The National Workers’
By: James N. McConnaughhay, General Chair
National Workers‟ Compensation Educational Conference
There is exciting news to share as we enter 2012. For 25 years the Florida Workers‟ Compensation Institute
has presented the Workers‟ Compensation Educational Conference in Orlando. In that time we have grown
from some 200 attendees and no exhibitors to over 8,000 attendees and hundreds of exhibitors. That
phenomenal growth has allowed us to continually reach out to more audiences, sponsors, speakers, and
participants. The Conference has evolved into a national presence, attracting national organizations, national
speakers, and attendees from across the country.
Today, I am proud to announce that we are a truly
national conference, and a name change and other
initiatives in 2012 will reflect that. While FWCI will
continue as a state-specific organization, we have
created the National Workers‟ Compensation Institute
(NWCI) as an umbrella organization, and have
formally renamed the conference the National
Workers„ Compensation Educational Conference
A major part of our rebranding efforts will be the
launch of a NWCI website this spring. The site will be
the main source of information on the annual
conference and also serve as a resource for all things
workers‟ comp. This is a massive task and was
undertaken only after a great deal of thought and FWCI Board Members, J. David Parrish, Entertainment Chair,
discussion. The new website and the entire rebranding Steve Rissman, Program Chair, Gerry Rosenthal, Vendor
process reflect our commitment to orient the Chair, and Jim McConnaughhay, General Chair.
conference toward a more national audience and to offer an increasingly dynamic forum for presenters and
We are not forgetting our roots, however. Orlando will remain the home base for our annual conference; we
are already booked at the Orlando World Center Marriott through 2014. FWCI will continue to be the premier
resource for those of you seeking Florida-specific workers‟ compensation educational opportunities.
We already are hard at work building the new site and gathering content. Joan Collier, the former editor-in-
chief of Florida Underwriter, is our online communications officer. For those of you who would like to
contribute material (articles, slideshows, PowerPoint), she has developed the editorial guidelines (see page 27).
I encourage you to contact her and talk over your ideas.
FWCI Hall of Fame
By: Steve Rissman, Program Chair and President
Florida Workers‟ Compensation Institute Hall of Fame
National Workers‟ Compensation Educational Conference
FWCI has recognized that there are a lot of individuals who have made the Florida workers' compensation
system work. In response to that, the Institute decided to sponsor a Workers' Compensation Hall of Fame
effective January 2012. In order to be elected to the Workers' Compensation Hall of Fame, an individual had to
devote an entire career to the betterment of the workers' compensation system. Individuals from industry,
attorneys and judges were all eligible for nomination and election.
Eighteen individuals were elected to the charter class of the Workers' Compensation Hall of Fame. An
induction dinner was held on January 13, 2012 for the 18 recipients. The members elected representing injured
workers were: David Parrish, Gerry Rosenthal, Richard Sicking, Ray Malca, Dan Hightower and Glen
Wieland. The members elected representing employers and carriers were Jim McConnaughhay, Al Frierson,
Steve Rissman, George Kagan, Steve Kronenberg and Tom Conroy. The members elected representing the
judiciary were: Judge John Lazzara, Judge Stephen Rosen and Deputy Chief Judge David Langham. The
members representing industry were: Joe Keene from FCCI and Bob O'Halloran from Summit‟s Claims
Center. Stewart Colling was elected to the charter class posthumously. At the meeting and induction, Steve
Rissman was elected President of the organization.
In addition to devoting ones entire career to making the workers' compensation system better, the elected
individuals had to have something more. The plaques that were awarded to the elected individuals say it best:
"In appreciation for devoting their distinguished career to the betterment of the workers'
compensation system in the State of Florida and for providing leadership, dedication and
service to advance the highest philosophy and practice of workers' compensation."
There really can be no question or debate
about the qualifications of the individuals
elected to the charter class. All of them
have noteworthy and spectacular personal
qualifications. Some are claimants' lawyers
and some are defense lawyers. Three are
judges of compensation claims and two are
among the giants of industry.
In order to be elected to the Workers'
Compensation Hall of Fame, a nominee
must receive 75% of the vote of the active
members. The charter class was
unanimously elected by the Board of
Directors of the Florida Workers' (Back Row, L-R), Hon. John Lazzara, Hon. Steve Rosen, J. David
Parrish, Jim McConnaughhay, Steve Rissman, Dan Hightower, George
Compensation Institute. In all subsequent Kagan, Joseph Keene, Glen Wieland, Steve Kronenberg, (Front Row, L-
years, it will be the members, rather than the R) Hon. David Langham, Ray Malca, Tom Conroy Gerry Rosenthal, Bob
Board of Directors that vote. O‟Halloran, (not pictured) Al Frierson and Richard Sicking.
It is the intention of the Hall of Fame to
create - next year - a wing of the Hall of
Fame dedicated to those whose broad
shoulders established the workers'
compensation in the 1950s, 1960s and 1970s. In order to be nominated for that wing of the Hall of Fame, one
has to be retired entirely from the field of workers' compensation. Naturally, for this wing of the Hall of Fame,
a deceased individual can be nominated and elected.
The members of the Hall of Fame hope that this organization will shine a positive spotlight on what is good
and positive about the workers' compensation system. In subsequent articles in this Newsletter, and upcoming
issues, the 18 individuals of the charter class will be profiled.
In partnership with the Marriott Hotel World
Center, the Workers‟ Compensation Institute in
2011 announced its newest “Spirit to Serve,” in
support of “Give Kids the World.” Many
participated in the program in 2011, providing their
labor on Saturday before the educational
conference. The Institute‟s commitment to this worthy cause will continue in 2012 in conjunction with the 67th
annual workers‟ compensation education conference (WCEC).
The “Give Kids the World Village” is a 70 acre “storybook” resort located in Orlando, minutes from the
WCEC host Marriott World Center. The story of “Give Kids the World Village” is inspiring, but more
humbling. The story of Give Kids the World begins with a little girl with a wish and the desire of one man to
make that wish come true.
The little girl's name was Amy. Amy had leukemia and one wish - to visit the theme parks in Orlando. To
facilitate Amy's wish, the request of a complimentary stay was made to a respected hotelier. As he had done
many times before, the hotelier gladly obliged and Amy's wish was that much closer to being realized. Sadly,
the remainder of Amy's travel plans took too long to arrange and her wish was never granted; Amy had passed
away. Time simply ran out. “Give Kids the World,” provides memorable, magical, cost-free experiences to
children with life-threatening illnesses and their families.
There are a variety of opportunities for volunteers, involving direct assistance to the children that are in
residence at that particular time or involving service to the facility itself, to keep it in prime condition for those
FWCI Hall of Fame Inducts Tom
Tom Conroy was born in Jersey City, New Jersey in 1949. In 1953 he and his
family moved to Lancaster, Pennsylvania where Tom completed his high school
education. After high school Tom attended the University of Miami and majored in
Politics and Public Affairs. Tom graduated from the University of Miami with a
B.B.A. in 1971. Tom moved upstate to attend Florida State University, receiving his
Juris Doctor from that institution in 1974.
Since his admission to the Florida Bar in 1974, he has specialized in the defense of
workers' compensation claims. Initially employed as house counsel for a major
insurance company, Tom went on to become an assistant city attorney for the City of
Miami. In this position, he began to acquire an expertise concerning the problems
unique to municipalities and self-insured's.
Tom Conroy and Bruce Simberg founded the firm Conroy & Simberg, P.A. in 1979 and Tom continued to
specialize in workers' compensation defense. During the years Tom was a partner at the firm, the firm grew
from having two founding partners to a firm comprised of over 140 attorneys in eight locations throughout the
state of Florida. When board certification in workers' compensation was started in 1988, Tom passed the
examination and remained board certified until his retirement in 2008. From 2004 through 2008, the South
Florida Legal Guide recognized Tom as one of South Florida's Leading Attorneys and he has also been named a
"Florida Super Lawyer" in that yearly publication. Tom has tried cases before Judges of Compensation Claims
throughout the State of Florida. In addition, he has argued before the Industrial Relations Commission, The
First District Court of Appeals and the Florida Supreme Court.
Prior to his retirement, Tom was a member of the American Bar Association, the Dade County Bar
Association, the Broward County Bar Association and the Palm Beach County Bar Association. He was also a
member of the Defense Research Institute and has emeritus status on the Workers' Compensation Executive
Council on which he served as its chair from August 2006 to
August 2007. He has served as a trustee and as president of the
Friends of 440. Tom is proud to be among those initially
involved in the Friends of 440 Scholarship Fund and continues
to serve on the Board of that organization.
Tom is now retired and lives with his wife, Michelle, in
Henderson, Nevada. He enjoys retired life and spends time
exercising and hiking in both the mountains and the desert.
