CA - With Presumption in Place, Investigators Could Play Role in COVID-19 Claims
| 46 min read
Now that Gov. Gavin Newsom has signed a COVID-19 presumption into law, employers and insurance carriers in California could turn to private investigators in hopes of rebutting claims that workers contracted the virus while on the job, experts said.
Using private investigators in workers’ comp cases is nothing new, but the practice could increase as companies look for ways to defend themselves against potentially pricy or drawn-out claims.
And in the age of social media, there may be more factors to consider than ever before for stakeholders on both sides of the process.
MI - Insurer's Telemed Plan Means Many Injured Workers Never Leave the Worksite
| 51 min read
A Michigan-based group of insurance companies has taken an integrated approach to telemedicine, making a triage nurse and an occupational medicine physician part of the policy and part of the work environment.
And while claimants' attorneys say the plan makes it too easy to minimize injuries and keep injured workers away from their own doctors, the AF Group's medical officials say the program has paid off handsomely: For more than 2,200 claims in the last three years, 64% of injured workers never left the workplace because of the injury.
And for at least one large employer, indemnity...
KY - Department Aims to Change Unfair Claims Settlement Rules
| 17 min read
The Kentucky Department of Workers' Claims will hold a public hearing next month to discuss proposed changes to regulations designed to prohibit unfair claims settlement practices.
The department can fine insurers that fail to properly notify injured workers when and why a claim was denied or threaten to appeal in order to compel a smaller settlement amount.
The proposed amendments would update the rules to reflect the correct name and structure of the department and change the title of the head of the department from director to commissioner. The changes would also remove benefit review...
NATL. - Court Affirms Benefits Awarded to Contractor Injured in Iraq
| 6 min read
A federal appellate court upheld an award of benefits to a worker who suffered injuries while providing security services to an American contractor in Iraq.
Case: G4S International Employment Services (Jersey) Ltd. V. Newton-Sealey, No. 19-2471-ag, 09/17/2020, published.
Facts: ArmorGroup Services (Jersey) Ltd. Hired David Newton-Sealey to provide security for an engineering company doing work in Iraq.
Newton-Sealey suffered serious injuries in March 2004 when the vehicle he was driving was struck by an apparently hostile Iraqi vehicle.
Procedural history: Newton-Sealey filed a claim for b...
Press - Philip Heasley Named to Jopari Board of Directors
Concord, CA - (Thursday, September 17, 2020 ) - After 15 years at the helm of ACI Worldwide, Phillip Heasley announced his retirement as of December 31st, 2019 and as of today, Mr. Heasley has joined the Board of Directors of Jopari Solutions, bringing a wealth of experience and expertise from the financial industry.
Phillip is a 45-year veteran of payment systems and financial services...
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NATL. - Paduda: Lots Going On in Workers' Comp
It's been a very busy week, indeed. Here’s what happened.
MedRisk’s management changes
Longtime CEO Mike Ryan has stepped up to executive chair, and President Ken Martino is moving up to CEO. Mike has led the organization as president for more than seven years. Founder and Chair Shelley Boyce named Ryan CEO several years ago. I know Shelley, Ken and Mike very well.
MedRisk’s annual growth has averaged over 20% for the last decade. The company now employs 1,200 people, all located here in the U.S.
There’s no question MedRisk, per...
CA - Central Valley Farm Worker Accused of Misrepresenting Injuries
| 21 min read
A Central Valley farm worker was arraigned Monday on multiple counts of felony insurance fraud after he allegedly collected $38,000 in workers’ compensation benefits he should not have received.
Eduardo Medina Ruelas, 46, of Sanger, was charged after allegedly defrauding his employer and RISICO Claims Management Co., according to a Department of Insurance news release.
In June 2017, Ruelas was working at Pitman Family Farms when he was struck by a forklift. Because of his injuries, he was placed on temporary disability and was unable to work, according to the news release.
OR - WCD Announces 2020 Travel Reimbursement Rates
| 22 min read
Injured workers who have to travel for medical appointments will be paid slightly less for mileage in 2020, but reimbursement rates for lodging and meals will be unchanged, the Oregon Workers’ Compensation Division announced.
The private vehicle mileage reimbursement rate is dropping to 57.5 cents per mile effective Jan. 1 from 58 cents for 2019.
