Author: WorkCompAcademy

The Division of Workers’ Compensation posted draft home health care fee schedule regulations on its forum.

California Senate Bill 863 requires the Administrative Director to establish a fee schedule for home health services. Home health services range from skilled nurses and therapy services provided by home health agencies to unskilled personal care or chore services that may be provided by personal care aides. The 2015 RAND study, Home Health Care for California’s Injured Workers – Options for Implementing a Fee Schedule, identifies options for a single fee schedule that would cover the full range of home health services.

Under the proposed regulations, home health care services shall be provided as medical treatment only if reasonably required to cure or relieve the injured employee from the effects of his or her injury and prescribed by a licensed physician and surgeon, in accordance with Labor Code section 4600, subdivision (h). Home health care services are subject to the utilization review and independent medical review processes set forth in Labor Code sections 4610 and 4610.5, et seq.

An in-home assessment of the injured worker’s need for home health care shall be performed by a qualified registered nurse, physical therapist or occupational therapist employed by a home health care agency. Assessments of an injured worker’s need for home health care will be performed using CMS’s OASIS (Outcome and ASsessment Information Set), a group of standard data elements used by CMS to assess patients’ needs for home health care services, which is incorporated by reference into the regulations.

Table A of the proposed regulations set forth a payment methodology and fees for skilled care by licensed medical professionals and unskilled personal and chore services for injured workers in the home setting. The lowest hourly rate specified on this Table is for chore services and Homemaker services NOS at $13.60 per hour. A home health aide or certified nurse assistant, is $17.10 per hour, and attendant care services show an hourly rate of $17.48.

The draft regulations will be posted on the DWC forum for a period of 10 days. Stakeholders and members of the workers’ compensation community are invited to comment on the draft regulations. Comments will be accepted on the forum until 5 p.m. on May 17, 2015.

The California Coalition on Workers’ Compensation (CCWC) announces three days of idea generation, education, and unparalleled networking opportunities – enhanced by the thrills and excitement of Disneyland® – at the CCWC 13th Annual Conference, taking place July 22-24 at Disney’s Grand Californian Hotel® and Spa. CCWC is dedicated to providing the leadership, education, and advocacy that are essential to an equitable and efficient workers’ compensation system. Each year, it demonstrate this focused commitment by presenting a content-rich conference that addresses all aspects of the industry. At the CCWC conference, you’ll find participants from the areas of human resources, health and safety, risk management, and claims – as well as medical professionals and service providers. It’s the place where leaders, key decision-makers, and employers gather to experience and share diverse perspectives, energetic interactions and enough stimulating input to keep ideas brewing and evolving long after the conference ends.

Among the many speakers over the three day event, David Lanier, the Secretary of the California Labor and Workforce Development Agency and Christine Baker, the Director of the Department of Industrial Relations will provide an update on the implementation of SB 863 and discuss other issues that are relevant to workers’ compensation stakeholders on the Thursday, July 23 session. CCWC’s advocacy will provide an update on California politics as it relates to workers’ compensation. They will also present a review of 2015 bills that affect the industry, offering information regarding the positions that the CCWC has taken on them.

Alfonso J. Moresi, Commissioner, Workers’ Compensation Appeals Board/Senior Partner, Law Office of Laughlin, Falbo, Levy and Moresi, Richard L. Newman, Chief Judge for the California Department of Industrial Relations, Division of Workers’ Compensation and Mark Priven, Principal, Bickmore Risk Services will present a lively discussion among experts about workers’ compensation in Northern and Southern California. What are the differences so many refer to, and why do the discrepancies exist when legislation, regulations, and case law are the same for all?

Tim East, Director, Corporate Risk Management, The Walt Disney Company will present his topic “China Today – Workers’ Compensation Is Born in the World’s Oldest Country.” For the past 10 years, China has emerged as a dominant economic and political power. Yet the country’s workers’ compensation system is only that old, becoming widely mandated in 2004. Learn what is taking shape in one of the world’s most populous nations and how workers’ compensation compares to our experience in California and the United States.

