Enlyte’s compliance update sheds light on recent legislative decisions in August and their impact on auto and worker injuries.
August 2022 has been a busy month across the United States for workers compensation and auto injury compliance. Monthly update Report From Enlyte takes a look at recent events in both areas and how these legislative decisions will affect coverage capabilities and policy drivers for the future.
In particular, worker determinations extend not only across state lines but also in scope. From COVID-19 rulings to objections to paying medical bills, the industry is expected to see a tidal wave of updates.
Car Accident Updates
In Michigan, reverse a previous decision in Andari vs USAA, the state court of appeals found that the new Michigan fee schedule does not apply retroactively to older claims. Alternatively, it may apply only to “claims with injury dates after the actual fee schedule”.
In the new ruling, the Michigan Court of Appeals also held that “even if intent is demonstrated retroactively, imposing the new limits would substantially impair no-fault insurance contracts prior to the effective date of the amendments, thus violating the contracts clause of the Michigan Constitution. .”
USAA, the defendant in the original case, intends to appeal the decision.
The Michigan House of Representatives introduced Bill HB 6335, which states that a car policy will not cover damages caused by sexually transmitted infections or pregnancy that occurs as a result of sexual relations in a car.
The New Jersey legislature introduced Bill S481, which requires auto insurance policies to provide a certain minimum liability, coverage for uninsured drivers and uninsured drivers.
The bill states that, with the exception of a basic auto insurance policy, a vehicle liability policy cannot be issued or this insurance policy renewed in New Jersey unless it includes coverage up to the limits of bodily injury or death as follows: An amount or limit of $15,000 for plans issued or renewed prior to Jan 1, 2023; $25,000 for plans issued or renewed on or after January 1, 2023 but before January 1, 2026; and $35,000 for plans issued or renewed on or after January 1, 2026; an amount or limit, subject to such limit for any person injured or killed, of $30,000 for plans issued or renewed prior to January 1, 2023; $50,000 for plans issued or renewed on or after January 1, 2023 but before January 1, 2026; and $70,000 for plans issued or renewed on or after January 1, 2026.
Workers’ compensation decisions
From California to Florida to Ohio, the range of workers’ compensation compliance issues from August covers it all — spinal cord stimulator payments for changes in approved health care networks (HCNs) to doctor-dispensed medications.
The Michigan Department of Insurance and Financial Services released its annual adjustment to the maximum loss of employment benefits and survivors’ loss benefits, both of which will reflect changes in the cost of living. Effective October 1 of each year, these adjustments apply only to benefits that arise from accidents occurring after the change date of the cap.
Effective October 1, 2022 (through September 30, 2023), Michigan’s new business loss and survivor’s benefit payable will not exceed $6,615 per one 30-day period. This is an increase over the maximum loss of employment and inheritance loss benefit for the previous year, which was $6,065 per one 30-day period.
COVID has played a large role in the rotation of workers compensation in various states. Recently, California extended some COVID claim assumptions through January 1, 2024 for first responders.
Specifically, the bill extended the COVID claim provisions currently applied to firefighters and police officers to firefighting personnel active in the Fire Department of State Department hospitals, the Department of State for Development Services, the Military Department, the Department of Veterans Affairs and to officers of a state hospital under the jurisdiction of hospitals. The Ministry of Foreign Affairs and the Ministry of Development Services in the state.
In August, California also saw a proposed measure to reduce the investigation period for selected claims from 90 days to 75 days. Additionally, workers compensation payments deemed “unreasonably late” will result in penalties of up to $50,000 for specific first responder claims.
The New York State Workers’ Compensation Board also posted a reminder that refusal of prior authorization (PAR) applications submitted to Level 2 review, without a physician’s review and signature by the insurance company’s physician, is invalid and subject to penalty.
The New York Workers’ Compensation Board has stated, “When a payer refuses or partially agrees to a PAR (MTG Variance, MTG Special Services, MTG Confirmation, Medicines, Durable Medical Equipment), the payer must also declare any other basis for the refusal or this will be considered the basis for the refusal.” relinquishing it.”
When objecting to payment of medical bills, the New York State Workers’ Compensation Board stated that payers will be required to use appropriate claim adjustment reason codes and Transfer Note Codes on Explanation of Benefits/Explanation of Review EOBs/EORs when objecting to a median bill payment.
In addition, the payer must also file one of two forms with the New York State Workers’ Compensation Board: Notice of Objection to Payment of a Bill for Treatment Provided or Notice of a Health Care Provider and Claim for the Insurance Company’s Refusal to Pay All (or Part of) a Medical Bill Due to the Assessment’s Objection(s).
Effective August 2, the state of Texas has introduced new rules governing Texas-certified healthcare networks (HCNs). Some of the new changes to HCN include eliminating the physical on-site visit for provider accreditation, clarifications regarding coverage maps, the addition of telemedicine as a reportable “practice focus”, as well as clarifications regarding coverage maps and clarifications of the HCN complaint process.
HCNs have until January 1, 2023 to comply with these new rules.
The Minnesota Department of Labor and Industry also recently released the state’s workers compensation medical fee schedules. The new Resource-Based Relative Value Schedule (RBRVS) is effective from October 1, 2022, to September 30, 2023.
While RBRVS conversion factors increased slightly for physical medicine/partially rehabilitation services and for chiropractic services compared to the fee schedules from October 1, 2021 to September 30, 2022, conversion factors or medical/surgical services, plus pathology and laboratory services decreased slightly compared to the same time period. &