Tag: Workers Comp

Since 2014, the percentage of indemnity claims involving a major surgery in the first two years has declined one percentage point per year, falling from 28% of the 2014 claims to 23% of the 2019 claims, according to a study released Monday by the California Workers’ Compensation Institute.

The study tracked treatment patterns in the California workers comp system for non-COVID claims, finding that medical services have “stabilized” in recent years, with only “minor” changes in the utilization rates and volume of services rendered to injured workers within the first two years for lost-time claims between 2014 and 2021.    

Other findings included that across the six-year span of the study, surgical claims averaged about seven to nine more evaluation and management visits in the first two years than claims without major surgery.

The study also found that the share of claims that had physical medicine, or physical therapy or rehabilitation, services in the first 24 months showed little change, even after the pandemic was declared. Claims with major surgery have consistently averaged about 26 physical medicine visits in the first two years, more than twice the average for claims without major surgery.

In examining mental health, researchers found that 5% to 6% of the claims without major surgery and 6% to 7% of the surgical claims received mental health services in the first 24 months of treatment. And though the percentage of claims with mental health services “showed little change after the pandemic was declared,” the average number of mental health visits within 24 months increased in the two most recent years.

 

A contractor and an equipment operator are both facing first-degree reckless endangerment charges in Vernon, Connecticut, following a fatal trench collapse that resulted in willful violations with proposed penalties of $375,021 issued by the Occupational Safety and Health Administration.

Special agents with the Department of Labor’s Office of Inspector General and detectives with the Town of Vernon’s Police Department investigated the collapse of an 8-foot-deep trench that killed an employee of Botticello Inc., a Manchester construction contractor, on July 22, 2022, according to a statement by OSHA.

OSHA determined that Dennis Botticello failed to provide legally required safeguards. The company has contested OSHA’s findings with the independent Occupational Safety and Health Review Commission.

The investigations led the Vernon Police Department to arrest Mr. Botticello, owner of Botticello Inc., and Glen Locke, a Somers, Connecticut equipment operator, on charges of first-degree manslaughter and first-degree reckless endangerment, OSHA said Friday. Further details were not available. 

 

CompScience Insurance Services on Monday announced a managing general agent agreement with Nationwide Mutual Insurance Co. and Swiss Re Ltd. to underwrite, bind and service workers compensation policies that will engage the company’s intelligence safety platform to help reduce costs.

The platform has been shown to “significantly reduce claims through actuarial analysis” by detecting previously unreported workplace risks by analyzing existing workplace video with a library of proprietary computer vision models built to detect 50+ behavioral and environmental hazards, according to a statement.

 

 

 

 

(Reuters) — A federal appeals court on Friday revived a lawsuit by Uber Technologies Inc. and subsidiary Postmates Inc. challenging a California law that makes it more difficult for them to save money by treating workers as independent contractors.

In a major win for app-based services that heavily rely on contractors, the San Francisco-based 9th U.S. Circuit Court of Appeals said the state must face claims that the law known as AB5 is unconstitutional because it improperly singles out the industry while exempting many others.

The decision comes after a California state appeals court on Monday revived a ballot measure approved by nearly 60% of voters in 2020 that exempts app-based transportation services such as Uber and rival Lyft Inc. from the scope of AB5, which had been struck down by a judge.

Uber and the California Attorney General’s office did not immediately respond to requests for comment on the decision.

AB5, which took effect in 2020, imposes a higher bar to show that workers are independent contractors rather than employees, who have greater legal protections and can cost companies up to 30% more.

California lawmakers exempted many jobs and businesses from AB5’s reach, including “referral agencies” that connect workers and customers, but explicitly did not exempt app-based transportation and delivery services.

That means Uber is subject to the law while pet-sitting service Wag, which has been called “Uber for dogs,” is not.

A three-judge 9th Circuit panel on Friday said the “piecemeal fashion” of the exemptions to the law was enough to keep Uber’s lawsuit alive.

“The exclusion of thousands of workers from the mandates of AB5 is starkly inconsistent with the bill’s stated purpose of affording workers the ‘basic rights and protections they deserve,’” Circuit Judge Johnnie Rawlinson wrote for the court.

A Pennsylvania appeals court ruled Friday that the state’s medical marijuana law does not prohibit insurers from reimbursing injured workers for medical marijuana in cases where the drug is used to treat accepted work injuries.

The Pennsylvania Commonwealth Court ruled that the state’s Workers’ Compensation Appeal Board erred when it upheld a decision by Firestone Tire & Rubber to deny reimbursement for the cost of Paul Sheetz’s medical marijuana.

Sheetz, now deceased, used medical marijuana to treat chronic pain from a 1977 work injury. He used the drug to ween off decades of prescribed opioid use.  

“I am so excited that the Commonwealth Court, in their wisdom, agreed that workers comp carriers are required to reimburse injured workers who use medical marijuana to treat severe and often life-long injuries,” Jenifer Kaufman, the Abington, Pennsylvania-based attorney who represented the claimant’s estate, said after Friday’s ruling. “This is a game-changer for those injured workers who have worked hard to get off dangerous and expensive opioids and are forced to pay the cost of medical marijuana treatment out of their fixed incomes.” 

