TAN Annual Meeting Set for Sept. 29 in Dallas — Register Today!
TAN’s annual meeting will be held on Thursday, Sept. 29, from 10 a.m. to 3:30 p.m. at 14785 Preston Road in Dallas, the location of the offices of the Combined Group. The program will include updates on regulatory issues of interest to nonsubscribers, a preview of the 2023 state legislative session, the always popular legal panel, a report on the 2022 midterm elections, and more. The event is free to TAN members. You may register today by clicking here.
Jeff Nelson Named Commissioner of Workers’ Compensation for Texas
Jeff Nelson has been appointed commissioner of workers’ compensation at the Texas Department of Insurance by Gov. Greg Abbott. He will fill the remainder of a term set to expire on Feb. 1, 2023.
Prior to the appointment, Nelson had served as director of external relations for the Division of Workers’ Compensation at TDI since 2016. As director, he was the primary point of contact for legislative offices and stakeholders and worked to advance DWC’s policies and initiatives.
TDI’s Division of Workers’ Compensation regulates the workers’ compensation system in Texas and is tasked with ensuring injured workers receive the necessary benefits to quickly return to work and that workers’ compensation costs are kept at a reasonable level for Texas employers.
The commissioner enforces the Texas Workers’ Compensation Act and rules and administers the certified self-insurance program for individual employers. DWC’s responsibilities also include resolving claim-level disputes about medical and income benefits, as well as medical fee disputes.
Nelson previously served as a senior campaign consultant for U.S. Rep. Kevin Brady, executive aide to Gov. Rick Perry, and as a legislative aide to State Sen. Tommy Williams. He is a board member of the Southern Association of Workers’ Compensation Administrators.
Owen & Fazio Wins Two Judgments for Nonsubscribers
Judgments from two Texas appellate courts on the same day on separate cases were recently made in nonsubscribers’ favor.
In Lupe Holdings, LP, et al. v. Sanchez, the First Court of Appeals ruled that a Harris County trial court erred when it denied a motion to compel arbitration between an injured worker and his nonsubscriber employer. The injured worker claimed he suffered an on-the-job industry injury on Aug. 1, 2018, and sued his employer on July 31, 2020, the last day before the expiration of a two-year statute of limitations for injury claims set forth in an arbitration agreement signed by both the company and the worker. In response, the employer filed a motion in March 2021 to compel arbitration, pursuant to the arbitration agreement.
The appeals court ruled on July 21, 2022, that the arbitrator, not the trial court, is the appropriate entity to determine if the employer’s motion to compel arbitration was filed within the agreed-upon time frame in the arbitration agreement.
Meanwhile, the Second Court of Appeals that same day affirmed a trial court’s order in Arrow Personnel, LLC, et al. v. Grant, that there is no reason for the case to proceed to a jury trial.
The case involves a staff leasing agency and nonsubscriber that had contracted with a manufacturing company that is a subscriber to the Texas Workers’ Compensation System. The agreement specifically called for the staffing agency to provide employees while the manufacturing company retained control of the workplace and provided necessary safety measures.
A worker provided by the staffing agency was injured when he was struck by steel I-beams falling from a forklift/conveyor system operated by an employee of the manufacturing company. Although the injured employee was an employee of the staffing company, the nonsubscriber successfully used the “right to control” test to argue that their client did not owe a duty to provide a safe workplace or have control of the liability-producing aspects where the staffing company did not provide task-specific training, supervision or equipment and did not control the property or task instructions. The manufacturing company also successfully barred claims against them filed by the employee pursuant to the Exclusive Remedy Rule.
Both cases were handled by Jerry Fazio of Owen & Fazio, P.C.
Managing Monkeypox in the Workplace
Differences in the way the monkeypox virus (MPV) and COVID-19 are transmitted make the risk of MPV spread or outbreaks in the workplace low, according to the CDC. However, there are steps employers should consider to prepare for positive MPV cases in the workplace.
Jackson Lewis P.C., a national law firm focused on labor and employment law, suggests employers consider proactive measures to educate their employees and avoid misinformation in the workplace. These may include communicating how MPV can be transmitted, encouraging employees to remain home when ill, and encouraging employees to wash their hands and disinfect their work areas.
