Work Comp and State Law Archives

WC Basics 101 – Kansas Workers Compensation

January 26, 2012 by Rebecca Shafer, J.D. Leave a Comment

Workers Compensation Laws change frequently. This is only a summary; a complete copy of the most up-to-date version can be found at: www.WorkCompResearch.com , an excellent service.

In Kansas workers compensation coverage is compulsory as to all employment, including corporate executives and employees of charitable organizations. Coverage is elective for individuals, partners or the self-employed. There are some exceptions. Real estate brokers and real estate salespeople on commission are excluded from the compulsory requirements. Also, farm labor and employees of any employer whose gross annual payroll is $20,000 or less are excluded from compulsory coverage.

Obtaining Coverage

To obtain workers compensation coverage in Kansas, the employer has three options which are

purchasing a workers compensation insurance policy from a state approved insurance company
applying to and being approved for self-insurance status with the Kansas Department of Labor.
being a part of a group-funded self-insurance plan that has been approved by the Kansas Department of Labor

Claim Reporting

The employee must provide notice of the injury to the employer with 10 days and up to 75 days with just cause. The actual claim of the employee must be served on the employer within 200 days after the accident, or last payment, or within 1 year of the employee’s death with death occurring within 5 years after the date of the accident. WCxKit

Medical Benefits

In Kansas, the employer selects the medical provider for workers compensation claims. The employer is required to provide all reasonable and necessary medical care free of any charges to the employee. The employer is also liable for up to $500 of employee incurred medical bills at a non-authorized doctor. The employee can also apply to the Director of Workers Compensation for a change of doctors. The employee is entitled to all medical treatment needed to cure or relieve the effects of the injury. Prayer or spiritual treatment is permitted by agreement.

Temporary Total Disability Benefits

The temporary total disability (TTD) benefits are calculated as two-thirds of the employee's average weekly. The maximum amount of TTD benefits that can be paid is $555.00 per week. The state maximum is subject to annual increase/decrease each July 1st, based on the state’s average weekly wage. The state minimum weekly benefit is $25.

The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days. TTD benefits can be paid until a cap of $100,000 has been reached.

Temporary Partial Disability Benefits

In Kansas if the employee is able to return to any type of work, but at a lesser rate of pay then the amount the employee was earning prior to the injury, the employee is entitled to temporary partial disability (TPD) benefits. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage. The TPD benefits are paid for up to a maximum of $100,000. The TPD benefits plus the post-injury pay rate cannot exceed the state's maximum indemnity benefits rate.

Permanent Partial Scheduled Disability

Kansas uses a Schedule to establish the value of an injury to all extremities, the shoulders, eyes and hearing. Each body part has a set number of weeks it is worth with a shoulder being worth 225 weeks of compensation and the number of weeks decreasing with other extremity body parts having lesser value down to a toe, other than a big toe, being worth 10 weeks of compensation. A 20% loss of use of the arm, which is scheduled at 210 weeks, would result in a permanent partial scheduled disability award of 42 weeks (210 weeks X 20%).

Permanent Partial General Disability

When the employee sustains a permanent partial general disability of a body part not listed on the Kansas Scheduled Injuries list and the employee is not permanent totally disabled, the employee receives permanent partial general disability. If the employee is able to return to work and is earning at least 90% of the average weekly wage, the employee is given a percentage of the whole body impairment based on the AMA Guidelines, Fourth Edition. The maximum in weeks is 415 weeks. An employee with a 10% rating would get an award of 41.5 weeks of compensation. The maximum an employee can collect for permanent partial disability is $100,000.

Permanent total disability

Kansas permits the employee to collect a maximum of 415 weeks of indemnity benefits for all types of indemnity combined, but the total amount of benefits collected for permanent total disability is $125,000 instead of $100,000 (the amount of TTD benefits paid to the employee is included in the $125,000 indemnity benefit cap).

Death Benefits

The burial expenses in Kansas are covered for a work-related death up to $5,000. The death benefits for a dependent spouse and children follow the same guidelines as TTD benefits – two-thirds of the average weekly wage – currently a maximum of $555 week, and a minimum survivor’s benefit of $370 per week, except there is a dollar maximum for death benefits in the amount of $250,000 with children, or $200,000 without children. If there is no spouse and no dependents, the death benefit is reduced to $25,000. WCxKit

Vocational Benefits

Vocational Rehabilitation is on a voluntary basis in Kansas. However, once it is started, it cannot be terminated without the agreement of the employee. The vendor of the vocational rehabilitation may be changed for good cause supported by substantial evidence. If so, the employee may select the replacement vendor from a list of three qualified vendors provided by the employer.

