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Alabama VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted Addendum 2 to the 2018 Alabama Workers’ Compensation Fee Schedule with changes to Physicians Fee Schedule, In-Office Surgery Fee Schedule and Clinical Lab Schedule with an effective date of May 4, 2018.

REGULATORY ACTIVITY:

  • Published Addendum 2 to the 2018 Medical Fee Schedule.  The addendum addresses adjustments to the maximum fee schedule making adjustments by adding new CPT and HCPCS codes, and clinical lab fees.  To view the addendum, go to https://labor.alabama.gov/wc/2018FeeSchedules.aspx.

LEGISLATIVE ACTIONS:

House Bill 192

  • The enacted legislation makes changes to death benefits paid to the surviving spouse if the surviving spouse was married to a law enforcement official or firefighter that was killed in the line of duty.  If the surviving spouse was married to a law enforcement official or firefighter and remarries, the surviving spouse will continue to receive benefits due.   Effective Date August 1, 2018.

Arizona VIEW STATE →

REGULATORY ACTIVITY:

  • On May 17, 2018, the Industrial Commission approved a substantive policy statement regarding the acceptance of medical-only claims that becomes effective on August 20, 2018.  This substantive policy statement is advisory only. A substantive policy statement does not include internal procedural documents that only affect the internal procedures of the agency and does not impose additional requirements or penalties on regulated parties or include confidential information or rules made in accordance with the Arizona administrative procedure act. If you believe that this substantive policy statement does impose additional requirements or penalties on regulated parties, you may petition the agency under Arizona Revised Statutes section 41-1033 for a review of the statement.  To view the substantive policy statement, go to https://www.azica.gov/news-and-events.

California VIEW STATE →

FEE SCHEDULE NEWS:

  • Medi-Cal rates have been released with an effective date of May 15, 2018. The next update is scheduled for June 15, 2018.

REGULATORY ACTIVITY:

  • The Division of Workers’ Compensation (DWC) has posted proposed amendments to the Medical-Legal Fee Schedule to its online forum where members of the public may review and comment on the proposals. The draft regulations include:
    • Objective standards for the application of complexity factors in the fee schedule;
    • Provisions that align the Medical-Legal Fee Schedule with the statutory scheme for reimbursement of medical-legal expenses;
    • Elimination of provisions that refer to medical-legal evaluations no longer being performed; and
    • Clarification of when billing under the Official Medical Fee Schedule can be accomplished in conjunction with billing under the Medical-Legal Fee Schedule.

There are no changes to the amount of fee schedule payments. The proposals clarify the use of the complexity factors relating to causation, medical research, record review and apportionment. The factors that indicate the presence of extraordinary circumstances in a medical-legal evaluation are more clearly defined. The language required in a report to define extraordinary circumstances is explained. Realistic limits on certain areas of billing are implemented. The forum can be found on the DWC forums webpage under “current forums.” To view the text of the regulation being proposed, go to  http://www.dir.ca.gov/dwc/DWCWCABForum/Reimbursement-of-Medical-Legal-Expenses.htm.

California-Auto VIEW STATE →

REGULATORY ACTIVITY:

Colorado VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill18-1003

  • The enacted legislation establishes in statute the opioid and other substance use disorders study committee, consisting of 5 senators and 5 representatives from the general assembly, to:
    • Study data and statistics on the scope of the substance use disorder problem in Colorado;
    • Study current prevention, intervention, harm reduction, treatment, and recovery resources available to Coloradans, as well as public and private insurance coverage and other sources of support for treatment and recovery resources;
    • Review the availability of medication-assisted treatment and the ability of pharmacists to prescribe those medications;
    • Examine measures that other states and countries use to address substance use disorders;
    • Identify the gaps in prevention, intervention, harm reduction, treatment, and recovery resources available to Coloradans and hurdles to accessing those resources; and
    • Identify possible legislative options to address gaps and hurdles to accessing prevention, intervention, harm reduction, treatment, and recovery resources.
  • The legislative committee is authorized to meet 6 times in a calendar year and may report up to 6 legislative measures to the legislative council, which bills are exempt from bill limitations and introduction deadlines. The committee is repealed on July 1, 2020. The enacted legislation requires the governor to direct the Colorado consortium for prescription drug abuse prevention to:
    • Create a process to develop a plan that addresses the full continuum of recovery services;
    • Develop a definition for recovery residences and recommend whether the residences should be licensed; and
    • Report recommendations to the general assembly.
  • The legislation specifies school-based health care centers may apply for grants from the school-based health center grant program to expand behavioral health services to include treatment for opioid and other substance use disorders and requires the department of public health and environment to prioritize funding to the centers that serve communities with high-risk factors.
  • The legislation directs the department of health care policy and financing, starting July 1, 2018, to award grants to organizations to operate a substance abuse screening, brief intervention, and referral program.
  • The legislation creates the Charlie Hughes and Nathan Gauna opioid prevention pilot program in the Tony Grampsas youth services program for preventing opioid use among the youth population and supporting youth whose family members experience addiction. The Tony Grampsas youth services board shall oversee a grant process for the pilot program using specific criteria. The Tony Grampsas youth services program shall award the grants on or before October 1, 2018. The bill creates a fund for the direct and indirect costs associated with the program. The department of human services is required to work with the grant recipients and submit a report to the general assembly on or before January 1, 2021, regarding the progress of the grant recipients. The enacted legislation directs the center for research into substance use disorder prevention, treatment, and recovery to develop and implement continuing medical education activities to help prescribers of pain medication to safely and effectively manage patients with chronic pain, and when appropriate, prescribe opioids. Sections 3 through 6 also direct the general assembly to appropriate money to implement those sections.  The legislation appropriates over 4.3 million dollars to various state entities for the implementation of the legislation and the research required. Effective Date May 21, 2018.

Connecticut VIEW STATE →

REGULATORY ACTIVITY:

  • The Workers’ Compensation Commission is pleased today to welcome Stephen M. Morelli as the newest Workers’ Compensation Commission Chairman. Morelli was recently appointed by Governor Dannel Malloy to this position following the retirement of Commissioner John A. Mastropietro. Chairman Morelli thanked Mastropietro in his communication with agency employees, “I share with you a debt of gratitude to Chairman Mastropietro for his years of excellent service and his outstanding stewardship of our organization. I look forward to working with you and am confident that together we can continue to meet the challenges we will face.” After studying at Boston College and the University of Connecticut, from which he earned a Bachelor of Arts degree, Morelli earned his Juris Doctor from the University Of Connecticut School Of Law. Following his collegiate studies, he served with the United States Peace Corps in Thailand. Morelli is a member of both the Connecticut and California Bars and is admitted to U.S. District Courts in both states as well, in addition to be a licensed realtor in the state of Connecticut.  Morelli brings with him more than twenty-five years’ experience in employment, general business, personal injury, real estate, and workers’ compensation law, in addition to litigation experience in both state and federal courts. From 1990-1994 he worked as an Associate in Legal Practice with the firm of Li & Kennedy and from 1994-2000 he was a partner in Roggi & Morelli, LLP. He later had his own practice as the Law Office of Stephen M. Morelli. Active as an elected official, Morelli has also served as the Deputy Mayor of the Town of Berlin, and as a member of the Berlin Town Council, the Budget Committee, and the Ordinance Committee (where he served as Chair). He also served previously as a member of the Berlin Housing Authority and the Democratic Town Committee, as well as being a Corporator of The Hospital of Central Connecticut. Morelli first joined the Workers’ Compensation Commission as a Commissioner in 2012, and during the past six years he has served in the agency’s Hartford, New Britain, Norwich, and Waterbury District Offices. We are happy to celebrate his continued public service to the citizens of the state of Connecticut, in his new capacity as Chairman of the Workers’ Compensation Commission.

Delaware Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Has issued Auto Bulletin Number 29 regarding policy renewal.  It has come to the Department's attention that not all Delaware automobile insurers are complying with the new minimum coverage limits that are now required for policies newly written or renewed after December 13, 2017. Therefore, the purpose of this bulletin is to remind all auto insurers, their brokers, and their agents that all newly written or renewed automobile insurance policies must be issued with the new coverage limits set forth in HB 114. To make compliance easier, the Department is not requiring brokers or agents to have their insureds fill out a new Regulation 603 Form A where the insured is renewing a policy that is written with limits in excess of the minimum limits set forth in HB 114.  To view the bulletin, go to https://insurance.delaware.gov/information/bulletins/#auto.

