The Best Tidbits of News From the Workers Comp Community

 

 News From Gould & Lamb

 
 
Now more than ever, a competent and comprehensive prescription drug management program is invaluable. With legislation in constant flux, "pill mills" and the current opioid crisis, you need the highest quality certified professionals to provide cost-savings solutions that take the beneficiary's best interests and care into account.  Read more…
 
 
 
Gould & Lamb is proud to announce its 2013 launch of the National Institute for Medicare & Medicaid Education (NIMME).  After an extremely successful Jackpot! Conference Series in 2012, which focused on the various aspects of Medicare Secondary Payer Compliance and Mandatory Insurer Reporting (MMSEA Section 111), we have expanded our program to become a self-standing educational entity.  Read more…
 
 
 
The National Institute for Medicare & Medicaid Education will be hosting the first of four Medicare Secondary Payer (MSP) Compliance conferences at Harrah's Resort in New Orleans, February 25th & 26th.
Building off the success of 2012's Jackpot! Conference Series,  NIMME will be raising the bar for education and resources in the MSP arena. With an extensive panel of faculty, these conferences will continue to be invaluable to any professionals dealing with MSP Compliance and MMSEA Section 111 Mandatory Insurer Reporting. Read more..
 
 
News From Lexis Nexis
 
 
"The astronomical benefits-related costs, protracted dispute resolution process, and numerous other ills associated with workers' compensation that have prompted reforms have also increased support for the "opt-out" movement. Opting out initially requires that a state enact a law that allows employers that would otherwise have to provide workers' compensation coverage to offer employees alternative forms of reimbursement for compensable harm. A study titled "Workers' Compensation Opt-Out: Can Privatization Work", of which Peter Rousmaniere is the primary researcher, comprehensively examines why some employers favor opting out over lobbying for reform." Read more
 
 
 
"On January 10, 2013, the White House announced that President Obama signed the Strengthening Medicare and Repaying Taxpayers Act (SMART Act) into law. Insurance organizations, including the American Insurance Association, hailed the SMART Act as facilitating property-casualty insurers’ compliance with Medicare Secondary Payer (MSP) Act Section 111 reporting." To read the bill,click here.  
 
 
 
“The Eighth Circuit Court of Appeals recently affirmed a criminal sentence on a defendant's guilty plea to wire fraud in connection with his scheme to reduce his company's workers' compensation premiums. The defendant had challenged the district court's "sophisticated means" and "leadership-role" enhancements under U.S. Sentencing Guidelines Manual §§ 2B1.1(b)(10)(C), 3B1.1(a), as well as the court's failure to vary downward, and its restitution award. Defendant admitted he had shifted payroll to less expensive job classifications over several years, and that he had also created shell corporations with unwitting or uninvolved individuals as ostensible "owners."" Read more…
 
 
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com
 
©2012 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

The Best Tidbits Of News From The Workers Comp Community

 

 
The United States House of Representatives today passed the Saving Medicare and Repaying Taxpayers (SMART) Act as part of a broader legislative effort. The SMART Bill was attached to House Bill 1845 Medicare IVIG Access Bill which provides for…Read More
 
 
 
Create a framework for your organization’s risk management program that aligns with its goals, sets roles and responsibilities for the team and provides communication strategies needed to report to senior management and other stakeholders.  Read more…
 
 
 
Broadspire, a Crawford Company (NYSE: CRDA; CRDB) and leading third-party administrator of workers compensation claims, liability claims and medical management services, announced today that it has been awarded continued accreditation for Case Management, Workers' Compensation Utilization Management, Health Utilization Management, and Independent Review Organization: Internal Review from URAC, a Washington, DC-based health care accrediting organization that establishes quality standards for the health care industry. Read more…
 
 
 
From now thru Dec 2012, if you buy either the 2012 RIMS Benchmark Survey Book or the 2012 Workers Compensation Management Program Book, we’ll send you a second copy at no charge.
The RIMS Benchmark Survey Book and our Workers Comp Cost Reduction Book are the most popular books that we offer, and we're trying to set a sales record in December.
Now thru December 31, 2012 order one copy of either of two books below and receive a second copy of that book for FREE.  Read more…
 
