Industry Leaders Discuss Challenges at Broadspires First Pharmacy Summit

April 5, 2012 by Leave a Comment

 

pictu1Medications and drugs continue to play an increasingly important role in the overall of medical costs in workers compensation claims. In addition to the increases in costs, the potential claim risks have also increased surrounding the growing use of narcotics in the treatment of pain. These issues impact all involved parties in the claim administration process – from injured worker, to employer, to carrier or payer. How to manage these issues has now become a critical issue.
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On March 22, 2012, Broadspire, a Crawford Company and leading third party administrator (TPA) and medical management services provider, brought together representatives from a number of key industry organizations to discuss the challenges in prescription drug management for workers compensation claims during its first pharmacy summit.

 

 

 

pictu2

The intention of the summit was to focus on global industry issues, trends and developments in the future. In bringing together resources from all aspects of the pharmacy management process, the group was able to have an all encompassing discussion of the issue, and examine the challenges from all perspectives and vantage points. Throughout the day, the group discussed the common threads that tie together claimant, payer, employer and carrier interests. The group also shared ideas that could be put into practice to improve outcomes for everyone concerned.

 

 

 

 

More than 50 brokers, practice leaders, clinicians and others from major insurers, insurance brokerage firms and pharmacy benefit management (PBM) organizations attended the summit, which was held at Broadspire’s Sunrise, Fla., medical management headquarters. The panels were divided into four key areas of focus

 

  1. Pharmacy program design
  2. Opioids and controlled substances
  3. Physician dispensing
  4. Key legislative updates.

 

 

 

pictu3The first session focused on the overall design of an effective pharmacy program. Panelists in the discussion included Eileen Ramallo, Executive Vice President of Healthcare Solutions; Lori Daugherty, President of PMSI/Tmesys; Atermis Emslie, President of MyMatrixx; and Kathy Tiemeier, Clinical Program Manager of Express Scripts.

 

 

 

 

 

 

pictu4Candy Raphan, RN, BSN, ARNP, MAOM Candy joined Broadspire in 1989.  For over 20 years, she has held various management roles within the Broadspire organization in a variety of functional areas, including Occupational and Non-occupational Disability Management, Utilization Management, Medical Bill Review, Quality, and Medical Management Strategic Outcomes.  In her current role as Director of Medical Services, Candy is a Practice Leader for Broadspire’s Comprehensive Pain Management Solution and responsible for the clinical components of the pharmacy program, medical analytics, reporting and other clinical program development.

 

 


In addition to her experience at Broadspire, Candy brings a varied background of clinical, managed care and health industry related experience.  She is a certified advanced registered nurse practitioner with a specialty in family practice, Candy holds a bachelor’s degree and advanced practice certificates in nursing from the University of Miami and a master’s degree in organizational management from the University of Phoenix.  Candy is also a member of the National Association of Professional Women and the American College of Healthcare Executives.

End Article
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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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Filed Under: Broker Issues & Relationships, Medical Cost Containment, Professional Development Issues, Seminars and Courses, TPA and Claims Administration Tagged With: , , , , ,

Lisenbey Takes over As CEO at Broadspire

March 25, 2012 by Leave a Comment
Congratulations to Danielle Lisenbey who has taken over as CEO of Broadspire, an international TPA well-regarded as one of the best in the industry. Selected as a Lexis Nexis Notable Person of the year in 2010 (see story here), she moves to the role from COO for Medical Services where she was responsible for the operation of all of Broadspire’s medical and case management services. “In this position, she drove the continued development and delivery of products and services that have generated cost containment results typically 10 to 15 percent better than those produced by other TPAs and medical management companies,” the company writes of her.



Lisenbey oversaw the development of the BOLD® Network, a state-stratified, multi-tiered approach to a preferred provider organization (PPO) strategy; a durable medical equipment (DME) formulary that applies the cost management principles of a pharmacy formulary to medical equipment; and a new chronic pain protocol, a multidisciplinary approach to addressing the complex chronic pain conditions that drive the duration of workers compensation and disability claims.[WCx]

 


She became chief executive officer of Broadspire in 2012. Immediately prior to this role, she was chief operating officer for Medical Services, responsible for the operation of all of Broadspire’s medical and case management services. In this position, she drove the continued development and delivery of products and services that have generated cost containment results typically 10 to 15 percent better than those produced by other TPAs and medical management companies.
 
 

In 2011, Broadspire’s case management services were recognized nationally with publisher Dorland Health’s Silver Crown award for innovative services to the mature case management market and the Platinum Award for overall case management services. Lisenbey was named a Workers’ Compensation Notable Person by the LexisNexis Workers’ Compensation Law Community for 2010.

 
Lisenbey’s career with Broadspire and its predecessor companies began in 1991 as an operations supervisor for the medical bill review unit. She was named vice president of medical bill review operations in 2006 and promoted to chief operating officer for Medical Services one year later.

 

She holds a bachelor’s degree in industrial engineering and technology from Western Illinois University. She is a member of The Society of Manufacturing Engineers and The National Association of Women Executives.

