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.
As expected, Commissioner Brannan also adopted new Division Rule 131.1 regarding initiation or denial of Lifetime Income Benefits. Under the new rule, an insurance carrier must review an injured worker’s eligibility for LIBs in a timely manner and review all statutory criteria. Carriers will have to develop criteria to narrow down which claims may have LIBs exposure. If the insurance carrier believes the injured worker is entitled to LIBs, it shall initiate payment within 15 days even if the claimant has not requested LIBs. But in the case where an injured worker requests LIBs in writing, the carrier has 60 days to determine eligibility. Any denial must be on form PLN-4.
A new PLN-4, Notice Regarding Eligibility for Lifetime Income Benefits, has been finalized. The revisions were made to ensure that the injured worker and the Division had a complete explanation as to why the insurance carrier is denying LIBs. The revised form adds a checkbox to clearly show that eligibility for LIBs is denied followed by a space for a full and complete statement.
States have been cracking down on the lucrative practice of physician dispensing of prescription drugs, a practice largely limited to workers’ compensation doctors. Some doctors are prescribing novel doses of common drugs for which they can charge more. For example, muscle relaxant cyclobenzaprine is commonly prescribed in 5 and 10 milligram doses. However, physicians are dispensing new 7.5 milligram doses of the medication for which they can charge nearly 5 times as much, despite the lack of any medical evidence that the new dose is any more effective. Another move we are seeing is physicians prescribing complex compounded medications, such as topical creams to treat pain, also despite evidence that these creams are not effective.
Nova Healthcare Management / Nova Medical Centers of Houston, Texas pled guilty to felony worker’s compensation fraud. An investigation by Texas Mutual revealed that Nova was billing for one-on-one physical therapy but was actually providing less expensive group therapy. Under the plea agreement, Nova has withdrawn from the Texas Star Network, repaid $6.5 million to Texas Mutual, and paid a $5,000 fine.
Dr. Marshall was ordered by DWC not to accept new patients nor participate in the comp system as a health care provider. DWC issued a violation order on the basis that he administered improper, unreasonable or medically unnecessary treatment by treating an injured employee for a diagnosis not supported by the medical record.
. . . was fined $1,000 and ordered to complete medical training because according to DWC he failed to provide acceptable health care to an injured employee by improperly utilizing diagnostic tests not supported by the medical record or evidence- based criteria. This is a familiar scenario.
Dallas Medical Center apparently ignored a refund request filed by a carrier, and ended up on December 2, 2014 with an order to pay a $15,000 fine. It is easy to forget that if a carrier makes a refund request against a provider and the provider fails to appeal the request to the carrier, or appeals a refund request and the carrier denies the appeal, the requested refund must be paid. The provider’s only remedy after paying the refund is to take the refund request to dispute resolution for a final determination by the agency– it cannot refuse to pay without risking the ire of the DWC (and a hefty fine).
The Texas Board of Chiropractic Examiners took Dr. VanderWerff to a contested case hearing after a complaint was filed with the Board accusing him of providing excessive and unnecessary treatments to a patient. The Board issued an order in the case determining that he had violated the Chiropractic Act by engaging in grossly unprofessional conduct and assessed a fine against him. He couldn’t appeal the Board’s order directly because he missed his deadline to do so. He filed suit for declaratory and injunctive relieve against the Board instead. The Board then filed a plea to dismiss his suit for lack of jurisdiction. The trial court granted the plea and dismissed the lawsuit. The Austin Court of Appeals affirmed the trial court, stating that the Board was acting within its statutory authority in issuing its order, and that the lawsuit appeared to be an attempt to create a way to get around his failure to timely file a direct appeal of the agency’s order. The bottom line is that the Board’s order and its finding of grossly unprofessional conduct against Dr. VanderWerff is final. Dr. Eric A. VanderWerff, D.C. v. Texas Board of Chiropractic Examiners,WL 7466814 (Tex. App.–Austin)
DWC is reminding all employers without statutory workers’ compensation coverage that there are reporting requirements that apply to them. They must report every year that they elect to opt out of the regulatory system. They also must report work-related fatalities, occupational diseases and on-the-job injuries.
West Star Transportation, Inc. faces a $5.3 million dollar liability judgment. The company did not carry workers’ compensation insurance at the time of the near-fatal fall suffered by one of its workers. This was a case in which the worker sued the company for negligence– a suit which would have been barred by the exclusive remedy provisions of the Labor Code had there been comp coverage. The 7th District Court of Appeals affirmed the judgment both as to the finding of negligence and as to the amount of the verdict. The appeals court found that the company created an unusually precarious work environment and an unreasonable risk of harm to its employees. The Amarillo Court of Appeals issued its opinion in the case last Friday.West Star Transportation, Inc. v. Charles Robison, et al, No. O7-13-00109-CV (7th Dist.).
If you haven’t been able to get through using the numbers you are used to, it is because the field office phone system has been revamped. You can get an updated directory of field office personnel numbers by emailing Hugo Salazar athugo.salazar@tdi.texas.gov. Or contact us and we can send you a copy current as of December 16, 2014.