Workers' Compensation: insurance

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Wednesday, December 4, 2013

Workers' Compensation Board hosts meetings to help improve services

New York state's Workers' Compensation Board has started a sweeping effort to examine the system, and look at how it could more effectively meet the needs of injured workers and employers. It's in the midst of holding sessions where injured workers can express their opinions.
The second of three sessions was held yesterday in Syracuse, and allowed injured workers to chime in on the discussion in central New York. Fidel, Alejandro Velacqueis Perez was among those telling stories.
His ankle was shattered on the job at a stone cutting company in Delaware County. While waiting four months for a Workers' Compensation hearing, he's basically homeless.
"I need help," Perez said. "I don't have any resources. I don't have money to buy food. I don't have money to get a phone and reach my family."
Interpreting for Perez is Rebecca Fuentes of the Workers Center of Central New York. She says immigrant voices especially need to be heard, but part of the problem is that many don't even know Workers' Compensation exists. An answer to that would be more outreach from the agency.
"People in this building need to get out," Fuentes said. "We want to see them out at events, tabling. We need to see them everywhere. Because workers are getting injured, and they're not having equal access to this right."
Fuentes says among other things, some immigrants lose their jobs after an injury because they apply for Workers' Compensation. She says it is a serious issue that the Workers' Compensation Board...

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Tuesday, December 3, 2013

The Workers' Compensation Nuclear Option: Detroit officially enters bankruptcy

The "nuclear option" for a workers' compensation claim is a public entity bankruptcy and Detroit got the Court's approval to go forward with the legal maneuver. Over the course of the last 3 decades, bankruptcy has become a common practice to shield private corporations from product liability claims. Asbestos claims have seen dozen of companies use this legal tactic to reduce payment to less that 5% on the dollar. As corporations struggle for life in this changing economy, workers are now experiencing the effects of bankruptcy ruling to reduce their benefits and break the promise made in 1911 for an efficient and cost effective benefit program. Today’s post is shared from deseretnews.com

Detroit is finally officially bankrupt, a federal bankruptcy judge certified on Tuesday.

"It is indeed a momentous day," U.S. bankruptcy judge Steven Rhodes said at the end of a 90-minute summary of his ruling, USA Today reported. "We have here a judicial finding that this once-proud city cannot pay its debts. At the same time, it has an opportunity for a fresh start. I hope that everybody associated with the city will recognize that opportunity."

Rhodes surprised some observers by saying he would support the city in shaving pension expenses, a key bone of contention. The ruling on pensions has significant implications for others cities elsewhere. In California, for example, cities such as San Bernardino could seize the precedent, the Sacramento Bee suggested.

"But one...

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Are Smokers Really the ACA’s Biggest Losers?

Smoking is a major pre-existing condition in workers' compensation claims and it is also a multiplier for medical conditions that result in malignancies. Penalizing smokers through the ACA (Affordable Care Act) will also have an effect on workers' compensation claims. Today's post was shared by The Health Care Blog and comes from thehealthcareblog.com

Facing thousands in extra insurance costs, smokers appear to be the Affordable Care Act’s (ACA) biggest losers. Employers are allowed charge smokers up to 50% more for their medical coverage than nonsmokers , starting in 2014.
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...

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NJ COLA Bill - Legislative Hearing Scheduled

The NJ Senate Budget and Appropriations Committee will hold a public hearing on a pending COLA bill S613 to increase benefits on 12/5/2013 1:00:00 PM.

The Senate Labor Committee report

The Senate Labor Committee reports favorably and with

committee amendments Senate Bill No. 613.

As amended by the committee, this bill provides, from July 1, 2013

forward, an annual cost of living adjustment (COLA) in the weekly

workers' compensation benefit rate for any worker who has become

totally and permanently disabled from a workplace injury at any time

after December 31, 1979 and for the surviving dependents of any

worker who died from a workplace injury after December 31, 1979.

The COLA would be an amount such that, when added to the

workers' compensation weekly benefit rate initially awarded, the sum

will bear the same percentage relationship to the maximum benefit rate

at the time of the adjustment that the initial rate bore to the maximum

rate at the time of the initial award, except that:

1. The bill reduces the amount of the adjustment as much as

necessary to ensure that the sum of the adjustment and the amount

initially awarded does not exceed the amount which would cause any

reduction of disability benefits payable under the Federal Old Age,

Survivors and Disability Act; and

2. The bill reduces the supplemental workers’ compensation

benefits (but not regular workers’ compensation) for claimants injured

after 1979 by the amount of any Social Security benefits (other than

Social Security disability benefits and any increases in Social Security

benefits due to federal statutory changes after May 31, 1980), Black

Lung benefits, or the employer’s share of disability pension payments

received from or on account of an employer, except that if the worker's

original workers' compensation award was already reduced under

current law, there would be no further reduction of the supplemental

benefits under the bill.

