The authors of this letter are journalists, columnists, bloggers and content publishers for the workers' compensation industry across the United States. We are a politically and professionally diverse group. We do not agree on everything, yet find ourselves of one opinion on a highly critical matter. We are competitors who are now colleagues for a common cause; to bring light to a serious injustice being committed within your state.
The prosecution of Charles (Sandy) Blunt was, in our view, an outrageous and almost farcical event. It is, in the final analysis, a travesty that has damaged the national view of your state, hampered the operation of a State agency, and ruined the life of a good man wholly undeserving of such results. (WCxKit)
Sandy Blunt was Director of North Dakota's Workforce Safety & Insurance from May of 2004 until December of 2007. He was, as you are likely aware, prosecuted by state authorities for “misspending government funds”. Specifically, he was charged and convicted on two counts
1. During his almost 4 year tenure his agency spent approximately $11,000 on employee incentive items, including flowers, trinkets, balloons, decorations and beverages for Workforce Safety and Insurance employee meetings, and on gift certificates and cards in small denominations for restaurants, stores and movie theaters. Blunt personally approved some of these expenditures. Others were made by managers as part of daily operations under his watch. Not a dime went into an employee’s pocket, nor did Blunt personally benefit from any expenditure.
2. His agency paid $8,000 to an employee, David Spencer, for sick pay when he was not apparently sick, and it also failed to collect $7,000 from Spencer when he left prior to the end of his employment agreement. The $7000 was for moving expenses incurred that prosecutors felt Spencer owed the state. Blunt’s position was that the agency was not entitled to collect these funds, since Spencer’s departure was not voluntary.
All told, the state prosecuted Sandy Blunt, and he is now a convicted felon for “misspending” $26,000 of government money.
No one has ever alleged that Blunt personally benefited from any of these expenditures. Blunt was acting like other capable, ethical North Dakota executives ‐ in the best interest of customers and of the mission of his employer. In our industry it is considered a best practice to provide employees and supervisors with incentives. It is not frivolous, it's necessary, and what every employer should do.
The first of these two charges would be, to many people, laughable if it were not for the damaging consequences associated with them. The notion that buying inexpensive incentive items for your employees could result in a felony conviction is simply stunning. This would not be elevated to a criminal status in most states in the nation. The fact that it is in North Dakota should have a chilling effect on businesses looking to move there.
The second and more serious charge, involving the sick pay and moving expenses of employee Spencer, has been fatally undermined by the revelation that the prosecutor in the matter, Cynthia Feland, withheld critical evidence from the defense – evidence that largely clears Blunt in this area. A disciplinary panel for the North Dakota Supreme Court has found on November 7, 2011 that
“Cynthia M. Feland did not disclose to Michael Hoffman, defense attorney for Charles Blunt, the Wahl memo, and other documents which were evidence or information known to the prosecutor that tended to negate the guilt of the accused or mitigate the offense.”
Withholding of evidence by prosecutors is one of the most serious acts of prosecutorial misconduct in North Dakota and all other states. In recognition of this, the panel recommended Ms Feland’s license to practice law be suspended. We urge that you read the entire report of the panel, including the penalties the board recommended be imposed on Ms. Feland. For the report, go here.
Had the prosecutor not withheld evidence, in all likelihood the case would never have come to trial, and the reputation of Blunt and the WSI would be free of taint. The evidence in question shows that WSI’s auditor’s own findings backed Blunt’s position on payments related with Spencer. However, those findings were not made available to the defense, and the prosecutor was found to have allowed testimony to be given at the trial that directly conflicted with information she had. As we indicated, Feland, now a judge in your state, has been recommended for suspension and a fine over these findings.
Yet Sandy Blunt remains a convicted felon. His crime? Buying balloons, trinkets and $5 gift cards – for his employees, not for himself. For that, Blunt, who is married with two children, has had to spend half a decade, and untold thousands of dollars trying to clear his name.
Some of us have known Sandy for quite a while. Some have come to know him while learning of his situation. Others of us have never met Sandy, but recognize the tenuous nature of his treatment. Collectively we speak to thousands within our industry every day. Our opinions have been clear; this situation needs the light of truth shone brightly upon it. The time and resources expended prosecuting a man on such questionable grounds should be more closely examined, by the business community, workers compensation professionals and the media in North Dakota. (WCxKit)
Sandy Blunt is a good and decent man. He deserves better. So, it would seem, do the people of North Dakota.
