TNSIA 2009 Conference Presentation

8/14/2019 TNSIA 2009 Conference Presentation

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3rd Annual ConferenceSeptember 17, 2009

Willis Conference Center

Nashville, Tennessee



Agenda

7:30 - 8:00 Registration, Continental Breakfast, Visit Vendor Booths

8:00 – 8:30 Opening Remarks – TNSIA Business Meeting

8:30 - 9:30 Douglas J. Holmes – National Issues Impacting Workers’ Compensation 9:30 – 10:00 Leslie Newman, John Morris & Mike Shinnick - Commerce & Insurance

10:00 –10:30 Break & Visit Vendor Booths in Refreshment Center

10:30 – 11:00 Sue Ann Head & Pete Halverstadt - TN Dept of Labor & Workforce Dev

11:00 – 12:00 Dr. Chrissane Gordon – Health, Wellness and the Aging Workforce

12:00 – 1:00 Lunch in Atrium & Visit Vendor Booths

1:00 – 1:45 Terry Hill - Workers’ Compensation Legislation

1:45 – 2:15 Break & Visit Vendor Booths in Refreshment Center

2:15 – 3:45 Legal Panel Discussion - Case Law / MSA’s / Benefit ReviewCliff Wilson / John Barringer / Richard Murrell

3:45 –4:00 Door Prizes

4:00 –5:00 Hospitality Room in Refreshment Center



Gold Sponsor of the 2009Gold Sponsor of the 2009

Tennessee Self-Insurers’Tennessee Self-Insurers’

Association ConferenceAssociation Conference



Opening Remarks – TNSIA Business Meeting

Terry Hill – TNSIA Executive Director

Susan Azar – TNSIA Chairperson

Micheline Parkey - Treasurer



TNSIA AccomplishmentsTNSIA Accomplishments

– Welcomed 5 New Board MembersWelcomed 5 New Board Members – Increased Membership LevelIncreased Membership Level

– 2008 Year End Bank Account Balance = $59,447.222008 Year End Bank Account Balance = $59,447.22

– Initiated Legislative BillsInitiated Legislative Bills

– Met with TN Dept of Comm & Ins coordinating on various issuesMet with TN Dept of Comm & Ins coordinating on various issues

– Submitted position letter, and attended public hearing on proposed rulesSubmitted position letter, and attended public hearing on proposed rules – Traveled to Little Rock, Arkansas with the TN Dept of Comm & Ins, toTraveled to Little Rock, Arkansas with the TN Dept of Comm & Ins, to

research the Arkansas Guaranty Fundresearch the Arkansas Guaranty Fund

– Submitted Amicus Brief, and participated in oral arguments, to the TennesseeSubmitted Amicus Brief, and participated in oral arguments, to the TennesseeSupreme Court regarding workers’ compensation issues for telecommutersSupreme Court regarding workers’ compensation issues for telecommuters

– Submitted Amicus brief to the Workers’ Compensation Appeals PanelSubmitted Amicus brief to the Workers’ Compensation Appeals Panel

regarding the Tennessee Medical Impairment Rating Registryregarding the Tennessee Medical Impairment Rating Registry

– Tennessean Newspaper recognition regarding Legislative BillsTennessean Newspaper recognition regarding Legislative Bills



Executive Director Terry Hill

Ajax Turner CompanyTodd Williams

Averitt Express, Inc.David McDowell

City of Knoxville

Gary Eastes

Cracker BarrelOld Country Store, Inc.

Rob Behnke

Goodyear Tire and Rubber CoRandy Triplett

Ingram Industries Inc.John Hayes

Johnson Controls, Inc.

Ronald Jones

Nissan North America, Inc.Mike Berger/ Mary Kay Donahue

Parker Hannifin CorpCurtis Gross

Tyson Foods, Inc. Allyn C. (Lynn) Tatum

United Road Services

Kristin Burman

Wasco, Inc.Paul Kneedler

Board of Managers

General Motors Corporation McKee Foods CorporationSusan Azar – Chairperson Micheline Parkey - Treasurer



Statement of Income and Expense2009

From01/01/2009

Cash Beginning of Year $59,447.22

Membership Due2009 Memberships $ 2,450.002010 Memberships

100.00

ConferenceAttendees

6,250.00

Sponsors13,750.00

Total Revenue $22,550.00

ExpensesWeb Hosting ($495/Month) $ 3,960.00Manier & Herod ($1,000/Month)

7,625.02

Amicus Brief 1,250.00

National Council of Self Insurers1,495.02

Conference798.18

Paypal198.55

Tax Preparation1,529.50



S



TNSIA Regular MembersTNSIA Regular MembersAjax Turner Company, Inc.

Albany International Corp.

American Electric Power Service Corp.

Ascension Health

Averitt Express

City of Knoxville

Cracker Barrel Old Country Store, Inc.

Det Distribution

Eaton Corporation

Ford Motor Company

General Motors LLC

Goodyear Tire & Rubber Company

Harrah's Entertainment, Inc.

Ingram Industries Inc.

International Paper Company

Johnson Controls, Inc.

Kroger

McKee Foods Corporation

Nissan North America, Inc. – Smyrna

Parker Hannifin Corporation

St. Jude Children's Research Hospital

The Pictsweet Company

The Sherwin-Williams Company

Thompson Machinery

Tyson Foods, Inc.

United Road

Vulcan Materials Company

Vanderbilt University

Wasco, Inc.



TNSIA Associate MembersTNSIA Associate Members

AccessOnTime

AON Risk Services

Alternative Service Concepts

Arnett, Draper & Hagood

Beecher Carlson Insurance Services

Berkley Risk Administrators Company

Black Diamond Services

Brentwood Services

Brewer, Krause, Brooks, Chastain & Burrow

CapRisk Con

Casualty Actuarial Consultants

Collins and Company

Commercial Insurance Associates

Constangy, Brooks & Smith

CoolSystems

NuQuest/Bridge Pointe

Occusure Work Comp Specialists

On-Site Rx

Physiotherapy Associates

Prevention Group d/b/a Lifesigns

Progressive Medical

Sedgwick Claims Mgmt Services

STAR Physical Therapy

Superior Investigative Services

Tennessee Chamber of Commerce

Tennessee Orthopaedic Alliance

Tennessee Urgent Care Associates

Underwriters Safety and Claims

Wells Fargo Disability ManagementWillis of Tennessee

Coventry Work Comp Services

Eckman/Freeman & Associates

Fara Insurance Services

GENEX Services

Health Systems International

Heffernan Insurance Brokers

Howard, Tate, Sowell, Wilson & Boyle

Innovative Risk Consulting

Johnston & Associates

Leitner, Williams, Dooley & Napolitan

Manier Herod

Marsh U.S.

Medicor

Moore Ingram Johnson & SteeleNetwork Synergy Group



Agenda















Douglas J. Holmes

President

UWC – Strategic Services onUnemployment & Workers’ Compensation

National Issues Impacting Worker’s Compensation



“The Voice of Business on

Unemployment & Workers’ Compensation”

Only association exclusively devoted to lobbying for business on

national workers’ compensation and unemployment insurance issues

• Lobbying

• Support for state lobbying organizations

• National professional society

• Employers, insurers, service providers, lawfirms, state administrative agencies, and associations

• Research/education arm is the National Foundation for

Unemployment Compensation & Workers’ Compensation

About UWCEstablished 1933



National Impacts onNational Impacts on

Workers’ CompensationWorkers’ Compensation

National Commission on State Workers’National Commission on State Workers’Compensation Laws Act of 2009 (HR 635)Compensation Laws Act of 2009 (HR 635)

New reporting requirements under Section 111 of New reporting requirements under Section 111 of the Medicare, Medicaid and SCHIP Extension Actthe Medicare, Medicaid and SCHIP Extension Actof 2007 (S 2499)of 2007 (S 2499)

Health Insurance Reform and State Workers’Health Insurance Reform and State Workers’

Compensation (HR 3200)Compensation (HR 3200)WCMSA Reform (HR 2641)WCMSA Reform (HR 2641)

Prospects for 2009 and 2010Prospects for 2009 and 2010





• Review findings of previous 1972 NationalCommission Report

• Study and evaluate state WC laws to determine if they provide adequate, prompt and equitablesystem of compensation for injury or death arisingout of or in the course of employment

• Study and evaluate whether additional remediesshould be recommended to ensure prompt andgood faith payment of benefits and medical care toinjured workers and their families.

Commission Duties



• Amount of permanent and temporary disabilitybenefits and criteria for maximums

• Adequate, prompt and equitable system of comp.

and medical care• Alternatives to reduce or eliminate bad faith

delays, discouraging misclassification of workersas independent contractors and/or leased

employees to avoid paying WC benefits• Amount and duration of medical benefits,

adequacy of medical care and free choice of physician

• Rehabilitation

Specific Items to beStudied and Evaluated



• Standards to determine assurance of benefitscaused by aggravation or acceleration of pre-existing injuries or disease

• Time limits on filing claims; waiting periods;compulsory or elective coverage; administration;ensuring prompt hearings and due processevidentiary rights in the resolution of claims;

• Relationship between WC, old age, disability, andsurvivors insurance and other insurance

Specific Items to beStudied and Evaluated



• Use of employer/insurer selected networks toimprove treatment outcomes

• Utilization Review• Use of science based information to determinepercent of impairment (ADA Guides)

• Managed care programs

• Focus on return to work treatments and strategies• Cost of workers’ compensation

premiums/payments and impact oncompetitiveness

Recent State Reforms Noton List for Review





• Interim reports to the President and Congress atany time

• Final report not later than 18 months after the date

of enactment to President and Congresscontaining findings, conclusions, andrecommendations for enhancements andimprovements in benefit levels, medical care, andadministration of State WC systems;

improvements in insurance practices, due processand evidentiary hearings and reduction of bad faithhandling and delays, as agreed by majority of Commission members.

