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Showing posts with label Legal Information. Show all posts
Showing posts with label Legal Information. Show all posts

Wednesday, February 5, 2014

The Rule of Law and The Media's Role

Today's post is authored by David DePaolo and shared from workcompcentral.com
Those not living in California are befuddled by our system. Heck, even those living in California are befuddled...

Yesterday was also the start of the 21st annual California Division of Workers' Compensation Educational Conference in Los Angeles, CA, where the weather is a bit warmer than it is here in CT.

So too has the activity been a bit warmer in California - at the Educational Conference Acting Administrative Director Destie Overpeck gave an overview of what has been going on with the division since the directive of SB 863 to implement numerous changes to the system.

The list of work that the division has been engaged in is impressive, and demonstrates just how vast the changes were in SB 863:
  1. New rules to reduce payments to ambulatory surgery centers from 120% of Medicare’s outpatient rate to 80%;
  2. A new fee schedule for providers based on a Resource Based Relative Value Scale;
  3. A lien fee system (currently partially in abeyance due to legal challenges which also adds to the division's work load);
  4. New statute of limitations for lien filers;
  5. New Independent Medical Review process and procedures;
  6. New Independent Medical Bill review process and procedures;
  7. Revised Medical Provider Network approval and renewal process and rules;
  8. Pending fee schedule for copy services;New penalties for failures in notifications and standards for MPNs.
This is all in addition to the normal work load...
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Tuesday, January 28, 2014

Will GPS "Dots" Change Our Privacy Standards in Workers Compensation

As Global Positioning Systems (GPS) expand and integrate with the Internet, the applications for the invasion of privacy seem endless in workers' compensation. GPS "dots" can be applied to employees and/or equipment, to delineate deviation from the course of employment, temporary disability non-work status and treatment compliance.

After listening to the TED Radio Talk this week on NPR, where Todd Humphrey's describes possibilities to of using GPS "dots," one wonders how much privacy an injured employee will be required to surrender because of an accident at work.

Click here to listen to: TED Radio Hour - Predicting the Future


Sunday, January 12, 2014

New York State is committed to improving outdated workers’ compensation system

Today's post is shared from buffalonews.com and is authored by Jeffrey Fenster, Executive Director of the New York State Workers’ Compensation Board.

Gov. Andrew M. Cuomo inherited a century-old workers’ compensation system in extreme dysfunction, caused by years of neglect and special interest lobbying. Independent research, such as studies by the Workers’ Compensation Research Institute, shows that compared to other states, New York’s system is slow to pay injured workers and produces poor medical outcomes.

It is undisputed that prompt delivery of benefits is good for injured workers and reduces employer costs. Yet those most in need receive least, our workers wait longer for benefits and our costs to employers are the fifth highest in the nation. Things needed to change.

Already, under Cuomo’s administration, the Workers’ Compensation Board has been aggressive in improving the system. We fully implemented and continue improving upon the 2007 reform. That was followed by an increase in the minimum benefit from $100 to $150, protecting New York’s most vulnerable employees.

Simultaneously, the board tackled the high and rising cost of workers’ compensation assessments on employers. In March 2013, Cuomo signed the Business Relief Act, which included $800 million in assessment savings to employers in 2014 – a drop from 18.8 percent to 13.8 percent of premium. Ensuing years will see assessment savings of $300...
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Saturday, December 28, 2013

N.Y. Workers’ Comp Board to Transition Established UEF Claims Management to Triad Group

The New York State Workers’ Compensation Board recently announced it will transition the management of established Uninsured Employers’ Fund (UEF) claims to the Triad Group, LLC effective Jan. 13, 2014.
Triad Group, based in Troy, N.Y., is a professional service organization providing comprehensive claims management.
These claims consist of established claims where liability has been determined, and medical, and/or indemnity payments must be made. Triad will perform all claim-related functions and legal representation. Claimants who have such UEF claims, and all parties of interest, including health care providers and legal representatives, will receive individual written notice of the change in claim administrator.
The Workers’ Compensation Board said the transition of claim management should have no impact on claimants receiving workers’ comp benefits. Claimants who are receiving biweekly indemnity benefits will continue receiving benefits on the same schedule currently in place.
For medical and transportation reimbursement requests after Jan. 13, 2014, Form C-257, Claimant’s Record of Medical and Travel Expenses and Request for Reimbursement, must be sent to Triad for processing with a copy to the Workers’ Compensation Board. For medical services provided on or after Jan. 13, 2014, in established cases only, health care providers should send new medical reports, bills and authorization requests to Triad, and a copy to the...

