CCM e-News Brief Vol. 8, No. 8, August 1, 2012
CCM e-News Brief
Vol. 8, No. 8, August 1, 2012
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Lump Sum Payments and RTW.
Lump-sum settlements paid in workers' compensation cases appear to encourage people to return to work, according to a new study. (See more stories on this insurance news topic.) Workers Compensation Research Institute's (WCRI) study, based on the analysis of 2,138 workers in Michigan who were injured in 2004, found that 78% of those injured workers receiving lump-sum settlements did not change their work status. The study tracked them through 2008. "This is an important study because we need to find out whether settlements discourage return to work for injured workers who want to return to work or assist them in closing this chapter of their life and moving on with their career," says Bogdan Savych, author and public policy analyst at WCRI. "My hope is this research will help policymakers and other stakeholders understand how workers respond to receiving a lump-sum settlement." Many of those who were employed at the time of the lump sum stayed employed and those who were not employed remained unemployed, researchers found. Of those injured workers that did change their employment status, 30% who were employed at the time of the lump-sump settlement left work and 19% of those who were not employed at the time of the lump sum attained employment. On average, more injured workers returned to work after receiving a lump-sum settlement than exited. Average employment in the sample increased from 25% to 32% among workers one year after a settlement. The exception is older workers who experienced a decline in employment after a settlement, according to the WCRI.
Turning Down the Heat.
As a model other drought-plagued states may follow, California OSHA is reminding all employers to protect their outdoor workers from the risk of heat illness, especially with heat waves expected this week in the Central and Inland Valleys. Cal/OSHA has maintained a constant presence to ensure that employers protect their outdoor workers from the risk of heat illness. While these ongoing efforts have saved lives due to greater compliance by employers, constant vigilance is particularly necessary during periods of high heat. "Cal/OSHA's enforcement of the nation's first and most comprehensive heat illness prevention regulation has saved many lives since its adoption, as is evident by the reductions in fatalities and serious illnesses since 2005," said Christine Baker, Director of the California Department of Industrial Relations. Cal/OSHA inspections occur year round to ensure that farm workers and other outdoor workers are protected from heat illness. The comprehensive inspections include a thorough review of employers to ensure they have enough water and shade, are providing rest breaks, and have provided adequate training for supervisors and workers about emergency procedures in case workers become ill from the heat. Cal OSHA has extended its effective statewide public awareness campaign that targets the most underserved population of outdoor workers and includes messages in Spanish, Punjabi, Hmong, Mixteco and Trique. The award-winning Water. Rest. Shade campaign is a multi-faceted initiative combining outdoor and radio announcements. For more information on heat illness prevention and training material visit http://www.workerscompensation.com/DOSH/HeatIllnessInfo.html and http://www.workerscompensation.com/heatillness.
CCM e-News Brief Vol. 8, No. 6, June 1, 2012
CCM e-News Brief
Vol. 8, No. 6, June 1, 2012
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Fewer New Jobs in May.
Businesses hired far fewer workers than expected in May, throwing into doubt the strength of the economic recovery. Only 69,000 jobs were added last month, the weakest growth in a year. The unemployment rate rose to 8.2%, as people rejoined the labor force. Economists surveyed by CNNMoney had expected to see employers add 150,000 jobs and the unemployment rate to remain at 8.1%. Revisions from previous months also showed the economy gained 49,000 fewer jobs in March and April than originally thought. Private companies sharply cut back on hiring last month, adding only a meager 82,000 jobs. Employment increased in health care, transportation and wholesale trade, but declined in construction. It was little changed in most other major industries. The public sector continued to shed jobs, losing 13,000 in May.
TDD Benefits Still Increasing.
NCCI's newest research brief updates a previous paper published in 2011. While this study confirms prior findings that average duration of payments for Temporary Total Disability (TTD) indemnity benefits has been increasing since the onset of the recession in late 2007, there is evidence that the trend might be moderating in 2010. Countrywide, our estimate of ultimate mean duration of TTD indemnity benefits has risen from about 123 days for injuries that occurred in 2006 to a forecasted high of 143 days for injuries that occurred in 2009, moderating slightly to 141 days in 2010. The national unemployment rate deteriorated nationally from 4.6% in December 2007 to 9.3% in December 2009, and rising further to 9.6% in December 2010. Data for this study is claims with injury dates from 1998 through the first six months of 2010 for which TTD indemnity benefits have been paid. The duration of TTD benefits is determined by adding the number of distinct compensated days reported on indemnity payment transactions. Lump sum settlements were included where the compensated days were listed as part of the payment. If a settlement transaction only included a single covered day, then only that one day was included as part of the claim duration.
Random Workplace Inspections Reduce Injuries.
A new study [ David I. Levine, Micheal W. Toffel, Matthew S. Johnson, "Randomized Government Safety Inspections Reduce Worker Injuries with No Detectable Job Loss, Science, Vol 336, 18 May 2012] using California data provides a well-researched answer. Michael Toffel, an environmental management expert (Harvard Business School), along with economists David Levine (University of California, Berkeley) and Matthew Johnson (Boston University) created 409 matched pairs of inspected and uninspected workplaces from Cal/OSHA data. Sectors were representative of the higher risk industries in the state and include construction ( general building, special trade contractors), wholesale trade (durable and non-durable goods), metal fabrication (doors, car parts, aerospace products), wood and lumber products, transportation and others. Firms included in the study had at least 10 employees and some had more than 500. The researchers looked at the records for up to four years before and after the year of inspection. Their study found 9% fewer injuries following the inspection and 26% lower injury costs but no negative impacts on economic factors such as employment, total earnings, or company survival. Importantly, the random-inspection effects endured at statistically significant levels even four years after the year of the inspection. The study certainly supports the idea that random workplace inspections reduce both minor and major injuries to workers and costs for employers without economic harm to the enterprise or reductions in the labor force.
CCM e-News Brief Vol. 8, No. 5, May 1, 2012
CCM e-News Brief
Vol. 8, No. 5, May 1, 2012
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
DOI Proposes New Illinois Rules.
The Department of Insurance has filed proposed rules on the Preferred Provider Program (PPP). PPPs were authorized by the 2011 legislation. To view the proposed rules. Select the Issue 17/April 27, 2012 Illinois Register, and go to item 6356 of the document (page 286 of the pdf). Note that any comments on the rules must be directed in writing to the DOI contact people listed (not the IWCC).
Illinois Workers Comp Audit.
The Illinois Auditor General's Office has recently released their audit of the Workers' Compensation Program as it applies to State employees, identifying what the auditor referred to as "numerous shortcomings in both the structure and operations" of the workers' compensation program. The Workers' Compensation Program as it applies to State employees involves three State agencies: the Department of Central Management Services (CMS), the Illinois Workers' Compensation Commission, and the Illinois Attorney General. According to data received from CMS, for the four-year period January 1, 2007, through December 31, 2010, State employees filed a total of 26,101 workers' compensation claims. As of July 2011, over $295 million was paid in workers' compensation for State employees on claims filed during the four year period.
AIA Supports Fed Legislation.
The American Insurance Association (AIA) recently applauded the introduction of bipartisan legislation, "The Medicare Secondary Payer and Workers' Compensation Settlement Agreement Act of 2012," by Rep. Dave Reichert (R-WA) and Rep. Mike Thompson (D-CA). The bill aims to resolve the routine delays and confusion in the review of workers' compensation Medicare set-asides by the Centers for Medicare and Medicaid Services (CMS). "This legislation will provide clear and consistent standards for the CMS administrative process," said Melissa Shelk, AIA vice president for federal affairs. "The current CMS set-aside review process is both cumbersome and confusing. Representatives Reichert and Thompson understand that a legislative solution is needed to address stakeholders' concerns and to reform a broken system." Currently, CMS takes too long to review proposed set-asides, fails to provide consistent standards for determining amounts to be set-aside, and provides no avenue to appeal CMS determinations. This is a pervasive workers' compensation claims problem that impacts all stakeholders, injured workers, employers, insurers and state workers' compensation agencies, nationwide. "Passage of this legislation will compel CMS to make timely coverage decisions and enable appeals when necessary," said Shelk. "The bill also contains much needed provisions to address costly problems and delays that will benefit injured workers, employers and insurers alike." "The Medicare Secondary Payer and Workers' Compensation Settlement Agreement Act of 2012" has been referred to the Ways & Means Committee for consideration.
CCM e-News Brief Vol. 8, No. 4, April 1, 2012
CCM e-News Brief
Vol. 8, No. 4, April 1, 2012
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
OSHA RFI.
The Occupational Safety and Health Administration (OSHA) today issued a "Federal Register - PDF" Request for Information that seeks comments on how to prevent injuries and deaths from reinforcing concrete activities in construction, and from vehicles and mobile equipment backing into workers in construction, general industry, agriculture and the maritime industry. OSHA will use the comments received to learn more about how workers get injured and what solutions exist to prevent injury and death, including possible regulatory action. Workers in the concrete industry use reinforcing methods to strengthen concrete. These workers face potentially life-threatening hazards including impalement, collapsed walls, and slips, trips and falls. OSHA data indicate that more than 30 workers died while performing these activities from 2000-2009. Safety issues relating to these operations were brought to OSHA's attention in a 2010 petition from the International Association of Bridge, Structural, Ornamental & Reinforcing Iron Workers and an industry coalition of stakeholders including the Concrete Steel Reinforcing Institute, the Western Steel Council, and the Center for Construction Research and Training. Workers also face fatal injuries when struck by vehicles backing up or when caught between backing vehicles and an object, such as a loading dock. OSHA found that about 360 workers died from backover incidents from 2005-2010. OSHA's request for information is consistent with other agencies' regulatory actions, including the National Highway Traffic Safety Administration, which issued a Notice of Proposed Rulemaking requiring cameras in certain vehicles under 10,000 pounds to prevent people from getting backed over. Comments on this RFI must be submitted by June 27, 2012. Interested parties may submit comments at Regulations.gov, the Federal eRulemaking Portal. Comments may also be submitted by mail or facsimile.
National Employer Survey.
A just released a survey of 3,500 employers around the country tells us that 59 percent of them list cost containment as their number one concern, saying they "are very or somewhat concerned about their ability to contain costs this year. "Zywave's Workers' Compensation Safety Survey" studied businesses within 20 different sectors, with 57 percent of them reporting workers' compensation premiums of less than $50,000 per year. The survey also reports that "after cost containment, employers expressed notable concerns about increasing exposures (35 percent), renewals (35 percent), and rising fraud behaviors (31 percent). Market availability was a concern of 26 percent of respondents, and just over 20 percent were worried about carrier stability." Of the employers who were experience rated, a whopping 88 percent of them did not know their rating, or were not familiar with the term. In other words, employers concerned about costs, wanting to reduce their exposure, were completely oblivious of the measurement criteria that can actually tell them how well they are doing. The survey reported that 65 percent of respondents "said the most effective measure they took to control workers' comp cost was having a safety-minded culture." You will get no argument from me on that – but I would emphasize that "having a safety-minded culture" is only effective when a company and its employees are fully informed, and are given clear measurement criteria. To be an experience rated company and not know what that means tells me that the organization is lacking a clear path to recognizable results. It is the Dilbert principle. They talk about safety and cost containment because they've been told it is the right thing to do. They just don't really understand what it means. They have not learned the underlying foundation to what it is they are trying to manage.
CCM e-News Brief Vol. 8, No. 2, February 1, 2012
CCM e-News Brief
Vol. 8, No. 2, February 1, 2012
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Three New Arbitrators for IWCC.
Governor Quinn announced the appointment of three more arbitrators. William Gallagher has 35 years of experience as an attorney concentrating on workers' compensation in Illinois and Missouri, both in solo practice and at Nichols Law Office. He also handled workers' compensation cases as in-house counsel for Kember National Insurance Company. He holds a BA in Political Science and Economics and a JD from Southern Illinois University. His term will expire on July 1, 2013. Arb. Gallagher will handle former Arb. Tobin's call in Region 2 (Quincy, Springfield, and Urbana). Douglas McCarthy has over 30 years of experience as an attorney concentrating on workers' compensation and Social Security disability law. He holds a BA in Communications from Illinois State University, an MA in Public Affairs Reporting from Sangamon State, and a JD from Southern. His term will expire on July 1, 2013. Arb. McCarthy will be based in Chicago and will serve at large where needed. Brandon Zanotti represented both petitioners and respondents at Feirich/Mager/Green/Ryan. He also clerked for Judge Joseph Leberman in the First Judicial Circuit Court, and worked as a congressional clerk to Sen. Dick Durbin. He holds a BS in Finance from Southern and a JD from Washington University. His term will expire on July 1, 2012. Arb. Zanotti will handle the Chicago "TBA" call formerly handled by Arb. Dollison. After training, the arbitrators will begin their assignments in March.
