June 19, 2018

TDI-DWC Seeking Input for Development of Lumbar Spine MRI Plan-Based Audit

Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) seeks input on the development of a Lumbar Spine MRI Plan-Based Audit (Plan-Based Audit) to evaluate the appropriateness of a doctor’s decision and recordkeeping that supports the ordering of lumbar spine MRIs prior to one month of conservative therapy. The Plan-Based Audit sets the scope, methodology, selection criteria, and program area responsibilities as laid out in the Medical Quality Review…[Continue Reading]

CA Labor Commissioner Stresses Importance of Valid Workers’ Comp Insurance

Oakland, CA – Labor Commissioner Julie A. Su is reminding employers they must maintain valid workers’ compensation insurance coverage or its equivalent. Employers who purchased insurance with American Labor Alliance and CompOne USA are advised that the companies are not licensed to sell insurance in California. “Employers who bought workers’ compensation insurance policies from these two firms do not have policies that meet the requirement to provide coverage and must…[Continue Reading]

Greg Agnone Joins Midwest Employers Casualty as Director of Business Development for Group Captives

St. Louis, MO – Midwest Employers Casualty (MEC), a Berkley Company, announced the addition of Greg Agnone as director of business development for group captives. In this newly created role, Greg will be responsible for identifying new captive opportunities for MEC. A veteran of the group captive business since 2004, Greg comes to MEC with more than 30 years of experience in the insurance industry. His experience includes group captive work with several major markets…[Continue Reading]

Former WA Insurance Agent Gets 60 Days Behind Bars for $233K Workers’ Comp Scam

Everett, WA – A Lake Stevens man who ran his own insurance agency while claiming he was too disabled to work must serve 60 days in jail. James C. Kooy, 53, was sentenced on Nov. 27, on one count of first-degree theft for wrongfully receiving more than $233,000 in workers’ compensation payments from the Washington State Department of Labor & Industries (L&I). Kooy had pleaded guilty to the felony charge in Snohomish County Superior Court in September…[Continue Reading]

WorkCompRecap: Fee Findings!

Today’s issue of WorkCompRecap interrupts your Cyber Monday shopping with the release of a new report from WCRI that examine all three rounds of the Delaware fee schedule changes that were enacted in House Bill (HB) 373. The fee schedule changes in HB 373 sought to reduce medical expenses by 33% by January 31, 2017…[Continue Reading]

New WCRI Study Examines Delaware Fee Schedule Changes

Cambridge, MA – A new report from the Workers Compensation Research Institute (WCRI), Evaluation of the 2015, 2016, and 2017 Fee Schedule Changes in Delaware, provides policymakers and other stakeholders with the ability to examine all three rounds of the Delaware fee schedule changes enacted in House Bill (HB) 373. “In many states, policymakers and other stakeholders are looking to fee schedules to help control the growth of medical care costs in their workers’ compensation systems…[Continue Reading]

TDI-DWC Seeking Input on Development of Medical Quality Review CY 2018 Annual Audit Plan

Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation recently announced that it is seeking informal input from workers’ compensation system participants concerning potential categories for the 2018 Medical Quality Review Annual Audit Plan. The Annual Plan sets the priorities for audits the Medical Quality Review Panel (MQRP) will initiate during the upcoming year per Section IV of the Annual Plan. This includes the scope, methodology, selection criteria, and…[Continue Reading]

MT Governor Bullock Announces New Commissioner of Department of Labor & Industry

Helena, MT – Montana Governor Steve Bullock recently announced he has appointed Galen Hollenbaugh to serve as the Commissioner of the Montana Department of Labor & Industry. “Montana’s economy is growing, and we need a strong leader at the Department of Labor & Industry who will ensure the state can keep pace with the rate of business growth and demand for skilled workers,” said Governor Bullock. “I’m confident Galen brings the right combination of expertise and energy to steer…[Continue Reading]

CA Father and Son Sentenced in $400,000 Workers’ Comp Scheme

Salinas, CA – Jaime Rosario Del Real, 61, and son Israel Del Real, 37, both recently pleaded guilty to four felony counts for their role in a $400,000 insurance fraud scheme denying workers’ compensation insurance and medical care for injured workers. The father and son duo were sentenced to 250 days in jail, 10 years felony probation, and ordered to pay $382,951 in restitution. This case was prosecuted by the Monterey County District Attorney’s Office. “Business owners are…[Continue Reading]

WorkCompRecap: Giving Thanks!

Today’s issue of WorkCompRecap finishes off the short week with WCRI’s release of the Florida edition of its CompScope™ Medical Benchmarks, which examines medical payments, prices, and utilization in Florida and compared them with 17 other states over a period from 2010 through 2015. Key findings from the study included that medical payments per workers’ comp claim in the state…[Continue Reading]

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