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A new Washington state law, protecting consumers from immigration-related fraud, went into effect, according to a report from the Attorney General’s Office.
The recently enacted Immigration Services Fraud Prevention Act, requested by the Attorney General’s Office, prohibits anyone from engaging in the unauthorized practice of law in an immigration matter, unless that person is a licensed attorney or is otherwise authorized to provide legal services under federal immigration law. (WCxKit)
Designed to protect consumers from deceptive business practices, the new law prohibits non-lawyers and unauthorized individuals from engaging in several other activities.
• Selecting or assisting another in selecting an immigration-related government form;
• Advising another as to his or her answers on an immigration-related government form;
• Soliciting to prepare documents for another for submission in a judicial or administrative immigration proceeding;
• Charging a fee for referring another to a person licensed to practice law;
• Drafting or completing legal documents affecting the rights of another in an immigration matter;
• Referring oneself as an “immigration assistant,” “immigration consultant,” “immigration specialist,” or any other term in any language (including the Spanish term notario publico), that conveys or implies that the person possesses professional legal skills in the area of immigration law
While the law does not prohibit the provision of translation services, the law does prohibit non-lawyers and other unauthorized persons from advising customers as to their answers on immigration forms.
As the new law goes into effect, the Attorney General’s Office warns consumers to be careful who they trust when it comes to immigrant assistance.
“In Washington and around the country, people advertising immigration services use the title notario publico on business cards and in their business dealings to deceive consumers into thinking that they have special legal training in immigration affairs,” said Attorney General Rob McKenna. “However, a notario publico is not a lawyer and is not authorized under state or federal law to provide you with legal assistance in your immigration case.”
In several Latin American countries, the term notario publico refers to an individual who has received extensive legal training over the course of several years.
In the United States, a “notary public” is an individual who has the authority to administer an oath or affirmation or witness the signing of papers. The title is relatively simple to obtain. (WCxKit)
Many people use this linguistic accident to deceive Spanish-speaking customers into thinking that they are experts in immigration law. Do not be deceived by a person described as a notario or notario publico. He or she is probably just a “notary public” with no legal skills whatsoever, according to McKenna.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Earlier this month the Los Angeles City Council passed an ordinance requiring condoms to be used in all permitted adult films shot within their city limits. It brings up many interesting workers compensation issues. After all, this requirement is for the health and safety of employees. Is it any different from requiring construction workers to wear a helmet? Road workers to wear a bright, orange vest?
In this commentary on Salon.com porn performer, writer and director Lorelei Lee calls the ordinance well intentioned but ineffectual. She notes that the new law requires adult film production companies to pay a fee with permit applications. “Currently, condoms are used in the mainstream gay adult film industry (which includes only gay male films), while the heterosexual industry (which includes both lesbian and straight films) has used mandatory STI (sexually transmitted infections) testing as a health and safety precaution since the early 2000s,” she writes.
Lee writes that until May of 2011, the Adult Industry Medical Center, founded by a retired performer, ran a nationwide STI testing service and database that certified heterosexual performers as STI-free previous to their working on any production whereas the new ordinance is in response to a San Francisco-based nonprofit AIDS Healthcare Foundation campaign along with other groups that have picked and boycotted companies which sell or show condom-free pornography.
One of the protest leaders called the testing service a “fig leaf” over the adult industry and backed the lawsuit that led to the organization’s financial insolvency and shutdown last year, which left a vacuum in health and safety protections in the industry, Lee writes. “(He) seemed to hope that leaving performers without any kind of health protection would force legislators to mandate condom use,” she writes.
Lee writes that she became a condom-only performer in 2010 but had worked for eight years previously relying only on the testing service. “But during my time as a non-condom performer, I never once contracted an STI on set that condoms would have prevented, and truthfully, I’m not sure that condoms actually keep me safer than testing alone,” she writes.
She writes that performers have a mix of opinions as to whether they mind actually using condoms on set and some are even strongly opposed to using condoms at work, believing that they may actually increase likelihood of STI transmission.