Unlike COVID-19, monkeypox is not an airborne virus and is spread primarily through close personal, often skin-to-skin, contact, including:
- Direct contact with monkeypox rash, scabs or body fluids from a person with monkeypox.
- Touching objects, fabrics (clothing, bedding or towels), and surfaces that have been used by someone with monkeypox.
- Contact with respiratory secretions.
- Intimate contact including sex, hugging, massage, kissing and prolonged face-to-face contact.
According to the CDC, gay, bisexual, and other men who have sex with men make up most cases in the current monkeypox outbreak. However, anyone who has been in close, personal contact with someone who has monkeypox is at risk. Jackson Lewis says employers should consider taking steps to avoid the stigma potentially associated with MPV and remind employees of applicable anti-discrimination and harassment policies. Policies or memos addressing MPV may want to include language that MPV can be acquired by all people, regardless of gender identity or sexual orientation.
The law firm says organizations with employees who test positive for MPV should encourage them to isolate and remain out from work, and to consult with their health care providers and local health departments. The CDC advises that individuals who have MPV should isolate for the duration of their illness, until all symptoms have resolved, which may last from two weeks to four weeks. Employers should review applicable state and local paid leave laws to see if employees are entitled to paid leave due to MPV.
TDI Provides Info for Claims EDI Billing
The Texas Department of Insurance, Division of Workers’ Compensation, designated Insurance Services Offices as its data collection agent for claim EDI release 3.1 data.
Insurance Services Office, Inc., a wholly owned subsidiary of Verisk Analytics, will bill insurance carriers, other than governmental entities, to recover the costs associated with collecting claim data for DWC.
According to DWC, the costs for the first year of data collection include the following:
- One-time startup costs allocated across Texas insurance carriers and certified self-insured employers and certified self-insured employer groups total: $368,350. These costs include trading partner profile registration and certification, programming, certification, website setup, and billing setup and coordination.
- First-year ongoing support costs allocated across Texas insurance carriers and certified self-insured employers and certified self-insured employer groups total: $458,850. These costs include staffing positions, infrastructure costs, insurance carrier support, report development, and EDI intake and pre-editing.
- Subsequent-year ongoing support costs allocated across Texas insurance carriers and certified self-insured employers and certified self-insured employer groups: Verisk will bill each insurance carrier, including certified self-insured employers and certified self-insured employer groups, a percentage of these costs based on fiscal year 2021 accepted claim EDI transaction volume. The 2021 transaction volume is at info/faq. Verisk will bill for future ongoing support costs based on the previous year’s accepted EDI transaction volume, plus an additional 3% annually.
Verisk will bill for half of the $368,350 one-time startup costs immediately after insurance carrier registration. Verisk will bill for the remaining half of their one-time startup costs and the cost of the first year of ongoing support costs on or after July 26, 2023, which is the Texas claim EDI release 3.1.4 implementation date. All insurance carriers or insurance carrier groups must register their billing contact information with Verisk as soon as possible.
Information about the registration and billing processes is available here.
Select Medical Programs Receive National Recognition
Four Select Medical inpatient rehabilitation hospitals, including one in Dallas, have been recognized by U.S. News & World Report as best hospitals for rehabilitation in the country.
For its 2022-2023 rankings, U.S. News evaluated rehabilitation hospitals’ performance using a variety of measures such as the scope of services, outcomes and quality/safety metrics, as well as reputational scores. Data from the Centers for Medicare & Medicaid Services, American Hospital Association, ERehabData, USDMR, and medical rehabilitation specialists were also considered.
Select Medical rehabilitation hospitals recognized are the Kessler Institute for Rehabilitation in West Orange, New Jersey, which was ranked fourth. It is the 30th consecutive year that Kessler Institute has been named to the list.
Baylor Scott & White Institute for Rehabilitation in Dallas, which Select Medical maintains as a joint venture partnership, was ranked 14th in the country.
The other three hospitals recognized were Kessler Institute in West Orange, New Jersey (4th), Emory Rehabilitation Hospital in Atlanta, Georgia (26th), and Ohio Health Rehabilitation Hospital in Columbus, Ohio (31st).
