TNSIA 2009 Conference Presentation

3rd Annual Conference
September 17, 2009

Willis Conference Center
Nashville, Tennessee
Agenda
7:30 - 8:00 Registration, Continental Breakfast, Visit Vendor Booths
8:00 – 8:30 Opening Remarks – TNSIA Business Meeting
8:30 - 9:30 Douglas J. Holmes – National Issues Impacting Workers’ Compensation
9:30 – 10:00 Leslie Newman, John Morris & Mike Shinnick - Commerce & Insurance
10:00 –10:30 Break & Visit Vendor Booths in Refreshment Center
10:30 – 11:00 Sue Ann Head & Pete Halverstadt - TN Dept of Labor & Workforce Dev
11:00 – 12:00 Dr. Chrissane Gordon – Health, Wellness and the Aging Workforce
12:00 – 1:00 Lunch in Atrium & Visit Vendor Booths
1:00 – 1:45 Terry Hill - Workers’ Compensation Legislation
1:45 – 2:15 Break & Visit Vendor Booths in Refreshment Center
2:15 – 3:45 Legal Panel Discussion - Case Law / MSA’s / Benefit Review
Cliff Wilson / John Barringer / Richard Murrell
3:45 –4:00 Door Prizes
4:00 –5:00 Hospitality Room in Refreshment Center

Gold Sponsor of the 2009
Tennessee Self-Insurers’
Association Conference
Opening Remarks – TNSIA Business Meeting
Terry Hill – TNSIA Executive Director
Susan Azar – TNSIA Chairperson
Micheline Parkey - Treasurer

TNSIA Accomplishments
– Welcomed 5 New Board Members
– Increased Membership Level
– 2008 Year End Bank Account Balance = $59,447.22
– Initiated Legislative Bills
– Met with TN Dept of Comm & Ins coordinating on various issues
– Submitted position letter, and attended public hearing on proposed rules
– Traveled to Little Rock, Arkansas with the TN Dept of Comm & Ins, to
research the Arkansas Guaranty Fund
– Submitted Amicus Brief, and participated in oral arguments, to the Tennessee
Supreme Court regarding workers’ compensation issues for telecommuters
– Submitted Amicus brief to the Workers’ Compensation Appeals Panel
regarding the Tennessee Medical Impairment Rating Registry
– Tennessean Newspaper recognition regarding Legislative Bills
Executive Director
Terry Hill
Board of Managers
General Motors Corporation McKee Foods Corporation

Susan Azar – Chairperson Micheline Parkey - Treasurer
Ajax Turner Company Goodyear Tire and Rubber Co Parker Hannifin Corp
Todd Williams Randy Triplett Curtis Gross
Averitt Express, Inc. Ingram Industries Inc. Tyson Foods, Inc.

David McDowell John Hayes Allyn C. (Lynn) Tatum
City of Knoxville Johnson Controls, Inc. United Road Services

Gary Eastes Ronald Jones Kristin Burman
Cracker Barrel Nissan North America, Inc. Wasco, Inc.

Old Country Store, Inc. Mike Berger/ Mary Kay Donahue Paul Kneedler
Rob Behnke
Statement of Income and Expense
2009
From
01/01/2009
Cash Beginning of Year $
59,447.22
Membership Due
2009 Memberships $ 2,450.00
2010 Memberships
100.00
Conference
Attendees
6,250.00
Sponsors
13,750.00
Total Revenue $
22,550.00
Expenses
Web Hosting ($495/Month) $ 3,960.00
Manier & Herod ($1,000/Month)
7,625.02
Amicus Brief
1,250.00
National Council of Self Insurers
1,495.02
Conference
798.18
Paypal
198.55
Tax Preparation
1,529.50
St
TNSIA Regular Members
Ajax Turner Company, Inc. International Paper Company
Albany International Corp. Johnson Controls, Inc.
American Electric Power Service Corp. Kroger
Ascension Health McKee Foods Corporation
Averitt Express Nissan North America, Inc. – Smyrna
City of Knoxville Parker Hannifin Corporation
Cracker Barrel Old Country Store, Inc. St. Jude Children's Research Hospital
Det Distribution The Pictsweet Company
Eaton Corporation The Sherwin-Williams Company
Ford Motor Company Thompson Machinery
General Motors LLC Tyson Foods, Inc.
Goodyear Tire & Rubber Company United Road
Harrah's Entertainment, Inc. Vulcan Materials Company
Ingram Industries Inc. Vanderbilt University
Wasco, Inc.
TNSIA Associate Members
AccessOnTime Coventry Work Comp Services NuQuest/Bridge Pointe
AON Risk Services Eckman/Freeman & Associates Occusure Work Comp Specialists
Alternative Service Concepts Fara Insurance Services On-Site Rx
Arnett, Draper & Hagood GENEX Services Physiotherapy Associates
Beecher Carlson Insurance Services Health Systems International Prevention Group d/b/a Lifesigns
Berkley Risk Administrators Company Heffernan Insurance Brokers Progressive Medical
Black Diamond Services Howard, Tate, Sowell, Wilson & Boyle Sedgwick Claims Mgmt Services
Brentwood Services Innovative Risk Consulting STAR Physical Therapy
Brewer, Krause, Brooks, Chastain & Burrow Johnston & Associates Superior Investigative Services
CapRisk Con Leitner, Williams, Dooley & Napolitan Tennessee Chamber of Commerce
Casualty Actuarial Consultants Manier Herod Tennessee Orthopaedic Alliance
Collins and Company Marsh U.S. Tennessee Urgent Care Associates
Commercial Insurance Associates Medicor Underwriters Safety and Claims
Constangy, Brooks & Smith Moore Ingram Johnson & Steele Wells Fargo Disability Management
CoolSystems Network Synergy Group Willis of Tennessee
Agenda

Douglas J. Holmes
President
UWC – Strategic Services on
Unemployment & Workers’ Compensation
National Issues Impacting Worker’s Compensation

About UWC
Established 1933
“The Voice of Business on

Unemployment & Workers’ Compensation”
Only association exclusively devoted to lobbying for business on
national workers’ compensation and unemployment insurance issues
• Lobbying
• Support for state lobbying organizations

• National professional society
• Employers, insurers, service providers, law

firms, state administrative agencies, and associations
• Research/education arm is the National Foundation for

Unemployment Compensation & Workers’ Compensation
National Impacts on
Workers’ Compensation
National Commission on State Workers’

