4-23-2018; Shawn Biery Confirms Change to IL Published Max PPD Rate; Kevin Boyle Updates IN Nurse Case Manager Guides and more

Synopsis: Illinois WC PPD MAX Adjusts DOWN!! Analysis and comment by Shawn R. Biery, J.D.

Editor’s comment: As we have noted from time to time, the Illinois Workers’ Compensation Commission or IWCC sometimes makes an adjustment to published WC rates after the formal adjustments are initially made and posted each January and July.

In this case, the  IL WC statutory maximum PPD rate is now listed on the website as $790.64 (up from $775.18!!). It has now been quietly reduced by $4 from the prior published max rate).

When it was published, this PPD Max rate changed retroactively from July 1, 2017 to present. If you have a pending claim with a date of loss after July 2017 and the claim has a max PPD rate, you need to take a look and see if the new maximum PPD rate applies. Reserves and future settlements/awards need to be adjusted accordingly.

We will update the KCB&A IL WC Rate Sheets when the new rates are posted in early & mid-July as are all other rates.

Shawn Biery at sbiery@keefe-law.com remains your go-to IL defense source on any issue relating to IL WC rates! Email Shawn for a copy of his IL WC Rate sheet and any question or concern.

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Synopsis: The Indiana Work Comp Board or IWCB is still working on their Section 15 changes, but also issued new important Nurse Case Manager Guidelines. Thoughts and analysis by our Indiana Defense Team Leader, Kevin Boyle, J.D.

Editor’s comment: Last week, I mentioned that a checklist of changes for Section 15s was released. However, also a few days ago, the IWCB abruptly issued notice that they are still working on the changes and to disregard the prior checklist that was distributed. So, we are not sure of the exact changes right now. But, I’ll keep you posted when they come out with those final approved changes.

The IWCB also issued new Nurse Case Manager (NCM) Guidelines last week, so let’s talk about those. It’s a good time to review these with your NCMs, and to remind NCMs and your staff that whatever NCMs put in writing or in an email could and likely will end up in the hands of the employee, employee’s counsel and/or before the IWCB. Please be very careful in what you/NCMs text, email,  copy, forward or post.

Here are some highlights:

-. The NCM is a liaison among the medical provider, the employer and the injured worker who plays an integral role in the coordination of medical treatment and the stay-at-work/return-to-work process.

 -. The NCM may provide information that speeds up the process of returning the injured worker to work as well as their recovery from the workplace injury.

-. The NCM may know specifics about the worker’s treatment plan that would be useful to the employer in finding suitable work within the employee’s medical restrictions. The NCM can also explain the treatment plan to the worker if there are questions about the medical terminology used.

 -. The NCM can ensure the claim’s adjuster is aware of the injured worker’s medical needs, so they can assist in expediting access to prescriptions, DME, medical tests, therapies, etc., as ordered by the treating physician.

 -. The NCM’s role in Indiana worker’s compensation claims includes providing information and communication among the parties and medical providers, scheduling appointments, helping to facilitate care recommended by the treating physician and reporting back to the employer and/or carrier. Any written notes or report prepared by a NCM and provided to the employer, adjuster or medical provider should also be made available to the injured worker upon request or shall be provided upon Board order. This does not include billing reports.

-. The NCM’s communication with the injured worker should be limited to details of the workplace, the relevant injury, medical treatment and pertinent history. 

-. It is not NCM’s role to determine compensability, make decisions regarding the administration of benefits, deliver or direct treatment, or provide medical opinions to either the injured worker or the medical provider regarding the worker’s appropriate course of medical care. However, this is not to say the NCM is precluded from making inquiries as to the treatment/medication options available to the worker from the medical provider.

-. The NCM must inform the employee that they may require that the NCM not be present during a medical examination. If the NCM meets with the physician before or at the conclusion of a medical appointment, the injured worker must be invited to participate as well.

-. All NCMs working in the field of worker’s compensation in Indiana must hold a professional degree as well as credentials through an approved certification organization, or be actively working toward credentials. Examples are a Certified Case Manager (CCM) certification through the Case Management Certification Commission (CMCC). URAC recognizes 9 different case management certifications.  The Board will also accept these.

-. Any NCM who is not yet certified must work under the supervision of one who is. All NCMs must follow the Standards of Practice for Case Managers by the Case Management Society of America (CMSA) as well as the CMCC’s Code of Conduct.

-. It must always be remembered that Indiana law places the responsibility for directing the medical care of a person injured in the course and scope of their employment solely on the authorized treating physician and the Board. 

If any questions on these and any other important Indiana or Illinois work comp or other legal issues that could affect your claims, please email me, kboyle@keefe-law.com.  

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