Tom also enjoys the excellent dining and shows that Las Vegas
has to offer and is known to occasionally drop into a casino to
make a wager. He considers himself fortunate to have fallen
upon the practice of workers compensation law, a field which
NWCI General Chair Jim McConnaughhay, Tom
Conroy, and NWCI Program Chair and Hall of
he barely even knew existed when he graduated from law
Fame President Steve Rissman at the Hall of Fame
school. Tom says, "To me, Workers' Compensation is the best
Inductions, January 13, 2012. area of practice that I could have possibly found. The
practitioners are extremely knowledgeable and the Judges are
competent to deal with any problem and any case presented to them. The mediators are excellent at facilitating
resolutions to allow the system to function without enormous backlogs. The most surprising thing about comp
was that I could argue with my opponents and my competitors during the day but still feel comfortable to
socialize with them at night. Because of that I count many of my legal adversaries as close friends. I am not sure
this is the case in other practice areas."
The Way It Was
By: Stephen L. Rosen, Judge of Compensation Claims, St. Petersburg
When asked to write about the practice of Workers Compensation in the Tampa Bay
area during the period of my early practice until December 31, 1993, I thought it
would be a fun trip down memory lane. And it was...
I took the Florida Bar examination in February of 1974 and started going through
the phone book to contact law firms to find a job. It didn't matter which area of law; I
just needed a job.
After only one day of searching, I was hired by the law firm of Marlow, Mitzel and
Ortmayer, based out of Miami with a Tampa office, handling personal injury and
Workman‟s Compensation (the former name of the law used only once in this article)
defense. I was assigned to the Workers Compensation department which was,
basically, me at that time.
I have broken my time as a Workers Compensation practitioner into two 19 year eras: the first, about which I
reminisce, is from 1974 to December 31, 1993 which I refer to as the "Golden Era of Workers Compensation
Practice." The second, which began January 1, 1994 with the effective date of drastically new amendments to
chapter 440, I refer to as "The Era to Be Named Later."
In Tampa up to 1993, the Comp judges in Tampa were Tom Miller, Daniel Gallagher, Louis Tidwell, CJ
Hardee, William D. Douglas, Kathleen R. Hudson, John Lazzara (still a JCC in Tallahassee), and Joseph
Murphy (still on the bench in Tampa). In St. Petersburg, the Comp judges were Richard Davis , Barry Salzman,
Stephen Masterson, Stephen Everhart, James T. Earle, Jr, Gary Frazier, Jonathan Alpert, Joe Willis, Ann
Robbins and Donna Remsnyder (currently administrative judge in St. Petersburg). In Lakeland, Leonard
Blanker was the Comp judge followed by Charles Hurt and Charles Vocelle. The Tampa office was located on
Twiggs street near the County Courthouse. The St. Petersburg office was on Mirror Lake Dr. and the Lakeland
office was on Lake Hollingsworth.
Upon becoming a member of the Florida Bar, I was immediately thrust into the litigation arena in Workers
Compensation. Hearings were not automatically set when a Petition for Benefits was filed. Claimant's attorney's
would have to file a Request For Hearing, a one page letter sized
form, and then the JCC would set the hearing, Pre hearings were
not mandatory and you could have the fun of trial by ambush.
Witness lists were not always required, and the attorneys had to
actually talk to each other to coordinate the final hearing.
In the 1970s and into the 1980s, many of the Workers
Compensation practitioners learned to handle personal injury cases,
both plaintiff and defense, having gotten a head start because of
their vast background in medical/legal issues they faced in Workers
Compensation. Many members of the Florida legislature were
experienced Workers Compensation practitioners in the Tampa Bay
area including such lawmakers as T. Terrell Sessums, Louis de la
Parte, H. Lee Moffitt, Tom J. Johnson, and Elvin Martinez. A
number of Circuit and County court judges had started off as
Workers Compensation lawyers or judges. When Workers
Compensation issues came up in other forums, it was not a voodoo
issue; the powers that be were knowledgeable about Workers
Compensation. It wasn't just another form of insurance. When
legislative reform was on the table (which it seemed to be every
year from 1973 to 1993) in the Florida legislature, many
committee members were actually Workers Compensation 5
practitioners who knew the ins and outs of the system.
When speaking about access to the legislature and Workers Compensation reforms, one name stands above all
in the Tampa Bay area, if not the entire state, as the "go to gal" regarding proposed legislation: that would be
Mary Ann Stiles, the universally acknowledged "Queen of Comp." Ms. Stiles, of all the lawyers who practiced
Workers Compensation in the Tampa Bay area, was the most involved in minimal and significant changes to the
law during the "Golden Era". In the 1970s and for the rest of that era to 1993, lawyers from around the state
such as Jim Mcconnaughhay, Steve Rissman, Gerry Rosenthal, Barry Keyfetz, E. J. Davis, Richard Sicking, J.
Mason Wines, Ray Malca, Barry Salzman, Mick O'Brien, Bill Douglas, Bud Adams, Al Frierson, David
Parrish, John Kest, David Roemer, Peter Burkert, Tom Koval, Richard Sadow and maybe even myself spent
countless hours in Tallahassee educating the lawmakers on the pros and cons (mostly) of proposed Workers
Compensation reforms. But, legislatively, Ms. Stiles stood above the rest in this writer‟s opinion.
Workers compensation was the type of practice at that time in which the experienced lawyers, claimant and
defense, would educate younger lawyers to keep them in the system. These lawyers worked hard for their
clients and wanted to win cases as badly then as lawyers do now. However, it did not seem that winning was
everything; you didn't make a lot of money per case on either side of the table, but you had a lot of cases. It was
clearly a volume practice rather than an attempt to squeeze every dollar out of every case. Attorneys fees
hearings were a rarity. There was really no such thing as "case costs." Judges could speak freely to lawyers on
or off the record without fear of complaint to some nominating committee. At that time, a sitting Comp judge
who was recommended for reappointment by the local nominating committee was automatically reappointed by
the current Governor who was required by statute to reappoint, basically without question, the sitting Comp
judge who was recommended by the nominating committee.
As a young defense attorney, the claimant‟s attorneys worked hard to develop a rapport with me rather than to
take me to the cleaners. They were so gentlemanly and smooth that I hardly felt the knife going in. And, then, it
was only the tip of the knife rather than pushing it through to my heart.
In 1979, the Legislature passed a compensation system for injured workers known as "Wage Loss." If the
Workers Compensation system was a rock 'n roll band at that time it would have been named "Widespread
Panic". But after four years of struggle, the "Golden Era" righted itself. In the Tampa Bay area, claimant and
defense lawyers took appeals on excellent issues which laid the groundwork for the ultimate decisions by the
appellate courts to clarify the new compensation system.
Prior to the 1979 amendments, the appellate court for Workers Compensation claims was a court dedicated
solely to workers compensation claims known as the Industrial Relations Commission. Led into the "Golden
Era" by Steve Slepin and Leonard Carson, this appellate court made many significant decisions in the
interpretation of the workers compensation law. Oral arguments were held on Monday, Tuesday, and
Wednesday in Tallahassee on the first two weeks of the
month. When you went up to Tallahassee for argument,
one would meet with comp lawyers from all over the
state and it was quite a friendly affair. Other members
of the court, at one time or another into 1979, included
Elmer Friday, Leander Shaw, Winifred Wentworth,
and Burnis Coleman. In 1979, this appellate body was
abolished and Workers Compensation appeals fell
within the jurisdiction of the First District Court Of
Appeal where it still lies. That court grew immediately
in size because it received about 1000 Workers
Compensation appeals as soon as the 1979
amendments became effective.
There are so many names to recall. If you practiced
in Tampa, then you probably also practiced Workers
Compensation law in Lakeland and St. Petersburg. If
you practiced in Tampa or St. Petersburg, you probably
went to Bradenton and Sarasota. Some of the
names of the skilled practitioners in the 6
Tampa Bay area to whom a young lawyer
could look to for guidance were Ric Mitzel, Joe Barrs, Joe Melendi, Steve and Terrell Sessums, Dal Albritton,
Bill and Paul Kaleel, Peter Behuniak, Guy Perenich, Bob Carroll, Joe Thury, Rodney Durrance, Richard
Crooke, Richard Senty, Frank May, Walter Crumbley, Calvin Pope, John Williamson, Bill Douglas, Cliff
Howell, Marvin B. Woods, Chester Skipper, Del Arduengo, Dan Burton Phil Rogers, Mason Wines, Bill Blake,
James B. Thompson, Jerry O'Riordan , Billy Rowe, Joe Carey, Jimmy "The Jet" Thompson (Tampa), Ray
Tavares, Sy Honig, Dick Valeri, Eugene (Gene) Harris, Bill Switalsky, John Chilldon, Bob Mann, George
Meros, and David Williams to name a few.
