MONTANA SELF INSURERS' ASSOCIATION
October 2022 Update
- Next MSIA Continuing Education Webinar Sponsored by Ritsema
Law and Midland Claims Service – November 9 10:a MDT
- Chronic Pain – Integrative and Complementary Strategies To Make a Difference
- MSIA Business & Annual Meeting Review
- Governor’s Conference Review
- Next MSIA Continuing Education Webinar - sponsored by Ritsema Law & Midland Claims Service – November 9 10:a MDT
Chronic Pain – Integrative and Complementary Strategies To Make a Difference
The next MSIA Continuing Education Webinar, set for November 9, starting at 10a MST is sponsored by
- Ritsema Law (WORKERS' COMPENSATION AND GENERAL DEFENSE EXPERTS) and
- Midland Claims Service (Midland Claims Service – Workers' Compensation in Montana)
Becky Curtis, founder and principal of Take Courage Coaching will present “Chronic Pain – Integrative and Complementary Strategies To Make a Difference.” Curtis speaks from personal knowledge about chronic pain, as she has suffered since a horrific auto accident in 2005. Rather than let it rule her life, Curtis has found a different way to deal with her pain. She has studied, learned and recognized there are alternatives to addressing chronic pain than just prescribing more opioids. Curtis is an engaging speaker with a heart-felt and a personal history with chronic pain and life recovery. At the least, her presentation will move you on a personal level - - and, it may provide a real opportunity for a different way to help your injured workers who deal with chronic pain. Curtis offers a unique perspective on the issues and can provide results that change the opioid spiral. Learn more about Take Courage Coaching - Take Courage Coaching
You will not want to miss this moving and educational presentation by a national speaker, who hails from Montana. Webinar attendees will learn:
- How to Establish a Restorative Partnership with Patients;
- How to Identify Contributing Factors to Non-Functionality;
- Techniques Used in Pain Management Coaching Increase Compliance and Functionality; and
- The Power of Positive, and Negative, Thoughts on Chronic Pain
This MSIA Continuing Education Webinar is sponsored by Ritsema Law and Midland Claims Service.
- For Ritsema Law, contact Danielle Vukonich at firstname.lastname@example.org or 406-471-4757.
- For Midland Claims Service, contact MSIA Secretary/Treasurer Michael Marsh at email@example.com or 406-656-9960.
MSIA Continuing Education Webinar seats are included in membership dues and MSIA members have access to an unlimited number of seats. If you are on this distribution, you are an MSIA member.
Advance registration is required for the MSIA CE Webinar, Chronic Pain – Integrative and Complementary Strategies To Make a Difference, on November 9, starting at 10a MDT. Claims Examiners, attorneys, insurers, medical providers, labor and business interests will want to take advantage of this opportunity to learn about alternatives in treatment for chronic pain first-hand from a personal expert.
We have received one Montana CE credit for licensed claims examiners for this Webinar. To sign up for the Chronic Pain – Integrative and Complementary Strategies To Make a Difference, on November 9, 2022, starting at 10:00a (MDT), contact the MSIA office by text, telephone or email. When you sign up, we will send you a webinar placeholder invitation and will provide the Zoom invitation for this webinar about a week prior to the event.
Attendance will be taken, via the Zoom application.
MSIA Business & Annual Meeting Review
MSIA held our 2022 Business & Annual Meeting, sponsored by Browning, Kaleczyc, Berry & Hoven and Definiti Comp Solutions and Definiti Rx, on September 28 in Missoula. Twenty two MSIA members were represented and we received seven quorum proxies. All told, there were close to 50 people in attendance including guests.
We reviewed the MSIA financial results from the prior year and the calendar year to date financials. Our bottom line is good – we have seen steady increases in our revenue from membership dues as well as sponsorship funds and the sale of seats to non-members for our new MSIA Continuing Education Webinar series. Our membership numbers continue to increase with new members joining fairly regularly. Our reserve investment accounts have suffered over the past year with the stock and bond market fluctuations. Even so, we continue to maintain about 150% of operating revenue in reserves.
The membership approved the proposed budget for the year. This budget reflects both an increase in expenses as well as revenue. We again adopted a deficit budget, with the expectation that our expenses would not be as great as forecasted – as was the case last year. In a worst-case scenario, our reserves are more than enough to cover the projected deficit, however, again, while we cannot pinpoint budget savings at this time, we do not expect to spend as much as projected.
A number of members provided their responses to our confidential member survey and we reviewed those results. The responses help the Board and I determine our positions on specific issues as they arise in the public policy forums. No individual responses were discussed and a review of the messages from the responses are part of the meeting minutes (for members only) and will be sent to members and available in the Members Only section of our website.