Survey on Workplace Bullying.
If your fear of work involves more than just that towering pile of assignments on your desk, you may not be alone.
According to a survey from CareerBuilder.com, 27% of employees have indicated they felt bullied while at the workplace. The survey notes that the problem is more commonly reported for women (34%) than for men (22%). (WCxKit) For those employees who reported they had been bullied, the following points were noted as the most typical forms of such actions:
- 1. My comments were dismissed or not acknowledged – 43%
- 2. I was falsely accused of mistakes I did not make – 40%
- 3. I was harshly criticized – 38%
- 4. I was forced into doing work that really was not my job – 38%
- 5. Different standards & policies were used for me than for other workers – 37%
- 6. I was given mean looks – 31%
- 7. Others gossiped about me – 27%
- 8. My boss yelled at me in front of other co-workers – 24%
- 9. Belittling comments were made about my work during meetings – 23%
- 10. Someone else stole credit for my work – 21%.
CCM e-News Brief Vol. 8, No. 1, January 1, 2012
CCM e-News Brief
Vol. 8, No. 1, January 1, 2012
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
New Rules OSHA Guidelines for Labs.
The Occupational Safety and Health Administration (OSHA) has published new educational materials for laboratory managers on protecting their workers from exposure to chemical, biological and physical hazards. The new materials include the Laboratory Safety Guidance document, which describes how electrical, fire, explosions and falls, among other hazards, can be minimized or eliminated if employers use safety plans, worker training, engineering controls and personal protective equipment. New laboratory safety materials also include fact sheets that each focus on a specific hazard related to laboratory environments. Practices and precautions to protect laboratory personnel include safety guidance for using autoclaves, use of chemical fume hoods, labeling and transferring chemicals, and latex exposure. Over the past several years, there have been a number of laboratory incidents resulting in fatalities and injuries caused by fires, explosions and equipment. These incidents have resulted in debilitating injuries and death. OSHA is collaborating with the National Academies on resources to help improve the safety of laboratory workers. OSHA used the original edition of the National Academies' Prudent Practices in the Laboratory manual, the authoritative source on the handling of chemical hazards, as the foundation for the agency's laboratory standard. The manual has since been revised, and the agencies are working together to update the non-mandatory appendices in OSHA's Laboratory Standard (29 CFR 1910.1450) to assure it is consistent with the guidance given in the revised manual. Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education and assistance.
New Federal Employees WC.
The U.S. House of Representatives has recently approved the Federal Workers' Compensation Modernization and Improvement Act (H.R. 2465), commonsense legislation that will strengthen and enhance the workers' compensation program for federal employees. House Committee on Education and the Workforce Chairman John Kline (R-MN) applauded passage of H.R. 2465. "Reform of the federal workers' compensation program is long overdue," he said. "I am grateful for the time and effort my colleagues on both sides of the aisle invested in advancing this responsible legislation. I hope this represents not only a first step toward modernizing the Federal Employees' Compensation Act, but also a renewed effort to work together in pursuit of meaningful solutions that better serve both workers and taxpayers."
Chairman Kline introduced the Federal Workers' Compensation Modernization and Improvement Act in July with support from Ranking Member George Miller (D-CA), Subcommittee on Workforce Protections Chairman Tim Walberg (R-MI), and Subcommittee on Workforce Protections Ranking Member Lynn Woolsey (D-CA).
CCM e-News Brief Vol. 7, No. 12, December 1, 2011
CCM e-News Brief
Vol. 7, No. 12, December 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
IWCC.
In November Governor Pat Quinn announced the appointments of 7 commissioners to the Illinois Workers' Compensation Commission (IWCC). Commissioners review workers' compensation appeals, and today's appointments relate to the package of reforms to the workers' compensation system that Governor Quinn led through the General Assembly and signed earlier this year. Commissioners sit on one of three IWCC panels that review appeals by petitioners or respondents to an arbitrator's decision. To ensure balanced reviews, each panel consists of three commissioners: a commissioner representing the public, a labor commissioner representing the employee community, and a business commissioner representing the employer community. In June, Governor Quinn signed House Bill 1698, a comprehensive overhaul of Illinois' workers' compensation system. The reforms are expected to save Illinois businesses between $500 and $750 million dollars annually, while continuing protections for injured workers. The reform package also included a major overhaul of Illinois' troubled Workers' Compensation Commission. The overhaul called for the Governor to make appointments or reappointments to fill all arbitrator positions, considering recommendations from the Workers' Compensation Advisory Board. Members of the board - six representing employers and six representing workers - were appointed by the Governor earlier this year. The new law requires both arbitrators and commissioners to follow the rules and ethical practices of judges. Arbitrators and commissioners must also take at least 20 hours of training every 2 years while in office regarding professional and ethical standards, detection of fraud, evidence-based medical treatment, and Coal Workers' Pneumoconiosis.
OSHA Citation.
The U.S. Department of Labor's Occupational Safety and Health Administration has cited Igor Jerema Construction Co. in Buffalo Grove for four willful safety violations after a worker applying stucco at a home under construction in Burr Ridge fell off a scaffold and sustained a fatal head injury in May. "Falls are the leading cause of death in the construction industry and failing to ensure workers use fall protection when required is unacceptable," said Gary Anderson, director of OSHA's Calumet City Area Office. "OSHA is committed to protecting workers, especially when employers fail to do so." Igor Jerema Construction has been cited for failing to provide fall protection for employees working from scaffolding at levels more than 10 feet high, erect scaffold supports on a firm foundation, provide a ladder as a point of access for workers on the scaffold and fully plank platforms on working levels of the scaffold. A willful violation is one committed with intentional, knowing or voluntary disregard for the law's requirement or plain indifference to employee safety and health. Detailed information about fall hazards and safeguards is available on OSHA's website. Detailed information on scaffold hazards and safe work practices, including an interactive e-Tool, is available at Information on scaffold hazards and safe work practices.
CCM e-News Brief Vol. 7, No. 11, November 1, 2011
CCM e-News Brief
Vol. 7, No. 11, November 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
New Rules OSHA Guidelines for Labs
The Occupational Safety and Health Administration (OSHA) today published new educational materials for laboratory managers on protecting their workers from exposure to chemical, biological and physical hazards.
The new materials include the Laboratory Safety Guidance* document, which describes how electrical, fire, explosions and falls, among other hazards, can be minimized or eliminated if employers use safety plans, worker training, engineering controls and personal protective equipment. New laboratory safety materials also include fact sheets that each focus on a specific hazard related to laboratory environments. Practices and precautions to protect laboratory personnel include safety guidance for using autoclaves, use of chemical fume hoods, labeling and transferring chemicals, and latex exposure.
Over the past several years, there have been a number of laboratory incidents resulting in fatalities and injuries caused by fires, explosions and equipment. These incidents have resulted in debilitating injuries and death.
"The chemicals and equipment that laboratory workers use present a number of serious, sometimes life-threatening hazards," said Assistant Secretary of Labor for Occupational Safety and Health David Michaels. "These educational materials will help employers identify hazards and measures to ensure safe and healthful conditions for their workers and promote a robust safety culture in the workplace."
OSHA is collaborating with the National Academies on resources to help improve the safety of laboratory workers. OSHA used the original edition of the National Academies' Prudent Practices in the Laboratory manual, the authoritative source on the handling of chemical hazards, as the foundation for the agency's laboratory standard. The manual has since been revised, and the agencies are working together to update the non-mandatory appendices in OSHA's Laboratory Standard (29 CFR 1910.1450) to assure it is consistent with the guidance given in the revised manual.
Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education and assistance.
Governor Pat Quinn announced the appointments of 7 commissioners to the Illinois Workers' Compensation Commission (IWCC). Commissioners review workers' compensation appeals, and today's appointments relate to the package of reforms to the workers' compensation system that Governor Quinn led through the General Assembly and signed earlier this year.
"We set out to review and reform our entire workers' compensation system in Illinois, and that's what we have done," Governor Quinn said. "Our reforms continue protections for workers, while also saving our businesses millions and improving Illinois' business climate. These commissioners will ensure that Illinois workers' compensation cases are judged fairly so that workers and business can have confidence in our system."
Commissioners sit on one of three IWCC panels that review appeals by petitioners or respondents to an arbitrator's decision. To ensure balanced reviews, each panel consists of three commissioners: a commissioner representing the public, a labor commissioner representing the employee community, and a business commissioner representing the employer community.
In June, Governor Quinn signed House Bill 1698, a comprehensive overhaul of Illinois' workers' compensation system. The reforms are expected to save Illinois businesses between $500 and $750 million dollars annually, while continuing protections for injured workers. The reform package also included a major overhaul of Illinois' troubled Workers' Compensation Commission.
Last Friday, the Governor appointed 29 arbitrators to the IWCC, following a rigorous vetting process by the Advisory Board and the Office of the Governor. The overhaul called for the Governor to make appointments or reappointments to fill all arbitrator positions, considering recommendations from the Workers' Compensation Advisory Board. Members of the board - six representing employers and six representing workers - were appointed by the Governor earlier this year.
The new law requires both arbitrators and commissioners to follow the rules and ethical practices of judges. Arbitrators and commissioners must also take at least 20 hours of training every 2 years while in office regarding professional and ethical standards, detection of fraud, evidence-based medical treatment, and Coal Workers' Pneumoconiosis.
The Governor appointed commissioners to seven positions that were on expired terms. Five commissioners were reappointed. Commissioner Molly Mason was appointed as an arbitrator on Friday. Three commissioners, Yolaine Dauphin, Thomas Tyrrell, and Chairman Mitchell Weisz, are in the midst of four year terms, set to expire on Jan. 21, 2013.
CCM e-News Brief Vol. 7, No. 10, October 1, 2011
CCM e-News Brief
Vol. 7, No. 10, October 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
New Rules OSHA Guidelines for Labs
The Occupational Safety and Health Administration (OSHA) today published new educational materials for laboratory managers on protecting their workers from exposure to chemical, biological and physical hazards.
The new materials include the Laboratory Safety Guidance* document, which describes how electrical, fire, explosions and falls, among other hazards, can be minimized or eliminated if employers use safety plans, worker training, engineering controls and personal protective equipment. New laboratory safety materials also include fact sheets that each focus on a specific hazard related to laboratory environments. Practices and precautions to protect laboratory personnel include safety guidance for using autoclaves, use of chemical fume hoods, labeling and transferring chemicals, and latex exposure.
Over the past several years, there have been a number of laboratory incidents resulting in fatalities and injuries caused by fires, explosions and equipment. These incidents have resulted in debilitating injuries and death.
"The chemicals and equipment that laboratory workers use present a number of serious, sometimes life-threatening hazards," said Assistant Secretary of Labor for Occupational Safety and Health David Michaels. "These educational materials will help employers identify hazards and measures to ensure safe and healthful conditions for their workers and promote a robust safety culture in the workplace."
OSHA is collaborating with the National Academies on resources to help improve the safety of laboratory workers. OSHA used the original edition of the National Academies' Prudent Practices in the Laboratory manual, the authoritative source on the handling of chemical hazards, as the foundation for the agency's laboratory standard. The manual has since been revised, and the agencies are working together to update the non-mandatory appendices in OSHA's Laboratory Standard (29 CFR 1910.1450) to assure it is consistent with the guidance given in the revised manual.
Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education and assistance.
CCM e-News Brief Vol. 7, No. 9, September 1, 2011
CCM e-News Brief
Vol. 7, No. 9, September 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
New Arbitration Regions in Illinois
As directed by House Bill 1698/Public Act 97-18, new downstate arbitration regions will take effect on January 1, 2012. Three arbitrators will appear at each hearing site, and cases will be randomly assigned among them. To accommodate this change, we will return to 90-day continuance cycles. IWCC is in the process of reassigning cases to these regions, and will send corrected notices. A new accident location table will be posted soon. Any partially tried cases will stay with the original arbitrator.
OSHA Standards Update
The U.S. Department of Labor's Occupational Safety and Health Administration announced the forthcoming release of a final rule that streamlines and simplifies standards while reducing employer burdens. The rule, which soon will be published in the Federal Register, will help keep OSHA standards up-to-date and better enable employers to comply with their regulatory obligations. "The final rule is the third in OSHA's Standards Improvement Projects initiative that periodically reviews OSHA regulations with the goal of improving and eliminating those that are confusing, outdated, duplicative or inconsistent," said Assistant Secretary of Labor for OSHA Dr. David Michaels. "OSHA estimates that the final rule, without reducing employee protection, will result in annual cost savings to employers exceeding $43 million and significant reductions in paperwork burden hours." These updates will be in line with the goals of the president's Executive Order 13563, "Improving Regulation and Regulatory Review," issued Jan. 18 to simplify standards and reduce unnecessary regulatory burdens. The executive order is available at on-line.