Saul Allweiss Esq. and Cathey Jackson from Safeway will discuss “How to Properly Assess Requests for Home Health Care through UR and IMR.” This informative session will cover a variety of topics, including responding to requests for home health care, applying best practices, and requiring physicians to quantify the nature and extent of the HHC and demonstrate the medical necessity. Additional areas of focus will include the timely submission of requests for HHC to UR, the need for complete documentation in response to requests for IMR, and appropriate reimbursement rates. Challenges presented by recent WCAB decisions in Neri-Hernandez and Patterson will also be discussed.

Jamie Berenson from Glauber/Berenson and Rene Folse and Todd Kelly from Floyd, Skeren and Kelly will provide a case law update. This session will focus on the latest and most impactful decisions at the board and present how both defense and applicant attorneys view them. These and many, many other notable speakers will present topics of interest at the three day event.

Minimum Continuing Legal Education (MCLE) credits are available to attorneys, and general continuing education credits are available to claims adjusters and CPDM/CCMP-designated individuals who attend the educational sessions. The specific number of credit hours will be determined by the State Bar of California and the Insurance Educational Association. Updates will be provided on the conference web page.

The California Coalition on Workers’ Compensation is a member-driven alliance that has gained prominence for extensive industry knowledge and an unwavering focus on advocacy and educational outreach. We are committed to applying these skills and services in ways that will have the most positive impact on the workers’ compensation industry. Strategically positioned at the forefront of legislative and regulatory reform, CCWC enjoys a vantage point that enables us to make our voices heard for the benefit of public and private sector employers and their workers throughout California. Our legislative advocates influence and incite change on behalf of our members, offering an invaluable benefit that affects the workers’ compensation arena in ways that no other organization can.

The Office of Administrative Law (OAL) has approved the Division of Workers’ Compensation’s (DWC) final version of the Copy Service Fee Schedule. The effective date of the regulations is July 1, 2015.

“The new copy service fee schedule, which was mandated by SB 863, is a flat $180 fee for a set of records from a single custodian. By reducing the items and services that can be separately billed, we expect fewer disputes and prompter payments. If there are disagreements about a copy service bill, the disputes can now be handled through Independent Bill Review instead of the more time consuming and costly lien process,” said DWC Administrative Director Destie Overpeck.

The Copy Service Fee Schedule regulations include the following:

1) Instead of a per-page fee and itemized fees for subpoena preparation, mileage, and other related fees, a flat fee of $180 covers records of 500 pages and under and includes mileage, postage, delivery, phone calls, page numbering, witness fees, release of information fees, and subpoena preparation.
2) Separate charges are allocated for cancellations, certificates of no record, for records obtained from EDD and WCIRB, and for additional sets for records.
3) For copies above 500 pages, an additional 10 cents a page is allowed.
4) Bills for copy services must include provider tax ID numbers, professional photocopier numbers, and claim numbers and may include newly-created billing codes.
5) DWC fees for transcripts will no longer be estimated. It will cost $100 to order a transcript of 33 pages and under; transcripts over 33 pages will cost an additional $3 a page. DWC fees for Public Records Act requests requiring staff research will be charged at $85 an hour instead of $40.
6) DWC can dispose of paper adjudication documents after 20 years.

Although the Fee Regulations become effective on July 1, claim administrators should be aware that photocopiers are already regulated by statute in California. A “professional photocopier” is defined by section 22450 of the Business and Professions Code. This code requires that a professional photocopier shall be registered by the county clerk of the county in which he or she resides or has his or her principal place of business, and in which he or she maintains a branch office. A certificate of registration shall be accompanied by a bond of five thousand dollars ($5,000) which is executed by a corporate surety qualified to do business in this state and conditioned upon compliance with the provisions of this chapter and all laws governing the transmittal of confidential documentary information. The county clerk shall maintain a register of professional photocopiers, assign a number to each professional photocopier, and issue an identification card to each one. Additional cards for employees of professional photocopiers shall be issued. A professional photocopier shall be responsible at all times for maintaining the integrity and confidentiality of information obtained under the applicable codes in the transmittal or distribution of records to the authorized persons or entities. At least one person involved in the management of a professional photocopier shall be required to hold a current commission from the Secretary of State as a notary public in California.

