(c) 2018 Jon L Gelman, All Rights Reserved.

Wednesday, May 28, 2008



Hear an expert analysis of key cases decided during the past year

Presented in cooperation with the NJSBA Workers’ Compensation Section

Tuesday, July 08, 2008 4:00 PM to 8:00 PMNew Jersey Law Center, New Brunswick / S1485d-14533

This fifth annual program features a panel of some of the most respected Workers' Conmpensation Judges and attorneys, who will review and provide insight on the top issues and cases that have emerged during the past year.

This fast-paced program will be packed with practical pointers that have proven successful in matters ranging from jurisdictional issues through coverage of employment. The program will expand your horizons and broaden your practice potential into expanding in developing areas of the law such as the Longshore Act, Defense Base Act claims, and actions involving New York jurisdiction, including 9/11 claims. Make plans to register today!

• Proving that a claim arose out of, and occurred in, the course of the employment: Mojica v. The Valley Hospital
• Interpreting the "Going and Coming Rule" to prove your case: Scott v. Foodarama Supermarkets • Determing jurisdiction of the court: Morella v. Grand Union/New Jersey Self-Insurers Guaranty Association 193 N.J. 350 (2008), Kibler v. Roxbury Bd. of Educ. 392 N.J. Super. 45 App. Div. 2007) , Flick v. PMA Ins. Co. and Kathleen Reed, 394 N.J. Super. 605 (App. Div. 2007)• What you need to know about counsel fees: Alvarado v. J & J Snack Foods Corp.
• How to handle a Longshore and/or Defense Base Act Claim
• What you need to know about NJ 911 exposure filing and proof requirements
...and more
Moderator:JON L. GELMAN, ESQ.

Speakers include:

Click here to print paper registration form

Sunday, May 18, 2008

Medicare Recovery Made Simple

Navigating the Medicare recovery system just became a whole lot easier with the deployment of the new website launched by the new national MSP Recovery Contractor (MSPRC). The Centers for Medicare & Medicaid Services (CMS) has consolidated all of the functions and workloads related to Medicare Secondary Payer (MSP) post-payment recoveries into one MSP recovery contract.

The contract for the new national MSP Recovery Contractor (MSPRC) was implemented on October 2, 2006. The MSPRC has taken over new MSP recovery cases and most existing cases. Chickasaw Nation Industries, Inc. (CNI) is the national contractor. CNI has received several prestigious national awards including: Top Small Businesses, ranked #23 by Federal Times 2006; U.S. Department of Commerce Minority Business Development Agency National Minority Small Business of the Year SBA Administrator’s “Award for Excellence” 2005; and American Indian-Owned Businesses, ranked #2 by New Mexico Business Weekly 2004.

The website explains in detail the procedures and forms utilized by CNI to contact the parties and implement the procedures that it utilizes for recovery in: Workers’ Compensation, Liability, Med-Pay, PIP and Group Health Plan recoveries.

The new website site is a major step forward in assisting all parties in the recovery process.

Tuesday, May 13, 2008

Are Second Injury Funds Going to be History Soon?

Second Injury Funds [SIF] are now undergoing a critical evaluation as the economy continues to deteriorate. Originally created post World War II, the SIFs encouraged the employers to hire handicapped employees who were hired and had pre-existing disability. The concept afforded a shared responsibility through pooled insurance and insulated the employer from the burden of on apportioning liability in total and permanent disability cases.

Recently, however, the SIF had become raided by State politicians in an effort to balance their State budgets. New Jersey highlights such a concern, and within the last decade funds have been raided three times in order to satisfy debt in the general treasury. Not only does it renege on the promise of providing benefits to injured workers, it slows down the bureaucracy of administrating a workers’ compensation program by inadequately funding staff. At recent hearings before the New Jersey State Senate there were a multitude of complaints concerning inadequate staffing of the SIF, including the need for more attorneys to represent SIF. As a result of this outrage there is pending before the state legislature a resolution to amend the New Jersey’s constitution to prohibit such raiding in the future of funds directed to employee benefits.

SIFs had been challenged by the insurance industry over the last 10 years and they have attempted to disband them and wind down their benefit distribution contributions. Such a challenge was recently opposed in the State of Missouri where an attempt to eliminate the SIF by 2011 was defeated.

Opponents the SIF’s indicate that the Americans with Disabilities Act insulates the employee from retaliatory claims, and the SIFs are no longer necessary. Additionally, insurance carriers would like more control over the distribution of the benefit dollars and the SIF appears as an additional obstacle to employers in crafting settlements in total and permanent disability cases.

It is likely that this debate will continue and that the trend towards elimination of SIFs will also continue.

