A medical-legal conference (often referred to by adjusters and attorneys as a “med-legal”) is an informal meeting between counsel and physician to discuss the medical aspects of a claimant’s case. In Connecticut, the professional guidelines provide direction as to the cost and scope of a medical-legal conference. Such meetings can be ex parte between the treating physician and claimant’s counsel, or the respondent’s examiner and respondent’s counsel.
While neither counsel has the right to an ex parte meeting with the opposing party’s physician, it is not uncommon for both counsel to meet with a physician to obtain an informal medical opinion without the costs associated with a deposition.
A medical-legal conference is appropriate where there is a concern regarding the best medical course of action for the claimant, to prepare the physician for testifying, and to learn the opinions of the physician prior to the issuance of a report.
These discussions should be used as a learning tool for both counsel and physician. An informal meeting provides a collaborative setting for counsel to consult with a physician to ensure that the physician has the right medical history, as well as to share additional information, such as medical documentation, surveillance, or the claimant’s job description, which may impact the physician’s ultimate opinion.
Counsel should use these meetings to obtain a greater depth of understanding of the medical issues inherent in the case. Workers’ compensation cases often involve medical questions outside the expertise of a litigator. At a medical-legal conference, counsel can ask the physician to educate them as to the medical analysis utilized in evaluating the claimant’s injuries. This information is particularly helpful in preparation for taking the deposition of the opposing expert, as counsel can seek an in depth explanation of why the opinion of the opposing party’s physician is incorrect from a medical perspective. (workersxzcompxzkit)
Medical-legal conferences are also useful tools for determining the likely future course of treatment and/or treatment options. Counsel can use the opportunity to obtain a physician’s opinions as to anticipated periods of future disability and the likely degree of permanent impairment.
Authors: Colette S. Griffin, Esq. & Christopher M. Russo, Esq. of Howd & Ludorf, LLC http://www.hl-law.com/ 1-860-249-1361
Atty. Griffin, a graduate of Quinnipiac College School of Law (1987) is a partner with a focus on workers’ compensation, defending corporations and their insures in the Workers’ Compensation Commission for the State of Connecticut, arbitration and mediation venues.
Atty. Russo is an experienced Hartford county litigator focusing on workers’ compensation and insurance defense litigation. He is admitted to practice in Connecticut, U.S. District Court of CT, U.S. Tax Court and U.S. Court of Appeals for the Second Circuit. He earned his J.D. from UCONN School of Law in 2006.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
9 Helpful Steps in Selecting a Third-Party Administrator (TPA) One of the most important decisions a company makes is deciding who will handle their workers' compensation claims. Depending on your insurance arrangement, an in-house insurance company or a third-party administrator can handle your claims – selecting the best one possible for your company is key in keeping costs down. Price and flexibility are both considerations in choosing to use a TPA. If your company integrates its disability programs, for example, (where sick leave is combined with short- and long-term disability) your insurance company may not be willing to handle the extra paperwork. Usually, ultimately, it's less expensive to buy the BEST claims handling service rather than the cheapest. Consider the following: 1. Who is the team that will service your account? 2. Has this TPA handled claims in your industry before? 3. Does the TPA proactively ensure internal quality control and correct any problems when they arise? 4. Do adjusters receive ongoing training to learn new laws, to fine-tune their expertise and learn new techniques? 5. Is there a Medical Director to provide updated occupational illness and injury medical information to adjusters? 6. Are specialists available to handle the most complex claims? 7. Does the TPA have an intake service, or will you have to supplement their service with an outside firm? 8. What medical management services are used? Are services well integrated, in-house services or outside services? (workersxzcompxzkit) 9. Do they have established relationships with investigators nationwide to use in all locations? Please note that these are just a beginning list of questions to ask a potential TPA. For more information, contact Workers' Comp Kit (http://www.workerscompkit.com/) or your insurance broker or agent. Author Rebecca Shafer,executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
More FREE tools to try: WC Calculator: www.reduceyourworkerscomp.com/calculator.php TD Calculator:www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Note: Workers’ Compenstion Insurance is a type of “property and casualty” business insurance required in all states, except Texas where an employer may opt out. It is referred to as a “line” of insurance coverage and is purchased from an insurance agent or broker.
