Author: WorkCompAcademy

The California Workers’ Compensation Institute (CWCI) has released an online application to support interactive analyses and comparisons of COVID-19 and Non-COVID-19 claims. The application is available to the general public.
The new tool features integrated data from CWCI, the Bureau of Labor and Statistics and the California Division of Workers’ Compensation, with detailed information on almost 600,000 reported claims for the first six months of accident years 2019 and 2020 – including 14,470 COVID-19 claims from accident year 2020. The application offers four areas of analysis that will let the user explore and analyze:

— COVID-19 claim counts by month with the ability to segment and filter results by industry, region, injured worker demographics and injury characteristics
— The declining volume of all reported workers compensation claims by industry and region
— Denial rates for COVID-19 and non-COVID-19 claims by month.

— The application provides detailed data on a dozen metrics, including claim volume and incidence, claimant demographics (gender and age), region, injury description (nature and cause of injury), payer type (insured vs. self-insured), and denial rates, In addition, users can also access claims data from the first half of AY 2019 in order to view and compare pre- and post-pandemic claims experience.

CWCI plans on regular refreshes of the application to keep it current as well as expanding the features and functions as additional data on claim type and average and system-wide cost become available.

Mitchell International owned Genex Services LLC, a provider of cost containment technology, clinical services, and disability management, announced it has finalized its acquisition of Coventry Workers’ Comp Services from CVS Health.

Coventry Workers’ Comp Services is a provider of care and cost management programs for workers’ compensation and auto insurance carriers, third-party administrators, and self-insured employers.

Coventry Workers’ Comp Services was formerly a division of Aetna, a CVS Health company.

The acquisition adds Coventry’s leading PPO network to Mitchell | Genex’s continuum of care and cost containment offerings for the workers’ compensation and auto industry.

Based in Downers Grove, IL, Coventry Workers’ Comp Services has been a full-service managed care organization for more than 35 years. Coventry Workers’ Comp Services will continue to be led by Art Lynch, President and CEO, and operate under its brand.

“The future brings new challenges and opportunities to our markets, and we’re proud to join the Mitchell | Genex team in enhancing and developing new strategies to help clients meet the evolving demands of our industry,” said Lynch.

The financial terms of the transaction are not being disclosed.

Marlene Cavalcanti, 40, pleaded guilty to two felony counts of insurance fraud and identity theft after falsifying documents to receive an additional $10,590 on her workers’ compensation claim.

Cavalcanti, employed as an executive assistant, reportedly fell at work and sustained injuries. As a result of her subsequent workers’ compensation claim, Cavalcanti received more than $42,000 in total temporary disability payments in addition to her medical treatment.

An investigation by the Department of Insurance revealed after being placed on disability, Cavalcanti ceased medical treatment and began working for another company. During this time, she submitted multiple fictitious doctors reports in an attempt to continue to receive disability payments from the workers’ compensation insurance company.

When confronted by detectives, Cavalcanti ultimately admitted to the fraudulent documents and forged doctors’ signatures.

During the investigation, department detectives discovered Cavalcanti attempted to file a new workers’ compensation claim at a different insurance company with her new employer.

The new workers’ compensation claim dates and injuries were similar and overlapped with her initial claim. The investigation by detectives prevented payment on this subsequent fraudulent claim and the insurance company incurred no loss.

“The Marin County District Attorney’s Office will continue to partner with the California Department of Insurance to investigate and prosecute workers’ compensation fraud in every form. Whether it is claimant fraud as in the case of Ms. Cavalcanti, which drive up premiums for employers, or businesses who seek to gain an unfair advantage by underinsuring their employees, workers’ compensation fraud remains a priority for our office,” said Deputy District Attorney Sean Kensinger.

Cavalcanti is expected back in court September 9, 2020 for sentencing. The Marin County District Attorney’s Office prosecuted this case.

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 added mandatory reporting requirements with respect to Medicare beneficiaries who have coverage under group health plan arrangements as well as for Medicare beneficiaries who receive settlements, judgments, awards or other payment from workers’ compensation, which is referred to as Non-Group Health Plan or NGHP insurance.

The purpose of Section 111 reporting is to enable CMS to pay appropriately for Medicare-covered items and services furnished to Medicare beneficiaries. Workers’ compensation claim information helps CMS determine when other insurance coverage is primary to Medicare, meaning that it should pay for the items and services first before Medicare considers its payment responsibilities.

