Registration

Breakfast

Keynote - Steve Pemberton

SESSION 1 - Canary in the Coal Mine: How the Florida Experience Could Affect the National WC Industry

• Speakers:

• Josephine Au, Suffolk Construction Company, Inc.

• Fred Karlinsky, Greenberg Traurig LLP

• Thomas Koval, FCCI Insurance Group

• Scott Miller, Hurley Rogner Miller, Cox, and Waranch P.A.

Two 2016 Florida Supreme Court rulings, Castellanos v. Next Door Company and Westphal v. City of Petersburg, will undoubtedly have a major impact on Florida’s workers compensation system.  This session will focus on the upheaval caused by these cases, past attempts to reform the workers compensation laws, the fallout from these two cases, and how industry is reacting.  The panel will also discuss any changes coming out of the 2017 Florida Legislative Session and potential lessons for national workers compensation carriers in light of Florida’s experience.

Takeaways

1. In 2016, the Florida Supreme Court changed the entire workers’ compensation landscape by reinstating hourly attorney’s fees.
2. The Court also found that caps on temporary benefits were unconstitutional reversing over 20 years of reforms and reviving the pre-1994 statute.
3. The recent decision’s impact on insurance rates have also resulted in litigation over the rate setting process. 

SESSION 1 - Telemedicine: Your Virtual Doctor Will See You Now

• Speakers:

• Debra Goldberg, Self Employed

• Mandi Karvis, Wicker, Smith, O'Hara, McCoy & Ford, P.A.

• David Vanalek, Richmond National

This session will provide a broad overview of the practical and legal implications of the provision of health care via telemedicine. The panel will analyze the history and development of telemedicine as well as the applicable statutes and regulations. The session will include an overview of the ATA (American Telemedicine Association) guidelines, which provide practice, technical, and administrative standards and direction. The panel will also discuss the issues that have already arisen in litigation and those it anticipates will arise in the future. The discussion will address how telemedicine affects venue selection and expert retention as well as how the practice of telemedicine requires physicians to be licensed in multiple states creating potential for a ripple effect when an administrative or litigation issue arises in one locale.  Lastly, the panel will discuss the use of telemedicine in private and correctional health care and the envisioned future expansion of telemedicine.

Takeaways

1. The law in this area is rapidly evolving and can vary greatly from state to state.
2. The telemedicine guidelines published by the ATA will likely be considered at least evidence of the applicable standard of care even if they are not ultimately deemed to set the standard of care.
3. The provision of telemedicine services presents unique challenges in claims and risk management and will need to be handled differently than typical medical negligence cases.

SESSION 1 - Top Employer Mistakes in the Claims Process

• Speakers:

• Judith Cole, K2 Industrial Services, Inc.

• Melissa Donovan, Cincinnati Insurance Company

• Kirsten Kaiser Kus, Downey & Lenkov LLC

• Stephanie Wood, Oswald Companies

This session will address top employer mistakes in the claims process from the unique perspectives of a corporate claims manager, insurance claims specialist and defense counsel. They will address improper safety training, delayed investigation, failure to report and send for medical evaluation, and more. The panel will detail how to avoid these problems and how to quickly and efficiently address and correct them should they arise so that the defense of  the claim can run smoothly going forward.

Takeaways

1. Implementing strict safety and reporting rules on the job will help prevent workplace accidents.
2. Once an accident occurs, prompt investigation and open communication are necessary steps in properly evaluating and defending a claim.
3. Medical treatment should be provided immediately to keep the claim under control if the claim is not being denied.

Break

SESSION 2 - New Strategies To Contain Workers' Comp Medical Costs: Targeting Issues In Diagnostic Testing

• Speakers:

• Magdalena Alvarez Miller, ICW Group

• Suzanne Ormond, Alsco Inc.

• Jeffrey Richmond, Jeffrey Richmond MD

• Steven C. Testan, Self Employed

As workers’ compensation medical costs continue to escalate, significantly driving up overall claim severity, risk managers and claim professionals have had limited success with utilization reviews and other tactics aimed at pinpointing areas where there are clear disconnects between prescribed treatments and successful patient outcomes. A risk manager at a large, national employer will share what she learned when her team investigated the application of widely used diagnostic procedures for costly back and upper extremity injuries. Notably, in many cases the diagnostics were found to be either unnecessary or ordered prematurely, triggering a chain of events that drove up medical costs and resulted in longer recovery periods. Presenters, including the risk manager, a claims consultant, an orthopedic physician and workers’ compensation litigation attorney, will unveil details of their findings and discuss what was involved in each of the steps they took to identify the problem and understand its consequences. They will also review challenges they faced in trying to develop and implement effective solutions in multiple states. The session, which will include a medical perspective on diagnostic issues, encourages audience participation and will conclude with an extensive Q&A.

Takeaways

1. The MRI is a sophisticated diagnostic that is prescribed and provided erroneously in approximately 70% of cases studied and piloted.
2. The iatrogenic effects of unnecessary MRIs to injured workers are rarely considered in the claims process yet are significant drivers of adverse loss development of claims.
3. The ROI associated with the deployment of appropriate countermeasures is not merely the cost of the exam, but savings of increases in other medical costs as well as indemnity.

