5-21-2018; Holy Subro! IL Appellate Court Rules IL WC Lien Recovery is Absolute!; Illinois Hospitals Now Have to Search All Patients for Weapons, analysis by John Karis and more

Synopsis: Holy Subro! IL Appellate Court Rules IL WC Lien Recovery is Absolute! This Ruling is Required Reading for All IL WC Insurance Subro Departments.


Editor’s comment: Throughout my legal career, I faced circuit court judges who fought to cut and cut IL WC lien recovery. The judges usually treat workers’ comp payments as being “insurance” and therefore have little value when trying to get a self-insured employer or insurance carrier their money back, regardless of the statutory imprimatur. The judges always feel and would argue insurance companies don’t need their money back, as they were paid premiums and could therefore afford the “loss.”


Now, in a very recent ruling In re Estate of Rexroad, 2018 IL App (5th) 170342 (issued May 15, 2018), the IL Appellate Court, in the most liberal District in this state, ruled a workers' compensation lien, pursuant to Section 5(b) of the Workers' Compensation Act, cannot be subject to reduction or elimination due to


·        Conduct on the part of the insurer in its handling of the workers' compensation claim itself,

·        Or in its cooperation with an investigation of 3rd-party causes of the injury, or

·        In its negotiations with the employee as to satisfaction of its lien.


Under Section 5(b) of the IL WC Act, they found an employer's right to reimbursement of full amount of benefits paid or to be paid to worker is absolute. They further found there was no basis in Illinois law to hold that alleged conduct on part of lienholder (workers' compensation insurer of employer) outweighs absolute right that it has to reimbursement of its IL WC lien.


In this claim, the worker sadly was killed. His widow applied for and is receiving IL WC death benefits. The claim is still pending on arbitration.


The third party claim was pending in Indiana. An action appears to have been started to adjudicate the WC lien to end or otherwise be blocked from enforcement, despite the continuing payment of death benefits. On October 26, 2016, the Estate filed a motion to adjudicate the workers’ compensation lien, in which it requested the remainder of the employer’s workers’ compensation lien be stricken in its entirety. The Estate argued the employer was not entitled to the remainder of its lien due to the following allegations of wrongdoing on the part of the employer:


(1)   Direct communications with the family of Decedent despite knowing the Estate was represented by counsel;

(2)   Obstructing the Estate’s counsel in investigating the wrongful death action by prohibiting the Estate from interviewing its employees, refusing to produce the truck and trailer the decedent was driving for inspection, and providing its inaccurate “alive and well” investigative reports to the defense;

(3)   Supposedly failing to pay Decedent’s widow the full amount of workers’ compensation benefits owed;

(4)   Demanding a distribution toward its lien from the interim settlement;

(5)   Objecting to an unspecified amount of court costs claimed by the Estate as required to effect a settlement of the remainder of the Indiana action; and

(6)   Seeking to recalculate its pro rata share of costs in light of the settlement of the remainder of the Indiana action, which the Estate characterized as a “reneg” of its prior agreement to pay its share of costs at the time of the interim settlement.


After complete briefing was filed by both sides, the Circuit Court struck the workers’ comp lien in its entirety. The appeal followed.


The IL Appellate Court unanimously ruled:


According to this plain language of section 5(b), an employer’s right to reimbursement of the full amount of benefits paid or to be paid to the injured or deceased worker is absolute. This is because the workers’ compensation lien is a crucial foundation of workers’ compensation law in Illinois. See, e.g., Taylor v. Pekin Insurance Co., 231 Ill. 2d 390, 397 (2008); Harder v. Kelly, 369 Ill. App. 3d 937, 942 (2007). This important public policy, that an employer, even if it is not negligent, should compensate the employee for an injury incurred on the job, is predicated upon there being no other recovery available. Denius v. Robertson, 98 Ill. App. 3d 83, 87 (1981). However, when recovery is obtained from the parties actually responsible for the employee’s injury, fairness and justice require that the employer be reimbursed for the workers’ compensation benefits he has paid or will pay. Id. There is no basis under Illinois law to hold that the alleged conduct on the part of [the employer], even if true, outweighs the absolute right, pursuant to statute, that [employer] has to reimbursement of its lien and the public policy underlying that right.


