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Workers Comp in the Time of COVID: Industry news, important updates and the DWC’s Response to the Ongoing Pandemic

According to a recent release from Stone, Loughlin and Swanson LLP, there are many changes on the horizon for the workers comp industry due to the vicissitudes of the novel COVID-19 virus. From return to work procedures to designated doctor exams and presumption laws, this virus is affecting many areas of workers compensation claims and insurance professionals are working tirelessly to keep up with the constant changes. Here are a few noteworthy updates that are impacting the workers compensation industry today. Texas and COVID-19 Presumption in Workers Compensation Unlike several other states across the U.S., Texas has not enacted any workers compensation presumption rules. Besides the existing presumptions, the DWC has stated that workers compensation carriers should follow the typical rules regarding investigating and adjudicating claims. A number of groups in Texas have called for Governor Abbott and the city to adopt a workers compensation coverage presumption, including the Texas AFL-CIO, The Combined Law Enforcement Associations of Texas and local firefighters, who believe that COVID-19 claims should be covered under workers compensation based on Government Code Chapter 607, which provides that, for firefighters, peace officers, or EMTs who suffer from tuberculosis or other respiratory illnesses which have [...]

Workers Comp in the Time of COVID: Industry news, important updates and the DWC’s Response to the Ongoing Pandemic2020-08-26T22:24:56+00:00

COVID-19 Debate: Examining Common Myths about Wearing a Mask

From respiratory problems to just plain inconvenience, the never-ending debate about wearing a mask during the ongoing COVID-19 virus has many arguments on both sides. While some arguments can - and should - be considered, others seem to be somewhat lacking in accuracy. According to the healthcare experts at Medical News Today, here is a look at the most common myths about wearing a mask - and what to consider about each: Argument 1: Masks Do Not Protect the Wearer, Only Those Around Them This argument seems to cause the most dissent among the general public, since it would seem the only mask that is effective at protecting the wearer from the new Coronavirus. Even most mass-produced masks come with the disclaimer that they cannot prevent the wearer from contracting the new virus. While this may presumably make a case that masks are futile in this pandemic, public health organizations urge everyone to wear masks to protect those around them against airborne particles from asymptomatic patients or carriers of COVID-19. This is called source control and is proven to be an effective way to slow down the spread of a virus as well as reduce its numbers significantly [...]

COVID-19 Debate: Examining Common Myths about Wearing a Mask2020-07-29T19:46:45+00:00

Psych Claims in Workers Compensation: What to Know

The effects of COVID-19 have had a major impact on the way insurance claims and workers compensation cases are handled, but it's not just physical health that is a concern for the workforce. While the physical symptoms of this novel virus may fade, there may be lasting psychological damage that needs to be accounted for and treated. In a recent webinar hosted by the National Workers Compensation Defense Network, these psych claims are explored and analyzed more closely, revealing that not only is this virus a complex issue to navigate in workers compensation, but also the surrounding psychological components that arise as a result of it. Here are some major topics discussed that show these devastating effects. Psychiatric components to COVID-19 claims may be the longest lasting and can also create the most exposure in workers compensation claims. Whether it is fear of claims or a positive COVID-19 diagnosis, it can morph into psych issues very quickly. The lasting impact of psychiatric exposure can result in activation or worsening of pre-existing psychological issues. Even the stay at home orders have been mentally challenging  for most and increase exposure and risk of developing lasting psychological issues. Isolation has taken [...]

Psych Claims in Workers Compensation: What to Know2020-07-10T13:24:51+00:00

7 Work from Home Tips to Stay Healthy and Productive

After a recent spike in COVID-19 cases across the country, many states are going back under quarantine to prevent further outbreaks. For all those who have been working remotely during the quarantine, here are a few helpful tips inspired by The Muse to stay healthy and productive while you work from home during quarantine: Get Dressed With most people working from home, it seems like an exercise in futility to get dressed before hopping on the computer for the day. But getting dressed is a great way to signify to your body and mind that it's time to get to work! You don't have to don your full business-casual attire, but avoiding wearing pajamas all day during the work week can have a significant positive outcome on your morale and work ethic. Getting dressed signifies that you're out of bed and ready to start the day as productively and constructively as possible. Define a Clear Workspace or Home Office Most people are used to leaving their homes to go to work, which is a clear sign that you are separating work life from home life. But for those working remotely, it's important to delineate a physical work [...]

7 Work from Home Tips to Stay Healthy and Productive2020-06-18T19:51:06+00:00

Elective Procedures and the Post COVID-19 Surge: What Happens Next?

Now that the COVID-19 quarantine is gradually being lifted, many hospitals and insurance providers are resuming elective procedures that were postponed due to the virus. According to the experts at Healthcare Bluebook, a leading provider of transparency data, 37 states canceled elective procedures during the peak of COVID-19 to conserve beds and resources for infected patients, postponing approximately 30% of all elective procedures across the country. 80% of these procedures are expected to be completed this year. But at what cost?? "When the first wave of this pandemic is behind us, the pent-up patient demand for surgical and procedural care may be immense..." -American Society of Anesthesiologists and the Association of PeriOperative Registered Nurses In the wake of the COVID-19 pandemic, many insurers and hospitals will most likely try to recoup their financial losses without regard to appropriate treatment or costs to the employee. After resuming elective procedures, the main patient concern will be "How soon can I get in?" and providers seeking volume will reschedule as quickly as possible, regardless of price. This surge in elective procedures could lead not only to increased volume but also higher prices and premiums as insurers and providers attempt to recover from the COVID-19 [...]