Ms. Kaufman said the case means insurers must reimburse marijuana costs in cases where the treatment is deemed “reasonable and necessary,” and that reimbursement would likely only come in serious or old injury cases where medical marijuana is the “primary treatment modality.”  

Firestone argued it would violate federal law if forced to reimburse for medical marijuana, which is illegal federally, but the court ruled reimbursement is not a federal crime because insurers are not prescribing the drug themselves.   

 

South Carolina officials have filed another federal lawsuit against the U.S. Department of Labor over a requirement that the state’s maximum civil penalties in workplace safety citations match or exceed those of the Occupational Safety and Health Administration.

The complaint, filed Tuesday in U.S. District in Columbia, challenges the requirement that the South Carolina State Plan increase its civil penalties to be in line with the federal civil penalties OSHA has increased annually since 2016 under the Federal Civil Penalties Inflation Adjustment Act of 2015.

The state, one of 21 permitted to have state-level OSHA plans, previously sued over the same issue, but a judge dismissed the complaint, determining the court didn’t have jurisdiction.

South Carolina asserts in the latest lawsuit that the OSHA regulation requiring state plans to have civil penalty maximums identical to or greater than federal penalties is inconsistent with federal law. 

The “only purported justification” offered in the 2016 rule requiring state plans to adopt civil penalties identical to, or at least as great, as federal ones is the assertion that increased penalties will have a “greater deterrent effect,” the suit states.

“This simplistic and conclusory claim ignores the fact that diligent administration and enforcement by state plans can still result in ‘safe and healthful employment and places of employment’ as federal standards, as South Carolina workplaces have demonstrated since 2016,” the lawsuit states.

South Carolina contends that despite having civil penalties lower than federal fines, workplaces in the state have reported fewer workplace injuries and illnesses than the national average.

A federal appeals court has denied a bid by a transit agency to dismiss a lawsuit by an injured worker who claims he was hurt after being forced to work an overnight shift, despite seeking accommodations for a sleep disorder.

The U.S. District Court for the District of Columbia ruled on Wednesday that a disability discrimination lawsuit initiated by Bilal Abdul Wadud Collins against the Washington Metropolitan Area Transit Authority can proceed.

Mr. Collins is suing his employer over claims that the transit authority violated the Rehabilitation Act when it denied his request for accommodation due to his sleep disorder.

Mr. Collins claims he was forced to work a midnight shift and that he hurt his back shortly thereafter.

The transit authority sought to dismiss the suit, arguing that exclusive remedy under Virginia’s workers compensation law requires injured workers to obtain relief through the state’s Workers’ Compensation Commission.

Mr. Collins already received a comp award after his injury.

The appeals court denied the transit authority’s motion to dismiss the case on the grounds that the litigation is not a tort suit, which would have been barred by exclusive remedy, but rather a federal anti-discrimination case.

The court said that a state law making recovery under workers comp the exclusive remedy for work-related injuries cannot prevent an employee from seeking relief for employment discrimination under the Americans with Disabilities Act or Section 504 of the Rehabilitation Act.  

 

 

 

The U.S. Occupational Safety and Health Administration Thursday announced it has cited BP Products North America Inc. after investigators determined the oil company failed to adequately train its workforce after two employees suffered fatal burns.

The Houston-based company, a subsidiary of BP of the United Kingdom, was cited for 10 serious violations and one other-than-serious violation in connection with the September 2022 deaths of two workers at an Oregon, Ohio, refinery.

The workers were attempting to correct rising liquid levels in a fuel gas mix drum when a flammable vapor cloud ignited and caused an explosion.

OSHA said that company training deficiencies and other safety failures led to the fatalities.

Inspectors also found that naphtha, a flammable liquid hydrocarbon mixture, was released when flow control valves were opened during the incident, which allowed the flammable liquid to get inside of the refinery’s fuel gas system.

The company is accused of failing to implement proper equipment shutdown procedures when requested to do so by the operators who responded to the incident.

OSHA said that BP failed to adhere to federal safety standards that require it to develop company process safety and response procedures that address “worst-case scenarios.”

BP is facing $156,250 in proposed penalties. It has 15 days to contest the citations.

 

 

 

Vertical integration in medicine is driving up patient care pricing in workers compensation, and provider consolidation is not necessarily translating to improvements in patient outcomes, according to research from the Workers Compensation Research Institute.   

The study released Thursday, Impact of Medical Provider Consolidation on Workers’ Compensation Payments, examined the impact of provider vertical integration on comp payments, showing how doctor costs changed after medical practices were acquired by hospitals and health systems.

The study shows there was an 8% increase on the average payment per medical procedure in comp claims involving vertical integration, and it found that the effects of consolidation on medical payments were greater in states with no medical fee schedules designed to control costs.

The study found that between 2012 and 2018, there was an increase in the number of both primary care physicians and orthopedic surgeons practicing at sites owned by hospitals and health care systems, with the former jumping from 32% to 49% and the latter increasing from 18% to 35%.

The researchers said while there are many trends in physician consolidation that are external to workers comp systems, “they still affect many aspects of the medical care provided to workers with injuries.”

“While this work provides suggestive evidence about changes in the utilization of care, more research is needed to examine specific mechanisms behind the changes in the mix of care and access to care when providers become vertically integrated,” the authors wrote.