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.

THE YEAR OF THE ADJUSTER ...

Editor's Note: Preparing this first issue of 2013 made me realize how much new information awaits the workers' comp claims adjuster. New York is improving medical treatment guidelines, Arizona employers are getting tougher on opiods, and California is dealing with wholesale changes.

Who thinks workers' comp is same old-same old? Not this year. Not for adjusters.

- Rob McCarthy, Newsletter Editor

WHAT TO DO IF YOU'RE AUDITED FOR MCLEs

(This article is reprinted with permission from the December California Bar Journal.)

With the California State Bar stepping up its efforts to ensure attorneys are meeting their continuing education requirements, experts offer a number of tips to avoid getting in trouble – and prevent problems from ballooning in the event of an audit.   

Last year, the bar audited 635 lawyers chosen at random – 1 percent of attorneys whose Minimum Continuing Legal Education (MCLE) requirements were due. This year's audit will be broader with the bar planning to look at a 5-percent sample, or roughly 3,000 to 4,000 lawyers. 

Discipline defense attorneys who represent lawyers in State Bar Court agree that the best tactic, short of completing your MCLE requirements in the first place, is honesty.

“If you haven't done it, be straight with them,” said Jonathan Arons, a San Francisco-based legal ethics attorney. Lying to the bar can give the agency the impression that you are also willing to lie to clients, he said.

“You lie, you are going to get into more trouble,” said Arons, who also cautions against ignoring an audit notice.

Susan Margolis of Margolis & Margolis in Los Angeles agreed, noting that while meeting the MCLE requirements might seem inconvenient, it pales in comparison to a discipline proceeding.

Failing to fulfill education requirements can result in an administrative suspension, but lying about having done so could lead to a much more damaging moral turpitude charge, Margolis said.

“One ends up on your record as discipline, where the other doesn't,” she said.

Of the 600-plus lawyers selected for last year's audit, 98 were found not in compliance. Twenty four are facing potential discipline for falsely reporting they had met their requirements, and five were suspended for failing to respond to the audit.

The State Bar requires active attorneys, with some exceptions, to complete 25 hours of continuing education every three years including at least four hours of legal ethics, one hour of elimination of bias in the legal profession and one hour of prevention, detection and treatment of substance abuse or mental illness.

The bar plans to send out letters for this year's audit in July. Those selected will need fill out an online MCLE compliance log and submit actual certificates of attendance, either by mail or email. For more information about the MCLE requirements, visit the State Bar's MCLE web page (calbar.org) or call the Member Services Center at 1-888-800-3400.

N.Y. REVISES TREATMENT GUIDELINES

The chairman of the New York Workers' Compensation Board announced that improvements to the treatment guidelines will take effect on March 1. State-sponsored training is now available. 

.

The free, online training courses are hosted at the board's website: www.web.ny.gov.

WCB Chair Robert Beloten issued an bulletin in which he suggests that anyone who completed coursework before mid-January 2013 should re-take the trainings for 2013 Medical Treatment Guidelines Update Overview, Carpal Tunnel Syndrome Guidelines, and Pre-Treatment Forms and Processes if applicable. 

OUR AWARDS CEREMONY WINNERS ... 

The photos are in from our first Workers' Compensation Holiday Educational Program and Awards Reception. I will share more in future newsletter issues, but here were three of our VIPs who received industry awards for their dedication to delivering and receiving workers' comp continuing education.

 

                                             Christina Lam
                                           

                                              Dr. Satish Kadaba

                                             Judge Paige Levy

                                            

That's WorkCompCentral President Dave DePaolo presenting Judge Levy's award. 

                                            

2 REASONS TO JOIN US FEB. 23 IN OAKLAND

Our seminar travel team will return to Mills College on Saturday, Feb. 23 for side-by-side continuing-education live seminars about SB 863 and your workers' comp practice. One session is for attorneys; the other is for psyche qualified medical evaluators. 

Both classes begin at 9 a.m. in the Lokey Graduate School of Business. 

"How SB863 & The New Regs Will Work; What Changed and What Didn't" features three judges from Northern California talking about new law, new rules, and new practices. This is a Minimum Continuing Legal Education program. Six CEUs are available with California Bar and Claims Professionals. Paralegals and hearing representatives should plan to attend. One of the presenters plans to talk about "SB 863 Traps for the Unwary." Need more detail?

