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Showing posts with label Law. Show all posts
Showing posts with label Law. Show all posts

Saturday, December 28, 2013

N.Y. Workers’ Comp Board to Transition Established UEF Claims Management to Triad Group

The New York State Workers’ Compensation Board recently announced it will transition the management of established Uninsured Employers’ Fund (UEF) claims to the Triad Group, LLC effective Jan. 13, 2014.
Triad Group, based in Troy, N.Y., is a professional service organization providing comprehensive claims management.
These claims consist of established claims where liability has been determined, and medical, and/or indemnity payments must be made. Triad will perform all claim-related functions and legal representation. Claimants who have such UEF claims, and all parties of interest, including health care providers and legal representatives, will receive individual written notice of the change in claim administrator.
The Workers’ Compensation Board said the transition of claim management should have no impact on claimants receiving workers’ comp benefits. Claimants who are receiving biweekly indemnity benefits will continue receiving benefits on the same schedule currently in place.
For medical and transportation reimbursement requests after Jan. 13, 2014, Form C-257, Claimant’s Record of Medical and Travel Expenses and Request for Reimbursement, must be sent to Triad for processing with a copy to the Workers’ Compensation Board. For medical services provided on or after Jan. 13, 2014, in established cases only, health care providers should send new medical reports, bills and authorization requests to Triad, and a copy to the...

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Tuesday, December 17, 2013

Governor Cuomo Announces Significant new Protections for World Trade Center Workers

Governor Andrew M. Cuomo today announced World Trade Center workers who performed rescue, recovery and clean-up in the year after 9/11 now have significant new protections for workers’ compensation benefits. The World Trade Center Registry was reopened and the deadline for joining extended to September 11, 2014; certain previously time-barred World Trade Center claims are being reopened and considered timely; and qualifying health conditions were added to the law.

New York State is committed to caring for those who stood up in the face of danger to assist in the rescue and recovery efforts during and after the horrific attacks at the World Trade Center,” Governor Cuomo said. “That is why we are providing new protections for the workers, including first responders, clean-up crews and volunteers, who answered the call for help and ensuring they have access to workers’ compensation benefits for the future. I urge those who worked at Ground Zero and other recovery sites to file a WTC-12 form today to apply for the benefits they deserve.”

Filing a WTC-12 form with the Workers’ Compensation Board preserves the workers’ compensation rights for those who performed rescue, recovery and clean-up after the World Trade Center attacks. The State again urges those who worked at Ground Zero, the Fresh Kills Landfill, on the barges, the piers and the morgues to file a WTC-12 form, no matter if they were injured or not and whether they were employed or volunteered.

The last national Tell Us You Were There campaign ended with 41,094 filings received by the previous Sept. 13, 2010, deadline. As part of a new law signed by Governor Cuomo, any WTC-12 filings received after that date are now consider timely.

The Board will also review its files to locate any World Trade Center claims previously disallowed as “untimely” under Workers’ Compensation Law Secs. 18 and/or 28 or from failure to file a timely WTC-12 form. The Board will, under its own initiative, now reconsider those particular World Trade Center claims “timely.”

A detailed list of qualifying health conditions resulting from hazardous exposure for World Trade Center workers who participated in rescue, recovery and clean-up operations was also added. The categories are diseases of the:
  • Upper respiratory tract and mucosae;
  • Lower respiratory tract;
  • Gastroesophageal tract;
  • Psychological axis; and
  • New onset diseases that develop in the future resulting from exposure.


“When New Yorkers needed their help, 9/11 rescue, recovery, and cleanup workers selflessly answered the call,” President of the New York State AFL-CIO Mario Cilento said. “It's incumbent upon us, as a state, to be there for them now and in the future as we continue to learn more about the growing impact of their exposure. We commend Governor Cuomo and the Legislature for ensuring that critical treatment and benefits will be available for the heroes who served in the aftermath of 9/11.”

“The enactment of this legislation is a major victory for those who worked in rescue, recovery and cleanup operations following the attack on the World Trade Center,” Executive Director Joel Shufro of the New York Committee for Occupational Safety and Health said. “By extending the deadline to register to file a claim for another year and reinstating those whose registrations were previously time barred, many workers who develop WTC related illnesses with long latency periods will be eligible to file for benefits under New York State’s Workers’ Compensation Law. The enactment of this legislation is an act of justice and equity and the legislature should be congratulated for passing the legislation and the governor for signing it.”

