12 Tips To Effectively Use Attorneys in Workers Compensation

Litigation cost is a factor calculated into premium as an allocated expense. Each state retains a record of all allocated cost expenses. Through the various state formulas, all allocated expenses become a part of the experience modification code. The experience modification code sets the stage for premium calculation.

 

 

Fee Determination

 
Plaintiff attorney fees are generally capped as a percentage of the employee’s benefits awarded in contested claims. They also become a part of the final ruling by the judge or mediator. When paid they are paid as part of the indemnity benefit. Since indemnity benefits are already part of the experience modification process there is no separate impact as an allocated expense.

 

Defense costs are based on billable hours at the attorney’s hourly fee rate. Defense attorney fees are payable regardless of a win or a loss of the case. The defense attorney bills are paid on the file in separate direct payment. Legal reserves are required to cover the payments.

 

Billable time includes: telephone calls, legal research, investigative steps, reporting, deposition time, trial time, and trial preparation, witness briefing, consultation time with fellow counsel and or witnesses, as well as negotiating time with plaintiff counsel.
In addition to the lawyer’s time fee, a defense legal bill may include clerical time charges, photocopying fees, postage, subpoena service cost, investigative cost, messenger service, witness fees, paralegal service time, travel time and cost. Some bills may even go so far as to charge for filing time and paper supplies.

 

 

Retaining Defense Counsel

 

All too often there can be a scarcity of local defense counsel. Fewer legal firms are taking defense work in rural areas or smaller towns. This limits legal counsel choices. All local claim units may be using the same attorneys. Fee rates and costs may become non-negotiable, and quality and quantity of defense work may be weak. Worst of all, the judges and mediators might give little credence to their defensive presentations. Larger communities might have more defense counsel choices, but all too often there is still a tendency to rely on the same legal firms.

 

Contacting the local legal bar association is one step to locate new attorneys. The association can advise of the current practicing and newly licensed counsel. They will also advise field of practice.

 

Attending a workers compensation court hearing and observing the defense counsel is a second way to search for new legal counsel. Probably the most used method, however, is to obtain a recommendation from professional associates or employers.

 

Before fully engaging any attorney, obtain their resume and request references. After reviewing the resume and contacting the references arrange for a personal interview. Discuss fees, reporting requirements, and all other expectations desired from the attorney. Do not be afraid to offer fees lower than those being asked as many attorneys will adjust fees to obtain business.

 

When reaching an agreement with an attorney follow through with a written confirmation.

 

 

Effective Use of Attorneys

 
Since attorney fees and bills are charged by the hour, it is incumbent on the claim technician to limit those hours. The following list of ideas should help:

 

  1. Keep telephone calls to a minimum. Know what you are going to discuss before calling. During the call gather the necessary information and terminate the call as quickly as possible. Document the telephone call information in the claim file notes.
  2. Use e-mail as much as possible and limit them to necessary information. This automatically documents the claim file and reduces time to document a telephone call. Use formal letters and regular mail only as necessary.
  3. Limit the attorney’s need for additional investigations. This is accomplished by the claim technician obtaining all defense and claimant statements. The adjuster should supply all personnel records that may be needed, arrange and forward all information from independent medical examinations, as well as supplying claim file reports and investigation information.
  4. Require a legal cost estimate and follow up on this for necessary revisions. Use the estimates as a basis for legal reserving.
  5. Require the attorney to obtain permission to do any additional investigations, hire private investigators, and schedule depositions (if statements are in the file defense depositions should be minimal).
  6. Limit verbosity in reporting. Once the attorney has made initial assessment (which should include a full review of the loss facts) and given a plan of action, it will only be necessary to comment on current happenings. It is not necessary to have the attorney copy the claim file on interrogatories, depositions etc. These are seldom needed if the attorney is reporting on the findings and results. The cost of reproduction and mailing can be eliminated.
  7. Obtain all information the attorney may request as promptly as possible.
  8. Try to employ more than one attorney. Competition generates better results in litigation and disposition.
  9. Negotiate settlements and agreements as much as possible. Attorney negotiating should be limited to court house steps, pretrial conferences, arbitration, and trial.
  10. When the attorney does negotiate, set limits and authorities. Require a telephone request for additional limits and authorities. If possible, serve subpoenas for the attorney.
  11. Require regular and timely billing by counsel. Audit each bill line by line to ascertain accuracy. It should also conform to the written agreement. Charges should coincide with legal information in the claim file records. If any reductions are necessary, let the attorney know why. Pay the bill promptly to avoid late fees and charges. Check to ascertain that a paralegal fee is not accidentally submitted as the attorney’s fee.
  12. Due to inflation and other impacting factors fees may need to be increased. This should always be done by mutual agreement and direct negotiation.