The rule will update OSHA's standards and identify requirements for revision based on an agency review, comments from the public and recommendations from an Office of Management and Budget report (Regulatory Reform of the U.S. Manufacturing Sector, 2005). It builds on the success of SIP-Phase I published June 18, 1998, and SIP-Phase II published Jan. 5, 2005. The new rule will result in several changes to OSHA's existing respiratory protection standard, including aligning air cylinder testing requirements for self-contained breathing apparatuses with U.S. Department of Transportation regulations, clarifying that aftermarket cylinders meet National Institute for Occupational Safety and Health quality assurance requirements and clarifying that the provisions of Appendix D, which contains information for employees using respirators when not required under the standard, are mandatory if the employee chooses to use a respirator. Other changes to result from the new rule will include updating the definition of the term "potable water" to be consistent with the current Environmental Protection Agency standards instead of the former and outdated Public Health Service Corps definition, removing the outdated requirement that hand dryers use warm air because new technology allows employers to use hand-drying products that do not involve hot or warm air and removing two medical record requirements from the commercial-diving standard because that standard no longer requires medical examinations.
Updates also will include deleting a number of requirements for employers to transmit exposure and medical records to NIOSH, thus saving NIOSH significant costs to store and maintain the records. According to NIOSH, these records did not serve a useful research purpose. The slings standards also will be updated and streamlined by requiring that employers use only slings marked with manufacturers' loading information. There will not be any new requirements set by this rule, so employers will be able to comply with it immediately.
Regulatory text on the SIP-Phase III final rule will be published in the Federal Register.
CCM e-News Brief Vol. 7, No. 8, August 1, 2011
CCM e-News Brief
Vol. 7, No. 8, August 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
The Worst State for Workers Comp?
Workers Comp rates in 2010 show national premium rate indices range from a low of $1.02 in North Dakota to a high of $3.33 in Montana. The 2010 median value is $2.04, which is a drop of 10 percent from the $2.26 median of the 2008 study. Three jurisdictions have an index rate in the $3.00 to $3.49 range; five are in the $2.50 to $2.99 range; 20 are in the $2.00 to $2.49 range; 16 are in the $1.50 to $1.99 range; and seven have indices under $1.50.
Medicare Trust Fund Reform
A group of about 50 employers, insurance carriers and vendors have formed a coalition to endorse legislation (H.R.1063) that would ease reporting requirements and reimbursement procedures of the Centers for Medicare and Medicaid (CMS). The Medicare Advocacy Recovery Group [MARC], contends that the proposed legislation:
- "Empower(s) Medicare to provide settling parties with the amount of their MSP repayment obligation during the settlement process, will allow taxpayers to settle quicker, and repay the Medicare Trust Fund faster.
- "MSP Reform will provide a more affordable and less intrusive MSP system that protects beneficiaries and the Medicare Trust Fund, but does not waste limited judicial and other resources or needlessly confuse parties trying to settle a claim resulting from an injury to a beneficiary.
- "MSP Reform will also eliminate the required use of Social Security Numbers (SSNs) and Health Insurance Claim Numbers (HICNs) in the reporting process, create a basic right of appeal for all parties to resolve a CMS MSP determination, clarify the statute of limitations, and require the CMS Actuary to determine a threshold below which the recoveries are so small it makes no sense to apply the complex MSP laws.
Theoretically it sounds like the change would create a more efficient system to establish: time limits for claim reimbursement; a statute of limitations for liability (3 years); an avenue for redress directly to the judicial system; and a threshold amount for reimbursement. However, the proposal would actually defeat the basic philosophy of the workers' compensation act. The convoluted logic of the employer/insurance group just makes no sense. It is like saying that I didn't bother buying enough postage on a timely basis so I will just mail my letter at half-price. The universal legislative intent of workers' compensation act mandates that the employer is responsible for medical care of its injured workers. The insurance industry has tried other gimmicks before to continue its long history of cost shifting, and those have rightly failed as Congress wouldn't buy into them. While employers and insurance carriers delay and deny compensation benefits, shifting the cost to the taxpayers through depletion of the Medicare system, is both offensive and repugnant. If the coalition wants to ride the carousel of "it's not how long, but how much," in doling out benefits, then they should not blame CMS for delays and penalties, caused by the coalition's own failure to report on a timely basis if the first place.
CCM e-News Brief Vol. 7, No. 7, July 1, 2011
CCM e-News Brief
Vol. 7, No. 7, July 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Governor Signs Workers Comp Reform Bill
Illinois Gov. Pat Quinn said companies should see their workers' compensation premiums drop because of a new law he signed Tuesday overhauling the system that takes care of employees injured on the job. "We're going to be helping the employers of Illinois, the workers of Illinois, all of those who are committed to economic growth by designing a law that will help our employers of Illinois reduce their premiums for workers compensation insurance by a huge amount," Quinn said at a bill-signing ceremony at a Navistar plant in west suburban Melrose Park. Illinois Retail Merchants Association president David Vite said changes in the business-funded insurance system that pays the medical costs of injured workers and compensates for lost wages would save companies between 10 percent and 20 percent on their workers compensation premiums. Quinn said the system also would become more efficient for injured workers. The changes include slashing medical payments to doctors and hospitals that treat injured workers and they're estimated to cut between $500 million and $700 million out of the $3 billion workers compensation system. The overhaul also includes new guidelines for treatment an injured worker can receive and it makes it harder for workers who were drunk when they were injured to win claims. The law also lets employers organize medical networks to handle workers' compensation cases and businesses have said that can help lower costs by choosing doctors who don't cater as much to workers. The new rules also would cap awards for carpal tunnel syndrome, a common complaint. Under the law, the new arbitrators who will decide cases will serve three-year terms instead of six and will be prohibited from accepting gifts. Business leaders said the changes passed by lawmakers were necessary.
Wi-Fi available at IWCC Chicago office
The Commission is pleased to offer free wireless Internet access at the Chicago office to the parties who do business with us. To register, you will need to read and agree to the terms of service. Send an email to the Information Department with the exact language, "I have read and agree to the IWCC Wi-Fi terms of service, and agree to be bound to them." with your name, employer name, business mailing address, and your computer's MAC (Media Access Control) address. If your organization will request access for a number of computers, please send all the MAC addresses in one email. To read instructions on how to find your MAC address, go to http://www.iwcc.il.gov/MAC.doc/. Only devices whose MAC addresses have been entered into our system will be able to access our network. To preserve bandwidth, users cannot videoconference using our wireless network, and smart phones will not have access. Within five business days after IWCC receives a proper request for registration, you will be able to access the wireless network using the password workcomp500. If you do not receive access, please contact the Information Department. Please note that, once we authorize access, we do not have the resources to provide technical assistance to wireless users. If you experience a technical problem, please work with your own technical staff.
CCM e-News Brief Vol. 7, No. 6, June 1, 2011
CCM e-News Brief
Vol. 7, No. 6, June 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Illinois Workers Comp Changes
State Senator Kwame Raoul (D–Chicago) passed legislation out of the Senate on Saturday with bi-partisan support that reforms Illinois workers' compensation system. House Bill 1698 will make Illinois more attractive to businesses, saving them more than $500 million. It addresses abuses in the system, while still ensuring that legitimately injured workers can make and receive their claims. Senator Raoul has negotiated with members of the business community, medical community, trial lawyers and labor unions to reach an agreement on workers' compensation. After months of talks, this legislation represents a consensus between most of parties involved. "As we continue to look for ways to attract businesses to our state, this is major reform in Illinois," Raoul said. "There have been serious abuses of our state's workers' compensation system and we had to take action to correct these abuses. This reform holds employers to a fair standard of accountability, while providing protection for employees that have valid claims." House Bill 1698 reduces the medical fee schedule for workers' compensation claims by 30 percent as of September 1, 2011. It also adopts the American Medical Association standards for determining disability, institutes workers' compensation provider networks that resemble those currently used for health care, and implements an enhanced claims review process. In addition, these reforms call for the appointment of workers' compensation arbitrators to three year terms that will be approved by the Senate. The legislation also makes another vital reform; if an employee's injury is a result of intoxication the employee will not receive workers' compensation benefits for that injury. Lastly, the legislation institutes a new system of fraud penalties with increased fines and possible prison time if there are additional cases of fraud. House Bill 1698, having passed out of the State Senate, will head to the Illinois House for consideration.
2011 Insurance Industry Report
The insurance industry faces a host of challenges in 2011, according to a new report from New York-based PricewaterhouseCoopers. The report, "The Insurance Industry in 2011," says much of the challenge will emanate from changes ushered in by the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010 (DFA). Under the DFA insurers will be under federal supervision and regulation for the first time, as the act empowers the Federal Insurance Office (FIO), which is housed within the U.S. Treasury Department. Moreover, the report notes many of the changes required by the DFA are only now being implemented and many decisions germane to insurers are still being made. "In light of the size and scope of this legislation, rules are evolving in a very dynamic regulatory environment," the report states. "Insurers should be acutely aware of how regulators formulate provisions, and how those provisions will be practically implied and enforced. In addition, the industry should continue to pay close attention to the 112th Congress' promises to "de-fund," rewrite, or otherwise lessen the expansion of government authority that Dodd-Frank stipulates." In addition to the DFA, insurers mist brace for changes in accounting models as the Financial Accounting Standards Board and the International Accounting Standards Board work to craft a common standard. While the final outcome of the convergence is unknown, insurers need to start preparing now for changes to their financial statements, data and systems, PWC contends. "Given the fundamental impact of these proposed standards on the measurement of an insurer's financial performance and position, many companies are dedicating additional resources to understand and anticipate how their business should react," the report states. "Although final standards likely will allow for at least a two- or three-year lead time prior to mandatory adoption, insurers have an opportunity to take a measured approach to evaluating the impact of change on the form and content of their financial statements, data and systems, processes and controls, and people." Lastly, the report notes that last fall's legislative upheaval in Washington means that fundamental changes to the U.S. tax code may be percolating.
"The results of the 2010 Congressional midterm elections may mark a turning point in debate over tax legislation, with control of Congress divided between a Republican-led House of Representatives and a Democratic-led Senate," the report states. One possible scenario is for corporate tax reform under which various deductions and credits would be reduced or eliminated in exchange for lower statutory tax rates.
CCM e-News Brief Vol. 7, No. 5, May 1, 2011
CCM e-News Brief
Vol. 7, No. 5, May 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Supreme Court Ruling
The Supreme Court recently increased the reach of the federal laws to combat job discrimination, ruling that employees are protected from illegal bias not just from a top decision maker, but from other supervisors too. According to a report from The Los Angeles Times, the justices commented the crucial issue is whether illegal bias was a "motivating factor" in the choice to terminate an employee. Companies and public agencies are not shielded from liability, they concluded, simply due to the fact the supervisor who made the decision to fire a worker did so for valid reasons. If other supervisors are biased and influence the decision, the employer can be held at fault, they argued. For at least a decade, lower courts have had differing views as to whether the workplace civil rights laws should center narrowly on the single supervisor who makes hiring and firing decisions, or more broadly on the many supervisors who influence the outcome. By a unanimous vote, the high court chose the broad approach. The decision restores a $57,640 jury verdict in favor of Vincent Staub, an Army reservist who was terminated from his employment as a medical technician at the Proctor Hospital in Peoria, Illinois. He contended a pair of his supervisors were biased against him because he was absent on weekends due to his military duties. They claimed he put a "strain on the department," and others had "to bend over backwards to cover" for him. The complaints go to the hospital's vice president for human resources. She looked into remarks that Staub was "abrupt" with others and was at times absent from his work location. She decided to terminate him. Staub sued, relying on the Uniformed Services Employment and Reemployment Act of 1994, which forbids discrimination against employees due to their military duties. Justice Scalia said this law is "very similar" to the other federal civil rights laws that forbid discrimination based on race, religion, sex or national origin. The pair of statutes is in play if the illegal bias was a "motivating factor" in the employers decision. Though a jury ruled for Staub, the U.S. 7th Circuit Court of Appeals in Chicago tossed out the verdict. Its decision discounted the comments of his direct supervisors and said the vice president for human resources acted by herself. Then-U.S. Solicitor General Elena Kagan encouraged the court to listen to the case of Staub v. Proctor Hospital and to adopt the broader interpretation of the federal workplace discrimination laws. They did so in an 8-0 vote, with Kagan not voting.
Illinois WC Reform
Illinois business leaders have welcomed Gov. Pat Quinn's call for workers' compensation reform, but a key lawmaker cautioned there's a long road ahead before reaching any compromise. Quinn told participants in Business Lobby Day in Springfield that an overhaul should happen before the Legislature adjourns at the end of May. He reiterated a plan he introduced earlier this month that includes a $500 million cut in the amount paid for medical procedures, enhanced authority to find and prosecute fraud, and tighter standards for arbitrators who decide work-related injury claims. Quinn's plan would reduce what he says is the nation's second-highest medical fee schedule by 30 percent to save businesses $500 million in workers' comp premiums -- which has already drawn Illinois State Medical Society opposition. He would cap payments for some kinds of injuries, rely more on physical therapy and other treatments and deny claims by intoxicated workers. Arbitrators who decide claims would be licensed attorneys whose performance would be reviewed and who would serve three-year terms.