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Sunday, December 15, 2013

Even Superwoman Can Have Back Problems

As workers' compensation professionals we have seen and handled thousands of back injury claims. We can recite the issues, observations, diagnostic findings and surgical reports by memory. The cases are cranked through workers' compensation systems at a steady stream. As we age we all realize that no one is immune from an occupational back disorder. Today's post is shared from the nytimes.com .

There are two kinds of people, my sister says. People with back problems, and people who don’t have back problems yet.

Are you the kind of person who will develop back problems? Take this easy test.

l. Are you alive?

2. Are you getting older?

3. Do you ever pick things up?

If you answered “yes” to any of these questions, back problems are probably in your future. (Eighty percent of adults experience them at some point.)

“But I’m not the kind of person who has back problems!” you protest.

That’s what everyone says. Right up until the moment his or her back goes out.

What did mine in was decades of library work. Hours spent lifting small weights (books). And heavier weights (reference books). Not to mention carrying carton after carton of donated books from the vestibule where patrons dropped them off into the storage room. All of which I handled with the casual assumption that I was, and would always be, Superwoman.

I thought nothing of stooping, hoisting up a mammoth box of books, then lugging it the length of the library.

People tried to warn me. “Watch your back!” a patron would caution as I staggered by with a large box.

“Thanks!” I would respond, while thinking: “Back problems? Me? Not a chance.”

Then one morning I got out of bed and I couldn’t stand up. My back refused to bear my weight. I hit the floor, then crawled back into bed and phoned my sister, who has coped with back problems...

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Thursday, December 12, 2013

Florida New Case Filings Continue To Go South

FL New Case Filings Decrease
Florida has again issued a through and expansive report concerning its workers' compensation system. A model for transparency, the report reflects a continued decline in new case filings.
Click here to read the complete report.

Wednesday, December 11, 2013

More Cost Shifting

A recent study reports that zero-cost workers' compensation claims merely creates cost shifting to other programs.


Objective: Previous research suggests that non–workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs.
Methods: Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments.
Results: Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims.
Conclusion: Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.


How ALEC Serves As A 'Dating Service' For Politicians And Corporations


ALEC has endorsed workers' compensation as program to shield corporate liability. "
NOW THEREFORE BE IT RESOLVED, that the State of (insert state) specifically reaffirms the principle of workers’ compensation as the exclusive remedy and rejects the rationale for tort liability based on legal theories such as dual capacity/dual persona, intentional injury without proof that the employer acted with deliberate intention to cause the injury, or third party action against employers for work-related injuries." Today's post is shared from NPR.org .

A batch of internal documents recently leaked to The Guardian has revealed new insights into the goals and finances of the secretive group called ALEC. The American Legislative Exchange Council is a group that brings together state legislators and representatives of corporations. Together, they develop model bills that lawmakers introduce and try to pass in their state legislatures. Through these model bills, ALEC has worked to privatize public education, cut taxes, reduce public employee compensation, oppose Obamacare and resist state regulations to reduce global warming gas emissions.
"ALEC is like an incubator of predominantly conservative legislation," Guardian correspondent Ed Pilkington tells Fresh Air's Terry Gross. "The vast majority of the model bills are conservative in their...
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Tuesday, December 10, 2013

Delay Or Deny At Your Risk

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

There are so many reasons why both employers and workers feel that workers' compensation is "broken" or doesn't work.

Peter Rousmaniere, who is beginning work this week for WorkCompCentral, suggests in his column reviewing two studies on perceived delays in medical treatment that delay may arise as much from indifferent doctoring skills as days elapsing on the calendar.

An employer consultant relayed to me a factual scenario indicating another cause of this perception - standard claims administration protocol, which is defensive in nature as opposed to being aggressively pro-active.

Rousmaniere cites a couple of studies in his column. A Texas Department of Workers' Compensation survey of injured workers documents wide discrepancy in perceptions, but also notes that up to 50% of all survey respondents complained of some delay in receipt of treatment.

Another study cited by Rousmaniere conducted by Harbor Health, which specializes in designing workers’ compensation provider networks, looked for differences in claims outcome, including medical cost and litigation rates, and if surgical treatment happened early or late in the course of treatment.

Harbor Health found that early surgery in carpal tunnel cases (earlier than recommended by treatment guidelines) produced slightly more cost in medical expense but much less cost in indemnity expense.

Let's put these findings into context.

