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.
DWC has for years hosted a conference for stakeholders. This year the
conference came around again on the August calendar in Austin. There was
something a little different and refreshing this year– the tone and focus of
one of the more memorable presentations. The WorkCompCollege presenters
went well beyond comp basics, calling for a paradigm shift in the way we view
the role of workers’ compensation by suggesting the focus should shift from
only compensating injured workers to focusing on helping them recover. A
new name could be the Workers’ Recovery System (this writer’s suggestion, not
theirs).
Their panel discussion addressed what a whole person recovery mind set can look
like. From rebranding to reflect the higher purpose of comp, to looking
beyond the physical to consider psychosocial issues, to choosing words and
attitudes carefully, the discussions included suggestions on best practices to
enable this change in approach to take hold. Perhaps if it does, less
regulation would result and injured workers would be better served. Maybe the
lawyers would be out of business. Definitely something to think about! If you
want to know more about this new idea, contact Mark Pew at mpew@workcompcollege.com. Mark has a
great work sheet he can send you called Establishing a Whole Person Recovery
Mindset in Workers’ Compensation.
Copyright 2023, Stone Loughlin & Swanson, LLP
We couldn’t help but state the obvious. Stay cool, and plan on supporting Kids’ Chance of Texas by coming to the Annual Kids’ Chance Golf Tournament in DFW. We can’t guarantee cool weather on October 23rd, but we can guarantee that it will feel good to support our Kids! Register NOW here. All levels of players are welcome!
Copyright 2023, Stone Loughlin & Swanson, LLP
EDI is thankfully something most of us never have to think about. But if you are into compliance issues (as in, avoiding TDI/DWC penalties) you want to know the Implementation Schedule for Claims Electronic Data Interchange Release 3.1.4. There are lots of DWC forms that have to be sent by way of EDI to DWC that give DWC a way to monitor insurance carrier performance and the delivery of benefits. We put this in the newsletter so that you can’t say we didn’t warn you. For more info, check out the implementation guide here.
Copyright 2023, Stone Loughlin & Swanson, LLP
Helpful reminder – July 31st is the last day-old versions of the following forms will be accepted by DWC: DWC Form-022; DWC Form-031; DWC Form-051; DWC Form-057. More riveting information regarding the new forms (always check for revisions) can be found on the DWC website. It isn’t clear what the consequence for using the old forms will be. However, beware.
Copyright 2023, Stone Loughlin & Swanson, LLP
If you have been around Texas comp for a while, you will remember some
interesting treatments prescribed by Texas doctors under the umbrella of things
that might relieve the effects of a work injury. For example, the
Theramed Bed, various iterations of electrical muscle stimulators (aka
transcutaneous electrical nerve stimulators), Vax-D (a spinal decompression
table), exercise bikes, recliners, mattresses, special shoes, hot tubs, and
placebo treatments galore. For those with an eye toward the lesson that
the past predicts the future, an entertaining read is Quackery: A Brief History of the Worst Ways to Cure
Everything. Some of the treatments (as we see nowadays),
seemed like good ideas at the time but were later determined either to be weird
and useless or weird and harmful. The common theme, however, is generally
profit, with the treatments often benefiting the doctor more than the patient.
Copyright 2023, Stone Loughlin & Swanson, LLP
The April 2023 edition of The
Compendium outlined recent changes to the designated doctor rules,
which were presumably designed to incentivize those already on the DD list to
maintain their status while increasing the number of new applicants.
However, as we pointed out, the amendments omitted any updates to the
reimbursement rates for DD exams, perhaps the component most to blame for the
dwindling number of available designated doctors overall and certainly a reason
for the dearth of M.D.s and D.O.s currently on the list.
That oversight seems poised to change, as the DWC announced on June 26, 2023, a
new set of proposed amendments to Rules 133 (General Medical Provisions) and
134 (Guidelines for Medical Services, Charges, and Payments). Key
modifications would include adjusting fees via the Medicare Economic Index
(MEI) percentage adjustment factor for the period of 2009 through 2024, then
annually thereafter every January 1. Fees would be rounded to the nearest
whole dollar, and a $100.00 missed appointment fee would also be permitted when
injured workers neglect to attend their exams. (More on that in a
moment.) These provisions can be found in the new Rule 134.210(b)(4).
The DWC released a table of fee adjustment estimates (estimated because the MEI
percentage adjustment factor for 2024 is not yet set) for Designated Doctor
Exams, Required Medical Examinations, and treating/referral doctor impairment
rating certifications. Fees for extent of injury, disability, return to
work, return to work for SIBs, appropriateness of care (RMEs only), and “other
similar issues” jump from $500.00 to $640.00 per issue (again, estimated).
Maximum medical improvement issues would invite an increase from
$350.00 to $448.00, while the first musculoskeletal impairment rating
assessment rises from a range of between $150.00 and $300.00 to $384.00.
Fees for subsequent impairment rating areas would also increase from
$150.00 to $192.00, approximately.
New additions to some designated doctor bills will include a “Specialist Fee”
of $300.00. Specialist fees pertain to designated doctors (though not
RMEs) asked to evaluate injuries itemized in Rule 127.130(b)(9)(B-I): traumatic
brain injuries, spinal cord injuries, severe burns, complex regional pain
syndrome, multiple fractures, complicated infectious diseases, chemical
exposure, and heart/cardiovascular conditions.
Comments on the proposed changes can be sent via email to RuleComments@tdi.texas.gov.
The DWC advises that “Chapters 133 and 134 Informal Posting” should be
included in the subject line. Comments must be received in writing by
5:00 p.m. on the still-not-random-in-the-least date of July 26, 2023.
