workers’ compensation like - a contact sport jeff rowley salt lake county

Workers’ CompensationLike - A Contact Sport

Jeff Rowley

Salt Lake County

Claims AdjusterDoctor

Physical Therapist

Pharmacist

Supervisor

Worker

Bill Review

MedicareLabor

Commission

Payroll

Spouse

Claims Adjuster

Doctor

Physical Therapist

Pharmacist

Supervisor

Injured Worker

Bill Review

Payroll

Spouse

Workers’ Compensation

A Government Mandated and Regulated

Program

What else is Mandated & Regulated:

• Taxes • Social Security

• Parking Meters • Medicare

• Death • Selective Service

What Can We As Individuals Do To Change These?

Some Things You Can’t Control

Workers’ CompensationIs Not Like That.

The only way to make sense out of change is to plunge into it, move with

it, and join the dance.Alan Watts

Changes Happen

Smalla) Rule Changes (Attorney’s Fees, Burial Expenses)b) New Forms (Or Elimination of Unnecessary Forms)

Not So Smalla) New Fines for Late Reportingb) Coordination of Benefits with Health Insurance

Landscape Changersa) Utah Supreme Court – Merrill Decisions (2009 &

2010)b) Legislature – Lifetime Medicals (2007)

You Can Have a Voice.

Workers’ Compensation Advisory Council

Labor Commission Medical Committee

Workers’ CompensationAdvisory Council

34A-2-107. Appointment of workers' compensation advisory council -- Composition -- Terms of members -- Duties -- Compensation.

(5) The council shall confer at least quarterly for the purpose of advising the commission, the division, and the legislature on:

a) The Utah workers’ compensation and occupational disease laws;

b) The administration of the laws described in (5)(a); and c) Rules related to the laws described in Subsection (5)(a).



(6) Regarding workers’ compensation, rehabilitation, and reemployment of employees who acquire a disability because of an industrial injury or occupational disease the council shall:

a) Offer advice on issues requested by:i. The commission; ii. The division; andiii. The legislature; and

b) Make recommendations to:i. The commission; andii. The division (Industrial Accidents)



1)The commissioner shall appoint a workers’ compensation advisory council composed of:

a) The following voting members:i. Five employer representatives; and ii. Five employee representatives; and

Employer RepresentativesTodd R. Bingham, Utah Manufacturers AssociationDave Davis, Utah Food Industry AssociationDavid R. Bird, Law Firm of Parsons, Behle & LatimerRichard J. Thorn, Utah Chapter of Associated General ContractorsM. Jeff Rowley, Salt Lake County Risk Management



1)The commissioner shall appoint a workers’ compensation advisory council composed of:

a) The following voting members:i. Five employer representatives; and ii. Five employee representatives; and

Employee RepresentativesReo Castleton, Salt Lake County Fire DepartmentK. Dawn Atkin, Law Firm of Atkin & AssociatesBrian Kelm, Law Office of Brian D. KelmRichard Brewster, Engineers Local Union #3William Brandt Goble, Painters and Tapers Union Local 77



b) the following nonvoting members: (i) a representative of the Workers' Compensation Fund;

-Ray Pickup(ii) a representative of a private insurance carrier;

-Kathleen G. Bissell (Liberty Mutual Insurance) (iii) a representative of health care providers;

-Dr. Edward B. Holmes, Summit View Medical (iv) the Utah insurance commissioner or the insurance

commissioner's designee; and -Todd Kiser, Tracy Klausmeier

(v) the commissioner or the commissioner's designee.



Legislative LiaisonsSenator Karen MayneRepresentative Jim Dunnigan


Ongoing Issues• Labor Commission Budget (partially funded by

tax on premiums)• Budgets and forecast for the Uninsured

Employers Fund and Employer’s Reinsurance Fund.

• Funding for the Safety Grant Program (Source of Funding Initiated By Advisory Council Years Ago).

• Approving the Medical Fee Schedule.


Other Issues• Proposed rule changes – attendees and council

members can propose them• Administrative issues within the Labor

Commission• Legislative initiatives

What currently needs to change and what is on the horizon?