Florida WC VIEW STATE →

REGULATORY ACTIVITY:

  • A proposed rule workshop regarding 69L-31 Florida Administrative Code was held on Wednesday, May 30, 2018 between the hours of 9:30 am - 12:00 pm EST in Room 105 of the Hartman Building, 2012 Capital Circle SE, Tallahassee, Florida.  The proposed rulemaking amends existing rules governing the process for the resolution of reimbursement disputes between workers’ compensation carriers and health care providers, creates a new rule, and repeals four existing rules. The major changes proposed include adding a rule for defined terms, simplifying requirements for submission of reimbursement disputes, repealing rules related to non-response by a carrier and joint stipulations, and the adoption of revised forms.  To view a copy of the rule and related documentation, go to https://www.myfloridacfo.com/Division/WC/noticesRules.htm.

Georgia VIEW STATE →

REGULATORY ACTIVITY:

Idaho Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Idaho Code § 41-2502 requires that insurers offer uninsured and underinsured auto coverage to Idaho consumers and also provides that a consumer can reject such coverage in writing when the policy is first purchased. Subsection (3) of this section also provides that the insurer provide a statement approved by the Director of the Department of Insurance explaining both types of coverage and the types of underinsured coverage that might be available in Idaho. The department fulfilled this directive initially by publishing Bulletin 08-08. Recently there has been discussion about whether consumers are adequately protected under the status quo. In 2017, there were three bills (H0163, S1048, and S1078) that considered proposing amendments to Idaho Code §§ 41-2502 or 41-2503 (the latter section containing definitions). Legislators suggested that the Director meet with industry to consider alternatives that might better serve Idahoans. The resulting pending rulemaking provides a revised disclosure form to be used by carriers no later than January 1, 2019.   To view the rule, go to  https://doi.idaho.gov/publicinformation/laws/Rulemaking.

Illinois VIEW STATE →

REGULATORY ACTIVITY:

  •  The Illinois Department of Public Health has amended the list of Trauma Centers by Region.  To view the updated list; go to http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems/trauma-program/centersByReg.
  • Chairman Joann Fratianni is pleased to announce another step forward in the IWCC's modernization and technological upgrade of operations.  Pursuant to the IWCC's Rules, as found in Section 50 of the Illinois Administrative Code, parties will receive case activity notices electronically beginning on July 2, 2018.  The IWCC will no longer send case notices via U.S. Mail as of this date. All parties (law firms on behalf of clients and pro se litigants) will be required to maintain a designated electronic mail ("e-mail") address for receiving case notices, just as they are now required to maintain a physical address to receive them by U.S. Mail.  You only need to fill out the "E-Mail Registration Form" once (just like providing us your physical address), so that we can update our system.  PLEASE NOTE that it does not matter if you already have an e-mail on file or in use with us – we are populating the system with new and updated information.  So, please submit a law firm/pro se e-mail address to us again. * The only exception to electronic notices is respondent parties at the time a case is initially filed, whom will be notified that a case has been filed against them by U.S. Mail at the address provided by the petitioner.  This is the current practice.   Attorneys – Our system links cases before the IWCC to the law firm, not the individual practitioner.  So, please provide us your firm's e-mail address for receipt of electronic notices.  If one of your attorney’s "updates" your firm e-mail address with their own, all firm notices will go to the most updated address.  To view the notice and all associated information, go to https://www2.illinois.gov/sites/iwcc/news/Pages/news.aspx#iwcc-57.

Indiana VIEW STATE →

REGULATORY ACTIVITY:

  • Public Law 204, previously SB290, will go into effect on July 1st, 2018.  This bill imposes new time frames for completing certain tasks and changes the way penalties are assessed for failing to maintain workers’ compensation insurance coverage on an employer’s workers.  It also extends the renewal period for Second Injury Fund wage replacement benefits from 150 weeks to three years.
  • Public Law 206, previously SB369, adopts a formulary for certain drugs often prescribed for injured workers. FAQs and guidance will be forthcoming before Appendix A to the Official Disability Guidelines; informally referred to as the “ODG,” will go into effect on January 1, 2019.
  • Indiana Workers' Compensation Community, Workers’ Compensation Board of Indiana (INWCB) will be implementing electronic reporting of workers’ compensation first reports of injury (FROI) and subsequent reports of injury (SROI).  Electronic reporting will be required for all trading partners:  insurers, self-insured employers, and claim administrators.  Mandatory implementation is planned for January 1, 2019. Please note that Indiana already has FROI 1.0 reporting in place.
  • Electronic reporting will be via Electronic Data Interchange (EDI) transactions using the Claims 3.1 reporting standards adopted by the International Association of Industrial Accident Boards and Commissions (IAIABC).  Additional information on the IAIABC EDI transactions for FROI and SROI can be found online at the IAIABC website, http://www.iaiabc.org.

Indiana has contracted with ISO's Workers’ Compensation Solutions division, to manage its FROI and SROI EDI reporting.  ISO will be administering registration of trading partners, testing, data collection and submission of EDI data to the State. INWCB will provide an enhanced EDI Website that will be available early June 2018. This website address will be provided at that time and will contain the following.  

  • Trading Partner Electronic Profiles Registration and Instructions to be completed by all Trading Partners
  • Trading Partner Training Schedule
  • Trading Partner Testing Documentation/Plan. (Note: For Trading Partners that will utilize a Vendor, the Vendor will perform the testing on your behalf)
  • INWCB Claims Release 3.1 Implementation Guide and Requirement Tables
  • EDI Vendors that may assist with EDI reporting
  • Implementation Information that will provide additional information to support the INWCB EDI-Reporting Requirements
  • Frequently Asked Questions (FAQ) for EDI
  • Helpful Web Links
  • What’s New: Announcements, etc.
  • Contact for help at INWCBEDI@iso.com

If you have any questions, please contact the INWCB EDI Support Team at INWCBEDI@iso.com.  

Iowa VIEW STATE →

REGULATORY ACTIVITY:

  • Posted notice in the state register to amend Chapter 8, "Substantive and Interpretive Rules in the Iowa Administrative Code. This amendment updates references to the tables which determine payroll taxes, as required by Iowa Code section 85.61(6).  To view the rule, go to https://www.legis.iowa.gov/law/administrativeRules.
  • By order of the Commissioner, beginning July 1, 2018, the Iowa Division of Workers’ Compensation will impose a monetary late settlement sanction on parties in cases where settlements are reported to the Division less than 24 hours before the scheduled start time of the hearing.  Settlements must be reported to both the Division and the Deputy Commissioner assigned to hear the case 24 hours or more before the hearing is scheduled to start to avoid imposition of the sanction.  This sanction is modeled on the late settlement sanction which is imposed by the Iowa District Courts.  The Division has recently experienced an increase in late settlements, which places further strains on diminishing resources.  This action is necessary to allow the Division to better serve the people of the State of Iowa.  The late settlement sanction order is effective for all cases with hearing dates of July 1, 2018, or later. Claims that have been assessed a late settlement sanction will not have the settlement approved until the sanction has been paid.  The late settlement sanctions shall be paid to the Division of Workers’ Compensation and all funds received will be paid over to the Iowa General Fund. The late settlement sanction will apply in cases filed using the Form 100.  It will also apply in full and partial commutation cases filed before July 1, 2017.  It is not applicable to alternate medical care, vocational benefits or compliance proceedings. Beginning in June 2018, the late settlement sanction order will be provided to the parties in all contested cases with hearing dates of July 1, 2018, or later, and it will also be incorporated into the hearing assignment order in all new cases.  The order is found below:

ORDER

Late Settlement Sanction.  Effective July 1, 2018, parties are hereby ordered to report any settlement in any contested matter to the Division of Workers’ Compensation and to the Deputy Commissioner assigned to hear the case no less than 24 hours before the scheduled start time of the hearing.  If a settlement is not reported, or if the settlement is reported less than 24 hours before the scheduled start time of the hearing,​ or if the case is settled during the hearing, or after the hearing before a decision of a deputy commissioner is issued, the parties shall be sanctioned a total amount of $300.00.​  The sanction shall be assessed in equal proportionate shares against the claimant and the self-insured employer or the insurance carrier(s), unless the parties reach a different arrangement among themselves as part of the settlement for payment of the sanction.  See 876 IAC 4.36 and 4.40.  This sanction will not apply in any case where the Second Injury Fund of Iowa is the only defendant and it will not be assessed against the Second Injury Fund in any other case.  This sanction will not apply in alternate medical care proceedings.  If there is a showing of good cause, this sanction may be waived at the discretion of the hearing deputy.  The sanction monies shall be made payable to the Division of Workers’ Compensation and sent to the Division of Workers’ Compensation, 1000 E. Grand Ave., Des Moines, IA  50319-0209.  The sanction monies will be forwarded by the Division of Workers’ Compensation to the Treasurer of the State of Iowa to be deposited into the Iowa General Fund.