“As an injured worker as of the result of working at Ground Zero, I know firsthand what this important piece of legislation means to those who are sick or injured from their heroic actions. This will bill not only provides those sick or injured the opportunity to apply for benefits, but more importantly it gives them hope that our Governor still cares about yesterday's heroes,” John Feal, founder of the FealGood Foundation, said.

Governor Cuomo is committed to ensuring all World Trade Center workers receive the benefits and protections they are accorded under the law. To achieve this, at his direction the Board has:
Contacted previously untimely filers;

Translated the WTC-12 form into seven languages other than English;

Reopened a dedicated phone line for World Trade Center workers, 1 855 WTC-2014 (1 855 982-2014);

Relaunched the web page www.wcb.ny.gov/WTC12 for World Trade Center workers; and
Planned outreach to workers and groups representing World Trade Center workers.

All these worker protections were added to Workers’ Compensation Law Article 8-A.

The Board’s dedicated World Trade Center work groups and hearing parts have functioned continuously since September 2001.
….
Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 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.

Oklahoma Supreme Court Rejects Challenge To Worker's Comp Law - Opt-Out is The Law

The Oklahoma Opt-Out Law for workers' compensation has been upheld by the Oklahoma Supreme Court. The Industry biased system will take the place of the traditional system in Oklahoma in February 2014. Today's post is shared from newson6.com  .

The Oklahoma Supreme Court has rejected a constitutional challenge to the state's new workers' compensation law.
The court handed down the ruling Monday, just one week after justices heard oral arguments in a lawsuit challenging the law. The court rejected allegations the law contains multiple subjects in violation of the Constitution's single-subject rule that legislation address just one subject.
The ruling says all sections of the new law are inter-related and refer to the single subject of workers' compensation or the way employees may ensure protection against work-related injuries.
The legislation was signed into law by Republican Gov. Mary Fallin in May. It was challenged in the lawsuit by state Sen. Harry Coates, state Rep. Emily Virgin -- both Democrats -- and the Professional Firefighters of Oklahoma.
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Monday, December 16, 2013

Victims of Misclassification

Misclassification is a major issue for workers' compensation programs. Misclassified workers are those who should be considered employes but have been denied employment status. This post is shared by from the nytimes.com

.LAST month, a Michigan construction worker named Matt Anderson testified in a Senate hearing about being a victim of employee misclassification. Mr. Anderson said that his employer forced him, after six years as an employee, to switch to “independent contractor” status. Though the move stripped Mr. Anderson of basic employee rights and protections, he went along with the change, he said, because “my fellow workers and I had families to support and we saw how bad the economy was.”

Today, millions of American workers in a wide variety of sectors, from construction and trucking to I.T. and professional services, are victims of misclassification, a tactic employers use to avoid paying taxes and providing benefits that are guaranteed to employees, such as workers’ compensation, overtime pay, minimum wage and unemployment insurance.

In 2000, a United States Department of Labor study estimated that up to 30 percent of employers misclassify workers. This year, the Treasury Department’s inspector general concluded that the problem had worsened. Fifteen states have now teamed up with the Department of Labor and the Internal Revenue Service to reduce misclassification through information sharing and joint...


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Sunday, December 15, 2013

Even Superwoman Can Have Back Problems

As workers' compensation professionals we have seen and handled thousands of back injury claims. We can recite the issues, observations, diagnostic findings and surgical reports by memory. The cases are cranked through workers' compensation systems at a steady stream. As we age we all realize that no one is immune from an occupational back disorder. Today's post is shared from the nytimes.com .

There are two kinds of people, my sister says. People with back problems, and people who don’t have back problems yet.

Are you the kind of person who will develop back problems? Take this easy test.

l. Are you alive?

2. Are you getting older?

3. Do you ever pick things up?

If you answered “yes” to any of these questions, back problems are probably in your future. (Eighty percent of adults experience them at some point.)

“But I’m not the kind of person who has back problems!” you protest.

That’s what everyone says. Right up until the moment his or her back goes out.

What did mine in was decades of library work. Hours spent lifting small weights (books). And heavier weights (reference books). Not to mention carrying carton after carton of donated books from the vestibule where patrons dropped them off into the storage room. All of which I handled with the casual assumption that I was, and would always be, Superwoman.

