Tnsia 2009 Conference Presentation

3rd Annual Conference September 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

Gold Sponsor of the 2009 Tennessee Self-Insurers’ Association Conference

Opening Remarks – TNSIA Business Meeting Terry Hill – TNSIA Executive Director Susan Azar – TNSIA Chairperson Micheline Parkey - Treasurer

TNSIA Accomplishments – – – – – – –

Welcomed 5 New Board Members Increased Membership Level 2008 Year End Bank Account Balance = $59,447.22 Initiated Legislative Bills Met with TN Dept of Comm & Ins coordinating on various issues Submitted position letter, and attended public hearing on proposed rules Traveled to Little Rock, Arkansas with the TN Dept of Comm & Ins, to research the Arkansas Guaranty Fund – Submitted Amicus Brief, and participated in oral arguments, to the Tennessee Supreme Court regarding workers’ compensation issues for telecommuters – Submitted Amicus brief to the Workers’ Compensation Appeals Panel regarding the Tennessee Medical Impairment Rating Registry – Tennessean Newspaper recognition regarding Legislative Bills

Executive Director Terry Hill Board of Managers General Motors Corporation Susan Azar – Chairperson

McKee Foods Corporation Micheline Parkey - Treasurer

Ajax Turner Company Todd Williams

Goodyear Tire and Rubber Co Randy Triplett

Parker Hannifin Corp Curtis Gross

Averitt Express, Inc. David McDowell

Ingram Industries Inc. John Hayes

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

City of Knoxville Gary Eastes

Johnson Controls, Inc. Ronald Jones

United Road Services Kristin Burman

Cracker Barrel Old Country Store, Inc. Rob Behnke

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

Wasco, Inc. Paul Kneedler

Statement of Income and Expense 2009 From 01/01/2009 $ 59,447.22

Cash Beginning of Year Membership Due 2009 Memberships 2010 Memberships

$

2,450.00

100.00 Conference Attendees 6,250.00 Sponsors Total Revenue Expenses Web Hosting ($495/Month) Manier & Herod ($1,000/Month)

 

13,750.00 $ 22,550.00 $

3,960.00

7,625.02 Amicus Brief 1,250.00 National Council of Self Insurers 1,495.02 Conference 798.18 Paypal 198.55 Tax Preparation 1,529.50

St

TNSIA Regular Members Ajax Turner Company, Inc.

International Paper Company

Albany International Corp.

Johnson Controls, Inc.

American Electric Power Service Corp.

Kroger

Ascension Health

McKee Foods Corporation

Averitt Express

Nissan North America, Inc. – Smyrna

City of Knoxville

Parker Hannifin Corporation

Cracker Barrel Old Country Store, Inc.

St. Jude Children's Research Hospital

Det Distribution

The Pictsweet Company

Eaton Corporation

The Sherwin-Williams Company

Ford Motor Company

Thompson Machinery

General Motors LLC

Tyson Foods, Inc.

Goodyear Tire & Rubber Company

United Road

Harrah's Entertainment, Inc.

Vulcan Materials Company

Ingram Industries Inc.

Vanderbilt University Wasco, Inc.

TNSIA Associate Members AccessOnTime

Coventry Work Comp Services

NuQuest/Bridge Pointe

AON Risk Services

Eckman/Freeman & Associates

Occusure Work Comp Specialists

Alternative Service Concepts

Fara Insurance Services

On-Site Rx

Arnett, Draper & Hagood

GENEX Services

Physiotherapy Associates

Beecher Carlson Insurance Services

Health Systems International

Prevention Group d/b/a Lifesigns

Berkley Risk Administrators Company

Heffernan Insurance Brokers

Progressive Medical

Black Diamond Services

Howard, Tate, Sowell, Wilson & Boyle

Sedgwick Claims Mgmt Services

Brentwood Services

Innovative Risk Consulting

STAR Physical Therapy

Brewer, Krause, Brooks, Chastain & Burrow

Johnston & Associates

Superior Investigative Services

CapRisk Con

Leitner, Williams, Dooley & Napolitan

Tennessee Chamber of Commerce

Casualty Actuarial Consultants

Manier Herod

Tennessee Orthopaedic Alliance

Collins and Company

Marsh U.S.

Tennessee Urgent Care Associates

Commercial Insurance Associates

Medicor

Underwriters Safety and Claims

Constangy, Brooks & Smith

Moore Ingram Johnson & Steele

Wells Fargo Disability Management

CoolSystems

Network Synergy Group

Willis of 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

Douglas J. Holmes President UWC – Strategic Services on Unemployment & Workers’ Compensation National Issues Impacting Worker’s Compensation

About UWC Established 1933

“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, law firms, state administrative agencies, and associations • Research/education arm is the National Foundation for Unemployment Compensation & Workers’ Compensation

National Impacts on Workers’ Compensation National Commission on State Workers’ Compensation Laws Act of 2009 (HR 635) New reporting requirements under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (S 2499) Health Insurance Reform and State Workers’ Compensation (HR 3200) WCMSA Reform (HR 2641) Prospects for 2009 and 2010

HR 635 Provisions • Establish National Commission of 14 members: President appoints the Chairman, 1 appointed by Senate majority leader to serve as Vice Chairman, 2 appointed by House Majority Leader, 2 appointed by House Minority Leader, 2 appointed by Senate Majority Leader, 2 appointed by Senate Minority Leader, 4 cabinet Secretaries from Labor, Commerce, HHS, and Education. • Not more than 6 from same political party • At least 3 representatives of injured workers, 3 representing insurance carriers or employers, and 1 representing the general public.

