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Find Solutions & Strategies April 11, 2011 |
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NCCI 2011 Workers' Comp Issues Report
Experts give partially gloomy forecast for workers' comp insurance industry and remind us to keep a weather eye on congressional activity | |
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| A Note From the Editor |  | |
Dear WC Professionals:
NCCI's annual issues report warns us that the financial situation of the workers' compensation insurance industry remains precarious. NCCI will be discussing their report at the May 5-6 Annual Issues Symposium in Orlando.
Sincerely,
Robin E. Kobayashi, J.D.
LexisNexis Editorial & Content Development
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Workers' Comp Profile | |
Workers Comp Zone, published by Julius Young, Esq. From his engaging commentary about backroom haggling in Sacramento to his careful and incisive analysis of Guzman and other important California workers' compensation cases, Julius Young's Workers Comp Zone is a must read for California practitioners and case managers. His thoughts on a broad list of topics-EAMS, medical cost containment, Senatorial politics, to name a few-are well-reasoned and generally even-handed. Even if you don't agree with Julius, he will make you think. It is an entertaining and informative read for interested parties in other states as well. | |
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| ncci workers comp issues report | |
Highlights From the National Council on Compensation Insurance's 2011 Workers' Compensation Issues Report
NCCI's 2011 issues report presents a picture of the workers' compensation insurance industry that is, while far from robust, at least marginally less gloomy than that presented in its 2010 report. From the viewpoint of society at large, however, as "Workers Compensation: What Made It a Radical Idea 100 Years Ago?" by Greg Krohm, Executive Director, IAIABC, and Jennifer Wolf-Horejsh, Assistant Director, IAIABC, reminds us, the workers' compensation insurance system has been such a resounding success that, today, as we celebrate its centennial in America, life without it is inconceivable.
"Previous Market Outlook Prevails," by Stephen J. Klingel, President and CEO of NCCI Holdings, presents an overview of the workers' compensation insurance industry's financial position as precarious but less bad than a year ago. Klingel draws attention to the potential effects on workers' compensation insurance of the various uncertainties surrounding the 2010 healthcare reform legislation enacted by Congress. > Read more |
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| Larson's spotlight: 5 recent cases you should know about | |
Larson's Spotlight reports noteworthy workers' comp cases each week. This list was c ompiled by Thomas A. Robinson, a staff writer for Larson's Workers' Compensation Law, the nation's leading authority on workers' compensation law.
 > Read the summaries & court decisions.
1. TX: Fatal Injuries Occurring in Auto Accident While Traveling to Training Conference Were Not Barred by Going and Coming Rule
2. NC: Worker's Seizures Were Related to Hot Conditions of Employment
3. IA: Worker's COPD Claim Fails Because of Equivocal Medical Evidence On Issue of Causation
4. MS: Presumption of 100 Percent Impairment Where Worker Unable to Return to "Usual Employment" is Not a Rigid Concept
5. OH: Separation From Work Was Voluntary Where Injured Worker Signed Severance Agreement |
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| blog round up at the lexisnexis workers' compensation law community |
 Workers' Comp Fraud Blotter - Recent Arrests, Charges, Convictions, Investigations - 4/7/2011. Read it.
Soup, Soap and Salvation -- Delaware IAB Rules That Salvation Army Rehab Program Participant Is Not an Employee, by Cassandra Roberts, Esq. Read it.
Iowa: Employee Compensated for an Injury While Tying His Boots, by H. Edwin Detlie, Esq. Read it. |
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| how to achieve medicare secondary payer compliance |
Take Control of Your Insurance Settlements With A Brand New Resource From LexisNexis!
 "Ms. Jordan and her contributors provide concise, practical analysis of the multiple layers and nuances of Medical Secondary Payer compliance. The Guide is a valuable resource for plaintiff and defense counsel, as well as insurance carriers, employers, and third party administrators."
- Ronald E. Weiss, Esq., Hamberger & Weiss, Rochester, New York.
"The range of topics included in the book and updates is a beacon of wisdom in the confusing MSP compliance field."
- Tim Nay, Esq., Law Offices of Nay & Friedenberg, Portland, Oregon. Mr. Nay is a co-founder of the National Alliance of Medicare Set-Aside Professionals (NAMSAP).
"I have a copy of Jennifer Jordan's book The Complete Guide to Medicare Secondary Payer Compliance and I am most impressed by same! I have recommended it to a number of attorneys here in Georgia."
- Richard C. Kissiah, Esq., Kissiah & Lay, Alpharetta, Georgia.