 
Summary

 

Litigation costs impact premium as allocated expenses. Controlling litigation cost is vital and requires the proper choice and use of lawyers.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

 

Texas DWC Provides Grace Period on Comp Coverage Needs

The Texas Department of Insurance, Division of Workers Compensation (DWC) is providing a grace period for employers without workers compensation insurance coverage or that terminated their coverage (non-subscribers) to report their non-coverage status to DWC without penalty.

 
This grace period also extends to non-subscribers with five or more employees that have not previously reported on-the-job injuries, illnesses, and fatalities to DWC. Historically, non-subscriber reporting rates are low, and DWC is offering this grace period to increase compliance with required state reporting.

 

Avoiding an Administrative Penalty

 

The grace period allows non-subscribers that have not previously reported their non-coverage status, to submit the DWC Form-005, Employer Notice of No Coverage or Termination of Coverage (DWC Form-005), without an administrative penalty during the Feb. 1, 2016, through April 30, 2016, reporting period.

 
Additionally, this grace period also allows non-subscribers with five or more employees that have not previously reported their injuries, illnesses, and fatalities, to submit the DWC Form-007, Employer’s Report of Non-Covered Employee’s Occupational Injury or Disease (DWC Form-007) without an administrative penalty for injuries, illnesses, and fatalities occurring on or after May 1, 2016.

 

By law, non-subscribers must annually notify DWC of their decision not to obtain workers comp insurance coverage by submitting the DWC Form-005 and must also report each on-the-job injury, occupational illness, or fatality resulting in more than one day of lost time to DWC by filing DWC Form-007.

 

Nonsubscribers that fail to comply with state requirements are subject to administrative penalties. Non-subscribers can file the DWC Form-005 with DWC online, by fax, or by mail. The DWC Form-007 may be filed by fax or by mail.

 

Non-subscriber Reporting Requirements A non-subscriber must file the DWC Form-005, Employer Notice of No Coverage or Termination of Coverage to DWC:

 

  • Between Feb. 1 and April 30 each year;
  • Within 30 days of hiring its first employee; or
  • Within 10 days of DWC’s request. Non-subscribers with five or more employees must report each fatality, occupational disease, and o-the-job injury that results in more than one day of lost time to the DWC.

 

Non-subscribers must submit the DWC Form-007, Employer’s Report of Non-Covered Employee’s Occupational Injury or Disease to the DWC within the seventh day of the month following the month in which:

 

  • The death occurred;
  • The employee was absent from work for more than one day as a result of the on-the-job injury; or
  • The employer acquired knowledge of the occupational disease.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Selecting the Right MSP Compliance Service Provider

Selecting the right Medicare Secondary Payer (MSP) compliance service provider is an important part of any claims operation.  These service providers are essential when it comes to making sure a claim complies with all aspects of the Medicare Secondary Payer Act by providing suggestions to help resolve troublesome cases.  This must include a focus on selecting someone who provides innovative solutions to complex problems.

 

 

Understanding the Medicare Secondary Payer Act

 

The Medicare Secondary Payer Act was passed into law in 1980, but was largely ignored until the late 1990s.  Since that time, claim management teams have paid considerable attention to compliance with the Act by considering Medicare’s interests in all workers’ compensation claims.

 

One part of MSP compliance is the projection of future medicals related to injury-related claims.  This includes the careful review of medical records related to the injury and projecting costs associated with future medical care reimbursable by Medicare.  The result should be a medical cost projection that is reasonable.  Another factor is an acceptable approval rate for those allocations submitted for review and approval under the voluntary workers’ compensation Medicare Set-aside submission process.

 

 

Threshold Factors for Consideration

 

There are several threshold factors for consideration when selecting a MSP compliance service provider.  When making this decision, it is important to answer the following:

 

  • How would you describe your current MSP compliance program for workers’ compensation?

 

  • What is the MSP compliance provider’s experience and expertise including legal/compliance, and pharmaceutical/medical?

 

  • How are clinical interventions handled? Is the process seamless?

 

  • What is your criteria for success? (or how do you measure success?)

 

  • What is the level of communication your current MSP partner provides during the Medicare-related processes?

 

By answering these questions, the leadership within a claims management team will understand the importance of a provider that offers innovative services.