Spring Ahead at Your Own Risk
The semi-annual tradition of changing the clock an hour ahead and an hour back has been reported to result in a high incident of work-related illness. A study in the New England Journal of Medicine reports, "More than 1.5 billion men and women are exposed to the transitions involved in daylight saving time: turning clocks forward by an hour in the spring and backward by an hour in the autumn. These transitions can disrupt chrono-biologic rhythms and influence the duration and quality of sleep, and the effect lasts for several days after the shifts." This may result in an increase of work-related accidents in the days following the time adjustment.
CCM e-News Brief Vol. 7, No. 4, April 1, 2011
CCM e-News Brief
Vol. 7, No. 4, April 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
MSHA Alert to Mines
The U.S. Department of Labors Mine Safety and Health Administration recently issued a fatality alert to the mining community profiling the causes of and circumstances surrounding the 71 fatal accidents that occurred last year.
"2010 will be remembered for the dramatic explosion that killed 29 men at the Upper Big Branch Mine and for the deaths of 42 other miners across the nation whose lives ended in needless tragedy," said Joseph Main, assistant secretary of labor for mine safety and health. "We can — and must — honor all of these miners by increasing our efforts to ensure safe and healthy workplaces for our nation's miners."
Of the 71 deaths in 2010, 48 occurred in coal mines. Twenty-three occurred at metal and nonmetal operations, and nearly half of those victims were contractors. Excluding the 29 miners who died at Upper Big Branch, preliminary information indicates that more than half of the remaining 42 deaths involved violations of the "Rules to Live By" standards, and represent the same causes of deaths that have occurred frequently over the past 10 years. "We must all learn from these tragedies and act to prevent additional fatalities," said Main. "Fatalities are not inevitable. They can be prevented using effective safety and health management programs, workplace examinations for hazards, and effective and appropriate training so that miners recognize and understand the hazards, and how to control or eliminate them." MSHA has posted summary information on its Web site, http://www.msha.gov identifying causes of the mining fatalities that occurred in 2010, best practices to prevent them, posters for mine operators to print and display in their organizations, and other information on preventing fatalities in mining workplaces. Fatal investigation reports, once completed, are also available at that site.
No Comp for Illegals
Federal law expressly prohibits illegal immigrants from working in the United States. That is undisputed. What's not as certain is whether under state laws, those same illegal workers can collect back pay and compensation benefits if they get hurt on the job. In short, it depends on what state they are in. http://www.foxnews.com/topics/politics/supreme-court.htm Supreme Court on Monday passed up an opportunity to hear arguments about one such dispute and presumably settle the conflict within the states. The issue of back pay to illegals has come up in at least a dozen states with mixed results. Judges in Louisiana, Pennsylvania, Georgia and Minnesota have issued rulings saying that illegals are entitled to collect on their benefits claims because state laws don't expressly prevent illegals from doing so. Meanwhile judges in other states including Virginia, Michigan and Nevada have tossed out these claims, saying the Immigration Reform and Control Act of 1986 passed by Congress prohibits illegals from collecting benefits for work they should never have been allowed to perform. A Louisiana business claimed there's no way it should be forced to pay workers' compensation to a Mexican who was never supposed to be working in the first place. Antonio Rodriguez was injured while doing some roofing work at the University of Louisiana-Lafayette. He was a subcontractor and under Louisiana law people can make workers' compensation claims to what is known as their "statutory" employer. That means Vaughan Roofing & Sheet Metal is the on the hook for injury claims by people, like Rodriguez, it didn't directly hire and didn't know was an illegal immigrant. Vaughn Roofing fought the claim saying federal immigration laws should preempt Louisiana, or any other state, from allowing illegals to collect workers' compensation. A Louisiana appellate court noted that it was "undisputed" that Rodriguez wasn't supposed to be working but cited a similar case siding with the illegal worker that concluded "there is no express statutory provision (in Louisiana) excluding undocumented workers from workers' compensation coverage." Kirk Landry, the roofing company's lawyer, said in his Supreme Court petition that the Louisiana court's logic is "particularly problematic" because of the federal immigration policy. He asked the high court to hear the case to resolve "an inconsistent and haphazard approach to analyzing issues of constitutional law and federal statutory interpretation." The court as is custom did not explain why it didn't take the case. It is unusual for the justices to take cases that do not involve conflicting rulings from federal appellate courts or state disputes that directly involve constitutional protections. In 2005, the justices also declined to hear a similar case from Georgia.
CCM e-News Brief Vol. 7, No. 3, March 1, 2011
CCM e-News Brief
Vol. 7, No. 3, March 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Social Security Meets Workers Comp.
When an employee is seriously injured and receives a disability rating that classifies the employee as permanently and totally disabled, the employee can be eligible to receive both workers compensation permanent total disability benefits (name of benefits vary by state) and social security disability benefits at the same time. If the injured employee was allowed to receive both workers compensation disability benefits and social security disability benefits at the same time, the employee would be receiving more compensation on a weekly or monthly basis than the compensation they would receive if they were still working. To prevent this duplication and overpayment of disability benefits, Social Security and state workers compensation statutes have offset provisions reducing the amount paid to the disabled employee. Disabled employees cannot receive more than 80% of their "average current earnings before the disability began. Average current earnings are defined by the Social Security Administration as the highest of:
- The average monthly earnings from covered employment (social security taxes paid) during the highest five years in a row, or
- The average monthly earnings in a single calendar year from covered employment after the disability began or any of the five calendar years before the disability began.
- If the disabled employee is 62 years old or older, the primary insurance amount upon which the disabled employee can receive disability benefits (the average earnings over the employee entire life time of paying social security taxes).
Disabled employees who have second jobs where they receive payments "under the table" – with no Federal Insurance Contribution Act (FICA) taxes paid, will learn the downside of not paying taxes is they cannot collect social security disability (or for that matter workers compensation disability) on the undeclared / untaxed income. Interestingly, the Social Security Administration defers to the laws of each state as to whether the workers compensation payment or the social security disability payment will be offset. In most states, the social security disability payment is reduced to the amount that will equal 80% of the average current earnings when added to the workers compensation disability payment. In a few states, the state law requires the social security disability payment to be primary, and the state work comp disability payment is reduced to make up the difference between what the social security disability payment would be and the 80% of the average current earnings.
Shift Workers Comp?
Workers on night and rotating shifts are almost twice as likely to be injured on the job as workers on regular day shifts, indicates a new study from the University of British Columbia in Vancouver. The study, published in the Scandinavian Journal of Work, Environment and Health, examined data collected from more than 30,000 Canadians in the Survey of Labour and Income Dynamics and compared workers involved in various types of shift work from 1996 to 2006. While the overall rate of work injuries in Canada decreased during those years, the rate of injuries for night shift workers did not decline. The study found women, especially those on rotating shifts, had a higher risk of work injury. Researchers speculated this is because women are more likely to handle childcare and housework, which may make it more difficult to adjust to shift work and maintain regular sleep schedules.
Employers Report
The Missouri Attorney General's office recently levied fines totaling over $100,000 against two national third party administrators (TPA) for the failure to file the Report of Injury form on some workers compensation claims. It has caught the attention of insurers and TPAs alike. Almost all jurisdictions require that some or all workers compensation claims be reported to the appropriate state workers compensation board, industrial commission or other state supervisory office. The name of the reporting form varies, but most states refer to it as the Employer's First Report of Injury. The requirements as to which workers compensation claims are reported to the state vary.
CCM e-News Brief Vol. 7, No. 2, February 1, 2011
CCM e-News Brief
Vol. 7, No. 2, February 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Illinois General Assembly Quiet on Comp.
The 96th General Assembly adjourned in January without acting on workers' compensation legislation. This, despite the Special Workers Compensation Reform committees who held public hearings and offered suggestions to improve the workers compensation system. Nonetheless, several amendments to the Workers' Compensation Act have been filed on Senate Bill 1066. To view them, go to:
http://www.ilga.gov/legislation/fulltext.asp?
Workplace Injuries Lower.
he U.S. Department of Labor's Bureau of Labor Statistics recently announced that non-fatal workplace injuries and illnesses among private industry employers declined in 2009 to a rate of 3.6 cases per 100 equivalent full-time workers, down from a total case rate of 3.9 in 2008. BLS also reported a decline in the total number of cases from 3.7 million in 2008 to 3.3 million in 2009. Secretary of Labor Hilda Solis issued the following statement: "While the reported decline in workplace injuries and illnesses is encouraging, 3.3 million workplace injuries and illnesses are 3.3 million too many. No worker should fear being injured or made sick for a paycheck. Complete and accurate workplace injury records can serve as the basis for employer programs to investigate injuries and prevent future occurrences. Most employers understand this and do their best to prevent worker injuries, but some do not. That is why my department's Occupational Safety and Health Administration is aggressively working to ensure the completeness and accuracy of injury data compiled by the nation's employers. We are concerned about the widespread existence of programs that discourage workers from reporting injuries, and we will continue to issue citations and penalties to employers that intentionally under-report workplace injuries."
Recurrence or Aggravation of Scheduled?
In a ruling that may have implications for other states, the Alabama Court of Civil Appeals released its opinion in Caseco, LLC. v. Dingman. At the trial Court level, it was shown that the employee suffered an ankle injury in 2001 and continued to have complaints of pain and several surgeries through 2009. Since the initial injury, the employee had worked for two different employers while treatment was continued from the initial 2001 injury. The Last-Injurious-Exposure Rule states that the carrier covering the risk at the most recent compensable injury bearing a causal relation to the disability bears the responsibility. In order to make this determination, the court has to decide if the second injury is a new injury, an aggravation of a prior injury, or a recurrence of an old injury. If the second injury does not contribute even slightly to the cause of disability, then it is deemed a recurrence. A recurrence is supported by continued complaints of symptoms indicating that the original condition persisted and that the second incident culminated in a second period of disability. The court will deem that its an aggravation and, therefore, a new injury if the second injury contributed independently to the final disability. The court in Caseco noted the following evidence indicating a recurrence instead of a new injury: continued complaints of pain throughout; and the authorized treating physician testifying that the injury with the original employer was the cause and not the employment with the two latter employer. The Court of Appeals said that this was sufficient evidence to show that the plaintiff suffered a recurrence and not a new injury. At the trial level, the court indicated that the employee's pain took the ankle injury out of the schedule; that a back problem related to the ankle took the injury out of the schedule; and that the psychological disorder took the ankle injury out of the schedule.
CCM e-News Brief Vol. 7, No. 1, January 1, 2011
CCM e-News Brief
Vol. 7, No. 1, January 1, 2011
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
CMS will Help
2011 stands to be a pivotal year for Medicare Secondary Payer because after significant delays in the implementation of the Medicare, Medicaid & SCHIP Extension Act of 2007 ("MMSEA"), the Centers for Medicare and Medicaid Services ("CMS") will finally be given the data necessary to recover years' worth of mistaken payments and shift a good portion of its Medicare benefit obligations to the private sector. A historical look at early MSP enforcement reveals years of frustrated efforts by the federal government in overcoming poorly written law. The MSP was written without a notice requirement so that CMS could be placed on notice of a settlement and thus be aware of its recovery right, and what little requirement that was included in the regulations provided no penalty for failure to comply. Then, even in cases where the government became aware of recovery opportunities, it lost several suits in federal court primarily due to technicalities, such as the definition of a self-insured. The final straw for early failed efforts of MSP enforcement came in the form of a GAO study released to Congress in March 2001, pointing out millions in erroneous Social Security Disability Insurance ("SSDI") payments made by the Social Security Administration ("SSA") that were not off-set appropriately because of simultaneous workers' compensation benefits. The reason given was mainly because the federal government was not on notice of the dual eligibility. Both SSA and the Health Care Finance Administration ("HCFA"), the agency name that was changed two months later to CMS in a public relations effort to prove to the public that improvements were made to its program, were asked to respond since these same individuals would automatically become entitled to Medicare after 24 months of receiving SSDI benefits, and in turn receive Medicare covered treatment that should have been provided by workers' compensation. The response from both the SSA and HCFA (now CMS) was that absent some "mandatory insurer reporting" of the insurance claim data, they would continue to be unable to administer their programs according to guidelines. Thus, the seeds of the MMSEA Section 111 reporting requirement were planted, and the "Patel Memo" was released by CMS just a few months later. Go to:
http://www.workerscompensation.com/compnewsnetwork/blogwire/medicare-scondary-payer-comes-of-age.html
IWCC Changes.
