02.21.2017By: Sidney Wong
The Centers for Medicare & Medicaid Services (CMS) moved forward with requests for proposal regarding the Workers’ Compensation Review Contractor (WCRC) contract by releasing a full solicitation notice before the holidays. Because the request is for a five-year contract, the solicitation information can provide clues to CMS’s long-term strategy regarding Medicare Set-Asides (MSAs).
Insights into Liability Medicare Set-Asides change timeline
The CMS solicitation notice...
At the 2017 PARMA Conference, a panel discussed cyber liability concerns for public entities. The panel was:John Chino – Arthur J Gallagher Steven Robinson – Risk Placement Services, Inc. Elissa Doroff – XL Catlin
Common Patterns of Cyber /Claims:Missing or stolen laptop or storage devices Mismailing Erroneous data posting Willful release based on fraudulent instruction (social engineering, Phishing), this is sometimes not covered under Cyber but instead crime Compromised system (hacking) Loss or theft of...
02.21.2017By: Darrell Brown, Chief Claims Officer, Sedgwick
It’s a topic that gets much buzz – how will the cloud of legislation surrounding recreational and medical marijuana use impact businesses, specifically when it comes to compensability for workers’ compensation? I am sure you have all caught up on news about additional states voting to legalize marijuana for medical use and adult recreational use during the Nov. 2016 election. Let’s take a look at those changes,...
Workers' Compensation matters were intended by the legislature to be summary and remedial actions. Accelerated justice does have its consequences on appeal, and should be implemented prudently.
In an effort to move case dockets at a quicker pace, New Jersey implemented an accelerated award procedure, "a trial on reports," that allowed for the disposition of cases at the pre-trial conference stage. It was to be utilized either by the consent of the parties where the only issue presented was...
02.20.2017By: Cynthia K. Karlen
Despite much confusion, calculating temporary disability (TD) can be easy—and fun—if we keep a few simple rules in mind.
All employees receive the maximum Temporary Disability rate UNLESS there is documentation proving the employee is not a max earner. First, get a wage statement from the employer and determine if the applicant is a full time or part time employee. When was he/she hired? Are there...
02.02.2017By: Robert Wilson
While perusing the news early this morning I came across several articles related to reforms pending or proposed in two key states. One such article was discussing potential reforms in a state dominated by a Republican governor and legislature; another was discussing a state with a Republican Governor but a legislature permanently controlled by Democrats. The former article was largely focused on the efforts of the state Chamber of Commerce to protect their members. The latter...
Synopsis: RICO Claims To Disappear from U.S. Workers’ Comp World And Good Riddens.
Editor’s comment: If you don’t know, the Federal RICO concept was, in my opinion, created to stop Mafia folks from defrauding and extorting money from our citizens. The Racketeer Influenced and Corrupt Organizations Act, commonly referred to as the RICO Act or simply RICO, is a United States federal law that provides for extended criminal penalties...
Synopsis: The Biggest News in Illinois Workers’ Comp History No One is Reporting—I Assure You The IL Workers’ Comp Commission Is Set To Close Thirty Days From Today!
Editor’s comment: I had a reader tell me Illinois State Government appears to be filling in for the Ringling Bros. and Barnum & Bailey Circus that is soon to close. Everything that is happening in our state government...
Chesapeake Employers Insurance Company, Maryland’s largest writer of workers’ comp insurance, has created a message kit for employers that is designed to help reduce opioid addiction. Information on the Chesapeake web page indicates that the kit is free. The kit promotes opioid use prevention and includes posters, flyers and tip sheets employers can post in break rooms and other places where employees gather. Per Chesapeake, 75 percent of injured workers are prescribed...
02.02.2017By: Gary L. Wickert
Every year, more than 170 billion cell phone texts are sent and received. Each year, an average of 3,000 people die and 450,000 are injured in motor vehicle accidents involving distracted drivers. Ten percent of all drivers who are 15 to 19 years of age involved in fatal crashes were distracted when the accident occurred. The significant safety problem of distracted driving has grown exponentially over the past decade and has reached epidemic proportions.