 

 

Moving Beyond the Basics of MSP Compliance

 

Countless MSP service providers do an excellent job providing precise medical allocations.  While this is an important component of effective compliance efforts, it is important to seek a provider who is able to offer innovative services that take the extra steep.

 

  • A sophisticated service provider utilizes technology that drives all compliance related processes.  This includes the ability to manage in an effective manner the three main components related to the MSP Act: conditional payment resolution; Medicare Set-asides; and Section 111 Mandatory Insurer Reporting.

 

  • Pre-MSA Triage. Stopping problems before they occur is an important component missing in most MSP compliance programs.  When selecting the right service provider, it is essential to work with a provider that can identify barriers to settlement and provide specific intervention recommendations.  This should include physician peer review, drug utilization review and clinical oversight.

 

  • Compliance automation and tracking services. Automation allows interested members of the claim management team to track Medicare related activity on a claim from the time a beneficiary is identified through final settlement via end-to-end visibility.  It also allows team members to view in real-time what actions the MSP service provider is taking and what additional steps will occur in the future.  This includes communication with physicians, pharmacists, conditional payment searches, and medical/pharmaceutical interventions.  This not only give claim handlers peace of mind, but also frees them to address issues that require attention.

 

Conclusions

 

Effective MSP compliance includes a service provider that goes beyond the basics.  These providers will offer services that allow members of the claim management team to focus on their job and provide information and resources to comply with Medicare regulations in workers’ compensation claims.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Lawsuit Filed Against Alabama Business for Workplace Hazards

The U.S. Department of Labor has filed a lawsuit against Lear Corp., doing business as Renosol Seating LLC, and three of its managers for suspending and terminating employees who reported workplace hazards in violation of the Occupational Safety and Health Act.

 
The suit follows an investigation by the U.S. Department of Labor’s Occupational Safety and Health Administration after three Renosol employees filed federal complaints. Based in Selma, the company is a high- and low-volume foam manufacturer.

 

Filed on March 4 in U.S. District Court for the Southern District of Alabama, Montgomery Division, the suit alleges that Lear discriminated against the employees by conducting retaliatory acts in violation of the OSH Act’s Section 11(c). The case is being litigated by the department’s Office of the Solicitor in Atlanta.

 

The suit seeks back wages, interest, and compensatory and punitive damages. Additionally, the suit seeks an order directing Lear to remove all references to this matter from the employee’s personnel records and barring Lear from future violations of the OSH Act.

 

The department’s action makes numerous allegations, including that the company harassed employees, reduced their overtime, segregated them from co-workers, suspended and later terminated one of the employees in retaliation for raising health concerns associated with exposure to toluene diisocyanate.

 

“Employees have the right to raise occupational safety and health concerns without the fear of retaliation,” said Kurt Petermeyer, OSHA’s regional administrator in Atlanta. “OSHA will continue to seek litigation for companies that violate the whistleblower provisions of the OSH Act to protect employees who report violations.”

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Waivers of Statutory Immunity Impact on Workers Compensation

When used properly, transferring risk for workers compensation exposure and losses can be an excellent tool for cost control. One such tool is known as Waiver of Statutory Immunity.

 

A Waiver of Statutory Immunity is: the abandonment, relinquishment, rejection, renunciation, surrender, release, cancelation, or loss (by implied conduct) of any known statutory or contractual legal right.  There are dozens of legal phrases outlining the various types of waiver and additional definitions.

 

While most waivers of immunity are in the construction industry, any employer using Sub- Contractors, Professional Employee Contractors, Leased Employee Vendors, Volunteers, Individual Specialists, or Temporary Help Agencies can face similar exposures.  The purpose is these entities take over exposures from the entity using their services.

 

Governments generally have almost full Statutory Immunity for negligence by either constitutional or legislative act.  Yet, if the loss is egregious enough, has major impact, or is not properly asserted, this immunity can be lost.

 

Hold Harmless and indemnification contracts (with or without Statutory Waiver) not properly written and designed to meet normal public practices, can held null and void by the courts, and/or workers compensation judicial ruling.

 

For purposes of this discussion two descriptions will apply.  Indemnitee: is the person or organization wanting to transfer risk.  Indemnitor: is the person or organization assuming or taking the risk.

 

 

Example of Exposure:

 

Company A (the Indemnitee) hires company B (the Indemnitor) to perform some computer adjustments.  The work is done on A’s premises.  A and B entered into contract with a standard hold harmless and indemnification agreement.  B also furnishes insurance endorsements naming A as an also insured.