I assure all my readers on both sides the language in the paragraph above should be required reading and part of any IL WC law school course on the issue of subrogation recovery of IL WC liens. If a motion is made attacking an IL WC lien, this most recent ruling is crystal clear—our IL WC Act provides no discretion in cutting or evading WC lien recovery. Click on the link above if you want to read the Appellate ruling.


I appreciate your thoughts and comments. Please post them on our award-winning blog.


Synopsis: Illinois Hospitals Now Have to Search All Patients for Weapons. Analysis by John Karis, J.D.

Editor’s Comment: The IL Appellate Court finds it was reasonably foreseeable to find liability upon a hospital if it did not search patient before being admitted, as the patient or others might be harmed. On May 14, 2018, the Appellate Court of Illinois ruled for viability of a wrongful death action, alleging Defendant hospital was arguably negligent in not searching Decedent for weapons on day of his admission was sufficiently established. The Court ruled a hospital owed decedent a duty to protect him from harming himself or someone else.

In the case of Coleman v. Provena Hospitals, a patient named Russell was admitted to defendant, Provena Hospital, doing business as Provena Mercy Medical Center. The day after patient Russell was admitted, a nurse discovered he had a gun. It appears police were called. Shortly thereafter, during a confrontation with the Aurora Police Department, Russell was shot to death. Plaintiff Coleman, Russell’s sister and the administrator of his estate, filed a wrongful-death action against Defendant, alleging it was negligent in not searching Russell for weapons on the day he was admitted. The Circuit Court of Kane County subsequently granted Defendant’s motion for summary judgment, finding Plaintiff could not establish Defendant had proximately caused Russell’s death, because there was no evidence Russell had a gun when he was admitted. The matter was appealed to the IL Appellate Court.

On appeal, Plaintiff argued the trial court erred in granting the defendant’s motion for summary judgment, because a question of fact remained as to whether the gun would have been recovered had a proper search been conducted. In response, Defendant maintained summary judgment in its favor was proper because, not only did its actions not proximately cause Russell’s death, it owed no duty to Russell to protect him from his own criminal acts. Defendant Hospital further argued summary judgment was proper because Plaintiff cannot recover any damages based on Russell’s criminal acts

In order to succeed in a negligence action, Plaintiff must prove three elements:

(1) Defendant owed a duty of care;

(2) Defendant breached that duty;

(3) Plaintiff’s resulting injury was proximately caused by the breach.

Whether Defendant owed a duty to Plaintiff is a question of law, to be decided by the court. Whether Defendant breached its duty and whether the breach was the proximate cause of the injury are factual questions, for a jury to decide, as long as there is a genuine issue of material fact about breach and causation.

A court will find a duty where a plaintiff and a defendant stand in such a relationship to one another that the law imposes upon the defendant an obligation of reasonable conduct for the benefit of the plaintiff. The “relationship” referred to in this context acts as a shorthand description for the sum of four factors:

(1) the reasonable foreseeability of the injury;

(2) the likelihood of the injury;

(3) the magnitude of the burden of guarding against the injury;

(4) the consequences of placing that burden on the defendant.

The Appellate Court noted it has long been recognized, hospitals are under a duty to exercise reasonable care to protect their patrons from harm. In their pleadings, Defendant insisted it owed no legal duty to Russell, because the harm that befell him was not reasonably foreseeable. Defendant maintained it was not foreseeable that a patient would engage in a series of bizarre acts that would ultimately result in his being shot and killed by police officers. The Appellate Court noted Defendant’s argument was undermined by its policy to search people going into its behavioral health unit. The apparent purpose of this policy is to prevent patients who are possibly mentally ill from harming themselves or others. Based on the existence of this policy, it was reasonably foreseeable someone would be injured if the policy were not adhered to. Plaintiff asserted there was no reason why the policy should not exist throughout the hospital. Therefore the court found allegations of their complaint sufficiently established Defendant owed the patient a duty to protect him from harming himself or someone else.