Commission Duties • Review findings of previous 1972 National Commission Report • Study and evaluate state WC laws to determine if they provide adequate, prompt and equitable system of compensation for injury or death arising out of or in the course of employment • Study and evaluate whether additional remedies should be recommended to ensure prompt and good faith payment of benefits and medical care to injured workers and their families.

Specific Items to be Studied and Evaluated • Amount of permanent and temporary disability benefits 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 workers as 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 be Studied and Evaluated • Standards to determine assurance of benefits caused by aggravation or acceleration of preexisting injuries or disease • Time limits on filing claims; waiting periods; compulsory or elective coverage; administration; ensuring prompt hearings and due process evidentiary rights in the resolution of claims; • Relationship between WC, old age, disability, and survivors insurance and other insurance

Recent State Reforms Not on List for Review • Use of employer/insurer selected networks to improve treatment outcomes • Utilization Review • Use of science based information to determine percent of impairment (ADA Guides) • Managed care programs • Focus on return to work treatments and strategies • Cost of workers’ compensation premiums/payments and impact on competitiveness

Powers and Authority of Commission • Hold hearings, take testimony, receive evidence, administer oaths • Require by subpoena or otherwise the attendance and testimony of witnesses, production of books, records, correspondence, memoranda, papers and documents • Subpoena authority vested in Chairman and Vice Chairman or 6 members of the Commission • Failure to respond to subpoena punishable as contempt of court and subject to prosecution by US Attorney

Commission Reports • Interim reports to the President and Congress at any time • Final report not later than 18 months after the date of enactment to President and Congress containing findings, conclusions, and recommendations for enhancements and improvements in benefit levels, medical care, and administration of State WC systems; improvements in insurance practices, due process and evidentiary hearings and reduction of bad faith handling and delays, as agreed by majority of Commission members. • Funding for staff and contractors needed.

Fundamental Issues • Unbalanced Commission with political agenda • Review of state WC system not the federal role • State WC system already continuously studied and evaluated • Unnecessary federal spending in time of tight federal budget • Trial lawyers (WILG and AAJ) and organized labor seeking changes on issues rejected by states • Many 1972 Report recommendations would impose significant cost and premium increases for employers

1972 Recommendations • 19 Primary Recommendations, with many controversial issues, including compulsory WC coverage, no exclusion based on number of employees, coverage of household and casual workers, farm worker coverage, presumption against independent contractor status, maximum wage benefits at least 200% of state average weekly wage, worker choice of physician, second injury fund, no limit on total benefits paid for PT, “full” coverage for work related diseases. • Cost of implementing the 1972 report recommendations in most states ranged from 30% to 80% per year.

Opposition to HR 635 building • Individual state chambers and business organizations communicating with Congressional delegations • Letter coordinated by UWC and US chamber to House Members from large list of national business organizations (US Chamber, NAM, NFIB, NRF, AIA, PCI,NCSI, and many others) • NCOIL and ALEC passed resolutions of opposition. Other organizations involved include IAIABC, State Funds, NCSL, SAWCA.

HR 635 Opposition Challenges 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 to the floor Posturing as “Just a Study” Carryover of “Academic” recommendations from President Nixon’s 1972 Report National Press – New York Times and Washington Post response

Organizational Strategy • Grass Roots Opposition from state and local business and state groups • Targeted pressure on swing members of Congress in House and particularly Senate; members with WC backgrounds • Policy group to develop responses to “academic” arguments and press reports • Development of news media campaign.

S 2499 Section 111 Reporting • 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 are Medicare entitled (No-fault auto and liability insurers also required to report)

S 2499 Section 111 Reporting (cont’d) • Interim Report Record Lay-outs available from CMS along with User Guide and training from CMS • Implementation through CMS web site -No formal regulations to be issued for comment • No formal administrative appeal

CMS New S 2499 Reporting Issues Verification of Medicare entitlement – query into CMS data base to verify is not yet working Definition of “Date of First Exposure” Thresholds for reporting ongoing responsibility for medical (ORM) payments – through December 2011, reporting not required if for medicals only, lost time maximum under the WC law or no more than 7 days if no WC law limit, payments directly to medical provider, and total payment does not exceed $750.

Other Reporting Issues • Report payments after July 1, 2009 if based on settlements, 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 be imposed until reporting registration and standards are finalized • www.cms.hhs.gov/MandatoryInsRep

Other Reporting Issues

• Reports of total payment obligations to claimants (TPOC) exempted if • Most recent (TPOC) payment is on or before December 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 not required – permitted at RRE discretion.

Costs of S 2499 Reporting Increased risk that old settlements will be reviewed with changes in Medicare recovery, increasing potential costs Administrative costs of reporting is significant for insurance carriers, self-insurers, state and federal agencies Increases in risk and prospective costs of WC where Medicare interests involved

HR 2641 WCMSA Settlement 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 medical Present value includes cash, purchase cost of annuities, amounts previously paid, but excludes previous medical expenses, fees for the claimant and any other procurement costs of agreement

HR 2641 Limits cases when not likely to be ineligible to 1) awarded SSDI; 2) applied for SSDI and determination pending 90 or fewer days; 3) appealing denial of SSDI; 4) at least 62 and ½ years old; 5) has end stage renal disease MSP satisfied when set aside amounts based on items and services under WC agreement and/or fee schedules, and reduced by direct costs of establishing and administering the WCMSA and costs of attorneys, TPAs, or administrators.