 

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WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com
VIEW SAMPLES PAGES
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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Filed Under: Medical Cost Containment, Professional Development Issues, TPA and Claims Administration Tagged With: ,

Robinson Reviews U.S. Supreme Court Case Roberts v. Sea-Land Services and other Work Comp Happenings

March 19, 2012 by Leave a Comment
 
LexisNexis Communities Offers This Week WC In Review
The Workers Compensation Law Community Powered by Larsons on LexisNexis offers three great pieces this week:
 
 
Jon Robinson asks if the Longshore Act was newly awarded, newly entitled or newly paid. In an insightful entry found here. Robinson details aspects of the Supreme Court of the United States Roberts v. Sea-Land Services, Inc., case addressing Section 906 of the Longshore and Harbor Worker’s Compensation Act.[WCx]
 
 
Mark Popolizio, writes an entry titled Court Dismisses Suit Seeking to Hold Carrier Liable for Reimbursing Medicare Payments, which is found here. His summary states, “In this case, Medicare paid for two lumbar surgeries during a period in which the carrier had denied medical benefits. The parties subsequently entered into an Agreed Judgment in state court through which it was established that the condition requiring back surgery was, in fact, related to the claimant’s work accident. While the carrier accepted compensability of the claimant’s injury, this agreement did not liquidate damages or require that the carrier make any specific payments.”
 
 
The community also reviews recent cases including one in which an injured HVAC worker established “odd lot” status. The blog observes, “Under the ‘odd lot’ doctrine … a claimant who is not actually permanently totally disabled is nevertheless eligible for permanent total disability benefits if his or her disability, combined with other factors, such as lack of education or transferable skills, lack of broad-based employment experience, age, etc., make the worker de facto unemployable.” This article, found here also includes:
 
1.Unless Specifically Stipulated, Causation is Always An Issue
2. Irrigation "Mechanic" is Nevertheless a "Farm Laborer" For Purposes of Agricultural Exclusion From Workers' Compensation
3. "Member" of Limited Liability Company Is Not Immune Under Exclusive Remedy Provisions of Workers' Comp Act
 
 
In Touch Awards Gala Thursday, March 29
The In Touch Gala of workers compensation professionals in Florida will be 7 p.m. March 29 in the Floridian Ballroom in Pembroke Pines, Fla. Gina Jacobs will present awards year, and Florida Senator and Chairman of the Healthcare Regulations Committee Rene Garcia will be guest speaker, representing Hurley, Rogner, Miller,Cox, Waranch & Westcott, P.A. Admission is free for claims adjusters, and other insurance professionals. Email your response to Melissa@myomservices.com. Attorneys and other vendors may contact Melissa Lopez at (866) 640-4060. More information on the In Touch with Today`s work Comp Professionals Online Community can be found here.
 
 
WCRI to Participate in Rx Drug Abuse Summit
Dr. Richard Victor, executive director of WCRI (Workers Compensation Research Institute) has been asked to join policymakers and stakeholders at the National Rx Drug Abuse Summit April 10-12. The event, hosted by Operation UNITE, includes the U.S. Surgeon General, the director of the White House Office of National Drug Control Policy, and others.[WCx]
 
 
For more information, read the complete release here where Victor notes, “The research WCRI has done on prescription medications in the treatment of injured workers shows us that many physicians are not following recommended guidelines to monitor use, abuse, and diversion. The result is wide variation in the length of narcotics use by injured workers across different states. For example, in Louisiana one out of six injured workers who were given narcotics initially still received three or more narcotics prescriptions six months after the injury. In the typical state, the figure was one out of 20.” For more information about the Summit, visit here.
 
Prescription Drug Summitt: These issues are also being addressed by a group of senior industry executives and thought leaders on March 22 at Broadspire in Sunrise, FL. For information, click here.

 

 

 

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

VIEW SAMPLES PAGES

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.

Filed Under: Professional Development Issues Tagged With: , , , ,

Broadspire Drug Abuse Summit and Other News from the Workers Comp Community

March 10, 2012 by Leave a Comment
 
Broadspire Rx Summit
Danielle Lisenbey, chief operating officer for the Medical Management Services of Broadspire announced its first annual Rx Summit in Sunrise, FL March 22. As a leader in the industry, Broadspire's first Pharmacy Issues Summit should prove to be helpful. They write, “The purpose of the meeting will be to bring thought leaders from various organizations together to discuss relevant topics and issues surrounding pharmacy benefits in the workers compensation setting.

The intent is not to share the specifics of what various companies are doing, but rather to focus on the global industry issues themselves and what may be the possible trends and developments for the future. One key objective of the program will be to help to identify and define common threads that run through all components of the industry – across claimants, payors, employers and carriers.

Defining some of these commonalities will help the consumer to maneuver through the market. Each participant is invited to bring one operations executive and one clinical representative. This will be an opportunity to brainstorm and share ideas amongst industry peers that can help to influence positive impacts for all.”[WCx]

 
 
Email Mjaynes@choosebroadspire.com by March 15, 2012 for more information. The Summit is by invitation only.
 