Police Officer Denied Workers’ Comp Benefits – the lengths to which some people will go to collect workers’ comp …. vigilant board reviews claim carefully
A suspended New York police officer failed to win his case with the state Workers Compensation Board. The WCB did not believe his story of being stabbed while on duty nearly three years ago.
The Binghamton Press & Sun-Bulletin, reports the officer, a 10-year force veteran, claimed he was attacked by a pair of men and sustained stab wounds while investigating a suspicious car in a local cemetery 2006.
After an investigation by the officer’s department and New York State Police, his claim was questioned and investigators maintained he was not eligible to receive disability benefits.
The Workers Compensation Board Administrative Law Judge sided with the village and reported the officer’s claimed injuries were actually self-inflicted and did not arise out or during the course of his employment as a police officer.
In November of last year, the officer was found not guilty on one count of first-degree offering a false report for filing, a felony, and third-degree falsely reporting an incident, a misdemeanor. However, in September the officer was indicted by a federal grand jury in the Northern District of New York and faces 20 counts of mail fraud. (workersxzcompxzkit)
According to the federal indictment, the charges are a result of the officer allegedly using the U.S. Postal Service to deliver documents with which he planned to defraud Johnson City, the Public Employer Risk Management Association and the state Retirement System of more than $90,000 in salary and medical benefits.
The indictment claims the officer falsely stated he was assaulted in the December 2006 incident. He is not eligible to receive workers’ compensation of $43,626 in salary and $47,607 in medical bills and other expenses, including post traumatic stress disorder, if his injuries were self-inflicted.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
We are accepting short articles* (200-600 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com. *Non-compensable.
6 Steps to Introduce the Preferred Provider Organization to Your Company
A PPO, or preferred (sometimes “participating”) provider organization or network is a managed care organization who agrees with the third-party administrator or insurance company to provide reduced rates to their clients. In addition to the preferred rates, there is hopefully preferred service also so that employees are treated promptly with little waiting time, and are treated well — almost like a preferred customer. The medical providers should have occupational medical experience and regard return to productive employment as top priority.
Your company’s general manager needs to create a personal relationship with the PPO clinic that provides medical care to his/her employees. Workers’ Comp Kit (http://www.workerscompkit.com/) recommends inviting the clinic director and administrator to your physical work site for a visit.
Establishing this relationship helps put your company’s priorities into focus. It is always best to have a face and place in mind when accomplishing any job, especially one involving employee health. You want clinic personnel to know your company, the type of workplace setting, job requirements and your managment approach.
In writing this invitation, be sure to include all your contact information as well as the employee and provider brochures.
Some other tips:
1. Be polite. Let them know you are pleased they are part of your insurance network.
2. Express that quality of care in your company is a top priority.
3. Let them know you want to be prepared when injuries occur, but let them know this is not a frequent event.
4. Explain the company offers a transitional duty program and you need the PPO’s cooperation.
5. Ask if the PPO administrators would be willing to visit your facility to meet employees, view work conditions and see the jobs employees perform.
6. Finalize by asking they email to suggest a date for such a meeting. (workersxzcompxzkit)
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
We are accepting short articles* (200-300 words) on WC cost containment. Send to: Info@WorkersCompKit.com. *Non-compensable.
WC Best Practices IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: www.reduceyourworkerscomp.com/calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Note: Workers' Compensation Insurance is a type of "property and casualty" business insurance required in all states, except Texas, where an employer may opt out. It is referred to as a "line" of insurance coverage and is purchased from an insurance agent or broker. For an overview of state laws go to: http://reduceyourworkerscomp.com/workers-compensation-state-laws-and-regulations.php. For detailed information about your state's requirements, contact your INSURANCE broker or agent. Rate Reduction in Hawaii Workers' compensation costs will decrease 4.1% this year according to the Hawaii Insurance Department (HID), allowing many premiums to fall, with new rates January 1, 2010. The loss-cost reduction is based on an on-going decline in the number of claims filed in 2007, the last complete available year. According to HID, workers' compensation insurance rates decreased 65.5% in the last five years. This will have a positive financial impact on employers in Hawaii carrying workers' compensation coverage.
