Workers’ Comp Cost-Raising Bills in Appropriations

The legislature’s Appropriations Committee is considering two proposals (SB 986 and SB 23) to hike employers’ workers’ compensation costs and administrative burdens.

SB 986 would significantly raise costs byrestricting the ability of employers andinsurers to manage workers’ compensation cases. It increases the number of routine examinations and treatments that must be covered and creates more hurdles for employers to dispute them.

The proposal shifts the burden of establishing the necessity of medical treatment from the medical provider to the insurance carrier and employer—who may dispute the treatment only after it has been given.

This will create an environment in which the prescribed treatment is simply assumed to be correct and employers must try to “close the barn door after the horse gets out.”

Local consequences

The legislature’s Office of Fiscal Analysis (OFA) says the proposal could result in a “significant impact to the state and municipalities.”

OFA noted that SB 986 could impact older, unsettled claims and their costs for routine medical examinations and treatment.

With approximately 250,000 claims over seven years old (for the state and municipalities alone), it will be difficult to assess the medical necessity of a routine examination or treatment in relationship to the employee’s original injury.

SB 986 opens the door to higher costs through increased medical utilization—such as exams, treatments and procedures—that might be unnecessary or even improper.

Employers will be forced to dispute claims (through Form 36 filings) to seek more information about, or dispute, the necessity of questionable treatments.

Expands benefits

SB 23 will raise costs by increasing workers’ compensation total incapacity benefits to claimants who were injured between 1993 and 2006 and who are still subject to the Social Security offset.

It will require employers and insurers to pay higher workers’ comp claims for claimants who were not originally accounted for when the carrier set its insurance premiums.

(Insurers determine what an insurance premium should be based on all their known risks and claimants. If this new class of claimants receives additional benefits, it will be outside of the factors originally considered when annual premiums were calculated.)

As a result, SB 23 will significantly increase workers’ comp costs for covered individuals in the private sector, and the fiscal impacton private-sector employers will be ongoing for the life of each claimant.