With the soaring cost of workers' compensation payments now exceeding 50% of payments, new and innovative approaches are being advanced.
Click here to read more: Some Patients Can Choose To Be Hospitalized At Home
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Showing posts with label Health care. Show all posts
Showing posts with label Health care. Show all posts
Thursday, May 31, 2012
Home Hospitalization
With the soaring cost of workers' compensation payments now exceeding 50% of payments, new and innovative approaches are being advanced.
Click here to read more: Some Patients Can Choose To Be Hospitalized At Home
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Friday, May 4, 2012
Sidetracked By Drugs
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| New York Mayor, Michael R. Bloomberg. (Photo credit: Wikipedia) |
The focus of major employer and insurance initiatives of so-called reform legislation in multiple jurisdictions has been to reduce the delivery of prescriptive pain relief. Actually, that is an enforcement issue only that globally exists in the health care industry. New York's Mayor Michael Bloomberg, is working diligently to identify and database the few prescribers and physicians involved. A national effort modeled after the New York process would go a long way to curtain excessive and unorthodox prescriptions.
To use the prescription drug abuse issue to attack workers' compensation generally is merely sidetracking the real problem with the medical delivery system which is the global denial of compensability of workers' compensation claims by employers and insurance carriers merely to delay and avoid payment of medical benefits.
The recent decision in Federal Court recognizing RICO violations by an insurance carrier, the employer medical expert, and the employer itself, puts the real focus on the problem. That decision demonstrates the need to get the workers' compensation train back on the tracks and redirect the system so that it pays benefits to injured workers in an efficient and timely basis.
Wednesday, March 21, 2012
Health Benefits, US Supreme Court and Workers Compensation
U.S. Supreme Court building. (Photo credit: Wikipedia)
On Monday, the US Supreme Court will hear oral arguments concerning the validity of the 2010 Patient Protection and Affordable Care Act. Whatever the US Supreme Court decides in the pending matters, the nation's patchwork of workers' compensation systems will ultimately feel the impact. The implementation of the Act will ultimately have far reaching consequences of the overall operation of both the delivery of workers' compensation medical benefits and the ultimate assessment/apportionment of permanent disability.
Workers' Compensation systems have been struggling with the delivery of medical benefits. As more cases are denied initial compensability determinations, and alterate medical care is sought for the prevention, identification and treatment of underlying, co-existing and pre-existing medical conditions will be even more significant issues in workers' compensation matters.
Thompson-Reuters News & Insight identifies some of the issues the US Supreme Court will consider:
"* Adult children remaining on their parents' insurance coverage through the age of 26.
* An end to lifetime limits on the dollar value of benefits available to people with serious medical conditions that can lead to astronomical treatment costs.
* Preventive healthcare benefits including free coverage for mammograms and birth control.
* For Medicare beneficiaries stuck in the prescription drug benefit coverage gap known as the "doughnut hole," a 50 percent discount on covered brand name drugs and 14 percent savings on generic drugs.
* A requirement that insurance companies justify unreasonably large healthcare premium increases.
* Tax credits for small employers with no more than 25 employees and average annual wages of less than $50,000 that provide health insurance for employees.
* Temporary insurance coverage programs for retirees who are over age 55 but not eligible for Medicare.
* Temporary insurance coverage for individuals with pre-existing medical conditions who have been uninsured for at least six months.
* A requirement that health plans report the proportion of premium dollars spent on clinical services, quality, and other costs, and provide rebates to consumers if the share of the premium spent on clinical services and quality is less than 85 percent in the large group market and 80 percent in the individual and small group markets.
National Federation of Independent Business v. Sebelius, No. 11-393; U.S. Department of Health and Human Services v. Florida, No. 11-398; and Florida v. Department of Health and Human Services, No. 11-400
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Monday, February 27, 2012
The Religious Opt-Out Scheme: A New Approach to Eliminate Workers' Compensation
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| Alex Berman |
Over a decade ago Bechtel Corporation initiated an opt-out program that took workers' compensation out of the adversarial system entirely. Shortly thereafter, the concept of universal healthcare emerged as a concept to remove all healthcare delivery and benefits from workers' compensation. Recently Republican presidential candidates have pledged to merge the system into an employee paid for program. Now, legislators in the State of Michigan, where unemployment soared to over 14% in 2009, are suggesting yet another approach to opt-out of workers' compensation based on a religious exemption.
