March 8 Senate Hearings on IME & PTD bills

They go by different names but their purpose is to deny new claims or close existing ones.

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March 8 Senate Hearings on IME & PTD bills

Postby Webmaster » March 1st, 2005, 6:10 pm

Hearings for the IME and Disability bills are scheduled in the Senate.
We support both which will help many, including those with open claims.

Please come forward and testify or send your testimony to us at iwa@injuredworker.org. Too often, we've heard in testimony from the insurer and employer side that a poor turnout by us means there can't be much of a problem.

We've heard from people that said they didn't show up for hearings in the because they figured others would...but others didn't!

Senate Bill 311 is "the" IME bill this session since the MLAC negotiated changes are being incorporated into it. The link below doesn't include the amendments though. We'll post a summary as soon as it's available.

Senate Bill 386 will, among other things, increase compensation by tying gainful employment to federal poverty guidelines for family size instead of Oregon's minimum wage.

SB 311: http://www.leg.state.or.us/05reg/measur ... intro.html
SB 386: http://www.leg.state.or.us/05reg/measur ... intro.html

Oregon Capital
900 Court Street NE, Salem, Oregon 97301
Directions: http://www.leg.state.or.us/capinfo/directions.htm
Commerce Committee Member Contact: http://www.injuredworker.org/Committees.htm#Commerce
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Senate Commerce Committee
Phone: 503-986-1643

Date: Tuesday-March 8
Time: 3:10 P.M.
Room: HR C


Public Hearing and Possible Work Session
    SB 311 - Requires Director of the Department of Consumer and Business Services to adopt rules specifying limitations on travel for workers attending required medical examinations for workers' compensation claims and requiring distribution of educational materials about examination process to workers by insurers and self-insured employers.
    SB 386 - Modifies process for reexamination of claim in which permanent total disability benefits are being paid and criteria for termination of those benefits.
All Bills on this notice may be carried over to the next meeting at the discretion of the Chair.[/list]Please note that all committee members have a Judiciary meeting directly before the Commerce Committee meeting, therefore the meeting may begin late.

Staff respectfully requests that you submit 20 collated copies of written materials at the time of your testimony.

Persons making presentations including the use of video, DVD, PowerPoint or overhead projection equipment are asked to contact Committee staff 24 hours prior to the meeting.
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Please attend or send us testimony specific to these issues. Please contact us if you plan to testify. Send testimony to the e-mail address above if you want us to provide it for you. You can also fax testimony to 503-656-9333.

Please forward this around.

Thank you.

Injured Workers' Alliance (Oregon)
www.injuredworker.org

P.S. Here's some useful information
How to testify: http://www.leg.state.or.us/comm/testify.html
The state's IME Study: http://www.injuredworker.org/ (it would be good in testimony to use quotes from various participants)
Contact your representatives: http://www.injuredworker.org/Senate.htm
IWA's File Library on IME's: (in a different section of this forum and even more info will be posted before Saturday)
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Here is an updated bill summary as of 3-2-2005

Postby Webmaster » March 1st, 2005, 7:49 pm

Senate Bill 311

The bill could see amendments but shouldn't change much. This post will be updated in time so please revisit.

Insurers will still choose the examiners. As much as we wanted an independent selection process, it simply wasn't going to happen. IME changes include:

Statute

Requires the department to develop:
    • A certification process and registry for required medical examination physicians, by establishing physician qualifications.
      • In consultation with the medical community, rules for professional and ethical standards, and standards of impartiality, including:
        • Grounds for removal from the list.

        • Educational and training requirements.
      • A process for investigating and reviewing complaints about medical examinations.

      • A process for referring complaints to the appropriate licensing board, if necessary.

      • A process for appeal by a required medical examination doctor on actions by the department.
    • Requires insurers to choose a certified required medical examination providers from a list established by the department.

    • Requires physicians of worker-requested medical examinations be selected from the certified list.

    • Allows injured workers to appeal the location of the exam to the department for dispute resolution. Decisions by the Director will not be subject to further review. (Many severely injured are now forced to drive 400 miles or more each way)

    • Requires department to approve training for insurers regarding conduct of required medical examinations. Gives authority to the department to impose a civil penalty to insurers who don’t provide the approved training to their claims examiners.

    • Requires department to establish a monetary penalty to injured workers who do not attend required medical exams without giving notice or having a justifiable reason. Rules adopted under this section would apply only to a worker that is not receiving benefits. Penalty would come out of any future benefits. ($100 has been discussed. Very unlikely to be more)

    • Requires adoption of rules to provide sanctions against a medical service provider that does not timely provide diagnostics for a required medical examination.
Administrative rules

In addition, the Management-Labor Advisory Committee has asked the department to work with stakeholders to develop rules that would:
    • Allow injured workers to have observers in the medical examination. (Currently, examiners can exclude witnesses)

    • Require insurers to send educational materials developed by the department to the injured worker at time of a required medical examination.