Lee says what she is most opposed to is regulating condom use in the industry through government regulation. “Many of the people attracted to this industry are still those who don’t care a lot about public opinion or about obeying authorities. In the case of a condom mandate tied to permits, many producers will simply shoot in Los Angeles without a permit. Others will move production outside of the city – to places like Las Vegas, San Francisco or Miami, where some companies are already established,” she writes, noting that perhaps that s what the city is after.
In effect, Lee writes, this legislation has made it more difficult for the industry to use the protections already in place with AIM’s testing program. “We’re also opposed to the squandering of AHF resources – resources that could be effectively used to help prevent and treat HIV and AIDS – on a political campaign against an industry whose health and safety regulations are already working. In the decade since AIM began the program of mandatory testing, six performers have tested positive for HIV, and only three of those have shown to be from on-set transmissions,” she writes. “That’s three transmissions during the course of filming tens (or perhaps hundreds) of thousands of scenes. There are no real statistics as to how this compares to transmission rates in the general population.”
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
A Midland County, Texas jury found Winkler County Sheriff Robert Roberts guilty of misuse of official information, retaliation, and official oppression.
According to the Texas Attorney General’s Office, the guilty verdict stems from the sheriff's attempt to retaliate against two nurses in Kermit, Texas, who filed anonymous complaints against Dr. Rolando Arafiles Jr., a physician who worked with both victims at the Winkler County Memorial Hospital. (WCxKit)
In an agreement reached at the close of the trial's punishment phase, Roberts, 56, was sentenced to four years felony probation on two counts each of misuse of official information and retaliation. He will serve 100 days in jail on each of four felony counts, to be served concurrently, and pay a $6,000 fine on four felony and two misdemeanor counts. Roberts will be removed from office by operation of law and will surrender his peace officer's license.
Sheriff Roberts was indicted on two counts each of misuse of official information, retaliation, and official oppression. Dr. Arafiles and County Attorney Scott Tidwell were also indicted on similar charges. Former hospital administrator Stan Wiley pleaded guilty to related charges after he acknowledged improperly terminating the nurses employment after they filed formal complaints against Arafiles with the Texas Medical Board. Under the terms of his guilty plea, Wiley was sentenced to 30 days in the county jail.
According to prosecutors with the Texas Attorney General's Office, the sheriff improperly used his position as the county's chief law enforcement official in order to help his friend, Dr. Arafiles, retaliate against the nurse’s for complaining to the Texas Medical Board about his professional conduct. Under Texas law, complaints filed against physicians with the Texas Medical Board are confidential. However, after Dr. Arafiles was notified about the complaints filed against him, Sheriff Roberts requested copies of the confidential complaints, which included the complainant’s names.
During the trial, Assistant Attorney General David Glickler explained to jurors that Sheriff Roberts improperly shared the confidential complaints with Dr. Arafiles and the hospital administrator. Subsequently, the sheriff executed a search warrant in order to obtain information stored on the nurse’s computers and confirm that the nurses were the source of the confidential complaints.
The nurses were improperly terminated in retaliation for complaining to the Texas Medical Board about Dr. Arafiles conduct. County Attorney Tidwell's office sought the nurse’s indictment and the Winkler County Sheriff's Department arrested the nurses for alleged criminal conduct they did not commit. A jury later acquitted one of the nurse’s, while charges against the other nurse were dropped by the prosecution. (WCxKit)
Dr. Arafiles and County Attorney Tidwell are still awaiting trial on retaliation and misuse of official information charges.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
A building firm and a contractor in North Yorkshire, Great Britain were recently fined after a worker was injured following a fall while working on the construction of a new farm building, according to a report from The Health and Safety Executive (HSE).
The 36-year-old worker, who asked not to be named, was employed by Stephen Ramsey, trading as Up & Cover, who had been subcontracted by Waddington Buildings Limited to carry out steel erection work and cladding on the building at Brierton North Farm, Billingham. Both Ramsey andWaddington Buildings Limited were prosecuted by the Health and Safety Executive (HSE). (WCxKit)
Teesside Magistrates’ Court was told the worker was standing on a pallet fitted to a fork attachment of a tractor, which was lifted to heights of around four and a half meters to allow the worker to measure and fit guttering to the building. The court heard the tractor was being operated by Stephen Ramsey when it unexpectedly moved with the pallet in a raised position causing the worker to lose his balance and fall to the ground.
