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TX - DWC Asks for Help on Balance Billing by Military Hospital

By William Rabb (Reporter)
12/13/2018 | 317 | 0 | 52 min read

Brooke Army Medical Center in San Antonio is known for its acclaimed trauma and burn-care units. It is the military’s only Level I trauma center, and one of only a few trauma centers in southwest Texas. The hospital treats soldiers and civilians alike, including hundreds of injured workers each year. In recent years, Brooke also has become known for balance-billing injured workers, sometimes for several thousand dollars, and for turning the unpaid bills over to the U.S. Treasury for collection. State law prohibits most medical providers from balance-billing injured workers. But that l... Read More

CA - Attorneys See Significant Ramifications From Lindh Decision

By Greg Jones (Deputy Editor)
12/13/2018 | 1118 | 2 | 25 min read

The latest California appellate court decision finding asymptomatic, pre-existing conditions are fair game for apportionment should shield employers from paying for disabilities arising from nonindustrial causes, according to workers’ compensation defense attorneys. On the applicants’ side, Monday’s decision by the 1st District Court of Appeals is seen as another case in which an injured worker got the short end of the stick in the name of cost containment. The court remanded Aaron Lindh’s case to the Workers’ Compensation Appeals Board with instructions th... Read More

MT - MSF Gives Overview of Formulary Rules That Kick in April 1

By Eddie Curran (correspondent)
12/13/2018 | 222 | 0 | 29 min read

A webinar sponsored by Montana State Fund on Wednesday gave stakeholders an overview of new rules that will become mandatory next year, as the state joins Indiana as the latest in a growing number of jurisdictions that have adopted workers' compensation drug formularies. The new formulary goes into effect Jan. 1, but it won’t apply to new claims until April 1, and won’t apply to legacy claims — defined by the law as those filed prior to April 1, 2019 — until April 1, 2020, said Bill Wheeler, chief of the Montana Workers' Compensati... Read More

LA - Employer's Right to Control Choice of Pharmacy Doesn't Allow Self-Designation

By WorkCompCentral
12/13/2018 | 122 | 0 | 36 min read

Although injured workers in Louisiana do not have the right to get their medications from the pharmacy of their choice, the Court of Appeal last week ruled that an employer cannot turn the restriction into a license for self-dealing. Allowing a retailer to compel a worker to fill prescriptions at the employer’s own pharmacy poses an impermissible conflict of interest, the court said in its decision for Soileau v. Wal-Mart Stores. Elizabeth Soileau had suffered injuries in the course of her employment with Wal-Mart in 2008. Her doctors prescribed her hydrocodone, Lyrica, ... Read More

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Press - RelayRIDES Greatly Reduces Missed Medical Appointments Through Real-Time Monitoring and Active Intervention

12/06/2018 | 141 | 0

Recent results reveal workers’ compensation technology holds great promise for the entire healthcare industry   JACKSONVILLE, Fla. (December 5, 2018) — One Call, the nation’s leading provider of specialized healthcare solutions for the workers’ compensation industry, today announced new, impressive results that demonstrate how RelayRIDE, the innovative addition to its transportation program, helps reduce missed medical appointments.    RelayRIDE works to solve this problem via proprietary technology that automatically assigns sedan transportation... Read More

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CA - Young: Rand Posts Med-Legal Study Draft Report

By Julius Young
12/12/2018 | 138 | 0

Rand Corp. has posted its draft report on medical-legal reporting in California workers’ compensation. Julius Young The report, authored by Rand researcher Barbara Wynn, titled “California Workers’ Compensation Medical-Legal Fee Schedule” notes that: “The California Department of Industrial Relations (DIR) Division of Workers' Compensation (DWC) requested that Rand review the California workers’ compensation medical-legal (ML) fee schedule, which has not been revised since 2007. Because evaluation and management maximum allowable fees wer... Read More

NY - No Benefits for Deputy Sheriff's Alleged Mental Injuries From Racial Harassment

By WorkCompCentral
12/13/2018 | 84 | 0 | 29 min read

A New York appellate court upheld a decision of the Workers’ Compensation Board denying benefits to a deputy sheriff for alleged mental injuries inflicted by his colleagues. Case: Matter of Karam v. Rensselaer County Sheriff's Department, No. 525286, 12/06/2018, published. Facts: James Karam worked for the Rensselaer County Sheriff's Department as the commander of the Internal Affairs division. He left his position in August 2012 and filed a claim for workers’ compensation benefits. Karam alleged that he had sustained work-related mental injuries arising from his str... Read More

OR - Court Tosses $8,000 Fee Award as Unsupported by Substantial Reason

By WorkCompCentral
12/13/2018 | 70 | 0 | 65 min read

The Oregon Court of Appeals tossed an $8,000 award of attorney fees to an injured worker, based on the failure of the Workers' Compensation Board to explain its reasoning. Case: In the Matter of Compensation of Taylor, Nos. 1403708 and A162892, 12/05/2018, published.   Facts and procedural history: Christopher Taylor filed a workers’ compensation claim against his employer seeking benefits for exposure to noxious fumes. His employer had workers’ compensation insurance coverage with the SAIF Corp. Taylor’s attorney filed a request for a hearing, asserting SAIF had ... Read More

NY - Attorney's Form Flub Forfeited Employer's Ability to Appeal

By WorkCompCentral
12/13/2018 | 96 | 0 | 17 min read

A New York appellate court ruled that a defense attorney’s use of the wrong form to request review of a workers’ compensation law judge’s ruling was fatal to the employer’s ability to obtain relief. Case: Matter of Waufle v. Chittenden, No. 526587, 12/06/2018, published. Facts: Bernard Waufle worked for Robert Chittenden as a route merchandiser, delivering bread products. Chittenden is an independent contractor responsible for delivering baked goods and bread products for Bimbo Bakeries USA. Waufle allegedly suffered injuries when a customer driving an electric ... Read More