Precisely which distractions are...
02.02.2017BY: Tom Lynch
First, a review.
Yesterday, we described the challenges confronting claims adjusters and injured workers when psychosocial issues are present in a workers’ compensation claim. These issues impede recovery and exacerbate costs. We confidently picked up our saw and walked out on the proverbial limb to suggest this thesis:
Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful...
Words matter. Right now, for good or bad, as the torch is being passed from one president to new one, one of the key platforms that PEOTUS ran on was eliminating Obamacare. But as the reality of that potential grows closer, social media is abuzz with debates. It would appear that some people didn’t fully understand what they signed up for. Going viral on Facebook, a poster celebrates the demise of Obamacare, patting himself on the...
A Federal Court has ruled that a Medicare Advantage Organization (MAO) is permitted under the law to sue a law firm and a lawyer for the failure to reimburse conditional medical expenses arising out of an accident.
US District Court Judge, Henry E. Hudson, ruled that the Medicare Secondary Payer statute created a private cause of action to pursue recovery for conditional payments that it made on the beneficiary's behalf for medical expenses resulting from...
01.23.2017By: Bryon Bass, SVP, Disability and Absence Practice & Compliance, Sedgwick
On December 8, I hosted a webinar along with Donna Hardaker, former Director, Wellness Works Mental Health America of California and Heather Holladay, Integrated Health Manager Pacific Gas and Electric Company. It was a fantastic discussion on a topic which needs much more attention: stigma and social prejudice toward employees with mental health challenges. If you were not able to attend, you can revisit the recorded webinar...
01.23.2017By: Lavonya Chapman
The Centers for Medicare & Medicaid Services (CMS) announced the organization will be reconsidering a new policy in 2017 regarding re-reviews of otherwise approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) amounts. According to the CMS announcement, this new policy would only apply to claims “where settlement has not occurred.” As such, if settlement has been agreed upon CMS will not consider a re-review. The timing of any such change, however is yet unknown....
01.23.2017By: Mark Popolizio
In an important new case—CIGA v. Burwell, 2017 WL 58821 (C.D. California, January 5, 2017)—the court ruled that the CMS practice of seeking full reimbursement of a medical provider’s single charge—even where some unsegregated portion of that charge relates to services not covered by a workers compensation plan—was improper under the Medicare Secondary Payer Statute (MSP) and its supporting regulations.
This new decision...
01.10.2017BY: Tom Swiatek UR Nation
UR Nation wishes everyone in the workers’ comp industry a happy 2017. We hope 2017 will be the best year yet for all our readers. What follows is a list of news stories that were important in 2016 and will have a significant impact in 2017.
CA Formulary Rule-Making Slated for January
The California Division of Workers’ Comp plans to start formal rule-making for a prescription drug formulary in January, according...
01.10.2017By: Robert Wilson
A Japanese insurance company is about to thrust the insurance industry into the future, as well as the ongoing debate over how much technology will really alter our industry.
I’ve spent a good deal of time this past year discussing the future of workers’ compensation at conference presentations around the nation. Obviously, technology is a big part of those discussions. I always caution my audiences that there is plenty of room...
Welcome to this month’s Comp Medical News update. Black lung, gun violence, and the ACA “deathwatch” are your headlines as we begin 2017.
Primary Care Physicians Identify Antibiotics and Opioids as Low-Value in New Survey
Primary care doctors surveyed by the American College of Physicians listed the use of antibiotics and opioids among the four most common low-value treatments that are most frequently used by doctors, according to survey data published...
01.10.2017By: Gary L. Wickert
Following an election cycle in which illegal immigration became a touchstone issue, it seems only appropriate that claims handlers and subrogation professionals have a clear understanding of the many nuances involving workers’ compensation claims made by undocumented employees. Indeed, with more than 11 million such immigrants living and working in the country according to the U.S. Department of Homeland Security, such an understanding is probably indispensable. When an injured employee initiates a workers’...