State News

NWCDN is a network of law firms dedicated to protecting employers in workers’ compensation claims.


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.


Now Considering Firms for Our Network in

Jurisdiction of Injured Employee's Claim

Letcher County Board of Education v. Hall, (2022-SC-0313-WC, 6/15/23) not final
 
Teacher filed WC claim alleging he developed mesothelioma after being exposed to asbestos during his employment in county high school. County School Board argued that the Board of Claims, not Department of Workers’ Claims, had exclusive jurisdiction over the claim under KRS 49.070(16) which states that “any claim” against the school district for damages as a result of asbestos exposure shall be brought before Board of Claims. Rejecting this argument, the Supreme Court of Kentucky concluded that KRS 49.070(16) pertains to claims by third parties, not employees. The Court cited the purpose of the Workers’ Compensation Act to compensate injured workers for loss sustained as a result of work-related injury or disease as well as its exclusivity. Furthermore, the Court pointed out that KRS 49.020(5) requires the Board of Claims to find negligence while the Workers’ Compensation Statute requires no showing of fault.
 

Should you have any questions or wish to discuss any related matters, please contact us at your convenience.

H. Douglas Jones, Esq. – djones@jsbattorneys.com, 859.594.4200
Margo Menefee, Esq. – mmenefee@jsbattorneys.com, 859.594.4200 

CHI St. Vincent Infirmary v. McCauley, 2023 Ark.App. 126. 

 

  • Claimant injured her hip and back after tripping on a sidewalk at work. The employer denied the claim as compensable on the grounds that she was not performing employment services at the time of the injury. Claimant was a nurse supervisor whose office was not equipped with basic office supplies, but she had the option of ordering supplies through the department secretary. Instead, because it was unclear when she would receive those supplies, she decided to purchase her own supplies and bring them to the office in her car. On her lunch break, she went to her car to retrieve the items and tripped on the sidewalk. The ALJ found that the Claimant was going to her car for her own sole benefit and convenience because she was retrieving nonessential, nonwork related items.

  • The Full Commission reversed the ALJ, finding that the Claimant was performing duties which at least indirectly benefitted the employer. 

  • On appeal from the employer, the Court of Appeals affirmed. The Court cited case law stating that an injury suffered by an employee while on break is compensable if the employer has imposed some duty or requirement on the employee to be fulfilled during a break. Moncus v. Billingsley Logging, 366 Ark. 383, 235 S.W.3d 877 (2006). The Court pointed to Claimant’s testimony that, as a nurse supervisor, she was still “technically on duty” and subject to being called back to work during her lunch break despite the employer noting it would be “very unusual.”

The rules for recording and taping IMEs in New Jersey became much clearer with the June 15, 2023, New Jersey Supreme Court ruling in DiFiore v. Pezic, (Nos. A-58/59/60-21) (087091). While the case involved three separate civil court defense exams, there is no reason that the principles set forth in this consolidated decision will not be applied to workers’ compensation cases.

The basic rule in this case is that if the examinee (petitioner) wishes to record or tape an examination, counsel for petitioner needs to make a request of respondent. Although the case does not discuss physician recording of examinations, it would seem that the same rule should apply to physicians.  The Supreme Court reviewed the three separate cases where objections were made by the defense to allowing third parties to attend an IME or to record an IME. The Court said, “We therefore hold that if a plaintiff seeks to bring a neutral third-party observer to a Rule 4:19 exam (defense medical examination), or to audio or video record the exam, plaintiff’s counsel should notify defendant. If defense counsel opposes the third-party observation or recording, the parties should meet and confer in an effort to reach agreement.  Failing an agreement, defendant can move for a protective order under Rule 4:10-3 to bar the observation or recording.”

In the three cases at issue in DiFiore, two involved objections to bringing a third party to the examination and one involved recording a psychological examination. One plaintiff had a cognitive disorder, and another had a language barrier. In the case involving a neuropsychological exam, the neuropsychologist refused to conduct the examination if it would be audio-recorded. A protective order was sought in that case. The Supreme Court said that the burden of seeking a protective order is on the defendant, not on the plaintiff.

The practice of seeking a protective order is not likely to spread to workers’ compensation given that there are about 100,000 active claim petitions in the Division and literally hundreds of thousands of IMEs done each year by a fairly limited number of physicians.  Judges are already handling enormous numbers of cases daily, so parties will simply work out the requests to record.   Many IME doctors already assume that recording is frequently being done without a request being made. There may also be IME doctors who are now recording examinations as well without a request being made. The rule of this case is that a request must be made to record; otherwise, the recording will not be evidentiary. This rule will almost certainly be applied to physicians as well as examinees.  The Supreme Court and the Appellate Division in DiFiore noted that the advent of smart phones makes it easy to unobtrusively record an examination.   