"Finally, someone delivers a clear, concise reading in this area, with some definitive answers for both lawyers and claims specialists and accurate reporting dealing with MSP compliance and MSA allocations with all of the necessary resources found in one place."
"An excellent new book ... a one-of-a-kind resource ... [Jennifer C. Jordan's] straight-talk is much appreciated when it comes to this illusive area of the law."
- Rebecca Shafer, JD, President, Amaxx Risk Solutions, Inc. Read her complete review at Workers Comp Kit Blog.
There are many people who don't understand that the Centers for Medicare and Medicaid Services' approval process of a Medicare set-aside arrangement is voluntary and carries  an inherent cost. In fact, many of the decisions that need to be made in a settlement negotiation are risk management decisions rather than being truly Medicare Secondary Payer-oriented. Once you understand why CMS wants what it wants, you will realize that its preference may not be the only way to achieve MSP compliance. The Complete Guide to Medicare Secondary Payer Compliance, Jennifer C. Jordan, Editor-in-Chief, will help you take control of your insurance settlements. > Read more about the contents (1,350 pages). List Price: $179
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| state news |
AK: Senate Committee Passes Bill to Adopt Fee Schedule Covering Medical Supplies, Injections, Emergency Transportation.
AZ: ICA Posts Notice of Proposed Change to Physician & Pharmaceutical Fee Schedule.
CA: Bickmore Risk Services Names John C. Duncan as Sr. VP Governmental and Regulatory Affairs.
CA: SB 684 Would Clarify Venue for Workers Comp Insurance Dispute Resolution, Arbitration Clauses.
CA: WCIRB Submits Informational Filing, Foregoes 40% Pure Premium Rate Increase Request.
CA: SB 575 Would Close Loopholes in Workplace Smoking Laws.
CO: A Comparator of Public vs. Private Jobs and Benefits in Colorado.
DE: Dept of Labor Posts Annual Report on Status of Workers Comp Case Management.
FL: Budget Bill Would Amend Section 440.13 to Cap Price of Repackaged Drugs.
FL: Budget Bill Would Amend Section 440.50 to Provide for Reversion of Funds to Workers Comp Administration Trust Fund.
IL: Case Management Conference Set for May in Class Action PPO Lawsuit.
IL: IWCC Announces Wifi Available at Chicago Office.
IL: HB 1902 Would Allow Joint and Several Liability in Civil Lawsuits.
IL: GOP Lawmaker Calls on Governor to Renegotiate State Worker Union Contract.
IL: House Committee Approves Bill to Abolish Workers Comp System.
IL: GOP Lawmaker Proposes to Cut Workers Comp Board From 9 Members to 5 Members.
IA: HF523 Workers Comp Credit Bill Dies.
IA: HF525 Public Employee Collective Bargaining Agreements Dies.
KY: DWC Posts New Cost-to-Charge Ratios for Hospitals, Ambulatory Service Centers.
MD: AIA Endorses General Assembly's Approval of Premium Tax Levy on Maryland State Fund.
MD: Workers Comp Medical Costs Per Claim Among Lowest of 16 States.
MA: DIA Announces Change to Fee Schedule for Impartial Medical Examiners.
MA: Supreme Court to Hear Workers Comp Insurance and Negligence Dispute.
MA: Workers Comp Total Costs Per Claim Showed Rapid Growth.
MI: State to Receive $3.25M From AIG Settlement.
MI: Workers Comp Total Costs Per Claim Among Lowest of 16 States.
MN: GOP Lawmakers Seek to Raid $13M From State Run Workers Comp Program.
MN: Governor Appoints Patricia Milun Chief Judge of Workers Compensation Court of Appeals.
MN: GOP Lawmakers Propose to Strip Collective Bargaining Rights of Public Employees.
MN: Workers Comp Costs Per Claim Grew at Relatively Slow Pace.
MO: AIA Urges Legislature to Adopt Beneficial Workers Comp Measures, Not Injurious Ones.
MT: NCCI Files Request for Loss Cost Decrease of 5.6% Effective 7/1/2011.
NE: WCC Announces Relocation Set for 7/1/2011.
NY: WCB Chairman Says State Budget Includes More Than $200M in Assessment Relief for Group Self-Insurance Trust Members.
NY: Insurance Dept Emergency Regulation on Insurer Assessments, WCB Operations Effective 3/16/2011.
NY: NYCIRB Posts Payroll Limitation Cap for Construction Industry Effective 7/1/2011.
NC: H709 Would Implement Major Reforms to Workers Comp System.
