December 2011 Issue

BEFORE OFFICES EMPTY FOR THE HANUKKAH AND CHRISTMAS WEEK CELEBRATIONS, I WANT TO SEND BEST WISHES FOR THE HOLIDAYS. THANK YOU FOR READING US EACH MONTH AND FOR FOLLOWING US ON FACEBOOK AND LINKEDIN. PEACE AND JOY .... ROB, SAM AND JAKE.

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

Some Random Stuff Before 2012 Arrives ...

Things to be thinking about now ...

• Electronic Medical Billing Officially Begins in California Next Year. Only the carriers and the payers are required to participate, however, medical providers, DMEs, PBMs and medical service providers may want to look into e-billing, too.
• Medicare Set-Asides on workers' comp awards and settlements continue to be a slippery slope. I'm told the only thing certain about MSAs is that the federal government is NOT backing down. 
• Opioids and Schedule II narcotics burst onto the workers' comp radar screen this year. Washington state is the model right now for controlling the prescription of addictive painkillers to treat pain. 
• The U.S. economy isn't creating jobs quickly enough. Hiring remains flat in construction and manufacturing. It's picking up jobs mainly in hospitality, retail (in November), professional services and health care.  The economy added 210,000 jobs last month and another 100,000 in October, the Labor Dept. said. 
• New York state is still sorting out the massive defaults in the self-insured trusts. Employers who joined industry risk pools are being held liable for hundreds of millions of dollars for comp claims. 
• The AMA Guides Sixth Edition were adopted this year for use in Illinois, where workers' comp arbitrators can refer to this latest edition of the guides for evaluation of disability.
• Medical cost-containment services, such as utilization and bill review, are behind the runup in claims costs in California, according to studies. The same is happening in Texas. 
• Social media is the newest tool for detecting claimant fraud. Investigators and claims adjusters routinely look at Facebook and verify that a claimant isn't lying about being physically unable to return to work due to lingering pain or injury. 

Did I miss anything in your state or industry? If so, write me at rob@workcompentral.com and I'll print your submission.

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

 Congratulations to the QME Class of Fall 2012

Eighty doctors who took the California Qualified Medical Evaluator Competency Exam in October passed. The state administers the exam twice each calendar year in Northern and Southern California locations. Before QMEs can begin a practice, they are required by law to take 12 hours of disability-evaluation report writing instruction. For information about becoming a medical evaluator, visit the DWC website. Take me there.

WorkCompCentral offers this pre-licensing course online. See.

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

Upcoming Webinar Aims to Turn Payer Data into Action

Jan.  9  - "Where the Most Valuable Asset for Managing Claims and Risk is Buried." Presented by Karen Wolfe. This is a discussion about workers’ comp data (claims, bill review, pharmacy etc.) and how it’s being used to improve business operations and decision-making by workers’ comp executives. Claims and TPA executives and risk managers will benefit from this    discussion. Free to attend.

Register soon. Attendance is limited.

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

 

Do the costs of your workers' comp program need trimming next year? Attorney Frank Russo of Oakland and former Oakland WCAB Presiding Judge George Mason delivered a one-hour talk this month about mediating workers' comp disputes. You can catch the program on a replay by clicking here.

November 2011 Issue

California

Valuable Reminder to Serve Lien Claimants in C&Rs

An article in this week's news highlights the importance of serving parties when a compromise and release is reached at a WCAB in California. WorkCompCentral Legal Editor John Kamin reported on a Workers' Compensation Appeals Board panel opinion in which a physician lien claimant argued that he was never served in the case. The physician failed to appear at the board, and his lien was dismissed.

"A panel decision issued last month suggests that the Workers' Compensation Appeals Board may be taking an aggressive new stance toward ensuring that defendants serve lien claimants with settlement notices, an attorney said.

