State of the States September 16, 2022



2014 legislative reforms to the workers’ compensation system continue to reduce costs according to WCRI study

injured-workers-pharmacy-blog-delaware The Workers’ Compensation Research Institute released its newest publication, “Trends in the Delaware Workers’ Compensation System, 2015-2020.” General findings show that Delaware’s reconstruction of the workers’ compensation system in 2014 continues to decrease overall costs. Using data from injuries between 2014 to 2017 and payments made through March of 2021 (excluding covid claims), total medical payments per claim decreased by approximately 30-35 percent. A significant decrease in medical payments per claim of 10 percent is noted in 2020, likely due to covid-19 effects. However, these steady decreases are primarily attributed to overall declines in utilization. Along with medical payments per claim, prescriptions per claim fell from 5.4 in 2019 to 4.7 in 2020. 


Colorado’s DWC approved fee schedule changes for pharmacies this week

injured-workers-pharmacy-blog-coloradoPharmacy changes to Rule 18 (Workers’ Compensation Fee Schedule) were approved this week, with an effective date set for January 1, 2023. Initially, the Division of Workers’ Compensation (DWC) proposed language requiring pharmacies to substitute any medication prescribed for a significantly lower-cost therapeutic equivalent, even in a different dosage or strength. Significantly lower cost meant that the therapeutic equivalent must cost at least $50 less and for the same number of days’ supply. Following the most recent stakeholder meeting regarding proposed changes to the state’s fee schedule the Division altered the adopted language to “Any non-steroidal anti-inflammatory drug (NSAID), muscle relaxant, or topical agent (rather than all medications) for which a significantly lower-cost therapeutic equivalent is available, including commercially or over-the-counter (OTC), even in a different strength/dosage.”


State officials fined Uber Technologies $100 million dollars for intentionally misclassifying workers 

injured-workers-pharmacy-blog-new-jerseyFollowing an investigative audit, the state’s Department of Labor and Workforce Development fined Uber Technologies and its subsidiary 100 million for improper misclassification. The Department claims that the rideshare company misclassified hundreds of thousands of drivers as independent contractors, depriving them of “crucial safety net benefits” including workers’ compensation. Through this misclassification, the state says the company failed to make the required contributions to unemployment, temporary disability, and workforce development. With the U.S. Department of Labor becoming stricter on employee misclassification, states like New Jersey are following suit.


State officials fined Uber Technologies $100 million dollars for intentionally misclassifying workers


In observation of the 21st anniversary of the 9/11 attacks, Governor Kathy   Hochul announced the signing of S.9370/A992A. The new law provides a presumption for any health impairment or death of individuals who participated in the World Trade Center rescue, recovery, or clean-up. Legislators saw the need for such legislation after several first responders and rescue/recovery workers were denied claims without cause from the New York Workers’ Compensation Board. 


Over 20,000 injured workers are waiting to have their workers’ compensation claims resolved as the state system experiences major delays

injured-workers-pharmacy-blog-nevadaApproximately 20,000 injured workers in Nevada are waiting for their cases to be resolved. The backlog and lack of communication from the hearing/appeals department is mostly attributed to covid and its effects, including issues with consistent staffing. The buildup of cases is creating a frenzy leaving injured workers with little direction and forcing many to take sick days and use up whatever PTO they have. Some injured workers point to quick claim denials from their employer’s insurance as one of the major reasons for increased caseloads. Nevada-based attorneys explain that these denials have severe consequences as private health insurance will not cover anything if they think the injury happened while working, so the injured workers must wait to go through the complexities of the appeals process before becoming eligible to be compensated by their private health insurance. Attorneys for injured workers experiencing the delays say that scheduling cases to be heard is taking three times longer than usual. As it stands, 3,000 cases have not been scheduled for a hearing yet. Attorneys approximated that in 2017 an average of 12 hearings were scheduled per day; since then, the numbers have more than doubled to 25 cases per day, leaving little wiggle room for the calendar. To remedy the situation those in the legal community suggest that health insurers should not lawfully be able to refuse to cover a person while their case is pending but should be entitled to compensation if the case is later found to be a valid workers’ compensation injury.


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