Schedule/Sessions

Breakfast

Keynote Speaker

• Speakers:

• Vince Ferragamo, Ferragamo Real Estate

• Tracy Hughes, Orange County District Attorney's Office

SESSION 1 - Presentation A: The Affordable Health Care Act: Expectations and Impact on the Insurance Industry

• Speakers:

• Angela Henderson, ESIS

• Marcos Iglesias, Travelers

• Margaret (Megan) Jones, Clark, May, Price, Lawley, Duncan & Paul LLC

There has been much written about the provisions of the Act with some speculation on political ramifications and personal finances. This session will focus on the impact the Act has on the availability of resources such as free health clinics and income-based reductions in care. Additionally how will the flood of new patients improve or decrease available physician resources as states determine the scope of program design and enforce compliance with the law. The program will also offer Carriers and TPA’s a new perspective so they can begin to use the option of available coverage via the Affordable Care Act to serve as a creative mechanism for resolving open claims.  The ACA provides two safety nets which can be used to assure claimants that they can safely close out their Workers Compensation medical benefits claim.  Participants will walk away from the presentation with a firm understanding of the current political climate with regard to state execution of the Act, the needs of the newly insured, and with strategies advising how to incorporate coverage into valuation and resolution of the risk.
 

SESSION 1 - Presentation B: Point/Counterpoint: Key WC Issues From the Perspective of an Employee Attorney and An Employer Attorney

• Speakers:

• Robert Baer, Arrowpoint Capital

• Grant Dixon, The Dixon Law Firm

• Rich Lenkov, Downey & Lenkov LLC

While workers’ compensation laws differ from state to state, key issues are common throughout the nation. These issues are often confusing and form the basis of much conflict in litigation.  
 
This seminar will present five key issues from the perspective of veteran attorneys representing both employers and employees. These attorneys will lead a lively and engaging discussion with the audience, providing real-world practical tips on how to deal with these issues from both sides of the aisle.
 

SESSION 1 - Presentation C: Get SMART about the SMART Law

• Speakers:

• Cliff Connor, Gallagher Bassett Services, Inc.

• Jacquelyn Miller, Bickmore Risk Services

• Bennett Pugh, Fidelity Fiduciary Company LLC

Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) placed a new reporting duty on both group health entities and non-group health entities.  For non-group health entities, the law states, “liability insurance including self-insurance, no-fault insurance, and workers’ compensation laws and plans” must report claims involving a Medicare beneficiary to Medicare when the claim is “resolved (or partially resolved) through a settlement, judgment, award, or other payment.” The Responsible Reporting Entity (RRE) is liable for the reporting.  RREs must provide two different reports to Medicare, ORM and TPOC. There are certain thresholds and exceptions to both ORM and TPOC reporting apart from risk management writes offs and property of value. 
 
The SMART Act amended Section 111 to allow for conditional payment downloads from a website, provided for safe harbors for good faith reporting efforts and softened the penalty. Regulations have been developed by CMS to implement the SMART Act and will likely take effect later in 2014 or early 2015.  Mandatory Insurance Reporting (MIR) will discuss how this process works in conjunction with the recovery audit contractor (RAC).  Finally, there are now at least two False Claims Act lawsuits brought by whistle blowers for reporting deficiencies.
 

Break

SESSION 2 - Presentation A: Up in Smoke? The Legalization of Marijuana for Medical and Recreational Use and It's Impact on Workers' Compensation

• Speakers:

• Edward Canavan, Self Employed

• Marie Johnson , Elwyn

• John Kutner, Weber Gallagher Simpson Stapleton Fires & Newby LLP

Still think Marijuana is for stoners and derelicts? Well maybe it is, but it has also been proven in to provide relief for various chronic pain sufferers and folks with terminal illnesses.  Marijuana has gone from Shakedown Street to Wall Street through its legalization for medicinal and recreational purposes in many states over the last 15 years.  As a result legalized marijuana use is now starting to become an issue in Workers’ Compensation courts around the country.
 
The aim of this discussion is to explore current laws in various states where marijuana has been legalized for medical purposes and to provide insight as to where we anticipate the law is going.  The program will provide information on the potential risks and benefits of medical marijuana and its legitimacy for treating petitioners who are injured on the job.  We will discuss and provide practical information regarding employers’ and employees’ rights under these laws.  Lastly, we will consider the impact medical marijuana may have on Insurance Carriers and Third Party Administrators.