    • Require an exit survey/complaint form be developed and sent to injured workers. A postage-paid envelope addressed to the department must accompany each form. The department would track and investigate complaints.

    • Require a statement on the insurer letter to attending physicians regarding their concurrence with the examination report. The attending physician would provide a written acknowledgement that they reviewed the report with their patient, with the exception of psychiatric examinations.

    • Require insurers to send two examination reports to the attending physician, for the attending physician to give one copy to the injured worker, with the exception of psychiatric examinations.

    • Develop continuing education requirements for independent medical examination providers and claims examiners.

Statute or rule to be determined by Legislative Counsel on the following two items:
    • Quality assurance components in the certification program.

    • Liability for false statements in required medical examination report.
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Senate Bill 984 / North Carolina

Postby softhec » May 25th, 2005, 2:11 am

GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 2005

S D

SENATE DRS75230-LD-75 (03/14)













Short Title: Amend Workers' Compensation Act.
(Public)

Sponsors:
Senator Hoyle.

Referred to:








A BILL TO BE ENTITLED

AN ACT to amend the workers' compensation act.

The General Assembly of North Carolina enacts:

SECTION 1. G.S. 97‑12 reads as rewritten:

"§ 97‑12. Use of intoxicant or controlled substance; willful neglect; willful disobedience of statutory duty, safety regulation or rule.

(a) No compensation shall be payable if the injury or death to the employee was proximately caused by:

(1) His intoxication, provided the intoxicant was not supplied by the employer or his agent in a supervisory capacity to the employee; or

(2) His being under the influence of any controlled substance listed in the North Carolina Controlled Substances Act, G.S. 90‑86, et seq., where such controlled substance was not by prescription by a practitioner; or

(3) His willful intention to injure or kill himself or another.

(b) A positive drug or alcohol test result shall be a conclusive presumption of impairment resulting from the use of drugs or alcohol. No compensation shall be allowed when the employee refuses to submit to or cooperate with a blood or other applicable medical test after the accident, if the employee had previously been warned in writing by the employer that such refusal would forfeit the employee's right to recover benefits under this Article.

When the injury or death is caused by the willful failure of the employer to comply with any statutory requirement or any lawful order of the Commission, compensation shall be increased ten percent (10%). When the injury or death is caused by the willful failure of the employee to use a safety appliance or perform a statutory duty or by the willful breach of any rule or regulation adopted by the employer and approved by the Commission and brought to the knowledge of the employee prior to the injury compensation shall be reduced ten percent (10%). The burden of proof shall be upon him who claims an exemption or forfeiture under this section."

SECTION 2. G.S. 97‑18(b) reads as rewritten:

"(b) When the employer admits the employee's right to compensation, the first installment of compensation payable by the employer shall become due on the fourteenth day after the employer has written or actual notice of the injury or death, on which date all compensation then due shall be paid. be paid within 14 days after the employer or carrier completes its investigation of the employee's claims. The employer shall make a decision whether to admit or deny an employee's right to compensation no more than 90 days after the employer has written notice of the employee's filing of a claim on an approved Commission Form 18, Form 18B, or Form 33. In the event the employer no longer exists as a legal entity, any carrier insuring the employer at the time of the injury or last injurious exposure shall have 90 days from the date of receipt of the notice of claim from the Industrial Commission to accept the claim or deny the employee's right to compensation. The Commission may extend the deadline for admitting or denying a claim at its discretion. Compensation thereafter shall be paid in installments weekly except where the Commission determines that payment in installments should be made monthly or at some other period. Upon paying the first installment of compensation and upon suspending, reinstating, changing, or modifying such compensation for any cause, the insurer shall immediately notify the Commission, on a form prescribed by the Commission, that compensation has begun, or has been suspended, reinstated, changed, or modified. A copy of each notice shall be provided to the employee. The first notice of payment to the Commission shall contain the date and nature of the injury, the average weekly wages of the employee, the weekly compensation rate, the date the disability resulting from the injury began, and the date compensation commenced."

SECTION 3. Article 1 of Chapter 97 of the General Statutes is amended by adding a new section:

"§ 97‑25.6. Reasonable access to medical information.

