(c) 2017 Jon L Gelman, All Rights Reserved.

Wednesday, July 30, 2008

World Trade Center Tragedy Needs National Workers Compensation Co-Ordination

It is approaching the 7th anniversary of the horrific events of the terrorist attack on the World Trade Center and the medical benefit and compensation program remains fragmented. The aftermath of the event leaves a cloud of smoke of the complex workers’ compensation issues. Many workers and volunteers throughout the United States lack treatment or compensation for past and potentially future compensable conditions as they struggle to identify a system under which to seek redress.

Dr. Robin Herbert, co-director of the World Trade Center Medical Monitoring Program at Mount Sinai Hospital, New York, has reported that significant medical findings have been identified in these workers. Over 70% of the first responders examined had respiratory problems while they were working on the World Trade Center site. The problems persisted in 60% of the workers. Over one-third of the workers had abnormal spirometry tests. Of the non-smokers examined the abnormal rates were five times that in a normal population. Mental health consequences, such as depression and post traumatic stress disorders, were observed in 40% of those who had physical findings.

It is anticipated that there will be two or three “waves” of disease cause by the exposure to the pulverized substances that composed the World Trade Center buildings. The building burnt at very high temperatures because of the 91,000 liters of jet fuel that cause a micronization of a million tons of building materials. The initial health acute respiratory problems were caused by the exposure to the irritations of the cement on the respiratory systems. They are now begining to identify higher rates of interstitial lung disease which has been designated as a second wave of disease. They are concerned about a third wave of disease, cancers. The pulverized materials contained a mix of known carcinogens such as: asbestos (estimated 400+ tons of sprayed on fiber alone), dioxin and other products which had synergistic effects upon the workers. Self-reported cancers of the blood and lymphatic systems, are being watched carefully.

The number of occupational exposures were enormous. The population of workers includes all those who were caught in the 9/11 dust cloud; workers and volunteers at Ground Zero, waste transfer operations, Staten Island landfill and Medical Examiners office; immigrant day laborers and building maintenance personnel; workers restoring essential services at and beyond Ground Zero; workers demolishing 9/11 contaminated buildings and workers and volunteers remaining in or returning to Lower Manhattan and exposed to primary and/or secondary sources of contamination.

The demographics of the population were national as volunteers and workers swarmed in throughout the United State to work and lend a helping hand. While the exposure was geographically in the State of New York, many employees were hired outside of New York State and the employers were out-of-state employers. Multiple state workers’ compensation systems have jurisdiction over the benefit delivery process. Therefore, workers and volunteers are required to meet the rules and regulations of possibly multiple jurisdiction that will govern the various and dissimilar benefits programs available.

The process to obtain benefits for injured workers and volunteers remains chaotic. Federal legislation, H.R. 3543 is pending to nationalize medical monitoring of 9/11 exposure through the National Institute for Occupational Safety and Health (NIOSH). Specific State programs have varying restrictions, limitations, requirements and different benefit structures. The State of New York requires registration by August 13, 2008. There remains no universal co-ordination of benefit programs or any unified guidance for injured workers and volunteers to obtain compensation benefits.

It has been 7 long years since the 9/11 tragedy and injured workers and volunteers are still without a co-ordinated national system for compensation. It is time to recognize that workers and volunteers of the 9/11 events should not be left in the dust. For a workers’ compensation program to be effective and credible it is essential that a co-ordinated system be established on a national level to adequately direct the injured workers and volunteers of the 9/11 tragedy for medical monitoring, treatment and compensation.

The Asbestos Debate is Over

Almost 45 years following the historic 1964 NY Academy of Medicine conference in New York experts continue to memorialize the history of asbestos related disease. Now enters, defense expert John E. Craighead, who has written his viewpoint on the subject.

Asbestos is one of the modern world’s most historic occupational medical disasters. Not only is it well documented, it continues not to be banned in the US , in fact, the incidence of asbestos related disease reported has turned upward, according to recently released NIOSH data (1979-2003.

In a recent review of the Craighead volume, the New England Journal of Medicine, has called it, “….highly personalized with strong individual viewpoints. It is less authoritative as a source for risk assessment and litigation issues.”

Yet others have including: Victor L. Roggli (Pathology of Asbestos-Associated Diseases), Barry I. Castleman (Asbestos: Medical and Legal Aspects, Fifth Edition) and Paul Brodeur (Outrageous Misconduct) have followed in the historic footsteps of the late, Irving J. Selikoff, MD and have guided us to seek a remedy and cure for wrongdoings of the past.

The asbestos debate is over. It is no longer time to profit from the debate and sell controversy. It is no longer time to allow this product to be sold anywhere in the world for profit. It is time to direct attention to provide medical treatment to those who suffer from asbestos related illness and draw our attention to find a cure for this disease.

Friday, July 25, 2008

The Future of Workers' Compensation: Navigating the New Benefit Highway

The Future of Workers' Compensation: Navigating the New Benefit Highway

The past and present will predict the future of the new workers' compensation benenfit highway. This Power Point presentation is available in a PDF format and for the next 14 days may be securely downloaded from at no cost to the first 500 requests.

Link available at:

The Federal Government is Offering Funding for a World Trade Center Non-Responder Medical Program.

An announcement has been for applications for the provision of screening, referral and treatment services for residents, students, and others in the community, related to the September 11, 2001 terrorist attacks in New York City. The program is aimed at the ‘non-responder population.’ Since September 11, 2001, the Department of Health and Human Services, CDC, and NIOSH have been active in assessing the health impact of the World Trade Center disaster. There is currently a program in place to provide health assessment examinations, diagnosis, and treatment for first response emergency personnel (the responder population) in the New York City (NYC) area. The application deadline is August 25, 2008.