 

Company B’s employee is injured and alleges A to have been negligent and cause of the injury.   B’s employee is paid compensation benefits by B’s insurance carrier.

 

B’s employee then sues A for negligence.

 

A, relying on the hold harmless clause and endorsements for liability coverage turns the lawsuit over to B for defense and disposition.

 

A is astounded when B’s liability carrier uses employer immunity as defense since B’s workers’ compensation carrier paid benefits.  Because the hold harmless and indemnity clause did not have a Waiver of Statutory Immunity, A is left without defense or coverage under B’s liability policy.

 

A may be denied coverage under its insurance policies.  A’s carriers may assert that A made its own assumption of risk.

 

The situation can be progressively worse depending on the number and type of insurance carriers, and parties involved, but most of these cases are resolved without lengthy litigation.  Records show that Indemnitees generally lose the most in exposure and cost.

 

There are numerous situations where Statutory Immunity is lost.  A few are:

 

  1. Violation of Public Practice.
  2. Late Reporting.
  3. Failure to properly assert.
  4. Vague or Cross interpretation of contract wording.
  5. Missing litigation time tables.
  6. Judicial or Administrative Ruling
  7. Indemnitor fails to Waive Immunity in proper written format.

 

 

Manuscript Policy

 

Standard insurance policies are seldom written to extend coverage for Waivers of Immunity, and State Insurance Departments may not have premium structures for the coverage.   Few carriers recognize waivers without specific endorsement, therefore, a manuscript policy may be necessary.

 

A Manuscript Policy is written to conform to tailored needs of the insured, or joint venture.  Policies can grant coverage for almost every legal operation.   Premiums may be negotiable, and shared among the various entities.  The policy generally defines every entity exposures and limits, and will define how the insured is to comply with the policy provisions. The policy is generally written for a single use and will expire or be cancelled when the use is completed.  An extending endorsement may be added to allow for injuries or claims incurred but not reported.

 

Most agents, brokers, and underwriters are not experienced enough to write a manuscript policy, therefore, a manuscript policy is usually prepared by the home office insurance carrier department. The same will apply to endorsements accepting Waivers of Immunity.

 

Manuscript policies are seldom offered to smaller organizations as premiums are generally expensive or have high retention limits.  Such retentions may be spread across all participants, therefore, it will be crucial that all participants are fiscally sound enough to absorb their share of retentions.

 

 

Summary:

 

Obtaining a Waiver of Immunity from another is a good way to transfer and protect against workers’ compensation claims and subrogation challenges by non-employees, or independent contractor relationships.  However, they must be prepared by properly experience lawyers, in conjunction with all entities and insurance carriers.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Pennsylvania Businesses to See Another Dip in Comp Rates

The Wolf Administration recently announced that Pennsylvania businesses will see another decrease in workers compensation insurance rates, while benefit levels for injured workers will be maintained.

 
Workers comp insurance rates will drop 0.90 percent, effective April 1, reducing a key expense for many companies and saving Pennsylvania businesses an estimated $20 million this year.

 

“Maintaining fair benefits for workers injured on the job is vital for Pennsylvania families’ financial well-being and peace of mind,” said Governor Tom Wolf. “Sticking to this responsibility, while still reducing rates on a key cost, helps business owners continue to create and support jobs that pay in Pennsylvania.”

 

The rate reduction follows the Insurance Department’s approval of the Pennsylvania Compensation Rating Bureau’s annual loss cost filing. These loss costs are used to determine the premiums businesses pay for workers comp insurance. The premium savings for an individual employer will vary based on the employer’s risk classification, claims experience, and other factors.

 

This is the fifth consecutive workers comp insurance cut in as many years, and brings the cumulative savings to $570 million for the past five years. Workers compensation insurance covers the cost of medical care and rehabilitation for injured workers, lost wages, and death benefits for the dependents of those killed in work-related accidents.

 

Approximately 325 companies are writing workers comp insurance currently in Pennsylvania.

 

More than 11,220 state-certified workplace safety committees have been established since March 1994, protecting more than 1,463,000 workers.

 

Additionally, employers with certified workplace safety committees have saved close to $604.2 million in workers comp premiums. These savings in insurance costs are due solely to the 5 percent premium discount provided to businesses that have these committees.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Broadspire Medigram: Revisiting Some Controversial Topics

dr. jake headshotBy Jacob Lazarovic, MD, FAAFP Senior Vice President and Chief Medical Officer, Broadspire

 

REVISITING SOME CONTROVERSIAL TOPICS

 

TAKING OUR PULSE

 

Practicing medicine, or making decisions about the appropriateness of treatment, and the presence and extent of disability, is not always a straightforward issue. How many times have you heard the “experts” change their minds about whether a certain vitamin is useful, or whether eggs and coffee are good or bad for you?