It is hard to wrap your head around this ruling as common sense would say the hospital owed no duty for someone who engaged in criminal acts. It is unclear what the result of this matter will as it is in the early stages of litigation. However the one take-away from the court ruling is that hospitals owe a duty to their patients to prevent them from harm.  Included in these duties is to search patients for anything that could harm them or others. From this ruling, we feel IL hospitals now have to search any patient regardless of whether they have a mental condition for weapons.

This article was researched and written by John Karis, JD. You can reach John 24/7/365 for questions about general liability, employment law and workers’ compensation at jkaris@keefe-law.com.

Synopsis: Marge (Keefe) Madden Kottcamp, Rest in Peace.

Editor’s comment: My Dear Aunt Marge passed away this past weekend. She was three weeks shy of her 95th birthday. She was an inspiration to me for always being healthy and athletic, well into her 90’s. Marge had 12 children and about one zillion grandkids and great-grandkids.

If you are someone who says prayers, please say a prayer for the passing of this wonderful person. There will always be a twinkle at the end of every rainbow when I think of her.

5-15-2018; IL State And Chicago Governments Continue Their Inescapable Plummet to The Bottom of the Financial Ocean; E-Notice Announcement from the IL WC Commission and more

Synopsis: IL State And Chicago Governments Continue Their Inescapable Plummet to The Bottom of the Financial Ocean. When Are You Moving?


Editor’s comment: While this article isn’t necessarily about workers’ comp, the crushing debt and skyrocketing taxes in this State are driving businesses, jobs and all of us over the borders. That is certain to affect this industry and all industries across this State. If you aren’t sure, keep reading.


About a year ago, Moody’s confirmed IL pension debt was about $250B. This State’s pending fiscal collapse is the culmination of decades of budget gimmicks used to cover over Illinois government’s structural spending problems that will soon crush ordinary taxpayers.


Please Remember Two Numbers When Considering Our Fake IL Gov’t Pensions—85 and 3.


Why are those numbers important? Well, IL State workers retire at 85% of their highest pay. Someone who makes $100K a year, retires at $85K a year. They don’t pay State income tax on that fake pension money. The reason I call it a “fake pension” is that it doesn’t make any difference how much they contributed to the pension—they all get 85% of their highest pay to start.


On top of that, add the ‘3’—all vested IL State workers get a constitutionally guaranteed 3% compounded bump on their fake pension every year, as long as they live. The bump doesn’t follow the Consumer Price Index or anything else—the worker above who starts at $85K a year will be making more on their gov’t pension in five years than they made while working. In just 23 years, the initial payout of $85K will be doubled!! Yes, that worker will be getting $170K a year in a fake and unfunded gov’t pension when their highest pay was only $100K a year. In 23 years after initial retirement, the gov’t pension will quadruple and they will be getting more than $1M every three years not to work. The 3% compounded annual increases continue for the life of the pensioner, again regardless of their contribution.


Many of my readers don’t believe this math—I point out the math is immutable. If you want me to prove it to you, send a reply. I also am advised something like 700,000 thousand former IL State workers are getting this impossible-to-fund benefit stream. Start to plan to move out of this State if you don’t want to have to pay 100% of the spiraling fake pension costs for all these former State workers who are becoming wealthy off our dime.


State politicians have resorted to all sorts of schemes, from pension “ramps” to issuing pension obligation bonds to temporary tax hikes, to help “balance” budgets without reforming the underlying spiraling costs. These ploys have enabled politicians from both parties to preserve the status quo and to spend more on their misplaced priorities, such as high government worker compensation and impossible-to-fund retirement benefits for State and City of Chicago government workers. The gimmicks are running out.


Illinois’ out-of-control spending spurred credit downgrades almost a decade ago


Illinois has suffered 21 credit downgrades from the three major ratings agencies since 2009. The only thing that slows down the credit free-fall are higher and more taxes on you. These credit downgrades began when Illinois gov’t started borrowing to conceal its growing gov’t pension crisis. As Governor, Quinn borrowed a total of more than $7 billion in two years to make the state’s pension contributions. That sort of borrowing hasn’t slowed and there is a plan to borrow $107B to cut the gov’t pension gap.


