Ronald A. Paulus, MD, President and CEO of Mission Health announced today the release of the North Carolina Department of Insurance Market Conduct Examination Report evaluating Mission Hospital’s self-insured, self administered workers’ compensation claims operation. The Market Conduct Examination uncovered no evidence of a pattern and practice of stubborn litigiousness, bad faith or fraud by Mission Hospital’s worker’s compensation program during the January 1, 2000 through December 31, 2009 review period, or in files examined prior to the review period, dating as early as 1996.
On September 22, 2009, North Carolina Industrial Commission Deputy Commissioner George T. Glenn II referred Mission Hospital’s workers’ compensation program to the North Carolina Attorney General and Department of Insurance for investigation of possible violations of unfair claim handling and settlement practices. Glenn’s opinion suggested that Mission Hospital demonstrated a pattern and practice of bad faith handling of workers compensation claims.
In January 2010, the Department of Insurance’s Market Regulation Division’s informed Mission Hospital that the Division would conduct a target examination of Mission Hospital’s workers’ compensation program for the ten year period beginning in January 1, 2000.
“The examination uncovered a few ministerial missteps, and no basis whatsoever for the allegations of impropriety levied against our workers’ compensation program. In fact, the Examiners were very complimentary of the organization of Mission Hospital’s workers’ compensation files and told us that our staff had put forth a ‘Herculean’ effort to arrange for the orderly examination of ten years of files” Paulus said.
“The Report specifically points out that after a review of volumes of file material in litigated claims ranging from 1996 to 2008, the Examiners determined that there was no evidence of any violations of the Unfair Claim Settlement Practices Act. One Examiner said that she did not see any files in which Mission Hospital misread the claims or improperly withheld compensation from its employees” Dr. Paulus concluded.
The examination found no problems in files in which Mission Hospital paid medical expenses only nor did it find any problems in files which had been closed without payment. Only 42 of more than 10,000 employee-related incidents that occurred at Mission Hospital from January 1, 2000 through December 31, 2009 were denied. The Examiners reviewed all 42 denied claims, and noted that 11 were missing a form or letter that should have been in the file. Mission Hospital General Counsel Ann Young stated: the missing forms had no impact on Mission employees or their ability to receive compensation for their injuries.
In addition, the Examiners identified 13 Mission Hospital workers’ compensation files during the examination period where, initially, Mission Hospital paid each employee’s medical expenses and later elected to resolve all remaining claims with a comprehensive, agreed-upon settlement. Although the Examiners located the complete settlement paperwork in the file, a statistical document, called a Form 28C, could not be located in seven of the files. “These forms [28C] have no practical impact on our employees. They are used simply for statistical purposes by the North Carolina Industrial Commission (NCIC),” Young said.
Young continued, “Mission Hospital acknowledges that it is required to comply with NCIC rules and the North Carolina General Statutes. However, no harm befell any employee of Mission Hospital as a result of any forms not being located in files. Mission Hospital accurately and affirmatively protected its employees’ substantive rights and such protection was reflected in all the files reviewed by the examiners.”
In all, the Examiners noted that 21 forms were missing; they had access to 10 years of claims and over 10,000 employee incidents, resulting in less than 0.2% missing forms. “The examination results illustrate Mission Hospital’s commitment to extraordinary compliance,” Young said. “We could not locate any other market conduct examinations published on the Department of Insurance’s website which covered as protracted a period of time and few, if any, exemplified the level of compliance evidenced by our workers’ compensation program.”
About Mission Health
Mission Health, based in Asheville, NC, is the state’s sixth largest health system and the tertiary care regional referral center for Western NC and the adjoining region. In 2012, Mission Health was named by Thomson Reuters as one of the top 15 health systems in the nation – the only health system in North Carolina to receive this recognition.
Founded in 1885, Mission Health is a not-for-profit, independent community hospital system that operates four hospitals, numerous out-patient and surgery centers, and the region’s only dedicated Level II trauma center. Its medical staff consists of more than 750 physicians, and is certified in over 50 medical specialties and sub-specialties. Centers of excellence include heart, stroke care and neurosciences, and pediatrics. Mission Hospital, the system’s flagship hospital, is licensed for 730 beds and is the busiest surgical hospital in North Carolina. Other Mission hospitals include Blue Ridge Regional Hospital in Spruce Pine, McDowell Hospital in Marion, and Mission Children’s Hospital in Asheville.
With nearly 8,500 employees and 700 volunteers, Mission Health is dedicated to serving and improving the health and wellness of the people of Western North Carolina.