 

In our world, we also must confront controversial issues and ensure that we are adopting “best practices” based on the most current evidence-based medical research.

 

So today we will revisit a few ongoing issues, see what the prevailing wisdom is, and review our current approaches.

 

JUST WHAT THE DOCTOR ORDERED

 

  1. Fibromyalgia

 

Fibromyalgia is not quite a disease, but rather a syndrome of various complaints involving fatigue, pains in muscles and other soft-tissues, and sleep disturbances. It doesn’t qualify as a disease because, to this point, there is really no firm evidence of any objective physical findings (that can be seen in lab tests, x- rays, tissue biopsies, etc.). It remains a largely subjective phenomenon.

 

There is debate about its cause, with proponents disputing whether it is a “brain” condition or a musculoskeletal one. Some scientists claim to have noted abnormalities on central nervous testing, such as MRIs. Others feel that is a psychological state akin to depression, which is why anti-depressants are often successfully used to treat it.

 

In 2013, one laboratory claimed to have discovered a blood test that can diagnose fibromyalgia, which would be a breakthrough. However, even though some insurance carriers now reimburse the test, many others consider it to be of unproven value, as do many researchers.

 

From our perspective the most important fact is that, regardless of what stance one takes on the above, there is certainly no evidence of an occupational causation. Consequently, our policy remains as follows, per our medical advisory on the subject:

 

FIBROMYALGIA MEDICAL ADVISORY

 

Medical Advisory:

Based on the above considerations, fibromyalgia, chronic fatigue syndrome (FM/CFS) and other related conditions, and treatments for such conditions, cannot be considered work-related. There is no evidence at all to substantiate any occupational factors or injuries as causative. The current best hypothesis is that FM/CFS, to the extent that it has “legitimacy as a discrete entity” represents a genetic pain sensitization phenomenon due to dysregulation of pain pathways related to atypical neurotransmitter levels. 

 

With respect to disability (functional impairment), this needs to be carefully evaluated based on objective evidence of physical and cognitive deficits. 

 

 

B)  Viscosupplementation (hyaluronic acid, HA) injections to the knee

 

These injections have been used for a long time to reduce the pain and stiffness of arthritic knees. They can be thought of as a “lubricant” that cushions the knee as the joint is in motion. However, there have always been skeptics questioning the effectiveness of this therapy.

 

Several recent studies, one of which is excerpted below, now validate this skepticism, demonstrating that there is no, or minimal, benefit from HA injections.

 

However, the Official Disability Guidelines (ODG) continue to recommend this therapy, although a very long list of utilization criteria must be met prior to approval. As further evidence is published, ODG may reconsider its stance on viscosupplementation.

 

Of course causality is also an important consideration. Knee osteoarthritis is a degenerative condition which, unfortunately, many of us will get, and not necessarily related to occupational activities. It typically affects multiple joints in the body and is thought to have a genetic predisposition as well. A careful analysis to determine whether the condition is genuinely causally related to an individual’s occupation is recommended.

 

ODG:

Recommended as an option for severe knee osteoarthritis (OA) for patients who have not responded adequately to conservative treatment (exercise, NSAIDs, corticosteroid injections), in order to potentially delay total joint replacement. Higher quality studies have shown the magnitude of improvement to be modest at best. While medial and/or lateral compartment OA is a recommended indication, there is insufficient evidence for other conditions including patella-femoral arthritis, chondromalacia patella, patella-femoral syndrome (kneecap pain), or osteochondritis dissecans. 

 


C)  Platelet Rich Plasma (PRP)

 

PRP is one of several blood products that can be extracted from a patient’s own blood, and then injected into a painful body part. In the case of PRP, the blood is concentrated to achieve a high number of platelets, which contain growth factors that, theoretically, when injected into damaged tissue, can help to heal and strengthen the involved area. It is commonly used for soft tissue injuries, although you may have noticed local newspaper ads in which medical entrepreneurs advertise its use for myriad conditions. Similar claims are being made for stem cell therapy.

 

Despite all the fuss, there remains no consensus that PRP or related therapies have meaningful benefit. Broadspire’s medical advisory, as well as the ODG, reinforce this view. The prevailing recommendation is that this therapy should be confined to rigorous clinical studies, and not used in the general population.

