The National Foundation for Unemployment Compensation and Workers’ Compensation reports that medical costs plummeted by more than 3.5 billion.
A New report from the National Foundation for Unemployment Compensation and Workers’ Compensation exposes the pandemic’s impact on workers’ compensation financials. Findings show that medical costs plummeted by more than 3.5 billion, almost 12 percent, which can be attributed to lower employment resulting in fewer claims coupled with relatively low cost of covid related claims. Total benefits payments dropped by almost 3.9 billion, and over the last decade, the national average benefit cost per employee declined by 10.2 percent before adjusting for inflation. After adjusting for cumulative inflation of 17 percent, the real decline in benefit cost per employee is around 27.3 percent.
After a series of troubling PTSD judicial rulings that went against first responders, a state appellate court ruled in favor of a police officer suffering from PTSD.
A state appellate court ruled in favor of an injured first responder regarding PTSD benefits. The police officer who filed for workers’ compensation PTSD benefits in November of 2018 responded to the Stoneman Douglas school shooting earlier that year in February which left 17 young adults dead. Before November 2018, mental health indemnity benefits were only awarded if a physical injury accompanied the mental injury. Legislative leaders agreed to a change to allow mental injury-only claims to access indemnity benefits commencing on October 1st, 2018, if certain conditions are met, including in the event of “seeing a deceased minor.” The officer’s employer contested that the day of the shooting should be considered the date of disability, whereas the first responder’s team argued the day of disability should be when the officer was placed on formal leave (November 2018). If the date of the traumatic event were considered the date of disability, the officer would be disqualified from indemnity benefits, although able to receive medical treatment through workers’ compensation. 1st District of Florida Court of Appeals emphasized that the “P” in PTSD stands for “post.” As such, the condition cannot occur until sometime after the traumatic event occurs, thus allowing for the claim to be compensable for medical and indemnity benefits. This new precedent is a change of course from recent judicial decisions and comes after the state CFO Jimmy Patronis warned the courts of misinterpreting existing mental injury statutes for first responders earlier this year.
Legislative leaders are eager to resurrect talks around mental injury presumptions for first responders.
State legislators will revamp efforts to allow for first responder PTSD/mental injury claims in workers’ compensation. While the House advanced the legislation to the Senate last session, the upper chamber could not find a compromise. SB81/82 currently with the Senate Judiciary Committee would amend state statutes to include injury “rising from the first responder’s involvement in a significant traumatic experience or situation in the course and scope of employment, without regard to whether the experience or situation was extraordinary or unusual in comparison to the normal working conditions of a first responder’s employment.” This language is welcome compared to states like AZ where “extraordinary and unusual” usually disqualify numerous mental injury claims (just look at last week), even claims with detailed medical records and eyewitness testimony of the traumatic event. However, the word “significant” could be misinterpreted down the line and potentially provoke a high burden of proof standard. SB81 does add 14 specific circumstances where first responders would qualify such as “witnessing the death of a child or transporting a gravely injured minor to a hospital” which usually helps courts with clarification on what events would qualify. Another bill SB251 lists circumstances that would be eligible, like SB81. However, instead of a formal definition, the bill generally states that first responders medically diagnosed with PTSD would qualify for benefits.
In preparation for the 2023 session state legislators have filed bills regarding physician dispensing and carrier communication requirements.
State legislators have begun prefiling bills for their upcoming 2023 legislative session, including HB790 and HB595/SB1503. Filed by Rep. Patterson of Frisco, Texas, HB790 would require the designated doctor evaluating an injured worker to provide an opinion of the extent of the compensable injury. In addition, bill language includes a provision where the injured worker may request information on the specific reasons why the carrier denied their claim. If a carrier fails to provide this information within 60 days, “it waives its right to contest, or deny the extent of the specific injury claimed by the injured worker or reasonably reflected in a review of the injured worker's medical records.” If passed, this legislation would take effect in September of 2023. HB595/SB1503 looks to make alterations to physician dispensing laws. The bills filed by Rep. Shaheen of North Dallas and Senator Buckingham MD, of Travis County, allow a physician to “dispense dangerous drugs to the physician’s patients and charge the patients for the drugs.” Per Sec 483.001 dangerous drug is defined as “ a drug that is unsafe for self-medication and that is not included in Schedules I through V or Penalty Groups 1 through 4 of the Texas Controlled Substances Act (i.e. Chap 481).” While physician dispensing is regarded as convenient for certain circumstances, the practice receives scrutiny for high expenditures, inadequate safety, and for posing potential conflict of interest situations. Currently, state statutes do not allow for wide-scale physician dispensing. The Lone Star state’s legislative session is set to begin on January 10th and run to May 29th.
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