All records transmitted or distributed by a professional photocopier shall be accompanied by a certificate containing the name, address, and registration number and county of registration of the professional photocopier as well as other mandated information specified in Business and Professions code 22462. A failure to comply with the professional photocopier requirements shall be punishable as a misdemeanor. It would be advisable for claim administrators to verify that all photocopied records comply with these provisions.

The text of the copy service fee regulations can be found on the DWC website..

A San Francisco janitor who had his face slashed by a passenger while working a nightshift as an UberX driver has filed a lawsuit seeking workers compensation insurance coverage from Uber Technologies, the ride hailing platform that classifies its drivers as independent contractors. The lawsuit, which was filed by Abdo Ghazi in San Francisco Superior Court on April 28, is seeking class action status as well as an injunction, damages and penalties against Uber.

According to the report in Biz Journals, it is the latest in a line of similar lawsuits with potentially far reaching implications for the on-demand economy that have been filed against Uber and other new tech platforms insisting that the workers providing the actual services they advertise be treated as employees. “Uber’s misclassification of drivers as independent contractors gave it an unfair advantage over competing transportation companies, harmed Uber drivers, and violated state law,” the suit claims. Even short of getting employment status, Ghazi’s suit demands that he be given workers compensation benefits, something that is allowed for and in some cases mandated even when workers are not considered employees, as is the case for taxi drivers in California.

San Francisco taxi officials say workers’ compensation coverage costs nearly $5,000 per cab a year, and they have long complained that it is unfair that taxi companies must provide drivers with workers compensation coverage while there is no similar requirement for drivers for Uber and similar on-demand platforms like Lyft and Sidecar, all of which are regulated by the state Public Utilities Commission.

Ghazi, 56, suffered a broken nose and four puncture wounds to his nose and mouth when he was attacked without provocation in the Richmond District by a male passenger shortly after midnight on Nov. 23, according to his complaint. David Lin, 26, fled after attacking Ghazi and was later taken into custody after attempting to break into someone’s house, a police spokesman said. He has been charged with one count of assault with force likely to cause great bodily injury, one count of battery with serious bodily injury, and one count of false imprisonment and has entered a plea of not guilty. Ghazi’s attacker was allegedly one of three people, including two men and woman, who originally got into Ghazi’s car at about midnight, said Conor Granahan, one of Ghazi’s attorneys. Ghazi was driving his Toyota Sienna and getting ride referrals through Uber’s UberX service, which enables people using a smartphone application to drive for hire using their own vehicles.

After dropping off one man and the woman, Ghazi was taking his remaining passenger toward Clement Street and 18th Avenue when the man suddenly leaped into the front seat and started punching Ghazi without warning, repeatedly striking Ghazi’s face while pulling on his seatbelt so he could not escape, Granahan said. Ghazi’s lip and chin were punctured by something sharp during the attack and he was taken to a local hospital where he was stitched up, and he still has “swelling and other issues with his mouth” as well as post-traumatic stress disorder, according to Granahan. He will need subsequent medical care, his suit states.

The result was that Ghazi, a resident of the Tenderloin, was off work for nearly two months from both Uber and also from his day job as a custodian at a downtown building, though he has since returned to both positions, Granahan said. Ghazi previously worked as a taxi driver at night, but when his earnings plummeted as a result of Uber’s impact on the market, he switched in June 2014 to the Uber platform, his complaint states.

