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Apr 16, 2014

CMS Issues WCMSA Self Administration Toolkit For Injured Employees

Last week, the Centers for Medicaid and Medicare Services (CMS) created a page with quite an amount of documentation for Workers Comp Medicare/Medicaid Set Asides (WCMSA).

The page is for injured employees that wish to Self-Administer their MSA account.  The CMS provided a laundry list of documents for claimants that did not wish to have an outside service handle their MSA account.  Click here for the page.   The PDF file for the toolkit is here.

The CMS does a great job of explaining the WCMSA process.   The amount of tracking and materials may be too burdensome for some of the injured employees.   CMS performed well for giving it a try.   The Table of Contents of the guide is below.   The page numbers were intentionally left off the Table.

There are a few interesting yet troubling areas in the guide.  Those will be included in tomorrow's article.

Table of Contents

Section 1: Introduction
Section 2: Setting Up the WCMSA Bank Account
Section 3: How Your WCMSA is Funded
Section 4: Using the Account
  • What medical and prescription expenses can I pay for from this account?
  • Can I use the account to pay for anything else?
Section 5: What to Tell Your Health Care Providers
  • How should my health care providers calculate the bill?
  • What if my health care provider is also treating me for other problems?
Section 6: Reviewing and Paying Your Bills
Section 7: Keeping Records
Section 8: Annual Attestation
  • Final depletion of funds
Section 9: Reporting Changes
  • Medicare entitlement status
Section 10: Inheritance
Section 11: Topics Unique to Structured WCMSA Accounts
  • What if I do not use all the funds in a year?
  • What happens if my funds run out before the next deposit?
Section 12: Where to Get Help
Section 13: Letters and Examples
  • Letters for your health care providers: Medical providers
  • Letters for your health care providers: Pharmacy providers
  • Lump-sum annual attestation and expenditure letter
  • Lump-sum annual attestation and expenditure letter: Exhausted lump-sum account
  • Structured account attestation and expenditure letter: Annual attestation
  • Structured account attestation and expenditure letter: Temporary exhaustion
  • Structured account attestation and expenditure letter: Permanent exhaustion
  • Transaction Record Sample
Section 14: Glossary

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Apr 15, 2014

The Best Workers Compensation Apps on Google Play Store Are.....

Last week, I wrote two articles on any Android apps that were in the Google Play store.  As promised, I have tried a few out to see if any actually worked and if any would be helpful.

The one that actually looked to be a timesaver and worked well was Sedgwick's ViaOne Express.   Even though there have been connection and leave reporting issues, it is one of the better ones on the Play store.  The app received 3.5 stars out of 5.  Even though the score could have been better, it is slim pickings on the the Play store website for WC apps.

Online claims access is always critical in controlling Workers Comp costs.  The ability to have the injured employee update their return to work date is a nice feature.

If there are better apps that are not on Google play, the provider can always upload it to the Play store.

A description of the Sedgwick app is below.

Sedgwick viaOne express mobile gives our clients’ employees instant access to view the status of their workers’ compensation, disability and FMLA/leave claims and cases managed by Sedgwick, as well as the ability to submit any questions they may have regarding claims, forms, benefit plans and more. Claimants can even update the claims examiner regarding their anticipated return-to-work date.
Login – Use your existing viaOne express web username and password to log in.
Self-registration – If you are not yet registered on the web, you can self-register by providing a valid claim/absence number or employee ID, along with key demographic information.
Claim and case summary – View a list of your recent workers’ compensation, disability and FMLA/leave claims and cases (open or closed within the last 24 months).
Claim and case details – Click on the claim number to view additional information concerning each claim or case.
Payment history – View a payment history log for workers’ compensation and disability claims that are scheduled or have been issued in the last 60 days.
Submit a request or inquiry – Use a secure online form to submit any of your requests. For example, submit a new return-to-work date or need for extension; indicate your next medical appointment or your plan to submit new medical information; or send a general question to be addressed by your claims examiner or leave specialist.
Claim status notification preferences - Now available for employees of select workers’ compensation clients, app users can opt in to receive notifications related to their cases and claims.
Contact technical support – Access viaOne express mobile support representatives.
Contact claim support – Simply click to call a Sedgwick claims representative focused on providing live support to answer your claim or case questions.

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Apr 14, 2014

Heartbleed Bug - Sorry About The Bad Link

Over the weekend, I received a few emails that said the link on the Heartbleed Bug on the April 11th update of my original April 10th article on a major security flaw involving  a large % of the Internet.   I corrected the link on this article over the weekend.   Please accept my apologies.  Kudos should be given to Alyssa Bereznak for her efforts in compiling the list.   

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Apr 11, 2014

Charity Of The Month - Jane Goodall Institute

I was reading on Yahoo News early this morning about chimpanzees at the Kansas City Zoo that had fashioned a makeshift ladder and almost escaped from their enclosure.   One of the commenters mentioned the Jane Goodall Institute as a worth charity.   After watching her undying work with trying to further our knowledge of  apes, gorillas,  and monkeys on TV for years, I decided to provide a link to her charity.  Please see below.  The website itself is an interesting diversion on a Friday.

