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Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts

Sunday, January 12, 2014

Massachusettes Senator Seeks to Double Payment for Workers Killed on the Job

Following the deaths of two workers last month at Boston construction and shipping sites, Senator Brian A. Joyce and the Massachusetts Coalition for Occupational Safety and Health (MassCOSH) are renewing their calls for passage of Joyce’s Bill, "The Families of Fallen Workers Burial Act," which would double the benefit amount paid by workers’ compensation when a loved one is killed at work.
“The amount paid out to grieving families has remained stagnant for decades while the cost of a burial has risen steadily,” said Joyce. “These families are going through enough already without the additional stress of coming up with thousands of dollars to put their loved ones to rest.”
According to the 2010 funeral price survey by the National Funeral Directors Association, the average funeral cost for an adult funeral is $7,775. With cemetery plot, grave marker, flowers or obituary notices, the “regular adult funeral” cost is at least $9,000. Joyce’s bill would increase the benefits allotment from $4,000 to roughly $8,000 (eight times the average weekly wage in the Commonwealth) and tie future increases to inflation.
“The Families of Fallen Workers Burial Act will ensure that no family has to shoulder the financial burden of a burial,” said MassCOSH Executive Director Marcy Goldstein-Gelb. “The increase adds up to very little for the workers’ compensation insurance system and will mean a huge difference...
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Saturday, January 11, 2014

Former Texas Workers' Compensation Director Pleads Guilty to $500,000 Fraud

Former Texas Association Of School Boards (TASB) Workers Compensation Claims Administration Director Pleads Guilty To Mail Fraud Charges

In Austin today, Herman G. Wilks, former Department Director of Workers’ Compensation Claims Administration for the Texas Association of School Boards, Inc. (TASB), pleaded guilty to stealing over $500,000 from the TASB’s Risk Management Fund announced United States Attorney Robert Pitman and Federal Bureau of Investigation Special Agent in Charge Armando Fernandez, San Antonio Division.

The TASB is a voluntary, non-profit, statewide educational association that serves and represents local Texas school districts, regional education service centers, community colleges, and tax appraisal districts. One of the products and services offered by TASB to its members is the TASB Risk Management Fund. The TASB Risk Management Fund provides specific coverage to members through their requisite financial contributions into the risk management pool. This coverage can then apply with regard to unemployment compensation claims, workers' compensation claims, auto, liability and property programs. Wilks’ TASB duties included the supervision of setting up member school districts' workers' compensation claims, adjudicating medical bills and carrying out the utilization, management and pre-authorization functions required by the workers' compensation statutes. Pursuant to his title and area of responsibility at TASB, Wilks had control over and direct access to the entire claimant pay process by which TASB accepted and paid workers' compensation claims for its contributing members by way of the TASB Risk Management Fund.

Appearing before U.S. District Judge Sam Sparks this morning, Wilks pleaded guilty to ten counts of mail fraud. By pleading guilty, Wilks admitted that from April 2008 until March 2013, he unlawfully obtained approximately $514,400 from TASB via the TASB Risk Management Fund by submitting fraudulent workers’ compensation claims on behalf of Medco Implantable Supply, a company he created for the sole purpose of carrying out his fraudulent scheme, for products and services that were never actually ordered, provided or rendered.

“Like many defendants, Mr. Wilks undoubtedly concocted his scheme of setting up a dummy company to steal hundreds of thousands of dollars from the TASB Risk Management Fund with full confidence that he would get away with it. This prosecution should remind would-be thieves like Mr. Wilks that their schemes will be discovered and they will lose not only their ill-gotten gain, but their livelihoods, reputations and quite likely their freedom as a result,” stated U.S. Attorney Pitman.

Wilks faces up to 20 years in federal prison per count. He is currently out on bond pending sentencing which has yet to be scheduled.

This indictment resulted from an investigation conducted by the Federal Bureau of Investigation. Assistant United States Attorney Ashley Hoff is prosecuting this case on behalf of the Government
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Sunday, December 29, 2013

Where the 1.3 million people losing unemployment aid this week live

NJ is going to suffer the most by the termination of the unemployment benefit extension. Today's post was shared by Steven Greenhouse and comes from www.washingtonpost.com

