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Montana Self Insurers' Association

July 2024 uPDATE

  • MSIA Membership Dues due
  • Independent Contractor Rules Proposed
  • Governor’s Conference & MSIA Business & Annual Meeting
  • View From the Front Lines – Rising Medical Annual Claims Benchmarking Webinar 7/24
  • US Supreme Court Overturns Chevron Deference – What Does It Mean for WC?
  • Welcome New MSIA Members: Sanderson Firm, PLLC and Webutation, Inc

MSIA Membership Dues – Due July 31

July 1 is the start of our fiscal year and time for most members’ annual dues to be paid. We ask that your dues payments are received by July 31. We can accept credit card payment through Montana Self Insurers' Association (hit the ‘Join Now’ button in the upper right-hand corner), a check mailed to the Association offices or, if you contact us, ACH/EFT or Venmo payments. 

This will be another active legislative session – MSIA is perceived to be one of the most credible workers’ compensation experts in the halls of the Capitol and by public policymakers – due to your support and willingness to share your perspectives on potential changes to our law. We cannot be successful without you – thank you for your support! 

Independent Contractor Rules Proposed

Two rule change proposals were released by the Department of Labor on Friday, July 5. The first is a ‘Red Tape Initiative’ and enactment of SB 22 (2023). For some background, SB 22 was the effort to clean up the IC law changes from 2021 which made the law a bit more confusing than not. SB 22 was negotiated by and ultimately supported by MSIA and our members. The public hearing on this rule will be held via Zoom on August 1, 2024, at 10:00 a.m. The language of the proposed rule is here: 24-35-420pro-arm.pdf (mt.gov).

The second proposal adds federally recognized Indian tribes under the laws of that tribe to the potential points awarded in reviewing an application for an Independent Contractor Exemption Certificate (ICEC). That hearing is on July 31, 2024, at 9:00 a.m. and the specific language is here: 24-35-421pro-arm.pdf (mt.gov).

MSIA will likely comment on the ‘Red Tape Initiative’ rules changes. At the least there is some time-line ambiguity relating to when the Department will provide notice of expiration of the existing ICEC. At this point, absent comment from our members, we will not be commenting on the second proposal on July 31. 

Governor’s Conference & MSIA Business & Annual Meeting – Butte 9/11 – 13

Registration and hotel rooms are available for the Governor’s Conference to be held in Butte this year. The theme this year is Better Medical – Better Outcomes and the line-up promises to bring new information, new approaches to medical treatments and of course the Workers’ Compensation Court discussion with new Judge Lee Bruner. Judge Bruner takes a different approach to interpreting our workers’ compensation law than many of his predecessors. As well, we will hear about some of Butte’s history – and its’ relevance to union history in the US and our safety work today from Chris Fisk when he talks about the Speculator Mine disaster – the deadliest underground mine event in US history. If you don’t know the story – it is chilling, revealing and resonates today, some 107 years later. Sometimes it is sad to realize what we have learned - - and forgotten. 

Given the quality of the Conference agenda this year, it may not be a surprise that this year’s Conference features seven MSIA members. 

  • Vicki Evans, with MCCF, who will update us on Kids Chance MT 
  • Dr. Silivia Sacalis & Dr. Amanda Waltermath with Health-e-Systems talking about Prescribing Empathy and Patient Well-Being in WC Drug Therapy Trends 
  • Rene Mills with Craig Hospital will talk about Assessing Brain Injuries
  • Dr. Laura Kirsch with Clarus IME talikd about Psych and Neuropsych IMEs and their Differences
  • Kerri Poe of Arcadia Settlements and Daniel Tiscareno Romero of Ametros will be joined by Hany Abelsayad to talk about a Hands-On Approach to MSA’s

Other presentations will feature Dr. Ethan Moses, CO WC Division Medical Director, Dr. Al Olszewski a MT Orthopedic surgeon and former political candidate, Dr. Daniel Whiting, Montana’s only dual fellowship trained hip surgeon, Dr. John Schumpert, formerly the state’s WC Medical Director with REOH in Missoula and Dr. Michael Wright talking about shoulders. 

We will also learn about Ethical choices and Improved Results from Brian Allen and from a physical therapist who went from working to being a workers’ compensation patient, Michelle Despres. Allen has spoken to MSIA and provides a fascinating and thought-provoking presentation based on his personal experiences. If you don’t know Despres story – it is a very interesting take on our systems from the perspective of someone who works in it – and became a patient in it! 