Compensation Laws Act of 2009 (HR 635)
New reporting requirements under Section 111 of
the Medicare, Medicaid and SCHIP Extension Act
of 2007 (S 2499)
Health Insurance Reform and State Workers’
Compensation (HR 3200)
WCMSA Reform (HR 2641)
Prospects for 2009 and 2010
HR 635 Provisions
• Establish National Commission of 14 members:

President appoints the Chairman, 1 appointed by
Senate majority leader to serve as Vice Chairman,
2 appointed by House Majority Leader, 2 appointed
by House Minority Leader, 2 appointed by Senate
Majority Leader, 2 appointed by Senate Minority
Leader, 4 cabinet Secretaries from Labor,
Commerce, HHS, and Education.
• Not more than 6 from same political party
• At least 3 representatives of injured workers, 3
representing insurance carriers or employers, and
1 representing the general public.
Commission Duties
• Review findings of previous 1972 National

Commission Report
• Study and evaluate state WC laws to determine if
they provide adequate, prompt and equitable
system of compensation for injury or death arising
out of or in the course of employment
• Study and evaluate whether additional remedies
should be recommended to ensure prompt and
good faith payment of benefits and medical care to
injured workers and their families.
Specific Items to be
Studied and Evaluated
• Amount of permanent and temporary disability
benefits and criteria for maximums
• Adequate, prompt and equitable system of comp.
and medical care
• Alternatives to reduce or eliminate bad faith
delays, discouraging misclassification of workers
as independent contractors and/or leased
employees to avoid paying WC benefits
• Amount and duration of medical benefits,
adequacy of medical care and free choice of
physician
• Rehabilitation
Specific Items to be
Studied and Evaluated
• Standards to determine assurance of benefits

caused by aggravation or acceleration of pre-
existing injuries or disease
• Time limits on filing claims; waiting periods;
compulsory or elective coverage; administration;
ensuring prompt hearings and due process
evidentiary rights in the resolution of claims;
• Relationship between WC, old age, disability, and
survivors insurance and other insurance
Recent State Reforms Not
on List for Review
• Use of employer/insurer selected networks to

improve treatment outcomes
• Utilization Review
• Use of science based information to determine
percent of impairment (ADA Guides)
• Managed care programs
• Focus on return to work treatments and strategies
• Cost of workers’ compensation
premiums/payments and impact on
competitiveness
Powers and Authority of
Commission
• Hold hearings, take testimony, receive evidence,

administer oaths
• Require by subpoena or otherwise the attendance
and testimony of witnesses, production of books,
records, correspondence, memoranda, papers
and documents
• Subpoena authority vested in Chairman and Vice
Chairman or 6 members of the Commission
• Failure to respond to subpoena punishable as
contempt of court and subject to prosecution by
US Attorney
Commission Reports
• Interim reports to the President and Congress at

any time
• Final report not later than 18 months after the date
of enactment to President and Congress
containing findings, conclusions, and
recommendations for enhancements and
improvements in benefit levels, medical care, and
administration of State WC systems;
improvements in insurance practices, due process
and evidentiary hearings and reduction of bad faith
handling and delays, as agreed by majority of
Commission members.
• Funding for staff and contractors needed.
Fundamental Issues
• Unbalanced Commission with political agenda

• Review of state WC system not the federal role
• State WC system already continuously studied and
evaluated
• Unnecessary federal spending in time of tight
federal budget
• Trial lawyers (WILG and AAJ) and organized labor
seeking changes on issues rejected by states
• Many 1972 Report recommendations would
impose significant cost and premium increases for
employers
1972 Recommendations
• 19 Primary Recommendations, with many

controversial issues, including compulsory WC
coverage, no exclusion based on number of
employees, coverage of household and casual
workers, farm worker coverage, presumption
against independent contractor status, maximum
wage benefits at least 200% of state average
weekly wage, worker choice of physician, second
injury fund, no limit on total benefits paid for PT,
“full” coverage for work related diseases.
• Cost of implementing the 1972 report

recommendations in most states ranged from
30% to 80% per year.
Opposition to HR 635
building
• Individual state chambers and business
organizations communicating with Congressional
delegations
• Letter coordinated by UWC and US chamber to
House Members from large list of national business
organizations (US Chamber, NAM, NFIB, NRF, AIA,
PCI,NCSI, and many others)
• NCOIL and ALEC passed resolutions of opposition.
Other organizations involved include IAIABC, State
Funds, NCSL, SAWCA.
HR 635 Opposition
Challenges
Priority for Rep. Baca

On the list of D Majority for action after card check
Likely to have votes to pass in House if it gets to
the floor
Posturing as “Just a Study”
Carryover of “Academic” recommendations from
President Nixon’s 1972 Report
National Press – New York Times and Washington
Post response
Organizational Strategy
• Grass Roots Opposition from state and local

business and state groups
• Targeted pressure on swing members of Congress
in House and particularly Senate; members with
WC backgrounds
• Policy group to develop responses to “academic”
arguments and press reports
• Development of news media campaign.
S 2499 Section 111
Reporting
• Enacted during last day of Senate session in 2007
• Projected to produce $1.1 billion in revenue for

Medicare over 10 years; CMS expects much greater
revenue as reporting is implemented
• Requires WC insurance companies and plans of

insurance to report all judgments, settlements,
awards and payments of WC to individuals who are
Medicare entitled (No-fault auto and liability insurers
also required to report)
S 2499 Section 111
Reporting (cont’d)
• Interim Report Record Lay-outs available from

CMS along with User Guide and training from CMS
• Implementation through CMS web site -No formal

regulations to be issued for comment
• No formal administrative appeal

CMS New S 2499
Reporting Issues
Verification of Medicare entitlement – query

into CMS data base to verify is not yet
working
Definition of “Date of First Exposure”
Thresholds for reporting ongoing
responsibility for medical (ORM)
payments – through December 2011,
reporting not required if for medicals only,
lost time maximum under the WC law or
no more than 7 days if no WC law limit,
payments directly to medical provider,
and total payment does not exceed $750.
Other Reporting Issues
• Report payments after July 1, 2009 if based on

settlements, awards or judgments prior to July 1,
2009
• CMS Reach Back Recovery
• RREs must report information even if not currently
captured on data bases – date of first exposure
• CMS guideline for SSNs acquisition from claimant
• $1,000 per day fine for failing to report will not be
imposed until reporting registration and standards
are finalized
• www.cms.hhs.gov/MandatoryInsRep
Other Reporting Issues
• Reports of total payment obligations to claimants

