LEGISLATIVE ACTIONS:

Senate Bill 290

The enacted legislation establishes a time frame for the payment of compensation under a settlement agreement, a permanent partial impairment agreement, and an award of compensation ordered by a single hearing member of the Worker's Compensation Board (board).  It provides that an employer that fails to make a timely payment is subject to a civil penalty.  It requires an employer that has mobile or remote employees to convey information about worker's compensation coverage to the employer's employees in an electronic format or in the same manner as the employer conveys other employment related information. It allows the electronic filing of certain documents with the board.  The legislation provides that a permanently, totally disabled worker must reapply to the second injury fund for a wage replacement benefit every three years instead of every 150 weeks.  It requires the reporting of workplace injuries needing medical attention beyond first aid instead of injuries causing an absence from work for more than one day. It provides that reporting requirements for workplace injuries are intended to be consistent with the recording requirements set out in the United States Occupational Safety and Health Administration's regulations. It changes from $50 per employee to $100 per day the civil penalty for an employer's failure to provide proof of worker's compensation coverage. The legislation revises the definition of employer to include corporations, limited liability companies, limited liability partnerships, and other entities that have common control and ownership. It establishes the assigned risk plan (plan) administered by the Worker's Compensation Rating Bureau (bureau). It provides that the plan may be substantially modified or eliminated only as the General Assembly provides by statute. The bill removes the requirement for representation in the management of the bureau by stock companies and nonstock companies. The legislation urges the Legislative Council to assign to an appropriate interim study committee the task of studying increases to the benefit schedules for worker's compensation and occupational diseases compensation.  Effective Date July 1, 2018.

Senate Bill 369

The legislation, except during a medical emergency, prohibits workers' compensation and occupational disease compensation reimbursement for drugs specified in the ODG Workers' Compensation Drug Formulary Appendix A published by MCG Health as "N" drugs. It permits a prescribing physician to request to prescribe an "N" drug. It provides that, if the employer approves the request, the prescribing physician may prescribe the "N" drug. It provides that, if the employer does not approve the request, the employer shall: (1) shall send the request to a third party that is certified by the Utilization Review Accreditation Commission to make a determination concerning the request; and (2) notify the prescribing physician and the employee of the third party's determination not more than five business days after receiving the request. The enacted legislation also provides that, if the third party's determination is to deny the request, the employer shall notify the prescribing physician and the employee, and the employee may apply to the Worker's Compensation Board for a final determination concerning the third party's determination. It provides that, if the employer fails to notify the physician and the employee of the third party's determination, the prescribing physician's request is considered approved, and reimbursement of the "N" drug is authorized.  Effective Date July 1, 2018.

REGULATORY ACTIVITY:

• Denial of a Provider Fee Application or refusal to pay a bill from a medical provider for authorized care provided to an injured worker based solely on 631 IAC 1-1-32 (2)(A)(i) is improper.  Provisions in the Indiana Administrative Code are rules authorized by IC 22-3-1-3 to assist the Board in carrying out the Worker’s Compensation Act. Medical providers may go to https://wcbnec03.wcb.state.in.us/jcn.asp available through the Board’s online services to ascertain the name of an injured worker’s employer, worker’s compensation insurance carrier and that carrier’s claim identification number, when available.  No audio or visual recording may be made of any worker’s compensation hearing, conference or proceeding. Social security numbers (SSN) of injured workers must be redacted from all documentation prior to submission to the Board. The Application for Adjustment of Claim is the only exception to this requirement.

REGULATORY ACTIVITY:

• The second injury fund has sufficient monies to pay its obligations through the end of December, leaving a chunk of change in reserve to offset next year’s assessment.  The balance remaining in the Fund as of this date is $3,383,380.  Monthly payouts average roughly $500,000, $100,000 of which goes to replace prostheses. Disbursements for 2016 totaled $6,298,675.  In accordance with IC 22-3-3-13(c) (2), an assessment is appropriate for 2018, as the assets in the Fund on or before November 1st are less than 135% of the previous year’s payments.  The final report and analysis will follow at the end of December, along with the formula for the 2018 assessment.

REGULATORY ACTIVITY:

• Indiana is set to formally begin its enforcement protocol concerning the untimely filing of statutorily required forms and payment of benefits. There will be a grace period on penalties through September 30, 2017.  During this period, carriers and third-party administrators will receive letters and notice of actions found to be in violation of IC 22-3-3-7, 22-3-7-16, 22-3-4-13(a) and 22-3-7-37 so that appropriate remedies can be put in place. We also encourage your comments and concerns with this process so they may be addressed by the Board prior to October 1st, 2017.For all injury dates on or after October 1, 2017, penalties will be assessed. Pursuant to IC 22-3-4-15 escalation of penalties will apply where more than one violation occurs in a single cause concerning the same injured worker and the same injury date. In the future, violations of 631 IAC 1-1-26 shall also become the subject of notice by the Board.

REGULATORY ACTIVITY:

• This year the two-dollar policy assessments will be issued August 1, 2017 with a due date of October 31, 2017. If you have any questions please contact: Mary Taivalkoski at mtaivalkoski@wcb.In.gov or David Babcock DBabcock@wcb.IN.gov.

REGULATORY ACTIVITY:

• “No version of a Worker's Compensation Handbook put out by the Worker's Compensation Board of Indiana that can be found online should be relied on as accurate. This website contains updated information and all changes to the law or procedures of the Board will be set out here. Handbooks or Guidelines put out by other organizations are neither reviewed nor approved by the Board for accuracy.”
• Failure to timely submit State Form 48557 as set out at IC 22-3-3-7(b) may result in the rejection of the request for additional time and the imposition of a fine. IC 22-3-4-15.
• In cases where there is an accident number, filing of an Application for Adjustment of Claim with a stipulated settlement agreement is unnecessary and the Application will no longer be filed or processed.

FEE SCHEDULE NEWS:

• The outpatient and inpatient fee schedules follow Medicare reimbursement guidelines and are updated when these Medicare modules become effective. The last update for the inpatient fee schedule was October 1, 2016 and January 1, 2017 for the outpatient fee schedule.

FEE SCHEDULE NEWS:

• The Outpatient and Inpatient fee schedules follow Medicare reimbursement guidelines and are updated when these Medicare modules become effective. The last update for the Inpatient fee schedule was October 1, 2015 and January 1, 2016 for the Outpatient fee schedule.

REGULATORY ACTIVITY:

• On November 9, 2016 the state of Indiana has published Title 631 of the Administrative Code regarding the workers’ compensation board of Indiana indicating the code has been updated.