TX - Court Blocks DWC's Work Search Rules for Supplemental Benefits
| 7 min read
Injured workers looking for supplemental benefits will no longer be able to show their eligibility simply by listing email contacts or citing newspaper ads as part of their work search efforts, a Texas district court ruled this week.
Workers' compensation insurers are hailing the decision as a major blow against claimants and their lawyers who have allegedly tried to game the system and collect thousands of dollars in benefits and fees.
Under the Division of Workers' Compensation rules at issue in the case, some manual-labor workers have tried to show they were searching for jobs...
CA - DWC Will Offer Data to Help Prioritize COVID-19 Vaccine Distribution, Director Says
| 8 min read
The California Division of Workers’ Compensation will provide injured-worker data to state advisory committees to help determine who might get the first dose of the COVID-19 vaccine when it becomes available next year, Administrative Director George Parisotto said.
Speaking during a public meeting for the Commission on Health and Safety and Workers’ Compensation on Thursday, Parisotto said researchers and public health officials will have full access to the division’s COVID-19 data before prioritizing vaccine distribution.
Commissioner Mitch Steiger, who also works as a leg...
DC - Federal Appellate Court Tosses Worker's Civil Suit for Assault by Co-Employee
| 10 min read
A federal appellate court upheld the dismissal of a transit employee’s claim for damages from a vicious on-the-job assault by a co-worker.
Case: Workagegnehu v. Washington Metropolitan Area Transit Authority, No. 19-7029, 11/24/2020, published.
Facts: Teshome Workagegnehu and Martin Van Buren both worked for the Washington Metropolitan Area Transit Authority. Both men were at a Metro station kiosk in Arlington, Virginia, when a customer approached and asked for help with the SmarTrip vending machine.
Van Buren swore at and dismissed the customer. When the customer became flustered, Wo...
OH - Worker Gets Award for Eye Conditions Caused by Food Poisoning
| 31 min read
An Ohio appellate court ruled that a nurse was entitled to a 70% bilateral loss of vision award because of eye issues she developed after ingesting lunchmeat contaminated by E. coli at a holiday work party.
Case: State ex rel. Bowman v. Industrial Commission, No. 19AP-109, 11/19/2020, published.
Facts and procedural history: Cami Bowman worked as a nurse for the Wexner Medical Center at Ohio State University. In December 2005, Bowman attended a work holiday party and ate lunchmeat that had been provided for the event. Later that day, she fell ill.
Doctors determined she had contracted ...
Press - Malingering and Brain Injury: A Panel Discussion and Webinar
Centre for Neuro Skills presents a webinar featuring top neuro and mental health clinicians
Bakersfield, CA (November 30, 2020) - Three renown neuro and mental health specialists will discuss "Malingering and Brain Injury" in a free panel conversation and webinar on Thursday, December 10, 2020, at 10 a.m. PST. The event is presented by Centre for Neuro Skills (CNS), a premier provider of treatment for traumatic and acquired brain injury in California and Texas. Register here.
Malingering has been defined as "faking illness, consciously lying about a condition to gain a ...
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NATL. - Duff: Businesses (and Others) May Negligently Expose You to Coronavirus With Impunity
If you work in the gig economy, you are not (or so the giggers contend) an employee and are, therefore, not entitled to workers’ compensation (among other employee rights).
The same is true if you are any other flavor of independent contractor. So, off you go to work in the intensifying pandemic. One day, your “not-employer” sends you out to clean coronavirus-infected surfaces, with no bleach and dirty rags. As a result, not only do you get sick, but anyone coming into contact with the “not cleaned” surface becomes sick.
So now I ask you:...
CA - Court Upholds Worker's Insurance Fraud Conviction, Sentence
| 7 min read
A California appellate court upheld the conviction and sentence of an injured worker for engaging in insurance fraud.
Case: People v. Johnson, No. E073978, 12/02/2020, unpublished.
Facts: Latonja Johnson worked two jobs in July 2013. She worked at Goodwill as an e-commerce book handler. She also worked for a company called Advantage Sales and Marketing as an events specialist.
Her job for ASM was hanging out food samples at Sam’s Club.
On July 18, 2013, Johnson filed a workers’ compensation claim against Goodwill, asserting she had injured her back while lifting books out of a ...
CA - WCIRB Actuarial Committee Meeting Tuesday
| 3 min read
The Actuarial Committee for the Workers’ Compensation Insurance Rating Bureau of California will discuss medical severity trends, large-deductible policy experience, third quarter insurer experience and emerging COVID-19 experience during a meeting Tuesday.