 
 
Tallahassee, FL (WorkersCompensation.com) – The Florida Legislature passed and Governor Rick Scott has signed into law CS/HB 941, which amends sections 440.02(9) and 440.05, Florida Statutes. Effective July 1, 2013, the law changes to include Limited Liability Company (LLC) members as employees.  Read more…
 
 
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com
 
 
©2012 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

The Best Tidbits of News From the Workers Comp Community

 

 
Gould & Lamb is pleased to announce the addition of Mark Masson  to the Executive Team as Chief Client Officer. In his role at Gould & Lamb, Mark will assume responsibility for our overall client interface with the marketplace through strategic management of our field sales operations, marketing, account management, lead development and specialty market initiatives. Read more…
 
 
 
Medcor offers unique, challenging, and rewarding career opportunities for medical professionals in non-traditional settings all across the country. Medcor clinics operate in facilities across a broad spectrum of industries, including major industrial, distribution, manufacturing, construction, entertainment, service, retail, and electronics businesses. Read more…
 
 
 
While many managed health care companies target the private market, Lisa M. Firestone’s has found its niche in the public sector.
 
Firestone, 53, has watched her company, Managed Care Advisors in Bethesda, grow from a two-person peer consulting business to a 37-employee workers’ compensation case management business that includes consulting. She is its founder, CEO and presidentRead more…
 
 
 
The average cost of a workers’ compensation claim in Indiana grew rapidly in recent years, mainly driven by the high price of medical care, according to a new study, Benchmarks for Indiana, CompScope™ 13th Edition, by the Workers Compensation Research Institute (WCRI). Read more.
 
 
 
After years of offshore production, General Electric is moving much of its far-flung appliance-manufacturing operations back home. It is not alone. An exploration of the startling, sustainable, just-getting-started return of industry to the United States. Read more…
 
 
Downs Stanford, P.C. is proud to announce that Austin attorney Stuart Colburn has recently co-authored the lauded Texas Workers’ Compensation 2013 Edition Handbook, published by LexisNexis.
 
 More than a year in the making, this handbook is specifically targeted to insurance professionals and attorneys and contains comprehensive information and practical tips to better educate you on how to handle a Worker’s Compensation case in Texas.
 
The book contains practical points and tips for handling Workers’ Compensation claims, statutes and regulations, case summaries and Appeals Panel decisions and is cross-referenced to Larson’s Workers’ Compensation Desk Edition, all written in a concise and easy-to-understand manner and precisely indexed for ease of use for the reader.  Learn how to get your copy.
 
 
 
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.
 
©2012 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

The Best Tidbits of News From the Workers Comp Community

 

 
Date: August 21, 2012
Time: 11:00 am CST
Duration: 1 hour
 
Employers often think that there is nothing that they can do to control workers’ compensation costs. Many times they don’t know where to start, don’t have the resources to get the job done, don’t have the time to do it themselves or don’t have the staff to support the cost-reduction efforts.  Register Here
 
 
 
The 67th Annual Workers’ Compensation Educational Conference and the 24th Annual Safety and Health Conference are just around the corner. Set for August 19 through 23, 2012 at the Orlando World Marriott, the conference will again focus on the national workers’ compensation and safety industries, serving… Read the Full Post »
 
 
 
Published in Business Insurance, Author Mark Walls, Safety National, mark.walls@safetynational.com
 
One of the biggest cost drivers in Workers Compensation is seemingly “average” claims that take a turn for the worst and result in several years of medical treatment and disability.   Mark Walls, vp of claims for Safety National Casualty Corp discusses the common threads of “creeping catastrophic” claims.  Read Full Article…
 
 
 
Posted by Marianne Cloeren, MD, MPH, FACOEM – Managed Care Advisors
 
The organization Physicians for Responsible Opioid Prescribing (PROP) filed a petition with the FDA to change the labeling for opioid analgesics so that it does not include use for chronic non-cancer pain. They make the excellent point that research is showing lack of effectiveness and high risk. 

Here is more information from the president of PROP, Dr. Andrew Kolodny about this effort:

"I’m writing in the hope that you’ll submit comments to FDA supporting the citizen petition for label changes on opioid analgesics. 

