Q4, 2015 – January 7, 2016
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Research Insured Claims Experience Through 3Q 2015. WCIRB’s summary of insured losses and premium through 3Q 2015 shows DWP gross of deductible credits through September was $13.4 billion, up 7% from the total for the same 9-month period of 2014. The average charged rate fell to $2.78/$100 of payroll, 7% below the average in the first half of the year, and the lowest charged rate since 2012. WCIRB projects that AY ’14 claim severity will increase 3.4% to nearly $84,000, and that ultimate losses ALAE will total $12.6 billion, about 7% above the projection for AY ‘13 and 29% above the AY ’09 projection, but still below the highs recorded prior to the ‘02-‘04 reforms. Average paid medical/claim was up 4% in the first half of 2015 compared to the prior 6 months, as physician, hospital, DME supplier and med-legal payments all rose, which WCIRB says may indicate that some SB 863 savings may be starting to erode. Executive Briefing (12/14/15) (members only) The L.A. Effect in California Workers’ Comp. Preliminary findings from an upcoming CWCI study on why claim costs in the L.A. region are the highest in the state show the entire process from injury to claim closure develops differently in L.A. than in the rest of the state. Among factors contributing to the higher costs: A higher proportion of claims involving PD, attorneys, mental health diagnoses, delayed claim notification and high claims management expense; longer lag times between injury date and employer notice; longer lag times between employer notice and initial medical appointment; and longer claim duration. Executive Briefing (12/14/15) (members only) Medical Review and Medical Dispute Resolution in California Workers’ Compensation. An analysis providing updated results on utilization review and independent medical review outcomes based on data from 5.6 million medical services from 2014 and 220,000 IMR determination letters from 2014 through the first half of 2015. The analysis includes a history of the UR/IMR process, results and graphics from the research, and a discussion section. CWCI Research Update (12/2/15) (public) Bulletin (12/2/15) (members only) News Release (12/2/15) (public) Executive Briefing (11/25/15) (members only) Job Injury & Illness Rate Declines. California’s Survey of Occupational Injuries & Illnesses (SOII) for 2014 shows the state’s work injury & illness rate dropped again last year, falling to the lowest level in 13 years. The survey recorded 460,000 injuries and illnesses in 2014, of which 265,000 were “lost time cases” involving lost time, job transfer, or restriction-from-duty, with more than 140,000 of those involving days away from work. Executive Briefing (11/24/15) (members only) The Utilization and Cost of Drug Testing in California Workers’ Compensation. A report to the industry examines the issue of urine drug testing in California workers’ comp, which now accounts for nearly half of all lab services and more than half of all lab service expenditures in the system. CWCI Research Update (10/12/15) (members only) Bulletin (10/12/15) (members only) News Release (10/12/15) (public) Executive Briefing (9/23/15) (members only)
Legal Cornejo v. Younique Café Inc. The WCAB Board Panel Decision issued in December 2015 which held that the registration and bonding requirements of Business & Professions sections 22450 and 22455 do not apply to a lien claimant copy service seeking to recover fees that are medical-legal expenses under LC section 4620(a) if the lien claimant is an agent and/or independent contractor of a member of the State Bar at the time the documents are photocopied. Executive Memo (12/24/15) (members only) Stevens v. WCAB. The First District Court of Appeal ruled that the independent medical review process for medical care in the California workers’ compensation system is a constitutional exercise of the Legislature’s plenary power. Significant Decision Summary (10/29/15) (members only) Batten v. WCAB. In a published opinion, the Second District Court of Appeal ruled that medical reports obtained privately at the injured worker’s expense under section 4064(d) are barred by section 4061(i) and are therefore inadmissible as they are specifically barred from evidence by section 4061(i). Significant Decision Summary (10/29/15) (members only) Lien Activation Fees: Ninth DCA Denies Petition for Rehearing in Angelotti v. WCAB. In a victory for workers’ compensation payers, the 9th Circuit Court of Appeals denied the plaintiffs’ Petition for Rehearing in in Angelotti v. Baker. A status conference on lien activation fees will be held 11/2/15, after which there may be an order lifting the preliminary injunction against the fees mandated by SB 863. The status of liens for which the activation fee was not paid prior to the November 2013 injunction remains unclear, but Judge Wu may give lien claimants a limited amount of time to pay the $100 per lien activation fee, after which unactivated liens would be dismissed by operation of law. Executive Memo (10/9/15) (members only)