While some may long for the old days when recording examinations was unheard of, those days are long gone. There may be positives that emerge from the practice of seeking consent to record. The rumor mill is often busy with comments that a certain doctor only spent one minute conducting the medical examination, or a certain claimant told the IME doctor that he or she had no complaints whatsoever. Recorded exams done by consent will provide answers and slow down the rumor mill. The Division should consider some basic rules for all practitioners to follow in requesting consent to record either by the physician or examinee or both.

 

-------------------------------

John H. Geaney, Esq., is a Shareholder and Co-Chair in Capehart Scatchard's Workers’ Compensation Group.  Mr. Geaney concentrates his practice in the representation of employers, self-insured companies, third-party administrators, and insurance carriers in workers’ compensation, the Americans with Disabilities Act and Family and Medical Leave Act. Should you have any questions or would like more information, please contact Mr. Geaney at 856.914.2063 or by e‑mail at jgeaney@capehart.com.

 

Written by: Tracey Jones

Philip A. Baddour was confirmed by the General Assembly to serve a second term as a commissioner.

The 28th Annual North Carolina Industrial Commission Workers’ Compensation Educational Conference will be held October 4 through 6, 2023 at the Raleigh Convention Center.

New Mediation Rules Regarding Participation

The Supreme Court of North Carolina has approved amendments to the Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions, which went into effect May 1, 2023. Among the amended Superior Court mediation rules is Rule 4, which governs attendance at Superior Court mediations.

Attendance at Industrial Commission mediations is governed by Rule 104 of the Industrial Commission’s mediation rules (11 NCAC 23G .0104). Paragraph (b) of Rule 104 provides that the attendance method for Industrial Commission mediations shall be the same as the attendance method set forth in Rule 4 of the Rules for Mediated Settlement Conferences and Other Settlement Procedures in Superior Court Civil Actions. Therefore, the Rule 4 amendments affect the way the attendance method will be determined in Industrial Commission mediations beginning May 1, 2023.

Under the Rule 4 amendments, if all parties and the mediator agree on the mediation attendance method (which can be remote, in-person, or a hybrid of the two where some parties are participating remotely while others are together in-person), then the mediation will be held using the agreed-upon attendance method. If an agreement on the attendance method cannot be reached, then attendance will be in-person unless the mediator has designated in the Dispute Resolution Commission’s Mediator Information Directory that he or she will only conduct remote mediations. However, in all cases, a party who is required to attend the mediation may file a motion with the Industrial Commission Dispute Resolution Coordinator asking that a different method of attendance be ordered. For example, a party who wishes to participate remotely but does not object to others participating in-person may file a motion requesting an order allowing a hybrid of remote and in-person attendance at the mediation.

This is a change to the rules in that the previous default method of attendance when agreement could not be reached was remote. This new change makes the default attendance in person. It is too early to tell how the Industrial Commission will rule on Motions submitted from either side regarding remote attendance.

Written by: Kyla Block

Prescription medications can be a stumbling block when it comes time to resolve a workers’ compensation claim. Insurance carriers often have preferred vendors they utilize to obtain favorable prescription costs or negotiated agreements with pharmacies, leading to less expensive medical exposure during the pendency of claims. However, claimants are often unable to benefit from these cost savings once their claim has been settled. This becomes a problem for both sides when trying to resolve a claim. The claimant is unsure of the price his/her medications will cost, causing them to demand a higher settlement value and making the overall process more expensive. It consequently costs defendants more to resolve the claim if they are able to do so.

Enter Mark Cuban CostPlus Drug Company. Co-founded by Dr. Alexander Oshmyansky and Mark Cuban in January 2022, Mark Cuban CostPlus Drug Company was created with the express purpose of providing patients with access to safe, affordable medicines regardless of whether they have insurance or a low deductible health care plan. Instead of negotiating prices through pharmacy benefit managers, the company directly negotiates with manufacturers to get generic drugs at wholesale prices. It then sells those drugs to consumers with prescriptions with a 15% markup, a $3 pharmacy labor charge, and $5 for shipping, according to the pharmacy’s website.