As you may have heard, a couple of weeks ago PROP filed this petition with FDA. This request has received support from members of Congress, including Rep. Mary Bono Mack and Hal Rogers, so we believe that FDA is paying close attention. 

Here’s the link where you can submit Comments:
 
 
 http://www.citizen.org/documents/2048.pdf 

And here’s a press release about the petition that was issued by Public Citizen:
 
 
If FDA implements our request, opioid manufacturers will be prohibited from promoting long-term use of opioids for chronic non-cancer pain and the medical community will be informed that this practice has not been proven safe and effective. We believe that this will help reduce overprescribing of opioids. And since it’s overprescribing that’s harming pain patients and fueling the opioid addiction epidemic, the label change could help bring this public health crisis under control
 
 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

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

 

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.

Workers Comp Tidbits of News You Can Use

 
Workers Comp this week provided a lot of fodder for discussion. Here’s a review:
 
Bison Jam Delays Dr. Glimp at Medcor
Remote medical support may hold down WC costs, but it does invite some interesting circumstances. In early May, Thomas Glimp, MD, Chief Medical Officer, at Medcor, was late to an important meeting due to a "bison jam" in Yellowstone National Park. Executive Vice President Curtis Smith said, "We were waiting for our Medcor doctor, Thomas Glimp, to join us on a conference call last week while he was doing some training at the three Medcor-run clinics in Yellowstone National Park… and he was a bit late…. BUT there was good reason… there was a "bison jam" and it's difficult to make a bison move faster.”
 
 
Glimp said, “I was trapped on the road in a ‘bison jam’ for 15 minutes. They’re often difficult to influence (not unlike physicians)!  There is little to no cell coverage in the park, so I needed a land line to call.”[WCx]
 
 
 
LexisNexis Examines Oklahoma Workers Comp Opt-Out, Benefits Review and More in WC World
The Workers Compensation Law Community Powered by Larsons on LexisNexis compiled a great newsletter evaluating the details of many current  WC cases this week. Sign up for their newsletter here and get all this and more in your inbox.
 
 
1. Robinson offers Post Mortem on OK Opt Out Legislation
Thomas A. Robinson writes here, the controversial bill that would have allowed some Oklahoma employers to “opt out” of the state’s traditional workers’ compensation system fell short of having sufficient votes to move legislation through. In his analysis, he says, “A number of the bill’s proponents were crowing about how its passage was a “done deal” and, buoyed on by the Oklahoma success, we’d see a wave of similar legislation in other states. So, we see the importance of counting our chicks only after they’ve hatched. Second, and more importantly, the bill provides us with a provocative example of how states are pulling out all the stops when it comes to attracting and keeping businesses within their borders.”
 
 
2. Koenig Offers Update From Benefits Review Board
Karen Koenig, associate general counsel of the Longshore Benefits Review Board at the U.S. Department of Labor writes here the Board received 201 appeals in cases under the Longshore Act, one more than the year before. In addition to summarizing these appeals, Koenig also includes developments from the DBA.
 
 
3. Larsons Spotlight Examines 4 Recent Cases:
Larson’s Spotlight looks at several important events this week, here.
1.In Maryland, Injuries Sustained While Returning From Physical Therapy Session to Treat the Effects of Earlier Work-Related Injury Are Not Necessarily Compensable.
2. From Iowa, Forty Years of Cigarette Smoking, Not Cold Conditions of the Employer's Meat Packing Facility Caused Claimant's COPD.
3. In Hawaii, Former Employee's Suit Against Co-Employees Related to Allegedly False Claims and Harassment Were Barred By Exclusivity-Claim for Wrongful Termination Not Barred.
4. From Colorado, Offset of Permanent Total Benefits With Old-Age Social Security Payments Was Appropriate.
 
 
5. WC Fraud Blotter Looks at Wrist Pain/Facebook Case, More
The blotter takes a look at a case where an employee claimed wrist pain stopped her from processing inmates’ mail and from typing at work, yet records showed frequent texts and Facebook updates. Read more about this case and five others here.

