outline of presentation for louisiana claims association …
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OUTLINE OF PRESENTATION FOR LOUISIANA CLAIMS ASSOCIATION ANNUAL CONFERENCE – JUNE 24‐26, 2015
STEPHEN W. GLUSMAN WAYNE FONTANA
WORKER’S COMPENSATION
RECENT DEVELOPMENTS, EMERGING AND CURRENT ISSUES AND THE 2015 LEGISLATIVE SESSION
I. INTRODUCTION AND OUTLINE OF CONTENT OF PRESENTATION
II. LEGISLATIVE SESSION
a. GENERAL DISCUSSION OF RECENT LEGISLATIVE SESSION, TRENDS AND POLITICS
b. PRESENTATION OF CONTENT OF BILLS WHICH PASSED AFFECTING WORKERS COMPENSATION HB 379 HB 498 SB 107 SCR 19
c. DISCUSSION OF BILLS WHICH DID NOT PASS BUT WHICH CONCERN ONGOING AND EMERGING ISSUES
HB 205 (Will DISCUSS THIS IN SECTION III) SB 256
III. UPDATE ON DEVELOPMENTS RELATIVE TO MEDICAL TREATMENT SCHEDULE AND UTILIZATION REVIEW, APPEALS AND COURT DECISIONS AFFECTING PROCESS
a. PRESENTATION AND DISCUSSION OF THE CURRENT STATUS, COURT DECISIONS REGARDING NEW EVIDENCE , ETC.
b. HB 205 ‐ GAINES BILL
c. DISCUSSION OF DRAFT PROPSED RULE CHANGES ON THIS ISSUE PRESENTED BY OWC INTERIM DIRECTOR PATRICK ROBINSON AT WCAC
IV. UPDATE ON DEVELOPMENTS IN COURT DECISIONS AND RULES RELATIVE TO THE 1002 PRELIMINARY DETERMINATION PROCESS AND SAFE HARBOR a. Hearing rules regarding 1002 preliminary determinations
b. Entitlement to PD
V. QUESTIONS, COMMENTS, ISSUES FROM THE FLOOR
LOUISIANA CLAIMS ASSOCIATION ANNUALLOUISIANA CLAIMS ASSOCIATION ANNUAL CONFERENCE – JUNE 24 – 26, 2015
Legislative Update and Current Issues in Workers’Legislative Update and Current Issues in Workers Compensation
Steve Glusman and Wayne Fontanay
LEGISLATIVE SESSIONLEGISLATIVE SESSION
General Discussion of Session – Political Climate
Bills That Passed
Other Bills of Interest Which Did Not Pass
Bill f I t t P dBills of Interest – Passed
HB 379
HB 498
SB 107
SCR 19
Bill f I t t N t P dBills of Interest – Not Passed
HB 205 – Appeals of 1009 Decisions
SB 256 ‐ Pharmacy Formulary
A l f 1009 D i iAppeals of 1009 DecisionsNew Evidence – Court DecisionsNew Evidence Court Decisions
A l f 1009 D i iAppeals of 1009 DecisionsNew EvidenceNew Evidence
HB 205
Possible Rule Revisions
1002 Process1002 Process Hearing Rules
Establishing Right to PD
Q ti ? C t ?Questions? Comments?Issues of Concern?Issues of Concern?
Time For Cool Blues Hot JazzTime For Cool Blues – Hot Jazz and Perhaps Some Adultand Perhaps Some Adult
Beverages?
