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(c) 2010-2024 Jon L Gelman, All Rights Reserved.

Monday, December 5, 2011

Workers Compensation on Drugs - Tenn Supreme Court Allows Fatal Case to Proceed

A major complaint of the failure of medicine is that sick people are sent to the pharmacy for pain relief without adequate evaluation instead of sent to the the physician's office for more costly medical treatment. The Tennessee Supreme Court has permitted a death claim to go forward against his employer where the employee died following an overdose of pain killers.

Click here to read Kilburn v Granite State (Tenn 2011)
".... the medical records show that on August 31, 2009, and November 2, 2009, Dr. Schwarz, the surgeon, found that Mr. Kilburn was plagued with lower extremity pain and lower back pain for which he recommended L4-S1 fusion surgery, but Employer denied treatment. " read more
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US Supreme Court Maybe Asked to Rule on CMS Issue: "The Doctrine of Equitable Allocation"

The 6th Circuit Court of Appeals has ruled that The Center for Medicare and Medicaid Services (CMS) is entitled to complete reimbursement of Medicare payments under the Medicare Secondary Payer Act (MSP) from a liability claim even though the beneficiary claimed that the settlement required allocation due to the law allocating liability.


I reported on this case last week:
The Doctrine of Equitable Allocation Not Applicable in a Medicare Secondary Payment Reimbursement Claim



A recent news report indicates that appeal maybe sought to the US Supreme Court.

Medicare payment ruling may hinder workers comp settlements

"A federal appeals court decision that allows Medicare to claim nearly half of a man's liability settlement could hinder insurers' ability to settle such claims and may be an issue that reaches the U.S. Supreme Court."





Friday, December 2, 2011

NJ Legislation Seeks To Increase Counsel Fees

Practicing workers' compensation law is difficult work, and not usually economically rewarding. Most lawyers who handle claimant's work have a passion to help people. In most, if not many cases, the time and effort that an attorney puts into the case usually just doesn't offset fee paid in the case.

Gone are the days when scores of cases were adjudicated on a daily basis in most jurisdictions. Many factors have caused the system to shift from high gear to what seems like reverse. The manufacturing workforce has dwindled, conditions have become safer, a good thing, and reforms to the system have thrown in hurtles that appear insurmountable to obtain benefits. The tightening of recovery procedures by collateral sources have changed the flow, from a tidal wave of dispositions, to a dribble through the funnel.

Fewer and fewer attorneys now participate in workers' compensation claims, even though other areas of the legal economy have gone into the tank. Those who are remaining are attempting to be even more selective in what representation they undertake. With limited assets to invest there needs to be a an economic certainty for recovery more than ever.

Legislation has been introduced in NJ to expand the recovery of counsel fees. The Senate Labor Committee will meet on Thursday, December 8, 2011 at 10:00 AM in Committee Room 6, First Floor, State House Annex, Trenton, New Jersey discuss a pending bill to increase the base for benefits. S2446 Concerns attorney fees for workers' compensation awards.

"This bill requires that in cases in which a workers’ compensation  petitioner has received compensation from an insurance company  prior to any judgment or award, the reasonable allowance for attorney fees will be based upon the sum of the amount of compensation already received by the petitioner, and the amount of the judgment or award in excess of the amount of compensation  already received by the petitioner. Currently, in cases in which a  petitioner has received compensation prior to a judgment or award, a reasonable attorney fee is based upon only that part of the judgment or award that is in excess of the amount of compensation already received by the petitioner."

Penalties for Insurance Companies Who Fail to Pay Enough for Medical Care

The quality of medical care for workers' compensation beneficiaries has always been a major issue. Injured workers just don't want to go to an employer selected physician.They want to go to a doctor who provides good quality medical care and one they have confidence in. It makes good medical sense. While one concept to adjust the issue is to compel insurance carriers to pay for outcome driven results. If the doctor cures you, then the doctor should be paid in full for the reasonable value of his or her services. If the opposite, well then maybe the doctor should get paid less.

Another approach, enacted by the federal government is to compel insurance carriers to pay a certain percentage of premiums collected for medical care, instead of paying large sums for administration expenses. That could be applied to workers' compensation carriers. Instead of paying 80% of the premium to fight the claim, workers' compensation insurance companies should be compelled to pay 80% to cure the medical condition.

Read more about this concept:
HHS Unveils Medical Loss Ratio Rule (Kaiser Health Breaking News)
"The Department of Health and Human Services today released its final medical loss ratio rule. According to an HHS press release, the rule will ensure that health insurance companies spend at least 80 percent of consumers' health insurance premiums on medical care rather than on income, overhead and marketing expenses. "If your insurance company doesn't spend enough of your premium dollars on medical care or quality improvement this year, they'll have to give you rebates next year," said CMS Acting Administrator Marilyn Tavenner, in the release . "This will bring costs down and give insurance companies the incentive to focus on what matters for patients – high quality health 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 occupational accidents and illnesses.

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Winners - Safe Workplaces for Everyone photo contest




Aaron Sussell, Cincinatti Ohio 
1st Place Winner of the Public Contest
"This is a great captured moment that tells the story of workplace safety. These men are perfectly covered up in hats to protect themselves from the sun. They are using proper tools and protecting themselves with gloves and foot coverings." 
-- Kathleen Klech, Photography Director, Condé Nast Traveler Magazine and Photo Contest Judge


In celebration of its 40th anniversary, OSHA held the Picture It!: Safe Workplaces for Everyone photo contest. The contest challenged anyone with a passion for photography to capture an image of workplace safety and health and share it with OSHA. In response, OSHA received more than 300 submissions portraying a wide range of industries and activities.


At the same time, OSHA held a second contest challenging OSHA staff to submit their images of workplace safety and health. 

More than 50 submissions were received for this internal contest.

Winners were selected by an expert panel of judges that included Earl Dotter, photojournalist; Carl Fillichio, the Department of Labor’s Senior Advisor for Communications and Public Affairs; Kathleen Klech, photography director for Condé Nast Traveler magazine; and Shawn Moore, the chief photographer for the Department of Labor. OSHA extends its thanks to these judges for their generosity and their critical expertise.

Roberto Carlos Vergara, Charlotte, North Carolina 
2nd Place Winner of the Public Contest

Roberto Rodriguez, Mesquite, Texas
3rd Place Winner of the Public Contest

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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 occupational accidents and illnesses.

Thursday, December 1, 2011

The Toxic Legacy of Raybestos-Manhattan Continues

The epic toxic legacy of asbestos brake manufacturer, Raybestos-Manhattan Inc., a/k/a Manhattan Rubber and Raymark, continues as waste from its former plants plagues present communities. Raybestos had several production plants in the US including Connecticut, South Carolina and Passaic, New Jersey.

Asbestos, labeled the "miracle mineral," was a known carcinogen and linked to: asbestosis, lung cancer and mesothelioma, a rare and fatal cancer. The company with knowledge of that information, as revealed in the famous "Sumner Simpson papers," ignored the available science and continued to manufacturer asbestos products including: bowling balls, radiator hoses and brake linings, as well as other products.

While the Raybestos is no longer producing asbestos products, the plants sites continue to be a problem to the communities as a toxic legacy continues.

Read the article Citizen group pushing for new way to detoxify Raymark wastemctpost.com

"STRATFORD -- A network of residents concerned about toxic waste in town is pushing the EPA to study and determine whether a relatively new technology that neutralizes asbestos can be used to detoxify dump sites in the city....." read more 

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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 occupational accidents and illnesses.