CA - DWC Agrees to Enforce QME Rules 'As Written' to Settle Lawsuits
04/20/2018 | 1603 | 1 | 37 min read
The California Division of Workers’ Compensation agreed to enforce medical-legal billing rules as they are written as part of a settlement with eight doctors who accused the agency of relying on underground regulations to deny their reappointment as qualified medical evaluators.
Nicholas Roxborough
Although the division didn’t admit to using regulations that weren’t properly vetted by going through the rule-making process in the Administrative Procedures Act, it still agreed to several changes in how it will interpret the Medical-Legal Fee Schedule in the April 4 agr...
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When is a worker considered an independent contractor? When he registers as one with the state Department of Labor and Industry, according to a bill making its way through the Pennsylvania General Assembly.
Rep. Fred Keller
HB 1781, introduced by state Rep. Fred Keller, R-Mifflinburg, would create a registration process, allowing workers, sole proprietors and independent businesspeople to sign an affidavit, essentially certifying that they are independent contractors, not employees covered by labor laws and insurance benefits.
Keller and other proponents said the registration would h...
Using alternatives to opioid therapy for treating non-cancer chronic pain, a recommendation of medical guidelines including those from the Centers for Disease Control and Prevention, will soon be a requirement of West Virginia state law.
Under Senate Bill 273, health care practitioners treating a patient “for any of the myriad conditions that cause pain” will be required to refer the patient to alternative treatments before prescribing an opioid.
Those alternatives may be physical therapy, occupational therapy, acupuncture, massage therapy, osteopathic manipulation, a chronic pai...
A Texas appellate court ruled that an allegedly injured worker who initiated a retaliation lawsuit against his former employer could not compel the employer to arbitrate the dispute after it agreed to litigate.
Case: Adcock v. Five Star Rentals, No. 04-17-00531-CV, 04/18/2018, published.
Facts and procedural history: Jimmy Adcock worked for Five Star Rentals. He alleged that he suffered an on-the-job injury in December 2014.
After Adcock filed a workers’ compensation claim, he contended that he was discharged from his position. Adcock retained an attorney to pursue a retalia...
A New York appellate court ruled that substantial evidence supported an administrative determination that a corrections officer was capable of returning to limited duty employment after undergoing spinal surgery to address injuries from an assault by an inmate.
Case: Matter of Mankowski v. Nassau County, No. 2015-08602, 04/11/2018, published.
Facts: Stanley Mankowski worked as a corrections officer for Nassau County. He suffered injuries in March 2013 when an inmate punched him in the neck.
Mankowski was unable to work after this incident, and he began receiving salary-continuation benefits...
Earlier this month, the Centers for Medicare and Medicaid Services issued a policy change revising the Medicare Advantage Program (MAP) Part C regulations, and Prescription Drug Benefit program (Part D).
Jean S. Goldstein
The ultimate goal of the new policy is to ensure that an individual’s treatment needs are met while improving the quality of care and providing greater choices to MA enrollees. The full text of the regulation can be found here, and an easy-to-read fact sheet on the final rule can be found here.
CMS estimates that the policy chang...
The Connecticut Appellate Court ruled that a hospital worker embroiled in a long-running dispute with her employer over alleged delays in treatment for her compensable injuries was wrongly denied an opportunity to amend her complaint before a trial judge dismissed it.
Case: Desmond v. Yale-New Haven Hospital, No. AC 39157, 04/17/2018, published.
Facts and procedural history: Sandhya Desmond worked for the Yale-New Haven Hospital. She allegedly fell while at work in December 2004 and was diagnosed with bilateral, acute post-traumatic carpal tunnel injuries.
Her employer accepted her cla...
Sullivan On Comp
The Oregon Court of Appeals ruled that a telemarketer was entitled to benefits for her injuries from an accident that occurred in the stairwell of her prospective employer's office while she was reporting for an orientation for potential new hires.
