INDIANA WORKER’S COMPENSATION UPDATE
Recent changes at the Indiana Worker’s Compensation Board are immediately affecting the handling of claims and filing of forms by Indiana adjustors. Out of state adjustors must be especially careful to stay attuned to Board activity by regularly visiting
the Indiana Worker’s Compensation Board’s website at http://www.in.gov/wcb/. Also, be sure you are registered on the Board’s electronic notification list in order to receive updates.
FULL TIME COMPLIANCE OFFICER
The Board now has a full-time compliance officer, Alan Buckley. He is charged solely with analyzing forms and submissions and determining if there is any basis for levying a fine under the Board’s authority. The Board’s representative will carefully scrutinize
the completion of forms, timing of filing forms, and information contained in the forms in order to determine if the Board can impose monetary fines associated with the filing of the forms (any such fines will generate funds for the operation of the Board
and its staff). So be aware and be careful. Some of the topics presented follow:
NEW FORMS FOR DENIAL OF CLAIM OR EXTENSION OF TIME TO CONTINUE INVESTIGATION
Notice of Denial of Benefits (State Form 53914) and Notice of Inability to Determine Liability/Request for Additional Time (State Form 48557).
These forms have been modified to convey the medical-only aspect of a claim. The Board’s intention is to avoid issuance of penalties on cases which appear to have not been timely filed when the delay was for a medical-only period which preceded a period
of disability. The new forms gather information which would make these reasons readily identifiable and preclude assessing fines which will be appealed by the employer/carrier.
(Make copies of these forms and begin using immediately…. Must be in use by September 27, 2012)
TERMINATION OF BENEFITS, FORM 38911
These forms are being scrutinized and returned for failure to complete the dates. The last date TTD was paid must be stated.
The Board made clear that utilization review is acceptable in certain cases. It should not be used to limit valid medical care but may be used to keep medical treatment from getting out of hand. Carefully consider why you are having a case reviewed and determine
if your reason falls within this latter category. Be mindful of the fact that if a test/procedure is recommended by an authorized physician, the Board will attach significant deference to that recommendation, and any decision to deviate from the test/procedure
will be closely scrutinized.
BOARD “HOLD” POLICY ON LITIGATED CASES
The Board has authorized its hearing officers to designate a case for the newly-created “Hold Docket.” On this docket a case will not be set for hearing and will be reviewed once a year for a status report. Either party may request it be removed from the hold
docket and placed back in the hearing stream. There is a specific pleading for this. Cases which may be placed in this “hold” position fall into the following categories:
1) Medicare – pending CMS approval or future medical evaluation or appeal.
2) Authorized Medical Care is being provided on an ongoing basis and benefits are being paid.
3) Protective Filings – A case is filed to protect the statute of limitations but is being handled elsewhere, i.e., Longshoreman’s Act cases.
4) Second Injury Fund Cases.
CHANGES EFFECTING UR/ODG USE AND CHARGES FOR BOARD OMBUDSMEN AS MEDIATORS
The following additions to the Indiana Administrative Code have been implemented and effect UR/ODG use and charges for board ombudsmen serving as mediators.
(11) Utilization review. The board recognizes the Utilization Review Accreditation Commission's (URAC) Workers' Compensation Management 2008 guidelines to medical utilization practices, as well as the Official Disability Guidelines (ODG) published by the
Work Loss Data Institute and the American College of Occupational and Environmental Medicine (ACOEM) guidelines. Recommendations from these, and other, reputable sources may be offered as one (1) form of evidence regarding appropriate medical care; however,
it will not be considered as conclusive evidence by the single hearing member or the full board.
(Worker's Compensation Board of Indiana; 631 IAC 1-1-32; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA)
631 IAC 1-1-33 Fees for mediation by the board
Authority: IC 22-3-4-4.5
Affected: IC 22-3-1-3; IC 22-3-4-5
Sec. 33. The charge for mediation by a qualified employee of the board shall be a flat fee of three hundred fifty dollars ($350) for five (5) hours of mediation, with an hourly rate of fifty dollars ($50) for each hour thereafter. No travel expenses will
be paid by the parties. (Worker's Compensation Board of Indiana; 631 IAC 1-1-33; filed May 4, 2012, 10:15 a.m.: 20120530-IR-631110357FRA)
Contact: Diana L. Wann
Phone: (765) 362-7553