August 2013

Sending Out an SOS

The Qualified Medical Evaluator Panel process in California has hit a setback. The wait for QME panels is months long. Could it be there aren't enough physician-evaluators to go around?

The California Division of Workers' Compensation back in May issued
an announcement ("Newsline") in which the division acknowledged that delays have returned in assigning QME panels. The DWC vowed to identify and correct them. The early blame points to lack a staffing at the Medical Unit.

The wait for a panel of three physicians to evaluate an injured work was five months in April, according to an email the DWC sent our Sacramento-based reporter, Greg Jones.

"Division spokeswoman Erika Monterroza said the Medical Unit was issuing panels within 30 days until July 2012, but is now about five months behind in processing requests," Greg wrote April 29 in a WorkCompCentral story.

“The subsequent delay in issuance of panels occurred after overtime and student assistant work was no longer available,” she explained. “The current backlog for represented cases is back to the end of November 2012.”

In talking with people in the legal system, I've been told there are not enough QMEs to assign. Could that be slowing down the panel process, too? Wouldn't recruiting more doctors to become QMEs be a reasonable place to start?  

There are between 3,000 and 4,000 QMEs across the spectrum of medical specialties. The exact number is probably somewhere in the middle. Unrepresented injured workers are getting their panel QMEs more quickly than do represented claimants, the DWC admits. Attorneys are frustrated and judges are empathetic. Neither has the authority to intervene. 

Even though the majority of California's population live in metro areas, the state is expansive. Our state extends 350 miles from east to west, and stretches 780 miles from the Oregon border to Mexico. Alpine County is the smallest in terms of population (1,208 residents), yet it covers 738 square miles. Sierra County has 3,555 people scattered over 953 square miles of land. Modoc has 9,449 people in a county of nearly 4,000 square miles. 

The rural areas are always in need of more QMEs, especially physicians who specialize in orthopedics, internal medicine and neurology. However, the metro areas could use more QME panelists, too.

Getting back to the question, "Would having more QMEs speed the process," there is a way to find out. If more medical treaters applied to become QMEs, we'd have an answer. 

QMEs include medical doctors, doctors of osteopathy, doctors of chiropractic, dentists, optometrists, podiatrists, psychologists and acupuncturists. As a QME, these medical professionals evaluate an injured worker when there are questions about what benefits they should receive. The QME is supposed to be impartial, issuing a medical opinion that can be admitted into evidence at trial. A judge is the arbiter of the physician's report, and the medical-report guides the judge in his or her decision.

Long story short. There is a QME state-administered exam Oct. 19. This is an opportunity for medical treaters who want to expand their practices to disability evaluation of California injured workers. The test is being administered once in 2013; there is time to apply and prepare.

The fee schedule and rules for QME evaluations are straightforward. Getting paid should be, too. 

Calling all qualified treaters in workers' comp.

If becoming a QME is something that interests you, great. The system would benefit from having more physicians on QME Panels. Follow these steps if you decide to answer the call for more evaluators. 

Timeline

1.  ASAP - Download the application to become a QME

2.  By Sept. 12: Postmark application to qualify for the exam.  

3.  Wait for the DWC to confirm you are eligible.  
4.  Pay the $125 fee.

5.  Start studying for the Oct. 19 exam.  DWC will email study guides.
6.  Consider taking a pre-exam study course. WorkCompCentral offers two next month.

7.  Oct. 19 - sit for the exam at Northern and Southern California locations. 

Call (510) 286-3700 or e-mail QMETest@dir.ca.gov for further assistance.

A Credit to California Physicians

WorkCompCentral will begin offering Continuing Medical Education coursework to California physicians through a newly struck partnership with the American Academy of Disability Evaluating Physicians.

AADEP's alliance with WorkCompCentral will allow physicians and QMEs who enroll and complete the disability-evaluation courses to receive both QME and CME credit for selected seminars, webinars or online courses. The American Academy of Disability Evaluating Physicians is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

A series of monthly webinars from WorkCompCentral in conjunction with AADEP will debut on Sept. 17. "The Physicians’ Assessment Tool Series"will begin with Dr. Mark Hyman, president of the American Academy of Disability Evaluating Physicians, discussing:

Part I: “Activities of Daily Living (ADL) Questionnaires"
Part II: “Pain Questionnaires” on Oct. 15. 

Start times: 4:15 p.m. Pacific Time.

The cost to attend is $69 for a single session, $109 for both. Register by calling the WorkCompCentral Education office, 805-484-0333, ext. 121.

The American Academy of Disability Evaluating Physicians is accredited by the ACCME to provide  2.0 AMA PRA Category 1 credits™ for the two-part webinar series, hosted by Dr. Hyman.

WorkCompCentral is an approved provider of continuing education for Qualified Medical Evaluators through the California Division of Workers' Compensation.

 AADEP is a society dedicated to serving physicians involved in disability management. Its activities include ongoing teaching of the management of disabled patients, impairment and disability evaluation to physicians and other health care providers, and educating attorneys, regulators, legislators and others involved in the care of the disabled. AADEP also coordinates research in disability management.


Pot Law's Impact on Illinois Employers 
The medical marijuana law signed Aug. 1 by Gov. Pat Quinn will have a relatively small impact on the daily operations of employers, despite some new protections for medical users, employment and workers' compensation defense attorneys say.



Attorneys told WorkCompCentral that employers have been calling for advice on whether they will have to tolerate stoned employees or allow workers to smoke in the workplace because of the "Compassionate Use of Medical Cannabis Pilot Program Act.

"

First of all, we are telling them, 'Do not panic,'" said Caryl Flannery, a partner with the Smith Amundsen law firm's St. Louis office. "There are a lot of protections for employers in this law. On a day-to-day basis, probably not much will change for most employers.

"

The crux of the law says that you cannot refuse to hire, terminate or take punitive action against a user based on their status," Flannery said. "So you cannot say, 'You are a medical marijuana user, I am not going to hire you.'"



Businesses, such as trucking companies, that are subject to federal transportation regulations, are concerned about whether the law will conflict with federal licensing provisions. 

Flannery said that employers who are required to follow federal law may continue to maintain drug-free workplaces, because marijuana is still a Class 1 drug under federal law. She said that reasoning should apply to businesses who are subject to federal licensing provisions, employers who are directly regulated by the federal government and companies that must follow federal guidelines to fulfill federal contracts.

Editor's note: Read the full article at WorkCompCentral.com. A subscription it required to access the news content.

Bethany Hamilton, pro surfer

'Soul Surfer' to Keynote Dana Point Conference Oct. 2-4

Professional surfer Bethany Hamilton, who was the inspiration for the biography and movie "Soul Surfer," is a keynote speaker at the 2013 California Workers' Compensation & Risk Conference in Dana Point, Calif.

Her motivational presentation, sponsored by Sedgwick, is part of the three-day conference of 95 expert speakers and leaders from the California workers' comp system. The conference runs Oct. 2-4 at the St. Regis Hotel in Dana Point. There also will be networking events, including a Monte Carlo Night, and an autograph session with Bethany Hamilton, whose left arm was bitten by a shark.