And then there were my peers of age in the Tampa-St. Petersburg-Lakeland-Sarasota-Bradenton area who
entered the "Golden Era" about the same time as I did: Jim Smith, John Shofi, Ivan Matusek, John Kaylor, John
G. Thompson, John H. Thompson, Jim Delesie, Bill Levens, Tom Cassidy, Mike Murphy, H. Guy Smith, Bob
Byelick, Charlie McQuillan, Harry Goodhart, Mark Hungate, Keith Mann, Mike Meksraitis, Larry Samaha, Jim
Jones, Mike Haworth, Alex Lancaster, Robert Todd, George Cappy, Larry Beltz, Scott Brasfield, Don
Anderson, John Kaylor, John McFadyen, “Big” Jim Clark, Richard Bokor, Bill Holt, Wayne Myers, Judge Tom
McGrady, Doug Spangler, Gary Frazier, Tom Masterson, Jake Smith and a host of young lawyers in the Tampa
Bay area who picked up the torch of the Workers Compensation practice.
Of course, in addition to Ms. Stiles, other ladies entered the Workers Comp arena as formidable litigators in
the Tampa Bay area: Nancy Cavey, Dawn Hayes, Rosemary Eure, Janet Jaspers Poluse, Ellen Lorenzen, and
Gwynne Young (current President-Elect of The Florida Bar).
However, in the Tampa Bay Workers Compensation arena, James T. Earle, Sr. deserves special mention. In a
40-plus year career over the 1960s, 1970s, 1980s, and 1990s, Mr. Earle made his mark as a defense attorney but
also represented many claimants in excellent fashion. In the 1970s, he decided that he was going to hire lawyers
who worked for the Special Disability Fund in Tallahassee since the Fund was a great source of return revenue
to insurance companies because the employer hired an employee with a pre-existing disability. So, many new
lawyers came in to the Tampa Bay area because of Mr. Earle. During his practice time, Mr. Earle trained nearly
two dozen superior lawyers, including his son, Jimmy, Jr., who went on to represent both employer/carriers and
claimants during the course of their practices. Mr. Earle had a favorite term that began with the word "sum” and
ended with a word referring to a female dog. It didn't matter if it was a doctor, lawyer, judge, legislator,
insurance adjuster, claimant or employer---Mr. Earle used his term of endearment indiscriminately. After Mr.
Earle passed away, Bill Douglas, while he was a Judge of Compensation Claims, kept a picture of Mr. Earle in
his office that depicted Mr. Earle irreverently indicating that everybody looking at the picture was "number one"
in his book... no human being, however self-important, avoided Mr. Earle's opinion.
There were some "larger than life" claimant and defense lawyers in the Tampa Bay area and the Workers
Compensation litigation system ran smoothly because all of the lawyers knew each other and were able to
accomplish excellent representation for their respective clients through the cutting of corners and getting to the
chase. It was a very professional practice and the Florida Bar would never have had to amend its oath of
attorney to include professionalism with these lawyers. We beat each other up between nine and five and it
rarely became personal. Once the closing bell rang, it was common to spend time together after hours simply as
a group of Workers Compensation practitioners.
In many ways, the Workers Compensation litigation system has become bigger and better, as well as bigger
and worse, but to have practiced in the "Golden Era" in Tampa Bay brings back fond memories that can never
be taken away. To those of you whose names I inadvertently left out, I apologize. To those of you who helped
me out with the depth of your memories, many thanks.
FWCI Hall of Fame Inducts Daniel
Daniel L. Hightower graduated from Stetson Law School
in 1973 and has been practicing law in Ocala since then. He
began his professional career by joining a law firm in Ocala
where he served for 14 years, and in 1987 he opened Daniel
L. Hightower, P.A., Lawyer. Dan has served as a part-time
Assistant State Attorney, President of the Marion County
Bar Association, and Chairman of the Marion County
Grievance Committee of The Florida Bar. In 1988, he was
appointed by Governor Bob Martinez to the Fifth Judicial
Circuit Nominating Commission and in 2011, he was
awarded The Florida Bar President‟s Pro Bono Service
Award at The Florida Supreme Court for legal services
provided to people who are unable to afford a lawyer. Dan
holds an AV® Preeminant™ rating from the Martindale
Hubbell Peer Review, which is the highest level attainable
by an attorney and represents the highest level of skill and NWCI General Chair Jim McConnaughhay, Dan
integrity. He has actively practiced in the areas of workers Hightower, and NWCI Program Chair and Hall of
compensation, personal injury and wrongful death since Fame President Steve Rissman at the Hall of Fame
1976. Inductions, January 13, 2012.
A Partnership Between
What is going to Happen
Compensation This Year?
By: Joe Paduda
There's a lot happening in the work comp industry: a hardening market; frequency ticking up;
consolidation/mergers/acquisitions and buyouts (“M&A”); legislative and regulatory changes; and management
moves. And all this against the backdrop of a very big election year.
So here's what I'm going to be watching for.
1. Health reform will impact workers comp.
I have no idea what the Supremes will do when they rule on the constitutionality of the PPACA, aka health
reform bill. Their ruling could kill the law, leave it alone, or eliminate the individual mandate. But no matter
what the official decision is, the health financing and delivery industries have changed dramatically over the last
two years, and that change will only accelerate over the next two. The rapid consolidation of health care
providers, growth (via acquisition) of delivery systems, and acquisition of providers and provider-based
managed care plans by payers is changing the landscape, as is the expansion of Medicaid. Health plans KNOW
they have to change their models, get bigger, invest billions in technology and solidify and strengthen
relationships with providers, regardless of whether reform survives or not. All health plans are very tightly
focused on those strategic imperatives. As a result workers comp, long a sideline, has been relegated to a
position of insignificance, with one exception - Anthem. I'd expect to see the Big Blue continue to expand their
work comp presence, but they'll be the only one to keep pushing. The rest are too busy worrying about the 98%
of the business that is group, Medicare and Medicaid. For comp, network discounts will diminish, That doesn't
mean medical costs will increase, as discounts don't always, or even most of the time, equal savings. Network
options will change, and we'll see more piece-mealing of networks as other payers follow the lead of
Broadspire and now ESIS and diversify their network relationships.
2. M&A (Mergers and Acquisitions) in comp is going to accelerate.
There was a lot last year, but 2012 is going to be the year of the deal. With the pending changes in capital gains
slated to kick in a year from now, several private equity-owned companies getting well past the three year
horizon (and a couple past five), some long-time entrepreneurs looking to ride off into the sunset, and what
appears to be an uptick in valuations, it's a no-brainer.
3. Comp rates will go up.
Well, this already started, but it bears repeating. After a way-too-long soft market, it's about time pricing sanity
returned. Higher work comp premium rates will drive business to TPAs, encourage risk managers to, well,
actually manage work comp risks, increase vendor business (think UR/case management, PT, bill review, and
networks) and generally help all of us in the industry.
4. Attacking opioid addiction and dependency will hit the top of many payers', regulators', and
Led by reports and publicity from notables including Gary Franklin, Medical Director of Washington
State's work comp fund, Alex Swedlow of CWCI, WCRI and NCCI, there's been a tremendous
awakening among stakeholders to the human and financial cost of opioid abuse in workers‟ comp.
The quicker payers are already moving from "oh my it's a big problem" to "here's the plan to fix it."
It's about time. The damage caused by rampant over-prescribing of opioids is immeasurable. Devastated
families, dead claimants, rising insurance premiums, increased crime, completely unnecessary disability and
higher costs for employers and taxpayers are the result. Identification of claimants at high risk for addiction
and treatment of those individuals must - must be a priority. Intelligent payers will stop ignoring the
problem or hoping it will go away, and work to a) prevent more overuse and b) help those already
addicted/dependent to get healthy.
5. Now that Illinois is starting to approve Preferred Provider Programs, there will be lots of interest
followed by disappointment that they really don't do much to control over-utilization.
I know, this is a gimme. The good folk at the Illinois Department of Insurance have been forced to come up
with regulations to implement legislation that is about as convoluted as it could possibly be. Unfortunately,
claimants who are interested in gaming the system will use the loopholes in the PPP system to get what they
want when they want it from the providers they want to get it from. The PPP will only really work for claimants
who weren't interested in gaming the system. Unfortunately the PPP isn't much of a solution.
6. As work comp premiums begin to rise, we're going to see a renewed interest in loss control, risk
management, and medical management.
With rate increases coming in California, Florida, and Massachusetts (among other states), employers are going
to have to dust off those yellowed risk management plans, recall the basics of loss prevention, and perhaps re-
hire the loss control pros they laid off over the last few years when their services weren't 'needed'. Look for the
big consulting houses, and smaller boutique firms, to emphasize their loss control expertise and capabilities;
mono-line (and heavily-workcomp-focused) carriers will also tout their knowledge and ability to help
employers control comp program costs.
