Comp Clues


Worker’s Comp Exchange Minutes of November 17, 2008

By Darren Dye
| Date: 02/01/2009

Attending: Linda Hamilton, Chairman; Mary Taivalkoski, Executive Secretary,

Ron Cooper, Michael Schoening, Karen Salwowski, Jen Meyer, Rhonda Moran, Neil Gath, Marty Woods, Robert Fanning, Doug Meagher, Richard Swanson, Georgia Hartman and Ann Stewart.

Chairman Hamilton made announcements regarding:

Starting the first of the year she will conduct quarterly meetings with insurance adjusters.

Form revisions are being made to the Report of Claim Status (SF 38911) and a new separate form is being developed for notification of denials.

Proposed legislation for the 2009 Session of the General Assembly will include implementation of fees for mediations conducted by the Board and the possibility of a medical fee schedule on charges for services provided to injured workers. Discussion involved what is being done in other states, the possible certification of data bases and network arrangements between providers and carriers and employers.

Issues raised by attendees and discussed :

Undocumented workers.
While each case is different, if the claim is compensable the employee should be provided with directed medical care and impairment until the Legislature or the courts say otherwise.

Legal filing requirements.
Each judge has different preferences as to what and when they want exhibits, etc. filed with them making it difficult for attorneys to know what is expected of them. For example, some judges want proposed orders, some don’t. To address this problem the Board is going to place on its website each individual judge’s requirements along with their bios.

Perceived bias at the Board.
There are concerns that the Board has become too employee oriented, specifically that some judges unfairly favor employees in their decisions. Specific concerns raised include:

Not giving each side equal time at hearing.
If the employer/carrier provides medical treatment and then finds the claim not compensable they are automatically made liable for that claim.

In a specific case, Anderson v. Belden Corporation, C-167715, the Board awarded the plaintiff attorney fees on medical treatment that had been provided by the employer’s group health plan before the dispute arose.

Instead of having their cases heard when the parties arrive for scheduled hearings with witnesses, they are being pushed to settle cases. If the involved litigants want to go to hearing that they should able to do so. Settlement has been attempted and failed and the parties want to be heard and have the case resolved by order of the Board.

Hearing members are stating in Awards that cases are not ripe for appeal, potentially delaying the disposition of cases and making it difficult to have those cases set for Full Board review. The Chairman suggested the possibility of expedited FB hearings on these cases, without a transcript. In such a case, would the parties agree to abide by the decision of the FB ?

Whether the Board is appropriately having bifurcated hearings, or hearings on specific , limited issues.

Concerns about the Board’s practice of not approving stipulated settlements without addressing provider fee claims and/or lacking the signature of the medical provider. Also, how this would be handled if the claim is on a balance due, as opposed to the full unpaid charge. It was clarified that a settlement between the worker and the employer could be approved without settling the provider claim, which can be separately set for hearing. The provider claim must be acknowledged and the provider must be provided with a copy of the settlement document. The provider claim must also be put on the docket. Balance bills need not be attached to a “C” claim, and as such, don’t come into play because responsibility for the bill is not in question.

The group agreed to meet again in January. Notice will be forthcoming as to the specific date and time.