The State of the States

Regulatory Review

Key workers' comp regulatory developments from around the country.
By: | April 21, 2014 • 4 min read


Fee Schedule. The Industrial Commission scheduled a hearing regarding the physicians’ and pharmaceutical fee schedule on April 17 at 1 p.m. at 800 West Washington Street in Phoenix. In addition to public comments, the commission will consider a report prepared by commission staff. The methodology committee recommended that the commission explore the possibility of conducting an annual review of all codes rather than every four years. The commission also welcomes public comment on whether it should adopt a different methodology to determine reimbursement values that is an “Arizona based product” as recommended by the methodology committee.


The committee also recommended that the commission update to the most recent current procedural terminology, review “follow up” or “after care” days associated with the “global period,” and adopt the health care common procedure coding system as published by the Centers for Medicare and Medicaid Services. Written comments will be accepted until 10 days after the hearing. Click here for more information.


Medical Provider Networks. The Division of Workers’ Compensation modified its proposed medical provider networks regulations. The proposed modifications include a further description of the requirements for physician acknowledgements obtained through a website listing. The rules also clarify the occurrences and dates when physician acknowledgements are required. The rules clarify that the geocoding results will be used by the division in reviewing MPN plans to give an approximation of MPN compliance with the access standards. The modifications clarify the definition of MPN medical access assistant and the requirements where the same individual performs both the duties of a MPN medical access assistant and a claims adjuster. The MPN website listing of all treating physicians in the MPN must indicate those not currently taking new workers’ compensation patients and designate “by referral only” those secondary treating physicians who may only be seen with an approved referral.

The modifications also set a requirement that MPNs that were approved before Jan. 1 that are not in compliance with current MPN regulations must file a modification and update to comply no later than Jan. 1, 2018. Penalties for a violation of MPN access standards may be assessed if the MPN applicant fails to permit an injured covered employee to obtain medical treatment from an out-of-network physician when the MPN medical access assistant fails to meet the required timelines. Click here for more information.

North Carolina

Industrial Commission Rules. The Industrial Commission adopted proposed rules. The rules state that copies of the commission’s rules and forms may be obtained by contacting the commission. The adopted rules amend the procedure for claims administration. The rules set the procedure for a worker’s request to reinstate compensation. The rules state the requirements for an employer’s safety rules or regulations to be considered approved by the commission. Upon the request of an employer to take a written or recorded statement, the employer must notify the worker that the statement may be used to determine whether the claim will be paid or denied. The rules state that medical motions must be submitted electronically. The rules also clarify that physical therapists, occupational therapists, speech therapists, and other direct care providers are not rehabilitation professionals. The rules set compensation for mediators. The amended rules went into effect on April 1.


Administrative Practice and Procedure. The Department of Labor and Industry, Workers’ Compensation Appeal Board, and Office of Adjudication proposed amendments to rules of administrative practice and procedure before the board and workers’ compensation judges. The rules clarify filing dates if filing by mail, common carrier, electronically, or by hand-delivery. The rules add definitions of “board,” claim petition,” and “UEGF claim petition.” The definition of “writing” is clarified to include electronic communications.The proposed rules require a worker’s attorney to submit a copy of the fee agreement or any other statement or claim for disbursements, costs, and expenses and to obtain approval from the judge or board before the agreement, statement, or claim will be valid. The proposed rulemaking does not require the creation of forms. The rules authorize a judge to compel the attendance of the parties at medication. Comments should be submitted to Elizabeth Crum at 1010 North Seventh Street, Harrisburg, PA 17102.


Utilization Review. The Department of Labor and Workforce Development approved amendments  regarding utilization review, case management, medical cost containment, the medical fee schedule, the inpatient hospital fee schedule, and the medical impairment rating registry program.


The rules state that the Workers’ Compensation Division will charge fees for each utilization review appeal that it completes. Unresolved disputes between a carrier and a provider concerning bills due to conflicting interpretation of the rules may be presented to the medical payment committee on or after July 1. The rules set the procedure for committee review. The rules delete references to the commissioner of the department and replace such with “administrator.” The changes went into effect on March 26. Click here for more information.


Medical Quality Review. The Division of Workers’ Compensation proposed changes to an internal revised medical quality review process document. The changes would require arbiter meeting to be held at least twice per year. Nurse investigators must present all complaint recommendations through the quality assurance committee. The changes also require informal settlement conferences authorized to be conducted with at least one qualified arbiter. A second arbiter or the associate medical advisor may be assigned if available. Those with questions should contact [email protected]

Christina Lumbreras is a Legal Editor for Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.


That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.


Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]