By Donna Motley, Vice President of Claims

Michigan Workers’ Compensation Administrative Rules dictate that once a claim form concerning an employee work related injury is submitted to the Workers’ Compensation carrier, the Workers’ Compensation carrier has 30 days to make a determination “of some kind”. A definite or final determination of benefits does not have to be made when a claim is first filed with the carrier; BUT the claim has to be addressed. If the initial investigation results in the carrier being able to make a determination that the claim is valid, benefits commence. Benefits would include authorization for medical testing and/or treatment, payment of related bills submitted and payment of wage loss benefits if/when applicable.

If the carrier is unable to make a valid determination within 30 days, it usually means additional investigation is necessary, medical records need to be obtained, written statements requested, a medical evaluation scheduled, etc. The 30 day clock is ticking, so the carrier has to file a form with the State of Michigan entitled Notice of Dispute. The Dispute includes the reason why it is being filed – under the above circumstances the reason would be “Further Investigation Required”, “Additional Information Required from Employee” or “Other”.

By Melanie English, Underwriter / LPT Program Manager

The MTM Underwriting and Marketing Departments regularly receive inquiries about Workers’ Compensation coverage for our Member’s out-of-state employees. Often it is because a Member has hired a salesperson, clerical staff or installers who work in other states or an acquired out-of-state facility. Due to an increase in these inquiries, we thought it was a good time to update you on the out-of-state coverage requirements.

By Donna Motley, Vice President of Claims

Summer in Michigan! It seems like we have been waiting a long time this year for the arrival of summer. Not that we had a harsh winter or even a long winter – it just seems that our weather has been so up and down. I think when you live in a State that has snow, ice, cold temperatures and power outages, you work hard and like to play hard too ! At the first sight of 60 degree temperatures, people native to Michigan break out the shorts and flip-flops. We’ve been waiting and we are anxious!

First of all, we have to clean up from the winter or maybe even the left-over fall season. Now we can ride our bicycles or motorcycles. We can plant and maintain our flower or vegetable garden(s). We can hand-wash the car, wash windows, cut grass, trim bushes. We can now golf, play baseball, swim in a pool or lake, play horseshoes, cornhole, Jarts, you name it. Let’s not forget about boating, jet or water ski’s, tennis, maybe even Pickleball? Camping and campfires (setting up and tearing down). Traveling to other states or countries, hiking, and all around site seeing.

By Donna Motley, Vice President of Claims

As employer I am sure you are acutely aware of the demand for higher wages merely to employ “a warm body” – not always acquiring talents that were promised. I was at my dentist this past week and was told they are having an issue finding a receptionist; a person was hired but quit after one week. My dentist is a female; her husband periodically “helps out” in the office because they are short staffed. Jobs are available!

It seems the price of everything has universally increased. While the price of gasoline may fluctuate, I haven’t seen the same phenomenon happen at the grocery store! The local Meijer has installed a large number of “selfcheck- out” scanners, almost totally eliminating human cashiers.

By Donna Motley, Vice President of Claims

Before setting goals, you need to evaluate the past. I’m not referring to New Year Resolutions – I’m referring to behavioral changes. Review the work related injuries that occurred at your facility this past year. If you count “zero” – keep up the good work – something is working in your favor! Is it your safety program? Safety meetings? Safety training? A Safety reward program? Open communication with your employees? Work place culture? All of the above?

Did your facility record a “near miss” or two? If so, consider a near miss to be a “warning” of what could have happened. Review the near miss scenario to de-termine what could have happened, i.e. the worst case scenario. Then review and implement corrective actions to avoid another such incident. Michigan is a “no-fault” system. Workers’ Compensation benefits are not deter-mined based on whether or not the employee was “at fault”, resulting in the injury. The only exception is if the employee is injured as a result of their intentional and willful misconduct, (i.e. – the employee punched the wall in anger).

By Donna Motley, Vice President of Claims

When someone tells you they have “good news” and “bad news” – which news do you want to hear first? For me, it depends on what kind of mood I’m in at the moment. As we all know, we are still feeling the aftershock of COVID-19 – and maybe will for a long time to come. One of the negative events was termed “The Great Resignation”. Employees resigned from their employment in record numbers. A large segment of those ending their employment were of, or nearing, retirement age. This resulted in a large loss of “experienced and skilled” employees. This loss of experience has a major impact on the employer, regardless of the industry; industrial, hospitality, construction, trucking, etc. This is bad news for employers.

After two years, The Great Resignation has morphed into “The Great Reshuffle”, meaning a significant number of employees that resigned (or were let go) are now working their way back into the workforce. Some workers returning to the same industry they worked in the past; some workers are attempting new career paths. Reports indicate that in May 2020, 54% of workers 55 and older were either working remotely or unable to work at all (in their particular industry). Today, that figure has decreased to 15%. The U.S. Bureau of Labor Statistics indicates that by year 2030, one in four U.S. workers will be 55 or older. That is the good news!

