Tag: Workers Comp

Sunnyvale, California-based Mulberri, an artificial intelligence insurance platform, on Tuesday announced the launch of its Risk Engine, a risk assessment tool for workers compensation underwriters.

The Risk Engine uses machine learning models to determine factors that impact claims based on information including previous loss experience. The cloud-based product allows access to claim frequency, probability and severity predictions on demand and enables users to analyze and score prospects one at a time or in bulk, according to a Mulberri statement.

 

 

 

A handful of drugs prescribed to injured workers in California make up a “disproportionate” share of workers comp prescription payments, according to research released Monday by the California Workers’ Compensation Institute.

The so-called “low-volume/high-cost” drugs include dermatological drugs, opioids and antidepressants and have become cost drivers, the researchers found.

The report says topical dermatologicals, the fourth-most prevalent drug category in 2021, accounted for 9.3% of workers comp prescriptions but 17.3% of all prescription drug payments. That was up from 12.8% of payments in 2012, which the study ascribes to increased use and the emergence of high-priced topical analgesics.  

Opioids’ share of overall prescriptions continued to drop, with the total drug spend falling to 5.8%, down from 26.7% a decade earlier. During the same period, the mix of opioids used to treat injured workers shifted, and the study noted three low-volume/high-priced opioids that have become cost drivers within their group, including oxycodone, a popular and strong pain medication. 

The top four antidepressants dispensed to injured workers in 2021 represented nearly 2/3 of the antidepressants used, but all four were relatively low-cost drugs, accounting for only 42.5% of the payments in that drug group.

 

Rhode Island lawmakers have introduced legislation that would amend reimbursement requirements in workers compensation claims where injured workers recover damages in third-party tort actions.

Senate Bill 1045, filed Friday, states that any money injured employees are awarded through third-party judgments or settlements that include damages for past or future pain and suffering, loss of consortium, loss of society, and loss of wages and earning capacity do not need to be reimbursed to comp insurers.

The measure also proposes to reduce any reimbursement amount by the percentage of an injured worker’s comparative negligence.

The bill would be applicable in cases involving third-person liability where injured employees seek damages from persons other than their employers.

Under existing law, insurers are entitled to suspend comp benefit payments to employees when damages recovered through third-party judgments or settlements exceed the amount of the comp benefits.

The bill states that any dispute regarding reimbursement apportionment must be heard in the trial court that has jurisdiction over the underlying third-party claim and not through comp proceedings.  

 

An Alabama road flagger injured while directing traffic was not permitted to sue the paving contractor because she was a “special employee,” and not an independent contractor, who was covered under workers compensation, the Alabama Supreme Court ruled.

The high court Friday ruled that Midsouth Paving Inc. and employee Christopher Nivert should have been immune from suit because the injuries sustained by traffic flagger Yvonne Mason should have fallen under the exclusive remedy provisions of the state’s Workers’ Compensation Act.

Ms. Mason applied with temporary job agency PeopleReady Inc. to work as a Midsouth flagger. On Aug. 13, 2020, she suffered serious leg injuries after being unintentionally hit by a vehicle driven by Mr. Nivert.

Ms. Mason underwent multiple surgeries and was hospitalized and in a rehabilitation facility for more than a month.

In November 2020, Ms. Mason filed a lawsuit against Midsouth and Mr. Nivert, but the company argued it was immune from suit because of workers comp exclusive remedy.

Ms. Mason argued that she believed she was an employee of PeopleReady, the temp agency, and that she was an independent contractor of Midsouth.

A trial court denied a defense motion for summary judgment in August 2022, but the state Supreme Court on appeal last week ruled summary judgment was appropriate because Ms. Mason was a “special employee” of Midsouth who was entitled to comp benefits and the suit should have been barred. 

 

 

 

 

A New Jersey manufacturer has been assessed steep fines after a worker lost three fingers in a workplace accident in November.

The U.S. Occupational Safety and Health Administration announced Wednesday that it cited Burlington, New Jersey-based United Hospital Supply Corp. for three willful violations, 17 serious violations and one other-than-serious violation and proposed penalties of $498,464 after a worker had three of his fingers amputated while operating a press brake that did not have required safety guards.

The willful violation was due to supervisors deliberately bypassing the press brake’s light curtain, which led to the amputations, OSHA stated.

The company was previously cited in 2010 and 2015, leading OSHA to place it in its Severe Violator Enforcement Program.

Following a November inspection, OSHA said the company also exposed workers to welding fumes above permissible exposure levels.

The company, which produces metal products for hospitals, laboratories and schools, has 15 days to contest the latest citations and fines.

The Appellate Division of the Supreme Court of New York has reversed a decision by the state Workers’ Compensation Board overturning a petition for comp benefits by a police detective injured while traveling to an investigation.