"When Dr. Kevin Aminian filed a petition for reconsideration contending that his lien claim in Montalvo v. Adir Restaurant was unfairly disallowed for failure to appear, he contended that the defendant failed to serve him notice that the claim had been resolved. He argued that this violated Rule 10886, which requires defendants to serve lien claimants with a notice of a compromise and release of the case in chief.

"The Workers' Compensation Appeals Board apparently saw potential merit in Aminian's argument, and issued a panel decision on Oct. 17 that gave Aminian a chance to prove that he had not been properly served."

Parties in California lien disputes routinely fail to serve all of the parties, not only in C&Rs. This is a risky practice that the WCAB is aware of, thanks to the case of Dr. Aminian. Commissioner Alfonso Moresi said in the panel opinion that the defendant could be sanctioned $500 if it's true that Dr. Aminian was not served for the C&R. Likewise, Dr. Aminian could be sanctioned if it turns out he was served and didn't acknowledge it.

The article is available to WorkCompCentral subscribers or for one-time purchase. Read it.

****


Free Webinar Topic for December is Mediation

The "One on One @ 1" webinar series continues in December with a topic that can help risk managers and employers with their comp costs next year. Mediation is a process that can produce faster results, gets the parties talking, and protects long-term relationships between an employer and employee or a provider/vendor and a carrier or TPA.

Mediation is more common in civil law than in workers' compensation. But, why is that? The proper use of mediation in workers' compensation law can save a lot of costs AND move matters along expeditiously with a resolution that is satisfactory to both parties.

Members of PARMA are encouraged to attend this continuing education program.

WEBINAR: "Mediating Workers' Comp Claims, Liens and Other Disputes"

WHEN: Thursday, Dec. 1 at 1 p.m. Pacific time

PRESENTERS: 

Retired WCAB Presiding Judge George Mason, now a mediator/arbitrator in the Bay area; attorney/mediator Frank Russo of Oakland.

WHO SHOULD ATTEND: 

Risk managers, applicants' and defense attorneys, lien claimants and hearing representatives, WCAB judges, employers and human resource professionals, insurance carriers, TPAs and anyone involved in claims litigation.

WHAT YOU'LL LEARN

- When to mediate a claim or lien

- What happens at a mediation

- How the process differs from a claim/lien trial

- Checklist for success with mediation

- Common misconceptions about mediation

- Creative solutions the process can uncover

- How liens can get resolved in batches

- How talking can save a claimant-employer relationship.

- Mediation's effect on return-to-work rates

One hour of CE credit is available for

- California Bar members

- Legal specialists

- Calif. Claims Professionals

To register, follow the instructions at the bottom of the course page.

****
New Stuff !!!

A California medical billing web-workshop given by Catherine Montgomery and Sarah Moray is now available to take online. Catherine and Sarah are both experienced in workers' comp medical billing, and they go box-by-box through a CMS 1500 form as they demonstrate how to comply with the new billing regulations. Those took effect in mid-October.

Major Medical Billing Changes Oct. 15, Get Ready or Get Denied - 2 Hours

Cost: $41.09, 2 CE Credits Available for CA Claims, Bill Review, MCLE.

Register online

We also added a permanent disability rating and law survey for attorneys, claims managers, hearing reps ... anybody who rates PD or litigates a claim. Judge Colleen Casey and Lexis-Nexis work comp legal contributor Robert Rassp presented this MCLE program recently in Camarillo and Oakland.

Top Secrets for Rating Permanent Disability & Ogilvie Update

Cost: $115.60, 6 CE Credits for Calif. Bar MCLE, Legal Specialization, Claims, Rating.

Register online.

Coming this month: "Road Map for the California QME/AME" (Judge Myrle Petty and attorney Jon Brissman) and "Gaining Cooperation from the Injured Worker" (Carl Van and Debra Hintz).

You can always find our new content at www.workcompschool.com under "What's New."