Saturday, May 10, 2008

Cost of Medical Benefits Continue to Soar in Workers Compensation

Medical benefits continue to soar in the workers compensation arena. They constitute the largest and most significant factor in the payment of workers' compensation claims. At a recent meeting of NCCI Holdings Inc. it was announced that data reflects a huge increase in the medical component.

What is significant is that medical now comprises 59% of the benefit dollar reflected in 2007 projections. The total indemnity in 2007 amounts to only 41% of the benefit dollar. In 1997 medical comprise 53% of the benefit dollar and in 1987. It comprised only 46% of the benefit dollar. This is a significant increase in a critical trend in the payment of workers' compensation benefits.

Workers compensation medical cost trends reflect a 6% increase in 2007. While this change is lower than the increase of 2006 which was 8.6%. The overall expenditures are increasing. Medical severity remains growing at a faster rate than the medical cost per loss-time claim. In 2007 while growth was at 6%., the medical CPI was only 4.4%.

Employer costs in workers' compensation have decreased to a projected 1.8% of the total cost in 2007 significantly down from the 2.2% reported in 1997. However, when combined, both the health insurance and workers' compensation programs, the employer' s costs continue to rise very significantly. Health insurance in 2007 amounted to 7.1% of the cost to employers for employee compensation while. In 1997 there were only 5.5%.

“Given the positive 2007 results, our short-term view of the market is optimistic,” added NCCI Chief Actuary Dennis Mealy. “However, our long-term outlook is cautionary due to the myriad of uncertainties that continue to face the business.”
Looking at an overview, when both benefit programs are combine, the statistics reflect a significant rise from the 7.7% in 1997 to the 8.9% in 2007. This trend, if continued, will probably result in consolidation of both benefit programs, and elimination of administrative and litigation costs, through use of a single-payer system.

Friday, May 2, 2008

Diagnosing and Curing the Ailing NJ Workers' Compensation System

On the eve the NJ Senate's investigation into New Jersey's workers' compensation system, the question lingers on how to evaluate its health. New Jersey has always had a very large and very dedicated workforce A recent newspaper series by Star-Ledger reporters Dunstan McNichol and John P. Martin revealed that the system is serious flawed and that it is in need of a “complete overhaul.”

The State has a history of being a heavily industrialized state with a huge legacy of pollution from asbestos to petrochemical. Dr. Irving J. Selikoff, of Paterson, NJ, began his landmark studies on asbestos workers in New Jersey. In 1911, almost a century ago, NJ adopted an administrative system known as workers' compensation and it was the intent of the Legislature to provide a speedy and cost effective system of delivering statutorily defined benefits to injured workers while passing the costs onto the consumers of products and services.

This will be the first major evaluation of the workers’ compensation system in 30 years. The last one resulted in a fraud report from the NJ State Commission of Investigation and subsequent statutory change.

Much has changed from the past. In 1911 modern medicine was unknown and so were the diseases that it now treats. The program’s benefits were meager and the conditions eligible for compensation were few and far between. More Americans have died from occupational disease in the United States of America in the past 40 years than in all wars dating back to 1776. Hearings on S.79 before the Subcomm. of Labor and Human Resources of the Senate Comm. on Labor and Human Resources, 100th Cong. 1st Session, S.Hrg. 100-56, pt. 1, at page 1 (1987). Collateral benefit programs did not exist: major medical insurance, long term disability, social security and pension programs.

We are experiencing a struggling economy today. Former Labor Secretary Robert Reich stated, “Fifty years ago, when over a third of the American workforce was unionized and most big industries were oligopolies, it was fairly easy for unionized workers to get higher wages and benefits without putting any individual company at a competitive disadvantage. The higher wages and benefits were merely passed on to consumers in the form of higher prices or came out of profits that would otherwise go to investors. Today, though, most companies are in fierce competition because new technologies combined with globalization have destroyed the old oligopolies and allowed many new entrants.”

Today the workers’ compensation process is confronted with the complexity of the causal relationship of new diseases to synergistic occupational exposures to complex substances as well as traumatic events. Multiple bureaucratic benefits programs that are not formally connected burden the system with claims and liens. Revenue is limited by fewer manufacturing facilities and it is more costly to provide medical treatment and pharmaceutical protocols that result in miraculous recoveries as well as serious and fatal unfortunate results. Benefits must be paid out longer since the average person has a greater life expectancy, ie 1911 – 50 yrs of age and 2007 – 78 years of age.

As in medicine, one must look at both subjective complaints and objective findings to guide its evaluation of the workers’ compensation system. One can hear the cry’s of injured workersWaiting in Pain,” and of the injured workers and the families of those who did not survive the compensation system. Stories of frustration and outrage are reported in the press. Testimony to the NJ Senate will come from the stakeholders who have economic interests in the system and those who are organized representatives of those who are unable to speak any longer. Those voices must be heard and evaluated. It is important to heed to words and wisdom of all and evaluate them in the context of self-motivation.

