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Workers’ Compensation Medical Prices Were Higher and Grew More Rapidly in States without Medical Fee Schedules, Says New WCRI Study

The prices paid for medical professional services for injured workers were higher and rising faster in states without fee schedules compared with states that have them in place, according to a new study from the Workers Compensation Research Institute (WCRI), Medical Price Index for Workers’ Compensation, Fourth Edition (MPI-WC).

Cambridge, MA (PRWEB) March 29, 2012

The prices paid for medical professional services for injured workers were higher and rising faster in states without fee schedules compared with states that have them in place, according to a new study from the Workers Compensation Research Institute (WCRI), Medical Price Index for Workers’ Compensation, Fourth Edition (MPI-WC).

The WCRI study is designed to help public policymakers and system stakeholders understand how prices paid for medical professional services for injured workers in their states compare with other states and know if prices in their state are rising rapidly or relatively slowly. They can also learn if the reason for price growth in their state is part of a national phenomenon or whether the causes are unique to their state and hence, subject to local management or reform.

“In documenting the growing prices paid for the medical care received by injured workers, this unique study also shows the effectiveness of medical fee schedules in controlling those costs,” said Dr. Richard Victor, executive director of WCRI.

For example, six states in the 25-state study-Indiana, Iowa, Missouri, New Jersey, Virginia, and Wisconsin-had no medical fee schedules as of 2011. The prices paid for professional services in Virginia, Missouri, New Jersey, Iowa, and Indiana were 27 to 51 percent higher than the median of the study states with fee schedules and the prices in Wisconsin were more than twice the median of the study states with fee schedules, the highest of all the study states.

States without fee schedules also saw more rapid price growth over the 2002 – 2011 study period, with prices in Missouri, Indiana, Iowa, Virginia, and New Jersey rising 32 to 38 percent, compared with the median growth rate of 14 percent for the study states with fee schedules. The prices in Wisconsin experienced the most rapid growth among the 25 study states, rising 50 percent.

The study also found that changes in fee schedules were an important factor driving changes in actual prices paid for professional services.

In addition, the study reported that in states with certain services not covered by their fee schedules, the prices paid for those services often grew more rapidly than those for the services covered by the fee schedules.

Unlike the consumer price index for medical care (CPI-M), which measures general prices paid for medical goods and services, the MPI-WC focuses only on the prices paid for the medical care that injured workers receive under their state’s workers’ compensation system.

The MPI-WC tracks medical prices paid in 25 large states from calendar year 2002 through June 2011 for nonhospital, nonfacility services billed by physicians, physical therapists, and chiropractors. The medical services fall into eight major groups: evaluation and management, physical medicine, surgery, major radiology, minor radiology, neurological and neuromuscular testing, pain management injections, and emergency care.

The 25 states included in the MPI-WC, which represent nearly 80 percent of the workers’ compensation benefits paid in the United States, are Arizona, Arkansas, California, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

Click here to download a free copy of this report.

NY factory owner where worker died is arrested

NEW YORK — The owner of a Brooklyn tortilla factory where a worker died after falling into a waist-high dough mixing machine has been arrested.

Erasmo Ponce was charged with underpaying employees, falsifying business records, violating workers’ compensation and unemployment insurance laws.

Authorities said Wednesday Ponce surrendered Tuesday and was released on bail.

According to The New York Times (http://nyti.ms/H1PvDQ ), his lawyer said he didn’t’ believe the case merited criminal prosecution.

Days after the Jan. 24, 2011, death of the worker, Juan Baten, the Tortilleria Chinantla (tor-tih-REE’-ah chee-NAHNT’-lah) was shuttered by state officials for operating without workers’ compensation insurance.

The factory eventually reopened, but last July federal authorities cited it for workplace safety violations. The most serious violation was failure to install a barrier on the mixer.

The company is contesting the citations.

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Information from: The New York Times, http://www.nytimes.com

Injuries Suffered on Break – Workers Compensation

A New York Court has ruled that workers injured while on break are entitled to receive workers compensation benefits.

March 07, 2012 /24-7PressRelease/ — During the work day there are often many opportunities to be injured. Depending on people’s jobs, dangers could lurk near machinery, in the form of slippery floors or in a cubicle from repetitive motions. However, many people often don’t consider the time taken for a break to be a particularly hazardous; yet, workers can be and are injured while taking breaks.

Recently, in the case of Richard Potter Jr. vs. VM Paolozzi Imports Inc., an appellate court in New York had to decide whether a worker who sustained injuries while on break was entitled to receive workers’ compensation benefits. And, according to the court, he was.