Jane Goodall Institute link

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Apr 10, 2014

Is Your Workers Compensation Data Safe Online With The New HeartBleed Bug - Update

As you may have already read, there has been a major "hole in the internet" that has caused many systems and websites to be vulnerable to hackers for many years.

UPDATE 4-11-14   This is a nice list of what passwords will need to be changed due to the bug.

This subject caught my interest as I used to have the job of breaking into systems for clients when I was a Systems Engineer.   In the 1980's and 1990's it was so very easy to break into systems.  My reports used to embarrass a few clients.

How did I do it?  I would type in such things as Administrator for the username and Password for the password.   That took care of about 50% of the systems in the old days.  Websites and systems of today are much more secure ---NOT.

Click here for an article that explains the recent largest breach ever on the internet.   The article is a little on the dramatic side, but it is simple, yet accurate.   Did we really need a guy in a stocking mask?

The answer right now is that if your system or your WC insurance provider or Third Party Administrator used OpenSSL,  it may be a good time to let the dust settle until they upgrade to the newest version.

This is a massive deployment that must be undertaken over the next few days to weeks.  The Heartbleed Bug does have a fix called Fixed OpenSSL.

Two thirds of the internet was affected overall.  For the techie-minded, the note on the fix is here.   There have been many article published on how to identify if your systems or your carrier/TPA's system was using OpenSSL.

Actually, there is a website here for your personal and business website vulnerability concerns.  There is a FAQ section if you find that any website you visit is vulnerable.

Most major banks, Microsoft and Apple never had any vulnerability.  BTW, the blog post you are reading and the website were never vulnerable.   

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Apr 9, 2014

North Carolina's Largest Safety Conference - And It Is Still Free!!!

Attendees register here.  Vendors register here


Joseph S. Koury Convention Center
Greensboro NC
MAY 13-15, 2014
“Safety in the 21st Century”
CONFERENCE REGISTRATION - 8:00 am - 5:00 pm – Heritage Room - 3rd Floor Atrium
EXHIBIT HALL CLOSED during Exhibitor Set-up - 4:00 pm - 9:00 pm
Moderator: Barbara Cassidy, President, NCALGESO, Winston-Salem, NC
8:45 - 9:00 “Welcome and Announcements”
Speaker: Barbara Cassidy, President, NCALGESO, MESH, Safety/Loss Control Analyst, Forsyth County Risk Management, Winston-Salem, NC 
9:00 - 10:00 “Planning For Mass Violence Incidents”
Speaker: August Vernon, Operations Officer, Forsyth County Emergency Management, Winston-Salem, NC 
10:00 - 10:45 “Facility Security Assessments”
Speaker: Randy Cranfill, Director of Safety & Loss Prevention, Surry Insurance, Dobson, NC 
10:45 – 11:00 “Break” 
11:00 – 12:00 “How to Eat on the Street: Real Work Employee Nutrition”
Speaker: Bryan Fass, STC, LAT, CSCS, EMT-P, President, Fit Responder, Charlotte, NC
(6 hours Professional Growth – Pre-registration REQUIRED)  To register for this workshop, CLICK HERE!
Moderators: Stephanie Glasgow, OWASA, Carrboro, NC
David Vann, Coty, Sanford, NC
Speakers: NC Safety Conference, Inc., Safety Consultants, Raleigh, NC
Co-sponsors: North Carolina Department of Labor; Eastern Carolina, North Carolina, Tar Heel, Triad & Western Carolina ASSE Chapters 
Exhibitors: Marcy Collyer, NC Department of Labor
Moderator: Marcy Collyer, MESH, C-MESH, Safety Education Specialist, NC Department of Labor, Raleigh, NC
1:00 – 1:50 “OSH Update”
Speaker: Allen McNeely, OSH Director, NC Department of Labor/OSH Division, Raleigh, NC
2:00 – 2:30 “Recognition Program Update”
Speaker: Lamont Smith, Recognition Program Manager, MS, CPM, NC Department of Labor/OSH Division, Raleigh, NC
2:30 – 2:45 “Break”
2:45 – 3:15 “Standards Update”
Speaker: Standards Supervisor, NC Department of Labor/OSH Division, Raleigh, NC
3:15 – 4:00 Conference Welcome and Announcement of 2015 Conference Dates”
Speaker: Dennis E. Parnell, Executive Director, NC Safety Conference, Roanoke Rapids, NC
2014 Wednesday May 14, 2014 Bulletin

