MONTANA SELF INSURERS' ASSOCIATION
MSIA UPDATE September 2024
- Montana Labor Day Report 2024
- MSIA Business & Annual Meeting – featuring Amy Lee – Reflections on a Reform
- Governor’s Conference – review and access to the presentations
- New Reporting Rules for MSAs – What You Don’t Know Can Hurt – Webinar 9/19 @ 10a MDT
- Montana Labor Day Report 2024
The Montana Department of Labor and Industry provides an annual Montana Labor Day Report. The report provides a perspective on Montana employment, business and general economy. This year, the report finds continued expansion, some easing of the tight labor market and the beginning of a taming of inflation. With that said, the report finds Montanans personal income grew 7.5% annually since 2020, the 4th fastest for growth in the country. As we know all too well, however, home prices continue to be the primary driver of inflation, but the report finds that home prices in Montana are moderating some.
The Montana labor force reached over 580,000 people, a record for the state. It is interesting to note that self-insured businesses, typically employ between 25 – 33% of all workers in a state – and based on our best estimates, that’s true for Montana as well – that means somewhere between 145,000 and 190,000 Montanans work in a self-insured business. Montana ranks 8th in the country for fastest employment growth since 2020. The healthcare sector added the most new jobs in 2023.
The average wage was just over $57,000 in 2023, about a 5% growth in wages, and making us second in the country for fastest wage growth since 2020. Despite the positive wage growth (which also leads to higher WC weekly indemnity benefits, which we have also seen) the labor market remains tight, with about 2 openings for everyone looking for work. As well, we have one of the highest rates of new business formations. We are 3rd in the country for self-employment and about 30% of the workforce operates their own business. Traditionally, we have also seen among the highest percentages of people working more than one job.
Finally, another kudo to our MT Department of Labor and Industry. They have one of the most user friendly and complete set of data I have seen across the country. There is an amazing amount of information available through their Data Dashboards, including WC information.
MSIA Business & Annual Meeting – featuring Amy Lee – Reflections on a Reform
The MSIA Business & Annual Meeting was successful in that we formally adopted a budget and elected Board members Dee Walcheck of Logan Health as Vice Chair, Michael Marsh of Midland Claims Service/Industrial Injury Claims as Secretary/Treasurer and Vicki Evans of MCCF as a Board member at large. The Business & Annual Meeting material has been sent to the members and will be available in the Members Only Section of the MSIA website soon. Our Board meeting minutes are also available there.
Amy Lee, former Director of the Texas Division of Workers Compensation and President of Steadfast Policy Strategies presented, Reflections on a Reform (also available in the Members Only Section). Her message was fairly straightforward and incredibly complex. Straightforward in that reforms are best when based on data – actual knowledge and real findings, rather than anecdotes. Those changes tend to last and can become fixtures within a system. Incredibly complex in that getting that data, verifying that data and combating perceptions, can be very difficult.
Her message, including the Montana reforms of 2011, is that data-driven changes, when paired with an evaluation of the results to determine if the changes had the desired effect, can be very powerful. Lee’s presentation deck is attached and will be on the website as well, in the Members Only Section.
Governor’s Conference – review and access to the presentations
The Governors Conference this year – Better Medical – Better Outcomes was a primer on medical care within our workers’ compensation system. Presenters covered just about everything we address on the medical side of our business. As always, the interactions between the audience and presenters, the opportunities for connections and conversations within the Montana WC community were rewarding and plentiful. The Conference this year also took a moment to remember some of those in our community who have left us so much.
Dr. Ethan Moses, CO Division of Workers’ Compensation Medical Director lead us off with that system’s use of psychosocial testing to help the treating physician to catch all of the issues that might impact recovery. In Assessing the Invisible, Psychsocial Services in Work Comp, Dr. Moses identified that the CO system has approved 9 assessment tools to identify non-physical issues – psychosocial issues - that might impact recovery.
Of course, some of those issues, have little if anything to do with the workers’ compensation injury. While it is good to get a broader perspective on the individual, the workers’ compensation system was never designed to and should not be the vehicle to cure all ills.