• Funding for staff and contractors needed.

Commission Reports



• Unbalanced Commission with political agenda

• Review of state WC system not the federal role

• State WC system already continuously studied andevaluated

• Unnecessary federal spending in time of tightfederal budget

• Trial lawyers (WILG and AAJ) and organized labor seeking changes on issues rejected by states

• Many 1972 Report recommendations wouldimpose significant cost and premium increases for

employers

Fundamental Issues



• 19 Primary Recommendations, with manycontroversial issues, including compulsory WCcoverage, no exclusion based on number of employees, coverage of household and casual

workers, farm worker coverage, presumptionagainst independent contractor status, maximumwage benefits at least 200% of state averageweekly wage, worker choice of physician, secondinjury fund, no limit on total benefits paid for PT,

“full” coverage for work related diseases.

• Cost of implementing the 1972 reportrecommendations in most states ranged from

30% to 80% per year.

1972 Recommendations



• Individual state chambers and businessorganizations communicating with Congressionaldelegations

• Letter coordinated by UWC and US chamber toHouse Members from large list of national businessorganizations (US Chamber, NAM, NFIB, NRF, AIA,PCI,NCSI, and many others)

• NCOIL and ALEC passed resolutions of opposition.Other organizations involved include IAIABC, StateFunds, NCSL, SAWCA.

Opposition to HR 635building



HR 635 OppositionChallenges

Priority for Rep. Baca

On the list of D Majority for action after card check

Likely to have votes to pass in House if it gets tothe floor

Posturing as “Just a Study”

Carryover of “Academic” recommendations fromPresident Nixon’s 1972 Report

National Press – New York Times and WashingtonPost response





• Enacted during last day of Senate session in 2007

• Projected to produce $1.1 billion in revenue for

Medicare over 10 years; CMS expects much greater revenue as reporting is implemented

• Requires WC insurance companies and plans of

insurance to report all judgments, settlements,awards and payments of WC to individuals who areMedicare entitled (No-fault auto and liability insurersalso required to report)

S 2499 Section 111Reporting



• Interim Report Record Lay-outs available fromCMS along with User Guide and training from CMS

• Implementation through CMS web site -No formalregulations to be issued for comment

• No formal administrative appeal

S 2499 Section 111Reporting (cont’d)





• Report payments after July 1, 2009 if based onsettlements, awards or judgments prior to July 1,2009

• CMS Reach Back Recovery• RREs must report information even if not currently

captured on data bases – date of first exposure

• CMS guideline for SSNs acquisition from claimant

• $1,000 per day fine for failing to report will not beimposed until reporting registration and standardsare finalized

• www.cms.hhs.gov/MandatoryInsRep

Other Reporting Issues

http://www.cms.hhs.gov/MandatoryInsRep

http://www.cms.hhs.gov/MandatoryInsRep



• Reports of total payment obligations to claimants(TPOC) exempted if

• Most recent (TPOC) payment is on or beforeDecember 31, 2011 and amount is $5,000 or less,2012 - $2,000 or less, 2013 - $600.00 or less,January 1, 2014 – no reporting exemption

• Reporting of TPOCs prior to January 1, 2010 is notrequired – permitted at RRE discretion.

Other Reporting Issues



Costs of S 2499 Reporting

Increased risk that old settlements will bereviewed with changes in Medicare recovery,increasing potential costs

Administrative costs of reporting is significant for insurance carriers, self-insurers, state andfederal agencies

Increases in risk and prospective costs of WCwhere Medicare interests involved



HR 2641 WCMSASettlement Reform

Introduced by Rep. John Tanner (D- TN)

WC settlement exempt from MSP if 1) present value of $25,000 or less; 2) likely ineligibility for Medicare; 3) no

future medical expenses; or 4) no limit on future medicalPresent value includes cash, purchase cost of annuities,amounts previously paid, but excludes previous medicalexpenses, fees for the claimant and any other procurement costs of agreement



HR 2641

Limits cases when not likely to be ineligible to 1) awardedSSDI; 2) applied for SSDI and determination pending 90 or fewer days; 3) appealing denial of SSDI; 4) at least 62 and ½years old; 5) has end stage renal disease

MSP satisfied when set aside amounts based on items andservices under WC agreement and/or fee schedules, andreduced by direct costs of establishing and administering theWCMSA and costs of attorneys, TPAs, or administrators.



HR 2641

CMS Decisions within 60 days of submission with specificCMS Decisions within 60 days of submission with specific

reasons if disapprovedreasons if disapproved

Safe harbor for submissions if 10% of present value of claimSafe harbor for submissions if 10% of present value of claim

submitted as long as settlement is $250,000 or lesssubmitted as long as settlement is $250,000 or less

Reconsideration of disapproval may be filed within 60 days;Reconsideration of disapproval may be filed within 60 days;reconsideration within 30 days; appeal within 30 days to ALJ;reconsideration within 30 days; appeal within 30 days to ALJ;decision within 90 days of appeal; judicial reviewdecision within 90 days of appeal; judicial review

Optional direct pay to CMSOptional direct pay to CMS



HR 2641

Optional compromise settlementOptional compromise settlement

WC law shall be conclusive as to matters under WC law and notWC law shall be conclusive as to matters under WC law and notsubject to CMS review – particularly helpful in determining prescriptionsubject to CMS review – particularly helpful in determining prescriptiondrug amounts to be set-aside in light of CMS policy of requiringdrug amounts to be set-aside in light of CMS policy of requiring

average wholesale pricesaverage wholesale pricesNo additional liability for a WC settlement agreement effective prior toNo additional liability for a WC settlement agreement effective prior toenactment of HR 2641 than on effective date of the agreementenactment of HR 2641 than on effective date of the agreement



Impact of HealthInsurance Bill on WC

Section 136 of HR 3200 as passed by House WaysSection 136 of HR 3200 as passed by House Waysand Means Committee providesand Means Committee provides

The Commissioner shall establish standards for theThe Commissioner shall establish standards for thecoordination and subrogation of benefits andcoordination and subrogation of benefits andreimbursement of payments in cases involvingreimbursement of payments in cases involvingindividuals and multiple plan coverage.individuals and multiple plan coverage.Committee summary indicates that workers’Committee summary indicates that workers’

compensation is an example of a plan that may becompensation is an example of a plan that may beimpacted.impacted.



Outlook for 2009,2010, and thereafter

Registration and development of Section 111 reportingRegistration and development of Section 111 reportingrequirements and implementation will continue throughrequirements and implementation will continue through2010 – current deadline to register is September 30,2010 – current deadline to register is September 30,

2009, but registration likely to be permitted by CMS2009, but registration likely to be permitted by CMSthereafter thereafter

Active enforcement and penalties imposed beginning inActive enforcement and penalties imposed beginning inlate 2010late 2010

Significant additional Medicare recoveries and costSignificant additional Medicare recoveries and costavoidance above $1.1 billion, shifting Medicare costs toavoidance above $1.1 billion, shifting Medicare costs tostate WC, self-insurers and insurance industrystate WC, self-insurers and insurance industry



Outlook for 2009,2010, and thereafter

HR 635 will be pushed after health insurance reform andHR 635 will be pushed after health insurance reform and

card check bill. Probably not until early 2010.card check bill. Probably not until early 2010.HR 2641 will continue to be refined to address cost issuesHR 2641 will continue to be refined to address cost issueswith possible addition to Medicare reform legislation in latewith possible addition to Medicare reform legislation in late2009; if not continuing into 2010.2009; if not continuing into 2010.



UWC -- Strategic Services on Unemployment &Workers’ Compensation

“The Voice of Business on Unemployment & Workers’ Compensation”

910 17th Street, NW, Suite 315

Washington, DC [email protected]

www.UWCstrategy.org202-223-8904

Join US



Agenda















Leslie Newman

Commissioner

TN Department of Commerce & Insurance

Topics of Discussion Overview of the Department

&Department Updates



John Morris

Deputy Commissioner

TN Department of Commerce & Insurance



Mike Shinnick

Workers’ Compensation ManagerTN Department of Commerce & Insurance

Topic of Discussion TN Workers’ Compensation Self Insurance

& Insurance Environment Update



2008 Market Segments2008 Market SegmentsIndividual Self Insureds are on an equivalent basisIndividual Self Insureds are on an equivalent basis

$884$832

$230 $200

$44 $33$63 $47

$0

$100

$200$300

$400

$500$600

$700

$800

$900

Voluntary Self Insurers SI Groups TWCIP

2007

2008

Million in Premiums

SI Groups exclude government groups.

