october 31, 2006 quarterly report july, august, september ... · 1st quarter, fy 2007 during the...

October 31, 2006

QUARTERLY REPORT July, August, September 2006

The following, as required by Act 1179 of 1999, is a report of activity by the ArkansasWorkers' Compensation Commission' s Health and Safety Division and the Medical CostContainment Division.

HEALTH AND SAFETY DIVISION

Ark. Code Ann. §11-9-409, as amended by Act 796 of 1993, established the Workers’Compensation Commission’s Health and Safety Division to launch educational programs;collect injury data; identify hazardous employers; monitor their progress with follow-upinspections; and monitor accident prevention programs of insurance carriers.

MEDICAL COST CONTAINMENT DIVISION

The Medical Cost Containment Division (MCCD) was established pursuant to Ark. Code Ann.§11-9-517 (1987) and is responsible for the implementation, revision, and compliance ofCommission Rules 30, 33, and 34. Rule 30 consists of an inpatient and outpatient medical feeschedule. Rule 33 is our managed care rule, and Rule 34 refers to the Impairment RatingGuide.

Quarterly Report

October 31, 2006

MEDICAL COST CONTAINMENT DIVISION

In the last quarter the following activities occurred regarding these rules:

Rule 30

Rule 30 was revised effective May 15, 2000. The AWCC adopted the Medicare RBRVSMedical Fee Schedule with Arkansas specific reimbursement multipliers. The new MedicalFee Schedule is available electronically from the AWCC Home Page. Since the Medical FeeSchedule is available electronically, we are no longer printing a medical fee schedule.Effective April 1, 2006, the Medical Fee Schedule reimbursement for anesthesia serviceswill be increased 11 percent, and an additional 11 percent April 1, 2007.

Administrative Review

Rule 30 contains an Administrative Review Process. This process allows providers orcarriers to request assistance from the Medical Cost Containment Division regarding disputes. Each administrative review requested consists of an investigation, desk audit by departmentstaff, and the issuance of an order, which determines the disputed issue. During this quarterthere were 33 review requests processed, 18 review requests granted, and 10 orders issued. The ongoing issues in dispute consist of nonpayment, untimely payment, penalty request, andreimbursement disputes.

Balance Billing

Rule 30 also contains a prohibition against balance billing by providers. The balance billingprocess involves: receipt of an allegation of balance billing by a claimant, carrier, employer,self-insured, etc.; notice being sent to all involved parties; an investigation; an audit; and adetermination order being issued. During this quarter, the MCCD received “zero” balancebilling allegations.

Investigations

There were 45 investigations completed in July, 67 in August, and 32 in September.

Quarterly Report

October 31, 2006

Rule 33

We have 12 certified Managed Care Organizations. We continue to receive inquiries fromself-insured employers regarding Internal Managed Care System certification, but we still havenot received any applications at this time.

Medical Reports

Medical Reports: As a result of a meeting held between the Chief Legal Advisor, the MedicalCost Containment Administrator, and the Chief Administrative Law Judge, the MCCD isobtaining medical records from the provider for carriers or employers that have been unable todo so. In the past the legal advisors would write to the provider requesting medical records. If the provider did not respond, then the Chief Administrative Law Judge would issue asubpoena in order to obtain the records. We thought perhaps there was another approach,especially since the MCCD staff has numerous medical contacts. We have thus far been ableto call the provider and obtain the records without any problems.

This quarter we received seven (7) cases involving disputes about obtaining the medicalrecords.

Change of Physicians

Change of Physician: To expedite Change of Physician (COP) requests and to comply withrecent legislative changes, new procedures and policies have been implemented. COPrequests are sent to the Clerk of the Commission, who then forwards them to the MCCD forprocessing. If an AWCC file has been established, the MCCD calls the carrier/self-insuredemployer to determine if a Managed Care contract exists. This call is followed with a letterwhich is faxed and mailed to all parties. When a response is received and a contract exists,the contract is reviewed to determine if it complies with Rule 33 and if appropriate internalpolicies were followed. MCCD will review the claimant’s medical records and determine anappropriate provider. An appropriate provider will be chosen on a case-by-case basis. If therequest is to the claimant’s treating physician, MCCD must determine if the provider meets thestatutory requirements for the regular treating physician. Once an appropriate provider ischosen, MCCD will determine that the provider is a member of either the carrier/employer’sMCO , if a contract exists, or a certified MCO if no contract exists. MCCD will contact theprovider and set up an appointment for the claimant. MCCD will issue an order stating this isthe claimant’s one-time-only change of physician. This order will contain the provider’s nameand appointment date. All parties will be copied. If either party objects to the MCCD order,it can appeal to an Administrative Law Judge.