By Donna Motley, Vice President of Claims

It has been two years since the start of COVID; and COVID continues to impact our daily lives. As the virus continues to linger and spread, albeit with “variations”, our lives have had to adjust. As we attempt to regain our independence and sense of “normalcy”, society has been attempting a Return to Work. Our department has seen an increase in work injuries, primarily injuries to workers with less than a year of seniority with the employer.

For multiple reasons, injuries to employees of less than a year on the job is common. During and post COVID, employers have been faced with an exodus of employees. Now that people are having to return to work, they may attempt work in a field entirely new to them. Commencing new employment of any kind requires a certain amount of training. The work environment may be foreign to a new hire, the pace may be different from that of their previous employment. Management’s structure most likely is different from what they were previously familiar. Expectations may be different. The actual “tools of the trade” may be new to them. Maybe the new employee hadn’t worked in a year or more and they now have to be at work by 7:00 A.M.

By Donna Motley, Vice President of Claims

With inflation as a 40-year high, it seems the price of everything is increasing. Medical expenses are no exception.

Workers’ Compensation wage loss benefits are established by the State of Michigan, at the beginning of the year, every year, based on the State Average Weekly Wage. These weekly benefit rates, which includes a “maximum” rate, are published “on line” on the State’s website. Remember, we only handle Michigan Workers’ Compensation claims in our office. Wage loss benefits are calculated based on the highest 39 weeks of the previous 52 weeks of gross weekly wages of the injured worker, along with the number of claimed dependents allowed by the Workers’ Compensation Act. The rate established at the time of injury remains the same for the life of the claim. There is no cost of living increase, but the rate can be decreased if a claimed dependent no longer qualifies. There are decreases in the weekly benefit once an injured worker turns 65 years old – typically 5% per year or reduction taken when the injured worker begins taking Social Security benefits. Other than that, a weekly benefit rate established in 1997 is the same amount the injured worker would receive in 2022 if they are under the age of 65. Not much we can do about an established benefit rate.

By Donna Motley, Vice President of Claims

Established in 1912, the Michigan Workers’ Disability Compensation Act provided the workers give up the right to sue their employer in Civil Court. In return, Workers’ Compensation is essentially a “no fault” system. If an employee is injured in the course of employment – regardless of who was at fault – unless it was an “intentional” act – the worker is compensated certain wage loss benefits and the cost of medical treatment and rehabilitation. Workers’ Compensation does not pay for “pain and suffering”.

The Workers’ Compensation Act, at 110 years old, has had multiple changes and amendments over the years. However, the ultimate goal remains the same – for the injured worker to return to their former job or another one with the same employer. A return to work is dictated by a medical professional. An injured worker cannot return to work following a work injury until a doctor provides the “O.K.”.

By Donna Motlet, Vice President of Claims

It is a New Year! It seems some things change and some things remain the same, almost as if we are in some sort of time warp!

What’s new?

• For the year 2022 the new maximum weekly Workers’ Compensation benefit rate is $1,048.00. The State bases this rate on a State Average Weekly Wage of $1,163.79. Compare the Workers’ Compensation maximum which is “non-taxable” to the State Unemployment weekly maximum benefit that IS TAXABLE, $362.00. Obviously, the Workers’ Compensation weekly benefit is determined by averaging the highest 39 of 52 gross weekly wages, pre-dating the date of injury. The maximum Workers’ Compensation weekly benefit rate for 2021 was $975.00.
• The new mileage rate paid for 2022 covering mileage to and from medical appointments is $.585. The mileage rate paid for 2021 was $.56.
• In December 2021 one of the appointed Workers’ Compensation Court Magistrates “quit”. The State’s Governor appoints the Workers’ Compensation Court Magistrates. A replacement Magistrate was appointed with an expiring term of January 26, 2023. Effective January 26, 2023, 7 of the 14 currently appointed Magistrates have a term expiration. The remaining 7 Magistrates remain through January 26, 2025. There is a gubernatorial election in November 2022. It would appear that the “incoming” governor would be responsible for the new Magistrate appointments.
• Michigan Workers’ Compensation Plaintiff Attorneys got a pay increase. Their fee has been calculated at 15% of the first $25,000 (settlement), then 10% of the settlement balance. Their fee is now calculated at 20% of the first $100,000 (settlement), then 15% of the settlement balance.
• Michigan Workers’ Compensation Courts are open but will still conduct business via Zoom and Affidavits on a case by case basis.
• Per the Michigan Workers’ Compensation Act, wage loss benefits can be coordinated with Unemployment Benefits, with Workers’ Compensation taking a 100% credit of the Unemployment Benefits paid. During COVID, workers alleging work related disability were allowed to receive both State and Federal (Unemployment) benefits. Attorneys representing injured workers are diligently attempting to have orders passed eliminating Workers’ Compensation coordinating with Federal benefits.
• Multiple platforms continue to push for legislation citing COVID as a work related occupational disease/condition. Said attempts are at both, State and Federal levels, and vary from state to state.

