Copyright
Tuesday, March 31, 2009
NY Times Series Calls The Compensation System "A Costly Legal Swamp"
“This is a terrible thing to say,” said Dr. Robin Herbert, co-director of the occupational and environmental division at Mount Sinai Medical Center, “but if I had a health problem at work, I’m not sure I’d file a workers’ comp claim. It’s the Wild West of health insurance.”
http://tinyurl.com/dyp4c7
Monday, March 30, 2009
Nationalizing Workers’ Compensation Medical Delivery
Recently the Obama Administration invited the medical insurance industry to the White House to discuss possible future scenarios on the delivery of health care. A planted floated at the meeting was one that President Obama advocated in h campaign. That proposal was allow the Federal government to sell health care coverage.
Sunday, March 29, 2009
Administration in California Requests Judges to Vacate Their Decision Against AMA Guides
Thursday, March 26, 2009
Salaries Frozen for State Workers' Compensation Staff
The bill directs that no Fiscal Year 2009 appropriations may be used to provide salary increases to workers' compensation judges or administrative law judges, retroactive to January 1, 2009. The legislation provides for an exception if Federal stimulus become available.
"Notwithstanding the provisions of R.S.34:15-49 to the contrary, including the reference therein to salaries of judges of the Division of Workers' Compensation determined as a percentage of the annual salary of judges of Superior Court, beginning on January 1, 2009 there shall be no increase paid from appropriations made herein for an annual salary increase for judges of the Division of Workers' Compensation."
2009 NJ Sess. Law Serv. Ch. 22 (SENATE 15)
Court Holds Autopsy Not Required in Mesothelioma Claim
Furthermore, since the trial in the matter had been scheduled to commence within two weeks of the death of the worker, the Court also held that the trial preparation in the claim was , "... in no way hampered by the denial of their [defendant's] request for a limited autopsy."
Defendants in the claim, including Chrysler Motor Corp and Honeywell International, obtained a Court Order to bar the funeral minutes before the burial of the deceased asbestos worker. On review, following an evidentary hearing, the Appellate Court denied the request by the defendant's for a limited autopsy of the deceased worker.
New Jersey ranks second highest in the nation for asbestos related deaths. Over 10,000 workers each year continue to die from asbestos related disease. Asbestos is not yet banned in the United States.
Harold St. John v. Affinia Group, Inc., et al., NJ Appellate Division, March 3, 2009.
Tuesday, March 24, 2009
6th Circuit Allows RICO Decision Against Employer to Stand
The Court held that 13 original predicated acts constituted a pattern of racketeering activity. The workers were not required to plead or prove reliance on the misrepresentations. The Circuit Court also ruled that the Michigan workers' compensation act did not reverse preempt RICO under the McCarran-Ferguson Act.
Brown v Cassens Transport Co. 546 F.3d 347 (6th Cir. 2009).
Monday, March 23, 2009
CMA Issues an Alert on MSP Reporting Data Extending Testing Period and Setting Thresholds
Sunday, March 22, 2009
The Voice of Change in the Medical Care Debate
Saturday, March 21, 2009
Getting Lead Out of the Workplace...Finally
The report concludes: "Much more is known today about the health effects of lead than was known when OSHA enacted its lead standards in 1978 (for general industry) and 1993 (for the construction industry). Research has identified significant health risks at low to moderate levels of lead exposure that were formerly without recognized harm. Because lead can seriously impair cardiovascular health, cognition, reproduction,and kidney function, the persistence of elevated blood lead levels in workers may be a significant contributor to chronic illness and societal health care costs."
CMS Publishes a User Manual for MSP Reporting
July 1, 2009 is the implementation date for mandatory reporting in workers' compensation claims. Section 111 adds reporting requirements and does not eliminate any existing statutory provisions or regulations. CMS' existing processes, including for example, CMS’ process for self-identifying pending liability insurance (including self-insurance), no-fault insurance, or workers’ compensation claims to CMS’ Coordination of Benefits Contractor (the COBC) or the processes followed by CMS’ Medicare Secondary Payer Recovery Contractor (the MSPRC) for MSP recoveries, remain undisturbed. The Act does impose penalties for noncompliance.
CMS has announced that it will offer a "query function" to required reporting entities to ascertain whether or not the claimant is a Medicare beneficiary. The query will be based upon identifying data including: HICN or SSN; first initial of the last name; first 6 characters of the last name; date of birth and gender.
Yet to be determined are a host of reporting issues including:
- Interim dollar reporting threshold for "Total Payment Obligation to the Claimant" (TPOC) amounts -- CMS’s decision on this issue will be released separately in the near future.
- Interim dollar reporting threshold for "Ongoing Responsibility for Medicals" (ORM) -- CMS has this issue under consideration.
- Further information regarding reporting for mass torts – This issue is still under discussion.
- ICD9 Codes – CMS is reviewing the codes to determine if there are certain codes which Responsible Reporting Entities (RREs) will be prohibited from submitting.
- Examples regarding "Who is the RRE" -- CMS is reviewing additional examples submitted by the industry for possible inclusion in the User Guide.
Tuesday, March 17, 2009
Private Claim for Medicare Reimbursement Dismissed
The Court reasoned that the law suit did not demonstrate the tobacco companies’s responsibility for the payment of a Medicare beneficiary’s medical costs. The plaintiff’s had attempted to rely upon the opinion in a bench trial instituted by the Federal government under the RICO Act.
The Federal Court judge held that the defendants, the tobacco companies, “are not subject to suit under the MSP unless and until they are found responsible for Medicare costs and they fail to reimburse Medicare within 120 days after that responsibility first arises.” The suit by the private parties was dismissed.
National Committee to Preserve Social Sec. and Medicare v. Philip Morris USA Inc., ___ F.Supp.2d ___, 2009 WL 590573 E.D.N.Y., March 05, 2009.
Saturday, March 14, 2009
Medicare Reporting - $1,000 fine/claim/day
The article:
http://tinyurl.com/bthcfm
Thursday, March 12, 2009
AMA Guides Tossed Aside in California
(1) the AMA Guides portion of the 2005 Schedule is rebuttable;
(2) the AMA Guides portion of the 2005 Schedule is rebutted by showing that an impairment rating based on the AMA Guides would result in a permanent disability award that would be inequitable, disproportionate, and not a fair and accurate measure of the employee’s permanent disability; and
(3) when an impairment rating based on the AMA Guides has been rebutted, the WCAB may make an impairment determination that considers medical opinions that are not based or are only partially based on the AMA Guides.
Almarz v Environmental Recovery, et al
Case No. ADJ1078163 (BAK 0145426) Decided Feb. 3, 2009
Monday, March 2, 2009
AIG Up For Sale
AIG, the distressed insurance company, is expected to announce a $60 Billion quarterly loss. The announcement, anticipated shortly, follows three separate failed efforts by the Federal Government to rescue the company.
Creditors of the company, and the US Government, have reached a four new deal to bailout the company. This time the company is being structured to be sold. It has been reported that the property and casualty lines maybe the first to go.
The US Treasury and AIG issued the following statement:
"The steps announced today provide tangible evidence of the U.S. government’s commitment to the orderly restructuring of AIG over time in the face of continuing market dislocations and economic deterioration. Orderly restructuring is essential to AIG’s repayment of the support it has received from U.S. taxpayers and to preserving financial stability. The U.S. government is committed to continuing to work with AIG to maintain its ability to meet its obligations as they come due."