CostPlus Drugs aims to disrupt the traditional pharmaceutical supply chain and offer transparency, affordability, and accessibility to prescription medications. Eliminating the middleman and replacing him with a straightforward 15% price markup results in an astonishing difference in the cost of many medications. For example, a 20 mg, 90-tablet prescription of Escitalopram, which costs around $180.00 from a regular pharmacy, would only cost $12.50 from Mark Cuban CostPlus Drug Company according to the latest data. Lidocaine ointment (Generic for Xylocaine) is $5.44 for a tube, compared to its $243.61 retail price. The Lidocaine patch (Generic for Lidoderm) is $46.50, compared to $246.90 retail. Meloxicam (Generic for Mobic) is $3.60 versus $21.39 at a retail price.

Being able to suggest lower prescription costs (and support it with evidence) allows the parties in a workers’ compensation case to reach common ground on future medical treatment costs, which is often murky depending on whether the claimant has insurance or not and what that insurance plan covers. Mark Cuban CostPlus Drug Company provides transparency on prescription costs after the claim ends and allows claimants to obtain much needed prescriptions at a fraction of the price. Suggesting options like Mark Cuban CostPlus Drug Company allows defendants to provide a solution to a potential barrier to settlement, hopefully facilitating resolution of the claim.

For more information on Mark Cuban CostPlus, see this interesting article.

2023 Legislative Session Overview 

Nathan C. Levy, Partner

Levy, Sibley, Foreman & Speir, LLC 

The Legislative session for 2023 has ended and there are only a few notable changes that we wanted to share with you. Be advised that per the normal course, these changes go into effect on July 1, 2023, and will apply to dates of accident from that date forward. Many of you might recall our newsletter from March 21, 2023, wherein we advised of possible increases in indemnity caps, a change in the language associated with dependency and the increase in the maximum recoverable by a surviving spouse with no dependents. HB 480 was passed and ultimately remained the only impactful legislation for Workers’ Compensation that emerged from the session. 

HB 480 specifically addresses: 

1. A revision to Code Section 34-9-13(e) that formerly allowed for the dependency of a surviving spouse to terminate with remarriage of upon a finding of cohabitation in a meretricious relationship with this latter language removed entirely. Replacing it will be a cessation of dependency benefits upon determination by the board of cohabitation continuously and openly in a relationship similar or akin to marriage that includes support of economic value to the Claimant Dependent. No consideration shall be given to payments made exclusively for board and lodging or to any payment for financial support for a period of less than three months. 

2. A revision to Code Section 34-9-261 increasing the statutory maximum for TTD to $800.00 per week (not less than $50.00 per week) for dates of accident on or after July 1, 2023. This is an increase from $725.00 per week. 

3. A revision to Code Section 34-9-262 increasing the statutory maximum for TPD to $533.00 per week up from $483.00 per week. 

4. A revision to Code Section 34-9-265 increasing the maximum amount paid to a surviving spouse with no dependent from $290,000.00 to $320,000.00. 

Moreover, as we stated in March, with these changes will come some new challenges related to attempts to suspend spousal dependency benefits in circumstances where there is cohabitation but not remarriage and what must be done from an accounting perspective to bear the employer’s burden. At first glance, the evidence appears to require a full forensic accounting to show a true commingling of household dollars in a manner that would be expected to appear with married couples. This new standard is a much greater hurdle to overcome than merely providing evidence that a spouse/dependent is actively living with someone else and holding themselves out as partners. One can expect an increase in litigation in this area until some judicial guidelines are established. 

Certainly, the continued increases in TTD and TPD should come with little surprise as employers and insurers are becoming very familiar with cap increases going into effect every July 1.  

From a Board Rule perspective, there are several modifications that also go into effect on July 1st. The below changes apply to all claims, regardless of the date of accident. 

·     Board Rule 200.2 clarifies the specific Certifications and Licenses that must be maintained in order to maintain status with the Board as a “Qualified Case Manager”. The Board rule does clarify that prior to initially contacting a treating physician, a qualified medical case manager working without consent of the employee (or counsel) must provide all parties with written notice of being retained by the employer/insurer. Qualified medical case managers must also provide copies of all written documents received from the treating physician to all parties and attorneys. 

·     Board Rule 100(i) and 102 (E)(1) expand professional conduct to include a general prohibition by any person in any claim to exhibit unprofessional, discourteous, or disruptive conduct and that certainly extends to the courtroom. 

·     Board Rule 203(e) also increases the rate of mileage from .40 to .45 cents per mile, and, finally, 

·     Board Rule 203 in relation to Peer Reviews of medical billing practices, gives the decision of the “peer review organization” the final say in ordering a lowering or increasing of any bill submitted for review and requires/allows the employer to remit payment or take credit based upon that outcome.  

As you can see, the session did bring about the expected changes and with very little surprise. In the end, that is the path that Georgia’s employers and insurers certainly prefer. As always, if you have any questions regarding these issues or would like clarification on any point, do not hesitate to contact us.

