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Showing posts with label WorkCompCentral. Show all posts
Showing posts with label WorkCompCentral. Show all posts

Tuesday, October 21, 2014

Good Things: No Chief's Disease Here

Today's post is shared from guest author David DePaolo and is shared from http://daviddepaolo.blogspot.com/

The California Highway Patrol, criticized in the past for exploitative "Chief's Disease," has a program in place that demonstrates that workers' compensation can accomplish amazing things when all of the right motivations are in all of the right places and everyone does their job.

Last week, CBS Sacramento ran a story about CHP officer Mike Mitchell and the CHP's program.

Mitchell lost his leg in 2011 in an automobile crash when he was responding to a call in Amador County. His car hit a tree so violently that he doesn't remember the crash at all, and his injuries were so severe his right leg had to be amputated.

His employer offered him a chance to return to the force, but he had to prove himself physically (and mentally) capable by going through the academy again, this time with a computerized prosthetic that is the stuff of imagination 40 years ago (think "Six Million Dollar Man" with actor Lee Majors as the star).

The prosthetic didn't cost millions - the article says it cost about $100,000.

“I have kids at home and I can’t let them see me quit,” he tells his interviewer.

“Officer-safety wise I still have to able to be able to fight, I still have to be able to shoot and drive. Do everything I’m suppose to do,” he goes on.

After going through retraining and passing the physical assessment tests he regained his uniform and is back on the job patrolling in a CHP cruiser.

“I love doing it,” he said, reflecting the attitude that is necessary for an injured worker to overcome huge obstacles. “I love being out in the public.”

According to the story, there are four other full time officers who are amputees.

I'm sure there are also many failure stories where benefits were not provided timely, or there is a dispute about treatment or indemnity, or where an officer attempts to take advantage of the generous disability compensation system in place for California peace officers.

Those negative situations get a lot of attention. It's easy to focus on the bad, to criticize, and blame.

It's much harder to be successful, to overcome huge obstacles, to achieve cooperation between the many people that need to contribute for a successful outcome - that requires communication, vision, and a huge helping of positive attitude.

The CHP says on its website that, "When injuries occur, our obligation is to ensure all appropriate benefits are accessed and received by those injured employees."

I have to believe that statement when I see a story such as Mitchell's.

We at WorkCompCentral believe that success should be celebrated. So much of workers' compensation is draped in negativity - after all, going through a life altering event such as a work injury is steeped in uncertainty, stress and disappointment.

But there are success stories, many of them. We don't hear about those, and some people have been critical of the Comp Laude Awards for injured workers stating that we are making a mockery of the system.

Nothing could be further from the truth, and the fact is that we have had many, many injured workers nominated, and many other injured workers praising our efforts to recognize people who have overcome the odds.

And this happens with the help of the teams of people, the employers, claims adjusters, doctors, attorneys, doing their jobs the best they can.

Stay in this industry long enough and cynicism can dominate your thoughts.

Workers' compensation does good things. We just don't hear about them very often.

When you go to work this morning, do good things - make a case work properly, get an injured worker back on the job, celebrate positive outcomes!

And join us Saturday, December 6, to recognize people and companies that make a difference.

Monday, August 25, 2014

Restoring Faith

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com
That was just one work comp group and happened to be the most prolific. Plenty of other comments have been made in other venues.
I never in my wildest dreams would have imagined that my little, slightly sarcastic, muse on being both an employee and employer dealing with the same work injury and ultimately deciding that work comp was the worst of all worlds for dealing with it would create such interest, controversy, engagement and interaction.
But it did.
Some disputed that it could be labeled industrial since it was only a back sprain. Others said to stay out of the work comp system at all costs. And others simply demonstrated a lack of understanding of work comp, at least relative to California law.
No one, though, said that I should file a claim as an employee or report the claim as an employer.
Perhaps that's because everyone is a professional in the system, an insider, and everyone knows that once a claim comes into the system both the employer and the employee lose control to the gaming that every single vendor - insurance company, doctor, lawyer, etc. - will engage in to "do the right thing" according to their special interest.
Certainly there were more "claim denied" or "services denied" responses than I thought would occur.
Just like real life work comp.
The California Workers' Compensation Appeals Board on Thursday designated a case a "Significant Panel Opinion" because a carrier that had approved nurse case manager services prior...
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Tuesday, December 10, 2013

Delay Or Deny At Your Risk

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

There are so many reasons why both employers and workers feel that workers' compensation is "broken" or doesn't work.

Peter Rousmaniere, who is beginning work this week for WorkCompCentral, suggests in his column reviewing two studies on perceived delays in medical treatment that delay may arise as much from indifferent doctoring skills as days elapsing on the calendar.