Assume a 28 year old male worker who complains of "...
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Wednesday, December 4, 2013

Workers' Compensation Board hosts meetings to help improve services

New York state's Workers' Compensation Board has started a sweeping effort to examine the system, and look at how it could more effectively meet the needs of injured workers and employers. It's in the midst of holding sessions where injured workers can express their opinions.
The second of three sessions was held yesterday in Syracuse, and allowed injured workers to chime in on the discussion in central New York. Fidel, Alejandro Velacqueis Perez was among those telling stories.
His ankle was shattered on the job at a stone cutting company in Delaware County. While waiting four months for a Workers' Compensation hearing, he's basically homeless.
"I need help," Perez said. "I don't have any resources. I don't have money to buy food. I don't have money to get a phone and reach my family."
Interpreting for Perez is Rebecca Fuentes of the Workers Center of Central New York. She says immigrant voices especially need to be heard, but part of the problem is that many don't even know Workers' Compensation exists. An answer to that would be more outreach from the agency.
"People in this building need to get out," Fuentes said. "We want to see them out at events, tabling. We need to see them everywhere. Because workers are getting injured, and they're not having equal access to this right."
Fuentes says among other things, some immigrants lose their jobs after an injury because they apply for Workers' Compensation. She says it is a serious issue that the Workers' Compensation Board...
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Tuesday, December 3, 2013

Are Smokers Really the ACA’s Biggest Losers?

Smoking is a major pre-existing condition in workers' compensation claims and it is also a multiplier for medical conditions that result in malignancies. Penalizing smokers through the ACA (Affordable Care Act) will also have an effect on workers' compensation claims. Today's post was shared by The Health Care Blog and comes from thehealthcareblog.com



Facing thousands in extra insurance costs, smokers appear to be the Affordable Care Act’s (ACA) biggest losers.  Employers are allowed charge smokers up to 50% more for their medical coverage than nonsmokers , starting in 2014.
On November 25, Fox News put it best:  “Obamacare Policies Slam Smokers,” , noting that “smokers are the only group with a pre-existing condition that Obamacare penalizes.”   THCB itself has headlined:  Smokers Face Tough New Rules under Obamacare.
And these headlines are absolutely accurate —  meaning that, with the possible exception of the e-cigarette, ACA is the best thing that has happened to employed smokers ever.
Here is how we arrive at this conclusion.  The data is mixed on whether smokers incur much higher healthcare costs or just slightly higher healthcare costs during their working ages than non-smokers do.  None of the data shows that their costs are lower, but let’s say there is no impact on health spending.
Nonetheless, the following is incontrovertible:  smokers take smoking breaks.
Remarkably, there are no laws specifically governing smoking breaks, and like most other quantifiable human resources issues, no one has quantified them.   But we all observe these breaks, and about a fifth of us participate in them.  They reduce productivity.  By definition, if you are outside smoking, you are not inside...
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Tuesday, November 26, 2013

The Next Wave: N.H.L. Players Sue League Over Head Injuries

Occupational illness claims have been a traditional battleground in workers' compensation for larger and more significant lawsuits and dynamic changes in the safety of the workplace induced by economics.

From the lack of the incorporation of occupational claims in the 1911 model workers' compensation acts, in the 1950's, employers and their insurance companies sought refuge under the "exclusivity bar" of the. workers' compensation act to shield themselves from negligence actions for silicosis and asbestosis claims.

The creativity of claimant's lawyers, and the blatant intentional tort acts of unscrupulous asbestos companies, brought forth a sweeping change in the economic balance as claimants used the civil justice system to establish an avenue for adequate compensation for asbestos victims (lung cancer, asbestosis and mesothelioma claims).

Asbestos litigation, "longest running tort, continues today and is the perfect example of the societal benefits of a working civil justice system.  In fact, the same dynamic existed in: tobacco litigation, lead paint litigation, latex litigation and has been repeated many times over.

The civil justice system, not the workers' compensation system, established an economic incentive establishing a safer workplace for workers and their families.

It is more than obvious that contact sports are seeing the next wave of litigation as the employers and their insurance companies accelerate the cycle, by barring professional athletic players from even seeking workers' compensation benefits, ie. California.

Since it appears that no safe helmet can be manufactured to protect the mayhem of some contact sports, the business of sports will be the next "industry" to experience economic incentives to make the workplace safer. The higher education system will just have to find another economic engine to fund colleges and university and stop luring students to play dangerous sports in hope of winning the professional sports lottery.

First football, now hockey, are emerging targets of the civil justice system as the economics of safety takes hold and the need for safety takes hold. Today's post is shared from the nytimes.com.

Ten former N.H.L. players sued the league Monday for negligence and fraud, saying the sport’s officials should have done more to address head injuries but instead celebrated a culture of speed and violence.

The players, who were in the league in the 1970s, ’80s and ’90s, filed their suit in federal court in Washington. One of the lead lawyers is Mel Owens, a former N.F.L. player who has represented scores of other retired players in workers’ compensation cases.
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Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  have been representing injured workers and their families who have suffered occupational accidents and illnesses.