-6%

-25%- 25%

-13%



4646

TN Large Deductibles HistoryTN Large Deductibles History

2500

2600

2700

2800

2900

3000

3100

3200

3300

3400

3500

'02 '03 '04 '05 '06 '07p

Policy Count

Source: NCCI

’ C



Workers’ Compensation IndemnityWorkers’ Compensation Indemnity

Claims Cost IncreasesClaims Cost Increases

10.10%9.20%

3.10%

4.40%

1.30%

3.00%

4.80%

3.40%

5%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

2000 2001 2002 2003 2004 2005 2006 2007 2008Source: NCCI (2008 preliminary)



WC Medical Claim Cost TrendsWC Medical Claim Cost Trends(Lost Time Cases)(Lost Time Cases)

6.00%5.80%

7.30%

13.50%

8.20%

7.10%

5.40%

7.70%

6.00%

0%

2%

4%

6%

8%

10%

12%

14%

16%

2000 2001 2002 2003 2004 2005 2006 2007 2008

Med Sev

Med CPI

Source: NCCI (2008 preliminary); Med CPI: Economy.com

L t Ti F



Lost Time FrequencyLost Time Frequency

Continues to DeclineContinues to Decline

-4.50%

-6.90%

-4.50%-4.10%

-3.70%

-6.70%

-6.00%

-2.60%

-4.00%

-7%

-6%

-5%

-4%

-3%

-2%

-1%

0%

2000 2001 2002 2003 2004 2005 2006 2007 2008Source: NCCI (2008 preliminary)

Impact of 2004 Reforms on WCImpact of 2004 Reforms on WC



Impact of 2004 Reforms on WCImpact of 2004 Reforms on WC

Premiums:Premiums: Estimated $490M Savings Since 2004Estimated $490M Savings Since 2004

(50-6-134)(50-6-134) CalendarCalendar

Yr YrDirect PremiumDirect Premium

WrittenWrittenNet EstimatedNet Estimated

Savings*Savings*Annual %Annual %SavingsSavings

20042004 $883M$883M $20M$20M 2.2%2.2%

20052005 $943M$943M $98M$98M 9.4%9.4%

20062006 $947M$947M $139M$139M 12.8%12.8%

20072007 $947M$947M $114M$114M 10.8%10.8%

20082008 $879M$879M $119M$119M 12.0%12.0%

* These preliminary estimates are based on the impact of loss costs and the mostrecent NCCI study of the estimated decreases in system costs seen in data periods

I t f 2004 R fI t f 2004 R f



Impact of 2004 Reforms onImpact of 2004 Reforms on

Premium: Other MeasuresPremium: Other Measures

26% drop in loss costs26% drop in loss costs andand filed loss costfiled loss costmultipliers (weighted average) sincemultipliers (weighted average) since9/1/049/1/04

28% drop in average premium per policy28% drop in average premium per policyof top 10 Tennessee workers’of top 10 Tennessee workers’compensation insurers comparing datacompensation insurers comparing data

from 2004 to 2008from 2004 to 2008

Overview of Self Insurance MarketOverview of Self Insurance Market



Overview of Self-Insurance MarketOverview of Self-Insurance Market

(2008)(2008)

Self-Insured EmployersSelf-Insured Employers – 105 – 105Number of employees – 266,912Number of employees – 266,912

Total “Premium Equivalent” – $200 millionTotal “Premium Equivalent” – $200 million

Self-Insured GroupsSelf-Insured Groups – 6 – 6

Number of employees – 42,572Number of employees – 42,572

Total Premium – $33 millionTotal Premium – $33 million



Overall Market SummaryOverall Market Summary

POSITIVESPOSITIVESFrequency continues toFrequency continues todecline nationallydecline nationally

Industry reserveIndustry reserve

deficiency remainsdeficiency remainsmoderatemoderate

Low company failureLow company failureraterate

Smallest TN residualSmallest TN residualmarket in 9 yearsmarket in 9 years

NEGATIVESNEGATIVES13 point TN profitability13 point TN profitabilityloss; worst “combinedloss; worst “combinedratio” in 6 yearsratio” in 6 years

Medical severityMedical severitycontinues rapid growthcontinues rapid growth

Low investment returnsLow investment returnscontinue to pressurecontinue to pressure

underwriting resultsunderwriting results



Agenda















Agenda





10:30 – 11:00 Sue Ann Head & Pete Halverstadt - Dept of Labor & Workforce Dev










Sue Ann HeadAdministrator of the Workers’ Compensation DivisionTN Department of Labor & Workforce Development

Pete Halverstadt

AttorneyTN Department of Labor & Workforce Development



Overview of TennesseeOverview of Tennessee

Workers’ CompensationWorkers’ Compensation20092009

Programs Within the TennesseePrograms Within the Tennessee



Programs Within the TennesseePrograms Within the Tennessee

Workers’ Compensation DivisionWorkers’ Compensation Division

The Workers Compensation Division manages tenThe Workers Compensation Division manages tendifferent programs concerning employees’ anddifferent programs concerning employees’ andemployers’ rights and responsibilities.employers’ rights and responsibilities.

They are:They are: –

Claims and Coverage—Dark Ages (1919)Claims and Coverage—Dark Ages (1919) – The Second Injury Fund—1946The Second Injury Fund—1946

– Benefit Review—1992Benefit Review—1992

– Case Management/Utilization Review—1992Case Management/Utilization Review—1992

– The Drug Free Workplace Program—1996The Drug Free Workplace Program—1996

– The Uninsured Employers Fund (UEF)—2001The Uninsured Employers Fund (UEF)—2001 – The Penalty Program—2004The Penalty Program—2004

– The Medical Fee Schedule—2005The Medical Fee Schedule—2005

– The Medical Impairment Rating (MIR) Registry—2005The Medical Impairment Rating (MIR) Registry—2005

– The Administrative Review Program—2006The Administrative Review Program—2006



Claims StatisticsClaims Statistics

July 1, 2008 through June 30, 2009July 1, 2008 through June 30, 2009

– 47,82447,824 Lost Time ClaimsLost Time Claims

– 58,45258,452 Medical-Only ClaimsMedical-Only Claims



Uninsured Employers FundUninsured Employers Fund



Uninsured Employers FundUninsured Employers Fund

In fiscal year 2008-2009, the UEFIn fiscal year 2008-2009, the UEFconductedconducted 4,072 investigations4,072 investigations..

The UEFThe UEF penalizedpenalized 205 employers205 employers for for

non-compliance i.e. failing to havenon-compliance i.e. failing to haveworkers’ compensation insuranceworkers’ compensation insurance

coverage.coverage.

In fiscal 2008-2009, the UEF collectedIn fiscal 2008-2009, the UEF collectedpenalties in the amount of penalties in the amount of $1,043,848$1,043,848 from non-compliant employers.from non-compliant employers.



Drug Free Workplace ProgramDrug Free Workplace Program

The DFPW program strives to assist employers inThe DFPW program strives to assist employers inproviding safe working conditions, reduce theproviding safe working conditions, reduce the

potential for injuries, and secure savings on thepotential for injuries, and secure savings on the

employers’ workers’ compensation premiums.employers’ workers’ compensation premiums.

For the Fiscal Year For the Fiscal Year ending June 30, 2009ending June 30, 2009 there werethere were9,087 employers participating in the Program.employers participating in the Program.

Projections are that DFWP membership by the end of Projections are that DFWP membership by the end of December 2009December 2009 will exceedwill exceed 10,000 employers.employers.

Benefit Review



Benefit ReviewRegional and Satellite Offices

DyersburgDyersburg ClarksvilleClarksville NashvilleNashville ChattanoogaChattanooga

JacksonJackson ColumbiaColumbia MurfreesboroMurfreesboro KnoxvilleKnoxville

MemphisMemphis CookevilleCookeville KingsportKingsport

Anderson

Bedford

Benton

Bledsoe

Blount

Bradley

Campbell

Cannon

Carroll

Carter Cheatham

Chester

ClaiborneClay

Cocke

Coffee

Crockett

Cumberland

Davidson

Decatur

De Kalb

Dickson

Dyer

Fayette

Fentress

Franklin

Gibson

Giles

Grainger

Greene

Grundy

Hamblen

Hamilton

Hancock

Hardeman Hardin

Hawkins

Haywood

Henderson

Henry

Hickman

Houston

Humphreys

Jackson

Jefferson

Johnson

Knox

Lake

Lauderdale

Lawrence

Lewis

LincolnFayetteville

Loudon

McMinn

McNairy

Macon

Madison

Marion

Marshall

MauryMeigs

Monroe

Montgomery

Moore

Morgan

ObionOverton

Perry

Pickett

Polk

Putnam

Rhea

Roane

Robertson

Rutherford

Scott

Sequatchie

Sevier

Shelby

Smith

StewartSullivan

Sumner

Tipton

Trousdale

Unicoi

Union

Van BurenWarren

Washington

Wayne

Weakley

WhiteWilliamson

Wilson

The Benefit Review Program StatsThe Benefit Review Program Stats



The Benefit Review Program StatsThe Benefit Review Program StatsTTD/Med:TTD/Med: Assistance with resolution of temporaryAssistance with resolution of temporary

disability and medical benefitsdisability and medical benefits

BRC: Benefit Review Conference:BRC: Benefit Review Conference: Mediation of Mediation of final settlementsfinal settlements

Approvals:Approvals: Approval of settlements reached withApproval of settlements reached withor without mediationor without mediation