“We are honored that four of our inpatient rehabilitation hospitals have been recognized among the best in the country,” said Jeff Ruskan, president, Inpatient Rehabilitation Hospital Division at Select Medical. “These prestigious rankings underscore our commitment to clinical excellence, innovative rehabilitative care, and outcomes that enable patients with catastrophic injuries and illnesses to rebuild their lives. We are also incredibly proud of the teams at these hospitals who are dedicated to delivering an exceptional patient care experience every day.”
More information about the rankings is available here.
Study Provides Insight on Musculoskeletal Injuries in the Workplace
Musculoskeletal disorders account for one-third of all workers’ compensation costs and result in almost 400,000 injuries a year, according to data from the U.S. Bureau of Labor Statistics. Yet one simple tip — storing items off the floor — could cut workers’ risk of back injury in half, says the Washington State Department of Labor & Industries.
The Washington Department of Labor & Industries says the best place to store heavy items at work is waist level and that lifting from the floor is twice as risky as lifting while standing upright. And lifting items above your shoulders puts workers at risk for neck and shoulder injuries. Additionally, heavy items shouldn’t be stored overhead because those items can fall and cause an injury.
In a tip sheet meant to inspire talking points for safety meetings, the department offers the following tips:
- If a load is too heavy to be lifted by one person, use a hand truck or ask a co-worker for assistance.
- Loads that can be safely lifted by one person should be brought as close to the body as possible when lifting. Lift with your legs, not your back. Keep your head up and your back straight, and bend at the hips.
- Keep the load close to your body as you walk. Shift — don’t twist — your body to turn.
- Let your leg muscles carry it down when setting down the load. Make sure your fingers and toes are clear of the load before setting it down.
The U.S. Occupational Safety and Health Administration estimates the direct costs of musculoskeletal disorders are $20 billion a year and indirect costs are $45 to $54 billion.
Protective Equipment Key in Reducing Workplace Injuries
Ensuring employees have the proper supplies and protective equipment for their job can reduce the number of reportable workplace incidents. AFFLINK, a global leader in supply chain management, provides the following suggestions for worker safety:
- OSHA requires hard hats whenever employees are working in situations where objects could fall on them or for workers performing electrical work.
- Eye and face protection is mandated when working around chemical, environmental, radiological, or mechanical irritants and hazards. Safety supplies often include things such as eye gear face shields, respirators, and eye wash stations.
- OSHA requires fall protection at a height of 4 feet or higher. That includes platforms, scaffolding, and any task near a building’s edge or a floor opening, such as a skylight. Fall protection is also required around dangerous machinery like galvanizing tanks or degreasing units.
- Hand injuries send more than 1 million workers a year to the emergency room. In 70% of those cases, the workers were not wearing gloves or were wearing the wrong kind. Typical injuries involve cuts, burns or absorbing hazardous chemicals. Ensure the proper gloves that meet the specific task are supplied.
- OSHA requires protective equipment like earplugs/coverings as well as physical barriers between workers and the source of the noise based on average decibel exposure over eight hours a day.
- OSHA requires the presence, placement and design of signs that warn employees of danger and/or provide safety instruction. Examples include warnings of chemical, biological or electrical hazards, fall hazards, and flammable materials.
- Back injuries can be prevented with safety supplies such as mechanical aids (like pneumatic lifts), back belts, and posters demonstrating proper lifting technique.
- OSHA requires foot protection when there is a risk of objects falling or rolling on workers’ feet, puncturing or electrocution. Stick to footwear with steel or fiberglass toes, puncture resistance, chemical protection, and compression and impact protection.
How Long is COVID Infectious? What Scientists Know so Far
When the US Centers for Disease Control and Prevention (CDC) halved its recommended isolation time for people with COVID-19 to five days back in December, it said that the change was motivated by science. Click here for full article.
Los Angeles Times
More People are Catching Coronavirus a Second Time, Heightening Long COVID Risk, Experts Say
Emerging evidence suggests that catching the coronavirus a second time can heighten long-term health risks, a worrisome development as the circulation of increasingly contagious Omicron subvariants leads to greater numbers of Californians being reinfected. Click here for full article.
Times of India
Coronavirus: Are You Overcautious Or Too Casual About COVID? These Questions Will Help You Decide
We have lived through the COVID pandemic for two years now. We know a great deal about how to manage the infection, how to remain safe, when should we go for COVID testing and how important it is to remain isolated from others when there is an infection. Click here for full article.