NEW WORKERS' COMPENSATION RATE EFFECTIVE JULY 1, 2023

The state of Delaware, Department of Labor, Secretary of Labor, Karryl Hubbard, has announced that the average weekly wage (AWW) in Delaware for the calendar year 2023 is $1,301.27 This wage figure was derived from data from employers participating in the State’s unemployment insurance system.


Based on this weekly wage figure, the maximum weekly worker’s compensation rate will be $867.52 The minimum workers’ compensation rate will be $289.18. The daily rates are as follows:


Effective July 1, 2023

Wage of $1,301.27 and over:

Maximum $867.52

$123.94

$247.87

$371.80

$495.73

$619.66

$743.59

$867.52

Minimum $289.18


STATE OF DELAWARE WORKERS’ COMPENSATION RATE CHART HISTORY


EFFECTIVE JULY 1, 2023

AWW $1,301.27 Maximum $867.52 Minimum $289.18


EFFECTIVE JULY 1, 2022

AWW $1,234.04 Maximum $822.70 Minimum $274.24

EFFECTIVE JULY 1, 2021

AWW $1,196.64 Maximum $797.96 Minimum $265.99

EFFECTIVE JULY 1, 2020

AWW $1,121.49 Maximum $747.66 Minimum $249.22

EFFECTIVE JULY 1, 2019

AWW $1,088.84 Maximum $725.89 Minimum $241.96

EFFECTIVE JULY 1, 2018

AWW $1,070.48 Maximum $713.65 Minimum $237.88

EFFECTIVE JULY 1, 2017

AWW $1,030.49 Maximum $686.99 Minimum $229.00

EFFECTIVE JULY 1, 2016

AWW $1,034.18 Maximum $689.45 Minimum $229.82

EFFECTIVE JULY 1, 2015

AWW $1,019.44 Maximum $679.63 Minimum $226.54

EFFECTIVE JULY 1, 2014

AWW $998.35 Maximum $665.57 Minimum $221.86

EFFECTIVE JULY 1, 2013

AWW $991.19 Maximum $660.79 Minimum $220.26

EFFECTIVE JULY 2, 2012

AWW $967.52 Maximum $645.01 Minimum $215.00

EFFECTIVE JUNE 13,2011

AWW $933.08 Maximum $622.05 Minimum $207.35

EFFECTIVE JUNE 22,2010

AWW $914.73 Maximum $609.82 Minimum $203.27

EFFECTIVE JUNE 16,2009

AWW $916.00 Maximum $610.67 Minimum $203.55

EFFECTIVE JUNE 3, 2008

AWW $907.73 Maximum $605.15 Minimum $201.72

EFFECTIVE JUNE 7, 2007

AWW $888.38 Maximum $592.25 Minimum $197.42

EFFECTIVE JUNE 7, 2006

AWW $857.46 Maximum $571.64 Minimum $190.55

EFFECTIVE JUNE 6, 2005

AWW $815.29 Maximum $543.53 Minimum $181.18

EFFECTIVE MAY 21, 2004

AWW $785.75 Maximum $523.83 Minimum $174.61

EFFECTIVE JUNE 4, 2003

AWW $760.21 Maximum $506.81 Minimum $168.94

EFFECTIVE JUNE 14, 2002

AWW $737.35 Maximum $491.57 Minimum $163.86

EFFECTIVE JUNE 20, 2001

AWW $703.65 Maximum $469.10 Minimum $156.37

EFFECTIVE JUNE 12, 2000

AWW $674.40 Maximum $449.60 Minimum $149.87

EFFECTIVE JUNE 15, 1999

AWW $652.02 Maximum $434.68 Minimum $144.89

EFFECTIVE JUNE 11, 1998

AWW $616.67 Maximum $411.11 Minimum $137.04

EFFECTIVE JUNE 18, 1997

AWW $588.69 Maximum $392.46 Minimum $130.82

EFFECTIVE JUNE 3, 1996

AWW $558.35 Maximum $372.23 Minimum $124.08

EFFECTIVE JUNE 15, 1995

AWW $535.79 Maximum $357.10 Minimum $119.06

EFFECTIVE JUNE 14, 1994

AWW $519.25 Maximum $346.17 Minimum $115.39

EFFECTIVE JULY 1, 1993

AWW $508.94 Maximum $339.29 Minimum $113.10

EFFECTIVE JULY 1, 1992

AWW $491.75 Maximum $327.83 Minimum $109.28

EFFECTIVE JULY 1, 1991

AWW $468.58 Maximum $312.39 Minimum $104.13

EFFECTIVE JULY 1, 1990

AWW $445.81 Maximum $297.21 Minimum $ 99.07

EFFECTIVE JULY 1, 1989

AWW $420.96 Maximum $280.64 Minimum $ 93.55

EFFECTIVE JULY 1, 1988

AWW $397.71 Maximum $265.14 Minimum $ 88.38

EFFECTIVE JULY 1, 1987

AWW $375.79 Maximum $250.53 Minimum $ 83.51

EFFECTIVE JUNE 5, 1986

AWW $366.33 Maximum $244.22 Minimum $ 81.41

EFFECTIVE JUNE 3, 1985

AWW $353.53 Maximum $235.69 Minimum $ 78.56

EFFECTIVE JUNE 15, 1984

AWW $347.45 Maximum $231.64 Minimum $ 77.22

