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Showing posts with label daviddepaolo.blogspot.com. Show all posts
Showing posts with label daviddepaolo.blogspot.com. Show all posts

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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Wednesday, February 12, 2014

Being Professional

Today's guest post is shared from David DePaolo from daviddepaolo.blogspot.com
The practice of workers' compensation law is relatively relaxed, at least in California, but I suspect the same in most of the rest of the country where it is an administrative system.

That's what attracted me to the practice in the first place nearly 30 years ago. Collegiality, informality - the emphasis was on substance over form, and the primary mission of the practice - delivering benefits to those entitled and discriminating against those not so entitled - took the forefront over everything else.

But relaxed doesn't mean sloppy, and does requires a higher level of self-discipline.

Unfortunately, too many people don't have the discipline to be let loose in an informal, relaxed legal system. Too many need more concrete barriers, more defined lines; perhaps because these folks lack the integrity or control to handle the responsibility that comes with such an insouciant practice.

Or perhaps these folks are, themselves, just sloppy and inconsiderate of the rules.

Rules - these are in place to make sure that everyone is playing on the same field, to keep anyone from having an unfair procedural advantage, and also to put checks and balances on the costs associated with litigation from the institutional perspective.

The California Workers' Compensation Appeals Board collected almost $300,000 in sanctions last year − three times the amount collected in 2012.

The WCAB had been warning...
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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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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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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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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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