Darker shading means a larger share of a state's population will lose emergency jobless benefits on Saturday. Scroll down for an interactive map.
Darker shading means a larger share of a state's population will lose emergency jobless benefits on Saturday. Scroll down for an interactive map.
Darker shading means a larger share of a state’s population will lose emergency jobless benefits Saturday. Scroll down for an interactive map. (Committee on Ways and Means Democrats/Labor Department)
A projected 1.3 million people will lose emergency unemployment benefits when they expire Saturday.
Congress offered the extended benefits as unemployment ballooned during the Great Recession and has put off their expiration 11 times since. Renewing the long-term insurance is a top agenda item for the Senate when it convenes  Jan. 6, Sen. Majority Leader Harry Reid (D-Nev.) has said. The body is expected to vote quickly on a three-month extension of the benefits.
Recipients still face, at best, a delay in their checks and, at worst, a permanent end to them. When the aid expires Saturday, the unemployed will only be able to collect a maximum 26 weeks of benefits in most parts of the U.S., down from about twice as much in many states.
The recession may technically be over, but for many the recovery has yet to begin. The plight of the long-term unemployed — a group the benefits are aimed at helping and whose ranks have swelled — has also proven particularly difficult to solve. Studies have shown that they are more likely to suffer mental-health setbacks and are less likely to be...
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Wednesday, December 25, 2013

Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met

Will these types of medical plans encourage a medical deductible for workers' compensation coverage? Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

If you buy one of the less expensive insurance plans sold through the health law’s marketplaces, you may be in for a surprise. Some plans will not pay for a doctor visit before you meet your annual deductible, which could be thousands of dollars.
"This could be the next shoe to drop, as people don't realize that if they're buying a bronze plan, they may have to pay $5,000 out of pocket before it contributes a penny," said Carl McDonald, senior analyst with Citi Investment Research, speaking at a Washington, D.C., conference last month.
Experts worry that some enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment.
Those who’ve bought their own insurance have always had to pay a set annual sum, called a deductible, before policies begin paying their claims.  But first-time insurance buyers may not realize they’re on the hook for additional costs before benefits kick in, and may choose a plan based solely on the monthly premiums.
Bronze and silver plans -- which have lower monthly costs but typically, higher deductibles -- are the most likely to require consumers to spend that amount themselves before the insurer pays any claims. There is no nationwide data on how many do that. But in seven major cities, half of bronze plans on average require policyholders meet the deductible before insurers help with the cost of a doctor visit, according to an analysis by...
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Saturday, December 21, 2013

Employer Fraud: NJ employer accused of stealing over $265K from workers' comp insurer

Charles Kelcy Pegler Sr.
TRENTON — Charles Kelcy Pegler Sr., 55, of Spring Lake, has been indicted for stealing more than $265,000 by providing false and misleading information to the workers compensation insurance carrier for his roofing company.

Pegler was charged Thursday with second-degree theft by deception, second-degree false contract payment claim for a government contract, third-degree insurance fraud and fourth-degree false swearing, the state Attorney Generals Office announced.

Pegler is the president of Roof Diagnostics Inc. located at 2333 Route 34 in Wall. During the time described by the indictment, the company was at 608 Brighton Ave. in Spring Lake Heights.

The indictment alleges that between June 6, 2002 and Oct. 5, 2009, Pegler stole $265,044 from New Jersey Casualty Insurance Co. by creating the false impression that Roof Diagnostics was not a roofing company, that it did not employ roofers and that it did not install, maintain or repair roofs. That meant he paid far less in insurance premiums than he should have, according to state investigators.

This defendant had a legal responsibility to provide adequate and lawful workers compensation coverage for employees, Acting Attorney General John J. Hoffman said in a release.

By providing misinformation to his workers compensation carrier, he not only failed in this responsibility but also defrauded an insurance company out of hundreds of thousands of dollars.

The cost of such fraud is passed...
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Wednesday, December 18, 2013

In Hollywood, Health Coverage Presents Unique Challenges

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


Inside the Fox Studios in Century City, crews are shooting the latest episodes of some of television’s biggest shows, including “Modern Family,” “How I Met Your Mother” and “Bones.” Just outside the lot, crew members on breaks are lining up at a mobile health clinic in a converted Winnebago, seeking treatment for both chronic diseases and common ailments.
The Hollywood film and television industry relies heavily on freelancers and independent contractors who are rarely offered health insurance from an employer. Throughout Southern California, producers, writers, actors, editors, camera operators and prop makers move from gig to gig and hold numerous jobs each year. Some get insurance through the industry’s unions – after paying hefty fees and dues and working enough hours on union jobs. Others pay for private policies – or simply go without.
The nation’s health law will offer financial help for those who buy policies through new insurance marketplaces and whose incomes are within the limits. But contract workers, freelancers and seasonal employees in a variety of industries will fall in and out of eligibility for subsidies, causing confusion and possible tax consequences at the end of the year.
Entertainment workers face an additional challenge on top of the constant job turnover and temporary nature of their employment. Crew members often work long hours rigging lights, moving gear and building sets, which can...
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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. 