What is not new ?

• Employees continue to diagnose with COVID/Omicron, continue to “test” for COVID/Omicron, allege exposure to COVID requiring the necessity to quarantine. Employers still suffer from a labor shortage, consumer products are experiencing shortages, a significant portion of the workforce continue to work from home, doctor offices limit visitor attendance, physician appointments are being cancelled and rescheduled. Debate continues over vaccination and vaccine mandates. Recreational marijuana is legal. Stress levels remain high. Everyone is anxious for Spring/Summer!

When hiring new employees, please make sure they receive proper training and instruction to perform their job duties. We have seen an increase in serious injuries of recent hire employees. Please stress the importance of NOT taking shortcuts – the results can be serious. Please make sure new employees are familiar with your company policies, procedures and protocols. While a short-cut may seem like a good idea at the time, taking a short cut can create serious long-term issues. Employers must also keep MIOSHA regulations in mind at all times.

Is this the employee covered in Michigan, or another state?

Part of my daily tasks is answering member’s questions. When a particular question begins to surface weekly, it’s time to share the question and answer with all of our members. The recent regular question looks like this “Is my employee in Indiana covered by my MTM policy?” With more remote working going on especially in sales and clerical/engineering jobs it seems logical that this question is coming up more.

While the rules can vary by state, and in fact even in Michigan there is a complicated more than 15 question criteria that is used, there are three or four much more simple questions that answer the vast majority of situations. Because our members need quick reference answers, let me walk you through this simple criteria.

By Donna Motley, Vice President of Claims

Summer is over, schools are back in session and hopefully, more people are returning to work. Everyone is aware of the “worker” shortage. Employers are placing signs outside their establishment seeking candidates. Some fast food restaurants have limited their hours of operation and some only operate the drive through window.

Advertised are: sign-on bonuses, paid college tuition, health care benefits, etc. Now that recreational marijuana has been legalized, prospective employees have one less hurdle to worry about. I just can’t imagine being on lay-off status and not looking for work.

By Donna Motley, Vice President of Claims

Finally, as promised, the Workers’ Compensation Courts are now open for “in person” business! Any way you look at it, this is a good thing! Over the last one and one-half years, the Workers’ Compensation Courts were still conducting business, but like everyone else in the business world, communication was via telephone or (computer) Zoom. While I can’t necessarily speak for Plaintiffs, I can tell you the Defense side of Workers’ Compensation is happy with the re-opening. It will take a while to get cases back “on track” but so far everyone in the litigation field seems anxious to get back to work.

By Donna Motley, Vice President of Claims

I didn’t grow up in a wealthy family. I received an allowance for weekly chores. Chores were not gender specific – my sisters and I did everything. We were expected to learn to budget our money. I can remember specifically receiving 25 cents per week and saving up to buy a record album that cost $3.50. Once I started to babysit (at age 12), I no longer received an allowance nor did my mother buy me clothes other than for birthday or Christmas. I was expected to buy my own clothes with the exception of an occasional purchase of material by my mother so I could sew my clothing. My best friend had the identical situation. I couldn’t wait to start working, which I did while in high-school at the age of 17. And yes, I would still babysit (at 25 to 75 cents an hour)! Right or wrong, it sure motivated me! I couldn’t wait to start working and earning money.

The point of my story – “COVID” Unemployment insurance and all the extras, is due to end – or least be substantially reduced. Theoretically, that should put a flood of people back in the workforce. I know employers are screaming for employees. It seems EVERYONE needs help! Bless the first responders and front line workers, but I think they are suffering from “burn out”. I drove past a cemetery last week that had a sign out front indicating “Help Wanted – $15.00 per hour”. The $15.00 per hour seems to be the magic number. I’m sure the cemetery is not looking for someone to dig holes in the ground – that would be a heavy equipment operator earning much more per hour. How hard could the job be? Picking up pine cones dropped by the trees? Trimming around headstones? Picking up trash? Painting a gate? While it might not be a career choice, it would certainly put money in your pocket.

So, if and when applicants are at your door, (assuming they will be), there are a few things you should consider:

By Donna Motley, Vice President of Claims

HOW TO FILE A CLAIM – Sounds simple, right? There is more involved than one might anticipate.

