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Monthly Archives: September 2010

New York State Adopts Workers’ Comp Treatment Guidelines

The New York State Workers’ Compensation Board has adopted new treatment guidelines for medical care that is provided to injured workers. The New York Medical Treatment Guidelines will become the mandatory standard of care for the back, neck, shoulder, and knee, and will be effective as of December 1, 2010. The new guidelines provide guidance on history taking, physical exams, testing and treatment.

States are increasingly adopting treatment guidelines as a way to guide healthcare practitioners and other workers’ compensation stakeholders in order to avoid delays for approving treatment, to provide better consistency of care, and to reduce unnecessary costs and procedures.

Medical treatment guidelines adopted by states are very carefully considered, taken from the highest quality data and knowledge available and are typically evidence-based and physician-reviewed. They often focus on each state’s most prevalent work-related injuries, which can differ from state to state, depending on prevalent industries and demographics.

New York State’s new treatment guidelines were adopted, with modifications, from several sources, including the State of Colorado Treatment Guidelines, the ACOEM (American College of Occupational and Environmental Medicine) Occupational Medicine Treatment Guidelines and the State of Washington Medical and Surgical Treatment Guidelines.

Reed Group’s MDGuidelines web-based platform (www.mdguidelines.com) is a convenient way to access all of these source guidelines in one easy-to-use location.

Reed Group® is dedicated to helping all stakeholders navigate the increasingly complex landscape of treatment and return-to-work duration guidelines with industry-leading tools that aggregate content.

We are pleased to partner with jurisdictions, legislators, regulators and stakeholders in states to help ease adoption of treatment guidelines and by providing resources to help improve outcomes for injured workers.

We look forward to any opportunity to help states such as New York roll out treatment guidelines and improve claims processing, therefore, improving outcomes for injured workers and expediting processing and adjudication of claims.

U.S. Department of Labor clarifies FMLA definition of “son or daughter” to include all “families”.

The United States Department of Labor has announced a clarification regarding the FMLA definition of “son or daughter” as it applies to an employee entitled to take leave for the birth or placement of a child, to care for a newborn or newly-placed child, or to care for a child with a serious health condition.

The DOL wants to ensure that an employee who assumes the role of caring for a child receives parental rights to family leave regardless of the legal or biological relationship, or lack thereof, to the child.

According to the DOL, parental rights under the FMLA extend to “the various parenting relationships that exist in today’s world. . . including families in the lesbian-gay-bisexual-transgender community.”

The FMLA has always provided parental rights to one standing in loco parentis to a child to take leave to care for the child. In loco parentis is defined by the FMLA regulations as including persons “with day-to-day responsibilities to care for and financially support a child”. 29 C.F.R. § 825.122(c)(3). A biological or legal relationship is not required.

The Interpretation further defines in loco parentis as “a person who has put himself in the situation of a lawful parent by assuming the obligations incident to the parental relation without going through the formalities necessary to legal adoption. It embodies the two ideas of assuming the parental status and discharging the parental duties.”

Read more about key points in the Administrator’s Interpretation in our September FMLA newsletter.

ClaimVantage Now Available with MDGuidelines

Good news for users of the ClaimVantage!

ClaimVantage’s cloud computing disability claims system is now available with our MDGuidelines return-to-work reference toolset. MDGuidelines can be embedded in ClaimVantage for seamless, easy-to-use claims and case management workflow.

“Reed Group is the de facto standard for return-to-work guidelines, and the new MDGuidelines predictive model is the best available anywhere,” says ClaimVantage CEO Leo Corcoran. “This allows our customers to add an additional best practice to claims management by enhancing the ability of claims adjusters to manage for best outcomes.”

“ClaimVantage is an excellent product, and we’re pleased to partner with them,” says Reed Group President, Guidelines, Jon Seymour, M.D. “MDGuidelines embedded in ClaimVantage creates a powerful decision-support toolset for benchmarking and improving outcomes for employee absence and return-to-work claims.”

ClaimVantage already has customers using the embedded MDGuidelines and is now implementing our MDGuidelines predictive modeling tool.

The ClaimVantage Absence Management system is designed to help companies manage the complexities of complying with Federal and state FMLA regulations. The system uses software-as-a-service (SaaS) technology to allow employers and their representatives to step through absence intake, eligibility and determination processes with easy-to-use wizards to adjudicate employee absence. Absence accumulators are managed and updated automatically by the system for accurate tracking and processing.

Claim Vantage Disability Claim software supports the full life cycle of claim management, including intake, assignment, eligibility, case management, workflow, tasks, payments and operational reports. Using SaaS technology, it is claim analyst-centric to drive accurate and timely claim decisions.

U.S. Dept. of Labor Announces 2011 Focus on FMLA Usage and Workplace Flexibility


“America’s families have evolved, so helping parents and other caregivers keep their jobs while balancing their responsibilities in the home is key to our long- term economic success.”

So stated Secretary of Labor Hilda L. Solis on July 10, 2010, announcing new Department of Labor initiatives addressing workplace flexibility.

To address issues related to work/life balance, the Labor Department’s Wage and Hour Division will conduct a new Family and Medical Leave Act survey in 2011 to provide insight into how families use leave.

The survey will provide a baseline data collection of current family workplace policies and practices, as well as information on regulatory changes. In addition, the Women’s Bureau intends to sponsor a supplement to the survey to gather more information on parental leave, child care, family leave insurance program usage, and other issues related to the intersection of work and family responsibilities.

Surveys such as these are often a precursor to regulatory change, which may include expanded leave rights and/or new regulations. Employers should be prepared—and indeed should seek out the opportunity—to participate in these surveys and also to submit comments to the DOL if there are proposed new regulations.

To read more about this, click here for our September FMLA newsletter.

MDGuidelines Now Available With Colorado and Washington State Treatment Guidelines

Great state news!

Our MDGuidelines reference toolset for improving return-to-work outcomes is now even more powerful with the addition of workers’ compensation treatment guidelines for Colorado and Washington states.

While the nationally-recognized ACOEM disability treatment guidelines are already available on MDGuidelines (www.mdguidelines.com), states often develop their own specific guidelines to address the most costly and/or common workplace injuries for the prevalent industries in that state. State treatment guidelines typically outline what will and won’t be reimbursed for medical providers handling workers’ compensation injuries with the intention of expediting treatment and lowering costs by limiting unnecessary or unproven treatments.

The Washington State Treatment Guidelines are arranged by medical topic (each of which encompasses multiple medical codes). The Colorado Guidelines are arranged by 10 regions of the body (such as “lower extremity”), each covering numerous medical topics.

While both sets of state guidelines are available as downloadable PDF documents from their respective state websites, MDGuidelines greatly improves functionality, access and usage, allowing you to easily search and navigate the content. Icons signify whether a procedure is recommended, not recommended, or should be approached with caution (meaning that there may be a list of objective data requiring documentation for the procedure to be approved). Hyperlinks help users quickly and easily jump to related sections or relevant outside content.

Ease of use is the critical factor for successful widespread and rapid adoption of state treatment guidelines. Our MDGuidelines platform makes it simple and easy for all stakeholders to access, understand and use the state guidelines, facilitating use and improving outcomes for everybody in the workers’ compensation system.

Attending IAIABC? Let’s Connect!

If you’re attending the IAIABC Annual Convention/IFDM 2010 Sponsorship Program in Los Angeles next week, be sure to stop by the Reed Group booth and hear about our exciting new ways to improve return-to-work outcomes for workers’ compensation. You’ll also three great chances to hear from Reed Group’s return-to-work experts.

Monday, September 20 3:30 pm Be sure to catch James Talmage, M.D., Chair of Reed Group’s Medical Advisory Board, in the IFDM Breakout IV: How Medical Providers Can Improve Outcomes in Disability Management. Dr. Talmage will be speaking on “How Physicians Should Determine an Individual’s Current Work Ability/Disability.”

Tuesday, September 21 1:30 pm Don’t miss Reed Group President, Guidelines, Jon Seymour, M.D.’s rapid-fire presentation on disability duration guidelines.  IFDM Breakout V: New Resources for Your Disability Management Toolkit (Rosewood Room).  To get a copy of the presentation paper on this topic, contact sales@reedgroup.com.

Wednesday, September 22 11:00 am Catch Reed Group’s Ken Eichler as he presents at the Convention Plenary Session: Answers to Your Questions About Adopting Medical Treatment Guidelines in the Golden State Room.

Hope to see you there!