On Monday, a federal judge ruled that Google had acted illegally to maintain a monopoly in online search. This landmark decision strikes at the power of tech giants in the modern internet era and may fundamentally alter how they do business.
Showing posts with label Lawyers and Law Firms. Show all posts
Showing posts with label Lawyers and Law Firms. Show all posts
Friday, August 9, 2024
Friday, January 13, 2017
Medicare Advantage Organization Allowed to Sue Law Firm and Lawyer Over Conditional Payments
A Federal Court has ruled that a Medicare Advantage Organization (MAO) is permitted under the law to sue a law firm and a lawyer for the failure to reimburse conditional medical expenses arising out of an accident.
US District Court Judge, Henry E. Hudson, ruled that the Medicare Secondary Payer statute created a private cause of action to pursue recovery for conditional payments that it made on the beneficiary's behalf for medical expenses resulting from an automobile accident.
"Although not binding precedent, this Court finds persuasive the Third Circuit's determination that a MAO may pursue recovery pursuant to the private right of action in § 1395y(b)(3)(A). Section 1395y(b)(2)(A)'s plain language establishes a private right of action to recover double damages where a primary plan fails to pay. Absent from the plain language of the statute is any restriction upon who may utilize that private right of action."
Humana Insurance Co. v Paris Blank LLP, 197 F. Supp. 3d 676 (E.D. Virginia 2016)
Tuesday, January 28, 2014
Will GPS "Dots" Change Our Privacy Standards in Workers Compensation
As Global Positioning Systems (GPS) expand and integrate with the Internet, the applications for the invasion of privacy seem endless in workers' compensation. GPS "dots" can be applied to employees and/or equipment, to delineate deviation from the course of employment, temporary disability non-work status and treatment compliance.
After listening to the TED Radio Talk this week on NPR, where Todd Humphrey's describes possibilities to of using GPS "dots," one wonders how much privacy an injured employee will be required to surrender because of an accident at work.
Click here to listen to: TED Radio Hour - Predicting the Future
After listening to the TED Radio Talk this week on NPR, where Todd Humphrey's describes possibilities to of using GPS "dots," one wonders how much privacy an injured employee will be required to surrender because of an accident at work.
Click here to listen to: TED Radio Hour - Predicting the Future
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...
[Click here to see the rest of this post]
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...
[Click here to see the rest of this post]
Thursday, December 12, 2013
Florida New Case Filings Continue To Go South
 |
| FL New Case Filings Decrease |
Click here to read the complete report.
Tuesday, December 10, 2013
Delay Or Deny At Your Risk
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 "... |
Tuesday, December 3, 2013
Are Smokers Really the ACA’s Biggest Losers?
On November 25, Fox News put it best: “Obamacare Policies Slam Smokers,” , noting that “smokers are the only group with a pre-existing condition that Obamacare penalizes.” THCB itself has headlined: Smokers Face Tough New Rules under Obamacare.
And these headlines are absolutely accurate — meaning that, with the possible exception of the e-cigarette, ACA is the best thing that has happened to employed smokers ever.
Here is how we arrive at this conclusion. The data is mixed on whether smokers incur much higher healthcare costs or just slightly higher healthcare costs during their working ages than non-smokers do. None of the data shows that their costs are lower, but let’s say there is no impact on health spending.
Nonetheless, the following is incontrovertible: smokers take smoking breaks.Remarkably, there are no laws specifically governing smoking breaks, and like most other quantifiable human resources issues, no one has quantified them. But we all observe these breaks, and about a fifth of us participate in them. They reduce productivity. By definition, if you are outside smoking, you are not inside... |
As Hospital Prices Soar, a Single Stitch Tops $500
| Medical delivery costs continue to soar and workers' compensation claims costs are running out of ontrol. Cost for emergency medicare are not usually regulated by workers' compensation prorams, eve where balance cillig is removed from the equation. Todays post is shared from the NYTimes.org With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center’s tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.  On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. “It was great — they had good DVDs, the staff couldn’t have been nicer,” said Emer Duffy, Orla’s mother. Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11. Orla’s forehead was sealed with a dab of skin glue for $1,696. “When I first saw the charge, I said, ‘What could possibly have cost that much?’ ” recalled Ms. Singh. “They billed for everything, every pill.” In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care... |
Saturday, October 26, 2013
Florida Upholds Low Counsel Fees
$164.54 for 107.2 hours of legal work
"Constrained by the statutory formula set forth in section 440.34(1), Florida
Statutes (2009), the judge of compensation claims awarded claimant’s counsel an
attorney’s fee of only $164.54 for 107.2 hours of legal work reasonably necessary
to secure the claimant’s workers’ compensation benefits. We do not disagree with
the learned judge of compensation claims that the statute required this result, and
are ourselves bound by precedent to uphold the award, however inadequate it may
be as a practical matter. "
*****
"In the circumstances, we certify to the Florida Supreme Court the following as a question of great public importance:
WHETHER THE AWARD OF ATTORNEY’S FEES IN
THIS CASE IS ADEQUATE, AND CONSISTENT
WITH THE ACCESS TO COURTS, DUE PROCESS,
EQUAL PROTECTION, AND OTHER
REQUIREMENTS OF THE FLORIDA AND
FEDERAL CONSTITUTIONS.