Committee members will also discuss a special data call to gather information about COVID-19 claims, experience rating eligibility and potential changes to how the bureau collects transaction data.
Other agenda items include a review of medical severity trends by component, unallocated loss adjustment expense projection methods, and...
OR - WCD Updates Informational Brochure
| 12 min read
The Oregon Workers’ Compensation Division posted an updated brochure that provides information for those who are injured while working.
The division said revisions to brochure 440-1138 — “What happens if I’m hurt on the job?” — improve readability, ensure that the table of contents matches chapter headings, and add language used in other agency publications.
“These changes are minimal,” the division said in a statement. “Therefore, you do not need to use the new updated brochures until you have exhausted your old supply.&rd...
CA - WCRI: Reforms Made Medical Payments Typical of Other States
| 2 min read
California’s medical payments for 2016 claims with experience through 2019 were typical of other states as a result of a series of legislative reforms, the Workers Compensation Research Institute reported.
Medical payments per claim in California were higher than typical in previous years, according to WCRI’s “CompScope Medical Benchmarks for California, 21st Edition.”
“Average payments in California reflected the effects of multiple policy changes, including Senate Bill 863, a drug formulary and two fraud-fighting measures,” WCRI said in a statem...
Press - Specialty Networks Play a Key Role in Fighting Opioid Misuse
Coventry, a leading provider of care-management and cost-containment solutions for workers' compensation, has released a new whitepaper entitled "Specialty Networks Play a Key Role in Fighting Opioid Misuse."
For all the progress made in reducing opioid prescriptions misuse remains an intractable problem. The health care system has grown more adept at deploying the right resources to give patients the best chance at recovery. These lessons are particularly relevant in the treatment of injured workers.
Recovery can be difficult and often protracted, and the greatest chance ...
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CA - State's Audit Results Identify Leading Options for Businesses, Agents and Risk Managers
| 16 min read
When the State of California issued its 30th annual Workers’ Compensation Profile Audit Review (PAR) exam on insurance companies, third-party administrators (TPAs) and self-insured employers, they continued to raise the bar on claims handling performance.
Workers’ compensation providers are now being held to an increasingly higher required passing score than in past years. The PAR audit process results in the state reporting a single exam score, released to the insurance industry, state businesses and the public, annually.
The PAR score serves as an indicator of how well cla...
CA - CHSWC Annual Report Shows $1.8B Drop in Administrative Expenses in 2019
| 79 min read
Administrative expenses in California’s workers’ compensation system fell by nearly $1.8 billion last year, according to a draft annual report from the Commission on Health and Safety and Workers’ Compensation.
Workers’ comp carriers and self-insured employers racked up approximately $6.8 billion in administrative expenses in 2019, a drop off of more than 20% compared to the $8.6 billion in expenses in 2018, according to a draft of the report posted online for comment.
The $6.8 billion in expenses accounted for 36% of all paid workers’ comp costs in California i...
TX - Stakeholders Question Move to Make Virtual Dispute Conferences Permanent
| 96 min read
The Texas Division of Workers' Compensation plans to ask lawmakers for the authority to make internet-based claims mediations the norm, long after the pandemic's social distancing requirements have been relaxed.
But some stakeholders are pushing back, arguing that video and telephone meetings leave much to be desired and are resulting in delays and further litigation.
At the very least, the current system of rotating remote benefit review conferences among different regions of the state needs to be fine-tuned. Review officers who are familiar with certain issues should pres...
LA - Court Tosses Worker's Civil Suit Over Accident Leading to Leg Amputation
| 36 min read
A Louisiana appellate court threw out a worker’s civil suit against his co-worker for negligence that allegedly led to an accident resulting in the partial amputation of his leg.
Case: Bagwell v. Quality Easel Co., No. 53,282-CW, 11/18/2020, published.
Facts: Douglas Bagwell worked for the Quality Easel Co. James Dugdale Jr. was the sole owner and manager.
On Sept. 2, 2015, Dugdale and Bagwell were both working at the Tremont westbound highway rest area. Dugdale was using a track hoe to lift concrete barriers onto a truck for Bagwell to transport to a storage yard.
As Dugdale was mov...
DE - Employer Can't Recover Payment of Commutated Benefits From 3rd-Party Tortfeasor
| 57 min read
The Delaware Supreme Court ruled that a third-party tortfeasor and his automobile insurance carrier were entitled to summary judgment on an employer’s claim of entitlement to a recovery of what it paid an injured employee as a commutated payment of workers’ compensation benefits.