The opening keynote session will focus on the California reforms for 2013 and include a cross-section of voices and perspectives. The moderator for this discussion is Mark Walls, who started the Work' Comp Analysis Group on LinkedIn, which is the largest social-network group of its kind for the workers' comp industry. The voices on the panel are:

Opening Keynote Session: "SB 863 – 10 months later, what works and what doesn’t" (Employers and Stakeholders)
* Max Koonce, Sr. Director, Risk Management (Wal-Mart)
* Mark Webb, Vice President & General Counsel (Pacific Compensation Insurance Company)
* Martin Brady, Executive director (Schools Insurance Authority)
* Steve Cattolica, Director of Government Relations for the California Society of Industrial Medicine and Surgery (
* Richard (Jake) Jacobsmeyer, Esq., (Shaw, Jacobsmeyer, Crain& Claffey PC)
* Robert G Rassp, Esq.(Author, "Lawyer's Guide to the AMA Guides and CA Workers' Compensation 2013  Lexis Nexis Matthew Bender & Co.), (Chairman of the Board of Directors, Friends Research Institute, Baltimore MD)

A second keynote session about SB 863 involves Christine Baker, the director of the Department of Industrial Relations and senior management and industry leaders.

- Keynote Session: "SB 863… 10 months later…. Update from the Director of the Department of Industrial Relations" presented by DIR Director Christine Baker.

- CEOs & Stakeholders “Open Mic” Q & A Panel: This session will feature E- and C-suite leaders, senior management and industry stakeholders from top TPAs and carriers identifying emerging trends that are of great importance to employers in California.  David North (Sedgwick), Robert Darby (Berkshire Hathaway Homestate Companies), Rich Friesenhahn (AIG), Barbara Luck (XL Group) and Kevin Finn (The Hartford) & Pamela Ferrandino, National Casualty Practice Leader, Placement (Willis North America) are invited panelists.

Twenty continuing education credit hours are available for California claims professionals, attorneys and insurance brokers.

A charity golf tournament is scheduled for Oct. 1. Email Kristi Hanson at kristihanson@cwcriskconference.org to register for the tournament. Conference and hotel pricing are available at www.cwcriskconference.org. 

AMA Redefines Obesity, and Ups the Ante 

Have you heard about this one yet? The American Medical Association decided to reclassify obesity as a “disease” rather than a “condition." A just-released study predicts the change could be costly for employers.

The California Workers’ Compensation Institute reports that historically obesity has been a comorbidity issue that’s largely gone unreported because it had not interfered with treatment for most injuries.

“The result could be an increasing number of claims that include obesity as a comorbidity, as well as an increase in cases in which obesity is claimed as a compensable consequence of injury in the same way that sleep disorders, sexual dysfunction and psychological disorders became commonplace prior to the passage of SB 863,”

CWCI President Alex Swedlow, who coauthored the research paper, said for the majority of injuries, such as minor wounds or abrasions, it doesn’t matter whether or not a worker is obese. It can be an issue with more significant injuries such as damage to the joints or spine.

“Obesity is a comorbidity issue and doesn’t happen very often,” Swedlow said. “Now, what’s happened, is they’ve essentially medicalized about one-third of the workforce and it raises the specter of the issue of obesity and creates a question mark as to whether or not this will influence the likelihood of obesity as a compensable consequence or as a primary injury.”

Although rarely a complicating issue in workers’ compensation claims, CWCI has identified obesity as one of the top 10 cost drivers for the past three years. Swedlow said in the few cases in which obesity is an issue, “it really contributes to adverse development.”

According to the research paper, a review of more than 1 million claims from accident years 2005 through 2010 found obesity was a comorbidity in just 5,597 cases, or 0.5% of the sample size. About 24% of all obesity comorbidity claims are for back problems without spinal cord involvement – typically sprains and strains – and 10% are for degenerative, infective and metabolic joint disorders. Of the claims without an obesity comorbidity, only 14% are for nonspecific back injuries and 2.5% are for joint disorders.

Additionally, claims with obesity comorbidities are 4.5 times more likely to involve an attorney and 3.7 times more likely to have a prescription for opioids. All told, average total benefits for claims with obesity comorbidities are 81.3% higher than for claims without an obesity comorbidity.

Making News in August
TX:  High Court Denies Review to Impairment-Rating Dispute
FL:  Investigators Arrest 5 in Staffing Company Probe
NC:  Calls Growing for McCrory to Veto Regulatory Reform Bill
CA:  Whistleblowers Allege Massive Spinal Fusion Scheme
NY:  Counties Say Schedule Loss Awards an Emerging Cost Drive
PA:  Lawmaker Seeking Mandatory Use of Coordinated Care Networks
PA:  Insurers Predicting 1,500 Fire Departments Will Migrate to SWIF
NY: SWCB Taps Deloitte for Major Systems Overhaul
FL:   Repackaged Drug Deal Struck in Legislative Hallway
Nation: Obamacare Top Issue at WCI Conference in Orlando
NJ:   Labor Officials Revamp PEO Regs

News articles mentioned in our newsletter are available for subscribers or single purchase at workcompcentral.com

Regulations Catch Interpreters Off Guard

The California DWC has permanent regulations regarding the standards interpreters must meet for legal proceedings and medical exams. The new rules took effect earlier than expected on Aug. 13.

The new regulations state that:

* Interpreters must be certified in order to be paid for services provided during a legal proceeding or a medical appointment. 

*. Interpreters for medical appointments must qualify for certification by passing an exam administered by either the Certification Commission for Healthcare Interpreters or the National Board of Certification for Medical Interpreters. 

* Interpreters can also be provisionally certified, indicating they are qualified to provide services when a certified interpreter is not available. 

The regulations are posted at the DWC web site. 

Interpreters say they were surprised by the early adoption of the rules, which took effect immediately instead of on Oct. 1. Representatives of interpreters and injured workers plan to ask the DWC acting Administrative Director Destie Overpeck for a grace period to allow them to take certification training.

The training typically requires three to four months to prepare for either of the exams, according to Gilbert Calhoun, president of the California Workers’ Compensation Interpreters Association.

Events in Your Area

-- The California Self-Insurers Association will hold its Fall Educational Conference on Sept. 20 at the Marriott Hotel in Walnut Creek, Calif.

- The California Workers' Compensation & Risk Conference, Dana Point, Oct. 2-4. Charity golf tournament, 20 CEs, exhibitors, nightly networking events. 

-- The Illinois Self-Insurers Association's annual workers' compensation seminar is being held on Oct. 3-4 at the Lincolnshire Marriott Resort at 10 Marriott Drive in Lincolnshire, Ill.

-- The Minnesota Department of Labor & Industry is accepting registrations for its 2013 Workers' Compensation Summit, to be held Sept. 12 at the Crowne Plaza Hotel in St. Paul.

-- The North Carolina Rate Bureau has scheduled its 36th annual meeting for Oct. 16 in Greensboro, N.C.

-- Target Markets Program Administrators Association will host its 13th Annual Summit in Scottsdale, Ariz., from Oct. 21-23. The summit at the Westin Kierland Resort & Spa is expected to draw 750 program business professionals.

- The 11th Annual California Workers' Comp Forum, Oct. 24-25, Hard Rock Cafe, San Diego. Keynote speaker: CWCI President Alex Swedlow. 

-- The Virginia Workers' Compensation Commission is planning a meeting for attorneys on Oct. 16 in Charlottesville, Va. The meeting will be held at the DoubleTree Hilton Hotel, 990 Hilton Heights Road in Charlottesville; phone: 434-973-2121.

- The National Workers' Compensation & Disability Conference and Expo, Nov. 20-22, Mandalay Bay Resort, Las Vegas. 

July 2013 Issue

Is negative media coverage for an on-the-job incident a cause for a workers' comp injury? That is a core issue in a case involving a University of California police officer who was photographed as he pepper-sprayed protesters at sit-in on the Berkeley campus.

