Combatting the Evils of Opioid Addiction And More News Tidbits

Businesswoman Lisa Firestone is a meticulous planner. When she approached her partners at an employee benefits consulting firm 15 years ago with a buyout offer in hand, she had a resignation letter in the other hand and four months of legal and financial strategizing behind her. Read more…
 
The light bulb has switched on for some organizations: risk management isn’t always done by someone with the title “risk manager.” The days of only hiring those with deep insurance, finance and compliance backgrounds are over — or at least they should be. Read more…
 
News From LexisNexis:
"The numerous ills associated with workers' compensation claimants abusing prescribed opioids is a perfect example of medical care professionals acting in haste in a manner that results in claimants and workers' compensation insurers repenting at leisure. High drug costs are a near certainty; addiction and a fatal overdose are additional significant risks." Read more…
 
“Wholesale pharmacies who contract with physicians to provide pharmaceuticals to them on a consignment basis for dispensing to their workers compensation patients, cannot seek payment for the pharmaceuticals directly from the employer/insurer underRebel Distributors Corp., Inc. d/b/a Physician Partner and Pharmacy Partner v. LUBA Workers' Comp., released by the Louisiana 3rd Circuit court of appeal on March 6, 2013.” Read more.
 
“The Los Angeles Times reports that drug manufacturers charge "wildly different prices for essentially the same generic medicine." Moreover, the average wholesale prices (AWP) are as "made up as the prices that come out of hospitals". Drugstores don't pay AWP for medicine, but rather negotiate "sweetheart deals" with drug manufacturers based on the volume of medicine retailed to customers. Pharmacies are not required to provide full disclosure to customers as to the prices for the same generics. Pharmacies are making more money on generics than name brands, and it's not to their advantage to help customers make informed decisions.” Read it
 
“Citing Larson's Workers' Compensation Law, the Court of Appeals of Oregon recently affirmed a finding that the subject truck drivers were employees of a frozen meat distributorship in spite of characterization within the contractor agreement's that the drivers were independent contractors. While the characterization carried some weight, there was direct evidence of the purported employer's right to control, and exercise of control over, the methods and details of the drivers' work. The court indicated that here the drivers provided their services; the distributor provided everything else. Read more about this case and other cases on Altercation, Substantial Deviation, and Abandonment of Employment.”
 

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.

 

©2013 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

 

 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.

Workers Compensation This Week In Review

LexisNexis Communities Highlights Hot Topics WC In Reviewpic3

The Workers Compensation Law Community Powered by Larsons on LexisNexis offers an interesting look at WC this week:

 

 

Ronald E. Weiss and Ronald Balter analyze in “New York Workers’ Comp Stakeholders Continue to Absorb 2007 Reform Changes,” found here, “During the past year, stakeholders in the workers’ compensation system in New York have continued to absorb legislative and administrative changes initiated by the 2007 reform. Maximum indemnity rates are now indexed to two-thirds of the State Average Weekly Wage.”

 

 

The Law Community also takes a look at the Workers Compensation Board policy on firearms here by examining what the policy is, how it affects law enforcement and what notification rules are.

 

 

They also take an insightful look into a Florida pizza delivery man who was fired after being robbed. See complete article here. Reporter Michael Miller notes the man is suing Domino’s, his former employer, “claiming (they) cruelly denied him workers’ compensation for his injuries from that night and then unlawfully fired him.”

 

 

In the Pittsburg Post-Gazette, writer Gina Passarell comments on how the Steelers football team does not have to pay attorney fees in a workers’ comp case. The incident (see full story here) is related to a former player’s WC case in which he suffered injuries while with the team. “The team argued he was not ‘disabled’ since he went on to play for other pro teams, the Commonwealth Court has ruled,” Passarell wrote. “Pennsylvania law automatically provides attorney fees to prevailing claimants when employers contest a claim for workers’ compensation benefits, unless that protest is ‘reasonable.’ “

 

 

Working Immigrants Blog Looks at Pew Study

Working Immigrants, a weblog about the business of immigrant work: employment, compensation, legal protections, education, mobility, and public policy writes this week that net migration from Mexico fell to zero.

 

 

“According to a report by the Pew Hispanic Center, ‘The largest wave of immigration in history from a single country to the United States has come to a standstill. After four decades that brought 12 million current immigrants—more than half of whom came illegally—the net migration flow from Mexico to the United States has stopped—and may have reversed, according to a new analysis by the Pew Hispanic Center of multiple government data sets from both countries.’ “The blog takes a deeper look into this study here.

 

 

TDI-DWC Approves 7 Companies to Self-Insure for Workers’ Compensation Claims

According to Stuart Colburn, shareholder in Downs Stanford, P.C. , the Texas Department of Insurance, Division Workers’ Compensation reports here The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) approved seven renewals of the Certificates of Authority for companies to self-insure their workers’ compensation claims for a one-year period under the TDI-DWC Self-Insurance Program. These companies collectively employ approximately 27,900 employees in Texas.

 

 

The report notes, “Under Texas law, certain large, private companies can self-insure for workers’ compensation claims, while retaining the protection of the Texas Workers’ Compensation Act for the company and for its employees. To qualify, a company must have a minimum workers’ compensation insurance unmodified manual premium of $500,000 and meet other requirements subject to annual review.”