He spent 15 days in a hospital after his left heel was smashed and his right ankle was fractured and treatment is still ongoing.
HSE’s investigation revealed Ramsey failed to carry out the work safely and Waddington Buildings Limited had failed to establish whether work carried out on their behalf would be done safely and whether Stephen Ramsey was competent to do the work.
Stephen Ramsey, pleaded guilty to breaching the Work at Height Regulations 2005 and was fined £1,000 ($1,567) and ordered to pay £250 ($3920) costs. (WCxKit)
Waddington Buildings Limited, of Station Road, Brompton on Swale, pleaded guilty to one breach of Section 3(1) of the Health and Safety at Work etc Act 1974 and was fined £3,500 ($5,484) and ordered to pay costs of £900 ($1,410).
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@WorkersCompKit.com
A Watertown, Massachusetts roofing company and its owners have been arraigned on charges they allegedly failed to disclose millions of dollars in misclassified subcontractor payroll and failed to pay the prevailing wage, Attorney General Martha Coakley’s Office announced.
Shaun Bryan and Antoinette Capurso-Bryan, of Newton, and their company, Newton Contracting Company, Inc., of Watertown, were arraigned on the following charges:(WCxKit)
Shaun Bryan, 47, of Newton
Workers Compensation Premium Evasion (4 counts)
Unemployment Contribution Evasion (12 counts)
Misclassification of Employees as Independent Contractors (4 counts)
Failure to Pay the Prevailing Wage
Newton Contracting Company Inc., of Watertown
Workers Compensation Premium Evasion (4 counts)
Unemployment Contribution Evasion (12 counts)
Misclassification of Employees as Independent Contractors (4 counts)
Failure to Pay the Prevailing Wage
Antoinette Capurso-Bryan, 47, of Newton
Misclassification of Employees as Independent Contractors (4 counts)
Failure to Pay the Prevailing Wage
Authorities began an investigation into the Bryans and their company in late 2008, after the JTF received complaints that Newton Contracting was misclassifying part of its workforce. The Attorney General’s Office also received a complaint that Newton Contracting had misclassified its roofing employees as laborers at the Suffolk County Jail Project and consequently failed to pay their employees the prevailing wage rate.
The EOLWD’s Division of Unemployment Assistance (EOLWD\DUA) conducted a compliance audit of Newton Contracting’s payroll records in early 2009. The EOLWD\DUA determined that Newton Contracting misclassified multiple employees as independent contractors and consequently failed to disclose to the EOLWD\DUA more than $2.4 million in misclassified subcontractor payroll for each quarter during 2006 through 2008. The EOLWD\DUA assessed more than $52,000 in additional unemployment contributions, including interest, against Newton Contracting.
During this time the IFB began an investigation of four of Newton Contracting’s worker’s compensation policies covering July 1, 2005, through July 1, 2009. The IFB discovered that the company allegedly misclassified half of its workforce as subcontractors. The IFB’s investigation further revealed that during its annual workers comp audits, Shaun Bryan allegedly failed to disclose to the auditor more than $3.4 million of Newton Contracting’s misclassified subcontractor payroll over the course of four policy periods.
The AG’s Fair Labor Division received a complaint that in 2009 Newton Contracting’s employees performing roofing work at the Suffolk County Jail Project were misclassified as laborers. The prevailing wage rate for roofing work was $53.86. Newton Contracting paid the workers $44.10 hour. In 2010, Newton Contracting paid two employees more than $5,000 in restitution for the misclassification and consequent failure to pay the prevailing wage violation.
A Suffolk County Grand Jury returned indictments against all three defendants on Dec. 19. The defendants were arraigned in Suffolk Superior Court where each pleaded not guilty and were released on personal recognizance.(WCxKit)
The defendants were to be in court Jan. 6, 2012 for further proceedings.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
2012 will be the major year for “Return to Work” (RTW) discussions in New York. A major decision on RTW will be coming from the Court of Appeals in early spring. (Zamora v NY Neurologic is set for argument on February 15, 2012.)
