NATL. - 'Nightmare' of Premature MSP Collection Activity May Be Ending
| 13 min read
A federal contractor responsible for collecting money owed to Medicare from workers’ comp and other payers may finally be cleaning up a mess created when cases were sent prematurely to the U.S. Treasury Department for collection.
And Performant Financial Corp., the contractor that came on board in February to run the Centers for Medicare and Medicaid Services’ Commercial Repayment Center, appears to have whittled down a backlog of cases that it inherited from the previous contractor. That means Performant will be “ramping up” collection efforts on ne...
CA - Consumer Privacy Law Has Implications for Comp Industry
| 8 min read
Consumer privacy legislation that California lawmakers rushed through the Capitol to fend off a ballot initiative could be extremely disruptive for the state’s workers’ compensation system, with the potential to create confusion, push litigation and drive up costs.
The California Consumer Privacy Act of 2018 gives consumers the right to ask a business to delete personal information and to disclose the kind of data being collected. The penalty for intentional violations is capped at $7,500 per violation.
The act also affords a private right of action, allowing co...
NC - NCCI Report Shows Medical Costs Dropping Since Fee Schedules Adopted
| 10 min read
Legislation passed in 2013 that switched North Carolina to a Medicare-based reimbursement plan continues to have its intended effect: The state’s medical costs for 2016 and 2017 were below regional and national averages in most categories, a new report shows.
But medical providers are feeling the pinch, and one group says stingy fees could ultimately result in fewer options for injured workers.
“It’s becoming a question of access to care,” said Peter Lohrengel, executive director of the North Carolina Ambulatory Surgical Center Association. “How long before some...
CO - Employer Not Liable for Cost of Guardian, Conservator for Brain-Damaged Employee
| 4 min read
The Colorado Court of Appeals last week ruled that an employer is not liable for the costs of providing conservator or guardian services to a permanently and totally disabled worker with a compensable traumatic brain injury.
Since such services don’t cure or relieve a claimant of the effects of his injury, the court said Brian Nanez’s employer did not need to pay for them.
Nanez had worked as a plumber for Mechanical & Piping. He developed significant cognitive deficits after he suffered head injuries while at work.
An independent medical examiner noted that Nanez was incapa...
Press - Pam Gore Receives 2018 Beverley Boesch Legacy Award
Downers Grove, IL. (November 14, 2018) – Coventry, a leading provider of care and cost management solutions for workers' compensation, is pleased to announce that Nurse Consultant Pamela Gore has received the 2018 Beverley Boesch Legacy Award.
Beverly Boesch was a highly respected Registered ...
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NATL. - Martin: Would Your Employees Take the Bait?
Since 2015, in at least three instances, third parties have illegally gained access to sensitive data via targeted phishing attacks on employee email accounts in workers’ compensation funds, and experts believe future attacks are inevitable.
Phishing takes the form of deceptive emails attempting to trick recipients into disclosing sensitive or confidential information, opening an infected attachment or clicking on a compromised web link. Sometimes the phishing email address is purposely created to look like it is from a legitimate or known email account.
In 2016, Pinnacol Assuranc...
NY - Court Upholds Board's Rejection of 'Pseudoscience Speculation' on Causation of Disability
| 19 min read
A New York appellate court ruled that a chiropractor’s opinion on causation, which an independent medical examiner dismissed as “pseudoscience speculation,” did not support an award to a transit worker.
Case: Matter of Molette v. New York City Transit Authority, No. 526569, 11/15/2018, published.
Facts and procedural history: Gregory Molette worked for the New York City Transit Authority. He tripped and fell while at work in 2011, injuring his left shoulder.
The Transit Authority accepted liability for the injury. It later accepted liability for a consequential right shoul...
NY - World Trade Center Response Worker Denied Benefits for Psyche Disability
| 11 min read
A New York appellate court rescinded an award of benefits to a worker who responded to the terrorist attacks at the World Trade Center, finding the evidence did not support a conclusion that her disability was related to psychiatric injuries from her work.
Case: Matter of Hughes v. World Trade Center Volunteer Fund, No. 526652, 11/15/2018, published.
Facts and procedural history: Rachel Hughes was a volunteer worker who responded to the Sept. 11, 2001, terrorist attacks on the World Trade Center. She began to suffer from gastroesophageal reflux disease, extrinsic asthma, chronic sinusitis, s...
MA - Employer Can Be Sued for Retaliating Against Worker
| 8 min read
The Massachusetts Appeals Court ruled that an employer can be sued for retaliating against a worker who filed a tort claim based on injuries she suffered as an employee of a staffing service.
Case: Bermudez v. Dielectrics, No. 18-P-7, 11/16/2018, published.
Facts: Ileana Bermudez worked for Career Group Staffing Services, a temporary employment agency. CGSS sent her to work for Dielectrics.
While Bermudez was working at the Dielectrics facility in July 2013, an employee allegedly caused several large metal sheets to fall on her right foot.