7. The physician dispensing cost control bill currently pending in Florida will pass.
After several years of political intrigue, huge campaign contributions from companies making enormous profits
from physician dispensing, and continual efforts by good actors in the system, outraged taxpayers and
employers will finally succeed in limiting reimbursement for drugs dispensed by docs to the original underlying
price of the non-repackaged drug. I hope. And so should you. That won't' be the end of the issue; Maryland,
South Carolina, and other states are also battling to limit this latest and greatest abuse of the comp
system. Even if we win in Florida, there will be many more battles ahead.
8. More payers will diversify their provider network partners.
As Aetna winds up its work comp network operation, payers' interest in exploring other network options will
increase. Following the lead of Broadspire and ESIS and enabled by technology that makes it easier than
ever to mix and match provider networks, we'll see several other large payers award more network business
to more network companies. Expect firms such as Anthem, HFN, Horizon, Cofinity, Rockport and Prime to
gain share. That doesn't mean anyone should count Coventry out. They are the oldest, largest, and most
entrenched, and are working hard to address network gaps that will arise when their relationship with Aetna
finally ends (which is still a long way away).
9. York Claims will finish the year well on its way to becoming a top-tier TPA.
Through savvy deal-making, a pretty intelligent sales approach, and what is by several accounts a strong
focus on doing the right thing for the employer (and not just generating fees for York), York has transformed
itself from what was a not-very-good TPA a decade ago to a well-regarded and very well run organization.
York's robust technology and strong market share in key sectors (especially governmental entities in several
states), coupled with the expertise they've added as a result of acquisition (I'm especially impressed with the
JI Companies deal) bodes well for their future. Perhaps I should modify the headline - York already is a top
tier TPA in terms of capabilities; these capabilities will drive them towards the top tier in terms of revenue
and market share.
10. Oklahoma will eliminate the requirement that all employers have workers comp insurance. There are
moves afoot in several states to reconsider the work comp mandate, but none have more traction than the one in
OK. Whether it's because they share a long border with the only state that doesn't require comp (Texas), many
of their larger employers also have big operations in Texas and like the opt-out there, or there's something more
ephemeral, a sense that work comp as currently constructed doesn't work the way it should anymore, Oklahoma
may well be the next state to allow employers to opt out. There's already a study group authorized by the
State Senate that's looking into the feasibility of the change; their findings should be released in the next
few weeks. That will be just in time for the next legislative session which starts in February. This may not
become law in 2012, but I'd expect some movement that allows some employers to opt out, perhaps in a pilot
program as early as next year. Well, there we have it. Oh, there's one more . . .
11. My annual April Fool's post will generate some controversy, tick off a few people, and generally cause
consternation among those who either don't have a sense of humor or can't read a calendar. It will also not get
me in as much hot water as some others because I have to vet it through my PR department...
Joseph Paduda is a nationally recognized expert, speaker, media source and author on managed care in group health and
in workers‟ compensation. He translates complex data into actionable knowledge and is able to take an aerial view or to
drill down into intricate niches.
His practical approach and 20 plus years experience in the field give clients precise direction and applicable programs.
He writes the popular weblog Managed Care Matters attracting more than 1500 unique visitors a day and a good deal of
comment in the health care world. His blogs are frequently republished on other sites. Mr. Paduda also conducts industry
surveys, including focused on managing pharmacy costs within workers‟ compensation, bill review in workers‟ comp, and
work comp claims systems.
Prior to founding Health Strategy Associates in 1997, Mr. Paduda served in sales, marketing and management positions
with managed care and insurance companies, including MetraComp, a United Health Care Company, Travelers Health
Company, Liberty Mutual and American International Healthcare/AIG.
A frequent speaker and prolific author, Mr. Paduda has appeared on ABC‟s Nightline, Fox Business News,
AirAmerica, and NPR and been featured in The New York Times, LA Times, TheStreet.com and many industry
Editor’s Note: Joe Paduda‟s predictions fail to mention one critical prediction for 2012. We predict that Joe
Paduda will appear at the 2012 NWCI Educational Conference in August as a keynote Speaker. Watch for the
complete program and registration materials coming soon. Do not miss the chance to hear this speaker!
Mark Your Calendars NOW!
WCEC 2012, August 19-22, 2012 - Marriott World Center, Orlando
WCEC 2013, August 18-21, 2013 - Marriott World Center, Orlando
11 WCEC 2014, August 17-20, 2014 - Marriott World Center, Orlando
FWCI Hall of Fame Inducts Joseph
Joseph A. Keene initiated his career by attending the University of Massachusetts in
the early 1960‟s and going into the pizza business there until mid 1966. At that point
he went into food management with Howard Johnsons and McDonalds until late 1967
when he was offered a job with Liberty Mutual as an adjuster trainee. Joe was an
adjuster with Liberty through the early days of no fault and stayed there until 1972
when he relocated to Florida.
Joe Keene then went to work as a Resident Senior Adjuster for the Insurance
Company of North America and handled all lines of insurance including workers‟
comp. In 1976 Joe was offered a Claim Supervisor position with Crum & Forster at
which time he interacted with most of the members of the Workers‟ Compensation Hall of Fame. In late 1977
Joe went to work for Frank B. Hall as a Claim Supervisor and was promoted to Vice President of Claims. Joe
then filed a program for the Kentucky AGC and the Virginia Municipal League self insurance funds. In 1981
he was hired to initiate a claims department for the Florida Roofers Association where he stayed until 1985
when he was asked to do the same thing for Combined Risk Insurance Management (CRIMS). In 1989 Joe
went into business for himself and formed Claims Capabilities, Inc. (CCI), handling self insurance funds and
insurance companies. Joe also consulted for many attorneys and insurance companies, specializing in the
Florida Special Disability Trust Fund. Joe continued in this business until 1998, when he came to work for
FCCI as Executive Vice President of Claims, where he remains at present.
Joe holds an adjuster, general agent and surplus lines licenses for the state of Florida, and multiple licenses
for other states. His activities over the last 25 years include speaking at the annual Work Comp Convention for
ten years specializing on the topic of the Special Disability Trust Fund. Joe Keene was a member of the Florida
Association of Self Insured‟s legislative committee and worked closely with GW Jacobs. Joe was also on the
State Second Injury Advisory Council Board from its inception until it was disbanded in 1997. He also was a
founding member and initial treasurer of WCCP from
Joe‟s philosophy on claims has been early
investigation and early conclusion of exposures. It is
his belief that because of rising medical costs in our
society that worker‟ comp cases should be concluded
as early as possible. Joe‟s largest love in the claim
area would be the catastrophic cases. He developed
wellness settlements for catastrophic cases in the
1980‟s. Joe believes that catastrophic claims must be
handled proactively by adjusters with specialized
knowledge and experience. Joe has worked with
some of the largest reinsurance companies in the
world, and his specialty has been consultation in the
NWCI General Chair Jim McConnaughhay, Joseph Keene, and catastrophic claims area. Nonetheless, at the end of
NWCI Program Chair and Hall of Fame President Steve the day, Joe Keene is basically an adjuster that loves
Rissman at the Hall of Fame Inductions, January 13, 2012. his profession.
FWCI TV Returns at WCEC 2012!
Based on the overwhelming success of FWCI-TV at the last two Workers‟ Compensation Educational
Conferences, FWCI-TV returns again in 2012. You can be a part of the action. FWCI-TV will feature daily
video headlines that highlight the events at the conference. By investing in a 60-second interview, your message
will be delivered to conference attendees, as well as, FWCI‟s database, a targeted industry audience. Your
company‟s message will become part of the daily
newscast, and it will be distributed in the following
Emailed directly to the FWCI Database
Played on televisions in hotel guest
Posted to the FWCI website
Posted on the FWCI Facebook page
Posted on You Tube
Played in both Corporate Theaters
Played on video screens in conference
DVD of your company interview or
advertorial presented by FWCI-TV daily
news broadcast to be used as a
Contact Cathy Bowman for more information about FWCI-TV and other sponsorships, firstname.lastname@example.org or
(850) 425-8186. To see an interview from the 2010 conference click this link to a video posted on FWCI‟s
Thanks to the 2011 Multistate
WCEC 2011 Multistate Program
Robert D. Stokes, Esq. of
Flahive, Ogden & Latson,
Austin TX explaining
important TX workers'
compensation tips in the
TX Multi-State Breakout
James Anderson, Esq. of
Anderson, Crawley and
Burke, PLLC Ridgeland, MS
discussing recent workers'
during the Multi-State
Mark Davis, Esq. of
McAngus, Goudelock &
Courie, LLC Charleston, SC
in celebrity costume as game
show host for "Workers'
Compensation Jeopardy" at
the Multi-State Closing
Assessing CMS’ Query Process System
in the Bigger Picture of MSP Compliance
By: Mark Popolizio, Esquire
Determining a claimant‟s Medicare status is an integral part in evaluating one‟s compliance obligations under
the Medicare Secondary Payer Statute (MSP). When a claimant is identified as a Medicare beneficiary,
several MSP compliance considerations come into play: MMSEA Section 111 reporting (Medicare‟s new
electronic reporting law), conditional payment reimbursement and Medicare Set-Asides.