1. Letter Carrier Fraud, Delivering the Mail Goes To the Dogs.

2. Pasta Alert: The "Noodle" Pleads Not Guilty To Workers' Compensation Fraud .

3. Doctor Indicted For Overbilling Workers' Compensation Insurer Amusement Park Owner Admits to Workers' Compensation Fraud and Tax Evasion .

4. Disability Claimant Caught On Video Working While Collecting Benefits

5. Construction Business Owner Charged With Underreporting Payroll to Workers' Compensation Insurance Carrier.

 
 
6. Read about Delaware Decision on Course and Scope
Cassandra Roberts writes here in Have Crockpot Will Travel, “I had a fall of sorts at work a month ago and a recent MRI now shows fractures of the cuboid and the calcaneous. So, no stilettos for me.  And I have a work comp prescription card. Vicodin on someone else's dime. Pretty darn sweet. Accordingly, I now relate to the plight of the injured worker. And the case recently offered up by Henry Davis strikes close to home.  Which you will understand even more so when  you hear the facts of the case.”
 
 
7. No Benefits for Alleged Fume Exposure in Missouri
Martin Klug writes here about a case in which the claimant lost his claim against the second injury fund when he failed to prove an accident that his alleged exposure to muriatic acid fumes caused a heart attack. “The court rejected an argument that the commission must award benefits because the fund did not produce any evidence,” he writes.
 
 
8. Court Rules That State Bar’s Professional Liability Fund Is NOT Subject to MMSEA Reporting
Mark Popolizio, of the Crowe Paradis Services Corp. explains the case of Oregon State Bar Professional Liability Fund v. United States Department of Health and Human Services & Kathleen Sebelius, here. In the case, he writes, “The court … ruled that a legal malpractice policy, which did not provide coverage for bodily or emotional injuries, was not an ‘applicable plan’ subject to Medicare’s mandatory reporting requirements under the Medicare, Medicaid and SCHIP Extension Act of 2007.”
 
 
9. Law360 Looks at CA Facebook Privacy Laws
Erin Coe writes about a piece of legislation trying to “block California companies from making employees and future workers disclose their usernames and passwords for Facebook, Twitter and other personal social media accounts that gained unanimous approval Wednesday from a state Assembly panel,” here.
 
10. CA Department of Industrial Relations Small Business Portal Up and Running
Check out California’s new site for small businesses here. They explain “Small businesses are critical to California’s economic recovery and strength, to building America’s future, and to helping the United States compete in today’s global marketplace. Small businesses also represent 99.7 percent of all employer firms and they employ just over half of U.S. workers and pay 44 percent of total U.S. private payroll.”
 
 
11. TDI-DWC Gives Authorization to Certify Maximum Medical Improvement (MMI) and Assign an Impairment Rating
The Texas Department of Insurance Division of Workers’ Compensation reminds all workers’ compensation system participants that the Texas Labor Code and TDI-DWC rules impose certain requirements for a doctor to become authorized to certify maximum medical improvement (MMI) and assign impairment ratings for claims in the Texas workers’ compensation system. For more information, look here.
 
 
12. Oklahoma WCC Posts Proposed Change for Rule 23, Eye Impairment
Oklahoma has offered a proposed change for consideration by its supreme court following adoption by the WC court regarding definitions for what constitutes eye impairment.
 
 
WorkersCompensation.com Hosts Video Roundup
WorkersCompensation.com has started a weekly video roundup. Check it out here.
 
 
Gould and Lamb Hosting Two Training Sessions
At two casinos in Atlantic City and St. Louis, Gould & Lamb will offer what they call the most comprehensive WC, liability and risk management conferences to date. The sessions will have special focus on Medicare & Medicaid compliance. The Atlantic City conference will be at Bally’s June 18-9 and the St. Louis session will be at Harrah’s Aug. 6-7. For more information, look here.[WCx]
 
 
The “Jackpot” sessions are being billed, “Don't Gamble on Workers' Compensation, Liability & Medicare/Medicaid Compliance!  We have gathered together some of the industry's most respected leaders and experts to provide attendees with two full days of compliance education and training, as well as an exciting look into the future of Medicare/Medicaid Compliance.”   
 