Read on to learn more about the issue and the officer's claim for a psychological injury. Plus, learn about upcoming chances to earn continuing-education credits between now and the end of summer.

- Rob McCarthy, newsletter editor

------------------------------------------

PEPPER-SPRAYING OFFICER WANTS COMP BENEFITS
A University of California, Davis, police officer is seeking workers’ compensation benefits for the psychological distress he allegedly suffered as the result of pepper-spraying protesters in 2011, according to a widely circulated news report.

The Davis Enterprise reported last week about a comp claim filed by former Officer John Pike. Back in November 2011, Pike gained notoriety after video and pictures showed him emptying a canister of pepper spray into the face of students who were sitting on a sidewalk in protest of tuition hikes. He was fired in late July 2012 by UC Davis Police Chief Matt Carmichael.

An internal affairs investigation sided with Pike, saying that he acted reasonably. The report recommended a suspension rather than dismissal from the campus police force.

The Enterprise reported that the pepper spray Pike used was not sanctioned by the department, and that proper protocol for using pepper spray doesn’t include spraying people in the face at close range.

Pike used MK-9 brand pepper spray, which claims to have 0.7% concentration of capsaicin, the active ingredient that makes it burn, making it more than three times stronger than the department-sanctioned pepper spray, which has a concentration of 0.2%. By comparison, the U.S. government says pepper spray formulated to deter bear attacks should have a concentration of at least 1%.

Pike says he received death threats after the video and pictures went “viral” and hackers posted his personal information online.

Pike filed his claim against UC Davis on June 10, alleging a single psychiatric injury. The claim is scheduled for a mandatory settlement conference on Aug. 13 in Sacramento, according to information in the Electronic Adjudication Management System.

With camera phones so prevalent in our society today, citizens are capturing confrontations with police on video and posting them to social media sites. This is a case worth watching, especially for claims adjusters and third-party administrators for public safety agencies.

Send your comments to me at rob@workcompcentral.com I'm not asking for a rush to judgment, however. I am interested in whether there is precedential case law for a psyche injury due to public outcry. 

Officer Pike was fired after dousing students at a 2011 sit-in.  

REFORM UPDATE: NORTH CAROLINA
North Carolina lawmakers just ended a busy session that included approval of bills that will shift the workers' compensation hospital fee schedule to the formula used by Medicare and strip the state's 20 workers' compensation judges of job protections provided by the State Personnel Act.

Gov. Pat McCrory signed the bill, SB 174, into law on July 18. SB 174 rejected three dozen of the 153 rules adopted by the Industrial Commission in response to 2011 legislation. The new law also requires the Industrial Commission to adopt a three-tiered system for resolving medical treatment disputes;

House Bill 74, the session's regulatory reform bill, also was among a major workers' compensation bill passed during the 2013 session. HB 74 removes deputy industrial commissioners – North Carolina's workers' compensation judges – and the commission's administrator and executive secretary from protections under the State Personnel Act. The act prohibits the firing of state workers with two or more years on the job without "just cause."

The House and Senate also approved HB 92, which includes a compromise between insurers and employers on one side and the North Carolina Hospital Association. The bill deletes the section of North Carolina law that bases inpatient and outpatient fees on a percentage of itemized charges and requires that hospital fee schedules be based on "Medicare methodology."

HB 94 requires that the Industrial Commission come up with a new fee schedule based on "applicable Medicare payment methodology" and that the schedule be periodically reviewed by the commission.

The news article appears in WorkCompCentral today, July 29. The link to the story is found here. You must have a subscription to access the news content; one-time purchase of this story is also available.

-------------------------------------------

UPCOMING WEBINAR SCHEDULE
More webinars are on the way this summer, including a complimentary program on August 6 about how one state is regulating pain meds.


1. TOPIC
"How Washington State is Changing Pain Treatment" - A Free Webinar

Summary: Presented by Dr. Gary Franklin, the Chief Medical Director for the Washington State Department of Labor and Industries. Dr. Franklin and his state are models for the rest of the states. He will discuss how prescription narcotics are curbed through regulatory measures.

Date & Time:
Tuesday, August 6
10 a.m. to 11 a.m Pacific                

Dr. Gary Franklin

Register:
This event is FREE to attend.
You must register yourself using this link


2. TOPIC
"The Influence of the Psyche on Pain" - Aug. 1

Overview: Psychologist and registered nurse Dr. Julie Armstrong focuses on the psychological influences of pain and pain reduction. Dr. Armstrong will address the role of the unconscious in patients with pain, and the various psychiatric diagnoses that are influenced by pain.

Date & Time:
1 p.m., Pacific
Thursday, August 1

Who Should Enroll:
Psychologists, Attorneys, Paralegals, Workers' comp program managers and employer representatives.

CE Credit: 1 hour is available for California attorneys and claims adjusters

Price:                                                             

Michael Sullivan

$69 or $199 for the 5-part series.

Register


3. TOPIC
"What's New & How to Best Manage Under SB 863: Part 1 of 2"

Summary: The lead author of the California workers' compensation legal treatise "Sullivan on Comp" surveys how reforms are being implemented and new strategies. This program is complimentary to full-access subscribers of Sullivan on Comp.

PART 1
Friday, August 23
2:00 p.m. to 3:00 p.m, Pacific

PART 2
Friday, September 13
2:00 p.m. to 3:00 p.m, Pacific

Continuing Education Credit:
1 Claims (per session)
1 Legal Specialization
1 MCLE

Register:
$69 each or $109 for both sessions. Please call to purchase the two-part series at the $109 rate.

Registration assistance is available by calling 805-484-0333, ext. 113 or 133.

-------------------------------

CALIFORNIA ANNOUNCES DATE FOR FALL QME EXAM
The California Division of Workers’ Compensation is accepting applications for the Oct. 19 qualified medical evaluator exam that will be administered in South San Francisco and Irvine.

Physicians and eligible medical treaters who wish to take the exam

can prepare with Judge Colleen Casey on consecutive Saturdays, Sept. 21 and 28. The prep class in Southern California is 9/21; the Northern California class is 9/28.

Class and exam details found on our web site.

QMEs are independent physicians certified by the division’s Medical Unit to conduct evaluations and determine issues, including whether an injured worker can perform certain work activities or has a permanent impairment or disability.

Applications for the October exam must be postmarked by Sept. 12 and include a nonrefundable $125 fee.

Additionally, before appointment as a QME, a physician will have to complete a course in disability evaluation report writing. WorkCompCentral has an all-new writing course aimed at compliance with the changes in the law for 2013. A description is here.

The QME exam will be administered at the South San Francisco Conference Center, 255 S. Airport Blvd., and the Irvine Marriott Hotel, 18000 Von Karman Ave.

An exam packet with additional information is available at the DWC web site.

For more information, contact the Medical Unit at 510-286-3700, Joanne Van Raam at 510-628-2004 or Francine Wooley at 510-628-2038.

--------------------------------------------

NEW SUPPLEMENTAL BENEFIT PROGRAM IN THE WORKS
California officials appear to have as many questions as answers when it comes to implementing a program that will make up to $120 million a year in supplemental payments to some injured workers.

Kathy Zalewski, chief counsel for the Department of Industrial Relations, said on the final day of the California Coalition on Workers’ Compensation 11th annual Conference, Legislative and Educational Forum that she has some ideas for the program the administration is calling the Special Earnings Loss Supplement.

Injured workers will have to receive a supplemental job displacement benefit voucher to be eligible for payments from the $120 million fund. They will also have to prove their post-injury earnings are disproportionately lower than what they were making before being hurt.