The Chairman has realigned the Commission panels, effective January 1, 2011. Panel A will consist of Commissioners Donohoo, Lamborn, and Mason. Panel B will consist of Commissioners Dauphin and Lindsay, with a vacancy until the replacement for Commissioner Sherman is appointed. Panel C will remain the same with Commissioners Basurto, DeMunno, and Gore. In addition, Panel B will not schedule oral arguments for the month of January 2011 because of the current vacancy and the relative number of backlogged cases assigned to each commissioner. There will be no change in current assignments and procedures regarding Motions on Review before each commissioner. One additional change: Due to a scheduling conflict, Commissioner Basurto will cover Commissioner Lamborn's Rockford review call on January 11.
House / Senate convene IWCC Committees.
The Illinois House and Senate have formed special committees to discuss workers' compensation reform. At the initial meeting of each committee, Chairman Weisz gave an overview of workers' comp in Illinois. Business, labor, and medical representatives then gave their testimony. The Senate's next meeting is on Dec. 8 in Chicago. The House plans to hold downstate meetings. You can keep track of future meetings at the following General Assembly websites:
CCM e-News Brief Vol. 6, No. 12, December 1, 2010
CCM e-News Brief
Vol. 6, No. 12, December 1, 2010
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
CMS in the Hunt.
The Centers for Medicare & Medicaid Services (CMS) has stepped up their efforts to enforce compliance with the Medicare Secondary Payor (MSP) statute. The MSP statute states CMS can recover damages from any entity [insurer, employer, employee, medical provider, plaintiff attorney or defense attorney] that attempts to shift the burden for workers' compensation medical cost to Medicare. The MSP statute states that Medicare does not pay for any medical expense that can reasonably be expected to be paid promptly under workers' compensation law (or other types of insurance). Workers' compensation is considered the primary insurer and CMS is considered the secondary insurer. (WCxKit) The MSP statute provides that CMS will not pursue recover from a work comp insurer who has their settlement of future medical benefits approved by CMS. In order to obtain CMS approval, the work comp insurer must provide a Medicare Set-Aside Arrangement (MSA) for CMS to approve before the claim is settled. The MSA states how many dollars of the total settlement is allocated to cover the cost of future medical care. The specified amount has to be "set-aside" in a trust arrangement to cover future medical bills. If CMS makes a payment and it is then determined that work comp should have paid, CMS will seek to recover the amount they have paid. If you are leaving the medical benefits open when the indemnity benefits are closed, then you do not need to be concerned about CMS compliance. If you are buying out the future medical benefits at the time of a settlement, you need an approved MSA on any claims where:
The employee/claimant is already Medicare eligible which includes
1. Anybody already 65 years of age or older
2 Anybody already collecting social security disability benefits for 24 months or longer
3. Anyone already eligible for Medicare or Medicaid and the total settlement is greater than $25,000
4. Anybody with End Stage Renal Disorder,
OR - The employee/claimant has a "reasonable expectation" of becoming a Medicare beneficiary within 30 months of the date of the settlement and the settlement is greater than $250,000 including the indemnity portion of the settlement. Go to:
http://www.workerscompensation.com/compnewsnetwork/blogwire/
stepped_up_enforcement_of_medicare.html
IWCC Update.
The Commission repealed emergency rules and withdrew proposed rules on implants and ASTCs on October 28, 2010. Medical treatment on or after July 6, 2010 and on or before October 28, 2010 should be paid pursuant to the emergency rules.
- Reimbursement for a medical implant shall be 25% over the manufacturer's invoice price less rebates, plus actual and customary shipping costs incurred for the implant.
- In the Ambulatory Surgical Treatment Center (ASTC) fee schedule, facilities accredited for surgical treatment by either AAAASF, AAAHC, or JCAHO were specifically deemed to be eligible for the payment of ASTC facility fees.
The Commission will continue to formulate solutions to the perceived problems of
accredited facilities and pricing of medical implants
Seeing Things.
According to a recent article in HR News by Beth Mirza computer vision syndrome (CVS) is more common than carpal tunnel syndrome and other musculoskeletal disorders.
According to the American Optometric Association, CVS is characterized by visual symptoms, which result from interaction with a computer display or its environment. In most cases, symptoms occur because the visual demands of the task exceed the visual abilities of the individual to comfortably perform the task. Symptoms of CVS are eyestrain and fatigue, dry eyes, headaches and neck and shoulder pain. The American Optometric Association notes that video display terminal (VDT) related vision problems are at least as significant a health concern as the musculoskeletal disorders, such as carpal tunnel syndrome that receive more attention. "The vision problems experienced by VDT workers are varied and are difficult to grasp and understand by those who don't specialize in vision. The misunderstanding may also be the result of unfounded reports of cataracts caused by VDTs, exaggerated manufacturer claims about the need for UV and other radiation protections, and misleading statements about the effects of specialty tinted and coated lenses (e.g., computer glasses) among other products." In most cases, CVS is treatable and modifications to the workplace and regular practices can help.
Source: http://www.workerscompensation.com/compnewsnetwork/news/computer-vision-syndrome.html
CCM e-News Brief Vol. 5, No. 5, May 1, 2009
CCM e-News Brief
Vol. 5, No. 5, May 1, 2009
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Fed Fights Fed.
OSHA has come under withering criticism in a report from the Department of Labor's inspector general for improperly enforcing safety and health laws against high risk employers with a history of safety violations and/or fatalities. In summarizing the report, Occupational Health & Safety notes: "The March 31 report says EEP [Enforced Enhancement Program] was mismanaged so badly that OSHA did not comply with EEP's requirements for 97 percent of sampled cases qualifying for it. No appropriate enforcement action was taken in 29 cases, the IG found -- and those employers subsequently experienced 20 fatalities, of which 14 deaths shared similar violations, the report states." The report - Employers with Reported Fatalities Were Not Always Properly Identified and Inspected under OSHA's Enhanced Enforcement Program (PDF) - summarizes the results of an audit of 325 work place inspections conducted under EEP from 2003 to 2008 in the Atlanta, Chicago, and Dallas regions. The Pump Handle posts not just about this report, but also about a second report by the DOL Inspector General concerning the services provided by Randy Kimlin. Celeste Monforton discusses remuneration and oversight irregularities in regards to the consulting services of Kimlin, friend of OSHA chief Ed Foulke. According to investigative reporting by Washington Post reporter Jeff Smith, Kimlin's salary for his contract was "higher than that received by Vice President Cheney, any member of Congress and Foulke himself during that period." And the contract was awarded without competition: Procurement Violations and Irregularities Occurred in OSHA's Oversight of a Blanket Purchase Agreement.
Source: [workerscompensation.com/compnewsnetwork/news/oshaunderfire.html]
Older, Wiser and More Costly?
Between 2005 and 2010 the number of workers in the U.S. aged 55 to 64 is predicted to increase by 52 percent. With worker maturity comes a new set of risks making it critical for insurance buyers and their representatives to better understand how to help keep these workers safe on the job and, when accidents happen, effectively manage their workers compensation claims. "The challenge is that while older workers generally have fewer workplace injuries, they are often more costly to treat and tend to be away from work almost twice as long as their younger co-workers," notes Dr. David Deitz, Liberty Mutual's National Medical Director, who leads a staff of 10 doctors. "By understanding the aging process and its impact on workers compensation claims, brokers, agents and employers can help keep employees on the job and better control the cost of their workplace injuries."
Source: workerscompensation.com/compnewsnetwork/news/3886.html
Meet and Greet Lost Time Workers.
Hold weekly meetings with injured employees to monitor progress and document return-to-work obstacles. Guidelines for these meetings include:
1. Present the cost-savings benefits of returning employees to work in transitional duty to build and maintain management commitment.
2. Invite a member of management to join the injury management team.
3. Work with senior management and middle managers to implement a dollar-for-dollar charge-back system to the units where losses occur.
4. Design work-arounds to facilitate a timely return to work.
5. Invite employee and family member (spouse) to bring the family on board.
Source: workerscompensation.com/compnewsnetwork/blogwire/weekly_meetings_with_
employees_on.html
CCM e-News Brief
Vol. 5, No. 4, April 1, 2009
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
New IWCC Rates Posted.
Due to a clerical error, the maximum PPD rate for 7/1/08 - 6/30/09 that was posted in January 2009 was wrong. Please note the correct rate is $664.72. We apologize for the inconvenience. In March, the IWCC collaborated with the Chicago Dental Society and the Illinois State Dental Society to inform dentists of the wc medical fee schedule. Because dentists may not treat workers' compensation injuries often, some are only learning of the fee schedule now.
Older Workers Spell Change for Workers Comp.
While the increase in older workers in the American workforce could suggest a corresponding decrease in workplace productivity and increase in accident claims, the opposite has proven to be true, says a risk management firm. Older workers can be a benefit to the companies that employ them, but when older workers do get injured those injuries tend to be more severe. U.S. companies should consider making workplace modifications that prevent injuries, says PMA Companies, in its new white paper, "Capitalizing on an Aging Workforce." Since 1977, the number of employed people 65 and older has increased more than 100%. In addition:
• It is estimated that workers in the age groups 65-74 and 75 and up will grow more dramatically than any other workforce age group - more than 80%.
• More than half of older workers are working full-time, up from 44% in 1995.
The paper notes that as over-55 workers increase in the workplace, so does productivity and overall workplace safety. However, when older workers do experience injuries, severity can be significant, which is an issue that must be considered by safety professionals. The author writes that these findings lead to two conclusions: one, older workers are a benefit to the company that employs them and, two, it pays to make modifications to work environments to prevent injuries and limit the severity of injuries commonly sustained by older workers.
In the New England Journal of Medicine
When surgical teams use a checklist with simple steps, the average patient death rate falls more than 40%. Checklists are a key to workers’ compensation cost containment also because they hold people accountable and remind them of basic but important procedures and steps that can be easily overlooked:
• The improvement was probably not due to any one or two items on the checklist but from a combination of factors.
• The change in procedure probably brought about a new awareness and improved safety behavior.
• That the surgical teams knew they were being studied probably also kept them on their toes.
Having an organized system and paying attention to details is what a cost containment program is about; more closely managing the processes. This rationale applies to workers’ compensation cost containment as well as to other protocol because it requires increased vigilance for everything from post injury procedures to how to work with your TPA.
CCM e-News Brief
Vol. 5, No. 3, March 1, 2009
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
New IWCC Rates Posted.
The new fee schedules, effective February 1, 2009, have been posted on the IWCC fee schedule web page at http://iwcc.ingenixonline.com/IWCC.asp .The Commission created new fee schedules for the following areas:
1. ambulatory surgical treatment centers;
2. hospital outpatient radiology, pathology and laboratory, physical medicine and rehabilitation services, and surgical services; and
3. rehabilitation hospitals.
There is now one set of rules for treatment before 2/1/09 and another set of rules for treatment on or after 2/1/09. Similarly, there are instructions and Guidelines for treatment before 2/1/09 and Instructions and Guidelines for treatment on or after 2/1/09. The IWCC will convert the hospital inpatient fee schedule from the DRG coding system to the MS-DRG coding system no later than June 30, 2009. They will announce when that work is complete. In other IWCC news, Mt. Vernon hearing site moved. Effective April, 2009, the Mt. Vernon hearing site will move to the Holiday Inn, 222 Potomac Boulevard. This is a permanent change. To accommodate the new location, Arbitrator Teague's calendar had to change. New hearing dates are November 5 & 6, and December 9 & 10. See http://www.iwcc.il.gov/pdfs/dwns2009.pdf. Arbitrator Jutila has returned to work and will conduct his trial cycle that begins on Wednesday, March 4, 2009.
RTW in the Current Market. By stepping in BEFORE these events unfold, employers can reduce their effect. Empowering workers before an injury occurs includes:
1.
Incorporating your human resources department. Make sure it is well informed about the organization’s internal and external return-to-work options. Its staff should be readily available to injured workers so when questions arise, prompt and accurate answers can be delivered.
2. Sending a clear, unanimous message. From the top brass to floor managers, from clinic nurses to payroll staff, the employees must understand that the organization has an aggressive return-to-work program and is committed to doing whatever it takes to bring workers back in some capacity.
3. Obtain clear work restrictions early in the process. Do not wait for doctors or lawyers to cultivate an attitude of helplessness. Using these as a guideline, look inside and outside the organization for alternative positions for the injured worker. Also, look for ways to relay this information to theworker each step of the way.
Introducing a strong return-to-work program builds up the employee’s confidence during his or her recovery. Rather than focusing on disability and the lure of securing a big settlement, workers are armed with a wealth of positive options.
CCM e-News Brief
Vol. 5, No. 2, February 1, 2009
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Return to Work in a "Bad Economy (cont.)."