****
They Like Us!

Who can forget Sally Fields at the Oscars when she uttered one of the most memorable acceptance speeches ever. "I can't deny the fact that you like me, right now, you like me!

In the spirit of liking (you Facebook users know what I mean), we are proud to share comments sent in by seminar attendees who "like us ... you like us!"

"Sam: Thank you for inviting us to the seminar, it was informative and gave me insight on items I need to present my case. I am sure that you are aware, that Pro-Per's, do not have the same resources, as what is available to the professionals." - T.B., an injured worker.

"This is just a short letter to say that I attended the one day seminar at Mills College, Oakland. The speakers were Judge Colleen Casey and Attorney Robert Raasp. In short, the above seminar was excellent as usual and contained up to date, cutting edge information that will be very helpful to me as a physician who performs work comp medical-legal reports full time in California. I always make an extra effort to attend any seminars run by these two individuals, for the very reason they present the "latest scoop." I think the above program should be repeated and if so, be sure to invite California work comp physicans, QMEs, AMEs, etc." - Brian Barber, M.D



Calif. Defense Attorneys Meeting Dec. 1-3

The California Workers' Comp Defense Attorneys Association meets Dec. 1-3 in Half Moon Bay. A program agenda is available for viewing online at the CWCDAA web site.
If you attend, please stop by and visit the "Sullivan on Comp" booth in the exhibit area. Register to win a free book set and yearlong subscription to the content on WorkCompCentral.com. Author Michael Sullivan will be available to talk about the 16-chapter treatise about California workers' compensation law and practice. This new resource is updated monthly with new case, and a summary is emailed to subscribers every month.

Jake Jacobsmeyer, one of the presenters at the upcoming CWCDAA conference, had this to say:

"I cannot say enough about how much people in our firm love the books and how often they consult them. "Sullivan on Comp" is the first place I turn to research a case. Congratulations, Mike, you've really nailed it — an impressive work and required reading in anyone's WC library. "

"Sullivan on Comp" is available on a no-obligation trial basis. We'll ship you a set of books and issue an online security code. Try the books for 30 days, and decide whether they belong in your law library.

Call Laura Maher, WorkCompCentral account representative, at 805-484-0333, ext. 123, to get started.

***
Upcoming Events

Nov. 24 - Thanksgiving Day. Our offices will be closed Thursday and Friday for the holiday.

Dec. 1 - Webinar, "Mediating Workers' Comp Claims, Liens and Other Disputes."

Dec. 1 - CWCDAA conference, Half Moon Bay, Calif.

Dec. 1 - EAMS and E-Filing Expo, Oakland WCAB. 10 a.m. to 3 p.m.

Dec. 2 - 2011 Worker's Compensation Holiday Conference, Tampa, Fla.

Dec. 7 - Los Angeles Chapter of Calif. Association of Licensed Investigators, Dinner Program About Work Injuries. Long Beach.

Dec. 8 - Claims & Litigation Management Alliance, Diversity Forum, New York City.

Jan. 26 - Calif. Applicants' Attorneys Winter Convention, Rancho Mirage, Calif.

(Holiday events are listed on the Upcoming Events calendar at ww3.workcompcentral.com/.)

October 2011 Issue

    

    CHANGES FOR CALIFORNIA 

Compound Drugs, Medical Bills

Come Under New Regulation 

Gov. Jerry Brown has signed a bill that brings compound drugs under the California Official Medical Fee Schedule. WorkCompCentral Western Bureau Chief reported earlier this month that pharmacists view the addition of compounded pharmaceuticals in the fee schedule as a victory. Carriers also supported the legislation. 

Medical billers and self-insurers are under new sets of regulations intended to streamline the process for doing business in California worker's comp. The new regulations took effect this month and WorkCompCentral's Greg Jones examined in an Oct. 24 article the administration's intent and the ramifications of the rule changes affecting the medical providers and the self-insureds. 

