OUTLINE OF PRESENTATION FOR LOUISIANA CLAIMS ASSOCIATION …

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