Making Movies Can Be Hazardous to Your Health

The recent blog about the Mad Hatter's exposure to mercury has drawn much attention. The National Institute of Occupational Safety and Health (NIOSH) has revealed more movies associated with dangerous exposures at work.

Making movies could be a dangerous activity. In 1954 asbestos was dumped onto Bing Crosby by a stage hand above to simulated the appearance of snow while he was singing the theme song from "White Christmas". Asbestos is a known carcinogen, ie. lung cancer and mesothelioma.

NIOSH has posted a blog for readers to vote and comment on the movies with occupational hazards. Visit the NIOSH science blog.

To read more about asbestos and workers' compensation click here.

Twittering Workers Compensation

Social media has taken off as a major communications tool for client, lawyers, educational institutions and governmental agencies. The exchange of information is now instantaneous and global. It is now a critical element in the constellation of available assets in legal research and practice.

Twitter is not an ordinary social media site. Everyday millions of "tweets" are created and read about workers compensation. Government transparency has now allowed more legal based information to become available online. The 140 character "burst" of information provides a fantastic resource on a current basis.

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Yet Another Attempt to Shift CMS Costs

The American Insurance Association (AIA) and collateral Industry groups have banned together in a formal attempt to avoid the Federal mandate to reimburse Medicare for conditional medical payments. This is yet a third assault on the responsibility of employers to avoid payment of medical treatment of injured workers and shift the burden upon the ailing and financially strapped Medicare. Two prior legislative attempts to modify the Medicare Secondary Payer Act (MSP) have failed.


The proposal is embraced in recently introduced HR4796. It is an attempt to modify the Medicare Secondary Payment Act by reducing conditional payment responsibilities of Industry. 


In the past, failures in the enforcement of reimbursement practices were highlighted in various investigative reports. Since the reporting of those failures, the Centers for Medicare and Medicaid Services (CMS) have enhanced its efforts to seek reimburse. The US Congress has also imposed compulsory employer/insurance carrier reporting requirements.


Recent studies presented at the National Association of Social Insurance (NASI) disclosed that the majority of conditional payment issues arise in occupational claims which traditionally are denied compensability initially by insurance carriers. 


A proposal was made at the NASI meeting to provide more effective and efficient delivery of medical care to injured workers. It was suggested that medical coverage in occupational disease claims  become the initial responsibility of US Medicare system who then could seek indemnification from insurance carriers and others who may be ultimately responsible. A pilot plan for this type of health care was embodied in the US Senate passed health care legislation.


Click here to read more about health care and workers' compensation.

NJ Mandates Proof of Insurance Coverance

The NJ Division of Workers' Compensation has clearly mandated that claimants have the burden of proving insurance coverage. In a memorandum letter issued by the Director/Chief Judge, injured workers and their representatives were advised that failure to have evidence of proof of coverage will result in a dismissal of the insurance carrier as a party to the claim petition. Dismissal will be effectuated administratively, without the need of the filing of a formal notice motion by the improperly named party.


"A earner is not required to prove the negative that the carrier did not cover a respondent. It is helpful if the carrier can provide information from CRIB or other sources as to the correct carrier if the respondent is insured. However, the petitioner must provide some sufficient basis for listing a carrier and keeping the carrier in the case if the petitioner objects to the dismissal as to carrier."


Click here to read more about insurance coverage and workers' compensation.

NJ Unemployment Worse Than Previously Estimated

NJ has released revised statistics reflecting than 2009 unemployment rates were worse than previously reported.


"New Jersey employers continued to trim payrolls in January as total employment fell by 9,100 jobs over the month. The state's unemployment rate for January fell by 0.1 percentage point to 9.9 percent.  The national rate was 9.7 percent for the month.

"In addition, the results of the annual benchmarking adjustment process - conducted each year at this time by every state - showed that the previously announced seasonally adjusted job loss from December 2008 to December 2009 of 90,100 was revised lower to reflect a loss of 114,100 jobs. New Jersey's over-the-year percentage loss of -2.9 percent was slightly better than the nation's -3.6 percent loss (-4.8 million jobs). Moreover, during the recession, December 2007 - December 2009, New Jersey has lost 228,300 jobs (-5.6% vs 6.1% nationally).

"Labor force estimates also were revised for 2009 and the state's revised 2009 unemployment rate averaged 9.2 percent, fluctuating within a wide range of 7.3 to 10.0 percent. The nation's unemployment rate averaged 9.3 percent in 2009.


