At the 2017 International Association of Industrial Accident Boards and Commissions (IAIABC) Annual Convention, workers’ compensation regulators from around the nation discussed regulatory and policy issues in their jurisdiction.
Just filed a 16% decrease in workers’ compensation rates. They are getting push back on that from carriers who feel it is excessive and not supported by continued loss development.
Biggest news this year is implementation of Colorado uninsured employers guarantee fund, which provides benefits for injured workers if their employer was not insured. Assessments cover the costs of this. The assessments may not be sufficient at first and, if that is the case, medical benefits are given the priority.
Law passed that provides rebuttal presumption on PTSD claims for all workers. Has resulted in a significant influx of claims.
Only workers’ compensation bill that was in legislature was to roll back to AMA 4th edition for disability evaluations. This did not move forward. This same issue is currently litigating in the courts on a constitutional challenge.
Increasing concerns about large deductible policies with employers taking very large deductibles, but not going through the qualification to self-insure. Performed a data call for all carriers providing deductible coverage in the state and are currently analyzing this.
Involved in a business process re-engineering process and will be putting out a RFP for a new system. Also working on developing medical treatment guidelines and drug formulary, which is a significant undertaking.
Recent statutory changes involving maximum medical improvement language actually being part of the statute. Unsure what impact this will have long term. Shareholders of S-corporations can now exempt themselves from coverage. One of their big initiatives is to modernize their computer systems, which are very outdated and inefficient.
Their big project is enterprise systems modernization. The goal is to get all processes online and significantly reduce or eliminate manual processes. They feel this will dramatically increase their efficiency.
Severity and frequency continue to decline, which means rates have been decreasing. Medical is now 76% of total costs in the state, up over 10% in the last year. There is currently no medical fee schedule in Wisconsin, but this is being explored.
They implemented a new computer system and there is hope this will make them more efficient. Lump sum payments are now allowed for PPD up to 30%. New law indicates testing for marijuana impairment is blood only and they have standards for impairment. Lots of discussion around police/fire presumptions for heart and lung conditions because the workers that are claiming the benefits are being unreasonably delayed. State is investigating this. Now has adjuster licensing and they are trying to figure out what education and testing requirements will be for this.
Going through a technology process and just issued RFP for replacement of their legacy system. Legislation cleanup is being done to allow for the change from paper process to electronic as current statutes specifically require mailed notices for many things.
Automation business process continues. They have been working on this for four years. There is now a mobile application for attorneys to utilize. Legislatively they are looking to increase their funding to the uninsured employer guarantee fund as their funding has not been sufficient. A portion of their statue was found unconstitutional and they are working on a legislative fix.
Just updated medical fee schedule, which is done annually. The Commission is forming an advisory committee to look into telemedicine and it’s application to workers’ compensation. Their system is 28-years old and they are looking to update it. Legislatively, they now allow compensation to be paid by electronic payment instead of paper check.
Updated medical fee schedule with a 2.8% cost of living increase for most fees. Because it is Medicare-based there were some reductions. They started fining for late filing of first reports of injury to hope and get better compliance. They have an uninsured employer fund but it has not gone into effect because it is not funded. Unfortunately this means it is not providing benefits to workers. They now hope the fund goes live in mid 2018.
Implemented firefighters cancer fund, which is separate from the regular workers’ compensation statutes. Legislative changes to how wage loss is calculated has resulted in lower costs and rates.
18 bills came up for consideration. Most did not get any traction. Two bills that passed included a presumption bill for first responders with regard to PTSD and a vocational rehabilitation bill that limits reduction in benefits while participating in voc rehab. They have a medical marijuana case before their state Supreme Court. Lower courts have allowed the treatment to be reimbursed under workers’ compensation.
State is working to be more efficient and reduce unnecessary delays in their system. Administrative changes have reduced costs in the system. They have authorization from the state to hire additional claim managers (monopolistic state). Medical is now about 30% of total costs in Washington.
They have had a significant focus on opioid reduction. This included mandatory use of the PDMP and a 7-day limit on initial prescriptions. They also have an alternative court system for people seeking to get non-opioid pain management treatment. They are also looking at implementing a prescription drug formulary.
Loss costs continue to drop in the state after the law changes several years ago. They are revising rules around fee schedules and drug-free workplace. Another revision is around the certification around claims adjusters. Their workers’ compensation statute has an automatic sunset provision, so they are working to get the statute extended. They are finalizing their system modernization, which will make their litigation process paperless.
Going live on the latest version of EDI in November. Recent court decisions now allow illegal immigrant workers to receive both disability and medical benefits. Previously they were only allowed medical benefits. This is being appealed to the state Supreme Court. They have a telehealth bill, but are working through the fee schedule on this. Their expectation was lower costs than in-office visits, but that is not what is being pushed.
Their main focus has been development and implementation of their medical fee schedule, which is supposed to go live in January 2018. They have had a 200% increase in ADR events with very high resolution rates and they are hoping the use of ADR will continue to grow.
They have had a big focus on addressing opioids, which includes treatment for drug addiction services. Legislation passed that allows for a firefighter presumption for cancer.
Since privatization, they have seen 13 straight premium reductions. Prior to going private, their system was running a significant deficit.