New York Moves to Expedite Some WC Claims

• The New York State Workers’ Compensation Board will next month begin using a new procedure to expedite claims for additional sites of injury and consequential injuries.
• If the board receives a Request for Further Action by Legal Counsel (Form RFA-1LC) presenting prima facie medical evidence (PFME) for an unestablished injury or condition, it will expedite a determination by issuing a Proposed Decision finding PFME.
• “With this new procedure it will be more important than ever for carriers, third party administrators (TPAs) and self-insured employers to monitor their proposed decisions and respond in a timely manner,” wrote attorney Sarah Thomas, managing partner of New York City’s Jones & Jones law firm.
• “The turnaround period on these decisions is tight. Any delay could result in your acceptance or rejection of the decision not taking,” she wrote on the firm’s blog.
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Enlyte Medical Price Index Shows Decline

• Enlyte’s third-quarter medical price index showed a 1% decline. 
• In workers’ compensation claims, the high-volume states of New York, California, Florida, and Texas provide what the company described as “noteworthy trends” related to charges of medical services. 
• Anchoring the data in 2020 demonstrates increases in Texas of 7% and California 12%; and decreases of 5% in New York and 7% in Florida.
• “This is a stark change from the first quarter of 2024 where minor changes were observed and as the year matures, we are likely to see comparable results in these states,” the report stated.
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Texas DWC Makes Changes in Drug Benefits Rule

• The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has made changes to the state’s rules concerning pharmaceutical benefits.
• The changes are necessary to remove obsolete provisions and to update references and language to be consistent with other rules. 
• When the rules were originally adopted, they included transition provisions to move workers’ compensation to a closed formulary system. Those transition provisions are no longer necessary, so the amendments remove them.
• The move updates and reorganizes 28 Texas Administrative Code Chapter 134, Subchapter F, concerning pharmaceutical benefits.
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Ontario to Return $2 Billion Workers Safety Surplus to Companies

• The Ontario provincial government will distribute a $2-billion surplus rebate from the Workers Safety and Insurance Board (WSIB) back to eligible businesses.
• The government made a similar move in April 2022 when it disbursed more than $1 billion to Schedule 1 businesses, those workplaces that have not been convicted of violating either the Workplace Safety and Insurance Act or an Occupational Health and Safety Act.
• The Canadian Federation of Independent Businesses hailed the surplus rebate to Ontario’s small business owners and lauded the WSIB’s reduction in the average premium rate.
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