WEDNESDAY, May 14, 2014
CONFERENCE REGISTRATION - 8:00 am - 4:30 pm – Heritage Room - 3rd Floor Atrium
EXHIBIT HALL OPEN - 8:00 am - 4:30 pm - 3rd Floor Atrium
Moderator:     Dennis E. Parnell, Executive Director, NC Safety Conference, Inc, Roanoke Rapids, NC
8:00 - 8:30 Work-Related Back Injuries-Pearls and Pitfalls
Speaker: Dr. O. Del Curling, MD, MBA, Neurosurgery & Pain Specialists of the Carolinas, Winston-Salem, NC
8:30 – 8:45 “Break”
Moderator:    Dennis E. Parnell, Executive Director, NC Safety Conference, Inc, Roanoke Rapids, NC
Sponsored by Carolina Back Institute
8:45 – 10:00 “Management of Low Back Pain”
Speaker: Jasbir Dhaliwal, Physical Medicine & Rehabilitation Specialist, MD, Carolina Back Institute, Raleigh, NC
10:00 -10:15 “Break”
10:15-10:30 Safety Education Section Update
Speaker: Dennis Parnell, Executive Director, NC Safety Conference, Roanoke Rapids, NC
Moderator:    Charles R. “Buster” Dawson, Board Chairman, NC Safety Conference, Inc., Wilson, NC
NC Statewide Safety Talk Competition – Regional Safety Contest Winners, AWARDS AND DOOR PRIZES
12:00 - 1:30 Visit the Exhibits
ASSE LUNCHEON - 12:00 pm - 1:30 pm – COLONY BC
Moderator: Rick Kilpatricj, President-Elect, Western Carolina Chapter ASSE, Connellys Spring, NC
Luncheon Tickets Required - Tickets available at ASSE Booth # 2 in the Exhibit Hall or from your local ASSE Chapter President
Topic Strategic Thinking for Excellence
Speaker: Trish Ennis, CSP.ARM CRIS ASSE President Elect
INDUSTRIAL SESSIONS - 1:30 pm to 4:00 pm
Moderator: Michael Nance, Safety Consultant, NC Safety Conference, Inc. Belmont, NC
Andy Spradley, Safety Manager for Biltmore Company, Asheville, NC
“Pesticide Safety & Updates”
Speaker: Eddie Nunn, Pesticide Inspector, NCDA&CS Pesticide Section, Raleigh, NC
2:15 - 3:15 Visit the Exhibits
3:15 - 4:00 “Safety in the Hospitality Industry”
Speaker: Andy Spradley, Safety Manager for Biltmore Company, Asheville, NC
Moderator: Eric Johnson, Safety Consultant, NC Safety Conference, Inc. Edenton, NC
Speaker: Michael Edens, CIH, CSP, CHMM, Edens EHS, Winston-Salem, NC

2:15 - 3:15 Visit the Exhibits
3:15 - 4:00 “GHS (Labeling Now & Later)””
Speaker: Kelley Sharma, Sales Manager, SiteHawk, Smyrna, TN
Moderator: Buford Ellis, Corporate Account Manger, CA Short, Shelby, NC
1:30 - 2:15 “Safety Incentive Programs: Are You Leading or Lagging?”
Speaker: Jim Barr, VP of Sales, C.A. Short Company, Shelby, NC
2:15 - 3:15 Visit the Exhibits
3:15 - 4:00 “Safety Incentive Programs: Are You Leading or Lagging?”
Speaker: Jim Barr, VP of Sales, C.A. Short Company, Shelby, NC
Moderator: Michael Bingham, EHS Professional, Duke Energy, Franklin, NC
1:30 – 2:15 “Electrical Safety”
Speaker: Parks Nesbit, Lead EHS Professional, Duke Energy, Franklin, NC
2:15 - 3:15 Visit the Exhibits
3:15 – 4:00 “Electrical Safety”
Speaker: Parks Nesbit, Lead EHS Professional, Duke Energy, Franklin, NC
Sponsored by NC Trucking Association, Safety Management Council
Moderators: Richard Hepler, Best Cartage, Kernersville, NC
Tim Long, Epes Carriers, Greensboro, NC
1:30 - 2:15 “How We Handle Accident Investigations”
Speakers: Teague Campbell Law Firm 
2:15 - 3:15 Visit the Exhibits
3:15 – 4:00 “How We Handle Accident Investigations”
Speakers: Teague Campbell Law Firm
CONFERENCE - EXHIBITOR RECEPTION - 5:00 pm - 7:00 pm – VICTORIA BALLROOM – Sponsored by Your Exhibitors!
The reception is open to all participants. Please join us for socializing with music and entertainment provided by Tom White, Classic Sound Entertainment, Lucama, NC. Mr. Jerry Frazee and his associate will be on hand again this year in the Exhibit Hall providing FREE caricature drawings10:00 am – 4:00 pm!
2014 Thursday May 15, 2014 Bulletin