HR 2641 CMS Decisions within 60 days of submission with specific reasons if disapproved Safe harbor for submissions if 10% of present value of claim submitted as long as settlement is $250,000 or less Reconsideration of disapproval may be filed within 60 days; reconsideration within 30 days; appeal within 30 days to ALJ; decision within 90 days of appeal; judicial review Optional direct pay to CMS

HR 2641 Optional compromise settlement WC law shall be conclusive as to matters under WC law and not subject to CMS review – particularly helpful in determining prescription drug amounts to be set-aside in light of CMS policy of requiring average wholesale prices No additional liability for a WC settlement agreement effective prior to enactment of HR 2641 than on effective date of the agreement

Impact of Health Insurance Bill on WC Section 136 of HR 3200 as passed by House Ways and Means Committee provides The Commissioner shall establish standards for the coordination and subrogation of benefits and reimbursement of payments in cases involving individuals and multiple plan coverage. Committee summary indicates that workers’ compensation is an example of a plan that may be impacted.

Outlook for 2009, 2010, and thereafter Registration and development of Section 111 reporting requirements and implementation will continue through 2010 – current deadline to register is September 30, 2009, but registration likely to be permitted by CMS thereafter Active enforcement and penalties imposed beginning in late 2010 Significant additional Medicare recoveries and cost avoidance above $1.1 billion, shifting Medicare costs to state WC, self-insurers and insurance industry

Outlook for 2009, 2010, and thereafter

HR 635 will be pushed after health insurance reform and card check bill. Probably not until early 2010. HR 2641 will continue to be refined to address cost issues with possible addition to Medicare reform legislation in late 2009; if not continuing into 2010.

Join US UWC -- Strategic Services on Unemployment & Workers’ Compensation “The Voice of Business on Unemployment & Workers’ Compensation” 910 17th Street, NW, Suite 315 Washington, DC 20006 [email protected]

www.UWCstrategy.org 202-223-8904

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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

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 Manager

TN Department of Commerce & Insurance

Topic of Discussion

TN Workers’ Compensation Self Insurance & Insurance Environment Update

2008 Market Segments Individual Self Insureds are on an equivalent basis Million in Premiums

$900 $800 $700 $600 $500 $400 $300 $200 $100 $0

$884 -6% $832

2007 2008 -13% $230

$200

-25%

25% $44

$33

VoluntarySI Groups Selfexclude Insuregovernment rs SI Groups groups.

$63

$47

TWCIP

TN Large Deductibles History 3 5 0 0 3 4 0 0 3 3 0 0 3 2 0 0 3 1 0 0 3 0 0 0 2 9 0 0 2 8 0 0 2 7 0 0 2 6 0 0 2 5 0 0

'0 2

'0 3

'0 4

'0 5

'0 6

Policy Count Source: NCCI

46

'0 7 p

Workers’ Compensation Indemnity Claims Cost Increases 12.00% 10.00% 10.10%

9.20%

8.00% 6.00% 4.00% 2.00% 0.00%

5%

4.80%

4.40% 3.10%

3.40%

3.00% 1.30%

2000 2NCCI 001 (2008 2002preliminary) 2003 2004 Source:

2005

2006

2007

2008

WC Medical Claim Cost Trends (Lost Time Cases)

16% 14%

13.50%

12% 10% 8% 6% 4%

7.30%

8.20%

Med Sever Med CPI

7.70%

7.10% 5.40%

6.00% 5.80%

6.00%

2% 0%

Source: NCCI (2008 preliminary); Med CPI: Economy.com 2000 2001 2002 2003 2004 2005 2006 2007 2008

Lost Time Frequency Continues to Decline 0% -1% -2% -2.60%

-3% -4% -5% -6% -7%

-4.50%

-4.50%

-4.10%

-3.70%

-4.00%

-6.00% -6.70% -6.90% 2Source: 000 20 01 (2008 2002 preliminary) 2003 2004 2005 2006 NCCI

2007

2008

Impact of 2004 Reforms on WC Premiums: Estimated $490M Savings Since 2004 (50-6-134)

Calendar Yr

Direct Premium Written

Net Estimated Savings*

Annual % Savings

2004

$883M

$20M

2.2%

2005

$943M

$98M

9.4%

2006

$947M

$139M

12.8%

2007

$947M

$114M

10.8%

2008

$879M

$119M

12.0%

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

Impact of 2004 Reforms on Premium: Other Measures 26% drop in loss costs and filed loss cost multipliers (weighted average) since 9/1/04 28% drop in average premium per policy of top 10 Tennessee workers’ compensation insurers comparing data from 2004 to 2008

Overview of Self-Insurance Market (2008) Self-Insured Employers – 105 Number of employees – 266,912 Total “Premium Equivalent” – $200 million Self-Insured Groups – 6 Number of employees – 42,572 Total Premium – $33 million

Overall Market Summary POSITIVES Frequency continues to decline nationally Industry reserve deficiency remains moderate Low company failure rate Smallest TN residual market in 9 years

NEGATIVES 13 point TN profitability loss; worst “combined ratio” in 6 years Medical severity continues rapid growth Low investment returns continue to pressure underwriting results

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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

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 - 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

Sue Ann Head

Administrator of the Workers’ Compensation Division TN Department of Labor & Workforce Development

Pete Halverstadt

Attorney TN Department of Labor & Workforce Development

Overview of Tennessee Workers’ Compensation 2009

Programs Within the Tennessee Workers’ Compensation Division The Workers Compensation Division manages ten different programs concerning employees’ and employers’ rights and responsibilities. They are: – – – – – – – – – –

Claims and Coverage—Dark Ages (1919) The Second Injury Fund—1946 Benefit Review—1992 Case Management/Utilization Review—1992 The Drug Free Workplace Program—1996 The Uninsured Employers Fund (UEF)—2001 The Penalty Program—2004 The Medical Fee Schedule—2005 The Medical Impairment Rating (MIR) Registry—2005 The Administrative Review Program—2006

Claims Statistics July 1, 2008 through June 30, 2009 – 47,824 Lost Time Claims – 58,452 Medical-Only Claims

Coverage Statistics July 1, 2008 through June 30, 2009 – 101,850 Proofs of coverage received – 167,562 Notices of cancellation, reinstatement, endorsements

Uninsured Employers Fund In fiscal year 2008-2009, the UEF

conducted 4,072 investigations. The UEF penalized 205 employers for

non-compliance i.e. failing to have workers’ compensation insurance coverage. In fiscal 2008-2009, the UEF collected penalties in the amount of $1,043,848 from non-compliant employers.