Click here to read more about workers' compensation and economic recessions.

NYC Settles 9-11 Rescue Workers' Suit for $657.5 Million

A lawsuit, involving over 10,000 9-11 Ground Zero workers, has been reportedly settled for $657.5 reports the NY Times. The case pending in US District Court has been pending for years on behalf of rescue workers and first responders for adverse health effects as a result of the explosion.


The read more about 9-11 claims click here.

Citing Violations Medicare Ends Contract with Fox Insurance Company Drug Plan

The Centers for Medicare and Medicaid Services has issue an announcement of the immediate termination of Fox Insurance Company.

Members Will Be Provided Access to Drugs While Transitioning to New Plans.

The Centers for Medicare & Medicaid Services (CMS) today terminated its contract with Fox Insurance Company. After an onsite review of the plan and its services, CMS determined that the plan’s significant deficiencies – not meeting Medicare’s requirements to provide enrollees with prescription drugs according to recognized standards of care – jeopardized the health and safety of Fox enrollees. CMS found that Fox committed a series of violations, including improperly denying its enrollees coverage of critical HIV, cancer, and seizure medications. The termination of the contract is effective immediately.

The immediate termination will not impact or delay access to drugs for the more than 123,000 Medicare beneficiaries currently enrolled in Fox plans. Beginning tomorrow, all enrollees will obtain their drugs through LI-NET, a program run by Medicare and administered by Humana, to ensure that beneficiaries receive their Medicare prescription drugs. Fox enrollees will be able to choose a new Medicare prescription drug plan through May 1, 2010. Current enrollees who do not choose a plan will be enrolled into a new plan by Medicare.

“The immediate termination of Fox as a Medicare prescription drug plan demonstrates our commitment to protecting the health of some of their most vulnerable enrollees from getting necessary drugs, in some cases life-sustaining medicines. CMS’s immediate action was essential to protect members’ health and safety – an integral part of our contract with all Medicare beneficiaries,” said Jonathan Blum, acting director of CMS’ Center for Drug and Health Plan Choices. “Fox enrollees also need to know that they are not losing their drug coverage and will continue to have access to needed medicines. We will be sending letters explaining the steps we are taking to ensure they continue to get their medicines. They can also call 1-800-MEDICARE or their local state health insurance assistance programs if they have questions.”

CMS issued an enrollment and marketing sanction to Fox on Feb. 26, 2010, because the organization was not following Medicare’s rules for providing prescription drug coverage to its enrollees. After an onsite audit, which ran between March 2 and March 4, CMS found Fox’s problems persisted and it continued to subject its enrollees to obstacles in getting needed and, in many cases, life–sustaining medicines. CMS also found that many of the obstacles were in place to limit access to high-cost drugs, which could have led to enrollees’ clinical needs not being met. In many cases, Fox enrollees were required to have unnecessary and invasive medical procedures before they were able to obtain drugs. Fox was unable to satisfactorily address these compliance concerns and furnish medicines to its Medicare enrollees.

Among the audit findings CMS found include:

· Failing to provide access to Medicare prescription drugs benefits by imposing unapproved prior authorization and step therapy criteria that made it more difficult for beneficiaries to get drugs that are protected by law.

· Not meeting the plan’s appeals deadlines,

· Not complying with Medicare regulations requiring enrollees to be transitioned to new drugs at the beginning of the new plan year.

· Failing to notify enrollees about prior authorization and step therapy determinations as required by Medicare.

According to CMS auditors, Fox was unable to satisfactorily address compliance concerns cited in the enrollment and marketing sanction and meet contractual obligations to provide medicines to Medicare beneficiaries enrolled in their plans.

“We take our oversight role of Medicare prescription drug plans seriously,” said Blum. “We review and take action on all complaints received about Medicare health and drug plans and will take appropriate and immediate actions wherever necessary.”

CMS encourages Medicare prescription drug plan enrollees having concerns with access to drug coverage to contact 1-800-MEDICARE (1-800-633-4227) or the state health insurance assistance program (SHIP) to help get them resolved. Medicare enrollees, their families and their caregivers can contact a SHIP near them by visiting:http://www.medicare.gov/Contacts/staticpages/ships.aspx

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NOTE: States in which the Fox plan was available were: Arkansas, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Missouri, North Carolina, New Jersey, New York, Nevada, Ohio, Pennsylvania, South Carolina, Texas and West Virginia.

To read more about CMS and workers compensation, click here.