Workers’ Compensation and Civil Litigation Consultation & Defense
News
ATBJ NEWS – CONNECTICUT
2011-06-29
Attorney Jason LaMark attended a seminar held by John A. Mastropietro, Chairman of the Workers' Compensation Commission. The purpose of the seminar was to educate payors and workers' compensation claim administrators regarding guidelines as it pertains to providing medical services. Chairman Mastropietro expressed concern throughout the seminar regarding what he perceived as dilatory practices among the major insurance company stakeholders, third party administrators and self-insureds. In response to these concerns, he developed guidelines to address universal concerns regarding communication failures among stakeholder groups. The guidelines were made effective, July 1, 2010, and were drafted and coordinated with representatives from each of the key stakeholder groups. The guidelines were also created in response to proposed reactionary legislation that could potentially generate an enormous amount of hearings, and make defense of workers' compensation claims much more difficult for respondents.
The purpose of the guidelines is to facilitate timely and effective communication between the respective parties. This is done with the hope that it will promote compliance and efficiency throughout the Workers' Compensation Commission. These guidelines will be incorporated as a minimum requirement for conduct under any managed care plan. If the insurer wishes to incorporate more stringent guidelines that will certainly be allowable, but the subject guidelines will be the minimum standard.
Chairman Mastropietro made very clear that he will be expecting commissioners to be much more liberal in their administration of fines and penalties. He stated that if respondents show up to hearings with no file materials or knowledge of their file they should expect to be penalized for the same. He advised that all defense counsel must show up with the authority to make decisions relative to the noticed hearing issues. Once again, he made very clear that the respondent's inability to resolve issues at hearings (thereby generating more hearings) will result in fines. This is in response to what he perceives as an abundance of hearings that require follow up hearings to report whether the requested action will be authorized. That being said, he also indicated that the claimant’s bar will "feel the pinch” too for similar actions.
To implement these guidelines and make them run efficiently, increased communication will be necessary. The increased communication will hopefully result in timely decisions which will provide optimal outcomes for everyone involved. "Non?responses”, and unprepared counsel (or counsel who has not been provided with decision making authority) will be interpreted as an insult to the Workers' Compensation Commission. This will result in progressive fines. Chairman Mastropietro continually delivered the message that you don't want to become "the problem child", as the problem children will be dealt with much more harshly and regularly.
Attorney LaMark was one of only two attorneys in attendance. The rest of the attendees were representatives of insurance carriers, third party administrators and major self insured employers. The Chairman expected everyone in attendance to return to their offices and “train” their claim teams on the guidelines. After the conference, Attorney LaMark prepared a detailed memorandum summarizing the conference, which was forwarded to our clients.
Recently, a criminal conviction was reached in a fraud referral generated by my defense of a workers' compensation claim. This resulted in felony charges of workers' compensation fraud and perjury being brought against the claimant. The claimant ended up pleading guilty to larceny charges and must pay restitution to our client. Attorney LaMark of our office also assisted in another party being arrested for workers' compensation fraud. Our client was held liable for a claim for an uninsured subcontractor due to the principle employer rule. Attorney LaMark established a sufficient basis for the fraud bureau that the subcontractor committed may have committed fraud when he classified all his "employees" under a separate business entity and paid them cash, while maintaining a workers' compensation insurance policy listing no employees under a separate business entity that he used to get his business contract with our clilent. Felony charges are pending against the subcontractor.
Sincerely,
Gerald V. Davino II
Managing Partner, Rocky Hill, CT