Kansas VIEW STATE →

REGULATORY ACTIVITY:

Kansas-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued Bulletin 2018-1 regarding legislative mandate of sweep of the service regulation fund. The purpose of this Bulletin is to provide notice, pursuant to K.S.A. 75-3036 (b), to all persons and entities that have paid money to the Kansas Insurance Department (KID) Service Regulation Fund in the past 24 months, of the pending sweep of $8 million dollars from the Fund to the State General Fund (SGF). House Substitute for Senate Bill 109, signed by Governor Colyer on May 15, 2018, effectively sweeps $8 million dollars from KID’s Service Regulation Fund into the SGF.  Under K.S.A. 75-3036(b), when a fee agency receives money for a specific purpose and the money is subsequently transferred into the SGF for general government services, the person or entity shall receive notice of the sweep by the fee agency.   To view the bulletin, go to http://www.ksinsurance.org/department/LegalIssues/bulletins.php.

Louisiana Auto VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill 644

  • The enacted legislation authorizes the denial of an application for licensure as a third-party administrator. Current law requires the commissioner of insurance to suspend or revoke the license of a third-party administrator or impose a fine for each separate violation not to exceed $5,000 per violation or $25,000 in the aggregate if the commissioner finds that the administrator is using methods or practices in the conduct of business that render the further transaction of business in this state hazardous or injurious to insured persons or the public. The enacted legislation retains present law and further requires the commissioner to deny the application for a license on the same basis. Currently the law authorizes the commissioner to suspend or revoke the license of a third-party administrator or impose a fine not to exceed $5,000 per violation or $25,000 in the aggregate if the commissioner finds the administrator has performed certain acts or meets certain criteria. The enacted legislation retains present law and authorizes the commissioner to deny the application for a license on the same basis. The enacted legislation further adds the basis of having provided incorrect, misleading, incomplete or materially false information or omitted material information in the license application.  Effective Date August 1, 2018.

House Bill 752

  • The enacted legislation provides for the use of motor vehicle reports procured by a licensed producer or insurance agency in the quoting and underwriting of automobile insurance. Currently the law prohibits an insurer from charging any fee, compensation, or consideration for insurance which is not included in the premium quoted to the insured and the premium specified in the policy delivered to the insured, except for the premium tax on a surplus lines policy, reimbursement for the producer's expenses, and any agency fee. The enacted legislation retains present law. Current law authorizes the producer to receive reimbursement from the insured for expenses incurred by the producer directly related to the insurance coverage for the insured and to charge a reasonable agency fee related to the services provided by the producer. The enacted legislation retains present law. The enacted legislation requires any insurer doing business in this state to accept a current copy of any motor vehicle report procured by a licensed producer or licensed insurance agency on behalf of a client in the quoting and underwriting of automobile insurance.  The enacted legislation further provides that the motor vehicle report shall be deemed current if the report was issued within 15 days of the requested quote.  The enacted legislation prohibits an insurer who chooses to procure a motor vehicle report after having been provided with a current motor vehicle report by a producer or agency from passing that cost on to the producer, agency, client, or insured.  The enacted legislation authorizes an insurer who did not receive a current motor vehicle report from an agency or producer with the request for a quote to procure any necessary motor vehicle report. It further authorizes the insurer to provide the producer or agency with a current copy of the motor vehicle report and charge the actual cost of the motor vehicle report to the producer or agency seeking the quote.

Finally, it also authorizes the producer or agency to charge the client the actual cost of the motor vehicle report. Effective Date August 1, 2018. Senate Bill 85

  • Current law provides for an insurance policyholder bill of rights, which serves as standard expectations for any insurance policyholder. Further, current law gives policyholders the right to receive payment of the amount of any property damage claim, or a portion of the claim, due or a written offer to settle any property damage claim within 30 days after receipt of satisfactory proof of loss in accordance with present law.  The enacted legislation retains present law and requires a claim payment to be made by check, draft, or, if offered by the carrier and the claimant requests, electronic transfer of funds.  Effective Date August 1, 2018.

Senate Bill 135

  • Current law applicable to vehicles registered in La. provides for limits of motor vehicle liability insurance policy coverage amounts. Current law applicable to vehicles registered in any state requires the commissioner of insurance to suspend the license and all registrations of an operator and owner of a motor vehicle involved in an accident resulting in bodily injury or death under certain circumstances.
  • The enacted legislation retains present law. Current law requires the owners of motor vehicles registered in other states or jurisdictions that require liability security to maintain the security and proof as required by their respective state or jurisdiction while the vehicle is operated in this state. The enacted legislation presents law and provides that a personal injury protection card issued from an insurer in another state or jurisdiction shall not be sufficient proof of liability security. The current statute provides exceptions to the required suspension including that the suspension shall not apply if the owner had, at the time of the accident, a liability policy in effect for the motor vehicle involved. Requires certain policy limits for the exception to apply.  The enacted legislation retains present law and increases the limits for out-of-state drivers to reflect the limits applicable in present law to Louisiana drivers as follows:
    • If the accident has resulted in bodily injury or death, to a limit, exclusive of interests and costs, of not less than $15,000 because of bodily injury or death of one person in any one accident;
    • If the accident has resulted in bodily injury or death, to a limit, exclusive of interests and costs, of not less than $30,000 because of bodily injury or death of two or more persons in any one accident; and
    • If the accident has resulted in injury to or destruction of property, to a limit of not less than $25,000 because of injury to or destruction of property of others in any one accident. The enacted legislation provides that a personal injury protection card issued from an insurer in another state or jurisdiction shall not be acceptable as proof of liability policy limits.  Effective Date August 1, 2018.

Maine VIEW STATE →

REGULATORY ACTIVITY:

  • On May 8, 2018, the Board of Directors voted to adopt an assessment rate for insurers of 2.77% for Fiscal Year 2019 beginning on July 1, 2018.  Assessment letters for insurers and self-insured employers will be mailed shortly and payments are due by June 8th. For questions contact Jan Adams (207) 287-7084. To find out more information regarding the assessment, go to http://www.maine.gov/wcb/Departments/businessservices/annualassessment.html.

Maryland VIEW STATE →

REGULATORY ACTIVITY:

  • The following forms have been revised and/or updated to include Healthcare Providers and their Attorneys as parties filing issues, entering appearances, requesting continuances, etc. Fillable PDF versions of the forms are available on the Forms and Instructions page. The Commission does not accept form filing via email/attachment or fax. Please begin using the new forms immediately.
  • H-12 Request for Hearing on Previously Withdrawn Issues
  • H-24R Issues
  • H-25R Request for Action on Filed Issues
  • C-24R Request to Enter Appearance of Counsel
  • C-25R Notice to Withdraw Appearance
  • H-28R Request for Continuance of Hearing

 

LEGISLATIVE ACTIONS:

House Bill 205 and Senate Bill 48

  • The enacted legislation alters the definition of “public safety employee” to include State correctional officers, thereby making these officers eligible for enhanced workers’ compensation benefits for claims arising on or the effective date. Effective Date October 1, 2018.

House Bill 1499 and Senate Bill 575

  • The enacted legislation expands the authority of the Maryland Insurance Administration’s (MIA) Insurance Fraud Division to encompass investigating and taking action on fraud committed by or against a governmental self-insurance (workers’ compensation) group and employers who self-insure. The bill also expands the definition of “insurance fraud” and requires governmental self-insurance (workers’ compensation) groups and employers who self-insure or participate in a self-insurance group for workers’ compensation to report suspected insurance fraud cases, in writing, to the Insurance Fraud Division.  Information submitted to the fraud division in this manner is not subject to public inspection, except under specified circumstances. Effective Date October 1, 2018.

House Bill 1500 and Senate Bill 979

  • The enacted legislation requires that, unless third-party reimbursement has been waived, a self-insured employer, insurer, or the Uninsured Employers’ Fund (UEF) be reimbursed before the Subsequent Injury Fund (SIF) when damages are recovered from a third party that is liable for the injury or death of a covered employee. The bill applies prospectively and may not be applied or interpreted to have any effect on or application to any action filed before the effective date of this legislation.  Effective Date October 1, 2018.

Maryland-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued bulletin 18-07 regarding cancellations of insurance policies.  During the week of May 13, 2018, Frederick and Washington Counties received unprecedented amounts of rain that caused significant damage to many properties in those counties and to the roads. Frederick and Washington Counties issued Local “States of Emergency.” Because of this weather event, daily life for many Maryland consumers has been disrupted. To avoid cancellations for personal automobile insurance, homeowners insurance, and other personal lines of insurance; commercial insurance; and life and health insurance, the Maryland Insurance Administration encourages insurers to provide reasonable accommodations, including a grace period for premium payment, to policyholders that reside in and the businesses located in the following zip codes: 21701; 21702; 21703; 21704; 21715; 21718; 21755; 21756; 21758; 21769; 21779; 21782; 21793 and 21770.  To view the bulletin in its entirety, go to  http://insurance.maryland.gov/Pages/newscenter/PropertyCasualtyBulletins.aspx.
  • Issued bulletin 18-09 is issued to all Property and Casualty Insurers, The Maryland Automobile Insurance Fund (MAIF), The Joint Insurance Association (JIA), Chesapeake Employers Insurance Company, All Premium Finance Companies, and All Life and Health Insurers regarding cancellations of insurance policies. To view the bulletin, go to http://insurance.maryland.gov/Pages/newscenter/PropertyCasualtyBulletins.aspx.

LEGISLATIVE ACTIONS:

Senate Bill 743

  • The enacted legislation establishes a regulatory framework for peer-to-peer car sharing in the State, including insurance requirements; a sales and use tax rate of 8% for sales and charges related to peer-to-peer car sharing for two years only; and related study and/or reporting requirements for the Consumer Protection Division of the Office of the Attorney General (OAG), the Motor Vehicle Administration (MVA), and the Comptroller’s Office. The Insurance Commissioner may adopt regulations to implement the bill, as specified.  The bill generally takes effect July 1, 2018; however, safety and inspection requirements take effect January 1, 2019.  The sales and use tax provision terminates June 30, 2020.  Effective Date July 1, 2018.

Massachusetts VIEW STATE →

REGULATORY ACTIVITY:

Medicare VIEW STATE →

FEE SCHEDULE NEWS:

  • Physician – CMS has posted new updates with an effective date of July 1, 2018. The next expected update is set of October 1, 2018.
  • HCPCS – CMS has published new HCPCS updates with an effective date of July 1, 2018. The next update is expected on October 1, 2018.
  • CCI/MUE Edits – CMS has adopted new updates to the CCI and MUE data sets with an effective date of July 1, 2018. The next update is expected on October 1, 2018.
  • ASP Drugs – CMS has posted new updates to the ASP Drugs module with an effective date of July 1, 2018. The next update is expected on October 1, 2018.
  • DMEPOS – CMS has adopted new  DMEPOS  rates with an effective date of June 1, 2018. The rates are the result of interim rule CMS-1687-IFC. The rule amends the regulation to resume the transition period’s blended fee schedule rates for items furnished in rural areas and non-contiguous areas (Alaska, Hawaii, and United States territories) not subject to the Competitive Bidding Program from June 1, 2018 through December 31, 2018. The next expected update is July 1, 2018.

Michigan VIEW STATE →

REGULATORY ACTIVITY:

  • The State has posted the following information on their web site with regards to Explanation of Benefits (EOB):  The Explanation of Benefits (EOB) serves many purposes, including notifying the parties of reimbursement decisions, educating the injured worker regarding balance billing, and outlining the provider’s right to appeal payment adjustments. Recently, we have seen an increase in the use of third-party medical cost-containment networks and payors within the workers’ compensation arena.  It is important to note that Rule 117 (R 418.10117) of the Workers’ Compensation Health Care Services (HCS) rules states in part: (4) A carrier or designated agent shall record payment decisions on a form entitled “The Carrier’s Explanation of Benefits” using a format approved by the agency.  The carrier or designated agent shall keep a copy of the explanation of benefits and shall send a copy to the provider and to the injured worker.  The carrier’s explanation of benefits shall list a clear reason for the payment adjustment or amount disputed and shall notify the provider what information is required for additional payment. The rules allow carriers and providers to utilize these networks if they choose; however, it is important to reiterate that the carrier or its designated agent must send a copy of the EOB to the provider and to the injured worker. The HCS rules define a provider as a “facility, health care organization, or a practitioner.”  A third-party payor or network is not considered to be the provider. In the event that a third-party payor or network is utilized, they should not be listed as the provider.  The carrier or its designated agent must send an agency-approved EOB form to the provider and the injured worker.  For additional reference, EOB requirements are outlined in R 418.10117, R 418.101001, R 418.101015, and R 418.101301. To view the information as posted, go to https://www.michigan.gov/wca/0,4682,7-191--468700--,00.html.

Michigan Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued bulletin 2018-12-INS regarding insurance sliding.  It has come to the Director's attention that some insurance producers are engaging in insurance "sliding." "Sliding" is defined as an agent's failure to fully disclose all the details of, and obtain informed consent to, the purchase of all products and services being included in an insurance transaction. When engaging in sliding, an agent, without disclosure to the customer, combines the charge for additional products or coverages with the premium charged for insurance. This results in an excessive charge to the customer for the sale of an insurance product. The Director has concluded that sliding is a form of misrepresentation and is therefore prohibited under the Insurance Code of 1956 ("Code"). See Final Decision in DIFS v Sinan Jamil, ProStar Insurance Agency, Inc., Docket No. 15-064706 (June 19, 2017).  In DIFS v Jamil, the Director found that failure to fully disclose the details and costs of each product being sold in an insurance transaction constitutes an omission of material fact that misrepresents the terms, benefits, advantages, or conditions of an insurance policy, and thus violates Sections 2005(a), 1239(1)(e), and 1239(1)(h) of the Code. See Final Decision, supra, p. 3. In addition, failing to remit payments for insurance to an insurer is a violation of Section 1207(1) of the Code, and failure to accurately record funds is a violation of Section 1207(2). Id. Examples of misrepresentations, commonly referred to as sliding, that are prohibited under the Code include, but are not limited to, the following: representing to an applicant that a roadside assistance product is part of a DIFS- approved insurance product when, in fact, it is not; representing to an applicant that a roadside assistance product is required for the purchase of automobile insurance, when it is not; representing to an applicant that any ancillary coverage or product is required in conjunction with the purchase of insurance when such coverage or product is not required; enticing customers into signing up for an auto club membership by failing to fully explain and disclose what is being signed or agreed to; enticing customers into signing up for insurance coverage without fully explaining all coverages included and the cost for each; representing to an applicant that an ancillary coverage, service, or product is included as part of an insurance product or without additional charge, when it is not or when such charge is in fact required; failing to accurately disclose the cost of insurance as charged by the insurer; failing to fully explain the details and separate cost of any ancillary product offered in conjunction with the sale of insurance; and  charging an applicant for an ancillary coverage or product, in addition to the cost of the insurance coverage being applied for, without the informed consent of the applicant. These activities violate numerous sections of the Code, including but not limited to Section 2005, Section 1207(1), Section 1207(2), and Section 1239(1)(d), (e), and (h). In addition, these activities also violate Section 1239(1)(h), which provides that the Director may take action against a producer who engages in "fraudulent, coercive, or dishonest practices or demonstrating incompetence, untrustworthiness, or financial irresponsibility in the conduct of business in this state or elsewhere."  Finally, if these activities are knowingly committed by a person with an intent to injure, defraud or deceive, then they would also violate Section 4503(g) and (i) of the Code. Pursuant to Sections 1242and 1244 of the Code, MCL 500.1242 and 500.1244, and the Michigan Administrative Procedures Act, the Director will commence administrative proceedings against producers who, at any time, have engaged in any form of sliding or otherwise made misrepresentations in connection with an insurance-related transaction. Through such proceedings, the Director is authorized to impose penalties including restitution, fines, and the suspension or revocation of a producer and/or agency license. To view a copy of the entire bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.

