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

Opioid Overdose Survivors are Prescribed more Opioids

Examining a national database of health insurance claims, researchers found that 91 percent of patients who suffered a nonfatal overdose of prescription opioid painkillers continued getting prescriptions for opioids following the overdose. The findings, published in the Annals of Internal Medicine, follow news earlier this month from the Centers for Disease Control and Prevention that drug overdoses, opioid overdoses in particular, have reached epidemic levels. Read Full Story

Opioid Overdose Survivors are Prescribed more Opioids2018-09-21T17:29:44+00:00
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