I thought nothing of stooping, hoisting up a mammoth box of books, then lugging it the length of the library.

People tried to warn me. “Watch your back!” a patron would caution as I staggered by with a large box.

“Thanks!” I would respond, while thinking: “Back problems? Me? Not a chance.”

Then one morning I got out of bed and I couldn’t stand up. My back refused to bear my weight. I hit the floor, then crawled back into bed and phoned my sister, who has coped with back problems...

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Saturday, December 14, 2013

AIA to Urge Renewal of TRIA to Workers Compensation

The American Insurance Association (AIA) will highlight the importance of renewing the Terrorism Risk Insurance Act (TRIA) at the National Association of Insurance Commissioners' (NAIC) 2013 Fall National Meeting, underscoring TRIA's role in the workers' compensation marketplace.   The NAIC meeting will take place December 14-18 in Washington, D.C.
"Workers' compensation insurers are particularly affected by a terrorist attack," said J. Stephen ("Stef") Zielezienski, AIA senior vice president and general counsel. "By definition, workers' compensation policies must cover all risks, including terrorism, because workers' compensation covers all injuries and deaths that are deemed under a state's law as work-related without distinguishing the source of the injury."  Coupled with the nature of a terrorist attack, this makes the risk difficult to manage without the partnership provided by TRIA."
Zielezienski will appear before the Workers' Compensation (C) Task Force on Tuesday, December 17.  In his presentation, Zielezienski will focus on the expected impact on employers, insurers and state regulators should TRIA sunset at the end of 2014.    
"Without TRIA, workers' compensation insurers would have to make difficult decisions on how to manage their aggregated exposure, particularly for geographically-concentrated risks like terrorism," said Zielezienski.  "If an insurance company elects to reduce their exposure by not offering as much capacity, then state residual markets and workers' compensation pools would have to absorb the risk.  Ultimately, workers' compensation insurers would be responsible for these losses because they reinsure these residual market risks, but the extreme losses from catastrophic terrorism could stress the private markets and create economic uncertainty."
Zielezienski will also focus on what responsibilities state governments might assume for workers' compensation should TRIA not be reauthorized.   Both AIA and the NAIC are advocating for the long-term reauthorization of TRIA.  The NAIC passed a resolution at its 2013 Summer National Meeting in Indianapolis urging Congress to reauthorize the successful program. 

Friday, December 13, 2013

Washington is reducing the deficit but abandoning the unemployed

When injured workers are hurt, employers have the tendency to replace the workers. After temporary disability benefits are exhausted then injured workers traditionally look toward State unemployment funds to survive. Congress is about to severely limit that safety net by drastically reducing unemployment benefits. Today's post was shared by Steven Greenhouse and comes from m.washingtonpost.com

There's one big thing left out of the Murray-Ryan budget deal: unemployment insurance.
On December 28, federal jobless benefits expire for 1.3 million workers. These aren't normal unemployment benefits. These are the extended, emergency benefits meant to help the long-term unemployed.
A little-known fact about the economy is that short-term unemployment -- the percentage of the labor force unemployed for five weeks or less -- is back down to where it was before the recession. It's long-term unemployment -- which lasts more than 27 weeks -- where the crisis lingers.
No one has a very good answer for these workers. They're often stuck in areas of the country where jobs are scarce. They face a vicious cycle of employment discrimination in which employers don't want to hire them because they've been unemployed for so long, which in turn extends their unemployment and makes it even harder for them to find a job. And now we're just cutting them loose.

Thursday, December 12, 2013

Florida New Case Filings Continue To Go South

FL New Case Filings Decrease
Florida has again issued a through and expansive report concerning its workers' compensation system. A model for transparency, the report reflects a continued decline in new case filings.
Click here to read the complete report.

Wah, Wah, Wah

Occupational disease claims present difficulty in the delivery of medical care. Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

At least that's the message that I got out of the latest study from researchers at National Institute for Occupational Safety and Health in their study just published by the Journal of Occupational and Environmental Medicine.

According to them, accepted workers' compensation claims that do not result in medical payments could be costing group health insurers at least $212 million a year because folks who don't get their treatment through work comp for their work injuries or illnesses do so through their group health provider.

Claims that do not result in medical payments through work comp are referred to as "zero-cost claims" in the study.