We began a rundown of workers comp strategies in the current economic environment in the January issue. We continue by encouraging you to not limit your strategy to Return to Work Programs. Look for ways to limit your risks especially when you are also looking at layoffs. Most workers' compensation cost containment programs focus on "workplace" safety, but some overlook a "vehicle" as a workplace. There are pre-loss and post-loss mitigation strategies a company can utilize to reduce those costs including:
1- Screen employees for safe driving records and don't allow anyone with any serious offenses to drive on company business.
2- Use/offer the safest (not the cheapest) vehicles as company cars and require use of seat belts, which almost goes without saying, but sometimes those things need to be mentioned and included in policies.
3- Require safe driving courses and refreshers.
4- Have strict policies on how a company-provided car is driven such as no use of alcohol, eating while driving, use of cell phones or PDAs, or other distractions. Strict disciplinary action for violation of the policy.
5- Easy to reach and easy to read accident documentation in the event of an accident. Keep contact numbers on the visor or in the dash.
6- Provide "on-star" type road service and/or cell phone as safety equipment in case of an accident or breakdown.
7- Require return to work when an employee is medically able to do so is a must for this and every workers' comp claim.
8- Closely manage the post injury process where the employee receives prompt medical care to hasten recovery and return to pre-injury condition.
9- Consider outsourcing deliveries and other activities done in a vehicle.
DOL Report on Union Finances.
The U.S. Department of Labor's Office of Labor-Management Standards (OLMS) announced that on Jan. 21 a final regulation will be published in the Federal Register to update the Form LM-2. The changes will ensure that relevant information on union finances is provided to rank-and-file union members to better ensure transparency and accountability as required by the Labor-Management Reporting and Disclosure Act of 1959 (LMRDA). The final rule continues the administration's commitment to transparency and accountability for corporations, pension funds and labor unions. The Form LM-2 is the annual financial disclosure report filed with OLMS by labor organizations with annual receipts of $250,000 or more. Smaller unions filing LM-3 forms that are delinquent or deficient in filing their simplified reports may have the privilege of filing the simplified form revoked. "Since fiscal year 2001, OLMS investigations have yielded a total of 1,004 indictments with 929 convictions and court-ordered restitution of more than $93 million.
New benefit rates posted.
The new benefit rates, effective January 15, 2009 through July 14, 2009, are now available online. The PPD rate effective July 1, 2008 through
June 30, 2009 is also online. To view, go to http://www.iwcc.il.gov/benefits.htm
CCM e-News Brief
Vol. 5, No. 1, January 1, 2009
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
OSHA Changes on Cranes.
The Department of Labor's Occupational Safety and Health Administration (OSHA) announced today that it will extend the public comment period for 45 days on the agency's Cranes and Derricks Proposed Rule. A notice on the extension will be published in the Federal Register soon. The proposal was originally published in the Oct. 9, 2008, Federal Register. The proposed rule addresses the key hazards associated with construction cranes and derricks. OSHA is extending the comment period because of the length of the original Federal Register notice, the comprehensive nature of the proposed rule, and the number of requests for public comment contained within the Notice. The agency will be scheduling a public hearing shortly. Public comments must be submitted no later than January 22, 2009, and may be sent electronically to www.regulations.gov, the Federal eRulemaking Portal. If submitting comments by regular mail, messenger, or courier service, send to them the OSHA Docket Office, Docket No. OSHA-2007-0066, U.S. Department of Labor, Room N-2625, 200 Constitution Avenue, N.W., Washington, D.C. 20210. Comments (10 pages or fewer) may be submitted via facsimile to 202-693-1648.
Return to Work in a "Bad Economy."
We all see the workforce layoffs as a side of a contracting economy, but one of the not-so-subtle indicators of a downturn is rates of lost time injuries. But there can still be a place for a Return to Work Program. If you can maintain the workforce…and the injured worker, there are some good reasons for an aggressive Return to Work Program. Here are a few:
• Employees stay physically conditioned.
• Recovery time is reduced.
• Indemnity payments are lower and claims are less expensive.
• Fewer attorneys become involved.
• Employees aren't afraid of re-injury if they return gradually.
• Permanency awards are likely to be lower.
• Employees maintain marketable employment skills.
• Employees' daily routine continues to include a regular work routine and maintain their identity as employees.
• There is a lower likelihood that an injured employee will become clinically depressed. (A high percentage of workers who are out of the workplace become clinically depressed which is often an expensive component of pain syndrome.)
More on this in the February issue of CCM e-News Brief.
IWCC Update.
The Jacksonville hearing site will move to Winchester in February, 2009. Effective with the February 11, 2009 call, cases assigned to Jacksonville will be heard at the Scott County Courthouse, 35 East Market St., main courtroom-second floor, Winchester.
CCM e-News Brief
Vol. 4, No. 12, December 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Tough Breaks.
There are 7.9 million fractures per year in the US. Most fractures heal with appropriate treatment but it is estimated that 5-10% of fractures go on to delayed union or nonunion. The estimated cost of each nonunion (lost wages and medical treatment) is $10,000 and the approximate total societal cost is $3-6 billion/year. The traditional definition given by the orthopaedic advisory panel to the Food and Drug Administration is that a nonunion is a fracture that is a minimum of 9 months post occurrence and is not healed and has not shown radiographic progression for 3 consecutive months. However, it is often inappropriate to wait 9 months due to the prolonged morbidity, lost work, emotional impairment and narcotic dependence. There are both patient (such as smoking and diabetes) and injury factors (mechanism of injury, severity of fracture, initial treatment) that increase the risk for nonunion. These all need to be thoroughly evaluated prior to embarking on any treatment. There are a multitude of options in the treatment of nonunions ranging from conservative to operative modalities. Conservative modalities consist of continued observation, cast treatment, progressive weightbearing, adjustment of metabolic profile, ultrasound or electrical stimulation. Operative methods include bone grafting, revision fixation and biologic adjuncts.
Jutila Resigns IWCC.
Illinois Workers' Compensation Commission Chairman Jerry Jutila has resigned for personal health reasons, effective November 6, 2008. He will return to his arbitrator position. There is no information at present on a successor to Chairman Jutila. In other IWCC news, Governor Blagojevich has named Amy J. Masters as Acting Chairman of the IWCC, effective 11/21/08. Chairman Masters first joined the Commission in 2003. She has served as the Secretary of the Commission and Operations Manager for the past two years, and previously served as Chief of Staff and Judicial Manager. Before joining the Commission, she managed public relations for the Chicago Bar Association and the Laborers' International Union-Midwest Region. The Workers' Compensation Advisory Board recommended the governor appoint Masters as Acting Chairman. Under the 2005 workers¹ compensation legislative changes, the bipartisan board now makes recommendations on Commission appointments to the governor. The board is made up of six representatives from the business community and six representatives from the labor community. Additionally, Bertha E. Parker will serve as Acting Secretary during the time Masters serves as Acting Chairman. Secretary Parker has worked at the Commission since 1978.
Federal Motor Vehicle Guidelines.
Federal Motor Carrier Safety Administration (FMCSA) adopts as final the provisions of the Agency's December 17, 2007, interim final rule concerning hours of service (HOS) for commercial motor vehicle (CMV) drivers. This final rule allows CMV drivers to continue to drive up to 11 hours within a 14-hour, non-extendable window from the start of the workday, following at least 10 consecutive hours off duty (11-hour rule). The rule also allows motor carrier and drivers to continue to restart calculations of the weekly on-duty limits after the driver has at least 34 consecutive hours off duty (34-hour restart). This rule is effective January 19, 2009.
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 11, November 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Return to Work.
Only 57% of employers taking an online poll at www.reduceyourworkerscomp.com reported having a return-to-work (RTW) program to help injured workers get back on the job sooner. Employers that have a large workers' comp deductible are missing a huge opportunity to save money almost instantly with a RTW program, according to site creator Rebecca Shafer. The main reason for excessive workers' comp costs is that most employees stay out of work too long after an injury. This happens for many reasons, but often the employer loses control of the process or doesn't let employees know that as soon as they can get a list of their medical restrictions, the employer wants them to come back to work. Usually, there's no need to wait until a worker is 100% recovered. Studies have shown that employees recover quicker when they return to work rapidly in transitional-duty jobs. A good RTW program ensures that employees come back as soon as they are medically able to perform any productive task. Proven savings range between 20% and 50%. Absence from work batters the bottom line. If an employee is out of work for two weeks and receives $200 a day in compensation and medical expenses and the company has a profit margin of 7%, it will take $57,000 of additional revenue to replace that two weeks of lost time.
Employee Substance Abuse.
In recognition of National Drug-Free Work Week (October 20-26), Louisiana Workers' Compensation Corporation (LWCC) is reminding employers to educate their employees that a drug-free workplace is a vital component of a safe workplace. A recent study by the University of Buffalo's Research Institute on Addictions found that an estimated 14.1 percent (17.7 million) of working American adults used illicit drugs last year. Of those, an estimated 3.1 percent (3.9 million) were under the influence during work hours. According to Mike Page, LWCC director of safety and loss prevention, "While LWCC encourages a 100% drug-free workplace regardless of industry, as rebuilding continues in south Louisiana following Hurricanes Katrina, Rita and Gustav, we strongly encourage the construction industry to do everything within its power to provide a safe and drug-free workplace. Research from the U.S. Department of Labor shows that the construction industry has high rates of worker alcohol and drug abuse - a serious concern given that it also tops the list of industries with the highest rates of occupational accidents and injuries." In addition to construction, other occupations with high rates of reported illegal substance use include: food preparers, waiters and waitresses. Lower rates of use were reported for data clerks, personnel specialists and secretaries. Substance abuse in the workplace is also higher among males than females; higher among part-time versus full-time workers, and higher among workers 18-25 years old versus 26 years old and older. Recognizing impairment on the job is key and there are many steps that employers can take to create a drug-free work environment, including providing a written policy, providing employee education, providing supervisor training, offering an Employee Assistance Program (EAP) and implementing a drug testing program.
Drug Costs Slowing with Economy.
The slowdown of the U.S. economy is expected to affect this country's 2009 pharmaceutical sales, which are projected to climb only 1 percent to 2 percent to between $292 billion to $302 billion, according to IMS Health Inc.'s annual forecast. Other factors expected to affect drug sales in the United States include fewer drug launches and increased competition from generics, IMS said.
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 10, October 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
IWCC.
Chairman Ruth's resignation is effective at close of business October 2, 2008. Governor Blagojevich has appointed Arbitrator Gerald Jutila to be Chairman of the Commission, effective October 3. Arbitrator Jutila has been unanimously recommended as the next Chairman by the Workers' Compensation Advisory Board. Under the 2005 workers' compensation reforms, the Workers' Compensation Advisory Board makes recommendations on Commission appointments to the governor. The board is made up of six representatives from the business community and six representatives from the labor community. Jerry Jutila began serving as an arbitrator in September 2004. Arbitrator Lammie will handle Arbitrator Jutila's docket for the remainder of 2008. In other news, Kimberly Moreland, vice president of Rising Medical Solutions, a medical-financial organization, was named one of nine governor-appointed seats on the State of Illinois Workers' Compensation Medical Fee Advisory Board. In this position, Moreland will advise the Illinois Workers' Compensation Commission on the establishment of fees for medical services and accessibility of medical treatment for Illinois workers who have experienced job-related injuries or illnesses.
Federal Whistleblower Legislation.
Congressional Democrats and employee rights groups are pushing to plug what they view as gaping holes in laws designed to protect workplace whistleblowers. Federal laws prohibit employers from retaliating against workers who alert authorities to health and safety problems on the job. Under the law, however, those who face such retribution have just 30 days to file a complaint with the U.S. Department of Labor. Many workers don't learn of their whistleblower rights that quickly, experts say. If employers refuse to settle such complaints, workers can't act on their own to take them to federal court. A bill introduced by U.S. Rep. Lynn Woolsey, D-Calif., would change that. The legislation would give workers a full year to file complaints, and allow them to request administrative hearings and file civil actions on their own in federal court. The bill also would prohibit companies from firing employees for reporting workplace injuries. In 2007, 22 percent of those who filed whistleblower complaints with the U.S. Department of Labor got settlements or rulings in their favor. That's down from 29 percent in 2000. Asked to comment, labor officials said they consider the current rate within the normal historical range. A new report from the Government Accountability Project highlights shortcomings in the coverage and enforcement of laws to protect corporate whistleblowers. Congressional leaders have also asked the U.S. Government Accountability Office to examine the Labor Department's investigation of whistleblower complaints.
Stimulating Debate.