THURSDAY, May 15, 2014
CONFERENCE REGISTRATION - 8:00 am - 4:00 pm - 3rd Floor Atrium
EXHIBIT HALL OPEN - 8:00 am - 3:30 pm - 3rd Floor Atrium
8:00 - 8:45 “The Who, What, When, Where, Why and How of Fit Testing Hearing Protection Devices”
Speaker: Sarah Ervin, Doctor of Audiology and Customer Relations Facilitator, Workplace INTEGRA,  Inc., Greensboro, NC
8:45 - 9:15 “Break”
Sponsored by Sensors Safety- Hazardous Air Testing
Moderator: Fletcher Bizzell, Glenoit LLC/Ex-Cell Home Fashions, Inc., Goldsboro, NC
9:15 - 10:00 “Thirty Years of Consequences-The John Martin Story”
Speaker: John Martin, Owner, Martin Safety Solutions, Charleston, SC
10:00 - 10:30 “Break”
10:30 - 11:55 “A Short Cut to An Injury”
Speaker: Speaker: John Martin, Owner, Martin Safety Solutions, Charleston, SC
11:55 - 12:00 “NC Safety Conference, Inc. Update”
Speaker: Dennis E. Parnell, Executive Director, NC Safety Conference, Inc, Roanoke Rapids, NC
12:00 - 1:30 Visit the Exhibits
12:00 – 12:45 – GRANDOVER WEST – CLOSED SESSION – Pre-registration Required!!!
Moderator: Cara Winstead, RN, MPH, COHN-S, Education Director, NCAOHN, Cary, NC
Luncheon tickets available from NCOHN Association by Pre-Registration ONLY.
For more information call Cara Winstead at (919) 362-1431 or email

INDUSTRIAL SESSIONS - 1:30 pm to 4:00 pm
Sponsored by the NC Association of Occupational Health Nurses
Moderator: Cara Winstead, RN, MPH, COHN-S, Education Director, NCAOHN, Cary, NC
Speaker: Debra Lord, Vice President, Job Ready Services, LLC, Cary, NC

1:45 - 2:00 “Break”
2:00 - 3:00 Workplace Discrimination Based on Safety: Is It Good or Bad?”
Speaker: Debra Lord, Vice President, Job Ready Services, LLC, Cary, NC
Moderator: Charles R. “Buster” Dawson, Dawson Construction Services Inc., Wilson, NC
Wendy Shepherd, Occupational Safety, NC State University Environmental Health and Safety, Raleigh, NC
Bill Walker, MSOS, CPEA, CRM, Vice President of Risk Management, Southern Piping Company, Wilson, NC
1:30 - 2:15 “Business Continuity”
Speaker: Katina Blue, Director of Business Continuity and Disaster Recovery, NC State University, Raleigh, NC
2:15 - 2:30 Visit the Exhibits
2:30 - 3:15 “Heat Stress”
Speaker: Kim Morton, Area Director, Federal OSHA, Raleigh, NC
Moderator: John Lemire, Forestry Mutual Insurance Company, Raleigh, NC
1:30 - 2:15 “The Role of Loss Control Personnel”
Speaker: Gene Seago, Safety & Loss Control Division, The Clement Companies, Greenville, NC
2:15 - 2:30 Visit the Exhibits
2:30 - 3:15 “Training Non-English Speaking Employees”
Speaker: Michael E. Bearak, Safety & Risk Manager, Budd Workforce Solutions, Wilson, NC

Moderator: Michael Bingham, EHS Professional, Duke Energy, Franklin, NC
1:30 - 2:15 “Electrical Safety”
Speaker: David Harmon, Lead EHS Professional, Duke Energy, Franklin, NC
2:15 - 2:30 Visit the Exhibits
2:30 - 3:15 “Electrical Safety”
Speaker: David Harmon, Lead EHS Professional, Duke Energy, Franklin, NC
Moderator: Ken Blake, American Red Cross, Greensboro, NC
1:30 - 2:15 “Flu Pandemic”
Speaker: Marguerite Davis, American Red Cross, Greensboro, NC
2:15 - 2:30 Visit the Exhibits
2:30 - 3:15 “Flu Pandemic”
Speaker: Marguerite Davis, American Red Cross
ModeratorsMatthew Schweitzer CIH, CSP, Safety Manager, City of Greensboro, Greensboro, NC
Denise Kennedy, Piedmont Natural Gas, Charlotte, NC
1:30 - 2:15 “Safety Past, Present and Future”
Speakers: Fred Allen, City of Greensboro, Safety Officer, Greensboro, NC
Barbara Cassidy, President, NCALGESO, MESH, Safety/Loss Control Analyst, Forsyth County Risk Management, Winston-Salem, NC
Debbie Meurs, Safety & Health Director, City of High Point Safety & Health Division, High Point, NC
2:15 - 2:30 Visit the Exhibits
2:30 - 3:15 “Safety Past, Present and Future”
Speakers: Fred Allen, City of Greensboro, Safety Officer, Greensboro, NC
Barbara Cassidy, President, NCALGESO, MESH, Safety/Loss Control Analyst, Forsyth County Risk Management, Winston-Salem, NC
Debbie Meurs, Safety Director, City of High Point, High Point, NC
EXHIBIT HALL CLOSES - 3:00 pm Exhibitor Door Prize and Grand Prize Drawings will be held in the Exhibit Hall at 3:30 pm. You must be present to win Grand Prize Drawing.
4:00 pm “Closing Comments” Dennis E. Parnell, Executive Director, NC Safety Conference, Inc.
Mark your calendar now for the 85thAnnual
May 12 - 14, 2015

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A Further Look at Android Apps for Workers Compensation

I decided to carry the apps examination from yesterday on through and look at each one. Please note that I did not access most of the apps themselves.