 

 

Capital Community College Offers Live Classes in Risk Management

Capital Community College of Hartford, CT is now offering these live instruction classes in ARM:

 

ARM 54: Risk Assessment (PRFD 5359-2176)

Tuesdays/Thursdays from 5 PM – 9 PM

May 8 – June 14, 2012

$699 plus textbook

 

ARM 55: Risk Control (PRFD 5360-2177)

Tuesdays/Thursdays from 5 PM – 9 PM

June 19 – August 2 (excluding July 3 & July 5)

$699 plus textbook

 

ARM 56: Risk Financing (PRFD 5395-3602)

Tuesdays/Thursdays from 5 PM – 9 PM

September 25 – Nov. 1

$699 plus textbook

 

To register by phone, call (860) 906-5130. Contact Carol Vassar-Pettit with questions, cpettit@ccc.commnet.edu.

 

 

Advisen’s Casualty Insights Conference Coming May 1

Register here for keynote speakers, Allied World’s Lou Iglesias, Navigators’ Stan Galanski, and Arch’s Mark Lyons and an all-star Risk Manager panel.

 

 

The casualty conference at the McGraw Hill Conference Center is free for risk managers and insurance buyers; Advisen Clients are $395; general registration is $495. Further, eight CE credits are available for $125.

 

 

Other speakers include: Mitchell J. Auslander of Willkie Farr & Gallagher, Alfred Bergbauer of Marsh and Carmelite Bertaut of Stone Pigman Walther Wittmann LLC

 

 

Broadspire Promotes Erica Fichter to Senior Vice President of Medical Management

Broadspire, a TPA WC claims administrator and medical management service provider, has named Erica Fichter to senior vice president of medical management services.

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Fichter will oversee a staff of more than 500 clinical professionals and support personnel located throughout the United States. Broadspire has the fifth largest medical management company in the country, with integrated services including: medical bill review, field and telephonic case management, utilization review, physician review, the BOLD® Network preferred provider offering and chronic pain management. “With this array of services, Broadspire’s cost containment results are typically 10 to 15 percent better than those produced by other TPAs and managed care companies,” they claim.

 

 

Note: If your company has any developments you’d like to share, please send them to us at: mbstack@gmail.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.

 
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.

 

Medical Treasure Trove for the Workers Comp Professional: Occupational Injuries and Illnesses

Written by medical experts for risk managers, agents and brokers, and legal practitionersOccupational Injuries and Illnesses is a goldmine of medical data especially designed for the workers’ comp professional. A leading resource for more than 20 years, this LexisNexis/Matthew Bender publication covers every major type of occupational injury and illness.

The book provides important information including

  •     tracks developments on methods of prevention and loss control in the work setting
  •     provides medical analysis to assess, manage and develop risk and litigation strategies for workers’ compensation claims

 

Well organized and easy-to-follow, each chapter explains the factors that contribute to work-related injuries or illnesses and highlights state-of-the-art technical data required to prove whether an injury or illness is job-related. Rounding out the offerings are helpful practice aids such as medical illustrations, and case annotations.

 

“As a workers’ comp attorney who trains work comp managers and risk managers, this is a fantastic training tool that can be used in self-evaluation exercises. It is an excellent replacement for an out of print disability duration guide used in the past to teach new work comp managers how to locate and use relevant information such as causation and possible medical complications. Within each chapter organized by injury type, there is discussion of state case law. Work comp adjusters will find this helpful to determine how pre-existing conditions affect case outcomes in various jurisdictions. It’s hard to imagine a workers comp attorney – either defense or claimant – that doesn’t keep this book nearby! ”

 

The October, 2011 edition has an updated key chapter on Risk Assessment in the Workplace that pays special attention to lead standards, cadmium contamination, and the growing risk of transmitting HBV.  Additional updates cover the ever-shifting spectrum in revised chapters on Low Back Injuries, Spinal Cord and Nerve Root Injuries, Heart Disease, and Acquired Immunodeficiency Syndrome (AIDS), which reflects advances in the diagnosis, treatment and transmission of this formerly fatal and now chronic disease. Available in e-book format for e-readers and tablets, on-the-go professionals can now bring this entire three-volume set with them as a handy field or courtroom reference.

 

 

 

Coverage of the AMA Guides in the 2011 edition is particularly helpful to the workers’ comp professional that must be well versed in medico-legal complexities. Occupational Injuries and Illnesses includes an AMA Guides Handbook that has been updated throughout to include the most recent noteworthy cases interpreting the industry’s bedrock of impairment evaluation, arranged by jurisdiction. There is also a new chapter that discusses Illinois’s adoption of the AMA Guides Sixth Edition in the wake of that state’s recent workers’ comp reforms, an updated graphic displaying state-by-state use of the AMA Guides, an overhauled chart listing significant issues relating to the AMA Guides with supporting citations, and links to FREE online information available from LexisNexis Impairment Guides Resource Center.

 

 

And that is not all. New case annotations were added throughout the new edition, which summarize the most recent medical and legal  issues relating to the Head and Neck, Toxic Neuropathy, Cerebral Deficit, Radiation Exposure, Carbon Monoxide Poisoning, the Spine, Chronic Pain, and Mesothelioma.

 

 

For a broad overview or a drill down into specifics, this book is the go-to medical information resource for the workers’ comp laypersonOrder your copy of the 2011 Edition today.

 
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.

 

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