Preathorization of Medical Treatment

At the recent Vermont Workers' Compensation Adjusters' Continuing Education Conference a number of participants had questions regarding pre-authorization under Vermont law.  The statute sets forth time lines and other obligations that are placed on a carrier/employer that receives a written pre-authorization request and supporting documentation.

 

The statute requires that a pre-authorization request must be submitted to the insurer with supporting medical documentation. Within 14 days of receipt of the request the carrier/employer shall either (1) authorize the treatment; (2) deny the treatment with appropriate documentation; or (3) notify the health care provider, the injured worker, and the department that the insurer has scheduled an examination of the employee or ordered a medical record review.  In that event the carrier/employer must notify the department, health care provider and the injured worker within 45 days of the request for pre-authorization of the decision to pre-authorize or not.  21 VSA §640b.

 

The statute is located here:

 

http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=21&Chapter=009&Section=00640b

 

The Director of Workers' Compensation has issued guidance regarding the pre-authorization statute.  Those memorandum are located here:

http://www.labor.vermont.gov/Portals/0/WC/preauthmemo.pdf

http://www.labor.vermont.gov/Portals/0/WC/preauthclarify.pdf

A form providers may choose to use for a pre-authorization request is located at: 

 

http://www.labor.vermont.gov/Portals/0/WC/preauthform.pdf. 

Medical Marijuana Not Required to Be Paid By Workers’ Compensation Carriers

The Vermont legislature recently passed a medical marijuana statute and some providers have prescribed marijuana as part of an injured worker’s treatment plan.  However, it should be noted that the statute itself states, in part, that the law shall not be construed to require that coverage or reimbursement for the use of marijuana for symptom relief be provided by an employer or for purposes of workers' compensation, an employer as defined in 21 V.S.A. § 601(3).  18 V.S.A. § 4474C(b)(3)(4). Additionally, marijuana remains a controlled substance under the Controlled Substances Act.  21 U.S.C. § 811 and § 812.

Department Reiterates Worsening of Preexsting Condition Compensable

Where a pre-existing condition is worsened by any degree because of a work injury or condition of work, resulting medical treatment is compensable.  Goodwin v. AmeriGas Propone, Op. No. 21-13WC (September 10, 2013). When considering a progressively degenerative disease, where "the disease, if left to itself, and apart from any  injury, would, in time, have inevitably caused a complete disability," the causation test becomes whether, due to a work injury or the work environment, "the disability came upon the claimant earlier than otherwise would have occurred." Stannard v. Stannard, 2003 VT 52 ¶11 (May 29, 2003), citing Jackson v. True Temper Corp., 151 Vt. 592, 596 (1989) (internal quotations and citations omitted).

 

The Department of Labor decision can be found here:

http://www.labor.vt.gov/portals/0/WC/GoodwinDecision.pdf

 

 

Department Rules No Wage Replacement When No Wages are Earned Prior to TTD Period

If an injured worker has not earned any wages at all during the weeks preceding a period of total disability, then unless the failure to earn wages was the result of an injury-related consequence rather than a personal choice, in most cases no benefits will be due. Duffy v. Sisler Builders, Op. No. 20-13WC (August 28, 2013), (citing See, e.g., Bacon v. Gerald E. Morrissey, Inc., Opinion No. 32-11WC (October 12, 2011); Giacobbe v. Verizon, Opinion No. 72-05WC (December 30, 2005); Knoff v. Joe Knoff Illuminating, Opinion No. 39-05WC (July 12, 2005); see also, Plante v. State of Vermont Agency of Transportation, Opinion No. 19-13WC (August 22, 2013) (applying same analysis to compensation rate computation for successive period of disability); Griggs v. New Generation Communications, Opinion No. 30-10WC (October 1, 2010) (same)). There are exceptions as noted in Machia v. Comet Confectionary, Op. No, 32-07WC (December 4, 2007).

 

The Duffy decision can be found at the Department of Labor Website:

 

http://www.labor.vt.gov/portals/0/WC/DuffyDecision.pdf

 

 

Schedule Announced For Continuing Education Confenence

Vermont Department of Labor’s

Adjusters’ Continuing Education

October 24 & 25, 2013 Schedule

Thurs. Oct. 24	ADIRONDACK AB	ADIRONDACK C	ADIRONDACK D
12:30 pm	Update on Issues
12:50	Basics of Workers’ Compensation (Jurisdiction-Compensability)	Permanent Total Claims	Traumatic Brain Injuries
1:50	Basics of Workers’ Compensation Benefits Issues	Ethics in Workers’ Compensation	Causation Issues in Workers’ Compensation Part 1
2:50	Break
3:00	Low Back Pain-What Do We Really Know	Vocational Rehabilitation	Causation Issues in Workers’ Compensation Part 2
3:50	Break
4:00	Observations on Opioids in Chronic Musculoskeletal Pain	Calculating Average Weekly Wage and Preparing Forms	Manipulative Therapy in Workers’ Compensation
5pm	Day 1 Ends
Friday Oct. 25
8:15 am	Breakfast
8:30	Legal Update	Meet the DOL - Situations That Cause the Most Confusion in Adjusting a Claim	Pain Disorders in Litigation
9:30	Break
9:45	Mock Mediation	Meet the DOL - Situations That Cause the Most Confusion in Adjusting a Claim	The FCE
10:50	Mock Trial	Meet the DOL - Situations That Cause the Most Confusion in Adjusting a Claim	Medicare Set A Side
12:00	Conference Ends

 

Vermont Workers’ Compensation Adjusters’ Continuing Education Approved for CLE Credits for Vermont Lawyers

The  "Vermont Workers’ Compensation Adjusters’ Continuing Education" to be held on October 24 & 25, 2013 has been approved for 7.5 general credits, including 1.0 ethics credits of continuing legal education. 

DOL Specialist Assignments Effective September 5

The Vermont Department of Labor has reassigned files, effective September 5, 2013, due to the departure of specialist Lisa Brassard.  Questions should be directed to the Department of Labor, (802) 828-2286.   

The Department Memo states in part:

Specialist II Reassignments, effective September 5, 2013:            

This reassignment plan contemplates the abandonment of the number –0.  If you have a claim ending in “-0,” for example EE-56090, go to the number immediately preceding to identify your assigned WC Specialists II and I.  In this example, given that the number previous to the “-0” is “-9,” your assigned Specialists would be WC Specialist II Anne Coutermarsh and WC Specialist I Shirley Houghton.

Assigned Specialist II                    Assigned Specialist I                                

-1        Anne Coutermarsh                   Shirley Houghton

-2        Anne Coutermarsh                   Shirley Houghton

-9        Anne Coutermarsh                   Shirley Houghton

-3        Mary Sarazin                            Muriel Landis

-4        Mary Sarazin                            Muriel Landis
-5*      Mary Sarazin                            Muriel Landis
 

-6        Julie Charonko                          Wendell Sargent

-7        Julie Charonko                          Wendell Sargent
-8        Julie Charonko                          Wendell Sargent

* In the short-term, some Form 27s and other matters in “-5” claims may be temporarily assigned to other staff to handle.  Nevertheless, all correspondence related to contested “-5” matters should be directed to Mary Sarazin until further notice.