Drug Free Workplace Program  The DFPW program strives to assist employers in

providing safe working conditions, reduce the potential for injuries, and secure savings on the employers’ workers’ compensation premiums.  For the Fiscal Year ending June 30, 2009 there were

9,087 employers participating in the Program.  Projections are that DFWP membership by the end of

December 2009 will exceed 10,000 employers.

Benefit Review Regional and Satellite Offices Stewart Lake Obion

Gibson

Macon

Davidson Dickson

Wilson

Haywood

De Kalb

Lewis

Fayette Hardeman

McNairy

Sullivan

Johnson

Washington Carter Unicoi

Jefferson Cocke

Loudon

Blount

Sevier

Rhea

Maury

Bedford

Bledsoe

Coffee

Sequatchie Grundy

Moore

Wayne

Grainger Hamblen Greene

Roane

Cannon

Marshall Hardin

Cumberland

White

Hancock Hawkins

Anderson

Warren Van Buren

Henderson Decatur Perry

Chester Shelby

Morgan

Rutherford

Hickman Madison

Union

Smith

Knox Williamson

Tipton

Campbell

Overton

Putnam

Humphreys

Lauderdale

Jackson

Claiborne

Scott

Fentress

Benton

Crockett

Pickett

Clay

Sumner

Cheatham

Houston Carroll

Robertson

Trousdale

Henry

Weakley

Dyer

Montgomery

Meigs McMinn

Monroe

Giles Lawrence

Lincoln Fayetteville

Dyersburg Clarksville Jackson Columbia Memphis Cookeville

Franklin

Marion

Hamilton Bradley

Polk

Nashville Murfreesboro

Chattanooga Knoxville Kingsport

The Benefit Review Program Stats TTD/Med: Assistance with resolution of temporary disability and medical benefits BRC: Benefit Review Conference: Mediation of final settlements Approvals: Approval of settlements reached with or without mediation FY

FY 04/05

TTD/Med BRC 6173 Approvals TOTALS

FY FY FY % change 05/06 06/07 07/08 08/09

2733 6976 5872 14,778

4008 4987 4948 5665 7311 6444 7044 14.1 % 6988 7053 7065 7938 17,972 19,351 18,457 20,647

since 2004 107.3% 35.2% 39.7%

Administrative Review July 1, 2008 through June 30, 2009 Total Number of Requests: Untimely Filed: 56 Withdrawn: 59 Orders Issued: 740 – Of Orders Issued

Affirmed: 537 72.6% Not Affirmed: 203 27.4%

856

Penalty Program July 1, 2008 through June 30, 2009 25% Penalties Number of Penalty Referrals: 114 Number of Penalties Assessed: 52 Total Penalties Assessed: $70,274.20 $10,000+ Penalties Number of Penalty Referrals: 33 Number of Penalties Assessed: 17 Total Penalties Assessed: $32,000.00

Penalty Program cont. Claims Number of Penalty Referrals: 58 Number of Penalties Assessed: 42 Total Penalties Assessed: $107,600.00 Medical Fee Schedule Number of Penalty Referrals: 5 Number of Penalties Assessed: 4 Total Penalties Assessed: $255,000.00

MIR Registry By the end of Fiscal Year 2008/2009: • There were 130+ Tennessee-licensed physicians on the Registry— Practicing in nearly 120 offices in nearly 30 Tennessee counties, and in Mississippi and Georgia, too • There had been over 230 valid requests for evaluations— Of which 12 cases settled prior to the evaluation Of which 7 cases were withdrawn prior to the evaluation • Every completed evaluation was conducted in a timely manner

Medical Fee Schedule T.C.A. 50-6-204

Amendments  Adoption of March 4, 2008 reimbursement levels as a floor for all workers’ compensation medical charges.  The department may assess a penalty for violations of the medical fee schedule rules of up to $10,000.  Division will update conversion factor multipliers via the website instead of the rules.  U & C defined as 80% of billed charges.

Second Injury Fund Year Opened

% Change

2000:

453

0.22% increase

395

935

5

2001:

562

24.1% increase

497

1000

6

2002:

677

20.5% increase

401

1276

7

2003:

793

17.1% increase

758

1311

7

2004:

814

2.6% increase

665

1460

7

2005

576

29.2% decrease

761

1275

8

2006 513

10.9% decrease

785

1003

7

2007

36.25% increase

579

1123

7

5.87% increase

738

1125

7

699

2008 740

Closed

Caseload

Attys

2009-2010 Compensation Levels Maximum weekly benefits as of July 1: – Temporary benefits--$837.00 – Permanent benefits--$761.00

Minimum weekly benefit as of July 1 – Temporary benefits--$114.15

Utilization Rules Beginning November 12, 2009, new utilization rules will apply to all recommend medical treatments and procedures. The trigger for UR is no longer a monetary amount—instead it is triggered when the payor disputes the medical necessity of the recommended treatment or procedure. The UR Rules provide timelines for conducting the UR.

Utilization Review cont. The UR agent must be a TN-license., Board-certified doctor in the same or similar specialty as the recommending physician. The only issue under consideration during UR is medical necessity. The UR agent’s decision must be in writing and distributed to all parties. Expedited appeal only for UR denials.