Quarterly Report

October 31, 2006

This quarter the MCCD received 208 COP requests. MCCD issued 178 orders, and 50requests were either returned to open general files, withdrawn, controverted, resolved, orreturned to the Clerk of the Commission’s office for other action.

Audits

Requests are received from the ALJ Division as well as outside entities (i.e. , caseworkers,attorneys, etc.) for medical bill audits.

This quarter the MCCD received two (2 ) audits.

Rule 34

Rule 34: There have been no changes at this time in Rule 34. Legislation was written toextend the legislative mandate regarding an impairment rating guide.

Speaking Engagements

Speaking Engagements: During this quarter the following engagement was attended:

/ IAIABC Annual Conference

Arkansas Workers’ Compensation CommissionHealth and Safety Division

Workplace Fatalities Reported to AWCC1st Quarter, FY 2007

During the 1st Quarter, FY 2007, 25 fatalities were reported to the Arkansas Workers’ Compensation Commission, 23 occurred in Arkansas, 2 out of the state and the exact location of the accident was not reported in 4 cases.

BooneBenton Carroll

Marion

Baxter FultonRandolph

Clay

GreeneLawrence

Izard Sharp

Craighead Mississippi

Poinsett

Cross

Crittenden

St. Francis

Lee

Washington Madison

Newton Searcy

Stone

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Prairie

Miller

Phillips

Monroe

LonokePulaski

Saline

GarlandMontgomeryPolk

Sevier

HowardPike

HempsteadLittle River

Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

ArkansasHot Spring

Workplace Fatilities by Quarter

05

1015202530

FY

2003

FY

2004

FY

2005

FY

2006

FY

2007

1st Q

2nd Q

3rd Q

4th Q

AWCC Workplace Fatilitie s, FY

Totals

0

2040

6080

100

FY 2003 FY 2004 FY 2005 FY 2006 FY 2007

1

2

1

1

1

1

3

1

1

2

1

2

4

1

2

2

Out of State


Workplace Fatalities Reported to AWCC1st Quarter, FY 2007

Reported to

AWCC Employer

Employer

Co. Injury Date Death Date

Length of

Service

(yrs.) Job Title NAICS Code Type Injury

9/15/2006

Bierbaum Timber

& Contracting Ashley 9/12/2006 9/12/2006 0.5 Truck driver 113310 Struck by

8/10/2006 George's Inc. Benton 8/1/2006 8/1/2006 9.2 Driver 551114 MVA

9/18/2006

Gilbert Central

Corp. Benton 9/8/2006 9/8/2006 2.1

Construction

worker 237310 Fall

8/2/2006 L & P Logging, Inc. Bradley 8/2/2006 8/2/2006 16.6 Foreman 113310 not given

7/13/2006 Summit Bancorp Clark 7/7/2006 7/7/2006 1.9

Equipment

operator 522110 MVA

4/7/2006

Arco Towers and

Contracting, Inc. Craighead 4/6/2006 4/6/2006 not given Technician 238322 Fall

7/26/2006 USA Truck Inc. Crawford 7/24/2006 7/24/2006 0.6 Truck driver 484121 MVA

8/7/2006 USA Truck Inc. Crawford 8/7/2006 8/7/2006 1.0 Driver 484121 MVA

8/14/2006

Peacock

Enterprises, Inc. Crawford 7/15/2006 7/15/2006 0.1 Driver 484121 not given

8/4/2006

Randstad North

America Crittenden 7/27/2006 7/27/2006 0.7

Materials

handler 561320 not given

9/28/2006 Adair Construction Dallas 4/4/2006 4/4/2006 not given Roofer not given Fall

7/12/2006

Arkansas Boll

Weevil Eradication Desha 10/1/2005 2/9/2006 not given not given 115112 not given

7/25/2006

Asc Property

Management Desha 7/12/2006 7/12/2006 0.4 Manager 722110 Homicide

8/16/2006

Klassmeyer

Construction Co. Faulkner 5/3/2006 5/3/2006 not given not given not given Struck by