 

Medical advisory:

Blood product injection therapies are not recommended for certification/ authorization due to an absence of high-grade medical evidence permitting an evaluation or confirmation of the efficacy of this modality. There is currently insufficient evidence to support the use of these injection therapies.  Rigorous studies of sufficient sample size, using validated clinical, radiological and biomechanical measures and tissue injury healing response biomarkers are needed to determine long-term effectiveness and safety. 


BLOOD PRODUCT INJECTIONS MEDICAL ADVISORY
 

 

 

ODG:  Platelet-rich plasma (PRP)

Not recommended for chronic pain except in a research setting. PRP therapies are more complicated than previously acknowledged, and an understanding of the fundamental processes and pivotal molecules involved will need to be elucidated. PRP therapies in clinical trials await assessment. Platelet-rich plasma (PRP) therapy is a recently developed technique that uses a concentrated portion of autologous blood to try to improve and accelerate the healing of various tissues. There is considerable interest in using PRP for the treatment of musculoskeletal disorders, particularly athletic injuries. Because PRP products are safe and easy to prepare and administer, there has been increased attention toward using PRP in numerous clinical settings. Platelet-rich plasma has been used to treat conditions such as lateral epicondylitis, ligament and muscle strains, and tears of the rotator cuff, anterior cruciate ligament, Achilles tendon, plastic surgery and other conditions. Platelet-rich plasma can be applied at the site of injury either during surgery or through an injection performed in the physician’s office. However, there is little published clinical evidence that proves its efficacy in treating the multitude of injuries/disorders that are thought to benefit from PRP. 

 
CIRCULATING IN THE PRESS 

 

More Insurance Companies Now Paying for Fibromyalgia Blood Test

 

“In 2013, Los Angeles-based biomedical company EpicGenetics made international headlines when it introduced FM/a, the first ever fibromyalgia blood test.

 

While FM/a hasn’t caught on in most doctors’ offices, more insurance companies are now paying for the test.

 

Dr. Bruce Gillis, EpicGenetics’ CEO, says the No. 1 reason patients get the test is to prove to family members and others that they are really sick.

 

He believes physician bias is the main reason why the test is not more widely used.

 

The legitimacy of fibromyalgia has been complicated for decades because of the lack of a diagnostic test to prove its existence. It’s typically a diagnosis of exclusion – meaning illnesses with similar symptoms have been ruled out through extensive (i.e. often expensive) medical testing.

 

We believe [the term] fibromyalgia is a misnomer, he says. These people aren’t suffering with anything that’s affecting the muscles, per say. What they are suffering with is their immune system cannot produce normal quantities of protective proteins. There are cells in the immune system called peripheral blood mononuclear cells. They are not producing normal quantities of the protective proteins called chemokines and cytokines.

 

EpicGenetics’ research and the FM/a test aren’t without critics. Fibromyalgia expert Dr. Daniel Clauw has said EpicGenetics’ studies contradict other research, which has shown normal or elevated cytokine levels in fibromyalgia sufferers.

 

Researcher and rheumatologist Dr. Fred Wolfe called one of EpicGenetics’ studies “junk science”, saying it didn’t meet minimal scientific standards.”

 

 

Viscosupplementation for Osteoarthritis of the Knee

 

“Knee osteoarthritis is responsible for a large burden of care and cost within health care. Osteoarthritis results from an imbalance between the breakdown and repair of articular cartilage in any joint and occurs as a result of multiple risk factors including mechanical overload (obesity, heavy lifting), trauma, overuse (repetitive knee bending), and genetic predisposition.

 

The CDC (U.S. Centers for Disease control and Prevention) reports that one in two individuals may develop symptoms of osteoarthritis in at least one knee by eighty five years of age.

 

In conclusion, this best-evidence systematic review assessing the clinical significance of outcomes involving pain relief and functional improvement does not support the routine use of intra-articular HA. In contrast to previous reviews, we found no significant evidence of publication bias in the studies that we selected for analysis. The patient benefit of intra-articular HA was not clinically important when compared with intra-articular saline solution injections used as a placebo. Subdividing HA preparations by molecular weight did not change the results of the analyses. Selecting the best evidence resulted in significantly reduced heterogeneity but did not change the outcome; no clinically important improvement in pain and other outcomes from a patient’s perspective was found.”

 

 

How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries?

 

“Platelet-rich plasma (PRP) has become increasingly popular in sports medicine and orthopaedic practice as treatment for muscle, tendon, and ligament injuries, and has received media attention because of its promise as a regenerative therapy.

