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

2. 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.

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

4. 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

5. We’ve Made a Good Start

6. Timely Adjudication of Claims
Court of Workers’ Compensation FY
Timeliness of orders
Expedited Hearings = 7.85 days
Compensation Hearings = 11.5 days

7. Timeliness
Workers’ Compensation Appeals Board FY
Timeliness of orders
Expedited Hearings = Average of 8.19 days from receipt of record to decision
Compensation Hearings = average days from receipt of record to decision

8. 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

9. 75% of mediations resulted in settlementsFY
75% of mediations resulted in settlements

10. 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

11. Assistance to Unrepresented Parties - Ombudsman ProgramFY
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

12. 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)

13. 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

14. 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

15. Lower Costs
NCCI Loss Costs are Decreasing
% & -5.9% % %
% and -12.8%
% recommended

16. We Are Not Finished
The Work Continues

17. 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

18. 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

19. 2017