Many of the apps were combined when they were from the same provider.  The rest of the 177 apps from yesterday were mainly plaintiff attorney-based or were unrelated to Workers Comp such as anime.

I did not included the provider's name unless it was necessary to describe the app.  You may use the link from yesterday to see a list of the apps.  When I accessed the apps early this morning using the same search term, the results were slightly different than yesterday

There are many apps for WC that are not in the Android marketplace for some reason.  I did not mention those apps.   I will be covering the best three out of the list next week. 
  •  Experience Mod app – did not work
  • State of Mississippi Annual WC Conference – good app
  • Digital Permanent Disability Calculator – cost $ to use
  • Oregon TPA – Risk Management Library – purports to provide invoices, schedules, documents, risk management library, publications as PDF documents
  • National PBM provider – good RX app
  • National occupational med clinic - good app that allows injured employees, adjusters, and employers to have access to records
  • National Third Party Administrator – app allows full access to claims information, my favorite if it works properly
  •  National Workers' Compensation and Disability Conference® & Expo app – for attendees.  I have used this app previously and it performed well
  • California Occupational Code lookup app, single impairment calculator, combined and full impairment calculator – all paid apps
  • Nevada TTD/PPD Calculator – simple table search and calculator
  • Texas lifetime, temporary, and supplemental benefits calculator
  • Workplace safety app
  • North Carolina single impairment calculator
  • North Carolina WC Statutes
  • Florida Temporary Partial benefits calculator
  • National PBM provider
  • Risk & Insurance Magazine – I read their emailed version

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Apr 8, 2014

Google Play Store Has 177 Workers Compensation Apps -Some Are Interesting, Very Few Are Helpful

I have owned a Google Nexus 4 phone for approximately one year.  There are so many apps to choose from for most of what I need that the experience is similar to car-shopping.   While I the Google Play store (never liked that name) I thought I would perform a search for Android Workers Compensation apps.

There are 177 apps on the results screen.  Many are from plaintiff attorneys from across the nation.  I am going to trudge through the apps to see if any are that helpful.   If anyone reading this article knows of a great app for Workers Comp, please feel free to post a reply, or email me.

I will provide updates as I eliminate any of the 177 that do not belong there.  I see that are a few anime apps that are beyond me why they would show up in the search results. 

My first one that I thought would be interesting was an app on Experience Mods (E-Mods/X-Mods).  It did not work whatsoever.  I had to remove it from my phone.  

 BTW- the most useful overall apps I have found are:
  • The Weather Channel(R) 
  • Amazon Kindle (R)
  • Audible (R)
  • Avast! Mobile Security (R)
  • SwiftKey(R)
  • Android Assistant(R)
  • QuickOffice(R) 
  • Google Maps(R)
  • Google Chrome(R)

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Apr 2, 2014

Saisfying Medicare MSA's and Conditional Liens

Carmen Bullard - Concierge Medical and Risk Consultants

Determining Medicare Status
  • Multiple Ways to determine Medicare/Potential Medicare Status
    • 65+ years old
    • Applied for SSDI
    • Between 62.5 and 65 years old
  • Conditional Lien (handout)
    • Contact the COBC and report the clam
    • Will receive
      • Rights and responsibilities letter
      • Conditional payment letter
Submit info through portal is the best way to report

Does the Lien need to be negotiated?
  • Are there unrelated payments
  • Is there a good legal or medical argument as to why the payments should not be reimbursed
  • Are you being charged for entire hospitalizations with only a portion is related to the claim
MSA's- Protecting Medicare from Future Payment
  • Is the injured person a beneficiary or will they be soon?
  • Has the injured person applied for SS benefits?
  • How serious is the injury?
  • Is future treatment anticipated? 
CMS states that Submission is a voluntary process

Conditional Liens - Pitfalls and Trends
  • Do not delay
  • Offer a solution

  • One right number
  • Current trends when reviewed
  • Re-review???


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Rated Ages - Kevin Puckett - KP Underwriting LLC

Plaintiff attorneys do not usually use rated ages as this may reduce their demand, etc.

Life Expectancy - The expected number of years of life remaining at a given age

Rated Age - is an age given based on an individual's medical impairments and the effect they have on their life expectancy.

