New Reforms Introduced for Workers’ Compensation

Meaningful workers’ compensation reforms were passed in the April 2017 budget, which John T. McDonald III - Member New York State Assembly highlighted in one of his recent postings in times union. Undoubtedly, workers’ compensation benefits granted after stringent medical records review are focused on making available the best treatment and care for injured employees, ensuring that the compensation reaches deserving workers. However, reforms are considered long overdue – while employers are burdened by rising costs, employees who with good reason feel they have been ignored have been expressing increasing dissatisfaction. The main problem is that serious effort is not taken in trying to get the injured employee back into the workforce. The reforms enacted are expected to ensure cost savings for employers as well as improved protection for injured employees.

New Reforms Introduced for Workers’ Compensation

Workers’ compensation benefits are granted after stringent medical records review. Here are Permanent Partial Disability (PPD) (non-schedule PPD) the latest reforms introduced.

Following are some of the important aspects of the reform legislation.

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Workers’ Compensation Law (WCL) § 15(3) (w) is being amended to provide a credit for periods of temporary disability that extend beyond 2.5 years or 130 weeks from the date of injury. This rule is applicable to all injuries with dates of accident or disability after April 9, 2017. Payers may receive a credit against the maximum benefits payable for PPD for any periods of temporary disability paid beyond the 130 weeks or 2.5 years.

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Safety valve: The reform creates a safety valve that extends the period of temporary disability beyond 2.5 years, when the WC Board makes a determination that the claimant has not yet reached maximum medical improvement on that date. Further guidance regarding application of the safety valve is expected to be released by the Board soon. This rule is applicable to all injuries with dates of accident/disability on or after April 10, 2017.

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Extreme Hardship Determination Threshold: The Board has lowered the threshold for determining when a claimant with a PPD may apply for a redetermination due to extreme hardship. Now, claimants who are found to have a LWEC (loss of wage earning capacity) of more than 75% (earlier this was greater than 80%) can apply for such determination. This rule takes effect immediately and applies also to claimants whose claims were earlier adjudicated with a LWEC greater than 75%.

Post PPD labour market attachment: After the Board makes a determination of permanent partial disability, a claimant entitled to benefits at the time of classification is no longer required to prove ongoing labor market attachment. The change in statute does not affect the I want an infograph created for this as well as a PPT which can go

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Meaningful workers’ compensation reforms were passed in the April 2017 budget, which John T. McDonald III - Member New York State Assembly highlighted in one of his recent postings in times union. Undoubtedly, workers’ compensation benefits granted after stringent medical records review are focused on making available the best treatment and care for injured employees, ensuring that the compensation reaches deserving workers. However, reforms are considered long overdue – while employers are burdened by rising costs, employees who with good reason feel they have been ignored have been expressing increasing dissatisfaction. The main problem is that serious effort is not taken in trying to get the injured employee back into the workforce. The reforms enacted are expected to ensure cost savings for employers as well as improved protection for injured employees.

Following are some of the important aspects of the reform legislation.

Permanent Partial Disability (PPD) (non-schedule PPD) ➢

Workers’ Compensation Law (WCL) § 15(3) (w) is being amended to provide a credit for periods of temporary disability that extend beyond 2.5 years or 130 weeks from the date of injury. This rule is applicable to all injuries with dates of accident or disability after April 9, 2017. Payers may receive a credit against the maximum benefits payable for PPD for any periods of temporary disability paid beyond the 130 weeks or 2.5 years.

•

Safety valve: The reform creates a safety valve that extends the period of temporary disability beyond 2.5 years, when the WC Board makes a determination that the claimant has not yet reached maximum medical improvement on that date. Further guidance regarding application of the safety valve is expected to be released by the Board soon. This rule is applicable to all injuries with dates of accident/disability on or after April 10, 2017.

•

Extreme Hardship Determination Threshold: The Board has lowered the threshold for determining when a claimant with a PPD may apply for a redetermination due to extreme hardship. Now, claimants who are found to have a LWEC (loss of wage earning capacity) of more than 75% (earlier this was greater than 80%) can apply for such determination. This rule takes effect immediately and applies also to claimants whose claims were earlier adjudicated with a LWEC greater than 75%.

