Midland Claims Service, Inc.

Montana Governor Reauthorizes WC Study Group LMAC

webuser — Tue, 21 May 2013 20:14:21 +0000

Press release from the Montana Chamber of Commerce. Despite significant efforts, the decision for inclusion on the LMAC panel has been limited once again to Labor (unions) and Business. A special ‘permanent’ sub-group was created to accomodate most of the parties that complained about the former LMAC operations, such as the Montana Hospital Association. Unfortunately, independent Third Party Claims Administrators, those that do the actual administration of the claims for Plan 1 self-insured organizations in Montana, were not included in any formal way. We fear that any outcome of the LMAC will mirror that from the last session of 4 years, a glazing over of the true cost drivers in the system and legislation that favors Plan 2 and Plan 3 entities. Proof of the failure of the prior reforms to equally protect Plan 1 self-insured organization is clearly in the data, overall costs of claims for Plan 1 entities continue to climb while Montana State Fund has made two base premium adjustments downward. We question if rates have actually fallen 25%…at least for our company and those that we have talked with, there have been minor (2% – 5%) reductions.

From the Montana Chamber of Commerce: For immediate release as of Tuesday, May 21, 2013, 1:30 PM

contact Webb Brown 406-431-9508 or Webb@MontanaChamber.com

Montana Chamber Applauds LMAC Reauthorization,

Dahlgren as Montana Chamber Representative

The Montana Chamber of Commerce strongly supports the reauthorization of the Labor-Management Advisory Council on Worker’s Compensation (LMAC) by Montana Department of Labor and Industry Commissioner Pam Bucy. The LMAC was created in 2006 to monitor worker’s compensation issues and to make policy recommendations to the Department and the Legislature. After the passage of workers’ compensation reforms in the 2011 Legislature, the LMAC disbanded in July of that year.

“The 2011 Legislature passed significant reform of our work comp system,” said Webb Brown, President/CEO for the Montana Chamber. ”However, there are still numerous issues that challenge our ability to reduce or even hold premiums steady.”

Since the enactment of House Bill 334 in the 2011 Legislature, premium costs have gone down about 25 percent. Nonetheless, worker’s compensation premiums in Montana are still some of the highest in the nation. Worker’s compensation premiums affect every business in Montana and constitute a sizeable operational expense. Our high premiums also deter businesses from moving to Montana and even cause some to leave. The LMAC will monitor the effectiveness of the HB 334 reforms and consider new ideas to reform the system.

The LMAC will be chaired by Lt. Gov. John Walsh. The newly-reauthorized LMAC consists of five representatives from labor and five from management, including specific representation from the Montana Chamber.

“We’re pleased that Commissioner Bucy re-appointed Bill Dahlgren, Operations Manager at Sun Mountain Sports, to serve on the Council as our representative,” noted Brown. ”Bill knows our worker’s compensation system and will be a solid advocate for the business community.”

In addition to monitoring the work of the LMAC, the Montana Chamber will participate in the Economic Affairs Interim Committee’s House Joint Resolution 25 study of various workers’ compensation issues. The State Chamber will also lead a private-sector effort to review recent Court cases on work comp.

The Montana Chamber is the state’s leading business advocate and the driving force in promoting a favorable business climate.

OSHA Announces Initiative to Increase Workplace Safety

webuser — Tue, 14 May 2013 14:03:58 +0000

DOL/OSHA Launches Initiative to Protect Temporary Workers OSHA has announced an initiative to further protect temporary employees from workplace hazards. A memorandum sent to the agency’s regional administrators directs field inspectors to assess whether employers who use temporary workers are complying with their responsibilities under the Occupational Safety and Health Act. Inspectors will denote when temporary workers are exposed to safety and health violations and assess whether temporary workers received required training in a language and vocabulary they could understand. The memo and press release, which can be viewed at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=23994, underscores the duty of employers to protect all workers from hazards. In addition, OSHA has begun working with the American Staffing Association and employers that use staffing agencies, to promote best practices ensuring that temporary workers are protected from job hazards. In recent months, OSHA has received a series of reports about temporary workers suffering fatal injuries – many during their first days on a job.

