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Top Stories

CA - CWCI Finds Dwindling Savings From Medical Networks

By Elaine Goodman (medical/business Reporter)
05/25/2018 | 882 | 3 | 40 min read

Medical provider networks, intended to improve care for injured workers and reduce medical spending, shaved only about 2% from average medical costs per claim in California, compared to non-network treatment, according to new data from the California Workers’ Compensation Institute. Alex Swedlow And opioid prescribing was more prevalent in cases where the injured worker’s primary treating provider was part of a medical provider network, CWCI found. An opioid was prescribed in 48% of the MPN claims versus 40% of non-network claims. “It’s very surprising,”... Read More

CO - Judge Tosses Class Action Challenging Air Ambulance Rates as Pre-Empted by ADA

By WorkCompCentral
05/25/2018 | 176 | 0 | 78 min read

A federal trial court in Colorado has thrown out a class action against an air-ambulance provider by plaintiffs who challenged the allegedly exorbitant fees they were billed. U.S. District Judge R. Brooke Jackson found that the class plaintiffs’ breach of contract claims against Air Methods Crop. were pre-empted by federal aviation law. He’s not the first to reach this conclusion. Courts in Florida, Kentucky, North Dakota, Florida and Wyoming have all ruled that the Airline Deregulation Act trumps state laws attempting to govern the rates that air ambulance companies can cha... Read More

CA - Supervisor's Lending Employer Can't Be Held Vicariously Liable for Worker's Electrocution

By WorkCompCentral
05/25/2018 | 363 | 0 | 21 min read

A California appellate court ruled that an employer that loaned a supervisory employee to another company could not be held vicariously liable for the electrocution of an agricultural worker who was following the supervisor’s instructions to pick fruit from a tree near a live power line. Case: Diaz v. S&R Farm Labor Contractor, No. D073115, 05/23/2018, unpublished. Facts: S&R Farm Labor Contractor and Gold Grower are both farm labor contracting companies. In February 2010, Gold Grower asked S&R to borrow a supervisory employee because the local packing houses liked hav... Read More

CA - 1st DCA Upholds Former Correctional Officer's Conviction for Insurance Fraud, Theft, Perjury

By WorkCompCentral
05/25/2018 | 338 | 0 | 13 min read

A California appellate court rejected a former correctional officer’s challenge to his conviction for insurance fraud, grand theft and perjury for collecting more than $74,000 in benefits while still physically capable of exercising, acting and cheating on his wife.   Case: People v. Morgan, No. A147072, 05/23/2018, unpublished. Facts: Hosea Morgan worked as a correctional officer at San Quentin State Prison. In 2009, he filed two workers’ compensation claims against the State Compensation Insurance Fund, asserting that his 24 years of dealing with inmates had take... Read More

NY - No Duty Disability Benefits for Corrections Officer Injured by Falling Inmate

By WorkCompCentral
05/25/2018 | 86 | 1 | 9 min read

A New York appellate court ruled that a corrections officer was not entitled to duty disability benefits for a neck injury caused by an inmate who had fallen on him while exiting a transport van. Case: Matter of Martin v. New York State Comptroller, No. 525315, 05/17/2018, published. Facts and procedural history: Joseph Martin worked as a county corrections officer. He suffered an injury to his neck in June 2012 when a fully shackled inmate fell while exiting a transport van and landed on him. Over time, Martin's condition worsened, and he filed an application for perform... Read More


NATL. - Paduda: Opioids, Marijuana, Pain and Workers' Comp

By Joe Paduda
05/25/2018 | 109 | 0

The National Council on Compensation Insurance's Raji Chadarevian discussed opioid utilization, price and cost at NCCI’s recent Annual Issues Symposium 2018. Joe Paduda Six percent of opioid medications used in workers’ comp is for treating opioid use disorder; methadone and suboxone are the drugs of choice. The older the claim is, the more opioids are prescribed. For 15-year-old claims, about 2.5 oxycodone pills were prescribed per day. As a result, claims that are more than 10 years old accounted for more than 50% of all oxycodone pills. And the top 1... Read More

OK - Worker's Delay in Requesting Hearing Didn't Warrant Dismissal of Claim

By WorkCompCentral
05/25/2018 | 69 | 0 | 57 min read

The Oklahoma Workers’ Compensation Commission ruled that a worker’s timely filed claim was not subject to dismissal because of his delay in requesting a hearing. The case was Jackson v. BJs Restaurants Operations Co. Chad Jackson worked at a BJs Restaurant. He filed a workers’ compensation claim in June 2016 for an alleged on-the-job injury from February of that year. BJs contested his claim. In August 2016, Jackson filed a request for a hearing on his entitlement to temporary total disability benefits and medical treatment. The initial hearing on Jackson’s claim wa... Read More

Sullivan On Comp

NY - Owners of 10 Medical Transport Companies Charged With False Billing, WC Fraud