Minnesota VIEW STATE →

LEGISLATIVE ACTIONS:

House Bill 3873

  • The enacted legislation makes changes to the workers’ compensation statute, which was recommended by the Workers’ Compensation Advisory Council. The legislation adjusts the salary of judges of the Workers’ Compensation Court of Appeals. The legislation established a quorum necessary for the Court of Appeals Court.  The legislation requires that a panel be made up of no less than or no more than 3 members. The statute allows that in the case where the number of Appeal Court judges available is insufficient to constitute a quorum, the Chief Judge may assign a judge retired from the Court of Appeals or the Office of Administrative Hearings. The statute establishes that information contained in reports filed with the commissioner may be used in hearings.  The reports filed with the commissioner are available for examination by the employer, insurer, employee or dependent of a deceased employee or any person who furnishes signed authorization from any of the parties mentioned above. The legislation established a new section in the statute entitled coordination of the office of administrative hearings’ case management system and the workers’ compensation imaging system.  This new section of the statute governs filing requirements pending completion of the workers’ compensation modernization program and access to documents and data in the office’s case management system, the workers’ compensation Informix imaging system and the system that will be developed as a result of the workers’ compensation modernization program.  These sections of the statute become effective June 1, 2018.
  • The enacted legislation establishes a new section entitled Workers’ Compensation Hospital Outpatient Fee Schedule. This section of the statute sets forth the requirements for the state to establish a hospital outpatient fee schedule. The statute identifies 4 terms critical to the establishment of the fee schedule: Use of OPPS APC for CY 2018; OPPS Payment by HCPCS Codes for CY 2018; HCPCS code and Hospital.  The statute sets forth specific requirements that the agency must take in establishing the fee schedule. The statute also establishes requirements for outpatient billing, payment and dispute resolution. It also establishes requirements for Ambulatory Surgical Center payments setting forth specific criteria that the state must use in establishing payment regulations. These sections of the statute become effective October 1, 2018.
  • The enacted legislation addresses benefits available for certain individuals suffering from post-traumatic stress disorder. Employees covered by this definition of occupational disease include licensed police officer, firefighter, paramedic, emergency medical technician, licensed nurse employed to provide emergency services outside of a medical facility, a public safety dispatcher, officer employed by the state or political subdivision at a corrections, detention, or secure treatment facility, a sheriff or full-time deputy sheriff or a member of the state patrol. The statute states that if any of the above-mentioned individuals are diagnosed with post-traumatic stress disorder and have not been diagnosed with a mental impairment previously, then the mental impairment is presumptively an occupational disease. This section of the statute shall become effective for employees with dates of injury on or after January 1, 2019.
  • The enacted legislation increases temporary partial compensation benefits from 225 weeks to 275 weeks or after 450 weeks after the date of injury, whichever occurs first. The enacted legislation increases the amount of benefits paid for permanent partial disability. The enacted legislation increases the age at which disability ceased from 67 years old to 72 years old except when an employee is injured after the age of 67, which direct that the benefits will cease after five years of those benefits being paid. This section of the legislation becomes effective on June 1, 2018.
  • To view the bill, go to https://www.revisor.mn.gov/bills/text.php?number=HF3873&version=latest&session=ls90&session_year=2018&session_number=0.

Mississippi VIEW STATE →

REGULATORY ACTIVITY:

  • Published a notice regarding the June 2018 settlement schedule changes. Be advised that the Mississippi Workers' Compensation Commission will not be processing walk-in settlement approvals on Tuesday June 12, 2018.

Montana VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted and published a new fee schedule for medical and hospital services with an effective date of July 1, 2018. The next update is expected in July 2019.

REGULATORY ACTIVITY:

  • Finalized Amendment for 2018 Fee Schedules Effective July 1, 2018: The fee schedules to be effective July 1, 2018, have been finalized and are now in rule. The message of "proposed" will be removed by June 30, 2018.
  • To view a copy of the order adopting amendments to the 2019 fee schedule, go to http://www.mtrules.org/gateway/ShowNoticeFile.asp?TID=8543.

Nevada VIEW STATE →

REGULATORY ACTIVITY:

  • The Division of Industrial Relations (DIR) in Southern Nevada has moved its office location and is settling in as quickly as possible. Effective immediately, the following numbers have changed:
  • The Division of Industrial Relations (DIR) has posted notice regarding proposed regulation of the board for the administration of the subsequent injury account for self-insured employers under LCB file no. R025-18.  A regulation relating to industrial insurance; establishing guidelines for the acceptance of ratings for permanent physical impairment and rulings on claims for reimbursement from the Subsequent Injury Account for Self-Insured Employers; establishing requirements for the service of certain documents on or by a claimant; establishing certain methods of proving a self-insured employer’s knowledge of an employee’s preexisting permanent physical impairment; establishing guidelines for determining a permanent physical impairment; providing for the reimbursement of certain benefits paid in the form of a lump sum or an annuity; establishing procedures to consider a petition to adopt, amend or repeal a regulation or to issue a declaratory order or advisory opinion; authorizing the Administrator of the Division of Industrial Relations of the Department of Business and Industry to refuse to process incomplete claims and to obtain additional information; extending the time in which the Administrator will examine and provide a recommendation relating to a claim; establishing procedures relating to a hearing on a claim; and providing other matters properly relating thereto.   To view the proposed regulation, go to  https://www.leg.state.nv.us/register/indexes/2018_NAC_REGISTER_KEYWORD.htm.
  • The Division of Industrial Relations (DIR) has posted notice regarding proposed regulation of the board for the administration of the subsequent injury account for associations of self-insured public or private employers under LCB file no. R026-18. A regulation relating to industrial insurance; establishing guidelines for the acceptance of ratings for permanent physical impairment and rulings on claims for reimbursement from the Subsequent Injury Account for Associations of Self-Insured Public or Private Employers; establishing requirements for the service of certain documents on or by a claimant; establishing certain methods of proving an employer’s knowledge of an employee’s preexisting permanent physical impairment; establishing guidelines for determining a permanent physical impairment; providing for the reimbursement of certain benefits paid in the form of a lump sum or an annuity; establishing procedures to consider a petition to adopt, amend or repeal a regulation or to issue a declaratory order or advisory opinion; authorizing the Administrator of the Division of Industrial Relations of the Department of Business and Industry to refuse to process incomplete claims and to obtain additional information; extending the time in which the Administrator will examine and provide a recommendation relating to a claim; establishing procedures relating to a hearing on a claim; and providing other matters properly relating thereto.  To view the proposed regulation, go to  https://www.leg.state.nv.us/register/indexes/2018_NAC_REGISTER_KEYWORD.htm.

New Hampshire VIEW STATE →

LEGISLATIVE ACTIONS:

Senate Bill 455

  • The enacted legislation exempts from public disclosure the details of an injury sustained by a state employee in the line of duty including employees name. Effective Date July 18, 2018.

New-Hampshire-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued bulletin Ins No. 18-020-AB regarding after-market parts law RSA 407-D. This bulletin provides guidance in regard to the proper interpretation of the After-Market Parts Law, RSA 407-D.   New Hampshire's general rule on statutory interpretation is that the words in a statute should be given their plain meaning to effectuate their underlying policies. See Appeal of Northern New England Tele.  Operations, LLC, 165H.  267, 271 {2013}. To view the bulletin, go to https://www.nh.gov/insurance/media/bulletins/2018/index.htm.

New Jersey WC VIEW STATE →

REGULATORY ACTIVITY:

  • Memo from Director/Chief Judge Wojtenko re: Medicare Conditional Payments: It is the position of the N.J. Division of Workers’ Compensation that litigants fully comply with and adhere to the Centers for Medicare & Medicaid Services’ (CMS) policies and procedures regarding its recovery of conditional payments, including the mandatory reporting requirements of Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007.  Before a N.J. Judge of Compensation can consider a proposed Order Approving Settlement or Order Approving Settlement under N.J.S.A. 34:15-20 (Section 20 settlement) involving a petitioner who is a Medicare beneficiary, the parties shall first report the required workers’ compensation claim information to CMS as set forth by Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007.  The parties shall also begin CMS’ process of obtaining conditional payment information.  In accordance with the Division’s memorandum of March 28, 2016, if conditional payments have been made, it is best left to the parties to decide how they will resolve their remaining Medicare issues.  The parties are strongly encouraged to reach specific agreements delineating how their remaining Medicare issues will be resolved, thus protecting the injured Medicare beneficiaries, employers, and workers’ compensation insurers, as well as honoring the rights and interests of Medicare.
  • Posted notice in the state register of adoption of rule NJAC 12:235-19 regarding electronic medical bills for workers' compensation claims.  The effective date of the rule is May 21, 2018.  To view the rule as adopted and comments and responses to the proposed rule, go to http://www.state.nj.us/oal/rules/accessp/.  On that site click on the hyperlink under the section Public Access to Online Register.

New York VIEW STATE →

FEE SCHEDULE NEWS:

  • The state has adopted revised fees for 2 codes in the DME fee schedule with an effective date of May 15, 2018.”