As part of this exercise, the important question of just how a claimant‟s Medicare status will be determined
must be addressed. One such method currently being used by a large segment of the claims industry is “Query
Process.” This system was introduced by the Centers for Medicare and Medicaid Services (CMS) in relation to
Section 111. Query Process was designed to provide an expedient and coordinated process to ascertain a
claimant‟s Medicare status to help determine Section 111 reporting obligations.
While Query Process is certainly a useful tool, the system‟s utility in assessing MSP obligations outside of
the Section 111 context must be carefully considered. In this regard, understanding the type of information
Query Process provides, and does not provide, is important to ensure that proper MSP protocols are in place as
part of claims handling and settling practices.
This article highlights how Query Process works and examines the system‟s function, utility and limitations
in the bigger picture of MSP compliance.
What is CMS’ Query Process and how does it operate?
CMS introduced Query Process as part of its implementation of Section 111. By way of brief background,
under Section 111 certain entities known as Responsible Reporting Entities (RREs)1 are required to (i)
determine a claimant‟s Medicare beneficiary status and (ii) report claims involving Medicare beneficiaries to
CMS if the claim meets a Section 111 “reporting trigger.” The penalty for non-compliance is steep: $1,000 per
day, per claim.
While Section 111 imposes a statutory duty on RREs to determine Medicare status, the statute does not
provide a specific system to be utilized. In response, CMS established a voluntary electronic Query Process
system to assist RREs make this determination.
Under Query Process, an RRE may submit an unlimited number of query requests once a month to determine
a claimant‟s Medicare beneficiary status. Only an RRE (or its registered Section 111 reporting agent) are
permitted access to the Query Process system. A “query response” file is returned to the RRE within 14
calendar days. Certain RREs may also have access to a new online query feature called “Beneficiary Lookup”
which provides an immediate response to a query request. Access to this new feature is not available to all
RREs, and eligible RREs are limited to only 100 query requests per RRE identification number per calendar
In order to utilize Query Process, the claimant‟s social security number (SSN) or health identification claim
number (HICN) is required. In addition, the RRE must submit the first initial of the claimant‟s first name, the
first six characters of the claimant‟s last name, and the claimant‟s birth date and gender. CMS‟ system must
find an exact match of the submitted SSN or HICN. Thereafter, at least three out of the four remaining
informational elements must yield an exact match.3
If the queried claimant is identified as a Medicare beneficiary, a response is returned indicating
that the claimant was “matched” to a beneficiary in CMS‟ data base. Due to privacy concerns, the 15
system does not provide the actual date of Medicare entitlement and enrollment, or the basis of the
claimant‟s entitlement. With this information, the RRE then assesses whether the claim meets a “reporting
trigger” thereby requiring it to be reported under Section 111.
Conversely, if the queried claimant is not identified as a Medicare beneficiary, a response is returned
indicating that the claimant was not “matched” to a beneficiary. In certain circumstances, the RRE will need to
re-query the claimant to determine if Section 111 reporting may be required at some subsequent point during
What information does Query Process provide, and not provide,
and how is this important in the bigger picture of MSP compliance?
With a basic understanding of how Query Process works under our belts, the focus shifts to analyzing the
nature and utility of the information provided. This involves assessing the type of information Query Process
provides (and does not provide) in relation to the bigger picture of MSP compliance.
As noted above, if the claimant is identified as a Medicare beneficiary, Query Process returns a response
simply indicating that the queried individual has been “matched” to a beneficiary in CMS‟ data base. No other
information is provided. With respect to Section 111, this limited information is adequate as positive
identification of Medicare beneficiary status alone is sufficient to determine reporting obligations. In this sense,
Query Process is precisely calibrated to deliver a very limited, but key, informational element for Section 111
purposes. However, in moving away from Section 111 the question becomes how helpful is this limited
information in evaluating the issues of conditional payment reimbursement and Medicare set-asides (MSAs)?
With respect to conditional payments, the fact that Query Process identifies a claimant as a Medicare
beneficiary is helpful in that it alerts the RRE to the possibility of a conditional payment issue. However, Query
Process does not provide any information regarding conditional payments; nor does it trigger the process for the
parties to receive this information. For that matter, Section 111 reporting, with limited exception, also will not
provide the parties with this information.
Thus, RREs need to ensure that separate compliance protocols are in place to procure conditional payment
information. On this point, it is generally prudent practice to begin this process once the claimant is identified as
a Medicare beneficiary, regardless of whether the claim is technically reportable under Section 111 at the time
this determination is made. This is so because obtaining conditional payment information involves a separate
multi-step process which takes time.
Under this process the RRE (or the claimant) must put the Coordination of Benefits Contractor (COBC) on
notice of the claim and provide this contractor with certain identifying information related to the case and
claimant. This notice is independent of Section 111 reporting and is provided via phone, fax or mail.
Once COBC receives this notice, it in turn notifies another contactor, the Medicare Secondary Payer
Recovery Contractor (MSPRC). The MSPRC then issues a Rights and Responsibilities Letter (RRL) advising
the parties of Medicare‟s potential interests. Thereafter, the MSPRC will issue a Conditional Payment Letter
(CPL) within 65 days of the date of the RRL (in practice this timeline can be longer than 65 days).
The CPL contains Medicare‟s claimed conditional payment amount and provides a corresponding listing of
the claimed charges. The CPL must be examined for accuracy and a request should be made to the MSPRC to
remove any inappropriate claims. It is often necessary to request updated CPLs as the claim matures to ensure
that the most current conditional payment information is obtained. Under current CMS policy, the parties are
generally unable to obtain Medicare‟s “final demand” until after the claim is settled and the executed settlement
document is forwarded to the MSPRC.4
As it can take several months to obtain this information, starting the process early allows the RRE time to
obtain the relevant information. Furthermore, addressing this issue during the course of the claim allows the
RRE adequate time to review Medicare‟s claimed conditional payment amount and, if necessary, seek removal
of inappropriate claims. Incorporating these practices as part of claims handling will aid the RRE in obtaining a
more realistic exposure assessment which, in turn, helps properly set reserves, evaluate case value, and optimize
On the MSA front, the utility of the information provided by Query Process is also a mixed bag. When
Query Process identifies the claimant as a Medicare beneficiary, this indeed provides the RRE with a valuable
piece of information for MSA evaluation purposes which should be appropriately noted. Armed with this
information, the RRE can then determine the appropriateness of a MSA. In the workers‟ compensation (WC)
context, this involves making sure that claims handlers have firm knowledge of CMS‟ WC-MSA review
thresholds. Per current CMS policy, a WC-MSA is deemed appropriate if at the time of the WC settlement the
claimant is a Medicare beneficiary and the total settlement amount5 is greater than $25,000.
However, it is important to remember that a MSA may also be considered appropriate in situations where the
claimant is not a Medicare beneficiary. For example, under CMS‟ WC-MSA review thresholds a MSA is
deemed appropriate in situations where the claimant is not a Medicare beneficiary but has a “reasonable
expectation of Medicare enrollment within 30 months of the settlement date” and the total settlement amount is
greater than $250,000.
CMS defines “reasonable expectation of Medicare enrollment” to include situations in which the claimant
(a) has applied for social security disability (SSD); (b) has been denied SSD but anticipates appealing that
decision; (c) is in the process of appealing or re-filing for SSD; (d) is 62.5 years or older; or (e) has End Stage
Renal Disease but does not yet qualify for Medicare based upon this condition.6
The question then becomes: Does Query Process provide any of the information necessary to determine if a
claimant who is not Medicare beneficiary has a reasonable expectation of Medicare enrollment for MSA
purposes as that term is defined by CMS? The answer is NO. Thus, RREs cannot rely solely on Query Process
to provide the information needed to determine MSA applicability in all instances.
Accordingly, RREs need to set protocols to obtain the information necessary to determine if a claimant has a
reasonable expectation of Medicare enrollment for MSA purposes when such determination is applicable.
These efforts should center on obtaining “best evidence” to demonstrate due diligence in protecting Medicare‟s
interests. In this respect, CMS‟ definitional factors call for a multi-faceted approach. Some measures for
consideration include: confirming the claimant‟s social security status directly with the social security
administration; determining how best to ascertain and affirm claimant intentions regarding whether he or she
“anticipates appealing” an adverse social security ruling (when applicable); and using other necessary discovery
measures to ensure that all areas of relevant inquiry are addressed.
Query Process certainly provides RREs with a powerful tool to obtain a major informational element
necessary to determine MSP compliance obligations. In assessing Query Process, it is important to keep in
mind that the system was designed to help RREs meet a very specific and limited compliance requirement in the
Section 111 context. The system was not intended to provide, nor does it provide, the necessary information to
address all MSP compliance areas. Accordingly, as discussed above, RREs need to have proper compliance
protocols in place to obtain the information that Query Process does not provide to ensure that all MSP
compliance obligations are being fully addressed.