How Long Can the Coronavirus Keep Reinfecting Us?
When the original Omicron variant swept across the country this winter, it launched America into a new COVID era, one in which nearly everyone—95 percent of adults, according to one CDC estimate—has some immunity to the virus through vaccines, infection, or both. Click here for full article.
How Millions of Americans Suffering from Long COVID can Find Support
Millions of Americans are suffering from long COVID, according to the U.S. Census Bureau, with symptoms ranging from mild to debilitating. Dr. Monica Verduzco-Gutierrez, chair of the Department of Physical Medicine and Rehabilitation at the University of Texas Health San Antonio, and Karyn Bishof, founder of the COVID-19 Longhauler Advocacy Project, join Geoff Bennett to discuss. Click here for full article.
New Test may Predict COVID-19 Immunity
Most people in the United States have some degree of immune protection against Covid-19, either from vaccination, infection, or a combination of the two. But, just how much protection does any individual person have? Click here for full article.
Americans Less Optimistic About COVID-19 Situation
Americans remain more optimistic than pessimistic about the coronavirus situation in the U.S., but substantially fewer express optimism than did so this spring. Gallup’s latest COVID-19 survey finds 41% of U.S. adults saying the COVID-19 situation is getting better, down from 63% measured in late April and early May. Thirty percent, up from 15%, say the situation is getting worse, while 29% believe it is staying the same. Click here for full article.
Millions of Americans have Long COVID. Many of Them are no Longer Working
More than two years after Georgia Linders first got sick with COVID, her heart still races at random times. Click here for full article.
Deputy who Nearly Died from COVID Denied Workers’ Comp
A Mesa County Sheriff’s deputy who nearly died from COVID-19 in 2021 is suing the third-party benefits administrator that denied his workers’ compensation claim last year. Click here for full article.
Battle for Workers’ Comp Over for COVID Long-hauler from Jefferson County
A long-haul COVID survivor is thankful that a worker’s compensation case against her former employer has been settled. Click here for full article.
How Workers’ Compensation Is Evolving Post-Pandemic
Workers’ compensation began as a system for injured workers in the early 1900s. Since that time we have seen numerous changes within each state system evolving to where we are today; however, the basic construct of workers’ compensation has remained the same. Click here for full article.
Business Insurance America
Tracking the Post-pandemic Workers’ Compensation Market
While many people would say that the world is currently in a post-pandemic phase, the sad truth is that the effects of COVID-19 have not actually gone away. While the coronavirus’ impact appears to be reduced, it continues to affect the world’s businesses by influencing government restrictions and inducing staffing shortages. Click here for full article.
Texas Comp Insurer Doesn’t Owe Coverage for Out-of-state Worker’s Accident
A Texas appellate court on Thursday ruled that an in-state insurer did not owe coverage for an out-of-state worker’s accident that happened in Louisiana. Click here for full article.
Records: Less than a Quarter of BCSO Deputy COVID-19 Benefits Claims have been Approved
Bexar County sheriff’s detention officers and deputies who have applied for COVID-19 workers’ compensation benefits since the start of the pandemic have been denied more than 75 percent of the time, records obtained by KSAT Investigates confirm. Click here for full article.
Texas Department of Insurance
La Barbecue Manager and Owner Indicted on Fraud Charges
The owner of an East Austin restaurant and her manager have been indicted and summoned to appear in Travis County District Court for their alleged role in a $350,000 workers’ compensation fraud scheme. Click here for full article.
California Department of Insurance
Surveillance and Social Media Posts Lead to Felony Arraignment of San Bernardino Mechanic Accused of Workers’ Compensation Fraud
Richard James McGee, 47, of San Bernardino, was arraigned today on two felony counts of workers’ compensation insurance fraud after a Department of Insurance investigation found he allegedly misrepresented injuries to his employer in order to receive over $30,000 in undeserved disability payments. Click here for full article.
Recent Changes to Colorado’s Workers’ Compensation Laws
The Colorado legislature approved changes to the state’s workers’ compensation landscape during the 2022 legislative session. Click here for full article.
Florida Sting Operation Busted 13 Contractors Without Workers’ Comp
Unlicensed contractors, all without proper workers’ compensation insurance on their workers, have been charged in another law enforcement sting operation in Florida, authorities said. Click here for full article.