At the same time, the division announced that the standard daily allowance of $55 for meals and $96 for lodging will remain unchanged. The lodging and meal rate is effective Oct. 1 through Sept. 30, 2021.
In addition to the standard rate, the...
AZ - CopperPoint Re-Elects 2 Members to Board of Directors
| 148 min read
A Phoenix-based commercial insurance company on Tuesday announced that two members of its board of directors had been re-elected.
Judith Patrick and Mike Tully will continue serving on CopperPoint Mutual Insurance Holding Co. board of directors, the company said in a news release.
The election results were announced Sept. 15 during an annual members’ meeting.
Patrick and Tully were re-elected to three-year terms. Survey & Ballot Systems, an independent election administrator, oversaw the voting process, according to the news release.
“Our Board of Directors contri...
NY - Court Finds Worker Hit by Falling Object Entitled to Summary Judgment
| 18 min read
A New York appellate court ruled that a worker was entitled to summary judgment on his Labor Law claim based on his injuries from a falling object.
Case: Aguilar v. Graham Terrace LLC, No. 2017-09885, 09/16/2020, published.
Facts: Graham Terrace LLC hired Townhouse Builders Inc. to serve as the general contractor for the renovation of a building in Brooklyn.
Townhouse then hired Atweek Inc. to do demolition work for the project.
Willan Enrique Macas Aguilar worked for Atweek. He said an air duct fell on him while he was standing on a beam, which then caused him to fall approximately one st...
Press - NCSI holds the second in the Webinar Series on October 8, 2020
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FL - New Cybersecurity Standards Happening Now, and Comp Firms Need To Get on Board
| 83 min read
Department of Defense contracts already are being signed that require much-heightened levels of cybersecurity, and vendors — even those providing workers' compensation services — should act now to meet the new standards, government and industry officials said last week.
“It's real. I cannot implore companies enough: Do not wait to get cyber-hardened,” said Katie Arrington, chief information security officer for acquisition and sustainment at the Defense Department.
Arrington, the federal government's point person on the new standards designed to prevent co...
TN - BWC To Hold Hearing on New Claims Handling Standards Required by EDI 3.1
| 47 min read
The Tennessee Bureau of Workers' Compensation will hold a public hearing on changes to claims handling procedures required by the switch to a new electronic reporting standard.
The electronic data interchange, or EDI, 3.1 standard developed by the International Association of Industrial Accident Boards and Commissions, requires much more information on claims. The bureau said in a statement the new standard required it to tweak the wording of claims reporting standards found in Rule 0800-02-14.
For claims reporting requirements, for example, the current rule requires adjusters file the F...
FL - 'Reasonable Reimbursement' Law for Air Ambulance Takes Effect This Week
| 130 min read
Florida Gov. Ron DeSantis signed a bill that took effect Monday proposing a new approach for determining air ambulance payments.
House Bill 747 requires insurers to provide only “reasonable reimbursement” to air ambulance company for a patient transport. The law defines that as payment that is based on a several factors, including the actual cost of the service, in-network fees, and what county-run operations may charge for similar transports.
A recent court case demonstrated that an air ambulance company charged more than $62,000, but a county air service charged $22,000 for a s...
MA - Agency Posts Home Health Reimbursement Rates
| 68 min read
The Massachusetts Executive Office of Health and Human Services has released new reimbursement rates for home health services, including those covered by workers' compensation insurance.
The rates appear to show few changes from existing rates. Billing code G0299, for a registered nurse for the first 30 days, remains at $89.21 per visit, the agency said in a bulletin. The rates apply to services provided on and after April 1, 2020.
The agency temporarily raised some home health reimbursement because of the COVID-19 pandemic. Those rates were for services rendered between April 1 and July...
NATL. - Insurance Carrier Conducting Ergonomics Assessments via Artificial Intelligence
| 41 min read
One of the nation’s largest insurance carriers says it’s the first to offer businesses ergonomics assessments using artificial intelligence.
The Travelers Cos. announced Monday that it will conduct virtual and on-site assessments using AI-based technology and ergonomic research, according to a company news release.
Assessors are expected to analyze smartphone videos of workers performing tasks to point out movements and positions that could cause injury.
An AI software then quantifies risk and creates a report so that ergonomics experts can prepare a plan to keep workers s...