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State lawmakers are considering altering workers’ compensation guidelines adopted last year that injured workers complain have resulted in reduced or denied medical treatment.

The debate centers on medical treatment guidelines for injured workers that the Workers’ Compensation Board adopted on Dec. 1, 2010.

Advocates for injured workers claim those guidelines should not apply retroactively to workers whose cases predate last Dec. 1, sometimes by years. They say the guidelines are interfering with care and causing confusion among health care providers.

But supporters of the guidelines say there ought to be a uniform standard of medical care for all cases in the system. And they say the guidelines help medical professionals identify whether the care patients receive is of good quality and is actually helping them restore function.

Legislation proposed in the State Senate and Assembly would tweak the guidelines so that they apply only to cases from Dec. 1, 2010 onward. State Sen. George Maziarz, R-Newfane, sponsored the Senate legislation. The Assembly version, sponsored by Assemblyman Keith Wright, D-Harlem, passed the Assembly on Monday.

Groups such as the New York Workers’ Compensation Alliance have opposed the medical treatment guidelines. “Carriers have denied treatment and medication in numerous cases, which has resulted in a flood of variance requests,” said Robert Grey, the Alliance’s chairman, in a letter to the Workers’ Compensation board’s chairman.

The Alliance argues that the guidelines are illegal, contending they violate sections of the workers’ compensation law.

Maziarz’s office received complaints from some constituents who had been receiving chiropractic care for workers’ compensation-related issues, but were impacted by the changes implemented last December, said Adam Tabelski, a spokesman for Maziarz.

The Business Council of New York State is among the opponents of the legislation. The group argues the Workers’ Compensation board’s guidelines should apply to every case, and that their adoption was a significant part of workers’ compensation reform in 2007.

“The legislation seeks to set two different standards of care for injured workers,” said Margaret Moree, director of federal affairs for the Business Council.

Moree said the guidelines do not preclude a medical professional from seeking to extend treatment for a patient if that treatment is showing progress. And she said costs are not the only issue.

“This was as much about ensuring people were getting quality care consistent with medical evidence,” she said.

The fate of the legislation was uncertain on Tuesday, as the State Legislature’s session was winding down. While the bill passed the Assembly, it was unclear if it would reach the Senate floor for a vote.

mglynn@buffnews.com

NEW YORK – New York City paid nearly $521 million in personal injury and property damage claims in 2010 — marking the first time in 30 years that the police department’s liabilities topped those of public hospitals, according to a city comptroller’s report issued on Wednesday.

The total payout, though, is down 7 percent from the previous year.

New York City comptrollers settle and adjust claims against the city for injuries, such as falls caused by flawed sidewalks, and other liabilities such as tuition for pupils with special needs beyond the scope of public schools.

In his report for fiscal 2010, Comptroller John Liu said that personal injury claims settled before litigation cost an average of $14,506. That figure is just under half the sum of $24,269 that the city had to pay after court proceedings had started.

New York City has the nation’s biggest public hospital system. When it comes to personal injury claims, medical malpractice was the costliest category, at $130 million.

The second-costliest category was the almost $79 million paid for civil rights judgments.

“Most of the increase was due to the December 2009 settlement of a $33 million class-action case that challenged strip-search procedures in Department of Corrections facilities,” the report said.

POLICE ACTION CLAIMS JUMP

Ranked third were motor vehicle settlements at $65 million, followed by $56 million for police actions claims, such as false arrest or excessive force or assault.

Last year marked the highest number of new police action filings in the last five fiscal years, the report said.

The total amount of settlements and tort claims for the Police Department was nearly $136 million in both 2009 and 2010.

The Health and Hospitals Corporation, which runs the public hospitals and serves 450,000 people a year who have no insurance, had around $134 million in claims in both years.

Last year also set the record for new personal injury and property damage claims: 32,913 were filed. This increase “can be attributed to the unprecedented filing of new claims related to the injuries claimed by those working or living at or near the World Trade Center site after the attacks of September 11, 2001,” the report said, noting they were 20 percent of the total.

For years, city comptrollers have tried to slice the costs of judgments, by using an electronic settlement program and pursuing out-of-court solutions. But not that much progress has been made since the $589 million record high hit in 2001.

Mayor Michael Bloomberg has estimated that these liabilities will cost the city $655 million in the new fiscal year that starts July 1, the report said, estimating that was about $50 million more than will be needed.

New York City’s Law Department defends the city from claims and in a statement it said its “risk management strategies” were succeeding. Total tort payments are down nearly 12 percent since 2001.

That is the year the mayor won his first four year term. The former Republican, now an independent, is now serving his third four-year term.

“The sidewalk law we drafted has saved the city millions of dollars in ech of the past two years — about $35 million a year,” the Law Department added. Settling non-frivolous cases early has also cut costs.

For the full report, see: http://www.comptroller.nyc.gov/bureaus/bla/pdf/2011_Claims_Report.pdf

Case name: Poli v. Taconic Correctional Facility, et al., No. 510991 (N.Y. App. Div. 04/21/11).