Claims can be filed with our department via facsimile, e-mail or MTMIC’s Portal. (No one uses U.S. mail anymore – if for no other reason, it takes too long!) Early reporting is best. The longer the delay between the date of injury and the date received in our office results in additional investigation of the circumstances surrounding the incident. Causal relationship has to be identified. When claims are reported within one or two days of occurrence, most, if not all, details are still fresh in everyone’s mind. Similar to the childhood game of “re-telling” a story, the more time that passes, the more likely the story (or in this case, facts) can change. Studies have been done where five people witness the same motor vehicle accident, and there are five different versions as to “how” the accident occurred. Wait an additional five days and details tend to blur, change or be forgotten.

By Donna Motley, Vice President of Claims

Statistics indicate 70% to 80% of individuals experience low back pain in their lifetime. I think most likely, everyone has had a sore back at some point in time.Think back to the last time you were working in your yard or garden, washing your car, cleaning your house, playing with your children/grandchildren. Or maybe your sore back is simply the result of an old bed mattress, saggy couch, sitting in one position for too long or driving a long distance. Could be anything.

A sore back can be the result of lifting, pushing, pulling, holding, carrying, throwing, slip/trip with a fall or without a fall, extended leaning, falling from ground level, falling from a height, climbing, bending, crawling, reaching, twisting, stepping, motor vehicle accident and repetitive motions.

By Donna Motley, Vice President of Claims

Pre-existing conditions, physical or mental, have a great impact on work related injury claims. The State of Michigan Workers’ Disability Compensation Act was predicated on the basis that “you take employees as you get them”. Everyone has their own set of baggage. Family health history pre-disposes some people to certain conditions as does our own personal history. Personal hobbies or activities outside of work, housework, yardwork, raking leaves, trimming bushes, shoveling snow can initiate physical conditions or ailments that are amplified or exacerbated when a person performs work functions.

By Donna Motley, Vice President of Claims

Do you believe in angels, ghosts or aliens from outer space? If not, is it because you have never seen one? Well, the average person cannot see the little bug causing havoc with the “world”, but we have “proof” it was here, is here and continues to be here! Something we cannot see is changing the way we live and go about our daily activities. Fall weather has arrived and we are fast approaching winter. And we are still under the watchful eye of COVID-19. Some restrictions have been partially lifted but we are a long way from “life as we knew it” prior to March 2020.

The Workers’ Compensation arena has been affected as well. As you may recall, doctor’s offices were closed for a short period, then only saw patients via telemedicine. While telemedicine was instrumental in a patient being able to be evaluated, the visits technically do not qualify as a form of treatment. Without an actual physical examination, doctors appeared to be somewhat reluctant to do more than prescribe the injured worker to “stay the course”. Of all the cases we handled during that time, not one patient was discharged from care via telemedicine. Typically, a medical professional would want a physical exam of the patient before declaring a full recovery and recommending a return to all normal activities. This results in continued lost wages if the injured worker had previously been diagnosed as disabled from working, and the added fee for a return visit.

By Donna Motley, Vice President of Claims

As we slowly attempt to return to our former lives (I’m not going to say “return to normal” because, let’s face it, I doubt things will ever be what we considered “normal” in the past), there will certainly be challenges that need to be met. MTMIC was fully functional during the “stay safe” order. Challenges were met in making sure injured workers received appropriate care and treatment. Telemedicine and Teletherapy were utilized. Nurse Case Managers were not allowed to attend appointments of those physicians that were continuing to see patients in person, so they would have a follow-up conference with the injured worker and the physician’s office and obtain the required paperwork for our department. However, for the most part, physicians were reluctant to do more than keep the injured worker “status quo” while utilizing Telemedicine. Teletherapy was a little more effective, as the therapist could actually watch and respond to the injured worker while maneuvers were performed. A few injured workers did advise they “preferred” in person therapy and returned (under CDC guidelines) as soon as they were allowed.

By Chris Boggs, CPCU, ARM, ALCM, LPCS, AAI, APA, CWCA, CRIS, AINS

Published with the author’s permission.

A pandemic is defined as, an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population.” Although the media lives by the motto, If it bleeds, it leads,” declaring a pandemic anytime more than a few people contract a virus, this time even the World Health Organization (WHO) is warning of possible Coronavirus (COVID-19) pandemic. Coronavirus expert, Professor Gabriel Leung, Chair of Public Health at Hong Kong University, says that unchecked, the virus could infect 60 percent of the global population meeting the definition of a pandemic.

My intent is not to accuse the media of sensationalism, nor to intimate that WHO is overreacting (I don’t think they are); my purpose is to answer the question, what makes an illness an occupational illness” and thus compensable under workers’ compensation? More specifically, how does or might workers’ compensation respond to the Coronavirus?