 

We argue that patients should only be offered PRP for musculoskeletal soft tissue injuries within the context of well-designed clinical trials, with informed consent, high quality verbal explanations, and supporting written information. Advise patients that there is currently insufficient evidence to show that it is effective treatment for musculoskeletal soft tissue injuries. Clinicians offering PRP should ask manufacturers for the evidence of the platelet and growth factor concentrations, the constitution, and the viability of their PRP product (platelet activation levels).”

 

 

Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis4

 

“The recent emergence of autologous blood concentrates, such as platelet-rich plasma, as a treatment option for patients with orthopaedic injuries has led to an extensive debate about their clinical benefit. We conducted a systematic review and meta-analysis to determine the efficacy of autologous blood concentrates in decreasing pain and improving healing and function in patients with orthopaedic bone and soft-tissue injuries.

 

The current literature is complicated by a lack of standardization of study protocols, platelet- separation techniques, and outcome measures. As a result, there is uncertainty about the evidence to support the increasing clinical use of platelet-rich plasma and autologous blood concentrates as a treatment modality for orthopaedic bone and soft-tissue injuries.”

 

 

****************

REFERENCES:

  

  1. “More Insurance Companies Now Paying for Fibromyalgia Blood Test”, Donna Gregory Burch, http://nationalpainreport.com.
  2. “Viscosupplementation for Osteoarthritis of the Knee”, David Jevsevar, MD, MBA, et al, J Bone Joint Surg Am. 2015;97:2057-60.
  3. “How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries?”, David Keene, et al, BMJ 2016;352:i517 doi: 10.1136/bmj.i517 (Published 17 February 2016).
  4. “Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis”, Ujash Sheth, et al, J Bone Joint Surg Am. 2012;94:298-307.

 


 

About Broadspire®

 

Broadspire (www.choosebroadspire.com), a global third party administrator, offers casualty claim, medical management, disability and absence management solutions, and risk management information services, helping increase employee productivity and reducing the cost of risk through early  intervention, professional expertise and data analytics. As a Crawford Company, Broadspire is based in Atlanta; Ga. Services are offered by Crawford & Company under the Broadspire brand in countries outside the U.S.

 


 

Nova Scotia Officials Move on New Partnership

A new strategic partnership will ensure consistent, focused care for injured workers who need more advanced treatment for work-related sprain and strain injuries, WCB Nova Scotia (Canada) announced recently.

 

The change will see WCB Nova Scotia enter a single contract with one health care provider for these particular services, building a stronger, more effective, and more efficient business relationship.

 
The approach will improve quality and consistency of the more complex functional rehabilitation services involved in helping injured workers return to the job.

 
CBI Health Group was the successful vendor in a tender issued to clinics across Nova Scotia last fall. WCB Nova Scotia and CBI Health Group are currently in contract negotiations.

 
Services will be delivered by CBI Health Group clinics and a number of their affiliates in a province-wide network which has clinics in all regions.
 

The new arrangement will become effective later this spring for new referrals of injured workers requiring Tier 2/3 care. All injured workers already receiving Tier 2/3 care will complete their treatments with existing clinics.

 

Services Help Those with Needs Exceeding Standard Physiotherapy

 
These health services help a small population of injured workers with needs that exceed standard physiotherapy. This may include other disciplines such as occupational therapy, psychology, or pain management. Today, WCB Nova Scotia has 56 contracts for the provision of Tier 2/3 care, serving about 750 injured workers annually.

 
This arrangement does not impact standard functional rehabilitation, known as Tier 1 care. About 10,000 injured workers receive Tier 1 care from 160 clinics across Nova Scotia; including the 56 clinics that currently also provide Tiers 2 and 3, and 104 clinics that provide only Tier 1.

 

All of these valued Tier 1 health service providers will continue to help injured workers recover from musculoskeletal injury, or sprains and strains, by far the most common workplace injury in Nova Scotia.

 

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Create A Workers’ Compensation GPS

Few managers would consider travel to a distant location without a global positioning system (GPS) on how to get to their destination.  The GPS provides precise information on the directions to travel and when to make a turn which impacts reaching the final destination. When precise directions are not available, it is easy to get lost.

 

Employers who attempt to handle their workers’ compensation claims without precise guidelines on how to get from the initial injury to the conclusion of the claim often get lost along the way, causing the injury claim to take longer and cost the employer additional time and money.

 

 

Written Claim Handling Protocols Should Be Established

 

Written claim handling protocols should be established by each employer outlining exactly what will be done on every workers’ compensation claim by the workers’ compensation coordinator, by the employee’s supervisor and by the employee.  While all the duties, responsibilities and steps each party should take in the handling of a worker’s compensation claim is beyond the scope of this blog, the following is a general overview of the most important steps.