You know there's a battle going on when a manufacturer of a device used in the procedure lobbies state workers' compensation regulators to disparage treatment guidelines which criticize the procedure. That's what Medtronics did last October when it wrote Tennessee officials over spinal cord stimulators. Medtronics makes about $15,000 in device sales when its product is used by the anesthesiologist or surgeon who implants a stimulator in a patient. The manufacturer criticized the then draft guidelines on chronic pain of the American College of Occupational and Environmental Medicine. Hundreds if not thousands of physicians today implant spinal cord stimulators in injured workers and swear by them. The cost to workers' compensation insurers ranges from $25,000 to $75,000 depending on the locus of care--surgical center vs. a hospital--and the ingenuity of the billers. But the results may not be gratifying to patients, because of a high complication rate and uncertainty about long-term benefit.
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 9, September 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
OSHA Releases Fatal Injuries Report.
A total of 5,488 fatal work injuries were recorded in the United States in 2007, a decrease of 6 percent from the revised total of 5,840 fatal work injuries reported for 2006. While these results are considered preliminary, this figure represents the smallest annual preliminary total since the Census of Fatal Occupational Injuries (CFOI) program was first conducted in 1992. Final results for 2007 will be released in April 2009. Based on these preliminary counts, the rate of fatal injury for U.S. workers in 2007 was 3.7 fatal work injuries per 100,000 workers, down from the final rate of 4.0 per 100,000 workers in 2006, and the lowest annual fatality rate ever reported by the fatality census.Key findings of the 2007 Census of Fatal Occupational Injuries:
· Fatal falls in 2007 rose to a high of 835--a 39 percent increase since 1992.
· Transportation incidents fell to a series low of 2,234 cases in 2007.
· Workplace homicides rose 610 in 2007 after a series low of 540 in 2006.
· Fatal injuries among protective service occupations rose 19 percent in 2007.
Fatal occupational injuries incurred by non-Hispanic Black or African American workers were at the highest level since 1999. For full details, please visit: http://www.bls.gov/news.release/cfoi.nr0.htm
IWCC Promotes Teague.
Boston-based Liberty Mutual Insurance Co. today is among the leaders of those companies using advanced predictive modeling tools to not only manage more effectively costs stemming from those core claims but, even more critically, provide the best quality of care possible. For the past four years, the carrier has been developing and using three data-driven claims tools aimed at the so-called "slow emerging" comp claims that do not always scream out for attention. But the claims slow to emerge present the main challenge because the impeding factors are often hidden and also tend to have many failed medical procedures, prescriptions and chronic pain associated with them. The "Predictive Model" tool is unleashed on all claims after 90 days and looks at more than 50 attributes, such as the number of specialists and the demographics of the claimant that are red flags for high costs, and thus pointing to candidates for focused intervention by claims and managed care experts. Each quarter, all noncatastrophe claims are run through the "Cost-Driver Model" that flags claims with three specific items showing costs above a certain figure for intervention. It is used to quickly identify claims where current treatment patterns and cost suggest problems that could lead to longer and costlier recovery periods unless different actions are taken. Finally, the "Chronic Pain Model" uses nine claims attributes, such as type and frequency of drugs, to identify candidates for a chronic pain program. It also serves as another tool to make sure the right resources are working on the claims and could point to the need for involvement of a medical director. "The whole goal is to identify claims that apply appropriate management tools," Hooyboer said. "After all, I can apply a tool to identify a claim, but if you did not apply the appropriate management, then you did not save any money at all."
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 8, August 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
IWCC Promotes Teague.
Effective July 15, 2008, Arbitrator Jennifer Teague will serve as acting commissioner, due to the temporary absence of Commissioner DeMunno. Oral arguments scheduled thereafter will proceed with Acting Commissioner Teague sitting on Panel C with Commissioners Basurto and Gore.
Got Comp?
"Employers: Do you have workers¹ comp insurance? It¹s the law." You may see this notice on billboards and bus posters in Chicago, Springfield, Aurora, Waukegan, and Elk Grove Village. The Commission is reminding employers of their legal obligation to purchase insurance for injuries that may occur on the job. Ads are posted in English and, as appropriate in some neighborhoods, in Spanish and Polish. To see the ad, please go to www.iwcc.il.gov/news.htm#ad
Injuries and Illness on the Job Underreported.
A report released by the U.S. House Labor Committee shows nearly 70 percent of work-related illnesses and injuries may be going unreported, calling into question federal regulators' claims that workplace problems are declining. Hearings will investigate whether the Occupational Safety and Health Administration is adequately enforcing construction safety rules. The committee chairman, Democratic Rep. George Miller of California, said in releasing the report that despite OSHA's repeated claims that workplace injuries are declining, the numbers from outside analyses tell a different story. "Although there is widespread agreement that workplace injuries and illnesses are woefully underreported, OSHA refuses to recognize that a problem exists," Miller told the Education and Labor Committee in prepared remarks. The report cited various reasons why workplace problems go unreported, but one is key: Employers, who are responsible for reporting to federal authorities, have incentives to keep their lost work days at a minimum. "Businesses with fewer injuries and illnesses are less likely to be inspected by OSHA," the report said. "They have lower workers' compensation insurance premiums; and they have a better chance of winning government contracts and bonuses." In the commercial construction industry, in particular, one expert said better safety records help as companies competitively bid for lucrative contracts. The report drew on various academic studies that compared reports filed with federal regulators with other sources, including local police department records, hospital emergency room logs and workers' compensation records. Miller said hidden injuries are not new. In the steel industry, workers hide their injuries to avoid being disciplined in what is called "bloody pocket syndrome," the report said. The hearing highlighted a recent investigation by The Charlotte Observer about conditions in the North Carolina poultry industry, where workers allegedly suffered injuries and were intimidated to keep quiet while a company claimed perfect safety records. The committee's ranking Republican, Rep. Howard "Buck" McKeon, issued an opening statement that questioned reliance on news stories to get to the facts. McKeon said the newspaper's report was "troubling and certainly warrants further investigation." But, he said, "I think we all must hesitate to draw broad-based conclusions from examples that have not been fully investigated." McKeon also said employers need to be given clear directions on reporting workplace problems. "We need to look more closely at the guidance offered to employers about what to record, what to report, and when to do so," he said.
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 7, July 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Programming WC Cost Controls.
The average employer cost for employee compensation was $28.46 per hour worked at the close of the first quarter this year, the U.S. Department of Labor reported Wednesday. The figures, based on a sample employer survey, indicated that wages and salaries accounted for an hourly average of $19.83, or 69.7 percent of total compensation costs. The cost of employee benefits averaged $8.63 per hour worked, or 30.3 percent of the total costs, according to the data, current as of March 2008. The survey provided a breakdown of how those benefit dollars were allocated. One category encompassed legally required benefits such as Social Security, Medicare, unemployment insurance and workers' compensation. Those costs averaged $2.24 per hour worked, or 7.9 percent of total compensation costs. The other category was discretionary benefits. Included in that section are employer costs for life, health and disability insurance benefits, which averaged $2.40 an hour, or 8.4 percent of total compensation costs. Also in the discretionary benefits category were paid-leave benefits (vacation, holidays, sick leave and other), averaging $2 an hour, or 7 percent of total costs, and retirement and savings benefits, averaging $1.26 per hour, or 4.4 percent of the total costs.The National Compensation Survey measures how much employers spend on wages, salaries and employee benefits in nonfarm private establishments and state and local government offices. In March, the average employer cost for employee health benefits was $1.92 per hour in private industry, up from $1.41 per hour in March 2003. The survey found a large range in employer costs for employee health benefits — from 90 cents per hour for service workers that received health benefits through their jobs, up to an average of $3.95 per hour for union workers. The survey also noted that average employer compensation costs in private industry were significantly lower than compensation costs for government workers. For example, the private sector average compensation cost per employee hour was $26.76 compared with $37.84 in state and local government. The share of total costs allocated to employee benefits also was higher in government than private industry: 34.1 percent of total compensation costs in government compared with 29.4 percent in private industry.
IWCC Changes
By the end of the current fiscal year, the Insurance Compliance Division of IWCC will have collected a record number of fines for the Injured Workers' Benefit Fund (IWBF). Thus far, $1.6 million in fines have been collected. Additionally, since January 1, 2006 the Commission has collected over $3 million in fines. All of that money will be used to pay benefits to victims of uninsured employers. To understand the eligibility requirements, check the Injured Workers' Benefit Fund web page at http://www.iwcc.il.gov/iwbf.htm.. The online case information page now offers detailed information on the settlements and decisions of closed cases. A white button now appears in the upper right corner of the web page. Click that button to view document information regarding the terms of a settlement or Arbitrator/ Commission decision. The web page contains all the decision/settlement information that appears on our mainframe computer system. Just as on the mainframe, if there are multiple documents on a case (e.g., an arbitration decision and a review decision), there will be more than one page of information, so scroll down to make sure you have seen everything that is on a case. To check it out, go to http://www.iwcc.il.gov/caseinfo.htm .
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 6, June 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Programming WC Cost Controls.
A new site provides a range of free workers' compensation cost-control tools, information and forms. Visitors can find best-practice guidelines, detailed case histories of companies that have slashed their costs, articles, and documents and regulations for all states. If you need Texas workers' comp forms in Spanish, or North Dakota rules, you'll find it here," said the site's creator, Rebecca Shafer, a pioneer in workers' comp cost control for more than 20 years. Besides the massive amount of free information, the site offers the Workers' Management Injury Tool Kit—a complete workers' compensation management program that lets employers start saving money almost immediately. It includes self-assessment tools, forms, schedules and training programs employers have used to cut their costs from 20 percent to 50 percent. For free information, visit: www.reduceyourworkerscomp.com .
Waukegan WC Review Site Moved.
Commissioner Mason's review hearings in Waukegan will now be held in the County Board Office on the 10th floor of the Lake County Courthouse, 18 North County Street. Arbitration hearings will continue to be held in the Jury Assembly Room of the Lake County Courthouse.
Workers Unprepared for Disability.
The results of a new survey released today by the nonprofit LIFE Foundation show that nearly 80 percent of working Americans say they would turn to their employer or the government for financial support in the event of a disabling illness or injury, rather than disability insurance purchased on their own. Released in support of Disability Insurance Awareness Month, these findings suggest that far too many working Americans are leaving themselves financially vulnerable by not having the disability insurance protection they need. Conducted by KRC Research between April 4-7, 2008, the LIFE survey asked 520 working adult Americans (employed either full- or part-time) which source of financial support they would rely on most if they were to become disabled for one year or more. Thirty-five percent say they would rely on employer-sponsored disability insurance coverage if they were to become disabled for one year or more. While coverage provided by employers is the main source of disability income protection in the United States, most employers don't provide disability insurance as an employee benefit. (According to the U.S. Department of Labor, less than 30 percent of U.S. workers have access to long-term disability coverage through work and only about 37 percent have access to short-term disability coverage.) Thirty-one percent say they would rely on government-provided benefits. (According to the Social Security Administration, in 2005 roughly 60 percent of people who applied for Social Security disability benefits were initially denied.) Finally, 13% say they would turn to Workers' Compensation. Only 11% would rely on disability insurance they had purchased on their own.
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 5, May 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Programming WC Cost Controls.
A new site provides a range of free workers' compensation cost-control tools, information and forms. Visitors can find best-practice guidelines, detailed case histories of companies that have slashed their costs, articles, and documents and regulations for all states. "If you need Texas workers' comp forms in Spanish, or North Dakota rules, you'll find it here," said the site's creator, Rebecca Shafer, a pioneer in workers' comp cost control for more than 20 years. Besides the massive amount of free information, the site offers the Workers' Management Injury Tool Kit—a complete workers' compensation management program that lets employers start saving money almost immediately. It includes self-assessment tools, forms, schedules and training programs employers have used to cut their costs from 20 percent to 50 percent. For free information, visit: www.reduceyourworkerscomp.com .
WC Reform Costs California More.
California's Workers' Compensation Insurance Rating Bureau has released a study that notes that following workers' comp reform, statewide average ratios of loss adjustment expense (LAE) to loss per claim have increased. However, depending on how various legal issues are resolved and whether reforms are rolled back, that LAE costs could increase. WCIRB conducted an analysis of LAE trends and projection methodologies, given the increase in LAE to loss ratios, as well as other factors. The resultant report, titled, "Analysis of Loss Adjustment Expense Trends," found that following the reforms, LAE amounts did not decline and, as a result, LAE increased significantly as a percentage of calendar year losses. Recent workers' comp reforms included tools for insurers to reduce the cost of claims. However, implementation of these tools has increased the complexity of administering and adjusting claims, thereby increasing the related costs. Based on the report, the WCIRB has recommended consideration of additional methodologies that relate LAE amounts to components other than incurred losses to augment its current LAE projection methodologies. To view the report and a complete list of conclusions and recommendations, visit https://wcirbonline.org/resources/data_reports/wcirb_reports.html.
Deceased Lose WC Benefits in Missouri.
