Update on Workers’ Compensation Reform TN Prima 2017 Annual Conference November 2, 2017 Update on Workers’ Compensation Reform Abbie Hudgens, Administrator BWC

The Reform Act of 2013 Intent To strike a balance between the interests of employees and employers and make the workers’ compensation system better for both.

Intent Led to Bureau’s Mission: Fulfilling the Promise of Workers’ Compensation Today and Tomorrow . . .

Fulfilling the Promise of Workers’ Compensation To Us That Means… Timely, fair (to both parties) adjudication of claims Fair and impartial review of disputed claims Assistance to unrepresented parties Enforcement of the requirements to provide benefits provided by law Appropriate, good, timely health care More employees return to work Appropriate costs

We’ve Made a Good Start

Timely Adjudication of Claims Court of Workers’ Compensation FY 2016-2017 Timeliness of orders Expedited Hearings = 7.85 days Compensation Hearings = 11.5 days

Timeliness Workers’ Compensation Appeals Board FY 2016-2017 Timeliness of orders Expedited Hearings = Average of 8.19 days from receipt of record to decision Compensation Hearings = 57.64 average days from receipt of record to decision

Cases Determined on Fewer Weeks Permanent Partial Indemnity Avg. Weeks per Case* Pre-Reform First Report 7/11 – 6/12 = 26 7/12 - 6/13 = 25 7/13 - 6/14 = 22 NCCI Report on Reform Post-Reform First Report 7/14 - 6/15 = 18 7/15 - 6/16 = 15

75% of mediations resulted in settlements FY 2016-2017 75% of mediations resulted in settlements

Fair and Impartial Review of Cases Court of Workers’ Compensation All orders are peer reviewed for compliance with statutes A sample of all judges opinions are reviewed by subject matter experts Resources (workbook and video) have been made available to unrepresented parties to assist unrepresented parties More access to legal assistance through legislation: ombudsman attorney and legal fees if suit is successful

Assistance to Unrepresented Parties - Ombudsman Program FY 2016-2017 21,048 contacts* 13,000 problems solved 96% of respondents to satisfaction survey responded favorably 4 ombudsmen 1 ombudsman who provides limited legal advice * Some individuals received more than one type of service

Appropriate, Good, Timely Medical Care Since the Reform Treatment guidelines Drug formulary Since last July the time for appeals of denied medical care have averaged 16 days 871 appeals 45% appeals upheld (the care was authorized) 37% denied (UR firm’s denial of care was upheld)

Positive Outcomes More Employees are Returning to Work 75.5% of injured workers returned to work in the two years prior to the implementation of 2013 law 86% of injured workers returned to work in the two and a half years after the implementation of the law

Lowered Costs Pre-Reform at First Report Post-Reform Permanent Partial Indemnity Avg. Cost per Case Pre-Reform at First Report 7/11 – 6/12 = $26,000 7/12 - 6/13 = $24,300 7/13 - 6/14 = $23,000 NCCI report on the reform Post-Reform 7/14 - 6/15 = $18,600 7/15 - 6/16 = $17,900

Lower Costs NCCI Loss Costs are Decreasing 2013 -6.95% & -5.9% 2014 -8.2% 2015 -.9% 2016 -2.7% and -12.8% 2017 -12.6% recommended

We Are Not Finished The Work Continues

Work in Progress Improvement of claims process through voluntary Claims Adjuster Certification program Opioid reduction program Vocational Recovery Assistance Program E-Billing Compliance Program Communication, communication, communication Animation, full-color guide booklets, increased visits to groups, outreach to insurance auditors, labor groups, and the Latino community, Web, Twitter, and Facebook

Issues on Our Mind Access to Care Access to legal assistance Neurologists/Neurosurgeons, Dermatologists, Pulmonologists Too many doctors don’t want to deal with WC patients Rural areas Access to legal assistance Medical outcomes are poorer for WC patients than for other patients Too many regulations (yes, we admit it) Opioids (on our mind even though we are working on it) Growing number who are not eligible for WC (gig economy) Employers who do not provide workers’ compensation Telemedicine

2017