MSIA members Medivest, PACBLU and Craig Hospital are hosting the Wednesday evening reception 

MSIA Business & Annual Meeting 9/11 8:15a – ALL members requested

We need you (or your proxy) to conduct our meeting – ALL members count and have a voice. Look for the Annual MSIA Member Survey coming in August. Your opinions drive our positions.

We will go through our Annual Membership Public Policy Survey (coming in August), the budget, financial results and will be electing members to the Board. We have three seats up this year, those currently held by Vice Chair Dee Walcheck of Logan Health, Secretary/Treasurer Michael Marsh of Midland Claims Service and the at large seat currently held by Vicki Evans of MCCF. Any member in good standing is eligible to run for a seat – Marsh currently serves as the Associate member representative on the Board. MSIA also has the opportunity for another employer member if you want to help run the Association. 

The MSIA Annual Meeting again kicks off the Governor’s Conference and our featured speaker, Amy Lee is the perfect person to start the Conference. Lee is a nationally recognized WC researcher and currently leading her own firm, Steadfast Policy Strategies focused on using data to drive public policy decisions. That’s not particularly surprising as that is how she has spent her entire career. She has served as Director of the Texas WC Division and has helped drive decisions in that system which saw it turn around from one of the most troubled system in the country to one held up as an example for other states to emulate. Some of Montana law is based on the results the Texas system has generated – and Lee helped drive those Texas results. Lee has been involved with the WCRI, IAIABC, NCOIL and has been a Fellow with the National Academy of Social Insurance. This is another ‘Can’t Miss’ presentation while we’re in Butte!

If you or a member of your company cannot make the MSIA Business meeting – please email your proxy for quorum purposes only – we need a majority of all members in attendance or via proxy to conduct our business. Our agenda and background material will be provided to everyone on our membership email list. 

View From the Front Lines – Annual Claims Benchmarking Study - Webinar 7/24 @ 12 MDT

One of the most important studies each year is the Annual Workers’ Compensation Benchmarking Study, sponsored by MSIA member Rising Medical Solutions. What has changed in claims management – how have AI, remote work, the hiring/retention crisis, heavy caseloads, administrative tasks, the need for training and other issues impacted the business and how has the industry responded? 

There is a free live webinar on July 24 at 12 noon MDT to learn more, before the study is published this fall - The View from the Front Lines of Claims Management.

The study provides up-to-date data information on how front-line claims people view their profession – and their work. Have predictive analytics and AI freed them to do their best work – focusing on injured worker advocacy, humane but swift claim closure and the best possible medical outcomes? Or are the needs to parse medical records, chase bills and payments or company administrative requirements creating problems in the process? 

We always learn something when we listen to the most important asset any employer has – the people who work with us. Over 1300 claims professionals have responded to the survey. What are truly the best practices? How many are implementing them? Can your injured workers benefit? Can your organization afford not to listen? 

Seats are limited and each attendee will receive a copy of the Rising Medical Solutions Workers’ Compensation Benchmarking Study when it is released. Make sure you have a seat for this FREE webinar The View from the Front Lines of Claims Management. 

Can’t make it for the live program? The sponsors are offering a recording Recording Only -The Front Lines of Claims Management Survey.

US Supreme Court Overturns Chevron Deference – What Does It Mean for WC? - Free Webinar 7/11 @ 11:30a MDT 

There is little question that this has been a precedent setting US Supreme Court term. Perhaps one of the most potentially impactful decisions for business has been in Loper Bright Enterprises v Raimondo (Loper). This decision, which was released on June 28, overturned what is known as the Chevron deference. That 1984 Supreme Court decision (Chevron USA, Inc, v Natural Resources Defense Council, Inc) dictated that the Courts defer to a federal agency’s interpretation of law when they had a specific expertise in the area. There was a two-part test – (1) has Congress specifically spoken to the issue in question and (2) is the interpretation of the law a “permissible construction,” (is the interpretation reasonable)? 

The 6 – 3 majority overturned Chevron and held that the Administrative Procedures Act requires the Courts to exercise their independent determination regarding whether a federal agency has acted within the scope of the statutory language. There is likely much to be written about the Loper decision and the new standards on the impacts on federal regulation and business operations. Sanderson Firm is hosting a  FREE webinar on Thursday July 11 at 11:30a on the decision and potential impacts REGISTER HERE

Since the early 2000’s workers’ compensation payers have had the responsibility of protecting the Medicare Trust Fund from future medical costs the Medicare as Secondary Payer law identifies. That law has led to the creation of Medicare Set Asides (MSAs) and a significant change in our business and settlement processes, as well as creating new businesses to quantify potential MSA amounts and in managing the MSAs on behalf of beneficiaries. At this point, I am going to rely on Brandon De Soua, Esq, of new MSIA member Sanderson Firm, PLLC for the potential impact on workers’ compensation:

De Souza points out this new Loper standard can have significant impact on all federal agencies, and for our business, specifically Medicare (the Centers for Medicare Services, CMS) and OSHA. De Souza writes, 

How could the Loper decision affect how [CMS] interprets the Medicare Secondary Payer Act, particularly as published in administrative guidance such as the Workers’ Compensation Medicare Set-Aside (“WCMSA”) Reference Guide and/or the Section 111 Reporting NGHP User Guide? [NGHP = Non-Group Health Plans - - generally WC and auto coverages]

Just as one example, consider Section 4.3 of the WCMSA Reference Guide which was added to the Guide in early 2022 and appeared to discredit non-submitted MSAs. As we [Sanderson Firm] have discussed in prior blogs, CMS has interpreted 42 C.F.R. 411.46 to allow the government, at its sole discretion, to deny a Medicare beneficiary’s coverage benefits if it determines that the funding of the non-submitted MSA was insufficient or the MSA funds were spent inappropriately. 

De Soua continues, 

Accordingly, we [Sanderson Firm] view CMS’ interpretation of the law in Section 4.3 of the WCMSA Reference Guide as an improper interpretation of the regulations supporting MSP. Further, guidance issued by administrative agencies has never held the weight of the law. Guidance from administrative guidance is merely, well, guidance. With this Loper decision, it is even more clear now that an agency’s interpretation of the law will not have automatic deference/authority and a court may question an administrative agency’s interpretation of laws. 

Under Chevron (had it not been overturned), a federal court may have deferred to CMS’ interpretation without issue. However, now under Loper, a federal court could freely decide that CMS’ interpretation is invalid, removing any potential attempts by CMS to question non-submission of MSAs.

Sanderson Firm is hosting a FREE webinar on Thursday, July 11 to discuss the decision and its’ potential impacts at 11:30a MDT - REGISTER HERE

Heather Schwartz Sanderson, Founder and CEO of Sanderson Firm, PLLC will be presenting the next MSIA CE Webinar on what’s going on in the MSA world on September 19, 2024 at 10a MDT. This Webinar is planned but has not yet been announced. With the Loper decision, it may be of more importance. As always, MSIA members will be eligible for an unlimited number of seats for this Webinar. 

Welcome New MSIA Member – Sanderson Firm PLLC

Passion. Experience. Diligence. Sanderson Firm specializes in Medicare Secondary Payer (MSP) services and is proud to be a woman-owned business. Our team of legal, clinical and claims professionals has over 200 years of experience in the MSP industry and we are proud to serve as trusted counsel and MSP compliance services vendor to some of the nation’s most well-recognized names, self-insurers and third-party administrators, as well as smaller regional carriers and governmental entities. 

Sanderson Firm, above all else, prides itself on innovative MSP solutions with a particular focus on client satisfaction as demonstrated through our 100% client retention. Our clients’ success in achieving MSP compliant settlements drive what we do every day, and thus, our reputation in the industry has allowed us to truly advocate on behalf or out clients through successfully lobbying the US Congress on MSOA legislation (SMART Act and PAID Act), serving as experts in seminal MSP class action litigation, and publishing MSP articles in national magazines. Sanderson Firm provides actionable, legal compliance advice in all areas of MSP and clients enjoy the benefits of confidential, attorney-client privilege for all compliance concerns. Contact Heather Schwartz Sanderson, CEO at Heather@SandersonComp.com or 941-212-7726

Welcome New MSIA Member – Webutation, Inc.

Webutation: Fighting Fraud with Cutting-Edge Technology and OSINT. Webutation.io takes social media investigations to a whole new level. They leverage Open-Source Intelligence (OSINT) methodologies alongside cutting-edge tech to go far beyond basic platform searches. Unlike traditional methods that rely on basic search engines and manual digging, Webutation employs proprietary software and advanced OSINT techniques to uncover the hidden digital breadcrumbs fraudsters often leave behind. This allows them to unearth critical, actionable intelligence that would otherwise be missed.

This powerful combination of technology and expertise empowers Webutation to deliver accurate, interactive, and legally defensible reports. Their platform provides real-time monitoring and alerts, comprehensive summaries with strategic recommendations, and interactive visualizations that bring key insights to life. This ensures businesses have the most up-to-date information to effectively combat fraud and protect their bottom line. For more information contact Michael Petrie at MPetrie@Webutation.io or 267-975-6880 or Lou Lesperance at LLesperance@Webutation.io or 609-694-8633