Tag: Workers Comp

Studies released Thursday by the Workers Compensation Research Institute show how the adoption of drug formularies in five states affected workers compensation costs.

The studies looked at the effect of formularies on prescription drug utilization and associated costs in the Arkansas, California, Indiana, Kentucky and New York comp systems.

All five states adopted prescription drug formularies between 2018 and 2019. They are now among a total of 17 states across the U.S. that have drug formularies in comp, which are a list of brand name and generic drugs approved to treat work-related injuries.

In all five studies, WCRI researchers used data from prescriptions filled between January 2016 and March 2021, by workers within 12 months of injury.

In Arkansas, quarterly trends in prescription utilization and payments show steady declines occurred throughout 2017 and 2018, the timeframe during which the state established its formulary, although researchers said comp system changes could also be attributed to other prescription drug policies implemented around the same time.

Still, Arkansas, during the study period, saw larger reductions in prescriptions and drug payments per claim compared with states with no drug formularies.

In New York, prescription payments per claim decreased by 34 percent in the third quarter of 2019, and quarterly trends in drug utilization and costs in that state “provide clear evidence of the impact of the drug formulary,” researchers wrote.

In California, drug payments per medical claim decreased by 39 percent between 2017 and 2018, which was attributed to the implementation of the formulary.

In Indiana and Kentucky, researchers said drug formularies had smaller effects on prescription utilization and payments.

 

 

The U.S. Occupational Safety and Health Review Commission has vacated a citation and $53,976 in fines issued to a mechanical contractor after a worker was seriously injured in a fall from a scaffold at a job site in Point Comfort, Texas.

The commission, in a ruling published Wednesday, found the Occupational Safety and Health Administration failed to prove its case against Palacios Marine & Industrial Coating Inc.

The Port Lavaca, Texas-based company was cited after a worker fell from a scaffold in 2019 and suffered broken bones and other injuries to his legs and feet that required reconstructive surgery.

The worker had fallen through a piece of rotted wood used as a plank on a scaffold.

The review commission determined OSHA failed to meet its burden of proving various workplace safety violations stemming from the accident.

This included allegations that the company failed to provide and inspect proper personal protective equipment to employees, failed to ensure a scaffold was not defective, and failed to carry out proper inspections of a scaffold and its components.

The commission vacated all six items from the citation and all related fines that had been issued following the workplace incident.

The ruling came after a two-day trial held in November 2021 in San Antonio, Texas.

 

A bill proposed in Louisiana would repeal the state provision that an employer and their workers compensation insurer are not required to pay for medical marijuana for injured workers.

H.B. 351, introduced Wednesday and sent to committee, would set parameters for workers who receive recommendations to use medical marijuana for treatment.

The bill mostly addresses that a worker would not be barred from benefits such as unemployment if they use medical marijuana yet includes language that would call on comp insurers to cover the drug for a “(q)ualifying medical marijuana patient,” which is described as “an individual who has been clinically diagnosed as suffering from a debilitating medical condition and an authorized clinician has recommended marijuana for therapeutic use.” 

 

A bill that would provide supplemental health care services and salary benefits to first responders diagnosed with certain mental conditions was introduced Wednesday in North Carolina’s House of Representatives.

H.B. 523 would create a mental health care benefits plan as a supplemental insurance policy that would provide reimbursement of up to $5,000 per 12-month period for any out-of-pocket medical expenses incurred and would include a salary benefit equal to 75% of the first responder’s monthly salary or up to $5,000 a month for up to 12 months.

The bill would also introduce a disability program for up to 36 months, providing 75% of the first responder’s monthly salary or up to $5,000 a month.

According to the bill, the program would cover “stress, mental injury, or mental illness that is medically diagnosed as an anxiety disorder, conduct disorder, depressive disorder, obsessive-compulsive and related disorder, sleep-wake disorder, or trauma and stressor-related disorder as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.”

The state Department of Insurance would run the program, which would aim “to promote healing and the return to service of first responders,” the bill states.

The Ohio Supreme Court has reversed a ruling by the state’s 10th District Court of Appeals that sided with a company that provides in-home care to developmentally disabled individuals who asserted that its workers are independent contractors and not employees.

The high court Monday, in reversing the appeals court, sent the case back to the Ohio Bureau of Workers’ Compensation, which previously determined those working for Columbus-based Friendship Supported Living Inc. were employees, not contractors.

If the workers were classified as employees, Friendship would be responsible for carrying workers compensation insurance.

In 2017, the bureau audited the company, finding that the workers were employees, but Friendship’s owner contested the findings.

The case ended up going through various stages of administrative and judicial appeals, and in 2019 Friendship sought review with the Ohio 10th District Court of Appeals seeking to be reimbursed for workers compensation insurance premiums it incurred as a result of the bureau classifying the workers as employees.

The appeals court agreed with Friendship and ordered the bureau to vacate its order.

The bureau subsequently appealed the 10th District’s decision to the state Supreme Court.

On Monday, the high court reversed the appeals court ruling and granted a limited order requiring the comp bureau to issue its own amended order accounting for “deficiencies” that the justices said were included in the bureau’s initial ruling that found the workers to be employees and not contractors.  

