Attorneys should follow the correct procedures to contest a lien asserted by a workers’ compensation insurance carrier. A recent case provides instructions on the appropriate techniques.
Showing posts with label Settlement. Show all posts
Showing posts with label Settlement. Show all posts
Sunday, May 5, 2019
Monday, April 30, 2018
NJ Mandates Reporting of Medicare Conditional Payments
The NJ Division of Workers’ Compensation has now mandated the reporting of pending workers’ compensation claims possibly eligible for reimbursement of conditional medical payments to the US Centers for Medicare and Medicare Services (CMS) as a condition precedent to the settlement of a pending claim for benefits. The directive was outlined in a memorandum issued by Russell Wojtenko, Jr., Director and Chief Judge of Compensation on April 18, 2018.
Thursday, March 22, 2018
Massachusetts Reaches Workers' Compensation Rate Settlement
Massachusetts businesses will save approximately $150 million under a settlement Attorney General Maura Healey reached with the State Rating Bureau (SRB) and the Workers’ Compensation Rating and Inspection Bureau (WCRIB). The settlement, which follows the AG’s intervention in an administrative rate proceeding at the Division of Insurance, results in an average rate rollback of 12.9 percent on workers’ compensation insurance in the state.
Friday, July 10, 2015
Injured worker has no standing in a subrogation claim
An injured worker has no standing in a subrogation action initiated by a tby the insurance carrier/employer against the ultimate wrongdoer where the injured worker takes no action to pursue a personal injury action against the third party. The injured worker, who fails to file an action, has no right to interfere with the subrogation claim and need not be notified of the settlement.
A NJ Appellate Court ruled that the failure of the injured worker to proactively initiate a third party claim prohibited the employee from involvement/recovery in the subrogation action.
A-4731-13T1
INAAM ELHELOU, ET AL. VS. LIPINSKI OUTDOOR SERVICES, ET AL.
VS. ALL STATE POWER WASH
July 9, 2015
2015 WL 4112210 (N.J.Super.A.D.)
A NJ Appellate Court ruled that the failure of the injured worker to proactively initiate a third party claim prohibited the employee from involvement/recovery in the subrogation action.
A-4731-13T1
INAAM ELHELOU, ET AL. VS. LIPINSKI OUTDOOR SERVICES, ET AL.
VS. ALL STATE POWER WASH
July 9, 2015
2015 WL 4112210 (N.J.Super.A.D.)
Saturday, May 18, 2013
NJ Court Approves Medicare Set-Aside Agreement Lacking CMS Review
A NJ Superior Court deemed a proposed Medicare Set-Aside Agreement to be satisfactory to protect Medicare's interests and granted a Motion to Enforce a Pending Settlement. This action by the Court was taken after CMS (Centers for Medicare & Medicaid Services) declined to rule on the adequacy of the Set Aside Agreement because of limited Federal resources.
"The court has thoroughly reviewed the sworn testimony of plaintiffs' expert regarding the proposed set-aside amounts for future medical expenses relating to the
underlying accidents/incidents, which would otherwise be covered or reimbursable
by Medicare. The court finds that the proposed set-aside amount in each case
fairly takes Medicare's interests into account in that the figures are both reasonable and reliable. Therefore, the court is satisfied that Medicare's interests
have been adequately protected pursuant to the MSP. Plaintiffs shall set aside the
proposed sums in self-administered interest-bearing accounts to be used solely for
the purpose of satisfying future medical expenses related to the underlying accidents/incidents."
DUHAMELL, Plaintiff v. RENAL CARE GROUP EAST, INC., RCG Southern New Jersey, LLC, Philadelphia Suburban Development Corporation, Defendants. Catherine A. Ney, Plaintiff, et al,, --- A.3d ----, 2013 WL 2102701 (N.J.Super.A.D.) Decided Dec. 7, 2012. May 16, 2013.
"The court has thoroughly reviewed the sworn testimony of plaintiffs' expert regarding the proposed set-aside amounts for future medical expenses relating to the
underlying accidents/incidents, which would otherwise be covered or reimbursable
by Medicare. The court finds that the proposed set-aside amount in each case
fairly takes Medicare's interests into account in that the figures are both reasonable and reliable. Therefore, the court is satisfied that Medicare's interests
have been adequately protected pursuant to the MSP. Plaintiffs shall set aside the
proposed sums in self-administered interest-bearing accounts to be used solely for
the purpose of satisfying future medical expenses related to the underlying accidents/incidents."
DUHAMELL, Plaintiff v. RENAL CARE GROUP EAST, INC., RCG Southern New Jersey, LLC, Philadelphia Suburban Development Corporation, Defendants. Catherine A. Ney, Plaintiff, et al,, --- A.3d ----, 2013 WL 2102701 (N.J.Super.A.D.) Decided Dec. 7, 2012. May 16, 2013.
Thursday, February 17, 2011
Hot Topics in Workers’ Compensation Law 2011 Seminar
This popular annual program, offered by the NJ Institute for Continuing Legal Education (NJICLE), is geared to both the novice and expert Workers’ Compensation attorney. It provides important and essential information to understand the cutting edge and critical issues confronting those who practice workplace injury law.