EFFECTIVE JUNE 7, 1983

AWW $335.66 Maximum $223.78 Minimum $ 74.59

EFFECTIVE JUNE 1, 1982

AWW $312.66 $208.45 Minimum $ 69.47

302 573-4800 ~ www.hfddel.com

On 5/2/21, Claimant was injured in a fall from a second story window during a training exercise as a volunteer firefighter. On 9/12/22, Claimant filed a Petition seeking pre-authorization of a single level lumbar fusion surgery recommended by Dr. Yalamanchili during his first visit with the claimant on 9/7/22.

The Board found that the proposed surgery was not reasonable and necessary treatment at this time, accepting the opinion of defense medical expert, Dr. Close, over Dr. Yalamanchili.

The Board agreed with Dr. Close that the claimant had not exhausted conservative care. Claimant had not received steroid injections, which could be both diagnostic and therapeutic. Further physical therapy could benefit the claimant, especially as she had experienced good relief with this particular modality in the past. Anti-neuropathy medications should be trialed. An EMG would be of diagnostic utility. Claimant should have a second opinion.

The Board was also not comfortable with the risks associated with the surgery. Even Dr. Yalamanchili testified that claimant’s chances of success were 60-70% at best. Even with the surgery, the balance of patients do not improve and may even get worse. Dr. Close testified credibly that there were several factors that caused him to question Dr. Yalamanchili’s projections. Specifically, Claimant’s imaging findings were degenerative, common in patients in her age group, and showed no spinal instability. There was a bulge without any cord compromise. Fusion surgery is not effective for predominantly axial low back pain. Claimant conceded that she had predominantly low back pain and her leg pain was only intermittent. Fusion surgery would predispose Claimant to developing adjacent segment problems, especially as she already had pathology in at least one adjacent level.

Should you have any questions regarding this decision, please contact Greg Skolnik or any other attorney in our Workers’ Compensation Department.

Jesika Martin v. State of Delaware, IAB Hrg. No. 1511181 (Mar. 6, 2023).

INDIANA

TTD AND PPI RATES

BEGIN JULY 1, 2023

 

The new statutory TTD and PPI rates for injuries occurring after July 1, 2023.  Rates are reflected in this summary: 

 

Date of Injury
on or After

Max AWW

Max TTD

Maximum
Compensation*

07/01/16-

06/30/23

$1,170

$780

$390,000

07/01/2023

$1,205

$804

$402,000

07/01/2024

$1,241

$828

$414,000

07/01/2025

$1,278

$852

$426,000

07/01/2026

$1,316

$878

$439,000

Minimum Weekly AWW, $75; Minimum TTD $75= Minimum Maximum Compensation of $37,500.00.

 

Body Part

Degrees

Body Part

Degrees

Upper Body

Thumb

Index Finger

Second Finger

Third Finger

Fourth Finger

Hand below elbow

Arm above elbow

Degrees

12

8

7

6

4

40

50

Lower Body

Great toe

Second toe

Third toe

Fourth toe

Fifth toe

Foot below knee

Leg above knee

Degrees

12

6

4

3

2

35

45

Vision/Hearing

Complete hearing loss, one ear

 

Complete hearing loss, both ears

 

Vision loss to 1/10 of normal vision

 

 

 

15

 

 

40

 

 

35

 

 

Other loss

One Testicle

Both testicles

 

 

Both hands, both feet, total vision in both eyes or two such loss in same accident

 

10

30

 

 

100

Whole Body

100

 

 

 

Date of Injury on
or After

Degrees

Dollars Per Degree

7/01/16-06/30/23

1-10

$1,750

 

11-35

$1,952

 

36-50

$3,186

 

51-100

$4,060

7/01/23

1-10

$1,803

 