REGULATORY ACTIVITY:

North Carolina VIEW STATE →

REGULATORY ACTIVITY:

  • The North Carolina Industrial Commission Rules for the Utilization of Opioids, Related Prescriptions, and Pain Management in Workers’ Compensation Claims are effective as of May 1, 2018. To assist employees, employers, carriers, health care providers, pharmacists, attorneys, and other stakeholders in the North Carolina workers’ compensation system in understanding and implementing these Rules, the Industrial Commission has adopted a Companion Guide, effective May 1, 2018. The Companion Guide does not cover every aspect of the Rules, but rather provides guidance on rule provisions or topics as deemed necessary by the Industrial Commission. The Companion Guide also contains some additional guidelines established by the Industrial Commission that are not contained in, but complement, the Rules.  To view all of the related materials, go to  http://www.ic.nc.gov/OpioidRulesResourcePage.html.
  • The Commissioners will convene for a working group meeting, transacting public business, and may take action and vote. In the event the Commission is unable to address all matters on the agenda, any recessed meeting will be announced in open session at the end of the Thursday, May 17th, meeting. The tentative agenda includes:
  1. Discuss the internal rules review committees’ reports on the Workers’ Compensation Rules.
  2. Discuss the internal rules review committees’ reports on the Tort Claims Rules.
  3. Address any other administrative matters, including approving the minutes from the previous Commissioners Meeting.
  • The meeting was held at 1:30 p.m. on Thursday, May 17, 2018, in the Industrial Commission Law Library, Room 6037, on the sixth floor of the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina 27603. This meeting was held pursuant to Chapter 143 of the North Carolina General Statutes. Accordingly, there will be no opportunity for public comment.
  • Effective June 1, 2018, the Industrial Commission’s rules will be re-codified from Title 04 Chapter 10 of the North Carolina Administrative Code to Title 11 Chapter 23 of the Administrative Code. The re-codification is part of the Industrial Commission’s transfer from the Department of Commerce to the Department of Insurance. As a result of the transfer, the Industrial Commission’s rules will move to Title 11 of the Administrative Code, the section under the Department of Insurance. All references and citations to an Industrial Commission rule on or after June 1, 2018, should use the re-codified title and chapter citation.

Ohio VIEW STATE →

REGULATORY ACTIVITY:

  • Posted draft rule 4123-6-33 regarding Payment for health and behavior assessment and intervention services. The rule has not been filed for adoption at this date nor has a hearing date been set.  To view the draft, go to  https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.
  • Posted notice regarding rules that have been proposed to the Board of Directors.  The rules being proposed are 4123-3-15 Claims procedures subsequent to allowance (amended); 4123-3-15.1 Dismissal of an application for the determination of percentage of permanent partial disability (new rule); and 4123-3-32 Temporary total examinations (amended). To view the rules being proposed, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.
  • Has posted notice of proposed rule amendments to Chapter 17 of their rule to the board of directors.  The entire chapter is being amendments.  Public comments are due by June 20, 2018.  To view a copy of the proposed rules, go to https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/OACInReview.asp.

Oklahoma VIEW STATE →

REGULATORY ACTIVITY:

  • Posted a notice that the agency would begin using Skype for Deliberations.  (Oklahoma City, May 15, 2018) Oklahoma Workers’ Comp Commission (WCC): The Commissioners at the WCC have integrated the use of the video conferencing tool “Skype” for their appellate deliberations. This technology allows the three commissioners and their legal counsel to communicate between Oklahoma City and Tulsa without leaving their offices. The use of this technology is an effort to cut down on travel for key staff, and is a service provided by the Office of Management and Enterprise Services. This offers an alternative to driving between Tulsa and Oklahoma City for the Commission Appellate Counsel and the Commission Chairman Mark Liotta, for deliberations. To view the full notice go to https://ok.gov/wcc/About_the_Commission/News/index.html.
  • In accordance with 85A O.S., § 31, the Multiple Injury Trust Fund (MITF) assessment rate to be charged for the four-quarter period of July 1, 2018 through June 30, 2019 shall be 6% of:
    • gross direct premiums written for workers’ compensation for risks located in this state (for insurance carriers),
    • normal premiums (for group self-insurance associations), or
    • actual paid losses (for individual self-insured employers).
  • The Workers’ Compensation Commission determined the rate using a statutory formula that caps the rate at not to exceed 6%.  The formula involves dividing $790,152,816.37 (total sum of gross direct written premiums, normal premiums and actual paid losses reported by workers’ compensation payors for calendar year 2017) into $74,689,910.00 (MITF’s projected obligations for calendar year 2018).  Assessments are due on the 15th day of the month following the end of the calendar quarter and are based on the payor’s premiums or losses (as applicable) during the quarter.  The assessment reporting form may be accessed directly from the Oklahoma Tax Commission website at: https://www.ok.gov/tax/Forms_&_Publications/Forms/Workers_Compensation/.  To view the complete notice, go to https://www.ok.gov/wcc/Legal/Alerts/index.html.

LEGISLATIVE ACTIONS:

House Bill 2722

  • The enacted legislation amends a definition within the Oklahoma Administrative Workers’ Compensation Act. The measure modifies the term "employee" to exclude any person who is employed in ranching by an employer who has a gross annual payroll in the preceding calendar years of less than $100,000 or any person employed in ranching that does not operate motorized machines.  The exemption of individuals employed in agricultural, ranching or horticulture jobs applies to any period of time for which the employment existed, even if the person is employed in other activities for which the exemption does not apply.  In these cases, the employer is only required to obtain workers’ compensation coverage for the period of time that the employee engages in nonexempt activities.   Effective Date November 1, 2018.

House Bill 2993

  • The enacted legislation transfers excess proceeds from any security released to pay claims associated with an impaired self-insurer to the Self-Insurance Guaranty Fund. The Self-Insurance Guaranty Fund Board may then use these excess funds as a credit against the assessment required to be paid by each self-insurer and group self-insurer association.  Effective Date October 1, 2018.

Senate Bill 1249

  • The enacted legislation allows individuals exempt from being covered under the Administrative Workers’ Compensation Act (AWCA) to execute an Affidavit of Exempt Status. Execution of the affidavit establishes a rebuttable presumption that the executor is not an employee for the purposes of the AWCA and therefore is not eligible to seek workers’ compensation benefits against any contractor that the individual does subcontracted work for. The Workers’ Compensation Commission is responsible to processing applications and may charge up to $50 per individual or business entity for filing an affidavit, which is valid for two years.  The measure also establishes penalties for knowingly providing false information on an executed affidavit which is a misdemeanor crime punishable by a fine up to $1000.  Effective Date August 13, 2018.

Oregon VIEW STATE →

REGULATORY ACTIVITY:

  • Published bulletin 378 on May 22, 2018.  This bulletin notifies self-insured employers of the base rates to be used for calculating the premium assessment for quarters occurring during the period from July 1, 2018 through June 30, 2019. In addition, this bulletin provides reporting instructions and rating plan options. This bulletin replaces Bulletin 376 dated May 30, 2017.  To view the bulletin, go to http://wcd.oregon.gov/forms/Pages/bulletins.aspx.
  • Published bulletin 124 regarding cost-of-living matrix and vocational assistance fee schedule effective July 1, 2018.  This addendum updates the cost-of-living matrix and fee schedule for vocational assistance expenditures provided in Bulletin 124. The cost-of-living matrix is defined in OAR 436-120-0005(1) and is used to adjust for changes in the cost of living under OAR 436-120-0147(4). This addendum replaces the cost-of-living matrix published in Bulletin 124 issued March 15, 2018 and provides the vocational fee schedule used under OAR 436- 120-0720.  To view the bulletin, go to http://wcd.oregon.gov/forms/Pages/bulletins.aspx.
  • Published bulletin 356 regarding attorney fees.  The bulletin becomes effective July 1, 2018.  This bulletin publishes the attorney fee matrix under Oregon Administrative Rule (OAR) 436-001- 0410(1)(d) for attorney fees awarded under Oregon Revised Statute (ORS) 656.385(1). This bulletin replaces Bulletin No. 356 issued May 25, 2017.
  • Posted Notice of a public hearing to be held on June 21, 2018 at 10:00 a.m. in the Portland State Office Building Room 1C at 800 NE Oregon St. Portland Oregon.  The hearing will be to take testimony regarding proposed amendments to OAR 436-060 regarding determining a worker's average weekly wages for workers with irregular wages.  To view the proposed rule, go to http://wcd.oregon.gov/laws/Pages/proposed-rules.aspx.
  • The WC Covered Employment Estimate is now available. This is the estimate of Oregon employees covered by Workers' Compensation (WC) insurance in 2017. The table includes final data for 2013-2016. The information in the table is organized by industry division, and by industry code/name.
    • Link to this report:

http://www.oregon.gov/DCBS/reports/Documents/general/wc-emp-est/2013-2017.pdf

  • Posted notice of proposed amendments to Chapter 436 Division 120 regarding vocational assistance eligibility; weekly wage determination if multiple jobs held at time of injury. A hearing will be held on June 21, 2018 at 10 a.m. in the Portland State Office Building, Room 1C at 800 NE Oregon St, Portland OR.   To view a copy of the notice and proposed rule, go to http://wcd.oregon.gov/laws/Pages/proposed-rules.aspx.

