HomeMy WebLinkAboutCOM 0683.011 1998-2000 4OVMtY Os M14'
Stephen K. Yamashiro Jay A. Sasan
Mayor Sa fep' Coordinator
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DIVISION OF INDUSTRIAL SAFETY ~ ^r
Workers' Compensation Unit ~ ~ 13 P~I'I 7 59
35 Wailuku Drive Hilo, Hawaii 96720 (SOR) 961-8344 Fax: (SOR) 961-841G -
MEMORANDUM
TO: Aaron S. Y. Chung
Chairman, Finance Committee
Hawaii County Council
FROM: Lester J. Ishado /fo0
Deputy Corporation Counsel
County of Hawaii
RE: Workers' Compensation Unit Staffing
DATE: April 11, 2000
Current Staff
In response to your request for additional information justifying the hiring of
additional staff, I am submitting this Memorandum. The County of Hawaii's Workers'
Compensation Unit (herein, "Unit") currently consists of one deputy corporation counsel,
two workers' compensation claims clerks, and three part-time filing clerks (from Senior
Employment, Cooperative Vocational Education, and First to Work programs,
respectively). At the present time, one workers' compensation claims clerk is on leave,
and the First to Work position is vacant.
Duties
The Unit is responsible for processing workers' compensation claims for the
County of Hawaii. Its duties include, but are not limited to:
1. Filing WC-1 forms (Employer's Report of Industrial Injury). The Unit
receives WC-1 forms from the various county departments and
processes the WC-1 forms (accepting or denying p workers'
compensation claim) for filing with the Department of Labor and
Industrial Relations (herein, "Department"). Under Section 386-95,
HRS, the Department could fine the County up to $5,000.00 for any
failure to file the WC-1 within 7 working days after knowledge of
such injury. t ~ c~• 0/
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Aaron S. Y. Chung, Chairman
April 11, 2000
Page Two
2. Filing WC-3 forms (Carrier's Case Report). The Unit must file WC-3
reports summarizing payments made within 30 days after the final
payment, or for ongoing cases, by January 31 of the next year. The
Department could fine the County up to $5,000.00 for any untimely
filing.
3. Filing WC-14 forms (Employee's Wage Report). Based on the WC-
14 forms from the county departments, the Unit calculates the
average weekly wage and the compensable weekly wage payable
under Chapter 386, HRS.
4. Reviewing WC-2 forms (Physician's Report). The Claimant's
treating physician prepares and files WC-2 forms on the diagnosis,
prognosis, and treatment of the Claimant. The WC-2 form is also
used to certify the periods of disability (to pay temporary total
disability to the claimants). The lack of adequate staff to properly
review the reports will delay payments to claimants and result in
authorizing unnecessary treatment.
5. Reviewing and approving or denying treatment plans and requests
for consultation or surgery. The Claimant's treating physician files
treatment plans, e.g. chiropractic care, and requests for
consultation or surgery. The plans must contain specific
information, including commencement and termination dates,
specific diagnosis, time schedule of measurable objectives, number
and frequency of treatments, modalities and procedures, and
estimated total cost. The requests for consultation and surgery
must also contain specific information. Some doctors have
bypassed treatment plans, using phone calls, slips, and
prescription forms to order treatment. The Unit spends a great deal
of time in reviewing and approving or denying treatment plans.
Each plan must be reviewed, and in some instances, further
information is needed. Numerous letters and phone calls are
sometimes required to follow up on each plan. Because treatment
plans have a limited duration of 120 days and different types of
treatment may be requested, each claim may involve many
treatment plans each year. The time to approve or deny a
Aaron S. Y. Chung, Chairman
April 11, 2000
Page Three
treatment plan is extremely limited. Unless the employer denies a
treatment plan within 7 calendar days, including weekends and
holidays, the plan is deemed approved. The lack of adequate staff
to properly review each plan will result in unnecessary treatment
being rendered and unnecessary costs to the County.