In the Potter case, a worker asked his supervisor if he could take a break and use his personal vehicle to go and pick up lunch. Permission was granted, but while returning to work, he was involved in an automobile accident

The appeals court agreed with the Workers Compensation Board that short breaks are not an interruption of employment because they are “closely related” to workers “performance of the job,” according to Insurance Journal. The appeals court also found that this particular employer routinely allowed workers leave the premises while on break. And, in this case, the employee had only been gone a short while and was on his way back to work when he was injured.

In general, workers who are injured during the workday — whether while performing their job or while on break — will be entitled to receive workers’ compensation benefits. However, each case is different and the determination of whether an employee injured while on break will be entitled to benefits or not will depend on the unique facts of the case.

If you are an employee who has been injured while working in New York, you may be entitled to benefits to help you while you are recovering. Speak with an experienced workers’ compensation attorney if you are seeking benefits or have had your benefits request denied.

N.Y. Workers’ Comp Board Moving to Electronic Claims Reporting

The New York State Workers’ Compensation Board is transitioning from a paper to an electronic employer report of injury system.

The board will adopt the IAIABC (International Association of Industrial Accident Boards and Commissions) Claims Electronic Data Interchange (EDI) Standard Release 3.0. Currently, the board accepts New York-specific claims information from employers and insurance carriers through paper submission. But beginning in early 2013, these submissions will be required to match the IAIABC standard and be made electronically.

Founded in 1914, the IAIABC is a not-for-profit trade association representing government entities who administer workers’ compensation systems.

“Electronic filing will reduce system waste and increase efficiency-meaning businesses will save while injured workers will receive their benefits faster,” the board’s executive director Jeffrey Fenster said. “We are working closely with employers and insurers in the workers’ compensation industry to ensure a seamless transition to electronic filing.”

More than 30 states currently use or are planning to use the IAIABC EDI standard for claim submissions. Most national insurance carriers already utilize this standard. The board will implement the mandate of electronic reporting in phases beginning with those national carriers that use IAIABC EDI in other states.

Based on the experience of other states that have implemented the IAIABC standard, the board anticipates that its adoption in New York will yield significant benefits, including:

• Improving the timely delivery of benefits to injured workers

• Providing a single, consistent data format

• Reducing waste, abuse, and delay in the system

• Reducing paper handling costs to system participants outside the Board, i.e., handling, completing, and shipping

• Reducing high costs to the Board for handling, processing, and scanning paper documents as well as certain data entry costs

• Reducing duplicative claim form filings

• Increasing the quality and timeliness of information received by the Board

• Improving data collection for system oversight and policy making

Mario Cilento, president of the New York State AFL-CIO, welcomed the change. “The heart of the workers’ compensation system is delivering benefits to injured workers when they need them. Labor supports implementing the new paperless standard, which will quicken the delivery of benefits,” he said.

“Anytime we can streamline that process without compromising the integrity of the system, injured workers are better served. The data collected will also lead to improved information for policy-making in the future. We appreciate the Board’s efforts to improve the delivery of service in this area.”

More information on the electronic claims filing process can be found on the New York State Workers’ Compensation Board’s website.

Source: New York State Workers’ Compensation Board

 

Are Four Limbs Worth $18 Million? Quadruple Amputee Gets Big Settlement From NYC, Brooklyn Hospital

Four years after her horrible ordeal began 32-year-old Tabitha Mullings, who became a quadruple amputee after a hospital “mistake,” is getting a hefty $17.9 million payday. After three years going through the courts, Brooklyn Hospital and its doctors have agreed to settle and fork over $9.4 million (the city will pay $8.5 million). Not quite the $100 million she originally was shooting for, but nothing to scoff at either.

Brooklyn Hospital, however, still says it gave Mullings “excellent care.” It just “decided to settle because a sympathetic jury would have been swayed by her ‘profound’ injuries.”

You’ll recall that back in September of 2008, Mullings went to Brookln Hospital in pain and was diagnosed with a kidney stone. She received painkillers and was sent home. But it turned out she had an infection that “choked off blood flow to her hands and feet and she lapsed into a semi-coma for two weeks,” leaving gangrene to set in. Doctors eventualy had to amputate all her limbs and she was left blind in one eye. She now wears her engagement ring around her neck.

Still, Mullings hasn’t let her setbacks bring her down, too much. Told of the settlement today the mother of three boys said, “Now that the lawsuit is behind me, I look forward to going on with my life and caring for my children the best I can. I pray what happens to me never happens to anyone again.”

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