FYFY FYFY FY FY FYFY FY FY % change% change

04/05 05/06 06/07 07/08 08/0904/05 05/06 06/07 07/08 08/09 since 2004since 2004

TTD/MedTTD/Med 27332733 40084008 49874987 4948 56654948 5665 107.3%107.3%

BRCBRC 61736173 69766976 73117311 6444 70446444 7044 14.1 %14.1 %

ApprovalsApprovals 58725872 69886988 70537053 70657065 7938 35.2%7938 35.2%

TOTALSTOTALS 14,77814,778 17,97217,972 19,351 18,457 20,64719,351 18,457 20,647 39.7%39.7%



Administrative ReviewAdministrative Review

July 1, 2008 through June 30, 2009July 1, 2008 through June 30, 2009

Total Number of Requests:Total Number of Requests: 856856

Untimely Filed:Untimely Filed: 5656

Withdrawn:Withdrawn: 5959Orders Issued:Orders Issued: 740740 – Of Orders IssuedOf Orders Issued

Affirmed:Affirmed: 537537 72.6%72.6%Not Affirmed:Not Affirmed: 203203 27.4%27.4%

P l P



Penalty ProgramPenalty ProgramJuly 1, 2008 through June 30, 2009July 1, 2008 through June 30, 2009

25% Penalties25% Penalties

Number Number of Penalty Referrals:of Penalty Referrals: 114114

Number of Penalties Assessed:Number of Penalties Assessed: 5252Total Penalties Assessed:Total Penalties Assessed: $70,274.20$70,274.20

$10,000+ Penalties$10,000+ Penalties

Number of Penalty Referrals:Number of Penalty Referrals: 3333

Number of Penalties Assessed:Number of Penalties Assessed: 1717

Total Penalties Assessed:Total Penalties Assessed:

$32,000.00$32,000.00



Penalty Program cont.Penalty Program cont.

ClaimsClaims



Total Penalties Assessed:Total Penalties Assessed: $107,600.00$107,600.00

Medical Fee ScheduleMedical Fee Schedule



Total Penalties Assessed:Total Penalties Assessed: $255,000.00$255,000.00



Medical Fee ScheduleMedical Fee Schedule



Medical Fee ScheduleMedical Fee ScheduleT.C.A. 50-6-204T.C.A. 50-6-204

AmendmentsAmendmentsAdoption of March 4, 2008 reimbursementAdoption of March 4, 2008 reimbursement

levels as a floor for all workers’levels as a floor for all workers’compensation medical charges.compensation medical charges.

The department may assess a penalty for The department may assess a penalty for violations of the medical fee scheduleviolations of the medical fee schedulerules of up to $10,000.rules of up to $10,000.

Division will update conversion factor Division will update conversion factor

multipliers via the website instead of themultipliers via the website instead of therules.rules.

U & C defined as 80% of billed charges.U & C defined as 80% of billed charges.

Second Injury FundSecond Injury Fund



j yj y

Year Year OpenedOpened % Change% Change ClosedClosed CaseloadCaseload AttysAttys

2000:2000: 453453 0.22% increase0.22% increase 395395 935935 55





20052005 576576 29.2%29.2% decreasedecrease 761761 12751275 88

20062006 513513 10.9%10.9% decreasedecrease 785785 10031003 77

20072007 699699 36.25%36.25% increaseincrease 579579 11231123 77

20082008 740740 5.87%5.87% increaseincrease 738738 11251125 77

2009 2010 C ti L l2009 2010 Compensation Levels



2009-2010 Compensation Levels2009-2010 Compensation Levels

Maximum weekly benefits as of Maximum weekly benefits as of July 1:July 1:

– Temporary benefits--Temporary benefits--$837.00$837.00

– Permanent benefits--Permanent benefits--$761.00$761.00

Minimum weekly benefit as of Minimum weekly benefit as of

July 1July 1 – Temporary benefits--Temporary benefits--$114.15$114.15



Utilization RulesUtilization Rules

Beginning November 12, 2009, newBeginning November 12, 2009, newutilization rules will apply to all recommendutilization rules will apply to all recommendmedical treatments and procedures.medical treatments and procedures.

The trigger for UR is no longer a monetaryThe trigger for UR is no longer a monetaryamount—instead it is triggered when theamount—instead it is triggered when thepayor disputes the medical necessity of thepayor disputes the medical necessity of therecommended treatment or procedure.recommended treatment or procedure.

The UR Rules provide timelines for The UR Rules provide timelines for conducting the UR.conducting the UR.



Utilization Review cont.Utilization Review cont.

The UR agent must be a TN-license.,The UR agent must be a TN-license.,Board-certified doctor in the same or Board-certified doctor in the same or

similar specialty as the recommendingsimilar specialty as the recommending

physician.physician.The only issue under considerationThe only issue under consideration

during UR is medical necessity.during UR is medical necessity.

The UR agent’s decision must be inThe UR agent’s decision must be inwriting and distributed to all parties.writing and distributed to all parties.

Expedited appeal only for UR denials.Expedited appeal only for UR denials.



Possible Future Laws & RulesPossible Future Laws & Rules

Venue—race to the courthouseVenue—race to the courthouse

AMA GuidesAMA Guides

TelecommutingTelecommuting

EEOICPAEEOICPA

DFWP notice requirementDFWP notice requirement

Construction lawsConstruction lawsAdjuster TrainingAdjuster Training

Contact InformationContact Information



Contact InformationContact Information

Workers’ Compensation DivisionWorkers’ Compensation DivisionWebsite:Website: www.state.tn.us/labor-wfd/wcompwww.state.tn.us/labor-wfd/wcomp

Phone Number :Phone Number : 1-800-332-26671-800-332-2667

Sue Ann Head, Administrator Sue Ann Head, Administrator [email protected]@tn.gov

Pete Halverstadt, Assistant Administrator Pete Halverstadt, Assistant Administrator

[email protected]@tn.gov

TNSIA Thanks our 2009

http://www.state.tn.us/labor-wfd/wcomp


mailto:[email protected]









TNSIA Thanks our 2009SILVER SPONSORS

Agenda



Agenda






11:00 – 12:00 Dr. Chrissane Gordon – Health, Wellness and the Aging Workforce12:00 – 1:00 Lunch in Atrium & Visit Vendor Booths








Dr. Chrisanne GordonPhysical Medicine and Rehabilitation Physician

The Challenges of Health, Wellness

and the Aging Workforce



The US WorkforceThe US Workforce

Comes of AgeComes of Age

Challenges of a Vintage Work ForceChallenges of a Vintage Work Force



Old age is the harbor of all illsOld age is the harbor of all ills

~Bion ~ 280 B.C.~Bion ~ 280 B.C.



Nature abhors the old, and old age seemsNature abhors the old, and old age seemsthe only disease; all others run into thisthe only disease; all others run into thisone.one.

~ Emerson ~ 1880~ Emerson ~ 1880



Getting old is not for sissies.Getting old is not for sissies.

~Bette Davis~ 1980’s~Bette Davis~ 1980’s

’ f ?Wh i A i ’ k f ?



Who is America’s work force?Who is America’s work force?

58 million workers over 45-years-old58 million workers over 45-years-old

Aging work force:Aging work force:

-- 2000 statistics – 13% US workers 55+2000 statistics – 13% US workers 55+

-- 2010 -17%2010 -17%

-- 20592059 - 19%- 19%

Wh d hi ?Wh t d thi ?



What does this mean?What does this mean?

– Health Care Costs are SoaringHealth Care Costs are Soaring (Union Wages)(Union Wages)

2000 $1.69/hour/employee2000 $1.69/hour/employee

2005 $2.59/hour/employee2005 $2.59/hour/employee2008 $4.00/hour/employee2008 $4.00/hour/employee

Average Annual Per-Employee Cost $9660Average Annual Per-Employee Cost $9660

Towers Perrin Health Care Cost Survey 2009Towers Perrin Health Care Cost Survey 2009



Workers older than 40 account for:Workers older than 40 account for:

50% short term disability50% short term disability

75% long term disability75% long term disability

Older employees utilize more health careOlder employees utilize more health care

-Life/Health Advisor December 2005-Life/Health Advisor December 2005

Chronic Illnesses Noted in AgingChronic Illnesses Noted in Aging



Chronic Illnesses Noted in AgingChronic Illnesses Noted in Aging

Work ForceWork Force

DiabetesDiabetesHypertensionHypertension

CADCAD

PVDPVDObesityObesity

Metabolic syndromeMetabolic syndrome

COPDCOPDArthritisArthritis



Smoking, obesity, inactivity cost 300%Smoking, obesity, inactivity cost 300%more for older workers than younger more for older workers than younger workers.workers.

- Life/Health Advisor December 2005- Life/Health Advisor December 2005



Increased health care dollars onIncreased health care dollars oninsurance.insurance.

Increased care dollars on BWC withIncreased care dollars on BWC with

recent tendency to shift responsibility torecent tendency to shift responsibility toemployer for age related degenerativeemployer for age related degenerativepathology.pathology.

Increased disability benefitsIncreased disability benefits

St ti ti f G dSt ti ti f G d



Statistics of Gender Statistics of Gender

Women share of labor forceWomen share of labor force

2002 - 46.5%2002 - 46.5%

2012 - 47.5%2012 - 47.5%

2016 - 48.0%2016 - 48.0%



68 million women employed in the US.68 million women employed in the US.