A Rand Corp. study that is expected to be completed soon will be the basis for determining what constitutes “disproportionate” loss of earnings, and the department hopes to release draft regulations sometime in September.

That’s where the certainty ends.

The questions include how a worker will prove pre- and post-injury earnings; whether retirement, disability and other sources of income should be counted as earnings; how long a worker must wait to qualify for the program; if the department will make a one-time payment to the injured worker or issue periodic payments; if a worker can appeal a decision to preclude him from receiving payments or challenge the amount of the payments and how he does this.

(The full article appeared July 22 on WorkCompCentral. Read it with a subscription or purchase it for one-time use on our web site.

-------------------------------------------

FLORIDA DWC READY WITH REPACKAGED DRUG RULE
The Florida Division of Workers' Compensation said last week it plans to adopt a rule to implement the cap on repackaged drug prices imposed by the Florida Legislature during the 2013 session.

The bill caps the price of repackaged drugs at 112.5% of the

average wholesale price set by the drug's original manufacturer, plus an $8 dispensing fee. State law caps the price of drugs dispensed by pharmacies at 100% of the AWP, plus a dispensing fee of $4.18.

DWC said in a regulatory notice that, in response to the new law, it is developing amendments to the Florida Workers' Compensation Health Care Provider Reimbursement Manual, Rule Chapter 69L-7.020 of the Florida Administrative Code, and the Florida Workers' Compensation Medical Services, Billing, Filing, and Reporting Rule, Florida Administrative Code Rule Chapter 69L-7.602.

DWC said that, if requested in writing and deemed necessary, the division will hold a rules-development workshop in Tallahassee, Fla., on Aug. 8. The notice of rules development was posted in the July 19 edition of the Florida Administrative Register.

Questions and comments should be submitted to Eric Lloyd, administrator for the Office of Medical Services. He can be reached at 850-413-1689 or at Eric.Lloyd@myfloridacfo.com.

------------------------------------------

EVENTS IN YOUR AREA

-- The Alabama Self-Insurers Association will hold its summer conference Aug. 11-13 at the Hilton Sandestin Beach Golf Resort & Spa in Destin, Fla.

-- Target Markets Program Administrators Association will host its 13th Annual Summit in Scottsdale, Ariz., from Oct. 21-23. The summit at the Westin Kierland Resort & Spa is expected to draw 750 program business professionals.

-- The California Self-Insurers Association will hold its Fall Educational Conference on Sept. 20 at the Marriott Hotel in Walnut Creek, Calif.

-- The Illinois Self-Insurers Association's annual workers' compensation seminar is being held on Oct. 3-4 at the Lincolnshire Marriott Resort at 10 Marriott Drive in Lincolnshire, Ill.

-- The Indiana Workers' Compensation Institute and Indiana Self-Insurers' Association are sponsoring the 22nd Annual Workers' Compensation Seminar on Aug. 7-8 in Indianapolis, Ind.

-- The Minnesota Department of Labor & Industry is accepting registrations for its 2013 Workers' Compensation Summit, to be held Sept. 12 at the Crowne Plaza Hotel in St. Paul.

-- The Nevada Division of Industrial Relations will explore drug testing, the impact of health care reform and when to operate on cervical spine injuries during its third annual Workers’ Compensation Educational Conference, Aug. 5 and 16 at the Tuscany Suites Hotel, 255 E. Flamingo Road in Las Vegas.

-- The North Carolina Rate Bureau has scheduled its 36th annual meeting for Oct. 16 in Greensboro, N.C.

-- The Texas Division of Workers' Compensation will host an Aug. 8 training session in Austin describing how carriers' loss-control personnel can implement new rules regulating accident-prevention services in the state of Texas.

-- The Virginia Workers' Compensation Commission is planning a meeting for attorneys on Oct. 16 in Charlottesville, Va. The meeting will be held at the DoubleTree Hilton Hotel, 990 Hilton Heights Road in Charlottesville; phone: 434-973-2121.

May 2013 Newsletter Issue

Despite a record cold spring across the nation, the weather is heating up in time for the Memorial Day Weekend. You know what else is heating up?

Brrr ... March 25 in Columbia, MO.

Efforts by lawmakers in nearly one in five states to push through new workers' comp laws before the term ends.

Reform brings change. Preparing for the change is one goal of our education team, which is why we've built the reform tracker.

Use this reform tracker to get ahead of the coming and proposed changes in your state or states, courtesy of WorkCompCentral.

Sit back, buckle up and let's go on a nationwide tour of statehouses with a focus on who's overhauling workers' comp and who's tinkering.

- Rob McCarthy

REFORM TRACKER 2013   

As promised, here is a rundown of states where workers' comp legislation is most active in the 2013 session. From the looks of things, Minnesota lawmakers are doing the heavy lifting in the 2013 session.

To learn more about state reform efforts, go to our web site and click on "News," then select a state. Click "sort" for a listing of recent news articles about that state. Articles are available for viewing either with a subscription or for one-time purchase. Look for "buy it" instructions at the bottom of each article.

ALABAMA
State lawmakers killed a reform bill that would have cut medical reimbursements, increased permanent partial disability benefits and raised attorney fees, because of opposition from medical providers. Senate Bill 453 failed to clear the Senate Business and Labor Committee.

"Lawmakers Kill Reform Bill" - the article.

ARIZONA
Gov. Jan Brewer signs into law a bill to allow property and casualty insurers to post policies online and send a link to policyholders instead of mailing a paper copy of the policy.

"Governor Signs Bill Allowing Carriers to Post Policies Online" - the article.

CALIFORNIA
A state Senate committee passed SB 809 to increase licensing fees for medical providers by 1.16% and impose an annual tax on drug manufacturers for enforcement of prescription controlled substances. The drug company tax will generate $4.2 million in 2014 to create an enforcement program in Northern and Southern California to monitor and investigate suspicious prescribing practices. The bill must pass in the Senate Appropriations Committee before a full vote of the Senate.

Other work comp-related bills are parked, pending further analysis.

AB 638 by Luis Alejo, D-Salinas, would allow expedited hearings to determine whether an injury arose out of and in the course of employment when the injured worker has not hired an attorney and the employer is illegally uninsured.

AB 454 by Roger Dickinson, D-Sacramento, would say a worker injured on a prevailing wage project should receive workers’ compensation benefits calculated using the prevailing wage rate, not the wages actually paid to the worker.

"Comp Bills to Suspense File" - read it.

CONNECTICUT
The Connecticut Senate is scheduled to vote this week on two controversial bills, both of which are opposed by cities as examples of "unfunded mandates." Senate Bill 823 would provide benefits in "mental-mental" cases and SB 925 expand the heart presumption for many first responders. SB 823 was filed in response to the fatal shootings at Sandy Hook Elementary School.

"Sandy Hook, Heart Bills Up for Final Votes in Senate" - coverage

FLORIDA
Lawmakers approved a compromise version of a bill that would cap cap repackaged drug prices in the workers' compensation system. This bill also awaits the governor's signature. Senate Bill 662 will cap the price of repackaged drugs – those primarily dispensed by physicians - at 112.5% of the average wholesale price set by the original manufacturer plus an $8 dispensing fee.

Both chambers of the state Legislature approved legislation for a new a database designed to crack down on construction subcontractors that skirt workers' compensation laws by laundering their payrolls through check-cashing houses. The bill awaits Gov. Rick Scott's signature.

