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NATL. - NCCI: No Evidence That ACA Reduced Claims Filed on Mondays

By Greg Jones (Deputy Editor)
09/20/2018 | 54 | 0 | 2 min read

The National Council on Compensation Insurance said it found no evidence that the Affordable Care Act reduced the number of workers’ compensation claims filed on Mondays. Slightly more workers’ compensation claims are filed on Monday than any other day of the week, and NCCI said it is hypothesized this is the result of workers filing claims for non-occupational injuries that occurred over the weekend. NCCI said there has also been speculation that the Affordable Care Act could reduce the number of non-work-related claims covered by comp, which would reduce the share of claims wit... Read More

FL - Proposed Rules Raise Many Questions on What Makes for PTSD

By William Rabb (Reporter)
09/20/2018 | 33 | 0 | 2 min read

Six months after the Florida Legislature deemed post-traumatic stress disorder a workplace injury, and just days before the law takes effect, state regulators are still grappling with the essence of the issue: What horrible scenes qualify a first responder for compensation? The process may have opened a can of worms that could take a few years to fully resolve, stakeholders said Wednesday. “I don’t know where to begin on this,” said Dr. Carolyn Stimel, executive director of the Florida Psychological Association. “They’re saying that seeing someone with thei... Read More

OK - Prior Rulings in Worker's Case Didn't Qualify Her for MITF Compensation

By WorkCompCentral
09/20/2018 | 25 | 0

A divided Oklahoma Supreme Court this week ruled that adjudication of a pre-existing, non-work related disability made simultaneously with adjudication of a pre-existing work-related injury could not support an award of permanent total disability benefits payable by the Multiple Injury Trust Fund. Trina Engles had suffered a neck injury in December 2005 after she fell backwards out of a chair at work. She received an award of temporary total disability benefits for her injury in August 2006. In January 2010, Engles stopped receiving TTD and began collecting permanent partial disability benef... Read More

TX - Court Revives Wrongful Death Claim by Worker's Alleged Common-Law Wife

By WorkCompCentral
09/20/2018 | 28 | 0

A Texas appellate court revived a wrongful death claim by the alleged common-law wife of a worker killed in a gas pipeline explosion. Case: Martinez v. Furmanite America, No. 04-17-00318-CV, 09/19/2018, published. Facts and procedural history: Jesus Gonzalez Jr. worked for Furmanite America Inc. He was killed in explosion while working on a pipeline at a gas processing facility in April 2016. Another worker, Dennis Henneke, also died in the explosion. Henneke’s family filed a wrongful death action against Furmanite and others. Lisa Bueno Martinez intervened in the suit, claiming she ... Read More

TX - Employer Owed No Duty to Provide Medical Care to Worker Who Suffered Stroke

By WorkCompCentral
09/20/2018 | 25 | 0

A Texas appellate court ruled that a worker could not proceed with a negligence claim against his employer for failing to provide medical assistance after he suffered a stroke at work. Case: Cooper v. M.N. Gumbert Corp., No. 04-17-00833-CV, 09/19/2018, published. Facts and procedural history: Bradford Cooper worked for the M.N. Gumbert Corp. After he arrived for work on Nov. 12, 2013, Cooper began experiencing right-sided weakness, right arm pain and profuse sweating. Although Cooper alleged that he was clearly in need of medical attention, his employer sent him home rather than t... Read More


CA - Cotter: The Continuing Saga of Vocational Evidence

By Jim Cotter
09/20/2018 | 43 | 0

Judges have thus far been somewhat split on whether vocational evidence is even admissible in injuries that occurred after Jan. 1, 2013, given the changes in the law reflected in Labor Code 4660.1. James Cotter The defense bar reasonably believes that there was legislative intent to curtail the use of diminished future earning capacity evidence in establishing disability, as indicated by the removal of the phrase “consideration being given to an employee’s diminished future earning capacity” in Labor Code 4660.1 for injuries that occur after Jan. 1, 2013, as well as ... Read More

MS - Court Tosses Employer's Challenge to Compensability of Assembly Line Worker's Foot Injury

By WorkCompCentral
09/20/2018 | 23 | 0

The Mississippi Court of Appeals rejected an employer’s challenge to a finding that a worker had suffered a compensable foot injury, since a commission decision had not resolved all of the disputed issues between the parties. Case: Cooper Tire & Rubber Co. v. Loveless, No. 2017-WC-01667-COA, 09/18/2018, published. Facts: Rondie Loveless worked on an assembly line for the Cooper Tire & Rubber Co. After she injured her neck while at work in June 2004, Loveless was assigned permanent restrictions on her activities. Cooper put her to work at a light-duty position. Loveless w... Read More

Sullivan On Comp

CA - DWC Schedules Public Hearing on Med-Legal Fee Schedule Changes

09/20/2018 | 40 | 0 | 3 min read

The Division of Workers’ Compensation said it will hold a public hearing to discuss changes to the Medical-Legal Fee Schedule after receiving an “overwhelming response” to rules that were proposed in May. The division in May posted to its online forum draft rules that it said would identify objective standards for the appropriate use of complexity factors used to determine how much a qualified medical evaluator should be paid for an exam. Users submitted more than 520 pages of comments during a two-week period suggesting that the DWC consider a more comprehensive overhaul o... Read More