The medical-legal education seminar is titled, "Rateable Psyche Reports, Part II: Causation and Apportionment." Dr. Julie Armstrong, Psy.D and a California Qualified Medical Evaluator will explore the legal difference between causation and apportionment, terms that trip up many QMEs. 

This six-hour report-writing seminar is the followup to a training Dr. Armstrong delivered in Oakland and Southern California in 2012. The class activities include group work identifying causation and apportionment issues that arise in workers' comp claims.  Psyche in comp is always interesting.

Six QME credit hours are available for attending. 

TEST YOUR SB 863 ACUMEN

I brought back this quiz from 2012 because of the considerable changes in California workers' comp law. The quiz about SB 863 gets progressively harder with each item. Good luck!


SB 863: ______________________________________________

IMR: _______________________________________________

IBR: _______________________________________________

IBR1: _______________________________________________

1/1/14: _______________________________________________

SJDB: ______________________________________________

EOR: ______________________________________________

$150: ______________________________________________

PQME: ______________________________________________

$10,000 ______________________________________________

BONUS:

LC 4903.6: ______________________________________________

LC 4600(c): ____________________________________________

ANSWERS: 

Senate Bill 863 (reform package); Independent Medical Review; Independent Bill Review; DWC form to Request IBR; date Medical Provider Network requirements take effect; Supplemental Job Displacement Benefit; Explanation of Review of a medical bill charge by the employer; cost of the lien filing fee; Panel Qualified Medical Evaluator; the maximum death benefit as of 1/1/13; 4903.6 puts filing restrictions on liens; 4600(c) says chiropractor as primary treater ends at 24 visits.

WEBINAR: ABUSE TRENDS WITH RX MEDICATIONS

Dr. Joel Mata, a Southern California-based pain medicine specialist, is leading a free webinar on Feb. 5 about the risks of opiods and safeguards to prevent harm from these powerful prescription drugs. This one-hour survey offers statistics about the use of opiods in the United States, injuries and deaths caused by overdoses, and what can be done to protect the health and lives of injured workers and employees with physical pain. The webinar begins at 11 a.m. PT. One Substance Abuse CEU with the California Bar is available. Also, one CEU for California Claims Professionals. Self-register by clicking here.

INDUSTRY EVENTS CALENDAR

Jan. 24-26: California Applicants' Attorneys Association Winter Conference, San Diego, Calif.

Jan. 24: Southern California Professionals in Workers' Comp Happy Hour Meet & Greet, Orange, Calif.

Feb. 3: PARMA Conference, Rancho Mirage, Calif.

Feb. 27-28: WCRI's Annual Issues & Research Conference, Boston

Feb. 28 - March 1: California DWC Educational Conference, Los Angeles

March 2: The Biggest, Baddest Lien Seminar Yet, Pomona, CA

March 4-5: California DWC Education Conference, Oakland

March 11-12: Illinois Workers' Comp Forum, Chicago

March 14-15: Calif. Self-Insurers Meeting & Educational Conference, Disneyland Hotel, Anaheim

Looking for an educational event in your area? Have an event to announce? Look here.

CONGRESS PASSES, PRESIDENT SIGNS SMART ACT

By Michelle A. Allan, Esq.

and Christina Horton Duty, Esq.

Now that President Obama has signed the SMART Act, Medicare compliance practitioners can start to ponder the potential and practical impact this bill’s passing will have on their day-to-day work. A point-by-point analysis of the bill shows that the effects may be varying and in fact may show that even prior to its passage, the SMART Act has already started to revolutionize the Medicare conditional payment process.

As a brief point of history, the SMART Act was introduced into Congress in March 2011. The industry at that time was in dire need of conditional payment reform. It was not unusual for the MSPRC to take an excess of twelve months to generate a simple conditional payment letter. The insurance industry was willing to reimburse Medicare for conditional payments, but Medicare’s unreasonable delays were frustrating the parties, slowing or destroying settlements and creating uncertainty as to whether additional monies would require post settlement reimbursement. That June, The United States House of Representatives Subcommittee on Oversight and Investigations, Committee on Energy and Commerce held a hearing on “Protecting Medicare with Improvements to the Secondary Payer Regime.” At this hearing, the lengthy and complicated process of obtaining conditional payment information from the MSPRC and the lack of an ability to get a timely response regarding what the parties to a settlement may owe for final payment were just a few of the topics discussed. Medicare was essentially lambasted for procedural failures and lack of accountability.

