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

Sunday, March 4, 2012

Premium Fraud: North Carolina Man Sentenced on Workers’ Compensation Insurance Scam

English: The Seal of the United States Federal...Image via Wikipedia

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Dan Anderson, Director, Department of Financial Services, Division of Insurance Fraud, announce yesterday’s sentencing of defendant Carl Dale Fuller, 52, of Wake Forest, North Carolina. U.S. District Court Judge Donald L. Graham, sitting in Ft. Pierce, Florida, sentenced Fuller to five years in prison, to be followed by three years of supervised release. In addition, Fuller was ordered to pay $2, 859,067 in mandatory restitution.

Fuller previously pled guilty to mail fraud in connection with a scheme to defraud National Employees Services (NES) of more than $2.8 million in what the company believed were insurance premiums for workers compensation insurance. NES, a Florida Corporation located in Avon Park, Florida, is a provider of cost-effective services for businesses that out-source employee insurance, including workers compensation insurance.

To execute his scheme, Fuller used the name David Walters in e-mails and phone calls and held himself out to NES as an insurance broker. Fuller falsely claimed that he would obtain workers compensation insurance policies for NES and the companies they represented. Instead, Fuller kept the payments and never provided insurance coverage.

From mid-2005 through September 2008, Fuller received more than $2 million of NES premium payments, which he used to fund his extravagant lifestyle in Wake Forest and Pinehurst, North Carolina. NES sent the premiums to Fuller under the name of Southeast Services, a company created and controlled by Fuller. The checks were deposited into numerous accounts all controlled by Fuller.

Mr. Ferrer commended the investigative efforts of the FBI and the Department of Financial Services, Division of Insurance Fraud. This case is being prosecuted by Assistant U.S. Attorneys Adrienne Rabinowitz, Emalyn Webber and Ellen Cohen.

Friday, March 2, 2012

BP and plaintiffs reach Gulf oil spill settlement

The Associated Press: BP, plaintiffs reach Gulf oil spill settlement: "BP PLC and a committee representing plaintiffs suing over the 2010 Gulf oil spill have reached an agreement, a federal judge said late Friday night. Specific terms have not been released."

COPD: The 3rd Leading Cause of Death

English: A chest X-ray demonstrating severe CO...Image via Wikipedia

A large number of disabled workers suffer from Chronic Obstructive Lung Disease (COPD). This compensable workers' compensation condition has now been recognized as the third leading cause of death in the US.

See Chronic Obstructive Pulmonary Disease and Associated Health-Care Resource Use — North Carolina, 2007 and 2009 MMWR 61(08)

"Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis, is a progressive condition in which airflow becomes limited, making it difficult to breathe. Chronic lower respiratory diseases, primarily COPD, are the third leading cause of death in the United States (1), and 5.1% of U.S. adults report a diagnosis of emphysema or chronic bronchitis (2). Smoking is the primary cause of COPD, and at least 75% of COPD deaths are attributable to smoking in the United States (3). Information on state-specific prevalence of COPD is sparse (4), as are data on the use of COPD-related health-care resources. To understand how COPD affects adults in North Carolina and what resources are used by persons with COPD, 2007 and 2009 data from the North Carolina COPD module of the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Among 26,227 respondents, 5.7% reported ever having been told by a health professional that they had COPD. Most adults with COPD reported ever having had a diagnostic breathing test (76.4% in 2007 and 82.4% in 2009). Among adults with COPD, 43.0% reported having gone to a physician and 14.9% visited an emergency department (ED) or were admitted to a hospital (2007) for COPD-related symptoms in the previous 12 months. Only 48.1% of persons reported daily use of medications for their COPD (2007). These results indicate that many adults with COPD might not have had adequate diagnostic spirometry, and many who might benefit from daily medications, such as long-acting bronchodilators and inhaled corticosteroids, are not taking them. Continued and expanded surveillance is needed to evaluate the effectiveness of prevention and intervention programs and support efforts to educate the public and physicians about COPD symptoms, diagnosis, and treatment."

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For over 3 decades the Law Offices of Jon L. Gelman1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

Falling Asleep On The Job: Insufficient Sleep Is A Compensable Condition


National Sleep Awareness Week — March 5–11, 2012

During March 5–11, 2012, National Sleep Awareness Week will be observed in the United States. The National Sleep Foundation recommends that U.S. adults receive, on average, 7–9 hours of sleep per night (1); however, 37.1% of adults report regularly sleeping <7 hours per night (2).
Persons reporting sleeping <7 hours on average during a 24-hour interval are more likely to report unintentionally falling asleep during the day at least 1 day out of the preceding 30 days (46.2% compared with 33.2%) and nodding off or falling asleep at the wheel during the previous 30 days (7.3% compared with 3.0%) (3). Frequent insufficient sleep (14 or more days in the past 30 days) also has been associated with self-reported anxiety, depressive symptoms, and frequent mental and physical distress (4).
Such findings suggest the need for greater awareness of the importance of sufficient sleep. Further information about factors relevant to optimal sleep can be obtained from the National Sleep Foundation (http://www.sleepfoundation.orgExternal Web Site Icon) and CDC (http://www.cdc.gov/sleep).

