USPS May Declare Bankruptcy Citing High Workers Compensation Costs

The Washington Post reported Saturday that the US Postal Service (USPS) may declare bankruptcy and cited high combined benefit costs as a major cause for its financial instability.  The quasi-governmental agency is running into problems it claims because of its requirement to to pre-fund $5.4 billion to a retiree health benefit fund and pay $2.5 billion to the federal workers' compensation fund.

The USPS's troubles mirror that difficulties stangulating the nation's network of state workers' systems caused by the inability to fund soaring medical costs enhanced by complications caused by duplicate administrative costs engulfed by a multiplicity of collateral programs. In contested claims injured workers are shifted to other benefit programs to pay for medical costs. Those secondary programs ultimately seek reimbursement from the primary benefit program, workers' compensation coverage, and literally clog up administrative dockets and create greatly enhanced processing costs and monumental delays.

While the USPS will seek assistance from the Republican majority in US Congress, it is uncertain what financial aid will be forthcoming, or whether Congress will take a deeper look at the nation's workers' compensation entirely. The last time the Republican's dominated Congress proposals were suggested by the former Speaker, Newt Gingrich, to over haul the national system entirely.

The medical component is now in critical condition. It remains uncertain if it will addressed in the next congressional term, or whether it will be the can that is kicked down the road to be dealt with in the future. The growing trend remains, that Federalization of the medical delivery component is the probable  solution to both the USPS's compensation difficulties as well as the the nation's.
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For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

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New Jersey Issues Workers Compensation Guidance on Evaluating Disputed Medical Provider Claims

A NJ Workers' Compensation Task Force report has been published that provides guidance to the parties in evaluating disputed medical provider claims. While declaring that, "certainly there are no overnight solutions," the report provides a manual type of suggestions for negotiation, litigation and resolution.

1. The new WCRI report, Benchmarks for Designing Workers’ Compensation Medical Fee Schedules. Fee schedules vary dramatically from state to state and based upon the type of payer;

2. The fees customarily paid for like services within the same community;

3. The fees paid to the same physician or medical provider by other payers for like treatment;

4. The fees billed and the accepted payments for such bills by a given provider. The Court may wish to consider the disparity in payments accepted from different sources (i.e. Medicare vs. PIP and commercial carriers);

5. A review of the Health Insurance Claim Forms (“HCFA”) submitted by the provider to the claim payer and the Explanations of Benefits (“EOB”) that that claim payer sends to the provider. The EOB provides the amount billed for a given procedure or service performed on a particular date of services. The EOB also provides the amount paid and, where applicable, identifies the reason why a disparity may exist in the amount billed and the amount paid. The use of certified professional coders may be employed to review the bill along with the medical records to be sure that it is consistent with CPT coding standards;

6. The HCFAs or EOBs from other medical providers in the same geographic area or community for the same medical treatment provided;

7. Using commercial and/or private databases such as Ingenix’s Prevailing Healthcare Charges System (“PHCS”); the Medical Data Resource (“MDR”) database, and; Wasserman’s Physician Fee Reference (“PFR”) database to name a few;

8. The type of facility where the procedure was performed. For example, was the services provided at a Level 1 trauma center versus a community hospital;

9. Consideration of whether there was a contract between a claim payer and the medical provider, such as a PPO network, in which case the contract would be controlling;

10. Consideration ofMedicare/Medicaid reimbursement rates;

11. Testimony from medical office personnel as to what services were billed for, the payments received and how the bill was formulated;

12. Consideration of state sanctioned PIP fee schedules;

13. Consideration of commercial carrier authorized payments.
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For over 3 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 work related accident and injuries.

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• wcri.org
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California Applicants' Attorneys Association Announces New Legislative Team

The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today announced a new legislative advocacy team. CAAA President Barry Hinden said, “CAAA is announcing a new team that will be a strong voice on behalf of the rights and dignity of Californians injured while doing their jobs. Our legislative team looks forward to working with all stakeholders to insure that insurance carriers pay to heal workers’ on-the-job injuries and income support while disabled. Over the past six years many families have been left without medical care or disability compensation due to changes demanded by Governor Schwarzenegger. We look forward to working with the new governor, legislature and the workers’ compensation community to make changes to restore balance, and make the system work more effectively and efficiently by reducing unnecessary delays and costs.”

Hinden announced the following legislative representation team:

Mike Herald – Legislative & Policy Advocate – Mr. Herald, an attorney, has spent the past two decades advocating on behalf of low income Californians in the State Capitol while representing the Western Center on Law & Poverty. “My experience representing struggling California families has shown me how important it is people injured at work receive adequate insurance coverage. Workers’ compensation insurance is to provide workers the opportunity to heal, knowing they won’t lose their home or drown in debt. It is in everyone’s interest to have adequate insurance so that costs for injured workers do not fall upon the taxpayers. I look forward to collaborating with legislators, administrators and stakeholders to improve the workers’ compensation insurance system.” Mr. Herald will be CAAA’s lead legislative representative in the Capitol.

Richie Ross – Legislative and Political Consultant – Mr. Ross, a longtime California labor advocate and campaign consultant, has advised CAAA for more than 15 years. He will now serve as political and legislative consultant, advising CAAA on strategy, lobbying, and political contributions and campaigns. “I look forward to strengthening CAAA’s alliances with organized labor, civil rights and consumer organizations. Californians injured at their jobs often have difficulty getting insurance companies to pay their legitimate claims.  There are many others who face similar obstacles. And when insurance companies don’t meet their obligations, it is the taxpayers who end up footing the bill. Californians want to prevent that cost shifting.”

Sen. Martha Escutia (Ret.) – Legislative Counsel – "The Senators (ret.) Firm - legislative counsel: founded by former Senators Martha Escutia and Joe Dunn, the firm brings extensive legislative and political experience to the CAAA team. In fact, Senators (ret) Escutia and Dunn were two of the three "no" votes in the State Senate on SB899. Sen. Escutia (ret) will serve as the lead partner from The Senators Firm for CAAA. Ms Escutia, trained as a civil rights attorney, and said, “I look forward to using my experience in advocating for the civil rights of women and minorities on behalf of those injured at work. Those injured on the job often have their medical care delayed or denied, and their permanent disabilities are largely uncompensated, and insurance companies discriminate in apportioning disability compensation. I intend to involve diverse California communities in efforts to improve California’s workers’ compensation insurance system, and seeking fair compensation and prompt, quality medical care.”
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For over 3 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 work related accident and injuries.

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NIOSH Supports Efforts To Ban Distracted Driving

The National Institute for Occupational Safety and Health (NIOSH) is following the lead of the US Department of Labor by encouraging employers to ban cell phone use while operating vehicles. An outright prohibition and supporting legislation may lead to the prohibition of workers' compensation benefits in many jurisdictions in the near future unless more global and radical action is taken to re-mediate this dangerous activity.

“While the basic distractions of cell phone calls or text messaging are similar whether one is driving on work time or on personal time, there are sources of distraction and incentives to engage in distracted driving behaviors that are unique to the workplace,” noted John Howard, M.D., Director of the National Institute for Occupational Safety and Health (NIOSH). “Someone driving on personal time has the leisure of waiting to return a friend’s call or text message. In these situations, minimizing risk is a matter of changing personal behavior and habits,” Dr. Howard said. “Workers, however, may be required or pressured by job demands to engage in distracted driving behaviors. Strong employer policies to curb the use of cell phones and in-vehicle technologies while driving are an important tool in creating a safe driving culture within an organization.”

Dr. Howard added, “NIOSH applauds the efforts of the Departments of Transportation and Labor to highlight the important role public and private employers can play in reducing distracted driving. We join them in urging employers to set policies to prohibit text messaging while driving. In addition, NIOSH will continue to work with our federal and other partners to support further efforts to reduce distracted driving in the workplace.”

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For over 3 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 work related accident and injuries.

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Court Grants Motion to Reconsider Statute of Limitations in CMS Case

In order to avoid any "maifest injustice," the Court that had previously dismissed the Government's case against insurance companies and lawyers for failure to reimburse the Centers for Medicare and Medicaid Services (CMS), has granted a motion to reconsider under the plaintiff's accrual theory.