These reductions parallel the reductions provided under current

law for claimants who were injured before 1980. The bill also

provides that no supplemental benefits would be paid in any case

where they are calculated to be less than $5 per week.

Current law requires such annual adjustments in the rate of

workers' compensation benefits for death and permanent total

disability to be paid from the Second Injury Fund (SIF), but only for

cases of injury or death occurring before January 1, 1980. The bill

extends the adjustments paid from the SIF to claims originating after

December 31, 1979, although the adjustments would apply only to

benefits paid on those claims after July 1, 2013, thus avoiding a

backlog of retroactive benefits.

The bill provides that supplemental payments will commence only

after SIF assessments are sufficient to pay them without using General

Fund money. The supplemental benefit payments would start on July

1, 2013 and the Department of Labor and Workforce Development is

required to take into account the supplemental benefits when

calculating the amount of the Second Injury Fund assessment which

starts on January 1, 2013, thus avoiding the need for any General Fund

appropriation.

To avoid an abrupt fiscal impact on the workers’ compensation

system, the bill provides that one third of the supplemental benefit rate

be paid during the first year, two thirds of the rate be paid during the

second year and the full amount be paid during the third and

subsequent years.

The bill sets time limits for workers’ compensation insurers and

self-insured employers to notify the SIF when supplemental workers’

compensation benefits are required under the bill. An insurer or selfinsured

employer is required to provide the notice not more than 60

days after the supplement is awarded or voluntary payment is to begin.

If a failure to notify results in the payment of an incorrect amount of

benefits, the liability for the payment of the supplemental benefits is

transferred from the SIF to the insurer or employer until the required

notice is provided.

The bill makes no change in the provisions of sections 1 and 9 of

P.L.1980, c.83 (C.34:15-95.4 and 34:15-95.5), which provide for the

reduction of certain portions of workers' compensation benefits by the

amount of Social Security disability benefits paid. In addition, the bill

expressly states that the supplemental benefits shall not be paid in a

manner which in any way changes or modifies the provisions of those

sections. The bill, therefore, will have no effect on existing provisions

of State and federal law regarding offsets between workers'

compensation and federal Social Security disability benefits.

The committee amendments provide that the application of the cost

of living adjustment commence on July 1, 2013, instead of July 1,

2011.

This bill was pre-filed for introduction in the 2012-2013 session

pending technical review. As reported, the bill includes the changes

required by technical review, which has been performed.

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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.

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...

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Monday, December 2, 2013

Consumers, Employers Face New Round Of Health Coverage Challenges, Decisions

This news roundup is shared from kaiser.org

The Washington Post: Consumer Tips For Healthcare.gov Show Administration's Cautious Optimism
The Obama administration on Sunday reported vast improvement with the HealthCare.gov health-insurance portal that opened with extensive glitches in October, while acknowledging that the site still needs more work. One sign of ongoing problems came in the form of a blog entry and infographic that Health and Human Services Secretary Kathleen Sebelius published on Huffington Post. Both items provide tips for consumers visiting the site, most notably by encouraging them to use it during off-peak hours — mornings, nights and weekends (Hicks, 12/2).
Kaiser Health News: With Three Weeks Left, Consumers Fear They May End Up Without Health Coverage On New Year’s Day
For people in the states with well-functioning insurance websites, such as California, New York and Kentucky, this appears to leave plenty of time. But making the deadline could be dicier for people in Arizona and the 35 other states where the federal website healthcare.gov is the path to coverage, as well as Oregon and Hawaii, which have struggled to get their sites functioning. On Sunday, the government reported progress in improving healthcare.gov, saying the site now allows more than 800,000 visits a day with the rate of timeouts or crashes reduced to below 1 percent. Officials said repairs continue (Rau, 12/2).
And for employers -
The Washington Post: New...

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How Much Is That X-Ray? Still Hard To Say, Even In Massachusetts

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Finding out how much an X-ray costs sounds like a simple question. But it is actually very difficult to get an answer. In Massachusetts, a new state law requires insurers to be able to tell members how much a test, treatment or surgery will cost.
But while the new law pulls back the curtain on prices of health procedures to some degree, the burden is still on the patient to ask for information. And, as a recent test drive of the new law showed, there are quite a few hoops for patients to jump through.

