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FL - Committee Passes Bill to Update Fee Schedule, Use Insolvent Carrier Data for Ratemaking

01/21/2022 | 0

The first fee schedule update for Florida physicians since 2016 cleared its first hurdle when it was unanimously passed by a Senate committee earlier in the week. The Senate Banking and Insurance Committee voted 9-0 to pass Senate Bill 1274 on Wednesday. The committee on the same day voted 9-0 to pass SB 1430, a multifaceted bill addressing insurer insolvencies that includes a provision that would require that past and prospective loss experience for bankrupt carriers be used to determine workers’ compensation rates. SB 1274, by Sen. Doug Broxson, R-Pensacola, would stamp the Legislatu... Read More

MT - Wages From Non-Concurrent Employment Properly Excluded From Benefit Calculation

01/21/2022 | 0

The Montana Workers’ Compensation Court upheld the State Fund’s calculation of a worker’s wages as excluding her income pursuant to her contractual employment with a school district. Case: Fite v. Montana State Fund, No. 2021-5416, 01/12/2022, published. Facts: In 2019 and 2020, Roberta Fite worked for Handley Transportation Inc. as a school bus driver during the school year and as a groundskeeper during the summer break. During the 2019-2020 school year, Fite also worked as a contract employee for the Clinton Elementary School District as a paraprofessional/aide. Fi... Read More

WV - Supreme Court Upholds Denial of Benefits to Widow of Worker With Pneumoconiosis

01/21/2022 | 0

The West Virginia Supreme Court upheld a denial of benefits to a worker’s widow, finding the man had occupational pneumoconiosis, but the condition did not materially contribute to his death. Case: Ash v. Glaspell Lumber Co. Inc., No. 20-0607, 01/11/2022, published. Facts: Roy Ash was a plant worker for 44 years, during which time he was exposed to hazardous dust. A computed tomography scan of his lungs taken in April 2015 showed findings suggestive of pulmonary fibrosis. There were no acute infiltrates or pulmonary fibrosis nodules. Dr. Johnsey Leef reviewed Ash’s chest X-rays... Read More

NY - Public Safety Officer Gets Benefits Despite Failure to Provide Timely Notice of Injury

01/21/2022 | 0

A New York appellate court upheld an award of benefits to a public safety officer despite his failure to provide his employer with timely notice of his injury. Case: Matter of McElroy v. Siena College, No. 532397, 01/06/2022, published. Facts: Samuel McElroy worked for Siena College as a public safety officer. He filed a workers’ compensation claim for alleged injuries he sustained in May 2019 while patrolling a college dormitory. McElroy asserted that he had stepped down on a step when he suddenly felt a burning sensation and pain in his right foot and ankle. McElroy claimed he gave... Read More

Industry Insights

CA - Young: 2022 Workers' Comp Quiz

By Julius Young
01/21/2022 | 0

Where is California workers’ comp headed in 2022? That’s the subject of the 2022 Workers Comp Zone quiz. Each year I kick off the year with a quiz for workers’ comp savants. In some instances, there may be more than one correct answer, or perhaps none. But perhaps you can see through the fog. Give it a whirl. 1. The Workers' Compensation Appeals Board has had an open slot since the 2021 departure of Juan Pedro Gaffney. In 2022, Gov. Gavin Newsom will:  Appoint an applicants' attorney to the slot. Use the slot for a retiring legislator. Appoin... Read More

NY - Worker Can't Challenge Decision Due to Incomplete Application for Review

01/21/2022 | 0

A New York appellate court upheld the dismissal of a worker’s challenge to the apportionment of his disability claim based on his incomplete application for administrative review. Case: Matter of Muse v. Asplundh Construction, No. 533139, 01/06/2022, published. Facts and procedural history: Scot Muse worked for Asplundh Construction. He suffered injuries to his right knee and hip in 2018. Muse established his entitlement to benefits for the injuries, and his claim was later amended to include a back injury. In May 2020, a workers’ compensation law judge found Muse had reached m... Read More

NY - Report: Contractor Charged With Payroll Fraud

01/21/2022 | 0

A New York contractor was indicted on suspicion of underreporting payroll to illegally reduce his workers’ compensation premiums, according to a report by the Rockland/Westchester Journal News. Anthony P. Frascone, 51, the owner and principal of Alpha-Omega construction company, was arraigned Jan. 13. He allegedly claimed he was operating a real estate company with only one employee and $40,000 in payroll when applying for workers’ compensation coverage for the period from November 2016 to November 2017. Prosecutors said Frascone employed more than 90 people with a payroll of mo... Read More

CA - QME Emergency Telehealth Regulations in Effect

01/21/2022 | 0

The California Division of Workers’ Compensation announced that emergency regulations allowing telehealth for medical-legal evaluations went into effect earlier this week and will expire July 19. The division said it can seek two 90-day extensions of the rule when they expire. “The emergency regulation will help reduce physician and injured workers’ exposure to the COVID-19 virus, reduce the use of personal protective equipment and allow injured workers and physicians flexibility in evaluation site locations, which will help injured workers and employers continue to move th... Read More

