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NC - Court Rules Against Ambulatory Surgery Centers in Fee Schedule Case

By J. Todd Foster (Reporter)
11/22/2017 | 241 | 0 | 0 min read

The North Carolina Court of Appeals ruled Tuesday that ambulatory surgery centers are not separate and legally distinct from hospitals, overturning a Wake County Superior Court decision that invalidated a new Medicare-based fee schedule for ASCs. The 3-0 ruling in favor of the North Carolina Industrial Commission was critical for employers and insurers because, had the commission’s appeal failed, payers would have been subject to at least $75 million in retroactive reimbursements. Surgical Care Affiliates sued the commission, alleging that the General Assembly did not authorize th. Read More

CA - Arbitration Over EquityComp Disputes Not Always Going Carrier's Way

By Greg Jones (Deputy Editor)
11/22/2017 | 351 | 0 | 0 min read

Employers who signed up for the EquityComp program and ended up litigating a dispute are in some cases benefitting more from mandatory arbitration clauses than Applied Underwriters, the program’s administrator. Judge James V. Selna Last week, a federal judge in Santa Ana refused to vacate an arbitration award declaring a document vital to the EquityComp program unenforceable. Two days later, the decision was cited in opposition to another motion by Applied Underwriters Captive Risk Assurance Co. Inc. to vacate an adverse arbitration award in a separate case before the federal court i. Read More

LA - Credibility Argument Persuades Jury to Exclude Future Medical From 3rd-Party Award

By Emily Brill (Reporter)
11/22/2017 | 148 | 0 | 0 min read

Despite a successful third-party lawsuit, a workers’ compensation carrier must still pay to treat an injured forklift operator because the suit’s damages did not include an award for future medical benefits. Though several physicians and a psychologist testified that James Thomas was in pain and in need of ongoing treatment, a jury believed the psychologist hired by the third-party company who testified that the 49-year-old father may be exaggerating his symptoms. The jury said Thomas had not done enough to reduce his damages and decided that the third-party company should not pa. Read More

NATL. - Tackle Concussion Symptoms Head-On, Specialist Advises

By Elaine Goodman (medical/business Reporter)
11/22/2017 | 147 | 0 | 0 min read

Concussion patients whose symptoms linger for more than a couple of weeks after their injury should be treated aggressively rather than through the traditional “watchful waiting” approach, a concussion specialist said. For example, patients with post-concussion sleep disorders can be coached on habits for good sleep, said Dr. Vernon Williams of the Kerlan-Jobe Orthopaedic Clinic in Los Angeles. Therapy is available for those having trouble with balance, he said. And headaches — a common continuing symptom after a concussion — can be treated with medication, physical t. Read More

CA - DWC Suspends Nine Providers Convicted of Fraud

11/22/2017 | 775 | 0 | 0 min read

Nearly 100 medical providers have been kicked out of California’s workers’ compensation system since the start of the year. The Division of Workers’ Compensation on Tuesday announced nine more suspensions, bringing to 94 the number of providers who have been suspended since the start of the year. The latest suspensions include: Sathish Narayanappa Babu, a physician in Bolingbrook, Illinois, who was convicted on federal charges of Medicare fraud and of fraudulently obtaining controlled substances in February 2015. Uche Chukwudi, a Gardena physician, indicted in 2013 in fe. Read More


FL - Langham: Mediation Success and Adding Capacity

By David Langham
11/22/2017 | 147 | 0 | min read

Mediation in workers' compensation is an area in which Florida was the pioneer. Judge David Langham In the 1990s, Florida tested and mandated mediation in workers' compensation claims. Mediation has been very effective in managing case volumes, and providing relief to the employees and employers served by workers' compensation. Ironically, there have been other states that joined the trend lately. To some, those late-adopters have appeared (or been portrayed) to be pioneers or innovators as they accepted and copied the paradigm that has been the norm here for almost . Read More

NY - Court Upholds Denial of Benefits for Alleged Respiratory Injury

By WorkCompCentral
11/22/2017 | 145 | 0 | 0 min read

A New York appellate court upheld the denial of benefits to a worker who claimed she developed asthma after being exposed to aromatherapy fumes at her workplace. Case: Matter of Boyuk v. Triad Retail Media, No. 524818, 11/16/2017, published. Facts and procedural history: Bonnie Boyuk worked for Trial Retail Media. She filed a workers’ compensation claim asserting she had developed asthma as a result of exposure to aromatherapy fumes emitted from a fragrance diffuser in her workplace.  A workers’ compensation judge found Boyuk had suffered a compensable injury, but the Worke. Read More