SESSION 2 - Polypharmacy and Workers' Compensation

• Speakers:

• Gregory McKenna, Gallagher Bassett Services, Inc.

• William Pipkin, Austill, Lewis, Pipkin & Maddox, P.C.

• David Randolph, Midwest Occupational Health Management

This session will address the controversial issue of polypharmacy from the perspectives of the medical community and the claims/legal community in two areas: medical issues and claims/legal issues. The medical issues to be addressed include: How did we end up with the concept of "the more the merrier" regarding the administration of powerful pain and psychological medication? What are the most commonly used/abused drug classes? What are the specific problems with polypharmacy and how do we effectively identify and address these problems with the treating health care providers? Is there any evidence that polypharmacy improve outcomes? Where did analog pain scores come from and do they have any validity or relevant medical meaning?
 
The claims/legal issues to be addressed include: How can the claims/legal community most effectively address polypharmacy? What events can be indicators that polypharmacy issues may arise and what are the best practices for intervention should it be determined that the claims/legal community should intervene? The panel will identify realistic objectives to be accomplished through intervention and will address the counter-productive behaviors of claimant's counsel, as well as that of the authorized treating physicians, and solutions to effectively address same.

Takeaways

1. Everything physicians do should be safe and effective.
2. Many pain management interventions lack scientific support.
3. High doses of narcotics and polypharmacy have been shown to be hazardous, and are rarely accompanied by meaningful functional restoration.

SESSION 2 - Walking Through the Risk Analysis to Consider a Medicare Non-Submit Program for MSAs

• Speakers:

• Darren Cartwright, Woodruff Sawyer

• Beth Hostetler, Albertson's LLC

• Kathleen Wyeth, AF Group

This panel will address issues that arise when considering a Medicare Non-Submit program for MSAs (Medicare Set Aside). The panel will discuss the Medicare Secondary Payer statute and regulations regarding MSA obligations, MSA liability under the False Claims Act, how the legal burden concerning Medicare could be satisfied without pursuing the CMS submission process for MSAs and what it means to write an MSA allocation report that accurately reflects the primary payer liability. The panel will also address important considerations for a party contemplating a non-submit program for MSAs as well as the role of professional administration and what it would look like legally if “Medicare came back.”

Takeaways

1. Federal law is virtually silent on any future medical burden concerning workers’ compensation settlements, but there are potential legal consequences to consider; compliance can be achieved without pursuing submission of an MSA to CMS for review.
2. Approaches to creating Medicare Set-Asides for non-submission programs can differ slightly, but good faith and integrity must be a goal of every approach.
3. There are various things to consider when drafting a defensible MSA allocation report intended for non-submission and various tools that can be of assistance; annuities and professional administration were discussed.

Lunch

SESSION 3 - Lower Extremity Injuries and Malpractice: Identifying False or Exaggerated Claims

• Speakers:

• Lynn Combs, Kopka Pinkus Dolin

• Michael Nirenberg, Friendly Foot Care, PC

• Lee Weatherly, Copeland, Stair, Valz & Lovell, LLP

Foot and ankle injuries on private property and in the workplace are common. The overall high incidence of genuine foot problems makes fraudulent or exaggerated ones difficult to identify. In the general population, one study that analyzed 31 different epidemiological foot and ankle studies encompassing over 75,000 people age 45 and older found that 24% had frequent foot pain and 15% had frequent ankle pain. For persons under age 45, one study found the incidence of foot pain was over 10%. This session will focus on factors to consider when investigating the legitimacy of foot and ankle claims, including footwear, surface, social and activity issues and methods to expose fraudulent or exaggerated claims.

Takeaways

1. When investigating a claimant’s lower extremity injury claim, investigators should consider whether the claimant’s injury is not due to the alleged accident but the result of an underlying medical problem.
2. Lower extremity injuries require investigators to consider factors that may impact the mechanics of the lower extremity, such as the claimant’s footwear, activity, the surface and so on.  
3. Investigators with a lower extremity claim should be vigilant for false and exaggerated claims and, when appropriate, use advance strategies to verify the truthfulness of a lower extremity injury claim. 

SESSION 3 - The Top Ten Subrogation Mistakes Carriers Keep Making

• Speakers:

• Fran Brooks, PMA Companies

• Quinn Conaboy, GUARD Insurance Group

• Gary Wickert, Matthiesen, Wickert & Lehrer, S.C.

This panel will address the ten most often repeated mistakes carriers make in recognizing and pursuing matters with subrogation and third-party recovery potential. The discussion will highlight ways to avoid repeating the mistakes that are most costly and commonly committed in the fast-growing and demanding world of insurance subrogation.

Takeaways

1. Attendees will be able to recognize several mistakes the industry continues making with regard to subrogation.
2. Attendees will be able to formulate better practices and procedures for avoiding the repetition of these mistakes.
3. Attendees will have a renewed appreciation for the value of aggressive and thorough subrogation practices in terms of dollars recovered. 