The grant awardee would be involved in the following activities:

1. Immediately provide for accessible health assessments, eligibility confirmation, diagnostic, referral and treatment services (including medications and durable medical equipment) to the non-responder population for health conditions associated with WTC dust/debris exposure.

2. Identify the organizational components required to support access to these services, including personnel, examination venues, maintenance of patient records, data platforms and management, compliance with applicable laws, assurance of quality care, coordination of healthcare benefits, and programmatic recordkeeping.

3. Provide referral and treatment services with grant funds only as the Payor of Last Resort. Private health insurance (self-funded or employer-funded), workers’ compensation insurance (employer-funded), and government-funded health insurance (Medicare and Medicaid) shall be used first before grant funds are used. Applicants should demonstrate their capacity to determine insurance status and to seek reimbursement from outside payers. Funds shall not be used to supplant existing activities or for the treatment of the responder population.

4. Establish service information and patient management systems as needed in order to accommodate intake, referral, prompt healthcare services, and reporting of the services provided to the non-responder population. In carrying out these activities, collaborate with other WTC-related healthcare providers, as appropriate and needed.

5. Develop a written Management and Prioritization Plan which identifies the projected service delivery area, explains how the assessment of potential non-responder patient needs will be determined, provides a strategy to ensure meeting those needs, and provides a section focused on ensuring prioritization and management of this program’s health services delivery to meet those needs, within the broader context of all organizational activities and responsibilities. The applicant should state an estimate for the number of non-responders to be served with the requested funds and provide a justification based on an estimation of the projected costs to provide health assessment examinations, and the costs to provide treatment for the expected World Trade Center-related conditions that will be identified.

6. Provide patient encounter reporting on health assessment examinations and treatment to NIOSH for quality assurance. 7. Establish and maintain information and data management systems that will ensure the provision to NIOSH of electronic data in a uniform fashion

Complete Announcement

Thursday, July 24, 2008

New Chemotherapy Treatment Reported "Responsive" to Mesothelioma

A new set of drugs has been reported responsive in treating mesothelioma, a tumor caused by exposure to asbestos fiber. The British Journal of Cancer has reported that cisplatin and vinorelbine effective in the treatment of mesothelioma. “Cisplatin and intravenous vinorelbine is a highly active regimen in MPM with a response rate and survival comparable to the most active regimens so far reported.”

The report appears in the June 10, 2008 edition of The British Journal of Medicine.

Saturday, July 12, 2008

NJ Workers' Compensation Legislative Analysis

Why there is a need to increase “The Cap.”

NJ’s Statutorily Imposed Cap of Benefits
The average worker is dependent upon his weekly wage to provide the necessities to maintain a standard of living for himself and his family. When the flow of salary ceases, immediate concern focuses on the provision of food, clothing and shelter. The Workers' Compensation system is a major social benefit program that addresses the need to provide for benefits to replace earned wages and a “socially adequate” standard of living.
Disability rates for workers' compensation benefits in the State of New Jersey are based upon the computation of the wages of the injured employee. Statutorily, the wages are defined to mean "the money rate" at which the service rendered is compensated.

Since the Act was amended in 1979, New Jersey workers' compensation benefits are based upon the statewide average weekly wage (SAWW). There are both minimum and maximum compensation rates. The Act provides for a sliding scale of maximum allowable weekly benefits through the first 180 weeks of disability, and thereafter eliminates the sliding scale, replacing it with a single percentage rate, which itself increases as the severity of the disability increases. The beginning rate of disability is 20% of the SAWW, and increases by approximately one percent until it reaches the level of 35% of the SAWW for injuries which warrant disability payments of over 180 weeks. [From that point on, as the severity of the disability increases, the percentage of the SAWW which is paid also increases by five (5) percentage points for approximately every 30 weeks of disability paid.

NJ’s Dilemma:
2008 State Average Weekly Wage (SAWW)
NJ State Average Weekly wage (SAWW) for all workers was determined to be $989.23, 39 N.J.R. 3714(a).
NJ State Average Hourly Wage for 2008, calculated as 1/40th of the SAWW = $24.73, NJSA 34:15-12. The Maximum Workers’ Compensation benefit, which is capped at $75% of the SAWW for 2008 is $742 per week.
The Maximum HOURLY Workers’ Compensation SAAW cap is, based on a 40 hour week, $18.55.

Many workers in NJ are earning wages that EXCEED $18.55 per hour!

Where NJ Stands in Comparison to Other States
13 States have SAWW Caps that are higher than 100%. Iowa has 200%. 20 States, including close or nearly adjacent States/Federal District (Pennsylvania, Rhode Island, Connecticut, Massachusetts and District of Columbia.), have 100%.

Of the States with fixed dollar caps on benefits, 33 States have caps that are 100% or greater than New Jersey and only 6 states have dollar caps lower than NJ.What an increase in “the cap” would cost NJ. It has been estimated that in increase in the cap merely from 75% to 80% would cost no more that a 1% percent increase in total cost and therefore an increase to 100% would be no more than 5% or about $100 million.
Cost of NJ System in Comparison to Other Systems
The most current numbers available indicate that the cost of workers’ compensation benefit per $100 payroll compare as follows:NJ = $0.85 (which amounts to 81% of the national average)All States – National Average = $1.05

NJ presently rates14th lowest in cost nationally and a mere increase of only 5% would increase the cost to $0.89 which equates to 85% of the national average which would rank NJ still as 19th lowest in cost.