Ruling: The New York Supreme Court, Appellate Division affirmed the Workers’ Compensation Board’s ruling that a correction officer was disqualified from receiving future wage replacement benefits based on his false statements on a patient intake form in which he denied any history of a back injury.

What it means: In New York, when a worker has a prior back injury but denies it on a patient intake form and during a medical examination, the worker may be disqualified from receiving future wage replacement benefits.

Summary: A correction officer sought workers’ compensation benefits after falling at work and allegedly injuring his lower back, shoulder, neck, arms, and legs. Evidence indicated that he previously suffered multiple nonwork-related herniated disks in his lower back and missed three months of work as a result of that injury. Both the treating doctor and an independent medical examiner testified that after the officer’s work injury, he denied having any history of back injury on the patient intake form. The medical examiner also testified that he specifically asked the officer if he experienced prior back pain, and the officer denied it, which was noted in the examination report. When questioned regarding these denials, the officer stated that either he was not asked or could not recall being asked about prior back pain.

The New York Supreme Court, Appellate Division affirmed the Workers’ Compensation Board’s ruling that officer was disqualified from receiving future wage replacement benefits based on his false statements.

In light of the testimony of both doctors, the court deferred to the board’s credibility determination against the officer and found substantial evidence supported the ruling that the officer made false representations regarding a material fact. Also, the board provided a sufficient explanation to warrant the discretionary penalty of disqualification from wage replacement benefits.

Source: SB County

Recommended Actions: That the Board of Supervisors: Approve and authorize the Chair to execute a standard agreement with Corvel Enterprise Company (Corvel), not a local vendor, to:

A. Review all workers’ compensation medical bills and to report medical bill payment information to the State of California as required by regulations, for one year beginning July 1, 2011, and ending June 30, 2012, at a cost not to exceed $700,000, and;

B. Provide the workers’ compensation claims administration for all open claims occurring prior to July 1, 2010 (tail claims) for a one-time payment of $302,204.17, which is contingent upon Corvel also providing the workers’ compensation bill review service.

Summary Text: Last year, Risk Management processed 11,751 medical bills totaling approximately $13,309,320. By utilizing our current vendor’s (StrataCare) professional bill review service, at a cost of $429,039, we were able to reduce bills by approximately $7,298,193, a net 53% reduction in billed medical costs. Other years have produced similar results.

The contract with Corvel will replace our current vendor and provide a similar service for the County with further medical bill savings. The reduction in billed medical costs is expected to be about 70% as compared to the 53% savings realized last year with StrataCare. Furthermore, Corvel will provide mandated State reporting services, 24-hr online access, full scanning/OCR and mandatory reporting to the Centers for Medicare & Medicaid Services at no additional cost.

Background: The County of Santa Barbara moved to a Primary Workers’ Compensation Program offered through CSAC-Excess Insurance Authority (CSAC-EIA) on July 1, 2010. This means all the Workers’ Compensation claims occurring after that date are paid for through that Primary Insurance Program. Corvel is the CSAC-EIA third-party claims administration firm handling those claims. The claims that occurred prior to July 1, 2010 are self-administered by County’s Risk Management Division; however, approximately 218 of the 500 self-insured claims (aka tail claims) are being administered by Corvel, via a service contract which will now become incorporated into this board contract.

The one-time cost of $302,204.17 for the administration of all the tail claims with no further annual fee is less than the payroll expenses of three in-house Worker’s Compensation Risk Analysts for one year that would be required to handle all 500 claims. There are other ancillary savings as well. The County of Santa Barbara is self-insured for Workers’ Compensation claims occurring prior to July 1, 2010 and is responsible for reviewing medical bills to ensure that the amount paid does not exceed the standard fee schedule or other negotiated rate with the medical services provider. While there is no mandate to conduct medical bill review, best practices of claims administration and risk management typically use outside bill review specialists to ensure that the lowest possible cost is paid for medical services. The bill review service has been contracted out by the County for over eighteen years. The fees for the service are charged directly to the individual workers’ compensation claims and are based on a percentage of the medical bill savings. Combining the claims administration of the tail claims along with bill review/reporting service under one vendor is more efficient, economical and easier. Fiscal and Facilities Impacts:

Budgeted: Yes Narrative: Costs are included in the budget for Fund 1911, an Internal Service Fund.

NEW YORK — A new report shows New York City paid nearly $521 million to settle personal injury and property damage lawsuits in 2010, with three agencies accounting for 67 percent of all settlements.

City Comptroller John C. Liu released the report Wednesday, showing that the amount paid has decreased by seven percent since 2009.

But Liu said city agencies need to continue to work to reduce the cost of litigation and settlements.

The three agencies with the most settlements were the New York City Police Department, the Health and Hospitals Corp. and the Department of Transportation.

The city’s Law Department said the total payouts have decreased by about 12 percent since 2001. They say a combination of tort reform and risk management strategies have helped to reduce settlements.
—Copyright 2011 Associated Press