11-35

$2,011

 

36-50

$3,282

 

51-100

$4,182

7/01/24

1-10

$1,857

 

11-35

$2,071

 

36-50

$3,380

 

51-100

$4,307

7/01/25

1-10

$1,913

 

11-35

$2,133

 

36-50

$3,481

 

51-100

$4,436

07/01/26

1-10

$1,970

 

11-35

$2,197

 

36-50

$3,585

 

51-100

$4,569

 

*Amputation: Calculated by doubling the dollar

amount of PPI rating. I.C. §22-3-3-10 (i)(1)

PART ONE: CHANGES EFFECTIVE AUGUST 1, 2023

 

ATTORNEY FEES & DISPUTE CERTIFICATION

Minn. Stat. § 176.081, subdivision 1c has been amended to state that fees under the chapter are “available to an attorney who procures a benefit on behalf of the employee” upon genuinely disputed claims or portions of claims. However, unless the employee is represented by an attorney in other litigation pending at the Office of Administrative Hearings, a fee may not be charged for services with respect to a medical or rehabilitation issue performed before the attorney has filed with the commissioner and served upon the employer/insurer (and their attorney, if any) “a request for certification of dispute containing the name of the employer and its insurer, the date of the injury, and a description of the benefits claimed” and the department certifies that there is a dispute and that it has tried to resolve the dispute.

If the department has not issued a determination of whether a dispute exists within 30 days of the filing of a request, the dispute shall be certified if all the following apply:

(1)    the insurer has not approved the requested benefit;

(2)    the employee, the employee's attorney, or the employee's treating provider has submitted any and all additional information requested by the insurer necessary to determine whether the requested benefit is disputed or approved; and

(3)    the insurer has had at least seven calendar days to review any additional information submitted.

Non-Emergency Surgery Disputes

If an employer/insurer has requested a second opinion (pursuant to 176.135) or an examination (pursuant to 176.155), a dispute shall be certified if 45 days have passed following a written request for a second opinion or examination, if the three conditions enumerated above are met as well. Cross-reference the amendments to Minn. Stat. 176.135, subdivision 1a for further details on procedures for second opinions on requests for non-emergency surgeries, as discussed below.

 

CUSTOMIZED MEDICAL ITEMS ARE PROPERTY OF THE EMPLOYEE AND MUST BE REPLACED

Minn. Stat. § 176.135, Subdivision 1(d) was amended to specify that any “artificial members, glasses or spectacles, artificial eyes, podiatric orthotics, dental bridge work, dentures or artificial teeth, hearing aids, canes, crutches, or wheel chairs” that had been customized specifically for an injured worker are the property of the injured worker. If any of these items


 

were damaged by reason of an injury arising out of and in the course of the employment, the employer shall furnish their replacement or repair. An employer/insurer’s inability or refusal to timely provide these items, will make it liable for the reasonable expense incurred by or on behalf of the employee in providing them.

 

REQUESTS FOR NON-EMERGENCY SURGERY AND SECOND OPINIONS

Minn. Stat. 176.135, subdivision 1a(a) was amended to specify that if an employer or insurer requires an employee to get a second opinion before undergoing an non-emergency surgery, the expense of that second opinion shall be paid by the employer or the insurer (the previous language only mentioned the employer).

Language stating that “the failure to obtain a second surgical opinion shall not be reason for nonpayment of the charges for the surgery. The employer is required to pay the reasonable value of the surgery unless the commissioner or compensation judge determines that the surgery is not reasonably required” has now been removed from the statute. The new language states that if an employer or insurer receives a request for non-emergency surgery, it must respond in writing no later than seven calendar days after receiving the request from the health provider or the employee either: approving the request, asking for additional information, requesting a second opinion, or requesting an examination by a physician chosen by the employer (under 176.155).

Subdivision 1a(b) has now been added to the statute. It states that if the employer or insurer requests a second opinion, it must notify the employee and the health care provider of this request within seven calendar days of the request for non-emergency surgery. If the authorization of the non-emergency surgery is denied within seven calendar days of receiving the second opinion, the health care provider may elect to perform the surgery, subject to a determination of compensability by the commissioner or compensation judge.

Subdivision 1a(c) has also been added. It states that “failure to obtain a second surgical opinion is not reason for nonpayment of the charges for the surgery. The employer or insurer is required to pay the reasonable value of the surgery unless the commissioner or compensation judge determines that the surgery is not reasonably required.”

 

CHARGES FOR MEDICAL BILLS AND RECORDS

Minn. Stat. § 176.135, subdivision 7 has undergone significant amendments, mostly limiting the dollar amounts that health care providers can charge for their records.