 
Everything Business Corp! Magazine Tells how to Fuse Workplace Wellness Programs With Recovery
An article by Lisa Firestone addresses the way employers are continuing to struggle with a challenging economy. “Maximizing efficiency and productivity is no longer a goal to strive for, it is essential for continued growth and even survival,” she writes. “Recognizing this dynamic, it is not surprising that more and more employers are actively engaging in worksite wellness programs that have proven to be effective in lowering health care costs – in fact, according to American Journal of Health Promotion every $1 invested in a corporate wellness program returns $4 in reduced health care costs and $5 in reduced absenteeism over a period of three to five years.”
To read more on this topic, look here.
 
 
LexisNexis Communities Highlights Weekly WC Hot Stories
The Workers Compensation Law Community Powered by Larsons on LexisNexis offers this week three fascinating news articles:
 
1. The Defense of Intentional Self-Injury: Russian Roulette, Workplace Frustration, Accidental Drug Overdose, and More reviews Rashness Versus Intention in Self-Injury Cases, Impulsiveness Versus Intention in Self-Injury Cases and Suicide Test as Test for Self-Injury. It can be found here.
 
 
2. LHWCA: Responsible Employer Determination in Cases Involving Multiple Traumatic Injuries: Seeking Analytical Clarity is a thorough look at the same using relevant precedent, post-Albina board decisions, burden of proof; aggravation vs. natural progression: identifying the cause(s) of disability and sequential vs. simultaneous consideration of evidence. It can be found here.
 
 
3. Larson’s Spotlight on Recent Cases: Firefighter’s Rule Did Not Bar Tort Action against Homeowner examines the firefighters’ rule, an important exception to the usual third-party liability rules in which a firefighter (or other first responder) may not recover in tort from a landowner or occupier who has been negligent in starting or failing to curtail a fire. Read more here.
 
 
LexisNexis Editor Featured in Risk Management Magazine
Thomas A. Robinson, a contributing author and editor of LexisNexis resources including Larson's Workers Compensation Law and Workers Compensation: The Survival Guide for Business, wrote a fascinating article that was recently featured in the well-known RIMS magazine. Also a member of the LexisNexis National Workers Compensation Advisory Board, Robinson writes about 10 bizarre WC case that ended unexpectedly here.
 
The article is a great read and includes juicy stories such as what the courts decided when an obese employee broke a leg trying to get unstuck from a cafeteria booth, whether a construction worker who lost an eye trying to sledgehammer a found bowling ball on site and whether a fatal heart attack while holding a termination letter is still covered.
 
 
For more like it, sign up for the free weekly enewsletters in national and California editions by Robin Kobayashi here.
 
 
Need More, Faster WC Info? We have the Newsletter for You
Check out this LexisNexis newsletter that can keep you on top of what’s happening in our industry. Learn more here and sign up here.
 
 
Texas Department of Insurance Changes Pay Advance Form
The Texas Department of Insurance Division of Workers’ Compensation recently changed the form injured employees use to request pay advances on their WC settlement checks. The form, DWC Form-047, Employee’s Request for Advance of Benefits, and the DWC Form-053, Employee Request to Change Treating Doctor is for an injured employee to request an advance of his/her workers’ compensation income benefits. The DWC Form-053 is for an injured employee who is not part of a certified workers’ compensation health care network, and whose claim does not involve medical benefits provided through a political subdivision pursuant to §504.053(b)(2) of the Texas Labor Code, to request a change of treating doctor.[WCx]
 
 
Workers’ compensation system participants should use the revised DWC Form-047 or DWC Form-053 on and after March 7, 2012. Previous versions of the form will no longer be accepted after June 1, 2012. For more information, check here.

 

 

 

 

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

VIEW SAMPLES PAGES

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.

Filed Under: Implementation and Rolling Out Your Program, Legal Doctrines, Management Commitment, Professional Development Issues Tagged With: , , , , , , ,

Vermont Proposes Radical Approach to Workers Compensation and other News

March 5, 2012 by Leave a Comment
 
Vermont H 762 — a radical approach to workers compensation in Vermont
Noted WC writer Peter Rousmaniere writes that Vermont is set to pass a radical approach to dealing with the independent contractor problem in workers comp. “The problem is this: many businesses in the past, across the country, have chosen to define their workers as independent contractors, thereby saving themselves serious money in workers comp insurance, unemployment compensation insurance, and other benefits mandatory or voluntary, and leaving their workers exposed to the elements .(There are also other state labor protections that come to play),” he says.[WCx]
 
 
“The house bill 762 has a provision expressly designed to let workers define themselves as independent contractors!” he notes. “The intent comes out in the hearings: to let employers such as contractors hire them without having to worry about the risk of the engagement being seen as employment — even if the engagement looks, talks and walks like employment.”
 
 
Volume Three of the LexisNexis eNewsletter Available
Follow this link to see a summary of state and world news in the WC industry. This edition includes information on North Carolina’s reforms, Retaliatory Discharge and an experts year-in-review among many other “goodies.” Check it out!
 
