P&C Update: Auto Liability and Workers’ Compensation Could See a Tide of Change in 2023: Risk and Insurance

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Enlyte’s Compliance Update examines recent August legislative decisions and their impact on motor vehicle accidents and workers’ compensation.

August 2022 has been a busy month across the United States for workers’ compensation and auto accident compliance. A monthly update report d’Enlyte examines recent events in both spaces and how these legislative decisions will impact coverage capabilities and policy triggers for the future.

In particular, workers’ compensation determinations not only span state borders, but also their reach. From COVID-19 provisions to medical bill payment objections, the industry is set to experience a tidal wave of updates.

Auto Accident Updates

In Michigan, the overturning of a previous decision in Andary vs. USAA, the state Court of Appeals found that Michigan’s new fee schedule does not apply retroactively to inherited claims. Rather, it can only be applied to “claims with injury dates after the current fee schedule.”

In the new decision, the Michigan Court of Appeals further ruled that “even if retroactive intent had been shown, imposing the new limits would significantly harm no-fault insurance contracts entered into before the effective date. amendments, and would therefore violate the contract clause of the Michigan Constitution.

USAA, the defendant in the original case, intends to appeal the decision.

The Michigan House of Representatives introduced Bill HB 6335, which states that an automobile policy will not cover damage resulting from a sexually transmitted infection or pregnancy resulting from sex in a motor vehicle.

The New Jersey Legislature introduced Bill S481, which requires auto insurance policies to provide certain minimum liability amounts, as well as coverage for uninsured motorists and underinsured motorists.

The bill clarifies that, except for a basic automobile insurance policy, no automobile liability insurance policy or renewal of such insurance policy may be issued in New Jersey unless it includes coverage within the following limits for bodily injury or death: an amount or limit of $15,000 for plans issued or renewed prior to January 1, 2023; $25,000 for plans issued or renewed on or after January 1, 2023 but before January 1, 2026; and $35,000 for plans issued or renewed on or after January 1, 2026; and an amount or limit, subject to this limit for anyone injured or killed, of $30,000 for plans issued or renewed before January 1, 2023; $50,000 for plans issued or renewed on or after January 1, 2023 but before January 1, 2026; and $70,000 for plans issued or renewed on or after January 1, 2026.

Workers’ Compensation Decisions

From California to Florida to Ohio, August’s range of workers’ compensation compliance issues cover everything from spinal cord stimulator reimbursements to changes to care networks (HCN) to medicines issued by doctors.

The Michigan State Department of Insurance and Financial Services has released its annual adjustment to the maximum compensation for job loss and compensation for loss of survivors, both of which will reflect changes in the cost of living. Effective October 1 of each year, these adjustments only apply to benefits resulting from accidents occurring after the date the maximum is changed.

Effective October 1, 2022 (through September 30, 2023), new Loss of Work and Survivors benefits payable in Michigan will not exceed $6,615 per single 30-day period. This is an increase from the previous year’s maximum work loss and loss of survivor benefits, which were $6,065 per single 30-day period.

COVID has played a big role in alternations to workers’ compensation in various states. Recently, California extended certain presumptive COVID claims until January 1, 2024 for first responders.

Specifically, the bill expanded the COVID claims provisions currently applicable to firefighters and police officers to include active firefighters from a fire department at the State Department of State Hospitals, the Department of State of Developmental Services, to the Military Department and the Department of Veterans Affairs and to officers of a state hospital under the jurisdiction of the State Department of State Hospitals and the State Department of Developmental Services.

In August, California also saw a proposed measure to reduce the investigation period for certain claims from 90 days to 75 days. Additionally, workers’ compensation payments that are deemed “unreasonably” delayed will result in penalties of up to $50,000 for specified first responder claims.

The New York State Workers’ Compensation Board has also issued a reminder that denials of Prior Authorization (PAR) requests that have progressed to Level 2, without the review and signature of a the insurance company, are invalid and subject to penalties.

The New York Workers’ Compensation Board stated, “Where a Payor denies or partially approves a RAP (MTG Deviation, MTG Special Services, MTG Confirmation, Drugs, Durable Medical Equipment), the Payor must also declare any other reasons for refusal or such reason for refusal shall be deemed waived.

When objecting to payment of medical bills, the New York State Workers’ Compensation Board said payers will be required to use Claim Adjustment Reason Codes and Claim Adjustment Remark Codes. appropriate payment notices on Explanation of Benefits/Explanation of EOB/EOR Review when objecting to payment of a medical bill.

In addition, the payer must also file one of two forms with the New York State Workers’ Compensation Board: a Notice of Objection to Payment of an Invoice for Treatment Provided or a Notice to health care provider and claimant of an insurer’s refusal to pay all (or part) of a medical bill due to valuation objection(s).

Effective August 2, the State of Texas introduced new rules governing Texas Certified Healthcare Networks (HCNs). Some of the new changes to HCNs include the elimination of the physical on-site visit for provider accreditation, clarifications regarding coverage maps, the addition of telemedicine as a reportable “practice focus,” as well as clarifications regarding coverage maps and clarifications on the HCN complaint process.

HCNs have until January 1, 2023 to comply with these new rules.

The Minnesota Department of Labor and Industry also recently released the state’s Workers’ Compensation Medical Fee Schedules. The new Resource-Based Relative Value Schedule (RBRVS) is in effect from October 1, 2022 to September 30, 2023.

While the RBRVS conversion factors have increased slightly for physical medicine/rehabilitation services in part and for chiropractic services compared to the fee schedules from October 1, 2021 to September 30, 2022, the conversion factors for medical services/ surgical services, as well as pathology services and laboratory services were slightly reduced compared to the same period. &

Based in Minneapolis, Minnesota, Maura Keller is a published writer, editor, and author with over 20 years of experience. She has written on business, design, marketing, healthcare and a host of other topics for dozens of regional and national publications. She can be reached at [email protected]
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