CA - CWCI: Claim Frequency Up for State's Self-Insureds
| 28 min read
Workers’ compensation claim frequency increased for the second year in a row among private self-insured employers in California in 2018, bucking a decades-long national trend of decreasing claim rates.
Claims per 100 employees climbed to 3.71 last year for private self-insured employers, up from 3.53 in 2017 and 3.30 in 2016, according to a bulletin the California Workers’ Compensation Institute released last week. The frequency increases were seen in both medical-only and indemnity claims.
Claim frequency for private self-insureds in California had been falling since 20...
CA - Insurance Department Schedules Hearing on SIU Rules
| 10 min read
The California Department of Insurance will hear public testimony on proposed rules intended to improve carrier fraud investigations, during a Sept. 5 hearing in Sacramento.
The department on Thursday proposed regulations that it says will improve the quality of fraud referrals put together by carrier special investigative units. In an initial statement of reasons explaining the regulatory proposal, the department said the SIU rules have not been amended since taking effect in October 2005. It is apparent that additional clarification and guidance is needed to ensure adequate investigations o...
OH - Commission Can't Rely on Equivocal Psychological Opinion
| 9 min read
A split Ohio Supreme Court ruled that a psychologist's report on a man's employability could not be relied upon to deny the worker’s request for permanent total disability benefits.
Case: State ex rel. Pilarczyk v. Geauga County, No. 2018-0728, 07/18/2019, published.
Facts and procedural history: Joshua N. Pilarczyk injured his back in 2002 while working for Geauga County. The Bureau of Workers’ Compensation determined that he was entitled to benefits for his back injury as well as related psychological conditions.
In April 2015, the bureau requested that Pilarczyk see p...
MN - Supreme Court Clarifies Requirements to Prove Entitlement to PTSD Benefits
| 80 min read
The Minnesota Supreme Court unanimously ruled that entitlement to benefits for post-traumatic stress disorder does not require an independent assessment to verify the diagnosis.
Case: Smith v. Carver County, No. A19-0199, 07/17/2019, published.
Facts: Chadd Smith was deputy sheriff for Carver County for nearly 10 years, witnessing several gruesome and tragic events.
Smith resigned in June 2016 and went to see Michael Keller, a licensed psychologist. Keller diagnosed Smith with post-traumatic stress disorder, major depressive disorder and anxiety disorder.
Smith filed a worke...
Press - Coventry Releases Part Two of its Annual Drug Trends Series
Coventry has releases part two of its Annual Drug Trends Series. In part two of the series we provide analysis on the trends experienced within our combined in- and out-of-network channels. Some highlights from the series include:
- 8 of the top 10 therapeutic classes experienced decreases
- Opioids decreased over 2% points from 2017
- Compounds fell out of the top 10 classes in both utilization and cost
Each part in the series is accompanied by a deeper dive into various related topics to address specific trends highlighted in the drug trend series. To find out more, visit the Coventry Bl...
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NATL. - Moore: What Happened to Positivity?
Measuring workers' comp negativity remains one of the easiest tasks for bloggers and authors inside and outside of the industry.
One has to ask how many times has a reader read an article extolling the virtues of a system that has been in existence since ancient Sumeria. Yes, the original workers’ comp coverage was not invented by Wausau or mariners in the 1800s.
What caused me to write this article began when I came across an article where a well-known blogger posted four negative articles in one post. I found that amazing.
One has to wonder what su...
OR - High Court Explains Requirements for Coverage
| 12 min read
The Oregon Supreme Court ruled that a business owner satisfied the statutory requirements to secure workers’ compensation coverage for her husband, who was her business partner and only employee.
Case: In the Matter of the Compensation of Pilling, No. S065737, 07/18/2019, published.
Facts: Mark Pilling worked for ACTMESS, organized as a partnership between him and his wife. In 2005, she registered the business as a sole proprietorship, naming herself as the owner and Pilling as her only employee.
In 2012, the City of Portland contracted with ACTMESS for the installation...
VA - Injured Worker Can't Get TTD for Condition Unrelated to Job
| 5 min read
The Virginia Supreme Court unanimously ruled that a worker with an arm injury was not entitled to temporary benefits for a total disability caused by kidney failure.
Case: Carrington v. Aquatic Co., No. 180243, 07/18/2019, published.
Facts: Carnell Carrington began working for the Aquatic Co. in 1992. He had pre-existing kidney disease that did not inhibit his ability to perform his job.
In 2013, Carrington injured his left arm at work, and received an award of medical and temporary total disability benefits.
Carrington was cleared by his doctors to return to light-duty work in November 20...
CA - Adviser Sentenced After Embezzling Almost $1 Million in Settlement Funds
| 10 min read
A Long Beach financial adviser has been sentenced to 124 months in state prison after being convicted of embezzling funds intended to pay for injured workers’ medical care after a settlement.
Tom Fallon, 65, was sentenced Thursday in Long Beach Superior Court after being convicted in an open plea of 25 criminal counts of money laundering and grand theft, the California Department of Insurance announced. In addition to serving time in prison, Fallon was ordered to pay restitution of $995,118.