"This is the largest workers' compensation insurance rate decline of any state in the nation, except possibly those states enacting major statutory reforms," said Hawaii Insurance Commissioner J.P. Schmidt. "These lower rates show Hawaii's employers effectively provide a safer work place for our workers. We continue to encourage employers to implement workplace safety programs and thereby qualify for insurer's discounts." (workersxzcompxzkit) The Hawaii Department of Labor and Industrial Relations and the Hawaii Occupational Safety and Health Division teamed with businesses and labor organizations to enforce workplace laws, leading to fewer claims being filed Schmidt said.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
We are accepting short articles* (200-600 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com. *Non-compensable.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@WorkersCompKit.com
Cancelling a New York State Insurance Fund Workers’ Compensation Policy
There are special rules for employers with a workers’ compensation policy with the New York State Insurance Fund (NYSIF), (the Fund) who wish to switch to a private carrier.
Rules are spelled out in Section 94 of the Workers’ Compensation Law for how this is done but adding a few more measures makes the process far more certain – and loose ends have been known to cause substantial, but unnecessary, expense.
If you wish to leave the NYSIF do this:
1. First get a new policy with an effective date of coverage comfortably greater than 30 days into the future.
2. You need to give NYSIF 30 days notice of intention to cancel MEASURED FROM THE DAY IT RECEIVES YOUR NOTICE.
3. You must also have a new policy ready to assume coverage, without lapse, from the date of cancellation with the NYSIF.
4. When the NYSIF receives your notification of intent to change coverage NYSIF must notify the WCB, in writing, of the proposed change in coverage AT LEAST ten days prior to the date of cancellation. Ten days after that, the process of cancellation will begin.
If the NYSIF does not notify the Board properly, coverage with the Fund will continue until it complies. This can be the source of much trouble since the Fund will continue to bill for premium at an enhanced rate, even though a new policy is ready to assume coverage and the delay is no fault of the employer.
ALWAYS, ALWAYS, ALWAYS
ALWAYS copy the WCB Compliance Unit on intention to change coverage and include proof of a new policy with the letter. Send the communication certified with return receipt requested.
ALWAYS send proof of new coverage to the NYSIF with the letter notice of intention to leave the FUND.
ALWAYS notify the Fund by express mail, certified letter, return receipt requested and make sure that notification arrives MORE than 30 days prior to change in coverage.
ALWAYS mail to the Board Compliance unit a copy of the signed return receipt from the NYSIF. Keep copies of all correspondence.
These Steps Are Important Because????
Even though sending a copy of the new coverage to the Fund is not necessary, and it is not necessary to copy the WCB, those extra measures will serve an employer well if any later dispute arises.
The Fund remains liable and the new coverage does not go into effect until the Fund properly completes its own responsibilities. The Fund may charge for the extended coverage but it may have to refund surcharges attached to extended periods that were due to its own failure to notify the Board in compliance with Section 94. The new carrier should be asked for adjustment of its premium if the Fund has caused extended coverage to occur since the new policy CANNOT go into effect until the Fund’s coverage ceases. These rules, which do not apply when the NYSIF is not a carrier, were intended to guarantee that there is no lapse in coverage AND no periods of duplicate coverage. (workersxzcompxzkit)
NYSIF is an insurer. Like all insurers, it has fiduciary responsibilities to the insured and may NOT benefit from its mistakes should these mistakes result in extra expenses.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
We are accepting short articles* (200-600 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com. *Non-compensable.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
What If Transitional Duty Doesn’t Work, don’t exceed restrictions
Despite your best efforts to get work ability forms from all treating physicians and evaluate your employee on a weekly basis, there are times when the medical provider says the injured employee can do more than s/he thinks s/he can.
For example, a bus driver injured his right arm in a work-related accident. The doctor finds the muscles and bones have mostly healed and the patient should no longer be feeling pain and may return to work for four, rather than an eight hour day.
But in your weekly reviews, the employee complains tha opening the bus door is still so painful he cannot drive home at the end of the day.