"As its fourth ground for reconsideration, Plaintiff argues that the court erred in concluding that the Government inadequately raised a theory of continuing accrual against all defendants concerning the annual $2.5 million payments from 2004 through 2014 contemplated in the Abernathy Settlement Agreement. Admittedly, Plaintiff did not address this theory in its responsive briefing to the Defendants’ motions to dismiss. At the September 13, 2010 hearing, the court granted verbal leave for Plaintiff to submit a motion to amend its complaint to more clearly articulate a claim on this issue. For whatever reason, Plaintiff has failed to do so, but argues in its motion to reconsider that it properly pled a theory of continuing accrual in its First Amended Complaint and raised it at the hearing. Though this theory should have been raised and argued in Plaintiff’s brief in response to the multiple motions to dismiss filed by Defendants, the court will allow Defendants an opportunity to respond in full to this issue to avoid any possible clear error. Therefore, the court GRANTS Plaintiff’s motion to reconsider as to the issue raised in part D regarding a continuing accrual theory and ORDERS that Defendants have until Tuesday, November 16, 2010 to respond as to whether the allegations pled in Plaintiff’s First Amended Complaint are sufficient to state a claim for a theory of continuing accrual; and if so, whether the court committed clear error in dismissing Count VI of Plaintiff’s First Amended Complaint.

"Finally, the court RESERVES RULING as to the tolling issue raised in part E of Plaintiff’s motion to reconsider. To avoid any possible clear error and/or manifest injustice, the court will allow Defendants until Tuesday, November 16, 2010 to respond as to: 1) whether the court should reconsider the issue of tolling; and 2) if the court does, whether it committed clear error in application of the appropriate burden of raising or pleading tolling in this context and in granting the motion to dismiss before discovery had yet occurred.

USA v James J. Strickler, et al CV 09=BE-2423-E

For over 3 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 work related accident and injuries.

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The Election Validates A New Approach to Workers Compensation

The recent election results confirm that a new approach to handling the century old workers' compensation is needed and that some definite trends are developing.

Washington State: The insurance industry initiative for privatization was defeated.

New Jersey: The constitutional amendment to prohibit raiding the Second Injury Fund revenue was passed.

California: Jerry Brown was elected governor and the Republican assault on the state compensation system rejected.

Nevada: Harry Reid was re-elected validating the innovated "Libby Health Care" Plan for medical care for occupational illness and the Federalization of the program and the US Senate's initiative.

New York: Andrew Cuomo was elected governor and revision is likely of the administrative assault on workers' rights.

Nationally, the soaring US deficit, and a State system that continues to fail to deliver health care to occupationally injured workers, will eventually need to be addressed by Congress. The 2008 strong Democratic mandate has not evaporated. The Democrats still control the Senate (51-D v 46-R) and downtown at White House. The newly acquired House Republican majority (234-R v 180-D) is instilled with the chaos of an unsettling newly emerging third party, Tea Party, alliance.

The course ahead still remains promising for enacting a unified and coordinate program to help injured workers obtain medical care for occupational diseases on a timely and effective basis without breaking the bank. The vision of a coordinated epidemiological research program to prevent occupational disease and  insure safe working conditions remains hopeful.

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For over 3 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 work related accident and injuries.

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Asbestos Danger Closes Madison Square Garden

Asbestos falling from the ceiling of Madison Square Garden (MSG) resulted a cautious closing of the arena because of the potential health hazards. On going construction and renovation of the facility resulted in workers dislodging the known cancer producing substance.

In a statement issued by MSG management, caution was stressed:
"Out of an abundance of caution, we are postponing tonight's Knicks v. Magic game. We will be working with the city and independent experts, ATC Associates and GCI Environmental Advisory, to evaluate and determine the most appropriate course of action. As the safety of our customers and employees are our top priority, we will not reopen the Garden until we are absolutely assured the Arena is safe.

Asbestos is a known carcinogen and exposure results in asbestosis, lung cancer and a rare and fatal disease, mesothelioma. There is no minimum safe dose level of exposure to asbestos. The disease manifests decades after the exposure to fiber occurs. The use of asbestos in the past has resulted in an epidemic of illness.

For over 3 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 asbestos related disease.

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