•

Post

PPD

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attachment:

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determination of permanent partial disability, a claimant entitled to benefits at the time of classification is no longer required to prove ongoing labour market attachment. The change in statute does not affect the

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(800) 670 2809

question of attachment during periods of temporary disability before classification. This rule also takes effect immediately.

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Mandatory Full Board Review: Any request for a Full Board Review will be considered as a request for Mandatory Full Board Review in an instance when a Board Panel reduces an LWEC finding to be below the safety net threshold, and the LWEC had earlier been determined by a workers’ compensation law judge to exceed the threshold.

Drug Formulary

By December 31, 2017 the Board is required to adopt a comprehensive pharmacy prescription drug formulary. Under this, drugs listed in the formulary may be prescribed for a causally-related condition. Non-preferred drugs can be prescribed only when a variance has been granted. This change will be effective on December 31, 2017. There will be a method for reviewing requests to add drugs to the preferred list, and this will be handled through the Medical Director’s Office (MDO).

Mandatory 45-day Hearing When there is medical proof of a work associated disability and the claimant is neither working nor receiving benefits, he/she can request a hearing that shall occur within 45 days of the Board’s receipt of the RFA-1. The RFA-1 is being revised to accommodate this request. The updated form and further guidance on the hearing process will be issued in the near future. This change is effective immediately.

Insurance-related Provisions ➢

The Insurance Law has been amended •

To extend the CIRB (Compensation Insurance Rating Board) tenure as a Rate Service Organization until 2028

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To require a public actuary to release an annual report on the savings to the industry-related to the 2017 Reforms in each of the next ten years

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To require insurers to refund current year savings due to the caps on injuries on or before December 31, 2018

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To require that workers’ compensation rate filings with 5% or greater increase over prior year’s loss costs would require a public hearing.

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The Board’s assessment fund balance allowance is reduced from up to 10% to no more than 5%.

Independent Medical Examination (IME) Study The Board must conduct a study on independent medical examinations in 2018. A new IME Advisory Committee will convene in 2019 to review the Board’s findings and make recommendations to improve the overall system.

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Stress Claims of First Responders Police officers, fire fighters, paramedics, EMTs, emergency dispatchers, emergency medical providers and other first responders who face tremendous stress in a workrelated emergency and file a claim for mental injury will not be barred from a compensable work-related stress claim.WCL § 30 remains fully in effect for police and fire fighters. This provision also takes effect immediately.

Reforms Related to Penalties These provisions take effect immediately. Penalties issued following WCL 25 (2) (a) can now be imposed without a hearing. These penalties may be imposed on a carrier who has failed to controvert or pay a claim within the 18 days required by that subdivision.

The Board may establish performance standards, and issue aggregate penalties against insurers or self-insured employers. It is expected that this will help the Monitoring Unit to more efficiently regulate carrier behaviour as regards timely filing, payment and controversy.

Permanent Impairment Guidelines The Chair of the Workers’ Compensation Board will adopt new Permanent Impairment Guidelines by January 1, 2018. These guidelines will incorporate advances in medicine that result in better healing and outcomes for injured employees to use in evaluations and determinations for schedule loss of use awards. These Guidelines will be published after consultation with business, labor and medical providers, insurance carriers and selfinsured employers. The Chair is required to publish the Guidelines for public comment pursuant to the State Administrative Procedure Act on or before September 1, 2017. If the guidelines are not adopted by January 1, 2017, the Board must adopt interim regulations. The New Impairment Guidelines will be effective on January 2, 2018.

Providers of medical review services, and the workers’ compensation attorneys / insurers/independent medical examiners they serve follow the developments in the workers’ compensation industry closely. It is indeed a great relief for all stakeholders to witness constructive efforts focused on reducing costs, ensuring the best care for injured workers, and encouraging a safer workplace.

www.mosmedicalrecordreview.com

(800) 670 2809