premium Fraud

05/07/2021 | 0

The owner of a construction company in Fresno self-surrendered Thursday after a warrant was issued for her arrest on six felony counts of fraud, the California Department of Insurance announced. Carolyn Plaza, 41, is accused of failing to report more than $3 million in payroll at a contracting business she co-owned, Absolute Urethane Inc. The Department of Insurance said Plaza over a five-year period illegally reduced her workers’ compensation premiums by $985,091 as a result of the alleged underreporting. The Department of Insurance said its investigation uncovered that Plaza had... Read More

CA - Construction Firm Owner Pleads to Workers' Comp Fraud

05/07/2021 | 0

The owner of a large Bay Area construction firm admitted to committing felony workers’ compensation insurance fraud after years of firing employees when they requested medical treatment for work-related injuries, the Santa Clara County District Attorney’s Office announced. Between 2016 and 2019, Man Tat Szeto, 71, of San Ramon, avoided approximately $86,000 in premium payments to his insurer by underreporting employees and injuries. To further his scheme, Szeto used the banking system to launder $165,000 to pay employees “off the books,” prosecutors said. Szeto was al... Read More

NATL. - Study: Outpatient Costs Higher Where Comp Fee Regulations Limited

05/07/2021 | 0

States with percent-of-charge-based fee regulations or no fee schedules for hospital outpatient care had exponentially higher costs nationwide, according to a report released Thursday by the Workers Compensation Research Institute. Cambridge, Mass.-based researchers compared hospital payments for a group of common outpatient surgeries in workers' compensation across 36 states from 2005 to 2019, finding costs to be more than double in certain instances when compared to costs in states with fee schedules. Specifically, hospital payments per outpatient surgical episode in states with p... Read More

NATL. - Generic for Lyrica Could Lower Claim Costs

05/07/2021 | 0

A generic pregabalin extended-release tablet that hit the market in April will likely lower costs on claims that include Lyrica CR as part of the medication regimen, according to Optum Workers’ Comp and Auto No-Fault. Although Lyrica CR is not commonly seen in workers’ compensation Medicare Set-Asides, Optum said it expects that the newly released generic will be about 40% cheaper. The generic extended-release pregabalin formulation is approved only to manage pain caused by damaged nerves related to diabetes and shingles. Unlike the immediate-release formulation, it is not a... Read More

NATL. - Federal Health Care Changes Could Trickle Down to Comp Systems, Expert Says

By Mark Powell (Reporter)
05/06/2021 | 0

Workers’ compensation systems could see impacts from recently enacted federal health care changes, including a new rule that will remove more than 1,700 procedures from the Centers for Medicare and Medicaid Services’ inpatient-only list by 2023, a comp and legislative expert said. “What do we see in workers’ comp? Orthopedic injuries or orthopedic surgeries,” said Lisa Anne Bickford, director of government relations for claims management company Coventry. “So, this will have a disproportionate impact on comp relative to, perhaps, other payers.&rdqu... Read More

TN - Worker Gets Reduced Award on Retaliatory Discharge Claim

05/06/2021 | 0

A federal appellate court ruled that an injured worker was entitled to damages for wrongful termination in retaliation for filing a workers’ compensation claim, but the award had to be reduced to account for the period in which he was an unauthorized alien employee. Case: Torres v. Precision Industries Inc., No. 20-5492, 04/22/2021, published. Facts: Ricardo Torres worked for Precision Industries Inc. from January 2011 until he was fired in September 2012. He was not legally authorized to work in the United States during this period and had used a fake Social Security number ... Read More

PA - Worker Can Have Total Disability Status Reinstated

05/06/2021 | 0

The Commonwealth Court of Pennsylvania ruled that a worker was entitled to the modification of his partial disability status following the invalidation of the state’s impairment rating evaluation process. Case: County of Allegheny v. WCAB (Butkus), No. 486 C.D. 2020, 04/29/2021, published. Facts and procedural history: Stanley Butkus suffered injuries in the course of his employment with the County of Allegheny in September 2006. The county accepted liability for medical benefits only. In May 2009, a workers’ compensation law judge ruled that Butkus’ foot and ankle injurie... Read More

IL - No Benefits for Worker Injured in Fall

05/06/2021 | 0

The Illinois Appellate Court ruled that a worker was not entitled to benefits for her injuries in a fall from hopping over a chain barrier to turn in her time card. Case: Purcell v. Illinois Workers’ Compensation Commission (University of Illinois), No. 4-20-0359WC, 04/27/2021, published. Facts: Emily Purcell worked as an administrative assistant for the University of Illinois on a temporary basis. Her regular work hours were 8:30 a.m. to 5 p.m. Monday through Friday, and she was paid for 7.5 hours per day. Purcell’s job required her to leave her office in the und... Read More

FL - OSHA: Judge Finds Health Care Center Exposed Workers to Attacks, Destroyed Video Evidence

05/06/2021 | 0

A federal administrative law judge determined that a behavioral health care center and its management company exposed workers to more than 50 attacks in a two-and-a-half-year period and deserve to be sanctioned for destroying surveillance videos showing workplace violence. In a 170-page decision, U.S. Department of Labor Administrative Law Judge Dennis Phillips found hospital management company UHS of Delaware Inc. and Premier Behavioral Health Solutions of Florida Inc. exposed employees to workplace violence and acted in bad faith by allowing the destruction of videos that sho... Read More

CA - Contractor Sting Cites 3 for Operating Without Comp

05/06/2021 | 0

A recent Contractors State License Board sting conducted with the Fresno County District Attorney’s Office, Clovis Police Department and California Department of Insurance led to three stop orders for failure to carry workers’ compensation coverage. CSLB said that in all, it cited 12 for suspected unlicensed contracting after they gave bids for home improvement jobs. Three of the contractors are facing additional charges for not having workers’ compensation insurance. “Consumers need to use caution when hiring a licensed contractor and make sure the contrac... Read More