The Missouri Department of Labor and Industrial Relations (DOLIR) and the Department of Health and Senior Services (DHSS) have bolstered their efforts to prevent compensation payments from going to deceased Missourian claimants. This first-ever agreement between the two departments allows DOLIR's Division of Workers' Compensation to check their record of payments from the Second Injury Fund (SIF) for payment of compensation and benefits to claimants, including weekly permanent total disability (PTD) benefits. The SIF compensates injured employees when a current work-related injury combines with a prior disability to create an increased combined disability. The agreement allows DHSS to match data of vital statistics to DOLIR for residents whose deaths occurred in Missouri. The Division of Workers' Compensation can then use the data to verify eligibility of those receiving SIF compensation and benefits. In February, the departments found their first match against the data. The match resulted in the identification of one deceased person receiving benefits, which was quickly addressed. The departments will routinely run this data, providing better efficiency and accuracy in state government.
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 4, April 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Proposed Rule Changes to IWCC Fee Schedule Online.
To view the proposed changes to the Illinois workers' compensation fee schedule, please go to http://www.iwcc.il.gov/news.htm#FSPR. The rules, guidelines, and fees are NOT in effect now. They are only proposals. When the rule-making process has been completed, the final versions will be posted on the fee schedule web page.
RSI on the OUT?
Repetitive Stress Injuries (RSIs), once considered the hallmark workers comp injury of the computer generation have not just been on the decline; they have been plummeting according to data from the Bureau of Labor Statistics. The number of carpal tunnel cases has dropped 21 percent in 2006 alone, and even as early as 2001, the rate of carpal tunnel injuries among heavy computer users (keyboard use in excess of seven hours a day) was no more than the population at large according to a study by the Mayo Clinic. There has been recent speculation that the "white collar epidemic" that carpal tunnel was expected to be may have been overblown. It is the blue collar workers on assembly or meat processing line who have the far greater incidence of the condition. The decline, some speculate may owe to early over-reporting or misdiagnosis, or it could be that the new ergonomic designs available for commuters on the information highway may be protecting the white collar workforce.
Workers Comp Homework Opens Door.
In a Nebraska case that may set precedent for other states, Attorney General Wayne Stenehjem says if a public official has e-mails on a home computer about public business, it`s an open record. Stenehjem`s opinion comes in response to a Bismarck attorney`s request for e-mail messages from North Dakota`s workers compensation agency. Chad Nodland asked for e-mails between former Workforce Safety and Insurance internal auditor Kay Grinsteinner and former WSI board member Evan Mandigo. Nodland asked for office e-mails during October 2007. He was told they did not exist. Then he asked for e-mails that were not on office e-mail accounts. He was told they were not public records. Stenehjem says the e-mails are public records and Nodland is entitled to get copies of them.
Research on Nursing Home Job Injuries.
In a University of Maryland study of work-related injuries at nursing home facilities, staffing level was the most important predictor of incidence of ion the job injuries. Researchers combined facility-level data from nursing homes in three states and found that worker injury rates were strongly associated with staffing levels. Findings were consistent across the three states despite differences in data collection, injury classifications, and reporting procedures. Additionally, a sizable proportion of variance in worker injury was explained by staffing. These data support smaller studies of single nursing homes and hospitals, which have also shown this association. Using an ecological framework allowed the researchers to circumvent some of the limitations of individual-level research on working conditions. Individual-level associations may be difficult if not impossible to ascertain because of turnover, floating among health care workers, and multiple workers caring for a single resident. Examining injuries to all resident care workers who worked in long-term care facilities in these states (a total of more than 400 facilities) enhanced the generalizability of the findings.
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 3, March 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Insurers and Treaters Partnering?
The American College of Occupational and Environmental Medicine has in recent years issued treatment guidelines and a return-to-work/ stay-at-work guide to shortening the path to recovery. Treatment guidelines for work injuries have, on balance, been good for the medical community, in particular the expert doctor. Guidelines isolate poorly performing clinicians without affecting the daily pattern of care of most providers, and they are authored largely by practicing clinicians. Top clinical skills, high respect among peers and an aptitude for helping injured workers' recover from accidents define the expert doctor in workers' compensation. These doctors and their staffs typically respond well to requests from insurers as they are good at keeping costs low. Case managers trust them implicitly as they know how best to treat complex injuries that can sometimes take years to heal. States where professionals and insurers have been successful in this partnership include Indiana, California, and Florida. For details:http://www.riskandinsurance.com/story.jsp?storyId=76640209
You Make the Call.
In a move that could have significant implications for any state that is home to a professional sports franchise, Texas is considering whether permanent damage to a player sustained while playing for the team is compensable under the Texas workers comp system. The Texas workers' comp law treats pro athletes as a special class. Under Texas Labor Code §406.095(a), a pro athlete "employed under a contract for hire or a collective bargaining agreement who is entitled to benefits for medical care and weekly benefits that are equal to or greater than the benefits provided" by workers' comp must make an election between the two types of benefits. The test case is that of Chad Hennings, former lineman for the Dallas Cowboys who has permanent damage to his back. At first, the court system threw Hennings for a loss. The 10th Court's original July 23, 2007, opinion deemed Hennings' overall contractual package of salary and medical benefits during his pro football career to be higher than benefits available under workers' comp, thus rendering Hennings ineligible for such benefits under Texas law. But in its Jan. 30 opinion, the court reversed itself and upheld a jury finding that, in Hennings' case, workers' comp was a better deal for him because of its longer duration. The court separated the indemnity benefit (where comp was insignificant) from the medical (where taken over a lifetime, comp might well exceed the deal offered by the Cowboys). The door has been opened for all professional athletes in the state and perhaps others. But there is a statute of limitations
Research Grants to Study Return to Work.
The CRCC Research Grant Program has made its first award, a $40,000 grant for 2007 to Michael P. Frain, Ph.D. and Malachy Bishop, Ph.D. for their project entitled, "An investigation of CRC's role in the return to work of military reservists." "This was our first of what will be an annual award. We are very excited about the possibilities and research potential that this type of award can generate," commented David Strauser, Ph.D., CRC, head of the Scientific Research Advisory Panel of the CRCC and a former Commissioner. The CRCC Research Grant Program is accepting applications for the 2008 award. For more information or to obtain a copy of the Research Grant Program application, see the CRCC web site at http://www.crccertification.com/pages/31research.html/. The deadline for grant submissions is April 15, 2008. The CRCC Research Grant Program offers researchers a unique opportunity to obtain support for innovative research that addresses issues specific to the field of rehabilitation counseling.
IWCC Calendars and Call Sheets.
The Illinois Workers Compensation Commission calendars, call sheets and Chicago trials have been updated. Arbitrator Cronin will not hold trials on March 21. Instead, March 24 has been added to his trial cycle. For an up to the minute listing, please visit the IWCC site at http://www.iwcc.il.gov/calendars.htm
The CCM e-News Brief.
For access to the archive of past issues of CCM e-News Brief, please visit: http://creativecasemanagement.com/eNews.aspx.
CCM e-News Brief
Vol. 4, No. 2, February 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
IWCC Calendars and Call Sheets
The Illinois Workers Compensation Commission calendars and call sheets for Arbitrators and Commissioners along with the calendars for Court Reporters and Chicago Trials are now available through the first half of 2008. For details and downloadable versions of these, please visit the IWCC site at http://www.iwcc.il.gov/calendars.htm .
Employers Holdings, Inc. of Reno, Nev
reports it has agreed to acquire AmCOMP Inc. for approximately $230 million, including the assumption of $37 million in debt. The acquisition will expand Employers' workers' compensation insurance operations to a total of 26 states. Under the terms of the merger agreement, holders of AmCOMP's approximately 15 million common shares will receive $12.50 in cash for each share. Employers said it expects to finance the purchase price through a combination of cash and debt. Douglas D. Dirks, president and chief executive officer of Employers Holdings, Inc., said the addition of AmCOMP's 900 agencies will "significantly" accelerate his company's growth in expansion states as well as open up new markets for its small business workers' compensation line. Employers has historically been focused in the Western states while AmCOMP has been in the Southeast and Midwest, thus there should be little to no overlap in markets, officials said.
Workers Comp Medical Care Reimbursed Higher than Group Health.
State workers compensation fee schedules are effective in controlling medical costs, but have a limited ability to bring workers comp utilization levels for similar injuries closer to group health levels, according to a study released Thursday by NCCI Holdings Inc. The study from Boca Raton, Fla.-based NCCI found that most states reimburse workers comp medical care at prices marked above what group health plans pay. Additionally, most states without fee schedules reimburse medical providers at a higher markup over group health than states with fee schedules. But when comparing workers comp and group health costs for similar injuries, higher utilization in workers comp accounts for more of the difference than the price markups over group health, the NCCI reported. That finding holds true regardless of the type of fee schedule used in a state or whether a state has a fee schedule. "We conclude that fee schedules by themselves have a very limited ability to bring workers comp utilization closer to group health levels," the NCCI said. Among states with fee schedules, reimbursements for doctor office visits and physical therapy are priced at about the same amount as in group health. Radiology treatments and surgery, however, show higher markups above group health than other medical services. The study, "Making Workers Compensation Medical Fee Schedules More Effective," is available at www.ncci.com/ncci/index.aspx.
Fraud Indictment Downstate.
An indictment released this week by the U.S. Attorney's office for the Southern District of Illinois details fraud allegations against two Du Quoin women who were partners in a small business consulting firm called L.T. Consulting, Inc. The indictment alleges that Laura Krpan (now Laura Zoller) and Tara Morgan (now Tara Prince) operated a business called L.T. Consulting from Jan. 17, 2002, through May 17, 2006, for the purpose of contracting with small businesses to administer payroll, insurance and other administrative functions of small businesses. Their responsibilities included obtaining and paying for workers compensation insurance for the individual small businesses.
CCM e-News Brief
Vol. 4, No. 1, January 1, 2008
[Compliments of Charlotte Bishop, President, Creative Case Management, Inc.]
Workers Comp Rx $$.
There are some signs that the workers' compensation prescription drug share of total medical costs is leveling off – at least temporarily, according to a National Council on Compensation Insurance study updated this year. Changes in utilization are the most significant driving force behind changes in total workers' compensation prescription drug cost, while some states' workers' compensation prescription drug costs per claim vary significantly from average, the NCCI study pointed out. Even though the growth rate in prescription drugs has slowed, overall workers' compensation medical expenditures continue to rise and prescription drug expenditures are growing at least as rapidly as overall medical costs, the report showed. In service year 2005, drugs with no generic equivalent accounted for 31 percent of prescription drug costs. This is down sharply from the 53 percent for service year 2002 that NCCI reported in 2004. In addition, the withdrawal of some major drugs from the marketplace that were used often in workers' compensation claims may have significantly impacted workers' compensation medical costs, NCCI said. Newly approved generic versions of popular drugs and a slowdown in the number of new drugs introduced also contribute to the overall picture. NCCI reported a significant slowdown in the growth of the prescription drug share of medical costs in the latest year. Whether this is a temporary slowdown or the beginning of a period of moderating trends in workers' compensation prescription drug costs remains to be seen, the organization said. The entire report titled "November 2007 Drug Study" can be viewed at www.ncci.com .
New Illinois Rate Sheet.
The new benefit rate sheet, effective January 15, 2008 through July 14, 2008, is now available online. The rate sheet reflects the new statewide average weekly wage of $883.86, as released by the Illinois Department of Employment Security. To view the new benefit rate sheet, go to http://www.iwcc.il.gov/benefits.htm.
MRSA a Workers Comp Issue?.
One of the latest reports published in the Journal of the American Medical Association states that there are about 100,000 new cases of Methicillin-Resistant Staphylcoccus Aureus (MRSA) per year, 14 percent of which are community-acquired (the balance are found in healthcare facilities). Presently Illinois has signed into law regulations that address control of these bacterial strains in healthcare settings (HB-192 and SB-0233). The state of Virginia, however, may offer a precedent for other states as they address the workers compensation implications of MRSA in the occupational setting. Virginia statute specifies that, “For workers’ compensation purposes, a MRSA infection may be considered an ‘ordinary disease of life.’ Ordinary diseases of life are those to which the general public is exposed outside of the employment. Under some circumstances, ordinary diseases of life may be covered by workers’ compensation. If you have an employee who develops a MRSA infection and reports it to you as work-related, you should file the claim with the Office of Workers’ Compensation for investigation.” To determine workers compensation qualification, the law further directs employers to address questions regarding: Plausible route of transmission, source test positive for MRSA, employee test positive, (If positive, evidence support workplace origin?), circumstances peculiar to employment, any other non-employment sites test positive. CCM has compiled a report on “MRSA in the Workplace.” If you would like an electronic copy, please contact: ssteiber@creativecasemanagement.com.