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.

Wednesday, December 11, 2013

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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Thursday, December 5, 2013

President Obama Statement on the Benefits of the Affordable Care Act

Thanks to Monica, thanks to everybody standing behind me, and thanks for everybody out there who cares deeply about this issue.  Monica’s story is important because for all the day-to-day fights here in Washington around the Affordable Care Act, it’s stories like hers that should remind us why we took on this reform in the first place.
And for too long, few things left working families more vulnerable to the anxieties and insecurities of today’s economy than a broken health care system.  So we took up the fight because we believe that, in America, nobody should have to worry about going broke just because somebody in their family or they get sick.  We believe that nobody should have to choose between putting food on their kids’ table or taking them to see a doctor.  We believe we’re a better country than a country where we allow, every day, 14,000 Americans to lose their health coverage; or where every year, tens of thousands of Americans died because they didn’t have health care; or where out-of-pocket costs drove millions of citizens into poverty in the wealthiest nation on Earth.  We thought we were better than that, and that’s why we took this on.  (Applause.)
And that’s what’s gotten lost a little bit over the last couple of months.  And our focus, rightly, had to shift towards working 24/7 to fix the website, healthcare.gov, for the new marketplaces where people can buy affordable insurance plans.  And today, the website is working well for the vast majority of users.  More problems may pop up, as they always do when you’re launching something new.  And when they do, we’ll fix those, too.  But what we also know is that after just the first month, despite all the problems in the rollout, about half a million people across the country are poised to gain health care coverage through marketplaces and Medicaid beginning on January 1st -- some for the very first time.  We know that -- half a million people.  (Applause.)  And that number is increasing every day and it is going to keep growing and growing and growing, because we know that there are 41 million people out there without health insurance.  And we know there are a whole bunch of folks out there who are underinsured or don’t have a good deal.  And we know the demand is there and we know that the product on these marketplaces is good and it provides choice and competition for people that allow them, in some cases for the very first time, to have the security that health insurance can provide. 
The bottom line is this law is working and will work into the future.  People want the financial stability of health insurance.  And we’re going to keep on working to fix whatever problems come up in any startup, any launch of a project this big that has an impact on one-sixth of our economy, whatever comes up we’re going to just fix it because we know that the ultimate goal, the ultimate aim, is to make sure that people have basic security and the foundation for the good health that they need.
Now, we may never satisfy the law’s opponents.  I think that’s fair to say.  Some of them are rooting for this law to fail -- that’s not my opinion, by the way, they say it pretty explicitly.  (Laughter.)  Some have already convinced themselves that the law has failed, regardless of the evidence.  But I would advise them to check with the people who are here today and the people that they represent all across the country whose lives have been changed for the better by the Affordable Care Act.
The other day I got a letter from Julia Walsh in California.  Earlier this year, Julia was diagnosed with leukemia and lymphoma.  “I have a lot of things to worry about,” she wrote.  “But thanks to the [Affordable Care Act], there are lots of things I do not have to worry about, like…whether there will be a lifetime cap on benefits, [or] whether my treatment will bankrupt my family…I can’t begin to tell you how much that peace of mind means...”  That’s what the Affordable Care Act means to Julia.  She already had insurance, by the way, but because this law banned lifetime limits on the care you or your family can receive, she’s never going to have to choose between providing for her kids or getting herself well -- she can do both. 
Sam Weir, a doctor in North Carolina, emailed me the other day.  “The coming years will be challenging for all of us in family medicine,” he wrote.  “But my colleagues and I draw strength from knowing that beginning with the new year the preventive care many of our current patients have been putting off will be covered and the patients we have not yet seen will finally be able to get the care that they have long needed.”  That’s the difference that the Affordable Care Act will make for many of Dr. Weir’s patients.  Because more than 100 million Americans with insurance have gained access to recommended preventive care like mammograms, or colonoscopies, or flu shots, or contraception to help them stay healthy -- at no out-of-pocket cost.  (Applause.)
At the young age of 23, Justine Ula is battling cancer for the second time.  And the other day, her mom, Joann, emailed me from Cleveland University Hospital where Justine is undergoing treatment.  She told me she stopped by the pharmacy to pick up Justine’s medicine.  If Justine were uninsured, it would have cost her $4,500.  But she is insured -- because the Affordable Care Act has let her and three million other young people like Monica gain coverage by staying on their parents’ plan until they’re 26.  (Applause.)  And that means Justine’s mom, all she had to cover was the $25 co-pay. 
