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Archive | 2014

CMS Issues Notice of Hydrocodone Combination Product Coverage Changes for WCMSA Proposals Submitted on or after January 1, 2015

In October 2014, the U.S. Drug Enforcement Administration rescheduled all hydrocodone combination products from schedule C-III controlled substances to C-II controlled substances. C-II controlled substances require new prescriptions at intervals no greater than 30 days, though a practitioner may issue up to three consecutive prescriptions in one visit (essentially authorizing the patient to receive a […]

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New Program Will Try to Reduce Fatal Falls for Cell Tower Technicians

Fatal falls are a big problem for cell tower workers, but a new national program will try to reverse this trend and save cell tower technicians’ lives. The Telecommunications Industry Registered Apprenticeship Program, which was developed with the help of the Federal Communications Commission (FCC), the Department of Labor (DoL) and AT&T (to only name […]

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Is Workplace Noise Exposure “A Growing National Problem”? The ATA Thinks So…

Each year in the U.S., roughly 30 million American workers are exposed to excessive noise in their workplaces, according to the National Institute of Occupational Safety and Health (NIOSH). Such dangerous levels of consistent workplace noise exposure can put workers at risk of sustaining serious injuries, including: Tinnitus Hyperacusis Deafness Physical and emotional stress. The […]

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Holders of Certificate of Insurance Required to be Notified of Cancellation of Workers’ Compensation Policy

The Court of Appeals recently remanded a case back to the Administrative Law Judge to determine whether Pinnacol Assurance should be estopped from denying coverage to a subcontractor because Pinnacol failed to notify the general contractor and the owner of rental property that Pinnacol cancelled the policy. Hoff v. Industrial Claim Appeals Office, ___ P.3d […]

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Changes to DWC Electronic Filing

The Division of Workers’ Compensation announced that starting on November 1, 2014 the EDI online application will be moving to a new server. When you access the program you will be redirected to the new server website. Therefore, if you have a bookmark or shortcut to the application on your computer or web browser, you will […]

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Travel to and from Work Compensable if Job Requires Use of Automobile

Colorado has recognized a longstanding rule that injuries sustained by workers traveling to work from home (and while returning home), are not compensable because they are not seen as arising out of employment. In 1999 the Colorado Supreme Court recognized that the facts of any particular case may justify an exception to this general rule, […]

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Notice of Rule Hearing – Proposed Changes to W.C.R.P. 5 – Claims Adjusting Requirements

The Division of Workers’ Compensation has scheduled a public hearing to to address the proposed changes to W.C.R.P. 5 – Claims Adjusting Requirements. The hearing will be held in the 12th Floor Conference Room at 633 17th Street in Denver. The public hearing will be held in accordance with the provisions of the Colorado Administrative […]

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New Information re: Collection of Prescription Drug Information for WCMSAs

On October 6, 2014, the Centers for Medicare and Medicaid Services will be implementing a change to its online portal which will allow users to enter prescription drug information directly into the portal, which will allow users to “input and calculate the proposed prescription drug portion of the WCMSA proposal.” A new informational alert titled […]

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Muddying the Waters on What Constitutes Horseplay

In Trujillo v. Lowe’s, W. C. No. 4-932-395 (July 29, 2014), the claimant was injured when he engaged in a “chest bump” with a co-worker to celebrate the completion of a particular job duty. It has long been settled law that an injury caused by “horseplay” does not arise out of or occur within the […]

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Preventing Workplace Back Injuries with Office Ergonomics (Pt. 2)

Picking up from where Preventing Workplace Back Injuries with Office Ergonomics (Pt. 1) left off, here we will continue discussing how sedentary workers can minimize their risk of developing workplace back injuries. While the first part of this blog focused on some of the specific risks these workers face, below, we will point out the […]

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Preventing Workplace Back Injuries with Office Ergonomics (Pt. 1)

Back injuries can be some of the most painful and debilitating types of workplace injuries people can sustain, as these impairments can end up impacting people’s abilities to move around or even sit for extended periods of time. Despite the fact that many back injuries arise from a single accident or traumatic incident, in some […]

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Medical Fee Schedule Addresses Compound Medications

