NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.
Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.
Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.
DWCreleased itsbiennial reportto the84th LegislatureinDecember. Accordingto thereport, injury rates,insurance rates,and premiumsand claimscosts aredown andemployerparticipation, return-to-work outcomes,access tocare, andmedicaldispute resolutionare betterthan ever.DWC didnote that there isroom forimprovementin reducingthe numberof designated doctor disputes, injuredemployee educationand outreachand reducingthe numberof work-related fatalities. DWC included two legislative recommendations in thereport: 1)increase themaximumreimbursement for burial benefits; and 2) establish a pilot safety reimbursement programfor small employers.
TDI alsopublishedan Analysis ofthe Impact ofthe 2005Legislative Reformson theTexas Workers’CompensationSystem inDecember– this wasthe “network” legislation. Thatreport also favorablyreports thestate ofworkers’ compensationin Texas.Highlights from the reportinclude:
1) workers’compensation insurancehas beenprofitable eachyear from2005-2013 (asmeasured by theindustry’s combinedratios andreturn onnet worth);2) thenumberof employersparticipating in networksand employeesbeing treatedby network providershas increased (approximately42% of new claims are network claims); 3) injured employeesatisfactionwithcare andhealth-related outcomes increased since 2005 (according to recent injured employee surveys); 4)total medical costsforprofessionalservices decreasedfrom itspeak in 2002until2007,buttherewasan increasing trend beginning in 2008, which seems to haveleveled off since 2011; and 5) overall wholeclaim denials,medical disputesand thenumberof claimswith disputesare atthe lowestlevel since 2008.
Accordingto arecent TDIreport resultingfrom aOpen RecordsRequest bythe Insurance Council of Texas, insurancecarriers prevailedthe majority ofthe timein bothprospective and retrospective medical necessityIndependent ReviewOrganizationreviews. Thereport coversthe years2009-2013. These numbers are not surprising since the adoption of the Official DisabilityGuidelines (effective 5/1/07),but itis goodto knowthattheIRO reviewsystem appears tobe producing consistent outcomes applying evidence-based guidelines fromthe ODG.
BeginningJune 1,2015, Carriersare requiredto usethe revisedDWCForm PLN-11 to disputea workers’ compensation claimand provide the factual basis of the dispute.
TheDivision’s statedreason forthe revision isto help theagency andinjured employeesclarify whether acarrier isdisputing extentof injury, disabilityand/or eligibilityto receivedeath benefits. In itsmemorandumannouncing the finalized form,theDivision alsowarned against usingthe PLN-11 for issues outside the
scope of the PLN-11.
Carriers haveuntil June1, 2015to begin usingthe newform,but there isno harm in practicing to doso nowin order toget used to using it. The finalizedform isavailable nowon theDWCwebsite at http://www.tdi.texas.gov/forms/form20numeric.html.
December ushered in a DWC effort to providemuch needed education to workers’ compensation treatingdoctors. Theeducation is aimedat teaching treatingdoctors theappropriate wayto address and report oncausation ofa claimedcompensableinjuryin hopesthat thereport willaid indispute resolution.
Wewelcomebetter reportsfrom treatingdoctors. Butthe training materialsfocus onthe formof the report over the substance of the opinion and the underlying science a doctor should use to formulate his or her opinion. The use of templates andmagic words should not replace a well- reasonedopinion thataddresses causationin thecontextof theclinical recordand evidence-based medicine relevantto thespecifics ofa given case.Weare awareof atleast onecase where ahearing officer under the guise of an LOC mid-hearing sent the trainingmaterials to a designated doctor where thedesignated doctorhad notprovided acausation opinion that met evidentiary standards. The expectation was that the doctor would then issue an “amended” report.
Ofnote isthe factthat thereis norequirementthat atreating doctorreview allthe medicalrecords and list what hehas reviewed. Thatis notthe casefor peerreview doctors,RMEdoctorsand designated doctors who are held to amuch more stringent standard.
Membership in the AWCO offers a number of professional and social opportunities annually to interact with other workers' compensation professionals. The highlight of the year is the annual AWCO Spring Conference where its members come together for three days of education, fun, and fellowship. Membership is only $75 if paid prior to February 27, 2015. After that, the annual fee goes up to $150. Once you are an AWCO member, the Spring Conference is free. You pay nothing, nada, zero, zilch to register and attend. If you have any questions about the AWCO, membership, the Spring Conference, or simply need an application for membership, feel free to call or e-mail Mike Fish (contact info below). ________________________ About the Author This blog submission was prepared by Mike Fish, an attorney with Fish, Nelson & Holden, LLC, a law firm dedicated to representing self-insured employers, insurance carriers, and third party administrators in all matters related to workers' compensation. Fish Nelson & Holden is a member of the National Workers' Compensation Defense Network. If you have any questions about this submission or Alabama workers' compensation in general, please contact Fish by e-mailing him at mfish@fishnelson.com or by calling him directly at 205-332-1448.