Jon L Gelman
Guest post by
Alex Berman of the Michigan Bar
Representatives Earl Poleski (primary), Matt Lori, Joe Haveman, and Margaret O’Brien have introduced new legislation that would exempt religious organizations from the Michigan workers compensation system.
House Bill No. 5371 provides that: “An individual is not an employee subject to this act if he or she is a member of a religious sect or division that is an adherent of established tenets or teachings by reason of which members are conscientiously opposed to accepting the benefits of any public or private insurance that makes payments in the event of death, disability, old age, or retirement or makes payments toward the cost of, or provides services for, medical bills, including the benefits of any insurance system established by the social security act, 42 USC 301 to 1397mm, and has the practice established for 10 or more years, for members of the sect or division to make reasonable provision for their dependent members. An employer shall retain a copy of the employee’s internal revenue service form 4029 that has been approved by the federal social security administration to assert an exemption under this subdivision.”
This legislation would take away protections that have been in place since the original workers compensation act was passed in 1912. It would allow religious organizations to exempt their employees from the workers compensation system if they are members of the same faith. The idea seems to be that religious groups who are conscientiously opposed to public or private insurance should not be forced to participate in the state workers compensation system.
We believe this legislation is awful and will lead to many unintended consequences. It is also unlikely to survive a constitutional challenge in the courts.
Michigan Workers Compensation Law 101
Workers compensation is a type of insurance that employers are required to purchase under Michigan law. It is intended to protect both employees and employers in the event of a work-related injury.
An employee who suffered a work injury before 1912 used to have to show that their employer was at fault to receive compensation. If the injured worker could prove fault, he or she was entitled to any damages that a jury could award. This included pain and suffering. The problem with this approach was that some employees were overcompensated for their injuries while others received nothing. Employers could also be forced to pay substantial damages for relatively minor injuries.
Michigan adopted its first workers compensation law in 1912. The law was a compromise between employee and employer interests. Employees gave up the right to sue in civil court in exchange for what are essentially no-fault benefits.
Workers compensation now pays wage loss, medical treatment, and vocational rehabilitation. Employers receive protection from civil lawsuits including actions for negligence. The amount of benefits that employers must pay are limited.
Michigan’s workers compensation system has worked for over 100 years and has served as a model for other states. It provides injured workers with fair compensation while protecting employers and business interests.
Unintended consequences
Exempting religious organizations from the workers compensation system creates a slippery slope and sets a bad precedent. Soon other groups will seek to be exempted and the entire system will be put in jeopardy.
Employees gave up their common law rights in exchange for limited workers compensation benefits. If an employer is exempted from the workers compensation system, presumably its employees would be free to file a tort action and seek civil damages. This is exactly what the workers compensation system was designed to prevent in the first place.
Just because someone has a religious belief does not mean they should be exempted from Michigan law. You could give religious organizations total immunity but the last time we checked this was not the middle ages.
Changes to the workers compensation law should not be done hastily
Any changes to Michigan’s workers compensation law should not be done without serious thought and consideration. All stakeholders need to be brought together to ensure continuing viability of the system.
Any changes to Michigan’s workers compensation law should not be done without serious thought and consideration. All stakeholders need to be brought together to ensure continuing viability of the system.
Alex Berman is the founding member of the Law Office of Alex Berman, P.C., of Farmington Hills, Michigan. For over 30 years he has handled workers' compensation claims for employees who had injuries or disabilities and has battled successfully against employers including automobile suppliers. He is a member of the State Bar of Michigan and the Michigan Association for Justice.
Wednesday, February 15, 2012
NIOSH Alerts Home Healthcare Workers About Latex Allergies
NIOSH (The National Institute for Occupational Health and Safety) has published a booklet to educate Home Healthcare Workers about preventing latex allergies. Latex products are made from natural rubber, and sensitivity can develop after repeated exposure. Limiting exposure to latex can help prevent allergic reactions for both home healthcare workers and their clients.
Once Natural Rubber Latex (NRL) sensitivity occurs, allergic individuals continue to experience symptoms, which have included life-threatening reactions, not only on exposure to NRL in the workplace but also upon receiving or accompanying a family member receiving healthcare services at inpatient as well as office-based settings.