In this situation write an email from the injury coordinator to the adjustor asking if a functional capacity evaluation (FCE) may be needed. Also, consider options for alternate work for a while longer.
In the email cover these points.
- Be sure to include claim number and all relevant addresses and contact information on the letter.
- Include the supervisor in any discussions.
- Clearly explain the situation: who is injured, what the injury is, what the current complaint is and what the physician says the worker should be able to do
- Explain the company’s medical advisor reviewed the reports and the employee’s complaints do not mesh with the current medical diagnosis.
- Acknowledge the pain could be imagined (but without judgment) or the result of the employee being fearful of additional injury. Be aware that the pain might be very real also, and don’t minimize the likelihood of this possibility. Anyone who has ever had repetitive arm injury knows how painful it can be and often even a small amount of use can trigger painful symptoms.
- Ask your adjustor if an (FCE) is needed and, depending on results, perhaps an off-site work hardening program is in order. In work-hardening the employee is allowed to build up to his regular job capacity in a supervised setting, removing the fear of reinjury.
- Ask the adjustor for suggestions of work-hardening centers in the area.
- Acknowledge the difficulty of this claim and the adjustor for the timely response. (workersxzcompxzkit)
Real or imagined, pain while doing one’s job benefits neither the company nor the employee. There are programs designed to help your employee work through these issues.
Vigilant attention to the employee will ease this process.
Author: Robert Elliott, J.D.
WC IQ Test: http://www.workerscompkit.com/intro/
WC Calculator: www.reduceyourworkerscomp.com/calculator.php
Follow Us On Twitter: www.twitter.com/WorkersCompKit
Do not use this information without independent verification.
All state laws vary.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Procedures to Control the Post Injury Process
The employer must TAKE CHARGE because workers’ compensation has a huge financial impact on the company. There must be a tight post-injury process describing exactly what happens after an injury. Most employers have no cohesive process for handling injuries, thus the employees decide which doctor they will go to and how long they need to be out of work.
Unfortunately, many employees try to stay out of work the entire time they are in pain when in reality current medical thinking is injured employees should return to work as soon as possible because they will recover faster.
Just like in hospitals, post-surgical care requires most patients to be ambulatory within the first 24 hours after surgery.
Agree on a Post Injury Procedure. Who should the employee report the injury to? Who should take the injured employee to medical clinic? Should initial care be at a local clinic or at the hospital, or will it differ depending on the degree of the injury? Each detail of what occurs after the injury must be spelled out in a post injury process.
Although many companies have good intentions and want to reduce their costs, they do not know how to actually reduce costs. It is important to give managers a tool-kit and explain how to use forms, sample letters to closely manage each of their claims.
An important part of any workers’ compensation program is an effective transitional duty program(TD), yet many managers do not know how to get an employee back to work in modified capacity if they are unable to return to work full duty until they are completely recovered. Provide each manager with the tools they need. (workersxzcompxzkit)
A ‘tool kit’ of resources contains communication tools so managers can communicate with their employees, their TPA, their medical providers and with Corporate WC Manager. A few items which are essential are employee brochure, brochure to medical providers, transitional duty policy, transitional duty job bank or task bank.
Author: Rebecca Shafer, J.D.
WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: www.reduceyourworkerscomp.com/calculator.php
Follow Us On Twitter: www.twitter.com/WorkersCompKit
Do not use this information without independent verification.
All state laws vary.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Alleged $1.2 Million in Workers’ Comp Fraud Leads to Arrest
Husband and Wife Charged With Workers’ Comp Premium Fraud
Owners of a drywall business were arrested on charges of felony theft and workers’ comp premium fraud totaling an estimated $1.2 million in unpaid insurance premiums, according to the Louisiana Workforce Commission.
The Louisiana Insurance Fraud Task Force, after searching the couple’s Lafayette home uncovered evidence of concealed payrolls and misrepresentation of workers to avoid the full payment due of workers’ compensation insurance premiums.
According to arrest records, (a joint effort of LWC, Louisiana State Police, Louisiana Department of Insurance and the Louisiana Attorney General’s Office) the task force received a tip from a representative of the Louisiana Carpenter’s Regional Council (carpenter’s union) based on financial reports and other records found in bags of trash left around the perimeter of the couple’s home.
