Tag: Workers Comp

Workers compensation was rated as a “top” or “significant” concern by 78% of employers surveyed by the California Workers’ Compensation Action Network.

According to the survey of 391 companies, 50% of employers said the workers compensation system “performs poorly,” 8% said the system “performs well” and 42% said the comp industry is “challenged, but adequate.”

More than half of respondents rated the system “poor” in several categories: costs to employers, ability to report and combat fraud, costs and time needed to resolve medical disputes, ensuring injuries are work-related, claim acceptance timelines, and claims and court fairness, among them.

Forty percent or more of employers rated access to care, quality of care, return to work, and indemnity payments as “adequate/OK.” 

One feature of the industry scored well, with over 40% of employers rating the ease of filing claims for workers as “good.” 

A financial adviser who was shot by a 90-year-old coworker suffering from psychological issues should have been permitted to move forward with his lawsuit against the man’s estate because the matter doesn’t fall within workers compensation exclusive remedy, the Oklahoma Supreme Court ruled Tuesday.

The high court said a trial judge wrongly granted summary judgment to the estate of the shooter, who shot Christopher Bayouth in June 2022 at a Morgan Stanley office in Oklahoma City.

Mr. Bayouth sued the shooter’s estate for assault, battery and emotional distress. He also sued the shooter’s wife for negligence.

The defendants sought the suit’s dismissal, contending Mr. Bayouth received workers compensation benefits for his injuries and was barred from suing.

Mr. Bayouth argued comp exclusive remedy didn’t apply because the shooter wasn’t working on the day of the incident and was not acting within the course and scope of his employment.

The trial court ruled the case was covered by exclusive remedy and that only an injured employee, not a perpetrator, must act within the course and scope of employment for an incident to be covered by comp. 

The high court disagreed, saying employees who seek exclusive remedy protections – in this case, the shooter’s estate – must also act within the course and scope of employment to keep the matter in workers comp.   

Business Insurance on Tuesday announced the winners of the 2024 Innovation Awards.

The awards program, which is in its 15th year, recognizes innovation in products and services provided to professional risk managers.

All entries were reviewed and scored by an independent panel of judges consisting of professional risk managers.

The 2024 Innovation Award winners are:

AdventureShield

vQuip Inc.

AI-Powered Risk Financing Solution Breaks Barriers to Captive Risk

Marsh LLC

AlliBot: AI Solution for Risk & Insurance Professionals

The National Alliance for Insurance Education & Research

Aon Health Risk Analyzer

Aon PLC

Generative AI Solution

CorVel Corp.

Ecosystem

Axa XL, a unit of Axa SA

NaVel

Schaefer City Technologies

Origami Mobile

Origami Risk LLC

Sentrisk

Marsh & McLennan Cos. Inc.

Writing Business into the United States via International Insurance Transactions

Zurich North America

The winners will be profiled in the September issue of Business Insurance. They will also be recognized at the U.S. Insurance Awards on July 18 in New York.

The West Virginia Workers’ Compensation Board of Review improperly calculated an injured worker’s permanent partial disability award because it relied on an erroneous method for determining impairment, the state’s Supreme Court ruled Monday.

David Lester injured his back and other body parts in an April 2017 fall while working for Logan-Mingo Area Mental Health Inc. He had a previous workers comp claim in 1999 for similar back injuries that resulted in a 20% permanent partial disability award.

In the subsequent case, a physician determined Mr. Lester had a 19% whole-person impairment attributable to the 2017 injuries, but another doctor performing a claim review used a different method of apportioning Mr. Lester’s preexisting impairment, which resulted in a 10% permanent partial disability award.

A workers comp judge affirmed a claim administrator’s decision to award 10% permanent partial disability. Mr. Lester appealed, and the review board reversed, granting a 19% award.

Logan-Mingo argued the review board erred in using an apportionment method that resulted in Mr. Lester receiving a cumulative permanent partial disability award that exceeded his actual total whole-person impairment.

The West Virginia Supreme Court agreed, saying that to accurately apportion preexisting impairments, a claimant’s final degree of permanent partial disability from injuries to multiple body parts should first be calculated using a combined values chart.

 

Black and Hispanic workers are more likely to be injured at work and “psychological safety” is among the reasons such groups are unlikely to report unsafe conditions, according to a study released Monday by the National Safety Council.

In studying safety practices in the context of diversity, equity and inclusion, and the prevalence of musculoskeletal injuries among minority groups, NSC found that so-called voice suppression can “prove particularly harmful to employees of color, as they may already perceive their voices and opinions as less valued than the majority group.”

As a result, “Black and Hispanic workers report the most unease about reporting unsafe work conditions when compared to other racial and ethnic groups,” the Itasca, Illinois-based nonprofit advocacy group reported.

