CA - Stakeholders, Industry Watchers Say New MLFS Unlikely to Fix Med-Legal Issues
03/02/2021 | 158 | 0 | 6 min read
The California Division of Workers’ Compensation’s final Medical-Legal Fee Schedule proposal may represent a step forward, but it’s not as big a step as many had hoped for, some stakeholders and industry observers said.
And while the proposal attempts to address recommendations listed in a 2019 State Auditor’s report that criticized the DWC’s handling of qualified medical evaluators, the new schedule’s lack of clarity could have providers and physician advocates relying on legislative efforts to improve the med-legal process going forward, they said.
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A California appellate court upheld an administrative determination that a municipal employer retaliated against a firefighter for engaging in protected union activities but that he had also misused his leave time.
Case: City of South Pasadena v. Public Employment Relations Board (Snider), No. B304596, 02/26/2021, unpublished.
Facts: Owen Cliff Snider worked for the City of South Pasadena from 2004 until 2016 and held various executive roles with the South Pasadena Firefighters’ Association. He served as president of the union in 2009 and again from 2011 until 2016.
In 2014,...
The Supreme Court of Tennessee’s Special Workers’ Compensation Appeals Panel ruled that if a worker’s activity results in an increase in pain but there is no new injury or aggravation of a prior compensable injury, the independent intervening cause principle is not applicable to relieve the original employer of liability.
Case: Paris v. McKee Foods Corp., No. E2020-00358-SC-R3-WC, 02/16/2021, published.
Facts and procedural history: Latoya Paris worked for McKee Foods Corp. as a palletizer. She injured her left wrist while at work in October 2005.
McKee accepted the injury...
The Iowa Court of Appeals ruled that an injured nurse was entitled to an award of benefits for a neck surgery that was related to her on-the-job injury, and to an award of penalties based on her employer’s termination of benefits without reasonable cause.
Case: Regional Care Hospital Partners Inc. v. Marrs, No. 19-2138, 02/17/2021, published.
Facts: Roberta Marrs worked as a nurse for the Ottumwa Regional Center. She injured her neck and back while at work.
Doctors diagnosed Marrs with thoracic and lumbar sprains. She received treatment and took four months off work before being clear...
Discovery can be a tricky subject, even for experienced attorneys.
The conduct of discovery in Florida "court" proceedings is governed by various subject-matter-specific rules adopted by the Florida Supreme Court. The Office of Judges of Compensation Claims is not a "court," and the Supreme Court does not make rules for workers' compensation proceedings.
That can be confusing. There are periodic questions about why discovery works the way it does (or more often, why it does not work the way someone wants it to). A focus of Discovery in Workers' Compe...
A Jacksonville construction contractor was sentenced to more than three years in federal prison last week after pleading guilty to mail and wire fraud and conspiring to defraud the U.S., the Department of Justice announced.
Hugo Cruz-Medina, 33, also pleaded guilty to illegally reentering the U.S. after being deported, the DOJ said.
A federal judge ordered Cruz-Medina to pay more than $3.2 million in restitution. The judge also ordered a money judgment of more than $1.4 million, which was the proceeds from the mail and wire fraud, the DOJ said.
Cruz-Medina pleaded guilty in September.
Pros...
A Missouri workers’ compensation insurance provider has denied a claim from a police officer who eventually died from COVID-19 because it ruled his exposure and death were not compensable, according to government officials and local media reports.
Officer Kendle Blackburn, 55, died Dec. 28 following a lengthy bout with the virus, according to news station KY3 and a news release from the City of Lebanon.
The city announced Friday that Missouri Employers Mutual, the city’s comp carrier, ruled that Blackburn’s illness and death did not satisfy workers’ comp statutes in t...
Virginia lawmakers over the weekend unanimously approved bills that would create a presumption that COVID-19 is a compensable occupational disease for first responders, corrections workers and health care providers.
Lawmakers also approved a bill that would extend a cancer presumption to emergency medical workers.
The state House of Delegates on Saturday voted 97-0 to approve conference committee amendments to House Bill 2207. The state Senate on the same day voted 39-0 to pass the bill by Del. Jerraud “Jay” Jones, D-Norfolk, that would create a presumption for firefighters, ...
The Montana Legislature passed a bill that would prohibit workers from receiving comp benefits in certain circumstances when they fail to disclose preexisting medical conditions on pre-employment questionnaires.
The state House of Representatives on Saturday voted 65-33 to pass Senate Bill 118, by Sen. Terry Gauthier, R-Helena. The Senate voted 31-18 to pass the bill Feb. 8.
The measure that is now heading to the governor’s desk would declare that a false statement on a pre-employment questionnaire asking about medical issues that are relevant to the offered job bars all indem...
Innovative Medical Management Acquires TPC Recovery,
Strengthening its Specialization in Revenue-Cycle Management for California
Anaheim, CA (February 1, 2021) - Innovative Medical Management, Inc. (IMM), a revenue-cycle management company specializing in complex claims management for California's healthcare providers for over 30 years, has acquired T...
ICW Group Insurance Cos. in San Diego says it has named a new vice president of product and pricing.
The large, private carrier announced last week that it has hired Iva Yuan, who has more than two decades of experience in the property and casualty insurance realm.
ICW Group said Yuan was hired to support the carrier's strategies for aggressive growth. Yuan will supervise the ICW Group’s strategic plans for product lines across various businesses, the company said.
She also is expected to collaborate with the company’s underwriters to offer “competi...
