1. UPDATE ON WORKERS’ COMPENSATION STATISTICS, LEGAL CHALLENGES AND EDI
Richard M. Fisher, President
Consolidated Benefits Resources

2. Litigation
Lit. rate will increase over time for newer years, probably to around 8%
Data source: CBR

3. Claims Costs
Data source: CBR

4. TTD-PPD Costs
Data source: CBR

5. NCCI Loss Costs
Source: National Council on Compensation Insurance

6. Important Supreme Court Rulings
Torres v Seaboard Farms
The 180 day employment requirement for a Cumulative Trauma claim to be compensable is unconstitutional.
DHS v Bruce
Major Cause can be applied to the injury, but not to need for treatment for pre-existing conditions
Gibby v Hobby Lobby
Missing 2 or more medical appointments does not automatically result in denial of benefits
Maxwell V Sprint
PPD Deferral is unconstitutional
6th Edition of the AMA Guides cannot be applied to Scheduled members
Bober v OSU
Premises claims (parking lot) are covered by the AWCA
Gillispie v Estes Express Lines
PTD rates apply when the 104 week TTD maximum is reached and ee is still TTD
AMA Guides for Spine/Shoulders/BAW
Oral Arguments made last month. Consensus is the AMA Sixth Edition will be tossed/

7. Update on EDI Effective date What data is being reported
What happens to paper forms
Potential savings
Measuring the system
Enforcing current regulations
Self-Insured data now available
Legislative needs
Effective Date: 1/1/2018 for all Payors; Mid October for Voluntary Group
Form 2, Form 2A, and Form 4 data
Paper forms eliminated 1/1/2018, with the exception of legal filings
Commission saves labor costs from manually entering the Forms-Carriers TPA’s and employers save postage and printing costs
Other than NCCI, who reports on statistical data for Oklahoma a few years after a claims year, no real-time data on WC system exists. The EDI will allow the WCC to measure and report on claims data, trends and analysis in a more timely manner
Suspect carrier compliance with paper forms to be questionable. Current law calls for fines for non-compliance. EDI will assist the WCC in enforcing current regs.
NCCI only reports data for insurance carriers. Self-insured data has been left out of the analysis. However, now the data can be compiled with carrier data for a better picture. SI data might be 25% of the marketplace, with best results
Legislature needs real data to help determine in legislation is needed. Right now data is anecdotal or incomplete

8. What Will Be Measured Timeliness of reporting by employer
Timeliness of paying benefits by carrier
Demographics of injuries
Denial of claim data
Compliance data
Settlement data
WCC Order data
Timeliness of reporting by employer-how quickly are Form 2’s reported to Carrier and State
Timeliness of paying benefits by carrier-how quickly does carrier start TTD benefits? How many violations?
Demographics-injury nature, type, extent, location; average TTD period by injury, cost per claim
Denial data-what carriers are denying claims? What are the reasons? How many reversed at WCC?
Compliance data-missing forms, error rate, Scoring profile
Settlement Data-settlements by carriers, rate and amount
WCC Order data-results of ALJ awards-amount, denial rates, timeliness

9. TPA Issues COSTS Mapping issues New data points Adjuster training
Daily error correction
Filing costs
Report Card
Savings
Registering with the State, multiple clients
Costs-Extensive Programming Costs if using vendor or direct file, per claim fees if using a vendor. Not offset by postage & printing costs.
Mapping-extensive amount of time mapping your claim system fields to the matching WCC fields…estimate 25% of fields don’t have natural match
New data fields the WCC wants may not be in your claim system…some claim systems may not be able to be edited-
Adjuster training-adjusters are not used to completing this panoply of data-will need extensive training to get in the habit of knowing when to complete, and what to put down
Daily error correction-errors in transactions will come in daily (missing data, error in sequencing, etc) and must be fixed immediately or you face fines scrutiny or low report card scores. Larger TPA’s will put together a response team to deliver consistent and timely responses back to state, rather than leaving it up to individual adjusters
Costs of filing passed on to client as ALAE
Report Card-State has ability to “grade” carriers, employers, TPA’s on their performance. Want to avoid issues here.
Registering with the State-some tpa’s multiple clients, both self insured and fully insured…what are the issues with registering

10. Employer Issues Timeliness concerns Some data not obtainable
Effects on WC coordinators
Public reporting of scores
Joint & Several aspect of reporting
Common problems and solutions
Timeliness-A complete Injury Report has to be submitted to Carrier/TPA within 24 hours….incomplete Form will be rejected at State or be accepted with errors
Not obtainable data-Conflicting goals-more important to get carrier handling claim than worrying about wage, injury location or NAICS code…legitimate worry that employers will not submit Injury report until complete…what to do?
WC Coordinators-expect many follow up s and phone calls from carrier staff trying to get all applicable data
Employer filing scores may be made public
If scores are public, employer performance affects carrier/tpa performance, and if enough bad employer performances, then the carrier suffers and could lose reputation
For OSAG-what to put down on hard to find data

11. Commission Issues Privacy concerns Enforcement concerns
Is auditing in the future?
Does the WCC really want to manage the claim?
Once data is compiled, State will need to find ways to protect the data from opportunists looking to comb through data looking to sign up employees for litigation
Enforcement-there are bound to be thousands of violations, and the potential for tens of thousands of dollars in fines. Will the due process costs (hearings, meetings, etc) outweigh the fines and be net revenue drain on the WCC?
Auditing-another way of enforcing compliance is through state auditing. This would require massive staffing increases at the WCC. Once you know about a problem, you can’t ignore it…..
WCC needs to decide if they really want the monitor the first payments and manage the claim process…may elect to step back and only record the 2 and 4 information, and litigated claims.

12. Jerry Whorton, CEO Consolidated Benefits Resources (CBR) Phone: Richard Fisher, President Phone: Workers’ Compensation Commission: Oklahoma Insurance Department: