Regulators Opine on Ways to Reduce Bureaucratic Complexities in the WC System

Sarasota, FL (WorkersCompensation.com) - Persuading every jurisdiction to agree on language for ‘First Report of Injury’ may be impossible. But getting a handful of states willing to discuss the issue might be a way to start. That’s the thinking of Abbie Hudgens. The Administrator of the Tennessee Bureau of Workers’ Compensation and President of the Board of the International Association of Industrial Accident Boards and Commissions said that model may be the best hope to reduce regulatory complexity in the workers’ compensation system.

Hudgens joined Frank McKay, Chair of the Georgia State Board of Workers’ Compensation during a ‘Hot Seat’ webinar hosted by WorkersCompensation.com to discuss regulatory complexity in workers’ compensation.

Langauge

Definitions of workers’ compensation terms among jurisdictions are one of the most oft cited complaints among stakeholders. A case in point is who qualifies as an employee.

“Many people use the IRS regulations [to determine] who is an employee, for example,” Hudgens said. “This is one of the roles organizations like the IAIABC or SAWCAA (Southern Association of Workers’ Compensation Administrators) can play; bring people together in smaller groups to forge similarities. When we try to do it across the board, we are shooting ourselves in the foot.”

Then again, standardization that is adopted is not always the best answer for everyone. “Dynamex  brought consistency but it certainly didn’t make anybody’s life easier. [It basically said] everybody’s an employee,” said Robert Wilson, President & CEO of WorkersCompensation.com. “If you want consistency, could states agree on a standard for what is an ‘independent contractor’? From a workers’ compensation perspective, you’re an independent contractor in this state but not in this other state. That’s the standardization people may want.”

Some states have tried to define ‘independent contractor’ via statute. Tennessee has had the question answered through various court decisions, McKay said. “There are a number of regulatory complexities at the legislature we are dealing with almost every day,” he said.  “The trade journals talk about presumption statutes for first responders and others as to whether or not cancers or PTSD are compensable. There’s a lot of complexity there where the answer is provided by a legislature and as a regulatory agency we’d be in charge of enforcing or regulating.”

Updated software systems in the future that include filters may help, Hudgens said. Also, regulatory bodies that reduce the number of definitions could also make a difference.

Paperwork

The number of forms required by jurisdictions is another bone of contention in the workers’ compensation system. Tennessee recently reduced the number of its forms down from 75. Texas has upwards of 143. Forms change among the 53 jurisdictions up to 400 times per quarter.

“We have 52 forms; I thought that was a lot,” McKay said. “We try to give a balance, give plenty of notice [when changing forms].”

Georgia, for example, recently expanded the requirement for FROI forms to be filed for all claims, not just lost-time claims. Regulators encouraged stakeholders to begin submitting them a year in advance.

“We said go ahead and do it now and get used to it because once January 1 hits, we will have penalties. We try to give warning.”

One sticking point is whether and to what extent penalties are imposed for failing to file the required forms. Wilson asked if states could do a better job of educating stakeholders on form changes.

“What I find in the judicial and regulatory role I play that is a little unforgiveable is when we have a litigated claim in which the forms have not been filed; like the lost time claim or the FROI not filed and the benefits were paid,” McKay said. “It’s impossible for our judges and regulators to know what happened on that case, and that’s going to mean penalties. So some forms are more critical than others.”

Hudgens suggested regulators go through their forms to determine “what value you get” from them and eliminate those that are unnecessary.

The paperwork required of physicians impacts the number of quality providers willing to work in the workers’ compensation system, even though the pay is generally higher than in the healthcare system. The regulators say that’s at least party the fault of payers.

“One question that puzzles me is why payers select doctors to be on their panels and then put them through a real obstacle course to get treatment,” Hudgens said. “We’ve looked at ours. Our medical director [says] there are lots and lots of situations where the doctor did not document what he was trying to do and if he had it would have been approved. If we’re going to have quality solutions we’ve got to find solutions to the complexity.”

A patient advocacy model, in which the payer works with the treating physician to help get the injured worker back to work helps, Hudgens said. Modernizing and improving utilization review is part of the answer.

Another potential solution is a program Georgia rolled out in July 2017. Called a petition to get medical treatment, it results in answers for recommended treatment coming quickly.

“It’s been very popular; 82 percent have been resolved within six days, so it’s very quick to get a decision made to either pay or not pay for the procedure,” McKay said. “Whether it is surgery or physical therapy or whatever the [recommended] treatment is … this petition for medical treatment resolves that very quickly; so whoever is handling that claim has to fish or cut bait.  We had seen months between those two points of time. That’s friction.”

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