ACTION IN THE LEGISLATURES: WORKERS COMP STABLE MAJOR CHANGES IN FEWER STATES (PART 3/5)Posted On: Jun. 29, 1997 12:00 AM CST
A proposed ban on so-called "balance billing" is stalled in the Illinois Legislature, after passing the state's House of Representatives last month (BI, May 26).
The bill would outlaw the practice of medical care providers directly billing injured workers for payments in excess of the amount paid by a comp insurer or self-insured employer. Nearly all other states ban this practice (BI, Feb. 3). Illinois employers, labor unions and insurers have been unsuccessful in urging legislators to pass such a ban in previous legislative sessions.
The bill could be discussed again in a veto session this fall.
A bill awaiting Gov. James Edgar's signature would set a variety of standards for employee leasing companies, including requiring them to provide workers comp coverage.
Indiana Gov. Frank O'Bannon called the General Assembly into a special session in May and presented a package of bills designed to finance a new sports arena that also contained unrelated provisions to increase workers comp benefits.
Although there was staunch business opposition to the workers comp provisions in the package, the legislation's key provisions to pay for a new sports arena for the Indiana Pacers and expand the Indiana Convention Center to appease the Indianapolis Colts drew support. The governor refused to break up the package and it cleared the Legislature May 28 and was signed into law in June.
Business analysts estimate the higher comp benefit costs will raise costs by 13.7%, or $42.6 million, over the next three years.
Minnesota workers will receive workers comp benefit payments on an interim basis, even if current and former employers are disagreeing over who is liable for payments, under a bill signed into law May 9.
Ohio employers' concerns over the timeliness, duration and delivery of lost-time and impairment-based benefits are the focus of new workers comp reform that was signed into law in April and takes effect July 21.
However, the severity of the cutbacks prompted a coalition of trade unions, injured workers and trial attorneys-called the Coalition for Workplace Safety-to draft a petition for a referendum to repeal the measure and begin collecting signatures to place it on the November ballot.
Major provisions of the new law will change operations of the state's exclusive state compensation fund by:
Reducing or eliminating claims for aggravation of pre-existing conditions, except where the aggravating incident can be shown to have substantially worsened the pre-existing disease or condition.
Limiting cumulative trauma claims by classifying them only as occupational disease-instead of injury-claims and generally excluding from compensability most diseases to which the general public is exposed unless they specifically arise from an occupational exposure.
Limiting the life of most claims to five years, excluding claims for some ongoing medical benefits and some occupational diseases. Currently, the state fund has a backlog of more than 3 million claims because medical-only claims can remain open for six years from the date of injury and a lost-time claim can remain open for 10 years from the date of the last payment of benefits, including medical expenses.
Giving the Ohio Bureau of Workers' Compensation the authority to require that any claimant submit to a vocational rehabilitation evaluation.
Creating the presumption that an injury to a claimant, found to have excessive levels of alcohol or any controlled substances in his system during a post-accident test, was caused by intoxication. However, the employer is required to have reasonable cause before it can require the test.
Encouraging prompt payment of benefits in a variety of ways, including eliminating a 40-week wait to apply for permanent partial impairment compensation.
Requiring use of the American Medical Assn.'s guides to evaluating impairment for determining applications for permanent partial impairment.
The new law also impacts employers in several ways, such as by:
Stating that employers that make false or misleading statements concerning payroll or manual classifications, forge or alter certificates of coverage or fail to obtain coverage for the purpose of defrauding the bureau will be guilty of felony workers comp fraud.
Creating a religious exemption for workers comp coverage for primarily an Amish employer and worker, if they are members of a recognized religious sect that is conscientiously opposed to acceptance of workers comp benefits.
The AFL-CIO views the Ohio law as "a disaster for injured workers," said Mr. Ellenberger. "Employers basically got everything they wanted," he said.
There was no significant workers comp legislative activity in Michigan or Wisconsin.
In Iowa, the ability of professional athletes to collect workers comp benefits has been limited with the passage of legislation signed into law April 18. The law ends benefits when the injured athlete is well enough to perform whatever job he or she was doing before becoming a professional athlete, rather than until he or she can compete as an athlete once more. The bill also changes how benefits are calculated for athletes. Instead of being based on weekly earnings in the job they were injured in, for professional athletes compensation is equal to one-50th of total earnings over the last year.
Iowa also enacted a measure that requires individual or group health insurers to begin paying all medical bills relating to an injury or illness arising out of employment, even if the employer disputes the validity of the claim.
Kansas lawmakers enacted a workers comp bill, effective July 1, that makes a number of changes to the workers comp act and statutes governing the operation of the second injury fund.
The bill will remove a statutory reference to the National Council on Compensation Insurance as the approved rating organization for workers comp pools.
It also expands the workers comp act to apply to subcontractors in certain situations; increases the amount of any award that can be allocated to attorneys' fees; and clarified that the 10 days in which one can appeal an award to the state's workers comp board exclude Saturdays, Sundays and legal holidays.
The new law also will allow the insurance commissioner or director of workers compensation to dismiss complaints filed against the second injury fund for lack of prosecution. The dismissal is considered final and not subject to appeal. The new law also states that reimbursement from the second injury fund for overpayment must be sought within one year of the date of final order.
A Missouri bill that the governor signed last week exempts from workers comp law any community service work performed as a condition of probation for a criminal conviction.
The Nebraska Legislature voted to eliminate its second injury fund during the recent legislative session and Gov. Ben Nelson signed it into law earlier this month.
North Dakota legislators passed a number of workers comp measures in the biennial session that ended in April that were subsequently signed into law.
Among them, one measure requires the state's Workers Compensation Bureau to adopt administrative rules setting maximum allowable costs to compensate an injured worker's attorney. Another new law allows the director of the Workers Compensation Bureau to choose not to participate in a claimant's health care malpractice action, waiving the bureau's subrogation interest and obligation to pay attorney fees or costs related to the action.
Other new legislation requires the North Dakota auditor to appoint an independent audit firm every two years to prepare a performance audit of the workers comp bureau. The firm must have extensive expertise in workers comp practices and standards.
Another measure requires that workers comp wage-loss benefits be suspended if a claimant is confined in a penal institution for more than 72 hours. It also broadens the wage reporting requirements of injured workers to include any work activities regardless of whether wages were received. The bill also allows the bureau to pay pre-acceptance disability benefits and changes medical information requirements by requiring doctors to report on the extent of the injured worker's abilities and restrictions.
Under another new law, an injured worker's failure to take a drug or alcohol test could result in the forfeiture of workers comp benefits. The final piece of legislation changes the definition of "permanent impairment" by no longer considering whether disfigurement diminishes the ability of an employee to obtain employment.
South Dakota Gov. William J. Janklow on March 11 signed a bill that makes volunteer emergency medical technicians and other volunteer rescue workers eligible for workers comp benefits. The bill became effective immediately.
Previously, rescue workers' injuries largely were covered by their employers' health plans. (continued in part 4).