IL - Cutbacks Could Further Dampen WC Fraud Investigations
04/24/2019 | 124 | 0 | 17 min read
Illinois' workers' compensation officials and insurers, hoping for more fraud investigators, not fewer, are feeling a little disheartened this week after learning that there may not be money for new hires with the governor considering budget cuts to all state agencies.
“I haven't noticed much of a decrease in service yet, but it will get worse, there's no doubt,” said Norman Burdick, an attorney and investigator with the Chicago insurance defense firm of Garofalo, Schreiber & Storm. “It's a sad situation.”
The Illinois Department of Insurance&#...
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Claims in which antidepressants were prescribed along with opioids had substantially higher costs than those with opioids alone, according to a new study from workers’ comp insurer AF Group.
Antidepressants plus opioids were also associated with a lower rate of claim closure three years after injury — 64.8% compared to 89.1% for opioids alone. Combining opioids with benzodiazepines, a class of anti-anxiety drugs, reduced claim closure rates to a lesser extent, to 75.8%, according to the study.
The lowest claim closure rate in the study, 58.3%, was seen when injured workers were p...
The Colorado Court of Appeals last week ruled an injured worker failed to assert a viable bad faith claim against Pinnacol Assurance when he alleged the carrier’s delay in authorizing surgery for his back injury had caused him to suffer permanent nerve damage.
Richard Lorenzen’s theory was that prolonged compression from a herniated disk irreparably damaged the nerve. He argued Pinnacol was liable for preventing him from obtaining surgery fast enough to avoid leaving him with a permanent impairment.
Lorenzen injured his back in 2014 while working as a groundskeeper. His employer ...
An Ohio appellate court ruled that an employer could not compel an injured employee to sign a release allowing for disclosure of her medical records for conditions that were not part of her workers’ compensation claim.
Case: State ex rel. Costco Wholesale Corp. v. Howard, No. 18AP-115, 04/18/2019, published.
Facts and procedural history: Jennifer Howard worked for the Costco Wholesale Corp. as a marketing representative. She suffered multiple injuries in a work-related car accident in August 2009.
Howard filed an application for permanent total disability benefits in October 2017. Cos...
The California Applicants’ Attorney Association is promoting Assembly Bill 1107 to California legislators in hopes of materially modifying utilization review exemptions for medical treatment.
CAAA has gone on the record stating it is “dealing with a system that is broken and has failed to deliver the necessary medical care to workers who suffer job-related injuries, whether by lack of accountability or blatant discrimination.”
Is AB 1107 a step in the right direction in promoting prompt, adequate medical treatment for injured workers in Californ...
A New York appellate court upheld the dismissal of a subcontractor’s claim against a worker’s employer seeking indemnification and contribution for damages owed to the worker’s widow for his fatal fall at a construction site.
Case: Wilk v. Columbia University, Nos. 9034, 105784/10, 590780/10, 590410/11, 590789/11, 311057/16, 04/18/2019, published.
Facts: Joseph Wilk worked for Breeze National Inc. He suffered fatal injuries while working at a construction site at Columbia University. Wilk fell through an elevator shaft window that the A.C.T. Abatement Corp. had removed and ...
A divided Mississippi appellate court ruled that a worker’s ex-wife was entitled to assert a lien against his employer and workers’ compensation insurance carrier for past-due child support after he was killed on the job.
Case: Young ex rel. Tewksbury v. Air Masters Mechanical Inc., No. 2018-WC-00401-COA, 04/16/2019, published.
Facts and procedural history: Daniel Tewksbury died on April 5, 2015, as a result of an accidental injury that arose within the course and scope of his employment with Air Masters Mechanical Inc.
His ex-wife, Bobbie Young, filed a petition with the W...
The Montana Workers’ Compensation Court ruled that an injured worker remains entitled to coverage for prescription pain medications a treating doctor credibly stated were required to treat his pain from an old industrial injury, and maintain his status at maximum medical improvement.
Case: Hagberg v. Ace American Insurance Co., No. 2018-4206, 04/15/2019, published.
Facts: Terry Hagberg injured his back in May 2006 while working for NAES Power in Rosebud County. NAES had workers’ compensation insurance coverage with the Ace American Insurance Co., which accepted liability for...