Possible Future Laws & Rules Venue—race to the courthouse AMA Guides Telecommuting EEOICPA DFWP notice requirement Construction laws Adjuster Training

Contact Information Workers’ Compensation Division

Website: www.state.tn.us/labor-wfd/wcomp Phone Number : 1-800-332-2667 Sue Ann Head, Administrator [email protected]

Pete Halverstadt, Assistant Administrator

[email protected]

TNSIA Thanks our 2009 SILVER SPONSORS

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 - 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

Dr. Chrisanne Gordon

Physical Medicine and Rehabilitation Physician

The Challenges of Health, Wellness and the Aging Workforce

The US Workforce Comes of Age Challenges of a Vintage Work Force

Old age is the harbor of all ills ~Bion ~ 280 B.C.

Nature abhors the old, and old age seems the only disease; all others run into this one. ~ Emerson ~ 1880

Getting old is not for sissies. ~Bette Davis~ 1980’s

Who is America’s work force? 58 million workers over 45-years-old Aging work force: - 2000 statistics – 13% US workers 55+ - 2010 -17% - 2059 - 19%

What does this mean? – Health Care Costs are Soaring (Union Wages) 2000 2005 2008

$1.69/hour/employee $2.59/hour/employee $4.00/hour/employee

Average Annual Per-Employee Cost $9660 Towers Perrin Health Care Cost Survey 2009

Workers older than 40 account for: 50% short term disability 75% long term disability Older employees utilize more health care -Life/Health Advisor December 2005

Chronic Illnesses Noted in Aging Work Force Diabetes Hypertension CAD PVD Obesity Metabolic syndrome COPD Arthritis

Smoking, obesity, inactivity cost 300% more for older workers than younger workers. - Life/Health Advisor December 2005

Increased health care dollars on insurance. Increased care dollars on BWC with recent tendency to shift responsibility to employer for age related degenerative pathology. Increased disability benefits

Statistics of Gender Women share of labor force 2002 - 46.5% 2012 - 47.5% 2016 - 48.0%

68 million women employed in the US. - 75% full time jobs - 25% part time jobs

Concerns with increased women in labor force may include: OB -Child bearing/infertility issues OB- Exposure issues GYN- Breast & Cervical cancer Arthritic conditions Strength issues – recurrent soft tissue injuries

There is a shift in US away from manufacturing – to service & technical support. This shift will benefit the aging work force. Eg: only 6% women in manufacturing jobs.

What are the major physiologic changes with maturing? These changes need to be understood so that adjustments can be made at the work site.

A – CARDIOVASCULAR Decreased maximum heart rate. Decreased maximum contraction. Decreased blood pumped. Decreased elasticity of arterial vessels.

After 30 – heart’s peak capacity declines by 5 – 10% per decade. After 40 – increased incidence of CAD especially with co-factors of Diabetes, HTN, Obesity, SMOKING

Adjustments may need to be made to accommodate the aging heart in manufacturing and heavy labor jobs.

B - PULMONARY Decreased ability to move air deeply and quickly – forced expiratory volume. Increased residual volume. Possible decreased air exchange with exposures; dust, asbestos, silicon Smoking increases all the above.

C - NERVOUS Decreased memory Decreased senses: sight, hearing. Decreased NCV – limits agility and speed. NCV declines 3% per decade after 55. Decreased balance and proprioception.

Adjustment is to slow down processes for the more mature workers and keep work place safe and free of oils, clutter, “accidents waiting to happen”.

EXAMPLE: 20-year-old slips on oil – contusion and sprain. 65-year-old hip fracture, pulmonary embolus, infection, possible death.

D - SKELETAL DDD – Degenerative Disc Disease

Dreaded Disability Disease -

Develops in everyone – starts at age 32 - 34. Genetic and environmental factors influence degree. - Many non-surgical treatments available. - Surgical options with mixed results. Look for osteoporosis for recurrent fractures.

Adjustment – Ergonomic work stations and exercise program should be available on site.

E - MUSCULAR 15% loss of strength per decade after 50. Decreased motor units. Increased fat in muscles. Fraying of muscle attachments, eg, rotator cuff tendinitis.

ADJUSTMENT – Better equipment for lifting heavy parts, job rotation, seniority positions.

F - MISCELLANEOUS DECREASED SENSES Adjustment for hearing and sight.

Cognitive decreases ADJUSTMENT – Classes and updates via newsletters and email. – Clear training objectives.

Hormonal Changes ADJUSTMENT – – Big concern for manufacturing with large women in labor force. – Consider counseling, dietary adjustments, education. – Menopause increases osteoporosis, joint stiffness, tendinitis via loss of estrogen.

Current trend is to have WC supplement Medicare & private insurance. 1) 2) 3) 4)

Eg: THR, TKR replacement surgery. Chronic pain management for DDD. Cardiovascular work-ups prior to minor surgeries. Allowances granted for aging process.

DEFINITIVE STUDIES NEED TO BE DONE 1.Serial MRI’s on non-working persons followed from 30’s - 70’s 2.Studies ongoing to prove natural course of aging. 3. Always consider genetic with vocational contributions. 4. Disability runs in families often.

COMPLICATIONS OF AGING ON BWC ALLOWANCESEg: Aggravation of pre-existing DJD; DDD. “Aggravation of old ACL tear”. Remote myocardial infarction. Pulmonary emphysema. Diabetes mellitus. Down’s Syndrome

DODM Longer recovery for underlying medical conditions and age. Co-morbidities After 90 days, only 10% RTW “Sandwich” generation with many social Issues.

