Printed from BusinessInsurance.com

ACTION IN THE LEGISLATURES: WORKERS COMP STABLE MAJOR CHANGES IN FEWER STATES (PART 4/5)

Posted On: Jun. 29, 1997 12:00 AM CST

Arizona Gov. Fife Symington earlier signed into law legislation that allows two or more employers to establish a self-funded workers comp insurance pool. Under the law, effective July 21, the employers have to be members of a pre-existing group, such as an industry association. Pool members also must have been in business for at least five years, and their pool premiums must total at least $750,000.

The law prohibits pool members from adopting managed care for injured workers.

Two other workers comp proposals died in the Legislature. One would have allowed the state to implement managed care for state employees who are hurt on the job. The other would have prohibited insurers from factoring into employers' experience modifiers the losses that employers paid as part of their deductibles, especially under large-deductible programs.

Before this year's legislative sessions, nine other jurisdictions that allow large deductible programs had enacted similar statutes, said Samantha Fearn, Arizona state director of the National Federation of Independent Business in Phoenix. Insurers in the 30 other jurisdictions that allow large deductible programs have been able to base experience modifiers in part on losses that employers pay, Ms. Fearn said. The bill likely will resurface next year, she added.

An Arkansas workers comp law that took effect May 21 eliminates offsets against permanent total disability benefits for Social Security, retirement and pension benefits for workers 65 and older. For permanent partial disability benefits, the retirement offset is reduced to 50% of the amount of benefits that the injured workers is receiving or is eligible to receive from other sources.

The bill also extends the durations of permanent partial schedule benefits for the amputation of arms, hands and fingers, but retains the current durations for other scheduled injuries.

A number of other workers comp bills were introduced during the session but were subsequently defeated. One such bill would have provided employees whose claim for workers comp was denied the option to commence a civil action in circuit court to recover damages against the employer as a result of the injury. The other measure would have removed carpal tunnel syndrome and other repetitive motion injuries and back injuries not caused by a specific incident from the definition of compensable injury for purposes of workers comp.

In New Mexico, a bill that would have clarified in what situations construction workers could sue their employers for injuries failed to pass the Legislature but is expected to be reintroduced next year, said J.D. Bollington, vp at the Assn. of Commerce & Industry of New Mexico in Albuquerque.

An ambiguity under New Mexico law concerning contractors and subcontractors now allows employees to sue their employers under certain circumstances, in spite of the exclusive remedy doctrine, said Mr. Bollington.

The bill would have closed this loophole by clarifying definitions involved.

Oklahoma's Senate and House could not work out most of their differences over two major workers comp reform bills. Instead, on May 29, a conference committee agreed on a compromise measure that did not include most of the cost-saving measures the bills originally contained.

The original version of the bill would have cut Oklahoma workers comp system costs 2.4% to 5.9%, according to the NCCI.

Any savings under the final version-which Gov. Frank Keating signed into law this month and becomes effective Nov. 1-will depend on how the workers comp court interprets the law and on the regulatory process, according to the American Insurance Assn.

Among other things, the new law:

Trims to 156 weeks from 300 weeks the duration of compensation payments for temporary total and temporary partial disabilities that occur after Nov. 1.

Defines permanent impairment as an anatomical or functional abnormality that exists after the employee has achieved "maximum medical improvement" rather than "reasonable medical improvement."

Limits the compensability of heart-related injuries to those caused only by stress that exceeds the normal amount of stress workers experience as part of everyday living.

Increases the permanent partial disability benefit for loss-of-eye injuries occurring prior to Nov. 4, 1994, to 250 weeks from 200 weeks.

Increases survivor benefits for families of workers killed on the job.

The surviving children benefit rises to 30% from 25% of the state's average weekly wage. The surviving spouse benefit rises to 70% from 50% of the average wage.

Bars coverage for injuries resulting from "horseplay" or other "willful behavior," unless the injured worker is "an innocent victim."

Allows employees to seek medical treatment on their own but at their employer's expense if the employer does not arrange treatment within three days of an injury. Previously, employers had to arrange treatment "within a reasonable time."

Directs the state's workers comp administrator to develop a new medical fee and treatment schedule that would have to be effective by Jan. 1.

The NCCI expects that the Legislature will attempt to pass additional reforms with even greater cost-saving potential next session.

Workers comp reform legislation in Texas calls for a State Office of Risk Management that will administer the state's workers comp program and help state agencies implement loss control programs.

The measure, which cleared the Legislature, calls for the new office to establish an allocation program that charges state agencies for workers comp costs based on claims' experience. State agencies that accounted for 90% of the costs during the previous two fiscal years would pay into the self-insurance fund while the remaining 10% would not be charged.

Agencies that pay into the fund will get back a portion of allocations not used to pay claims but would be required to make up the shortfall if claims exceed the allocation.

The risk management office, which replaces the division of risk management in the Texas Workers Compensation Commission, will be headed by a six-member board appointed by the governor. The members must have "demonstrated experience in the field of workers' compensation and risk management administration," according to the legislation.

Gov. George W. Bush signed the bill, which will become effective Sept. 1.

Other legislation the governor signed included a measure that will require utilization review of health care services in workers comp cases. The bill takes effect Sept. 1.

But he vetoed a bill that would have clarified that the burden of proof is with an employee who charges he or she is being discriminated against in the workplace for filing a workers comp claim. (continued in Part 5).