The members adopted the three recommended bylaw changes for this year:
- To clarify that Associate members counted towards creating a quorum for MSIA meetings;
- To permit Captives, in any legal form, to become Employer members of the Association; and
- To clarify the Executive Director of the MSIA is a non-voting, ex-officio member of the Board of Directors of the Association.
We reviewed the successful change in our tax status as recognized by both the IRS and Montana from a for-profit corporation to a tax-exempt corporation. The import of this should be reduced accounting bills as filing as a 501(c)(6) tax-exempt trade association of our size should be far simpler than the for-profit filings we have made in the past. State approval of our tax-exempt status also eliminates the minimum $50 corporate tax we had been paying. This status is a more accurate reflection of our organization. Since we are tax-exempt, not a charitable organization, our educational and advocacy efforts on public policy issues are not impacted.
Earlier this year the Board adopted a Conflict of Interest statement for itself and the Executive Director. This was the next logical step after last years’ adoption of the Board of Directors Responsibility Statement and provides greater transparency in our Association governance. All Board members, including the Executive Director, have filled out the Conflict of Interest Statement and the statements are on file. Should conflicts arise, the individuals involved recuse themselves.
Finally, the membership re-elected Michael Marsh of Midland Claims as Secretary/Treasurer and Dee Walcheck of Logan Health as a Member at Large to the Board of Directors for two year terms each. Next year, based on our staggered terms the Chair, Vice Chair and another Member at Large seat will be up for election. Our Bylaws specifically provide that the members elect our Board officers, not just members who then select the officers.
Meeting minutes have been drafted and will be reviewed by the Board of Directors at their next meeting. Upon their approval, the minutes, along with supporting documentation, will be provided to the members and made available through the Members Only section of the MSIA website.
Annual Meeting - - Our featured guest speaker, Dr. Greg Vanichkachorn, of the Mayo Clinic was not able to join us as he contracted COVID over the weekend.
Mark Pew, the Rx Professor, stepped in and did a wonderful job. Pew talked about his work as the Provost and co-founder of the WorkCompCollege.com – an educational effort for the industry to help attract, train, retain and increase the level of professionalism of our staff and specifically claims examiners. The course structure is such that anyone in the industry can benefit and is built so that it is much more encompassing than just workers’ compensation statutes and rules. The professors, trainers and educators come from all walks of life, and include workers’ compensation experts, to provide a well-rounded and complete educational experience. The culmination of the course work will be a Workers’ Recovery Program certificate, which will be recognized throughout the industry as documentation that not only can the individual help manage claims but knows how to address workers’ compensation issues from a humanistic perspective. The anecdotal results so far of organizations that reflect that approach indicate significant cost savings through faster return to work and lower litigation levels. More information can be found at www.workcompcollege.com. While not state specific at this time, the expectation from WorkCompCollege.com is they will be soon. More to the point, as Mike Marsh of Midland Claims pointed out, Montana State University – Billings is starting a workers’ compensation course study. Marsh and MSU-B have already gotten commitments from carriers to send people as interns through the program. Pew and Marsh agreed continued discussion about Montana, through MSU–B may be a good pilot program for the WorkCompCollege.com individual state certification program.
Governor’s Conference Review
It struck me that this year’s Governor’s Conference was one of the better ones I have attended. I have been at the Conferences since sometime in the mid-90’s and they have ranged from a very good use of my time, to relatively deadly. This year the speakers, the topics and the administration of the Conference, as well as the vendors who had booths, all contributed to one of the best in my experience.
Presentation packages from the Conference are available at 2022 Governor's Conference (mt.gov)
The Conference kicked off with an interesting perspective on the workers’ compensation system from someone who admitted that they had not been involved with workers’ compensation until four years prior, and at that, they were involved from a researchers’ perspective.
Elaine Weiss, Policy Director for the National Academy of Social Insurance (NASI) presented “Workers’ Compensation: 100 Years Since Enactment, 50 Years Since the Commission. Where Do We Go Now?” Weiss reported the National Commission report issuance 50 years ago immediately lead to some very positive and needed changes in the states’ workers’ compensation systems. However, since the 1990’s or so, the “reform wave” of that time have cut benefits, reduced access to benefits and reduced access to care. The result, from Weiss’s perspective is the potential of breaking the promise of the Grand Bargain.
Weiss relied on a taped interview with Commission Chair John Burton NASI did in 2021. Burton, who directed the Commission and supported the increase in both access to and benefits provided at that time, remained in that mode. He has generally opposed even the requirement that work be the major contributing cause of the injury or illness claimed. Based on his statements, Weiss was very critical of the changes in workers’ compensation system which have led to greater stability and lower costs. She characterized the changes as states racing to the bottom to attract economic development. Weiss was even dissatisfied with the improvements in safety in the past 50 years. Weiss insisted that the safety advances were not available to all workers. She cited independent contractors, whom she characterized as being forced into that role, as not having the opportunity to access to safety or benefits. Based on that premise, Weiss contended the advances in safety and the reported reduction in claims was likely to be inaccurate and inadequate.