References

  1. National Sleep Foundation. How much sleep do we really need? Arlington, VA: National Sleep Foundation; 2011. Available athttp://www.sleepfoundation.org/article/how-sleep-works/how-much-sleep-do-we-really-needExternal Web Site Icon. Accessed February 24, 2012.
  2. CDC. Effect of short sleep duration on daily activities—United States, 2005–2008. MMWR 2011;60:239–42.
  3. CDC. Unhealthy sleep-related behaviors—12 states, 2009. MMWR 2011;60:233–8.
  4. Strine TW, Chapman DP. Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Med 2005;6:23–7.

Thursday, March 1, 2012

US Supreme Court Rules State Mesothelioma Claim Preempted By Federal Locomotive Statute

The US Supreme Court ruled yesterday in Kurns v. Railroad Friction Products Corp.that a claim can not be brought under state law  for either design-defect for failure-to-warm because they are preempted under Federal law (Locomotive Inspection Act). The plaintiff, George Corson, contracted mesothelioma after working as a welder repairing asbestos brakes for the railroad.

See: Supreme Court Rules State Tort Law Claims Preempted by Federal Locomotive Statute (Justica.com)

"Justice Elena Kagan, in her concurring opinion, concluded that the design-defect and failure-to-warn claims were preempted by the LIA because "Napier recognized the federal agency's delegated authority over "the design, the construction and the material of every part of the locomotive."" Justice Sonia Sotomayor concurred in part and dissented in part, and was joined by Justices Stephen Breyer and Ruth Bader Ginsburg. Though they agreed that the design-defect claim was preempted by the LIA, they concluded that the failure-to-warn claim was not preempted because the field defined in Napier differently today because recent cases have regularly rejected the field preemption doctrine when statutory language does not contain an express preemption clause."

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For over 3 decades the Law Offices of Jon L. Gelman1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

Tuesday, February 28, 2012

EPA Approves New Jersey’s List of Polluted Water Bodies; Sewage Pollution Continues to be a Major Problem in New Jersey

Passaic River
(c) 2012 Jon Gelman
The U.S. Environmental Protection Agency has approved the 2010 list of waters in New Jersey that are considered either impaired or threatened by pollutants. An impaired water body is one that does not meet federal water quality standards even after pollution controls have been put in place. A threatened water body is one that is expected to be impaired within two years. The list helps establish priorities for addressing threats from water pollution.

“Identifying and prioritizing the state’s most seriously polluted waters are important steps in our work to reduce water pollution,” said Judith Enck, EPA Regional Administrator. "New Jersey faces serious water quality challenges including the need to reduce pollution from combined sewer systems that allow raw sewage to flow into waterways when it rains. By upgrading old infrastructure and implementing green infrastructure strategies, New Jersey communities can improve water quality.”

The Clean Water Act requires states to assess the quality of their waters and to report their findings to the EPA every two years. The list is compiled by the New Jersey Department of Environmental Protection and is a valuable tool for reaching the Clean Water Act goal of “fishable and swimmable” waters for all of New Jersey.

The list specifically includes impaired waters for which the development of budgets for the amount of water pollution allowed is necessary. The budgets define the maximum amount of a pollutant that a water body can receive and still meet water quality standards. They are developed by states and approved by the EPA once the agency determines that the budget will allow the water body to achieve water quality standards.

The most common pollutants causing impairment in New Jersey water bodies include PCBs (8.33%), dissolved oxygen (8.19%), phosphorus (7.86%), pH (7.62%), and arsenic (6.89%). New Jersey’s 2010 list identifies 2,112 instances in which a pollutant is causing an impairment of a water body that keeps it from supporting its “designated use” for drinking water, swimming and recreation, fishing or other activities specified by the state.

The list also notes the most common sources of water pollutants, which include urban/stormwater runoff, combined sewer overflows from systems that capture both domestic sewage and stormwater, and air pollution, including acid rain. A pollutant may come from more than one source.

In 2010, new pollutants were included for waters in the basins of the Hudson River, the Passaic River, the Raritan River, the Delaware Bay, and others. The EPA will continue to work with state and local governments to ensure that impaired waters are cleaned up.

A complete list of impaired waters in New Jersey is available at:http://www.epa.gov/region02/water/waterbodies.