Price per claim increases with increased age and underlying health problems. Eg. Medicare pays $3000 - $6000 more annually on obese seniors and this is now – being shifted to employers. – CDC July 2009 – Tennessee #4 in US -30.2% adult obesity

How does your company adjust to Vintage Work Force?

A - ERGONOMICS 1) Better equipment for lifting. 2) Better ergonomic tools to accommodate arthritis. 3) Job rotations. 4) Seniority jobs – disguised. 5) Automation assisted activities.

B - EDUCATION 1)

Must have company-wide education on health and effects of aging ongoing. 2) Promote smoking cessation. 3) Weight loss program. 4) Anger and stress management. 5) Counseling for aging parents; ailing spouse or children. 6) Reward healthy habits.

C - EXERCISE The only effective way to slow down the aging process and effects of aging is exercise.

BENEFITS INCLUDE: 1) 2) 3) 4) 5) 6)

Muscle mass Bone mass Stress reduction Balance and agility Increased cardiovascular Cognitive benefits

Work Exercise Into The Work Day Exercise should be part of the work day – 1. part of work process and break – 2. exercise equipment or program on site – 3. benefits of wellness program and education. Employee rewards for Healthy Habits.

The Whole Story: Gordon and Gleeson Workforce Healing Opportunities and Lifestyle Enhancements.

Promoting Wellness Through Age-Friendly Physical Activities Publication January 2010

Wellness programs need to incorporate: – 1. cardio conditioning (40’s – 60’s) – 2. strength training (50’s – 60’s) – 3. flexibility/balance training (60’s) – Reward the Healthy Employee and their family.

Benefits include: 1. Better CV health – fewer MI’s 2. Better Respiratory status, fewer URI’s 3. Better bone strength – fewer fractures 4. Better reaction times and balance 5. Improved mood and cognition 6. Increased strength and ROM

Onsite monitoring of glucose, BP, weight Employee health diary with counselors; exercise, nutrition, social services Rewards for healthy living either by decreased premiums or end of the year bonuses.

Cost Savings of Wellness Programs – Dupont - $1.42 for every $1.00 invested – Providence Health Care – 28% decrease – Travelers - $3.40 for every $1.00

– Towers Perrin Health Care Cost – Sept. 2008

Many savings are qualitative not quantitative. – Eg. Phoenix – 46% increase work productivity – Savings included fewer sick days and appointments.

IHPM – July 2009

Men do not quit playing because they grow old; they grow old because they quit playing.

Oliver Wendell Holmes.

Most people think that aging is irreversible and we know that there are mechanisms even in the human machinery that allow for the reversal of aging, through correction of diet, through antioxidants, through removal of toxins from the body, through exercise, through yoga and breathing techniques, and through meditation. ~Deepak Chopra~

Aging grapes produce great wine. Aging humans produce great whining. Exercise is the #1and ONLY PROVEN deterrent to aging.

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 - 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

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 - 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

Workers’ Compensation Legislative Updates New Laws Change WC Practice Terry Hill

TNSIA Executive Director

SB 1574: Now TCA §50-6-204(a)  This bill puts to rest the Overstreet decision, a

2008 Supreme Court case preventing employers, insurance carriers and attorneys from communicating with the authorized treating physician. SB 1574 allows us to communicate with the authorized treating physician under the following terms…

1. The employer may send written communications to the treating physician, but must copy the employee or the employee’s attorney on the correspondence with any attached materials and must provide the employee or the employee’s attorney with copies of the physician’s response to the correspondence within 7 days of receipt.

2. The employer may communicate orally with the treating physician, but must send the employee or the employee’s attorney a written summary of the opinions or statements of the physician within 7 days of a request by the employee or the employee’s attorney.

3. The employer’s attorney may communicate orally with the authorized treating physician, but must provide written notice to the employee or the employee’s attorney at least 7 days prior to the communication and must provide the employee or the employee’s attorney with a written summary of all opinions expressed by the physician within 7 days of the communication.

Language Required for Releases  THIS MEDICAL AUTHORIZATION FORM ONLY

PERMITS THE EMPLOYER OR THE DIVISION OF WORKERS’ COMPENSATION TO OBTAIN MEDICAL INFORMATION THROUGH ORAL OR WIRTTEN COMMUNICATION, INCLUDING, BUT NOT LIMITED TO, CHARTS, FILES, RECORDS, AND REPORTS IN THE POSSESSION OF A MEDICAL PROVIDER AUTHORIZED BY THE EMPLOYER PURSUANT TO T.C.A § 50-6-204 AND A MEDICAL PROVIDER THAT IS REIMBURSED BY THE EMPLOYER FOR THE EMPLOYEES TREATMENT.

SB 1909: Now TCA §50-6-110 (a) This bill disallows employees from recovering for injuries sustained during recreational activities, except in the following limited circumstances…

1: When the employee’s participation was expressly or impliedly required by the employer;

2: When the employee’s participating produced a direct benefit to the employer beyond improvement in employee

3: When the employee’s participation was

during the employee’s work hours and was part of the employee’s work related duties; or

4 :

When the injury occurred due to an unsafe condition during voluntary participation using facilities designated by, furnished by or maintained by the employer on or off the employer’s premises and the employer had actual knowledge of the unsafe condition and failed to curtail the activity or program

SB 1567:Now TCA § 50-6-241(a)1(c) This bill states that if an employer is bought out by another company and retains the employee at the same or greater pay, the employee is not entitled to reopen his case under T.C.A §50-6241(a). Prior case law counter-intuitively dictated that when a company simply changed its name, the employee could reopen his case and still keep his job. This bill was signed by the Governor on June 5, 2009 and will be effective on July 1, 2009.

