At the 2019 California Self-Insurers Annual Conference, a panel discussed fraud in California Workers’ compensation. The speakers were: James Riddle – President and CEO, JLR Investigations John Riggs – Senior Manager Workers’ Compensation, The Walt Disney Company Jennifer Snyder – Head Deputy District Attorney Los Angeles According to one the panelists, these are what they consider the top sources for fraud in workers compensation. Employer Fraud Statistically speaking this is the leading source of workers’ compensation fraud. This includes failure to secure workers’ compensation coverage and intentionally misclassifying workers as independent contractors. Intentionally misclassifying workers’ into safer occupations is also
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At the 2019 California Self-Insurer Association Annual Conference, Bill Armstrong from the Armstrong Law Firm highlighted some important recent California workers’ compensation case law. Young vs Splash Studio WCAB panel majority ruled that applicants home was employer authorized second job site and therefore injuries sustained traveling between home and other fixed work site was considered to be in course and scope of employment. There was a dissent around the issue that the injury was sustained in a road rage incident and the dissenting judge felt this took the worker out of the course of employment. Pearson Ford vs WCAB (Hernandez)
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At the 2019 California Self-Insurer Association Annual Conference, George Parisotto, Administrative Director from California Division of Workers’ Compensation discussed their ongoing activities. Medical Treatment Utilization Schedule The MTUS guidelines are an independent guideline that contains definitions and evidence based treatment guidelines. They include the ACOEM guidelines but can go beyond them. They are constantly looking to update their guidelines and the regulations provide a methodology to easily make adjustments based on the latest evidence based treatment guidelines. Recent updates include October 2018 traumatic brain injury guidelines and April 2019 updates on a variety of issues including post-traumatic mental health. Physicians
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At the 2019 California Self-Insurer Association Annual Conference a panel discussed the costs of denied claims. The speakers were: Alex Swedlow – President, CWCI Bill Zachry – Senior Fellow, Sedgwick Institute Mark Priven – Director Specialty Actuarial, Bickmore Lockton Study The genesis of this session was a report that was published by Lockton last year. You can view the Lockton study HERE The study reviewed over 270,000 claims from 150 employers. Data was from 2013-2017. These were all claims that were initially denied and eventually converted to an accepted claim. The study found a 20% increase in denied claims during
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A the 2019 California Self-Insurer Association Annual Conference, John Howard MD, Director for National Institute for Occupational Health and Safety (NIOSH), talked about the evolving labor market in the United States. The first industrial revolution used water and steam power to mechanize production. The second industrial revolution used electric power to create mass production. The third industrial revolution used electronics to automate production. Now the fourth industrial revolution uses artificial intelligence to replace many workers. People like to talk about “standard” vs “non standard” work when referencing the workforce today. The reality is what we consider the “standard” workforce is
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At the 2019 California Self-Insurers Association Annual Conference a panel discussed strategies for settling claims with injured workers’ that do not have attorney representation (pro-se). The speakers were: Julianna Cipraino, Law offices of Kollitz & Kollitz Lisa Kollitz – Law offices of Kollitz & Kollitz Tristan Juan – Information & Assistance officer, Division of Workers’ Compensation, California Department of Industrial Relations Stella Wolfe – Information & Assistance officer, Division of Workers’ Compensation, California Department of Industrial Relations Cathey Jackson – Albertson’s Holdings/Safeway (moderator) DWC established the Information and Assistance (I&A) program to provide information to all parties regarding the rights,
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At the 2019 California Self-Insurer Association Annual Conference, a panel discussed ways to maximize the partnership with your excess carriers. The speakers were: Cathey Jackson – Director Workers’ Compensation, Albertson’s Jennifer Nicholson – Senior Director Corporate Claims, Keenan Debra Russell – Senior Director, Strategic Initiatives, Workers’ Compensation Program, Schools Insurance Authority EDITORS NOTE: The content of this blog is based on comments from the panelists for this session. They do not necessarily reflect the opinions of Safety National who publishes the Conference Chronicles blog. Before a Claim Occurs Know your policy. Each policy has their own language. Do not assume
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At the 2019 California Self-Insurer Association Annual Conference, Joe Paduda with Health Strategy Associates kicked off the conference with a session talking about the workers’ compensation implications of single payer healthcare. Characterizations of a Centralized Single Payer System Concentrated Financing Government is dominant payer. Funded primarily through taxes. Providers and hospitals can be a mix of public and private. Universal access. Everyone has insurance. Very little out of pocket spending. Private insurance is limited. Government is the revenue collector and central authority/gatekeeper. Models There are many different models for single payer health systems. As examples, look at four different countries
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At the 2019 WCRI Annual Conference, Dr. John Ruser, WCRI, talked about the variety of factors contributing to the trend of workers’ compensation benefits being a declining share of the payroll. According to the National Academy of Social Insurance, the ratio of workers’ compensation benefits paid to total wages has dropped since the 1990s and is currently at it’s lowest level since the 1980’s. Some stakeholders have interpreted this to mean there has been an erosion of workers’ compensation benefits. However there are other factors that can also impact this. Since the late 1990s, there has been a sizable reduction
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At the 2019 WCRI Annual Conference, a session discussed the challenges and opportunities of telemedicine. The panel was: Moderator: Dr. David Deitz, David Deitz & Associates Speakers: Ms. Amy Lee, Texas Department of Insurance Mr. Kurt Leisure, The Cheesecake Factory Mr. Dan Allen, Construction Industry Service Corporation (CISCO) Dr. Stephen Dawkins, Caduceus USA Telemedicine is growing rapidly in the group health setting but we have only begun to scratch the surface on it’s potential. It is estimated that up to 40% of medical visits could be done by telemedicine, while currently less than 1/100% actually are. There is almost no
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