At the 2016 WCRI Annual Issues & Research conference, Carol Tellis from WCRI discussed CompScope findings on trends in medical payments per claim from 2009-2014. From 2009-2014, half the study states had little change in medical payments per claim. 9 of the study states had increases under 3% with three states having a reduction in medical costs per claim. The focus of the rest of the presentation was the three states with reductions in medical costs (CA, IL, NC). All these states had significant policy changes that led to these cost reductions: Illinois – 2011 legislation included a 30% reduction
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At the 2016 WCRI Annual Issues & Research conference, a panel discussed the pros and cons of opt-out.  The speakers were Trey Gillespie with PCIAA and Bill Minick from PartnerSource. It is important to distinguish between Texas and other opt-out models. In Texas, workers’ compensation is not mandatory for private employers. Employers can go completely bare with no coverage if they choose to do so. Most large employers in Texas use opt-out to replace workers’ compensation with an ERISA-style benefit plan. 95% of Texas workers are either covered by workers’ compensation or an alternative benefit plan with a small percentage
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At the 2016 WCRI Annual Issues Symposium, Dr Rebecca Yang and Dr Bogdan Savych from WCRI presented the findings from a very narrow ongoing study that focused on claims from New York City that sought medical care at ambulatory surgical centers (ASC). This study was triggered by the fact they were seeing over a 30% increase in ASC payments from 2011 to 2012 with no change in fee schedule. The study only looked at claims where the worker worked and lived in New York City and had received medical care in New York City. The study found that in 2011,
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At the 2016 WCRI Annual Issues & Research Conference, Alex Swedlow from California Workers’ Compensation Institute (CWCI) discussed their studies around medical review and medical dispute resolution in California workers’ compensation. CWCI studies many potential areas of of friction to see the impact this had on state benefit costs. There is almost no correlation between regulatory staff per capita and costs for workers’ compensation benefit delivery. In addition, they also found little correlation between fee schedule rates and claim costs. However, they did find that attorney involvement and other issues have a significant impact on claim costs. In particular, they
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At the 2016 WCRI Annual Issues & Research Conference, WCRI representatives presented a session comparing workers’ compensation outcomes across states. Panelists included: Dr. Sharon Belton – WCRI Dr. Bogdan Savych – WCRI Dr. Vennela Thumula – WCRI The purpose of this study and other similar studies recently conducted by WCRI was to analyze the outcomes reported by injured workers. The study went beyond claims data and involved conversations with over 6,000 injured workers with over seven days of lost time due to a work injury. The interviews were conducted three years post-injury. There were 15 states in the study and
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At the 2016 WCRI Annual Issues & Research Conference, Dr. John Ruser and Dr. Olesya Formenko from WCRI discussed a not-yet published study on the impact that medical fee schedules can have on case-shifting in workers’ compensation. Studies have shown that a fee schedule changes not only change the price paid for services, but it also impacts the utilization of services and the shifting of claims in and out of workers’ compensation. The fundamental purpose of this study was to see to what extent higher workers’ compensation fee schedules influenced a provider’s decision to classify a back injury as work
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Conference Chronicles will be blogging from WCRI’s 32nd Annual Issues & Research Conference on March 10-11, 2016, in Boston, MA. The two-day program highlights presentations of the Workers’ Compensation Research Institute’s latest research findings while drawing upon the diverse perspectives of highly respected workers’ compensation experts and policy makers from across the country. Conference participants will leave with new insights, valuable networking contacts, and a better understanding of key issues in today’s competitive environment. For more information, visit https://www.wcrinet.org/conference.html.

At the 2016 PARMA Conference, David Parker, an attorney with Parker, Kern, Nard & Wenzel, discussed the strategies around defending peace officer presumption claims in California. Under California law, certain “peace officers” and first responders as defined by the statutes receive a presumption of compensability for certain conditions. Defending such cases can be extremely challenging because, absent other evidence clearly demonstrating an alternative cause, the condition is presumed to be caused by work. The presumption laws in California cover the following: Hernia, Heart and Pneumonia – Police, firefighters. Does not include prison guards. Cancer and Leukemia. Includes prison guards. Must
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At the 2016 PARMA Annual Conference, Mark Pew from PRIUM talked about general guiding principles for developing workers’ compensation drug formularies and how this applies to current efforts in California. As has been widely reported, the misuse and abuse of opioids and other prescription drugs has reached epidemic proportions in this country. Between 1999 and 2013, over 175,000 people have died from prescription drug overdoses. Who is responsible for this epidemic? The seven “P’s”; prescribers, patients, pharmacists, big Pharma, payers, politicians and plaintiff attorneys. A drug formulary is an important part of a comprehensive strategy to prevent the overuse of
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At the 2016 PARMA Conference, a panel discussed negative attitudes toward law enforcement and how this impacts jury selection for cases involving police officers. The panel consisted of: David Cannon with Trial Innovations Catherine Mathers with Collins, Collins, Muir and Stewart LLP Shawn Mathers with Sheriff’s Information Bureau Social Media Social media searches can be an important element in selecting a jury pool. Attorneys search social media for comments from potential jurors that are derogatory toward police. This helps them identify which potential jurors they should try to strike from the jury. Comments posted on online news articles are also
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