Workers' Compensation Loss Costs Going Down Again in Kentucky
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Workers' Compensation Task Force meets
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The loss cost figures show an average reduction of 7.9 percent for the 590 industrial classes used in Kentucky, the same decrease as in 2012. The industrial classes include manufacturing, office and clerical, contracting, and goods and services. For coal classes, surface mining decreased 4.9 percent and underground mining costs decreased 4.8 percent. Sharon Clark, state insurance commissioner, said her department approved the loss costs filing effective Oct. 1. The figures are submitted by the advisory organization, the National Council on Compensation Insurance Inc. (NCCI), on behalf of all workers compensation carriers writing in the state. We recently heard from NCCI management that the countrywide outlook for workers comp rates has changed from conflicted to encouraging, said Clark. Kentucky workers and employers have enjoyed eight consecutive decreases, lowering loss costs on average 46.8 percent.
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Workers' Compensation Extended for Spouses of Emergency Personnel
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In his prime, "Neon" Deion "Prime Time" Sanders juggled his NFL career with a stint in Major League Baseball , made cameos in M.C. Hammer videos and served as the inspiration for Jaime Foxx's Willie Beamen character in the 1999 film "Any Given Sunday." On Thursday, The Los Angeles Times revealed that Sanders filed a workers' compensation claim in California in 2010, claiming he suffered head trauma and other injuries while playing with the Dallas Cowboys. During the pregame show before February's Super Bowl, however, Sanders had different thoughts about such claims as an NFL Network analyst. "The game is a safe game," the Hall of Fame cornerback said. "I don't buy all these guys coming back with these concussions. I'm not buying all that. Half these guys are trying to make money off the deal." Given how Sanders' compensation case is proceeding, it's likely he considers himself in the other half of that equation. In November 2010, Sanders was deemed 86% disabled by the Division of Workers' Compensation. The four doctors who examined Sanders diagnosed more than a dozen medical conditions, including cognitive impairment, behavioral/emotional disorder, arthritis and "arousal disorder" -- which is a sleep disorder that isn't nearly as humorous as it sounds. 
Sanders called the lawsuit a money grab, but it turns out that Prime Time isnt above making a little cash off the injuries he suffered during his playing days. Documents obtained by the Los Angeles Times indicate that Sanders filed a workers compensation claim in May 2010, alleging a litany of injuries including head trauma suffered while playing for the Cowboys in the late 1990s. According to the documents, the Division of Workers Compensation determinedthe Hall of Famer to be 86 percent disabled, and a team of four doctors diagnosed him with more than a dozen medical conditions, including cognitive impairment and behavioral/emotional disorder. A host of current NFL employees have filed similar claims, the Times reports, including Sanders and six of his fellow NFL Network analysts. It would take the league an estimated $1 billion to resolve the nearly 4,000 claims filed against it in California. Sanders case is currently pending. Scoreboard 
In addition, the lieutenant governor suggested hiring a part-time attorney to represent business during the rate- setting process as well as new system to encourage injured workers to return to work more effectively. Finally the task force advocated for improvements to the state workplace safety program. Despite the legislation, Lt. Gov. Denn said there are still issues that could be addressed concerning the progress of the Health Care Advisory Panel as well as the Delaware Compensation Rating Bureaus 2013 rate filing. 
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The Special Investigations Department in Ohio's Bureau of Workers' Compensation is among them. During the unit's 20-year history, it has apprehended enough cheats to save the workers' compensation program an estimated $1.5 billion. That's a substantial chunk of change saved for Buckeye State businesses, which pay premiums to provide coverage for their employees. It also is money that helps to ensure workers injured on the job get help. Here are a few of the cases the SID has handled during the past couple of years: Yet SID investigators got tape of her walking around, using both her arms and legs. They also taped her using a wheelchair for a visit to the doctor, then getting out of it after she left. She was convicted of fraud and sentenced to a year in prison. The two were ordered to pay $173,332 in restitution. 
29, 2013 photo, Rick Gregory, the new director of the Special Investigations Unit at the Ohio Bureau of Workers' Compensation, poses for a photo in his office in Columbus, Ohio. Gregory says it's not fair that people following workers' comp rules are penalized by those who don't. Photo: Andrew Welsh-Huggins In this Thursday, Aug. 29, 2013 photo, Rick Gregory, the new... 
"We reconcile the accounts--the volumes and the dollars that are sent and sent back--we monitor the cash collections and really that is all we do." Convergent handles all of the traditionally difficult tasks associated with workers' compensation follow-up. Working directly from Community's HIS system, the national revenue cycle management firm used its own technology to calculate the expected reimbursement based on California's complex fee schedules, comparing actual payments and identifying underpaid claims. Whenever an underpayment is identified, Convergent provides the appropriate follow-up through phone calls, letters, and litigation if necessary. "Our success at partnering with top performing providers is founded on our ability to quickly and effectively increase reimbursement for healthcare services with the appropriate resources and adherence to regulatory requirements," said Derek Pickell, CEO of Convergent Revenue Cycle Management. Founded in 1992, Convergent's healthcare division serves hundreds of hospitals and healthcare providers across the nation. Their regulatory expertise and patient-focused contact center technology optimize revenue cycle performance, enhances the patient experience, and improves provider relationships. To access the case study, visit www.convergentusa.com/library. About Convergent Revenue Cycle Management, Inc. Convergent Revenue Cycle Management is recognized as the premier niche revenue cycle management company in healthcare, providing innovative solutions across the revenue cycle spectrum including patient access solutions, early out self-pay collections, attorney-powered third party reimbursement and bad debt recovery (through Convergent Healthcare Recoveries, Inc.). 