The Zamora decision is expected to resolve many of the claims involving voluntary withdrawal from work, but only on those claims where there were no valid offers by the employer. The case will most likely deal with people who have made little demonstrable effort to return to work, even though the employer has made no offers.
It is no exaggeration to say that an offer by the employer is 99% of the battle in RTW. The employer, alone among the nearly 100,000 employers in New York, knows the injured worker, the former job duties and the best fit for a sllight modification which would permit, at least, a trial RTW effort. Where employees are left to search on their own, among strangers offering strange jobs, the chances of success are slim.
How much different the interactions are when the employer is directly involved. All parties, carriers/TPA, lawyers and the Board included, are much more likely to get a detailed description of the efforts when the employer is the entity making the offer. All other employers are outsiders in the claim and what they offer or why they refuse is information obtained only after great effort, if ever obtained at all.
The real message of the coming decision will be that an employer who chooses not to be active in the RTW process will be missing the greatest single cost containment tool they possess – the ability to assist (not necessarily guarantee) the effort to return the worker to a job.
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. medsearch7@optonline.net
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
The U.S. Department of Labor (DOL) is proposing revisions to child labor laws that will strengthen safety requirements for young workers in agriculture and related fields. The regulations that bar them from certain tasks under the Fair Labor Standards Act have not been updated since they were created in 1970.
According to a report from the DOL, the plan would strengthen current child labor regulations prohibiting agricultural work with animals and in pesticide handling, timber operations, manure pits, and storage bins. It would prohibit farm workers under 16 from participating in the cultivation, harvesting, and curing of tobacco. And it would ban youth in agricultural and nonagricultural employment from using electronic devices while operating power-driven equipment. (WCxKit)
The Department is also proposing to prevent children under 18 from storing, marketing, and transporting farm product raw materials. Prohibited places of employment would include grain elevators, grain bins, silos, stockyards, and livestock exchanges and auction. The revisions would prohibit farm workers under 16 from operating almost all power-driven equipment.
Noting the vulnerability of children working in agriculture Labor Secretary Hilda Solis stated, “Ensuring their welfare is a priority of the department, and this proposal is another element of our comprehensive approach.”
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
According to a recent survey from Littler Mendelson, P.C. (Littler), a nationwide employment and labor law firm representing management, companies are growing increasingly concerned regarding whistle-blowing activity.
An overwhelming majority of respondents (96%) reported they are either very concerned (27%) or moderately concerned (69%) regarding possible whistleblower claims and 73% identified whistleblowing and retaliation as emerging risk areas. (WCxKit)
Survey respondents seem to be anticipating growth in claims as the program develops and the SEC’s new Office of the Whistleblower, which opened its doors in August, continues to gather as many as 100 tips per day, according to SEC officials.
Although an already high percentage of respondents (45%) reported their companies experienced a whistleblower claim in the last 12-24 months, 67% anticipate whistleblower claims to gain steam within the next 12-24 months.
While companies see whistleblowing as a major risk that is likely to grow in the near-term, most of the respondents (65%) reported the companies are only moderately organized to handle whistleblower claims and only 54% were confident that executives in their organizations understand unlawful retaliation concepts and understand how not to engage in such conduct.
After expressing uncertainty as it relates to their current level of preparation, 84% of respondents indicated their companies have taken preventative steps to protect against unlawful retaliation claims and 59% are either undergoing training in the next year or plan to do so. (WCxKit)
Lastly, the survey also revealed concern among respondents that provisions within Dodd-Frank could undermine their present compliance programs. Just 12% reported this was not a concern, while 51% were concerned and 37% remain unclear as to what the impact will be.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contactInfo@ReduceYourWorkersComp.com.
The Federal Employees Compensation Act (FECA) covers 2.7 million federal employees and postal workers and paid out $1.9 billion in wage-loss compensation, impairment and death benefits and $898 million in medical and rehabilitation services and supplies during the 2010 charge back year, which ended June 30, 2010.