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 the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.

NEW 2012 WORKERS COMP BOOK: www.WCManual.com

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SUBSCRIBE: Workers Comp Resource Center Newsletter

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.

Filed Under: WC 101 Tagged With: Kansas, WC 101, Work Comp and State Law

Get to Know the Greats in Workers Compensation – Arthur Larson

August 4, 2011 by Rebecca Shafer, J.D. Leave a Comment

If you don’t know the name Arthur Larson but you work in the insurance industry, maybe you should.

Larson, who died in 1993, is most famous for his authorship of the still-used legal treatise on the Law of Workmen’s Compensation, written while he was assistant professor of law at Cornell Law School, which led to his being named dean of the University of Pittsburgh School of Law in 1953.

The treatise is still in use today and has since been edited by his son, Lex, who is affiliated with Lexis Nexis. The book was formative in that it was the first document that looked to standardize workers compensation across the nation not only for the benefit of companies and legal representatives but also for the American worker. It has grown from two to 12 volumes. Larson’s Workers’ Compensation, Desk Edition eBook from LexisNexis® is now available with coverage on the exclusive remedy defense, employment status, medical and death benefits, psychological injuries, and third-party claims from various jurisdictions with appropriate WC interpretation.

According to Peter Rousmaniere, a blogger and expert in the compensation industry who has researched Larson’s life, “Larson had the idea that (in his son Lex’s words) ‘if you can find common threads in the way courts in the various states were deciding various legal issues, the field of workers’ compensation could be recast much more as a single, national body of law.’ A currently practicing lawyer calls Larson’s guide essential. He said, ‘It is imperative to see the breadth of possible interpretations from various jurisdictions to fully understand what is at stake.'”
Rousmaniere goes on to write, “Larson’s vision was apparent in his other writings, perceptively analyzed by his biographer, David Stebenne. Larson saw workers’ compensation law not as a radical redesign of the old tort system but rather as the earliest element of a new and peculiarly American system of social benefits. Unemployment insurance, nonoccupational disability insurance and retirement programs were part of this system. He thought some programs were better run in the public sector, others in the private sector. Workers compensation was for him well designed: privately financed, with benefits set according to the injured worker’s wages. He applauded state-mandated nonoccupational disability insurance, an idea since endorsed by few states.”

Among advents Larson brought about were unemployment insurance, nonoccupational disability insurance and retirement programs.

Larson went on to write A Republican Looks at His Party, which propelled him to go on to be President Dwight Eisenhower’s top speech writer and director of the United States Information Agency. He was a law professor at Duke University at the time of his death.

PETER ROUSMANIERE is an expert on the workers compensation industry and a columnist with Risk & Insurance. His original and more-complete article on Larson can be found here.

Peter Rousmaniere can be reached at 802-457-9149 or by email at pfr@rousmaniere.com. His professional website is www.peterrousmaniere.com and his well-known blog about immigrants is: www.workingimmigrants.com

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SUBSCRIBE: Workers Comp Resource Center Newsletter

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.

Filed Under: Legal Doctrines Tagged With: Arthur Larson, Larson's, Lex Larson, Lexis Nexis, Peter Rousmaniere, Risk & Insurance, the Law, Work Comp and State Law

Seminars on Texas Pharmacy Formulary and Claims/eBill

July 19, 2011 by Stuart Colburn Leave a Comment

The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) will present a series of free, half-day educational seminars titled Pharmacy Closed Formulary and Clean Claims/eBill. The seminars are being offered in cooperation with Small Business Development Centers.

The Pharmacy Closed Formulary portion of the seminar will provide an overview of the pharmacy closed formulary rules adopted by the TDI-DWC in December 2010 for both certified network and non-network workers’ compensation claims with dates of injury on or after Sept. 1, 2011.

The Clean Claims/eBill portion of the seminar will provide an overview of the new TDI-DWC requirements related to submitting paper and electronic medical bills, including a discussion of the changes from the previous requirements and a brief introduction to the new electronic medical billing standards. This presentation also provides an opportunity for new and experienced medical billing employees to recognize how to complete medical bills to minimize insurance carrier returns or rejections after the Aug. 1, 2011 effective date.(WCxKit)

House bill 528, which becomes effective June 17, can be found here.

