Courtesy: American Immigration Council
Montana Looks to Bar Undocumented Workers from WC
- Montana State legislators want to make undocumented workers ineligible for workers compensation if they are injured on the job.
- H.B. 805, introduced recently, adds to the definition of eligible workers “aliens who are lawfully employed.”
- Additionally, the bill would allow insurers to deny any claim or close any claim in which the claimant has left the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Virgin Islands, or American Samoa in the process of making a claim for workers’ compensation benefits, or while a claim for workers’ compensation benefits is ongoing.
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Utilization of Medical Services by Injured Workers Has Declined Post-Pandemic
- A new study confirms that there’s been a nationwide sustained decrease, up to 7%, in utilization of medical services by injured workers in all age and tenure groups, both in the pandemic and post-pandemic period relative to the pre-pandemic period.
- The Workers Compensation Research Institute’s study also found that younger workers and workers with shorter job tenure experienced faster decreases in the utilization of ER services than other workers.
- Writing on the LexisNexis Workers Compensation blog, Susan Hamilton, former Assistant Secretary and Deputy Commissioner, California Workers’ Compensation Appeals Board, said “While the study’s findings don’t purport to be a crystal-ball forecast for future trends in the utilization of medical services in the workers’ compensation arena, they do suggest reasonable expectations of medical utilization in the coming years.”
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Florida DWC Medical Spend Tops $900 Million
- Florida Division of Workers’ Compensation’s 2024 review reveals that the state’s physician dispensing scam continues to be a problem, costing employers and taxpayers millions in fraudulent fees.
- Opioid prescriptions fell 62% from 2019 to 2023.
- Another key finding shows frequency is down significantly, resulting in fewer claims, along with less need for medical management services, and lower premiums.
- The top industrial classifications for calendar year 2023 lost-time claims were Retail Trade (7,703 claims) and Administrative, Support, Waste Management, Remediation Services (6,266).
- The 75-pp report issued this week revealed that the state fund’s total medical spend was just over $900 million. The 3.7 million bills reported averaged $243 per bill and 2.4 line items per bill.
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AI in WC Process: Two Updates
- Sedgwick has launched an AI-generated claims summary feature in its viaOne portal that provides clients with real-time access to their data and visibility into every aspect of their claims.
- This new feature allows examiners and claims professionals to quickly view a summary of the past 12 months of information for a particular claim.
- The claims management solutions provider said the new feature should be of particular help to examiners when taking over existing claims or conducting claims reviews.
- Separately, the Hawaii Employers’ Mutual Insurance Company (HEMIC) said it will collaborate with EvolutionIQ, using the insurtech’s AI claims management tools.
- HEMIC will deploy EvolutionIQ’s Claims Guidance and Medhub Active Medical Summarization across its claims operations
READ MORE: Sedgwick, HEMIC