Oregon-Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Oregon has issued bulletin 2018-3 regarding auto insurers. This Division of Financial Regulation (DFR) Bulletin provides guidance for auto insurers regarding the new Department of Transportation, Driver and Motor Vehicle Services Division (OMV) rule which allows the election of "X" for not-specified as a person's sex on their driver license, driver permit, or identification card.  Auto insurers that have rating plans which rate using the sex or gender of the insured are required to accommodate consumers who designate their sex as not-specified. Rating plans, rating systems and applications that do not allow applicants who designate their sex or gender as not-specified to obtain coverage from an insurer will be considered unfairly discriminatory on the basis of sex.   To view a copy of the bulletin, go to http://dfr.oregon.gov/laws-rules/Pages/bulletins.aspx.

Rhode Island VIEW STATE →

REGULATORY ACTIVITY:

  • Issued information letter 2018-02 regarding spendable base wage information. The Spendable Base Wage Information effective May 10, 2018 is now available on our web site at http://www.dlt.ri.gov/wc/infowages.htm.  You can view, print and save an electronic copy.   For questions on how to use spendable earnings, please contact a Claims Analyst at (401) 462-8100, or WCClaimsAnalyst@DLT.ri.gov.

Rhode Island Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Issued insurance bulletin Number 2018-7 regarding insurers and groups that must participate in the auto body labor rate survey of 2018.  To view the bulletin, go to http://www.dbr.ri.gov/news/insurance.php.

South Carolina VIEW STATE →

REGULATORY ACTIVITY:

LEGISLATIVE ACTIONS:

House Bill 5153

  • The enacted legislation amends section 42-17-20, code of laws of South Carolina, 1976, relating to certain workers' compensation commission hearings concerning compensation payable. The hearing shall be held in the district in which the injury occurred, but no greater than seventy-five miles from the county seat of the county in which the injury occurred, unless otherwise agreed to by the parties and authorized by the commission. For purposes of this section, the 'county seat' is the county courthouse. These districts are defined as those districts designated by the commission and in effect as of January 1, 2018.   Effective Date May 18, 2018.

South Dakota VIEW STATE →

REGULATORY ACTIVITY:

  • This notice is to replace and correct the previous notice published pertaining to rules in Chapter 47:03:05. The date for the public hearing and the comment period have been amended as stated below. The Division of Labor and Management will hold a public hearing in the Sharpe Conference Room, Missouri River Plaza, 123 W. Missouri Avenue, Pierre, South Dakota, on May 14, 2018 at 2:00 p.m., to consider the adoption and amendment of proposed rules Chapter 47:03:05 regarding the workers' compensation fee schedule.  A copy of the updated text of the proposed rule can be viewed at http://dlr.sd.gov/workers_compensation/proposed_admin_rules.aspx.

Tennessee VIEW STATE →

REGULATORY ACTIVITY:

LEGISLATIVE ACTIONS:

Senate Bill 1649

  • This bill establishes a liability framework for employers that accept or employ students participating in the Labor Education Alignment Program (LEAP), and provides for a tax credit for such employers, as discussed below. Under present law, students in colleges of applied technology (CATs) may participate in work-based learning (WBL), which provides credit for work experiences such as internships, practicums, or clinicals. WBL is incorporated into coursework or related to a specific field of study, and may or may not include wages, salary, or other compensation to the student.  This bill specifies that an employer that accepts or employs a student through WBL: (1) Will not be liable for actions relating to that student unless the employer acted willfully or with gross negligence; and (2) May elect to provide workers' compensation insurance coverage to compensate a participating student for any injury that is covered under worker's compensation law. If an employer elects to provide workers' compensation insurance coverage: (A) The coverage will serve as the participating student's exclusive remedy for any compensable injury that is covered under worker's compensation law; and (B) The employer must not disclaim the participating student's eligibility for such coverage. This bill requires an LEA that coordinates WBL for students to maintain liability insurance coverage for all participating students. If an employer elects to provide workers' compensation insurance coverage to a participating student, then the LEA must maintain liability insurance coverage to compensate the participating student for any injury that is not covered under worker's compensation law. This bill specifies that an employer participating in LEAP is not prohibited from employing a student who is receiving a secondary education and who is under the age of 18, provided, that the employer is in compliance with state and federal law. This bill also allows for a franchise and excise tax credit of $500 for each WBL student employed by a taxpayer, limited to $5,000 per taxpayer in any tax year. All credits will be nonrefundable and nontransferable and will be awarded on a first come, first served basis. Any unused credit allowed may be carried forward for five years after the tax year in which the credit originated. This bill specifies no more than $1 million dollars in tax credits will be allowed under this bill. The legislation creates a liability framework for an employer that accepts or employs a student who is participating in work-based learning coordinated through the student's LEA or a state institution of higher education, including, but not limited to, Tennessee colleges of applied technology. The legislation requires an LEA or state institution of higher education that coordinates work-based learning for students to maintain liability insurance coverage for all participating students. If an employer elects to provide workers' compensation insurance coverage to a participating student pursuant to this amendment, then the LEA or state institution of higher education must maintain liability insurance coverage to compensate the participating student for any injury that is not covered under the Workers' Compensation Law. This amendment specifies that an employer will not be prohibited from employing a student who is under the age of 18; provided, that the employer is in compliance with state and federal law. It establishes a qualified work-based learning student grant program, to be administered by a nonprofit entity selected by the department of economic and community development to administer the program (a "program operator") and creates a separate fund within the general fund to be known as the qualified work-based learning student grant fund. The grant fund will be composed of funds specifically appropriated by the general assembly for the grant fund and gifts, grants, and other donations received for the grant fund. An employer that accepts or employs qualified work-based learning student may apply to the department for a grant in a manner determined by the department.  The grant amount will be limited to $5,000 per employer in any calendar year. The total amount of grants provided to employers will not exceed $1 million for any calendar year. Effective Date May 21, 2018.

Texas VIEW STATE →

REGULATORY ACTIVITY:

  • The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) is accepting public comments on the proposed repeal of 28 Texas Administrative Code (TAC) §108.1.  If you want to comment on the proposal, submit your written comments by 5:00 p.m. Central time on June 04, 2018. A request for a public hearing must be sent separately from your written comments. Send written comments or hearing requests by email to Rulecomments@tdi.texas.gov or by mail to:  Texas Department of Insurance, Division of Workers' Compensation Maria Jimenez Workers' Compensation Counsel MS – 4D 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1645. If a hearing is held, TDI-DWC will consider written comments and public testimony presented at the hearing.
    The proposal was to be published in the May 4, 2018 issue of the Texas Register and would be available at sos.state.tx.us/texreg/index.shtml once published. A courtesy copy will also be available on the TDI website at www.tdi.texas.gov/wc/rules/proposedrules/index.html.
    The TDI-DWC proposes the repeal of 28 TAC §108.1 because the rule is outdated. Other statutes and rules currently govern charges for copies for public information.  To view the notice, go to http://www.tdi.texas.gov/alert/whatsnew/index.html.
  • DWC has finalized the Opioids Plan -Based Audits.  On April 2, 2018, The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) solicited and received constructive input from workers’ compensation system participants on the proposed Opioids Plan-Based Audit (Plan-Based Audit).  TDI-DWC appreciates the input provided by system participants.  All comments were carefully considered and discussed.  The Commissioner of Workers’ Compensation W. Ryan Brannan approved the Plan-Based Audit on April 30, 2018.  All medical quality reviews initiated on or after January 1, 2018, will follow the approved Medical Quality Review Process (Process) in effect.  The Process and Plan-Based Audit are posted on the TDI website at:  tdi.texas.gov/wc/hcprovider/medadvisor.html.   If you have any questions regarding this memo, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov.
  • The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) is accepting public comments on proposed rules to amend 28 Texas Administrative Code (TAC) §134.230, regarding return to work rehabilitation programs and 28 TAC §134.600, regarding preauthorization, concurrent utilization review, and voluntary certification of health care.  Proposed amendments to 28 TAC §134.600 implement Senate Bill 1494 of the 85th Regular Legislative Session that amended Labor Code §413.014 regarding preauthorization and concurrent utilization review of work conditioning (WC) and work hardening (WH) services.  SB 1494 added subsection (c-1), which gives the commissioner discretion to exempt from preauthorization and concurrent review WC and WH services “provided by a health care facility credentialed by an organization designated by commissioner rule.”  Additionally, in September 2017, the Workers’ Compensation Research and Evaluation Group published an analysis of return to work rehabilitation programs by accreditation status and found that work conditioning utilization was significantly higher for CARF accredited claims and there was no statistical difference in the disability duration, measured by the length of Temporary Income Benefits, between CARF accredited and non-CARF accredited programs for WC and WH programs. The proposed amendment to §134.600 reflects the commissioner’s decision to exercise his discretion to not designate a credentialing organization for preauthorization exemption.  The proposed amendments would make it so that all WC and WH services must be per-authorized.  Proposed amendments to 28 TAC §134.230 set a single reimbursement rate for WC services and WH services, regardless of a program’s accreditation status.  The amendments to 28 TAC §134.230 are necessary to set a single reimbursement rate for WH or WC services.  Amendments to 28 TAC §134.230 also include several non-substantive changes for readability.  If you want to comment on the proposal, submit your written comments by 5:00 p.m. Central time on June 4, 2018.  A request for public hearing must be sent separately from your written comments. Send written comments or hearing requests by email to rulecomments@tdi.texas.gov or by mail to:  Texas Department of Insurance, Division of Workers' Compensation Maria Jimenez Workers' Compensation Counsel MS – 4D 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-16  To view the proposed rules, go to http://www.tdi.texas.gov/wc/rules/2018rules.html.
  • Published in the state register proposed rules Designated Doctor Procedures and Requirements 28 TAC 127.1; 127.5; 127.10; 127.100; 127.110; 127.130; 127.140; and 127.220.  The division also posted proposed rules regarding Monitoring and Enforcement TAC 180.8 and 180.26.  To view the rules proposed at the state register site, go to http://www.sos.state.tx.us/texreg/sos/index.html.
  • The department of Insurance has adopted amendments to rules regarding the licensing and regulation of insurance professionals.  The Texas Department of Insurance adopts amendments to 28 TAC §§801, 19.1003, 19.1004, 19.1010, 19.1013, 19.1016, 19.1019, 19.1310, and new §§19.803 - 19.810, concerning licensing and continuing education requirements of insurance professionals, including agents, adjusters, public insurance adjusters, managing general agents, risk managers, and home office salaried employees. The amendments and new sections are adopted with changes to the proposed text published in the March 9, 2018, issue of the Texas Register (43 TexReg 1391). TDI adopts amended §§19.1003, 19.1010, 19.1013, 19.1016, 19.1019, 19.1310, and new §§19.805 - 19.809 without changes to the proposed text. TDI revised §§19.801, 19.804, and 19.810 in response to public comments. TDI revised typographical errors in §19.803 and §19.1004.  The rules become effective May 31, 2018.  To view a copy of the adopted rules, go to  http://www.sos.state.tx.us/texreg/archive/May252018/Adopted%20Rules/28.INSURANCE.html#111