Case: Meyers v. SAIF Corp., No. 176, 04/18/2018, published.
Facts: Mary Meyers worked as a telemarketer for the Crystal Marketing Group. After Crystal began shutting down its operations in 2011, its owner invited a representative of Jadent Inc. to speak to the employees about the possibility of working for Jadent.
Severa...
The Arkansas Court of Appeals found that a worker was entitled to coverage for her knee replacement surgery, since substantial evidence supported a conclusion that the procedure was necessary to treat the worsening of a degenerative condition that had been accelerated by an industrial injury.
Case: Arkansas Department of Human Services v. Shields, No. CV-17-783, 04/11/2018, published.
Facts and procedural history: Cindy Shields worked for the Arkansas Department of Human Services. She injured her left knee while at work in November 2012.
After a hearing in November 201...
The Colorado Senate on Thursday passed a bill that would create a reciprocal coverage exemption for workers temporarily within the state, while a measure that would clarify coverage requirements for independent contractors driving commercial vehicles is awaiting a final vote.
Rep. Tracy Kraft-Tharp
House Bill 1308, by Rep. Tracy Kraft-Tharp, D-Jefferson, would allow employers in a neighboring state to use their work comp policies to cover workers temporarily in Colorado if that state allows Colorado employers to use their policies to cover workers temporarily in its jurisdiction.
The bill...
The Idaho Department of Insurance has approved a 3.4% rate decrease as proposed by the National Council on Compensation Insurance. It takes effect May 31.
Dean Cameron
The mid-year rate reduction follows a 5.8% decrease that took effect Jan. 1. Together the two reductions cut premium costs by more than 9%.
“We rarely see midyear rate change proposals for workers’ compensation insurance,” Insurance Department Director Dean Cameron said in a press release. “But the passage of the Tax Cuts and Jobs Act reduced the needed premium, so we are happy that savings can be pa...
A Florida man has been arrested for allegedly selling business insurance policies and pocketing the premiums while providing false documentation of coverage.
Michael Hensley
(Florida CFO photo)
Michael Christopher Hensley, owner of BOSC Insurance Co. and Hensley Insurance Co., admitted to stealing $61,954 in insurance premiums between 2011 and 2018 in Orange County, the Florida Department of Financial Services said in a news release.
Hensley’s arrest followed an investigation by the department’s Disaster Fraud Action Strike Team, which is working in areas heavily impacted...
Sullivan on Comp is hosting a free webinar on Marijuana & Workers’ Compensation airing live on May 8 ...
The Workers' Compensation Board of Indiana has released new guidelines for nurse case managers and will soon unveil new protocols for disputed claim settlement documents.
With fewer hearings and more settlements, "the legal environment surrounding Indiana workers' compensation cases is changing," the board announced this week.
Documents submitted for approval in disputed claims, also known as "C" claims, will need to go the respective single hearing members. More information will be posted as the board finalizes internal procedures.
The board also ...
Kentucky has joined a growing list of states suing drug manufacturers because of the opioid addiction crisis.
Kentucky Attorney General Andy Beshear filed the lawsuit for the state, alleging that pharmaceutical giants Johnson & Johnson, Janssen Pharmaceuticals and Ortho-McNeil-Janssen Pharmaceuticals engaged in deceptive marketing that led to widespread addiction to painkillers, The Hill news site reported.
"To make that happen, Janssen and other opioid makers had to turn the standard of care on its head — persuading doctors that drugs they had been unwilling to pres...
A 9% surcharge that West Virginia employers have been paying since 2008 to pay off claims against the state’s old monopoly insurer will cease to exist on Jan. 1.
House Bill 4628 discontinued the Workers' Compensation Deficit Reduction Surcharge. State lawmakers passed the bill in March because the surcharges paid by employers had raised enough money to pay off the last of the liabilities against the “Old Fund” that had been established to pay Workers’ Compensation Commission claims.
The Old Fund started out with $3 billion in liabilities when it was created ...