"The billing regulations, which went into effect on Oct. 19, require the use of a standard billing form and standard bill-review messages," Greg writes in his Monday article. "The self-insured regulations, which took effect on Oct. 19, require self-insured groups to provide financial information in March rather than in June so regulators can take action before the July 1 start of the policy year." 

WorkCompCentral on Oct. 13 hosted a web workshop to demonstrated how properly to fill in a CMS 1500 form for billing charges, using the new standardized paper medical billing rules. The takeaway message from the webinar, led by billing professionals Catherine Montgomery and Sarah Moray of Clarity Medical Billing Resources of Goleta, Calif., was that bills with errors will be denied.  

The full article is available for viewing or purchase. 

A COMMON FRUSTRATION 

ADDRESSED IN NOV. 7 WEBINAR

When a workers' comp claim takes on an adversarial tone, it can be difficult for an adjuster or attorney to deal with the claimant. What do you do when the injured worker is uncooperative? You are invited to register for a free webinar on Monday, Nov. 7 at 1 p.m. Pacific time for some advice. 


Based on their book "Gaining Cooperation: 3 simple steps to getting the injured worker to do what you want them to do," authors Carl Van and Debra Hinz will highlight basic principles for gaining cooperation. This webinar is specific to workers' compensation, and the lessons relevant in any state where you may practice.

Carl Van is a frequent speaker at conferences and to insurance company employees. He is a graduate of California State University, Sacramento where he received his bachelor's degree in Insurance. He is author of more than 75 technical and soft skill workshops being taught in the United States, Canada, and in the United Kingdom.

Debra Hinz is the founder and past president of the Association of Insurance Professionals (AIP). She teaches workers' comp continuing-education courses in California and is the Southern California manager for Macro Pro legal-copy service.

Attendance is limited to the first 100 people to register.  Register me. 

(The book Gaining Cooperation: 3 simple steps ..." can be purchased online at Amazon.com or by contacting author Debra Hinz at debra.hinz@yahoo.com. It retails for $19.95. Go to Amazon.)

OPIODS: Treating Pain at What Risk?

There is a growing sense among workers' comp observers that opiods are becoming an epidemic. These painkillers are addictive, deadly and they hinder the patient's recovery from a work injury in most cases.

Those are just some of the alarming conclusions you'll hear from a pair of experts, Dr. Thomas F. Jan of Long Island, N.Y., and Joe Paduda, a pharmacy-industry consultant who tracks Rx drug utilization and costs trends in worker's compensation. In two separate presentations (now available online), they explain opiod and how the daily dosage for patients with pain has tripled. This increase carries a risk of addiction and accidental overdose for injured workers under a doctor's care.  The reality is that for any employer and its comp carrier, the overutilization of strong painkillers is a liability risk.  

Program:  Treating Opiod Dependency and Addiction in Work Comp

A one-hour discussion, with PowerPoint slides. Led by Dr. Thomas Jan, an osteopathic physician in private practice located in Massapequa, N.Y. He is credentialed and sub-specializes in Pain Management, particularly patients suffering from alcoholism and addiction. He is board certified by the American Board of Addiction Medicine and has been in the field of addiction medicine for a decade. 

Program:  Prescription Drug Abuse in Workers' Comp

A one-hour discussion, with PowerPoints. Led by consultant and blogger Joe Paduda, this is an overview of critical issues, such as the utilization of narcotics for treating work injuries; benchmark studies about opiods and workers' comp; how the states compare; the risks posed by long-term use of opiods; addiction problems and liability; and encouraging steps being taken to curb the abuse of prescription pain drugs in the states of Washington and California. California CE credits available. 

GUIDE TO GETTING PAID FOR MED-LEGALS

Still Time for QMEs to Enroll in Saturday's Seminar

A special program for Qualified and/or Agreed Medical Evaluators who do work in California is scheduled for Saturday, Oct. 29 at the WorkCompCentral training center in Camarillo. 