In a Thursday decision, the appeals court ruled the board was wrong to deny comp benefits to Tulio Serrata, a detective sergeant with the Suffolk County Police Department, who was injured after his vehicle was struck by a garbage truck while he was driving to a suspect interrogation.

Mr. Serrata was on call during the overnight hours of April 26, 2021, and he used his personal vehicle to travel from his home to the police precinct, where he was scheduled to pick up a department car and then head to the crime scene.

He was stopped at a traffic light when he was struck from behind by a garbage truck.

Mr. Serrata filed a claim for comp benefits stemming from his injuries, and a comp judge found the accident arose out of and in the course of employment since he was traveling to a crime scene, but the decision was overturned by the comp board.

The appeals court determined the board was wrong to deny the claim, since a special exception applied at the time Mr. Serrata was traveling from his home to the police precinct to check out a department vehicle.

The case was remanded to the comp board.   

 

 

The Ohio Supreme Court ruled Wednesday that a deceased worker’s fiancée should have been given the opportunity to prove she was a “family member,” wholly dependent on the worker and therefore entitled to benefits after he was killed in a trench collapse.

Christopher R. McDonald was killed in April 2019 while working for J&J Schlaegel Inc. He was engaged to Amanda Carpenter at the time of his death and the two had been in a relationship for 11 years and had two children together, according to State ex rel. McDonald v. Industrial Commission.

Ms. Carpenter filed a workers compensation claim seeking death benefits and supported her claim with an affidavit stating she and Mr. McDonald had owned real property jointly with a right of survivorship; they had been jointly responsible for the mortgage on the real property; they had been jointly liable for several credit-card accounts and vehicle leases or payments; they each had life insurance policies naming the other as the sole beneficiary; and Mr. McDonald had provided the primary financial support for her and for their children.

The Ohio Bureau of Workers’ Compensation denied Ms. Carpenter’s claim and a district hearing officer affirmed that decision, but a staff hearing officer vacated it, saying Ms. Carpenter proved she was wholly dependent as a member of Mr. McDonald’s family.

The Industrial Commission vacated that decision, and the Court of Appeals for the 10th District of Ohio remanded the case back to the commission.

The case ultimately founds its way to the state’s highest court, where justices ruled the law provides for death benefits payable to “wholly dependent persons at the time of the death.”

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

The number of U.S. workers who tested positive for marijuana following work-related accidents reached its highest level in a quarter-century last year, and researchers say the positive drug test increase correlates with more states legalizing cannabis recreationally and medicinally.

The new analysis released Thursday by Quest Diagnostics shows that workers who tested positive for THC, the psychoactive component of cannabis, following job site incidents increased to 7.3% in 2022 from 6.7% in 2021, and that the figures follow a steady increase in post-accident cannabis positivity each year between 2012 and 2022.

Analysts looked at more than 6.3 million urine tests across the general U.S. workforce, and found that year-over-year positivity increased in nine out of 15 industries examined during the 10-year period, and that over the most recent five years workforce drug positivity increased in every industry category.

Marijuana positivity was highest in retail trade and accommodation and food services, while cocaine positivity also increased in 12 out of 15 industries during the study period.

The study shows that the combined U.S. workforce positivity for all drugs in 2022 was at the highest level in two decades, and that the 2021 and 2022 positivity rates were the highest they have been since 2001.

While the main focus was on marijuana, the study also showed that amphetamine use was also on the rise among U.S. workers, with positive drug tests for amphetamines increasing by 15.4% in 2022. The amphetamine data, researchers noted, does not differentiate between illicit drugs and prescribed medications.  

 

States that don’t have workers compensation medical fee schedules for professional services tend to have much higher prices compared with states that have fee schedules, according to updated findings by the Workers Compensation Research Institute.

The WCRI on Thursday released the updated version of its ongoing study, WCRI Medical Price Index for Workers’ Compensation, which looks at a variety of professional services billed by physicians, physical therapists and chiropractors treating injured workers.

Researchers found prices paid for a similar set of professional services in comp varied drastically between the 36 states making up the study group, mostly depending on whether fee schedules are in place.

This ranged from 31 percent below the median in Florida to 163 percent above the median in Wisconsin.

Researchers, who monitored price changes between 2008 and 2022, also found many states saw significant price growth for evaluation and management services beginning in 2021, after the Centers for Medicare & Medicaid Services revised its fee schedules and the American Medical Association updated its coding guidelines.

Professional services include evaluation, management, physical medicine, surgery, radiology, neurological testing, pain management injections and emergency care.

The study said eight states that implemented major fee schedule changes during the study period – Arizona, Illinois, Kentucky, Massachusetts, New York, North Carolina, Texas and Virginia – had significant changes in overall prices paid for comp medical services.

The 36 states in the study represent 87% of all comp benefits paid in the U.S.