 
Broadspire Holds First Annual Rx Summit
Danielle Lisenbey, chief operating officer for the Medical Management Services of Broadspire announced its first annual Rx Summit here in Sunrise March 22. As a leader in the industry, Broadspire first Pharmacy Issues Summit should prove to be helpful. They write, “The purpose of the meeting is to bring thought leaders from various organizations together to discuss relevant topics and issues surrounding pharmacy benefits in the workers compensation setting. The intent is not to share the specifics of what various companies are doing, but rather to focus on the global industry issues themselves and what may be the possible trends and developments for the future. One key objective of the program will be to help to identify and define common threads that run through all components of the industry – across claimants, payors, employers and carriers. Defining some of these commonalities will help the consumer to maneuver through the market. This will be an opportunity to brainstorm and share ideas amongst industry peers that can help to influence positive impacts for all.”
 
 
Email Mjaynes@choosebroadspire.com by March 15, 2012 for more information. The Summit is by invitation only.
 
 
TDI-DWC Launches Redesign of Homepage on the TDI Website
Texas Department of Insurance, Division of Workers' Compensation changed its site this week. The redesign of its homepage on the TDI website at http://www.tdi.texas.gov/wc/indexwc.html.
 
 
“In an effort to make online resources for workers’ compensation system participants more user friendly, the TDI-DWC homepage redesign features a new tab style menu with three sections to assist system participants in accessing workers’ compensation information. Topics A-Z features an alphabetical listing of workers’ compensation-related subject matter that directly links to website content. Online Services features direct links to services, including: safety violation reporting, employer coverage verification and attorney fee processing.
Resources features direct links to resources, including the Texas Labor Code, TDI-DWC rules, calendar of events and training and TDI-DWC forms,” they write.
 
 
There are many other helpful changes. Go take a look!
 
 
WCRI Releases Study of WC Laws
The Workers Compensation Research Institute (WCRI) and the International Association of Accident Boards and Commissions (IAIABC) just released a joint study, Workers’ Compensation Laws as of January 2012.
 
 
This tool allows users to compare WC system laws across U.S. and Canada. More information is available here.
 
 
WCRI calls it, “An essential tool for researching and understanding the distinctions among workers’ compensation laws in all U.S. states and certain Canadian provinces.”
 
 
LRP Publications Announces New EEO/Federal Manager Book
To prevent age discrimination and sexual harassment complaints, managers need guidance. EEO complaints can be avoided.
 
 
This new guide is updated with changes in the ADA and the Genetic Information Nondiscrimination Act. Follow this link to learn more: EEO and Federal Managers: Following the Principles, Avoiding Complaints. The book could be handed out to all managers to get everyone up to speed on their EEO responsibilities.
 
 
Chapters include:
EEO Responsibilities
Sex Discrimination and Sexual Harassment
Race and Color Discrimination
National Origin Discrimination
Age Discrimination
Religious Discrimination and Accommodation
Disability Discrimination and Accommodation
Toward a Diverse Federal Workplace
 
 
Early MRIs Impact Outcomes Workshop March 14
Liberty Mutual Insurance knows that while MRIs are commonly used in workers compensation claims, their findings may or may not always be related to workplace injury. To this end, they are hosting a workshop March 14. More information is available here.
 
 
Among the topics to be discussed will be the results from a Liberty Mutual Research Institute for Safety study on the early use of MRIs as they relate to claims outcomes, case studies from the field and best practices around the use of MRIs.[WCx]
 
 
The company recommends people with claims, loss control, risk consulting, or managed care responsibilities should attend as well as risk managers interested in the latest issues and research associated with MRIs and claims outcomes.

 

 

 

 

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

VIEW SAMPLES PAGES

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.

Filed Under: Professional Development Issues Tagged With: , , , , , , , , , , , , ,

OSHA Extends Temporary Enforcement Actions in Residential Construction

February 27, 2012 by Leave a Comment

The Occupational Safety and Health Administration (OSHA) recently reported it will extend for six months its temporary enforcement measures in residential construction.

 

The measures, extended through Sept. 15, include priority, free on-site compliance assistance, penalty reductions, extended abatement dates, measures to ensure consistency and increased outreach. Fatalities from falls are the No. 1 cause of workplace death in construction.

The National Roofing Contractors Association (NRCA) previously had voiced its opposition to OSHA's regulatory directive, believing it will hinder rather than improve workplace safety and make it more difficult for roofing contractors to operate their businesses.


 
NRCA also had urged OSHA officials to delay enforcement of the directive indefinitely while it works with the roofing industry to resolve roofing contractors' many concerns. To view a Special Report regarding NRCA's opposition to the directive, visit http://tinyurl.com/6qdeoav.


During the past year, OSHA has conducted more than 1,000 outreach sessions across the U.S. to help employers comply with the new directive. OSHA will continue to work with employers to ensure a clear understanding of the new policy and facilitate compliance. [WCx]


A variety of educational and training materials to help employers with compliance can be found at www.osha.gov.


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. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.

 

 



WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

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.