Alec Segarich, another of Ghazi’s lawyers, who specializes in employment law, said he was aware of other lawsuits like Ghazi’s that are seeking employee status and have been filed against other tech-enabled companies which claim they are simply a communication platform to connect customers with independent contractors providing services ranging from house cleaning to grocery delivery. Other San Francisco firms named as defendants in such cases include Caviar (owned by payments provider Square), Homejoy, Instacart, Lyft and Postmates.”Our legal theory is that not providing workers compensation and misclassifying workers is an unfair business practice,” Segarich said.

“A lot of companies are trying to get out of pretty basic employment rights that have been around for a century. We think that just because you have an app it doesn’t change the employer-employee relationship, and that’s a lot of what this lawsuit is about.”

Traditionally, claim administrators project the cost of a lifetime award using statistical actuarial tables that predict life expectancy based upon historical data. The settlement value of a workers compensation claim also considers the expected lifetime cost of the claim. But now, researchers say it may be possible to slow and even reverse aging by keeping DNA more stably packed together in our cells. Perhaps evaluating the cost of settlement value of a claim is getting far more complicated than just using an actuarial table.

In a breakthrough discovery, scientists report that they have found the key to keeping cells young. In a study published Thursday in Science, and reported by Time Magazine, an international team, led by Juan Carlos Izpisua Belmonte at the Salk Institute, studied the gene responsible for an accelerated aging disease known as Werner syndrome, or adult progeria, in which patients show signs of osteoporosis, grey hair and heart disease in very early adulthood.

These patients are deficient in a gene responsible for copying DNA, repairing any mistakes in that replication process, and for keeping track of telomeres, the fragments of DNA at the ends of chromosomes that are like a genetic clock dictating the cell’s life span. Belmonte – together with scientists at the University Catolica San Antonio Murcia and the Institute of Biophysics at the Chinese Academy of Sciences – wanted to understand how the mutated gene triggered aging in cells. So they took embryonic stem cells, which can develop into all of the cells of the human body, and removed this gene. They then watched as the cells aged prematurely, and found that the reason they became older so quickly had to do with how their DNA was packaged.

In order to function properly, DNA is tightly twisted and wound into chromosomes that resemble a rope in the nucleus of cells. Only when the cell is ready to divide does the DNA unwrap itself, and even then, only in small segments at a time. In patients with Werner syndrome, the chromosomes are slightly messier, more loosely stuffed into the nuclei, and that leads to instability that pushes the cell to age more quickly. Belmonte discovered that the Werner gene regulates this chromosome stability. When he allowed the embryonic stem cells that were missing this gene to grow into cells that go on to become bone, muscle and more, he saw that these cells aged more quickly. “It’s clear that when you have alterations in [chromosome stability], the process of aging goes so quickly and so fast that it’s tempting to say, yes, this is the key process for driving aging,” says Belmonte.

Even more exciting, when he analyzed a population of stem cells taken from the dental pulp of both younger and older people, he found that the older individuals, aged 58 to 72 years, had fewer genetic markers for the chromosome instability while the younger people aged seven to 26 years showed higher levels of these indicators.

“What this study means is that this protein does not only work in a particular genetic disease, it works in all humans,” says Belmonte. “This mechanism is general for aging process.” Before it can be considered as the Fountain of Youth, however, Belmonte says new and better techniques need to be developed that can more specifically and safely alter the Werner gene in people, not just a culture dish of human cells. He also stresses that there may be other processes contributing to aging, and it’s not clear yet how important chromosome stability is compared to those factors. But, he says. “having technologies like this will allow us to determine how important each of these parameters are for aging.” And if the findings hold up, they could be first step toward finding a way to help cells, and eventually people, live longer.

Closer to home, Stanford University seems to agree with this science. Its website proclaims “”Now we have found a way to lengthen human telomeres by as much as 1,000 nucleotides, turning back the internal clock in these cells by the equivalent of many years of human life,” said Helen Blau, PhD, professor of microbiology and immunology at Stanford and director of the university’s Baxter Laboratory for Stem Cell Biology. “This new approach paves the way toward preventing or treating diseases of aging,” said Blau. “There are also highly debilitating genetic diseases associated with telomere shortening that could benefit from such a potential treatment.”