My company deals with a massive amount of workers’ compensation information. Between news, statutes, regulations, forms, court decisions, legislative and rule changes, there is plenty to keep us busy. Many people are not aware of it, but between our (shameless plug) online claims compliance and research library, our forms auto-population and management systems, our Virtual Claims Kits, our Benefit Calculator engines and our workers’ comp conference registration services, our data impacts thousands of claims and comp professionals every single day. And very few people seem to realize that. We even considered making our company tagline, “We’ve Touched You, and You Don’t Even Know It,” but in marketing focus groups that was determined to be “creepy.”
Go figure.
Our associates have become so good at what they do, that no fewer than four times this year they have discovered errors by state workers’ compensation agencies; errors that were corrected after we brought them to their attention. Those errors were varied, from form issues to miscalculated benefit rates. One of them was a rule that directly contradicted statutory requirements in the state. In most instances, the communications with the states is friendly and straightforward.
But once in a while, interactions occur that just leave you shaking your head. Or laughing your ass off. We’ve had two of those instances just this past week.
As January approaches, many, if not most states issue updates to their Min/Max benefit rates. This past week one state sent out such a notice updating their amounts for the coming year. One of our compliance people noticed that the minimum amount did not match percentages that were quoted and contacted the state to let them know of the apparent error. We won’t disclose the state or the job title of the person who was contacted, but suffice it to say that the message went to the “Big Giant Head” within the agency that oversees the workers’ compensation department. The response from the office of the Big Giant Head was swift and friendly. It said:
“Hi, Do you know who in WC puts these bulletins together? I am happy to reach out to them to get this fixed. Thank you!”
Huh? Do we know who in your department does this for you? While we could not answer that question, the state did issue a correction very promptly after that.
The other exchange this week, which made me laugh raucously, occurred when we needed specific information.
Earlier I referenced an online claims compliance and research library we run. It is called WorkCompResearch.com. One of the things we do for clients of that system is to try and help them find information they need or get clarifications when the legislative/legal language available is not obvious. One customer asked our staff if we had a list of states where “benefit payments (checks, etc.) are required to be issued from an office within the state?” Since the answer to that question is not clear in many jurisdictions, the quest was on to provide one.
Following is the email exchange that occurred between one of our compliance people and a customer service rep of one state’s workers’ compensation agency. It occurred over a span of two business days. We have replaced the state name with [your state]:
Our Compliance Person:
I received the following question from a client and I was hoping you could help.
1. Are benefit payments (checks, etc.) required to be issued from an office within the state?
Do you have this requirement? And if so, can you point me to the rule/statute?
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State Employee:
Please be advised that we do not issue out any checks to clmt’s. The employer’s-insurer send payments out to the injured workers per week if it’s found to be compensable.
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Our Compliance Person:
Does the employer’s insurer have to issue the payments from an office in [your state]?
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State Employee:
Good afternoon,
Payments only comes from the employer- insurance company.
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Our Compliance Person:
Yes, I understand. Some states require that the insurer have an office in the state and must issue the payments from there.
So if the insurer’s main office is in a different state, say Florida, they can issue the payments from the Florida office, correct?
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State Employee:
Good evening,
What your claim number?
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Our Compliance Person:
There is no claim. It’s a general question.
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State Employee:
Good morning,
If the injury was sustained and claim was filed in Florida. Florida’s Worker’s comp Employer-insurer would pay the loss wages.
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Our Compliance Person:
I guess I’m not being clear as to what I’m asking.
Let’s say an employee is injured in [your state], claim is filed in [your state]. The insurance company uses a third party administrator that has their office in Florida. Can the TPA issue the check to the [your state] claimant from an office in Florida.
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State Employee:
It’s not uncommon for a Employer-insurer to have a Third party Administrator .That’s just A Comp carrier under the umbrella of an Insurance co.
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It was somewhere after this point we had to talk our employee off the ledge. Thank God she is in a first-floor office. We long ago removed all sharp objects from the Compliance Department.
And we are also thankful to our NWCDN partner in that state, as they answered the question with just one email.
I read that entire exchange to a friend over the phone. He suggested the state may be employing artificial intelligence, and that we were in fact trying to reason with a chat bot. I considered that for a moment but rejected the idea. A chat bot would have employed better grammatical structure, and probably provided a more intelligent answer overall.
While state agencies differ, and some seem a little more on top of things than others, it is a reminder that it really doesn’t matter what state you are doing business in when it comes to workers’ comp. The State of Confusion generally rules the day.