(TPOC) exempted if
• Most recent (TPOC) payment is on or before
December 31, 2011 and amount is $5,000 or less,
2012 - $2,000 or less, 2013 - $600.00 or less,
January 1, 2014 – no reporting exemption
• Reporting of TPOCs prior to January 1, 2010 is not
required – permitted at RRE discretion.
Costs of S 2499 Reporting
Increased risk that old settlements will be

reviewed with changes in Medicare recovery,
increasing potential costs
Administrative costs of reporting is significant for
insurance carriers, self-insurers, state and
federal agencies
Increases in risk and prospective costs of WC
where Medicare interests involved
HR 2641 WCMSA
Settlement Reform
Introduced by Rep. John Tanner (D- TN)

WC settlement exempt from MSP if 1) present value of
$25,000 or less; 2) likely ineligibility for Medicare; 3) no
future medical expenses; or 4) no limit on future medical
Present value includes cash, purchase cost of annuities,
amounts previously paid, but excludes previous medical
expenses, fees for the claimant and any other
procurement costs of agreement
HR 2641
Limits cases when not likely to be ineligible to 1) awarded

SSDI; 2) applied for SSDI and determination pending 90 or
fewer days; 3) appealing denial of SSDI; 4) at least 62 and ½
years old; 5) has end stage renal disease
MSP satisfied when set aside amounts based on items and
services under WC agreement and/or fee schedules, and
reduced by direct costs of establishing and administering the
WCMSA and costs of attorneys, TPAs, or administrators.
HR 2641
CMS Decisions within 60 days of submission with specific

reasons if disapproved
Safe harbor for submissions if 10% of present value of claim
submitted as long as settlement is $250,000 or less
Reconsideration of disapproval may be filed within 60 days;
reconsideration within 30 days; appeal within 30 days to ALJ;
decision within 90 days of appeal; judicial review
Optional direct pay to CMS
HR 2641
Optional compromise settlement

WC law shall be conclusive as to matters under WC law and not
subject to CMS review – particularly helpful in determining prescription
drug amounts to be set-aside in light of CMS policy of requiring
average wholesale prices
No additional liability for a WC settlement agreement effective prior to
enactment of HR 2641 than on effective date of the agreement
Impact of Health
Insurance Bill on WC
Section 136 of HR 3200 as passed by House Ways

and Means Committee provides
The Commissioner shall establish standards for the

coordination and subrogation of benefits and
reimbursement of payments in cases involving
individuals and multiple plan coverage.
Committee summary indicates that workers’
compensation is an example of a plan that may be
impacted.
Outlook for 2009,
2010, and thereafter
Registration and development of Section 111 reporting

requirements and implementation will continue through
2010 – current deadline to register is September 30,
2009, but registration likely to be permitted by CMS
thereafter
Active enforcement and penalties imposed beginning in
late 2010
Significant additional Medicare recoveries and cost
avoidance above $1.1 billion, shifting Medicare costs to
state WC, self-insurers and insurance industry
Outlook for 2009,
2010, and thereafter
HR 635 will be pushed after health insurance reform and

card check bill. Probably not until early 2010.
HR 2641 will continue to be refined to address cost issues
with possible addition to Medicare reform legislation in late
2009; if not continuing into 2010.
Join US
UWC -- Strategic Services on Unemployment &

“The Voice of Business on Unemployment & Workers’
Compensation”
910 17th Street, NW, Suite 315
Washington, DC 20006
holmesd@UWCstrategy.org
www.UWCstrategy.org
202-223-8904
Agenda

Leslie Newman
Commissioner
TN Department of Commerce & Insurance
Topics of Discussion
Overview of the Department
&
Department Updates
John Morris
Deputy Commissioner

Mike Shinnick
Workers’ Compensation Manager

Topic of Discussion
TN Workers’ Compensation Self Insurance
& Insurance Environment Update
2008 Market Segments
Individual Self Insureds are on an equivalent basis
Million in Premiums
$884 -6%
$900 $832
$800
$700
$600 2007
$500 2008
$400 -13%
$300 $230
$200 - -25%
$200 25%
$100 $44 $33
$63 $47
$0
VoluntarySI Groups
Selfexclude
Insuregovernment
rs SI Groups
groups. TWCIP
TN Large Deductibles History
3
500
3
400
3
300
3
200
3
100
3
000
2
900
2
800
2
700
2
600
2
500
'0
2 '0
3 '0
4 '0
5 '0
6 '0
7p
Policy Count
Source: NCCI 46
Workers’ Compensation Indemnity
Claims Cost Increases
12.00%
10.00% 10.10%
9.20%
8.00%
6.00%
4.80% 5%
4.40%
4.00%
3.10% 3.40%
3.00%
2.00%
1.30%
0.00%
2000 2NCCI
Source: 001 (2008
2002preliminary)
2003 2004 2005 2006 2007 2008
WC Medical Claim Cost Trends
(Lost Time Cases)
16%
14% 13.50%
12%
10%
8.20% 7.70% Med Sever
8% 7.30% 7.10% Med CPI
6% 6.00%
5.40% 6.00%
5.80%
4%
2%
0%
Source: NCCI (2008 preliminary); Med CPI: Economy.com
2000 2001 2002 2003 2004 2005 2006 2007 2008
Lost Time Frequency
Continues to Decline
0%
-1%
-2%
-2.60%
-3%
-3.70%
-4% -4.10% -4.00%
-4.50% -4.50%
-5%
-6% -6.00%
-6.90% -6.70%
-7%
2Source:
000 20 01 (2008
NCCI 2002 preliminary)
2003 2004 2005 2006 2007 2008
Impact of 2004 Reforms on WC
Premiums: Estimated $490M Savings Since 2004
(50-6-134)
Calendar Direct Premium Net Estimated Annual %
Yr Written Savings* Savings
2004 $883M $20M 2.2%
2005 $943M $98M 9.4%
2006 $947M $139M 12.8%
2007 $947M $114M 10.8%
2008 $879M $119M 12.0%
* These preliminary estimates are based on the impact of loss costs and the most
recent NCCI study of the estimated decreases in system costs seen in data periods
Impact of 2004 Reforms on
Premium: Other Measures
26% drop in loss costs and filed loss cost
multipliers (weighted average) since
9/1/04
28% drop in average premium per policy
of top 10 Tennessee workers’
compensation insurers comparing data
from 2004 to 2008
Overview of Self-Insurance Market
(2008)
Self-Insured Employers – 105
Number of employees – 266,912
Total “Premium Equivalent” – $200 million
Self-Insured Groups – 6
Number of employees – 42,572
Total Premium – $33 million
Overall Market Summary
POSITIVES NEGATIVES
Frequency continues to 13 point TN profitability
decline nationally loss; worst “combined
Industry reserve ratio” in 6 years
deficiency remains Medical severity
moderate continues rapid growth
Low company failure Low investment returns
rate continue to pressure
underwriting results
Smallest TN residual
market in 9 years
Agenda