The presentation was interesting and provocative. Weiss also mis-characterized some of the 2011 changes in the Montana system – interestingly, to a Montana audience who generally knew better.
I had seen an earlier version of this presentation at the WCRI Conference back in March and reported on it at that time. It was my impression the labor representative there did a superior job in making their points. To be fair, he was a much more polished speaker, is a workers’ compensation practitioner and was part of a panel including an industry representative and a WC judge from Florida. My report, from the MSIA April 2022 Update Part II, is attached.
Dr. John Schumpert of the Resources for Occupational and Environmental Health (REOH) next presented “Plumbing and Wiring – Occupational Thoracic Outlet Syndrome (TOS). Schumpert provided case examples he had personally been involved in to identify the differences in the three basic forms of TOS, the basic anatomic causes of TOS and how the three forms of TOS should be properly diagnosed. As is always the case in my experience with Dr. Schumpert’s presentations, he helps lay-people understand the sometimes very complex medical issues involved with workers’ compensation injuries. He also provided sound advice for those involved with claims:
- Ask the provider which type of TOS they have diagnosed and the basis for their diagnosis – do not just accept the TOS diagnosis – learn more about it from the provider;
- Don’t forget that disputed TOS is the most common form of TOS diagnosed – seek objective findings beyond a non-dermatomal sensory loss; and
- While COVID-19 can be associated with TOS, typically, as the COVID symptoms wind down, so do the TOS symptoms.
Patrick Robinson, VP of Government Affairs for ODG by MCG, presented “ODG by MCG - Using Evidence Based Medicine to Improve Workers’ Compensation Outcomes for Montana.” Montana adopted medical treatment guidelines based on the Colorado WC Treatment Guidelines in 2011. Since that time, the state had adopted the ODG by MCG for a Drug Formulary guideline.
Robinson provided a good background discussion on what “evidence-based medicine” is and how it came to be. He reviewed and contrasted the ODG medical treatment guidelines with the Colorado guidelines and provided a brief primer on how to use the Montana Drug Formulary platform – from either the provider’s perspective or the claims examiner’s perspective. One of his key points is that the ODG guidelines, and all quality guidelines are living documents. There are appropriate exceptions, changes and deviations that should be considered and approved particularly for individual situations. All guidelines, at least in the medical field, should allow for these differences, allow for changes and should be flexible to allow for individual treatments, while maintaining reasonable standards.
Bob Wilson, recently retired from WorkersCompensation.com, and co-founder of the new WorkCompCollege.com (see above) was unable to attend the Conference due to Hurricane Ian aiming at his living room. Mark Pew, the Rx Professor and the other co-founder of WorkCompCollege.com, (and MSIA Annual Meeting guest speaker) filled in for Wilson and did a more than admirable job. In presenting Wilson’s “When Words Don’t Help” Pew pointed out that the language of the industry is part of our problem.
He posited that we first consider the name – workers compensation (emphasis added). The focus is on compensation, not on the injured worker, their injury, the impact on their family or most important, their recovery. We employ claims examiners who investigate incidents as opposed to people who provide assistance in an injured workers’ recovery process.
Pew ultimately had some fun with the audience in asking for alternative terms for claims examiner. In addition to the “worker recovery specialist,” there was the suggestion of a “talent restoration specialist,” which we all thought was cute (if you consider employees as the talent that makes our individual businesses work, you can connect the dots to see how we got to this phrase). As a result, Wilson (through Pew) contends we are hurting ourselves in creating a less than ideal, if not hostile, relationships with injured workers and discourage new generations of employees, if only because of the words we use to discuss and describe what we do.
Pew also provided his presentation, which piggy-backed Wilson’s presentation nicely. His scheduled presentation, “Lighting the Torch,” was all about working in a multi-generational workplace, finding and keeping new talent. His sub-heading for the presentation was “Not only do we need to pass the torch, but we need to effectively light it.” Continuing with the words theme from Wilson’s presentation, Pew compared what is too often our reality, with what attracts talent more often than not .
Rules driven insurance - Agile
Complicated - Collaborative
Antagonistic - Win-win
Closing a Claim - Recovery
Dollars - Sense (as in it makes sense to provide additional services to help someone feel comfortable – and keep them away from attorneys)
Finding a way to say “No” - Helping people in their time of need
Continuing on the attract talent and retain them theme, Pew challenged us to pick someone to mentor by Thanksgiving and to document five things we do that no one knows about.