The researchers' analysis of more than 12,000 claims from 2002 through 2005 revealed that 15.9% of the claims were zero-cost claims. Claimants with zero-cost claims were more likely to use group health insurance services and incur more group health costs.

"In the three months before an occupational injury, 53.9% of workers with positive-cost workers' compensation medical claims and 61.6% of workers with zero-cost workers' compensation medical claims used the outpatient group health insurance at least once," the study says. "Within three months after an occupational injury, group health insurance utilization for outpatient services increased to 61.2% and 74.1% for workers with positive- and zero-cost workers' compensation medical claims, respectively."

In addition, one of the study's most significant findings...
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SEAK Announces 2014 Seminar Schedule

SEAK is the sponsor of the largest and most highly regarded national workers’ compensation and occupational medicine conference. SEAK’s Workers’ Compensation and Occupational Medicine Conference was first held in 1980 and takes place each July on Cape Cod. Their attendees learn from international thought leaders and go home with cost saving solutions to their issues. They have over 50 exhibitors in attendance each year and SEAK's conference is an annual networking event.



Wednesday, December 11, 2013

More Cost Shifting

A recent study reports that zero-cost workers' compensation claims merely creates cost shifting to other programs.


Objective: Previous research suggests that non–workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs.
Methods: Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments.
Results: Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims.
Conclusion: Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.


Oklahoma workers' compensation opt-out provisions spark judicial questions


The new law enacted by the Oklahoma Legislature would convert the state from a judicial workers' compensation system to an administrative one.
Photo - Oklahoma Gov. Mary Fallin talks with reporters in Oklahoma City, Wednesday, July 17, 2013, following a speech to the National Lieutenant Governors Association annual meeting. (AP Photo/Sue Ogrocki)
Oklahoma Gov. Mary Fallin talks with
 reporters in Oklahoma City,
Wednesday, July 17, 2013, following
 a speech to the National Lieutenant
Governors Association annual meeting.
 (AP Photo/Sue Ogrocki)
It would allow employers to opt out of the system as long as they provide coverage for the same injuries as the state-operated administrative system and provide benefits to injured workers that are at least as generous.
Law a high priority
The law was a high priority of Gov. Mary Fallin and Republican legislative leaders, who have said it will help businesses by reducing workers' compensation costs. Opponents claim cost savings will come at the expense of injured workers.
Oklahoma City attorney John McMurry, who is challenging the law on behalf of two state lawmakers and the Professional Fire Fighters of Oklahoma, argued that not all Oklahoma employers and employees would be treated equally under the law.
Employees of companies that opt out of the system would have “fewer rights” than employees of companies that participate in the administrative system, McMurry argued.
An employee of an opt-out company who is dissatisfied with the way the employer has handled a claim would first have to appeal to a panel of three persons appointed by the employer, McMurry said.
Eventually, the employee would be able to appeal a series...
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How ALEC Serves As A 'Dating Service' For Politicians And Corporations


ALEC has endorsed workers' compensation as program to shield corporate liability. "
NOW THEREFORE BE IT RESOLVED, that the State of (insert state) specifically reaffirms the principle of workers’ compensation as the exclusive remedy and rejects the rationale for tort liability based on legal theories such as dual capacity/dual persona, intentional injury without proof that the employer acted with deliberate intention to cause the injury, or third party action against employers for work-related injuries." Today's post is shared from NPR.org .

A batch of internal documents recently leaked to The Guardian has revealed new insights into the goals and finances of the secretive group called ALEC. The American Legislative Exchange Council is a group that brings together state legislators and representatives of corporations. Together, they develop model bills that lawmakers introduce and try to pass in their state legislatures. Through these model bills, ALEC has worked to privatize public education, cut taxes, reduce public employee compensation, oppose Obamacare and resist state regulations to reduce global warming gas emissions.
"ALEC is like an incubator of predominantly conservative legislation," Guardian correspondent Ed Pilkington tells Fresh Air's Terry Gross. "The vast majority of the model bills are conservative in their...
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Tuesday, December 10, 2013

Delay Or Deny At Your Risk

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

There are so many reasons why both employers and workers feel that workers' compensation is "broken" or doesn't work.

Peter Rousmaniere, who is beginning work this week for WorkCompCentral, suggests in his column reviewing two studies on perceived delays in medical treatment that delay may arise as much from indifferent doctoring skills as days elapsing on the calendar.

