Survey Lists Top 10 Challenges Facing Workers' Compensation in 2019

Our friends at Risk & Insurance recently published an article showing the results of a survey they conducted at the 2018 National Workers’ Compensation and Disability Expo in Las Vegas, NV, in which the respondents revealed what they felt would be their top 10 challenges for 2019.  The article summarized the responses of 512 attendees, most of which were claims managers and risk managers.  You can click here to link directly to their article, but we felt there were a couple of noteworthy issues to mention in our blog.

The two issues we found most compelling were the Growth of Complex Claims coming in at #5, and Cumulative Trauma (CT) claims coming in at #9.  These two resonated with us as we often encounter these types of files through our core service offering of helping clients settle their legacy claims, or old dog files.  Both types of claims, in our experience, must be given special attention to prevent them from spiraling out of control leading to increased costs and complexities.

As noted in the article, a complex claim does not always start that way.  A variety of factors including atypical recovery time, heavy prescription medication use, implanted devices, and psychological developments can all indicate that a particular file may be going down the “legacy path”.  They evolve over time due to a variety of factors and quickly reach “complex” status when left unchecked.  Our file reviews with clients often indicate that a relatively small portion of claims in a workers’ compensation program are classified as legacy claims, but those few claims represent a large portion of the cost associated with the overall program, so it is imperative to identify trends and make accommodations for amicable settlement discussions.

CT claims, or claims involving an injury resulting from repetitive trauma over a period of time, achieve “legacy status” simply by the amount of time they tend to persist. While the costs associated with CT claims are not always significantly higher than those of a typical workers’ compensation claim on an annual basis, the duration of time from injury to settlement is usually much higher.  CT claims, as the article states, often last a decade or more.  As with any legacy claim, approaches to settlement of these claims does not always follow a traditional path, so proper consideration must be given to a settlement negotiation.  

The Workers’ Compensation Insurance Rating Bureau of California (WCIRB), recently released a report on CT trends in California which we found particularly interesting, and this report can be viewed by clicking here.

Reversal of Medical Director’s Approval in Louisiana

We recently received a letter from an attorney colleague of ours in Louisiana, Wayne Fontana with Roedel Parsons Koch Blache Balhoff & McCollister, informing us he recently received a judgement out of District 07 which overturned a medical director’s decision approving a $40,000 knee surgery.  Of note, the trial judge “specifically determined that the knee surgery was not in accordance with the medical treatment schedule and thereby overturned the medical director’s approval.”  It has historically been very difficult, if not impossible, to overturn the opinions of medical directors in Louisiana.  This has resulted, in our opinion, in inflated costs of future medical care as unapproved and unnecessary care has to be accounted for at the settlement of a workers’ compensation claim.  Once improper decisions are rendered by a medical director, decisions are typically made to not approach a settlement due to the increased cost to do so. Hello legacy claim.

This reversal is noteworthy as it could open the door for an increased number of successful, and medically appropriate, appeals.  Mr. Fontana said to us via email, “The more people who know that this medical director should be challenged and that, with the right case, his rubber stamp approvals can be reversed, the better.”  To our Louisiana clients, it would be a good idea to review prior unfavorable decisions from medical directors and investigate whether or not you might have a case for a successful appeal.

To view the letter from Mr. Fontana, please click here.

Article Details Evolving Trends in Catastrophic Workers' Compensation Claims

We ran across an article by Insurance Business recently that details some evolving trends in catastrophic workers’ compensation cases.  We took a particular interest in this because while not all of the cases we assist in settling are catastrophic in nature, many of them are, and maintaining a keen understanding of the trends within the workers’ compensation industry helps us to better understand our client’s current approach to settling claims.  

 The article indicates the soft market experienced by the workers’ compensation industry over the last several years may be reversing.  There are a variety of factors that contribute to the current landscape of catastrophic workers’ compensation claims, including injury frequency, escalating costs of medical goods and services, and the advancement of modern medicine and procedures that prolong the life of injured workers.

 In our experience, these types of trends can elevate the status of a workers’ compensation claim from “standard” to “legacy” quick, fast, and in a hurry.  It simply becomes less and less advantageous to settle a claim when projecting the escalating costs of medical needs over one’s lifetime. It is imperative to get out ahead of these claims and implement mitigation strategies to help resolve them once and for all.  We are here to help bridge the settlement gap and assist our clients in tackling these difficult to settle cases in their entirety.

 Again, our thanks to Insurance Business for a very informative article that can be read by clicking here.