By 2010, Moody’s had already downgraded Illinois’ credit to the worst rating in the nation. The next five downgrades happened in the midst of the State’s record tax hike. The tax hikes that brought in $32 billion in new revenues failed to quell rating agencies’ concerns about Illinois gov’t finances. And since then, in the absence of major economic reforms, eight more downgrades have followed. The only thing that slows credit downgrades are higher taxes.


Why Does IL State Government Over-staff, Over-Pay and Over-Retire Its Workers?


The answer is simple—all those workers are voters. They vote in a bipartisan bloc to keep their pay, benefits and unfunded pensions in place. Even at record taxing levels, State gov’t still has to borrow to make ends meet. The seams on this huge debt are starting to swell and the bolts are popping out.


The common theme in Illinois’ budget and ratings history is that the state has refused to pass real spending and economic reforms. They are ready, willing and able to pass a constitutional amendment to pass a graduated income tax—they aren’t willing to cut fake and impossible-to-fund gov’t pensions.


Aren’t We In the Middle of a State-Wide Election? What Are the Candidates for Governor Saying About This Crisis?


As I indicate above, this is another 800lb. pink gorilla that no one is mentioning. Neither billionaire IL Governor candidate, JB Pritzker or Bruce Rauner, are saying anything about it. Why? They don’t want to alienate the voting bloc of thousands of current and past IL government workers who won’t be happy to hear things have to change to their impossible-to-fund compensation, benefits and gov’t pension.


So What Happened This Week?


Crain’s Chicago Business reported Illinois homeowners, who already pay some of the nation's highest property taxes, should pay 43 percent more for the next three decades to wipe out the state's crippling pension debt, according to a trio of economists from the Federal Reserve Bank of Chicago. The economists argue paying off the State's $129.1 billion in unfunded pension obligations cannot be done with revenue from new taxes.


"In our view, Illinois' best option is to impose a statewide residential property tax," they wrote, in part because it would be somehow “fair.” They claimed "Illinois residents who have benefited most from the past services of governmental employees are more likely to be homeowners, so it seems reasonable that they should pay a larger share of the costs."


The economists are proposing a statewide tax of 1 percent of a home or building's value. Under their plan, the RE tax bill on a $500,000 house would go from about $11,600 to $16,600, an increase of $5,000, paid each year for 30 years. Please note the RE tax payout at $16,600 over 30 years would equal the current value of the home! These economists—Thomas Haasl, Rick Mattoon and Thomas Walstrum—calculated a property tax equal to 1 percent of a home's value could possibly plug the State's pension gap in a mere 30 years.


Right now, Illinois homeowners pay an average of 2.32 percent of their home’s value in property tax every year, which according to WalletHub is second only to New Jersey's 2.40 percent. Please note the economists proposal would raise IL property taxes by 43 percent making the RE tax 3.32 percent of the home value—this would put this State way into the lead on having the highest property taxes in this country. Please note this staggering tax increase might kill your neighborhood dry cleaner or convenience store who would be hard-pressed to raise their prices to cover the new RE tax. Please also note the 4.95% IL State income tax is expected to possibly double or more if JB Pritzker is elected and the Governor’s mansion, IL Senate and House are all controlled by the free-spending Democrat party leaders.


From Gene Keefe—How Do These Skyrocketing Taxes “Cure” The Underlying Gov’t Problems? In Short, They Don’t.


To all my readers, please note the systemic failure of our current government to cut State staff, cut gov’t worker compensation and truly reform these hilarious fake gov’t pensions isn’t going to be changed by this proposed RE tax. The IL WC Commission is the agency I am most familiar with. I am sure this agency could be combined with other agencies to dramatically cut costs while preserving services. Their $30M annual budget could be cut to $25M or even $20M. Yes, it might take longer to get some things done but I bet we can and would adjust.