Among some the regulations in the bill include:

Insurance carriers must reimburse health care providers in accordance with the TDI-DWC’s pharmacy fee guideline or at a contracted rate.
Insurance carriers may also reimburse health care providers for pharmaceutical services at rates inconsistent with the TDI-DWC’s pharmacy fee guideline if the carrier has a contract with that health care provider that includes a specific fee schedule.
Insurance carriers or their authorized agents may use a pharmacy informal or voluntary network to obtain these contractual agreements with health care providers. If an insurance carrier chooses to use a pharmacy informal or voluntary network, there must be: a contractual arrangement between the insurance carrier or its agent and the pharmacy informal or voluntary network authorizing the network to contract with health care providers for pharmaceuticals on the insurance carrier’s behalf; and a contract between the network and the health care providers that includes a specific fee schedule and complies with the health care provider notice requirements of Texas Labor code.
The carrier must notify each health care provider, at least quarterly of any person, other than the injured employee, to which the network’s contractual fee arrangements with the health care providers are sold, leased, transferred or conveyed.
Each informal or voluntary network that has contracts in effect on June 17, 2011, must report the information listed in the labor code by July 17, 2011.
Failure for a pharmacy informal or voluntary network to comply with the registration requirements will result in an administrative violation.

Details of these new requirements will be explained at the conference.

Due to limited space, registration is required. For more details on the following educational seminars, visit the TDI-DWC Events and Training Calendar at www.tdi.state.tx.us/wc/events/index.html. Pharmacy Closed Formulary will be presented from 8 a.m. to 11 a.m. and Clean Claims/eBill will be presented from 11 a.m. to 12 p.m. at each venue. Texas workers’ compensation system participants may attend one or both portions of the seminar.

Training Dates

Date City

May 6, 2011 Dallas

May 7, 2011 Fort Worth

May 20, 2011 San Antonio

May 25, 2011 Wichita Falls

June 3, 2011 Corpus Christi

June 8, 2011 San Antonio

June 10, 2011 Houston

June 24, 2011 Edinburg

July 15, 2011 El Paso

Aug. 18, 2011 Austin

This information was provided by attorney Stuart Colburn, a Shareholder at Downs Stanford in Austin, Texas. Colburn has extensive experience in all phases of dispute resolution before the Texas Department of Insurance, Division of Workers Compensation and in district courts across the state. Stuart represents clients regarding workers compensation, non-subscription, subrogation, and bad faith litigation. He is the founder and the first chairman of the State Bar of Texas (SBOT) Workers Compensation Section; course coordinator for the SBOT the Advanced Workers Compensation Seminar; and course coordinator for the Texas Workers Compensation Forum. He can be reached at: scolburn@downsstanford.com

Filed Under: Legal Doctrines, Professional Development Issues, Seminars and Courses Tagged With: Pharmacy Benefit Management, Texas Workers Comp Issues, Work Comp and State Law

Using Cheat Sheets to Learn New State Laws

June 9, 2011 by Senior Editor Leave a Comment

One of the scariest parts of expanding a business into a new state for the self-insured employer is learning the workers compensation laws and state mandates in the way of forms, filings, hearings, etc. While an employer can hire a third party administrator (TPA) to handle claims, or a law firm to guide you through all the steps of workers comp claims handling, it is in your best interest to learn the basics of the workers comp system in the new state quickly. Or, get a good resource that has such information. Ask your TPA what resources they use. Even though they have professional resources, similar resources can be very helpful for the self-insured company.

Self-insured employers have two choices: spend weeks/months learning the new workers comp system or, to borrow a video game phrase, get “cheat sheets” to speed up the learning process. (WCxKit)

Many law firms specializing in insurance defense work sometimes offer “cheat sheets” to new adjusters and potential new clients as a way of building business. Instead of the employer spending “forever” learning the basics of the new state’s workers comp law, the cheat sheets give a synopsis of important information the self-insured employer needs to know.

If you want a jump of learning this information and don't want to rely on free cheat sheets, excellent information – in easy to use tables — is available from www.workcompresearch.com.

