Department of Workforce Development

Draft
Council on Worker's Compensation
Meeting Minutes
Madison, Wisconsin
December 11, 2002

Members present: Mr. Bagin, Mr. Beiriger, Mr. Buchen, Ms. Connor, Mr. Glaser, Mr. Newby, Ms. Norman-Nunnery, Mr. Olson, Ms. Vetter, Mr. Welnak, Mr. Rostan for Rep. Hundertmark

Staff present: Mr. John Conway, Mr. O’Malley, Ms. Knutson, Mr. Shorey

1. Minutes . Ms. Norman-Nunnery convened the meeting in accordance with Wisconsin’s open meetings law. Ms. Vetter moved adoption of the minutes of the June 6, 2002 meeting; Mr. Bagin seconded the motion. The motion was unanimously approved.
   
2. Letter of Resignation. After serving 28 years on the Council, Mr. Emil Muelver submitted a letter of resignation for health reasons. He previously received a plaque for years of service on the Council. The Council will send a letter of appreciation to Mr. Muelver. Mr. Newby introduced Mr. Ron Kent with AFSME to replace Mr. Muelver as a labor representative on the Council. A nomination letter and his resume will be forwarded to the Department Secretary.
   
3. Council Retreat Follow-up. Mr. Conway reported that training for council members was discussed at the retreat several and topics were considered including a general orientation to worker’s compensation with an online tutorial. There also would be the possibility of e-mail connectivity to experts at the Division. Advanced/master level topics could be presented once a year at one of the council meetings and could address future trends in worker’s compensation. Ms. Connor researched the possibility of revitalizing the John R. Commons seminars. The last few years the seminars were not well-attended. The Council would need to breathe new life into whatever seminar format was considered. Mr. Glaser recalled that the Commons seminars were presented at UW-Madison with national speakers on controversial topics. Mr. Bagin commented that Arthur Larsen was the initial presenter. Ms. Norman-Nunnery indicated that the Division’s role in organizing and conducting the Commons seminars was minimal. Funding for the program was provided by UW and Wausau Insurance. Mr. Glaser indicated that while council members attended the seminar, they did not get involved in the organization or funding of it. Ms. Connor will continue to research the issue of organizing and funding a worker’s compensation seminar. The Council is not directing the Division to use its resources to fund a seminar.

John Conway indicated that the Division would supply information to the Council including critical indicators and emerging issues in worker’s compensation. A bulletin could be developed and sent out on a quarterly basis. The published critical indicators were included in a handout for the Council. Ms. Norman-Nunnery proposed that basic information on worker’s compensation (e.g. top ten topics) be available in an electronic, self-paced format with links to individual staff members to answer questions on individual topics. Mr. Glaser indicated that a synopsis of significant court cases should be included in the information, which would be especially helpful to new council members. Ms. Norman-Nunnery indicated that the Division would make sure that the Council had updates to the Neal & Danas Handbook. Mr. Bagin indicated that the council members would benefit from a short synopsis, in layman’s terms, of recent court cases. Mr. Beiringer commented that the tutorial should contain information on processes including what happens after the point that an injury occurs, including the forms that are completed, and the procedures involved in the hearing process after a claim is disputed. Mr. Glaser inquired whether there could be access to this tutorial outside the Council, especially if there was a considerable cost in its development. Ms. Norman-Nunnery indicated that the Division could launch the tutorial from its website. New York State has a wonderful document for workers and the Division could incorporate some of those ideas. The Division’s first objective would be to educate the Council, and later access to the public could be incorporated. Ms. Norman-Nunnery indicated the Division would move forward with contacting UW about developing a tutorial.

