Tag: Workers Comp

Colorado Gov. Jared Polis on Tuesday signed legislation to permit workers compensation claimants to refuse offers of modified employment in certain situations.

The legislation, House Bill 1220, allows employees who receive temporary total disability benefits for a work injury to refuse an employer’s offer of modified employment if the offer requires the person to commute more than 50 miles or if it requires the claimant to drive to visit a treating physician when there is a medical restriction placed on driving.

The new law also makes other minor changes to workers compensation, including a provision instructing insurers and self-insured employers to pay all temporary and permanent disability benefits through direct deposit if that is a claimant’s preferred method of receiving benefits. 

A federal judge has halted a lawsuit by a civilian U.S. Navy engineer who alleges she was raped while working aboard a naval ship because of questions over workers compensation exclusive remedy.

U.S. District Judge Edward Kiel, of the District of New Jersey, granted on Tuesday a motion by the federal government to stay a lawsuit by the Navy engineer, who claims she was raped in December 2021 by the ship’s captain.

The alleged incident occurred during a night when the crew was drinking at a bar in Italy. The engineer claimed she had very little to drink and believes her drink was drugged because she later passed out. She claims the rape occurred later that night.

U.S. government lawyers in February sought to stay the lawsuit, claiming civilian workers are considered federal employees while working aboard naval ships, and that job-related injuries are covered by federal workers comp.  

In its filing, the government said if the rape allegations are found to be true, “there is a substantial likelihood that her claim would be covered by” federal workers compensation benefits. The government contended that if the Labor Department finds the injuries noncompensable, the engineer would still be able to maintain her lawsuit.

 

 

 

 

 

 

The U.S. Occupational Safety and Health Administration said Wednesday that it cited a New Jersey construction contractor for exposing workers to deadly fall hazards.

OSHA cited Long Branch-based Road Contractor Corp. for 32 safety violations and proposed $819,417 in penalties following eight inspections in Evesham, Freehold, Manalapan, Marlton, Mullica Hill and Rumson as part of the agency’s national program focused on falls.

OSHA said the company failed to provide employees with required fall protection, allowed workers to use portable ladders unsafely, exposed workers to silica hazards, allowed the operation of machinery without guarding, failed to provide employees with eye and face protection, and failed to have hazardous communication or written exposure control programs.

The citation includes “willful,” “repeat,” and “serious” violations.

The company, which provides wood framing and sheathing services for residential construction projects, has 15 business days to contest the citation and proposed penalties.

A hospital worker who says she contracted tuberculosis at work but was denied workers compensation benefits should have been permitted to pursue her claim, the Hawaii Intermediate Appeals Court ruled Tuesday.

The court vacated a state Labor and Industrial Relations Appeals Board decision affirming an administrative finding that a claim filed by Teresa Weis was time-barred.

Ms. Weis, employed by Pali Momi Medical Center, claims she was exposed in December 2008 to a patient who was infected with tuberculosis while working at another hospital. She tested positive for latent tuberculosis, which causes no symptoms and doesn’t always lead to developing the disease.

In January 2012, while working at Pali Momi, Ms. Weis learned she tested positive for the disease. Four months later, she attempted to file for workers comp, but the claim was denied. The employer said Ms. Weis would need to know who infected her for the claim to be compensable, the ruling states. She resigned in August 2014.

The Labor and Industrial Relations director upheld the claim denial, as did the review board.

The appellate court said the denial was improper, not because the injury was necessarily compensable, but because the employer didn’t take the proper administrative steps to address the case.

The appeals court, in remanding the case to the review board, said the board must apply the proper standards to determine whether the employer should be prevented from relying on a statute of limitations defense in its decision to deny the claim.  

 

 

Commercial property insurance policyholders with good loss records will likely see flat renewals to 10% increases for the remainder of this year, but the liability rating environment will likely remain tougher, according to USI Insurance Services LLC.

In a report issued Tuesday, the brokerage said property rates are finally stabilizing.

“After the most challenging property insurance market in decades, 2024 is proving to be a more stable and capitalized market. Although some pockets of disruption still exist,” the report said.