LASIE Bill Progress Matrix 06-09-2015 - 08:55:24
ca = committee amendment, cs=committee substitute, a = floor amendment. s = signed by the Governor
Bill Description Author 1st-Chamber Comm
Report Passed 2nd-Chamber
Comm
Report Passed
Signed
Fil/Vet
HB 136 Jury Trial Threshold Amount Harris L 3/24 HCLPC
HB 205 Workers' Comp Medical Treatment Schedule Gaines R 3/30 HLIRC
HB 247 LA Physical Therapy Board Discipline
Process Huval M 3/31 HHWC 4/22 5/ 4 5/ 5 SHWC 5/27 6/ 3
HB 256 Interlocal Risk Management Agencies
Pope R 4/13 HMPAC 4/22 5/ 4 5/12 SLMAC 5/25ca 5/27ca
HB 259 Surplus Lines of Insurance Tax Thierry L 3/31 HWMC 5/18ca 5/26ca 5/27 SRFAC 6/ 5ca 6/ 6ca/a
HB 379 Drug Testing Standards, CAP-HAIR Hollis P 4/ 2 HHWC 4/22 5/ 4a 5/ 6 SHWC 5/20 5/26 a: 74-e: 8/ 1
HB 393 Workers Comp-Self Insurance Funds Investments Lorusso N 4/ 2 HLIRC 5/ 4ca 5/12ca/a 5/14 SLIRC 6/ 1ca 6/ 4ca
HB 425 La. Natl Guardsmen Disability Benefits Hazel C 4/ 2 HJC 5/ 4 5/12 5/13 SJC-B 5/19 5/26
a: 77-e: 8/ 1
HB 498 Health Services Pricing Transparency Talbot K 4/ 3 HHWC 5/ 6 5/14 5/19 SHWC 5/27 6/ 3
HB 568 Licensing and Regulation of Pharmacists Thierry L 4/ 3 HHWC 5/ 6ca 5/14ca 5/19 SHWC 6/ 2ca 6/ 6ca
HR 10 La. Physical Therapy Association Commendation
Montoucet 4/13 4/13
SB 22 Local Housing Authorities' Pooled Risk LaFleur 3/ 4 SLMAC 5/11 5/13 5/18 HMPAC 6/ 1 6/ 7
SB 56 Chiropractic Practice Provisions Dorsey-Col 4/13 SHWC 5/ 6ca 5/13ca 5/18 HHWC
SB 84 LA Family and Medical Leave
Benefits Act Peterson 4/ 1 SLIRC
SB 107 Extends Deadline, Work. Comp. Sec.
Injury Fund Peacock 4/ 1 SLIRC 5/11ca 5/13ca 5/18 HLIRC 6/ 1 6/ 8
SB 173 Obesity Treatments, Health Insurance
Heitmeier 4/30 SFC 5/11ca 5/13ca/a 5/18 HIC
SB 256 Closed Pharmacy Formulary Provisions Martiny 4/ 3 SHWC
SCR 19 Physical Therapy Patient Access
Review Cmte. Mills 4/14 SHWC 4/22ca 4/28ca/a 5/28 HHGAC 6/ 2 6/ 7
21
100% - Totals -
21
100.0% 16
76.2% 16
76.2% 15
71.4% 13
61.9% 13
61.9% 2
9.5%
Louisiana Register Vol. 40, No. 09 September 20, 2014 1845
procedure for the orderly handling of disputes brought to the Workers’ Compensation courts by the filing of Form LWC-WC-1002, as provided by R. S. 23:1201.1, both as amended by Act 337 of the 2013 Regular Session of the Legislature of the State of Louisiana. Act 337 allows for a “preliminary” determination of the correct amount of any payment made under that Chapter for the purposes of insuring the correct payment and relieving the payor of exposure for future penalties.
Title 40 LABOR AND EMPLOYMENT
Part I. Workers Compensation Administration Subpart 3. Hearing Rules
Chapter 55. General Provisions Subchapter C. Commencement §5507. Commencement of a Claim
A. "Form LWC-WC-1008" shall be the form to initiate a claim or dispute arising out of Chapter 10 of Title 23 of the Louisiana Revised Statutes of 1950, except that:
B. - C. … D. Any request for a preliminary determination pursuant
to Louisiana Revised Statutes Title 23, Section 1201.1 shall be made in the answer or amended answer and shall be accompanied by a copy of the LWC-WC-1002 and Notice of Disagreement, along with a Motion and Order to Set Telephone Status conference attached and shall proceed with the following steps.
