Worker's Compensation Advisory Council
Council on Worker's Compensation
GEF-I, 201 E. Washington Ave.
Madison, Wisconsin
March 12, 2013

Members present: Mr. Beiriger, Ms. Bloomingdale, Mr. Brand, Mr. Brandl, Mr. Buchen, Mr. Redman, Mr. Ginsburg, Mr. Kent, Mr. Metcalf, Ms. Nugent, Ms. Pehler and Mr. Schwanda

Staff present: Mr. Ezalarab, Mr. Krueger, Mr. Moreth and Mr. O’Malley

Excused: Mr. Brand, Mr. Collingwood and Ms. Thomas

  1. Call to Order/Introductions: Mr. Metcalf convened the Worker’s Compensation Advisory Council (WCAC) meeting at approximately 10:00 a.m. in accordance with Wisconsin’s open meetings law. WCAC members, staff and members of the audience introduced themselves.
  2. Approval of Minutes: Mr. Kent had corrections to be made in the minutes of the February 12th, 2013 meeting on page 7, item number 10. The corrections are to correctly reflect comments made by Mr. Kent at the meeting. Approval of the minutes was deferred until the next meeting.
  3. Correspondence: Mr. O’Malley reviewed the correspondence received by the WCAC since the last meeting.

    A letter was received from Ms. Christine Brooks, VP, Human Resources, Maysteel, LLC dated February 13th, 2013 expressing support for the proposals made by Wisconsin Employers for Equitable Workers Compensation at the public hearing held in December, 2012. Ms. Brooks also expressed her hope that proposals for medical cost containment will be addressed in the Council’s agreed upon bill.

    A letter was received from Terry Reed, President, US Special Delivery dated February 19th, 2013 expressing support for the proposals made by Wisconsin Employers for Equitable Workers Compensation at the public hearing held in December, 2012. Terry Reed also expressed hope that proposals for medical cost containment will be addressed in the Council’s agreed upon bill.

    A letter was received from Mr. David Balistreri, President, Select Technical Staffing, Inc. dated March 4th, 2013 expressing support for the proposals made by Wisconsin Employers for Equitable Workers Compensation at the public hearing held in December, 2012. Mr. Balistreri also expressed his hope that proposals for medical cost containment will be addressed in the Council’s agreed upon bill.
  4. Self-Insurers Advisory Council Proposals: Mr. Joe Moreth, Section Chief of the Self-Insurance Unit, reported on the progress of the Self-Insurance Advisory Council’s suggested proposed administrative rule changes. The chairperson of the Self-Insurance Advisory Council will appear at the next meeting of the Council to present proposals for consideration.
  5. Database Audit Committee: Mr. Krueger reported that the audit is moving forward and the report from the auditor will be presented at the Council’s meeting in May.
  6. Permanent Total Disability Study Committee: Mr. O’Malley updated the progress of the Permanent Total Disability Committee. As of yesterday 250 cases have been received claiming compensation for permanent total disability. 130 of these cases have been scheduled for hearing. Twelve of these cases have been resolved by settlement.
  7. Secretary Newson’s comments at Council meeting: Secretary Newson greeted the Council and thanked them for their efforts on improving the workers compensation system in Wisconsin and he also thanked them for their service. He looks forward to continuing to work with the Council.
  8. Work Injury Supplemental Benefit Fund: Mr. Krueger provided financial information on the WISBF and reviewed the revenue expenditures and cash balance of the Fund through March 11, 2013. Mr. Krueger indicated fiscal year 2013 revenues have been $2,234,858; expenditures have been $2,074,149. Mr. Krueger indicated the unencumbered cash balance is $1,948,582 and accounts receivable are $764,096, with a total balance of $2,712,678.At this time pending reimbursements for supplemental benefits are $949,210. May & June are the heaviest months when reimbursement requests for supplemental benefits are received. There was enough money in the fund to pay all supplemental benefit reimbursements before 2012.There is still enough money in the Fund to make current payments for other benefits. Reimbursement for supplemental benefits paid in 2012 are being held in abeyance