In September of 1997, the Food and Drug Administration (FDA) issued a final rule requiring cautionary statements in the labeling of all medical devices that contain natural rubber likely to come in contact with humans. The rule provides that such products must contain the following cautionary statement in bold print: "Caution: This product contains natural rubber latex which may cause allergic reactions." Additionally, the FDA issued a final ruling that the labeling of medical devices that contain natural rubber, likely to come in contact with humans, shall not contain the term "hypoallergenic".
Over the last few years, there has been a significant increase in the number of workers' compensation claims filed against employers on behalf of individuals who have suffered latex allergic reactions. Scientists and government officials estimate that about 950,000 U.S. health care workers have developed an allergic sensitivity to latex.
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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, January 5, 2012
Contagion in The Workplace: Ready or Not
Whether the release is because of an unintentional act, or a terrorist attack, the workers' compensation system has not established a protocol for responding with urgent medical care and an elaborate and expedited medical delivery and benefit system.
Read more: Debate Persists on Deadly Flu Made Airborne (NY Times)
“This research should not have been done,” said Richard H. Ebright, a chemistry professor and bioweapons expert at Rutgers University who has long opposed such research. He warned that germs that could be used as bioweapons had already been unintentionally released hundreds of times from labs in the United States and predicted that the same thing would happen with the new virus.
“It will inevitably escape, and within a decade,” he said.
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Friday, December 9, 2011
The Times They Are Changing
Today, David DePaolo, the President & CEO of WorkCompCentral, has editorialized of the lack of the ability of the workers' compensation system to meet present needs is now a major concern and that generally workers' compensation is just no longer relevant.
Click here to read his recent post: Professional Sports and the Relevancy of Comp
"I see all of this as evidence that things are changing, and that the pace of change is quickening. Obviously such things don't change overnight, but I would wager that the work comp world is going to be a much different landscape in 20 years, or even 10."
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Friday, December 2, 2011
Penalties for Insurance Companies Who Fail to Pay Enough for Medical Care
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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Tuesday, August 30, 2011
What Hurricane Relief Volunteers Need to Know About Workers Compensation
1. Make sure that they establish an employment relationship for the agency or company conducting the relief work. In other words, the volunteer, even if earning no money, must be an employee of the the company conducting the rescue and/or relief effort. The best evidence would be a written agreement that the worker is to be considered an employee of the company.
2. Report to the report if an accident or injury occurs arising out of and in the course of the employment. This report should be made as quickly as possible following the event or manifestation of illness. This should be followed up immediate with a written communication to the employer advising that an injury or illness occurred and that medical treatment, if necessary, is being sought.
3. Record the names and addresses witnesses to the even or exposure.
4. Seek medical care if required. If it is an emergency and you are unable to first notify your employer, seek medical attention first and then report the event. Most emergency rooms will record your event history and notify your employer, but that is not always the case. Therefore, advise your employer where and when you sought emergency medical care as soon as possible.
5. If you are advised by a medical profession to stay out of work, then obtain that information in writing. Make a copy of the lost time order and give the copy to your employer.
6. See the advice of an attorney at law familiar with workers' compensation matters since volunteer work in emergency situations produced a lot of complication issues. Those issue are inherited from the chaos and complications that occur in the wake of a major natural disaster such as a hurricane.
Volunteering for the hurricane relief effort is a noble gesture. Workers, in the emotional haste to assist, must also insure that they remain insured for workers' compensation benefits.
Thursday, July 28, 2011
Deal or No Deal: Judge Relies on Court Appointed Physician
An Appellate Court has rule that a Judge of Compensation can select an independent physician to review the need for medical treatment. It doesn't matter whether or not the parties agreed formally or informally as to the binding effect of the physician's opinion as to causal relationship and the need for treatment.
The Court has discretion to merely rely upon the physician's opinion and reach a reach a decision based upon the report. The cost of the evaluation is to be paid for by the employer /insurance carrier. Furthermore, the Court need not hold a hearing for oral argument on the issue and can reach a binding on the papers alone.
Thompson v. Quality Et al., 2011 WL 3107767, Docket No. A-1177-10T1 (NJ App. Div.) decided July 27, 2011.
The Court has discretion to merely rely upon the physician's opinion and reach a reach a decision based upon the report. The cost of the evaluation is to be paid for by the employer /insurance carrier. Furthermore, the Court need not hold a hearing for oral argument on the issue and can reach a binding on the papers alone.