Agenda
10:30 – 11:00 Sue Ann Head & Pete Halverstadt - Dept of Labor & Workforce Dev

Sue Ann Head
Administrator of the Workers’ Compensation Division
TN Department of Labor & Workforce Development
Pete Halverstadt
Attorney
TN Department of Labor & Workforce Development
Overview of Tennessee
2009
Programs Within the Tennessee
Workers’ Compensation Division
The Workers Compensation Division manages ten
different programs concerning employees’ and
employers’ rights and responsibilities.
They are:
– Claims and Coverage—Dark Ages (1919)
– The Second Injury Fund—1946
– Benefit Review—1992
– Case Management/Utilization Review—1992
– The Drug Free Workplace Program—1996
– The Uninsured Employers Fund (UEF)—2001
– The Penalty Program—2004
– The Medical Fee Schedule—2005
– The Medical Impairment Rating (MIR) Registry—2005
– The Administrative Review Program—2006
Claims Statistics
July 1, 2008 through June 30, 2009

– 47,824 Lost Time Claims
– 58,452 Medical-Only Claims

Coverage Statistics

– 101,850 Proofs of coverage received
– 167,562 Notices of cancellation,

reinstatement,
endorsements
Uninsured Employers Fund
In fiscal year 2008-2009, the UEF
conducted 4,072 investigations.
The UEF penalized 205 employers for
non-compliance i.e. failing to have
workers’ compensation insurance
coverage.
In fiscal 2008-2009, the UEF collected
penalties in the amount of $1,043,848
from non-compliant employers.
Drug Free Workplace Program
 The DFPW program strives to assist employers in
providing safe working conditions, reduce the
potential for injuries, and secure savings on the
employers’ workers’ compensation premiums.
 For the Fiscal Year ending June 30, 2009 there were
9,087 employers participating in the Program.
 Projections are that DFWP membership by the end of

December 2009 will exceed 10,000 employers.
Benefit Review
Regional and Satellite Offices
Macon Pickett
Montgomery Robertson Clay Hancock Sullivan Johnson
Claiborne
Stewart Sumner Fentress Scott Hawkins
Lake Obion Trousdale Campbell
Henry Jackson Overton Washington
Weakley Cheatham
Houston Union Grainger Carter
Davidson Wilson Smith Hamblen Greene
Dickson Morgan
Gibson Carroll Putnam Anderson
Dyer Benton Unicoi
Humphreys Knox Jefferson
De Kalb White Cumberland
Williamson Roane Cocke
Rutherford
Lauderdale Crockett Hickman Cannon Loudon Sevier
Blount
Henderson Warren Van Buren
Haywood Madison Decatur Perry Rhea
Maury Bledsoe
Lewis Bedford Coffee Meigs
Tipton
Monroe
Chester Sequatchie McMinn
Marshall
Grundy
Shelby Moore
Wayne
Fayette Hardeman Hardin Giles
McNairy Lawrence Lincoln Franklin Hamilton Bradley
Fayetteville Marion Polk
Dyersburg Clarksville Nashville Chattanooga

Jackson Columbia Murfreesboro Knoxville
Memphis Cookeville Kingsport
The Benefit Review Program Stats
TTD/Med: Assistance with resolution of temporary
disability and medical benefits
BRC: Benefit Review Conference: Mediation of
final settlements
Approvals: Approval of settlements reached with
or without mediation
FY FY FY FY FY % change
04/05 05/06 06/07 07/08 08/09 since 2004
TTD/Med 2733 4008 4987 4948 5665 107.3%

BRC 6173 6976 7311 6444 7044 14.1 %
Approvals 5872 6988 7053 7065 7938 35.2%
TOTALS 14,778 17,972 19,351 18,457 20,647 39.7%
Administrative Review
Total Number of Requests: 856

Untimely Filed: 56
Withdrawn: 59
Orders Issued: 740
– Of Orders Issued
Affirmed: 537 72.6%
Not Affirmed: 203 27.4%
Penalty Program
25% Penalties
Number of Penalty Referrals: 114
Number of Penalties Assessed: 52
Total Penalties Assessed: $70,274.20
$10,000+ Penalties
Penalty Program cont.
Claims
Medical Fee Schedule
MIR Registry
By the end of Fiscal Year 2008/2009:
• There were 130+ Tennessee-licensed physicians on
the Registry—
Practicing in nearly 120 offices in nearly 30
Tennessee counties, and in Mississippi and
Georgia, too
• There had been over 230 valid requests for
evaluations—
Of which 12 cases settled prior to the evaluation
Of which 7 cases were withdrawn prior to the
evaluation
• Every completed evaluation was conducted in a
timely manner
Medical Fee Schedule
T.C.A. 50-6-204
Amendments
 Adoption of March 4, 2008 reimbursement
levels as a floor for all workers’
compensation medical charges.
 The department may assess a penalty for
violations of the medical fee schedule
rules of up to $10,000.
 Division will update conversion factor
multipliers via the website instead of the
rules.
 U & C defined as 80% of billed charges.
Second Injury Fund
Year Opened % Change Closed Caseload Attys
2000: 453 0.22% increase 395 935 5
2001: 562 24.1% increase 497 1000 6
2002: 677 20.5% increase 401 1276 7
2003: 793 17.1% increase 758 1311 7
2004: 814 2.6% increase 665 1460 7
2005 576 29.2% decrease 761 1275 8
2006 513 10.9% decrease 785 1003 7
2007 699 36.25% increase 579 1123 7
2008 740 5.87% increase 738 1125 7

2009-2010 Compensation Levels
Maximum weekly benefits as of

July 1:
– Temporary benefits--$837.00
– Permanent benefits--$761.00
Minimum weekly benefit as of

