Problems with the national workers' compensation system are addressed in today guest post authored by David DePaola and shared from http://daviddepaolo.blogspot.com/ Then I get an email from a former claims professional turned auditor that completely deflates my enthusiasm and makes me angry. The emailer has been in the process of auditing some cases on behalf of an insurance carrier whose cases are administered by a Third Party Administrator. This is a pretty typical arrangement. Carriers are very good at "writing the paper" and all the processes involved from brokerage administration to determining the risk (underwriting) and marketing. Then the job of actually handling the claims gets outsourced to specialized companies: TPAs. The auditor writes she's appalled; outraged at the lack of any sense of urgency, the lack of responsiveness to defense attorneys, not to mention applicant's attorneys. She's astounded at the failure to pay temporary total disability, the failure to advance permanent disability a year after the Agreed Medical Examiner's findings are undisputed to a person who's getting $500.00 a month from Social Security. She's offended that the TPA lets the defense attorneys handle the files, lets cases linger until a pinky finger from 2008 ends up turning into hand, arm, neck, back, internal, sleep, psyche, etc., etc. - on a case that was really ready to settle no less than 4 years ago. She asks, "Why would these cases still be open (excluding those with obvious complex if not catastrophic issues) when the file reflects many opportunities for settlement that slipped away?" Of... |
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Showing posts with label Total permanent disability insurance. Show all posts
Showing posts with label Total permanent disability insurance. Show all posts
Wednesday, August 27, 2014
The Word Didn't Get There
Monday, August 25, 2014
The Father of the 11th Circuit Court Decision
Today's post is authored by Peter Rousmaniere and shared from workcompcentral.com The Florida 11th Circuit Court decision on Aug. 13 appears to be the first state court decision in many years to declare an entire workers’ compensation statute as unconstitutional. The fingerprints of the Dean of Workers’ Compensation Research John Burton are all over Judge Jorge Cueto’s reasoning. Since the 1970s, Burton, with a law degree and PhD in economics, has been the leading academic scholar in workers’ compensation, even now years after his retirement from a faculty position at Rutgers University. Burton surely thinks that this decision is long coming. So, what’s his complaint? Cueto wrote that through the years, the state has cut back permanent partial disability benefits so severely that the state “no longer provides any benefits for this class of disabled worker.” Burton’s writings indicate that he holds that whatever permanent disability benefits there are in Florida, they are so low and PPD so significant, that the entire workers’ comp system in Florida is inadequate. Cueto agrees. He cites National Council on Compensation Insurance estimates that legislative changes in 1979, 1990, 1994 and 2003 cut PPD benefits severely. Per Burton, Florida “eviscerated the permanent partial benefit system.” The current benefits are “less than available during the 1970s and markedly lower than... |
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Thursday, February 13, 2014
Missouri Further Defines Permanent Total Disability
"The PTD test is whether the worker can compete in the open labor market.
Schussler, 393 S.W.3d at 96. A worker who cannot return to any normal or
reasonable employment is totally disabled; she need not be inert or completely
inactive. Id. “The key question is whether any employer in the ordinary course of
business would reasonably be expected to hire the worker in his or her current
physical condition.” Id. "
MARLENE STEWART, Respondent vs. CLINT ZWIEFEL, TREASURER OF THE STATE OF MISSOURI AS CUSTODIAN OF THE SECOND INJURY FUND, Appellant
No. SD32827 ) FILED: February 10, 2014
Schussler, 393 S.W.3d at 96. A worker who cannot return to any normal or
reasonable employment is totally disabled; she need not be inert or completely
inactive. Id. “The key question is whether any employer in the ordinary course of
business would reasonably be expected to hire the worker in his or her current
physical condition.” Id. "
MARLENE STEWART, Respondent vs. CLINT ZWIEFEL, TREASURER OF THE STATE OF MISSOURI AS CUSTODIAN OF THE SECOND INJURY FUND, Appellant
No. SD32827 ) FILED: February 10, 2014
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Monday, February 3, 2014
Substantial Credible Evidence Remains the Rule
Despite the informality of a workers compensation hearing, the evidence relied upon by the hearing official must be substantially credible in order to meet the burden of proof to assess disability. When the claimant has had a history of a multitude of back injuries, sorting out the claims maybe a complicated and difficult process. The compensation judge is compelled to ascertain which accident is the ultimate triggering incident that resulted in permanent disability.
The last back claim of a worker did not meet the evidential standards to sustain a claim for disability when the diagnostic tests, as interpreted by the treating physician, did not support the evidential requirements to establish the assessment of permanent disability.
A worker in New Jersey, who has a long history of back injuries, both at work and at home, was unable to meet the evidential requirements to to establish a case for increased disability. An MRI, interpreted by the treating physician, demonstrated no change in the injured workers medical condition following the last incident at work.
Accordingly, The NJ Appellate Division sustained the ruling by the compensation judge, who had held that proofs offered at trial were insufficient to meet the requirement of the statutory credible evidence standard. The trial judge was held to have correctly relied upon the treating physician’s diagnostic MRI taken subsequent to the last accident to rule out the final incident as the triggering episode that generated the claimant’s disability.
Beausejour v Chamberlin Plumbing & Heating, Inc., 2014 WL 300929 (N.J. Super. A.D.), Jan. 29, 2014
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Saturday, September 14, 2013
CA's New Rate Filing Reflects Uncertainty
The political grandstanding that is typical this time of year when the California Workers' Compensation Insurance Rating Bureau publishes is pure premium rate request should be boisterous.
The WCIRB's Governing Committee yesterday voted unanimously to approve a 2014 advisory pure premium rate of $2.70 per $100 of payroll. This is 3% more than the $2.62 rate the committee approved in August and is 6.9% higher than the average insurer filed rate of $2.53. And even then rates may be inadequate to cover loss developments according to members. The combined ratio remains well north of 100%. Much of the uncertainty stems from the pending conversion to the Resource Based Relative Value Scale for physician reimbursement. Estimates on the impact of the conversion range from no impact to an increase of up to several hundred million dollars. The reason for the vagueness is that there are codes in the current system that have not yet been "cross talked" to the RVRBS. Adding to the complexity is that for unknown reasons claim frequency has been climbing. Increased frequency and medical loss-cost development that was observed in data collected through the end of June accounts for more than two-thirds of the proposed rate increase. (About 2% of the increase for 2014 is attributed to higher permanent disability benefits.) Some suspect this is due to resolution of complex older claims that had been languishing because of Medicare set-aside requirements as well as the nature of the injuries. Since... |
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