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.
A California federal
judge has sentenced neurosurgeon, Lokesh Tantuwaya, to five years in prison for
his part in a multimillion dollar, 15-year-long fraud scheme that used bribes
and kickbacks to funnel thousands of patients to now-defunct Pacific Hospital
for overcharged invasive spinal surgeries.
Tantuwaya, who raked in $3.3 million for his part in the scheme, is just the
latest to be convicted and sentenced in the scam which was led by the former
owner of Pacific Hospital who paid kickbacks of $15,000.00 per lumbar fusion
and $10,000.00 per cervical fusion and then inflated the costs of implanted
medical devices to insurers, many of which were workers’ compensation
carriers.
Reportedly, many of Tantuwaya’s patients are now agonizing over the quality of
their implants as well as whether they even needed the surgery in the first
place.
Copyright 2023, Stone Loughlin & Swanson, LLP
A common refrain of
late is that nobody seems to want to work anymore. While that’s nothing
new for those of us in workers’ comp, we were surprised to hear that even the
beloved CEO of Jolly St. Nick, Inc. (JSN) experienced significant difficulty
this past year obtaining a sufficient number of qualified workers to
manufacture the toys necessary for him to complete his annual task. The
shortage of qualified staff appears to be linked in part to post-pandemic
preferences many workers hold for working from home rather than in the Far
North. There were also some recruiting snafus . . .
We are hopeful that personnel matters improve for the big guy next year . . .
Best Wishes for the New
Year from all of us at Stone Loughlin and Swanson, LLP!
Copyright 2023, Stone Loughlin & Swanson, LLP
November 14th was the
first day of bill prefiling for Texas’ upcoming 88th Legislative Session. 921
bills and resolutions were filed that day, including a couple that are of
particular interest to workers’ compensation participants.
Benefits for the National Guard
On April 25, 2022, Texas National Guardsman Bishop E. Evans died on duty while
attempting to save lives but because he was serving in a State Active Duty
status as opposed to federal order, his family was not guaranteed any surviving
financial assistance. Texas legislators thus introduced HB 90 and SB 155 to
improve workers’ compensation and death benefits for Texas Military Forces
while serving in a State Active Duty status. Among other things, the proposed
bills would authorize a $500,000 death benefit lump sum payment for surviving
families, apply accelerated dispute resolution procedures to guardsmen claiming
workplace injuries, and include PTSD coverage similar to that given to first
responders.
Bundling Benefits
Pending legislation also has been proposed to allow Texas companies to offer
their employees a bundled workers’ compensation plan with group health
coverage. HB 351 authorizes a workers’ compensation insurance company to
contract with an accident and health insurance company to offer a packaged plan
that would provide for medical benefits under the group health plan and other
benefits to be paid exclusively through the workers’ compensation policy. The
packaged plan would not permit cost-sharing requirements for workers’
compensation medical benefits nor for employee contributions to the premiums
paid for the group health coverage allocated to workers’ compensation medical
benefits.
Copyright 2022, Stone Loughlin & Swanson, LLP
The number of designated
doctors in the state continues to decline, with only 251 doctors (63 MDs, 11
DOs, and 177 DCs) now certified to perform exams, a decrease from the 273
certified doctors a year ago. So last month’s private letter ruling by the
Texas Comptroller of Public Accounts that DD exam charges are now taxable was
especially unwelcome, as it was expected to result in even more DDs jumping
ship.
We are relieved to report that the Comptroller delayed implementation of its
ruling that charges for designated doctor exams are subject to Texas sales and
use tax until after the 2023 legislative session to allow DWC and system
participants to seek a legislative change. Designated doctors are not
currently required to collect tax on charges for exams.
In other news, proposed rule changes and increased fees for DDs and RMEs are on
the agenda for the stakeholder meeting scheduled tomorrow, Thursday, December
1, at 1:30 p.m. A draft revised fee schedule includes proposed increases for
all elements of DD and RME exams, and new fees for missed appointments and
specialists:
https://www.tdi.texas.gov/wc/rules/documents/drddfee1122.pdf
Comments to the proposed changes should be emailed no later than 5:00 p.m. CST
on Friday, December 16, 2022 to RuleComments@tdi.texas.gov with “Chapters 133
and 134 Informal Posting” noted in the subject line. You may also mail or
deliver comments to Legal Services, MC-LS Texas Department of Insurance,
Division of Workers’ Compensation, P.O. Box 12050, Austin, Texas, 78711.
Copyright 2022, Stone Loughlin & Swanson, LLP
Stone Loughlin & Swanson
joined in honoring our good friend Marvin Kelly, recently retired after 30
years as the first, and to date only, Executive Director of the Texas Property
and Casualty Insurance Guaranty Association (TPCIGA). For those that
don’t know, when an insurance company is declared impaired, TPCIGA fulfills
certain policy obligations of the impaired insurance company including the
obligation to pay workers’ compensation benefits. Marvin was instrumental
in creating what is now commonly recognized as one of the best, if not the
best, insurance guaranty associations in the country. We wish him well
and appreciate his many years of service protecting Texas claimants and
policyholders impacted by insolvent insurance companies.
