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SC Workers’ Compensation Commission

SC Workers’ Compensation Commission. SC Hospital Association Managed Care Directors October 9, 2012. South Carolina Workers’ Compensation Commission. System Overview Perspective. South Carolina Workers’ Compensation Commission. General Information Organization Budget

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SC Workers’ Compensation Commission

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  1. SC Workers’ Compensation Commission SC Hospital Association Managed Care Directors October 9, 2012

  2. South Carolina Workers’ Compensation Commission System Overview Perspective

  3. South Carolina Workers’ Compensation Commission General Information Organization Budget Statistical Information System Cost, Premiums Paid, Taxes Paid Current Issues/Ongoing Efforts

  4. South Carolina Workers’ Compensation Commission Organization Commissioners - 7

  5. South Carolina Workers’ Compensation Commission Commissioners Susan S. Barden Term Expires June 30, 2016 T. Scott Beck Chairman Term Expires June 30, 2014 Andrea C. Roche Term Expires June 30, 2012 Derrick L. Williams Term Expires June 30, 2014 Melody L. James Term Expires June 30, 2014 Avery B. Wilkerson, Jr. Term Expires June 30, 2014 Gene McCaskill Term Expires June 30, 2018

  6. South Carolina Workers’ Compensation Commission Organization Executive Director Administration Claims Judicial Information Technology Insurance and Medical Services

  7. South Carolina Workers’ Compensation Commission FTE’s 54 employees 64 approved FTEs (81 in 2001)

  8. South Carolina Workers’ Compensation Commission Annual Budget $4.99 million (FY12-13) General Fund $1.7 million Earmarked Funds $ 3.2 million

  9. South Carolina Workers’ Compensation Commission Claim Review Process • Injured Worker Files Claim • Minor Medical • No lost time • Medical Cost < $ 2,500 • Form 12 A • Submitted to Commission • Coverage determined

  10. South Carolina Workers’ Compensation Commission Hearing Process • Informal Conference • Single Commissioner • Appeal - Full Commission • Appeal - Court System Circuit Court (Pre 2007) Court of Appeals (Post 2007)

  11. South Carolina Workers’ Compensation Commission Statistical Abstract

  12. South Carolina Workers’ Compensation Commission Accidents Filed FY 2007 – 2012

  13. South Carolina Workers’ Compensation Commission Informal Conferences Assigned & Conducted FY 2006-2012

  14. South Carolina Workers’ Compensation Commission Hearings Assigned & Conducted FY 2006-2012

  15. South Carolina Workers’ Compensation Commission Appeals to Commission FY2006-12

  16. South Carolina Workers’ Compensation Commission Appeals to Higher Court FY06-FY12

  17. South Carolina Workers’ Compensation Commission Compensation & Medical Cost FY2008-12 ($ millions)

  18. South Carolina Workers’ Compensation Commission Compensation by Category FY2008-FY12 (millions)

  19. South Carolina Workers’ Compensation Commission Work Comp Premiums (millions) FY11FY12 Commercial Market CY 2011 $ 540.3 $ 576.5 Self Insurance FY 2012$ 215.8 $ 210.9 State Accident Fund FY 2012 $ 86.7 $ 69.2 Total $ 842.8 $ 856.3

  20. South Carolina Workers’ Compensation Commission Work Comp Premium Taxes (millions) FY11FY12 Commercial Market $ 11,424,000 $ 14,407,303 Self Insurance FY 2011 $ 4,775,811 $ 4,663,681 Total $ 16,199,811 $ 19,070,984

  21. South Carolina Workers’ Compensation Commission Statutory Changes & Regulatory Changes

  22. South Carolina Workers’ Compensation Commission StatutoryH 3111 • Impacts Physicians Fee Schedule • Service providers may appeal to ALJ • 10% change in fee schedule • Governor Signed June 7, 2012

  23. South Carolina Workers’ Compensation Commission Regulations • Mediation 67-1801 • Oral Argument 67-706

  24. South Carolina Workers’ Compensation Commission Mediation 67-1801 • Admitted Cases 42-9-10 & 42-9-30 • Occupational diseases • Third party lien reduction • Contested death • Mental/mental injury • Concurrent jurisdiction • Federal Longshore and Harbor Workers Comp Act • Multiple employees with same employer admitted or not

  25. South Carolina Workers’ Compensation Commission Oral Argument Regulation 67-706 • Require parties to be present 30 minutes before appellate hearing

  26. South Carolina Workers’ Compensation Commission Ongoing Efforts Transparency Communication Emails to Stakeholders Update Website

  27. South Carolina Workers’ Compensation Commission Ongoing Efforts Stakeholder Advisory Committees Fee Schedules Surgical Implantable Devices Commuted Values

  28. South Carolina Workers’ Compensation Commission Cost Control Fee Schedules Improved Processes Filing Claims Scheduling Hearings

  29. South Carolina Workers’ Compensation Commission Physician’s Fee Schedule Medicare based 2010 RBRVS – Conversion Factor $50

  30. South Carolina Workers’ Compensation Commission Inpatient Fee Schedule Ambulatory Surgery Fee Schedule Medicare plus 40%

  31. South Carolina Workers’ Compensation Commission Pharmacy Fee Schedule • Adopted Advisory Committee • Repackaged pharmaceuticals • Physicians may dispense • MAP based on original NDC Surgical Implantable Devices • Advisory Committee

  32. South Carolina Workers’ Compensation Commission Information Technology • Electronic Filing • Proof of Coverage – Notice of cancellation • Notices/Orders Informal Conference Process • Adjusters Roundtable

  33. South Carolina Workers’ Compensation Commission NCCI Rate Filing SC Vocational Rehabilitation Department Claimant Referrals

  34. South Carolina Workers’ Compensation Commission Medical Services Payment Dispute Resolution Process SC Code of Laws - Section 42-9-360(d) Payment to an authorized health care provider for services shall be made in a timely manner but no later than thirty days from the date the authorized health care provider tenders request for payment to the employer's representative, unless the commission has received a request to review the medical bill.

  35. South Carolina Workers’ Compensation Commission Medical Services Payment Dispute Resolution Process http://www.wcc.sc.gov/insurance/Pages/MedicalProvidersPaymentDispute.aspx

  36. South Carolina Workers’ Compensation Commission How can we serve you better? System…. Processes…..

  37. South Carolina Workers’ Compensation Commission Contact Gary M. Cannon gcannon@wcc.sc.gov (803) 737-5744 www.wcc.sc.gov

  38. South Carolina Workers’ Compensation Commission THANK YOU

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