Numerous other IL State agencies and positions could be cut without any impact on gov’t services. Please note there is no reason for


·        The State of Illinois to have a do-nothing Lieutenant Governor;

·        The State of Illinois to have two mirror agencies--a Treasury Dep’t and Comptroller that fulfill precisely the same job;

·        At least seven State agencies have their own “police departments” that I assure you are cushy, no-work jobs;

·        Several State agencies, including the IWCC, have “remote offices” that are do-nothing, no-work jobs.

·        The State of IL has “tow-trucks-that-don’t-tow-trucks”—the Minutemen tow trucks aren’t allowed to tow your car in a wreck. Why bother buying expensive equipment that isn’t used for its intended purpose?


If we don’t have the money and we aren’t going to be able to borrow to make up the gap forever, folks are going to continue to quietly start leaving. For this State to remain viable, things are going to have to change.


Wanna Get Away?


I can’t help you avoid property taxes, specifically the new and huge tax increase proposed by these federal economists. I can legally help you avoid skyrocketing IL income and estate taxes if you are interested in moving to a different state while maintaining a part-time IL residence. I can send you the lead ruling from the IL Supreme Court on how to do so. Just send a reply.


I appreciate your thoughts and comments. Please post them on our award-winning blog.



Synopsis: E-Notice Announcement from the IL WC Commission.

Editor’s comment: IWCC Chairman Joann Fratianni is pleased to announce another step forward in the IWCC’s modernization and technological upgrade of operations. Pursuant to the IWCC’s Rules, as found in Section 50 of the Illinois Administrative Code, parties will receive case activity notices electronically beginning on July 2, 2018. The IWCC will no longer send case notices via U.S. Mail as of this date.*  All parties (law firms on behalf of clients and pro se litigants) will be required to maintain a designated electronic mail (“e-mail”) address for receiving case notices, just as they are now required to maintain a physical address to receive them by U.S. Mail. You only need to fill out the “E-Mail Registration Form” once (just like providing the IWCC your physical address), so they can update their system.  PLEASE NOTE it does not matter if you already have an e-mail on file or in use with the IWCC – they are populating the system with new and updated information.  So, please submit a law firm/pro se e-mail address again.


* The only exception to electronic notices is respondent parties at the time a case is initially filed, whom will be notified that a case has been filed against them by U.S. Mail at the address provided by petitioner. This is the current practice.


Attorneys – Their system links cases before the IWCC to the law firm, not the individual practitioner. Please provide your firm’s e-mail address for receipt of electronic notices. If one of your attorneys “updates” your firm e-mail address with their own, all firm notices will go to the most updated address.


INSTRUCTIONS (for law firms and pro se litigants) There are two ways to provide the IWCC an e-mail address:


1.         Go on their website to: https://www2.illinois.gov/sites/iwcc/resources/Pages/Request-for-Attorney-Code-Number-.aspx (their website, followed by “forms”).

Fill out the “E-Mail Registration Form” and click “submit.”

2.         Fill out the “E-Mail Registration Form” in person at the IWCC’s Chicago office located at:


Illinois Workers’ Compensation Commission

100 W. Randolph St.

Suite 8-200

Chicago, IL 60601


You will receive a confirmation e-mail to the address provided in three to five business days.  If you are concerned you failed to receive an e-mail from the IWCC, please contact Greg Ettling at (312) 814-6639.

5-7-2018; Gene Keefe on Narcotics/Opioids in U.S. Work Comp Claims; Indiana WC Board Stays on the Cutting Edge of Reporting Technology and more

Synopsis: Gene Keefe on Narcotics/Opioids in U.S. Workers’ Compensation Claims.

Editor’s comment: I/We can’t keep ignoring this one, as it clearly is an 800lb. pink gorilla that is threatening our WC system and lives.

From my perspective, the most addicting substances on this planet are tobacco/nicotine and narcotic/opioid medications.


I am sad to report I have had literally dozens of wonderful clients who passed from an addiction to tobacco/nicotine. These clients left children and grandchildren and families in the lurch, some of these folks smoking during chemotherapy. The scientific and common-sense approach to this substance is simple. If you are using it, please, please save your life and stop. If you are a client or close friend of KCB&A and truly want help to stop, please send a reply.