Brie Meyer and Dr. John Schumpert presented Manganese: Exposure, Health Effects and Controls. Manganese exposure – inhaled, absorbed or injested into the body system - can cause Parkinsons like symptoms. The greatest exposure is to welders, but manganese is used as an alloy in most steels, stainless steel and aluminum. 1 – 2% of workers are welders and therefore routinely exposed to manganese and in danger of at least inhaling it.
Dr. Al Olszewski provided a primer on Work Related Knee Injuries In The MT Worrkers’ Compensation System. 10% of all injuries in our system involved the knee. Of those, 56% are sprains, strains or contusions, which one would expect to be non-operative. Non-operative knee injuries can be expected to resolve in 3 months or so. Operative knee injuries will take longer, 6 – 8 months time.
Dr. Dan Whiting provided his perspective on hip injuries in Hip 201: Anatomy, Exam, Injuries & Treatments. Hips are one of the two ball & socket joints in our body and the far more stable of the two. In the Montana system, hip injuries are most likely to occur in Health Care & Social Assistance, Education and Retail Trade.
Michelle DesPres talked about her experience in Tables Turned: A Work Comp Exec’s Takeaways From Living the Injured Worker Experience. DesPres story is a fascinating, and frankly scary one. She is a PT and executive with OneCall, one of the nation’s larger WC vendors. You would expect she would know the system – you might also expect the system to take care of her. One of those was true. DesPres had one of our nightmares happen – she got seriously injured while on a business trip – a good distance from home. She stepped off a curb and wound up with a significant fracture of her foot, ankle and leg. Please look at her presentation package and read the stories already published about her story. The message – very clearly - is that we all have to do better for injured workers, and we should feel an obligation to be the best we can be in our chosen profession.
Brian Allen of Optimized Outcome Solutions taught us about Ethics. You might recognize the name and the presentation as Allen was the presenter for the December 2023 MSIA CE Webinar. Ethics is tricky, and we can find ourselves doing something ethically, but illegal, or we can find ourselves doing something legal, but maybe not ethical.
MSIA member Health – e – Systems sent Silvia Sacalis and Amanda Waltemath to talk about Prescribing Empathy – Weighing Patient Well-Being in Workers’ Comp Drug Therapy Trends. While there is a lot to take in from their presentation – one of the things that makes the Montana Governor’s Conference special is the personal connections, the personal interactions because we are a small state system, and the personal stories people bring to our work. This was one of the most impactful personal presentations I have ever seen.
MSIA member Craig Hospital provided Rene Mills to present Managing Challenging Behaviors in Brain Injury. Craig Hospital is a national leader in brain injury treatment as well as significant spinal injury treatments. They are consistently cutting edge in their approach and fully focused on working with their patients. There are no easy answers here – just consistent efforts to help people who have suffered injuries to the head severe enough to impact their behaviors in a less socially acceptable manner. The presentation provides details regarding best approaches towards working with someone in that situation and what you might expect in response.
MSIA members Kerri Poe, with Arcadia Settlements and Daniel Tiscareno Romero, with Ametros were joined by Hany Abelsayed with Tower MSA in providing A Hands-On Approach to Medicare Set Asides (MSAs). Rather than a legal dissertation of the ins and outs of CMS requirements and reporting rules (see the MSIA Webinar 9/19/2024), this presentation was, as advertised a working desk level discussion of MSAs.
In those situations where you have reached agreement with the injured worker on a settlement, if certain conditions are present – like the potential of Medicare being tapped for some of the medical expenses as a result of the injury, you have an obligation to protect the Medicare Trust Fund, under federal law. Vendors can help identify what the MSA should be. Poe and Arcadia can help set up the funding mechanism, whether it is a structured settlement or as part of an annuity and Ametros can provide professional financial management to make sure funds are there when needed by the injured worker. This is a growing complicated area of our business and Medicare is becoming more aggressive in seeking information regarding settlements. They will be starting to apply civil monetary penalties to WC benefit payers for poor reporting. And, while this idea may be off in the future, we have to consider what happens if there is a funded MSA, that no longer has money and the beneficiary (the injured worker) gets turned down by Medicare for medical bills that would have otherwise been paid through the MSA. That’s the importance of financial management. The services offered by Arcadia and Ametros are paid for separately from the settlement and not by the carrier or the injured worker.