Copyright 2022, Stone Loughlin & Swanson, LLP
Reliable sources
inform us that Cole Fulks has replaced Kevin Henry as the Administrative Law
Judge in Tyler. Cole joins the agency after representing injured workers for
several years at Bailey & Galyen. Welcome, Cole!
Erica De La Cruz has been promoted to Deputy Commissioner of Claims and
Customer Services. The new program area includes Claims Services,
Self-Insurance Regulation, and the Subsequent Injury Fund.
Mary Landrum, the new Deputy Commissioner for Health and Safety, will oversee
the Office of the Medical Advisor, Health Care Business Management, Medical Fee
Dispute Resolution, Workplace Safety, and Return to Work programs. She will
also continue to oversee the operations, training, and certifications for the
Designated Doctor program.
Kimberly Donovan, who joined DWC in November, has been named as DWC’s new
Deputy Commissioner of Operations and External Relations. This new program area
includes Communications, External Relations, and the Research & Evaluation
Group.
Tammy Campion is the new Deputy Commissioner for Business Process, which
includes the management of DWC’s technology modernization efforts, Electronic
Data Interchange (EDI) processes, system data and electronic records
management.
Kate Sidora is the new Director of External and Media Relations and will manage
DWC’s government relations, legislative activities, and stakeholder outreach.
Copyright 2022, Stone Loughlin & Swanson, LLP
Sehgal & Sons Enterprises (Ultra Business Services Inc.), owned by Kunal Puri, was convicted of first-degree felony for defrauding its workers' compensation carrier, Texas Mutual Insurance Company. From August 2011 through December 2014, the company concealed payroll by having two separate payroll accounts with the Texas Workforce Commission, but reported only the small payroll account to Texas Mutual. The company has been ordered to pay $300,000.
Copyright 2022, Stone Loughlin & Swanson, LLP
The DWC recently began
holding contested case hearings in Austin at the new Barbara Jordan Building in
the Capital Complex, located at 1601 Congress Avenue. However, parking
and entering the building is so complicated that it prompted DWC to create the
following instructional video:
https://www.youtube.com/watch?v=e4PMzgw52eA
The video discusses parking options “if you are driving to your Austin
hearing.” Due to the parking situation, you might consider some easier
alternatives than driving like taking the bus or an e-scooter. The video
also reminds participants not to show up more than 15 minutes before the
hearing because they won’t be allowed in the building before then.
Here is actual video showing the dire consequences when one injured worker
arrived too early for his hearing in Austin:
https://youtu.be/CrRudfWIKmA
SLS scoped out the situation and after reaching several dead ends and
approaching multiple locked entrances, confirmed that the new Austin digs are
indeed a veritable maze due to the ongoing construction and construction fences
surrounding the building.
Therefore, to help you find your way we’ve created a map to simplify
matters:
Good luck trying to find your way in! And be sure not to arrive too early for
that CCH.
Copyright 2022, Stone Loughlin & Swanson, LLP
Evidence-based medicine is the standard of compliance written into the Labor Code and used in evaluating causation issues, but in our experience the standard is often ignored or not understood. For example, studies show that baseline MRIs do not predict future low back pain, and up to 93% of them show degenerative disc disease regardless of whether the patient is reporting symptoms. The ODG in fact warns against attempting to correlate MRIs with symptoms. There is a great new summary written by a well-respected doctor which was provided to us that has the medical statistics thoroughly reviewed for neck, thoracic, lumbar, wrist and hand, shoulder and knee imaging findings. Of particular interest is the information regarding evaluating the chronicity in shoulder issues and the explanation of the reasons why so many rotator cuff surgeries fail over time. Ever tried sewing tissue paper to tissue paper? A link to the article can be found here.
Copyright 2022, Stone Loughlin & Swanson, LLP
We can’t send a
newsletter out without mention of KCTX. We have 35 current scholarship
recipients and are especially grateful to the brave and water-proof golfers who
participated in a very soggy golf tournament at the Dallas Cowboy’s Golf Club
on October 28th. The final numbers aren’t in yet, but the enthusiasm for
the cause was not dampened at all. There is pride in overcoming adversity, and
the KCTX Board (especially Wendy Schrock with Downs & Stanford, Joanne
Anderson with OIEC, Catherine Benavidez with IMO, and all the volunteers)
should be very proud of what they managed to weather through – they are true
KCTX Champions!
Newsflash: Save the date for the KCTX Top Golf event in
The Colony on November 13th from 12:00 noon to 3:00 p.m. The event
is in conjunction with the PRIMA conference in the Frisco, Texas area. If
you are attending PRIMA and get a copy of this newsletter, make sure to sign
up!
Copyright 2022, Stone Loughlin & Swanson, LLP