SB 2162:Now TCA §50-6-241(e)(1) This bill makes it clear that an employee who is an illegal alien may not recover more than 1.5 times his impairment rating. The argument here is that the employee should not be able to go up to the 6 times cap if the employer is required to fire the employee because of the Federal law that prohibits the employer from retaining illegal workers.

SB 2162:Now TCA §50-6-241(e)(1)

cont’d

…However, the bill also holds that if the employer is aware that the employee is illegal, there will be an automatic award of 5 times the rating. The employee will not get those funds, which will go to the State Second Injury Fund.

SB 2000:Now TCA §50-6-102(13) & TCA §50-6-207(1) * This bill amends two existing statutes and: (1) Disallows the employer from claiming a credit for TTD benefits paid in a 400 week case; (2) Caps the amount of TTD an employee may receive in a mental injury case at 200 weeks

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 - 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

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 - 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

LEGAL PANEL DISCUSSION RECENT DEVELOPMENTS AT CMS John Barringer, Esquire MANIER & HEROD

CASE LAW & BENEFIT REVIEW Cliff Wilson, Esquire

HOWARD, TATE, SOWELL, WILSON & BOYTE

Richard Murrell, Assistant Director

BENEFIT REVIEW DIVISION, DEPT OF LABOR & WFD

ANSWER THIS! QUESTION: How much will the Medicare deficit be in 40 years? – $31 Trillion

QUESTION: How much is S-CHIP projected to collect in fines over the next 5 years? – $1.1 Billion

THE S-CHIP Extension Act The Centers for Medicare and Medicaid Services (CMS) held an Open Door Forum Teleconference on October 1, 2008 regarding its efforts to implement the Mandatory Insurer Reporting (MIR) section of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). Town hall meetings continue. The next is scheduled for September 30, 2009

CMS continues to update with supplemental alerts March 26, April 7, May 11, July 13, July 17, July 31, August 24, Version 2.0 User Guide now available on website

Terms NGHP – Non Group Health Plans MIR - Mandatory Insurer Reporting MMSEA- Medicare Medicaid & SCHIP Extension Act Section 111 – When a claim needs to be reported

THE S-CHIP Extension Act Non-GHP includes Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers’ Compensation. Responsible Reporting Entities (RREs) are: Carriers Self Insureds Joint pools State assigned funds TPA is not a RRE, except to the extent it might self insure its own WC and liability exposures.

Recent development Who Needs to Report? July 31 alert. Drafted with “proposed language”

WC “Proposed” Defines RRE Plan directly funded = Self insured Plan indirectly funded = Insurer/ carrier

Liability “Proposed” Same principles Entity that gets paid a premium to pay claims is the RRE No Fault – N/A in Tennessee

Deductible amounts question What if liability is ultimately with an excess carrier? “Up to deductible amounts” CMS considers you to be self insured so must report

What about pools? Three criteria 1. WC self insurance pool is a separate legal entity 2. With full responsibility to resolve and pay for claims using pool funds 3. Without involvement of participating employer

THE S-CHIP Extension Act If an entity (such as a TPA) is acting as an Agent for multiple RREs, the Agent must submit a separate electronic reporting file for each RRE. If the RRE uses an agent, the RRE remains ultimately liable under section 111

New issues: Bankruptcy If paid on behalf of another entity from that other entity’s assets ( guarantee fund) entity that makes payment is the RRE If Employer pays directly, then RRE

THE S-CHIP Extension Act The first step in complying with the MIR will be completed by the RRE submitting registration data to the COBC via its secure website portal; the COBSW. Date for Registering begins May 1, 2009 through September 30, 2009 The RRE must be the one to complete the registration process. The RRE may assign an Agent for ongoing reporting at that time by completing the Agent Registration section. Agents are NOT permitted to complete the registration process

THE S-CHIP Extension Act The first step in complying with the MIR will be completed by the RRE submitting registration data to the COBC via its secure website portal; the COBSW (still under construction). The RRE must be the one to complete the registration process. The person reporting is the Authorized representative. (AR) RRE must also name an Account Manager. (AM) The RRE may assign an Agent (Account Designee) (AD) for ongoing reporting at that time by completing the Agent Registration section. Agents are NOT permitted to complete the registration process

Important dates: “Query function Testing Period” July 1, 2009 begins First “Claim input file testing” will be scheduled January 1, 2010 through March 31, 2010 However, if RREs complete testing before 1/10/10, they may begin submitting live files in the October-December 2009 quarter April 1, 2010 through June 30, 2010 Begin Official production of claim input file submissions

THE S-CHIP Extension Act Reporting will be quarterly. CMS has established two reporting triggers. Cases involving Medicare beneficiaries should be reported (1) when responsibility for the claim has been assumed by the RRE ORM = “Ongoing Responsibility for Medical Payments” Two reportable events: 1) When assumes ORM determination is made 2) When ORM Terminates Date of July 1, 2009 determines responsibility

(2) when the RRE's responsibility for the claim has been terminated by a settlement, judgment or award, or other payment on or after July 1, 2009. TPOC TPOC= Total Payment obligation to the claimant One time lump sum payment Note: In disputed/denied claims where no responsibility for the claim has been assumed by the RRE AND no payment is made by the RRE, reporting is not needed until there is a settlement, judgment or award, or other payment

THE S-CHIP Extension Act Date of injury, settlement date, and exhaust information are required reporting data elements. If CMS has regulatory definitions of terms they will utilize those definitions even if they do not comport with industry definitions of the terms. Example, Closed files vs. inactive files