Mr. Newby indicated that information contained in the critical indicators would be beneficial to the Council. Mr. Buchen indicated that the steady decline in first open claims and first payment of compensation was a positive trend. Mr. Shorey explained that ever since 1993, that number has been declining. For 2002, the Division was projecting 4000 fewer first open claims. Mr. Glaser inquired whether there was information concerning the types of industry with the most claims. Mr. Shorey indicated that the database does contain the industrial code associated with each employer. Mr. Newby indicated that it would be useful to have the critical indicator report at each meeting with the Division’s objective reflected for each indicator. Ms. Norman-Nunnery indicated that the Division would continue to share at future meetings the critical indicator information provided to the Council at this meeting. Regarding claim trend information, Division staff would provide brief explanation of the cause and effect of the trend. Mr. Glaser indicated that it would be good to provide to the Council a chart of indemnity cost comparisons. Mr. Bagin commented that the information provided by the Division revealed that the Uninsured Employers Fund accounts receivable had increased. Mr. Conway stated that the Division’s collections of fines had also increased. Mr. Glaser questioned the data that indicated $20 million was uncollected. Mr. O’Malley indicated that the number was a rolling total average. Mr. Conway indicated that the Division was now levying employers if bank accounts can be located. Some amounts were uncollectible, bad debt. The data provided at this meeting does not show the amounts collected by the Division. Ms. Norman-Nunnery indicated that Mr. Brian Krueger would be invited to the next Council meeting to further explain the amount of collections and accounts receivable for the Uninsured Employers Fund. Mr. Buchen indicated that he would like to see the critical indicator information prior to the next meeting.

4. Hearings Update. Mr. O’Malley reported on the pilot project and judicial critical indicators. The number of hearing applications is a rolling total to 1999. The average is 570 per month, with close to 7000 total for 2002 projected. The Division is streamlining the hearing process through the pilot project, which officially started on November 1, 2002. Mary Lynn Endter is the administrative law judge assigned to this project. Some initial computer-generated data has been gathered on this project. The Division will follow cases to see what happens to them after they go through this process and a hearing is scheduled. In addition, cases with partial success will be followed. So far, 213 cases have been routed through the process, with results reported on 81 cases. Hearings have been scheduled on 72 cases. In addition, 7 cases were resolved in part and two cases were resolved by compromise settlements. Most cases are put on a 60 to 90 day follow-up. By March 1, 2003, the Division will be able to have a better analysis of the process when more data is available and more files have completely moved through the hearing process. Ms. Knutson indicated that defense attorneys are pleased with the Division’s actions in streamlining hearing applications.
   
5. Medical Databases Update. Mr. Shorey provided information that was requested at the Insurance Focus Group meeting. He indicated that that the Division has one-half dozen certified databases with one decertified and an addition of a couple. Some databases have consolidated. The Division does not have any technical or official audit of the databases. The Division looks at new databases to see how they align with existing ones. If there is a big change or irregularities, the Division will question it. If there is a problem with customers, the Division will try and follow-up to get at the source data to see if the changed data is not accurate. The source data is twelve months old. The bill reviewers use private databases, and are required to indicate which database and specific CPT code was used. The process has not changed over the years. Wisconsin does not have a unified database like some other states. The data is based on 1.5 standard deviations from the mean on charged data. There are database comparisons from year to year. Ms. Connor inquired as to whether this was in line with overall medical inflation. Mr. Shorey responded that this is not a cost containment system. Most charges are between the 85^th to 93^rd percentile. Mr. Buchen indicated that it was a start when it was first implemented, but it is not enough. Mr. Shorey added that pharmacy charges are not included in this bill review system. Mr. Scott Shaver from Briggs and Stratton stated that there was a noted increase in third party administrators involved in prescriptions and that some pharmacies were billing two to three times more for worker’s compensation claims. He stated this occurred with pharmacies that direct bill the insurance companies or self-insured employers. Mr. Glaser indicated that there were regulatory agencies in Wisconsin that could address this issue, including any ethical problems. Mr. Shorey commented that some states have price indexes for the cost of drugs, with averaging of wholesale prices. Ms. Norman-Nunnery indicated that this is an emerging issue. She questioned whether the Council wanted to address this issue or whether the information was too limited for a systemic solution. Mr. Glaser indicated that in contrast to this issue, the chiropractors brought 400 problem cases to the attention of the Council. Mr. Bagin suggested that the Council explore whether the reasonableness of fee databases should be applied to prescription drugs. Mr. Buchen indicated that if the Council deals with medical cost charges, prescription charges should be included. Ms. Connor indicated that Wausau Insurance’s data for prescription drug payments is itemized. She agreed to look at trend data. Mr. O’Malley agreed to look at the legal issues involved in this issue.
   