Workers’ Compensation Rates Could be Reduced by 8.4% in 2023
The National Council on Compensation Insurance (NCCI) this week submitted a filing to the state insurance department that recommends an 8.4% reduction on new and renewed policies effective Jan. 1, 2023. Click here for full article.
NCCI Recommends 8.4% Cut in Florida Workers’ Comp Rates for 2023
The National Council on Compensation Insurance is recommending an average 8.4% cut in workers’ compensation rates for the Florida voluntary market – the seventh straight reduction and double the size of the decrease for this year. Click here for full article.
Appeals Court Denies Enhanced Benefits to Worker Hit by Car
An Ohio appellate court on Tuesday ruled that a worker was not entitled to an enhanced award of benefits for his injuries from being struck by a car, because the accident did not occur in a “workshop.” Click here for full article.
Workers’ Compensation Pays for Home Modifications. What About a New Home?
Pennsylvania’s workers’ compensation law authorizes modifications to a home to accommodate an injured employee’s needs. It also may require paying for a new van for a disabled worker. Click here for full article.
Danville Register & Bee
10 of the Most Common Workers’ Compensation Claims
More than 100 Americans die on the job every week, according to the Occupational Safety and Health Administration, the federal agency tasked with regulating workplace safety. It may not come as a surprise that industries such as transportation and construction report the largest number of workplace fatalities. Click here for full article.
Risk & Insurance
In Court: What’s New on the Medical Marijuana Front for Workers’ Compensation
The regulatory and legal landscape of medical marijuana continues to shift and as we look to 2023 many questions still need answers. Several states have ruled that medical marijuana is a reasonable and necessary medical treatment for work-related injuries, including neuropathy, chronic pain, and post-traumatic stress disorder. Click here for full article.
Employee Benefit News
3 Ways to Build Engagement and Trust in Workers’ Comp Claimants
When an employee is injured on the job, it is in everyone’s best interest to mobilize for a fast and complete recovery. However, that outcome may be unintentionally sabotaged by an unlikely development: lack of patient engagement and trust. Click here for full article.
Improved Comp Claims Management Hinges on Mental, Social Elements
Tackling societal health disparities and training frontline staff on psychological issues are among the areas where the workers compensation industry can improve, according to a study released Monday that examined hurdles in getting better care and recovery for injured workers. Click here for full article.
Business Insurance America
Could Changes be Coming for the Workers’ Comp Space?
It’s been quite a couple of years for the insurance industry, with the impacts of COVID-19, inflation, and fundamental changes to the labor market taking their toll. Despite all this, however, the workers’ compensation system is booming – it remains one of the most profitable segments of the US property and casualty insurance industry. Click here for full article.
Dobbs, Workers’ Comp. Brief Hint At Biden’s Cannabis Stance
The overturning of Roe v. Wade, combined with a largely unknown workers’ compensation case presented to the U.S. Supreme Court — for which certiorari was recently denied — reveal the Biden administration’s position on cannabis: The Biden administration doesn’t care about cannabis issues. Click here for full article.
Workers’ Comp for Remote Employees: Here’s What You Need to Know
According to the US Bureau of Labor Statistics, 47 million Americans voluntarily quit their jobs during this time as a result of COVID-19 and the initiation of the Federal Stimulus program. However, since the fall of 2021, workforce participation has been on the incline and by February 2022, 1.87 million workers had rejoined the workforce, which was triple the 621,000 who returned in the three prior months. Click here for full article.
Compared to Filing a Personal Injury Lawsuit, Getting Hold of Financial Compensation is Easier when you File a Workers’ Compensation Claim
If you have been injured in a New York workplace accident, you have a number of choices. If you need compensation for things like missed wages and medical expenses, you may be considering either a workers’ comp claim or a personal injury claim. Click here for full article.
Workers’ Compensation Rates Keep Falling in Q2
U.S. states employ a variety of rate regulation mechanisms, including prior approval, modified prior approval, file and use, and use and file. Some states do not require explicit regulatory approval prior to insurers using new rates. Click here for full article.
Carriers Toughen up on Workers’ Comp as Post-COVID Inflation Concerns Mount
Talking to Program Manager, Michigan-based Clifford, who serves RPS as area president, explained that the significant price decreases seen in recent years have slowed. Click here for full article.