- 75% full time jobs- 75% full time jobs

- 25% part time jobs- 25% part time jobs

Concerns with increased women inConcerns with increased women in



Concerns with increased women inlabor force may include:labor force may include:

OB -Child bearing/infertility issuesOB -Child bearing/infertility issues

OB- Exposure issuesOB- Exposure issues

GYN- Breast & Cervical cancer GYN- Breast & Cervical cancer

Arthritic conditionsArthritic conditions

Strength issues – recurrent soft tissueStrength issues – recurrent soft tissue

injuriesinjuries



There is a shift in US away fromThere is a shift in US away frommanufacturing – to service & technicalmanufacturing – to service & technicalsupport. This shift will benefit the agingsupport. This shift will benefit the aging

work force.work force.Eg: only 6% women in manufacturingEg: only 6% women in manufacturing

jobs. jobs.



What are the major physiologic changesWhat are the major physiologic changeswith maturing?with maturing?

These changes need to be understood soThese changes need to be understood sothat adjustments can be made at the workthat adjustments can be made at the worksite.site.

A CARDIOVASCULARA CARDIOVASCULAR



A – CARDIOVASCULARA – CARDIOVASCULAR

Decreased maximum heart rate.Decreased maximum heart rate.

Decreased maximum contraction.Decreased maximum contraction.

Decreased blood pumped.Decreased blood pumped.

Decreased elasticity of arterial vessels.Decreased elasticity of arterial vessels.



After 30 – heart’s peak capacity declinesAfter 30 – heart’s peak capacity declinesby 5 – 10% per decade.by 5 – 10% per decade.

After 40 – increased incidence of CADAfter 40 – increased incidence of CAD

especially with co-factors of Diabetes,especially with co-factors of Diabetes,HTN, Obesity, SMOKINGHTN, Obesity, SMOKING



Adjustments may need to be made toAdjustments may need to be made toaccommodate the aging heart inaccommodate the aging heart inmanufacturing and heavy labor jobs.manufacturing and heavy labor jobs.

B PULMONARYB PULMONARY



B - PULMONARYB - PULMONARY

Decreased ability to move air deeply andDecreased ability to move air deeply andquickly – forced expiratory volume.quickly – forced expiratory volume.

Increased residual volume.Increased residual volume.

Possible decreased air exchange withPossible decreased air exchange withexposures; dust, asbestos, siliconexposures; dust, asbestos, silicon

Smoking increases all the above.Smoking increases all the above.

C NERVOUSC NERVOUS



C - NERVOUSC - NERVOUS

Decreased memoryDecreased memory

Decreased senses: sight, hearing.Decreased senses: sight, hearing.

Decreased NCV – limits agility and speed.Decreased NCV – limits agility and speed.

NCV declines 3% per decade after 55.NCV declines 3% per decade after 55.

Decreased balance and proprioception.Decreased balance and proprioception.





EXAMPLE:EXAMPLE:

20-year-old slips on oil – contusion and20-year-old slips on oil – contusion andsprain.sprain.

65-year-old hip fracture, pulmonary65-year-old hip fracture, pulmonaryembolus, infection, possible death.embolus, infection, possible death.

D SKELETALD SKELETAL



D - SKELETALD - SKELETAL

DDD – Degenerative Disc DiseaseDDD – Degenerative Disc DiseaseDreaded Disability DiseaseDreaded Disability Disease

- Develops in everyone – starts at age 32 - 34.- Develops in everyone – starts at age 32 - 34.

- Genetic and environmental factors- Genetic and environmental factorsinfluence degree.influence degree.

- Many non-surgical treatments available.- Many non-surgical treatments available.

- Surgical options with mixed results.- Surgical options with mixed results.

Look for osteoporosis for recurrent fractures.Look for osteoporosis for recurrent fractures.



Adjustment – Ergonomic work stations andAdjustment – Ergonomic work stations andexercise program should be available onexercise program should be available onsite.site.

E MUSCULARE MUSCULAR



E - MUSCULARE - MUSCULAR

15% loss of strength per decade after 50.15% loss of strength per decade after 50.

Decreased motor units.Decreased motor units.

Increased fat in muscles.Increased fat in muscles.

Fraying of muscle attachments, eg, rotator Fraying of muscle attachments, eg, rotator

cuff tendinitis.cuff tendinitis.



ADJUSTMENT –ADJUSTMENT –

Better equipment for lifting heavy parts, jobBetter equipment for lifting heavy parts, jobrotation, seniority positions.rotation, seniority positions.

F MISCELLANEOUSF MISCELLANEOUS



F - MISCELLANEOUSF - MISCELLANEOUS

DECREASED SENSES -DECREASED SENSES -

Adjustment for hearing and sight.Adjustment for hearing and sight.

Cognitive decreasesCognitive decreases



Cognitive decreases -Cognitive decreases -

ADJUSTMENTADJUSTMENT – Classes and updates via newsletters andClasses and updates via newsletters and

email.email.

– Clear training objectives.Clear training objectives.

Hormonal ChangesHormonal Changes -



Hormonal Changes -Hormonal Changes -

ADJUSTMENT –ADJUSTMENT – – Big concern for manufacturing with largeBig concern for manufacturing with large

women in labor force.women in labor force.

– Consider counseling, dietary adjustments,Consider counseling, dietary adjustments,education.education.

– Menopause increases osteoporosis, jointMenopause increases osteoporosis, joint

stiffness, tendinitis via loss of estrogen.stiffness, tendinitis via loss of estrogen.

Current trend is to have WCCurrent trend is to have WC



supplement Medicare & privatesupplement Medicare & private

insurance.insurance.

1)1) Eg: THR, TKR replacement surgery.Eg: THR, TKR replacement surgery.

2)2) Chronic pain management for DDD.Chronic pain management for DDD.

3)3) Cardiovascular work-ups prior to minor Cardiovascular work-ups prior to minor surgeries.surgeries.

4)4) Allowances granted for aging process.Allowances granted for aging process.

DEFINITIVE STUDIES NEED TODEFINITIVE STUDIES NEED TO



BE DONE -BE DONE -

1.1.Serial MRI’s on non-working personsSerial MRI’s on non-working personsfollowed from 30’s - 70’sfollowed from 30’s - 70’s

2.2.Studies ongoing to prove naturalStudies ongoing to prove natural coursecourseof aging.of aging.

3. Always consider genetic with vocational3. Always consider genetic with vocational

contributions.contributions.

4. Disability runs in families often.4. Disability runs in families often.

COMPLICATIONS OF AGING ONCOMPLICATIONS OF AGING ON



BWC ALLOWANCES-BWC ALLOWANCES-

Eg: Aggravation of pre-existing DJD;Eg: Aggravation of pre-existing DJD;DDD.DDD.

““Aggravation of old ACL tear”.Aggravation of old ACL tear”.Remote myocardial infarction.Remote myocardial infarction.

Pulmonary emphysema.Pulmonary emphysema.

Diabetes mellitus.Diabetes mellitus.Down’s SyndromeDown’s Syndrome

DODMDODM



DODMDODM

Longer recovery for underlying medicalLonger recovery for underlying medicalconditions and age. Co-morbiditiesconditions and age. Co-morbidities

After 90 days, only 10% RTWAfter 90 days, only 10% RTW

““Sandwich” generation with many socialSandwich” generation with many social

Issues.Issues.



Price per claim increases with increasedPrice per claim increases with increasedage and underlying health problems.age and underlying health problems.

Eg. Medicare pays $3000 - $6000 moreEg. Medicare pays $3000 - $6000 more

annually on obese seniors and this is nowannually on obese seniors and this is now – being shifted to employers.being shifted to employers.

– CDC July 2009CDC July 2009 – Tennessee #4 in US -30.2% adult obesityTennessee #4 in US -30.2% adult obesity



How does your company adjust to VintageHow does your company adjust to VintageWork Force?Work Force?

A - ERGONOMICSA - ERGONOMICS



A - ERGONOMICSA ERGONOMICS

1)1) Better equipment for lifting.Better equipment for lifting.

2)2) Better ergonomic tools toBetter ergonomic tools toaccommodate arthritis.accommodate arthritis.

3)3) Job rotations.Job rotations.

4)4) Seniority jobs – disguised.Seniority jobs – disguised.

5)5) Automation assisted activities.Automation assisted activities.

B - EDUCATIONB - EDUCATION



B - EDUCATIONB EDUCATION

1)1) Must have company-wide education onMust have company-wide education onhealth and effects of aging ongoing.health and effects of aging ongoing.

2)2) Promote smoking cessation.Promote smoking cessation.

3)3) Weight loss program.Weight loss program.

4)4) Anger and stress management.Anger and stress management.

5)5) Counseling for aging parents; ailingCounseling for aging parents; ailingspouse or children.spouse or children.

6)6) Reward healthy habits.Reward healthy habits.

C - EXERCISEC - EXERCISE



C EXERCISEC EXERCISE

The only effective way to slow down theThe only effective way to slow down theaging process and effects of aging isaging process and effects of aging isexercise.exercise.

BENEFITS INCLUDE:BENEFITS INCLUDE:



BENEFITS INCLUDE:BENEFITS INCLUDE:

1)1) Muscle massMuscle mass2)2) Bone massBone mass

3)3) Stress reductionStress reduction

4)4) Balance and agilityBalance and agility

5)5) Increased cardiovascular Increased cardiovascular

6)6) Cognitive benefitsCognitive benefits

Work Exercise Into The Work DayWork Exercise Into The Work Day



Work Exercise Into The Work DayWork Exercise Into The Work Day

Exercise should be part of the work dayExercise should be part of the work day

– 1. part of work process and break1. part of work process and break

– 2. exercise equipment or program on site2. exercise equipment or program on site

– 3. benefits of wellness program and3. benefits of wellness program and

education. Employee rewards for Healthyeducation. Employee rewards for Healthy

Habits.Habits.