Accounts with poor loss experience will likely see rates increase by 10% to 20% in the remainder of 2024, compared with 15% to 30% in the first half of the year. Property rates have been rising since 2018, and buyers saw significant rate hikes last year.

General liability rates are flattening in some sectors, but real estate and habitational risks remain challenging.

“The focus on assault and battery exposures contributes to these sectors’ challenges,” the report said.

Average primary general and product liability rates are expected to increase by 5% to 10% for the remainder of the year. Umbrella and excess liability rates will be flat to up 12.5% for middle-market companies and 5% to 20% for larger companies, the report said

While auto fleets with a good loss history and fewer than 200 vehicles will see flat to 5% renewals, fleets of that size with poor loss records should expect 20% to 30% increases, USI said.

Excess auto buffer policies, which sit above primary policies, will likely increase up to 40%, the report said.

USI said workers’ compensation remains competitive, with rate changes for guaranteed costs coverage in the -10% to up 3% range and loss-sensitive programs -7.5% to flat.

 

Employers, insurers and claimants should start planning for changes to how Medicare’s liabilities are accounted for in workers compensation settlements, experts say.

The changes, which will remove the reporting threshold in settlements that include Medicare set-asides and define penalty amounts, could increase the likelihood of significant fines for noncompliance and prolong settlement negotiations, they say.

The Centers for Medicare & Medicaid Services announced in late April reporting requirement revisions to Medicare set-asides that are part of workers comp settlements involving injured workers who are also on Medicare or are Medicare-eligible.

An MSA is an agreement with Medicare under which a portion of a workers comp settlement will help fund an injured worker’s future treatment rather than Medicare paying the whole cost.

The revisions mandate that responsible reporting parties – employers, workers comp insurers or self-insureds – report all MSAs to CMS regardless of the settlement amount. Currently, parties only have to submit MSAs in cases where settlements are $25,000 or higher.

“This is going to have a major impact on the workers compensation industry,” said Jason Beans, CEO of Chicago-based Rising Medical Solutions, a medical bill review and cost containment company.

Another significant change is a new maximum $365,000 fine for reporting parties that fail to report MSAs within a year of a work injury. Currently, there is no maximum, but Medicare rarely imposes penalties for failing to report.

The revisions were initially slated to take effect in October, but CMS recently announced that it moved the effective date to April 2025.

“It’s a big deal, and not enough folks understand really what this means,” said Shawn Deane, general counsel and vice president of claims solutions for J29 Solutions Inc., a Millersville, Maryland-based health care management consulting company. “CMS is going to have unprecedented insight and visibility into all these Medicare set-asides.”

Once the changes go into effect, CMS would have a mechanism to deny future medical coverage for injured workers who are also Medicare beneficiaries who use proceeds for non-health-related expenses, Mr. Deane said.

“It really puts into focus this post-settlement period that a lot of folks don’t think about because once they settle a case, it’s kind of like, ‘OK, we’re all done. Have a nice life,’” he said.

Mr. Beans said the MSA information reported to CMS determines who pays first for claims submitted because Medicare wants to know if it is solely responsible or a secondary payer.

Currently, CMS doesn’t define penalties for noncompliance and “they aren’t really penalizing,” Mr. Beans said.

The $365,000 maximum fine for failing to report MSAs in comp settlements is a “huge” change from the current system, as it means CMS will start issuing fines for noncompliance, he said.

Kaitlin Files, a Levittown, Pennsylvania-based claimants attorney, said the change could slow down settlements.

“It’s definitely a change in practice,” she said.

Insurers may have to fund more MSAs, “and the claims will probably take longer to settle,” Ms. Files said.

One reason for the revisions is that when parties don’t submit an MSA, Medicare has no way of knowing how to coordinate benefits or potentially deny payment if it receives a bill for injured worker care, said Dan Anders, chief compliance officer for Delray Beach, Florida-based Tower MSA Partners LLC.

Under the revisions, reporting parties will have to report the MSA amount, coverage years or life expectancy of the claimant, and whether the MSA was funded through a lump sum payment or structured annuity.