Narcotic/Opioid Medications

We are in the midst of a national narcotic/opioid overdose epidemic. I personally dislike the term ‘opioid’ because it sounds technical and medical—everyone knows ‘narcotics’ are bad for you and almost uncontrollably addictive.

Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Narcotic/opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015. 5 From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate.

In 2012, 259 million prescriptions were written for narcotic/opioids, which was more than enough to give every American adult their own bottle of pills. Four in five new heroin users started out misusing prescription painkillers. 94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use prescription narcotics/opioids because they are easier to get and use.

“Chronic pain” affects as many as 100 million Americans, more than the number affected by heart disease, diabetes and cancer combined. The prevalence of chronic pain is growing and is likely to continue to do so. As the rate of reported chronic pain increases, it has been accompanied by a rise in the rate of adults reporting the use of prescription drugs for pain, including narcotics/opioids such as OxyContin, Percocet and Oxycodone products.

Workers’ compensation

In workers’ comp cases, spending on narcotics/opioids far outpaces utilization and spending in the group health market. Narcotics/opioids comprise almost 34% of the total drug spend for workers’ comp payers as opposed to about 3% in the group health market. Of the total medical expense for workers’ compensation claims, the cost of prescription medications accounts for 19%, according to the National Council on Compensation Insurance.

The impact on the cost of WC claims is significant. When a workers compensation claim involved any narcotic/opioid, the claim cost averaged nearly $20,000 more than claims without opioids. The use of narcotics/opioids also affected time lost from work. Odds of chronic work loss were six times greater when narcotics/opioids were used.

Please also remember settling a claim involving a narcotic/opioid addict causes the MSA or Medicare Set-Aside Trust value to be gigantic. All parties have to assume the addiction is going to continue and to pay for a lifetime of narcotics/opioids won’t ever be cheap. The MSA cost can easily be much higher than the PPD or impairment value of a given claim—this always confuses injured workers. For this reason alone, the entire U.S. WC industry has to do whatever it can to stop narcotic/opioid abuse and addiction in workers’ comp claims.

How Does the WC Industry Counterattack the Use of Narcotics/Opioids in WC Claims?

First, I recently saw a study of total shoulder replacement surgeries in North Carolina. The docs running the study compared recoveries/complaints with patients that used narcotics/opioids in contrast to those who used traditional ANSAIDS like Extra-Strength Tylenol© or Advil©. The results showed little difference in recovery and complaints. I am sure there were no lasting drug addicts that came from the test group that used traditional ANSAIDS. I strongly hope more similar studies will be published, as the medical/surgical industry starts to refuse to use/promote narcotics/opioids in all patients.

Second, our firm also had a major national client decide on a 7-day rule for prescription narcotics/opioids. They asked me how to “enforce” such a rule. I confirmed three solid tools that can and should be considered in Illinois WC claims.

1.      UR or utilization review is the fastest and easiest method to block prescription narcotic/opioid use. If an employer/insured can get a UR non-cert for continued prescription narcotic/opioid use, it is presumptively correct.

2.      An IME is also a tool to put into the claims bag to use/comment on such prescriptions—the problem with IME’s is the delay encountered in setting and getting the report.

3.      Finally, what this client did by letting everyone know of their “rule” may also “work” to the extent you let the docs/surgeons and others know you have such a rule and refuse to divert from this challenging path. It is hard for IL Claimant lawyers, no matter how dedicated they may be to get such issues rapidly in front of an Arbitrator and force approval of prescription narcotics/opioids.

We are sure our IL WC Arbitrators and Commissioners are well-educated, professional and know what is at stake when they are dealing with prescription narcotics/opioids. These strong hearing officers are generally reluctant to order an IL employer to pay for months and possibly years of prescription drug use/abuse when it comes to narcotics/opioids. Our Midwest hearing officers want injured workers to get healthy after an injury and stay clean and sober when doing so.