submit to an examination by a physician or surgeon of the employers choice... which, the Commission noted, leaves the choice of EME physician exclusively with the employer. A Rule 35 medical evaluation, in contrast, may be ordered by a judge only on motion for good cause shown and upon notice... to all parties and shall specify the time, place, manner, conditions, and scope of the examination and the person or persons by whom it is to be made. The Commission also noted thatLangfeldt-Haaland was a 3-2 decision that explicitly limited its holding to Civil Rule 35 medical evaluations. The majority had argued the importance of allowing counsel to observe shortcomings and improprieties during the examination which could be the subject of inquiries on cross-examination at trial; and ... [to] object to questions posed to the plaintiff during the examination that concern privileged information. The dissenting judges pointed out that adopting such a rule could have a chilling effect on otherwise reputable physicians performing medical examinations. The Commission found the dissents position more persuasive, and also took into account a survey of SIME physicians that showed a significant percentage of the physicians surveyed would decline to perform evaluations if they were required to allow the evaluation to be witnessed and recorded. 
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While these fines vary state-to-state, in Florida, for example, penalties increase from $100 for a one-to-seven-days-late filing, on up to $500 for more than 28 days of untimely filing. Once the claims examiner accepts the claim, any temporary disability payments must occur after the state's designated waiting period, in some cases after 7 or 14 days, depending upon the state. The state's weekly average wage and a calculation similar to that used by unemployment departments helps determine how much an employee receives while the injury heals. Late payments also receive fines and penalties, typically paid to the injured worker. No-Fault System Workers' compensation insurance operates on a no-fault system, finding neither fault nor blame on behalf of the employer or employee for the injury. 
In the construction or mining industries, however, employers must provide coverage even if there is only one employee. What the employer pays for that insurance depends on each employees classification, how long the employer has been in business, the type of business the employer is in, and the employers total workforce, according to TDLWD. The current workers comp system saw more than 100,000 medical and lost-time claims in the 2011-12 fiscal year. While employers dealt with lost productivity, employees in those claims faced job and financial loss, and physical impairments. There are a lot of difficult claims to manage, Francis said. We had 19 people who went to work [during that year] and did not come home [due to death]. Every year in America, nearly 4 million people suffer a workplace injury, with some never recovering, according to the Tennessee Occupational Safety and Health Administration (TOSHA). The leading causes of occupational injuries, says TOSHA, include sprains, cuts and lacerations, bruises and fractures. A sprain could cost a business more than $60,000 in direct and indirect costs, TOSHA projects. Tennessee, Francis noted, is surrounded by eight Southeast states that have cheaper workers comp coverage rates. Nationally, TDLWD says only Tennessee and Alabama use trial courts to resolve workers comp claims. That situation, the department insists, has led to a litigious system, plus inconsistency and poor timeliness in court rulings. The [Tennessee] Supreme Court has heard some workers comp cases that are 12, 13 years old, Francis said. The employer didnt win, they just outlasted [the case]. 
"That's a no-brainer," Councilwoman Susan Guidry said. "That absolutely should be done. We don't need to study that." "Absolutely," Bagneris agreed. Nick Felton, president of the firefighters' union, said in a later interview that the Fire Department's high level of workers' comp claims is only to be expected, given the nature of the job. "I wouldn't be surprised if those numbers would be a little higher than for people working down at City Hall," he said. "We're running into burning buildings." Felton said he believes firefighters would support a light-duty regimen. The chance to return to work earlier would cut down on the limited amount of paid time off a firefighter can take to recuperate from an injury. State law gives firefighters 365 days of injury leave, although there is a dispute over the interpretation of that statute. 
The delay in their settlement. The lack of authorization on their prescriptions, or the one who should know Johnny down the street is committing fraud. This basic lack of awareness or information hurts both the newly injured and the industry established to tend to them. The belief that workers' comp is in any way simple, controlled by one overarching entity, does not leave the injured worker at all prepared for the juggernaut of complexity headed their way. Likewise, newly injured are often confused and frightened. They lack much control over what is happening to them, their income and livelihood are at risk, they are handed off to someone they do not know who works for a company they have never heard of, and everyone from the Doctor on down is too busy to answer their many, many questions. It is a recipe for litigation stew, and we are unfortunately excellent cooks. These misperceptions also encourage the disability mindset that we have spent so much time discussing of late . 
Section 8 (1) of the Workers Compensation Act guides that where any person, in this section referred to as the principal, in the course of or for the purposes of that persons trade or business, contracts with any other person, in this section referred to as the contractor, for the execution by or under the supervision of the contractor, of the whole or any part of any work undertaken by the principal, any worker engaged on such work shall be deemed to be the worker of the principal unless and until the contractor in respect of the work has been assessed as an employer and has paid all assessments due to the fund. And any reference in this Act to the employer shall be deemed to be a reference to the principal. My readers may also wish to make reference to subsection (3) which guides that the principal shall ensure that any assessment for which the contractor is liable is paid and if the principal fails to do so, that principal shall be personally liable to pay the assessment. And the provisions of this Act with regard to enforcing assessments shall apply to the principal but that the principal shall be entitled to re-imbursement by the contractor of any sum paid out under this subsection. We normally invoke section 8 of the Act as a necessary corrective measure where it is found that an employer is circumventing the law, albeit this is usually one of the last enforcement options. We have brought out this information to guide organisations which may be deemed to be principal employers in order that measures to protect their business interests may be taken as far as they relate to compensation matters. This information is intended to meet needs of business organisations which may be contracting out portions of work without paying attention to workers compensation issues. Our revenue manager has advised that communication to this effect has been made with principal employers in the country and that the subject section will be invoked very soon. We therefore call on principal employers to take necessary measures to comply with the law in terms of their dealings with contractors and suppliers.