6. Providing medical records and reports to the Claimant and the
Department. The production of documents has been hampered by
the absence of permanent, full-time clerks. At the present time, the
deputy corporation counsel and the two claims clerks are doing
their own typing, and if staff is unavailable, their own copying and
mailing. Mail must be taken to the County building by 3:00 p.m. of
each day. The Department could impose penalties for missing
deadlines for the production of documents, in particular, for
hearings.
7. Approving and processing payments to claimants and medical
providers. Payments to claimants and medical providers are
sometimes delayed pending decisions on compensability, approval
of treatment plans, and further information or medical review, etc.
The Unit does not have the staff to make review, approve, and
make timely payments. The lack of adequate staff will result in
delays in making payments or in making payments prematurely but
erroneously. On the one hand, if payments are not made when
due, claimants and medical providers will become frustrated, and
the Department could, in some instances, impose penalties. On the
other hand, if payments are made prematurely but erroneously, the
County may be unable to contest compensability or recover
overpayments. Even in cases where payments should be denied,
the Department has allowed the payments to continue, noting that
the County has made these payments in the past and why change
it now.
8. Preparing for and attending hearings at the Disability
Compensation Division level, Labor Appeals Board level, and if
necessary, on the appellate court level.
Aaron S. Y. Chung, Chairman
April 11, 2000
Page Four
9. Negotiating the settlement of claims and the collection of the
County's subrogation claims.
10. Communicating with attorneys, claimants, physicians, county
departments, etc.
Workload
As of March 29, 2000, the Unit had 722 open cases. The Unit has attempted to
close as many cases as possible. As indicated at the Finance Committee March 29,
2000 hearing, however, cases generally cannot be closed until eight years have passed
since the last payment of compensation, the claimant dies, or a full settlement (wash) is
reached. Thus, cases will remain open for a very long time. The Unit will informally
close a case after a long period of inactivity, but this is little more than moving files from
the "active" filing cabinets to the "inactive" filing cabinets.
The Unit's current staff of a deputy corporation counsel and two claims clerks
will:
1. Process approximately 60 medical bills per day (14,400 per year).
2. Photocopy and mail about 264,000 pages of medical records,
reports, etc. per year.
3. Handle approximately 40 phone calls per day and write and/ or
receive approximately 60 letters per day (9,600 phone calls and
14,400 letters per year).
4. Review WC-1 forms for approval or denial.
5. Review for approval approximately 20 treatment plans per day
(4,800 per year).
6. Review approximately 100 WC-2 forms per day and pay TTD if
applicable (24,000 per year).
Aaron S. Y. Chung, Chairman
April 11, 2000
Page Five
7. Prepare for and attend approximately 6 to 12 DCD hearings (in
Kona and Hilo) each month. The Unit also has 13 cases on appeal
before the Labor Appeals Board.
8. Order independent medical examinations and review resulting
reports.
9. Negotiate PPD settlements.
Benefit to the County
As indicated at the hearing, the benefit to the County of Hawaii cannot be
adequately measured in terms of closing more claims. Unless the claimant dies or
agrees to a "wash", the County is required to keep claims open for at least eight years
after the last payment is made. Thus, the number of cases can be expected to remain
steady or increase.
State law mandates benefits under Workers' Compensation, and the County of
Hawaii, as an employer, must comply with this law. The primary benefit of additional
staffing to the County will be in the efficient handling of processing workers'
compensation claims, and the attendant cost savings therein.
Insurance adjusters generally handle between 150-175 cases each. Adjusters
with the City and County of Honolulu handle approximately 100 to 150 cases each, with
clerical help. Adjusters with the County of Hawaii handle approximately 300-350 cases
each.
The hiring of additional staff will enable the Unit to spend more time on each
case. This in turn will help to avoid errors in determining compensability and errors in
making payments; avoid potential fines and problems in untimely filings; renew
confidence in the workers' compensation system; and settle or close more cases.
Please call if you have any questions or comments.
cc: Corporation Counsel
Safety Coordinator