Dr. Michael Wright provided his perspective on shoulder issues in Common Work-Related Shoulder Conditions & Treatments. Like the hip, the shoulder joint is a ball & socket joint. The most significant difference is the number of muscles, tendons and ligaments holding the shoulder together and the cup is significantly more shallow than the hip joint. This works well as, unlike the hip, we can move our appendage (arm) behind us while twisting. In short, it is likely the most complicated joint in our bodies and injuries in this area are sometimes the most confounding. As an example, smaller shoulder injuries, AC joint, biceps tendinosis, labral repairs and clavicle fractures, will take 6 months to heal. Rotator cuff repairs can take a full year. And, many of these injuries require immobilization, work modification, time and physical therapy.
MSIA member Clarus IME psychologist Dr. Laura Kirsch presented Psychological and Neuropsychological IMES Everything you wanted to know, but were afraid to ask. Dr. Kirsch also presented the September, 2022 MSIA CE Webinar. Her presentation provided background om the differences between psychological and neuropsychological exams. Both however, have the same goal - to provide psychological data to assist in making claim determinations, be they about the initial injury or delayed recovery. Dr. Kirsch’s presentation style is such that she helps us understand significantly important issues, while remembering that we are dealing with people, their issues and sometimes their families, as well as a complex legal system.
The Governor’s Conference this year started a new tradition, which we hope they will continue. They took a moment to remember those the workers’ compensation community has lost recently. For MSIA, Judy Hosford, founder of Industrial Injury Claims and one of the pioneering women leaders in our industry and Larry Jones, former MSIA Executive Director and an attorney who is likely to have appeared before the MT Workers’ Compensation Court more times than anyone else, including the Judges. Montana is a small town – the Montana WC community a tight knit group within that small town, When we lose someone, we notice. Our thanks to the Governor’s Conference committee at the Department of Labor for taking a moment to honor those who have come before us and left so much.
As always, the Workers’ Compensation Court Judge provided his perspectives on the Court and practice at the Court. Judge Lee Bruner is relatively new to the Court and shared his judicial philosophy and approach towards the law. He will be looking to provide greater privacy of personal information through Court processes and will request attorneys representing either side, who provide filings, which wind up being public documents, take the time to limit the personal information contained in them. He will reject those filings where personal information may be unnecessarily included. Presumably, he will provide some time to correct the filings. As well, he looks at the language of the law, as it is written, not necessarily as it has operated.
New Reporting Rules for MSAs – What You Don’t Know Can Hurt – 10a MDT 9/19
Join us September 19 at 10a MDT for the MSIA CE Webinar, New Reporting Rules for MSAs – What You Don’t Know Can Hurt
Presented by Heather Schwartz Sanderson of Sanderson Firm, PLLC. Advance Registration required – contact MSIA or use the link to sign up. MSIA members have access to unlimited free seats (if you are receiving this you are eligible for free seats)
CE Credit for Insurance Producers available through the MT Commissioner of Insurance and Securities* CE Credit for WC Claims Examiners through the MT Dept of Labor
Heather Schwartz Sanderson is a nationally recognized legal expert in Medicare Secondary Payer (MSP) Compliance, known for her cutting-edge expertise, practical analysis, and industry advocacy. Her extensive legal experience includes federal class action litigation and state-level matters and contributing to MSP legislative reforms since 2011.
One thing is clear – Medicare issues, MSAs, CMS reporting and penalties and ongoing responsibility to protect the Medicare Trust Fund, as created by the Medicare Secondary Payer Act, are not going away. You don’t want to miss this important MSIA CE Webinar - New Reporting Rules for MSAs – What You Don’t Know Can Hurt - Webinar - on September 19.
This MSIA Webinar is sponsored by:
Debbie.CollinsMcCune@mesgroup.com / 503-545-5857
Michael Marsh at MMmarsh@midlandclaims.com / 406-656-9960