During the program, you’ll gain insight into understanding both simple and complex jurisdictional issues, medical benefits, and off-premises injuries. The seminar will enlighten you of ethical issues in obtaining and utilizing social networking evidence. The program will provide guidance by a judicial panel of ethical considerations in the negotiation, presentation and finalization of a settlement in workers’ compensation matters.
The seminar features a panel of some of the most respected New Jersey Workers' Compensation Judges and attorneys, who will review and provide insight on the top issues and cases that have emerged during the past year.
As an attendee, you’ll pick up practical pointers that have proven successful in matters ranging from jurisdictional issues through coverage of employment. The program will expand your horizons and broaden your practice potential into expanding in developing areas of the law. Make plans to register today!
Program Agenda
· The Ethical Considerations of the Settlement, Strategy & Tactics· Medical Benefits: Compliance, Penalties and Counsel Fees
· Social Networking: The Perils & Pitfalls for Employee & Employers
· Multi-State Jurisdictional Issues and Apportionment of Liability
· Off Premises Injuries: When Is A Trip to the Coffeehouse Compensable
· Discrimination Claims: Current Developments
Program Moderators
Author, NJ Workers' Compensation Law 3rd Ed (Thompson-West)
Jon L. Gelman, LLC
(Wayne)
Weston Stierli McFadden & Capotorto
Certified by the Supreme Court of New Jersey as a Workers’ Compensation Attorney
(Parsippany)
Speakers
Supervising Judge of Workers’ Compensation
(Camden)
Supervising Judge of Workers’ Compensation
(Bridgeton)
Judge of Workers’ Compensation
(Newark)
Judge of Workers’ Compensation
(Hackensack)
Rabner Allcorn Baumgart & Ben-Asher, P.C.
(Upper Montclair)
Kancher Law Firm, L.L.C.
(Haddonfield)
Certified by the Supreme Court of New Jersey as a Workers’ Compensation Attorney
Smith Magram Berenato & Michaud
(Burlington)
(Burlington)
Certified by the Supreme Court of New Jersey as a Workers’ Compensation Attorney
Pietras, Saracino, Smith & Meeks
(Cherry Hill)
Certified by the Supreme Court of New Jersey as a Workers’ Compensation Attorney
David Tykulsker & Associates
(Montclair)
Wednesday, February 16, 2011
Court Holds Parties May Assert A Third Party Lien Against Lump Sum Payment
A NJ Court of Appeals has held that parties may stipulate, as part of a workers' compensation settlement, that a third party lien may be asserted against a lump sum payment. A workers' compensation settlement contracted into by the parties, and approved by a Judge of Compensation, supersedes the statutory prohibition against the assertion of a lien on such proceeds.
Statutorily workers' compensation settlements made pursuant to NJSA 34:15-20 are immune form the assertion of a third party recovery lien made in accordance with a settlement under NJSA 34:15-40. As part of the workers' compensation settlement, the parties stipulated to the assertion of a third party recovery lien, and the Appellate Court held the contractual agreement made between the parties to be valid.
The effect of this ruling will ultimately dilute, yet again, the value of a workers' compensation award globally. Claimants and their attorneys will be hard pressed to avoid the the inclusion of the stipulated waiver in Section 20 settlements since the alternative route would be the trial of a claim where the statutory lien mandated under NJSA 34:15-40 would be applied."The resolution of plaintiff's claims, including retention of the Section 40 lien, was negotiated as a material part of the settlement. A settlement agreement between parties in litigation is a contract. Nolan v. Lee Ho, 120 N.J. 465, 472 (1990) (citing Pascarella v. Bruck, 190 N.J.Super. 118, 124- 25 (App.Div.), certif. denied, 94 N.J. 600 (1983)). Accordingly, American Style's right of reimbursement on the $50,000 is contractual rather than statutory.
"Significantly, Calle acknowledged under oath his understanding that a Section 40 lien amount of $50,000 of the money ... [was] reservable by the insurance company as pay back for authorized treatment. This money will come from the part of the case that was handled by [the Law Firm in the Superior Court action] should they have a financial recovery.
"The parties relied upon that understanding when they entered into the settlement agreement. It would be inconsistent with the agreement and unjust to permit Calle to repudiate that understanding after the fact. See Knorr v. Smeal, 178 N.J. 169, 178 (2003) (observing that estoppel "is designed to prevent injustice by not permitting a party to repudiate a course of action on which another party has relied to his detriment").
DANIEL AQUILINO CALVA CALLE Administrator ad prosequendum of the Estate of CHRISTIAN DANIEL CALVA SIGUENA, Deceased and DANIEL AQUILINO CALVA CALLE individually v. HITACHI POWER TOOLS, AMERICAN STYLE CONSTRUCTION, INC HITACHI KOKI, USA , LTD., DOCKET NO. A-1015-09T1--- A.3d ----, 2011 WL 499345 (N.J.Super.A.D.)
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