Gilson Daub, a workers’ compensation defense, subrogation and general liability firm, announced that it is opening an office in Utah.
The office in Salt Lake City will be managed by trial attorney Spencer Orr and primarily handle work comp defense, general liability, commercial auto defense and subrogation recovery, the firm said in a statement.
Gilson Daub said plans to open an office in Utah were initiated when Orr returned to the state from the firm’s office in Arizona. The firm said some of its national clients had requested litigation defense in Utah because their busine...
The New Jersey Compensation Rating and Inspection Bureau on Monday posted an address for system users to report technical concerns and ask questions about new electronic filing systems.
NJCRIB said all technical support questions should be sent to web.support@njcrib.com.
Examples of common technical issues identified in Advisory Bulletin No. 84 include having difficulty accessing an online service; failing to receive a confirmation email after signing up; not receiving an email when attempting to reset a password; and not being able to upload or save data.
NJCRIB in August 2020 announc...
The Florida Legislature convenes Tuesday and the workers' compensation bill that seems to be gaining the most attention is one that would force employee leasing companies to cover workers they may not know are on the job.
The National Association of Professional Employer Organizations “is very concerned with this legislation,” said Michael Kreiter, senior director of state government affairs for NAPEO.
Others said the bill, SB 820, would make professional employer organizations do what they should have been doing all along — accounting for and insuring all their workers...
The District of Columbia Court of Appeals upheld the calculation of a journeyman carpenter’s average weekly wage based on his total earnings over the 26 weeks before his injury.
Case: Hawk v. Department of Employment Services, No. 19-AA-1014, 01/22/2021, published.
Facts: Richard Hawk was a journeyman carpenter who did not regularly work for a particular employer. He would instead receive notice of specific jobs through his union. Hourly salaries for union carpenters are set by a collective bargaining agreement, and the number of hours available to work depends on the job.
Journeyman ...
A Louisiana appellate court issued three decisions granting summary judgment resolving issues in a complex, multi-party case arising from a worker’s accident during a hotel construction project.
Case: Maroulis v. Entergy Louisiana LLC, Nos. 20-C-226, 20-C-241 and 20-C-246, 02/10/2021, published.
Facts and procedural history: Hotel Investors LLC hired Sigur Construction and Castleman, Donlea, and Associates LLC to serve as the general contractors for the renovation of the Hampton Inn located in Metairie.
Castleman hired Sunbelt Rentals Scaffold Services LLC as a subcontractor.
Ioannis...
State Compensation Insurance Fund on Friday dismissed a lawsuit filed in federal court accusing the California Department of Insurance and Insurance Commissioner Ricardo Lara of violating terms of a settlement agreement.
The voluntary dismissal notice filed with the U.S. District Court for Central California says State Fund is dismissing the complaint because the Insurance Department vacated its order in a decision regarding Sessions Payroll Management that gave preclusive effect to an order issued in an administrative case involving A-Brite Blind & Drapery Cleaning.
Former Insurance Com...
The California Division of Workers’ Compensation posted a copy of final proposed Medical-Legal Fee Schedule changes it plans to adopt effective April 1.
The proposed fee schedule would pay $2,015 for a comprehensive medical-legal evaluation, including the review of up to 200 pages of records. Reimbursement for reviewing additional records would be $3 per page.
Payment for a follow-up evaluation would be $1,316.25, under the DWC’s proposal. The follow-up fee would cover the review of 200 pages of records that weren’t reviewed as part of the initial evaluation. Reimbursement ...
The Workers’ Compensation Insurance Rating Bureau of California on Friday submitted a proposed Sept. 1 regulatory filing that would, among other things, lower the experience rating threshold.
The WCIRB is proposing that the insurance commissioner reduce the experience rating eligibility threshold to $9,500 from $9,900 to reflect wage inflation and proposed expected loss rates.
Proposed changes to the California Workers’ Compensation Uniform Statistical Reporting Plan would improve clarity and consistency, the WCIRB said. Amendments to the Miscellaneous Regulations for the Recordi...
The Virginia General Assembly on Thursday approved a bill that would extend a respiratory, heart disease and cancer presumption to emergency medical service workers, starting in July.
The Senate voted 39-0 to agree with changes the House of Delegates made to Senate Bill 1275, by Sen. David Marsden, D-Burke.
When the Senate first passed the bill in early February, the effective date for the proposed presumption was July 1.
The House removed the date but later agreed to include it, along with an amendment removing a section that would have required emergency medical employees to work a m...
The Washington state Senate passed a bill that would create a presumption of compensability for health care workers who contract a contagious disease that is the subject of a public health emergency.
The Senate on Thursday voted 34-15 to pass SB 5190, by Sen. Jeff Holy, R-Spokane.
The bill would create a presumption covering health care workers at any type of facility who have direct contact with a person who has been exposed to or tested positive for a disease that is the subject of a health emergency.
Employers could rebut the presumption with clear and convincing evidence that exposure o...
The average total incurred cost for a claim with a traumatic brain injury was more than double the average of all lost-time claims between 2013 and 2018, according to a new report from the National Council on Compensation Insurance.
Average incurred costs per traumatic brain injury during the five-year study period were about $136,000, compared to an average of $51,000 for all lost-time claims. NCCI reports about 2.5% of TBI claims exceed $1 million.
NCCI said its research on megaclaims found brain and head injuries accounted for 17% of claims costing between $3 million and $5 million, and 3...