A wastewater worker in Northern California was charged with fraud after a qualified medical evaluator said surveillance footage showed the man engaging in activities that were contrary to his stated complaints.
Robert H. Lisher was arraigned in Nevada County Superior Court Monday. He was ordered to report to county jail by May 3 for booking and release, and he signed a promise to appear in court again May 23, according to information provided by Intercare Holdings Insurance Services Inc.
Lisher claimed to have injured his back while pulling on a hose he was using to clean sewer lines in Octo...
fter years of commitment to the Workers' Compensation community, Jeffrey M. Adelson, Esq., has launched his own firm, Adelson McLean, APC. This new firm's mission is to leverage its unique litigation management services, called Targeted Lawyering (trademark pending), to Adelson McLean's Workers' Compensation, General Liability, Subrogation and Employment Law&nbs...
The average cost of claims with more than seven days of lost time dropped in Tennessee following the workers’ comp reforms of 2013, and the state fell to second-lowest in an 18-state cost ranking, according to a new report from the Workers Compensation Research Institute.
For 2011 claims, Tennessee’s average cost per claim was $36,264 at 36 months of experience, placing the state in the middle of the pack of 18 states that WCRI studied. But for 2015 claims, average total cost per claim had fallen, to $32,120.
Only Michigan had a lower average cost for 2015 claims among the 18 stu...
California workers would be able to pursue a benefit increase if independent medical review authorizes a treatment request denied by utilization review, under amendments to a bill scheduled for a hearing today.
Assemblyman Kansen Chu, D-Milpitas, on Monday amended AB 1107 to propose eliminating statutory language under which IMR decisions finding treatments appropriate are not considered proof of an unreasonable denial of benefits. As introduced, the bill would have restrained California employers from performing utilization review on some medical treatment requests.
Labor Code Section 5...
Alaska lawmakers will hear testimony this week on a pair of bills that would merge the Division of Workers’ Compensation and the Division of Labor Standards and Safety.
Senate Bill 66 and companion measure House Bill 68 would create the Division of Workers’ Safety and Compensation. The new agency would be charged with administering Alaska’s workers’ compensation system, and also investigating wage violations and working conditions.
Analyses of the measures project about $283,000 in annual savings resulting from the merger. The bills would take effect July 1 if sig...
AM Best has revised its outlook from stable to positive, and affirmed the financial strength rating of A-minus, or excellent, for Maryland-based Chesapeake Employers’ Insurance Co.
AM Best’s long-term issuer credit rating for Chesapeake Employers’ Insurance remains a-minus.
AM Best said its credit ratings reflect Chesapeake’s balance sheet strength, which the rating agency categorizes as strongest, as well as its adequate operating performance, limited business profile and appropriate enterprise risk management.
The positive outlook reflects the continued strength of...
Ian Williams has joined Oregon workers’ comp insurer SAIF as vice president of human resources.
In addition, SAIF promoted Laura Robison to vice president of actuarial, audit and underwriting services. She will also continue to serve as chief actuarial officer.
Williams will oversee all aspects of HR, including compensation and benefits; employee engagement and retention; recruitment; diversity and inclusion; and professional development.
A graduate of the University of Bedfordshire in the United Kingdom, Williams has worked in HR positions in the U.K. and the U.S. Most recently, ...
California's State Compensation Insurance Fund is getting ready to launch an automated utilization review system that it says will give medical providers approval of treatment requests in many cases in a matter of seconds.
State Fund developed the new system, called UR Connected, in partnership with Texas-based technology company Conexia. The insurer expects to roll out the system over the summer.
The idea is to speed up the approval process for most UR requests, help physicians treat their patients more quickly and get injured workers back on the job sooner. State Fund said the syst...
The New York Workers' Compensation Board took a page from other states' experience in proposing to require preapproval for all compounded drugs, not just those with certain ingredients.
The proposed revision to the formulary rules is good news to insurers, pharmacy benefits managers and employers that have complained about the ways some doctors and compounding pharmacies around the country have devised to charge eye-popping prices for compounded pain creams.
“This closes a sizable loophole in the proposed regulations,” said David Price, director of government af...