Filed Under: Professional Development Issues, Safety and Loss Control Tagged With: , ,

Workers Compensation News in Brief for February 2012

February 26, 2012 by Leave a Comment
How Can You Find Quality Providers?
According to a recent MedMetrics blog, finding quality providers in your data has never been easier. See the complete blog here.
 
 
Author Karen Wolfe explains in the blog there are several steps, including:
1. Identify and avoid the poorly performing doctors
2. Having good data.
3. Keeping a historic perspective.
4. Provider performance evaluation is essential.
5. Defining good data.
 
6 Record proliferation.
7. Data entry procedures.
8. Provider performance suite.
 
 
To learn more, visit MedMetrics and to learn how, contact KarenWolfe@MedMetrics.org
 

The Texas Department of Insurance Offers New Rulebook
Texas Department of Insurance, Division of Workers’ Compensation just supplemented its Rulebook for 2012-02. It is now available online for amendments and new rules to 28 TAC chapter 180 regarding the monitoring and enforcement authority of the division of workers’ compensation.
 
 
The supplement can be printed from the TDI website here.
 
16th Annual Texas Safety Summit for Employers and Employees April 10-12 in Austin
The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) will host the 16th Annual Workplace Safety Conference, the Texas Safety Summit, on April 10-12, 2012 in Austin at the Doubletree Hotel Austin, 6505 IH-35 North. The TDI-DWC is hosting the conference to help all employers reduce injuries and their associated costs through workplace safety and return-to-work programs, whether or not they subscribe to workers’ compensation insurance.
A pre-conference session entitled Workers' Compensation 101 and Return to Work will be offered from 1 p.m. to 4 p.m. on April 10.
 
 
Conference general sessions include Technology in Collision Reconstruction presented by Clifford McCarter of Rimkus Consulting Group; Occupational Safety and Health Administration (OSHA) Region VI Update presented by John Hermanson, Regional Administrator of OSHA, Region VI; Generational Issues in the Workplace presented by Dr. Richard Lewis of Round Top Consulting Associates; and Personal Fitness for Work presented by Petti Redding of the Redding Group.
 
 
In addition, over 20 breakout sessions are planned to address pertinent issues facing Texas workplaces, including:
Accident/Incident Investigation;
Asbestos Awareness;
Combustible Dust/Respirable Dust;
Components of Effective Safety Programs;
Drug and Alcohol Awareness for Employees;
Effective Safety Committees;
Fatal Driving Distractions;
Federal and State Reporting Requirements;
Fire Safety in the Wild and Urban Interface;
Hazard Communication and Material Safety Data Sheets for Small Employers;
Heat Illness Prevention and Response;
ICS402 Incident Command System (Disaster Planning);
Job Safety Analysis;
Lockout/Tagout;
Management’s Role in Slips, Trips and Falls;
Material Handling;
Office of Injured Employee Counsel;
Personal Protective Equipment: Employer Responsibilities;
Tips for Safety Trainers;
Top Ten New Traffic Laws;
Uses of Injury/Illness Data Requested by OSHA and the Bureau of Labor Statistics (BLS);
Traffic Work Zone Safety; and
Workplace Violence Prevention
 
 
Conference rates for hotel reservations are available at the Doubletree Hotel until March 19 or until the conference block of rooms is full. To make hotel reservations, call the hotel at 512-454-3737 and reference “Texas Safety Summit” or register online using the Doubletree Hotel website here.
 

Texas Supreme Court Grants Rehearing in Ruttiger Case
Feb. 22, the Texas Supreme Court issued its long-anticipated option in Texas Mutual Insurance Co. v. Ruttiger. A divided Court held that some, but not all, “bad faith” claims based upon alleged violations of the Insurance Code are “at odds with” the works’ compensation system and, thus, may not be presented to, or considered by, the district courts. To read more on this case, click here.
 

Study Provides Baseline to Measure Impact of Reforms on Illinois Workers' Compensation System
A new study, CompScope™ Benchmarks for Illinois, 12th Edition, by the Workers Compensation Research Institute (WCRI) shows baseline data to measure the future impact of 2011 reforms in Illinois, which are designed to ensure that the state’s workers’ compensation costs are reasonable and competitive.
 
 
According to a WCRI release, “The reform legislation addressed key cost drivers in the workers’ compensation system, especially medical prices, by reducing fee schedule rates by 30 percent, introducing preferred provider networks for selecting treating physicians, implementing American Medical Association (AMA) guides for evaluating impairment, and requiring clinical reports by physicians.”
 
 
For more information about WCRI or to purchase this study, visit: http://www.wcrinet.org.
 

The Texas Department of Insurance Shows Proposed Revisions
The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) is accepting comments on proposed revisions to the following employer and self-insured political subdivision forms:
 
 
1. DWC Form-005, Employer Notice of No Coverage or Termination of Coverage;
2. DWC Form-007, Employer’s Report of Non-covered Employee’s Occupational Injury or Disease;
3. DWC Form-020SI, Self-Insured Governmental Entity Coverage Information.
 
 
These proposed form revisions are not a formal proposal and comments received will not be responded to in accordance with the Texas Administrative Procedure Act. The proposed draft form is available from the TDI-DWC website here.
 