An employer consultant relayed to me a factual scenario indicating another cause of this perception - standard claims administration protocol, which is defensive in nature as opposed to being aggressively pro-active.

Rousmaniere cites a couple of studies in his column. A Texas Department of Workers' Compensation survey of injured workers documents wide discrepancy in perceptions, but also notes that up to 50% of all survey respondents complained of some delay in receipt of treatment.

Another study cited by Rousmaniere conducted by Harbor Health, which specializes in designing workers’ compensation provider networks, looked for differences in claims outcome, including medical cost and litigation rates, and if surgical treatment happened early or late in the course of treatment.

Harbor Health found that early surgery in carpal tunnel cases (earlier than recommended by treatment guidelines) produced slightly more cost in medical expense but much less cost in indemnity expense.

Let's put these findings into context.

Assume a 28 year old male worker who complains of "...
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Friday, November 15, 2013

Work Comp Lost Focus

Today's post was shared from daviddepaolo.blogspot.com

As part of a cadre of bloggers that write about workers' compensation, one of the questions we are often asked to address is, "what is wrong with workers' compensation?".
The California Division of Workers' Compensation largely answered that question by announcing that they have issued a new, mandatory, Form 105 for unrepresented workers to request a panel qualified medical examination.
The new form is at http://www.dir.ca.gov/dwc/FORMS/QMEForms/QMEForm105.pdf. Take a look at it, and tell me if you were not savvy about workers' compensation if you would not be intimidated and/or befuddled by this monstrosity of bureaucratic irrationality.
I know what the administration was thinking when this form was developed - that claims administrators would be the primary users.
But if it is an unrepresented injured worker the amount of data required, the exact procedure to be used, and the terms contained within the form all conspire against a fair outcome for the claimant.
For instance, is an injured worker going to understand that the reason for a QME panel request is based on Labor Code section 4060, 4061 or 4062?
NO.
And unless your claim is relatively simple, are you, as an unrepresented, likely unsophisticated consumer of workers' compensation resources really going to know which medical specialty should be performing the services?
NO.
And how about this daunting, foreboding warning: "If you do not select a QME from the panel, schedule an appointment with the QME and inform the...
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Thursday, October 31, 2013

DePaolo's Work Comp World: Trucks, WBV and Cancer

The National Cancer Institute (NC!) reports that over 230,000 males in the US will diagnosed with prostate cancer in 2013 and that 29,790 deaths will result. David DePaolo, published of WorkCompCentral®, writes today of the potential new wave of workers' compensation claims arising from the association of whole-body vibration syndrome (WBV) experienced by truck drivers and its relationship to prostate cancer. He links source material to support the argument. This post is shared from http://daviddepaolo.blogspot.com .

You just never know what the next big risk category is going to be in workers' compensation.
I had been persuaded by an argument offered by Charlie Kingdollar, Vice President emerging issues unit for General Re Corp., that nanomaterials would be the next asbestos.

OSHA has been particularly concerned with silica in the past couple of years.

Tuesday, October 22, 2013

DePaolo's Work Comp World: Genetic Testing?!

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

The reason lawmakers and regulators create rules that seem onerous and ponderous to the vast majority of us is because there are "outliers" that ruin it for everyone else because of indescribably selfish behavior.
There's always someone taking a new angle to take advantage of the liberal rules of workers' compensation for their own profit regardless of the social consequences. This seems particularly acute in California, but nevertheless occurs in other jurisdictions too.
Recently posted in the WorkCompCentral Forums was an inquiry as to whether anyone else in the community is starting to see bills for unsolicited services related to genetic testing for drug addition predisposition.
The author of the post, an attorney for the employer/carrier, says that the case in question had been settled. In preparing the settlement documents a review of California's Electronic Adjudication Management System database was conducted to identify all parties. Nearly all lien claims had been settled, but one remained stubbornly immovable (and I'm not even clear that the parties were ever properly served and/or noticed of this particular vendor until the end of the case).
For this one particular lien the claim file notes apparently show a request for billing and report after discovery of the vendor in the EAMS search. The carrier got fax copies of a bill and report with a demand for payment.
The bill was for $3,626.00 for the genetic testing.
According to the post, the initial report, based on an...
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Sunday, October 20, 2013