Paragraph (a) has added language specifying that health care providers may charge for copies of their records or reports pursuant to Minnesota Rules, part 5219.0300, and directs the commissioner to adopt, by rule, a schedule of reasonable charges that will apply to charges not addressed by paragraphs (d) and (e) (see below).

 

2


 

Paragraph (d) was added to the subdivision, it provides that:

(1)   Health care providers must notify requestors of the estimated cost before sending copies of records. If the requestor approves the costs and record copies are provided, the payment due is the applicable fee under paragraph (e) (see below);

(2)   Health care providers shall not require prepayment for the costs of copies unless there is an outstanding past-due invoice for the requestor for previous records requests;

(3)   Health care providers shall provide copies of medical records in electronic format;

(4)   The charges scheduled under paragraph (e) includes fees for retrieval, downloading, or other delivery of records;

Paragraph (e) then provides the following limits for how much a health care provider may charge for any records provided under paragraph (d):

1.     No more than $10 if there are no records available;

2.     No more than $30 for records of up to 25 pages;

3.     No more than $50 for records of up to 100 pages;

4.     No more than $50, plus and additional 20 cents per page for pages 101 and above; or

5.     No more than $500 total for any request.

 

MEDICAL EXAMINATIONS

Minn. Stat. § 176.155, subdivision 1 was amended, largely to provide further parameters regarding requests for extension of time for file I.M.E. reports. Paragraph (a) added language allowing employees to have a “witness” present at any examinations performed that the request of the employer (previously the paragraph only allowed employees to have “a personal physician” present at their own expense).

Paragraph (b) removed language providing that IME reports must be made available to the employee or employee’s representative upon request, and now states that: regardless of whether litigation is pending, the report must be served upon the employee and employee’s attorney no later than 14 days within the issuance of the report or written statement.

Paragraph (d) states that “any request for a good cause extension pursuant to paragraph (e) must be made within 120 days of service of the claim petition” with the following exceptions:

1.       There has been a change to the employee’s claim regarding the nature and extent of the injury;

2.       There has been a change to the permanency benefits claimed by the employee, including a change in permanent partial disability percentage;

3.       There is a new claim for indemnity benefits; or

4.       The employment relationship is not admitted by an uninsured employer.

 

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SCOPE OF .239 CONFERENCES

176.239, subdivision 6 was amended to state that “only reasons specified on the notice of discontinuance shall provide a basis for a discontinuance, unless the parties agree otherwise,” striking the word “information” from that sentence. This appears to indicate that

.239 conferences will be decided much more on just the four corners of the reasons provided on Box 3 Notices of Intent to Discontinue, and that Employer/Insurers may not be able to rely on providing additional information or arguments not previously raise in the discontinuance notice at the time of the conference.

However, subdivision 7 adds the term “exhibits filed by the parties with the office” to “information provided by the parties at the administrative conference” as the information to be considered in issuing administrative decisions on .239 conferences.

 

CLAIM PETITION PROCEDURE AND REQUIREMENTS

176.291 has been amended, apparently to require greater specificity and documentary support in Claim Petitions, especially those asserting multiple claims. Under paragraph (b) the petition shall state and include: the extent and character of each injury; copies of medical records supporting each claim asserted; copies of other information in support of the claim, witness information for all known witnesses to be called in support of each injury and claim; the nature and extent of each claim.

Paragraph (c) now allows “incomplete” petitions to be stricken or dismissed from the calendar pursuant to 176.305, subd. 4. Further, an employee who has filed a claim petition shall provide a list of their physicians and health care providers who have provided treatment for same/similar conditions as well as authorizations for relevant information, data, and records within 14 days to any requester (previously it was 30 days).

 

CASES WITH DEFICIENT PETITIONS MAY STRICKEN FROM THE CALENDAR AND DISMISSED IF NOT CORRECTED IN 180 DAYS

176.305, subdivision 4 now allows a compensation judge, upon a properly served motion, to strike a case from the active trial calendar after the employee has been given 30 days to correct a deficient petition if the information on the petition was incomplete (see the amendments to 176.291 above). If a case has been stricken from the calendar for 180 days (previously, it was 1 year) or more and no corrective action has been taken, the judge may dismiss the case (sua sponte, or upon the motion of a party). The petitioner must be given 30 days notice of the proposed dismissal before the dismissal is effective.