Following both the SMART Act’s introduction and the above-mentioned hearing, the MSPRC made several changes to its processes. First, the MSPRC created The Medicare Secondary Payer Recovery Portal, a tool that beneficiaries, attorneys, insurers and TPAs could use to submit pertinent documents, request conditional payment information, dispute claims included in a conditional payment letter, and submit case settlement information. Second, a Self-Service Information Line was established where once a claim is reported to the MSPRC and a rights and responsibilities letter generated, a party can call the line to get Demand and Conditional payment amounts, as well as the dates of those letters without having to speak to a customer service representative. Third, a fixed percentage option for calculating the repayment amount was also introduced for use in certain liability and self insurance cases. Finally, the MSPRC implemented a Self Calculated Final Conditional Payment Amount option, whereby plaintiffs in liability cases meeting specific criteria could calculate the amount of repayment they believed to be owed (although in doing so the parties would give up a right of appeal). Many of the points of the SMART Act intersect with the steps already taken by the MSPRC, and an analysis of the effects of the SMART Act must be performed under this purview.

So what about its future impact? The Act first intends to establish a password-protected website to be used by the beneficiaries, their authorized families or other representatives, and applicable plans with proper consent, to access conditional payment information and determine the final reimbursable amount prior to the date of settlement. Based upon the establishment of the web-based portal and the alternative methods for recalculating repayment amounts, it appears that the MSPRC has already tried to consider this objective. However, in order to comply with the tenants of the Act, the portal will certainly need to be expanded upon. The SMART Act does not identify any penalties should Medicare fail to provide conditional payment information within the proscribed timeframes. Unless the Secretary would establish specific consequences for failure to provide information in a timely manner, further action may be necessary to enforce this area of the SMART Act.

Second, the Act intends to establish new processes by which an individual can both address discrepancies with the final reimbursable amount, and to establish the right to an appeal and an appeal process regarding the recovery of conditional payments from an applicable plan. This point of the Act has not yet been addressed by the MSPRC, and so the implementation of the Act will be the first to create these processes. Currently, parties have the opportunity to dispute a conditional payment amount, and appeal a final demand amount with the MSPRC. The first step in current conditional payment appeals involves a written request explaining why the amount is incorrect. This must be done within 120 calendar days from the date a party receives notification of the initial determination. While the MSPRC may issue a letter altering the conditional payment amount in favor of the appellant, there is little formality to this process and, at least in the past, has been questionable accountability on the MSPRC if they fail to respond. If the MSPRC disagrees with a written request to appeal a conditional payment amount, the matter can be taken to an independent contractor for review. This step is considered the Qualified Independent Contractor (QIC) review. The MSPRC may also refer to this process as “reconsideration.” A request for this review must be filed within 180 calendar days from the date the party receives a response from the first step.

According to 42 C.F.R § 405.900 et.seq., there are five levels of appeal afforded to Medicare providers and suppliers. If the Secretary were to adopt the uniform Medicare Part A and B appeals processes found within this regulation, a third level of appellate review would occur before an Administrative Law Judge. Additional appellate review could consist of an appeal before the Medicare Appeals Council and then possibly review in a Federal District Court. Whether the appellate procedures referenced in the SMART Act will be consistent with other existing Medicare procedures is yet to be determined.

Third, the Act states that mandatory penalties for Section 111 noncompliance will now become discretionary, rather than mandatory. The Act establishes a procedure for the Secretary to collect proposals to determine in what circumstances penalties will be levied. After consideration of the proposals, the Secretary will issue final rules regarding these penalties. It is likely that these proposals will include punishment for blatant lack of effort to comply with reporting guidelines and fraudulent reporting practices. Perhaps reporting entities demonstrating a good faith effort to comply will be warned rather than penalized for claims that “fall through the cracks,” so to speak. The discretion afforded under the SMART Act may possibly allow for the presentation of evidence, such as documented reporting policies and procedures implemented by a responsible reporting entity, as well as a demonstrated history of compliance efforts before Medicare would automatically slap the entity with the $1,000 per day per claim fine. As to the exact situations subject to penalties, we will have to wait and see what the Secretary decides.