About the Author
Mark Popolizio, Esquire is Section 111 Senior Legal Counsel for Crowe Paradis Services Corporation. Mark is
a nationally recognized authority in MSP compliance. He has authored numerous articles on MSP issues
including MMSEA Section 111, MSAs and conditional payments. Mark is a regularly featured presenter at
national seminars and other industry events. Prior to dedicating his practice to MSP compliance in 2006, Mark
practiced workers‟ compensation and liability insurance defense for ten years representing carriers, employers,
third party administrators and self insureds. Mark is based out of Miami, Florida and can be reached at
email@example.com or (786) 459-9117. 17
RRE determination is fact and situational specific in accordance with CMS‟ RRE directives. Under CMS‟ directives, there are a
number of potential entities that could be RREs for Section 111 purposes. While a detailed discussion of CMS‟ RRE directives is
beyond the scope this article, in general RREs typically include, but are not limited to, carriers and self-insureds. It is important to
note that claimants and their lawyers are not RREs under the Section 111 reporting law. To review CMS‟ RRE directives, see
CMS’ NGHP User Guide (December 16, 2011, Version 3.3), Chapter 7 and any subsequent “Alerts” that the agency has released or
This article provides only a general overview of how the Query Process system operates. A detailed examination of the technical
aspects of the Query Process s (e.g. required software, file types, etc.) is beyond the scope of this article. To review this information
see CMS‟ NGHP User Guide (December 16, 2011, Version 3.3), Chapters 13 and 15.5.
CMS states that the query process “is to be used only for Section 111 reporting purposes” and refers the RRE to the Section 111
Data Use Agreement for restrictions on the use of the data exchanged for Section 111 purposes. See, CMS’ NGHP User Guide
(December 16, 2011, Version 3.3), Chapters 13.1 and 16.
As an exception to the above process, CMS will issue a Conditional Payment Notice (CPN), in lieu of a CPL, in situations where (a)
the MSPRC is notified of a settlement, judgment, award or other payment through Section 111 reporting rather than from the
beneficiary or their representative and (b) the MSPRC has been alerted to a settlement, judgment award, or other payment by the
beneficiary or their representative before the usual CPL has been issued.
On a related note, some RREs are reporting that they have received CPLs which they believe were triggered from their filing of a
Section 111 ORM report (on-going responsibility for medicals). To the extent these reports are accurate this would represent a
change from CMS‟ current process, and may signal an eventual coordination between Section 111 reporting and CMS‟ larger efforts
at benefit coordination. In the author‟s view, further investigation into these interesting reports is in order. As part of this
investigation, an important fact to ascertain would be whether the RRE, in addition to filing a Section 111 ORM report, had also
reported the claim to the COBC. If so, the issue for determination would then become whether it was the Section 111 filing or the
COBC report that triggered release of the CPL.
To learn more about CMS‟ processes to obtain conditional payment information, the reader may wish to review the website
CMS defines “total settlement amount” as follows: Total settlement amount includes, but is not limited to, wages, attorney fees, all
future medical expenses (including prescription drugs) and repayment of any Medicare conditional payments. Payout totals for all
annuities to fund the above expenses should be used rather than cost or present value of any annuities. Also note that any
previously settled portion of the WC claim must be included in computing the total settlement. Gerald Walters, CMS Memorandum
to All Regional Administrators, April 25, 2006.
Thomas L. Grissom, CMS Memorandum to All Regional Administrators, April 22, 2003.
THE NATIONAL WORKERS’
COMPENSATION INSTITUTE WILL PRESENT
THE 67TH ANNUAL
& 24TH ANNUAL SAFETY AND HEALTH
August 19 - 22, 2012 18
WCEC 2011 Multistate Program
ipating in the "Workers'
Kyle Kinney, Esq of
Miller, Christie, & Kinney,
P.C, Birmingham AL makes
a point during the General
R. Briggs Peery, Esq. of
Swift Currie McGhee &
Hiers, LLP Atlanta GA
introduces the speakers at
the Multi-State opening
FWCI Hall of Fame Inducts
Honorable John Lazzara
The Honorable John J. Lazzara is Judge of Compensation Claims (JCC) for the
Tallahassee District, being first appointed in 1990. Prior to his appointment, he was
in the private practice of law in Tampa and acted as a circuit civil mediator and
federal court arbitrator. He also worked under contract as a Hearing Officer for the
Hillsborough County Environmental Protection Commission; the Property Appraisal
Adjustment Board; and a Panel Arbitrator on the first New Motor Vehicle
Arbitration (Lemon Law) Board. Judge Lazzara served as President, Conference of
JCCs (1997-99); Chair, Florida Bar Workers‟ Compensation Rules Committee
(1994-95); Member, Appellate Court Rules Committee (2001-07), twice chairing its
Workers‟ Compensation Law Subcommittee; Chair, DOAH/OJCC Workers‟
Compensation Rules Revision Committee (2005-06); and is currently a member of
the Florida Bar's the Standing Committee on Professionalism, the Workers' Compensation Section and its
Professional Conduct Guidelines Committee, and the Alternative Dispute Resolution Section. In 1998 and 2002
Judge Lazzara was nominated for appointment to the First District Court of Appeal. In November, 2005,
Governor Jeb Bush appointed him Interim Deputy Chief
Judge, a position he held until May, 2006. In 2008, the
judge was elected Inaugural President of the National
Association of Workers‟ Compensation Judiciary, and
currently serves on its Board of Directors. In 2009, Judge
Lazzara was inducted as a Fellow of the ABA-affiliated
College of Workers‟ Compensation Lawyers and was
recently elected to its Board of Governors (2011-13). He
frequently lectures on workers ‟ compensation matters, and
volunteers and sits on the Boards of Directors of the Literacy
Volunteers of Leon County and the Epilepsy Association of
the Big Bend. Judge Lazzara received his B.A. and J.D.
degrees from the University of Florida.
Thanks to the 2011 Safety Program Committee
Abe Agront, Jr. Carmen Calderon Richard Lavery Gary Porter
Donald Ames Kevin Dodson C. Gary Lopez Diane Ray
Cathy Anton G. Scott Dotson Henry Losada Michael A. Reali
Gary Archer Randy Free David J. Martens Claude Revels
Margaret Baumann Raymond Harbison Diana McCluskey Rene Salazar
Sharon Bramlett Kenia Harrell Dr. James McCluskey Virginia Sablet
Todd Brouette Joan Haynes Bob Nesbit Bill Shooter
Charles Brush Linda Horner Hana Osman Ryland Thompson
Daniel Byrne Scott Johnson Margie Perry Thomas Truncale
The OJCC, FWCI, the Division, and
the First DCA Will Team-Up to
Present Free CEU/CLE Program
Titled “Answers from the Experts,” this full day CEU/CLE
program was presented February 10, 2012 at the Florida First
District Court of Appeal in Tallahassee. This program brought
together the claims process from a variety of perspectives.
The Florida Division of Workers‟ Compensation presented a
panel from the Bureau of Employee Assistance and Ombudsman
Office (EAO). This illuminated the variety of assistance available
from the Division of Workers‟ Compensation, before a claim Judge Lazzara
Steven Rissman enters the litigation process. The EAO noted the significant volume
of telephone requests they receive annually, and the effort they
invest in responding to those caller‟s concerns. Clearly, there are
injured workers for whom the mailed information is not sufficient.
This panel discussed their role educating workers and employers
about rights and responsibilities they have in the system.
FWCI Program Chair Steven Rissman, State Mediator Wilbur
Anderson, and Judge John Lazzara each moderated a panel 25
discussion. Following the EAO panel discussion, the topic turned Mediator Suskin
to mediation. Mediator Wilbur Anderson led a discussion among
mediators Susan Bisbee (TLH), Stuart Suskin (GNS), Eddie
Oramas (PMC), and private mediator Robert Dietz. They focused
on appropriate mediation preparation for the parties and provided
tips for successful conclusion of the mediation. The distinctions
between state and private mediation were highlighted in several
instances. There was unanimous agreement that in-person
attendance at mediation is a major advantage for resolution of
issues or settlement.
Steven Rissman moderated a lively panel discussion including Judge Winn
Judges Hill (GNS), Holley (JAX), and Portuallo (DAY). Judge
Lazzara moderated an informative and insightful panel including
Judges Humphries (JAX), Roesch (PMC), and Winn (PNS). The
Judicial panels addressed issues such as advances on
compensation, interplay of job search for entitlement to TPD
benefits, cost issues in motion to tax instances and in washout
settlements, continuances, need for orders on non-fee stipulations,
discovery issues in pre-PFB & post-PFB matters,
ethics/professionalism issues, proper docket entry & indexing, and
sanctions. Judge Hill
The program concluded with a presentation by members of the
First District Court of Appeal Workers‟ Compensation Unit.