July 1
– Temporary benefits--$114.15
Utilization Rules
Beginning November 12, 2009, new
utilization rules will apply to all recommend
medical treatments and procedures.
The trigger for UR is no longer a monetary
amount—instead it is triggered when the
payor disputes the medical necessity of the
recommended treatment or procedure.
The UR Rules provide timelines for
conducting the UR.
Utilization Review cont.
The UR agent must be a TN-license.,
Board-certified doctor in the same or
similar specialty as the recommending
physician.
The only issue under consideration
during UR is medical necessity.
The UR agent’s decision must be in
writing and distributed to all parties.
Expedited appeal only for UR denials.
Possible Future Laws & Rules
Venue—race to the courthouse
AMA Guides
Telecommuting
EEOICPA
DFWP notice requirement
Construction laws
Adjuster Training
Contact Information
Workers’ Compensation Division
Website: www.state.tn.us/labor-wfd/wcomp
Phone Number : 1-800-332-2667
Sue Ann Head, Administrator

SueAnn.Head@tn.gov
Pete Halverstadt, Assistant Administrator

Pete.Halverstadt@tn.gov
TNSIA Thanks our 2009
SILVER SPONSORS
Agenda

Dr. Chrisanne Gordon
Physical Medicine and Rehabilitation Physician
The Challenges of Health, Wellness

and the Aging Workforce
The US Workforce
Comes of Age
Challenges of a Vintage Work Force

Old age is the harbor of all ills
~Bion ~ 280 B.C.

Nature abhors the old, and old age seems
the only disease; all others run into this
one.
~ Emerson ~ 1880
Getting old is not for sissies.
~Bette Davis~ 1980’s

Who is America’s work force?
58 million workers over 45-years-old
Aging work force:

- 2000 statistics – 13% US workers 55+
- 2010 -17%
- 2059 - 19%
What does this mean?
– Health Care Costs are Soaring (Union Wages)

2000 $1.69/hour/employee
Average Annual Per-Employee Cost $9660

Towers Perrin Health Care Cost Survey 2009
Workers older than 40 account for:
50% short term disability
75% long term disability
Older employees utilize more health care
-Life/Health Advisor December 2005

Chronic Illnesses Noted in Aging
Work Force
Diabetes
Hypertension
CAD
PVD
Obesity
Metabolic syndrome
COPD
Arthritis
Smoking, obesity, inactivity cost 300%
more for older workers than younger
workers.
- Life/Health Advisor December 2005

Increased health care dollars on
insurance.
Increased care dollars on BWC with
recent tendency to shift responsibility to
employer for age related degenerative
pathology.
Increased disability benefits
Statistics of Gender
Women share of labor force
2002 - 46.5%
2012 - 47.5%
2016 - 48.0%
68 million women employed in the US.
- 75% full time jobs
- 25% part time jobs
Concerns with increased women in
labor force may include:
OB -Child bearing/infertility issues

OB- Exposure issues
GYN- Breast & Cervical cancer
Arthritic conditions
Strength issues – recurrent soft tissue
injuries
There is a shift in US away from
manufacturing – to service & technical
support. This shift will benefit the aging
work force.
Eg: only 6% women in manufacturing
jobs.
What are the major physiologic changes
with maturing?
These changes need to be understood so

that adjustments can be made at the work
site.
A – CARDIOVASCULAR
Decreased maximum heart rate.
Decreased maximum contraction.
Decreased blood pumped.
Decreased elasticity of arterial vessels.
After 30 – heart’s peak capacity declines
by 5 – 10% per decade.
After 40 – increased incidence of CAD
especially with co-factors of Diabetes,
HTN, Obesity, SMOKING
Adjustments may need to be made to
accommodate the aging heart in
manufacturing and heavy labor jobs.
B - PULMONARY
Decreased ability to move air deeply and
quickly – forced expiratory volume.
Increased residual volume.
Possible decreased air exchange with
exposures; dust, asbestos, silicon
Smoking increases all the above.
C - NERVOUS
Decreased memory
Decreased senses: sight, hearing.
Decreased NCV – limits agility and speed.
NCV declines 3% per decade after 55.
Decreased balance and proprioception.
Adjustment is to slow down processes for
the more mature workers and keep work
place safe and free of oils, clutter,
“accidents waiting to happen”.
EXAMPLE:
20-year-old slips on oil – contusion and
sprain.
65-year-old hip fracture, pulmonary
embolus, infection, possible death.
D - SKELETAL
DDD – Degenerative Disc Disease
Dreaded Disability Disease
- Develops in everyone – starts at age 32 - 34.
- Genetic and environmental factors
influence degree.
- Many non-surgical treatments available.
- Surgical options with mixed results.
Look for osteoporosis for recurrent fractures.

Adjustment – Ergonomic work stations and
exercise program should be available on
site.
E - MUSCULAR
15% loss of strength per decade after 50.
Decreased motor units.
Increased fat in muscles.
Fraying of muscle attachments, eg, rotator
cuff tendinitis.
ADJUSTMENT –
Better equipment for lifting heavy parts, job
rotation, seniority positions.
F - MISCELLANEOUS
DECREASED SENSES -
Adjustment for hearing and sight.
Cognitive decreases -
ADJUSTMENT
– Classes and updates via newsletters and
email.
– Clear training objectives.
Hormonal Changes -
ADJUSTMENT –
– Big concern for manufacturing with large
women in labor force.
– Consider counseling, dietary adjustments,
education.
– Menopause increases osteoporosis, joint
stiffness, tendinitis via loss of estrogen.
Current trend is to have WC
supplement Medicare & private
insurance.
1) Eg: THR, TKR replacement surgery.

2) Chronic pain management for DDD.
3) Cardiovascular work-ups prior to minor
surgeries.
4) Allowances granted for aging process.
DEFINITIVE STUDIES NEED TO
BE DONE -
1.Serial MRI’s on non-working persons
followed from 30’s - 70’s
2.Studies ongoing to prove natural course
of aging.
3. Always consider genetic with vocational
contributions.
4. Disability runs in families often.
COMPLICATIONS OF AGING ON
BWC ALLOWANCES-
Eg: Aggravation of pre-existing DJD;
DDD.
“Aggravation of old ACL tear”.
Remote myocardial infarction.
Pulmonary emphysema.
Diabetes mellitus.
Down’s Syndrome
DODM
Longer recovery for underlying medical
conditions and age. Co-morbidities
After 90 days, only 10% RTW
“Sandwich” generation with many social
Issues.
Price per claim increases with increased
age and underlying health problems.
Eg. Medicare pays $3000 - $6000 more
annually on obese seniors and this is now
– being shifted to employers.
– CDC July 2009