MT Legislature Firms Up Standard of Proof for “Intentional Injury”

webuser — Fri, 05 Apr 2013 21:59:34 +0000

The Montana legislature passed, and the Governor signed into law, HB-0232. The change creates a higher standard of proof for claims against an employer or fellow employee for ‘intentional’ injuries alleged to go beyond the Exclusive Remedy. Allegations after the effective date of the change (July 1, 2013) must now show that the intentional and deliberate injury through “clear and convincing evidence”.

http://data.opi.mt.gov/bills/2013/billpdf/HB0232.pdf

Pain in WC

webuser — Mon, 01 Apr 2013 14:33:51 +0000

The North Dakota legislature has debated the issue of pain in the context of pre-existing conditions and claims made for such pain if the pain gets worse at work.

http://bismarcktribune.com/news/local/govt-and-politics/senators-debate-pain/article_881a171a-98af-11e2-b7f3-001a4bcf887a.html

Pain continues to be an issue in workers’ compensation across the US, as the population average age increases and the number of pre-existing issues climbs. Montana has had a number of decisions with its one politically appointed judge system that has obligated the employer to pay for, in some people’s opinions, the treatment of conditions that clearly predated any employment incident or exposure. MCSi continues to advocate for expansion of the existing system in Montana to revise the Workers’ Compensation Court to include three (3) full time judges, one a political appointee as the current system requires, and two judges elected on alternating six (6) year terms, one elected by popular vote in the Western half of the state, the other by the Eastern side. Not only will the decisions be less politically/advocacy driven, the entire workers’ compensation community will benefit by a more stable environment. A stable claims environment leads to a more predictable landscape, which will lead to a more attractive environment for insurance companies to compete…which leads to more competitive premiums and higher levels of service for injured workers and employers.

Milestones Continue Proud Tradition

webuser — Mon, 11 Mar 2013 14:19:06 +0000

Midland Claims Service, Inc. and its subsidiary Industrial Injury Claims® , based in Billings, MT, celebrates 12 years with two of its valued workers’ compensation claims clients in 2013. The two clients make up over 10,000 employed staff in Montana, both operating in the challenging field of health care.
The company has proudly represented these two clients, among the largest self-insured groups in Montana, for 12 years for their Montana workers’ compensation claims. MCSi / IIC is responsible for more than 26% of all self-insured claims in Montana as a full service claims Third Party Administrator, with overall responsibility for more than 23,000 claims representing a total incurred loss of $103 Million. Despite jurisdictional challenges, the company and its staff have used their many years of experience nationwide to implement workers’ compensation claim processes which have led to some of the lowest “cost per claim per client” levels in the industry. Combined with the recognition that the company received in 2011, winning the Roche Jaune award for Customer Service Excellence (in all fields), we are proud to be able to help our clients and their injured employees through our claims services, reporting capabilities and safety efforts. Midland Claims Service, Inc. and Industrial Injury Claims® are Redefining Best Practices® .

Contact: Michael J. Marsh, RPA – President
Midland Claims Service, Inc.
PO Box 20151
Billings, MT 59104
(406) 656-9960

CT Court Steps Around Medicare Secondary Payer Guidelines

webuser — Thu, 07 Mar 2013 21:14:34 +0000

My reading of this case and the comments is that the Connecticut court has averted compliance with the spirit AND the letter of the Medicare Secondary Payer guidelines…and has placed the attorneys (both sides), the payer and (most importantly) the injured party at a direct risk of a) an action by Medicare for recovery of any/all funds paid for medical care of the injured party and b) a Medicare action against the injured person denying benefits for treatment in some way related to the paralysis resulting from the fall. Uncharted territory to be sure.

———————————————————————————————–
The Official Medicare Set Aside Blog And Information Resource published a new post entitled “Connecticut Courts Willing to Make MSA Determinations Too” on 3/7/2013 3:19:21 PM, written by Medicare Set Aside Services.

Connecticut Courts Willing to Make MSA Determinations Too

As the court opinions involving MSA issues continue to roll in throughout the nation, we add the State of Connecticut’s opinion to the mix. In recent weeks we have had a Florida court say that it would not add terms to a settlement agreement nor issue an advisory opinion as to whether an MSA was appropriate or not, and a Mississippi court not only feel that it had a duty to resolve the MSA issue but the judge went so far as to disagree with the MSA expert’s testimony and increase her MSA, that she swore under penalty of perjury would have been approved by CMS had it been reviewable, by over $100,000. This week we have a Connecticut court telling us that it agrees with the parties in that an MSA is not needed in a $550,000 settlement because none of the $550,000 represents compensation for future medical costs. Let’s see what you think.