    There was a motion by Ms. Bloomingdale, second by Mr. Berigier to adjourn to closed caucus. The motion carried unanimously and the WCAC went in to closed caucus at approximately 10:20 a.m.
  9. Labor and Management Present Proposals: Labor and Management returned from closed caucus at approximately 11:45 a.m. Ms. Bloomingdale presented Labor’s proposals:
    1. Administrative Law Judges should be granted the authority to issue prospective orders for proposed periods of retraining.
    2. Allow medical providers to provide copies of medical records in electronic format for a fixed per request fee of $20.
    3. The payment rate for repackaged medications at a medical provider facility shall be paid at the pharmacy fee schedule rate.
    4. The payment rate for surgical implants shall be based on actual cost pricing plus a 10% markup.
    5. Provide indexing of PTD benefit rate after 6 years, paid for directly by employer/carrier for injuries occurring after 1/1/2014.
    6. Curtail the drain on the Work Injury Supplemental Benefit Fund by eliminating reimbursement for supplemental benefits paid for injuries occurring before January 1, 2014. Also establish the long requested goal of a 6 year time lag between the injury and indexing the PTD rate.
    7. The amount of reduction in benefits due to application of the Social Security Disability offset will be paid to the Work Injury Supplemental Benefit Fund.
    8. Increase the maximum weekly benefit rates for permanent partial disability (PPD) to $337 for injuries occurring in 2014 and to $352 for injuries occurring in 2015
    9. Index the permanent partial disability (PPD) rate for increased permanent disability occurring more than 4 years after the date of injury
    10. Require payment for medical insurance coverage for an injured employee and his or her family members. Under this proposal worker’s compensation insurance carriers and self-insured employers would pay 100% of the employer’s contribution for general health insurance coverage or self-funded coverage for as long as the employee is in the period of temporary disability from the work-related injury. Payments for medical insurance coverage are required when the employer provided or contributed to payment for health insurance coverage. These payments are in addition to temporary disability due to the injury and not subject to the maximums set forth in s. 102.11, Stats.
    11. Require orders awarding medical expense to provide health care providers the same remuneration for medical care whether it is a conceded claim or disputed case won by the applicant at hearing. Provide attorney fees for applicants’ counsel limited to 20% of medical expenses that are unpaid/unadjusted as of the time of hearing.
    12. Remove the sunset provision from 102.43 (5) (c) Stats., providing for no reduction of compensation for temporary disability for part-time work by an employee while retraining

    Mr. Beiriger presented Management’s proposals:
    1. Where an employer has a written substance abuse testing policy that is reasonable, uniformly enforced and in place at the time of an accident, an employee who is injured and who fails a post accident drug/alcohol test will be denied indemnity benefits.
    2. Establish a medical fee schedule that uses Medicare rates as the basis for the schedule. Health care providers will be paid at 175% of the then-current Medicare rate.
    3. Allow for Employer-directed care for the first ninety (90) days. Where there is a union agreement covering the workplace, allow Labor and Management to negotiate regarding this provision, to agree upon a panel of providers, and to create incentives for the use of the agreed-upon panel of providers.
    4. Reduce the statute of limitations from twelve (12) years to three (3) years
    5. Following a review of the treatment guidelines, implement the guidelines as treatment parameters. For treatment outside the scope of the parameters or alternate treatments, require the treating physician contact the carrier/self-insured to discuss the treatment plan with a medical professional before such care is provided. If the carrier/self-insured denies further care, it shall state the reasons why in writing.The treating physician can appeal the decision of the carrier/self-insured to the Department.
    6. For injured workers receiving indemnity benefits, there shall be a Social Security offset applicable at age sixty-seven (67), the time at which the injured worker begins to receive Social Security retirement benefits, or five (5) years from the date of injury, whichever is later.
    7. As a condition of receiving benefits, all initial reports of injuries must be made by employees within one (1) year of the date of a traumatic injury.
    8. Where an injury results in PPD and medical evidence shows there was a pre-existing condition or disability present in the claimed body part, apportionment shall be made. The employer/carrier will be responsible only for the amount of permanent disability resulting directly from the work-related injury
    9. The status of all PTD recipients shall be reviewed every three (3) years by the Department and the Department shall report to all carriers/self-insured employers the name and address of any employers who have reported wage income for an individual receiving PTD benefits. Where there is W-2 wage income or where the injured worker is receiving Social Security (disability or retirement) benefits, the Department shall, at the request of the carrier/self-insured, reconsider eligibility for benefits and calculate an offset to modify benefits accordingly.
    10. If the prescription drug dispensed outside of a retail, mail order, or institutional pharmacy is for a repackaged drug, the maximum reimbursement amount shall be calculated utilizing the average wholesale price set by the original manufacturer of the underlying drug, which may not be the manufacturer of the repackaged or relabeled drug.If the National Drug Code (NDC) of the underlying drug cannot be determined from the billing, the maximum reimbursement amount shall be calculated utilizing the lowest cost, therapeutically equivalent drug
    11. Medications dispensed outside of a licensed pharmacy to a worker’s compensation claimant may be reimbursed for a period no greater than 15 days from the date of injury. Refills of medications dispensed within 15 days from the date of injury will not be reimbursed.
    12. The hearing test most proximate to the date of employee removal from a “noisy work area” as defined by OSHA standards, whether before or after such date and whether the employee is removed by reassignment, quit, termination, or retirement, shall be used to establish any loss of hearing claim.
    13. Repeal s. 102.59, Stats., as it applies to the Second Injury Fund.
    14. Management reserves the right to add/modify proposals.