(a) It is the policy of the State that all parties have reasonable access to medical information to facilitate the administration of this Article. An employee who reports an injury or illness to the employer that the employee claims is work‑related waives any physician‑patient privilege with respect to any condition or complaint reasonably related to the condition for which the employee seeks compensation. Any medical records, reports, and information for an employee relevant to the injury or illness for which the employee is seeking compensation must be furnished when requested by the employer, the insurance carrier, an authorized qualified rehabilitation provider, or the attorney for the employer or carrier, along with any necessary discussion of the medical condition, when the medical records, reports, information, and discussion are restricted to conditions relating to the injury.

(b) Release of medical information under subsection (a) of this section by the health care provider or other physician does not require the employee's authorization. If medical information of an employee under subsection (a) of this section is sought from health care providers who are not subject to the jurisdiction of State courts, the injured employee shall sign an authorization allowing the employer or carrier to obtain the medical information. Any such release of information may be held before or after the filing of a claim for compensation under this Article without the knowledge, consent, or presence of any other party.

(c) A health care provider who willfully refuses to provide medical records, reports, or information or to discuss the medical condition of the injured employee under this section, after a reasonable request is made for such information, shall be subject to sanctions determined by the Commission.

(d) The Commission may adopt rules to implement this section."

SECTION 4. G.S. 97‑29 reads as rewritten:

"§ 97‑29. Compensation rates for total incapacity.

Except as hereinafter otherwise provided, where the incapacity for work resulting from the injury is total, the employer shall pay or cause to be paid, as hereinafter provided, to the injured employee during such total disability a weekly compensation equal to sixty‑six and two‑thirds percent (66 2/3%) of his average weekly wages, but not more than the amount established annually to be effective October 1 as provided herein, nor less than thirty dollars ($30.00) per week. With respect to injuries that occur when the employee is age 60 or younger, the period covered by the compensation shall not, subject to G.S. 97‑31(17) only, extend beyond the date that the employee reaches age 65, and in no case shall the period covered exceed 500 weeks from the date of the injury. With respect to injuries that occur after the employee reaches age 60, the period covered by compensation shall not exceed 260 weeks from the date of the injury.

In cases of total and permanent compensation, including medical compensation, shall be paid for by the employer during the lifetime of the injured employee. If death results from the injury then the employer shall pay compensation in accordance with the provisions of G.S. 97‑38.

The weekly compensation payment for members of the North Carolina national guard and the North Carolina State Defense Militia shall be the maximum amount established annually in accordance with the last paragraph of this section per week as fixed herein. The weekly compensation payment for deputy sheriffs, or those acting in the capacity of deputy sheriffs, who serve upon a fee basis, shall be thirty dollars ($30.00) a week as fixed herein.

An officer or member of the State Highway Patrol shall not be awarded any weekly compensation under the provisions of this section for the first two years of any incapacity resulting from an injury by accident arising out of and in the course of the performance by him of his official duties if, during such incapacity, he continues to be an officer or member of the State Highway Patrol, but he shall be awarded any other benefits to which he may be entitled under the provisions of this Article.

Notwithstanding any other provision of this Article, on July 1 of each year, a maximum weekly benefit amount shall be computed. The amount of this maximum weekly benefit shall be derived by obtaining the average weekly insured wage in accordance with G.S. 96‑8(22), by multiplying such average weekly insured wage by 1.10, and by rounding such figure to its nearest multiple of two dollars ($2.00), and this said maximum weekly benefit shall be applicable to all injuries and claims arising on and after January 1 following such computation. Such maximum weekly benefit shall apply to all provisions of this Chapter and shall be adjusted July 1 and effective January 1 of each year as herein provided."

SECTION 5. G.S 97‑30 reads as rewritten:

"§ 97‑30. Partial incapacity.

Except as otherwise provided in G.S. 97‑31, where the incapacity for work resulting from the injury is partial, the employer shall pay, or cause to be paid, as hereinafter provided, to the injured employee during such disability, a weekly compensation equal to sixty‑six and two‑thirds percent (66 2/3%) of the difference between his average weekly wages before the injury and the average weekly wages which he is able to earn thereafter, but not more than the amount established annually to be effective October 1 as provided in G.S. 97‑29 a week, and in no case shall the period covered by such compensation be greater than 300 weeks from the date of injury. week. With respect to injuries that occur when the employee is age 60 or younger, the period covered by the compensation shall not extend beyond the date that the employee reaches age 65, or shall not exceed 500 weeks from the date of the injury, whichever occurs sooner. With respect to injuries that occur after the employee reaches age 60, the period covered by compensation shall not exceed 260 weeks from the date of the injury. In case the partial disability begins after a period of total disability, the latter period shall be deducted from the maximum period herein allowed for partial disability. An officer or member of the State Highway Patrol shall not be awarded any weekly compensation under the provisions of this section for the first two years of any incapacity resulting from an injury by accident arising out of and in the course of the performance by him of his official duties if, during such incapacity, he continues to be an officer or member of the State Highway Patrol, but he shall be awarded any other benefits to which he may be entitled under the provisions of this Article."

