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Big Win in KY Political Wrangling Today regarding Worker's Comp Coverage!

Hi all,

  My elected State House Representative co-sponsored a Bill this session (HB 2) that would kick people off Workers Comp benefits after 750 weeks regardless of injury status.  Additionally, it allows the Official Disability Guidelines (ODG) to become controlling documentation regarding "approved procedures".  Keep in mind the ODG is written by a For Profit company that is intended to rush injured workers back to work instead of relying on the treating physicians opinion.

  I sent him a pretty heated e-mail last night and started a "FB" page regarding the legislation.  I got the first return e-mail back this morning.  He was not understanding my frustration regarding the Bill.  I then sent him another reply laying it all out.  He replied back and apologized for not knowing the ramifications nor how negative the "re-opening" procedures for a WC claim are in KY.  He is contacting Senators and asking them to either amend or kill the Bill because of our conversation.  He has also agreed to meet with me so I can show him actual documentation of the "Re-opening" process and how dishonest it is!

  It may not sound like much but this is something that typically does not happen in KY politics!

Keith

   

Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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Comments

  • Currently, workers with permanent-partial disabilities receive lifetime benefits. If passed, the bill would only apply to future workers’ compensation claims.
  • Actually, the biggest issue is the use of the ODG.  That is my biggest concern.  I've been on the receiving end of the ODG and it's not good!  No one should be denied care based on a guideline written for the best interest of the Insurance company and not based on the recommendations of the treating physician.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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  • L4_5 - What page out of the 61 page regulation states Permanent Partial Disabilities receive lifetime coverage?  They amended part of that language I found to "Permanent Partial Paralysis" as a result of conditions found in subsection 9.

    Keith 

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Google “Kentucky Worker’s Compensation” — it’s in an article from yesterday. I can’t post the link otherwise I would.

  • Well, the KY House and Senate passed the proposed legislation.  So, here is what is changing for Worker's Comp in KY;

    1.  KY will now be utilizing the "Official Disability Guidelines".  This is a book written by a "for profit" company that expedites treatment options so that injured workers get sent back to work as quickly as possible.  The ODG also says when Opioids can/should be prescribed.  Be prepared folks!

    2.  Utilization Review will continue to be done by various doctors (typically from out of state and not licensed to practice medicine in KY)that review your medical files and determine how you can be treated regardless of what your actual doctor prefers to do. 

    3.  Workers comp benefits will only go up to 780 weeks (15 years) for permanent partial disabilities.  Essentially, in KY, the definition for "Permanent"  means 15 years (better call Webster's so they can update the dictionary).There is no grandfathering.  At the 15 yr point, you may file to reopen your case and allow an Administrative Law Judge (ALJ) determine if your disability should be allowed continued coverage.  The ODG will be used in that decision making process.  Based on past case history, you will have ten (10) minutes for your hearing with the ALJ (over the telephone).

    4.  There are a few cases that will be covered permanently (for real).  Loss of a limb, Total Permanent Disability (unable to work at all), Partial Permanent Paralysis, or a lost tooth.

    5.  Lawyers may now charge clients higher fees.  They were capped for years.  This was a concession in order to keep lawyers from opposing the Bill.  There were several proposed amendments that would have been advantageous to workers, but they all got rejected.  

    6.  The number of urinalysis drug tests a patient may have to take are now limited.  It's important to note that SB 1 from six years ago is what set the number of urinalysis doctors were requiring.  So, the government set the bar, didn't like having to pay for so many tests, so now they are limiting how many you have to take.  A perfect example of politician's trying to practice medicine. 

      As I explained to my Representative, instead of fixing the reasons why healthcare costs are skyrocketing, they decided to control costs by taking it out on injured workers.  This is/was a 100% partisan Bill.  One Party (who is controlling the House, Senate and Governor's office) pushed this legislation through.  I do feel that many of the new provisions are going to be challenged in court.  But that will take time and Lord only knows how much money.

        

     

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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  • Thanks for the update and explaination.

    Are you sure these changes apply to injured workers with existing claims?

    I saw a news story that said the 780 weeks was only applicable for new claims (claims initiated in 2018 or after).

  • I was told by one of the House Representatives that it applies to everyone regardless of when the injury occurred.  He said that the reason they put the re-evaluation at 15 yrs in was to give those people who have open contracts the opportunity to continue coverage.  I'm glad they at least put that in there, but what is worrisome is that the ODG is going to be used by the ALJ's to determine if the "permanent" injury is work related, reasonable and necessary care.  The only people who are "grandfathered" are those with total permanent disabilities. 

    Both times my claim was re-opened by the WC company, they used the ODG to try and discredit the care my PM doctor wanted to perform.  The ODG is simply being used to reduce WC costs.  I don't feel based on how it was used against me that it has squat to do with ensuring injured workers get quality care.  It's all about getting workers back to work quicker, not getting them healed.

    Last night I was running all the different scenarios through my head about how this could go regarding my care.  At the end of the night, I came to the point where if they stop my WC coverage, I will no longer have to battle WC lawyers, no longer have to deal with an adjuster who goes out of her way to deny my care and can go to whatever specialist I need to see, so long as my PM or PCP agree.  The only unknown is if my regular health insurance company is going to balk at covering a 15 yr old work related injury or are they going to deny because it was work related.  They failed to address that in the new legislation. 

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I found yet another article that says the new laws only apply to new claims. Not sure if that’s misinformation or not.

  • I found one of the articles.  I think it's unintentionally misleading.  If a person has a permanent partial paralysis or a permanent total disability, they are grandfathered.  If you have a permanent partial disability, after 780 weeks of coverage you are cut off.  There is some language that describes on-going treatment and starting dates of treatment, but it's going to take an Attorney General's Opinion to clarify the meaning of the language. You have the option to file a "reconsideration" through the Dept of Worker's Claims.  Essentially, it's another re-opening of your claim and must be handled by an Administrative Law Judge.  It's a one-time deal though.  If the ALJ says you should not continue to receive care, then you're done.  If they concur and agree that coverage should continue, it never has to be re-opened again.  But, what scares the bejesus out of me is that KY will now be allowing the ODG to determine what should/can be done medically. 

    Keep in mind it's the stated goal of the ODG to "return injured workers back to work as quickly as possible".  It's not about trying to heal or even control medical issues.  Its strictly to get you back to work. 

    This was passed by the same legislature that did a pension overhaul Bill last Thursday night that was cloaked in a Sewage Treatment Bill.  It is in my mind going to be ruled unconstitutional because the required actuarial analysis was not done, did not have a public hearing, and was introduced and passed within two hours.  They admit no one read the Bill because they didn't have time.  Rumor is on Monday, we are going to have a tax reform shoved down our throats in the same manner.  Plus, the ruling Party in KY has done a great job convincing KY citizens that the Pension crisis is the fault of greedy state employees.  The truth is that the Legislature grossly unfunded the pension for decades to use the money for pet projects.    

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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