The Whole Story: Gordon and GleesonThe Whole Story: Gordon and Gleeson

WWorkforceorkforce HHealingealing OOpportunities andpportunities and LLifestyleifestyle EEnhancementsnhancements..

Promoting Wellness ThroughPromoting Wellness Through

Age-Friendly Physical ActivitiesAge-Friendly Physical Activities

Publication January 2010Publication January 2010





Wellness programs need to incorporate:Wellness programs need to incorporate: – 1. cardio conditioning (40’s – 60’s)1. cardio conditioning (40’s – 60’s)

– 2. strength training (50’s – 60’s)2. strength training (50’s – 60’s)

– 3. flexibility/balance training (60’s)3. flexibility/balance training (60’s)

– Reward the Healthy Employee and their Reward the Healthy Employee and their

family.family.





Onsite monitoring of glucose, BP, weightOnsite monitoring of glucose, BP, weightEmployee health diary with counselors;Employee health diary with counselors;exercise, nutrition, social servicesexercise, nutrition, social services

Rewards for healthy living either byRewards for healthy living either bydecreased premiums or end of the year decreased premiums or end of the year bonuses.bonuses.



Cost Savings of Wellness ProgramsCost Savings of Wellness Programs – Dupont - $1.42 for every $1.00 investedDupont - $1.42 for every $1.00 invested

– Providence Health Care – 28% decreaseProvidence Health Care – 28% decrease

– Travelers - $3.40 for every $1.00Travelers - $3.40 for every $1.00

– Towers Perrin Health Care Cost – Sept. 2008Towers Perrin Health Care Cost – Sept. 2008





Men do not quit playing because theyMen do not quit playing because theygrow old; they grow old because they quitgrow old; they grow old because they quitplaying.playing.

Oliver Wendell Holmes.Oliver Wendell Holmes.



Most people think that aging is irreversible and weMost people think that aging is irreversible and weknow that there are mechanisms even in theknow that there are mechanisms even in the

human machinery that allow for the reversal of human machinery that allow for the reversal of aging, through correction of diet, through anti-aging, through correction of diet, through anti-

oxidants, through removal of toxins from theoxidants, through removal of toxins from thebody, through exercise, through yoga andbody, through exercise, through yoga and

breathing techniques, and through meditation.breathing techniques, and through meditation.

~Deepak Chopra~~Deepak Chopra~



Aging grapes produce great wine.Aging grapes produce great wine.

Aging humans produce great whining.Aging humans produce great whining.

Exercise is the #1and ONLY PROVENExercise is the #1and ONLY PROVENdeterrent to aging.deterrent to aging.

Agenda




g









2:15 – 3:45 Legal Panel Discussion - Case Law / MSA’s / Benefit Review

Cliff Wilson / John Barringer / Richard Murrell3:45 –4:00 Door Prizes




Agenda

















Workers’ CompensationWorkers’ Compensation

Legislative UpdatesLegislative UpdatesNew Laws Change WC Practice New Laws Chang e WC Practice

Terry HillTerry HillTNSIA Executive DirectorTNSIA Executive Director







SB 1574: Now TCA §50-6-204(a)SB 1574: Now TCA §

50-6-204(a)



§ ( )§ ( )

This bill puts to rest theThis bill puts to rest the OverstreetOverstreet decision, adecision, a2008 Supreme Court case preventing employers,2008 Supreme Court case preventing employers,

insurance carriers and attorneys frominsurance carriers and attorneys from

communicating with the authorized treatingcommunicating with the authorized treating

physician. SB 1574 allows us to communicatephysician. SB 1574 allows us to communicate with the authorized treating physician under the with the authorized treating physician under the

following terms…following terms…

1. The employer may send written1. The employer may send written



communications to the treating physician,communications to the treating physician,

but must copy the employee or the but must copy the employee or theemployee’s attorney on theemployee’s attorney on the

correspondence with any attachedcorrespondence with any attached

materials and must provide the employeematerials and must provide the employeeor the employee’s attorney with copies of or the employee’s attorney with copies of

the physician’s response to thethe physician’s response to the

correspondence within 7 days of receipt.correspondence within 7 days of receipt.

2. The employer may communicate orally 2. The employer may communicate orally i h h i h i i b d



with the treating physician, but must send with the treating physician, but must send

the employee or the employee’s attorney athe employee or the employee’s attorney a written summary of the opinions or written summary of the opinions or

statements of the physician within 7 daysstatements of the physician within 7 days

of a request by the employee or theof a request by the employee or theemployee’s attorney.employee’s attorney.

3. The employer’s attorney may communicate3. The employer’s attorney may communicate



orally with the authorized treating physician,orally with the authorized treating physician,

but must provide written notice to the but must provide written notice to theemployee or the employee’s attorney at least 7employee or the employee’s attorney at least 7

days prior to the communication and mustdays prior to the communication and must

provide the employee or the employee’s provide the employee or the employee’sattorney with a written summary of allattorney with a written summary of all

opinions expressed by the physician within 7opinions expressed by the physician within 7

days of the communication.days of the communication.

Language Required for ReleasesLanguage Required for Releases



THIS MEDICAL AUTHORIZATION FORM ONLY THIS MEDICAL AUTHORIZATION FORM ONLY PERMITS THE EMPLOYER OR THE DIVISION OFPERMITS THE EMPLOYER OR THE DIVISION OF

WORKERS’ COMPENSATION TO OBTAIN MEDICAL WORKERS’ COMPENSATION TO OBTAIN MEDICAL

INFORMATION THROUGH ORAL OR WIRTTENINFORMATION THROUGH ORAL OR WIRTTEN

COMMUNICATION, INCLUDING, BUT NOT LIMITEDCOMMUNICATION, INCLUDING, BUT NOT LIMITED

TO, CHARTS, FILES, RECORDS, AND REPORTS INTO, CHARTS, FILES, RECORDS, AND REPORTS IN

THE POSSESSION OF A MEDICAL PROVIDER THE POSSESSION OF A MEDICAL PROVIDER

AUTHORIZED BY THE EMPLOYER PURSUANT TO AUTHORIZED BY THE EMPLOYER PURSUANT TO

T.C.A § 50-6-204 AND A MEDICAL PROVIDER THATT.C.A § 50-6-204 AND A MEDICAL PROVIDER THAT

IS REIMBURSED BY THE EMPLOYER FOR THEIS REIMBURSED BY THE EMPLOYER FOR THEEMPLOYEES TREATMENT.EMPLOYEES TREATMENT.

SB 1909: Now TCASB 1909: Now TCA §50-6-110 (a)

§50-6-110 (a)



§ ( )

This bill disallows employeesThis bill disallows employeesfrom recovering for injuriesfrom recovering for injuries

sustained during recreationalsustained during recreational

activities, except in theactivities, except in the

following limitedfollowing limited

circumstances…circumstances…



3:3: When the employee’s participation wasduring the employee’s work hours and was



during the employee s work hours and waspart of the employee’s work related duties;

or

4

:

When the injury occurred due to an

unsafe condition during voluntaryparticipation using facilities designatedby, furnished by or maintained by theemployer on or off the employer’s

premises and the employer had actualknowledge of the unsafe condition andfailed to curtail the activity or program

SB 1567:Now TCASB 1567:Now TCA §§ 50-6-241(a)1(c)50-6-241(a)

1(c)



This bill states that if an employer is bought outThis bill states that if an employer is bought out

by another company and retains the employee by another company and retains the employeeat the same or greater pay, the employee is notat the same or greater pay, the employee is notentitled to reopen his case under T.C.A §50-6-entitled to reopen his case under T.C.A §50-6-

241(a). Prior case law counter-intuitively241(a). Prior case law counter-intuitivelydictated that when a company simply changeddictated that when a company simply changedits name, the employee could reopen his caseits name, the employee could reopen his caseand still keep his job. This bill was signed byand still keep his job. This bill was signed by

the Governor on June 5, 2009 and will bethe Governor on June 5, 2009 and will beeffective on July 1, 2009.effective on July 1, 2009.



SB 2162:Now TCA §50-6-241(e)(1)SB 2162:Now TCA §50-6-241(e)(1) cont’dcont’d



……However, the bill also holds that if theHowever, the bill also holds that if theemployer is aware that the employeeemployer is aware that the employee

is illegal, there will be an automaticis illegal, there will be an automatic

award of 5 times the rating. Theaward of 5 times the rating. Theemployee will not get those funds,employee will not get those funds,

which will go to the State Second which will go to the State Second

Injury Fund.Injury Fund.