Case: ACW Corp. v. Maxwell, No. 302, 11/18/2020, published.
Facts and procedural history: Shanara Devon Waters worked for the ACW Corp. She was traveling within the course and scope of her employment in February 2016 when she suffered injuries in a car accident caused by Christopher Maxwell.
CA - Employer's Appeal Untimely, but It Can Assert Equitable Tolling Claim
| 21 min read
A California appellate court ruled that an employer cited for a safety violation did not timely seek review of an administrative decision, but it is entitled to assert a claim of equitable tolling.
Case: Ventura Coastal LLC v. Occupational Safety and Health Appeals Board (Department of Industrial Relations), No. F077267, 12/01/2020.
Facts: Isaul Alvarado worked for Ventura Coastal LLC. He suffered a serious leg injury in August 2014 when he stepped into an uncovered auger located below ground level on Ventura’s premises.
In September 2014, the Division of Occupational Safety and Healt...
CA - Roofer Accused of $2 Million Payroll Fraud Scheme
| 35 min read
The owner of a Simi Valley roofing business was arraigned on five felony counts of insurance fraud for allegedly underreporting payroll by more than $4 million, resulting in a loss of more than $2 million for State Compensation Insurance Fund, the California Department of Insurance announced.
The department said it received a referral on Dec. 18 alleging that Judy Hein, 71, was underreporting payroll at her business, Cal Roofing Inc., to reduce the cost of workers’ compensation coverage.
“An investigation discovered internet searches that indicated the number of roofing proj...
FL - Max Weekly Benefit Climbs to $1,011 for 2021
| 9 min read
The average weekly wage in Florida rose to $1,011 this year, triggering an increase in the maximum weekly workers' compensation benefit, the state Division of Workers' Compensation announced.
The maximum benefit in Florida is set by law at 100% of the average weekly wage, and that wage has risen almost every year, according to data compiled by the U.S. Department of Labor and the Florida Department of Economic Opportunity.
The new weekly maximum for temporary total and permanent partial disability benefits will take effect Jan. 1, the DWC said in a bulletin. The rate is an increase f...
KY - Department to Hold Hearings on Pharmacy, Filing Rule Changes
| 161 min read
The Kentucky Department of Workers' Claims is reminding stakeholders that it will hold public hearings next month on changes to the pharmacy fee schedule and on new requirements for filing claims and insurance information.
The department has proposed a number of changes to the prescription drug fee schedule, including a new method of determining the lowest possible reimbursement amount. The Zoom hearing will be held at 10 a.m. Eastern time on Jan. 21. The link is here and the passcode is 652032.
At 10 a.m. on Jan. 22, a hearing will be held on proposed changes to electronic filing r...
OR - COVID Updates on Deck for MLAC Dec. 11 Meeting
| 44 min read
Members of Oregon’s Management-Labor Advisory Committee will hear about COVID-19 audits and rulemaking activities during a Dec. 11 meeting.
The Department of Consumer and Business Services, the parent agency for the Division of Workers’ Compensation, will present updates on COVID-19 audits, educational outreach and rulemaking efforts during the meeting.
Temporary rules that are in effect through March 29, 2021, require audits of carriers that have reported five or more claims for COVID-19. The audits are intended to ensure carriers are conducting reasonable investigations before ...
TN - Regulators Tout Larger, 9.2% Rate Decrease for 2021
| 71 min read
Many Tennessee employers should see a decrease in workers' compensation premiums next year after regulators approved a 9.2% cut in loss costs for the voluntary market, the Department of Commerce and Insurance announced.
The National Council on Compensation Insurance in August recommended the 9.2% decrease, and the state's Advisory Council on Workers' Compensation urged a smaller loss cost decrease of 8.4%. Insurance Commissioner Carter Lawrence last month went with the larger rate reduction, which takes effect March 1 for new and renewal policies.
“During a year wh...
TX - DWC Report to Legislature Says All Is Well With Comp System, but Critics Disagree
| 73 min read
If everything's bigger in Texas, it's also better, at least in the workers' compensation system, says a report from the Division of Workers' Compensation.
The division's Research and Evaluation Group's Report, titled "Setting the Standard," is required by law every other year. It found that since a 2005 reform law was passed, measurements have continued to improve in almost every category for employers, insurers, medical providers and injured workers.
Claimants' attorneys and a worker advocacy group argued that the report leaves out some key metrics,...