Common cheat sheets/reference tools include:

1. A list or a table of state forms and when each is to be filed.

2. Explanations of state forms and rules associated with each form.

3. Table of temporary total indemnity benefits by calendar or fiscal year.

4. Table of temporary partial indemnity benefits by calendar or fiscal year.

5. Table of permanent partial disability benefits.

6. Table of scheduled injuries.

7. Charts for combining two or more impairment ratings.

8. Death benefit tables.

9. Table on statutes of limitations on filing claim, appealing claims, etc

10. Calculation of indemnity benefit guidelines.

11. Checklist of defenses to claims.

12. Charts or tables on how the judicial system works.

13. Claim settlement guidelines.

14. Guidelines on the selection of medical providers.

15. Guidelines on posting a panel of physicians

16. Forms for:

· New employees/transferred employees to sign acknowledging the selection of a physician.

· Injured employees to acknowledge the attending physician requirement(s).

· Requesting a new physician.

· Employee to decline medical treatment.

17. Samples of required state notices for posting.

18. Recent changes in the state law.

In addition to the cheat sheets, get a glossary of workers compensation jargon and terms as used in a particular state. This type of glossary also assists you in understanding the abbreviations often used within the state, for example – DOAH (Florida Division of Administrative Hearings), BRC – Benefits Review Conference, or IW – injured worker. (WCxKit)

Summary

A new employer in a state can spend time learning the workers comp system, contact some of the law firms specializing in insurance defense work or consider www.WorkCompResearch.com as eventually learning the system in the new state definitely has it benefits, but quickly learning the basics summarized by experts speeds up the learning curve and assists in understanding the workers comp system.

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.

Our WC Manual: http://corner.advisen.com/partners_wctoolkit_book.html

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SUBSCRIBE: Workers Comp Resource Center Newsletter

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.

Filed Under: Insurance Issues, Rates, Premiums, Litigation Management, Seminars and Courses, WC 101 Tagged With: Legal Issues by State, Self-Employed and WC, State-by-State Issues, Work Comp and State Law

Montana House Committee Pushes Workers Compensation Bill Forward

February 9, 2011 by Robert Elliott, J.D. Leave a Comment

Montana Republicans on a House panel endorsed a bill Feb. 8 that is expected to be the sessions major workers compensation reform measure. Meantime, a leading Democrat claims its savings fall too much on the backs of injured workers.

The bill createsa huge amount of up-front savings, all taken out of workers benefits, said Rep. Chuck Hunter, D-Helena. "We don't agree that's the right thing to do." (WCxKit)

According to The Missoulian, the House Business and Labor Committee endorsed House Bill 334 on a party-line 14-7 vote, with all Democrats coming out against it.

Rep. Scott Reichner, R-Bigfork, the sponsor of HB334, states the Republican majority in the House will approve the bill the week of Feb. 7 and send it on to the Senate, where another workers comp bill was to be heard.

Yet, as Hunter pointed out, whatever bill passes the Republican-controlled Legislature still must gain the approval of Democratic Gov. Brian Schweitzer.

"He has already signaled that hes not going to accept a bill that balances this whole program on the backs of injured workers," Hunter said of the governor.

Montana premiums for workers comp, which businesses are required to have to insure against on-the-job injuries, rank among the largest nationwide.

Republicans and Democrats both agree the problem needs to be addressed, to decrease costs for employers in Montana.

According to the language in HB334:

1. It ends medical benefits for work-related injuries five years after the injury. A two-year exception can be granted for surgery to help the worker return to work.

2. It redefines who is eligible for payment for a "permanent impairment," cutting out most that would be eligible under current law.

3. It creates a list of physicians that injured workers must see, rather than letting them choose any doctor.

On Feb. 8, the House Business and Labor Committee also backed Hunters HB186, which would spend $1 million a year on workplace safety programs, to attempt to lessen Montanas high workplace accident rate. (WCxKit)

The panel amended the bill to state it will fail unless Reichners HB334 is approved by the Legislature.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.

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

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WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: Workers Comp Resource Center Newsletter

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.

Filed Under: Insurance Issues, Rates, Premiums, Legal Doctrines, WC 101 Tagged With: labor, Montana, Work Comp and State Law

Florida Workers Compensation Basics 101

December 2, 2010 by Rebecca Shafer, J.D. 1 Comment

Workers Compensation Laws change frequently. This is only a summary; a complete copy of the most up-to-date version can be found at: www.WorkCompResearch.com an excellent service.