Thompson v. Quality Et al., 2011 WL 3107767, Docket No. A-1177-10T1 (NJ App. Div.) decided July 27, 2011.
Thursday, June 9, 2011
3 Ways Infections Become Compensable in Workmens Comp
Infections that flow from a traumatic event are generally compensable. Even if there is a delay in seeking professional medical care the injured employee may be entitled to benefits. Sometimes the infections is dormant and does not become manifest for some time after the traumatic event that caused the injury. Preventative antibiotic treatment is sometimes recommended.
Some infections are contracted during treatment such as infection that are acquired during hospital stay. Those are called Hospital Acquired Infections (HAI). These infection are expensive to treat and are a major concern to insurance carriers and government insurance programs such as Medicare. Medicare plans to impose economic penalties on hospitals for infections, ie. staph (MRSA), that patient acquired during hospital stays.
A third type of infections are those that are the result of occupational accident and injuries. First responders and medical personnel who suffer from exposure to meningitis, strep and HIV patients. These exposures may occur by simple contamination of the work area. In California legislation has been offered to establish a presumption that hospital employees infected on the job qualify for workers' compensation benefits.
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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Monday, June 6, 2011
NJ Urged to Adopt Single Payer System for Workmens Comp
Citing that in 1777 the Commonwealth of Vermont became the first sovereign state in the world to abolish slavery the coalition, the coalition is now advocating a similar nation adoption of Vermont legal precedence. On May 26, 2011. Vermont became the first state in the U.S. to commit itself to establishing a truly universal single-payer healthcare plan that includes workers' compensation medical care.
Tuesday, May 31, 2011
Medicare to Partially Resume Workmens Comp Collection Letters
CMS has a statutory obligation to seek recovery of medical benefits that it has paid to beneficiaries in those matters where Medicare is not the primary insurance carrier responsible for medical care. CMS seeks to recovery the money that it has apid from the workers' compensation insurance carrier. The process has evolved where in CMS sends notice to the attorneys in the pending workers' compensation claim seeking reimbursement at the time of resolution of the workers' compensation claim.
The Medicare Secondary Payer Recovery Contractor (MSPRC) is contracted to issue a letter know as the "Review of the Rights and Responsibility Letter" (RAR). The MSPRC has announced that the RAR letters will resume in some format on or about June 10, 2010.
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Monday, May 16, 2011
FDA Orders Surveillance of Hip Implants
Image via WikipediaHip replacements are utilized through the workers' compensation medical delivery system in an effort to cure and relieve medical conditions arising out of employment injuries and exposures. The US Food and Drug Administration (FDA) has recently announced that it is widening its roll in monitoring the hip implants. This follows a recent recall of defective hip implants.
"The FDA is continuing to gather and review all available information about currently marketed metal-on-metal hip systems, including information related to adverse events that may be associated with increase levels of cobalt and chromium in the bloodstream. To that end, on May 6, 2011 the FDA issued orders for postmarket surveillance studies to manufacturers of metal-on-metal hip systems. The FDA sent 145 orders to 21 manufacturers. Manufacturers will be required to submit a research protocol to the FDA that addresses specific safety issues related to these devices. Data from the studies conducted will enable the agency to better understand these devices and their safety profiles.
Friday, May 13, 2011
Common Themes, The Green Mountain System & Newt Gingrich
Editors note: This is a re-post of yesterday's blog. Google had a systemwide issue and during their maintenance they did not restore this post.
Common themes of a single payer medical system are emerging. History can repeat itself. The announcement by NewtGingrich to run for the presidency in 2012, and the anticipated signing of the Vermont Single Payer medical care legislation, may set the stage for "the perfect storm" to gather impetus for a system that brings workers' compensation care into a unified system.
As the Vermont legislation goes to Governor Peter Shumlin for signing in a couple of weeks, the eyes of the nation will switch focus to the debate in Washington and the presidential race of 2012. Congress and the new administration will be required to focus on the issue of waivers that will be effective in 2014.
Newt Gingrich had advocated in the past to move the cost occupational medical care onto the backs of employees. He would relieve employers from contributing to workers' compensation medical care and Medicare.
Workers' Compensation is a summary and remedial system that affords injured workers medical care to cure and relieve medical conditions that result from occupational exposures and accidents. In most instances employees find it necessary and prudent to retain the professional assistance of an attorney to assist them in obtaining medical treatment for work related accidents and occupational exposures.
