Workers' Compensation Notes - KY January 2019
Arcadia Settlements Group
KY House Bill 2 Introduces a
780-Week Limit on Some
Permanent Partial Disability
Medical Treatment Benefits
KRS 342.020 Could Affect WCMSA Proposals
By: Ndeto Mwose, Settlement Consultant
Kentucky legislators made Kentucky State Capital in Frankfort
headlines for major workers’ compensation As with most new pieces of legislation, there are still a few wrinkles to
reforms in 2018. House Bill 2 introduced a iron out. That said, benefit continuation application reviews won’t occur
long list of changes, including a new limit until 2033 at the earliest. This gives Kentucky’s workers’ compensation
on Permanent Partial Disability medical community ample time to address concerns regarding the application
benefits. Injured workers are now limited process. However, there are questions concerning how the statutory limit
by statute to 780-weeks (15 years) of will affect Workers’ Compensation Medicare Set-Asides (WCMSA). For
medical treatment—for certain claims. The example:
780-week limit does not apply if the claim Is Medicare’s interest protected by a WCMSA proposal limiting
involves an amputation, loss of hearing,
loss of eye(s), loss of teeth, paralysis, or treatment funding to 780-weeks?
permanent total disability. Are rated ages necessary for WCMSA proposals that limit benefits
The new limit will add a few new to 780-weeks?
responsibilities for parties involved in the Will CMS approve WCMSA proposals limited to 780-weeks?
claim process. First, the Commissioner Version 2.9 of the CMS WCMSA Reference Guide addresses state
must provide notice informing the injured legislated limits on benefits. The updated guide provides that:
worker of the approaching expiration date.
This notice must be delivered at week 754. “In order to protect Medicare’s interests, a WCMSA should be
Then, the injured worker can apply for funded based on the life expectancy of the injured worker unless
continued benefits, and must do so at least state law specifically limits the length of time that WC covers
75 days before the 780-week limit is work-related conditions.”
reached. In other words, the injured worker
has a window of 105 days, or roughly 2 ½ It is unclear whether CMS will interpret the possibility of continued
months, to apply for continued benefits. An benefits beyond 780-weeks as a ‘soft cap’, since some workers could
ALJ will then review the matter and receive benefits for the duration of their injury. Further, guidance will be
determine whether to grant an order for necessary from CMS on this matter.
The author’s statements do not necessarily reflect the positions, views, or opinions of Arcadia Settlements Group.