1. A telephone conference shall be set within 15 days from receipt of the answer or amended answer, with accompanying attachments. A preliminary determination hearing shall be set within 90 days from telephone status conference. The deadline for any discovery shall be 30 days before the preliminary determination hearing. The parties must exchange evidence 15 days before the hearing, with copies of the exhibits, exhibit list and memorandum sent to the presiding workers’ compensation judge.
2. The workers’ compensation judge or the judge’s designee, shall advise all parties of the deadlines set forth hereinabove in the telephone status conference.
3. A scheduling conference order shall be forwarded to the parties within three days of the telephone status conference. The order shall include a list of issues to be determined, the date of the scheduled hearing, the deadline for discovery, the deadline for the exchange of exhibits, the deadline for the submission of exhibits and the deadline for the submission of memoranda to the court.
4. After the preliminary determination hearing, the court shall forward a written preliminary determination to the parties within 30 days of the hearing.
5. A notice shall accompany the written preliminary determination. The notice shall advise the parties of their options to accept or reject the finding and it shall advise the parties that, if the court does not receive written notification within 15 days of further action by the parties, the court will close the file or proceed to trial on the merits on all remaining issues.
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1310.1(C).
HISTORICAL NOTE: Promulgated by the Department of Labor, Office of Workers' Compensation Administration, LR 25:265 (February 1999) amended LR 25:1860 (October 1999), LR 33:652 (April 2007), amended by the Workforce Commission, Office of Workers’ Compensation, LR 37:1626 (June 2011), LR 40:
Family Impact Statement This amendment to Title 40 will have no impact on
families. Poverty Impact Statement
This amendment to Title 40 will have no impact on poverty or family income.
Provider Impact Statement 1. This Rule change will have no impact on the
staffing level of the Office of Workers’ Compensation as adequate staff already exists to handle the procedural changes.
2. This Rule change will create no additional cost to providers except that in certain circumstances, it will more efficiently and quickly provide for services to injured workers, resulting in additional payments to medical providers and protecting employers from penal damages.
3. This Rule change will have no impact on ability of the provider to provide the same level of service that it currently provides.
Public Comments Written comments may be addressed to Carey R. Holliday,
Special Assistant to the Director, Office of Workers’ Compensation P.O. Box 94040 Baton Rouge, LA 70804-9040 until 4:30 p.m. on October 10, 2014.
Public Hearing A public hearing will be held on October 29, 2014, at 9:30
am at the Louisiana Workforce Commission Training Center located at the Corner of Fuqua St. and N. 22nd Street across from the main campus of the Workforce Commission, in Baton Rouge, LA. The public is invited to attend.
Wes Hataway Executive Director
FISCAL AND ECONOMIC IMPACT STATEMENT
FOR ADMINISTRATIVE RULES RULE TITLE: Appeals of the Decision of the
Medical Director and Preliminary Determinations of the Average Weekly Wage
I. ESTIMATED IMPLEMENTATION COSTS (SAVINGS) TO
STATE OR LOCAL GOVERNMENT UNITS (Summary) The proposed rule amends Title 40 Labor and Employment,
Part 1 Workers’ Compensation Administration, Subpart 3 Hearing Rules, Subchapter C, Section 5507 Commencement of a Claim to add a new procedure for the preliminary determination of the correct amount of any payments due under controversy of compensation and medical benefits claims between an employer/payor and an injured employee or his representative as set out in R. S. 23:1201.1. The proposed rule implements the requirements of Act 337 of the 2013 Regular Legislative Session that established a new procedure in Workers’ Compensation Courts to arrive at “preliminary determinations” of the amounts due under the law prior to a trial on the merits.
Besides the cost to publish in the Louisiana Register, the proposed rule will not result in any additional expenses to the Office of Workers’ Compensation Administration (OWCA) nor will the proposed rule result in any material savings to OWCA. The proposed rule merely change the procedure already utilized by existing OWCA staff in preliminary determination of payment under R.S. 23:1201.1. The Division of Administration indicates that the proposed rule will have no fiscal impact on the Office of Risk Management. The implementation of this