Worker Compensation Bill Includes Managed Care Plan

Article excerpt

The introduction of managed health care into Oklahoma's workers compensation system makes House Bill 1002, which was signed into law Friday, the strongest workers compensation reform measure passed during David Walters's administration, the governor has said.

Other equally ambitious provisions in the original bill, such as a mandatory independent medical examiner system to rate all injuries and a required safety program for businesses with more than 25 workers, were watered down during the legislative process.

The bill's provisions targeted at helping injured workers include an increase in disability benefits for workers who make more than $400 weekly, a shortened waiting period _ from seven to three days _ for disability benefits, and a doubling of death benefits.

Specifically, the law's provisions are: Certified workplace medical plans for treatment of workplace injuries and illnesses. This is a type of managed health care plan similar to the managed care provider networks that are part of many employees' regular health care plans. If a business contracts with a workplace medical plan, a worker at that business would join the plan or designate his or her own family physician for treatment in case of a work-related injury or illness.

If an employee chooses a family physician, all treatment by the physician and any referrals must comply with the rules of the workplace medical plan if the employer has such a plan. An employer cannot fire an employee for not choosing the workplace medical plan. Workers can change choice of physician during an annual enrollment period.

The law also provides that self-insured employers that have collective bargaining agreements in place must have workplace medical plans approved by the union. At least one lawmaker has said this provision probably will be altered during the regular session next spring.

Certified plans will be approved by the health department and must provide "quality services," convenient access for participants in a geographic region, financial incentives to reduce service costs, peer review, dispute resolution, case management and utilization reporting. They also must provide timely emergency authorization of medical providers not in the plan. An approved plan cannot discriminate against any provider.

The state health commissioner will review plans for approval and may add additional requirements. Mandatory safety programs for the most hazardous workplaces. The state labor commissioner must compile a list each year of the most hazardous industries in the state and distribute that list to every insurer that writes workers compensation insurance in the state. The law does not specify how many industries will be on the "most hazardous" list. The insurers must develop safety programs for all policyholders that are on the list and that have workplace accident or health risk experiences that are 25 percent or more worse than other businesses in their industry. Safety programs will also be required of policyholders with accident or risk experiences that are twice as bad as other businesses in the same industry category and of all self-insured employers.

Insurers must notify policyholders when they are required to develop safety programs. Safety programs may be developed by the insurance company, the labor department, private safety consultants or vocational-technical schools.

In addition to the safety programs, all workers compensation insurers must provide "safety services," including safety training and consultations. Equalization of premium rates among high- and low-wage employees. The Oklahoma Property and Casualty Rates Board will devise a method, subject to legislative review, for equalizing premiums among high-wage and low-wage employees. Currently, employees with high wages can only collect up to a percentage of the state's weekly wage, although their premiums are higher. …