    The meeting was recessed at approximately 12:10 p.m. for a lunch break. The meeting reconvened at approximately 1:15 p.m.

    Mr. Beiriger mentioned there are a few other proposals that were not included on list of proposals from Management. The issue with sports officials was not included on Management’s list. A study committee may be formed to look into the sports officials issue further. There is also the high deductible program (loss reimbursement program) that was proposed by the insurance companies. Management representatives want to know more about the high deductible program and would like to keep this as part of the discussion for the next “Agreed Upon Bill “. While these issue were not on their list, Management representatives want to continue discussions.

    Mr. Beiriger requested further explanation of Labor Proposal No. 5 related to indexing permanent total disability rates. Ms. Bloomingdale advised that Labor was requesting benefit rate increases after a 6 year lag and that worker’s compensation insurance companies and self-insured employers would begin paying for the increased benefit rates on claims filed after January 1, 2014.

    Mr. O’Malley inquired about whether the $20 fee in Labor Proposal No. 2 about electronic medical records applied to each CD or per request. Ms. Bloomingdale advised that the $20 fee was payable for each request. When medical records are provided in paper the $7.50 per request plus $.45 per page would still apply.

    For Labor Proposal No. 9 about indexing compensation payments for permanent partial disability (PPD), Mr. Beiriger had a question about claims where medical treatment continued. Ms. Bloomingdale stated that under the proposal for an injury that occurred in 2010 the employee would receive payments for PPD at the 2010 benefit rate and in 2014 the benefit rate would change to the 2014 benefit rate. The employee would not get a new PPD rating. In 2015 the rate would be the 2015 PPD rate.

    Mr. Beiriger inquired of the reasoning for Labor Proposal No. 12 related to part-time wages while receiving vocational rehabilitation training. Ms. Bloomingdale stated there was a need for additional time to see how provision was working.

    Ms. Bloomingdale stated the Labor representatives were open to talking about a fee schedule but the fee schedule must be fair to everyone. Mr. Beiriger stated that information can be obtained on what is paid for work-related injuries, what is paid for group health and what is paid based on 175% of Medicare.

    Ms. Bloomingdale requested the Department to obtain numbers on Management Proposal No. 4 about reducing the statute of limitations to 3 years. Mr. O’Malley stated that the Department can provide some projections on additional costs to the Work Injury Supplemental Benefit Fund if the proposal was implemented.

    For Management Proposal No. 5 Ms. Bloomingdale inquired about what other states were doing with treatment guidelines. Mr. Kent inquired if the guidelines are used for parameters how treating doctors would be involved with the parameters and would treating doctor have direct appeals to the Department if there are disputes?

    Mr. Kent noted Helen Schott’s memo regarding pre-existing disabilities. He expressed a concern about how apportionment for pre-existing disabilities would be made with Management Proposal No. 8. In response Ms. Piehler has examples of how other states apportion for pre-existing disabilities.

    Mr. Kent inquired how Management Proposal No. 12 to eliminate the Second Injury Fund would be applied. Mr. Beiriger advised that if adopted this would apply going forward with the Second Injury Fund accepting no new claims made after January 1, 2014.

    Mr. Beiriger and Ms. Nugent expresses their wishes to work with the issue involving sports officials. Mr. Krueger stated the Department was having ongoing discussions about this issue.
  10. Other Business: Mr. Metcalf stated there may be some additional proposals from the Department. A representative from the Self-Insured Advisory Council will appear at the next meeting to discuss proposals from that group. The report from the auditor of the certified data based may generate some additional proposals. Mr. Metcalf also stated that it is uncertain if the Health Care Provider Advisory Committee will have any proposals on opioid use and the Department may have future proposals on opioid use.
  11. Adjournment: Motion by Ms. Beiriger, second by Mr. Kent to adjourn. The motion carried unanimously and the meeting was adjourned at approximately 1:35 p.m.
Next meeting: April 9, 2013
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