Now, about that “Missed Appointment Fee”…
Copyright 2023, Stone Loughlin & Swanson, LLP
While we’re on the
topic of proper Plain Language Notice protocol, the Appeals Panel issued
Decision No. 230503 on June 12, 2023. The case involved an injured worker
who initially reported to his employer—in writing—that his injury occurred in
June 2022. The employer dutifully alerted its work comp carrier to the
injury once it was reported. The carrier, in turn, filed a PLN-1 denying
the claim in full within sixty days following notice.
Thereafter, the claimant asserted that he had been mistaken about the date of
his injury, that it was not June
28 but rather July
28. The Division, operating under the assumption that this was an entirely
different injury, generated a new DWC number for the ersatz second claim.
Claimant and his attorney argued that the carrier waived into accepting the
July 2022 injury because no PLN-1 had been filed to combat it. The
Administrative Law Judge agreed that the carrier accepted the claim via waiver,
even after Claimant testified that he never sustained an injury in June, that
he had mistakenly reported the incorrect date to his employer, and that the two
dates of injury were actually one and the same.
The Appeals Panel reversed, reasoning that the carrier had disputed the claim
when first alerted to it. “Under these facts, to require the carrier in
this case to again dispute the injury it had previously disputed simply because
the claimant alleged a different date of injury due to a typographical error
would represent an elevation of form over substance.”
Copyright 2023, Stone Loughlin & Swanson, LLP
That may soon be the question. Ever since reporting back in February 2022
that changes to TDI’s Plain Language Notice forms were on the horizon, eager
system participants have been dying to know when they will be able to use the
new versions. The wait is almost over! The new PLNs become
effective on the not-at-all-random date of July 26, 2023.
The new PLN-2B (Notice of First Payment of Income Benefits on an Acquired
Claim) distinguishes itself from the rechristened PLN-2A (Notice of First
Temporary Income Benefit Payment) by apprising its recipient that his/her claim
administrator has changed and will be sending its first payment. Astute
readers will notice that 2A is limited to Temporary Income Benefits, while 2B
pertains to the first Income Benefit of any type paid by the new administrator
and omits any reference to the injured workers’ average weekly wage. Form
2B should only be used to report the first payment on an acquired claim.
Not to be outdone, the PLN-10 (Reinstatement of Indemnity Benefits) shall
henceforth be known as PLN-10A, while the sleek new PLN-10B alerts injured
workers or beneficiaries to expect a lump sum payment of workers’ compensation
benefits, with the type, amount, and reason for the benefit explained
therein. System participants will be seeing a lot of the PLN-10B, as it
is to be used whenever lump sum payments are issued pursuant to a DWC-24
agreement, a Decision and Order, an interlocutory order, an Appeals Panel Decision,
an advance/acceleration/commutation of benefits, or when past due benefits are
paid with interest.
The time-honored PLN-11 Notice of Disputed Issues and Refusal to Pay Benefits
comes with a new admonition in its instructions. If disability is in dispute,
the Carrier must file the requisite Electronic Data Interchange (EDI)
transaction before the notice of refusal to pay benefits will be considered
complete.
Other changes to the revised forms, including the PLN-8, PLN-10A, PLN-11, and
PLN-14 are more subtle, mostly involving the insertion of the word “Insurance”
before “Carrier” throughout each. This serves as a helpful reminder that
it is Insurance Carriers
who should be using these forms, not any of the following groups:
Copyright 2023, Stone Loughlin & Swanson, LLP
Yet more changes to
the Administrative Code. This one involves Rule 133.30, pertaining to
billing for Telemedicine and Telehealth Services. The proposed
modification adds “Teledentistry” to the list of reimbursable remote health
care and incorporates the (somewhat redundant) definition from the Texas
Occupations Code, Section 111.001: “ ‘Teledentistry dental service’ means a
health care service delivered by a dentist, or a health professional acting
under the delegation and supervision of a dentist, acting within the scope of
the dentist's or health professional's license or certification to a patient at
a different physical location than the dentist or health professional using
telecommunications or information technology.” Billing for teledentistry
services would follow applicable Medicaid payment policies. The DWC
invites feedback, again via RuleComments@tdi.texas.gov, this time by July
24, 2023.
We were all set to mock the very concept of “Teledentistry” until we happened
upon Marathon Man
on Turner Classic Movies last night.
https://youtu.be/GZayydR4DPs
If nothing else, at least teledentists can’t torture their patients remotely.
Congratulations, Teledentistry. You win.
Copyright 2023, Stone Loughlin & Swanson, LLP
SLS partner Jane Stone
will be the faculty member providing training in Texas law for
WorkCompCollege.com, which recently initiated a scholarship program for Kids’
Chance recipients, a cause dear to our hearts. Bob Wilson, a long-time
supporter of Kids’ Chance chapters, and Don Abrams and Mark Pew, all of whom
founded the College, have generously committed to providing the scholarships.
More information about that in the link below:
https://urldefense.com/v3/__https://workcompcollege.com/workcompcollege-com-opens-scholarship-program-for-kids-chance-recipients/__;!!Dsthdr1F7A!GuhY24LgRy20lccPSJCHHRbdrSDrdQxZe2xF8o2jTBISh-46psashw6h59YxHt1DYycv5-daXQQ6rA2W8VkoT-rhjUI$
It always amazes us what a small and supportive community workers’ compensation
system participants have established, not just in Texas, but all over the
country. We wish WorkCompCollege.com the best!
Copyright 2023, Stone Loughlin & Swanson, LLP