Tag: Workers Comp

A Massachusetts contractor who reneged on a federal settlement agreement in 2017 and who has a history of workplace safety hazards has once again been cited by the Occupational Safety and Health Administration over alleged job site dangers.

OSHA on Thursday announced it issued citations to Quincy, Massachusetts-based The Roof Kings LLC for four willful violations for failing to provide workers with adequate fall protection and related failures.  

The company is facing proposed penalties of $137,508.

The Roof Kings, which OSHA termed a “serial violator,” has a long history of allegedly exposing workers to dangerous fall hazards.

The latest citations arose from a worksite visit in Quincy on Dec. 8, 2022, during which OSHA inspectors discovered that employees were being exposed to falls of up to 18 feet while working to remove shingles from an unprotected, two-story roof.  

Less than three months prior to that inspection, OSHA cited the company for fall protection hazards after inspectors said they observed workers exposed to fall hazards of up to 21 feet during work in Boston.

The company was issued $137,196 in penalties from that citation. The citations in that case are being contested, according to OSHA.

The U.S. Court of Appeals for the 1st Circuit found the company in contempt in May 2021 after it failed to honor a 2017 settlement agreement with OSHA in which it was supposed to pay outstanding penalties for inspections between 2014 and 2016.

Because the company reneged on the prior settlement agreement, the U.S. Department of Labor is now seeking greater penalties plus interest against the company, which would be separate from this most recent citation, according to OSHA.

The company, in business for 30-plus years, has contested these latest citations and penalties to the Occupational Safety and Health Review Commission, OSHA stated.

 

A Texas appeals court has reversed a trial judge’s decision that denied a bid by retailer Walmart that sought to compel arbitration and stay litigation in a case brought by an injured worker.

The Court of Appeals of Texas, Ninth District on Thursday said a trial court was wrong to deny a motion by Walmart Texas LLC to halt a lawsuit brought by employee Tony Peavley, who sued the company for negligence after he was allegedly injured while moving pallets of water.

Walmart responded to the civil complaint by demanding arbitration, arguing that there existed a valid, enforceable arbitration agreement that should have barred litigation.

As a non-subscriber to Texas workers compensation insurance, employees who are injured on the job should be covered by the Texas Injury Care Benefit Plan, the company stated.

Texas is the only state in the nation that does not force employers to carry workers compensation insurance.

Walmart argued that binding arbitration should be the exclusive remedy for resolving claims between the company and employees.

Mr. Peavley counter-argued that he did not recall signing arbitration agreement when he began working for Walmart, but the appeals court found that there was evidence to the contrary.

The appeals court determined that Walmart had met its burden of proving the existence of the valid arbitration agreement that said the trial court was wrong to deny the company’s bid to compel arbitration.

The court remanded the case to the trial judge for further proceedings. 

 

Lawmakers in Washington state aim to overturn a Board of Industrial Insurance Appeals decision denying a COVID-19 workers compensation claim and to amend the definition of “occupational disease.”

H.B. 1785 would declare that any infectious disease is a compensable occupational disease provided it is the subject of a public health emergency, is spread through respiratory droplets or aerosols or through contact with contaminated surfaces, and the employee’s infection was proximately caused by work conditions or employment.

The measure would apply to all claims regardless of the date of exposure or the date a claim is filed. If passed, the bill would take effect immediately and allow people to refile workers comp claims for COVID-19 that were denied before the effective date of the measure.

While the state created presumptions for first responders and essential frontline workers in 2021, language in the bill aims to provide “consistent presumptive protections to all workers” who contracted the disease when proximately caused by work.

The intent statement also says the legislature wants to overturn an August 2022 decision in which a log scaler working for a company providing essential infrastructure work contracted the virus from coworkers and was denied workers compensation because he could have been exposed to the virus “anywhere.”

H.B. 1785 was referred to the House Committee on Labor and Workplace Standards, which has scheduled a Feb. 17 public hearing on the measure.

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

 

The treatment request denials for injured workers in California that were overturned most often in 2021 were for behavioral and mental health services, with 15% overturned, according to a report released Wednesday by the California Department of Industrial Relations, Division of Workers’ Compensation.