NC: Legislative Debate Over Workers Comp Reforms Heats Up.
OH: BWC to Conduct Five-Year Review of Procedure, Benefits, Fee Rules.
OH: Governor Slams State Medical Board for Not Suspending Doctor in Pill Mill Probe.
OH: BWC Proposes Changes to Claimant Reimbursement Rule.
OH: Court Denies BWC Appeal to Stop Class Action of 100 Small Businesses Seeking Restitution.
OH: Governor to Tackle Workers Comp Privatization in Second Half of 2011.
OH: SB 5 Repeal Campaign Draws 11,000 Union Supporters.
PA: Randy Rohrbaugh Named Executive Deputy Insurance Commissioner.
SD: Governor Vetoes Own Bill to Regarding Appointments to Workers Comp Advisory Panel.
TX: Workers Comp Medical Costs Per Claim Rose After Period of Decreases Following Reforms.
TX: Texas Medical Association Raises Concerns About Bills to Restrict DWC's Ability to Remove Doctors.
TX: TDI Updates Workers' Comp and Employers' Liability Insurance Manual.
WA: 7,000 Union Protestors at State Capitol Tell Lawmakers to Support Workers.
WV: Governor Signs Bill to Help Fund Workers Comp Coverage for Volunteer Fire Depts. |
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 | 2010 Edition -
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| what's new in larson's workers' compensation law |
 Lexis.com subscribers to Larson's Workers' Compensation Law can link to the chapter discussion below. Find out more about how to become a Larson's online subscriber by contacting: Robin.E.Kobayashi@lexisnexis.com.
Heritability and Assignability of Claims and Benefits; Taxability of Benefits. One of the features distinguishing a workers' compensation award from a tort recovery is the general absence of any property right in an award which can survive in favor of heirs. As a general proposition, therefore, the right to receive future workers' compensation benefits is not inheritable. However, accrued but unpaid benefits are inheritable, and in the case of a lump sum settlement agreement which has not yet been paid, the entire lump sum is considered accrued. Similarly, generally speaking, the right to receive compensation benefits in the future is not assignable, but there is a strong recent trend towards exceptions to this principle in favor of spouses, former spouses, and children whom the employee has an obligation to support. Chapter 89, which discusses the important dynamics of these issues, has been revised as well. A distinction should be drawn between a claim for workers' compensation benefits and, for example, a claim against an employer for retaliatory discharge. A recent Alabama decision, Gibson v. Staffco, L.L.C., 2010 Ala. Civ. App. LEXIS 338 (Nov. 19, 2010), illustrates that this sort of action does survive the worker's death [see Ch. 89, § 89.05 n1 (Digest)]. |
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| ncci issues report, continued... |
 Harry Shuford, Chief Economist for NCCI Holdings, writes in "Will There Be a Recovery in Workers Compensation in 2011?" that uncertainty as to the American economy's outlook is inhibiting the business community's willingness to invest, which in turn restrains growth in the economy, including growth in employment on which the financial health of the workers' compensation insurance business depends. Shuford points out that, while the economy has grown since the end of the recession in 2009, this growth has not been matched by a growth in employment. This state of affairs particularly plagues the construction and manufacturing industries, both of which have historically generated high workers' compensation premiums and both of which suffered severely in the recession. While Shuford sees little likelihood that the economic recovery will translate into robust workers' compensation premium growth in the near future, he suggests that the period during which those premiums fell appears to have ended. Finally, the Federal Reserve's ongoing monetary policy of keeping short-term interest rates at historical lows, coupled with quantitative easing via its purchase of long-term government bonds with newly printed money, means that workers' compensation insurers face a financial market that offers extremely low returns on their investments.
Robert P. Hartwig, President and Economist, Insurance Information Institute, points out in "The Road to Recovery: The Workers Compensation Insurance Industry in the Aftermath of the Great Recession," that factors other than the recession contributed to the 29-percent drop in workers' compensation premium, which began in early 2006, more than a year before the start of the recession in late 2007. Most importantly, writes Hartwig, that drop was caused by aggressive pricing, the increased popularity of large deductible policies, captives, and self-insurance. According to him, pricing was probably responsible for roughly half of the drop. Thus, in his view, underwriting performance, rather than the economy, is the most important factor influencing workers' compensation insurers' bottom line.