In addition, other research – such as that conducted by the U.S. Department of Labor — found that fear of income and job loss spurs the discomfort in reporting unsafe practices and, in some cases, injuries, the report said.

The report also highlighted Bureau of Labor Statistics data showing that such groups are more likely to work in high-risk occupations, with 24% of Hispanics, 21% of non-Hispanic Blacks, 20% of American Indians/Alaska Natives, 22% of foreign-born workers and 26% of workers with no more than a high school education employed in fields with high injury rates. This compares with 13% of white workers and 9% of workers with higher than a high school level of education in high-risk occupations.

The report said companies should provide improved and anonymous reporting procedures for all workers and communicate such protocols often. It also suggests that companies should be “mindful of jobs that demand high exertions, awkward or sustained postures, and a fast pace and eliminate them when able.”

 

 

The California Division of Workers’ Compensation on Friday introduced a proposal to speed up the delivery of medical care to injured workers by implementing provisions from bills passed in 2015 and 2016 that exempted certain procedures and treatments from utilization review.

One law, which created a prescription drug formulary, states that certain drugs designated as “exempt” can be dispensed to injured workers without prospective utilization review, as can certain other drugs that are authorized for expedited dispensing immediately after an injury or in the period immediately before and after surgery.

Another law includes a provision allowing a member of a medical provider network to perform certain procedures without prospective review in the first 30 days of treatment if it is for a body part or condition that has been accepted by the claims administrator and is included in the state’s Medical Treatment Utilization Schedule.

DWC is also proposing statutory accreditation requirements and oversight for companies providing utilization reviews and more required forms for treating physicians.

A public hearing on the measures is slated for July 25.

Direct written premium in California’s workers compensation system rose to $11.8 billion in 2023 from $11.6 the prior year, marking the third consecutive annual increase, according to a report released Friday by the California Workers’ Compensation Institute.

The CWCI said last year’s direct written premium was the highest since 2018.

The report, based on data from the National Association of Insurance Commissioners, said growth in covered wages last year drove direct written premium up by $220 million, or 1.9%.

The report looked at premium volume across 80 insurers representing 238 companies. The State Compensation Insurance Fund remained the largest California workers comp insurer, with $1.1 billion in premium, even though its premium fell by $36 million from 2022.

Long COVID can cause more than 200 symptoms and a positive COVID-19 test is not necessary to make a long COVID diagnosis, according to a report released Wednesday by the National Academies of Sciences, Engineering, and Medicine that researchers say may not clear the air on guidelines for disability.

Symptoms of long COVID, including chronic fatigue and post-exertional malaise, cognitive impairment, often referred to as “brain fog,” and autonomic dysfunction, “can impair an individual’s ability to work or attend school for six months to two years or more after COVID-19 infection,” the Washington-based National Academies said in a statement on findings, going on to say it “can be difficult to clinically assess these health effects, or to determine their severity and effect on a person’s ability to function. They also may not be captured in the Social Security Administration’s Listing of Impairments, which is used as an initial screening step in determining disability.”

The academies also said that “(e)ven patients with a mild case of COVID-19 can go on to develop Long COVID with severe health effects” but that the risk is greater with patients who were hospitalized with the virus.

“Diagnosing, measuring, and treating Long COVID is complicated,” Paul Volberding, professor emeritus in the department of medicine at the University of California, San Francisco, and chair of the committee that wrote the report, said in the statement. The disease “can present differently from person to person and can either resolve within weeks or persist for months or years.”

 

 

A university employee who was walking across campus and collided with a jogger should have been entitled to workers compensation benefits even though she technically stepped foot off campus and onto a public walkway at the time of the incident, the District of Columbia Appeals Court ruled Thursday.

The court reversed a Compensation Review Board decision overturning a workers comp judge’s decision awarding benefits to Miriam Rieger.

Ms. Rieger, a faculty member at Howard University, was walking from one university building to another when she was struck by a jogger, an accident that led to a concussion, whiplash and nausea, according to the ruling in Rieger v. D.C. Department of Employment Services, et al.

After being dropped off for work, Ms. Rieger realized she needed a document from the medical-arts building. The route required her to briefly leave university grounds and use a public sidewalk. The incident happened on the sidewalk.

A workers comp judge found the injuries compensable, but the review board reversed, saying Ms. Rieger had the option of being dropped off directly at the medical-arts building, which would have ensured she remained on campus property, but that she engaged in a “purely personal” choice to use a public sidewalk.

The appeals court said Ms. Rieger’s workday began upon arrival at the university, and that the claim should have been accepted under a “going and coming rule” that serves as an exception to employees injured while on a work-related errand.

The court remanded the case for further proceedings.