WorkCompNews

NA - Health care costs rising; NA - Heat injury goals shift; MO - the waiting period highlighted Health Care Is Fixable: Workers' Compensations Shows Employers Don't Need to Wait for ... "Health care is more complex, but the lesson is clear. When incentives are aligned around results, better performance follows." Inspection Goals Removed from Trump Administration Heat Program "the program will now focus on a 'continued need for heat-related outreach and compliance assistance activities, as well as on-site consultation visits and programmed enforcement.'" Cole County ends extra workers comp pay | Jefferson City News Tribune "It's a three-day waiting period, plain and simple,"

PA - Self-referral does not cover pharmacy; NJ - Jurisdiction over neighbors' claims; CA - claims fraud guilty plea Workers' Comp Self-Referral Ban Doesn't Cover Prescription Drugs, Pa. High Court Rules "The majority ruled that physicians aren't barred from referring patients to pharmacies they own or have a financial interest in" NJ Clarifies Medical Provider Claims in Cross-Border Workers' Comp Cases | JD Supra "holding that because New Jersey did not have jurisdiction over the underlying workers’ compensation injury, it also lacked jurisdiction over the derivative medical provider claim." UPS Mechanic Pleads to Workers' Comp Fraud - Sacramento County District Attorney's Office "sentenced to 90 days in jail, 2 years of formal probation and was ordered to pay $50,000 in restitution"

NA - Litigation prevalence increasing; CA - Cumulative Trauma driving news; NA - Transport and translation are critical elements. Litigated comp claims climb as more injured workers lawyer up - Business Insurance “the share of workers compensation claims in litigation rose to 12.3% of the brokerage’s total claims inventory in 2024, up from 7.6% in 2018,” California Cumulative Trauma Claims Surge, Now Represent a Quarter of Workers' Comp ... "Total pure premium costs attributable to CT claims have more than doubled since 2021, while costs for non-CT claims have increased by more than 30% since 2020" Why Transportation and Language Services Are Essential to Injured Worker Recovery "Missed health care appointments can derail recovery and drive up claim costs."

NA - severity, inflation, and demographics creating claim pressure; CA - Medical inflation driven by new unlisted treatment codes; TX - nonsubscription and next steps Workers' comp's golden era may be ending as claims severity climbs | Insurance Business "a combination of rising claim severity, medical inflation, and workforce demographic shifts is creating new pressures that could gradually overhaul underwriting and claims strategies." CWCI: California Workers' Comp Medical Inflation Driven by Growing Use of Unlisted Codes "a growing share of treatment rendered to injured workers in the state is billed under unlisted codes that fall outside fee schedule pricing controls" Hurt at work? What to do if your employer doesn't have workers' comp - KSAT "what it means to work for a “non-subscriber,” why reporting an injury quickly matters, and when a case may need to be filed in court"

GA - Comp shields employer of teenager; CA - premises deemed controlling; KY - Notice and filing in retaliation Georgia court says comp bar applies in teen worker's fatal heavy equipment accident "a 16-year-old worker who was killed while operating heavy machinery at a construction site, (the court) ruling that the state’s workers compensation law provided the exclusive remedy." Could Parents of Taco Bell Worker Stabbed in Parking Lot Sue for Wrongful Death? "The court pointed out that a parking lot is generally considered to be part of an employer’s premises. Thus, the worker in this case never left the premises." Kentucky court upholds coal miner's comp retaliation verdict - Business Insurance "a worker does not need to formally file a comp claim to bring a retaliation claim if there is evidence the worker was pursuing benefits."

AZ - the "comma bill"; OR - Burden of proof; FD - Formulary burdens Arizona's 'comma bill' faces last-minute insurance opposition "Firefighters say a missing comma in Arizona law is threatening workers' compensation coverage" Oregon appeals court revives worker's combined-condition comp claim "the state Workers’ Compensation Board applied the wrong burden of proof in denying a combined-condition claim" Nonformulary Misstep: ECAB Upholds Denial of Brand-Name Pain Patch "As neither the claimant nor her physician pursued prior authorization or provided a rationalized medical explanation establishing the necessity of the nonformulary medication over available formulary alternatives"

NA- Labor market strong; NA - Fall prevention and losses; CA - Cumulative trauma is increasing U.S. Labor Market Shows Signs of Acceleration, Pointing to Stronger Workers' Comp Payrolls "approaches the pre-pandemic average of 191,000 monthly jobs. The trend carries direct implications for workers’ compensation exposures" Understanding fall accident: Prevention tips and legal rights | Daily Inter Lake "In 2024, 43,020 adults aged 65 and older died from preventable falls" California cumulative trauma comp claims rise sharply - Business Insurance "the share of indemnity claims involving cumulative trauma was relatively stable before the pandemic but has risen sharply since then, reaching a high in 2024 of 26% of indemnity claims, up from 13% in 2012."