Sulivan On Comp

NY - Court Upholds Finding of Further Disability for Worker With PTSD

By WorkCompCentral
11/22/2017 | 99 | 0 | 0 min read

A New York appellate court upheld a finding that a worker suffering from post-traumatic stress disorder had a further causally related disability from an armed robbery. Case: Matter of Perez v. SN Gold Corp., No. 524983, 11/16/2017, published. Facts and procedural history: Jose Perez worked for SN Gold Corp., a jewelry manufacturer. Perez was robbed at gunpoint while at work in 1991 and developed post-traumatic stress disorder. A workers’ compensation law judge found Perez was entitled to benefits for PTSD. The Workers’ Compensation Board later upheld the judge&rs. Read More

UT - Court Finds Worker's Accident Was Not Result of Willful Safety Violation by Employer

By WorkCompCentral
11/22/2017 | 96 | 0 | 0 min read

The Utah Court of Appeals ruled that a worker was not entitled to an enhanced award of disability compensation because his injury did not result from a willful safety violation by his employer. Case: Rojas v. Labor Commission, No. 20160644-CA, 11/16/2017, published. Facts and procedural history: Javier Rojas worked for Ferrari Color as a printing machine operator. He would place print media onto a machine's rollers and watch it to make sure the media did not become wrinkled during the printing process. While he was at work in January 2013, he reached into the machine to smooth out . Read More

LA - Contractor's Performance of Odd Jobs Didn't Prove Change in Condition

By WorkCompCentral
11/22/2017 | 94 | 0 | 0 min read

A Louisiana appellate court ruled that an insurance carrier failed to prove that a former electrical contractor was no longer totally disabled, as his performance of odd jobs without pay did not establish his ability to be gainfully employed. Case: LUBA Workers’ Compensation v. Babineaux, No. 17-365, 11/15/2017, published. Facts and procedural history: Albert Dennis Babineaux had worked as a self-employed electrical contractor. He injured his back while working in June 2000, then underwent surgery. Babineaux had workers’ compensation insurance coverage through LUBA Wor. Read More

NJ - Lawmakers Seek to Establish Light-Duty Return-to-Work Program

11/22/2017 | 154 | 0 | 0 min read

A workers’ compensation bill introduced last year in the New Jersey State Senate was unanimously approved by the chamber’s Budget and Appropriations Committee on Monday. The bill would establish a partial return-to-work program that permits the payment of temporary disability insurance benefits on a reduced basis to injured workers who return to light-duty work. The Senate Labor Committee reported the bill favorably last spring. The Budget and Appropriations Committee voted 13-0 to report the bill favorably on Monday. New Jersey’s workers’ compensation premium rates . Read More

AR - Court Upholds Worker's Award for Neck Injury, Rejects Claims of Causally Related Injuries

By WorkCompCentral
11/22/2017 | 84 | 0 | 0 min read

The Arkansas Court of Appeals ruled that a worker had established compensability of a neck injury, but it rejected his claims of causally related injuries to his arm and shoulder. Case: Harrison v. Street & Performance, No. CV-17-201, 11/15/2017, published. Facts: Larry L. Harrison worked for Street & Performance as a hemi technician for more than 11 years. On May 27, 2014, Harrison went to Sparks Preferred Clinic complaining of tingling and loss of muscle mass in his right-arm. A magnetic resonance imaging scan revealed multiple disc protrusions, chronic compression conformity. Read More

TX - Audit to Target Heavy Ordering of Lumbar Spine MRIs

11/22/2017 | 132 | 0 | 0 min read

The Division of Workers’ Compensation wants stakeholder input in developing an audit plan to evaluate the appropriateness of a doctor’s decision and record-keeping that supports the ordering of lumbar spine MRIs before one month of conservative therapy. The agency on Monday released its proposed Lumbar Spine Magnetic Resonance Imaging Plan-Based Audit and will seek public comments until 5 p.m. Central on Dec. 4. The proposed audit states that indications for ordering lumbar spine MRIs will be identified by the criteria in the Official Disability Guidelines. ODG does not rec. Read More

MT - MSF Asks Court to Stop Management Fee Transfer

11/22/2017 | 128 | 0 | 0 min read

Montana State Fund is asking a court to declare unconstitutional legislation awaiting Gov. Steve Bullock’s signature that would impose a 3% “management fee” on the carrier’s investment portfolio, according to media reports. Laurance Hubbard The complaint filed with the District Court in Helena argues that state law prohibits legislative raids on any money the carrier collects, which includes money it has invested and income from the investments. On the same day the complaint was filed, Judge Mike McMahan denied a request for a temporary restraining order, saying th. Read More

NY - Construction Company to Repay State Agencies Deprived by Work Comp Misrepresentations

11/22/2017 | 122 | 0 | 0 min read

The owner of a Brooklyn construction company has pleaded guilty to grand larceny for stealing $700,000 from workers by failing to pay the prevailing wage on public works projects, the borough’s acting district attorney announced last week. Maria T. Vullo MSR Electrical Construction Co.’s actions “deprived the State Insurance Fund of significant payments” in addition to depriving workers of wages, New York State Department of Financial Services Superintendent Maria Vullo said in a statement. Had MSR Electrical Construction Co. paid its workers fairly and not ma. Read More