Bermudez suffered a fracture a...
NE - Worker's Catastrophic Stroke Didn't End Employer's Liability for PTD Benefits
| 20 min read
The Nebraska Supreme Court unanimously ruled that an employer was not relieved from its duty to pay permanent and total disability benefits to an injured employee who suffered a catastrophic stroke unrelated to her compensable injury.
Case: Krause v. Five Star Quality Care, No. S-18-009, 11/16/2018, published.
Facts: Linda Carlson worked for Five Star Quality Care. She fell while at work in February 2013, breaking her leg.
She underwent surgery and was cleared to return to light-duty work in April 2013.
Carlson continued to complain of pain, and in June 2013, her doctor recommend...
Press - 2018 Comp Laude® Awards Winner Information
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OH - BWC to Hold Hearing on Hospital Fee Schedule Changes
| 56 min read
The Ohio Bureau of Workers' Compensation is proposing an update to its hospital inpatient fee schedule that would reduce overall payments to hospitals by about $6 million a year.
The BWC will hold a public hearing Dec. 18 on the fee changes, which would adopt a number of modifications, including Medicare's final rules on:
National standardized amounts.
Diagnosis-related groups (DRG) changes.
Updates to the International Statistical Classification of Diseases (ICD-10).
Payment adjustment factor (PAF) to reflect the statewide reimbursement to a cost benchmark of 114%.
Adopt a &ld...
NE - Staffing Agency Fined $11,641 Over Farmworker Death
| 1 min read
The U.S. Occupational Safety and Health Administration has cited a Nebraska staffing agency following the death of a farmworker from apparent heat-related causes.
Rivera Agri Inc., a provider of temporary agricultural labor in Grand Island, is facing proposed penalties of $11,641. OSHA issued the citations on Nov. 6.
News reports identified the worker who died as Cruz Urias-Beltran, 52, from San Luis, Arizona. Urias-Beltran failed to return from working in the cornfields on July 11. His body was found the next day.
According to OSHA, the heat index in Grand Island reached 100 degrees on two...
FL - Manufacturer Cited for Multiple Violations Following Finger Amputation
| 4 min read
A window and door manufacturer in Hialeah, Florida, is facing proposed federal penalties of $398,545 after part of a worker’s finger was amputated.
PGT Industries Inc., operating as CGI Windows and Doors Inc., was cited Thursday by the U.S. Occupational Safety and Health Administration. The company has 15 business days to contest the citations.
OSHA said a worker suffered a partial finger amputation while working on an unguarded punch press.
OSHA cited the company for an alleged lack of machine guarding on several pieces of equipment; for failing to inspect mechanical power press...
NATL. - Potent New Opioid Dsuvia an 'N' Drug in ODG
| 12 min read
A potent new opioid called Dsuvia that has not yet hit the market has already received a thumbs-down from the Official Disability Guidelines.
ODG by MCG has designated Dsuvia as “not recommended as a first line therapy for acute or chronic pain.” That means Dsuvia will be an “N” drug in the ODG drug formulary, which is used as the basis of workers’ comp prescription drug formularies in several states.
Dsuvia is a 30 microgram sufentanil tablet that is administered sublingually, or under the tongue, by a single-dose, pre-filled applicator. It is intended to treat...
CA - DWC Announces 2019 Audit Standards
| 18 min read
Claims shops in California will need better scores to pass their 2019 audits after the Division of Workers’ Compensation announced it is tightening the audit standards again.
The division said the Profile Audit Review performance standard for 2019 will be 1.36133, down from 1.47573 that was used for 2018.
Claims administrators that receive a score equal to or less than the standard are required to pay outstanding compensation, but are not assessed administrative penalties. Shops that score higher than the standard are subject to a heightened Full Compliance Audit.
The FCA performance ...
NC - Commission Adopts Group 2, Death Benefit Act Rules
| 26 min read
The North Carolina Industrial Commission on Monday formally adopted changes to workers’ compensation procedural rules, and amendments to the Public Safety Employees’ Death Benefits Act rules.
The procedural rules are known as the Group 2 Rules because they were the second batch of proposed amendments that the commission proposed after reviewing its regulations. They now go the state legislature’s Rules Review Commission for approval.
The Rules Review Commission approved the first batch of rule changes, known as the Group One Rules, on Thursday. They take effect o...
MI - Detroit Doctor and Crew Indicted on Charges of Illegal Opioid Distribution
| 53 min read
A Detroit general practitioner, his office manager and her brother have been indicted on federal charges of illegal distribution of $2.6 million worth of controlled substances, including opioids.
Dr. Otis Leon Crawford and Debbie Ann Taylor opened Doctors Creative Care in 2016. For two years, Crawford provided little or no medical examination but prescribed Xanax, Valium, codeine cough syrup and other drugs, according to a news release from the U.S. Attorney for Eastern Michigan.
Taylor, the office manager who has no medical license, recommended medications for...