The instructors are WCJ Myrle Petty of Riverside and attorney Jon Brissman of Colton. Seating is limited for this CE event that focuses on the med-legal practitioner's role, reports and practice tips. 

QMEs and AMEs who attend will find answers about their roles, responsibilities and those medical-legal reports at an upcoming live seminar at WorkCompCentral, titled, " Road Map for the California QME." We are offering 6 QME continuing-education credits. This training is open to medical-office staff for the QME/AME, and for attorneys who want to learn to critically review med-legal reports. 

Six QME continuing-ed credit hours are available. The seminar price is $329, and $299 for WorkCompCentral eligible subscribers. Call our offices at 866-975-2667 for the special price. 

See what the course is about online.

Coming to the Bay Area ... a PD and DFEC Program

What did Ogilvie III do to the rebuttal criteria laid by the WCAB? Bay area attorneys, paralegals and claims professionals will want to attend this redux of a Southern California program we put on last month.

"Ogilvie III Update and PD Rating Secrets" is the title of the seminar. The date is Saturday, Nov. 5  from 9 a.m. to 4 p.m. at Mills College in Oakland. Six MCLE or Legal Specialization credits with the the California Bar are available.  The instructors are WCJ Colleen Casey of San Francisco and Lexis-Nexis author and comp attorney Robert Rassp of Los Angeles. 


Call 866-975-2667 to sign up. Or see our ad at www.workcompschool.com.

Our final worker's comp legal seminar for 2011 is taking place
next month on the Mills College campus.

Newsletter, September 2011

WE MOVED THE NEWSLETTER. HERE'S WHY ...
Welcome to our new location on the web for regular updates about continuing education. We moved the newsletter because alot of email servers thought that our monthly newsletter was some kind of spam. Your newsletter now arrives as text in a plain email from liveseminars@workcompcentral.com. That's the email address we use during the workweek to alert customers to promotions and announcements.
That's a quick explanation for the change.

WE'RE NOT CLOSE TO BEING DONE FOR 2011!
We packed the October schedule here in Camarillo, Calif., with a solid lineup of live events for continuing education credit. We have never attempted so many live events in a single month - EVER. We have completely booked October with seminars and webinars for anybody who works in a workers' comp state system (or federal). Look what we're offering next month:

Webinar about Rx drug abuse, Oct. 3
"Treating Opiod Dependency and Addiction in the Work Comp System," with Dr. Thomas Jan. 1 hour.
- Monday, Oct. 3, 1 p.m. Pacific time, 4 p.m. Eastern.
Register


Webinar - California medical billing rules, Thursday, Oct. 13
"Major Medical Billing Changes Coming Oct. 15 - Get Ready or Get Denied!"
- 10 a.m. PDT, 1 p.m. Eastern.
Register

Live - California legal training, October 15, Camarillo
"Preparing Your Case for the WCAB & Recons, Removals and Writs"
 - Saturday, October 15, Camarillo, 6 CE Credits. (Legal)
Register

Live - Medical evaluator continuing education, Oct. 29
"Road Map for the California QME/AME."
- Saturday, October 29, Camarillo, 6 CE Credits. (Med-Legal and QME)
Register 


CALIFORNIA AD MORAN MAKING FIRST PUBLIC APPEARANCE

Rosa Moran, the newly-appointed administrative director of the California Division of Workers' Compensation, will speak Sept. 26 about the future of the DWC at the inaugural California Workers' Compensation and Risk Conference in Dana Point. The California Workers' Compensation & Risk Conference is on Sept. 26-28 at the St. Regis Hotel. The hotel is located at One Monarch Beach Resort in Dana Point. Moran is set to appear the opening day.

AUTHOR MIKE SULLIVAN AT DANA POINT CONFERENCE

Stop by the Sullivan on Comp booth in the exhibitor area at next week's California Workers' Compensation and Risk Conference and meet author Michael Sullivan. Mike is at booth 26. WorkCompCentral offers a 30-day preview of the entire set, plus online access. You can start by calling 805-484-0333, ext. 1. If you decide not to keep the books, we'll even pay the return shipping.