Mediator Anderson 21
After the efforts of the EAO, the mediators and the tribulations
of litigation, some cases end up before the Court. This
presentation provided interesting insight into the modern
appellate process in the First District Court of Appeal.
This free program was an unprecedented opportunity for legal
practitioners, claims adjusters, risk managers and other workers‟
compensation professionals. Over 100 professionals attended
from across the state.
This program would not have been possible without the
contributions of the First District Court of Appeal, our host, the Mediator Bisbee
Florida Workers‟ Compensation Institute, the Division of
Workers‟ Compensation, Resource Managers Incorporated
(RMI), and the OJCC. In particular, however, the efforts of
Steven Rissman, Jim McConnaughhay, Kathy Shelton (RMI),
Woody Douglas (RMI), Stephanie Dodson (RMI), Shirley
Kendall (RMI), Cathy Bowman (RMI) and the rest of the
RMI/FWCI team were noteworthy.
The program preparation effort was led since last fall by Judge
John Lazzara (TLH). In addition to managing the preparations
Judge Portuallo for the program, Judge Lazzara managed the program day, made
introductions and announcements, and acted as a moderator for
one of the panels. Without his effort, leadership, and patience,
this program would not have been possible.
Thanks to the 2011 FWCI Program Committee
James N. McConnaughhay, General Chairman Steven A. Rissman, Program Chairman
Robert Barrett Teresa Elkins John J. Lazzara Claude Revels
Margaret Baumann Dino Fabrizio Nat Levine Steven A. Rissman
Geoffrey Bichler Jean Feldman James McConnaughhay Harry Rosenthal
Maxine Boyer Gregory Foppiani Diana McCluskey Marc Salm
April Brader George Furlong Dr. James McCluskey Debbie Scott
Sharon Brown Kevin Glennon Kris McConnell Mark Siciliano
Candice Buchanan Rafael Gonzalez Nell Merritt Scott H. Silver
Joan Collier Michele Hand Ray Neff Dr. Sanford Silverman
Steve Coonrod Raymond Harbison Dr. Gary Newcomer Jacque Steele
Melissa Corah Debra Hoffman Bob O‟Halloran Ellen Townsend
Sue Coterel Tracey Hyde Hana Osman Karen Ursulich
Ann Crutchfield H. George Kagan Janet Phillips Lisa Wagner
Lorry Davis Joan Kantrowitz Bill Pipkin Dr. Michael J. Webb
Maria Dayi Monnie Kinlaw Rigoberto Puente-Guzman Scott Westman
Robert Dietz David W. Langham Betty Reid Glen D. Wieland
2012 Legislative Update
The following bills each affect some portion of the Florida Workers‟
Compensation law. The list is likely not exhaustive, and the FWCI
would appreciate hearing from you if you know of other pending
legislative action that should be published in the next edition. The
abbreviations “SB” and “HB” stand for Senate Bill and House Bill
SB 140: Repeal of Workers’ Compensation Reporting Requirement
Sponsor: Senator Bennett
The bill repeals Fla. Stat. §440.59, F.S., which requires the Department
of Financial Services (DFS) to compile an annual written report on the
administration of Florida‟s Workers‟ Compensation Law and submit
copies of the annual report to the Legislature and the Governor. The
Division of Workers‟ Compensation within the DFS is responsible for
preparing this report. Information contained in the annual report is
available at the DFS website. This bill was passed on third reading on February 8, 2012 and sent to the House
for their action.
Companion Bill: HB4019, sponsored by Representative Nelson. This companion bill was reported out of
Government Operations favorably on December 6, 2011, and was reported favorably our of Economic
Affairs Committee January 12, 2012.
SB 214: Workplace Safety (NHC)
Sponsor: Senator Lynn
This bill creates Fla. Stat. §440.1026. This new section requires all public employers to collect and retain injury
and illness data using OSHA form 300. The collected data must be submitted to the Division of Workers‟
Compensation, and the Division must compile the data, by employer, and post it on their website. The
information is also to be included in the report required by Fla. Stat. §440.59 (see discussion of SB140). The
bill mandates that the Division procedures shall facilitate Florida‟s participation in the U.S. Bureau of Labor
Statistics database. The Division is also mandated to “publicize the availability of a toll-free telephone for 54
public employees to ask questions, request materials, seek 55 assistance related to workplace safety, and report
perceived 56 unsafe workplace conditions.” This bill was referred to the Banking and Insurance, Governmental
Oversight and Budget committees in September, 2011, but was withdrawn from those committees and
“withdrawn prior to introduction” in December 2011.
Companion Bill: as of 01.26.12 no companion bill identified.
SB 400: Patient Brokering
Sponsor: Senator Jones
Patient Brokering is prohibited by Fla. Stat. §817.505. That statute is focused on any person, or health care
facility soliciting, offering any “commission, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or
in kind, or engage in any split-fee arrangement, in any form whatsoever,” to induce or in return for referring
patients. SB 400 would add violation of this statute to the definition of “racketeering activity” in Fla. Stat.
§895.02. Essentially, this bill would increase the potential penalties for those convicted of patient brokering.
This bill was referred to the Criminal Justice, Health Regulation, and Budget Committees in November 2011.
The Bill was introduced January 10, 2012.
Companion Bill: as of 01.26.12 no companion bill identified.
SB 668: Workers’ Compensation Medical Services (H511)
Sponsor: Senator Hays
This bill amends Fla. Stat. §440.13(12) regarding the reimbursement limits for workers‟ compensation
prescriptions. The focus of the change is on the effects of the practice of repackaging of relabeling
pharmaceuticals. The Amended statute would mandate that the reimbursement statutorily allowed would be
limited to the “average wholesale price set by the original manufacturer,” plus a statutory dispensing fee. This
bill was referred to the Banking and Insurance, Health Regulation and Budget Committees in November 2011.
On January 19, 2012 it was reported favorably out of Banking and Insurance with one amendment. It is
currently pending in Health Regulation Committee, but no hearing has been scheduled as of this time.
Companion Bill: HB511, sponsored by Representative Hudson. This bill was referred to the Insurance
and Banking Subcommittee, the Health and Human Services Committee, and the Economic Affairs
Committee in November 2011. It was reported favorably out of the Insurance and Banking
Subcommittee on December 7, 2011 and was introduced January 10, 2012. The Health and Human
Services Committee substituted new language into the bill and recommended that amended bill to the
House. The amended bill was read on the floor on February 10, 2012. The bill as amended can be
viewed here: http://www.flsenate.gov/Session/Bill/2012/0511/BillText/c1/PDF
SB 676: Workers’ Compensation Certificate-of-exemption Process (H307)
Sponsor: Senator Smith
This bill amends Fla. Stat. §440.02 regarding election of exemption from Workers‟ Compensation, by deleting
the requirement for corporate officer‟s elections are in writing. The amendments also add “a member of a
limited liability company” to those who are “employees” under Fla. Stat. §440.02(15)(c). This bill was referred
to the Banking and Insurance Committee, Commerce and Tourism Committee and Budget Committee in
November 2011. The Banking and Insurance Committee reported the bill out favorably on January 9, 2012.
The Commerce and Tourism Committee scheduled it for hearing on January 26, 2012. It is now in Budget
Subcommittee on General Appropriations.
Companion Bill: HB307, sponsored by Representative Bernard. This bill was referred to the Insurance
and Banking Subcommittee, the Government Operations Appropriations Subcommittee, and the
Economic Affairs Committee. The Insurance and Banking Subcommittee reported the bill out favorably
in November 2011, as did the Government Operations Appropriations Subcommittee in December 2011.
The Economic Affairs Committee reported it out favorably on January 12, 2012 and it was passed on
third reading January 25, 2012.
SB 896: Florida Statutes
Sponsor: Senator Thrasher
This bill amends Fla. Stat. §440.45 which has specific references to July 1, 1999 and the expiration of various
terms of office on that date. The provisions relate to the members of the Statewide Judicial Nominating
Commission for Judges of Compensation Claims. The bill summary describes these provisions as either
“having become obsolete, have had their effect, have served their purpose, or have been impliedly repealed or
superseded.” This bill was referred to the Rules Committee in December 2011. The Rules Committee reported
the bill out favorably on January 30, 2012 and placed on the Senate Special Order Calendar for February 13,
Companion Bill: HB 7007, sponsored by Rules and Calendar Committee. This bill was introduced in
December 2011 and referred to the Calendar. It was passed on third reading on January 25, 2012 and
sent to the Senate.
SB 910: Public Employees
Sponsor: Senator Hayes
This bill amends Fla. Stat. §112.18, which provides a presumption of compensability of medical conditions
“tuberculosis, heart disease, or hypertension.” The presumption currently applies to “any Florida state,
municipal, county, port authority, special tax district, or fire control district firefighter or any law 24
enforcement officer, correctional officer, or correctional probation officer as defined in s. 943.10(1), (2), or (3).”
