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We hope you find this Workers' Compensation Alert useful. Please send any questions to Practice Group Chair Ellen Adams.

 

Maximum Comp Rate Increases in 2012

Collins & Lacy Kristian Cross

  

By Attorney Kristian Cross

 

The South Carolina Workers' Compensation Commission has approved a 3 % increase to the maximum compensation rate for 2012. The approval happened at the Commission's Business Meeting yesterday (December 19, 2011).

 
The South Carolina Department of Employment and Workforce (formerly the South Carolina Employment Security Commission) has certified the average weekly wage in South Carolina for the period July 1, 2010 through June 30, 2011 was $725.47.  That means for accidents occurring on or after January 1, 2012, the maximum weekly compensation rate will be $725.47. 

 
The maximum weekly compensation rate in 2011 was $704.92. The new rate increases the maximum weekly compensation rate by $20.55; three percent greater than the rate in 2011.  In 2012, an individual earning $1,088.15 or more per week will be at the maximum weekly compensation rate.

For additional information on the rate increase and how it may affect your business, contact Collins & Lacy's Workers' Compensation Team.

 

New Pharmacy Fee Schedule

 

Also at yesterday's meeting, the Commission approved the Pharmacy Fee Schedule Advisory Committee's recommendations about "repackaged" medication.  The approved recommendation provides payment for prescription drugs limited to the amount established by the following formula, "Average Wholesale Price + $5.00 Dispensing Fee," or by the pharmacist's or health care provider's usual or customary charge, whichever is less. The formula applies to both brand name and generic drugs. However, all prescriptions must be filled using generic drugs, if available, unless the authorized treating physician directs that it is dispensed otherwise.

 

What does this mean? The former fee schedule did not equitably address "repackaged" medications. Therefore, the new schedule seeks to regulate such medications. The new fee schedule limits the amount pharmacies can charge an employer/carrier for "repackaged" medication and provides new procedures for reimbursement. The goal of the new fee schedule is to create balance in the workers' compensation marketplace and reduce overall system costs.

 

To see a copy of the complete recommendation as approved by the Commission on December 19, 2011, click here.

Changes to Informal Conference Process  

Collins & Lacy Anne Marie Hempy

 

 By Attorney Anne Marie Hempy

 

 Just last week, the South Carolina Workers'

 Compensation Commission hosted a

 roundtable discussion to address the new

 changes to the informal conference system.

 Pursuant to Reg. § 67-202, "an informal

 conference is a meeting with the claimant, the

 employer's representative and a Commissioner or claims mediator." The purpose of the informal conference is to review a proposed Form 16 or Form 16-A settlement. In the past, a Deputy Commissioner appeared on behalf of the Commission, reviewed the ratings assigned by the treating provider, analyzed any work restrictions and questioned the pro se claimant about any continued complaints of pain. The Deputy Commissioner then suggested an award, opining what he or she felt would constitute a fair settlement based on the evidence presented. The adjuster and claimant could either agree to the valuation or decline settlement and proceed to a hearing.

 

How will the process change? From now on, the informal conference will work more like a mediation. The employer's representative/adjuster is charged with making an initial offer to the claimant. The Deputy Commissioner will no longer make a suggestion as to the value of the claim. Like a true mediation, the Deputy Commissioner's purpose will be to facilitate discussions about settlement. If the parties are able to reach an agreement, the Deputy Commissioner will sign the Form 16 or Form 16-A. If not, as in the past, the Commission will schedule the claim for hearing.

 

Practice Point: An adjuster or other representative attending the hearing on behalf of the employer needs to come prepared to the informal conference with appropriate settlement authority and with evidence to support the employer's position. For instance, if the medical records indicate the claimant is a malingerer or has not been compliant with recommended treatment, the adjuster needs to bring those records to the informal conference and show the records to the Deputy Commissioner (and claimant) during the discussion of the case. Surgical notes, treatment records, personnel documents and any other evidence to support the rationale behind the employer's valuation should be available for review at the conference.

 

Click here for a schedule from the Commission's website of upcoming informal conferences.

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