There have been no major revisions to the law since 1974. Currently there are two bills pending. Both would put in place a few significant changes. “The Federal Workers Compensation Modernization and Improvement Act” (HR 2465), was passed in the House and has been sent to the Senate Committee on Homeland Security and Government Affairs. Another proposal that originated in the Senate, “The 21st Century Postal Service Act of 2011” (S1789) has made it out of committee. Both include significant provisions related to FECA reform.(WCxKit)
THE 21ST CENTURY POSTAL SERVICE ACT OF 2011 (S 1789)
There are several provisions in the current version of the bill that would have a material impact on the claimants and the manner in which claims are managed. Section 302, Federal Workers Compensation Reforms for Retirement Age Employees, will reduce total available compensation rates and re-define coverage at and beyond retirement age. This particular provision would have a positive effect on cost as well as remove any notion that FECA is a retirement plan.
This legislation also includes provisions that are directly related to case management; one in particular supports increased involvement by the employing agency in managing its’ workers compensation claims. This provision requires an independent medical assessment of disability and potential for return to work for beneficiaries after six months of disability and on a regular basis thereafter.
Currently, federal agencies do not have the authority to schedule or direct the scheduling of independent medical evaluations. They can request that the Department of Labor set up an exam, but the final decision on whether and when to refer for an IME (independent medical evaluation) is in the hands of the claims examiner (DOL). In addition to requiring periodic scheduling of independent medical evaluations by the DOL, the current draft of the proposed legislation provides a mechanism for the employing agency to direct the scheduling of an IME, subject to review of the request by the Secretary of Labor.
The complementary piece of legislation that has passed the House is THE FEDERAL WORKERS COMPENSATION MODERNIZATION AND IMPROVEMENT ACT (HR 2465), which among other things would streamline the claims process for those workers who sustain a traumatic injury in a designated armed conflict zone, would permit physician assistants and nurse practitioners to certify disability for traumatic injuries and ensure that they are reimbursed for their services, and would allow the Department of Labor to verify federal employees salaries against social security administration data, all of which will modernize and streamline administration of FECA benefits.(WCxKit)
PRESCRIPTION OPIOID ABUSE
One significant industry-wide issue that is not explicit to either piece of proposed legislation is prescription opioid abuse. Prescription opioid abuse is being addressed in most workers compensation systems by establishing controls on prescribing with the help of Pharmacy Benefit Management (PBM) programs. In the federal workers compensation system, only the Department of Labor has the authority to adjudicate claims, including those for ancillary services, which limits the employing agency’s ability to control the inappropriate use of pharmaceuticals.
Although federal agencies can, and a few do, hire PBMs to help address the efficacy and cost of prescription drugs, neither the agency nor the PBM have the authority to place any limits on prescribers or fulfillment beyond those established by OWCP, which are extremely limited. It is hard to imagine how the federal workers compensation system, which provides workers compensation coverage for almost 3 million workers, is going to be able to handle the opioid epidemic without a significant change in policy related to the use of formularies and other preventive controls applied at both the benefit level and the point-of-sale.
Authors Lisa M. Firestone, MHSA and Marianne Cloeren, MD, MPH, FACOEM provide services at Managed Care Advisors, Inc. (MCA) an innovative, woman-owned business specializing in workers' compensation, employee health benefits, disability management consulting, and full service workers compensation case management. Based in Bethesda, Maryland, MCA services customers throughout the United States and U.S. Territories. Visit the MCA’s website www.MCACares.com.
Lisa M. Firestone, MHSA is the company’s president and owner and brings her 30 years plus experience to the healthcare industry. She is a recognized expert in the areas of employee benefit program development, evaluation, and strategic planning. She has been actively involved in the evolution of workers’ compensation case management and disability management programs, most recently focusing on the federal workers’ compensation and disability systems. She can be reached at lfirestone@managedcareadvisors.com.
Marianne Cloeren, MD, MPH, FACOEM Medical Director of MCA where she supports the company’s federal workers’ compensation case management services, oversees quality assurance, and develops educational offerings related to disability management and evaluation. Dr. Cloeren’s experience includes managing employee health in the Veterans Administration system, serving as medical director for several companies, and as an occupational medicine physician for the Army’s Center for Health Promotion and Preventive Medicine, where her focus was federal workers’ compensation case management. She can be reached at mcloeren@managedcareadvisors.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
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