– Tennessee #4 in US -30.2% adult obesity
How does your company adjust to Vintage
Work Force?
A - ERGONOMICS
1) Better equipment for lifting.
2) Better ergonomic tools to
accommodate arthritis.
3) Job rotations.
4) Seniority jobs – disguised.
5) Automation assisted activities.
B - EDUCATION
1) Must have company-wide education on
health and effects of aging ongoing.
2) Promote smoking cessation.
3) Weight loss program.
4) Anger and stress management.
5) Counseling for aging parents; ailing
spouse or children.
6) Reward healthy habits.
C - EXERCISE
The only effective way to slow down the
aging process and effects of aging is
exercise.
BENEFITS INCLUDE:
1) Muscle mass
2) Bone mass
3) Stress reduction
4) Balance and agility
5) Increased cardiovascular
6) Cognitive benefits
Work Exercise Into The Work Day
Exercise should be part of the work day

– 1. part of work process and break
– 2. exercise equipment or program on site
– 3. benefits of wellness program and
education. Employee rewards for Healthy
Habits.
The Whole Story: Gordon and Gleeson
Workforce Healing Opportunities and Lifestyle Enhancements.
Promoting Wellness Through
Age-Friendly Physical Activities
Publication January 2010

Wellness programs need to incorporate:
– 1. cardio conditioning (40’s – 60’s)
– 2. strength training (50’s – 60’s)
– 3. flexibility/balance training (60’s)
– Reward the Healthy Employee and their

family.
Benefits include:
1. Better CV health – fewer MI’s
2. Better Respiratory status, fewer URI’s
3. Better bone strength – fewer fractures
4. Better reaction times and balance
5. Improved mood and cognition
6. Increased strength and ROM
Onsite monitoring of glucose, BP, weight
Employee health diary with counselors;
exercise, nutrition, social services
Rewards for healthy living either by
decreased premiums or end of the year
bonuses.
Cost Savings of Wellness Programs
– Dupont - $1.42 for every $1.00 invested
– Providence Health Care – 28% decrease
– Travelers - $3.40 for every $1.00
– Towers Perrin Health Care Cost – Sept. 2008

Many savings are qualitative not
quantitative.
– Eg. Phoenix – 46% increase work productivity
– Savings included fewer sick days and

appointments.
IHPM – July 2009

Men do not quit playing because they
grow old; they grow old because they quit
playing.
Oliver Wendell Holmes.

Most people think that aging is irreversible and we
know that there are mechanisms even in the
human machinery that allow for the reversal of
aging, through correction of diet, through anti-
oxidants, through removal of toxins from the
body, through exercise, through yoga and
breathing techniques, and through meditation.
~Deepak Chopra~
Aging grapes produce great wine.
Aging humans produce great whining.
Exercise is the #1and ONLY PROVEN

deterrent to aging.
Agenda

Agenda

Legislative Updates
New Laws Change WC Practice
Terry Hill
TNSIA Executive Director
SB 1574: Now TCA §50-6-204(a)
 This bill puts to rest the Overstreet decision, a
2008 Supreme Court case preventing employers,
insurance carriers and attorneys from
communicating with the authorized treating
physician. SB 1574 allows us to communicate
with the authorized treating physician under the
following terms…
1. The employer may send written
communications to the treating physician,
but must copy the employee or the
employee’s attorney on the
correspondence with any attached
materials and must provide the employee
or the employee’s attorney with copies of
the physician’s response to the
correspondence within 7 days of receipt.
2. The employer may communicate orally
with the treating physician, but must send
the employee or the employee’s attorney a
written summary of the opinions or
statements of the physician within 7 days
of a request by the employee or the
employee’s attorney.
3. The employer’s attorney may communicate
orally with the authorized treating physician,
but must provide written notice to the
employee or the employee’s attorney at least 7
days prior to the communication and must
provide the employee or the employee’s
attorney with a written summary of all
opinions expressed by the physician within 7
days of the communication.
Language Required for Releases
 THIS MEDICAL AUTHORIZATION FORM ONLY
PERMITS THE EMPLOYER OR THE DIVISION OF
WORKERS’ COMPENSATION TO OBTAIN MEDICAL
INFORMATION THROUGH ORAL OR WIRTTEN
COMMUNICATION, INCLUDING, BUT NOT LIMITED
TO, CHARTS, FILES, RECORDS, AND REPORTS IN
THE POSSESSION OF A MEDICAL PROVIDER
AUTHORIZED BY THE EMPLOYER PURSUANT TO
T.C.A § 50-6-204 AND A MEDICAL PROVIDER THAT
IS REIMBURSED BY THE EMPLOYER FOR THE
EMPLOYEES TREATMENT.
SB 1909: Now TCA §50-6-110 (a)
This bill disallows employees
from recovering for injuries
sustained during recreational
activities, except in the
following limited
circumstances…
1: When the employee’s participation was
expressly or impliedly required by the
employer;
2: When the employee’s

participating produced a
direct benefit to the
employer beyond
improvement in employee
3: When the employee’s participation was
during the employee’s work hours and was
part of the employee’s work related duties;
or
4 When the injury occurred due to an

: unsafe condition during voluntary
participation using facilities designated
by, furnished by or maintained by the
employer on or off the employer’s
premises and the employer had actual
knowledge of the unsafe condition and
failed to curtail the activity or program
SB 1567:Now TCA § 50-6-241(a)1(c)
This bill states that if an employer is bought out
by another company and retains the employee
at the same or greater pay, the employee is not
entitled to reopen his case under T.C.A §50-6-
241(a). Prior case law counter-intuitively
dictated that when a company simply changed
its name, the employee could reopen his case
and still keep his job. This bill was signed by
the Governor on June 5, 2009 and will be
effective on July 1, 2009.
SB 2162:Now TCA §50-6-241(e)(1)
This bill makes it clear that an employee
who is an illegal alien may not recover
more than 1.5 times his impairment rating.
The argument here is that the employee
should not be able to go up to the 6 times
cap if the employer is required to fire the
employee because of the Federal law that
prohibits the employer from retaining
illegal workers.
SB 2162:Now TCA §50-6-241(e)(1) cont’d
…However, the bill also holds that if the

employer is aware that the employee
is illegal, there will be an automatic
award of 5 times the rating. The
employee will not get those funds,
which will go to the State Second
Injury Fund.
SB 2000:Now TCA §50-6-102(13) &
TCA §50-6-207(1)
* This bill amends two existing statutes and:
(1) Disallows the employer from claiming a
credit for TTD benefits paid in a 400 week
case;
(2) Caps the amount of TTD an employee
may receive in a mental injury case at 200
weeks
Agenda

