Vol. 6, Issue 39

Find Solutions & Strategies October 5, 2015

What Affordable Care Act "Case-Shifting" Incentives Could Do to Workers' Compensation

In This Issue

- ACA CASE SHIFTING

- LARSON'S: Employment Contract, Heart Attack, Seasonal Worker, Subrogation

- NATIONAL & STATE NEWS

- eNEWSLETTER ARCHIVES

A Note From the Editor

affordable care act "case-shifting" incentives may result in increased medical costs for workers' comp

By Thomas A. Robinson, J.D., Feature National Columnist and co-author of Larson's Workers' Compensation Law.

As incentives within the Patient Protection and Affordable Care Act (ACA) push more and more patients toward so-called "capitated" health insurance plans--in which payments are "prospectively" made to health care providers at the beginning of the plan year on a per capita basis--and away from "traditional" fee-for-service health plans, a likely consequence will be an unwelcome increase in workers' compensation medical payment costs, according to a study recently released by the Workers' Compensation Research Institute (WCRI). The researchers posit, for example, that if just three percent of group health cases with soft tissue conditions were shifted to workers' compensation, as seems likely according to the study, overall workers' compensation costs in Pennsylvania could increase by nearly $100 million. In California, the so-called "case-shifting "effects would be...read more.

LARSON'S SPOTLIGHT ON RECENT CASES

Thomas A. Robinson, J.D., our Feature National Columnist, is the co-author of Larson's Workers' Compensation Law (LexisNexis).

North Carolina: Situs of Employment Contract Not Changed by Modification in Another State. In a divided decision, the Supreme Court of North Carolina held that once an employment contract has been made--in this case, in South Carolina--the contract's situs is not changed merely because the contract is...read more.

Wyoming: Unusual Exertion Opening Mud-Caked Access Panel Means Fatal Heart Attack Was Compensable Injury. Where a heavy equipment maintenance worker died following a massive heart attack and prior to the onset of the worker's cardiac symptoms he complained to his wife that...read more.

Arizona: Ballet Dancer Is Not "Seasonal" Worker for Purposes of Computing Average Monthly Wage. An Arizona appellate court held that the Industrial Commission erred when it found a professional ballet dancer's work was "seasonal" because...read more.

Georgia: Employer's Subrogation Lien Fails Where No Proof That Injured Employee Had Been Made Whole. Unlike the situation in many other states, the subrogation lien of a Georgia employer and/or its insurer attaches to third-party recovery by the injured employee only after the...read more.

national & state news

NCCI Posts Sept. 2015 Quarterly Economics Briefing Newsletter.

ProPublica Wins Journalism Award for 'Insult to Injury' Workers' Comp Series.

EEOC Declares Workers Comp Guidelines Don't Supersede ADA.

AL: NCCI Explains 8.2 Percent Decrease in Loss Cost Filing.

CA: DWC Launches New Online QME Form 106 Panel Process 10/1/2015.

CA: Grand Jury Testimony Released in Alleged Insurance Fraud Scheme Case.

CA: Claims Adjuster Pleads Guilty for Paying Bogus WC Claims for Pro Athlete.

CA: DWC Posts Draft Revisions to Benefit Notice Manual.

CT: NCCI Explains 3.9 Percent Decrease in Loss Cost Filing.

CT: WCC Posts Latest Maximum Weekly Compensation Rate.

FL: NCCI Explains 1.9 Percent Decrease in Loss Cost Filing.

FL: DWC Posts Reminder of New Reimbursement Manual for ASCs Eff. 1-1-2016.

FL: Nominating Commission Lists Judges for Reappointment, New Nominees.

GA: SBWC to Upgrade Integrated Claims Management Web-Based System.

LA: Louisiana Work Fatalities for 2014 Released.

ME: MEMIC Announces $18M Dividend for Policyholders.

MA: DIA Announces Public Comment Sessions to Conduct Regulatory Review.

MS: WCC Posts FAQs on ICD-10 Transition, Fee Schedule.

MO: Jury Awards $7M to Former ALJ of DLIR in Disability Lawsuit.

NE: Lawmakers Mull Over Problems With Vocational Rehabilitation.

NM: WCA Posts Fee Schedule, Billing Instructions Eff. 1-1-2016.

NC: Misclassification Bill H482 Stalls While Legislature Set to Adjourn.

NC: IC Releases 2015 Annual Report.

OH: BWC Says New Comp Law Provides Relief for Ohio Nonprofit Organizations.

OK: WCC to Hear Injured Worker's Appeal Even Though Employer Opted Out.

OR: SAIF Board of Directors Announce $120M Dividend.

OR: WCD Updates Medical Reporting Forms.

OR: WCD Updates Spanish Version of Health Care Provider's Report.

TN: Bill Seeks to Cap Benefits, Limits Coverage of Workers Comp Claims.

TN: High Court Orders Payment of $16M Refund to Out-of-State Insurance Companies.

TX: Opinion Piece Blasts Texas Mutual's System of Justice.

TX: Travis County DA Suspends Fraud Agreement With Texas Mutual.

TX: DWC Posts Interest Rate, Discount Rate for 10/1/2015-12/31/2015.

TX: DWC Seeks Input on Claim File Retention Period.

TX: DWC Proposes Changes to Amount, Payment of Temporary Income Benefits.

ENEWSLETTER ARCHIVES

Take a deep dive into our past eNewsletters for 2015 and prior...warning - some links to articles may not work...report any linking problems to Robin.E.Kobayashi@lexisnexis.com.

September 28, 2015: Adversaries and Frenemies of Workers' Compensation.
September 21, 2015: Undocumented Status: Impact on Workplace Safety.
September 14, 2015: Industrial Injuries in the U.S.: A 14-Year Study.
September 8, 2015: Occupational Safety Research and WC Data.
August 31, 2015: Impact of OSHA Developments on Workers' Comp.
ACCESS 2010-2015 ARCHIVES AND ARTICLES LIST HERE.

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