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.
Related articles
- Vermont Single Payer System Called the Dawn of A New Era (workers-compensation.
blogspot.com) - RICO Issues Can Be Cured With A Single Payer Medical System (workers-compensation.
blogspot.com) - Vermont Universal Health Care to Embrace Workers Compensation (workers-compensation.
blogspot.com) - Newt Gingrich's New Strategy for Workers' Compensation (workers-
compensation.blogspot.com) - Green Mountain Dreams (slate.com)
- Progressives and Conservatives Agree: Single Payer Healthcare is Inevitable (pnhp.org)
- 300 Million Payer Healthcare System -- New Gingrich (youtube.com)
Monday, April 4, 2011
The Republican Plan: Just End Medicare
This week, the Republicans will offer a proposal that ultimately would end Medicare involvement. The plain is simply end Medicare. The proposal outlined is outlined in the Wall Street Journal today.
"The plan would essentially end Medicare, which now pays most of the health-care bills for 48 million elderly and disabled Americans, as a program that directly pays those bills. Mr. Ryan and other conservatives say this is necessary because of the program's soaring costs. Medicare cost $396.5 billion in 2010 and is projected to rise to $502.8 billion in 2016. At that pace, spending on the program would have doubled between 2002 and 2016."
Converting the program for coverage to the poor only would still not end the plans' involvement in workers' compensation and in fact may only increase it. The dichotomy between rich and poor will increase. The numbers of uninsured are growing as well as the working elderly.
It is anticipated that Medicare premium costs will continue to increase under the present plan and wealthy Americans will opt-out. This proposal will merely mean a universal opt-out plan leaving the Federal program strapped for cash. The premium base needs to be increased rather than diminished.
As Peter Rousmaniere, a noted workers' compensation commentator, recently observed, the workers' compensation program has "leaks in the system." Occupational disease claims will continue to be denied at increasing rates, and the cost shifting will merely be perpetuated from workers compensation to the taxpayers. Just ending Medicare will not solve the problems with the Workers' Compensation medical delivery system.
Sunday, April 3, 2011
Vermont Single Payer System Called the Dawn of A New Era
Friday, March 18, 2011
Industry Coalition Wants to Cut CMS Conditional Payments
A group of about 50 employers, insurance carriers and vendors have formed a coalition to endorse legislation (H.R.1063) introduced this week that would ease reporting requirements and reimbursement procedures of the Centers for Medicare and Medicaid (CMS). The organization, the Medicare Advocacy Recovery Group [MARC], contends that the proposed legislation will:
- "Empowering Medicare to provide settling parties with the amount of their MSP repayment obligation during the settlement process, will allow taxpayers to settle quicker, and repay the Medicare Trust Fund faster.
- "MSP Reform will provide a more affordable and less intrusive MSP system that protects beneficiaries and the Medicare Trust Fund, but does not waste limited judicial and other resources or needlessly confuse parties trying to settle a claim resulting from an injury to a beneficiary.
- "MSP Reform will also eliminate the required use of Social Security Numbers (SSNs) and Health Insurance Claim Numbers (HICNs) in the reporting process, create a basic right of appeal for all parties to resolve a CMS MSP determination, clarify the statute of limitations, and require the CMS Actuary to determine a threshold below which the recoveries are so small it makes no sense to apply the complex MSP laws.
Theoretically it sounds like the change would create a more efficient system to establish: time limits for claim reimbursement; a statute of limitations for liability (3 years); an avenue for redress directly to the judicial system; and a threshold amount for reimbursement. However, the proposal would actually defeat the basic philosophy of the workers' compensation act.
The convoluted logic of the employer/insurance group just makes no sense. It is like saying that I didn't bother buying enough postage on a timely basis so I will just mail my letter at half-price. The universal legislative intent of workers' compensation act mandates that the employer is responsible for medical care of its injured workers. The insurance industry has tried other gimmicks before to continue its long history of cost shifting, and those have rightly failed as Congress wouldn't buy into them.
While employers and insurance carriers delay and deny compensation benefits, shifting the cost to the taxpayers through depletion of the Medicare system, is both offensive and repugnant. If the coalition wants to ride the carousel of "it's not how long, but how much," in doling out benefits, then they should not blame CMS for delays and penalties, caused by the coalition's own failure to report on a timely basis in the first place.
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