The fee award is affirmed, and the question of its constitutional adequacy is
certified to the supreme court. "
MARVIN CASTELLANOS,
Appellant,
v.
NEXT DOOR COMPANY/
AMERISURE INSURANCE
CO.,
Appellees. (Filed Oct. 23, 2013)
"Constrained by the statutory formula set forth in section 440.34(1), Florida
Statutes (2009), the judge of compensation claims awarded claimant’s counsel an
attorney’s fee of only $164.54 for 107.2 hours of legal work reasonably necessary
to secure the claimant’s workers’ compensation benefits. We do not disagree with
the learned judge of compensation claims that the statute required this result, and
are ourselves bound by precedent to uphold the award, however inadequate it may
be as a practical matter. "
*****
"In the circumstances, we certify to the Florida Supreme Court the following as a question of great public importance:
WHETHER THE AWARD OF ATTORNEY’S FEES IN
THIS CASE IS ADEQUATE, AND CONSISTENT
WITH THE ACCESS TO COURTS, DUE PROCESS,
EQUAL PROTECTION, AND OTHER
REQUIREMENTS OF THE FLORIDA AND
FEDERAL CONSTITUTIONS.
The fee award is affirmed, and the question of its constitutional adequacy is
certified to the supreme court. "
MARVIN CASTELLANOS,
Appellant,
v.
NEXT DOOR COMPANY/
AMERISURE INSURANCE
CO.,
Appellees. (Filed Oct. 23, 2013)
Friday, October 25, 2013
mHealth: A Potential Player for Workers' Compensation
Delivery of workers' compensation medical care is one of the most costly items on the landscape of the social, remedial program. A recent article in the AMA Journal raises doubts that the delivery of medical care utilizing electronic mobile technology will be an advantageous solution to spiraling costs.
"mHealth technologies have the potential to change every aspect of the health care environment and to do so while delivering better outcomes and substantially lowering costs. For consumers, mHealth offers the promise of improved convenience, more active engagement in their care, and greater personalization. For clinicians, mHealth could lead to reduced demands on their time and permit them to instead refocus on the art of medicine. Much remains to be done to drive this transformation. Most critically needed is real-world clinical trial evidence to provide a roadmap for implementation that confirms its benefits to consumers, clinicians, and payers alike."
Click here to read the entire article appearing in the AMA Journal
"mHealth technologies have the potential to change every aspect of the health care environment and to do so while delivering better outcomes and substantially lowering costs. For consumers, mHealth offers the promise of improved convenience, more active engagement in their care, and greater personalization. For clinicians, mHealth could lead to reduced demands on their time and permit them to instead refocus on the art of medicine. Much remains to be done to drive this transformation. Most critically needed is real-world clinical trial evidence to provide a roadmap for implementation that confirms its benefits to consumers, clinicians, and payers alike."
Click here to read the entire article appearing in the AMA Journal
Tuesday, October 22, 2013
DePaolo's Work Comp World: Genetic Testing?!
The reason lawmakers and regulators create rules that seem onerous and ponderous to the vast majority of us is because there are "outliers" that ruin it for everyone else because of indescribably selfish behavior.
There's always someone taking a new angle to take advantage of the liberal rules of workers' compensation for their own profit regardless of the social consequences. This seems particularly acute in California, but nevertheless occurs in other jurisdictions too. Recently posted in the WorkCompCentral Forums was an inquiry as to whether anyone else in the community is starting to see bills for unsolicited services related to genetic testing for drug addition predisposition. The author of the post, an attorney for the employer/carrier, says that the case in question had been settled. In preparing the settlement documents a review of California's Electronic Adjudication Management System database was conducted to identify all parties. Nearly all lien claims had been settled, but one remained stubbornly immovable (and I'm not even clear that the parties were ever properly served and/or noticed of this particular vendor until the end of the case). For this one particular lien the claim file notes apparently show a request for billing and report after discovery of the vendor in the EAMS search. The carrier got fax copies of a bill and report with a demand for payment. The bill was for $3,626.00 for the genetic testing. According to the post, the initial report, based on an... |
Thursday, October 17, 2013
Goleta California: Workers' Comp Office Closing
The workers’ compensation office in Goleta — the only one in the county and open since 1999 — is being closed on November 30 with all of its clients and employees transferred to the Oxnard branch. The state’s Department of Industrial Relations (DIR) announced the decision last month.