The resulting investigation showed the company reported around 35 employees with a payroll of about $145,347 when it should have reported more than 300 employees and a payroll of more than $4.2 million for 2007 and 2008.
This case in only one of the LWC current investigations. LWC has made over seven arrests throughout the year as part of the task force investigating suspected employer and employee fraud. Through the second quarter of 2009, nearly 1,600 investigations were completed by the LWC Office of Workers’ Compensation Fraud and Compliance Units, with 13 cases referred to the AG’s office for possible prosecution.
Much of the work is done by analyzing claims processed for workers’ comp and unemployment insurance and reviewing employer quarterly records.
The bottom line is it is illegal for businesses to misrepresent the status of their employees in an effort to avoid paying workers’ compensation insurance, payroll taxes and other employee-related costs in Louisiana.
”All employers doing business in Louisiana are required to provide workers’ compensation coverage for their employees. Businesses not covering their employees are shortchanging those employees and driving up costs for other businesses,” said Curt Eysink, executive director of the Louisiana Workforce Commission. “This is an important step in creating a level playing field for all businesses to compete fairly.” (workersxzcompxzkit)
Non-compliance results in a $250 fine per employee per incident, ever increasing fines, an injunction from doing business in Louisiana and jail time.
Reposted with Permission Visit LexisNexis for more information and full reports.
The latest workers’ comp fraud blotter see
http://law.lexisnexis.com/practiceareas/Workers-Compensation-Law-Blog/Workers-Compensation/Workers-Comp-Fraud-Blotter-9112009—Recent-Arrests-Charges–Convictions
We are accepting short articles* (200-600 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com. *Non-compensable.
Try Our FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
Follow Us On Twitter: www.twitter.com/WorkersCompKit
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Actively Monitoring Your Claims If your company is a large organization with many locations and numerous open claims at each location, you may need to consider have several return-to-work (RTW) coordinators. Have one RTW coordinator for each region. For example, one large company has East, Mid-West and Western Region coordinators. The number of coordinators depends on your claims volume, making sure each coordinator has enough claims to justify a full-time position and they are not overloaded and thus unable to follow-up on each claim. Coordinators do not do the work of adjusters, but facilitate transitional duty and guide location management. Understand What Your Third-party Administrator (TPA) Provides Start your program with ‘Vendor Day.' Look at the capabilities and services provided by your claims administrator; regardless of whether it is an insurance company or a TPA, you need to know all of their capabilities in detail. Have the claims administrator describe each of their services – a formal presentation; have your TPA come to your office to ‘introduce' and explain each service. Ask them to bring examples of each report. For instance, ask to see a sample nurse case management report, or an investigators report. Make sure you clearly state your expectations. You want the practice leader or a person who can explain everything about the services to attend. Include all services: medical cost containment, medical management, investigative, recovery, and risk management information systems. To prepare for Vendor Day, gather all literature from the claims administrator — have all sales brochures sent to you advance — and review the response to request for proposal (RFP) if the claims administrator was selected through the RFP Process. Familiarize yourself with each available service, learn its name and find out how much it costs. For example, is a nurse case manager a telephonic nurse case manager or a field-based case manager who will attend medical visits with the injured employees? Ask lots of questions. Is the ‘case manager' an RN, an LPN, or a non-licensed person with internal medical training? Before you can determine how effectively a service is delivered, learn the specifics of each service. (workersxzcompxzkit) Companies often start the workers' compensation correction process by selecting a new TPA without even knowing they are not using all of the services of their current TPA. For example, a major carrier has nurses who will go to each unit to help identify transitional duty jobs, yet their client was unaware of this service and its benefits. They didn't know what they didn't know. Author: Rebecca Shafer, J.D.
WC IQ Test: http://www.workerscompkit.com/intro/ TD Calculator:www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php Follow Us On Twitter: www.twitter.com/WorkersCompKit Never use this information without independent verification. All state laws vary. Consult with your insurance broker or agent about workers' compensation insurance issues.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in