7/14/2006

McGeorge

Contracting Co.,

Inc. Jefferson 7/10/2006 7/10/2006 0.2 Truck driver 212319 MVA

8/28/2006

Wheeling Machine

Products Jefferson 4/20/2006 4/20/2006 0.1

Maintenance

Mechanic 332996 not given

7/11/2006 C.C. Jones, Inc. Pulaski 7/7/2006 7/7/2006 3.1 Driver 484121 MVA

7/20/2006

McCormick

Industrail

Abatement Pulaski 7/18/2006 7/18/2006 3.2 Foreman 562910 not given

8/17/2006 KATV Pulaski 7/31/2006 7/31/2006 27.9 Sports Director 515120 MVA

9/25/2006 Kohls Dept. Store Pulaski 9/6/2006 9/6/2006 2.7

District loss

prevention 452112 MVA

7/17/2006

Rheem

Manufacturing Co. Sebastian 3/10/2005 3/10/2005 1.0 Laborer 333415

Chemical

exposure

7/27/2006

Kilgore

Construction Washington 7/24/2006 7/24/2006 not given not given not given Fall

8/16/2006

Charley

Transporation, Inc. Washington 8/13/2006 8/13/2006 0.4 Driver 484121 Struck by

8/3/2006

Constructor

Services, Inc. out of state 10/6/2005 not given not given not given not given Fall

8/14/2006 Arkansas Gas out of state 9/25/2005 9/25/2005 27.5 Service tech not given MVA


Employers Placed in the Rule 32 Program1st Quarter, FY 2007

During the 1st Quarter, FY 2007, 46 places of employment were placed in the Rule 32 Program. Employers are identified for the Rule 32 Program if they have a higher-than expected number of compensable claims for their industry group. Employers placed in this program are encouraged to work with their workers’ compensation insurance carrier, in-house staff, or other professional safety sources to develop management tools which will help them run safer workplaces and minimize workers’ compensation costs through the use of such tools as return-to-work programs, drug-free workplace programs, claims management, etc.

BooneBenton Carroll

Marion


Clay

GreeneLawrence

Izard Sharp


Poinsett

Cross

Crittenden

St. Francis

Lee

Washington Madison

Newton Searcy

Stone

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Prairie

Miller

Phillips

Monroe

LonokePulaski

Saline


Sevier

HowardPike


Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

ArkansasHot Spring1

1

1

41

1

11

1

3

2

1

1

1

1

1

1

1

1

1

2

1

1

8

1

5

1

1


Employers Completing the Rule 32 Program1st Quarter, FY 2007

During the 4th quarter, FY 2002, 72 employers successfully completed the Rule 32 Program.

Boone

Miller

Benton Carroll

Marion


Clay

GreeneLawrence


Poinsett

Cross

Crittenden

St. Francis

Lee

Phillips

Washington Madison

Newton Searcy

Stone

Izard Sharp

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Monroe

LonokePulaski

Saline


Sevier

HowardPike


Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

Arkansas

Prairie

Hot Spring

11

1

1

116

6

1

1

1

6

1

1

3

4

4

1

2

2

1

1

1

1

1

11

2

722

1

1


Rule 31: Accident Prevention Services ProgramArkansas Workers’ Compensation Insurance Companies

1st Quarter, FY 2007

The Accident Prevention Services (APS) group conducts audits of all insurance companies writingworkers’ compensation insurance policies in Arkansas. During the 1st Quarter, FY 2007, the APS group inspected the following companies:

Company AR Account Premiums No.of AR PolicyholdersWausau Insurance $19,525,676.00 215Federated Mutual - Federated Service Insurance

Co. $3,825,009.00 408Argonaut Great $363,003.00 105

Zurich American Ins.- American Guarantee &

Liability Insurance Co., American Zurich

Insurance Co., Assurance Co. of America,

Colonial American Casualty & Surety, Fidel ity &

Deposit Insurance Co., Maine Bonding & Casualty

Insurance Co., Maryland Casualty Insurance Co.,

National Standard Insurance Co., Northern

Insurance Co., Valiant Insurance Co., Zurich-

American Insurance Co., Zurich Am erican

Insurance Co. Of Illinois. $11,489,314.00 1,874Triangle Insurance $20,136.00 1

Safeco Insurance - Safeco Insurance Co. of

America, First National Insurance Co. of America,

General Insurance Co. of America, American

States Insurance Co.,American Economy

Insurance Co., $2,003,790.00 352Sompo Japan Insurance $456,612.00 11Guarantee Insurance $3,863,322.00 200Transguard Ins. Co $214,644.00 37Hanover - Hanover American, Massachusetts

Bay Ins. $502,889.00 132Union Standard $2,926,334.00 142

Meadowbrook - Star Insurance Co, William sburg

National Insurance Co., Star Insurance Company $508,556.00 222Vanliner Ins. Co. $238,252.00 6


Presentations and Speaking Engagements1st Quarter, FY 2007

The AWCC Health and Safety staff receive frequent requests to speak on a variety of topics related to loss control, drug-free workplace programs, and related topics. If your constituents would like to host a program by the Health and Safety staff on these or other subjects, please contact Patricia Burge at 501-682-2063 or [email protected].