 

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PROCEEDINGS WHEN ANSWER NOT FILED (.331 HEARINGS)

In an apparent move to provide a bit of a “speedbump” for a full-blown hearing on a short turn-around time, 176.331 was amended to have OAH set the matter for an immediate pretrial conference and hearing when an adverse party fails to file and serve an answer or obtain an extension to answer. The adverse party that failed to file and answer or appear at a pretrial conference may appear at the hearing, but will not be granted a continuance except for good cause.

CESSATION OF DEPENDENT BENEFITS NOTICE REQUIREMENTS

Minn. Stat. § 176.111, subdivision 16 added language stating that the cessation of dependent benefits (due to the death or marriage of any dependent) requires notice pursuant to subdivision 23.

Subdivision 23, in turn, is a new subdivision stating the procedural requirements of notice of cessation of dependency benefits. An employer seeking to discontinue dependency benefits must file with the commissioner and serve upon the dependent written notice within 14 days of the discontinuance. The notice must state the date the benefits will be discontinued and provide a statement of facts clearly indicating the reason the individual will no longer receive dependency benefits and is no longer considered a dependent under § 176.111. Any document relied upon for the discontinuance must be attached to the notice. Failure to file the notice as required may result in a penalty under § 176.231, subdivision 10.

 

PART TWO: CHANGES EFFECTIVE OCTOBER 1, 2023

 

CHANGES TO THE PERMANENT PARTIAL DISABILITY SCHEDULE: EFFECTIVE FOR INJURIES ON OR AFTER OCTOBER 1, 202

176.101, subdivision 2a, has been significantly amended. Paragraph (a) now contains a provision stating that “during the 2026 regular legislative session, and every even-year legislative session thereafter, the Workers' Compensation Advisory Council must consider whether the permanent partial disability schedule in paragraph (b) represents adequate compensation for permanent impairment.”

Paragraph (b), in turn, provides significantly higher base dollar amounts by which the impairment rating percentages are derived. This appears to be an approximately 31% increase for lower-end percentages, and it tapers to an approximate 5% for the high ratings. For example, the amount for impairment ratings of less than 5.5% is going to $114,260 (from $78,800), whereas ratings of 95.5% and higher only go up to $567,840 from $540,800.

 

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HOSPITAL OUTPATIENT FEE SCHEDULE

Minn. Stat. §176.1364, subdivision 3, which addresses the Hospital Outpatient Fee Schedule (HOFS) was amended to included a new paragraph (g), which directs the commissioner, beginning October 1, 2023 to October 1, 2025, to adjust the conversion factors provided in the subdivision to result in an overall reduction in total payments of hospital outpatient service by 3% for services effective October 1, 2023, a further 3% overall reduction starting October 1, 2024, and then a 4% overall reduction for services effective October 1, 2025.

Minn. Stat. §176.1364, subdivision 6 is repealed.

 

PART THREE: POST-TRAUMATIC STRESS DISORDER STUDY

 

This new legislation directs the commission of labor and industry to “conduct a study to identify systemic or regulatory changes to improve the experience and outcomes of employees with work-related post-traumatic stress disorder.” This study must:

(1)  identify evidence-based methods and best practices for early detection and treatment of post-traumatic stress disorder;

(2)  review models, including those used in other jurisdictions and systems, for delivering mental health wellness training or employee assistance programs, treatment for post- traumatic stress disorder, and benefits related to post-traumatic stress disorder. Review must include outcomes and cost considerations;

(3)  identify any programs in other jurisdictions with effective prevention, timely and effective medical intervention, or high return-to-work rates for employees with work- related post-traumatic stress disorder;

(4)  review the definition of post-traumatic stress disorder provided in Minnesota Statutes, section 176.011, subdivision 15, paragraph (d), and compare to definitions in other jurisdictions; and

(5)  consider the list of occupations subject to the rebuttable presumption in Minnesota Statutes, section 176.011, subdivision 15, paragraph (e).

Any relevant state agency, and specifically the Public Employees Retirement Association, Minnesota State Retirement System, and Minnesota Workers’ Compensation Insurers Association are directed to cooperate with the commissioner in conducting this study. The commissioner must report the results of this study to the Workers’ Compensation Advisory Council and the chairs and ranking minority members of the house of representatives and senate committees with jurisdiction over workers’ compensation by August 1, 2025.

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PART FOUR: CHANGES EFFECTIVE “THE DAY AFTER FINAL ENACTMENT”

“RELATIVE VALUE FEE SCHEDULE” DEFINED

Minn. Stat. § 176.011 was amended to include Subdivision 17b which provides the statutory definition of “relative value fee schedule” as “the medical fee schedule adopted by rule under section 176.136, subdivision 1a, using the Physician Fee Schedule tables adopted for the

federal Medicare program.”