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Department Submits Proposals to Improve w e Dispute Resolution By Regina Marie Glick

Sometimes even the most com-plicated issues can be resolved by going back to the basics, and that includes workers' compensation reform.

In a letter to the Workers' Com- pensation Board Chairperson, Donna Ferrara, the Insurance Department laid out its proposals to streamline adjudication procedures for disputed cases as part of the department's larger overhaul of the state's workers' compensation practices.

The first step to cut dispute resolu- tion times from as long as six months to no more than 90 days will be as simple as improving the initial forms that employers, employees, physicians, and insurers fill out when a case is first opened. According to the depart- ment, the current forms are crowded, convoluted, and they do not collect all of the necessary information. This results in incomplete records, a problem that echoes throughout the entire resolution process.

According to the letter, "It is gen- erally not until the pre-hearing con- ference that the parties may learn for the first time the facts supporting the claim and any defenses to it. In practice, this means that pre-hearing conference time is wasted on cases that could have been easily settled beforehand, or on needless adjourn- ments for the parties to continue to gather information and prepare the case for a hearing."

In addition to improving the look and comprehensiveness of the forms, the department advocated includ- ing a limited medical release form with the initial paperwork to make the relevant medical documentation available to insurers, physicians, and legal counsel in a timely fashion.

Currently, the department said, insurers often feel pressured to contro-

vert cases before they receive all of the relevant information before deadlines expire. The new forms are intended to put the appropriate informafion in the hands of the various stakeholders very early on in the process and to eliminate unnecessary hearings.

Under the current system, approximately 48 percent of claims are resolved at the pre-hearing con- ference. The department wants to see both sides sharing relevant informa- tion earlier in the process to encour- age settlements prior to the pre-hear- ing conference and without the time and cost of additional hearings that result from a slow process to receive medical data.

In addifion, the department made a number of other recommendations: • Carriers will be required to

describe the factual basis for their claims disputes, a practice that is often overlooked, according to the department, because of the slow disclosure of claim information and cumbersome paperwork;

» Supporting medical documenta- tion will be required to accompany carrier disputes;

• Early mediation of disputes will be required under the assumption that the greater disclosure provid- ed by improved forms will make such mediation more likely to be successful;

0 According to the letter, "At the time of the pre-hearing confer- ence, all discovery will be com- plete, medical reports filed, and unsupported defenses waived. Thus, the case will be trial ready;"

o The first hearings, including all testimony from witnesses, for trial-ready cases will take place immediately after the conclusion of pre-hearing conferences;

o For most cases, a conclusion will be issued from the bench imme- diately after the end of a final hearing, or within 10 business days thereafter;

» Adjournments will be strictly regulated.

Although the board is still review-

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S I N C E 1 8 8 9

VOLUME 118, NUMBER 13 JUNE 18. 2007

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ing the recommendations at the time of this writing, Cheryl Wood, the board's general counsel, said that the boards first priority will be to redesign the various forms that lay the foundation for every claim. A specific timeline for implement- ing these procedures has not yet been laid out.

Morelle to Chair Assembly Insurance Committee By Jessica McKee

ALBANY, N.Y., June 7 - Assembly-man Joseph D. Morelle (D- Rochester) has been named Chairman of the New York State Assembly Committee on Insurance by Speaker Sheldon Silver (D-New York).

"The choice of Joe Morelle to head this important committee promises to deliver sound, judicious leadership," said David Dickson, president of the Professional Insurance Agents of New York State, Inc. (PL\NY). "He is known as a business-friendly member of the Assembly Majority who approaches the issues thoughtfully and seeks a deep understanding of their complexi- ties as well as their practical effects on each stakeholder."

Dickson praised Morelle for taking a leadership role in the Assembly on the major issue of the state's unique Scaffolding Law and the exposure it presents to contractors, property own- ers, and others when certain types of accidents occur on the job.

Morelle has also been a champion of a bill to decrease the number of auto- mobile accidents that would result in future premium surcharges.

Ellen Melchionni, vice president of the New York Insurance Association (NYIA), also praised the appointment. "We think Speaker Silver made an excel- lent choice in Joe Morelle," Melchionni said. "In our dealings with Assemblyman Morelle, we have found him to be well- informed on business issues, and a staunch defender of New York's con- sumers. The New York Insurance Association welcomes that balanced approach and looks forward to working

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with the new Assembly insurance chair- man and his colleagues to address many of the vexing issues that affect New York insurers and policyholders."

Paul Magaril, regional manager and counsel for the Property Casualty Insurers Association of America (PCI), commented in a statement, "We are very encouraged by the appointment of Assemblyman Morelle because of his fair and balanced approach to legisla- tive issues as well as his commitment to improving New York's business cli- mate. His experience will guarantee that issues facing insurance consumers will be addressed and bring greater compe- tition to the insurance marketplace in New York."

Blli Would Expand Timothy's Law to CHP and FHP By Muriel Gibbons

LBANY, N.Y, June 1 - Timothy's iLaw would be expanded to extend

mental health and substance abuse parity to Child Health Plus (CHP) and Family Health Plus (FHP) under legislation introduced in the Senate and Assembly.

"[l]n many instances, the state's policy makes it iiarder for peopie

to get the services they need, and it ends up costing the taxpayers more money."

— Assemblyman Paul D. Tonko

The legislation, which was intro- duced with 83 sponsors in the Assem- bly, would provide full mental health and substance abuse to both health programs.

According to Assemblyman Paul D. Tonko (D/L-Montgomery). there are now approximately 390,000 children in CHP and 510,000 people in FHP Due to improved access changes in the program, another 400,000 individuals would be covered over the next five

years, bringing the total to over 1.3 mil- lion children and families.

Often, when CHP-eligible children lose coverage under the program, their families will soon become eligible for Medicaid, which has always had full parity for mental health and substance abuse, Tonko pointed out. The federal government currently pays 65 percent of the costs associated with CHP, as opposed to 50 percent with Medicaid. "Therefore, in many instances, the state's policy makes it harder for people to get the services they need, and it ends up costing the taxpayers more money."

Assemblyman Richard N. Gottfried (D/L-New York), Chairman of the Assembly Health Committee, said the failure to provide mental health and substance abuse parity to those who rely on Child Health Plus and Family Health Plus is a relic left over from an era when society did not recognize the importance of treating mental health.

Tom O'Clair, father of Timothy O'Clair - for whom Timothy's Law was named - and co-chairman of the Timothy's Law Campaign, praised Tonko and Gottfried, as well as every other sponsor, for "showing they are champions of the causes that are impor- tant, not just to their constituents, but to the state."

O'Clair said, "I wish to thank them all for taking the necessary steps to extend the benefits of Timothy's Law to over one million more New Yorkers. By proposing this legislation to include Family and Child Health Care Plus, we are once again breaking down long- standing barriers that have prevented those who suffer from mental illness and substance abuse from receiving the care and treatment they need - the same care and treatment that allows them to be everyday members of society."

The legislation is supported by Families Together in New York State, Mental Health Association in New York State, Coalition for the Home- less, National Association of Social Workers - New York State, New York Association of Psychiatric Rehabili- tation Services, Medical Society of New

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