Underwriting Process
  • Date of injury
  • Current functional status
  • Look for medical conditions
  • Consult Underwriting manual
  • Consult life tables 
Independent vs. Life Company
  • Underwriter opinion - manuals are different for each rating company
  • Conservatism - varies between life companies
  • Policies and guidelines vary greatly among Life Companies
  • Underwriting Manuals are very different for each Life Company
  • Life Tables - Life companies use gender specific, etc. tables and are also sometimes old
Medical Records
  • Current, within past two years
  • Lots of details on impairments
  • Acceptable medical info
    • IME, AME, Life Care Plan, Orthopedic notes
    • Medical records within past five years
    • The older the information, the more conservative the rated age
Supplying full medical information will always help with the rated age.  Lack of medical records can cause a lower rated age for a healthier  individual.

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Determining Future Medical Exposure - Life Care Plans and Medical Cost Projections

Presenters - Alisa Cornetto and Carmen Bullard, Concierge Medical and Risk Consultants

Hire someone certified due to Daubert  rules and also that have proper credentials

Review CV's of life care planners and other consultants

Definition of Chronic Pain - daily pain that has lasted six months to on year after the original pain incident

15% - 20% of the population has chronic pain

Cost of Chronic pain (annually):
  • 2003 - $25 billion
  • Present - exceeds $40 billion
  • 25% of all sick days = $50 million
  • 80% of all physician visits
Definition of A Life Care Plan:

A life care plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research which provides an organized concise plan for current and future needs with associated costs, for individuals who have experienced catastrophic injury or have chronic care needs

  • Provide health education to the interested parties, when appropriate.
  • Develop accurate and timely costs information 

Collect data that is systematic, comprehensive, and accurate

  • Use reliable sources
  • Sources that are readily available to the client
  • Duration of care
  • Replacement frequency
  • Appropriate use by client
  • Care is reasonably available
MSA Analyis and Life Care Plan are two very different things

Life Care Plan needs to be collaborative

Medical Cost Projections are not the same as Life Care Plan

No governing body for Medical Cost Projections

Goal is the patient 

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Maximizing The Use of Medical Experts - Ralph and Anita Hunt - The Hunt Law Firm

Ralph and Anita Hunt have their own plaintiff law farm.  They have to examine the potential value very closely as they are a small law firm that does not have the financial backing of large law firms.

Their analysis today will be from the view of the plaintiff law firms.

The average liability case in North Carolina is $6,000.

Three times the specials used to be the norm, but not any longer.   Tort reform is changing the trends of legal practice.

Types Of Medical Experts
  • Legal Nurse Consultant
  • Nurse Case Manager (NCM)
  • Treating Physician 
  • Independent Medical Exams (IME)
Workers Comp may have a lower level of proof than State Superior Court on a liability file.

Medical cost projection versus Life Care Plan
  • Medical cost projections are much more exact
  • Use Legal Nurse Consultant - pattern jury instructions
Medicare/Medicaid Set Aside
  • Sharing information will help all parties
  • MSA's can take a very long time
  • Doctors may not keep seeing patient if legal is involved
Attorney Anita Hunt presented a skull that had injuries projected on it that was fascinating.   There are firms that will alter skulls to show injuries. 

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Chronic Pain 101 Evidence Based Medicine, Opioids, Injections and More - Dr. William Nemeth and Dr. Suzanne Novak

Dr. Nemeth  ( with RestoreFx was the prior Medical Director for the TDI - State of Texas.  He is from Austin, TX.   He is going to talk about medication misuse.

  • Abuse - Addiction is a brain disease with loss of control, compulsive use, craving, and consequences. 
  • Tolerance - the state of physical adaption in which exposure to a drug induces changes that result in decreases of drug effect over time
  • Hyeralgesia-  a state of hypersensitivity following the withdrawal or of opioids or in chronic addiction
  • Pseudoaddiction - drug seeking due to the undertreatment of chronic pain
  • Acute
  • Chronic
  • Nocieceptive
  • Neuropathic
Chronic Pain Syndrome
  • Copers - tolerate the pain
  • Chronic pain syndrome
  • Up to 56% of Pain Clinic patients
  • Alcohol/Drug/Use
  • Family History of Addiction
  • Behavioral indicators
  • Urine Drug Screening
  • Smoking
  • Medical Indicators

Dr. Suzanne Novak - Board Certified Anesthesiologist, PhD Outcomes research and pharmacoeconomics, Professor in pharmacotherapy, at University of Texas, lead author ODG Treatment Guidelines 

She is the wife of the prior speaker - Dr. Nemeth

ODG- National Guidelines- prescribing guidelines that are now accepted in the 13 states.