SESSION 3 - Today's "Medical Only" Claim is Tomorrow's "Indemnity Claim"

• Speakers:

• Michelle Leighton, Conner Strong & Buckelew

• Michele Punturi, Marshall Dennehey

• Kimberly Vaughn, Amerisure Mutual Insurance Company

The challenges faced by employers, insurance carriers and third party administrators are mounting in the workers' compensation arena. More often than not, claims initially identified as "medical only" are increasingly being categorized as "indemnity" claims. What can be done to better protect companies? Clearly, injury prevention is key, and while each claim has its unique facts and not all will be handled in the same manner or by the same claims professional, setting and maintaining strategic goals in every case will avoid unnecessary costs. What are the factors that give rise to these ever-expanding claims? Do such claims share common characteristics? Are there ways to identify, prevent and limit them? How can the use of predictive analytics, which allows organizations to identify troublesome claims before they become complex and costly, support a positive outcome? This session will provide valuable insights about preventing medical-only claims from becoming indemnity claims. Attendees will recognize the issues and causes that arise and learn how to mitigate the costs of such claims to achieve the most favorable results. 

Takeaways

1. Recognize injury prevention strategies and best practices to implement and establish a safe environment in an effort to reduce claim costs.
2. Educating and training supervisors, managers and employees is key to help prevent injuries from happening in the first place, but you should also have an effective medical treatment protocol for when injuries do occur.
3. Maintain a proactive claims management approach when investigating and monitoring claims to achieve the most favorable results.

Break

SESSION 4 - Opting Out: Workers' Compensation System Alternatives

• Speakers:

• Chris Mandel, Self Employed

• Allen Wingfield, Big Lots

• William Zachry, State Compensation Insurance Fund

This session will explore the impact on employers of “opting out” of workers’ compensation. As the cost to employers of providing benefits under workers’ compensation systems skyrockets, several states are beginning to follow Texas’ lead by giving employers the ability to “opt out.” Although Oklahoma’s high court struck down a state law allowing employers to opt out of the workers’ compensation system, observers expect opt-out proponents to keep working to create alternatives to traditional workers’ compensation plans nationwide. For instance, Tennessee and South Carolina introduced similar workers comp opt-out bills last year, though both states have put the legislation on hold, leaving Texas as the only state where employers can opt out of the workers’ compensation system. Meanwhile, Arizona, Arkansas, Georgia, Indiana, West Virginia and Wisconsin are considering opt-out plans. Nonsubscribers may lose the exclusive remedy protection afforded to employers that do subscribe to the workers compensation system.

Takeaways

1. Texas Non-subscribers have proven the multiple benefits of leveraging their version of the “option”.
2. While Oklahoma’s version of an option was eliminated by the judicial branch, it served employers well for the time it lasted.
3. The pursuit of an increasingly improved version of an “option” is continuing in TN, SC, FL and AR; expect more.
4. While not for everyone, having choice in how employers administer employee injury programs has substantial benefits for those who want to invest.

SESSION 4 - Rise of Specialty Drugs

• Speakers:

• Heather M. Carbone, Marshall Dennehey

• K. Martine Cumbermack, Swift, Currie, McGhee & Hiers, LLP

• Kimberly Simmons, Fidelity National Financial, Inc.

This session will address the rise of specialty drugs, including antivirals such as Truvada, Combivir and Kaletra, and how they are utilized in workers' compensation claims. The panel will also discuss the financial impact of specialty drugs on workers compensation claims and what is in the pipeline for new specialty drugs.

Takeaways

1. Specialty drugs address the needs of patients that are either non-responsive to existing treatment therapies, or for those patients with conditions for which there were not treatment options in the past.  Administration of certain specialty drugs are performed in the medical provider’s office, increasing Carrier costs because they are billed as part of a physician or hospital bill. An average specialty drug costs $1,200 per month, but can range from $500-$2,500 per month.
2. Early intervention can help to identify claims that are high risk and may lead to the need for specialty drugs. These claims require attention to get them back on track clinically and financially.
3. It remains to be seen whether injuries and diseases that require the use of specialty drugs may ultimately cost the system more or less. If a chronic disease is modified or mitigated by the use of expensive specialty drugs, Carriers may actually save costs in the long run. 

SESSION 4 - To Pay or Not to Pay (for Medical Records Review), that is the Question

• Speakers:

• Kerri Crosby, Rollins Inc.

• Cristine Huffine, Swift, Currie, McGhee & Hiers, LLP

• Tammie Kater, PruittHealth, Inc.

This panel will address how medical records are used in the discovery process to secure information that is critical to the defense of a workers compensation claim. Specifically, the panel will address the importance of gathering necessary information at the outset of a case and how medical summaries and Independent Medical Examinations (IMEs) can help in the claims process.

Takeaways

• In determining whether you should pay for a certain group to perform various types of medical records reviews, remember that spending some money on the front end may save a lot of money on the back end.
• It is important to ask your claims handling group what they do and do not allow your attorneys to perform as it may be impacting your case.
• Review and utilization of medical information from the very start of your case is important for the overall success of your case. 

Cocktail Reception