Workers’ comp execs uneasy about the economy

• A new survey by the National Council on Compensation Insurance had familiar feedback as workers’ comp executives expressed unease about rate adequacy, medical inflation, economic uncertainty, and the shifting workplace and workforce.
• Executives worry about the steady decline in rates loss costs and other potential risks to the long-term health of the system. NCCI expects a 2023 combined ratio under 100, which would be the 10th consecutive year of underwriting profitability.
• Medical costs are rising, causing uncertainty for carriers that are troubled about frequency, severity, and large claims. NCCI analysis shows that medical costs are climbing modestly in workers’ comp, medical severity has been moderate in recent years, and fee schedules in most states are mitigating medical cost increases.
• Wages have been increasing along with consumer prices. The NCCI report shows that the labor market remains robust and the probability of a recession has diminished during the past quarter.
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Final rule on worker classification under Fair Labor Standards Act

• The U.S. Department of Labor issued a final rule to help employers and workers better understand when a worker qualifies as an employee and when they may be considered an independent contractor under the Fair Labor Standards Act.
• The rule guides proper classification and seeks to combat employee misclassification, a serious problem that impacts workers’ rights to minimum wage and overtime pay, facilitates wage theft, allows some employers to undercut their law-abiding competition, and hurts the economy at large.
• The new “independent contractor” rule restores the multifactor analysis used by courts for decades, ensuring that all relevant factors are analyzed to determine whether a worker is an employee or an independent contractor.
• The rule addresses six factors that guide the analysis of a worker’s relationship with an employer, including any opportunity for profit or loss a worker might have, the financial stake, and the nature of any resources a worker has invested in the work.
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Texas clinic office manager sentenced for $1.2M scheme

• A medical clinic office manager in Texas was recently sentenced to seven years in prison for operating a pill mill clinic that unlawfully distributed over 600,000 opioid pills in exchange for cash.
• According to court documents and evidence presented at trial, Andres Martinez Jr. of Laredo, Texas, was the office manager of Jomori Health and Wellness (Jomori), a purported Houston pain management clinic. Martinez operated Jomori with Dr. Oscar Lightner also of Laredo, as a pill mill.
• Lightner, who was the owner of and physician at Jomori, unlawfully prescribed dangerous combinations of controlled substances — including hydrocodone, carisoprodol, and alprazolam — to his patients without a legitimate medical purpose in exchange for cash payments ranging from $250 to $500.
• Martinez and Lightner were convicted of unlawfully distributing and dispensing controlled substances and conspiracy. Lightner was sentenced to seven years in prison.
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Pennsylvania rules on CBD oil

• The Commonwealth Court of Pennsylvania ruled that cannabidiol (CBD) oil was a reimbursable treatment under the WCA because it was both a medical “supply” and a “medicine” under the Workers’ Compensation Act.
• Mark Schmidt, a workers’ compensation attorney, suffered a back injury while loading files into his trial bag and was later diagnosed with aggravating a preexisting degenerative disc disease in his lumbar spine. He took CBD oil  to ease the pain
• A workers’ compensation judge concluded that the CBD oil was compensable under the WCA, finding that the treatment was reasonable and necessary to manage Schmidt’s work injury-related pain while avoiding increased opioid use and delaying the need for surgery.
• The Workers’ Compensation Appeal Board reversed the decision, holding there was no need to reach the question of whether CBD oil was a “supply” under the WCA because Schmidt did not comply with the legal requirements that would trigger his employer’s duty to pay, but the court reversed the decision.
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