Penalty: $1000 per day

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

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

Denny Crane of Boston Legal

John W. Barringer, Jr. Manier & Herod, P.C. [email protected] (615) 742-9345

LEGAL PANEL DISCUSSION RECENT DEVELOPMENTS AT CMS John Barringer, Esquire MANIER & HEROD

CASE LAW & BENEFIT REVIEW Cliff Wilson, Esquire

HOWARD, TATE, SOWELL, WILSON & BOYTE

Richard Murrell, Assistant Director

BENEFIT REVIEW DIVISION, DEPT OF LABOR & WFD

Additional Materials Public Chapters – Public Chapter 526 – Illegal Immigration – Public Chapter 364 – Reconsideration – Public Chapter 407 – Recreational Activity – Public Chapter 599 – Max Total Benefit & Psychological Injury – Public Chapter 486 – Overstreet

Rate Chart

Public Chapter 486 – Communication with Authorized Treating Physician Old - T.C.A § 50-6-204 (1)(2) – Allowed Certain Records to be Released

Without Consent

– All Treatment Required “As Ordered by

Attending Physician”

– Covered Any Medical Provider Where

Origin of Injury Was Work–Related

Public Chapter 486 – Communication with Authorized Treating Physician New - T.C.A § 50-6-204 (1)(2) – Statute Only Covers Communication

with Authorized Provider

– Must Have Special Language in

Release for D.O.I. 7/1/09 or After

– All Communication Requires Release

Public Chapter 486 – Communication with Authorized Treating Physician BOTTOM LINE ________________________________

YOU NEED A RELEASE! PRE JULY 1, 2009 INJURIES & POST JULY 1, 2009 INJURIES

Public Chapter 486 – Communication with Authorized Treating Physician

Discovery – Safety Net – Subpoenas – Pre-Existing Records – Discovery Depositions

Public Chapter 599

Maximum Total Benefit MAXIMUM TOTAL BENEFIT 50-6-102 (13) – OLD - 400 x Comp Rate up to State Average Weekly Wage

– NEW – 400 x State Average Weekly Wage Plus TTD

THE SUPREME COURT OF TENNESSEE SPECIAL WORKERS’ COMPENSATION APPEALS PANEL KENNETH CONAWAY v. U.S. PIPE AND FOUNDRY COMPANY ET AL. – Employee filed a complaint seeking workers’ compensation benefits following a bench trial, the trial court found the employee to be totally and permanently disabled – The employer appealed, contending that the employee’s continuing employment as a pastor precluded a finding of total and permanent disability – An Appeals Panel reversed the trial court’s conclusion that the employee was totally and permanently disabled and modified the award to seventy-two percent (72%) permanent partial disability to the body as a whole

THE SUPREME COURT OF TENNESSEE SPECIAL WORKERS’ COMPENSATION APPEALS PANEL KENNETH CONAWAY v. U.S. PIPE AND FOUNDRY COMPANY ET AL. – The Employee, who had resigned as a pastor before the Appeals Panel decision was issued, filed a motion for modification pursuant to Tenn. Code Ann. § 50-6231(2) (2008). – Following a second evidentiary hearing, the trial court again found that the employee is permanently and totally disabled. – The employer appeals contending that the employee failed to present sufficient proof that he sustained an increase of incapacity solely as a result of his workrelated injury. We affirm the judgment of the trial court.

THE SUPREME COURT OF TENNESSEE SPECIAL WORKERS’ COMPENSATION APPEALS PANEL LISA SHELTON v. CENTRAL MUTUAL INSURANCE COMPANY – Employee was found to be permanently and totally disabled as a result of a work-related injury. In January 2006, he died as a result of an overdose of prescription medication. His widow sought workers’ compensation death benefits, alleging that his death was the direct result of his prior work injury. Employer filed a motion for summary judgment, contending that the medical evidence was insufficient. – The trial court granted the motion. Employee’s widow has appealed. – Judgment reversed and remanded for further proceedings

THE SUPREME COURT OF TENNESSEE SPECIAL WORKERS’ COMPENSATION APPEALS PANEL THOMAS MICHAEL ROSS v. DELTA INDUSTRIAL COATINGS, INC. ET AL. – Employee was injured when lifting a can of paint at work. Employee’s treating physicians recommended surgery, but Employee refused surgical treatment – The trial court found that Employee had sustained a 60% permanent partial disability (“PPD”). The court also found that the date of maximum medical improvement (“MMI”) was January 26, 2007, and that Employee was entitled to temporary total disability (“TTD”) until that date

THE SUPREME COURT OF TENNESSEE SPECIAL WORKERS’ COMPENSATION APPEALS PANEL THOMAS MICHAEL ROSS v. DELTA INDUSTRIAL COATINGS, INC. ET AL. – Employer appealed, arguing that the trial court erred in its determination of the date of MMI and that the award of PPD is excessive. – WC Panel concluded that the evidence did not preponderate against the trial court’s findings concerning the impairment rating and vocational disability and reversed the trial court’s finding as to the date of maximum medical improvement

THE SUPREME COURT OF TENNESSEE SPECIAL WORKERS’ COMPENSATION APPEALS PANEL

CONNIE ERDMAN v. SATURN CORPORATION – On appeal, Employee contends that the trial court erred in two ways:  By finding that Employee’s permanent partial disability

award should be capped at one and one-half times her medical impairment rating;  Second, in finding that Employee is not entitled to reconsideration of a prior injury to her left shoulder. Because the evidence does not preponderate against the findings  WC Appeals Panel affirmed the judgment of the trial court.

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 - 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

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 - 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 Review Cliff Wilson / John Barringer / Richard Murrell

3:45 –4:00

Door Prizes

4:00 –5:00

Hospitality Room in Refreshment Center

Reminder: Conference Evaluation Forms

Recycle Name Badges at Registration Table