RI - State Making Another Pass at Setting Up Uninsured Employers Fund

09/20/2018 | 24 | 0

Rhode Island regulators will make another pass at establishing an uninsured employers fund next year, but it won’t pay medical bills, and benefits will be limited to $50,000 per claim, according to a legislative update posted online by Beacon Mutual Insurance Co. Mike D. Lynch Mike D. Lynch, vice president of claims legal for the carrier, said the state legislature established an uninsured employers fund in 2007, but it never started operating because lawmakers did not appropriate adequate funding.  Senate Bill 2924, signed into law by Gov. Gina Raimondo in June, created t... Read More

TX - TDI Proposes Rules to Implement Captive Legislation

09/20/2018 | 36 | 0 | 1 min read

The Texas Department of Insurance has proposed rules to implement legislation passed in 2017 intended to make it easier to form captive insurance companies. Proposed rules would allow a captive insurance company to be formed as a captive exchange, the department said. The rules would also authorize the secretary of state to form a captive insurance company prior to receiving department approval of the captive insurance company’s formation documents. The proposed rules would allow the insurance commissioner to waive the actuarial opinion required with the annual report for a captive ins... Read More

CA - DWC Posts Adjustments to Fee Schedule

09/20/2018 | 62 | 0 | 1 min read

The California Division of Workers’ Compensation posted an order incorporating into the Official Medical Fee Schedule changes that were made by Medicare. The order updating the Physician and Non-Physician Practitioner Fee Schedule incorporates the following changes: CMS Medicare National Physician Fee Schedule Relative Value File RVU18D, Oct. 1, 2018, quarterly update. National Correct Coding Initiative Physician/Practitioner Services CCI Edits, Oct. 1, 2018, quarterly update. National Correct Coding Initiative Medically Unlikely Edits, Oct. 1, 2018, quarterly update, excluding med... Read More

CA - Rand: Workers With Indemnity Claims Lose 20% of Pre-Injury Wages

By Greg Jones (Deputy Editor)
09/19/2018 | 518 | 0 | 35 min read

California workers injured in 2013 who received indemnity benefits were earning about 20% less than they would have, while permanently disabled workers earned about 31% less two years after the date of injury, according to a new Rand Corp. study. Michael Dworsky (Rand Corp. photo) That compares to a 7% earnings loss suffered by all workers who filed injury claims, including medical-only cases. Although Rand said data on permanent data claims was not fully mature, it estimated that the benefit increase in the Senate Bill 863 reform measure passed in 2012 will erase more than half... Read More

NY - NYCIRB's Transformation Into 'Thought Leader' Welcomed by Stakeholders

By Elaine Goodman (medical/business Reporter)
09/19/2018 | 151 | 0 | 10 min read

The New York Compensation Insurance Rating Board’s two-year effort to transform itself into “an objective and trusted thought leader” for the state’s workers’ comp system is being deemed a success by stakeholders who are often on opposite sides of issues. Jeremy Attie In an annual membership letter on Monday, NYCIRB President and Chief Executive Officer Jeremy Attie recapped the organization’s progress as it wraps up the second year in a five-year strategic plan. The rating board has released its 2018 State of the System report, and also this month issu... Read More

ME - New Rules Forbid Selective Editing of Surveillance Video

By William Rabb (Reporter)
09/19/2018 | 90 | 0 | 35 min read

No more selective editing of surveillance video of injured workers. That’s one of several new rules that took effect this month, part of a significant rewrite of regulations affecting workers' compensation claims, hearings, Social Security offsets, employment rehabilitation and more — all designed to make the process more streamlined and equitable, officials said. “This is the first time we went through the rules in a very comprehensive fashion,” said Paul Sighinolfi, executive director of the Maine Workers’ Compensation Board. “We think this... Read More

OH - Court Upholds Dismissal of Worker's Claim of Fraud by Employer's TPA

By WorkCompCentral
09/19/2018 | 78 | 0 | 18 min read

An Ohio appellate court last week upheld the dismissal of a worker’s suit alleging that the claims administrator for his self-insured employer committed fraud to secure a termination of benefits. Keith McCloud had worked as a professional truck driver. He suffered injuries in a car accident when a motorist crossed the center line on a road and collided with his truck head-on. The motorist was killed.   McCloud filed a workers’ compensation claim against his self-insured employer. Associated Compensation Resources served as the third-party claims administrator for McCloud&rsq... Read More

CA - Insurance Commissioner Accuses Drugmaker of Paying Kickbacks

09/19/2018 | 572 | 0 | 16 min read

California Insurance Commissioner Dave Jones on Tuesday accused drug manufacturer AbbVie Inc. of paying kickbacks to doctors who prescribed Humira. Commissioner Dave Jones The department alleges in a complaint filed in Alameda County Superior Court that AbbVie used cash, meals, drinks, gifts, tips and patient referrals to induce providers to prescribe Humira. Private carriers allegedly paid $1.2 billion for the anti-inflammatory used to treat arthritis and other conditions. AbbVie allegedly sent registered nurses it called “ambassadors” directly to the homes of patients who we... Read More