Workers’ Compensation Like - A Contact Sport Jeff Rowley Salt Lake County.
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Transcript of Workers’ Compensation Like - A Contact Sport Jeff Rowley Salt Lake County.
Workers’ CompensationLike - A Contact Sport
Jeff Rowley
Salt Lake County
Claims AdjusterDoctor
Physical Therapist
Pharmacist
Supervisor
Worker
Bill Review
MedicareLabor
Commission
Payroll
Spouse
Claims Adjuster
Doctor
Physical Therapist
Pharmacist
Supervisor
Injured Worker
Bill Review
Payroll
Spouse
Claims Adjuster
Doctor
Physical Therapist
Pharmacist
Supervisor
Injured Worker
Bill Review
Payroll
Spouse
Workers’ Compensation
A Government Mandated and Regulated
Program
What else is Mandated & Regulated:
• Taxes • Social Security
• Parking Meters • Medicare
• Death • Selective Service
What Can We As Individuals Do To Change These?
Some Things You Can’t Control
Workers’ CompensationIs Not Like That.
The only way to make sense out of change is to plunge into it, move with
it, and join the dance.Alan Watts
Changes Happen
Smalla) Rule Changes (Attorney’s Fees, Burial Expenses)b) New Forms (Or Elimination of Unnecessary Forms)
Not So Smalla) New Fines for Late Reportingb) Coordination of Benefits with Health Insurance
Landscape Changersa) Utah Supreme Court – Merrill Decisions (2009 &
2010)b) Legislature – Lifetime Medicals (2007)
You Can Have a Voice.
Workers’ Compensation Advisory Council
Labor Commission Medical Committee
Workers’ CompensationAdvisory Council
34A-2-107. Appointment of workers' compensation advisory council -- Composition -- Terms of members -- Duties -- Compensation.
(5) The council shall confer at least quarterly for the purpose of advising the commission, the division, and the legislature on:
a) The Utah workers’ compensation and occupational disease laws;
b) The administration of the laws described in (5)(a); and c) Rules related to the laws described in Subsection (5)(a).
Workers’ CompensationAdvisory Council
34A-2-107. Appointment of workers' compensation advisory council -- Composition -- Terms of members -- Duties -- Compensation.
(6) Regarding workers’ compensation, rehabilitation, and reemployment of employees who acquire a disability because of an industrial injury or occupational disease the council shall:
a) Offer advice on issues requested by:i. The commission; ii. The division; andiii. The legislature; and
b) Make recommendations to:i. The commission; andii. The division (Industrial Accidents)
Workers’ CompensationAdvisory Council
34A-2-107. Appointment of workers' compensation advisory council -- Composition -- Terms of members -- Duties -- Compensation.
1)The commissioner shall appoint a workers’ compensation advisory council composed of:
a) The following voting members:i. Five employer representatives; and ii. Five employee representatives; and
Employer RepresentativesTodd R. Bingham, Utah Manufacturers AssociationDave Davis, Utah Food Industry AssociationDavid R. Bird, Law Firm of Parsons, Behle & LatimerRichard J. Thorn, Utah Chapter of Associated General ContractorsM. Jeff Rowley, Salt Lake County Risk Management
Workers’ CompensationAdvisory Council
34A-2-107. Appointment of workers' compensation advisory council -- Composition -- Terms of members -- Duties -- Compensation.
1)The commissioner shall appoint a workers’ compensation advisory council composed of:
a) The following voting members:i. Five employer representatives; and ii. Five employee representatives; and
Employee RepresentativesReo Castleton, Salt Lake County Fire DepartmentK. Dawn Atkin, Law Firm of Atkin & AssociatesBrian Kelm, Law Office of Brian D. KelmRichard Brewster, Engineers Local Union #3William Brandt Goble, Painters and Tapers Union Local 77
Workers’ CompensationAdvisory Council
34A-2-107. Appointment of workers' compensation advisory council -- Composition -- Terms of members -- Duties -- Compensation.
b) the following nonvoting members: (i) a representative of the Workers' Compensation Fund;
-Ray Pickup(ii) a representative of a private insurance carrier;
-Kathleen G. Bissell (Liberty Mutual Insurance) (iii) a representative of health care providers;
-Dr. Edward B. Holmes, Summit View Medical (iv) the Utah insurance commissioner or the insurance
commissioner's designee; and -Todd Kiser, Tracy Klausmeier
(v) the commissioner or the commissioner's designee.
Workers’ CompensationAdvisory Council
34A-2-107. Appointment of workers' compensation advisory council -- Composition -- Terms of members -- Duties -- Compensation.
Legislative LiaisonsSenator Karen MayneRepresentative Jim Dunnigan
Workers’ CompensationAdvisory Council
Workers’ CompensationAdvisory Council
Ongoing Issues• Labor Commission Budget (partially funded by
tax on premiums)• Budgets and forecast for the Uninsured
Employers Fund and Employer’s Reinsurance Fund.