Other NCCI reports focus on the legal environment in which the workers' compensation insurance industry operates. Peter Burton, Senior Division Executive, State Relations, NCCI Holdings, writes in "2011 Legislative and Regulatory Outlook" that the 2010 elections, having given Republicans control of many more governorships and one or both houses of a number of state legislatures, are likely to result in more workers' compensation legislation in 2011 than in the preceding year. Burton names around 30 states in which significant workers' compensation legislation can be expected. Among these, he anticipates that only two, Connecticut and Hawaii, with newly elected Democratic governors and Democratic majorities in both houses of their legislatures, are likely to enact increases in benefits for injured workers.
With respect to the U.S. Congress, Nancy Grover, Editor, Workers' Compensation Report, Program Director, National Workers' Compensation and Disability Conference & Expo, writes in "Workers Comp and Congress: A Look at the Possible Ramifications of the 111th Congress and a View to the 112th" that workers' compensation stakeholders are keeping their eyes on three areas of past and potential congressional activity: healthcare reform, Medicare requirements, and financial regulation.
- While the Patient Protection and Affordable Care Act signed into law in March 2010 does not include workers' compensation insurers within its definition of covered health insurers, the industry is monitoring the drafting of regulations under the statute to ensure that workers' compensation insurers, whose policies provide medical care to injured workers, are not pulled within the statute's coverage. One piece of the statute that does affect workers' compensation insurers is Black Lung, since it creates a presumption that a mine worker with a minimum of 15 years on the job who suffers a lung disease contracted it at work, and makes this provision retroactive to claims filed after January 1, 2005.
- Although no significant action by the 111th Congress affected Medicare's relationship with workers' compensation, pre-existing Medicare Secondary Payer statutes have required workers' compensation insurers, since the beginning of this year, to fulfill information-reporting requirements of those statutes. Insurers are hoping, but doubtful, that the present Congress will make changes to the Centers for Medicare and Medicaid Services' (CMS) procedures for reviewing workers' compensation set-asides generated by compromise and settlement of injured workers' claims.
- The Dodd-Frank Wall Street Reform and Consumer Protection Act, signed into law in July 2010, creates a Federal Insurance Office (FIO) as well as an Office of Financial Research (OFR), both within the Department of the Treasury. As each of these offices is organized, workers' compensation insurers are watching to see how they may affect their industry.
Effects of the Affordable Care Act on workers' compensation insurers are further outlined in the report "The Affordable Care Act and Workers Comp," discussing changes to the Federal Black Lung Benefit Entitlement Provisions and the Federal Coal Mine Health and Safety Act. In general, these changes will make it easier for injured workers to receive approval of benefit claims and increase the amounts of these benefits. Such changes are, of course, likely to result in a rise in insurance premiums. In addition, this report points out that, although the details remain to be revealed, any modifications in the CMS-authorized reimbursement levels for Medicare may affect insurance costs in states that base the reimbursements in their workers' compensation fee schedules on Medicare. Finally, this report presents a useful timeline of effective dates for the various provisions of the Affordable Care Act.
"Workers Compensation Prescription Drug Study: 2010 Update" by Barry Lipton, Chris Laws, and Linda Li, of NCCI's Actuarial and Economic Services Division, presents an overview of central findings of the complete 2010 Workers Compensation Prescription Drug Study, which may be viewed at ncci.com. Among these findings is the sharp rise in the volume of prescription drugs dispensed by physicians to workers' compensation claimants in recent years. Consequently, workers' compensation costs attributable to physician-dispensed drugs have risen, dramatically so in 2008. Moreover, contributing to these increasing costs is the fact that the unit cost of a physician-dispensed drug is typically higher than the unit cost of that drug when dispensed by a pharmacy. Interestingly, while the portion of all workers' compensation drug costs attributable to physician-dispensed drugs decreases as claims age, the incremental drug share of total workers' compensation medical costs increases as claims age.
Read the NCCI Workers Compensation Issues Reports.
© Copyright 2011 LexisNexis. All rights reserved. |
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| ENEWSLETTER ARCHIVES |
Take a deep dive into our past eNewsletters for 2011 and prior...warning - some links to articles may not work...report any linking problems to Robin.E.Kobayashi@lexisnexis.com. April 4, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104945262995.html
March 28, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104894130984.html
March 21, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104811663296.html
March 14, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104742747659.html
March 7, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104678900034.html
February 28, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104610168211.html
February 21, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104523576536.html
February 14, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104442568785.html
February 7, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104372668124.html
January 31, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104299196240.html
January 24, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104266393145.html
January 17, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104223885217.html
January 10, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104176109384.html
January 3, 2011
http://archive.constantcontact.com/fs077/1102828640660/archive/1104102646819.html
ACCESS 2010 ARCHIVES AND ARTICLES LIST HERE. |
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