I threw out my back in September playing squash and went to the doctor. She sent me down the hall for X-rays. I may need more. I'm curious about what my costs will be, so I call my insurer, Blue Cross.
The recorded menu option doesn't mention health care prices, so I press zero, for all other inquiries.
Eventually, I connect with Jamie D. (customer service reps at Blue Cross don’t give their last names). I explain that I'd like to compare the price of lower back X-rays at a few facilities.
She starts in with the questions: What's the doctor's name? What's the facility where I want to have the X-ray? I have the doctor's name and facility, but I’m stuck on the next question. Blue Cross wants the procedure codes for each X-ray I may need, my doctor's national ID number and the name, address and ID number for my hospital or lab, so it can consolidate all the charges into one estimate.
Jamie directs me to a form online. I call my doctor and get the info. If I...

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Wednesday, November 27, 2013

The World Trade Center Registry Opened Again to Register 9-11 Workers

On November 13, 2013, Governor Andrew M. Cuomo signed significant protections for World Trade Center workers into the Workers' Compensation Law under Article 8-A. The legislation extends and enhances workers' compensation eligibility and benefits for World Trade Center workers. Most notably, the legislation reopens the World Trade Center Registry; extends the deadline period for filing Form WTC-12, Registration of Participation in World Trade Center Rescue, Recovery and/or Clean-up Operations, with a deadline to September 11, 2014; reopens previously time-barred World Trade Center claims and considers them timely; and adds qualifying conditions to the law.

Reopening of Registry and Extension of Filing Period for Form WTC-12

The World Trade Center Registry, which preserves workers' compensation rights for those who performed rescue, recovery, and clean-up operations after the World Trade Center attacks, is now reopened and will remain open until September 11, 2014. Previously, any claims for which the associated Form WTC-12 was received after September 13, 2010 were time-barred. Those workers were not entitled to benefits. These claims will now be reopened and considered timely.
Workers who participated in the rescue, recovery, and clean-up operations of the World Trade Center between September 11, 2001 and September 11, 2002, should promptly register their service participation with the NYS Workers' Compensation Board (Board). This registration will preserve workers'...

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Tuesday, November 26, 2013

NJ Workers Compensation Rates 2014

Revision of Rates and Rating Values – Effective January 1, 2014

The Commissioner of Banking and Insurance (“Commissioner”) has approved a 3.6%
increase in rates and rating values applicable to New Jersey workers compensation and employers
liability insurance effective January 1, 2014 on a new and renewal basis. The rating components of the increase are summarized below.

PREMIUM AND LOSS EXPERIENCE

Analysis of data for the latest two complete policy years and the latest calendar-accident
year, following adjustment to present premium and benefit levels, using paid and incurred losses
separately, indicates a premium level adjustment factor of 0.979 (-2.1%) due to experience.

A trend factor of 1.055 (+5.5%) is included to recognize changing exposures and losses.

BENEFIT CHANGES

Effective January 1, 2014, the maximum weekly benefit with respect to all types of injuries,
except permanent partial disabilities, will be changed from $826 to $843. The minimum weekly benefit will be changed from $220 to $225. In cases involving permanent partial disabilities, the present maximum weekly benefits ranging from $220 to $826, varying on the basis of duration of disability, will be changed to $225 and $843, respectively. The minimum weekly benefit for permanent partial injuries will remain at $35. The effect of the changes to the minimum and maximum weekly benefits results in a premium level adjustment factor of 1.007 (+0.7%) due to benefits.
EXPENSES

There is need for decreases in the provisions for Loss Adjustment Expense, the Security
Fund and Bureau Expense. The changes to the expense provisions result in a premium level adjustment factor of 0.996 (-0.4%).

OVERALL PREMIUM/RATE LEVEL CHANGE

The combined effect of the above adjustment factors results in an indicated premium level
adjustment factor of 1.036 (+3.6%). The rate level adjustment is also an increase of +3.6%.

CATASTROPHE PROVISIONS

A Terrorism Premium Charge of $0.03 per unit of exposure applies to all policies except
for the exclusions in 3:9-2 and 3:9-5 of the Manual. Upward deviation from the $0.03 rate is
permissible.

A Catastrophe (Other than Certified Acts of Terrorism) Premium Charge of $0.01 per
unit of exposure applies to all policies except for the exclusions in 3:9-9 and 3:9-12 of the Manual.

CLASSIFICATION RATES

The adjustment of classification rate relativity is based on the policy experience for 2006
through 2010, as reported through the Statistical Plan. The changes in the rates for the individual
classifications including those in the Admiralty and Federal Employers Liability Act coverage are
supported by, and derived from, the experience.

