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Industry Insights

Paduda: COVID and Work Comp in the Sunshine State

  • State: Florida

WorkCompCentral hosted a webinar last week (you can watch at no cost) diving into key issues related to Florida’s experience with COVID-19 and workers’ comp.

Joe Paduda

Joe Paduda

Moderated by Rafael Gonzalez (one of the nicest people you’ll ever meet), the panel included a defense attorney, judge and managed care executive providing different perspectives on COVID’s impact.

Most of the discussion focused on solutions; we’ll touch on the ongoing issue of claim acceptance before highlighting some of the solutions discussed by the panelists.

Claims filed versus accepted

Deputy Chief Judge of Compensation Claims David Langham noted that about 7,000 of roughly 17,000 COVID claims filed have been partially or completely denied, yet to date only a handful have filed petitions seeking benefits (a petition would lead to a formal hearing).

Ya’Sheaka Williams, a defense attorney, spoke at length about health care workers’ exposure, indicating that in her experience, claims filed by these workers weren’t contested. She provided good insight into differences between “essential” versus “non-essential” workers, noting sanitation workers are even more important now than ever, as it is critical to safely dispose of potentially contaminated materials.

Langham also noted that 96% of accepted cases have resulted in payments less than $5,000; the average is less than $1,000 (consistent with data Mark Priven and I previously reported).

Of course, as Langham indicated we do not know what the long-term impact of COVID-19 on individuals will be; there’s evidence that some individuals have lasting chronic conditions, some of which can be quite debilitating.

Langham averred that, “in the United States, we aren’t reporting who has recovered, whatever that means.” That surprised me, as a slide displayed earlier in the same presentation specifically reported recoveries in the U.S.

In defense of Judge Langham, I hasten to add that, in fact, that while there is some reporting of “recoveries,” there’s no universally accepted definition of recovery, nor is the reporting of recoveries consistent across states or even counties within states. For example, Texas has reported 680,000 recoveries while New York, a state with much higher infection counts, has reported only 77,000, and California and Florida have not reported any recoveries (at least as reported by Johns Hopkins).

The lack of clear and specific definitions and guidance from the federal government — and a federal mandate that reporting entities stick to those definitions and guidance — is highly problematic.

Matthew Landon, chief strategy officer of MTI America (an HSA consulting client), suggested that employers ensure they are using the same processes, procedures and strategies to evaluate COVID-19-related claims that they use for all claims. Consistency is critical to demonstrate objectivity.

Lessons learned

Judge Langham noted that virtual hearings are proving we can use technology to speed up cases, engage with claimants more effectively and get to resolution quickly despite the inability to get together in person. He also encouraged all of us to “protect ourselves mentally and physically” so we can help others.

Kudos to Judge Langham for reminding us that before one can help others, one has to take care of oneself.

Landon identified telephonic translation services as a key tool speeding up claims handling and ensuring the right care is getting to workers with language limitations. He also noted that care within medical offices seems to be more effective, as patients are seen more quickly with lower waiting times; office managers are working to keep the number of patients in offices as low as possible.

More care is being delivered in the home of late, a response to workers’ desire to avoid medical facilities.

Williams reported that Tampa International Airport is partnering with BayCare Health System to provide passengers coronavirus tests on-site at no cost to the passenger, highlighting one example of companies working together to come up with creative solutions to reduce risk and personal stress levels.

She also was encouraged that the delays in accessing care experienced by many injured workers seem to have abated somewhat, a promising development as more clinical practices open up for on-site care and more providers adopt telemedical solutions.

What does this mean for you?

Good information from folks with deep knowledge of Florida’s experience, much of it applicable to other states as well.

Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.

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