Elective Procedures and the Post COVID-19 Surge: What Happens Next?2020-06-02T22:45:54+00:00

Reopen Texas Phase I

It's been a week since Governor Abbott announced the reopening of businesses in Texas, and the COVID-19 quarantine is gradually being lifted. State by state, industries are reopening and slowly recovering from the devastating effects of COVID-19. But what can we expect now that workers are returning to work amidst a pandemic? The U.S. unemployment rate has jumped from 3.5% in February to 4.4% in March.  In the four weeks preceding April 11, 22 million new unemployment claims were filed "In the case of active claims, many injured workers are experiencing delayed recovery due to the pandemic. Hospitals and clinics have halted non-essential surgeries and procedures to free up resources, conserve supplies for doctors treating COVID-19 patients and to prevent the spread of the virus. " As always, Clinical Compensation Consultants is ready to handle any workers compensation claims that you may have, even those related to COVID-19. Read more from NCCI on how COVID-19 has affected the workers compensation industry below: Read More

Reopen Texas Phase I2020-05-11T18:48:24+00:00

The Effects of COVID-19 on Workers Compensation Claims: What Adjusters Should Know

As a result of the current COVID-19 epidemic, many adjusters and workers compensation professionals have been faced with determining compensability for this COVID-19 diagnosis. Those of us who deal with workers’ compensation claims regularly can argue any number of positions, including the issue of occupational disease as it is discussed in the statute. As a general rule, and by statute in most jurisdictions, employees who have been exposed to an infectious disease that exists not only in their industry but outside of it historically have not been eligible for workers compensation benefits unless that disease is an incident to a compensable injury or occupational disease. Today, many experts in our industry believe that the statutes will have to be modified given the current predicament of much of our healthcare workforce. For example, there are existing exceptions in Texas to the presumption that infectious diseases fall under the "ordinary disease of life" category. But those exceptions are limited by certain job titles, ie. peace officers, firefighters, first responders and emergency medical technicians). Labor Code section 504.055(b) applies only to a first responder who sustains a serious bodily injury, as defined by Section 1.07, Penal Code, in the course and scope [...]

The Effects of COVID-19 on Workers Compensation Claims: What Adjusters Should Know2020-04-03T21:06:10+00:00

Insurance Carrier PBO Assessment Methodology Released

As a regulatory agency, the Texas Department of Insurance, Devision of Workers Compensation (TWI-DWC) is required to monitor system participants’ compliance with the Texas Workers’ compensation Act and Rules and to take appropriate action to ensure compliance. Compliance objectives are achieved through performance-based oversight (PBO), data monitoring, complaint handling, audits, and when appropriate, enforcement actions.\ Read Full Story

Insurance Carrier PBO Assessment Methodology Released2019-01-03T02:26:05+00:00

Texas Department of Insurance Releases Fatal Occupational Report

The Texas Department of Insurance released their Fatal Occcupational Insurance Injuries in Texas 2017 report in December 2018. Some highlights: The report states there were 534 fatal occupational injuries in Texas in 2017, a 2% decrease from 545 in 2016, according to data from the U.S. Department of Labor, Bureau of Labor Statistics (BLS), and Census of Fatal Occupational Injuries (CFOI). The rate of fatal occupational insuries in Texas was 4.3 per 100,000 full-time employees in 2017. Nationally, there were 5,147 fatal occupational insuries. Read Full Story

Texas Department of Insurance Releases Fatal Occupational Report2019-01-03T02:24:36+00:00

Independent Medical Review cuts costs!

Senior executives from some of the top California workers’ compensation carriers identified emerging trends that are of great importance to California employers at the 2015 California Workers’ Compensation and Risk Conference. Panelists were: Moderator: Pamela Ferrandino, national casualty practice leader at Willis North America Mike Mulray, chief underwriting officer at Everest National John Dickey, regional president at Liberty Mutual Mike Hessling, chief client officer at Gallagher Bassett Glen-Roberts Pitruzzello, vice president of workers’ compensation, group benefits claim strategy and clinical operations, at the Hartford The WCIRB projects the estimated average medical cost-per-claim will be the lowest since 2007. What do you think are the key drivers behind this improvement? The independent medical review (IMR) process. IMRs are being upheld in favor of the employer – around 90% of the time. That is showing that evidence-based protocols are being followed. Medical inflation has decreased. Effective utilization review (UR) programs have had a positive effect on controlling medical costs. Will the greater use of generic drugs in the California drug formulary materially lower workers’ compensation costs? Texas is a good example. We have not seen any major pushback from what Texas has done. Texas communicated to the providers, so they know how [...]

Independent Medical Review cuts costs!2018-09-21T17:29:44+00:00