"Legislature Adjourns After Contentious and Busy Comp Session" - wrap-up

ILLINOIS
The state House Labor and Commerce Committee unanimously approved Senate Bill 1847 in early May. The measure would clarify that the state's rebuttable presumption of compensability does not apply to most private-sector paramedics or emergency medical technicians. The bill was unanimously approved by the state Senate on April 25 and was headed toward a vote in the House of Representatives.

WorkCompCentral reported on May 9 that at least four other bills affecting workers' compensation insurers or employers were active with three week left in the session. Bills on paramedics, construction premiums, insurance pool reporting and social media statutes were moving toward floor votes.

"Bills on EMTs, Construction Premiums, Privacy Near Finish Line" - coverage

INDIANA
Gov. Mike Pence over the weekend signed House Bill 1320, which would install a hospital fee schedule with reimbursements set at 200% of Medicare.

"Gov. Pence Signs Hospital Fee Schedule Bill" - the details

MINNESOTA
The House of Representatives unanimously approved a bill May 10 to provide coverage for post-traumatic stress disorder, increase attorney fees, create an advocacy program for spinal-fusion patients and clarify that provider reimbursements are bound by the state's fee schedule.
The bill has Senate approval, and is on Gov. Mark Dayton's desk.

The bill included the Workers' Compensation Advisory Council's nine-point legislative proposal, which reflected a deal between business and labor lobbyists that took three months to negotiate.

"House, Senate Sign Off on PTSD, Attorney Fees Bill" - big changes

MISSOURI
The state House of Representatives has scheduled two bills that impact the state's workers' comp system for potential floor votes in the immediate future:

SB 1 would restore the state's Second Injury Fund by increasing the surcharge on workers' compensation premiums to 4.5% for the next two years and as high as 6% in the future;

SB 34 would require the Division of Workers' Compensation to create and maintain a claims information database.

And both chambers passed a measure to strengthen the Second Injury Fund, and sent it to the governor.

"House Approves Second Injury Fund Bill" - what they did 

NEW YORK
The state Financial Services Superintendent Benjamin Lawsky has approved a change in the split point used by the New York Compensation Insurance Rating Board to determine experience modifications in the workers' compensation system.

"Lawsky Approves Change in Split Point" - the details

TENNESSEE
Gov. Bill Haslam signed legislation that mandates fines against construction companies that misclassify workers or low-ball payrolls to reduce workers' compensation premiums.

"Haslam Signs Construction Industry Misclassification Bill" the news


TEXAS
A controversial bill, House Bill 1468, aimed at preventing employer-carrier communications from becoming evidence is moving in the House. HB 1468 seeks to reverse that portion of the XL Specialty decision by allowing insurers to keep communications with employers confidential during court proceedings.

Lawmakers are considering bills that would affect specialty networks, allow nurses to file civil suits and protect employer-insurer discussions with only two weeks left until the end of the current legislative session on May 27.

The House approved SB 8, a bill amended to add a provision supported by the Texas Medical Association to require the adoption of national standards for medical preauthorization forms. The primary focus of SB 8 is to detect activities by providers that may be fraudulent.

"Lawmakers Show Support for DME, Home Services Networks" - the story\

ETHICAL DILEMMAS FOR COMP ATTORNEYS 

Available now is a one-hour ethics overview for workers' compensation attorneys and legal specialists in California. Marina del Rey Presiding Judge Paige Levy discusses ethics and ethical dilemmas in this lively and entertaining program.

Judge Levy covers the California Rules of Professional Conduct and the ABA Model Rules and highlights such issues as:

• If I take my client to lunch do I violate an ethics rule? - When can I take a referral fee?
• What are the potential ethics problems when representing a carrier and an employer with adverse interest, and what are my legal and ethical obligations?
• What are the rules governing legal advertising and what should I look out for? If my client will no longer pay my bill can I stop showing up to court?

One credit hour of Ethics is available with the California Bar. California Claims Professionals may also receive one credit hour for completion.

The cost is $24.19. Register by calling 805-484-0333, ext. 113 or 133 or visit the course page.



PAIN" SERIES STARTS THURSDAY WITH A FREEBIE

What is pain? How is it categorized?

The May 23 introductory session of the new web series, "Ouch! Rethinking Pain," will help participants to define and understand pain, including the ways pain is categorized and manifest in workers' compensation injuries. Program begins at 1 p.m. Pacific Time.

Pre-registration is required before the session begins at 1 p.m. Pacific time. Register.

Our presenter is Dr. Julie Armstrong, who is a clinical nurse specialist and a psychologist. She worked as an RN for 13 years at UCLA's Neuropsychiatric Hospital, and has firsthand knowledge about pain complaints by patients. Today, she is a respected disability evaluator in the California workers' comp system.

Please plan to attend the opening session of "Ouch, Rethinking Pain."
This information would help anyone in the medical, psychological, legal or claims professions. Four sessions will follow Thursday's program.

For information about the full series for continuing-education credit, look here.


N.Y. TIMES CONTRIBUTOR NAILS PAIN

I came across this New York Times commentary recently and, looking back now, I don't recall why. However, the commentator references some clinical studies about pain and how people perceive it.

Don't let the title of the commentary, "How Colonoscopies Are Like Home Renovations") fool you. Writer Eziekiel Emanuel, in drawing a parallel between the medical test every man 50 and over dreads most and hiring a home contractor, connect some salient points about physical pain. Read him.


FEATURED EVENT: BURNS IN FOOD SERVICES

Dr. Grossman

Heat and steam are two of the common causes of burn injuries to cooks, servers and baristas in today's food-service businesses. Burn surgeon Dr. Peter Grossman talks about these industrial accidents on June 5 in a special one-hour web presentation.

"Burn Injury in the Food & Beverage Work Place" is a continuing education program specifically for restaurant risk managers, claims and workers' comp program managers and medical-claims adjusters. 


The program is free, courtesy of WorkCompCentral and Grossman Burn Centers. Space is limited.

Read about the Grossman Burn Center and its treatment and rehabilitation services on the web.


UPCOMING TRAINING EVENTS IN YOUR AREA

June 1-2: The Essential Guide to Writing a Medical Report, Camarillo, CA. A two-day training for both the medical evaluator and the treating physician in California comp. With updates about SB 863 changes. Register 

June 13: Ouch! Rethinking Pain, Session 2: Influence of the Psyche on Pain. On the web. 1 p.m. Pacific time. Must register to attend. Second in a five-part series.

June 13-14: Central States Association Spring Seminar, Madison, WI.
Hosted by IAIABC, this seminar brings together representatives to discuss the challenges and successes of workers' compensation law administration affecting the central region of the United States. Info.

June 20-23, CSIMS Mid-Summer Seminar, Newport Beach CA
A program listing and other information available at the csims.org.

June 22: Hearing Representatives Training Day on The Queen Mary, Long Beach, CA. A professional development day for non-attorneys in the California workers' comp system. Led by 3 workers' comp judges. Course and registration information.

June 22, On Your Way to Becoming an E-Filer, The Queen Mary, Long Beach. Demonstration of e-filing by Long Beach board Presiding Judge Cynthia Quiel. Learn to get forms in and case information out of EAMS. Click to learn more.
 June 27-29: CAAA Summer Conference, Mirage Hotel, Las Vegas.
For program details, go to the CAAA web site.

July 16-18: SEAK 33rd Annual Conference, Cape Cod, Mass. This is the longest-running national workers’ compensation and occupational medicine conference of its kind in the United States. Learn more about the program and how to register at seak.com

WHAT DO YOU KNOW? 