There are 572 classifications in the Manual effective January 1, 2014 including the codes to
accommodate Federal employments. Eight classifications carry no rate assignment. Of the remainder, 381 will experience increased rates, the rates for 167 classes will decrease, and 16 are unchanged. There are no changes to the annual policy charges for private estate or residence employees as set forth in 3:5-12 of the Manual.

In order to comply with the decision of the Commissioner, changes in manual rates for any
classification have been limited to an increase of 15% from last year’s rate. The increase percentage applicable to non "F" classifications when coverage is provided under the United States Longshore and Harbor Workers Compensation Act remains unchanged at 50%.

MINIMUM PREMIUM FORMULA

The minimum premium multiplier is increased from 100 to 150 and the maximum
minimum premium is increased from $850 to $900. The change to premium resulting from the new
rating values in the minimum premium formula is minimal and does not impact the overall rate level.
Special minimum premiums applicable to private residence classifications and to classifications subject to Maritime or Federal Employers Liability Act coverage are not affected.

SURCHARGES

New Jersey law mandates application of separate policyholder surcharges to finance the
Second Injury and Uninsured Employers’ Funds. Based on the Department of Labor and Workforce
Development’s estimate of 2014 Fund requirements, the policyholder surcharge percentages effective January 1, 2014, on a new and renewal basis to be applied to the modified premium are:
Second Injury Fund 6.56%
Uninsured Employers’ Fund 0.00%

The Next Wave: N.H.L. Players Sue League Over Head Injuries

Occupational illness claims have been a traditional battleground in workers' compensation for larger and more significant lawsuits and dynamic changes in the safety of the workplace induced by economics.

From the lack of the incorporation of occupational claims in the 1911 model workers' compensation acts, in the 1950's, employers and their insurance companies sought refuge under the "exclusivity bar" of the. workers' compensation act to shield themselves from negligence actions for silicosis and asbestosis claims.

The creativity of claimant's lawyers, and the blatant intentional tort acts of unscrupulous asbestos companies, brought forth a sweeping change in the economic balance as claimants used the civil justice system to establish an avenue for adequate compensation for asbestos victims (lung cancer, asbestosis and mesothelioma claims).

Asbestos litigation, "longest running tort, continues today and is the perfect example of the societal benefits of a working civil justice system. In fact, the same dynamic existed in: tobacco litigation, lead paint litigation, latex litigation and has been repeated many times over.

The civil justice system, not the workers' compensation system, established an economic incentive establishing a safer workplace for workers and their families.

It is more than obvious that contact sports are seeing the next wave of litigation as the employers and their insurance companies accelerate the cycle, by barring professional athletic players from even seeking workers' compensation benefits, ie. California.

Since it appears that no safe helmet can be manufactured to protect the mayhem of some contact sports, the business of sports will be the next "industry" to experience economic incentives to make the workplace safer. The higher education system will just have to find another economic engine to fund colleges and university and stop luring students to play dangerous sports in hope of winning the professional sports lottery.

First football, now hockey, are emerging targets of the civil justice system as the economics of safety takes hold and the need for safety takes hold. Today's post is shared from the nytimes.com.

Ten former N.H.L. players sued the league Monday for negligence and fraud, saying the sport’s officials should have done more to address head injuries but instead celebrated a culture of speed and violence.

The players, who were in the league in the 1970s, ’80s and ’90s, filed their suit in federal court in Washington. One of the lead lawyers is Mel Owens, a former N.F.L. player who has represented scores of other retired players in workers’ compensation cases.

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Wednesday, December 4, 2013

Workers' Compensation Board hosts meetings to help improve services

Tuesday, December 3, 2013

The Workers' Compensation Nuclear Option: Detroit officially enters bankruptcy

Are Smokers Really the ACA’s Biggest Losers?

NJ COLA Bill - Legislative Hearing Scheduled

As Hospital Prices Soar, a Single Stitch Tops $500

Monday, December 2, 2013

Consumers, Employers Face New Round Of Health Coverage Challenges, Decisions

How Much Is That X-Ray? Still Hard To Say, Even In Massachusetts

Wednesday, November 27, 2013

The World Trade Center Registry Opened Again to Register 9-11 Workers

Reopening of Registry and Extension of Filing Period for Form WTC-12

Tuesday, November 26, 2013

NJ Workers Compensation Rates 2014

The Next Wave: N.H.L. Players Sue League Over Head Injuries

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