In Florida, every employer who has four or more employees, whether full time or part time is required to carry workers compensation insurance. [Corporate officers who have elected to exempt themselves from work comp coverage do not count as an employee]. There are a couple of exceptions to this rule. If you are in the construction industry and have one or more employees, you are required to have work comp coverage. Florida farmers who have more than five regular employees, or twelve or more seasonal workers who are employed for 30 days or more, are required to have work comp coverage.

Obtaining Coverage:

To obtain workers compensation coverage in Florida, the employer has several options including:

1. purchasing a workers compensation insurance policy from a state approved insurance company

2. qualifying as an approved self-insured employer

3. contracting with a professional employer organization [employee leasing] that has a group workers compensation policy

4. purchasing a workers compensation insurance policy from the Joint Underwriting Association, a Florida state agency that sales workers compensation insurance coverage to employers who are unable to obtain coverage in the open market (WCxKit)

Claim Reporting:

The employee must report the injury to the employer within 30 days of the occurrence. If the injury is not reported timely, the insurance carrier has the option to deny the claim. The employer is under a strict time limit of 7 days to report the claim to the insurance carrier. The insurance company then has 3 days to send to the employee an informational brochure which outlines the employees rights and responsibilities under the workers compensation statutes.

Medical Benefits:

The employer selects and authorizes the initial medical provider. All subsequent medical treatment must be at a medical provider approved and authorized by the workers compensation insurance carrier. All authorized medical care and associated expenses (prescriptions, prostheses, mileage reimbursements) are covered by workers compensation.

Temporary Total Disability Benefits:

The temporary total disability (TTD) benefits are calculated as two-thirds of the employees average weekly wage over the 13 weeks prior to the injury, not counting the week the injury occurred. The maximum amount of TTD benefits that can be paid weekly changes every January 1^st. The maximum TTD benefits per week for accidents occurring on or after January 1, 2010 is $772.00 per week. The state minimum weekly benefit is $20, which has not changed since 1972.

The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days. TTD benefits can be paid for a maximum of 104 weeks. There is no provision in the Florida law that requires the employer to hold open a job for an employee who is unable to work due to the employee being unable to work. (Holding the position for the employee is the smart thing for the employer to do in most cases).

Temporary Partial Disability Benefits:

Florida work comp also provided for temporary partial disability (TPD). An employee will receive TPD if the medical provider releases the employee to work with restrictions on the number of hours the employee can work. If the employee is unable to earn 80% of his wages prior to the injury, the insurance carrier will pay TPD benefits on the hours the employee is unable to work per week.

Impairment Benefits:

When an employee reaches maximum medical improvement, the medical provider will determine whether or not the employee has any permanent partial disability. If the employee receives a disability rating, the employee is entitled to Impairment Benefits (IB). The amount of IB is one-fourth of the TTD rate plus 1 cent. For example if the weekly TTD rate is $600.00, the IB rate would be $150.01. The number of weeks of IB is determined by a disability scale. A 10% rating on the scale is worth 20 weeks of IB; a 25% rating is worth 85 weeks of IB, while a 50% rating is worth 235 weeks of IB.

Permanent Total Disability Benefits:

Florida has a unique way of determining if an employee who has reached maximum medical improvement has a permanent total disability (PTD). If the employee can be placed in a sedentary job within 50 miles of his residence, the employee is not PTD, unless he has a severe injury as defined by the Florida work comp statutes. Some of the severe injuries include spinal cord injuries that involve paralysis of an arm, leg or the trunk; amputation of a hand, arm, foot or leg; severe brain injury; and, second or third degree burns over 25% of more of the body. If the employee is classified by the Division of Workers Compensation as PTD, the employee will receive PTD benefits which are the same as TTD benefits until the age of 75. If an employee is drawing social security benefits, the PTD benefits are reduced to the point where the social security benefit plus the PTD benefit equals 80% of the average weekly wage earned prior to the injury.

