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(c) 2014 Jon L Gelman, All Rights Reserved.

Monday, December 31, 2012

Compensation for Secondary Smoke Inhalation

Today's post comes from guest author Charlie Domer from The Domer Law Firm.

Recent article indicates some public health departments are offering incentives to create smoke-free policies in buildings. The idea is to reduce the exposure to second-hand smoke. While substantial strides have been made in many states to provide both smoke-free public places and smoke-free workplaces, the dangers of secondary smoke inhalation remain.

In Wisconsin, a case I handled established the compensability of secondary inhalation [Kufall v. Wisconsin Bell, Inc. WC Claim No. 88-000676 (Labor and Industry Review Commission, December 11, 1990]. In that case, Wisconsin Bell refused to provide a smoke-free environment for a worker who had a specific tobacco allergy, despite her several efforts and requests to be free of secondary smoke.
Ms. Kufall was entitled to claim a Loss of Earning Capacity for her permanent allergy to tobacco smoke
Because the employer could or would not provide such an environment, Ms. Kufall was entitled to claim a Loss of Earning Capacity for her permanent allergy to tobacco smoke, based upon the number of workplaces from which she would be precluded from working because of such exposure. Benefits are also payable for lost time and for Permanent Partial Impairment to the lungs (based upon lung capacity diminution tests). Although many if not most workplaces are smoke-free, policies are often “honored in the breach” suggesting smokers are using hallways, bathrooms, and other public areas inside and outside the building, catch a quick smoke, often exposing co-employees to the dangers of secondary smoke inhalation.

Read more about "tobacco exposure" and workers' compensation:

53 minutes ago
In that case, Wisconsin Bell refused to provide a smoke-free environment for a worker who had a specific tobacco allergy, despite her several efforts and requests to be free of secondary smoke. Ms. Kufall was entitled to claim ...
Apr 12, 2012
The new requirements of graphic image and textual warning labels were imposed by the Family Smoking Prevention and Tobacco Control Act (FSPTCA) [HR 1256 text]. Related articles. National Asbestos Awareness Week ...
Dec 10, 2010
Workers who are exposed to tobacco smoke, even in small quantities, are subjecting themselves to an increased risk of illness and disease. The newly published Surgeon General Report, How Tobacco Smoke Causes ...
Jul 21, 2010
The health dangers emanating from the unregulated cosmetic industry are becoming more apparent and more tragic. The serious health consequences of exposures flowing from the cosmetic industry may generate the next ...


Saturday, December 29, 2012

Class Action by Medicare Advantage Beneficiares Dismissed By Federal Court

A federal class action, by a group of plaintiffs who alleged that they were a class of Medicare-eligible individuals enrolled in a Medicare Advantage plan, and received benefits under part C of the Medicare program, was dismissed by a federal court under the preemption doctrine. In an action removed to Federal court, the plaintiffs sought to bring a class action in state court alleging that New York state law applied regarding reimbursement for for monetary settlements from third-party tortfeasors.

The court ruled that the interpretation of the secondary payer provision of Medicare part C, 42 USC section 1395W-22 (a)(4), preempted any state law provisions.

Meek-Horton v. Trover Solutions, Inc., No. 11 CV 6054(RPP), 2012 WL 6699776, (SD-NY 2012) Decided December 26, 2012

Read more about "The Medicare Secondary Payer Act" and workers' compensation


Oct 01, 2012
US Supreme Court Denies CMS-MSP Case - Hadden. 2012 WL 1106757. Supreme Court of the United States. HADDEN, VERNON V. UNITED STATES. No. 11-1197.Oct. 1, 2012. Opinion. The petition for writ of certiorari is ...
Dec 28, 2012
CMS/MSP Requires Deceased Beneficiary Information. CMS has announced that workers' compensation information concerning deceased beneficiaries must be reported by insurance carriers. "We received another question ...
Apr 03, 2009
CMS/MSP Requires Deceased Beneficiary Information. CMS has announced that workers' compensation information concerning deceased beneficiaries must be reported by insurance carriers. "We received another question ...
May 18, 2011
"IT IS FURTHER ORDERED that Defendant's demand for payment of her MSP reimbursement claims, under threat of collection actions before there has been a resolution of an appeal regarding the amount of the Defendant's ...