Evidence Based Medicine (EBM) is here to stay
There are obviously limitations to the use of EBM 

Handling a Complex Case Main Focus
  • Evidence based
  • Effective 
  • Safe
  • Cost-effective in most cases
Paying for something that is not work-related
  • Diabetes
  • Hepatitis
  • Autoimmune disease
  • Numerous other conditions
Part of the problem missed
  • Injections
  • Other care - e.g. urine drug screens
  • Compounded drugs
  • Causality
  • Underlying comorbidity 
Why to do the review and uses of info
  • Treatment plan issues
  • Settlement//MSA
  • Have a plan
  • Get a team
  • Who will first contact provider?
  • Type of info
  • Options to offer
State of Washington - Labor and Industry has a daily morphine equivalency calculator - used to see the amount of morphine can be equated to a daily amount of narcotics.   There is also a a benzodiazipine equivalency calculator.

  • Interventional techniques  increased by 228% - 2000 to 2011
  • Medicare expenditures increased by 240% - 2000 to 2008
  • Office of Inspector General (DHHS) significant proportion of facet joint and ESI's were not medically necessary. 
  • A single facet joint injection is recommended 
  • If 50% or more pain relief for 6 weeks from the single facet injection,  proceed to other blocks
  • Series of three injections is antiquated 
Urine Drug Testing 
  • A Point of Care screen is recommended before initiating chronic opioid therapy
  • Risk assessment should be made on a schedule determined by patient abuse risk factor
  • Random collection is encouraged
  • Quantitative testing is not recommended

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Blogging Live From the Concierge Medical and Risk Consultants Conference

I will be blogging live from the Concierge Medical and Risk Consultants Conference in Burlington, NC.  I apologize upfront for any typos or improper grammar.    It is hard to do much checking while doing the conference  live.   Please feel free to comment on any of the articles.   I will blog one for each speaker or set of speakers.   Thanks. 

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A Great WC Medical Conference - Burlington, NC April 1st and 2nd 2014

Concierge Medical Consultants is holding a WC medical conference in Burlington, NC on April 1st and 2nd 

The details and registration can be found here or check out the details below.   You can even email in questions to the panel for April 1st. 

Lead Author of the ODG Pain Management Guidelines
& Dr. William Nemeth, MD, Addictionologist

Join us for Mastering the Medical Portion of the Case, a comprehensive program comprised of medical experts and legal experts who will inform the audience of how to best prepare for the medical portion of complex cases/claims involving pain management issues.  Physicians will discuss current evidence based guidelines speaking in detail on opioids, injections, psychiatric comorbidity, functional restoration programs and diversion.  Participants will gain a legal perspective from attorneys on both the plaintiff and defense side of how they use different types of medical experts to prepare their cases and how they deal with these complex cases/claims.

Life care planning and medical cost projections will be explored as we talk about how to determine the future medical exposure of a case/claim.  A licensed underwriter will discuss rated ages.   The Medicare Secondary Payer Act, particularly the SMART Act will be discussed and satisfying Medicare, both the liens and future medicals will be explored.  Finally, a Medicare Secondary Payer legal update will be provided.

Pending Approval: 6.5 CLE (including 2.5 hours ethics) & 6 CE hours
Approved for 6.5 CCM Hours and 6.5 MSCC/CLCP hours including 5 hours of MSCC ethics

Networking Session: 4/1//2014
5:30 pm - 7:30pm

Case Scenario Panel Discussion with Dr. Suzanne Novak and Dr. William Nemeth
Registrants may email their questions for the panelist to

Seminar: 4/2/2014
8:30am - 4:30pm

7:30 am - 8:30 am

8:30 am – 10:00 am
Chronic Pain 101: Evidence Based Medicine, Opioids, Injections and more.
Dr. Suzanne Novak, MD, PhD and Dr. William C. Nemeth, MD

10:00 am - 10:15 am

10:15 am - 11:15 am
Chronic Pain 101: Evidence Based Medicine, Opioids, Injections and more (continued).
Dr. Suzanne Novak, MD, PhD and Dr. William C. Nemeth, MD

11:15 am - 12:00 pm
Maximizing the Use of Medical Experts
Anita Hunt, The Hunt Law Firm
Ralph Hunt, The Hunt Law Firm

12:00 pm - 12:30 pm
Creating an Expert Medical Defense
John Jeffries, McAngus, Goudelock and Courie

12:30 pm - 1:30 pm
Lunch (served onsite)

1:30 pm - 2:30 pm
Determining future Medical Exposure: Life Care Plans and Medical Cost Projections
Alisa Cornetto, Concierge Medical and Risk Consultants
Carmen Bullard, Concierge Medical and Risk Consultants

2:30 pm - 3:00 pm
Rated Ages: Determination and Use
Kevin Puckett, KP Underwriting LLC

3:00 pm - 3:15 pm

3:15 pm - 4:00 pm
Satisfying Medicare: MSA’s and Conditional Liens (SMART ACT Update)
Alisa Cornetto, Concierge Medical and Risk Consultants
Carmen Bullard, Concierge Medical and Risk Consultants

4:00 pm - 4:30 pm
Medicare Secondary Payer Legal Update
Amber Liggon, Hedrick , Gardner, Kincheloe and Garofalo LLP

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Apr 1, 2014

Tina Fey May Have Had Workers Comp Coverage After All - Well Kind Of

A recent article in the Insurance Journal indicates that Tina Fey may have had continuous coverage.   I found an article last weekend which said she owed $79,000.