The Claims Examiner roundtable, featuring MSIA member Kevin Bartsch of the Montana School Boards Group, MSIA member Jamie Kern of Intermountain Claims and MSF Claims Manager Chris Simonson was a great discussion of the realities of the work of claims examiners in the Montana system. Let there be no question the people who work claims in Montana are dedicated and caring people who honestly try to do the best they can. We are somewhat hampered by our laws and requirements to follow the letter of the law or regulation. Even so, Montana claims examiners are among the best in the business.
The Physician Roundtable, hosted by Montana Department of Labor Medical Director Maggie Cook-Shimanek featured Dr. John Schumpert of REOH, Dr. John Petrisko of the Billings Clinic in Billings, Dr. James Owens and Dr. Hans Schwertz, both of the Billings Clinic in Bozeman. The physicians discussed their perspectives, as practitioners in our system on
- Marijuana and Workplace Safety and Health,
- Long Haul COVID-19 and related issues,
- The use of Evidence-Based Medical Treatment Guidelines and specifically the MT Treatment Guidelines, and
- A brief discussion on the AMA Guides updates and telehealth in Montana.
All members of this panel are well versed in our system and what it takes to practice in it – as a result, they had a lot to share and provided some interesting perspectives regarding our work. Specifically, Schwertz identified studies had found that driving while under the influence of cannabis led to more accidents. However, numerous studies on cannabis and workplace safety other than driving, did not conclude there were workplace injury increases – in fact, could not identify a higher level of concern. One of the issues in the United States is that cannabis is still illegal under federal law, and therefore US studies on the effects of cannabis on workplace safety are scant, if any.
I provided a presentation on what I see as the Topics, Trends and What Will Happen Next in Workers’ Compensation. About half of my presentation was a contrasting perspective on where we are 50 years after the release of the National Commission report from Weiss’s presentation. I spent some time on where the US is in terms of our workers’ compensation systems, how we got here and where we have been heading over the past 10 – 15 years.
I joined the industry in time to see the liability crisis of the 80’s which coincided with the meltdown of the workers’ compensation markets in the states (for different reasons). I was tapped by the industry to sheppard some of the major workers’ compensation system reforms into enactment. Based on my first-hand knowledge, I discussed some of the how’s and why’s of necessary reforms and how we came to agreement with all sides on the changes. Do not be mistaken, the reforms passed in the 90’s generally were supported by all stakeholders. Negotiations included everyone involved in the systems, not just the business side.
Those of us in Montana who remember the Old Fund Liability Tax deducted from our paychecks know all too well what happens when we expand opportunities for benefits and “rights” to those benefits and increase benefits. Across the country we have seen almost complete acceptance of presumptions of injury or illness applied to workers’ compensation. In addition, this year some states have statutorily increased benefits, statutorily increased access to care by permitting additional licensed professionals to become treating providers (beyond physicians) and expanded their presumptions. These changes are in addition to increases in benefits based on increases in SAWW. There is only one logical conclusion from increased benefits, access and “rights” to coverage - costs will go up. Our only questions are when and how will the markets will respond.
Amber Worman, of AK Worman Associates provided a primer on the new requirements to protecting Medicare’s rights under the Medicare as Secondary Payer (MSP) law. Worman, along with Ciara Koba of Allan Koba Compliance Solutions provided the first MSIA Continuing Education Webinar on this same topic in March 2022.
Recent changes have clarified that not only Medicare, but the privately sold Part C and Part D coverages – Medicare Advantage Plans (MAP) and Drug coverage respectively – have the same rights as a secondary payer as Medicare. While CMS is required to provide known Part C & D coverage contacts in response to the required reporting for potential Medicare beneficiaries by casualty insurers (workers’ compensation benefit payers) their response information is limited to what they have, and only covers the prior three years. Since individuals can (and do) change MAP and Drug plans somewhat routinely, getting the accurate information is, well, interesting sometimes. More to the point, 46% of Medicare beneficiaries have purchased Part C and or Part D coverage.
The reason this is important, in addition to our requirements to follow the law, is the potential $1000 per day, per claim penalty AND the private right of action and double damages the Parts C and D coverage providers have against casualty insurers in the law. Even if we try and fail, we are still responsible for making sure Medicare and the Part C and D coverage providers MSP rights are protected. Should we fail, we are responsible and the beneficiary – our injured worker – may also suffer benefit denials from Medicare if we do not perform the required tasks properly in our settlement processes.
The ultimate message is that this is a complicated process, there are Medicare acronyms and language we as workers’ compensation providers are not familiar with, and the consequences of not properly protecting Medicare’s and Part C and D coverage MSP rights, can be financially severe.
If you are aware of something we should be looking at, or looking into, please do not hesitate to contact us. Have a happy and safe Halloween!