The State of the States

Regulatory Review

Key workers' comp-related regulatory developments across the country.
By: | May 16, 2014

California

Electronic Data Reporting. The Division of Workers’ Compensation proposed changes to regulations reflecting a transition from International Classification of Diseases, Ninth Revision to ICD-10. The deadline for the United States to begin using ICD-10 is Oct. 1. The division will update its regulations and forms to refer to ICD-10.

Florida

Self-Insured Rules. The Division of Workers’ Compensation proposed amendments to rules regarding self-insured employers. The proposed rule deletes references to a current or former self-insurer’s net worth requirements with regards to financial statements reporting requirements. The rules are amended to provide guidance to current and former self-insured entities regarding purpose-specific distinctions in methodologies used when determining a self-insured’s net worth.

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The proposed rule is amended to increase a self-insurer’s maximum per occurrence retention from the greater of $500,000 or 1 percent of the self-insurer’s net worth to the greater of $600,000 or 1.5 percent of the self-insurer’s net worth. The proposed rule also clarifies factors that the Department of Financial Services must consider when reviewing a current self-insurer’s request for a higher self-insured retention.

New York

Independent Medical Examinations. The Workers’ Compensation Board adopted amendments to the regulations regarding the conduct and reporting of independent medical examinations. Notice of the scheduled IME may be made using overnight mail as long as the notice is received by the worker at least seven days before the scheduled examination. A new requirement was added that requires every record, document, or test result supplied to an IME examiner for review in connection with an IME or records review must be part of the board file. A records review conducted by a medical provider without physically examining the worker must be completed by a medical provider authorized to treat workers’ compensation claimants, authorized to conduct IMEs, or “qualified” within the meaning of the regulations. The regulations clarify that an IME examiner may not refuse to conduct an IME when a worker appears at the IME prepared to record or videotape the IME. The regulations also set forth specific criteria for the content, certification, and signing of an IME report and a records review report. A carrier’s medical professional is not an IME examiner. The amended regulation went into effect on Feb. 26.

Penalties from Final Conciliation Decisions. The Workers’ Compensation Board announced that it will suspend the application of a rule regarding penalties pursuant to conciliation decisions. A rule provides that carriers are directed to make timely payments within 10 days of finalized conciliation decisions or face a $500 fine. A second rule provides that in such instance, penalties and assessment for late payment of awards pursuant to conciliation decisions are not applicable. The board will suspend the application of the second rule. The change affects proposed decisions issued on or after May 1. Any mandatory penalties under the conciliation process will be subsumed within another rule providing that if a carrier fails to make payments of compensation according to the terms of the award within 10 days, a penalty of 20 percent of the unpaid compensation must be paid to the injured worker if 20 percent of the award exceeds $500. The chair of the board noted that the late payment of compensation awarded by a final conciliation decision must in most cases be the same as the late payment penalty stemming from a notice of decision rendered by the workers’ compensation law judge.

Rhode Island

Cost-of-Living Increase. The Division of Workers’ Compensation issued an informational letter announcing a cost-of-living increase. Effective May 10, weekly benefits for total incapacity and partial incapacity should be increased by 1 percent. Increases must be paid by insurers and employers without further order of the court. Late payment of the increase can result in the assessment of a 20 percent penalty on the unpaid amount.

Medical Fee Schedule. The Division of Workers’ Compensation issued an informational letter announcing that changes to the medical fee schedule went into effect on May 1. The revised fee schedule will apply to medical services on or after May 1 regardless of the date of injury. Those with questions should contact [email protected]

Washington

Explosive Safety Standards. The Department of Labor and Industries adopted an amendment to a rule regarding safety standards for possession and handling of explosives.

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The rule permits local law enforcement tactical response teams to store and transport explosive actuated tactical devices in accordance with Bureau of Alcohol, Tobacco, Firearms, and Explosives regulations and rulings. The rule went into effect on May 1.

Retrospective Rating. The Department of Labor and Industries proposed changes to a rule regarding the retrospective rating for workers’ compensation insurance. The proposal modifies a formula that allowed a small number of retro participating employers to receive refunds or larger refunds inconsistent with the intent of the retrospective rating program when their loss ratio exceeds the maximum loss limit they had chosen. The department proposed to remove the performance adjustment factor from the calculation of insurance charges for those retro participants whose insurance charges are based on standard premium paid.

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]

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The R&I Editorial Team can be reached at [email protected]