However, the newest article did not say that WC coverage was found for a period from November 2012 to November 2013.

The New York Comp Board said that it was a clerical error.  I have rarely seen a WC Board admit to the press that a clerical error was made after fining a company for no WC insurance.

I rarely do previous article retractions of any type.   

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Mar 29, 2014

New York Workers Compensation Board Hits Actress Tina Fey With $79,000 Judgment

According to an article in the Smoking Gun, Tina Fey of Saturday Night fame was hit with a $79,000 judgment by the New York Work Comp Board  (5 pages)  for having no Workers Compensation insurance.

The name of the production owned by Tina Fey is Little Stranger, Inc.  However, the judgment was in Fey's name only.  The judgement was for failure to carry Workers Comp insurance.

It seems, as in many cases with the NY Workers Comp Board, no one can exactly figure out how the $79,000 judgment was arrived at in the court documents.   However, all of  Fey's appeals have now been exhausted which means it is pay-up time.

One has to wonder how the round number of $79,000 was arrived at in the judgment.  

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Mar 28, 2014

Certificates of Insurance - Delaware Increases Fraud/Improper Use Enforcement

Delaware recently decided to increase the enforcement of their Certificates of Insurance laws by amending their old law on improper use.  Certificates of Insurance have long been a bane of premium auditors nationwide which has resulted in complete refusal of any presented to them.

Delaware also brought job banks to light as a great risk management tool in 2013 when a bill was passed that required job banks by employers.  The article on job banks is one of the most popular on this blog.  More states should look at adding the job bank law.

The new Certificates of Insurance  law bans any request for by any party for an untruthful certificate.  Agents were producing this type of certificates to keep the employer's business.  

The basic tenets of the law are that any party cannot:

  • Request of a certificate that does not accurately reflect the underlying policy 
  • Issue of a false or misleading certificate or one that purports to alter, amend or extend the coverage provided by the insurance policy
  • Use of a certificate to warrant that a policy complies with the insurance or indemnification requests of a contract

The legislation also enables the Delaware Department of Insurance to issue cease-and-desist orders and to assess fines against those who request false or misleading certificates

The main part of the bill without the term definition clauses is:

 4503.  Certificate forms.
        (a)  The Commissioner shall prohibit the use of a certificate of insurance form if the form:
         (1) Is unfair, misleading, or deceptive, or violates public policy; or
         (2) Violates any law, including any regulation promulgated by the commissioner of insurance.
        (b) A certificate of insurance is not a policy of insurance and does not affirmatively or negatively amend, extend, or alter the coverage afforded by the policy to which the certificate of insurance makes reference.  A certificate of insurance shall not confer to any person new or additional rights beyond what the referenced policy of insurance expressly provides. 
        4504.  Limitations on use.
        (a) A person shall not:
                (1) Prepare, issue, or request or require the issuance of a certificate of insurance that contains any false or misleading information concerning the policy of insurance to which the certificate of insurance makes reference; or
                (2) Prepare, issue, request, or require the issuance of a certificate of insurance that purports to affirmatively or negatively alter, amend, or extend the coverage provided by the policy of insurance to which the certificate of insurance makes reference.
        (b) A certificate of insurance shall not warrant that the policy of insurance referenced in the certificate comply with the insurance or indemnification requirements of a contract, and the inclusion of a contract number or description within a certificate of insurance shall not be interpreted as doing such.
        § 4505.  Notice requirements.
        A person is entitled to notice of cancellation, nonrenewal, or any material change, and to any similar notice concerning a policy of insurance only if the person has such notice rights under the terms of the policy of insurance or any endorsement to the policy. The terms and conditions of the notice are governed by the policy of insurance or endorsement and may not be altered by a certificate of insurance.
        § 4506.  Applicability.
        (a) The provisions of this Act shall apply to all certificates of insurance issued in connection with property, operations, or risks located in this State, regardless of where the policyholder, insurer, insurance producer, or person requesting or requiring the issuance of a certificate of insurance is located. 
        (b) A certificate of insurance or any other document or correspondence prepared, issued, requested, or required in violation of this Act shall be null and void.
        § 4507.  Enforcement and Penalties.
        (a) The Commissioner shall have the power to examine and investigate the activities of any person that the Commissioner reasonably believes has been or is engaged in an act or practice prohibited by this Act. 
        (b) The Commissioner shall have the power to enforce the provisions of this Act, including the authority to issue orders to cease and desist and to impose a fine of up to $1,000 per violation against any person who violates this Act.

        (c) The Commissioner may adopt reasonable rules and regulations as are necessary or proper to carry out the provisions of this Act. 
        Section 2. Effective Date.
        This Act shall take effect 90 days after enactment. 

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