The WorkCompentral Education office is looking for subject-matter experts for webinars in 2013-14 in the following areas:

Spinal injury best practicesN.Y. treatment guidelinesHow to communicate with clientsReturn-to-work best practicesStrategies for settling claimsAffordable Health Care Act and Workers' Comp

Contact Rob McCarthy, rob@workcompcentral.com or by phone (805) 484-0333, ext. 121 if you or someone you know can lead a webinar about any of the above topics.


THANK YOU FOR SUBSCRIBING 

Thank you for subscribing to and reading the WorkCompCentral monthly Education Newsletter. Contact us at 805-484-0333, ext. 113 or 133 or email Sam Abusada at sam@workcompcentral.com with questions about continuing education mentioned in this newsletter. When you call, ask about group continuing education and training for today's busy claims adjusters. We're learning together.

1947 FERTILIZER EXPLOSION WAS WORST EVER

            A ship loaded with chemical fertilizer started a chain reaction disaster in Texas City.                        

The televised images of the fiery explosion at a fertilizer plant near Waco, Texas, brought back horrible memories for anyone who witnessed the worst industrial disaster in U.S. history.

On April 16, 1947, a ship full of ammonium nitrate exploded in the Texas City port, down near Houston. According to official reports, 581 people died. Many of the dead had come out to watch the burning ship. As many as 5,000 people are believed to have been injured.

"There were multiple explosions and fires. Enormous petrochemical plants and oil tanks were destroyed and the disaster resulted in untold amounts of toxic chemicals being released into the land, air and water," Bill Minutaglio, author of "City on Fire," said in an interview published last week with the Christian Science Monitor.

When asked what lessons can be learned from Texas City that will help the community in West, Minutaglio pointed to the inspections and regulatory oversight that are a divisive issue in many states. Some people say there is too much regulation; others insist not enough.

"Greater attention has to be paid to safeguard communities, to provide oversight, to commit to government inspections, to err on the side of caution. In Texas City, in 1947, people said they were simply not made aware of the dangers of ammonium nitrate. They wished they had been told," he added.

Ammonium nitrate was the explosive last week and in 1947 in the Texas City inferno. Both were tragedies of epic proportion, separated by 66 years - and almost to the day.

The book, "City on Fire," can be purchased at Amazon. com. Click here.

PAIN SERIES STARTS IN MAY

A five-part web series about pain will begin Thursday, May 23 at 1 p.m. Pacific time. Dr. Julie Armstrong, PsyD, who began her medical career as a registered nurse will begin with an overview that starts with understanding types of pain associated with physical injuries.

"Ouch! Rethinking Pain" will be broken into five sessions. Each session takes place on a Thursday afternoon. Continuing education credit will be available on purchase of the entire series or single topics:

Session 1: Overview and Types of Pain (free)

Session 2: Influence of the Psyche on Pain

Session 3: Treatment of Pain, Part I - Surgery and Meds

Session 4: Treatment of Pain, Part II - The Alternatives

Session 5: Intervention for Adjusters.

The series costs $199, with a $179 special member price for WorkCompCentral subscribers. Individual sessions are $69.

Register or more more online by clicking here. Call 805-484-0333, ext. 113 or 133 to ask about this continuing education.

BRAIN INJURY CASES ... THE LONG ROAD AHEAD

The after-effects of a brain injury can alter the path of an individual's life forever. Brain injury claims are often associated with tremendous long-term medical and indemnity costs, and can consume administrative and case management resources for years.

A webinar on May 16 will provide a useful overview of the types of injuries to the brain, insights for effectively managing these cases, and costs associated with a claim of this level - including ideas on containing expenses when possible.

Dr. Jeff Snell, director of Psychology and Neuropsychology Services for QLI, will be joined by QLI Director Kristin Custer, on this program.

QLI (Quality Living, Inc.) is a private, nonprofit corporation that was founded in 1987. Its missionis to promote purpose, privacy, dignity, and independence for individuals with brain injury, spinal cord injury, or other severe physical disability.

The webinar starts at 1 p.m. PT. Self-register using this link.

S.C. JUSTICES CLARITY 'PHYSICAL BRAIN INJURY' 

The South Carolina Supreme Court issued two recent opinions defining "physical brain damage" that entitles an injured worker to lifetime indemnity benefits.

The issue of what qualifies as "physical brain damage" has been litigated over the years, and the high court recognized the problem and decided to provide a definition, according to Suzanne Boulware Cole, vice chairwoman of the South Carolina Bar Workers' Compensation Section.

The high court provided a more specific definition in Crisp v. SouthCo. Inc., No. 27230, and Sparks v. Palmetto Hardwood Inc., No. 27229, both issued March 6, 2013.

In the Crisp decision, Chief Justice Jean Toal elaborated that "only in cases of physical brain damage that are both permanent and severe would an employee-claimant be entitled to benefits for life."

Toal explained that a qualifying brain injury must be "so severe that the person could not subsequently return to suitable gainful employment," and "the severity of the injury is the lynchpin of the analysis" for determining if a worker should get lifetime benefits.

Writing for the court in the Sparks case, Justice Costa Pleicones concluded that the "General Assembly meant to require severe, permanent impairment of normal brain function in order for an injured worker to be deemed physically brain damaged under Section 42-9-10(C)."

Hugh McAngus, Weston Adams III, M. McMullen Taylor and Helen Faith Hiser of McAngus Goudelock & Courie represented Sparks' employer.

McAngus said he understood the court as saying a brain injury has to cause "cognitive or physical deficits that in and of themselves are disabling," so that minor brain injuries will not result in an award of lifetime benefits.

This is good for employers, he said, since lifetime benefits can be very expensive.

The full article about can be found by clicking here.

HAVE AN EAMS QUESTION? ASK THE HELP DESK

Today, our staff held an EAMS training in Woodland Hills. To prepare, we've turned to the EAMS Help Desk for answers to questions that had us stumped.

We've been impressed with the service provided by the EAMS Help Desk. EAMS, for those who don't do workers' comp in California, is the electronic court management system that captures all of the case information for the judges and the parties to access. EAMS has been around since 2009, but as with any new techology, there is a learning curve.

Here are answers to two recent questions about EAMS we asked:

Q: Why is a lien claimant on the Official Address Record in the Public Search but not on the lien activation screen?

A: There was a back log of liens when EAMS was implemented in 2008. There was a movement to get all the liens entered and current. During that process, some of the lien claimants were not inputted completely into the system. When the new regulations went into place this year they discovered the issue. The lien claimant simply has to notify us here if they are efilers or the WCAB if they paper filed. We will go in and put them in the system correctly so they can activate the lien.

Q: How many exhibits can I e-file at a time?
A: Each exhibit has to be uploaded on its own. You can upload as many exhibits individually as your heart desires. There is no maximum on the amount of exhibits you can upload.

Send your questions about EAMS and filing to EAMSHelpDesk@dir.ca.gov.. This is an excellent resource for law offices and lien claimants. If you wish to talk with someone here at WorkCompCentral about EAMS or third-party filing, call 805-484-0333, ext. 1, and ask for Rachel or Laura.

===== NEWS DIGEST =====

Carriers Won't Write Penn. Fire Departments: Volunteer fire departments across Pennsylvania are flooding the State Workers' Insurance Fund with applications for workers' compensation coverage because carriers fearing big payouts from cancer claims are leaving the market. Many of the state's 2,100 volunteer fire departments have seen rates more than double. Others have lost coverage through private carriers and PennPrime, the managed-risk pool run by the Pennsylvania Municipal League.

