Archives for April 2016

Colorado Workers Comp Single Payer Conundrum

April 7, 2016 By JL Risk Management Consultants

Colorado Workers Comp Single Payer Plan Up For Vote This Fall

The vote for Colorado Workers Comp single payer plan will occur this fall. One of the major components of a 24-hour single payer plan is that Workers Comp may no longer exist inside this type of health plan.

Universal health care will be on the ballot in a major move by single payer advocates. ColoradoCareYes has gathered well over the minimum 100,000 petition signature to put single payer health on the ballot.

Why is the topic covered – it may be coming to a state near you as this is akin to the Oklahoma and Texas Opt Out Plans.

While this is not federalization of Workers Comp, the plan may look similar to ObamaComp if it ever came into existence. Colorado has been on the forefront of many issue lately including the non-medical legalization of marijuana.

Vermont disbanded their Universal Healthcare due to the overburden to the state’s budget. One of the striking parts of the amendment is that even if a citizen has their own healthcare policy, they would still have to pay the Colorado Care premiums – ouch!

Colorado’s Amendment 69 would also address Workers Compensation- but the medical part only. Employers would still have to buy indemnity only Workers Comp <<guessing a little on that one. Would Colorado allow a plan such as AFLAC to substitute for an indemnity policy?

Pinnacol Assurance of Colorado, of course, came out against measure due to the severe increase in employer taxes. Pinnacol functioned as a monopolistic type fund in Colorado for many years but then was privatized over the last decade.

If Amendment 69 is voted in, then it will be an interesting time in Colorado at the end of this year. All eyes will be on Colorado from both the healthcare and workers compensation industry. The Colorado Workers Comp single payer conundrum will be in an operational mode.

How would a WC carrier write an indemnity only policy and how would they control the medical treatment that the indemnity payments center on for an injured employee? There are so many WC questions with no answers.

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Filed Under: Colorado Tagged With: amendment 69, colorado care yes, indemnity, Opt out, Pinnacol, single payer, universal healthcare

Workers Compensation Records Retention Question

April 7, 2016 By JL Risk Management Consultants

Workers Compensation Records Retention

The subject of Workers Compensation Records Retention is not as popular pre-2010 for some reason. We do receive a question on this topic every few months.

Workers Compensation mail headaches was covered a few years ago. I recommend reading that older article.

We received the question – How long should we (employer) hold onto Workers Compensation records such as policies, premium audits, claims info, Experience Modification sheets, and other similar records?

That is a tough “overall” question to answer as each state has specific record requirements. The length of time to retain records can vary greatly.

The best overall way to handle the records is to digitize them and keep them forever. That does seem extreme. However, there are many Workers Comp files where the “disease statutes” kick in once an injured employee “has been diagnosed” with an occupational disease. Having claims records can be a make-or-break situation.

Also, when we perform any type of data analyses or forecasting, the more data there is into the past, the better that we can predict the future. Business cycles of up to 20 years are present in much of the data we have reviewed for certain clients.

This kind of goes against the current actuarial position of the most recent data holding more weight than very old Workers Comp data. Of course, this is a debatable point.

My advice to to retain all Workers Comp data permanently by digitizing it using a scanner. A scanner is a relatively cheap investment. Any of our clients that have Workers Comp data digitized has saved $$ on our services.

Most data arrives in digital form nowadays. Copying it to a reliable thumbdrive that has security will always have your Workers Comp data at your fingertips. Asking your agent to be a data storage provider is not the best advice. Agents do retain limited data for quite some time.

A 128gb thumbdrive such as the one in this article can be found for $35 or less. That size will hold approximately 1,664,000 pages of scanned data. Only having Workers Comp related data on the thumbdrive will save data retrieval headaches later.

Workers Compensation can be assigned to a certain person in the office to make sure all the data is in one place. Workers Compensation records retention can be an easy process unless you are searching for a piece of paper from 12 years ago.

Article provided by James J Moore, AIC, MBA, ChFC, ARM. All articles are original content. Check out the full website at www.cutcompcosts.com

Filed Under: records retention Tagged With: actuarial, scanner, thumbdrive

North Carolina vs Texas Formulary – WCRI Study

April 6, 2016 By JL Risk Management Consultants

North Carolina vs Texas Formulary Now Tabled Until 2017 and Beyond

A North Carolina vs Texas Formulary study by WCRI caught my eye a few weeks ago. I decided to look further into the comparison.

The state of North Carolina has tabled a Workers Compensation formulary until 2017 and beyond. Workers Compensation Research Institute (WCRI) had performed a great study last month comparing and contrasting a proposed North Carolina vs Texas Formulary.

As a side note, critics of eliminating informal medical networks in Texas had commented earlier as to a negative effect on their Workers Compensation system.

The main aspect of the WCRI study was how a closed formulary would have affected the supply and price of various medications. WCRI used the Workers Comp figures available from state employees as the comparative database.

According to the study there were 183,000 prescriptions filled at a cost of $29 million for the years 2012 – 2014. The results were that under different scenarios, a savings of up to $8.7 million would be incurred for the 14,000 state employees.

WCRI had noted that 23% of all the North Carolina prescriptions were non-formulary accounting for 39% of the costs.

An example of the astounding data in the study was –

For long acting opioids 91% of the North Carolina prescriptions were non-formulary. Topical analgesics which were non-formulary amounted to 99% of that type of prescription.

The enacting of any legislation has been tabled to the future. From this study, one would have to say that the savings for North Carolina are there once legislated into action.

The very intensive study can be obtained from the WCRI here.

The CMS provided a great page on a discussion of formulary and non-formulary here.

Filed Under: WCRI North Carolina Tagged With: analgesics, CMS, opioid, WCRI

Workers Comp Adjusters – Feel Good Friday

April 1, 2016 By JL Risk Management Consultants

Video By Rising Medical Solutions Is A Pick-Me-Up For Workers Comp Adjusters

Unfortunately, Workers Comp adjusters have been and will always face the brunt of the WC process. I have often defended adjusters and the whole WC system against the likes of ProPublica and the general click-bait WC environment – that is what we call social media of today. The environment has gone for the lowest common denominator – the sometimes fallible WC insurance claims system.

I usually only read the opinions on claims originating from a person that has served some capacity in the WC claims side. In other words, you have to ride in that saddle before you can talk about the horse.

The video is three+ years old. Rachel Fikes and her group put together as simple video. Simple is good in most instances. I first met everyone from Rising last May at a WC think-tank in Chicago. They were a good group of people. That was my first time for an extended stay in vibrant yet eclectic Chicago.

Rising Medical Solutions did not pay me any incentive for running their video. Great marketing is indirect marketing. The video is about Workers Comp adjusters and, in fact, the whole claims staff, and their valuable worth in the claims process.

So here is the link to the video – in fact, it has its own website. Click here for the video. Make sure you have the sound on for the full effect.

Sip your coffee or other beverage and enjoy.

Filed Under: workers compensation claims adjuster Tagged With: propublica, rachel fikes, Rising Medical Solutions