 
Informal comments may be submitted to the TDI-DWC by e-mailing
informalrulecomments@tdi.state.tx.us.
 

The Texas Department of Insurance Seeks Comments
The Texas Department of Insurance Division of Workers’ Compensation formally proposed in February new Rules Relating to Notice and Reporting Requirements for Subscribing and Non-Subscribing Employers; and Rules Relating to Notice of a Texas Labor Code §504.053(b)(2) Election by a Self-Insured Political Subdivision.
 
 
TDI-DWC is accepting public comment on the proposals to add new 28 Texas Administrative Code (TAC) §§110.7, 110.103, 110.105, and 160.1, and to amend 28 TAC §§110.1, 110.101, 160.2, and 160.3.
 
 
The proposal relates to various notice and reporting requirements imposed upon subscribing and non-subscribing employers, specifically requirements for notifying the TDI-DWC of non-coverage status, termination of coverage, and occupational injuries, illnesses and fatalities; and requirements for notifying employees of the employer’s coverage status.
 
 
The primary purpose of the proposal is to update and clarify these notice and reporting requirements. The proposal also contains a new rule that would require a self-insured political subdivision that elects to provide medical benefits in accordance with the manner described by Texas Labor Code §504.053(b)(2) to notify the TDI-DWC of its election to provide medical benefits in that manner. [WCx]
 
 
The proposal will be published in the February 24, 2012, issue of the Texas Register and may be viewed on the Secretary of State website at http://www.sos.state.tx.us/texreg/index.shtml once published. Public comments may be submitted by e-mailing rulecomments@tdi.state.tx.us.

 

 

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

VIEW SAMPLES PAGES

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.

Filed Under: Assessment & Diagnostics, Federal Workers Compensation, Insurance Issues, Rates, Premiums, Professional Development Issues, Seminars and Courses Tagged With: , , , , , ,

Amaxx Details 2012 Workers Compensation Management Program Updates

February 5, 2012 by Leave a Comment
Workers’  Compensation Costs Can Be Reduced by Implementing Operational Best Practices: Learn How With This New Guidebook.
 
A company that wants to implement a new workers compensation program or revamp an existing system will find this book helpful. Maybe your company has recently expanded and you realize the need to train a workers compensation manager or regional coordinators how to hold down compensation costs. Whatever your need, here is the answer: Workers Compensation Management Program: Reduce Workers’ Comp Costs 20%-50%.
 
 
Used by more than 150 firms across the country, this is THE book to help every employer develop a more effective workers compensation program to reduce workers compensation costs. It is based on field research and decades of experience in workers compensation from all aspects of the business. Best practices are described in detail for each person in the injury process.
 
 
This easy-to-read manual has been updated for 2012. It now includes:
 
An index for quick topic look-up so you can view a term or a procedure and see all relevant references.
 
NEW – Workers Compensation Basics
Purpose of Workers Compensation
Who Pays for Workers Compensation?
Parties Involved in Workers Compensation
Benefits for the Employer
Independent Contractors
Benefits for the Employee
Injuries Covered
Types of Workers Compensation
How Losses are Categorized
How Losses are Reported
Calculating Your Premium
How Mod Effects Your Premium
Good/Bad Mod Example
Five Ways to Reduce Your Mod
 
NEW – Fundamentals of Cost Containment
Reasons Workers Compensation Costs are High
Who is in Charge?
Work Ability Form Properties
Who is Responsible for Managing Workers Compensation Claims?
Who is Responsible for Managing Workers Compensation Process?
Hidden (Indirect) Costs of Workers Compensation
Additional Costs
Calculating WC Costs
External Obstacles to Cost Control
Internal Obstacles to Cost Control
 
NEW – Working with Your Adjusters or TPA
Account Handling Instructions
MD Participation
 
NEW- Reporting a Claim
Critical Issues
Essential Intake Considerations
Nurse Triage
 
NEW- Directing Medical Care
Occupational Health Clinics
Remote Health Services
Directing Medical Care in California
 
NEW- Return to Work
What to Include in a Transitional Duty Policy
Non-Profit, Volunteer or Charitable Positions
Employees Who Never Return to Work
Coordinating WC with Federal and State Leave Statutes
 
NEW – Other Indemnity Cost Containment Services
Telephonic Disability Intervention
 
NEW – Medical Cost Containment
URAC Certification
Mental Health RNs
Chronic Pain Programs
An Aging Workforce
At Home Recovery Services
Medical Fee Schedules
Fee Schedule Coding
ICD-9 and CPT Codes
 

NEW- Physical Therapy and Physical Rehabilitation

Differences between Physical Rehabilitation Programs
Pharmacy Benefits Management Program
Authorized Drug Formulary
Toxicology Screening
 
NEW – Fighting Fraud and Abuse
Medical Terminology Used to Identify Malingering
Reviewing Investigation Reports and Videos
Avoid good Day/Bad Day Syndrome
 
NEW – Claims Resolution and Settlements
Conditional Payment and Final Demand
Pharmacy Component of MSA
California Settlement Process
 
 
A 183-page guide covering how to assess your workers compensation program, design program materials, roll out a program to the organization, and monitor and manage the program once implemented.
 