BooneBenton Carroll

Marion


Clay

GreeneLawrence

Izard Sharp


Poinsett

Cross

Crittenden

St. Francis

Lee

Washington Madison

Newton Searcy

Stone

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Prairie

Miller

Phillips

Monroe

LonokePulaski

Saline


Sevier

HowardPike


Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

ArkansasHot Spring

4


Voluntary Drug Free Workplace ProgramNew Approvals and Renewals


During the 1st Quarter, FY 2007, the following Arkansas companies received approval of their Voluntary Drug Free Workplace Programs:

BooneBenton Carroll

Marion


Clay

GreeneLawrence

Izard Sharp


Poinsett

Cross

Crittenden

St. Francis

Lee

Washington Madison

Newton Searcy

Stone

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Prairie

Miller

Phillips

Monroe

LonokePulaski

Saline


Sevier

HowardPike


Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

ArkansasHot Spring

4

3

1

1

3

1

1

1

2

1

1

1

6

1

1

74

25

1 Out of State1

2




Company City CountyThree Lakes Distributing Little Rock PulaskiThree Rivers Distributing Little Rock Pulaski

White River Beverage Little Rock PulaskiBeard-Breeding Painting Mabelvale Pulaski

Chief Seahawk Transport LLC North Little Rock PulaskiSecuritas Security Services Little Rock PulaskiLift Truck Service Center Little Rock Pulaski

Fleming Electric, Inc. Bryant SalineFleming Network Services, Inc. Bryant Saline

Grace Healthcare of Benton Benton SalineBR McGinty Mechanical Contractor Bryant Saline

Fort Smith Airport Commission Fort Smith SebastianForsgren, Inc. Fort Smith Sebastian

Howard Barnes Trucking Fayetteville WashingtonFayetteville Mechanical Contractors, Inc. Fayetteville Washington

Haynie Utility Construction, Inc. Searcy WhiteNorth Star EMS Searcy White

Delk Construction Co. Bald Knob WhiteD & H Electrical Cont. Inc. Searcy White

Collins Pipeline Construction, LLC Bald Knob WhiteThe McBurney Corporation Norcross Out of State




Company City CountyKing Ready Mix, Inc. Mountain Home Baxter

Guy King & Sons Mountain Home BaxterTwin Lakes Quarrys, Inc. Mountain Home Baxter

Crawford Electric, Inc. Mountain Home BaxterCrafton, Tull & Assoc. Inc. Rogers Benton

Roll Off Service Lowell BentonBella Vista Village POA Bella Vista Benton

Mike Rogers Drilling Co., Inc. Magnolia ColumbiaHummelstein Iron & Metal, Inc. Jonesboro Craighead

McExpress, Inc. Jonesboro CraigheadDixie Contractors Inc. Jonesboro Craighead

Tankersley Food Service LLC Van Buren CrawfordLanston Companies, Inc. West Memphis Crittenden

Leer, Star/Starrett Dumas DeshaSeaArk Marine, Inc. Monticello DrewArkansas One Call Conway Faulkner

Cajun Brothers Conway FaulknerEagle Heating & Air Conditioning, Inc. Hot Springs Garland

Rock City Mechanical Nashville HowardRonnie Dowdy Batesville Independence

Smith Concrete LLC Star City LincolnInterstate Mobil #1 Osceola Mississippi

Stop N By #3 Osceola MississippiInterstate Shell #6 Blytheville MississippiShell Truckstop #8 Osceola Mississippi

Stop N By #11 Manila MississippiGibson Oil Co. Osceola Mississippi

Greenway Equipment, Inc. Weiner PoinsettW.E. Clark & Sons North Little Rock Pulaski

Security Airport Parking Little Rock PulaskiEast Harding, Inc. Little Rock Pulaski

Jason International, Inc. North Little Rock, PulaskiCummins Mid South Little Rock PulaskiOak Forest Cleaners Little Rock PulaskiOak Forest Cleaners Little Rock Pulaski

Arkansas Precast Jacksonville PulaskiRobert M Goff & Associates/Holiday Inn

Select Little Rock PulaskiRobert M. Goff & Associates/Hampton Inn

& Suites Little Rock Pulaski

october 31, 2006 quarterly report july, august, september ... · 1st quarter, fy 2007 during the...

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