Statutory/Regulatory Change in California WC Medical Mileage Rate. The mileage rate WC claims administrators pay injured workers for travel related to medical care or evaluation of their injuries will drop to 54¢/mile for medical travel on or after 1/1/16, regardless of the injury date (NOTE: the old rate of 57.5¢/mile still applies for reimbursements of travel that occurred from 1/1/15 thru 12/31/15). Claims administrators will need to reprogram their systems to reflect the change. Executive Memo (12/18/15) (members only) Bulletin (12/18/15) (members only) News Release (12/18/15) (public) Executive Briefing (12/24/15) (members only) Update on New Notices and Forms Effective 1/1/16. Benefit notice regs adopted in Sept take effect 1/1/16. In late December DWC advised that it had posted its revised sample benefit notice manual on its website along with an updated URL address to link directly to Spanish versions of the Injured Worker Guidebook and the corresponding chapters required in the new benefit notice letters. Links to the QME form and instructions in Spanish were also updated. Claims administrators & employers should have up-to-date notice materials and new DWC-1 claim forms ready for 2016. Updated posting notices, new hire and injured worker pamphlets & claim forms can be ordered from our store www.cwci.org/store.html. Executive Briefing (12/24/15) (members only) 1/1/16 DMEPOS Changes to the OMFS Will Require Last Minute Reprogramming. New Payment rates for Durable Medical Equipment, Prosthetics, and Supplies that take effect 1/1/16 vary depending on whether the injured workers’ residence is classified by Medicare as having a rural or non-rural ZIP code. This is a new factor for fee schedule repricing, so claims operations will need to program this into their systems to assure accurate payment. Executive Memo (12/18/15) (members only) Summary of 2016 Employment Law Changes. Several new California laws affecting employers (and in some cases, WC) were enacted in 2015, including the increase in the state minimum wage, the Fair Pay Act which address gender-based wage differentials and the Contractor License Board enforcement of WC coverage. In late December DIR also issued a digest of 2015 enacted and vetoed legislation that will or would have had some impact on its operations. CWCI’s Bulletin on enacted legislation related to WC issues was released in October and is posted in the Members section of our website. Executive Briefing (12/24/15) (members only) Chronic Pain Treatment Guideline Update. In early December, the DWC posted the first 15-day notice of modification to the proposed Chronic Pain and Opioid Treatment Guidelines. CWCI is compiling comments from members and will submit them to the Division by the December 19 deadline, after which they will be posted in the Regulatory section of our website. Executive Briefing (12/14/15) (members only) 1st 15-Day Comment (12/19/15) (public) New SJDB Voucher Form Is Now in Effect. On December 1, the DWC announced that a revised Supplemental Job Displacement Benefit voucher form, updated to conform to recently adopted regulations (CCR §17303) in regard to DIR’s $120 million a year Return-to-Work Fund, has been posted on its website and is now in effect, so claims administrators must begin using it immediately. Executive Briefing (12/14/15) (members only) PAR and Full Compliance Audit Standards for 2016. The DWC has announced that the 2016 ratings, based on 2012-14 audits, will be lower than in 2015. The 2016 PAR standard will be 1.51082; the full compliance audit standard will be 1.67880. Executive Briefing (12/14/15) (members only) Executive Memo (12/9/15) (members only) Update on Benefit Notice Letters, Translations, Other Benefit Notice Changes Revised workers’ compensation benefit notice regulations take effect in less than a month, so claims administrators are assembling their claims kits and updating their systems so the new notices will be available for use beginning January 1. DWC also recently announce a new SJDB form that is already in effect and should be used by claims administrators. The update notes where the notice materials are available. Bulletin (12/8/15) (members only) Home Health Care Draft Regulations. CWCI’s 45-day public comments on proposed regulations governing home health care in workers’ compensation. 