SB 2162:Now TCA §50 6 241(e)(1)SB 2162:Now TCA §50 6 241(e)(1) cont dco t d

SB 2000:Now TCA §50-6-102(13) &SB 2000:Now TCA §5

0-6-102(13) &

TCA §50-6-207(1)TCA §5

0-6-207(1)



TCA §50-6-207(1)TCA §50-6-207(1)

** This bill amends two existing statutes and:This bill amends two existing statutes and:(1) Disallows the employer from claiming a(1) Disallows the employer from claiming a

credit for TTD benefits paid in a 400 week credit for TTD benefits paid in a 400 week

case;case;(2)(2) Caps the amount of TTD an employeeCaps the amount of TTD an employee

may receive in a mental injury case at 200may receive in a mental injury case at 200

weeks weeks



Agenda

















Agenda















LEGAL PANEL DISCUSSIONLEGAL PANEL DISCUSSION



RECENT DEVELOPMENTS AT CMSRECENT DEVELOPMENTS AT CMSJohn Barringer, EsquireJohn Barringer, Esquire

MANIER & HERODMANIER & HEROD

CASE LAW & BENEFIT REVIEWCASE LAW & BENEFIT REVIEWCliff Wilson, EsquireCliff Wilson, Esquire

HOWARD, TATE, SOWELL, WILSON & BOYTEHOWARD, TATE, SOWELL, WILSON & BOYTE

Richard Murrell, Assistant DirectorRichard Murrell, Assistant Director

BENEFIT REVIEW DIVISION, DEPT OF LABOR & WFDBENEFIT REVIEW DIVISION, DEPT OF LABOR & WFD

ANSWER THIS!ANSWER THIS!



QUESTION: How much will the MedicareQUESTION: How much will the Medicaredeficit be in 40 years?deficit be in 40 years?

– $31 Trillion$31 Trillion

QUESTION: How much is S-CHIPQUESTION: How much is S-CHIPprojected to collect in fines over the next 5projected to collect in fines over the next 5

years?years? – $1.1 Billion$1.1 Billion

THE S-CHIP Extension ActTHE S-CHIP Extension Act



The Centers for Medicare and MedicaidThe Centers for Medicare and MedicaidServices (CMS) held an Open Door ForumServices (CMS) held an Open Door Forum

Teleconference on October 1, 2008Teleconference on October 1, 2008regarding its efforts to implement theregarding its efforts to implement the

Mandatory Insurer Reporting (MIR) sectionMandatory Insurer Reporting (MIR) sectionof the Medicare, Medicaid, and SCHIPof the Medicare, Medicaid, and SCHIP

Extension Act of 2007 (MMSEA). Town hallExtension Act of 2007 (MMSEA). Town hall

meetings continue. The next is scheduledmeetings continue. The next is scheduledfor September 30, 2009for September 30, 2009



CMS continues to update with supplementalCMS continues to update with supplementalalertsalerts

March 26,March 26,

April 7,April 7,

May 11,May 11,July 13,July 13,

July 17,July 17,

July 31,July 31,

August 24,August 24,Version 2.0 User Guide now available on websiteVersion 2.0 User Guide now available on website



TermsTermsNGHP – Non Group Health PlansNGHP – Non Group Health Plans

MIR - Mandatory Insurer ReportingMIR - Mandatory Insurer Reporting

MMSEA- Medicare Medicaid & SCHIPMMSEA- Medicare Medicaid & SCHIPExtension ActExtension Act

Section 111 – When a claim needs to beSection 111 – When a claim needs to be

reportedreported




Non-GHP includes Liability Insurance (includingNon-GHP includes Liability Insurance (includingSelf-Insurance), No-Fault Insurance, andSelf-Insurance), No-Fault Insurance, andWorkers’ Compensation.Workers’ Compensation.

Responsible Reporting Entities (RREs) are:Responsible Reporting Entities (RREs) are:CarriersCarriers

Self InsuredsSelf Insureds

Joint poolsJoint pools

State assigned fundsState assigned fundsTPA is not a RRE, except to the extent it mightTPA is not a RRE, except to the extent it mightself insure its own WC and liability exposures.self insure its own WC and liability exposures.



Recent developmentRecent developmentWho Needs to Report?Who Needs to Report?

July 31 alert.July 31 alert.

Drafted with “proposed language”Drafted with “proposed language”



WC “Proposed”WC “Proposed”Defines RREDefines RRE

Plan directly funded = Self insuredPlan directly funded = Self insured

Plan indirectly funded = Insurer/ carrier Plan indirectly funded = Insurer/ carrier



Liability “Proposed”Liability “Proposed”Same principlesSame principles

Entity that gets paid a premium to payEntity that gets paid a premium to payclaims is the RREclaims is the RRE

No Fault – N/A in TennesseeNo Fault – N/A in Tennessee



Deductible amounts questionDeductible amounts question

What if liability is ultimately with an excessWhat if liability is ultimately with an excess

carrier?carrier?

““Up to deductible amounts” CMSUp to deductible amounts” CMS

considers you to be self insured so mustconsiders you to be self insured so mustreportreport



What about pools?What about pools?

Three criteriaThree criteria

1. WC self insurance pool is a separate1. WC self insurance pool is a separatelegal entitylegal entity

2. With2. With full responsibility full responsibility to resolve andto resolve andpay for claims using pool fundspay for claims using pool funds

3. Without involvement of participating3. Without involvement of participatingemployer employer




If an entity (such as a TPA) is acting as anIf an entity (such as a TPA) is acting as anAgent for multiple RREs, the Agent mustAgent for multiple RREs, the Agent mustsubmit a separate electronic reporting filesubmit a separate electronic reporting file

for each RRE.for each RRE.

If the RRE uses an agent, the RREIf the RRE uses an agent, the RRE

remains ultimately liable under section 111remains ultimately liable under section 111



New issues:New issues:BankruptcyBankruptcy

If paid on behalf of another entity from thatIf paid on behalf of another entity from that

other entity’s assets ( guarantee fund)other entity’s assets ( guarantee fund)entity that makes payment is the RREentity that makes payment is the RRE

If Employer pays directly, then RREIf Employer pays directly, then RRE




The first step in complying with the MIR will beThe first step in complying with the MIR will becompleted by the RRE submitting registration data to thecompleted by the RRE submitting registration data to theCOBC via its secure website portal; the COBSW.COBC via its secure website portal; the COBSW.

Date for Registering begins May 1, 2009 throughDate for Registering begins May 1, 2009 through

September 30, 2009September 30, 2009

The RRE must be the one to complete the registrationThe RRE must be the one to complete the registrationprocess. The RRE may assign an Agent for ongoingprocess. The RRE may assign an Agent for ongoing

reporting at that time by completing the Agentreporting at that time by completing the AgentRegistration section. Agents are NOT permitted toRegistration section. Agents are NOT permitted tocomplete the registration processcomplete the registration process




The first step in complying with the MIR will be completed by theThe first step in complying with the MIR will be completed by theRRE submitting registration data to the COBC via its secure websiteRRE submitting registration data to the COBC via its secure websiteportal; the COBSW (still under construction).portal; the COBSW (still under construction).

The RRE must be the one to complete the registration process. TheThe RRE must be the one to complete the registration process. Theperson reporting is the Authorized representative. (AR) RRE mustperson reporting is the Authorized representative. (AR) RRE mustalso name an Account Manager. (AM)also name an Account Manager. (AM)

The RRE may assign an Agent (Account Designee) (AD) for The RRE may assign an Agent (Account Designee) (AD) for ongoing reporting at that time by completing the Agent Registrationongoing reporting at that time by completing the Agent Registrationsection.section.

Agents are NOT permitted to complete the registration processAgents are NOT permitted to complete the registration process



Important dates:Important dates:““Query function Testing Period” July 1, 2009Query function Testing Period” July 1, 2009beginsbegins

First “Claim input file testing” will be scheduledFirst “Claim input file testing” will be scheduled

January 1, 2010 through March 31, 2010January 1, 2010 through March 31, 2010

However, if RREs complete testing beforeHowever, if RREs complete testing before1/10/10, they may begin submitting live files in1/10/10, they may begin submitting live files inthe October-December 2009 quarter the October-December 2009 quarter

April 1, 2010 through June 30, 2010 BeginApril 1, 2010 through June 30, 2010 BeginOfficial production of claim input file submissionsOfficial production of claim input file submissions




Reporting will be quarterly.Reporting will be quarterly.

CMS has established two reporting triggers. Cases involvingCMS has established two reporting triggers. Cases involvingMedicare beneficiaries should be reportedMedicare beneficiaries should be reported

(1) when responsibility for the claim has been assumed by the RRE(1) when responsibility for the claim has been assumed by the RREORM = “Ongoing Responsibility for Medical Payments”ORM = “Ongoing Responsibility for Medical Payments”

Two reportable events:Two reportable events:

1) When assumes ORM determination is made1) When assumes ORM determination is made

2) When ORM Terminates2) When ORM Terminates

Date of July 1, 2009 determines responsibilityDate of July 1, 2009 determines responsibility



(2) when the RRE's responsibility for the claim has been terminated(2) when the RRE's responsibility for the claim has been terminated

by a settlement, judgment or award, or other payment on or after Julyby a settlement, judgment or award, or other payment on or after July

1, 2009. TPOC1, 2009. TPOC

TPOC= Total Payment obligation to the claimantTPOC= Total Payment obligation to the claimant

One time lump sum paymentOne time lump sum payment

Note: In disputed/denied claims where no responsibility for the claimNote: In disputed/denied claims where no responsibility for the claim

has been assumed by the RREhas been assumed by the RRE ANDAND no payment is made by theno payment is made by the

RRE, reporting is not needed until there is a settlement, judgment or RRE, reporting is not needed until there is a settlement, judgment or

award, or other paymentaward, or other payment




Date of injury, settlement date, andDate of injury, settlement date, andexhaust information are required reportingexhaust information are required reportingdata elements.data elements.