Recently I have had a number of clients inquire about the exorbitant cost being charged by pharmacies for compound medications – usually topical anti-inflammatory agents combined with topical local anesthetics. Pharmacies have been charging upwards of $3,000 or more for a one-month supply, depending on the agents/ingredients in the compound medication. Surprisingly, all of these […]

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Workers’ Compensation Benefits vs. Social Security Disability Benefits (Pt. 2)

Continuing from where we left off in Workers’ Compensation Benefits vs. Social Security Disability Benefits (Pt. 1), below we will resume our discussion regarding some of the important differences between Social Security disability benefits and workers’ compensation benefits for people who’ve sustained permanent impairments as a result of workplace accidents and injuries. In addition to […]

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Workers’ Compensation Benefits vs. Social Security Disability Benefits (Pt. 1)

When a workplace injury is severe enough to result in permanent impairments, the injured person may be able to seek compensation for his injuries and losses via the Colorado workers’ compensation system and/or via the Social Security disability system. While the amounts of these benefits can differ (as can the process of obtaining these benefits), […]

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CMS Issues Updated WCMSA Reference Guide

On June 3, 2014, the Centers for Medicare and Medicaid Services (CMS) issued an updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide. The following sections of the Guide have been enhanced or added: 4.1.4          Hearing on the Merits of the Case: Section added to reflect the April 22, 2003 WCMSA […]

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Calculation of Lump Sums in Excess of $60,000

In a previous post I reported that effective July 1, 2014, the legislature amended § 8-43-406(2) to increased the maximum amount of all lump sums to $80,000, for all dates of injury prior to July 1, 2014 (and to adjust that maximum amount on July 1 of each calendar year).  W.C.R.P.  5-10(B)(1) requires the respondents to […]

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Statutory Changes – Designated Provider List

Effective April 15, 2015, § 8-43-404(5) will require employers to increase the number of physicians which must be offered to an employee on the Designated Provider List from two to four physicians, corporate medical providers or a combination of both, where available. At least one of the designated providers must be at a distinct location […]

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Statutory Changes – Reimbursement to Claimant to Attend an IME

The legislature amended § 8-43-404(1)(b)(I) to require a respondent to reimburse a claimant for uncompensated wage loss up to $75.00 per day for attending an independent medical examination requested by the employer/insurer. Note that the amendment requires reimbursement only for “uncompensated” wage loss. Thus, if the employer pays an hourly employee (or does not charge […]

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Division Posts 2014 Compensation Rates – New Lump Sum Maximum

The Division of Workers’ Compensation has posted the new compensation rates, effective for injuries on or after July 1, 2014: Maximum Compensation Benefit Rate: $881.65 per week. Scheduled Impairment Rate: $277.03 per week. Whole Person PPD Rate: $484.44 per week. Disfigurement: $4,673.47/$9,345.38. Lump Sums*: $81,435.67. *The Colorado Legislature amended §8-43-406 to increase the aggregate of […]

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“Significant Causative Factor” Applied to Deny Permanent Total Disability Benefits to a Worker Without Prior Permanent Restrictions

It has long been the law that although a claimant is not required to establish that an industrial injury is the sole cause of an alleged inability to earn wages, the claimant must nonetheless demonstrate that the industrial injury is a “significant causative factor” in her alleged permanent total disability. Under this test, the Administrative […]

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Failure to Pay Mileage Reimbursement Timely not a Violation of W.C.R.P. 16-11(A)

The Industrial Claim Appeals Office reversed an Order of an Administrative Law Judge awarding penalties for a violation of W.C.R.P. 16-11(A), based on the insurer’s failure to reimburse a claimant timely for mileage expenses. The Industrial Claim Appeals Office reasoned that although W.C.R.P. 16-11(A) provides that an uncontested bill submitted by a “provider” is due […]

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CMS Adds Self-Administration Page to Its Website

The Centers for Medicare and Medicaid Services (CMS) has added a new web page to its website designed to assist individuals in self-administering Workers’ Compensation Medicare Set Aside Arrangements (WCMSAs).  Materials available on the new page include: • New Self-Administration Toolkit for WCMSAs; • Account Expenditure for Lump Sum Account (Attestation Letter); • Account Expenditure […]

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SSDI Offset Calculated Using 52 Weeks