Okla. 'Opt Out' Cause for Concern: A ranking member of the Oklahoma House says that lawmakers are concerned about the "opt-out" provision of Oklahoma's key reform bill. House Minority Leader Scott Inman told the Daily Oklahoman that passage of Senate Bill 1062 is not guaranteed. House members from both parties reportedly have concerns about a provision that allows employers to avoid participating in the workers' compensation system, if the employers create their own benefits delivery system.

Legacy Claims Dwindle Ahead of Texas Deadline: The number of legacy claims in which Texas injured workers are still receiving drugs outside of the state's closed pharmacy formulary has declined by nearly half and doctors appear to be reducing their reliance on opioids, the state Executive Deputy Workers' Compensation Commissioner told an insurer group. The DWC is in the final stages of complying with a 2005 mandate from the Texas Legislature to implement the closed drug formulary. Workers with dates of injuries before Sept. 1, 2011, who were receiving at least one excluded drug were allowed to remain in an open formulary until Sept. 1, 2013.

Summit Exposes Opiods Trend: The proliferation of opioid use and its impact on workers’ compensation insurance took center stage at this year’s National Rx Drug Abuse Summit in Orlando, Fla. Workers Compensation Research Institute Economist Dongchun Wang summarized the findings of a recent study showing opioids are the most prescribed pain relievers for injured workers. In some states, more than 80% of injured workers receive the narcotics. In New York and Louisiana, for instance, one out of every six injured workers receives opioids on a long-term basis. Pennsylvania and Massachusetts also had unusually high opioid usage rates. Vicodin and Percocet accounted for 58% and 28% of injured worker opioid prescription usage, respectively.

Kansas Lawmakers Approve 6th Edition: Kansas state lawmakers have passed a bill to create a payer-friendly panel to appoint workers' compensation judges and require use of the 6th Edition of the AMA Guides in the state's system. Gov. Sam Brownback is expected to sign Senate Bill 187, which could become law by early June.

AFFORDABLE CARE ACT'S IMPACT ON COMP ???

Key provisions of the Patient Protection and Affordable Care Act take effect just nine months from now, and yet there is still significant uncertainty about the impact of the bill on the workers' compensation insurance line.

Industry experts are bracing for possible effects on liability, accessibility and costs trends, but there is a wide range of opinions, some conflicting, about the magnitude of those impacts.

"If you read the press it seems like many experts are having a hard time quantifying the impact of the Affordable Care Act on the U.S. health care system generally, and therefore it is not surprising that it is equally, if not more difficult, to try to assess the impact on workers' comp," said Harry Shuford, the chief economist at the National Council on Compensation Insurance.

Currently, work comp medical spending in NCCI-reporting states makes up only about 3% of the total health care spending in the United States. That explains why there is virtually no discussion, much less specific provisions in the Affordable Care Act, on workers' compensation. "It means what we have to do is really just speculate," Shuford said.

One theory is that the cost of employers providing workers' comp insurance could decline since, fundamentally, greater access to health care creates a healthier workplace. Or, with millions of new insureds seeking treatment, costs could rise if it causes a doctor shortage and delayed treatment.

Also, some are skeptical about the argument that the Affordable Care Act will increase access to health insurance and increase demand for medical services because there is uncertainty about whether people will actually take advantage of the health exchanges created by the legislation.

There are experts who believe that some would choose to pay a penalty rather than buy insurance, even at subsidized rates.

To read the full article, you must have a subscription. This article also can be purchased.

NEXT WEEKEND Spring Rating Seminar 

We have a Rating Seminar about impairment, permanent disability, the AMA Guides 5th Ed., and the changes in the law for California workers' comp that impact PD and indemnity. Call 805-484-0333 to get registered. The event page is online at WorkCompCentral Education.

For a listing of upcoming continuing education from WorkCompCentral, go to our web site. Check back often as we add live seminars and webinars throughout each month. 

March 2013

LIEN CLAIMANTS: BEWARE OF NEW ACTIVATION FEE

Two medical providers learned the hard way that California workers’ compensation judges will not hesitate to dismiss liens when there is no proof that the $100 activation fee has been paid.

Senate Bill 863 instituted a $100 “activation fee” on liens that have been filed before Jan. 1, 2013. A judge can dismiss a lien if a claimant appears at a lien conference or hearing without proof of having paid the activation fee.

Judge Donald H. Johnson of Bakersfield in January cited new Labor Code Section 4903.06 in dismissing liens filed by Psychological Centers of Beverly Hills and KVP Pharmacy.

The dismissal (only a week after the law took effect) was one of the first times a judge has cited the activation fee requirement created by SB 863 in dismissing a lien.

Bruce K. Wade, a senior administrative partner in the Bakersfield office of Mullen & Filippi who defended against the liens, told WorkCompCentral bureau chief Greg Jones that the Electronic Adjudication Management System showed no record that the activation fee was paid and listed both liens as “inactive.”

What’s more, the lien claimants didn’t appear at the conference, so they had no opportunity to show that they had paid the required fee. Because the claimants didn’t appear, the judge immediately signed the order dismissing the liens with prejudice.

While the two claimants are prevented from refilling the same lien claims, they can still object to the order. Wade said his office and the Appeals Board both notified the claimants about the conference, and he doesn’t think a challenge will succeed.

Anush Tergevorkyan, a representative for KVP Pharmacy on the case, told WorkCompCentral that she plans to appeal, citing two reasons. One, the new lien rules are confusing and secondly, the company she represents wasn’t notified about the lien conference.

There are other cases being reported, too. LexisNexis' Workers' Compensation e-Newsletter led the Monday morning issue this week with two WCAB Panel opinions in lien-dismissals due to non-payment of the new fees. One of the liens was dismissed on Jan. 2; the other on Jan. 10.

The cases were Meyer v. Target Corporation, PSI, 2013 Cal. Wrk. Comp. P.D. LEXIS (ADJ4146782) and Soto v. Marathon Industries 2013 Cal. Wrk. Comp. P.D. LEXIS – (ADJ7407927, ADJ7407928).

LexisNexis contributor David Bryan Leonard says about the Meyer decision that involves failure to pay the lien fee prior to the start of the 1/2/13 hearing, "Of particular note is the swiftness in which the laws are being applied and the lack of appreciation for subsequent efforts to issue payment."

Of the Soto case involving failure to activate a lien filed before 1/1/13, he wrote, "The WCAB panel has relied primarily on a lien activation enabling regulation, 10208, subsection (a) to interpret and apply a broader statutory requirement set forth in Labor Code Section 4903.06(a)(4). ... For the moment, it appears that a conservative lien claimant would pay the activation fee no later than two hours prior to the start of a scheduled hearing."

P.S.  BAD-FAITH PRACTICES CALLED OUT

The California DWC issued this announcement in late February, responding to reports that claims administrators were refusing to negotiate liens unless the lien claimant had paid a new lien fee.

The DWC in a Feb. 27 Newsline warned, "Payors must negotiate in good faith with potential lien claimants - filing a lien is not a prerequisite

"The Audit Unit of the Division of Workers’ Compensation has received an increasing number of complaints from individuals and entities providing services on a lien basis in workers’ compensation claims. The complainants report that some payors have adopted a policy of refusing to discuss negotiating the provider’s liens until the provider of the services demonstrates it has filed a lien with the WCAB and paid the applicable lien filing or activation fee required by the enactment of SB 863. Such a policy is both unsupported by the plain language of Labor Code sections 4903.05 or 4903.06, and directly contrary to the legislative intent of those sections and existing law.