Workers Compensation Law 2012 Now Shipping

Highlights Include:
Electronic Discovery s.22.33
Medicare Conditional Payments 29.32 and 29.33

Jon L. Gelman's 2012 supplement to the 3 volume hard bound practice series, Workers' Compensation Law 3rd Ed.,  has been published. Order these important supplements now. The supplement provide almost a quarter of a century continuing and unparalleled analysis on workers' compensation law. The volumes and supplements are integrated into the Westlaw(R), part of Thomson Reuters system for "Better Results Faster."
The newly enacted statutory changes to the New Jersey Workers’ Compensation Act and promulgated Rules permitting Emergent Medical Care Motions, new registration requirements for insurers, and new judicial enforcement powers of Judges of Compensation, including sanctions and contempt powers, are contained in this supplemental material.An analysis of the newly adopted procedures for the reimbursement of conditional payments established by Medicare and the protocols to co-ordinate  workers’ compensation claims with the Centers for Medicare and Medicaid Services is contained in this supplement. The materials also provide the authorizations required to obtain conditional payment  information from the Coordinator of Benefits. Debt collection referral to the Department of the Treasury is also reviewed.
The new Community and Worker Right to  Know material has been incorporated into this supplement. The current hazardous substance lists and the substances that have been deemed extremely dangerous are provided.The supplement reviews new case law concerning electronic cancellation of coverage as well as the standard for claims to be considered casually related to the employment.The mandatory reporting requirements of the SCHIP Extension Act of 2007 are described as well as the appeal procedure under the reimbursement provision of the Medicare Secondary Payer Act.These pocket parts provide information concerning the requirements for medical monitoring in workers’ compensation claims. It discusses. the Asbestos Fund, which has been established for those entities where workers’ compensation coverage cannot be established.  
The newly designed forms that need to be utilized in filing for benefits are included.  Also, the recently modified Motion for Temporary and Medical Benefits, including a form Certification, is provided and discussed.The newly revised Judgments for Total and Permanent Disability are provided in this pocket part.  The Judgments include new refinements in offsets for pensions and Social Security disability benefits. Reviewed also is the “intentional wrong exception” to the Exclusivity Bar which has been the subject of new workers’ compensation insurance policy language and regulation.The recently promulgated administrative rules governing the disposition of Temporary Disability Benefits are discussed. The non-duplication of benefits provisions are reviewed including the multiple agency adjudication process.
An expansion of benefits available to Federal public safety officers is reviewed in this supplement.Collateral medical benefit issues are discussed in light of the recent Supreme Court decision concerning this matter.  The pocket parts include a Motion to Join the Collateral Health Carrier and provide sample Certifications to be used in support of the application.Additionally, these pocket parts provide information concerning the new rules of the Division of Workers’ Compensation embodying electronic filing requirements and new procedures involving both formal and informal proceedings, motion practice, post judgment process, and judicial performance. The expanded Medicare secondary reporting requirements and the mandatory coordination of benefits are reviewed in this supplement.
The recovery aspects of Medicare conditional payments as well as future medical provisions are updated and discussed. The new Child Support Lien distribution forms, computation worksheets and judgments are provided and explained in depth. The NJ Supreme’ Court ruling and the legislative enactments are discussed concerning same sex couples and the availability of workers’ compensation benefits.This supplement reviews the newly promulgated Rules concerning the Uninsured Employers’ Fund and audio and video coverage of workers’ compensation proceedings.  The horrific tragedy of September 11th, 2001 and the impact it has upon the Workers’ Compensation system is discussed.
This supplement reviews the newly enacted Smallpox Emergency Protection Act as well as recent court decisions concerning acts of terrorism.
The subsequent legislative changes enacted in response to potential terrorist threats are reviewed, including the Public Safety Officers’ Benefit Act as well as the liberalized legislative enactments involving rescue workers and medical personnel. The impact of the newly promulgated Federal rules and regulations concerning medical record privacy and compliance with the Health Insurance Portability and Accountability Act (HIPPA) medical authorization requirements are reviewed in this supplement and model forms are furnished.  The recently enacted statutory workers’ compensation coverage options available to proprietors and partners are discussed. The supplement reviews the recent court decisions expanding the responsibility of the Second Injury Fund for pre-existing medical conditions in cases in which latent diseases become manifest during retirement.  The statutory enactments concerning State Temporary Disability Benefits are reviewed.  


The recently amended Energy Employees Occupational Illness Compensation Act is explained in detail and forms are furnished and discussed.The recent Supreme Court decisions concerning the high judicial threshold for evaluation of scientific evidence are analyzed. The requirements for proof of scientific evidence in complex workers’ compensation cases are discussed including the admissibility of testimony from non-physicians experts. Furthermore, the evolving and expanding issues concerning medical monitoring are reviewed.This pocket part also discusses recent changes in the application for counsel fees.
The supplement includes the newly promulgated administrative directive embodying those changes.