Reporting is accomplished by either the submission of an electronic file of liability, no-fault, and workers’ compensation claim information, where the injured party is a Medicare beneficiary, or by entry of this claim information directly into a secure Web portal, depending on the volume of data to be submitted.

Upon receipt of this information, CMS checks whether the injured party associated with the claim report is a Medicare beneficiary, and determines if the other insurance is primary to Medicare. CMS then uses this information in the Medicare claims payment process and, if Medicare paid first when it should not have, uses it to seek repayment from the other insurer or the Medicare beneficiary.

The Centers for Medicare and Medicaid Services (CMS) has released a notice announcing it will be holding a webinar for Section 111 non-group health plan (NGHP) reporting on August 13, 2020, at 1:00 p.m. ET.

The agency released a new Section 111 NGHP User Guide in June, which contained a reminder regarding the $750 low dollar reporting threshold, incorporated its recent alert addressing no-fault and med-pay reporting, and provided several other technical update changes. This User Guide is the primary source for Section 111 reporting requirements.

Those interested in attending CMS’s webinar, please see CMS’s notice for further details and webinar registration information.

Please note that for this webinar you will need to access the webinar link and dial in using the information above to access the visual and audio portion of the presentation. Due to the number of participants please dial in at least 15 minutes prior to the start of the presentation

Millions of workers have been uprooted by COVID-19 and been thrown into a “new normal” of working from home offices. To further complicate things, many individuals were provided with only a laptop and little, if any, education on setting up an ergonomically correct workstation.

As a result, many home office – based workers potentially face suboptimal working conditions. Workers across the nation have converted their basements, spare rooms, dining room tables or bedrooms into makeshift offices.

Kermit Davis, PhD, an expert in office ergonomics at the University of Cincinnati College of Medicine, conducted an ergonomic assessment of employees at the University of Cincinnati sending out an email survey to 4,500 faculty and staff after the coronavirus pandemic prompted the university to join many other employers across the nation in sending workers home to continue operations.

The survey had 843 people complete it. As part of the study, 41 employees sent Davis photos of workers at home workstations for ergonomic review. This subset showed some trends and offered a glimpse into what many who work from home are encountering. The survey’s findings were recently published in the scholarly journal Ergonomics in Design.

Davis says the ergonomic evaluations of the home workstations identified many issues that could be adversely affecting the workers. Many chairs were the wrong height with about 41% too low and 2% too high. Fifty-three percent of workers had armrests on their chairs, but 32% did not use them and for 18% of workers the armrests were improperly adjusted, the study found.

Davis says not using the armrests causes contact stress on forearms when rested on the hard front edge of work surfaces and strain across the upper back as the arms need support. Also, support of the back of the chair was not used by 69% and often without any lumbar support for 73% of survey participants. That meant many individuals did not have proper support of their lower back, maintaining the lumbar curvature.

The position of a computer monitor was often too low or off to the side. Three quarters of monitors were laptops, which were too low relative to the workers’ eye height, the study found. External monitors were also routinely set up too low in 52% of participants or too high in 4%. Another common issue with the monitors was the lack of the primary screens centered in front of the workers occurring in 31% of workers and resulting in twisting of the neck and/or back to view the monitor, according to the study.

Here are a few tips that might be helpful for the homebound office worker:

— Place a pillow on your seat to elevate the seat height.
— Place a pillow or rolled up towel behind your back to provide lumbar and back support.
— Wrap armrests when they are low and not adjustable.
— Move your chair closer to the desk or table to encourage having the back against the back of the seat.
— If a laptop is too low, place a lap desk or large pillow under the laptop to raise the monitor when using it on the lap.
— Use an external keyboard and mouse, along with raising the laptop monitor by placing a stack of books or a box under the laptop when using a laptop on a desk.
— An appropriate standing workstation should have the top of the monitor at eye height and directly in front, keyboard at a height so that forearms are parallel to the ground (approximately 90° elbow angle), and a soft or rounded front edge to the working surface.
— If obtaining a new chair or identifying an appropriate sitting workstation at home is not possible, rotating between a poor sitting workstation and a standing workstation would be the next best practice. There are many simple, makeshift standing workstations available in the home, including implementing the use of an ironing board, a kitchen counter, the top of a piano, a clothes basket placed upside down on a table or desk or a large box under the laptop.