Death Benefits:

If an employee dies as a result of an on-the-job accident within one year of the date of the accident, or if the employee dies as a result of an on-the-job accident within five years with continuous disability, funeral expenses up to $7,500 is covered by workers compensation. The spouse is entitled to 50% of the average weekly wage, not to exceed $772.00 (for calendar year 2010). The spouse plus one child is entitled to two-thirds of the average weekly wage, not to exceed $772 (year 2010). If the employee leaves behind one child as the only beneficiary of death benefits, the child receives one-third of the average weekly wage, not to exceed $772 (year 2010). There is no time limit on how long benefits can be paid, but the maximum amount of death benefits is $150,000 (not including funeral expenses). If the spouse remarries, the spouse receives a lump sum payment of 26 weeks (as long as the $150,000 cap is not exceeded. The spouse is also eligible for tuition benefits at a vocational technical center or community college. (WCxKit)

Vocational Benefits:

If due to the employees on-the-job injury the employee is unable to return to work because of permanent work restrictions, the employee is entitled to assistance from the Workers Compensation Vocational Rehabilitation Section of the Florida Department of Education. At no cost to the employee, the employee can receive vocational counseling, transferable skill analysis, training on job-seeking skills, job placement, on-the-job training and formal retraining.

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

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

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

Filed Under: Broker Issues & Relationships, Buying Workers' Comp, Implementation and Rolling Out Your Program, Insurance Issues, Rates, Premiums, WC 101 Tagged With: Florida Insurance Commission, Work Comp, Work Comp and State Law, Work Comp Information Gathering, Work Comp Insurance by Industry

IDAHO Small Businesses Receive Workers Comp Settlement

July 22, 2010 by Robert Elliott, J.D. Leave a Comment

Some 30,000 small businesses in Idaho will reportedly prosper from a nearly $7 million settlement over dividend and other payments they claim they are owed from the state’s workers comp insurer.

According to the Idaho Statesman, policyholders with yearly premiums amounting to $2,500 or less have not receive their portion of dividend and related payments from the State Insurance Fund for the last seven years. As to how much each small business will receive depends on the amount each contributed to the fund. (WCxKitz)

The lawsuit was filed four years ago, with a legislator who serves on the insurance fund’s board unveiling a bill to end the fund’s dividends in 2009. As it turns out, the bill did not go through.

The newspaper goes on to note that companies acquiring workers comp coverage between July 1, 2001, and June 30, 2007, maintaining premiums of $2,500 or less may qualify. (WCxKitz)

Lawyers representing the plaintiffs are requesting up to one-third of the settlement amount as it pertains to their services.

WC Calculator: http://www.LowerWC.com/calculator.php
TD Calculator: http://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.

Filed Under: Insurance Issues, Rates, Premiums Tagged With: Idaho Workers Comp, Work Comp and State Law

The Longshore and Harbor Workers Compensation Act

July 1, 2010 by Rebecca Shafer, J.D. Leave a Comment

It is unknown by many that some private employers have to buy federal workers' compensation insurance coverage for their employees. Approximately 500,000 employees in the United States are excluded from coverage under state statutes as these employees are covered under a federal statute, the Longshore and Harbor Workers' Compensation Act (LHWCA).

However, workers' compensation insurance carriers are very aware of this market and some 400 plus work comp insurers offer coverage. In addition to these 400+/- insurance carriers, there are approximately 200 large companies self-insuring for coverage required by the LHWCA.

LHWCA coverage requirements are very broad and do not only apply to the stevedores loading/unloading ships. Coverage is required of employers emploing workers for maritime work or in a maritime profession on the navigable waters of the United States and in adjoining waterfront areas. These employers could include:

1. commercial ports

2. ship builders

3. barge builders

4. ship repairers

5. ship breakers

6. dock workers other than stevedores

7. barge loading facilities of products such as coal, grain, gravel, sand

An oddity of the LHWCA is employers also must buy a second state workers' compensation insurance policy to cover workers excluded from coverage under the LHWCA. The excluded workers would include:

1. workers who build, repair or dismantle recreational vessels under 65' in length

2. the master or member of any vessel crew

3. workers who load or unload or repair any vessel under 18 tons

4. office clerical or secretarial

5. security guards

6. data processors

7. club, camp or recreational workers on a navigable water way

8. restaurant workers

9. retail outlet employees

10. museum workers

11. marina workers who are not engaged in construction, replacement or expansion

12. workers who are temporarily doing business on the premise of a maritime employer

13. aquaculture workers

When an employee is injured while working for an employer covered under the LHWCA all medical cost are paid by the LHWCA insurer. The employee can select any physician to treat the injury, as long as the physician is pre-approved by the office of the Secretary of the U.S. Department of Labor.