Agenda

LEGAL PANEL DISCUSSION
RECENT DEVELOPMENTS AT CMS
John Barringer, Esquire
MANIER & HEROD
CASE LAW & BENEFIT REVIEW

Cliff Wilson, Esquire
HOWARD, TATE, SOWELL, WILSON & BOYTE
Richard Murrell, Assistant Director

BENEFIT REVIEW DIVISION, DEPT OF LABOR & WFD
ANSWER THIS!
QUESTION: How much will the Medicare
deficit be in 40 years?
– $31 Trillion
QUESTION: How much is S-CHIP

projected to collect in fines over the next 5
years?
– $1.1 Billion
THE S-CHIP Extension Act
The Centers for Medicare and Medicaid
Services (CMS) held an Open Door Forum
Teleconference on October 1, 2008
regarding its efforts to implement the
Mandatory Insurer Reporting (MIR) section
of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (MMSEA). Town hall
meetings continue. The next is scheduled
for September 30, 2009
CMS continues to update with supplemental
alerts
March 26,
April 7,
May 11,
July 13,
July 17,
July 31,
August 24,
Version 2.0 User Guide now available on website
Terms
NGHP – Non Group Health Plans
MIR - Mandatory Insurer Reporting
MMSEA- Medicare Medicaid & SCHIP
Extension Act
Section 111 – When a claim needs to be
reported
Non-GHP includes Liability Insurance (including
Self-Insurance), No-Fault Insurance, and
Workers’ Compensation.
Responsible Reporting Entities (RREs) are:

Carriers
Self Insureds
Joint pools
State assigned funds
TPA is not a RRE, except to the extent it might
self insure its own WC and liability exposures.
Recent development
Who Needs to Report?
July 31 alert.
Drafted with “proposed language”
WC “Proposed”
Defines RRE
Plan directly funded = Self insured
Plan indirectly funded = Insurer/ carrier

Liability “Proposed”
Same principles
Entity that gets paid a premium to pay

claims is the RRE
No Fault – N/A in Tennessee

Deductible amounts question
What if liability is ultimately with an excess

carrier?
“Up to deductible amounts” CMS

considers you to be self insured so must
report
What about pools?
Three criteria
1. WC self insurance pool is a separate
legal entity
2. With full responsibility to resolve and
pay for claims using pool funds
3. Without involvement of participating
employer
If an entity (such as a TPA) is acting as an
Agent for multiple RREs, the Agent must
submit a separate electronic reporting file
for each RRE.
If the RRE uses an agent, the RRE

remains ultimately liable under section 111
New issues:
Bankruptcy
If paid on behalf of another entity from that
other entity’s assets ( guarantee fund)
entity that makes payment is the RRE
If Employer pays directly, then RRE
The first step in complying with the MIR will be
completed by the RRE submitting registration data to the
COBC via its secure website portal; the COBSW.
Date for Registering begins May 1, 2009 through

September 30, 2009
The RRE must be the one to complete the registration

process. The RRE may assign an Agent for ongoing
reporting at that time by completing the Agent
Registration section. Agents are NOT permitted to
complete the registration process
The first step in complying with the MIR will be completed by the
RRE submitting registration data to the COBC via its secure website
portal; the COBSW (still under construction).
The RRE must be the one to complete the registration process. The
person reporting is the Authorized representative. (AR) RRE must
also name an Account Manager. (AM)
The RRE may assign an Agent (Account Designee) (AD) for

ongoing reporting at that time by completing the Agent Registration
section.
Agents are NOT permitted to complete the registration process
Important dates:
“Query function Testing Period” July 1, 2009
begins
First “Claim input file testing” will be scheduled
January 1, 2010 through March 31, 2010
However, if RREs complete testing before
1/10/10, they may begin submitting live files in
the October-December 2009 quarter
April 1, 2010 through June 30, 2010 Begin
Official production of claim input file submissions
Reporting will be quarterly.
CMS has established two reporting triggers. Cases involving

Medicare beneficiaries should be reported
(1) when responsibility for the claim has been assumed by the RRE
ORM = “Ongoing Responsibility for Medical Payments”
Two reportable events:

1) When assumes ORM determination is made
2) When ORM Terminates
Date of July 1, 2009 determines responsibility

(2) when the RRE's responsibility for the claim has been terminated
by a settlement, judgment or award, or other payment on or after July
1, 2009. TPOC
TPOC= Total Payment obligation to the claimant
One time lump sum payment
Note: In disputed/denied claims where no responsibility for the claim

has been assumed by the RRE AND no payment is made by the
RRE, reporting is not needed until there is a settlement, judgment or
award, or other payment
Date of injury, settlement date, and
exhaust information are required reporting
data elements.
If CMS has regulatory definitions of terms
they will utilize those definitions even if
they do not comport with industry
definitions of the terms.
Example, Closed files vs. inactive files
Penalty:
$1000 per day

Resources
http://www.cms.hhs.gov/MandatoryInsRep
Questions?
* Always consult with a qualified attorney such as:
Denny Crane of Boston Legal

John W. Barringer, Jr.
Manier & Herod, P.C.
jbarringer@manierherod.com
(615) 742-9345
LEGAL PANEL DISCUSSION
RECENT DEVELOPMENTS AT CMS
John Barringer, Esquire
MANIER & HEROD
CASE LAW & BENEFIT REVIEW

Cliff Wilson, Esquire
HOWARD, TATE, SOWELL, WILSON & BOYTE
Richard Murrell, Assistant Director

BENEFIT REVIEW DIVISION, DEPT OF LABOR & WFD
Additional Materials
Public Chapters
– Public Chapter 526 – Illegal Immigration
– Public Chapter 364 – Reconsideration
– Public Chapter 407 – Recreational Activity
– Public Chapter 599 – Max Total Benefit &
Psychological Injury
– Public Chapter 486 – Overstreet
Rate Chart
Public Chapter 486 – Communication
with Authorized Treating Physician
Old - T.C.A § 50-6-204 (1)(2)

– Allowed Certain Records to be Released
Without Consent
– All Treatment Required “As Ordered by
Attending Physician”
– Covered Any Medical Provider Where
Origin of Injury Was Work–Related
New - T.C.A § 50-6-204 (1)(2)

– Statute Only Covers Communication
with Authorized Provider
– Must Have Special Language in
Release for D.O.I. 7/1/09 or After
– All Communication Requires Release
BOTTOM LINE
________________________________
YOU NEED A RELEASE!
PRE JULY 1, 2009 INJURIES & POST JULY 1, 2009 INJURIES

Discovery – Safety Net

– Subpoenas – Pre-Existing Records
– Discovery Depositions
Public Chapter 599
Maximum Total Benefit
MAXIMUM TOTAL BENEFIT