CA - WCIRB C&R Committee Meets Feb. 1

01/21/2022 | 0

The Workers’ Compensation Insurance Rating Bureau of California Classification and Rating Committee is meeting at 9:30 a.m. Feb. 1. Committee members will discuss classification relativities and review payroll limitation methodologies. Members will also discuss computer programming in the electronics manufacturing industry. The C&R Committee will meet virtually. More information, including a link to the agenda with instructions for registering to attend the meeting, is here. ... Read More

CA - Cost Disparities Complicate Efforts to Exempt Topical Analgesics From UR

By Greg Jones (Senior Editor)
01/20/2022 | 0

Some members of the committee advising the California Division of Workers’ Compensation on its prescription drug formulary would like to fast-track certain topical analgesics by exempting them from utilization review. Doing so, however, will require more analysis of the different prices for similar products and how to protect against bad actors who might game the system by prescribing the most expensive formulations, according to a discussion during the Pharmacy and Therapeutics Committee meeting Wednesday. The P&T Committee advises the division on evidence-based changes to the for... Read More

NY - Court Revives Widow's Claim for WTC Worker's Fatal Lung Cancer

01/20/2022 | 0

A New York appellate court revived a widow’s claim for benefits for her husband’s death from lung cancer following his work during the cleanup efforts at the World Trade Center aftermath of the Sept. 11, 2001, terrorist attacks. Case: Matter of Murphy v. New York State Courts, No. 532023, 01/06/2022, published. Facts: At the time of the Sept. 11, 2001, terrorist attacks on the World Trade Center, Theresa Murphy’s husband was working as a court officer. He participated in the World Trade Center rescue, recovery and cleanup operations from September 2001 through February 2002... Read More

NY - No Benefits for Truck Driver With Alleged Back Injury From Heavy Lifting

01/20/2022 | 0

A New York appellate court upheld the denial of benefits to a truck driver for an alleged back injury from lifting a heavy box. Case: Matter of Moore v. U.S. Xpress Inc., No. 532233, 01/06/2022, published. Facts: Jerry Moore worked for U.S. Xpress Inc. as a truck driver. He allegedly injured his back on Oct. 15, 2015. According to Moore, he experienced a sharp pain in his back as he was lifting a heavy box from above his head. He admitted, however, that the pain subsided and that he continued to manually unload his truck and did not report the incident to his employer. Moore continued work... Read More

AR - Truck Driver Gets Benefits for Fall

01/20/2022 | 0

The Arkansas Court of Appeals upheld an award of benefits to a truck driver for his injuries from a fall after he had clocked out for the day and was removing his personal items. Case: Wal-Mart Associates v. Anderson, No. CV-21-244, 01/12/2022, published. Facts: Willie Anderson worked as a truck driver for Wal-Mart Associates Inc. Anderson lived in Arkadelphia, but his employment was based in Searcy. On a typical work week, Anderson would drive his personal vehicle from his home in Arkadelphia to Searcy on Monday night, then spend the night in a Wal-Mart truck. On Tuesday morning, he w... Read More

NJ - Supreme Court Awards Benefits to Librarian Struck by Snowplow

01/20/2022 | 0

The New Jersey Supreme Court ruled that a librarian was entitled to benefits for her injuries from being struck by a snowplow as she walked from her workplace to her vehicle. Case: Lapsley v. Township of Sparta, No. A-68/69, 01/18/2022, published. Facts: Diane Lapsley worked for the Township of Sparta at the Sparta Public Library. The library is in a municipal complex with athletic fields, offices and three common-use parking lots. The township owns and maintains the parking lots, which are open to employees and the general public alike. The township did not direct employees to use th... Read More

NY - Employer Waits Too Long to Assert Cross-Examination Right

01/20/2022 | 0

A New York appellate court ruled that an employer waived its right to cross-examine a worker’s attending physician by waiting too long. Case: Matter of Lazalee v. Wegmans Food Markets Inc., No. 532932, 01/06/2022, published. Facts and procedural history: Thomas Lazalee worked as a truck driver for Wegmans Food Markets Inc., a self-insured employer. He established a workers’ compensation claim for an occupational disease to his right hand. Lazalee had surgery in October 2018 to repair a trigger thumb and carpal tunnel syndrome. Dr. Raymond Stefanich performed an approved surgery ... Read More

NY - Board Properly Denies Worker's Request for Rehearing/Reopening

01/20/2022 | 0

A New York appellate court ruled that the Workers’ Compensation Board did not abuse its discretion in denying a worker’s application for rehearing or reopening based on her challenge to jurisdiction over her claim. Case: In the Matter of Fuller-Astarita v. ABA Transportation Holding Co., No. 532903, 01/06/2022, published. Facts: Joanne Fuller-Astarita worked for the ABA Transportation Holding Co. as a bus driver’s assistant. She suffered injuries when she was struck by a bus owned by ABA. Procedural history: Although Fuller-Astarita did not file a claim for workers' co... Read More