SC Workers’ Compensation Commission

SC Workers’ Compensation Educational Association Medical Seminar

Commission Update

March 1, 2011

COMMISSION

UPDATE

South Carolina Workers’ Compensation Commission

Claims Activity

FY FY FY 08-09 09-10 10-11

(YTD)

Hearings Set (Docketed) 9,866 10,912 6,107

Hearings Held (Single Commissioner) 2,345 2,211 1,242

Settlements 10,506 10,715 6,117

South Carolina Workers’ Compensation Commission

South Carolina Workers’ Compensation Commission

Informal Conferences

AssignedConducted

FY 09-10 6,264 3,549

FY 10-11 (YTD) 3,410 2,518

South Carolina Workers’ Compensation Commission

Informal Conferences

Adjusters please bring ………

14B’s

Medical Narrative

South Carolina Workers’ Compensation Commission

South Carolina Workers’ Compensation Commission

Don’t Request a Hearing Unless You Are Ready……

Hearing Requests Processed 29 days

Hearings Scheduled 102 days

Appellate Appeals 117 Days

South Carolina Workers’ Compensation Commission

Appeals to Full Commission

FY FY FY08-09 09-10 10-11

(YTD)

Docketed 700 647 397

Hearings 450 357 168

Legislative Audit Council Report

September 2010

IssuesDepositing of ChecksVocational Rehabilitation ReferralsInformal Conference MediatorsIncreased Compliance Enforcement

South Carolina Workers’ Compensation Commission

Focus Groups

Attorney Add

Additional Case Status Information

Register at www.wcc.sc.gov

South Carolina Workers’ Compensation Commission

eCase

• Website: WWW.WCC.SC.Gov

• Commissioners Preferences

• Case Status Information eCase

• Business Meetings Agendas

South Carolina Workers’ Compensation Commission

Medical Fee Schedule

Surgical Implant Fee

Repackaged Pharmaceuticals

Claims Administrations Workshops

South Carolina Workers’ Compensation Commission

South Carolina Workers’ Compensation Commission

Electronic ServiceHearing NoticesOrders

Coming SoonConsent OrdersClinchersFee Petitions

South Carolina Workers’ Compensation Commission

LegislationH 3653

Annual Review MSPMAppeals to ALJ

S 407Transfer 10% Earmarked FundsFY 2010-11FY 2011-12

South Carolina Workers’ Compensation Commission

Legislation

FY 2011-12 Budget

10% Reduction General Fund

$193,675

South Carolina Workers’ Compensation Commission

Comp System CostHospital Fee Schedule

Reductions

Actual FY FY 08-09 09-10 Savings

MedicalExpense $422.4 $296.0 $126.4

South Carolina Workers’ Compensation Commission

Premiums Paid (millions) % of total

Commercial Market CY 2009 $586.9 63.10%

Self Insurance FY 2010 $253.3 27.23%

State Accident Fund FY 10 $ 90.0 9.67%

Total $ 930.2 100.0%

South Carolina Workers’ Compensation Commission

Premium Tax Paid To General Fund

Commercial Market (CY 2009) $ 14,673,877 Self Insurance Tax (FY 2010) $ 4,909,000

___________Total $ 19,582,877

Commission Budget General Fund FY10-11 $ 1,919,955

Proposed FY11-12 $ 1,743,070

South Carolina Workers’ Compensation Commission

System Cost Total

(millions) % of Total

Medical $ 296.0 36%

Indemnity (Comp.) $ 528.2 64%

Total $ 824.2 100%

South Carolina Workers’ Compensation Commission

IndemnityTotal

% of Total

(millions) Indemnity System*

Agreements $ 498.9 94.46% 60.54%

Awards Awards $ 29.3$ 29.3 5.54% 5.54% 3.55% 3.55%

Total $ 528.2 100%

*System Cost = Medical and Indemnity

South Carolina Workers’ Compensation Commission

Indemnity – TemporaryAwards

% of Total (millions) Awards

System*

Partial $ .7 2%

Total $ 14.3 98%

Total $ 15.0 100% 1.82%

*Total System Cost = Medical and Indemnity

South Carolina Workers’ Compensation Commission

Indemnity – PermanentAwards

% of Total (millions) Awards

System*

Partial $ 10.5 73%

Total $ 3.7 26%

Disfigurement $ .068 <1%

Total $ 14.3 100% 1.74%*Total System Cost = Medical and Indemnity

South Carolina Workers’ Compensation Commission

Indemnity – PermanentAgreements

% of Total (millions) Agmts System*

Partial $ 48.3 13%

Total $ 16.0 5%

Disfigurement $ .4 <1%

Clinchers $ 291.0 82%

Total $ 355.7 100% 43.15%

*System Cost = Medical and Indemnity

South Carolina Workers’ Compensation Commission

Average Cost Per Case Closed

FY 2009 FY 2010

$12,821 $13,181

Medical ($ 5,869) ($ 4,734)Indemnity ($ 6,951) ($ 8,448)

South Carolina Workers’ Compensation Commission

Questions?

Comments?

Suggestions?

Thank you!

www.wcc.sc.gov

South Carolina Workers’ Compensation Commission

Compliance Activities

Increased enforcementSC DEW Wage Information

Fines/Assessments

Show Cause Hearings

South Carolina Workers’ Compensation Commission

ComplianceFY09 FY10 FY11

(YTD)

Investigations Initiated 1,092 1,375 1,204

Show Cause Hearings Set 111 193 100

Compliance Agreements 344 409 185

Total Investigations Closed 443 1,257 751

Claims Activity

FY FY FY 08-09 09-10 10-11

(YTD)

Accidents Reported 71,973 58,783 N/R

Ind. Reported Accidents 26,313 23,686 15,278

Reopened ( 1,575) (1,738) (1,669)

South Carolina Workers’ Compensation Commission

South Carolina Workers’ Compensation Commission

FY FY FY 08-09 09-10 10-11

(YTD)

Cases Closed 71,973 62,536 N/R

Ind. reported (26,313) (29,044) 18,026

Minor Medical (45,660) (33,492) N/R

South Carolina Workers’ Compensation Commission

Indemnity – TemporaryAgreements

% of Total (millions) Agmts System*

Partial $ 3.0 2%

Total $ 140.0 98%

Total $ 143.0 100% 17.38%

*Total System Cost = Medical and Indemnity

Claims Administrations Workshops

May 5, 2011

September 29, 2011

South Carolina Workers’ Compensation Commission

South Carolina Workers’ Compensation Commission

Hospital Fee Schedule

Approved 2006

Inpatient Outpatient Ambulatory Surgery Centers

Medicare + 40%