"If a claims administrator has reasonable grounds to contend that nothing is owed, then good faith negotiation does not necessarily require an offer of compromise. In the absence of a good faith contention that nothing is owed, however, a refusal to negotiate prior to payment of the filing fee would not be in good faith"

The Newsline explained that "Additionally, Title 8, California Code of Regulations, section 10109(e) mandates that “[a]ll Insurers, self-insured employers and third-party administrators shall deal fairly and in good faith with all claimants, including lien claimants.”

Read the Newsline at the DWC web site.

WEBINAR EXPLORES A GAP IN PAYER PROCESSES  

Cost drivers in workers' compensation stem from many sources. One that is frequently overlooked is caused by a gap between the bill review system and the medical-treatment authorization process within a claims organization.

This is both a fiscal and a workers' comp management issue for employer, and one that will be addressed on April 9 at 1 p.m. Pacific time in a webinar hosted by WorkCompCentral and presented by EK Health. We welcome anyone who pays claims or is a decision-maker within a claims, third-party administrator, joint powers authority or any other self-insured/self-administered arrangement to participate.

Sean Mullen, Senior Management Analyst with the County of Santa Clara, Calif., is a co-presenter. Sean has nearly 25 years of analytical and administrative support for the County of Santa Clara, including analyzing program, performance, and costs of the County’s Workers’ Compensation Division, and overseeing the medical and disability management program. He has advised other public entities on vendor selection, contract negotiation, and program performance for their medical and disability management program. He has also conduct statewide bench marking studies of public entities.

His co-presenter is Anita Breedlove, Executive Vice President with EK Health Services. She has nearly 30 years of experience in the managed care workers’ compensation industry, and has led the development of several medical bill review software systems, program management, and currently acts as an on-staff consultant for EK Health’s medical bill review team. Her experience includes serving as the program manager for various insurance companies, employers, for-profits and public entities.

This is a complimentary education webinar. You must self register before April 9.

TOP JUDGE QUESTIONS NEED FOR E-FILE HELP 

David Langham, the deputy chief judge of the Florida Office of Judges of Compensation, has written an opinion piece in which he questions why the Florida Legislature should spend $1.1 million to staff a help desk for e-filing documents in civil cases.

The column basically says that attorneys are smart. They can figure out how to file documents electronically the same way they learn the law. They'll read a book or a manual that shows them how.

As for a prediction by one county clerk that the majority of attorneys will ignore the e-filing rule on April 1 and file paper documents, Langham scoffs.

"If e-filing saves attorneys money, they will come. If e-filing saves attorneys time, they will come. As the voice kept telling Kevin Costner in Field of Dreams, if you build it, they will come."

Read Judge Langham's article here.

  Source: WCIRB data, CHSWC calculations

COST SHIFT TAKES PLACE IN CALIF. COMP SPENDING

Medical expenses weren’t the single largest cost for carriers and self-insured employers in California, according to the Commission on Health and Safety and Workers’ Compensation 2012 Annual Report.

Instead, loss-adjustment expenses have risen to become the top expense in California's workers' compensation system. The last time medical spending wasn't No. 1 was 13 years ago.

Paid dollars for calendar year 2011 show employers paid:

- $6.745 billion for loss adjustment and other expenses (38%)
- $6.672 billion for medical care (37%)
- $4.506 for indemnity benefits (25%)

The full report can be read at the commission's web site.

UPCOMING SEMINARS AND CONFERENCES ...

March 29, Sacramento: AWCP – “Nightmare Cases III: Claimants that won’t get better!” 8 a.m. to 12:30 p.m., National University, Sacramento. Four hours of continuing education for MCLEs, Nurses, Claims Examiners, WCCPs, Nurse Case Managers and State Bar Legal Specialization in Workers’ Comp. Visit www.awcp.org to learn more.


April 6, West Los Angeles: "What Judges Expect After SB 863 (Southern Calif.)". Features Presiding Judges from L.A. and Orange County DWC District offices. Plus, the associate PJ at the Oxnard board is speaking. Information and registration.

April 9, San Diego: AIP Annual Full-Day Seminar and Exhibitor Fair, 9 a.m. to 4:30 p.m. Hilton Mission Valley, San Diego. More at www.aipcalifornia.com.

April 13, Concord, CA: California Bar Worker's Compensation Section 2013 Spring Conference, 7:30 a.m. to 4:30 p.m. Concord Hilton. 6 Hours of MCLE and Legal Specialization Credits. Register online at The California Bar web site.

April 21, Los Angeles: RIMS Annual Conference & Exhibition. L.A. Convention Center. Call 213-741-1151 or visit www.rims.org.

April 26, Woodland Hills, CA: "EAMS & Liens Workshop." Led by Kristen Chavez, the IT manager for WorkCompCentral and Hosai Himmat, paralegal for Riverside law firm Heggeness, Sweet, Simington & Patrico. 1 to 4 p.m., with demonstration and tips for filers and EAMS users.
Call 805-484-0333, ext. 113/133. View details online.


May 4, Sportman's Lodge, Studio City, CA: WorkCompCentral Spring Rating Seminar. An expert panel of physicians, raters, judges and workers' comp attorneys will discuss a range of issues, arising under both SB 863 and since the passage of SB 899, which mandated use of the AMA Guides for evaluation disability in California. 805-484-0333 to register. Details.

May 4, Shell Beach, CA: California Bar Worker's Compensation Section 2013 Spring Conference, 7:30 a.m. to 4:30 p.m. Cliffs Resort at Shell Beach. Learn more.

For more industry events, refer to the Upcoming Events calendar.

QUICK MENTIONS !!!

- The New Mexico Workers' Compensation Administration has become the 30th state to adopt evidence-based treatment guidelines. New Mexico chose the Official Disability Guidelines (ODG), which received the most support in public comments.

- Telemedicine is not very common in workers' comp, however, Nevada is considering adopting telemedicine for injured workers in remote areas of the Silver State. Telemedicine stands to be used most for medical-legal examinations where getting the patient to the examining physician poses travel and transportation barriers.

- Florida in February launched a certification program for health-care providers, which requires study and testing all done online. The certification ensures the doctors have a working knowledge of Florida's workers' compensation and occupational medical system.

- More from Florida: Suspicious insurance claims rose by 22% in that state between 2010 and 2012 and pose a continuing problem across the nation, National Insurance Crime Bureau President and CEO Joe Wehrle told a conference in Orlando in March. Wehrle said insurers reported 8,723 questionable claims across Florida in 2010 and 10,693 in 2012. He said 49% of the increases came from Broward, Miami-Dade and Palm Beach counties.

- The New York Compensation Insurance Rating Board estimates an overhaul of the state's workers' compensation system proposed by Gov. Andrew Cuomo could boost loss costs and produce up to $1.6 billion in unfunded liabilities, but nevertheless represents a net savings for the state's employers.

- The Missouri Senate gave final approval in February to legislation requiring the Division of Workers' Compensation to create an online database for businesses to check whether prospective employees have a history of filing workers' compensation claims. Senate Bill 34 by Sen. Mike Cunningham, R-Rogersville, moved to the House of Representatives for a vote in that chamber.

- Mike Nolan announced his retirement as president of the California Workers’ Compensation Institute (CWCI) effective May 1. The Institute’s Board of Directors selected Alex Swedlow, CWCI’s Executive Vice President for Research, as his successor. Nolan joined the Institute in June 2001 as president.