SECTION 6. G.S. 97‑31(24) reads as rewritten:

"(24) In case of the loss of or permanent injury to any important external or internal organ or part of the body for which no compensation is payable under any other subdivision of this section, the Industrial Commission may award proper and equitable compensation not to exceed twenty thousand dollars ($20,000). This subdivision does not apply to the loss or permanent injury to the lungs and parietal and visceral pleura surrounding the lungs resulting from exposure to asbestos or silica."

SECTION 7. G.S. 97‑31 is amended by adding a new subdivision:

"(25) In case of the loss of, or permanent injury to the lung, which includes the parietal and visceral pleura surrounding the lung, resulting from exposure to asbestos or silica for which no compensation has been paid or is payable for partial or total disability, compensation shall be payable in an amount not to exceed twenty thousand dollars ($20,000) and shall be in lieu of compensation under any other subdivision of this section. Compensation under this subdivision is subject to the following limitations:

a. Compensation awarded shall be for the loss of use attributable to the disease alone. If the employee has smoked within 10 years of the employee's date of diagnosis of the loss of, or permanent injury to, the lung, which includes the parietal and visceral pleura surrounding the lung, resulting from exposure to asbestos or silica, the compensation awarded pursuant to sub-subdivision b. of this subdivision shall be reduced by one-half. For purposes of this sub-subdivision, "smoked" means the personal use of cigarettes or cigars at a level of at least one-fourth pack a day history at any time within the 10 years prior to the diagnosis.

b. Compensation shall be in the proportion that the partial loss bears to a total loss of use of the lung, which includes the parietal and visceral pleura surrounding the lung, as measured by the following schedule and diagnosed by a competent medical authority:

1. ILO Grade 1/1 or greater with or without pleural changes with zero percent (0%) AMA impairment: zero percent (0%) to not more than four percent (4%) loss of, or permanent injury to, the lung, which includes the parietal and visceral pleura.

2. ILO Grade 1/1 or greater with or without pleural changes with a Class II AMA impairment: five percent (5%) to not more than twenty‑four percent (24%) loss of, or permanent injury to, the lung, which includes the parietal and visceral pleura.

3. ILO Grade 1/1 or greater with or without pleural changes with a Class III AMA impairment: twenty‑five percent (25%) to not more than forty‑nine percent (49%) loss of, or permanent injury to, the lung, which includes the parietal and visceral pleura.

4. ILO Grade 1/1 or greater with or without pleural changes with a Class IV AMA impairment: fifty percent (50%) to one hundred percent (100%) loss of, or permanent injury to, the lung, which includes the parietal and visceral pleura.

For purposes of this sub-subdivision, "competent medical authority" means a medical doctor who is board‑certified as an internist, pulmonary specialist, oncologist, pathologist, or occupational medicine specialist."

SECTION 8. G.S. 97‑32 reads as rewritten:

"§ 97‑32. Refusal of injured employee to accept suitable employment as suspending compensation.

If an injured employee refuses employment procured for him suitable to within his capacity physical limitations, he shall not be entitled to any compensation at any time during the continuance as a result of such refusal, unless in the opinion of the Industrial Commission such refusal was justified.refusal."

SECTION 9. G.S. 97‑61.1 through G.S. 97‑63 are repealed.

SECTION 10. It is the intent of the General Assembly to provide the North Carolina Industrial Commission with adequate resources by establishing new positions to assist the Commission in performing its important task.

SECTION 11. This act becomes effective October 1, 2005, and applies to injuries that occur on or after that date.
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IME

Postby softhec » May 25th, 2005, 2:21 am

In my case we were able to prove Wal-Mart did in fact have influnance over medical care a doctor was allowed to give an injured worker. This is against the rules of workers comp. in my state of north carolina. A ruling was made against Wal-Mart in this matter.
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March 8 Senate Hearings on IME PTD bills

Postby obtaick » March 16th, 2010, 1:04 am

Dear friend
Frquent medical bills can raise doubt to any one including the HOO who is responsible for reimbursement of these bills. Your office can ask in writing from the treating AMA/Govt. Hospital regarding geniuneness of claim made by the employee. Believe me in 9 out of ten such cases AMA replied negatively and clearly states that the amound claimed is fake.
Jitendra
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