Hot Topics in Workers Compensation Law 2013



This popular annual program will cover the year’s hottest topics - as well as what’s coming in 2013 and will provide both novice and expert workers’ compensation attorneys with a comprehensive understanding the new issues facing the practice of workers workplace injury law.

From the entirely new considerations placed on us by Social Networking sites to new and important case law and regulatory changes, you won’t want to miss this essential annual update. In just one evening, you’ll gain the confidence you need to handle the many unexpected challenges that are likely to come your way - make your plans to attend today!

As an attendee, you’ll gain insight into essential tips and strategies that will assist you in representing injured workers and/or employers, including:

• Social Networking and Workplace Litigation: Attorney Advertising Opportunities and Responsibilities

• Compliance with new CMS / MSP protocols "CMS never says goodbye..."

• New 9/11 Victims Compensation Fund Claims: What attorneys need to know about the process and NIOSH regulations qualifying 50 types of cancers


 Medical Records: How to read an emergency room chart

• The employment status of a volunteer

• Ethical considerations in handling a workers' compensation claim.

• Case Law, Legislative and Regulatory changes impacting the Workers' Compensation practice

...and more!

NJ CLE information: This program has been approved by the Board on Continuing Legal Education of the Supreme Court of New Jersey for 4.5 hours of total CLE credit.

Seminar Agenda

Time
Presenter
Topic
4:00pm
Jon L. Gelman, Esq.
Nancy J. Johnson, Esq.
Introduction
4:01pm
Hon. Vicki Citrino
Randy Grossman, Esq.
NJ Supreme Court Case Law Update: Jurisdictional (Lempke) and Cardiovascular (Renner) Issues
4:30pm
Dr. Salvatore Pepe, IV
Medical Records: How To Read An Emergency Room Chart
5:00pm
Vincent I. Parrett, Esq.
New 9/11 Victims Compensation Fund Claims: What Attorneys Need to Know
5:30pm
M. Scott Tashjy, Esq.
Ethical Considerations in Handling a Workers’ Compensation Case
6:00pm
Break
6:05pm
Christopher P. Gargano, Esq.
Social Networking and Workplace Litigation: What You and Your Clients Need to Know. 
6:35pm
Jason L. Gelman, Esq.
Social Networking and Workplace Litigation: Attorney Advertising Opportunities and Responsibilities
7:05pm
Dorothy T. Daly, Esq.
The Employment Status of a Volunteer.
7:30pm
Hon. Richard E. Hickey III
Compliance With New CMS / MSP Protocols, "CMS never says goodbye..."
8:00pm
Jon L. Gelman, Esq.
Nancy J. Johnson, Esq.
Closing Remarks


Program Moderators / Speakers

Author, NJ Workers' Compensation Law 3rd Ed (Thompson-West)
Jon L. Gelman, LLC 
(Wayne)

Weston Stierli McFadden & Capotorto
Certified by the Supreme Court of New Jersey as a Workers’ Compensation Attorney
(Parsippany)

Speakers

Hon. Vickie Citrino, 
Judge of Compensation
(Lebanon)

Hon. Richard E. Hickey III, Ret.
Supervising Administrative Judge of Compensation
Of Counsel Capehart and Scatchard
(Mt. Laurel)

Dorothy T. Daly, Esq.
Christie, Pabarue, Mortensen and Young
(Westmont)


Law Office of Christopher P. Gargano
(Jersey City)

(New York City)

Greenberg, Wallen & Grossman, LLC
(West New York)

Motley Rice LLC
(Mt. Pleasant, SC)

Dr. Salvatore Pepe IV
(Wall)

The Tashjy Law Firm, LLC
(Wall)

........ 
4pm to 8pm
The Law Center
1 Constitution Square
New Brunswick, NJ
732-214-8500

Friday, December 28, 2012

Legislation Goes to President Obama on CMS Condition Payment Procedures

The US House (H.R. 1845) and US Senate has passed legislation to modify procedures for processing conditional payments under the Medicare (S. 1718) Secondary Payer Act. It establishes parameters for repording, processing and appealing issues concerning conditional payments.