 

 

The workers’ compensation coordinator’s road map would include:

 

  • Oversee pre-injury training of supervisors on what to do in case of an injury
  • Oversee pre-injury training of employees on what to do in case of an injury
  • Reporting of the injury claim to the claims office
  • Coordinating with all involved parties to insure compliance with the workers’ compensation claim protocols including:
    • Post-injury response
    • Verifying a complete investigation into the cause of the injury is completed
    • Arranging for transitional duty
    • Overseeing the return-to-work program
  • Verify compliance with the proper filing of all state forms
  • Verify compliance with the paper work requirements including:
    • Employee Report of Incident
    • Work Ability Form
    • Witness Report Form(s)
    • Supervisor Report
  • Keep on-going contact with the injured employee until the claim is concluded

 

 

The key points on the supervisor’s road map would include:

 

  • Arrange immediate medical attention for an employee when an injury occurs
  • Provide the employee with a Work Ability Form to take with them to the medical provider
  • Accompany the employee to the initial emergency treatment
  • Arrange for the medical provider to return the Work Ability Form to the employer within 24 hours of the initial medical visit
  • Arrange transitional duty work for the employee who has work restrictions

 

 

The employee’s road map would include:

 

  • Participation in all safety training to prevent injuries from occurring
  • Review and study of the employer’s requirements of the employee when an injury occurs
  • Know the required (or recommended) medical provider(s)
  • Present the Work Ability Form to the medical provider at the first medical treatment
  • Participate in the return-to-work transitional duty program
  • Keep the workers’ compensation coordinator and the supervisor advised of the medical progress

 

 

Many Work Comp Problems Can Be Prevented With Proper Education

 

The establishment of written protocols that have been provided to the employee will eliminate the “I didn’t know that” excuse and is a major control point in preventing the employee from getting lost on the road to recovery.  By educating the employee on what is expected if a workers’ compensation injury occurs, many of the problems that can develop on a work comp claim will be prevented.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Texas DWC Provides Grace Period on Comp Coverage Needs

The Texas Department of Insurance, Division of Workers Compensation (DWC) is providing a grace period for employers without workers compensation insurance coverage or that terminated their coverage (non-subscribers) to report their non-coverage status to DWC without penalty.

 

This grace period also extends to non-subscribers with five or more employees that have not previously reported on-the-job injuries, illnesses, and fatalities to DWC. Historically, non-subscriber reporting rates are low, and DWC is offering this grace period to increase compliance with required state reporting.

 

Avoiding an Administrative Penalty

 

The grace period allows non-subscribers that have not previously reported their non-coverage status, to submit the DWC Form-005, Employer Notice of No Coverage or Termination of Coverage (DWC Form-005), without an administrative penalty during the Feb. 1, 2016, through April 30, 2016, reporting period.

 

Additionally, this grace period also allows non-subscribers with five or more employees that have not previously reported their injuries, illnesses, and fatalities, to submit the DWC Form-007, Employer’s Report of Non-Covered Employee’s Occupational Injury or Disease (DWC Form-007) without an administrative penalty for injuries, illnesses, and fatalities occurring on or after May 1, 2016.

 

By law, non-subscribers must annually notify DWC of their decision not to obtain workers comp insurance coverage by submitting the DWC Form-005 and must also report each on-the-job injury, occupational illness, or fatality resulting in more than one day of lost time to DWC by filing DWC Form-007.

 

Nonsubscribers that fail to comply with state requirements are subject to administrative penalties. Non-subscribers can file the DWC Form-005 with DWC online, by fax, or by mail. The DWC Form-007 may be filed by fax or by mail.

 

Non-subscriber Reporting Requirements A non-subscriber must file the DWC Form-005, Employer Notice of No Coverage or Termination of Coverage to DWC:

 

  • Between Feb. 1 and April 30 each year;
  • Within 30 days of hiring its first employee; or
  • Within 10 days of DWC’s request. Non-subscribers with five or more employees must report each fatality, occupational disease, and o-the-job injury that results in more than one day of lost time to the DWC.

 

Non-subscribers must submit the DWC Form-007, Employer’s Report of Non-Covered Employee’s Occupational Injury or Disease to the DWC within the seventh day of the month following the month in which:

 

  • The death occurred;
  • The employee was absent from work for more than one day as a result of the on-the-job injury; or
  • The employer acquired knowledge of the occupational disease.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

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