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State of the States August 4, 2023

medical claims

Workers’ compensation insurance carriers continue to see significant profitability according to the Insurance Information Institute (III)

NationalWorkers’ compensation carriers recorded the lowest combined ratio among major product lines last year, according to the Insurance Information Institute (III). Since 2014 carriers have continued to experience strong underwriting profitability, with the net combined ratio below 100 percent. For 2022, the net combined ratio of workers’ compensation carriers came in at 87.4 percent when including state funds and 84 percent for private carriers only. III says that improved workplace safety measures, remote work arrangements, and a generally strong economy remain beneficial to carriers. The Institute also credits state fee schedules with reducing costs over time.  

WCRI’s latest study shows that despite high inflation in most economic sectors, workers’ compensation medical prices/payments were minimally impacted by inflationary pressures

NationalResearchers from the Workers’ Compensation Research Institute (WCRI) released their latest study this week concerning medical inflation in workers’ compensation. Findings show no evidence of steeper growth in medical prices and payments for most states despite recent inflationary pressures in other sectors of the economy. Overall, growth in medical payments per claim continues to be driven primarily by increases in hospital inpatient, hospital outpatient, and ambulatory surgery center (ASC) facility payments per claim, greatly outpacing growth in payments for nonhospital professional services. The study's authors concluded that fee schedules are “effective tools to temper medical inflation.” 

The state’s Workers’ Compensation Board announced it will hold a hearing on August 25

injured-workers-pharmacy-blog-alaskaOfficials from the state Workers’ Compensation Board (WCB) will hold a joint meeting with the Medical Services Review Committee on August 25th to discuss recommendations for the 2024 medical fee schedule. Public testimony will be permitted from 10:15 to 11:15 AM. Interested stakeholders may watch via Zoom, in person, or submit comments to  

Personnel from the Workers’ Compensation Division (WCD) are asking for public input regarding a new agency rule proposal

injured-workers-pharmacy-blog-oregonThe state’s Workers’ Compensation Division (WCD) is asking for input on rules regarding legislation passed during the 2023 session. The division posted a draft proposal of its rules late last month concerning HB3412, which would expand treatment authority for physician assistants, and HB2696, that establishes licensing procedures for sign language interpreters. Division personnel will accept comments on these rules until August 18th. WCD officials say they will consider holding an “advisory meeting” to discuss the proposed regulations if requested by industry stakeholders. A public rulemaking hearing set for later this year will be scheduled before formally adopting the rules, providing stakeholders with another opportunity for comments. Proposed rules are set to become effective on January 1st of 2024.  

Officials from the Bureau of Workers’ Compensation (BWC) released their 2022 Annual Report

injured-workers-pharmacy-blog-tennesseePersonnel from the Bureau of Workers’ Compensation released their 2022 Annual Report. Data from the Bureau indicates that the average medical expenses paid per claim were $26,654 for claims settled in 2022. Permanent Partial Disability (PPD) decreased by 5.3 per average claim, while Temporary and Total Disability (TTD) increased by 5.2 percent per average claim. For return-to-work outcomes, BWC figures show that 72 percent of injured workers returned to work following their injury. BWC officials see the report’s findings as positive and likely a result of legislative reforms in 2013.  

A recent ruling from the State Office of Administrative Hearings (SOAH) could make the state’s cancer presumptions increasingly difficult to access for first responders

injured-workers-pharmacy-blog-texasFirst responders with cancer claims experienced another setback in the Lone Star state after a State Office of Administrative Hearings (SOAH) Panel ruled against the Division of Workers’ Compensation (DWC). DWC officials sought to impose $80,000 in sanctions against the City of Baytown (Houston area), alleging that the city “failed to adequately investigate and process two workers’ compensation claims made by firefighters diagnosed with cancer while working for the city.” Administrative law judges from SOAH expressed concern that the DWC failed to present a statute or regulation that established a minimum amount of time required for an investigation “to be deemed reasonable and prudent.” SOAH judges also took concern with how the DWC calculated their penalties and determined that the agency did not present any guidance, penalty matrix, or agency policy that could help justify the $80,000 fine. Justices with the SOAH, in this case, clarified that the injured worker who seeks the presumption is responsible for gathering specific documentation and evidence for a claim investigation.  

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