05/25/2018 | 149 | 0 | 8 min read

The owners of 10 medical transport companies in upstate New York this week were charged with leading an extensive scheme to defraud the workers' compensation and Medicaid systems of millions of dollars, law enforcement officials announced. “With these medical transport companies it was the New York taxpayers who were taken for a ride,” New York State Inspector General Leahy Scott said in a news release. “For years, the Northway corridor has been plagued with corruption in the medical transport industry, and this week’s law enforcement actions send a clear message t... Read More

PA - Surveillance Leads to Fraud Conviction

05/25/2018 | 81 | 0 | 8 min read

A Pittsburgh man who made the mistake of running for a bus while holding his crutches pleaded guilty to a theft by deception charge last month, the Pennsylvania Insurance Fraud Prevention Authority said in its monthly newsletter.  Saeed A. Anglin pleaded guilty on April 3 to theft by deception in a plea agreement with prosecutors. He was sentenced to 12 months of probation, and ordered to pay $475.01 in restitution and $1,577 in court costs, the authority said. Prosecutors say Anglin reported to his supervisor at a Sears Outlet Distribution Center that he injured his left ankle while at... Read More

IN - Medical Costs Down, Indemnity Up After 2013 Changes, Study Says

05/25/2018 | 107 | 0 | 53 min read

Five years after Indiana adopted a hospital fee schedule but raised some workers' compensation benefits, medical costs dropped slightly and indemnity costs climbed by 15%, a study shows. The Benchmark Report by the Workers Compensation Research Institute shows that medical payments per claim dropped 12% from 2014 to 2015, then rose 9% the next year. Indemnity benefits per claim increased 4% from 2014 to 2015, and 11% from 2015 to 2016. After then-Gov. Mike Pence signed House Bill 1320 into law in 2013, the National Council on Compensation Insurance predicted that it would cut total ... Read More

GA - Garage Door Company Owner Charged With Falsifying WC Insurance Coverage

05/25/2018 | 98 | 0 | 41 min read

The owner of a garage door company in the Atlanta-area has been charged with falsifying insurance coverage, the Georgia insurance commissioner announced this week. Maria Estela Castillo, 34, of Lilburn, presented a proof of workers' compensation insurance to a subcontractor, claiming that her business was covered by Biltmore Insurance Agency. But an investigation showed the document to be false and that Biltmore never wrote a policy for the door company, according to a bulletin from the Insurance Department. Castillo was booked into the Cobb County Jail and released on bond. Insura... Read More

MN - Governor Signs Pay Raise for WC Appeals Judges

05/25/2018 | 62 | 0 | 16 min read

Minnesota Gov. Mark Dayton has signed into law a $7,000 pay raise for workers' compensation appeals judges. Gov. Mark Dayton House Bill 3873, passed by the House and Senate this month with no dissenting votes, corrects an oversight by last year's session, which raised district court judges' and workers' compensation judges' pay, but forgot about appeals judges. Beginning June 1, the four appeals court judges will make 105% of what compensation court judges are paid, or about $158,628 annually. The chief compensation appeals court judge will be paid at 107% of compensat... Read More

CA - WCIRB Classification and Rating Committee Meets Thursday

05/25/2018 | 118 | 0 | 8 min read

The California Workers’ Compensation Insurance Rating Bureau’s Classification and Rating Committee will meet in Oakland on Thursday. The meeting, which is open to the public, will include a review of preliminary 2019 classification relativities. The meeting will begin at 9:45 a.m. and will take place at WCIRB’s office, 1221 Broadway, Suite 900, in Oakland. An agenda is available here. ... Read More

MA - Governor Reappoints Omar Hernandez as Administrative Judge

05/25/2018 | 74 | 0 | 102 min read

Gov. Charlie Baker has nominated Omar Hernandez for reappointment to the position of administrative judge on the Industrial Accident Board at the Department of Industrial Accidents. Hernandez served as an administrative judge from 2003 until 2011 and has been the senior judge at the DIA since 2011.  DIA oversees the Massachusetts workers’ compensation system. The Industrial Accident Board consists of 21 administrative judges who preside over disputed workers’ compensation cases. Hernandez’s nomination is subject to the approval of the Governor’s Council. The rea... Read More

OH - Board Approves $1.5 Billion Rebate for Employers

05/25/2018 | 66 | 0 | 34 min read

The board of directors for the Ohio Bureau of Workers' Compensation on Thursday approved a $1.5 billion rebate on premiums to 180,000 employers, making it the fourth billion-dollar rebate in six years. The rebate amounts to about $8,300 per employer, and replaces 85% of what employers paid in premiums in 2017, the bureau announced. The checks should be in the mail by July. The bureau said employers must pay any overdue premium amounts and submit outstanding payroll reports before June 8. Employers can do that, and can verify demographic and address information, by logging into their e-ac... Read More