The annual report provides a snapshot of independent medical review activity in accordance with California law that requires reviewers follow guidelines in the state’s Medical Treatment Utilization Schedule for determinations of medical necessity in treating injured workers.

The program received 178,927 requests for reviews in 2021. Overall, 7.2% of the earlier decisions that denied treatment requests made by physicians treating injured workers were overturned. The previous report in 2020 showed that 9.5% of decisions were overturned. 

As with previous years, pharmaceutical requests accounted for the highest number of requests at 31%. This percentage continued the decrease from 2020 (34% of all requests), 2019 (37%) and 2018 (42%). Of the 2021 numbers, opioid prescriptions comprised 27% of review requests. The second- and third-highest number of requests were for diagnostic tests, such as imaging and radiology, and rehabilitation requests, such as physical therapy and chiropractic care, each representing 19% of all services.

After behavioral and mental health services, functional restoration programs and gym memberships were the second most overturned decisions, with 13% of reviews reversing earlier denials. Evaluation and management services, which include specialist consultations and dental service, placed third at 12% overturned.

Physical medicine cost was the largest driver of annual physician cost increases in workers compensation during the past decade, according to a new report from the National Council on Compensation Insurance.

The report, titled “Inflation and Workers Compensation Medical Costs – Physician Services,” was released Tuesday by Boca Raton, Florida-based NCCI and is the third installment in a planned four-part series examining inflation and comp medical costs.

Among the report’s highlights were the moderate growth of average physician-paid cost per comp claim, which rose about 1.5% per year. Overall, between 2012 and 2021, nationwide average annual doctor payments grew by about 15%.

Growth for average doctor payments was about the same across different regions of the country, with the Northeastern U.S. experiencing the slowest growth and the Midwest seeing the fastest.

The Midwest is home to some states that do not have comp medical fee schedules for doctor services. There are only six such states in the nation.

Physician costs in the Western U.S., as well as the Southeastern and Northeastern parts of the country, all increased at a slower pace than the countrywide average, the report states.

The main driver behind growth across all regions of the U.S. was pricing for physician services.

NCCI researchers say that payments for physician services make up about 40% of all comp medical costs.

Physician services were broken out into different categories, including physical medicine, evaluation and management, surgery, radiology and others.

While physical medicine costs increased, costs associated with surgery and radiology decreased.

 

Texas Mutual Insurance Co. has named Chief Operating Officer Jeanette Ward as its next president and CEO, effective March 1.

Ms. Ward will replace retiring president and CEO Rich Gergasko, who has served in those positions for the past decade, Texas Mutual said Tuesday in a statement.

Ms. Ward joined the Austin-based workers compensation insurer 29 years ago, starting as a receptionist. She later held roles in strategic planning, claims oversight, and with the safety and medical network operations teams.

Ms. Ward was named one of Business Insurance’s Women to Watch in 2018, the year she became COO of Texas Mutual.

 

A workplace explosion that killed a Mississippi welder this summer could have been prevented if the employer adhered to proper workplace safety standards, according to the Occupational Safety and Health Administration.

OSHA on Tuesday cited Bentonia, Mississippi-based W.S. Red Hancock Inc. for willfully failing to fill a saltwater disposal tank with water and for failing to clean, ventilate and test the tank for flammable substances at the time of the July 2022 explosion in Flora, Mississippi,  that killed one worker and sent six others to the hospital.

The explosion occurred during welding operations on a job to replace old metal tanks with fiberglass tanks at a saltwater disposal site for oil and gas fields.

OSHA, which proposed $196,886 in penalties, said the company failed to instruct workers on proper ways to work with equipment containing flammable substances, failed to make medical attention available to workers exposed to explosion hazards, failed to remove or protect fire hazards near welding operations, and other alleged violations.

The company has 15 days to contest the citations.

In a separate case, OSHA on Monday cited a Missouri cattle processor for allegedly exposing workers to potentially lethal carbon dioxide levels.

OSHA cited Lone Jack, Missouri-based ZMDR LLC, doing business as Republic Foods, for two willful, four repeated and seven serious safety and health violations. It proposed $573,913 in fines.

OSHA alleges the company exposed employees to levels of carbon dioxide that exceed permissible exposure levels.

The company received similar citations in November 2020.

