Enlyte’s Compliance Update explores recent legislative decisions made in August and their implications for auto accidents and workers’ compensation.
August 2022 was a busy month across the nation in the areas of workers’ compensation and auto accident compliance. A monthly update report from Enlyte examines recent events in both spaces and how these legislative decisions will affect future coverage features and policy triggers.
In particular, workers’ compensation decisions span not only state lines, but their confines. From COVID-19 regulations to medical payment disputes, the industry is expected to experience a wave of updates.
Auto accident updates
Michigan reverses previous decision Underley vs. USAAa state appeals court found that Michigan’s new rate schedule does not apply retroactively to traditional claims. there is.
In the new decision, the Michigan Court of Appeals further stated that “even if retroactive intent is proven, imposing the new limit would materially undermine faultless policies entered into prior to the effective date of the amendments.” and therefore violate the terms of the contract.” of the Michigan Constitution. “
USAA, a defendant in the original lawsuit, intends to appeal this decision.
The Michigan House of Representatives introduced Bill HB 6335. The bill states that car insurance will not cover damages that are the result of sexually transmitted diseases or pregnancy that occur as a result of sexual relations in the car.
The New Jersey Legislature introduced Bill S481. This requires auto insurance to provide a certain minimum amount of liability, coverage for uninsured and underinsured drivers.
The measure would prevent New Jersey from issuing motor vehicle liability insurance or renewals of such policies, except for basic motor vehicle insurance policies, unless coverage was included in the limits of personal injury or death as follows: It specifies: $15,000 amount or limit for plans issued or renewed before January 1, 2023. $25,000 for plans issued or renewed on or after January 1, 2023 and before January 1, 2026. $35,000 for plans issued or renewed after January 1, 2026. For Plans issued or renewed prior to January 1, 2023, the amount or limit subject to such limitation for one injured or fatality, $30,000. $50,000 for plans issued or renewed on or after January 1, 2023 and before January 1, 2026. $70,000 for plans issued or renewed after January 1, 2026.
Industrial accident compensation decision
From California to Florida to Ohio, August’s series of workers’ compensation compliance issues covers everything from spinal cord stimulator reimbursements to changes to a licensed health care network (HCN) to doctor-dispensed medications. increase.
The Michigan Department of Insurance and Financial Services has announced annual adjustments to maximum lost-time and survivor benefits to reflect changes in the cost of living. Beginning October 1 of each year, these adjustments apply only to benefits resulting from accidents that occur after the cap change date.
As of October 1, 2022 (through September 30, 2023), Michigan New Work Loss and Survivor Loss benefits may not exceed $6,615 for any one 30-day period. This is an increase from the previous year’s maximum work loss and survivor’s loss benefit of $6,065 per 30-day period.
COVID has played a major role in changes to workers’ compensation in various states. Recently, California extended the first responder COVID claim presumption to January 1, 2024.
Specifically, the bill expands the COVID billing provisions that currently apply to firefighters and police officers to include active duty firefighters in the State Hospital Department, State Development Services Department, Department of Military Affairs, and the Department of Veterans Affairs fire department. included. Employees of state hospitals under the jurisdiction of the State Hospital Authority and the State Development Services Authority.
In August, California also saw a proposed action shortening the investigation period for selected claims from 90 days to 75 days. In addition, workers’ compensation payments that are deemed to be “unreasonably” delayed are subject to penalties of up to $50,000 for designated first responder claims.
The New York State Workers’ Compensation Board also posted a reminder that denials of pre-approval requests (PARs) that proceed to Level 2 review without being reviewed and signed by the insurer’s physician are void and subject to penalties. did.
The New York Workers Compensation Board said: Any grounds for denial shall be deemed waived. “
The New York State Workers Compensation Board requires payers to use the appropriate claim adjustment reason code and remittance advice remark code in the benefit description/review EOB/EOR description when disputing a medical payment. I said yes. Medical bills.
In addition, the payer must submit one of two forms to the New York State Workers Compensation Commission: part of a medical bill due to an appraisal dispute).
Effective August 2, Texas introduced new rules governing the Texas Certified Healthcare Network (HCN). New changes to the HCN include elimination of physical onsite visits for provider qualification, clarifications regarding coverage maps, addition of telemedicine as a reportable “focus of care”, and changes to coverage maps. clarifications, and HCN complaints process clarifications.
HCNs must comply with these new rules by January 1, 2023.
The Minnesota Department of Labor and Industry also recently released the state’s workers’ compensation medical expense schedule. The new Resource Based Relative Value Schedule (RBRVS) is effective from October 1, 2022 through September 30, 2023.
The RBRVS conversion factor increased slightly for some physical/rehabilitation and chiropractic services compared to tariffs from October 1, 2021 to September 30, 2022, but Conversion factors for services and pathology and laboratory services decreased slightly compared to the same period. &