So Plaintiff, a “social invitee” at defendant’s home, fell backwards while ascending some stairs and is now a paraplegic. Plaintiff alleges Defendant was negligent because the stairway did not have a handrail. Defendant argued contributory negligence since plaintiff was drunk. The parties settled for $550,000 at mediation, agreeing that the payment to plaintiff does not address any future medical expenses that may be covered by Medicare and that the defendants lack liability for any such expenses. Given the special defenses and the substantial verdict possibilities, this court agreed that this settlement was severely compromised and does not reflect compensation for future medical costs. There is however sufficient compensation for lots of other damages, specifically $183,333.33 for loss of consortium compensation for Mrs. Sterrett as well as costs associated with future home health services not covered by Medicare (and likely also provided by Mrs. Sterrett). It even includes $14,448.30 in Medicare conditional payment reimbursement. Just nothing for future Medicare covere! d medical expenses.

Rather than mount my soapbox and express my disgust as a tax payer, I instead am going to contemplate what’s going on over at CMS in reaction to this decision. We have a federal court completely complicit in allowing Medicare to absorb the entire burden of this paraplegic’s future medical care because rather than prorate the settlement equally over all claims for damages, it permitted the parties to prioritize some claims to completely deplete the payment before Medicare’s interests were even a factor (they did in fact consider them, but just not before they considered their own). Note that $183,333.33 is exactly a third of $550,000 so I suspect I know where an identical amount went. I sincerely hope that Medicare appropriately denies related care so that these parties are forced to bring a 10th Amendment argument back to court to finally determine if it is just this easy to force the taxpayers to absorb the entire burden of litigation expenses. Will a state court issued order trump a federal statute expressly prohibiting Medicare from making payment? While this settlement would never completely cover plaintiff’s future care and forever exclude Medicare benefits, it should have at least deferred some of the cost of the future care, particularly since it provided compensation specifically for the future non-Medicare covered care. I’m going to have to set a Lexis search specifically on plaintiff’s name because I suspect this isn’t the last we are going to see of him.

Clifford Sterrett et al. v. Thomas T. Klebart et al.

LLICV126007442S

SUPERIOR COURT OF CONNECTICUT, JUDICIAL DISTRICT OF LITCHFIELD AT LITCHFIELD

2013 Conn. Super. LEXIS 245

February 5, 2013, Filed

Permalink: medicaresetasideblog.com/2013/03/07/connecticut-courts-willing-to-make-msa-determinations-too.aspx

Mark Walls to Move to Marsh

webuser — Mon, 04 Mar 2013 16:03:41 +0000

According to Joe Paduda, Mark Walls is making an employment move to international broker Marsh. Walls was a senior executive at Safety National, a company known for excellence in Workers’ Compensation Excess insurance.

http://www.joepaduda.com/2013/03/mark-walls-moves-marsh/

MCSi Given BEST’s Recommended Adjuster Status for Over 10 Years

webuser — Wed, 27 Feb 2013 14:37:45 +0000

A. M. Best has awarded Midland Claims Service, Inc. with its coveted Best’s Recommended Adjuster status again for 2013. For more than 10 years MCSi has been on the Best’s Recommended list. We are proud to be among the highest quality independent adjusting and Third Party Administration companies in the United States to receive the Best designation.

Marsh Presentation to Billings West High School Business Class 2/25/2013

webuser — Tue, 26 Feb 2013 19:59:21 +0000

Michael Marsh was honored to have been given the opportunity to speak to Shelly Stanton’s Business class at Billings West High School on Monday, February 25, 2013. Mr. Marsh talked about building a business, use of the SWOT concept on a recurring basis, the current and recent economy, risk and risk finance, insurance, self-insurance, the workers’ compensation system (and of course some claims stories) and the safety and SAW/RTW ideas that are part of the mission of WorkSafeMT. Showed the WorkSafeMT video about the Coors barley plant near Huntely, a facility that is known for its excellent record of and engagement with a safe workplace. The young people were interested, engaged and asked some excellent questions. Mrs. Stanton was an excellent host. And we are ready to do it again, any time we can talk about workers’ compensation, risk and risk finance, safety and insurance/self-insurance with young people we love the opportunity!

Mike’s speech outline….

MT Supreme Court Validates Intentional Injury Standard for WC Exclusive Remedy

webuser — Mon, 25 Feb 2013 19:37:14 +0000

The Montana Supreme Court has validated the intentional injury rule for piercing of the workers’ compensation exclusive remedy rule. In Harris v The State of Montana and Department of Corrections, the court found that the employer’s training in the use of tasers did not go beyond knowledge that an injury was possible. In order to pierce the exclusive remedy rule, an injured worker must show that the employer has acutal knowledge of the injury’s certainty as required by the statute (Alexander (Mont. 2010).

http://law.justia.com/cases/montana/supreme-court/2013/da-11-0260.html