 
Written by a national expert on workers compensation cost containment with over 25 years experience helping companies reduce their losses 20% to 50%.
 
 
T. Ronca, a workers’ compensation defense attorney from Long Island, NY, said the book is an invaluable desk reference. “It is one of the tools that should never be out of reach for a risk manager. Direct employer involvement with claims in the first weeks is the difference between success and failure. This manual will guide the conscientious employer through the pitfalls,” Ronca said.
 
 
What’s more, the book can be delivered with your company logo on the cover and a full-color ad for your company on the back cover. 

Take it out to the field. Text tabs are available to put on each chapter and it is ready to go as your company training manual. All you will have to do is customize the Training Agenda that is in Part I of the book.

 
 
Included in the manual are topics such as: Return to work and transitional duty, claim reporting, employee communications, controlling fraud and abuse, directing medical care, medical cost containment solutions, post injury response procedures, reporting procedures, working with your carrier and third party administrator. There is information about physical therapy, pharmacy benefits management programs, training supervisors and gaining management commitment. It also contains concepts of claim settlement and resolution as well as safety and loss control. New areas are identified above.
 
 
There are 5 sample worksheets in the manual to help organize an efficient workers’ compensation program. These include: timetable for implementation, the injury coordinator job description, and several sample roll-out letters. We recently received a terrific phone call from a third-party administration firm saying how the manual provided an organized way to train clients at loss prevention and has helped their clients put "layers of better WC management" in place. Everyone benefited.
 
 
One large distribution firm wrote to us to say the chapter on safety and loss control led to a company-wide safety change that only cost a few hundred dollars but prevented a specific type of injury that had been draining its budget, says Rebecca Shafer, Esq., President of Amaxx Risk Solution, Inc. who authors the book. Shafer is a national expert on workers’ compensation cost containment with more than 25 years of industry experience helping many companies reduce their losses 20-50%.
 
 
When you order your copy of Manage your Workers’ Compensation Program from Advisen at http://corner.advisen.com/wcbooks, the 183-page guidebook shows how to assess your program, design program materials, roll-out a program to the organization, and monitor and manage the program once implemented.
 
 
The workbook is also available with a customized front and back cover for bulk purchases. Discounted rates apply to bulk orders.
 
 
One company said, "After reading the manual, we took a look at past workers comp practices and saw that every department did things differently. Manage Your Workers’' Compensation Program 2012 gave us the guidance we needed to standardize our workers’ compensation programs across the country. It was like a pre-prepared lesson plan," according to the risk manager.
 
 
A regional hospital in North Dakota wrote that, "Our small company expanded rapidly and we actually didn’t have any official workers’ compensation program in place. This manual gave us step-by-step procedures from the first meetings with management to monitoring the final program. Buying and reading the book was almost like hiring another employee – one who was an expert in workers’ compensation."
 
 
Who Uses the Workers’ Compensation Book?
Risk Managers and Workers’ Comp Managers find it useful learning about the cost containment niche and use it for themselves and to bringing new team members up to speed very quickly. The book becomes a “lesson plan” tool.
 
 
Safety Directors use the book to train supervisors in workers’ compensation claims management. They learn more about their area of responsibility — post loss cost containment — adding to their overall knowledge. They also learn what to do after an injury and what steps are supposed to take place during the first 24 hours.
 
 
Brokers use it for prospects, as well as, to learn about specific aspects of cost containment, passing their knowledge on to their clients. For example, when discussing how to develop a return-to-work program and a client asks about, “off-site return-to-work programs,” the broker quickly finds the relevant section in the book, reviews it and passes the answer on to the client, along with a copy of the cost containment book with the broker’s logo.
 
 
Adjusters use the book to gain a better understanding of the employer’s perspective. Adjusters also want to learn more about cost containment to add to their overall workers’ compensation knowledge in order to grow their careers and stay abreast of new services.
 
 
Account Producers give the book to prospects during formal presentations to illustrate their company is on top of the workers’ compensation industry. The book makes an excellent client gift.
 
 
Vendors such as doctors, physical therapy networks, occupational clinics and medical management firms learn how their service might fit into the workers’ compensation marketplace, what is important to employers, and what they look for in medical services to enable the vendors to enter the workers’ compensation marketplace.
 
 
The manual is a cost-cutting tool to learn more about systematic and operational techniques for reducing workers compensation costs.

 
 
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.
 
 
2012 NEW WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/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.
Filed Under: Claim Audits & File Review, Communication with Employees, Coordinating Medical Care, Federal Workers Compensation, Fight Workers Comp Fraud & Abuse, Insurance Issues, Rates, Premiums, Lowering Premiums & Experience Mod, Management Commitment, Medical Cost Containment, Medicare Set Asides (MSAs), Professional Development Issues, Return to Work and Transitional Duty, Risk Management, Safety and Loss Control, Settling WC Claims, TPA and Claims Administration, WC 101, WC in Other Countries (International) Tagged With: , , ,

WCRI Provides Unbiased Research to Industry

October 30, 2011 by Leave a Comment
Few people realize the workers’ compensation industry is actually 100 years old. It’s one of the most-successful public-private partnerships in U.S. history.
 