If CMS has regulatory definitions of termsIf CMS has regulatory definitions of termsthey will utilize those definitions even if they will utilize those definitions even if they do not comport with industrythey do not comport with industry

definitions of the terms.definitions of the terms.Example, Closed files vs. inactive filesExample, Closed files vs. inactive files



Penalty:Penalty:

$1000 per day $1000 per day



ResourcesResourceshttp://www.cms.hhs.gov/MandatoryInsRephttp://www.cms.hhs.gov/MandatoryInsRep

Questions?Questions?

** Al l i h lifi d hAl lt ith lifi d tt h



** Always consult with a qualified attorney such as:Always consult with a qualified attorney such as:

Denny Crane of Boston LegalDenny Crane of Boston Legal



LEGAL PANEL DISCUSSIONLEGAL PANEL DISCUSSION



RECENT DEVELOPMENTS AT CMSRECENT DEVELOPMENTS AT CMS

John Barringer, EsquireJohn Barringer, EsquireMANIER & HERODMANIER & HEROD

CASE LAW & BENEFIT REVIEWCASE LAW & BENEFIT REVIEW

Cliff Wilson, EsquireCliff Wilson, EsquireHOWARD, TATE, SOWELL, WILSON & BOYTEHOWARD, TATE, SOWELL, WILSON & BOYTE

Richard Murrell, Assistant DirectorRichard Murrell, Assistant DirectorBENEFIT REVIEW DIVISION, DEPT OF LABOR & WFDBENEFIT REVIEW DIVISION, DEPT OF LABOR & WFD



Public Chapter 486Public Chapter 486 – Communication – Communication

with Authorized Treating Physicianwith Authorized Treating Physician



Old - T.C.A § 50-6-204 (1)(2)Old - T.C.A § 50-6-204 (1)(2)

– Allowed Certain Records to be ReleasedAllowed Certain Records to be Released

Without ConsentWithout Consent – All Treatment Required “As Ordered byAll Treatment Required “As Ordered by

Attending Physician”Attending Physician”

– Covered Any Medical Provider WhereCovered Any Medical Provider WhereOrigin of Injury Was Work–RelatedOrigin of Injury Was Work–Related







BOTTOM LINEBOTTOM LINE

________________________________ ________________________________

YOU NEED A RELEASE! YOU NEED A RELEASE!

PRE JULY 1, 2009 INJURIES & POST JULY 1, 2009 INJURIESPRE JULY 1, 2009 INJURIES & POST JULY 1, 2009 INJURIES





Discovery – Safety NetDiscovery – Safety Net

–Subpoenas – Pre-Existing RecordsSubpoenas – Pre-Existing Records

–Discovery DepositionsDiscovery Depositions

Public Chapter 599Public Chapter 599

Maximum Total BenefitMaximum Total Benefit



MAXIMUM TOTAL BENEFITMAXIMUM TOTAL BENEFIT

50-6-102 (13)50-6-102 (13)

– OLDOLD -- 400 x Comp Rate up to State Average400 x Comp Rate up to State AverageWeekly WageWeekly Wage

– NEWNEW – – 400 x State Average Weekly Wage400 x State Average Weekly Wage

Plus TTDPlus TTD

THE SUPREME COURT OF TENNESSEETHE SUPREME COURT OF TENNESSEE

SPECIAL WORKERS’ COMPENSATION APPEALS PANELSPECIAL WORKERS’ COMPENSATION APPEALS PANEL



KENNETH CONAWAY v. U.S. PIPE AND FOUNDRYKENNETH CONAWAY v. U.S. PIPE AND FOUNDRYCOMPANY ET AL.COMPANY ET AL.

– Employee filed a complaint seeking workers’Employee filed a complaint seeking workers’compensation benefits following a bench trial, thecompensation benefits following a bench trial, thetrial court found the employee to be totally andtrial court found the employee to be totally and

permanently disabledpermanently disabled – The employer appealed, contending that theThe employer appealed, contending that the

employee’s continuing employment as a pastor employee’s continuing employment as a pastor precluded a finding of total and permanent disabilityprecluded a finding of total and permanent disability

– An Appeals Panel reversed the trial court’sAn Appeals Panel reversed the trial court’s

conclusion that the employee was totally andconclusion that the employee was totally andpermanently disabled and modified the award topermanently disabled and modified the award toseventy-two percent (72%) permanent partialseventy-two percent (72%) permanent partialdisability to the body as a wholedisability to the body as a whole





KENNETH CONAWAY v. U.S. PIPE AND FOUNDRYKENNETH CONAWAY v. U.S. PIPE AND FOUNDRYCOMPANY ET AL.COMPANY ET AL.

– The Employee, who had resigned as a pastor beforeThe Employee, who had resigned as a pastor beforethe Appeals Panel decision was issued, filed a motionthe Appeals Panel decision was issued, filed a motionfor modification pursuant to Tenn. Code Ann. § 50-6-for modification pursuant to Tenn. Code Ann. § 50-6-231(2) (2008).231(2) (2008).

– Following a second evidentiary hearing, the trial courtFollowing a second evidentiary hearing, the trial courtagain found that the employee is permanently andagain found that the employee is permanently andtotally disabled.totally disabled.

– The employer appeals contending that the employeeThe employer appeals contending that the employee

failed to present sufficient proof that he sustained anfailed to present sufficient proof that he sustained anincrease of incapacity solely as a result of his work-increase of incapacity solely as a result of his work-related injury. We affirm the judgment of the trial court.related injury. We affirm the judgment of the trial court.





LISA SHELTON v. CENTRAL MUTUAL INSURANCELISA SHELTON v. CENTRAL MUTUAL INSURANCECOMPANYCOMPANY

– Employee was found to be permanently and totallyEmployee was found to be permanently and totallydisabled as a result of a work-related injury. In Januarydisabled as a result of a work-related injury. In January2006, he died as a result of an overdose of prescription2006, he died as a result of an overdose of prescription

medication. His widow sought workers’ compensationmedication. His widow sought workers’ compensationdeath benefits, alleging that his death was the directdeath benefits, alleging that his death was the directresult of his prior work injury. Employer filed a motionresult of his prior work injury. Employer filed a motionfor summary judgment, contending that the medicalfor summary judgment, contending that the medicalevidence was insufficient.evidence was insufficient.

– The trial court granted the motion. Employee’s widowThe trial court granted the motion. Employee’s widow

has appealed.has appealed. – Judgment reversed and remanded for further Judgment reversed and remanded for further

proceedingsproceedings





THOMAS MICHAEL ROSS v. DELTA INDUSTRIALTHOMAS MICHAEL ROSS v. DELTA INDUSTRIALCOATINGS, INC. ET AL.COATINGS, INC. ET AL.

– Employee was injured when lifting a can of paint atEmployee was injured when lifting a can of paint at

work. Employee’s treating physicianswork. Employee’s treating physicians

recommended surgery, but Employee refusedrecommended surgery, but Employee refusedsurgical treatmentsurgical treatment

– The trial court found that Employee had sustainedThe trial court found that Employee had sustaineda 60% permanent partial disability (“PPD”). Thea 60% permanent partial disability (“PPD”). The

court also found that the date of maximum medicalcourt also found that the date of maximum medicalimprovement (“MMI”) was January 26, 2007, andimprovement (“MMI”) was January 26, 2007, andthat Employee was entitled to temporary totalthat Employee was entitled to temporary total

disability (“TTD”) until that datedisability (“TTD”) until that date





THOMAS MICHAEL ROSS v. DELTA INDUSTRIALTHOMAS MICHAEL ROSS v. DELTA INDUSTRIALCOATINGS, INC. ET AL.COATINGS, INC. ET AL.

– Employer appealed, arguing that the trial courtEmployer appealed, arguing that the trial court

erred in its determination of the date of MMI anderred in its determination of the date of MMI and

that the award of PPD is excessive.that the award of PPD is excessive. – WC Panel concluded that the evidence did notWC Panel concluded that the evidence did not

preponderate against the trial court’s findingspreponderate against the trial court’s findingsconcerning the impairment rating and vocationalconcerning the impairment rating and vocational

disability and reversed the trial court’s finding as todisability and reversed the trial court’s finding as tothe date of maximum medical improvementthe date of maximum medical improvement





CONNIE ERDMAN v. SATURN CORPORATIONCONNIE ERDMAN v. SATURN CORPORATION

– On appeal, Employee contends that the trial courtOn appeal, Employee contends that the trial courterred in two ways:erred in two ways:

By finding that Employee’s permanent partial disabilityBy finding that Employee’s permanent partial disabilityaward should be capped at one and one-half times her award should be capped at one and one-half times her medical impairment rating;medical impairment rating;

Second, in finding that Employee is not entitled toSecond, in finding that Employee is not entitled toreconsideration of a prior injury to her left shoulder.reconsideration of a prior injury to her left shoulder.

Because the evidence does not preponderate againstBecause the evidence does not preponderate againstthe findingsthe findings WC Appeals Panel affirmed the judgment of the trialWC Appeals Panel affirmed the judgment of the trial

court.court.

Agenda





8:30 - 9:30 Douglas J. Holmes – National Issues Impacting Workers’ Compensation

9:30 – 10:00 Leslie Newman, John Morris & Mike Shinnick - Commerce & Insurance










Agenda





8:30 - 9:30 Douglas J. Holmes – National Issues Impacting Workers’ Compensation

9:30 – 10:00 Leslie Newman, John Morris & Mike Shinnick - Commerce & Insurance












Reminder:Reminder:

Conference Evaluation FormsConference Evaluation Forms

Recycle Name BadgesRecycle Name Badgesat Registration Tableat Registration Table



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