The opportunity for medical cost saving is significant. Many changes have been made in the workers' compensation system over the last few years that have produced significant results. These changes have been in the areas of Utilization Review, Bill Review, Lien Resolution and Pharmacy Benefit Management. The National Council on Compensation Insurance (NCCI) continues to report that medical costs remain the largest percentage of Workers' Compensation expense and continues to grow.
We have improved and will continue to improve our decision making power with data analytics. We must know that simple and easy to implement data mining and data analytics can be very powerful. We do not always require very complex systems to be able to organize ourselves for effective data analytics.
Workers Compensation is currently faced with complexities that has continuously and will continuously grow in severity. The increase in medical costs, incidence of fraud, growing dependency on prescription drugs, use of spinal cord stimulators and diagnoses related to subjective symptoms such as Fibromyalgia, Reflex Sympathetic Dystrophy, etc. have all contributed to the complexities.
To settle a claim for an auto or personal injury, the payer usually calculates a reasonable amount. The claimant is asking for a settlement of $150,000. How much is reasonable? What is reasonable? Can you defend your position? Do you pay out the $150,000 and be done? Do you negotiate? What is your baseline for negotiation? Is your baseline scientifically backed up and defensible?
The California Division of Workers’ Compensation (DWC) has announced that a public meeting will be held to discuss the creation of a drug formulary and associated rules.
As the 2015 calendar year comes to a close, California Workers’ Compensation insurance companies, self-insured employers, and third-party administrators have been continuously reviewing their compliance requirements in preparation for any upcoming investigations by the Audit and Enforcement Unit of DWC.
The DWC announced today the first 15 day comment period regarding changes to the MTUS Chronic Pain Medical Treatment Guidelines, as well as the newly proposed “Opioids Treatment Guidelines." These announcements come as the workers’ comp community and nation have come to grips with an “epidemic” of opioid usage.
The injunction that went into effect Nov. 19, 2013, preventing the Division of Workers’ Compensation from collecting the $100 activation fee for pre-2013 liens under a provision in SB 863 has officially been lifted. HCRG covers its' impact on the California Workers' Compensation Insurance Industry.