In a decision likely to save the insurance industry hundreds of cents per year, the Industrial Claim Appeals Office finally has settled the issue of how to calculate the SSDI offset properly. In Keel v. Transportation Technology Services, W. C. No. 4-897-030 (April 1, 2014), the Industrial Claim Appeals Office rejected the claimant’s argument that […]

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DWC Posts Form for Abandonment of Claim

In a prior post, I addressed the recently-added three subsections to W.C.R.P. 7-1, including subsection subsection (E), which provides that an insurer may file a final admission of liability based on the claimant’s voluntary abandonment of a claim if the claimant: (1) is not receiving temporary disability benefits; (2) provides written notice (in a forthcoming Division form) […]

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5 Things to Know about Workers’ Compensation Fraud (Part 2)

Wrapping up our two-part blog 5 Things to Know about Workers’ Compensation Fraud, below is some more important information regarding workers’ compensation fraud. If you have specific questions regarding workers’ compensation benefits and would like to know more about your rights and options, contact the Law Office of Steven J. Picardi. We are happy to answer […]

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5 Things to Know about Workers’ Compensation Fraud (Part 1)

Workers’ compensation benefits are intended to provide injured workers with financial support as they focus on recovering from on-the-job injuries. Despite the fact that this system has limited resources and that many people who apply for these benefits have a real need for them, there are some people who may try to take advantage of […]

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Fatal Work Injury News: Deadliest Cities for American Workers

Smaller cities that are focused on a certain industry tend to be the most dangerous for American workers, as they are where the most fatal work injuries and occupational illnesses tend to arise (according to data gathered by various federal agencies). In fact, recently released data indicates that the following are the deadliest cities for […]

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Supreme Court Sets New Standard of Compensability for Unexplained Falls

The Supreme Court of Colorado recently issued an opinion which significantly changes the traditional analysis of claims based on an unexplained fall. City of Brighton v. Rodriguez, 2014 CO 7, 318 P.3d 496 (Colo. 2014). In the underlying case, the claimant fell while walking down a set of stairs.  The employer filed a General Admission […]

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Updated Life Tables Required for WCMSAs

The Centers for Medicare and Medicaid Services (CMS) has announced that it will begin referencing the Centers for Disease Control’s Table 1: Life Table for the total population: United States, 2009, to calculate life expectancies for all Workers’ Compensation Medciare Set-Aside Agreements, effective March 31, 2014. The CDC’s 2009 Life Tables may be found here.

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Recent Changes to the Workers’ Compensation Rules of Procedure

On January 21, 2014, the Director of the Division of Workers’ Compensation adopted changes to Rule 5-5 (admissions of liability) and Rule 7. To see the new changes to both Rules, click here. The amendments are effective on March 17, 2014. You may remember that the legislature recently amended Section 8-42-107.2(4)(c) to require the Division IME Unit […]

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DWC Prehearings and Settlement Unit Address Change

Effective immediately, all correspondence sent to the Prehearings and Settlement Unit should be sent to the 4th Floor: Division of Workers’ Compensation Prehearings and Settlement Unit 633 17th Street, 4th Floor Denver, CO 80202 In addition, on February 13 and 14, 2014, the Division of Workers’ Compensation’s Prehearings and Settlement Unit is moving its offices […]

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Mileage Rate Increase

The rate for mileage increased to $.53 per mile effective January 1, 2014.  If you want to bookmark W.C.R.P. 18-6 Division Established Codes and values, click here.

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Cold Weather Injuries and How Outdoor Workers Can Avoid Them

If you work outdoors, then the winter season can be a particular dangerous time, especially if you are in the Midwest or Northeast, as the record-breaking cold temperatures have made it riskier than ever to be outside for extended periods of time. Whether this is your first winter working outdoors or you have been facing […]

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An Administrative Law Judge Has No Authority to Extend the Time for a Respondent to Take a Position on a Division IME Physician’s Impairment Rating

It has long been settled law that if the respondent fails to file an Application for Hearing timely challenging the opinions of the Division IME physician, the opinion becomes binding. Leprino v. Industrial Claim Appeals Office, 134 P.3d 475 (Colo. App. 2005)(the requirements of §8-42-107.2(4) are jurisdictional and if the parties fail to request a […]

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