IL - Pension Board's Denial of Application Went Against Manifest Weight of Evidence

By WorkCompCentral
12/13/2018 | 60 | 0 | 1 min read

The Illinois Appellate Court ruled that an injured police officer was entitled to a disability pension for his injuries, as the decision to deny his application went against the manifest weight of the record evidence. Case: Ashmore v. Board of Trustees of the Bloomington Police Pension Fund, No. 4-18-0196, 12/11/2018, published. Facts and procedural history: Mark Ashmore worked as a police officer for the City of Bloomington. In February 2013, Ashmore responded to a call about an abandoned vehicle. The car was covered in snow and blocking the driveway to an apartment complex. It was also pa... Read More

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Press - Mayor’s Toy Drive Celebrates Two Anniversaries

12/07/2018 | 64 | 0

Boxer & Gerson will be helping to celebrate two milestones on December 11 when the firm hosts the opening reception for the annual Oakland Mayor’s Toy Drive for the 10th consecutive year. That decade of gatherings at which Boxer & Gerson rolls out the carpet for the Oakland workers’ compensation community coincides with the Toy Drive’s 40th anniversary, making this year’s event all the more significant in its history. Some 250 or more guests are expected to attend.   The traditional “admission charge” for the opening reception will hold s... Read More

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KY - Settlement Agreements Must Be Filed Electronically Starting Jan. 1

12/13/2018 | 61 | 0 | 39 min read

The Kentucky Department of Workers’ Claims is reminding attorneys that all settlement agreements must be submitted electronically starting Jan. 1. The department will not accept paper settlement agreements after that date, and the DWC is offering a PowerPoint presentation on its website that shows how to access the web-based litigation management system. The system, which requires users to log in, “provides users with web-based forms, and further permits interested entities ... to utilize group functions in an effort to promote work distribution,” the department notes on it... Read More

CA - DWC Posts Adjustment to Ambulance Fee Schedule

12/13/2018 | 186 | 0 | 13 min read

The California Division of Workers’ Compensation posted to its website an order adjusting the ambulance services section of the Official Medical Fee Schedule to conform to changes made by Medicare. Ambulance services provided on or after Jan. 1, 2019, will be capped at 120% of the applicable California fees set forth in the calendar year 2019 Medicare Ambulance Fee Schedule File, according to the order. A copy of the order and supporting documentation can be found here. ... Read More

IL - Commission Secures New Hearing Site in Urbana

12/13/2018 | 63 | 0

The Illinois Workers’ Compensation Commission announced Tuesday that it has secured a new hearing location in Urbana, at the Lincoln Square Mall. The new location is a few blocks from the current hearing location at the Urbana Civic Center, the commission said in an emailed announcement. It will become available for the January trial cycle. The first status call is for Arbitrator Hemenway’s docket on Jan. 15. Arbitration status calls, arbitration hearings and review hearings will be held at the new location, in the lower level of the mall at 201 Lincoln Square. Parking... Read More

NJ - Bill Would Let Retired Comp Judges Get Pensions

12/13/2018 | 73 | 0 | 34 min read

Legislation introduced this week would allow workers' compensation judges and administrative law judges to switch from a 401(k)-type retirement plan to the state's pension system. Sen. Sandra Cunningham Senate Bill 3284, sponsored by state Sen. Sandra Cunningham, D-Hudson, was referred to the State Government, Wagering, Tourism and Historic Preservation Committee. It would specifically exempt the compensation judges and law judges from a 2007 law that moved new elected state officials to a defined-contribution retirement program. Under Cunningham's bill, the judges, like ... Read More

NY - High Court Puts Limits on Duration of Extra Benefits in Schedule Losses

By William Rabb (Reporter)
12/12/2018 | 174 | 0 | 32 min read

New York’s highest court on Tuesday ruled that an injured employee who received a schedule loss of use award and “additional compensation” was not entitled to continued benefits payments until his Social Security retirement kicked in. In Mancini v. Office of Children and Family Services, a majority of the Court of Appeals held that the plain language of Section 15(3)(v) of the state’s workers’ comp statute requires awards of additional compensation to be subject to the durational limitations set out under Section 15(3)(w) — those for workers with non-s... Read More

CA - State Orders Voc Training School to Close

By Greg Jones (Deputy Editor)
12/12/2018 | 1319 | 0 | 34 min read

California regulators ordered the closing of a vocational school that focused on retraining permanently disabled workers, alleging that it charged more than it was allowed to and accepted state retraining funds in violation of its exempt status. The Bureau for Private Postsecondary Education also hit the iLearn Institute in San Francisco with a $100,000 fine, the largest allowed by law, for seven violations identified in a Nov. 29 order. Jeff Malmuth, owner of iLearn Institute, said he appealed the bureau’s penalty and abatement order, but that he wouldn’t offer additio... Read More

NATL. - Portable-Benefits Platform Includes Accident Insurance for Workers

By Elaine Goodman (medical/business Reporter)
12/12/2018 | 195 | 0 | 26 min read

The National Domestic Workers Alliance on Tuesday officially launched what it is calling the first portable-benefits platform in the U.S., a program called Alia that is geared toward domestic house cleaners. Alia allows a house cleaner’s clients to contribute toward the worker’s benefits on a monthly basis. The suggested contribution is $5 per cleaning, which would be $20 per month if the home is cleaned each week. House cleaners select the benefits they want to receive, which may include sick days and other paid time off, accident insurance, critical illness insurance,... Read More