Decrying the lack of public outreach, the Goleta City Council voted unanimously Tuesday to send a letter to the department opposing the closure and requesting it be postponed until people can weigh in. “It’s really going to be troublesome,” Mayor Roger Aceves said. “We regret any inconvenience,” said DIR spokesperson Peter Melton. “Because [Oxnard is] less than an hour away, the decision was made to merge the offices.” Melton added that the closure is mainly due to the building’s monthly rent — more than $20,000 — and the increased space at the Oxnard office. He added that the Goleta branch — the only one closing right now — is one of the smallest out of the state’s 24, with only one judge and 1,254 hearing requests so far this year. Aceves said he hopes the letter results in a public hearing or perhaps a compromise in which cases are held in Goleta a couple of days per week. There is no word on whether other cities in the county plan on taking similar action. Employees at the Goleta office said they couldn’t comment on the closure. Megan Compton, an attorney for the Santa... |
Thursday, September 26, 2013
NJ Workers' Compensation Maximum Rate Rising in 2014
The maximum NJ Workers' Compensation is proposed to rise to $843.00 per week in 2014. The rate is based upon the State's Average Weekly Wage (SAWW). The rate applies to temporary disability, permanent disability, permanent total, permanent partial total, and dependency benefits.
The rate for 2013 is $826.00.
NJAC 12:235-1.6 (September 3, 2013)
2013 NJ REG TEXT 335666
The rate for 2013 is $826.00.
NJAC 12:235-1.6 (September 3, 2013)
2013 NJ REG TEXT 335666
Thursday, September 19, 2013
Medical Costs Still Treading Upward
The cost of medical treatment in workers' compensation claims, despite a resumed trend in lower claims, is continuing to increase.
View complete report: NCCI Workers Compensation Claim Frequency—2013 Update
Wednesday, April 25, 2012
A Milestone for Workers' Compensation
Today, marks a significant milestone for this blog. It has had over 250,000 page views. When I launched it about 4 years ago, I wasn't really sure how much interest readers would have in the developments and trends of a system that was almost a century old.
Community involvement has been very instrumental in making the effort successful. I am very grateful to our readers and the large number of outstanding guest bloggers who have contributed to reaching this milestone.
Our current analytics reflects that there is a strong interest in the health and safety of workers, and the benefit system know as workers' compensation. It exists every single jurisdiction in the nation, and around the globe. The spectrum of story interest is as widely diverse as the multitude of programs in existence.
It is very encouraging to know that the expanding readership base has a growing concern about worker's health and safety. Hopefully, as workers' compensation programs continue to mature and develop, there will also remain a strong desire to create a healthier work environment. Hopefully this blog can continue to provide a forum for creative ideas.
Community involvement has been very instrumental in making the effort successful. I am very grateful to our readers and the large number of outstanding guest bloggers who have contributed to reaching this milestone.
Our current analytics reflects that there is a strong interest in the health and safety of workers, and the benefit system know as workers' compensation. It exists every single jurisdiction in the nation, and around the globe. The spectrum of story interest is as widely diverse as the multitude of programs in existence.
It is very encouraging to know that the expanding readership base has a growing concern about worker's health and safety. Hopefully, as workers' compensation programs continue to mature and develop, there will also remain a strong desire to create a healthier work environment. Hopefully this blog can continue to provide a forum for creative ideas.
Monday, February 27, 2012
The Religious Opt-Out Scheme: A New Approach to Eliminate Workers' Compensation
 |
| 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.
Thursday, February 23, 2012
Workers Compensation: The Next Wave From California
The California Division of Workers' Compensation has announced a series of public discussions for comments and concerns as it struggles in crafting a potential modification of its system.
Click here to read the California DWC Announcement
Click here to read the California DWC Announcement
Topics of discussion will include:
- Provision of appropriate medical treatment without unnecessary delay, the Medical Provider Network (MPN), Utilization Review (UR) or other issues
- Enabling injured workers to return to work as quickly as medically feasible
- Adequate compensation for permanent disabilities
- Reducing the burden of liens on the system
- Identification of appropriate fee schedules
- Reducing unnecessary litigation costs
- Assessing appropriate use of opiates and other care
- Any other improvements needed
Tuesday, February 14, 2012
Subscribe to Workers Compensation on Google Currents
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Source: http://goo.gl/mag/vLHRn
or
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Tuesday, January 24, 2012
Workers Compensation Fails to Cover Most Occupational Disease Claims
Click here to read the entire report: Economic Burden of Occupational Injury and Illness in the United States Get PDF (611K)
"The medical and indirect costs of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Workers’ compensation covers less than 25 percent of these costs, so all members of society share the burden. The contributions of job-related injuries and illnesses to the overall cost of medical care and ill health are greater than generally assumed."
Wednesday, January 11, 2012
Saying "I Do" In Workers' Compensation Court
Read the bill: NJ S.746
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