FEHA Ain't Work Comp

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

Whether one is an employee is always an interesting question in workers' compensation.
Many employers, and workers for that matter, erroneously believe that if they are designated as an independent contractor for tax purposes, receiving a 1099 report on their wages, that they are not employees for workers' compensation matters. This is a relatively common occurrence.
But the issue can arise in other contexts, and a recent California case highlights this paradox.
Sierra Madre is a small city in the north-east sector of Los Angeles County.
Kailyn Enriquez applied for a position as a firefighter for the Sierra Madre Fire Department in October 2007. The city selected her to work as a probationary volunteer firefighter the following January.
The city hires and fires volunteer firefighters, sets the rules and regulations for their work, requires them to work specific shifts and to arrive on time and requires them to report to supervisors and to work within the framework of the SMFD. Volunteer firefighters also receive training and workers' compensation coverage.
The city pays volunteer firefighters a stipend of $1 per day, every 90 days, and also pays the volunteers $33 per day if they are "hired out" to other agencies.
On April 10, 2008, Enriquez began the background check procedure required for employment by the Sierra Madre Police Department.
Four months later, the SMFD issued her a disciplinary notice stating that she was "[d]ishonest," "[d]isobedient" and had taken actions that...
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Wednesday, October 16, 2013

Too Much Temptation To Do the Wrong Thing

The business of workers' compensation in New York, and the economic tension it generates, is the focus of a commentary by the publisher of Work Comp Central, David Depaolo. Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com


The problem with workers' compensation being funded and managed by private interests is that there is simply too much temptation to do the wrong things for the wrong reasons - usually those reasons involve profiting at the expense of everyone else.

And so it seems in New York where an associate attorney in the State Workers' Compensation Board General Counsel's Office said in an affidavit filed in New York Supreme Court Friday that improper cost-shifting by the state's workers' compensation carriers has caused the liabilities of the state's Reopened Case Fund to "spiral exponentially," of course at the expense of employers.

After the historical reform of New York's system by then Gov. Eliot Spitzer, that imposed the state's first duration caps on permanent partial disability benefits, carriers began settling the indemnity portion of claims, leaving medical treatment open.

Three years after the indemnity payments run out, carriers can then file claims with the fund providing medical evidence that the workers' condition has changed, thereby shifting the cost of medical care for injured workers over to the Fund.

The lawsuit in which the affidavit was filed was initiated by Liberty Mutual Insurance Co. and 19 of its sister insurers to block a section of Gov. Andrew Cuomo's 2013-2014 budget the close the fund on Jan. 1, 2014.

Coumo made closing the fund part of the "Business Relief Act" included in his $141.3 billion budget and predicted that closing the fund will save New York...
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Saturday, October 12, 2013

Where's the New Jersey Conference?

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com


There's going to be lots of press surrounding the latest CompScope Benchmarks Study
released by the Workers' Compensation Research Institute, as there always is, and should be. After all, the WCRI is one of the top research groups in our industry and the leadership and staff there work hard to provide as complete and unbiased data as possible.

What is unique about the latest study of 16 states is one common theme - controlling costs has more to do with instituting price schedules for medical services than any other single factor.
The premier example is Illinois, which, after reducing medical fees by 30% across the board on Sept. 1, 2011, saw all medical payments for claims with seven days of lost time declined by 5% for injuries arising in 2011 and evaluated as of 2012. Prices paid for non-hospital services dropped by 24% between 2010 and 2012.

And Texas' claim costs, which ranked the highest in the nation prior to a set of reforms passed in 2005, are now typical of the states studied, according to WCRI , with medical costs per claim 17% lower than the 16-state median for 2009 claims evaluated in 2012. The Institute expects costs to decline further in Texas with the prescription drug formulary that became effective 9/1/2011.
The state's claim cost growth rate is also slowing. Claims costs in Texas grew by between 3% and 6% per year between 2006 and 2011. Costs per claim for the 2010/2012 study period were $5,829 – slightly higher than the $5,354 median.

The flip side is...
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Wednesday, October 9, 2013

Family Makes the Difference

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com


Mom and Dad are late in their years. Mom is 89 and has moderate dementia. Dad just turned 91 and was in excellent physical health despite a history of heart disease and bypass surgeries.
"Was" is the critical verb in the prior sentence.
Dad is the decision maker, always has been. A retired dentist who had a successful practice, he is a leader and is used to being in charge.
Also a faithful husband and family man, Dad made a personal commitment to himself years ago to take care of his wife to the end.
He will also admit that he is the world's worst planner ... except for when it came to vacations.
He didn't count on disability.
Having elderly parents, seeing their travails on a weekly basis (my commitment to them was to visit at least once a week), and watching them sunset physically and mentally, provides some awareness of the disabled state.
Dementia is a terrible disease. It progresses gradually, taking elements of memory away from daily functioning in a cruel manner. At Mom's stage, she forgets sometimes just how to walk, so she falls and then can't get back up.
Dad thought he could deal with this. He thought wrong.
Dad has sciatica and pain radiates down his leg. This started a few months ago.
A shot of cortisone every once in a while alleviates the symptoms and he goes about his days with good energy and strength. But when he has to wait because of dosing issues, or just access issues, he can't move much without a walker.
This past week was a seminal week in my father's...
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Saturday, September 14, 2013

CA's New Rate Filing Reflects Uncertainty

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com


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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