A recent study has confirmed what many of you already knew: California employers pay the highest workers' compensation costs in the nation – by a wide margin.
Although the study by the Oregon Department of Business and Consumer Services has ranked California consistently among the most expensive states for more than a decade, we have not been tagged with the #1 spot since 2004.
So, why does California continue to be so expensive? Some of the reasons include:
California has among the highest medical costs per workers’ compensation claim in the nation, and higher-than-average costs per claim for cash benefits. Since 2005, average costs per claim have increased by $30,000.
California’s rate of work injury claims per 1,000 workers is 46% higher than the national median. Since 2012, California’s “claim frequency” has been increasing, even as the rate in most states has declined. This includes a higher-than-average rate of “permanent disability” cla...
The minimum and maximum temporary total disability (TTD) rates for 2015 will increase on January 1, 2015. The minimum TTD rate will increase from $161.19 to $165.49 and the maximum TTD rate will increase from $1,074.64 to $1,103.29 per week.
Labor Code section 4453(a) (10) requires the rate for TTD be increased by an amount equal to percentage increase in the State Average Weekly Wage (SAWW) as compared to the prior year. The SAWW is defined as the average weekly wage paid to employees covered by unemployment insurance as reported by the U.S. Department of Labor for California for the 12 months ending March 31 in the year preceding the injury. In the 12 months ending March 31, 2014, the SAWW increased from $1,067.25 to $1,095.70—an increase of just under 2.6666 percent.
Under Labor Code section 4659(c), workers with a date of injury on or after Jan. 1, 2003 who are receiving life pensions (LP) or permanent total disability (PTD) benefits are also entitled to have their weekly LP or...
DIR Reduces Fees for Independent Medical Review, Independent Bill Review, by 25 Percent
The Department of Industrial Relations (DIR) has announced a reduction in Independent Medical Review and Independent Bill Review fees effective April 1, 2014. These new fees represent a 25 percent reduction. Parties who submitted an IMR or IBR on or after April 1, 2014 will receive a refund in the amount of fees paid in excess of the new fee schedule. Reference Links on our website: "Contact/Helpful Links."
Any IMR application submitted on or after April 1, 2014 will be subject to the following fee schedule:
Standard IMRs Involving Non-Pharmacy Claims*
Previous Fee: $560 per IMR
Fee Effective April 1, 2014: $420 per IMR
Expedited IMRs Involving Non-Pharmacy Claims
Previous Fee: $685 per IMR
Fee Effective April 1, 2014: $515 per IMR
Standard IMRs Involving Pharmacy Only Claims**
Previous Fee: Not Applicable
Fee Effective April 1, 2014: $390 per IMRs
IMRs Terminated or Dismissed Not Forwarded to a...
On April 2, 2014, the Workers’ Compensation Appeals Board (WCAB) issued an en banc decision in Navarro v. City of Montebello which invalidated part of QME Regulation 35.5(e). Pursuant to the WCAB’s ruling that the applicable Labor Code provisions do not require an employee to return to the same panel QME for an evaluation of a subsequent claim of injury, the DWC Medical Unit will now issue new QME panels for claims made after an evaluation has taken place. Initial QME panel requests must be submitted using QME Form 106 for represented cases or QME Form 105 for unrepresented cases. To avoid unnecessary rejection of appropriate requests, in cases in which additional panels are required in different specialties, parties and attorneys are reminded to use QME Form 31.7.
The Office of Administrative Law (OAL) approved the Independent Medical Review (IMR) and Independent Bill Review (IBR) regulations. Both sets of regulations were filed with the Secretary of State on February 12, 2014 and are effective immediately. Prior to March 1, 2014, any version of the IMR application form adopted by the Administrative Director under Section 9792.10.2 may still be used.The final IMR regulations include the following:· Revisions to the IMR application form and improved instructions. · Clarification that IMR determination cannot be based solely on information provided by a UR determination.Provisions for penalties to be assessed against a claims administrator for failure to timely produce medical records. The final IBR regulations include:· Revision to the forms used by providers to request a second bill review and IBR.· Limitations on the consolidation of separate IBR requests to 20 requests.· Required index of supporting documentation.· Updated versions of the Elec...