Fourth, the Act proposes to modify reporting rules to eliminate the requirement of the use of Social Security account numbers or health identification claim numbers. The Act states that within a set period of time (although extensions may be given upon cause) the Secretary must modify the reporting requirements so that Social Security numbers or health identification numbers will not have to be used. This is perhaps the most challenging aspect of the Act to wrap one’s head around, as the creation of alternate identification numbers seems daunting at best. However, the concern regarding the security of beneficiaries’ personal information and identity is one of great importance and will hopefully be addressed with the passing of this Act.

Finally, the Act establishes a three year statute of limitations in which the United States may bring an action regarding payment owed under 43 U.S.C. 1395y after the date of the receipt of notice of a settlement, judgment, award or other payment. This statute of limitations has yet to be codified, and only had been established through case law, most notably through U.S. v. Stricker, et al., No. CV-09-BE-2423-E (N.D. Ala. Aug. 12, 2011).

Certainly, we, as an industry, still have much yet to gain from the SMART Act, and, its effect will forever change MSA practice. However, and thankfully so, the SMART Act has already effectuated significant change on conditional payment processes.

(Michelle, a Member of Burns White, joined the Medicare Compliance Group in 2003. She can be reached at maallan@burnswhite.com. Christina is an Associate practicing on the Medicare Compliance team at Burns White. She can be reached at chduty@burnswhite.com.)

FINAL THOUGHTS 

The Work Comp Institute (formerly Florida WCI) announced Aug. 18-21 as the dates for its 2013 annual conference in Orlando ... NCCI reports that the costs are rising on the latter stages of long-term claims ... Joe Paduda explains what NCCI's data means in his Jan. 22 (blog) ... Nevada is exploring whether telemedicine can improve delivery of care to injured workers ... and there's talk in Texas about arming investigators looking into "pill mills."

Thank you for reading this issue of the newsletter. You can connect with me on LinkedIn by searching for Rob McCarthy, Marketing Director at WorkCompCentral. LinkedIn is the business social marketing site used by many workers' professionals. You can write me at rob@workcompcentral.com

with comments, feedback or to ask for my Super Bowl prediction. 

A LETTER FROM THE PUBLISHER

Greetings:

Workers' compensation is ever evolving, and some years, such as in 2012, there is radical change. Complex systems demand highly educated professionals to ensure smooth operations.

Nothing could be more obvious with the ongoing implementation of SB 863 as we head into 2013. The California Division of Workers' Compensation (DWC) is scrambling to make regulatory changes necessary to meet statutory deadlines. It is also undergoing severe work loads as it tries to institute changes to its computer systems to take electronic payments for lien filings.

New forms, new regulations, new procedures - all in an evolving complexity that may seem like it is too overwhelming to even begin to absorb, let alone come to terms with in our daily business lives.

Carriers, third party administrators, law firms, medical firms all are scrambling to come to terms with the new law and regulations, and are in the process of changing business practices and systems to be ready for 2013.

WorkCompCentral Education during 2012 provided continuing education to over 4,000 individuals. Professionals who sought to maintain their proficiency in areas of workers' compensation law, report writing, bill review, and claims administration.

My projection is that in 2013 WorkCompCentral will educate nearly 6,000 individuals. Sweeping change means many, many people need to be brought up to date. Our mission is to educate as much of the workers' compensation industry as possible and to encourage the sharing of thoughts and ideas.

I know that you, by participating in educational events, online training and webinars, are as committed to professionalism in workers' compensation as we are.

With this in mind, we are assembling a diverse set of top educators to share their unique perspectives on SB 863 and the new regulatory environment as we enter the year of implementation.

In 2013 we will be building and launching a new online educational system that tightly integrates with the main WorkCompCentral site and the new Community system of sharing, messaging and purchasing. Community allows everyone to share their thoughts with another, network and make new contacts (or greet old friends) while enjoying volume based pricing without having to be part of a corporate account.

We will recognize individuals through out the year who have greatly contributed to growing professionalism in our industry through education and community action and, of course, I'll ask you to keep us honest by telling us what we're doing right and what we need to do better.

If we all work together, with Community at our core, we can make the system that involves our profession work as efficiently and properly as possible given the laws, regulations and court decisions as they issue.

In the meantime, on behalf of everyone at WorkCompCentral, I wish you and those you love all the good fortunes of life, health, happiness and peace throughout the New Year.

David DePaolo

david@workcompcentral.com

2012 AWARD WINNERS ANNOUNCED

Nine individuals, one employer and one workers' comp service company were honored by WorkCompCentral on Saturday in Anaheim at the 2012 Holiday Education Program and Awards Reception. 

