The State of the States

Regulatory Review

Key workers' comp-related regulatory developments across the country.
By: | May 16, 2014 • 4 min read

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]

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.

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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.

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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]