Texas Auto VIEW STATE →

REGULATORY ACTIVITY:

Utah WC VIEW STATE →

REGULATORY ACTIVITY:

  • Utah has proposed amendments to rule R612-100-4 Designation as Informal Proceedings. The purpose of this amendment is to designate a proceeding initiated under Section 34A-2-114 as an informal adjudicatory proceeding. This proposed rule change provides that proceedings initiated against employers who unlawfully interfere with an employee's workers' compensation claim will be designated as informal adjudicatory proceedings.  To view the rule, go to https://rules.utah.gov/publications/utah-state-bull/ and click on the Volume 2018 No. 9 Bulletin.

Vermont VIEW STATE →

REGULATORY ACTIVITY:

  • Published new form 27 regarding the employer's notice of intention to discontinue payments, which became effective May 25, 2018. To view the new form, go to http://labor.vermont.gov/forms/#comp.
  • Has posted notice of amendments to the Workers' Compensation Rule Vocational Rehabilitation.  Rules hearings have been scheduled at the following dates, times and places: 7/9/18, 9:00 a.m., Department of Labor, 5 Green Mountain Drive, Montpelier; 7/11/18, 10:00 a.m., Department of Labor, 200 Asa Bloomer Building, Rutland; 7/13/18, 9:00 a.m., Department of Labor, 63 Pearl Street, Burlington. The deadline for public comment is July 20, 2018. Should you have any questions please do not hesitate to contact Trudy Smith at 802-828-2991 or trudy.smith@vermont.gov.  To view the rules, go to http://labor.vermont.gov/legal-information/proposed-rules/.

Vermont Auto VIEW STATE →

REGULATORY ACTIVITY:

  • Has adopted Regulation I-79-2 Regarding Fair claims practices. The rule revises the existing insurance trade practices regulation to update the methodology used to determine the cash settlement value insurers pay in motor vehicle total losses. The rule clarifies how the value of a replacement vehicle is determined in the event that the claimant's vehicle is determined to be a total loss. The rule also codifies requirements for matching of replacement items and parts for partial losses.  The rule becomes effective July 1, 2018.  To view the adopted rule, go to dfr.vermont.gov/proposed-rules-and-regulations.

Virginia VIEW STATE →

REGULATORY ACTIVITY:

Washington VIEW STATE →

REGULATORY ACTIVITY:

  • Subject of Possible Rule Making: Chapter 296-15 WAC, Workers' compensation self-insurance rules and regulations. Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 51.04.20 [51.04.020] and 51.32.190. Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Existing rules are outdated and have been a point of concern for both business and labor. An advisory workgroup of business and labor representatives has worked with the department to formulate modernized rule concepts for consideration by the broader communities. Key objectives of this rule-making effort: Better communication to workers; Greater certainty for employers; and Reduced re-adjudication and strengthened regulation by the department of labor and industries that better aligns with statutory mandates. Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: No other state, local, or federal agency regulates this subject. Process for Developing New Rule: The department of labor and industries will work collaboratively with representatives of the labor and self-insured employer communities throughout all phases of this rule-making process. A public hearing will be held after the proposal is filed. Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting James Nylander, Self-Insurance Program Manager, P.O. Box 44890, Olympia, WA 98504-4890, phone 360-902-6907, fax 360-902-6977, email Nylander@lni.wa.gov.
  • Posted notice of intention to adopt 31 days after publication amendments to rule WAC 296-06-120 Copying fees charged by the Department of Labor and Industries.  The purpose of this rule making is to implement an agency fee schedule for reimbursement of the costs associated with fulfilling public records requests. The current rule does not include a fee schedule for providing electronic records. An agency study has been conducted to determine the actual costs associated with copying, scanning, electronically producing and delivering records and the guidelines to appropriately assess the fees.  To view the rule, go to http://lawfilesext.leg.wa.gov/law/wsr/2018/10/18-10-081.htm.
  • Posted notice of the effective date for updated rules WAC 296-20-135, WAC 296-23-220, and WAC 296-23-230.  This rule updates conversion factors provided in WAC 296-20-135 and maximum daily fees provided in WAC 296-23-220 and 296-23-230 for certain professional health care services for injured workers. Rule changes are necessary to maintain current overall fees for health care services, which are published annually in the medical aid rules and fee schedules. These rules increase the resource based relative value scale, anesthesia conversion factors and the maximum daily caps to be consistent with the changes for other professional fees resulting from increases in the relative value units published by the Centers for Medicare and Medicaid Services.  The effective dates of these amendments to the rules is July 1, 2018.   To view the rule, go to http://lawfilesext.leg.wa.gov/law/wsr/2018/10/18-10-082.htm.
  • Published two new coverage decisions regarding conditions covered in workers' compensation. The decisions are as follows:

Wyoming VIEW STATE →

REGULATORY ACTIVITY:

  • On January 1, 2017, the Federal Occupational Safety and Health Administration (OSHA) implemented a new requirementthat certain employers must submit injury and illness data electronically using OSHA's new Injury Tracking Application (ITA). OSHA began enforcement in states they cover on December 1, 2017.  The electronic reporting requirement does not apply to Wyoming OSHA covered employers despite an April 30, 2018 OSHA news release stating all employers across the country are subject to the rule. The State of Wyoming has not yet adopted the new electronic reporting requirement. Wyoming OSHA, not Federal OSHA, covers nearly all employers in Wyoming, the only exception being Federal employers that fall under Federal OSHA's jurisdiction. Wyoming employers do not have to provide this information to Federal OSHA until Wyoming adopts the same requirement and may continue to keep their OSHA 300 logs just as always. Employers may choose to provide this information to Federal OSHA on a voluntarily basis. Wyoming OSHA is currently in the process of rulemaking to adopt the electronic reporting requirement in Wyoming State later this year. The proposed rule was filed with the Secretary of State's office on April 20, 2018 and is open to comments from the public until June 4, 2018. The Wyoming OSHA Commission will review any public comments received and consider voting to adopt the proposed rule at its June 19, 2018 meeting.  If you have specific questions about record keeping requirements in Wyoming, please call (307) 777-7787 and ask to speak with a consultant.



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