The compensation system has been portrayed as, “a dead elephant in the room,” and one that fails to carry out the legislative intent of 1911. Professor Emeritus, John F. Burton, Jr., of Rutgers University of the School of Management and Labor Relations, describes the NJ system as, "It's kind of a sleepy system…” that is “…not particularly worker-friendly."

Unlike The Constitution, the workers' compensation act deals not in the theoretical and vague general concepts of Democracy. The compensation act is a document, which within its four comers, speaks with certainty, specifics and details.

The program has failed because under the present system the Legislative intent cannot be carried out. One cannot drive a 1911 model car on the NJ Turnpike today. Workers' Compensation should be viewed in that context, and not as a cash cow for any interest parties.

The Act can no longer provide medical treatment in an efficient and effective manner consistent with the legislative intent to provide social remedial benefits through a liberal and summary social insurance program. Medical coverage has become acute in NJ and in other jurisdictions. Almost a majority of workers will soon be uninsured for major medical coverage. NJ should take the initiative, as other states have, to provide for universal health care. NJ should combine workers' compensation medical coverage with a universal employer based medical care program and have a single payer system. A single payer system will be cost effective, efficient and provide more appropriate delivery of medical care.

The workers' compensation system began in 1911 with the noble mission as a social remedial system providing an efficient and certain system of benefits to injured workers. Today, the system struggles to protect employees as the rapidly evolving landscape is demanding increased attention to reconsideration of an IHC system in light of the consequences of the program's costs and the consequences of being uninsured for healthcare benefits. The participants in the current program, including employees and employers , will require a more balanced and certain medical delivery system. The lack of healthcare coverage takes an enormous toll on the uninsured, which results in avoidable deaths each year, poorly managed chronic conditions, undetected or under treated cancer and untried life-saving medical procedures. An Integrated Health Care plan is a potential national shift to reduce costs so that a healthcare safety net can be maintained for workers and their families.

“Full-time healthcare would save money. Instead of paying for two insurance plans – one to cover healthcare for injuries and illnesses on the job and another for injuries and illness off the job – businesses would buy one plan. As Roger Thompson, former director of Travelers Insurance Workers’ Compensation Strategic Business Unit put it, the present system is ‘like having two trains going down separate tracks and it doesn’t make a lot of sense to have all the administrative costs to maintain these separate systems.’” R. McGarrah, “Full-time Healthcare for America’s Working Families [Draft],” AFL-CIO (August 22, 2003).

In the short run, adopting such concepts, proposed by Senator Stephen M. Sweeney and Assemblyman Neil M. Cohen, would be fine initial steps:

By evaluating the health of the compensation system thorough an intensive analysis of both the objective findings and subjective complaints, the NJ Senate will have the opportunity to enact modern, creative and innovative solutions that will be able meet the present needs of the workers, the employers and taxpayers of State. The NJ Legislature has the opportunity to craft an up-to-date system that will cure the ailing and antiquated workers’ compensation system and embrace today’s needs and tomorrow’s future and bring the State into a new century.

Thursday, May 1, 2008

Opposition Continues to Swell Against Utilization of the AMA Guides 6th ed

Resistance continues to mount against adoption of the AMA Guides to Impairment 6th edition. Joining the growing chorus of opposition are John Burton, a leading expert in workers' compensation, and the Attorney General of Tennessee who issued an opinion against adoption of the 6th Edition.

Workers’ compensation expert, John Burton, at a presentation to the NY State Workers’ Compensation Board expressed his disfavor in adoption to the AMA Guides 6h edition to determine disability. He recommended that all 40 US State jurisdictions and Canada abandon the AMA Guides altogether.

Burton said, "My concern about the AMA guide ... is that it's simply not evidence-based. It's ignoring the evidence that's available to do it right," "I think the AMA has now shown it's incapable of doing it right and this thing ought to be referred to the Institute of Medicine to look at this issue and figure out how to do a decent rating system."

Additionally, the automatic adoption of the AMA Guides 6th Ed. is unconstitutional states Attorney General of the State of Tennessee. “While there is not any controlling authority in Tennessee on this issue, and while Tenn. Code Ann. § 50-6-102(2) is defensible, this provision is vulnerable to attack as an unconstitutional delegation of legislative authority in violation of Tenn. Const. art. II, § 3, because by making the “most recent” edition of the AMA Guides that is in effect on the date of the employee’s compensable injury the applicable edition, § 50-6-102(2) may be construed as incorporating future changes of the AMA Guides to Tennessee’s statutory scheme.”

As the debate continues concerning the adoption of the AMA Guides to Impairment 6th Ed. the issue continues to focus on whether the AMA Guides to Impairment should be utilized at all to determine disability in at all in a workers’ compensation claim.