According to CDI, Fallon worked in the same office as the victims’ attorney. Fallon u...
NY - Agency Cracks Down on Towing Industry Over Insurance Issues
| 8 min read
A New York state agency is threatening to revoke the licenses of 130 tow truck companies after an investigation allegedly found widespread insurance and workers’ compensation fraud in the industry.
The New York Department of Consumer and Worker Protection said the 130 tow truck companies represent a quarter of all tow truck licensees in the state. Each licensee will have a chance to meet with DCWP to dispute the charges and submit documents in support of their defense.
DCWP will issue final determinations after reviewing all defenses.
An ongoing investigation indicates that the compan...
Press - MTI America Welcomes Marc Pyatt as New Physical Medicine National Product Leader
POMPANO BEACH, Fla. (July 16, 2019) - MTI America announces that Marc Pyatt has joined the company as the Physical Medicine National Product Leader.
Pyatt brings more than two decades of experience as a physical therapist, manager and senior clinical specialist, for some of the nation's leading workers' compensation firms.
In his role at MTI America, he'll work closely with the compa...
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OH - BWC Proposes Rules for Treating Concussions
| 102 min read
The Ohio Bureau of Workers’ Compensation is holding a hearing in August to review proposed rules for treating concussions.
At the same time, the BWC will hear testimony on proposed changes to four additional sets of regulations arising out of the agency’s five-year rule review process, including:
4123-3-32 Temporary total examinations.
4123-18-03 Guidelines for referral to and acceptance into vocational rehabilitation.
4123-18-04 Living maintenance allowance.
4123-18-14 Injured workers suffering compensable injuries, occupational diseases or death while in an approved vocati...
NATL. - Marc Pyatt Joins MTI America as Physical Medicine National Product Leader
| 3 min read
MTI America, a provider of workers’ comp ancillary health care services, has hired Marc Pyatt as its physical medicine national product leader.
Pyatt will work with the company’s director of physical medicine, Jeff Ziblut, in developing and marketing new physical medicine services and clinical oversight programs. He will also develop and present continuing-education programs for clients and MTI America’s in-network physical medicine vendors.
Pyatt has more than two decades of experience as a physical therapist, manager and senior clinical specialist. He has worked for c...
AK - Labor Department Seeks Input to Define Contractor
| 27 min read
The Alaska Department of Labor and Workforce Development is holding a public hearing in August to discuss adopting a new definition of what constitutes an independent contractor.
The department said it wants a single definition of who is a contractor that would be used for unemployment, workers’ compensation, workplace safety, and wage and hour disputes.
State lawmakers spent two years working on creating a test to determine whether a worker is an independent contractor as part of the discussions surrounding House Bill 79 in 2017 and 2018.
The bill signed into law in August 2018 close...
OR - WCD Proposes Rules to Implement Legislation
| 23 min read
The Oregon Workers’ Compensation Division on Friday posted draft rules intended to implement legislation passed over the last two years.
House Bill 2087, enacted this year and effective Jan. 1, 2020, increases caps on violations for carriers, self-insured employers and service companies that fail to pay assessments or comply with the law.
The division’s rules refer to the current cap of $2,000 per violation and $10,000 in any three-month period. The caps increase to $4,000 per violation and $180,000 per year starting next year.
The division proposed removing any reference to spe...
NY - Applied Underwriters Fined $3 Million Over EquityComp Program
| 45 min read
The New York State Department of Financial Services has fined Applied Underwriters $3 million for offering workers’ compensation insurance bundled with side agreements that weren't filed with or approved by the department.
In announcing the fine on Thursday, DFS said the bundled programs were sold under names including EquityComp and SolutionOne. The products, sold in New York from 2010 through 2016, included guaranteed-cost workers’ comp policies issued by Continental Indemnity Co., an Applied subsidiary, along with a “reinsurance participation agreement” that emp...
CA - Report: Lara Campaign Accepts More Than $45,000 From People Linked to Applied Underwriters
| 34 min read
Although California Insurance Commissioner Ricardo Lara pledged not to accept money from the industry he regulates as part of his 2018 campaign, four months into his first term he took more than $45,000 from people tied to Applied Underwriters, the nonprofit Consumer Watchdog alleges.
The commissioner pledged to return the money shortly after the San Diego Union-Tribune wrote about the allegations for a July 7 story, Consumer Watchdog said.
The donations to Lara included $31,000 in contributions — $15,500 each from Stephen Acunto and his wife, Carole Acunto. Campaign finance record...
MT - Supreme Court Denies Benefits for Security Guard
| 31 min read
The Montana Supreme Court unanimously ruled that a security guard was barred from receiving benefits for an assault injury because he waited too long to file his workers’ compensation claim.
Case: Richardson v. Indemnity Insurance Co. of North America, No. DA 18-0594, 07/16/2019, published.
Facts: Brian Richardson worked for Securitas as a security guard. In November 2006, he was working at the Billings Clinic when he responded to an altercation involving a patient. Richardson’s supervisor prepared a report indicating the patient had hit Richardson in the mouth, ...