6. Videotape – Plan for Legislators. Mr. Buchen reported that the videotape was completed and there would be systematic visits to the Legislature, with the bulk of the visits done by outside consultants. Insurers were willing to pay for part of the cost. The process would begin early in the next session. The plan was to retain an individual with experience in the legislature. Ms. Norman-Nunnery indicated that the videotape should be shared with the Council at the next meeting.
   
7. Compscope Public Briefing. Ms. Norman-Nunnery reported that the Worker’s Compensation Research Institute has scheduled a public briefing tentatively for January 29^th and 30^th in Milwaukee.
   
8. Agreed Bill Timeline/Meetings. Ms. Norman-Nunnery indicated that the Department proposals would be ready in December, and ready to be shared at the January 16, 2003 meeting. There will be no meeting in February. At the March 25, 2003 meeting the management/labor proposals will be reviewed. The April 22, 2003 meeting will be time for caucuses. There are also meetings scheduled for May 13, 2003 and June 9, 2003.
   
9. Correspondence. Ms. Norman-Nunnery presented several pieces of correspondence to the Council.

1. Small pox vaccinations are still an issue. Ms. Connor indicated that there have been inquiries from insureds concerning the Department’s position with respect to vaccinations if mandated by the government versus vaccinations that are voluntarily received by employees. Mr. Glaser commented that if the vaccination was suggested for employment purposes, any reaction was probably work-related. Mr. Bagin indicated that if there was a possibility of exposure to small pox, it was likely related to work issues, similar to EMT and first responder shots. Mr. Newby stated that decision had not yet been made as to whether it would be voluntary or mandatory. Mr. Beiringer stated that the situation may involve the employer providing the shot or the employer receiving the shot to be available for work. Mr. Glaser commented that a license requires a registered nurse to treat patients with contagious diseases. Mr. O’Malley stated that Professor Larsen addresses this issue in his treatise and indicates that if there is some employer inducement or guidance, it would fall into the compensable category and the consequences would be work-related. If the employer gives time off work to get the shot or the employer suggests it, that is enough to make it compensable. Mr. Bagin commented that there may be a reasonable expectation that health care workers get the shot with the threat of an epidemic. Mr. Buchen stated that this issue is likely to get resolved through some federal legislation. The Council agreed to table the issue for now. Ms. Norman-Nunnery indicated that the Department would keep the Council apprised of any further developments.

2. Senator Baumgart had contacted the Department with questions regarding the three-day waiting period, and the Department responded.

3. Correspondence was received from Mr. Koehler and Ms. Linde concerning changes to the worker’s compensation law. Ms. Linde also appeared at the public hearing and testified. The Department responded to this correspondence.

4. The Department received an e-mail from Senator Lazich’s office concerning eligibility for temporary disability benefits when an employee is discharged for misconduct or cause. Mr. O’Malley responded to this e-mail. However, the Department has since received another letter from the senator and the issue of amending Administrative Rule DWD 80.47 will be placed on the agenda for the next Council meeting.

10. Adjournment. Ms. Norman-Nunnery expressed her thanks to the Council for their support. She is leaving her position on January 6, 2003 at noon. Mr. Glaser, on behalf of the Council, expressed appreciation to Ms. Norman-Nunnery for her service as the Division Administrator and Council chair. The Council adjourned until the next meeting.