WC Insurers and TPA’s Can’t Hide Their Heads in the Sand on this One—Step Up and Start Fighting Narcotic/Opioid Abuse Every Way You Can

With the help of WC insurers and third-party administrators, employers have to play an important role in promoting appropriate use of narcotics/opioids. This can mean early and appropriate return to work to prevent an otherwise simple claim from turning into an expensive and never-ending legacy claim. Companies should look for WC Insurers/TPAs that offer several critical capabilities. These include:

·        Early intervention and Use of Nurse Case Managers: The first few hours after an employee is injured are critical. This is when initial decisions about treatment are made, including what to prescribe for pain. Look for an insurer/TPA with a clinical resource hot line to access nurse case managers that can help assess injuries and direct employees to urgent care or an appropriate network doctor who are positioned to best handle the treatment of injured workers and have a proven track record of successful outcomes.

·        Ongoing Claims insight: At specific junctures throughout the life of a WC claim, the continued use of narcotics/opioids should be evaluated. I like the “hard line” that provides a cut-off date/time. When narcotics/opioids are prescribed, there should be notations in the claim file and a mechanism in place to monitor the types of drugs and duration of use. Use of pharmacy benefit management with aggressive utilization review is critical.

·        Predictive analytics: Strong partnerships between employers and insurance carriers/TPAs are the result of ongoing and meaningful interaction. An insurance carrier/TPA that uses predictive analytics can extract value from a company's claim experiences. This can help pinpoint problems and spur collaborative approaches to develop plausible solutions.

·        Return-to-work programs: Any time an injured worker loses time from work, there is a risk that the individual will never return, leading to total and permanent disability. When narcotics/opioids are involved, the odds of chronic work loss are significantly higher. Aggressive return-to-work programs, therefore, are critical. Employers should look for ways to provide employees with modified job duty whenever possible to get them back on the job.

I appreciate your thoughts and comments. Please post them on our award-winning blog.

Synopsis: Indiana WC Board Stays on the Cutting Edge of Reporting Technology. For answers to your concerns, contact Kevin Boyle, J.D., KCB&A’s Indiana WC Defense Chair.

Editor’s comment: The Hoosier WC Board just announced their EDI 3.1 ROLLOUT to start on 01/01/2019.

The Indiana Worker's Compensation Board (INWCB) will be implementing electronic reporting of workers’ compensation first reports of injury (FROI) and subsequent reports of injury (SROI).  Electronic reporting will be required for all trading partners: insurers, self-insured employers, and third party claim administrators. Mandatory implementation is planned for January 1, 2019.

Electronic reporting will be via Electronic Data Interchange (EDI) transactions using the Claims 3.1 reporting standards adopted by the International Association of Industrial Accident Boards and Commissions (IAIABC). Additional information on the IAIABC EDI transactions for FROI and SROI can be found online at the IAIABC website, http://www.iaiabc.org.

The INWCB has contracted with ISO's Workers Compensation Solutions division, to manage its FROI and SROI EDI reporting.  ISO will be administering registration of trading partners, testing, data collection and submission of EDI data to the State. 

INWCB will provide an enhanced EDI Website that will be available early June 2018. This website address will be provided at that time and will contain the following.


  • Trading Partner Electronic Profiles Registration and Instructions to be completed by all Trading Partners
  • Trading Partner Training Schedule
  • Trading Partner Testing Documentation/Plan. (Note: For Trading Partners that will utilize a Vendor, the Vendor will perform the testing on your behalf)
  • INWCB Claims Release 3.1 Implementation Guide and Requirement Tables
  • EDI Vendors that may assist with EDI reporting
  • Implementation Information that will provide additional information to support the INWCB EDI Reporting Requirements
  • Frequently Asked Questions (FAQ) for EDI
  • Helpful Web Links
  • What’s New: Announcements, etc.
  • Contact us for help at INWCBEDI@iso.com


If you have any questions, please contact the INWCB EDI Support Team at INWCBEDI@iso.com. If you have further questions/concerns, email Kevin Boyle at kboyle@keefe-law.com.