Purposes

•How to allocate resources.•How to help the system avoid financial collapse.•Which behaviors and coping styles to reward.•How to identify patients who are likely to succeed.


Committee Make-Up

Orthopedist Initial Care

Occupational Medicine Physical Therapist

Chiropractor Nurse Practitioner

WCF Self-Insured Employer

Private Insurer Injured Worker Legal

Employer Legal


Most time spent on setting up the modification factors for the physician medical fee schedule.

Intent is to stay in the top 1/3 of all payers.


Intent is to stay in the top 1/3 of all payers.

Medical Access Sensitivity

Physician Shortage

Injured workers require:More timeMore paper workMore Non Physical IssuesGreater dissatisfaction with treatment


Fee Schedule Changes - 2014

You Must Be The Change You Want To

See In The WorldMahatma Gandhi

What Issues Have The Council and Committee

Addressed?

Sample Issues Addressed By The Committees

2011SB-11 & SB-35 (Enrolled) Created the Worker Classification Coordinating Enforcement Council made up of the Labor Commission, Workforce Services, Tax Commission and Department of Commerce. Aim: fight misclassification of workers as independent contractors as a way of getting around the workers’ compensation system.

HB-61 (Failed) Sought to exempt home businesses from workers’ compensation requirements. No limitation on the type of business.

HB-55 (Enrolled by Unanimous vote) Provides full workers’ compensation coverage (medical and indemnity) for county search and rescue volunteers.


2013SB-59 (Enrolled) Coordination of benefits between workers’ compensation and health insurance carriers.


2014HB-10 (Enrolled, Unanimous Vote) Removed the mandatory reemployment filings and made the notice to the employee of vocational rehabilitation opportunities voluntary.

SB-44 (Enrolled Unanimous) No disability compensation to be paid for intentional misuse or abuse of drugs when said use is a major contributing cause of an injury. %15 reduction in disability compensation when drugs are a contributing cause.


2015SB-135 Created a rebuttable presumption of coverage for listed cancers in firefighters when the following conditions are met.1.Annual physical exams2.Firefighter subject to emergency call out over the last 8 years3.No tobacco use as certified by a doctor for the last 8 years

Destiny is not a matter of chance, but a matter of

choice. It is a thing to be achieved.

William Jennings Bryant

What issues are on the horizon?

Issues on the horizonShould Utah consider a closed

pharmaceutical formulary?



Formularies help change prescribing patterns … by requiring proof that non-formulary drugs are medically necessary(.)

Business Insurance Excluded medications include some opioid painkillers, benzodiazepine psychoactive drugs, soma muscle relaxants and other medications



Let’s Take A Vote!

Issues on the horizonShould Prescribed use of Medical

Marijuana be Allowed in Utah?

Issues on the horizonShould medical marijuana use be allowed in workers’ compensation

in Utah?


Issues on the horizonShould there be a specific test for workers’ compensation adjusters

to receive their licenses?


Issues on the horizonShould Utah consider developing a

hospital fee schedule?

44% 28%



Proposed Solution1.Seek a statutory change – Allow action2.Presumed reasonable when based on the average of the top three provider and payer representatives in the health industry in Utah.

Issues on the horizonOther issues that may come up:

1.Opt in, opt out of WC System.2.Should there be a clearer burden of proof for lifetime medicals?3.Currently 8% interest is used universally in the WC system. Is that fair and reasonable?4.Are death benefits sufficient and reasonable?

The Point – Get Involved!We must create the future by design,

not by accident.Riddhima Yadav

Workers’ CompensationLike - A Contact Sport

Thank you.

Projections based on projected interest rates of 2% in FY16, 3% in FY17, and 4.25% in FY18 and beyond.

Employers Reinsurance Fund

Projections based on projected interest rates of 2% in FY16, 3% in FY17, and 4.25% in FY18 and beyond.

Uninsured Employers Fund

workers’ compensation like - a contact sport jeff rowley salt lake county

Documents

utah workers compensation

workers compensationlike

terms of members

following voting members

division andthe legislature

law firm of parsons

law office of brian

legislature lifetime