 
Since 1983, the Workers Compensation Research Institute (WCRI) has been providing the public with research on WC public policy issues. Based in Cambridge, Mass., the organization includes among its members employers, labor organizers, public and private insurers, health care providers, managed care companies, and state government representatives from the U.S., Canada, New Zealand, and Australia.
 
 
Dr. Richard Victor, WCRI executive director, oversees the institute’s studies and analysis that has added ammunition for the reforms to various aspects of the workers' comp system. Prior to working at the institute, he spent seven years conducting research at The Rand Corporation in Washington , D.C., and Santa Monica , Calif. His law degree and Ph.D. in economics is from the University of Michigan.
 
 
LowerWC recently asked Victor for his impressions of the industry. What follows are some of his comments:
 
 
“One of the most important, and troubling, areas for workers’ compensation systems is to find the appropriate ways to use narcotics – and to discourage abuse and diversion. A second critical issue is to find new and innovative ways for help workers return to productive employment,” Victor says.
 
 
To this end, WCRI is conducting several research phases to help find answers for WC narcotic use and return-to-work issues, he says.
 
 
Victor says the latest trends in workers’ compensation also include medical cost management. “Medical costs now represent more than half of workers’ compensation costs in most states. There is increasing focus on pharmaceutical costs and utilization and the payments made to hospitals and ambulatory surgery centers,” he says.
 
 
Further, everyone wants to know how to save the employers money. Victor says, “Most large employers are focused on three legs of the four-legged cost containment table – risk financing, injury prevention, and claim management. The fourth leg is a large opportunity because employers have underinvested in it – improving the ‘rules of the game’ to make the system more effective for workers and more cost effective for employers.”
 
 
He continues, “This requires that employers join together to formulate political positions and strategies and gather available evidence about how a given state system is performing, how it might be improved, and what lessons can be learned from other states.”
 
 
California and Texas are good examples of where employers have taken collective action and costs have fallen significantly, Victor says. One of the chief objectives of the WCRI CompScope benchmarking studies is to help stakeholders and public officials set priorities and debunk myths.
 
 
One important part of this research is an upcoming conference. The WCRI Annual Issues and Research Conference will be Nov. 16-17 in Boston with keynote speaker Peter Barth, professor of economics emeritus at the University of Connecticut. This will be its 28th year.
 
 
The goal there to present new ideas and alternative views, Victor says. “Whether you are managing workers’ compensation claims, involved in strategic planning, concerned with medical costs and utilization, or just looking for a better understanding of workers' compensation – this is the conference for you.”
 
 
All of the sessions highlight the first presentations of the latest research findings from WCRI while drawing upon the diverse perspectives of highly-respected workers’ compensation experts and policymakers from across the country, he says. “Attendees tell us that they value the large attendance because it allows them to leverage their time while at the conference. There are also opportunities to meet and interact with WCRI researchers.”
 
 
“The most important advice I can give remains a secret until the WCRI conference, when I (present) ‘The Elephant in the Room.’ It will highlight some things that are underappreciated, but are likely to shape workers’ compensation systems for the next decade. The future is not always like the past,” Victor says. “Of course, I would like to see your readers attend to stretch their thinking, gain a competitive edge, and network with peers.”
 
 
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 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. She is the author of  Manage Your Workers Compensation: Reduce Costs 20-50% on cost containment techniques.  www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
 

Our WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/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.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Filed Under: Assessment & Diagnostics, California Workers Comp, Communication with Employees, Drug, Alcohol & Impairment Testing, Employment Law Issues, Federal Workers Compensation, Implementation and Rolling Out Your Program, Management Commitment, Professional Development Issues, Return to Work and Transitional Duty, Seminars and Courses Tagged With: , , ,

One More Day to Vote for The Best Blog Award for Your Favorite or Most Helpful Blog Blog

October 19, 2011 by Leave a Comment
The LexisNexis Workers Compensation Law Community Staff plans to make its selections for the annual Top 25 Blogs for Workers Compensation and Workplace Issues.
 
 
They will be honoring ongoing achievement by blogsites as well as point out the best newcomers and are focusing on quality of writing, frequency of posting, topics covered, interaction with the Internet community, format and design of blogsite, impact on workers compensation and workplace issues, Google ranking and/or mentions by other sites.
 
 
The LexisNexis Staff will review all comments through October 21, 2011, and then make final determinations for the top 25 blogs.
 
 
"Talk up" your favorite blog at the Workers Compensation Law Community. Go to  
 
 
Copyright 2011 LexisNexis. All rights reserved. This material is excerpted from Larson’s Workers Compensation Law. Reprinted with permission.

OUR BOOK: www.WCManual.com
WORK COMP CALCULATOR:  www.LowerWC.com/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.
 
©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.
Filed Under: Professional Development Issues Tagged With: ,
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