 
Note: If your company has any developments you'd like to share, please send them to us at: RShafer@ReduceYourWorkersComp.com

 

 

 

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.

 

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their Workers Compensation costs by 20% – 50%.  He is a writer, speaker, and website publisher.  ContactMstack@ReduceYourWorkersComp.com

 

WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com
MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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.

5 Things Employers Must Know About Medicare Set-Aside Custodial Administration Arrangements

 
LowerWC.com interviewed Christie Luke, vice president of operations at Gould & Lamb, in Bradenton, FL about custodial administration arrangements for Medicare Set-Asides (MSAs). She started off  with the basics.
 
Define Medicare Set Aside
The Centers for Medicare/Medicaid Services (CMS) require their interests be protected prior to any settlement of the medical portion of a claim for qualified individuals. Medicare secondary payer laws are intended to prevent the shift of financial responsibility from primary payers to Medicare. The Medicare Set-Aside Agreement (MSA) allocates a portion of claims settlement for future medical expense, placed into custodial administration.
 
 
What is Custodial Administration?
Once a case is settled MSA funds are placed into custodial administration, or “handling,” into either the hands of the claimant (self administration) or with a custodian (professional administration) on the claimant’s behalf. This can include cases sent to CMS for approval, wherein the CMS approval indicates the intent of administration; or in cases where the client chose not to send to CMS but wants the case properly administered.(WCxKit)
 
 
Self Administration involves claimants’ handling their own money, with the intent to follow CMS’ guidelines.
 
Professional Administration involves a pre-designated custodian hired to administer MSA funds on the claimant's behalf. This usually occurs in larger settlements and/or those with severe injuries (e.g. traumatic brain injuries, paraplegics/quadriplegics).
 
 
Are there exceptions to those who need custodial arrangements?
There are no formal rules or regulations in most cases to those needing post-settlement administration. The exceptions are cases in which a court has deemed a person incompetent. In those cases the claimant is required to assign a custodian . In other cases, it is up to the settling parties how to proceed — this is driven by the risk of adversity to the carrier or self-insured employer.
 
 
What impact does it have on insured clients? Whom does it affect?
Post settlement administration programs can provide insured clients with comfort knowing they are providing claimants with post-settlement support. This ensures they are able to manage their Medicare Set Aside funds. In many of these cases, the parties are overwhelmed and, at times it may discourage them from entering into a settlement. Knowing these tools and resources are provided, reducing the potential negative actions by CMS and ensuring post-settlement compliance and risk mitigation is a benefit to all parties to settlement.
 
 
How should employers proceed when becoming aware of their obligations? How do they then set up an arrangement with a custodial administrator?
Once a carrier or self-insured employer has set standards with regard to their comfort level on post settlement administration, they can decide how to set processes and procedures. Generally, they should begin including information on the topic as soon as possible with the parties, at least during settlement discussions. This way, all of those involved are aware of available resources and costs, as well as the potential implications of non-compliance and the benefits of available programs.
 
During these discussions they can include administration companies. In order to ensure the administrator’s notifications to Medicare and to the claimant and their medical providers is seamless before and after settlement, they can check to be sure all information is accurate and the program is administered in a timely manner.(WCxKit)
 
 
Why is it better, more cost effective, etc., to use a formal administration company?
The administration of an MSA is quite challenging. It requires in-depth knowledge of Medicare policy, individual state fee schedules, and an understanding of Medicare coverage application and claim related care. Without this detailed knowledge, it is very easy to improperly disperse funds from an MSA or pay amounts above fee schedules, risking future Medicare benefits and entitlement.

Thank you, Christie for your time filling us in on this very important topic that all employers need to be aware of.
 
 
Author Christie Luke of Gould and Lamb has worked for nearly a decade in claims management, followed by over five years in all aspects of MSP compliance. She has an undergraduate degree in business and an MBA focusing in Healthcare Administration, Quality Management, and Economics. She is MSCC certified and is currently earning her Green Belt certification in Six Sigma. She is also a member of NAMSAP. Contact Christie at 941-798-2098, Ext.1314; or email: Christie.Luke@gouldandlamb.com.   GOULD And LAMB BLOG
 
 
 
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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