The weekly benefit for temporary total disability and permanent total disability is two-thirds of the employee's average weekly wage. The indemnity benefits under the LHWCA have a very high maximum weekly amount of $1,224.66. The employee has to be making in excess of $95,000 per year to max out on the weekly benefit. The weekly benefit is adjusted each fiscal year by the Department of Labor.

An ESSENTIAL RTW Program

An odd thing occurs when the weekly indemnity benefit is $1,200+ a week. The work comp indemnity benefit is often higher than the net pay the employee took home including all the deductions from the paycheck for federal income tax, state and local income tax, social security tax, Medicare tax, medical benefits, 401k contributions and union dues (most stevedores are union members).

When the employee's work comp check is bigger than the paycheck, it is often difficult to get the employee back to work. No surprise there! It is essential for the employer to have a light duty return-to-work program, with the adjuster and the employer working with the treating physician to get the employee back to work.

The LHWCA requires a 3 day waiting period before indemnity benefits start. If the employee is off work more than 14 days, the initial 3 day waiting period for benefits is paid retroactively.

The LHWCA has a permanent partial disability schedule for loss of body parts—finger, hand, arm, toe, foot, leg, sight and hearing. Permanent partial disability for non-scheduled body parts is based on two-thirds of the average weekly wage or the loss of wage earning capacity.

Death benefits are also provided under the LHWCA including reasonable funeral expenses up to a maximum of $3,000. The death benefit is paid to the spouse or other eligible survivors. The spouse receives 50% of the average weekly wage for life or until remarriage occurs If there are dependent children, they share 16.66% of the average weekly wage, until they are 18 years old or 23 years old if enrolled in higher education.

Vocational rehabilitation is also provided under the LHWCA. If an employee is unable to return to prior employment, the worker may be eligible for retraining and job placement. The vocational rehabilitation expense is paid for by the U.S. Department of Labor, not by the work comp insurer. (workersxzcompxzkit)

If an employer has anything to do with maritime work or has facilities on or adjacent to navigable water, consult with your insurance broker to see if you need to have the federal workers’ compensation coverage required by the LHWCA.

Author Rebecca Shafer, Risk Consultant / Attorney, President, Amaxx Risks 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. She serves on the Executive Committee of Lexis Nexis Workers' Compensation Law Center. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.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.

Filed Under: Federal Workers Compensation, Union Issues Tagged With: Federal Workers Compensation, Longshore and Harbor Workers, Unions and Workers Comp, Work Comp and State Law

Waiting Periods in Work Comp A Fascinating and Complex World

June 10, 2010 by Robert Elliott, J.D. Leave a Comment

The purpose of the waiting period is to eliminate the administrative work involved for the claims handler in paying an employee for a very short period of time. The purpose of the retroactive period is to pay the employee indemnity benefits for all time missed from work when the claim is significant enough to cause the employee to be off work a greater period of time.

Every employee injured on the job knows workers' compensation pays the medical bills and pays indemnity benefits. However, when an employee is injured and talks to the work comp adjuster for the first time, the employee is almost always dismayed to hear there is a waiting period before indemnity benefits are paid for time missed from work. There is no waiting period for medical benefits.

The first question the work comp adjuster hears from the employee is “what is a waiting period?” The adjuster's answer will be something like, “Employees who are injured on the job receive no wage replacement during the first X number of days they are off work due to their injury, unless they are off work more than Y numbers of days.”

The X number is the waiting period, which varies by jurisdiction. The Y number of days is the retroactive period. This is the length of time the employee must miss from work before indemnity benefits are paid retroactively for the days missed during the waiting period.

An Example

1. The employee is injured. At the time of the first contact between the adjuster and the employee, the employee does not know how long before the doctor will allow him to return to work on either light duty or full duty. However, 15 days after the accident, the employee is still out of work.

2. If the jurisdiction has a 7 day waiting period and a 14 day retroactive period, the adjuster will pay indemnity benefits retroactively for the first 14 days the employee was unable to work, plus continue the indemnity benefits until the employee is able to return to work.

3. If the employee only missed 4 days in the above example and the waiting period is 7 days, no indemnity benefits would be paid to the employee.

4. If the employee missed 10 days from work in the above example and the waiting period is 7 days, the employee would be paid indemnity benefits for 3 days. The retroactive period does not apply as the employee did not miss the required 14 days of the retroactive period.

