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.
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
On October 20, 2022, the Texas Comptroller’s office ruled in a Private Letter that Designated Doctor exam charges are now taxable. We worry that this sales-and-use tax will drive the remaining Designated Doctors and independent doctors who perform Required Medical Exams and peer reviews further out of the system. The decision is specific to Designated Doctors, but the rationale may apply across the board for doctors who provide services other than medical treatment for system participants. Of note, sales tax has to be collected “up front”, even before the doctor is paid his fee for the services, and even if they never get paid (or are paid late) on their bill. No doubt the DWC will have some head-scratching to do to figure out the EDI ramifications of this development, since the decision specifically states that these services are not medical treatment. Might this mean that there is no EDI reporting requirement? We shall see once the dust clears. We note that large exam scheduling companies can best handle this new administrative burden. The word is that DWC took the position with the Comptroller that these services should not be subject to sales-and-use tax. So much for the concept of comity.
Copyright 2022, Stone Loughlin & Swanson, LLP
Crime doesn’t pay
forever. On October 11, 2022, Ms. Khyati Undavia, owner of Memorial Compounding
Pharmacy, was sentenced to 27 months in prison by U.S. District Judge Andrew
Hanen. Ms. Undavia was indicted on July 9, 2021 for conspiracy to defraud
federal government programs by billing for compounded drugs that were not
medically necessary and that she paid doctors an illegal kickback to prescribe.
She pled guilty on October 12, 2021. The judgment against Ms. Undavia
orders her to pay restitution of six million dollars to Tricare and six million
dollars to the U.S. Department of Labor, Office of Workers’ Compensation
Programs (DOL-OWCP).
Memorial Compounding Pharmacy was also active in the Texas workers’
compensation system. The Division issued numerous medical fee dispute
decisions ordering carriers to pay Memorial for its expensive compounded
topical creams on the grounds that Memorial didn’t have to get
preauthorization. Nonetheless, at least three different SOAH administrative law
judges have reached the opposite conclusion that Memorial was required to
obtain preauthorization for its compounded creams and therefore, it should not
be paid. Upon her release, Ms. Undavia will be excluded from
participating as a provider in Medicare, Medicaid, and all Federal health care
programs. However, the judgment does not prevent her from participating in the
Texas workers’ compensation system. We may see her again one day.
To view the judgment, click here.
Copyright 2022, Stone Loughlin & Swanson, LLP
Amber Morgan is moving up to the DWC’s Appeals Panel from her position as an Administrative Law Judge. She also has the distinction of having the position of president of the Texas State Bar Worker’s Compensation section. Also on the move is Nick Morgan, who will make the transition from private practice representing injured workers to be the resident administrative law judge in the Waco field office. We look forward to these changes and wish them both the best!
Copyright 2022, Stone Loughlin & Swanson, LLP
DWC’s Subsequent Injury Fund (a separate account at the State Treasury) was recently audited by an actuary. The SIF is funded solely by death benefit payments from insurance carriers where a compensable death occurs but there is no eligible beneficiary, or the claim for benefits is untimely. We don’t understand all the numbers, but the bottom line appears to be that insurance carriers are safe from being assessed to make up for any negative balance at the SIF for the foreseeable future. A link to the report can be found here.
Copyright 2022, Stone Loughlin & Swanson, LLP