Marina del Rey Presiding Judge Paige Levy received the Magna Comp Laude Award "for her commitment to excellence in continuing education on the law and practice of workers' compensation."

Other individuals receiving awards were:

Top Attendee: Christina Lam of California State Compensation Insurance Fund.

Top QME Attendee: Dr. Satish Kadaba, Orthopedic Surgeon and Qualified Medical Evaluator

New Instructor Awards: Sean Hermanson, JD, Managing Attorney in the Riverside Office of Heggeness, Sweet, Simington & Patricio. Dr. Julie Armstrong, Psychologist, Medical Evaluator and a Forensic Psychologist and TV Personality

Top Tandem: Jon Brissman, JD, and Judge Myrle Petty. Jon is a Lien Attorney with a law practice in Colton; Judge Petty is a Workers' Compensation Judge at the San Bernardino DWC District Office; she also occasionally hears cases in Bishop, Calif.

Panel Moderator: Kenneth Kingdon, JD, an Attorney and Rating Specialist and Author of Three Books About the AMA Guides Fifth Edition and "The Kingdon Rating Newsletter."

Webinar Presenter: Michael Sullivan, JD, Attorney and Author of "Sullivan on Comp."

Training Partner: Farmers Insurance Co. and its Western States Claims Offices.

CE Sponsor: WorkCompEDI and Manager Chris Mueller, an Electronic Medical Billing Clearinghouse for Carriers and Providers.

These individuals, organizations and other presenters made continuing education programs possible this year because of their efforts and energy. Due to the success and positive feedback after Saturday's event, the Educational Program and Awards Reception will become an annual event. 

More than 160 people attended our inaugural event.

IAIABC HOSTING "GUIDE TO THE GALAXY" WEBINAR

IAIABC is hosting a complimentary member e-vent, "Guide to the Galaxy," on Dec. 13 at 2 p.m. Central Time. Five workers' compensation insiders will guide you through external forces that will impact the work comp galaxy in 2013.

The experts will answer such questions as:

What's the Buzz in Claims? Is the Economy Headed Up or Down? Reform: Why is Opt-Out In? Implementing Affordable Care Act - What Does Work Comp Need to Know? Who Are Tomorrow's Leaders?

This e-vent is complimentary for IAIABC members, but register soon because space is limited! For non-members, registration is $75. Registration information is at IAIABC web site.

PUTTING SB 863 INTO PRACTICE FOR YOUR CLIENTS - JAN. 12

The California workers' comp reform law, SB 863, starts phasing in on Jan. 1, 2013. A daylong continuing-education program 12 days later is designed to give practitioners the tools they need to master SB 863 and to best represent their clients in the coming year.

This program is designed for attorneys, paralegals, hearing representatives and anyone making decisions about claims administration and whether to litigate. The focus is permanent disability rating issues and medical treatment authorization under SB 863. Practice tips will be given and proposed regulations discussed.

"How to Use SB 863 to Best Represent Your Clients," takes place at 9 a.m. Saturday, Jan. 12 at National University in Los Angeles. One hour of California Bar Ethics credit is available.

Judges Colleen Casey, Mark Kahn (retired) and Paige Levy will co-present. Attorney and DWC Community Service Award recipient Robert Rassp, JD, joins them on the panel. Register at 805-484-0333 or at our web site.

WHAT IS A NEVADA COMP CLAIMS LICENSE?

Texas, Oregon and Connecticut are among the states to require claims adjusters who handle workers’ compensation claims be licensed by the state. There is no such requirement in Nevada by the Department of Administration, Hearings Division.

However, a Nevada license is required for anyone representing an employer at a workers’ compensation with the exception of attorneys and full-time employer, insurance carrier, or TPA representatives. NRS 616C.325 mandates this licensure.

Those representing employees at a hearing must be employed full time by the employee’s labor organization; admitted to practice law in Nevada; be employed full-time and be supervised by a Nevada attorney; or be appearing without compensation on behalf of the employee.

Applicants for a Workers’ Compensation Representative license must submit a Worker's Compensation License application, with notary acknowledgement; provide a copy of their driver’s license; pay a
$78 application fee to the Department of Administration; and pass the Workers Compensation Representative Examination. Applicants are tested on NRS and NAC 616 and 617. The test is comprised of 60 multiple choice and true/false questions with a minimum 75 percent passing score. Applicants have up to three attempts to pass the test before reapplying. Tests are given at will.