 

An Ocala, Florida-based framing contractor is facing $464,079 in proposed fines by the U.S. Occupational Safety and Health Administration over alleged continued safety violations, the fines coming three years after a roofing employee fell to his death.

OSHA on Tuesday announced the citations against Domingos 54 Construction Inc. for three willful violations and one repeat violation after inspectors in September 2022 observed employees working atop a 15-foot residential roof in Tampa without safety gear.

OSHA said the company has still failed to train workers on fall hazards and that employees continue to use pneumatic nail guns, circular saws and hammers without proper eye protection.

The company has 15 days to contest the citations and proposed fines.

OSHA said it has inspected the company’s job sites 11 times since February 2019.

One of the company’s worker’s suffered a fatal fall in March 2020.

 

The price of prescription drugs used in workers compensation cases grew at an annual rate of 3.7% average over a nine-year period, which was offset by a 6% decline in the volume of prescriptions, according to a research paper published Tuesday by the National Council on Compensation Insurance. 

Analyzing data from 2012 to 2021, NCCI also found that the average drugs-paid cost per claim decreased about 2.6% per year. The annual reduction in drug payment per claim varied across four regions, ranging from 2.0% in the Southeast to 3.9% in the West.

Opioid claims saw the largest decrease in drug costs, according to the paper. Of claims with prescription claims, the share of those that included at least one opioid decreased from 55% in 2012 to 26% in 2021. 

Changes in opioid prescription trends have resulted in an average annual decrease of 3.8% in costs, yet nonopioid claims added 1.3% to the average change in drug costs, NCCI found. 

 

Texas lawmakers have introduced bills that would require the Division of Workers’ Compensation to conduct contested case hearings telephonically or by videoconference in some instances.

H.B. 4214 and companion measure S.B. 1640, both introduced this month and sent to committees, would require the state to adopt rules allowing remote case hearings upon mutual agreement of the parties. Contested case hearings are currently held live in field offices closest to the injured employees’ homes.

American Claims Professionals proposed the legislation, which is supported by attorneys who represent insurance companies.

Alan Tysinger, a San Antonio-based attorney who represents injured employees, said he also supports the bill.

“There are limits to what can be done by video, but during the COVID-19 pandemic, we learned we could make the hearings process function via remotely if we needed to,” Mr. Tysinger said.

However, he said, contested case hearings lose something with the lack of physical presence, and he opposed a proposal from the last legislative session that would have required that all hearings be held online.

“Subtleties of communication and body language just can’t be replicated online,” he said. “The personal relationships that help the system function smoothly are not fostered by online hearings.”

WorkCompCentral is a sister publication of Business Insurance. More stories here.

 

PHOENIX – Inflation, labor shortages in the health care industry and unknown costs related to long COVID-19 are some of the prime concerns in the workers compensation sector in 2023, according to experts. 

States that have controls in place to limit injured worker claims costs will likely fare better on medical claims than states without controls such as fee schedules, they said.

But much remains unknown about how long COVID claims will develop, they said last week at the Workers Compensation Research Institute’s annual Issues & Research conference.

Hospital payments were a major contributor to medical inflation in the general health care system in the past few years and states with comp medical fee schedules were more likely to keep physician expenses at or below the levels in the general health care system, they said.

During a panel discussion on medical inflation, WCRI economist Olesya Fomenko said factors that could lead to higher medical inflation include health care labor shortages, changes in pricing contracts and network discounts, a rise in medical facility fees and enhanced negotiation power from hospital systems, and medical provider consolidation.

A developing concern is the issue of long COVID, she said.

A wave of retirements during the pandemic meant that more experienced workers left the workforce and were replaced by younger and less experienced workers.

The change led to an increase in work-related injuries, which contributed to increased treatment and costs. Policymakers and comp professionals should be aware of the trend, said Rebecca Yang, senior public policy analyst with WCRI.

It remains unclear what effect long COVID will have on comp.

Early in the pandemic, many workers infected with COVID-19 only received indemnity benefits, because, although they could not go to work, they did not require much medical care, panelists said.

During a study period from March 2020 to September 2021, WCRI researchers determined that 68% of claims were indemnity-only, while medical constituted 17% of COVID comp claims.

About 3% to 5% of workers with little medical care early after infection were treated for long COVID, but half of workers hospitalized after contracting COVID-19 received treatment for long COVID, according to WCRI senior policy analyst Bogdan Savych.

“The main takeaway here is that the prevalence of long COVID varies widely based on your experience,” Mr. Savych said.

Mr. Savych said 18 months after the acute infection period, 20% of workers who were admitted to intensive care units continued to receive medical care for long COVID.

Long COVID comp claims are often expensive and symptomatic workers received more than five months of temporary disability benefits, Mr. Savych said. Claims that did not include a long COVID component had about three weeks in benefits, he said.

Steve Wurzelbacher, manager of the Center for Workers’ Compensation Studies at the National Institute for Occupational Safety and Health, said compensability for long COVID varies by state because comp presumptions vary by state. The definition of long COVID also varies by state, he said.

Since comp systems are designed to track outcomes over several years, workers comp is a great way to evaluate the long-term effect of COVID-19, he said.