CompScope WCRI Blogging Live – State of States

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CompScope – State of the States – WCRI – Blogging Live

States of the States WCRI CompScope annual conference 2016 Blogging Live.

Preliminary  Research  – Subject to change

Over view of Hug conference room CompScope in palace of nations
Wikimedia Commons – Tryfon Kar

Two New States  – Kentucky and Georgia are being added to the CompScope(R)

Wage Loss States that have wage loss and PPD – North Carolina and Georgia

Wage Loss states are not PPD states –

Georgia 

TTD = Temporary Total Disability

Georgia is a combined PPD and Wage Loss state

TTD benefits paid – No maximum medical (MMI) in Georgia

TTD maximum weeks = 400 weeks

Maximum 300 PPD Weeks

Georgia – one of higher states for TTD – median state $18,313

Georgia – Approximately $26,000 per claim average on TTD

Weekly TTD benefits rate lower than median state

Average duration of TD benefits  were lower than median state

40% lower statutory maximum

31% of claims were limited by maximum TTD rate – highest of all studied states

Georgia and North Carolina had the highest rate of lump sum settlements

Big Conference Room CompScope Empty
Wikimedia Common -Own work

Georgia had:

  • higher medical benefit involved in PPD settlements  than median states
  • higher litigation related expense than median state
  • higher  payments for defense attorney than the median state
  • is based on an administrative system

Kentucky 

No TPD – Temporary Partial Disability

Longer Temporary Total Disability period

Kentucky is close to median state for TTD length

Kentucky  was:

  • PPD benefit payments were higher than the median
  • Close to median state were for benefit delivery expenses
  •  Medical-legal services expense were much higher than the median state

Medical trends across the States 

Half of studied states – had a moderate growth rate in medical costs

The other half had very low growth rates in medical costs

What factors caused the very low growth rate?

  • Illinois –
    • 30% reduction in fee schedule rates 
    • 29 different fee schedules in the state (regions) were reduced to 4
    • 76% higher than Medicare fee schedule rates
  • North Carolina  –
    • Outpatient hospital -utilization per claim lowered
    • Fee schedule reduced outpatient charges from 95% of charges to 76% of charges
    • 2013 – froze rates – cut by 15%
    • Outpatient hospital rates were tied to Medicare rates in 2015
    • Goal – balance out hospital charges with non-hospital charges
  • California  –
    • SB 863 effects
    • Reduced ASC rates from 120% to 80% of Medicare outpatient hospital rates
    • Trend of billing frequent complex office visits stopped in 2014
    • Neurological testing fees reduced by 43.6%
  • Louisiana –
    • Colorado – based guidelines introduced
    • Decrease in medical visits per claim possibly due to changes in 2011

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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