Anyone with questions on new licenses or license renewal should contact Hope DiBartolomeo, (702) 486-2531, dibartolomeo@hearings.state.nv.us.

Source: Nevada WC Section December Newsletter

Dec. 10: The State Affairs Committee will meet in Austin to review workers’ compensation issues – including the adequacy of benefits to high-wage earners – as the first step in preparing its recommendations to the 2013 Legislature in January. The committee will meet at 9 a.m. in the Senate Chamber at the State Capitol.

Dec. 13: The Alaska Workers' Compensation Board will hold a special meeting to discuss the findings and recommendations of its subcommittee on medical costs and associated cost drivers. Details

Dec. 14: The Texas Division of Workers’ Compensation will accept comments until 5 p.m. Dec. 14 on an informally proposed rule involving certification of maximum medical improvement and evaluation of permanent impairment. Comments may be submitted before 5 p.m. by mail or delivery to Maria Jimenez, Texas Department of Insurance, Division of Workers’ Compensation, Office of Workers’ Compensation Counsel, MS-4D, 7551 Metro Center Drive, Suite 100, Austin, Texas 78744-1645, or by email to InformalRuleComments@tdi.state.tx.us

Dec. 20: The Louisiana Association of Self-Insured Employers will hold a seminar on Medicare secondary payer compliance in Baton Rouge. View

Jan. 11: The Nevada Workers’ Compensation Section of the Division of Industrial Relations published forms and instructions for carriers to use in completing mandatory activity reports that are due on Jan. 11. Forms and instructions are available on the Workers’ Compensation Section website

Jan. 24-25: The Maine Workers' Compensation Board announced training sessions for employers and insurers on Jan. 24-25, April 25-26, June 20-21 and October 20-25. The Winter newsletter lists details

Feb. 28-March 1: The California Division of Workers’ Compensation Education Conference in Los Angeles. Register

March 4-5: The California Division of Workers’ Compensation Education Conference in Oakland. Register

April 10-12: The Florida Bar annual forum on workers' compensation in Orlando. Information

IN THE NEWS 

Calif. - DIR Assessment Increasing by 44% for Insured Employers: 12/05/12

Texas - Larger Firms Returning to Comp while Small Businesses Opt Out: 12/04/12

National - Employers Have Final Say over Marijuana Use: 12/03/12

Texas Mutual Wants to Cut Government Ties, Share Assigned Risks: 11/30/12

N.Y. - SWCB Adopts Final Pharmacy and DME Fee Schedules:11/30/12

Okla. - Labor Commissioner Touts Admin. System, Wants Lawyers Out: 11/29/12

Florida - Claimants' Attorneys Leading Downward Trend in Legal Fees: 11/27/12

National - False Claims Act May Be New CMS Recovery Tool against Employers: 11/21/12

Illinois - Proposed Rules Would Require Medical E-Billing in June 2013: 11/19/12

Georgia - Supreme Court OKs Ex Parte Communication with Worker's Doctor: 11/06/12

Read the full articles with a WorkCompCentral subscription or buy the individual article.  Subscribe
Buy an article using the News search tool at our web site. Tip: Type in the headline of the article next to the magnifying glass (top right of page) and click the eyeglass to search. 

JOBS IN YOUR AREA

Applications for employment are being accepted for: 

Senior (Sr) Loss Control Specialist - Oklahoma City / Tulsa Area‚ OK
Senior (Sr) Loss Control Specialist - Northern Calif / SF Bay Area‚ CA
Senior (Sr) Loss Control Specialist - So CA - Los Angeles Area‚ CA
Legal Assistant / Paralegal - Los Angeles‚ CA 90010
Litigation Manager - Glendale‚ CA
Lien Negotiator - Buena Park‚ CA
Workers Compensation Claim Manager - Canton, MA
Managing Attorney - New York City‚ NY
Workers Compensation Defense Attorney - Cherry Hill‚ NJ;
Philadelphia‚ PA
WC Information Person - Orange County, CA
Surgical Scheduler - UTC La Jolla, CA
Occupational Business Office Supervisor - St. Joseph Heritage Healthcare of Fullerton, CA

CLICK  for these and other job listings.

Thank you for reading WorkCompCentral and for subscribing to this newsletter. If you liked an article or a topic, please let me know in an email. Write in the subject line, What I Liked.

Cheers!

- Rob