45-Day Public Comment (11/3/015) ( public) 2016 Assessment Rates.State law requires that employers pay annual assessments to fund DWC’s budget and 5 other programs set up by state lawmakers. Workers’ compensation insurers must advance the money to the state on behalf of policyholders, then recoup it via policy surcharges & assessments. At the end of November DIR issued the rates for, so insurers and self-insured employers need to prepare their initial payments which are due January 1. Bulletin (11/18/15) (members only) News Release (11/19/15) (public) Executive Memo (11/17/15) (members only) Executive Briefing (11/25/15) (members only) Reminder: 2016 Benefit Increases. The State Average Weekly Wage rose last year, so TTD rates for AY 2016 claims will increase along with other benefits tied to SAWW changes. The new maximum TTD for claims with dates of injury o/a 1/1/16 will rise to $1,128.43/week, the minimum will rise to $169.26. Executive Briefing (11/25/15) (members only) Heads Up: OSHA Fines to Rise in 2016. For the first time in 25 years, Fed-OSHA fines for safety violations will increase in 2016. A labor-backed provision in the federal budget deal removed OSHA from the list of agencies with fines that are exempt from inflation adjustments, so OSHA penalty amounts that take effect sometime in 2016 should jump about 80% to reflect the change in inflation since 1990. In addition, the amounts will continue to increase in the future, based on annual changes in inflation. Executive Briefing (11/25/15) (members only) DWC Releases Revised Benefit Notices. The DWC has posted the revised Benefit Notice Manual with updates to the sample benefit notice letters that reflect the regulatory changes adopted in August. The effective date for using updated benefit notice letters is January 1, 2016. The revised manual can be accessed on the Division’s website under Publications and Print Materials. Executive Memo (10/30/15) (members only) First Forum Comments on DWC’s Draft Guidelines for Occupational/Work-Related Asthma and Interstitial Lung Disease. CWCI’s first forum comments on proposed guidelines for Occupational/Work-Related Asthma and Interstitial Lung Disease as drafted by the Division of Workers’ Compensation 1st Forum Comments (10/26/15) (public) Summary of Workers’ Compensation-Related Legislation Enacted in 2015. CWCI’s summary of bills enacted by the Legislature and signed by the governor that may be of interest to the workers’ compensation community. Bulletin (10/12/15) (members only) First Forum Comments on DWC’s Proposed Benefit Notice Instruction Manual. CWCI’s first forum comments on the proposed revisions to its Benefit Notice Instruction Manual. 1st Forum Comments (10/9/15) (public) Governor Signs Workers’ Compensation Formulary Bill, Vetoes Gender Bias Apportionment Bill. Governor Brown acted on the two most high-profile workers’ comp bills passed by the state Legislature this year, signing AB 1124 (Perea), the workers’ compensation formulary bill, and vetoing the California Applicants’ Attorneys Association-backed bill (AB 305, Gonzalez) that would have prohibited the use of certain gender-related characteristics in the calculation of PD benefits. Executive Memo (10/6/15) (members only) CWCI Begins Shipping Claim Forms, Posting Notices & Pamphlets With 2016 Updates. CWCI has taken delivery of the updated DWC-1 claim forms and Notice of Potential Eligibility, the new hire pamphlets and the revised posting notices that employers and claims administrators will be required to use as of 1/1/16. Shipments have begun for those who pre-ordered their notices, others may order online from the Institute’s website to obtain the updated notices in time for the January 1 deadline. News Release (10/14/15) (public) Executive Memo (10/1/15) (members only)
Other CWCI Member Webinar on UR/IMR Research. To provide additional insight and a broader understanding of the issues surrounding medical review and dispute resolution and the results of the Institute’s research on UR and IMR, CWCI has scheduled a free 1 hour webinar exclusively for representatives of our member companies. Executive Briefing (12/14/15) (members only) Executive Memo (12/3/15) (members only) CWCI Staff Members Receive Industry Awards. CWCI president Alex Swedlow was honored this month w/the “Summa Comp Laude” (with highest honor) Award bestowed by Work Comp Central at its 2015 “Comp Laude” Gala and Awards Ceremony, while CWCI General Counsel Mike McClain recently received the “Workers’ Compensation Lifetime Achievement Award” from the Workers’ Compensation Section of the California Bar Assn. CWCI staff joins the rest of the community in congratulating Alex and Mike. Executive Briefing (12/14/15) (members only) Another New Opioid. A new tamper-resistant opioid is about to the market. Belbuca, a film patch infused with buprenorphine that goes on the inside of the cheek where the drug is absorbed into the bloodstream. Because it is difficult to crush or liquefy, Belbuca is less prone to abuse so physicians can write a 6-month prescription instead of a 1-month supply, so claims and medical staff and workers’ comp PBMs may want to keep an eye out for it. Executive Briefing (11/25/15) (members only) CWCI Hotlinks Update. Quarterly listings of all CWCI publications, including publication dates, brief summaries of each topic and the various formats in which the information is available (e.g., research report, Bulletin, Executive Briefing, news release), so users can choose the level of detail they want to view. Listings include live links so users can click into the CWCI website to access specific documents quickly and easily. Hotlinks (10/1/15) (members only) |