50-6-102 (13)
– OLD - 400 x Comp Rate up to State Average
Weekly Wage
– NEW – 400 x State Average Weekly Wage
Plus TTD
THE SUPREME COURT OF TENNESSEE
SPECIAL WORKERS’ COMPENSATION APPEALS PANEL
KENNETH CONAWAY v. U.S. PIPE AND FOUNDRY

COMPANY ET AL.
– Employee filed a complaint seeking workers’
compensation benefits following a bench trial, the
trial court found the employee to be totally and
permanently disabled
– The employer appealed, contending that the
employee’s continuing employment as a pastor
precluded a finding of total and permanent disability
– An Appeals Panel reversed the trial court’s
conclusion that the employee was totally and
permanently disabled and modified the award to
seventy-two percent (72%) permanent partial
disability to the body as a whole
KENNETH CONAWAY v. U.S. PIPE AND FOUNDRY

COMPANY ET AL.
– The Employee, who had resigned as a pastor before

the Appeals Panel decision was issued, filed a motion
for modification pursuant to Tenn. Code Ann. § 50-6-
231(2) (2008).
– Following a second evidentiary hearing, the trial court
again found that the employee is permanently and
totally disabled.
– The employer appeals contending that the employee
failed to present sufficient proof that he sustained an
increase of incapacity solely as a result of his work-
related injury. We affirm the judgment of the trial court.
LISA SHELTON v. CENTRAL MUTUAL INSURANCE

COMPANY
– Employee was found to be permanently and totally

disabled as a result of a work-related injury. In January
2006, he died as a result of an overdose of prescription
medication. His widow sought workers’ compensation
death benefits, alleging that his death was the direct
result of his prior work injury. Employer filed a motion
for summary judgment, contending that the medical
evidence was insufficient.
– The trial court granted the motion. Employee’s widow
has appealed.
– Judgment reversed and remanded for further
proceedings
THOMAS MICHAEL ROSS v. DELTA INDUSTRIAL

COATINGS, INC. ET AL.
– Employee was injured when lifting a can of paint at
work. Employee’s treating physicians
recommended surgery, but Employee refused
surgical treatment
– The trial court found that Employee had sustained
a 60% permanent partial disability (“PPD”). The
court also found that the date of maximum medical
improvement (“MMI”) was January 26, 2007, and
that Employee was entitled to temporary total
disability (“TTD”) until that date
THOMAS MICHAEL ROSS v. DELTA INDUSTRIAL

COATINGS, INC. ET AL.
– Employer appealed, arguing that the trial court
erred in its determination of the date of MMI and
that the award of PPD is excessive.
– WC Panel concluded that the evidence did not
preponderate against the trial court’s findings
concerning the impairment rating and vocational
disability and reversed the trial court’s finding as to
the date of maximum medical improvement
CONNIE ERDMAN v. SATURN CORPORATION

– On appeal, Employee contends that the trial court
erred in two ways:
 By finding that Employee’s permanent partial disability
award should be capped at one and one-half times her
medical impairment rating;
 Second, in finding that Employee is not entitled to
reconsideration of a prior injury to her left shoulder.
Because the evidence does not preponderate against
the findings
 WC Appeals Panel affirmed the judgment of the trial
court.
Agenda

Agenda

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3rd Annual Conference

September 17, 2009

8:00 – 8:30 Opening Remarks – TNSIA Business Meeting

8:30 - 9:30 Douglas J. Holmes – National Issues Impacting Workers’ Compensation

10:00 –10:30 Break & Visit Vendor Booths in Refreshment Center

12:00 – 1:00 Lunch in Atrium & Visit Vendor Booths

1:00 – 1:45 Terry Hill - Workers’ Compensation Legislation

1:45 – 2:15 Break & Visit Vendor Booths in Refreshment Center

3:45 –4:00 Door Prizes

4:00 –5:00 Hospitality Room in Refreshment Center

Terry Hill – TNSIA Executive Director

Susan Azar – TNSIA Chairperson

Micheline Parkey - Treasurer

General Motors Corporation McKee Foods Corporation

Averitt Express, Inc. Ingram Industries Inc. Tyson Foods, Inc.

City of Knoxville Johnson Controls, Inc. United Road Services

Cracker Barrel Nissan North America, Inc. Wasco, Inc.

8:00 – 8:30 Opening Remarks – TNSIA Business Meeting

8:30 - 9:30 Douglas J. Holmes – National Issues Impacting Workers’ Compensation

10:00 –10:30 Break & Visit Vendor Booths in Refreshment Center

12:00 – 1:00 Lunch in Atrium & Visit Vendor Booths

1:00 – 1:45 Terry Hill - Workers’ Compensation Legislation

1:45 – 2:15 Break & Visit Vendor Booths in Refreshment Center

3:45 –4:00 Door Prizes

4:00 –5:00 Hospitality Room in Refreshment Center

National Issues Impacting Worker’s Compensation

“The Voice of Business on

• Support for state lobbying organizations

• Employers, insurers, service providers, law

• Research/education arm is the National Foundation for

National Commission on State Workers’

• Establish National Commission of 14 members:

• Review findings of previous 1972 National

• Standards to determine assurance of benefits

• Use of employer/insurer selected networks to

• Hold hearings, take testimony, receive evidence,

• Interim reports to the President and Congress at

• Unbalanced Commission with political agenda

• 19 Primary Recommendations, with many

• Cost of implementing the 1972 report

Priority for Rep. Baca

• Grass Roots Opposition from state and local

• Enacted during last day of Senate session in 2007

• Projected to produce $1.1 billion in revenue for

• Requires WC insurance companies and plans of

• Interim Report Record Lay-outs available from

• Implementation through CMS web site -No formal

• No formal administrative appeal

Verification of Medicare entitlement – query

• Report payments after July 1, 2009 if based on

• Reports of total payment obligations to claimants

Increased risk that old settlements will be

Introduced by Rep. John Tanner (D- TN)

Limits cases when not likely to be ineligible to 1) awarded

CMS Decisions within 60 days of submission with specific

Optional compromise settlement

Section 136 of HR 3200 as passed by House Ways

The Commissioner shall establish standards for the

Registration and development of Section 111 reporting

HR 635 will be pushed after health insurance reform and

UWC -- Strategic Services on Unemployment &

8:00 – 8:30 Opening Remarks – TNSIA Business Meeting

8:30 - 9:30 Douglas J. Holmes – National Issues Impacting Workers’ Compensation