Under the proposed legislation time periods for reporting by parties to CMS (The Center for Medeicare and Medicaid Services) are eased, penalities for insurance carriers are reduced, and a 3 year statute of limitations is established.

The legislation was merged into another pending bill for medical services and was rushed to a favorable vote in both the House and Senate in the last moments before Christmas.

What remains to be determined are the regulations that will be established to implement the legislation. In the past, such regulations usually set boundries for such legislation and may in the end further complicate and even prolong resolution of the issues.

Read more about "The Medicare Secondary Payer Act" and workers' compensation


Oct 01, 2012
US Supreme Court Denies CMS-MSP Case - Hadden. 2012 WL 1106757. Supreme Court of the United States. HADDEN, VERNON V. UNITED STATES. No. 11-1197.Oct. 1, 2012. Opinion. The petition for writ of certiorari is ...
Apr 03, 2009
CMS/MSP Requires Deceased Beneficiary Information. CMS has announced that workers' compensation information concerning deceased beneficiaries must be reported by insurance carriers. "We received another question ...
May 18, 2011
"IT IS FURTHER ORDERED that Defendant's demand for payment of her MSP reimbursement claims, under threat of collection actions before there has been a resolution of an appeal regarding the amount of the Defendant's ...
Dec 23, 2008
A formal process exits to obtain a waiver of an Overpayment Recovery request from The Center for Medicare and Medicaid Services [CMS]. If SSA advises you or your client that it has made an overpayment, ie. Medicare ...


Thursday, December 27, 2012

Who Calls The Shots, Your Employer-Selected Doctor Or The Insurance Company?


Insurance companies sometimes tell doctors that they will not pay for procedures that the doctor says are medically appropriate.

Today's post comes from guest author Nathan Reckman from Paul McAndrew Law Firm.

In Iowa, employers have the right to control an injured worker’s medical care. This means that if you are injured at work, your employer gets to send you to a doctor of their choosing. The doctors chosen by the employer are called “authorized treating physicians.” In theory, after an employer chooses their authorized treating physician, they are required to pay for any care that doctor believes is necessary to treat the work injury. In practice, the employer and their workers’ compensation insurance company often try to interfere with the care the injured worker is entitled to by refusing to pay for procedures or tests recommended by their handpicked doctor.

Typically, when an authorized doctor suggests an expensive course of care (like surgery) the first thing the doctor will do is check with the insurance company to make sure the surgery is going to be paid for. Instead of immediately scheduling the needed surgery, the doctor will wait until the insurance carrier agrees to pay for the procedure. Doctors do this so they don’t have to worry about how they are going to be paid. Asking for this unneeded authorization from the insurance company means the insurance company now has a say in determining what individual procedures are proper for the care of the work injury.

We often see injured workers whose injury was initially accepted by the employer until the doctor requests authorization for an expensive surgery. When faced with the additional cost of surgery, the insurance carrier denies the work injury hoping the injured worker will either forego surgery or try to pay for the surgery through other means, such as their personal health insurance.

This situation may also arise when the authorized doctor recommends expensive diagnostic procedures, like CT scans, or refers the injured worker to a specialist, for example a psychiatrist for depression related to the work injury.

To make sure your rights are protected, it’s often helpful to have an experienced workers’ compensation attorney on your side if you’re facing a situation where your employer is trying to interfere with the decisions of their handpicked doctor. Injured workers should get the care that their doctor, not an insurance company, determines is medically appropriate.

Read more about "medical treatment" and workers' compensation.


Nov 16, 2012
New York Worker's Compensation Board's proposed new medical treatment guidelines that will modify 2010 previously implemented. Adopt the new carpal tunnel syndrome (CTS) medical treatment guidelines (MTG) as the ...
Nov 09, 2012
On Tuesday, the American people expressed its support for a unified medical care program that will embrace all aspects of life, including industrial accidents and diseases. They validated, as did the Supreme Court, the ...
Nov 01, 2012
Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers' compensation medical treatment. Proposed changes to the Federal program will indirectly ...
Jan 22, 2011
The court held that the failure of the employer/insurance carrier to provide medical care for out-of-state treatment, even though requested by the employee, was deemed a refusal of the employer to provide adequate medical ...

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