The revisions add a requirement that the affected employee also have been “employed by the current employer
for at least 5 years and who is less than 37 years of age.” The law requires a pre-employment physical
examination requirement for firefighters and law enforcement officers; the bill would add that requirement for
“correctional officer(s), correctional probation officer(s).” The bill also specifies that “risk factors and
epidemiological data” related to nonwork-related conditions of the injured worker “are appropriate for
consideration in denying or overcoming the presumption.” The law currently provides some statutory
parameters specifically for “law enforcement officer(s), correctional officer(s), or correctional probation
officer(s)” in Fla. Stat. §112.18 regarding independent medical examinations, time limits for seeking to use the
presumption, and limitations on the presumption in some instances in which an employee has “departed in a
material fashion from the prescribed course of treatment.” The bill would make several of these provisions
likewise applicable to “firefighter(s).” This bill was referred to the Banking and Insurance Committee,
Governmental Oversight and Accountability Committee and Budget Committee in December 2011. The Bill
was introduced January 10, 2012. It was recommended favorably by the Banking and Insurance Committee and
the Senate Rules committee referred the bill to Governmental Oversight and Accountability and the Budget
Committee. The bill is currently in the Governmental Oversight and Accountability Committee.
Companion Bill: HB 365 is similar but not identical, sponsored by Representative Costello. This bill
was introduced January 10, 2012. It has been referred to the State Affairs Committee.
SB 918: State Group Insurance Program
Sponsor: Senator Oelrich
This bill amends Fla. Stat. §110.123 to add
subsection (14), establishing a state employee
health and wellness clinic pilot program.
This will provide state employees with
primary care services, wellness services and
occupational health services. The bill
provides in section (c) that the “vendor is not
required to file insurance claims, including
medical, health, and workers‟ compensation
claims, for any service provided by the
clinics.” This bill was referred to the Health
Regulation Committee, the Governmental
Oversight and Accountability Committee and
the Budget Committee. It has not been scheduled on the agenda of any committee at this time.
Companion Bill: HB203, sponsored by Representative Nelson. This bill was introduced January 10,
2012. It has not been referred for committee consideration or scheduled for any votes.
SB 938: Insurance Agents and Adjusters
Sponsor: Senator Richter
This bill amends Fla. Stat. §626.221 regarding examination requirements for insurance professionals. As the
law currently provides, there is an examination exemption for “(f) A person who has been licensed as a
company employee adjuster or independent adjuster for motor vehicle, property and casualty, workers‟
compensation, and health insurance may be licensed as such an adjuster without additional written examination
if his or her application for licensure is filed with the department within 48 months after cancellation or
expiration of the prior license.” This bill would delete that exemption. This bill also amends Fla. Stat.
§626.241(6)(a) regarding the test for an “all-lines adjuster” by removing the alternative for an examination
limited to adjusting in a particular field such as automobile, health or workers‟ compensation. This bill also
amends Fla. Stat. §626.2815 by exempting “public adjusters for workers‟ compensation insurance or health
insurance” from requirements for “elective continuing education hours required by chapter 648. This
bill also clarifies Fla. Stat. §626.869 regarding the qualification conveyed by an “all lines” adjuster 25
license. The bill includes a “safe-harbor” provision allowing those currently licensed (as of 10.01.12) in a
limited line, such as “workers‟ compensation,
or health insurance,” to remain so licensed
until such time as they renew their license.
This bill was referred to the Banking and
Insurance Committee and the Budget
Committee in December 2011. Banking and
Insurance reported a committee substitute of
the bill out favorably on January 9, 2012. The
Budget Subcommittee on General Government
Appropriations reported the bill out favorably
on January 19, 2012 and it remains pending in
the Budget Committee.
Companion Bill: HB725, sponsored by
Representative Hager. This bill was considered
by the Insurance and Banking Subcommittee
January 11, 2011, and a committee substitute
was reported out favorably by the committee that day. The committee substitute has been referred to the
Government Operations Appropriations Subcommittee and Economic Affairs Committee. It was on that
Committee‟s agenda on February 9, 2012.
SB 1094: Workers’ Compensation
Sponsor: Senator Hays
This bill amends Fla. Stat. §440.107 to alter the calculation of penalties for failure to secure payment of workers
Compensation. The law currently calculates this as 1.5 times the amount the employer would have paid in
premium within the preceding three years, or $1,000.00. The revisions alter this to 2 times the premium in the
preceding one year period, or $1,000.00. This bill was referred to Banking and Insurance and the Budget
Committee on January 10, 2012. The Banking and Insurance Committee reported the bill out favorably on
January 9, 2012. The Economic Affairs Committee recommended the bill favorably on February 1, 2012 and it
has been placed on the calendar for reading.
Companion Bill: HB789, sponsored by Representative O‟Toole. This bill was referred to the Insurance
and Banking Subcommittee, the Government Operations Appropriations Subcommittee and the
Economic Affairs Committee in December 2011.
HB 4085: Workers' Compensation
Sponsor: Representative Caldwell
This bill repeals Fla. Stat. §627.092 and amends Fla. Stat. §627.312. The current provision of Fla. Stat.
§627.092 provides “there is created within the office the position of Workers‟ Compensation Administrator to
monitor carrier practices in the field of workers‟ compensation.” The amendment of Fla. Stat. §627.312 deletes
(2), which currently provides “Any policy issued by the Florida Workers' Compensation Joint Underwriting
Association with an effective date between the date on which this act becomes a law and June 30, 2004, shall
be rerated and placed in the appropriate tier provided in s. 627.311(5), as amended, effective July 1, 2004, and
shall be subject to the premiums and charges provided for in that section as amended.” This bill passed on third
reading on January 25, 2012 and sent to the Senate.
Companion Bill: as of 12.01.11 no companion bill identified.
The Regular Session of the Florida Legislature convenes January 10, 2012 and concludes March 9, 2012. For
more information about pending legislation, schedules of hearings, and the legislature generally, visit
http://www.flsenate.gov/ and http://myfloridahouse.gov/.
THE NATIONAL WORKERS‟ COMPENSATION INSTITUTE
EDITORIAL GUIDELINES FOR WEBSITE SUBMISSIONS
The National Workers‟ Compensation Institute (NWCI) is a nonprofit
educational organization that serves as a comprehensive resource to all
workers‟ compensation stakeholders. The NWCI is an outgrowth of the long-
established Florida Workers‟ Compensation Institute. FWCI remains in
existence under the NWCI umbrella and continues its Florida focus, while the
national organization provides a broader outreach across all states. The NWCI
sponsors an annual National Workers‟ Compensation Educational Conference
(NWCEC) in Orlando in August, familiar to many through the sponsorship of
FWCI. Now in its 67th year, the conference brings together workers‟
compensation professionals from across the country for networking and
information sharing and provides an opportunity for vendors to display their
products and services.
The NWCI website contains state-specific and national workers‟ compensation news and feature articles
targeted toward claims professionals, the legal and medical communities, insurers/brokers/agents, employers,
and employees. In addition to providing information to all stakeholders, the website offers a platform for
interaction and community-building and promotes the annual national conference. We welcome website
submissions of bylined articles and press releases from companies and individuals based on the following
· Bylined articles must be of general interest to members of the workers‟ compensation community
(claims professionals, risk managers, health care and medical providers, legal community, insurance
executives, employers, employees). The articles may be state-specific (e.g., new legislation in
California) or broader-based (e.g., How to Create an Effective Safety Program; Return-to-Work Can
Save You Money). While case studies or proprietary data may be cited, articles should not be
“advertorials” for specific companies or products.
· Articles may not have appeared previously in wide circulation (limited prior release to membership
groups, clients and the like is acceptable).
· Original articles are embargoed until publication on the NWCI website, after which the author may
distribute to other media or interested parties, provided the article carries the tag line: “This article
originally appeared on DATE on the National Workers‟ Compensation Institute‟s website, and is
republished here with permission.” Linking to the NWCI website is encouraged and unrestricted.
LENGTH: Recommended length is 600 - 900 words; longer articles will be considered.
FORMAT: Word document, Times New Roman, 12-point, single space, no headers or footers or special
ID: Author‟s byline appears at the top of article. Author is further identified on the website with name, title,
company, brief description of company, e-mail, phone, and website.
DEADLINE: Time-sensitive articles may carry a deadline, which will be mutually agreed upon by the author
Press releases publicizing a company‟s or person‟s accomplishments, new products, financial results/ratings,
and the like are accepted. Press releases are subject to editing and will be posted by the NWCI editor as time
Thank you for your interest in submitting material to the NWCI website.
Joan E. Collier, Online Communications Officer, Phone 941-954-3365; firstname.lastname@example.org 27