Of the 54 jurisdictions (50 states, District of Columbia, Puerto Rico, Virgin Islands, and Guam) where there are United States style workers' compensation systems, only one jurisdiction, Virgin Islands, does not have a waiting period. Twenty-four jurisdictions have a 3 day waiting period and twenty-three jurisdictions have a 7 day waiting period. Four states—Idaho, Massachusetts, Mississippi, and Nevada—have a 5 day waiting period. Two states, North Dakota and Montana, have a 4 day waiting period.

Just as there is variance among the jurisdictions for the waiting period, there is even more variance in the length of the retroactive period. The retroactive period varies from zero days to 42 days. Some jurisdictions state their retroactive period in days, for example 14 days, while other jurisdictions will state their retroactive period in weeks, for example 2 weeks. For the purpose of this blog 2 weeks will equal 14 days and all information will be given in days.

Five jurisdictions, Hawaii, Montana, Oklahoma, Puerto Rico, and Rhode Island, have no retroactive period. Two states, Nevada and North Dakota have a 5 day retroactive period. Seven states have a 7 day retroactive period—Connecticut, Delaware, New Jersey, South Dakota, Vermont, West Virginia and Wisconsin. Wyoming has a 9 day waiting period. Two jurisdictions, Minnesota and Puerto Rico have a 10 day waiting period.

The most popular period of time for a retroactive period is 14 days with 25 jurisdictions having a 14 day retroactive period. Eight states—Alabama, Florida, Georgia, Indiana, Kansas, Massachusetts, North Carolina and Virginia, have a 21 day retroactive period. Two states, Alaska and New Mexico, have a 28 day retroactive period. The longest retroactive period of 42 days is in the states of Louisiana and Nebraska.

Some states make special exceptions to their waiting period. For instance in New Jersey, the waiting period does not apply to volunteer firefighters, rescue squad workers, and fire marshals. In Illinois the 3 day waiting period applies only to temporary total disability benefits, but it is the rare claim where it is known in the first three days that the employee would collect permanent partial disability or permanent total disability in the first days after the accident.

Most employers will allow the employee to use sick leave time or vacation time if the disability days do not exceed the waiting period. Check with your state work comp board or industrial commission before doing so to be sure it is permitted.

The two federal programs, the Federal Employees' Compensation Act and Longshore and Harbor Workers Compensation Act, both have a three day waiting period and a 14 day retroactive period. (workersxzcompxzkit)

The best way to be fully informed on all matters of workers’ comp jurisdiction for workers covered by United States style workers' compensation systems is to review the “Legal Library” at ReduceYourWorkersComp.com entitled: Workers' Compensation State Laws and Regulations Resources for Employers from Workers' Comp Kit™.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.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.

Filed Under: Litigation Management, Risk Management Tagged With: Waiting Periods and Work Comp, Work Comp and State Law

New York Employer Floored with Workers Comp Fraud Charge

May 11, 2010 by Director Leave a Comment

New York Employer Floored with Workers’ Comp Fraud Charge

The 28-year-old owner of a Bayshore, New York flooring company faces a charge of workers’ compensation fraud for allegedly cheating the New York State Insurance Fund out of $33,000 in unpaid premium.

The Suffolk County District Attorney’s Insurance Crime Bureau arrested the man recently, charging him with fraudulent practices in violation of Section 114 of the New York State Workers’ Compensation Law, a felony.

The man’s arrest followed a joint investigation by Suffolk County DA Thomas Spota’s Office, the New York State Insurance Department Frauds Bureau and NYSIF’s Division of Confidential Investigations.

Investigators said the man, owner of North Star Flooring in Bayshore, N.Y., carried workers’ comp insurance for his company with NYSIF, but allegedly underreported his payroll to lower his premium.

According to investigators, the defendant allegedly failed to report approximately $700,000 in sales from 2008 to 2009, resulting in a lower cost for workers’ comp insurance during that period. (workersxzcompxzkit)

By allegedly falsifying his payroll reporting, the man underpaid his NYSIF premium by $33,000, investigators said.

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WC Calculator: http://www.reduceyourworkerscomp.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' compensation issues.

Filed Under: Fight Workers Comp Fraud & Abuse, NY Workers Comp Issues Tagged With: Work Comp and State Law, Workers Comp Fraud