SESSION 2 - Presentation B: Close Your Workers' Compensation Claim Fast with Mediation

• Speakers:

• Jill Dulich, California Self-Insurers’ Security Fund

• James M. Poerio, Poerio & Walter, Inc.

• Teddy Snyder, Snyder Mediations

This presentation will present techniques for claim resolution by mediation, including characteristics of the mediation process, how to proceed in mediation, who should be involved, and where it should take place.  The presentation will also address how the potential for mediation impacts the overall litigation plan.

SESSION 2 - Presentation C: Advocacy for the Injured Employee: How Doing the Right Thing Pays Big Dividends For All Involved

• Speakers:

• Darrell Brown, Self Employed

• William Pipkin, Austill, Lewis, Pipkin & Maddox, P.C.

• Dawn Watkins, Los Angeles Unified School District

This presentation will examine why claims which initially appear normal degenerate into protracted and expensive litigation.  The panelists will provide their experience from the different perspectives of the Employer/Risk Manager, the Carrier/TPA and litigation counsel, along with their recommendations for best practices to avoid common traps for claims professionals and attorneys.  Attendees will hear how advocacy for the injured employee can result in better outcomes, in less time, with reduced overall cost.  While it may sound too good to be true, industry data on the subject is changing how many employers and their carriers and TPAs approach claims handling.  The term “advocacy” is being used more frequently to describe superior customer service and claims techniques to ensure the best possible outcomes.  The benefits of advocacy - ensuring that the claimant understands his or her role in the system and what to expect - will be explored during this session.  We will also discuss how these strategies can prevent litigation, ensure the appropriate treatment is provided and achieve the best possible outcome. 
 

Break

SESSION 3 - Presentation A: Issues Regarding Jurisdiction for Former Athletes Filing Workers’ Compensation Claims

• Speakers:

• Theresa Babbitt, AIG

• Michael Pang, Adelson McLean

Former athletes from all leagues have been filing class action lawsuits over concussions and the use of prescription of pain medication.  They are also filing workers’ compensation claims in various states, but most especially in California, to collect money for disability and medical treatment as a result of the wear and tear suffered through the duration of their professional careers.  This presentation will provide background information as to how these athletes can collect, what the teams and insurance carriers need to do to limit the liability, and the defenses that need to be asserted to prevent abuse of the system.

SESSION 3 - Presentation B: Subrogation Statutes and Their Impact on Workers' Compensation Claims Settlements Strategies

• Speakers:

• Michael McLean, Adelson McLean APC

• Heath Sherman, The Sherman Law Group

• Wanda Weniger, Travelers

Carriers often assign claims representatives and counsel to represent the employer in different capacities, i.e. to defend the workers’ compensation action, to obtain a recovery of the lien, and in a few states, to defend the employer in a contribution action. It is not uncommon for each representative/counsel to take a myopic approach and focus entirely on the assigned matter. However, in order to reach a global settlement that reduces indemnity exposure and legal fees, the claims representatives and carriers must communicate and engage in a global analysis of the claim. The strategies to employ will vary by state due to different approaches to workers’ compensation lien recovery and employer liability. This presentation is designed as a springboard for communication and analysis that you need to apply to your claims.
 

SESSION 3 - Presentation C: Cutting Edge Issues Impacting Ethics in Workers’ Compensation Claims Handling

• Speakers:

• Ralph Barham, Southwest Airlines Co.

• Scott Marshall, American Claims Management, Inc.

• Bill Randall, Veracity Research Co. Investigations

• Robert Walter, Poerio & Walter, Inc.

This presentation will examine common and recently created ethical issues which arise in the handling of workers’ compensation claims.  Hear from the different perspectives of the Employer/Risk Manager, the Carrier/TPA, the SIU Investigator, and litigation counsel, along with their recommendations for best practices to avoid common ethical traps for claims professionals and attorneys.  Panel members and attendees will examine the use of social media, surveillance and the disclosure of privileged information, with an eye on best practices and risk avoidance. This session will also examine the unique state laws allowing the sharing of information with law enforcement and between SIU staff, without the use of a subpoena.
 
The panel members will discuss how a coordinated approach to claims handling with active participation from the employer and the TPA places the lawyer and investigator in the best position to obtain a just and fair outcome, in less time, with reduced overall cost.  Effective and ethical claims handling requires all the participants to understand their proper role and the limits and consequences of their actions.  We will also discuss how these strategies can prevent litigation, ensure thorough investigation and achieve the best possible outcome. 
 

Networking Lunch and Keynote Speaker