OSHA said the company also exposed workers to fall hazards, violated electrical workplace safety standards and failed to provide required machine guarding.

OSHA has cited the company for 35 violations since it opened in 2020.

 

Maryland lawmakers have filed follow-up legislation to a bill introduced last month that would subject workers compensation benefits to child support arrearages.

State delegates introduced HB 800 on Wednesday, which allows for 25% of the net recovery by debtors in workers comp claims to be subject to execution on a judgment for past child support.

The measure was cross-filed with Senate Bill 71, which was introduced Jan. 11 and contains similar provisions.

The text of the House bill was not immediately available.

The Senate bill, which is currently going through the committee process, defines net recovery as money that claimants receive in workers comp cases after deductions for attorneys fees, expenses, medical bills and any outstanding liens or claims for personal injury.

After being introduced Wednesday, HB 800 was sent to the House Judiciary Committee for consideration. 

 

 

 

New Mexico lawmakers are considering a bill that would increase to $2,500 the maximum fine for those who violate the state’s Workers’ Compensation Act.

H.B. 329, introduced Tuesday and sent to committee, applies specifically to “any person who fails to file a report required by, or who violates any provision” of the state’s comp law.

The state has discretion on fines, which are currently capped at $1,000 for each occurrence with a minimum of $25.

Workers compensation claims involving long COVID may rise this year, though cost projections are hard to come by, experts say.

In January, the Workers Compensation Research Institute reported that comp claims with long COVID had higher-than-average medical payments and indemnity payments and longer durations of temporary disability than regular COVID-19 claims.

“In particular, we found a nearly 10-fold difference in the average medical payment per claim,” WCRI researcher Bogdan Savych wrote in the report, which analyzed infections between March 2 and Sept. 30, 2020.

The National Council on Compensation Insurance reported in October 2022 that post-infection health issues appeared in 24% of all COVID-19 comp claims between March 2020 and June 2021, and that the average temporary disability indemnity benefit duration for long COVID patients was just over four months for hospitalized patients and around 95 days for non-hospitalized patients.

Yet putting a dollar figure on the cost of long COVID comp claims for employers and insurers is difficult because there is no universal definition of long COVID, according to Nedzad Arnautovic, associate actuary at NCCI.

Mr. Arnautovic said there’s a “reasonable expectation” that long COVID claims will continue in 2023. “Of course, this is highly subject to virus variants, long-term effectiveness of vaccines, and population rate of re-vaccination,” he said.

“From the WC insurer perspective, I am not sure there is much difference in whether a claim is regular or long COVID,” Mr. Arnautovic said. “As long as the claim is compensable, they will continue to provide medical/indemnity benefits regardless of how it is classified.”

Employers, however, may be more concerned about how COVID-19 claims are classified, since long COVID could result in decreased productivity, revenue loss and costs for substituting workers, Mr. Arnautovic said.

Mr. Savych wrote in an email that factors that could affect long COVID claims in 2023 include new virus variants, vaccination impact and the “responsiveness of state and federal policies.”

Joe Paduda, principal with Plainfield, New Hampshire-based Health Strategies Associates, said the nuances of long COVID makes it a challenge for an industry seeking information on costs.

“Complicating this is the wide range of potential signs, symptoms and effects of COVID, many of which might be caused or exacerbated by patients’ other health factors, medical history, lifestyle, genetic profile and/or pre-existing conditions,” Mr. Paduda said.

He said long COVID claims will likely increase this year,  “particularly in states with broad or ill-defined definitions of and/or presumptions relative to COVID.”

Mr. Paduda said payers are concerned about the potential for additional costs for long-term claims, “however, there’s far too much catastrophizing based on far too little actual data or research.”

“Reality is we don’t know much about COVID’s long-term impact, how it can vary by person, the effect of comorbidities and past medical history, and treatment options,” he said.

Delainne Bond, CEO of Kissimmee, Florida-based COVID Care Group LLC, said there is “broadly a lack of awareness of how long COVID is affecting claims,” and that her concern is that “long COVID is affecting our workforce whether or not there’s a claim associated with it.”

“What I’m seeing now is so tragic,” Ms. Bond said. “These people with long COVID are not able to maintain their jobs” and the issue is creating a “ripple effect on the employment sector.”