• Funding for the Safety Grant Program (Source of Funding Initiated By Advisory Council Years Ago).
• Approving the Medical Fee Schedule.
Workers’ CompensationAdvisory Council
Other Issues• Proposed rule changes – attendees and council
members can propose them• Administrative issues within the Labor
Commission• Legislative initiatives
What currently needs to change and what is on the horizon?
Labor Commission Medical Committee
Purposes
•How to allocate resources.•How to help the system avoid financial collapse.•Which behaviors and coping styles to reward.•How to identify patients who are likely to succeed.
Labor Commission Medical Committee
Committee Make-Up
Orthopedist Initial Care
Occupational Medicine Physical Therapist
Chiropractor Nurse Practitioner
WCF Self-Insured Employer
Private Insurer Injured Worker Legal
Employer Legal
Labor Commission Medical Committee
Most time spent on setting up the modification factors for the physician medical fee schedule.
Intent is to stay in the top 1/3 of all payers.
Labor Commission Medical Committee
Intent is to stay in the top 1/3 of all payers.
Medical Access Sensitivity
Physician Shortage
Injured workers require:More timeMore paper workMore Non Physical IssuesGreater dissatisfaction with treatment
Workers’ CompensationAdvisory Council
Fee Schedule Changes - 2014
You Must Be The Change You Want To
See In The WorldMahatma Gandhi
What Issues Have The Council and Committee
Addressed?
Sample Issues Addressed By The Committees
2011SB-11 & SB-35 (Enrolled) Created the Worker Classification Coordinating Enforcement Council made up of the Labor Commission, Workforce Services, Tax Commission and Department of Commerce. Aim: fight misclassification of workers as independent contractors as a way of getting around the workers’ compensation system.
HB-61 (Failed) Sought to exempt home businesses from workers’ compensation requirements. No limitation on the type of business.
HB-55 (Enrolled by Unanimous vote) Provides full workers’ compensation coverage (medical and indemnity) for county search and rescue volunteers.
Sample Issues Addressed By The Committees
2013SB-59 (Enrolled) Coordination of benefits between workers’ compensation and health insurance carriers.
Sample Issues Addressed By The Committees
2014HB-10 (Enrolled, Unanimous Vote) Removed the mandatory reemployment filings and made the notice to the employee of vocational rehabilitation opportunities voluntary.
SB-44 (Enrolled Unanimous) No disability compensation to be paid for intentional misuse or abuse of drugs when said use is a major contributing cause of an injury. %15 reduction in disability compensation when drugs are a contributing cause.
Sample Issues Addressed By The Committees
2015SB-135 Created a rebuttable presumption of coverage for listed cancers in firefighters when the following conditions are met.1.Annual physical exams2.Firefighter subject to emergency call out over the last 8 years3.No tobacco use as certified by a doctor for the last 8 years
Destiny is not a matter of chance, but a matter of
choice. It is a thing to be achieved.
William Jennings Bryant
What issues are on the horizon?
Issues on the horizonShould Utah consider a closed
pharmaceutical formulary?
Issues on the horizonShould Utah consider a closed
pharmaceutical formulary?
Formularies help change prescribing patterns … by requiring proof that non-formulary drugs are medically necessary(.)
Business Insurance Excluded medications include some opioid painkillers, benzodiazepine psychoactive drugs, soma muscle relaxants and other medications
Issues on the horizonShould Utah consider a closed
pharmaceutical formulary?
Let’s Take A Vote!
Issues on the horizonShould Prescribed use of Medical
Marijuana be Allowed in Utah?
Issues on the horizonShould medical marijuana use be allowed in workers’ compensation
in Utah?
Let’s Take A Vote!
Issues on the horizonShould there be a specific test for workers’ compensation adjusters
to receive their licenses?
Let’s Take A Vote!
Issues on the horizonShould Utah consider developing a
hospital fee schedule?
44% 28%
Issues on the horizonShould Utah consider developing a
hospital fee schedule?
Proposed Solution1.Seek a statutory change – Allow action2.Presumed reasonable when based on the average of the top three provider and payer representatives in the health industry in Utah.
Issues on the horizonShould Utah consider developing a
hospital fee schedule?
Let’s Take A Vote!
Issues on the horizonOther issues that may come up:
1.Opt in, opt out of WC System.2.Should there be a clearer burden of proof for lifetime medicals?3.Currently 8% interest is used universally in the WC system. Is that fair and reasonable?4.Are death benefits sufficient and reasonable?
The Point – Get Involved!We must create the future by design,
not by accident.Riddhima Yadav
Workers’ CompensationLike - A Contact Sport
Thank you.
Projections based on projected interest rates of 2% in FY16, 3% in FY17, and 4.25% in FY18 and beyond.
Employers Reinsurance Fund
Projections based on projected interest rates of 2% in FY16, 3% in FY17, and 4.25% in FY18 and beyond.
Uninsured Employers Fund