MCLE DEADLINE FOR CALIFORNIA BAR GROUP 2

Are you a California Bar member in Group 2 (H-M)? Your MCLE credits must be completed by Feb. 1, 2012. Minimum Continuing Legal Education (MCLE) refers to the approved continuing legal education required of California attorneys. Attorneys are required to complete a total of 25 hours of approved credit every three years. Go to Calbar.org for credit details, exemptions and specifics about requirements. 

NEWS DIGEST

... The City and County of San Francisco asked the California Supreme Court to review the Ogilvie case, contending that the 1st District Court of Appeal's ruling was erroneous and could prove disastrous for the economy. (Sept. 13)

... The California Workers' Compensation Institute says the average amount paid per claim for treatment, prescriptions and durable medical equipment, medical management and cost-containment programs, and med-legal reports have exceeded levels that preceded reform legislation passed in 2002 through 2004. (Sept. 13) 

... The 2nd District Court of Appeal has scheduled oral arguments for the case of Contreras v. WCAB on Oct. 12. The 2nd District will consider whether an unrepresented applicant's filing mistake was excusable neglect, or if the mistake should bar him from reopening his claim altogether.

... The California Division of Workers' Compensation announced that it is delaying until 2012 two Workers' Compensation Information System (WCIS) implementation guides that were scheduled to take effect on Nov. 15. The division said on Tuesday that a "critical issue" surfaced during testing of programming changes necessary to implement the new regulations. 

... The California chapter of the International Association of Rehabilitation Professionals (CA- IARP) has scheduled a one-day seminar focusing on the recent appellate court decision in the Ogilvie case for Sept 30 at the Hyatt Hotel in Santa Barbara.

... The Workers' Compensation Section of the State Bar of California named Southern California attorney Adam Dombchik as its 2011 applicants' attorney of the year at its recent annual meeting in Long Beach.

... An employer who defeated a disability discrimination suit by proving that an employee lied about his medical condition is not entitled to nearly $500,000 in attorney fees, because the attorney fees award would bankrupt the plaintiff, the California 4th District Court of Appeal ruled in an unpublished decision. (Sept. 20)

-- From WorkCompCentral News

WHAT'S NEW?

Our school staff always is on the lookout for new case law for short, one-hour coursework. Short courses can be completed online in about an hour for CE credit. Our live seminars also are posted online, sometimes within a week of the live event. To find out more, visit What's new? on our home page.

COLAs Start Retrospectively on Total PD, Life Pensions. 1 CE Hour

Old vs. New PD Schedule Question Hinges on Notification. 1 CE Hr. 

Minimum Wage Ranger's Earnings Include Housing, Car Allowance. 1 Hr. CE .

OUR FIRST WEBINAR WAS A HUGE SUCCESS! THANK YOU, EVERYONE.

The hurricane that lashed New England in August forced us to postpone the debut of "One on One @ 1," the free monthly webinar series. Then, we lost our Internet connection briefly during the postponed webinar because of a fire. Despite the glitch, the webinar went smoothly and we heard an excellent presentation from Joe Paduda about prescription drug abuse with opiods in workers' comp cases. For those who were unable to register because the session was full or missed the webinar's new date, not to worry. We captured it and will release it online very soon. Stay tuned for an announcement. 

THANKS FOR READING OUR NEWSLETTER. CONTACT US WITH ANY QUESTIONS at our email or call us at 805-484-0333, ext. 113 or 133. Our director Sam Abusada and school adviser Jake Parres are available weekdays 8 a.m. to 5 p.m. Pacific time. 

Training is Available. Sign up today!

It's Moving Day

The WorkCompCentral Education newsletter officially moved today. More details to come ...