An employer consultant relayed to me a factual scenario indicating another cause of this perception - standard claims administration protocol, which is defensive in nature as opposed to being aggressively pro-active.

Rousmaniere cites a couple of studies in his column. A Texas Department of Workers' Compensation survey of injured workers documents wide discrepancy in perceptions, but also notes that up to 50% of all survey respondents complained of some delay in receipt of treatment.

Another study cited by Rousmaniere conducted by Harbor Health, which specializes in designing workers’ compensation provider networks, looked for differences in claims outcome, including medical cost and litigation rates, and if surgical treatment happened early or late in the course of treatment.

Harbor Health found that early surgery in carpal tunnel cases (earlier than recommended by treatment guidelines) produced slightly more cost in medical expense but much less cost in indemnity expense.

Let's put these findings into context.

Assume a 28 year old male worker who complains of "...
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Monday, December 9, 2013

Deadly Factory Fire Bares Racial Tensions in Italy

Fashion safety was the catalyst for the US workers' compensation program in 1911 following the Triangle Shirt Waist Factory fire in NY. Internationally it appears that not much has changed over a century as workers' continue to work in unsafe conditions throughout the world. Today's post was shared by Steven Greenhouse and comes from www.nytimes.com

PRATO, Italy — Dozens of bouquets block the entrance to the Teresa Moda outlet and factory where seven Chinese workers died last Sunday in a fire that swept through the establishment where they worked and lived.
Enlarged photos of the seven victims, two women and five men, have been affixed to the door under a handwritten sign that reads: “Sorrow Has No Color.” Behind police barricades, in soggy piles, are charred bolts of cloth, mountains of plastic hangers and garbage bags full of newly cut garment pieces.
The building, which houses Teresa Moda, a wholesale distributor which also prepared clothing for assembly lines, did not have emergency exits, officials said. Windows were blocked by bars. Officials believe that a camp stove used for cooking probably caused the fire, in which two others were seriously hurt.
It took calamity to fan national outrage at the low-cost business model that took root here 20 years ago and that has transformed the economy of this Tuscan town 12 miles north of Florence.
But for officials who have tried to get a grip on the problem, “a tragedy is always just around the corner,” said Stefano Bellandi, the local secretary for the CISL, one of Italy’s main unions.
The fire at Teresa Moda, and the uproar that followed, exposed the complicated, and at times tense, cohabitation in Prato of Italian residents and Chinese immigrants, who now own nearly 45 percent of the city’s manufacturing businesses.
Law...
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Friday, December 6, 2013

Keeping privacy in focus

Confidentiality has been the hallmark of Workers' Compensation since the inception of the program. Has been challenged federally through the portability act concerning the privacy of medical records. All that reach was bad enough, a data breach from and a governmental site is even worse. It is becoming more than obvious, but the weak financial infrastructure, of the patchwork of worker's Compensation systems for the country are creating serious challenges. Instead of attempting to run 50 different programs throughout the country, it is probably A good idea to start looking inward, and establishing a single solid system that can meet the needs required to run A multibillion-dollar benefit system the rep country and also maintain the confidentiality and privacy that the parties participating in it require. Today's post shared from therepublic.com

Hackers gained access to the personal information of about 26,000 Pennsylvanians who use debit cards to receive jobless and workers' compensation benefits, the Pennsylvania Treasury Department said Thursday.
The incident was part of a wider security breach affecting 465,000 holders of JPMorgan Chase & Co. prepaid cash cards nationwide.
The breach affects only cardholders who used the JPMorgan Chase UCard Center website between mid-July and mid-September, the Treasury Department said. Michael Fusco, a spokesman for JPMorgan, said the bank found no evidence any information was used improperly.
JPMorgan first contacted the Pennsylvania Treasury Department on Tuesday, agency spokesman Gary Tuma said.
JPMorgan has referred the matter to law enforcement and would not explain details of how the breach occurred, the Treasury Department said.
The Pennsylvania agency wants details from JPMorgan Chase about the bank's response to the breach, including an explanation for any delay in notifying it and the additional measures it will undertake to protect against a recurrence.
The department said most of the personal information that might have been viewed includes card numbers, dates of birth, user IDs, email addresses. Information on external bank accounts might have been exposed, as well, if a cardholder completed a transaction to it, the department said.
Cardholders are being contacted by letter with instructions and are being urged by JPMorgan Chase in the meantime to...
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