 

Clara Analytics Inc., a Sunnyvale, California-based developer of artificial intelligence technology for the insurance industry, said Tuesday it has released Clara Fraud, a platform that works to increase visibility into suspicious workers compensation claims.

The AI product helps claims professionals uncover fraudulent activity and provides alerts to enable insurers to more easily refer suspicious claims for investigation, according to the company.

Clara Fraud analyzes factors including servicing locations, claimants having multiple claims open simultaneously, attorneys working similar cases and exaggerated workers comp claims.

The company said the product examines detailed claims documents to try to uncover suspicious fraud markers using supervised and unsupervised learning to enhance accuracy.  

 

 

 

Mental stress and burnout, which experts recently said are contributing to higher workplace injury rates, are some of the top reasons nurses are leaving the health care profession, according to a research study published in the Online Journal of Issues in Nursing, a journal of the American Nurses Association.

The findings, published Friday, found that intense working conditions emerging during the COVID-19 pandemic exacerbated workplace stress and burnout in nursing, causing many nurses to leave their jobs and creating a workforce shortage.

Earlier this year, experts said increasing rates of mental health issues, such as anxiety and depression, are leading to more hazards and workplace injuries in various professions.

Friday’s study, authored by researchers from NYU Rory Meyers College of Nursing, said that inadequate nurse staffing and turnover are linked with increased costs for health systems and poor-quality patient care.

The authors said they surveyed 629 U.S. nurses across 36 states. Many respondents reported that having workplace support systems in place was the strongest factor in determining whether they intend to stay on the job.

Symptoms of depression, on the other hand, were associated with many nurses deciding to leave their job within a year, the study states.

The researchers urged employers to implement programs, and make available resources, designed to better support nurses who are struggling with work-related mental health issues and stress.

 

 

 

The 7th Circuit U.S. Court of Appeals on Monday ordered a retail service management company to respond within 14 days to a sanctions award in a contractual dispute with American Zurich Insurance Co. over workers compensation policy language.

The court said Dallas-based Sun Holdings Inc. must address why it continues to ignore an order to pay Zurich attorneys fees following an arbitration decision that found Sun Holdings failed to live up to its end of a contract that requires the policyholder to pay the first $250,000 of each workers comp claim.

Zurich asserted that Sun Holdings violated the policy’s contractual dispute-resolution clause by disregarding an arbitrator’s order to pay Zurich $1.1 million, 9% in interest and $175,000 in legal fees as a sanction for “defending frivolously” its position, according to the appellate ruling American Zurich Insurance Company v. Sun Holdings Inc.

Although Sun Holdings has still not paid the claims costs and interest, the appeal centered around the company’s failure to pay attorneys fees. Sun Holdings invoked policy language that it contends requires each side to pay its own legal fees.

“Sun has followed up a frivolous defense during the arbitration with a frivolous strategy in court,” the ruling states.

A trial judge was permitted to calculate monetary restitution in a workers compensation criminal fraud case, despite the defendant arguing that the decision should have been left to jurors, the Alaska Court of Appeals ruled Friday. 

The appellate court said a judge did not err in ordering Scott Abraham Groom to pay $259,881.12 in restitution after he was convicted of engaging in a scheme to obtain more than $10,000 in state workers comp funds.

Mr. Groom and his codefendant, Laurayne Fischer, had submitted false claims to the Alaska Division of Risk Management seeking reimbursement for medical treatments that Ms. Fischer purportedly provided to Mr. Groom.

Mr. Groom had been awarded a workers comp settlement that entitled him to reimbursement for the cost of medical treatment. Ms. Fischer filled out forms stating that she provided treatment to Mr. Groom, but she never actually treated him, according to the ruling.

Both defendants were charged with multiple felonies. Ms. Fischer pleaded guilty, but Mr. Groom’s case went to trial, during which a jury convicted him on all but one criminal count in the indictment.

Mr. Groom appealed the sentence, arguing that his constitutional rights were violated because a jury, not a judge, must calculate restitution.

The appeals court disagreed, saying judges are permitted to order restitution. The court likened the process to a criminal judge calculating a prison sentence following a jury’s verdict.