Because of the Affordable Care Act, more than 7 million seniors and Americans with disabilities have saved an average of $1,200 on their prescription medicine.  (Applause.)  This year alone, 8.5 million families have actually gotten an average of $100 back from their insurance company -- you don’t hear that very often -- (laughter) -- because it spent too much on things like overhead, and not enough on their care.  And, by the way, health care costs are rising at the slowest rate in 50 years.  So we’re actually bending the cost of health care overall, which benefits everybody.  (Applause.)
So that’s what this law means to millions of Americans.  And my main message today is:  We’re not going back.  We’re not going to betray Monica, or Julia, or Sam, or Justine, or Joann.  (Applause.)  I mean, that seems to be the only alternative that Obamacare’s critics have is, well, let’s just go back to the status quo -- because they sure haven’t presented an alternative.  If you ask many of the opponents of this law what exactly they’d do differently, their answer seems to be, well, let’s go back to the way things used to be.
Just the other day, the Republican Leader in the Senate was asked what benefits people without health care might see from this law.  And he refused to answer, even though there are dozens in this room and tens of thousands in his own state who are already on track to benefit from it.  He just repeated “repeal” over and over and over again.  And obviously we’ve heard that from a lot of folks on that side of the aisle.
Look, I’ve always said I will work with anybody to implement and improve this law effectively.  If you’ve got good ideas, bring them to me.  Let’s go.  But we’re not repealing it as long as I’m President and I want everybody to be clear about that.  (Applause.) 
We will make it work for all Americans.  If you don’t like this law -- (applause) -- so, if despite all the millions of people who are benefitting from it, you still think this law is a bad idea then you’ve got to tell us specifically what you’d do differently to cut costs, cover more people, make insurance more secure.  You can’t just say that the system was working with 41 million people without health insurance.  You can’t just say that the system is working when you’ve got a whole bunch of folks who thought they had decent insurance and then when they got sick, it turned out it wasn’t there for them or they were left with tens of thousands of dollars in out-of-pocket costs that were impossible for them to pay.
Right now, what that law is doing -- (baby talks.)  Yes, you agree with me.  (Laughter.)  Right now, what this law is doing is helping folks and we’re just getting started with the exchanges, just getting started with the marketplaces.  So we’re not going to walk away from it.  If I’ve got to fight another three years to make sure this law works, then that’s what I’ll do.  That’s what we’ll do.  (Applause.)
But what’s important for everybody to remember is not only that the law has already helped millions of people but that there are millions more who stand to be helped.  And we’ve got to make sure they know that.  And I’ve said very clearly that our poor execution in the first couple months on the website clouded the fact that there are a whole bunch of people who stand to benefit.  Now that the website is working for the vast majority of people, we need to make sure that folks refocus on what’s at stake here, which is the capacity for you or your families to be able to have the security of decent health insurance at a reasonable cost through choice and competition on this marketplace and tax credits that you may be eligible for that can save you hundreds of dollars in premium costs every month, potentially.
So we just need people to -- now that we are getting the technology fixed -- we need you to go back, take a look at what’s actually going on, because it can make a difference in your lives and the lives of your families.  And maybe it won’t make a difference right now if you’re feeling healthy, but I promise you, if somebody in your family -- heaven forbid -- gets sick, you’ll see the difference.  And it will make all the difference for you and your families.
So I’m going to need some help in spreading the word -- I’m going to need some help in spreading the word.  I need you to spread the word about the law, about its benefits, about its protections, about how folks can sign up.  Tell your friends.  Tell your family.  Do not let the initial problems with the website discourage you because it’s working better now and it’s just going to keep on working better over time.  Every day I check to make sure that it’s working better.  (Laughter.)  And we’ve learned not to make wild promises about how perfectly smooth it’s going to be at all time, but if you really want health insurance through the marketplaces, you’re going to be able to get on and find the information that you need for your families at healthcare.gov.
So if you’ve already got health insurance or you’ve already taken advantage of the Affordable Care Act, you’ve got to tell your friends, you’ve got to tell your family.  Tell your coworkers.  Tell your neighbors.  Let’s help our fellow Americans get covered.  Let’s give every American a fighting chance in today’s economy.
Thank you so much, everybody.  God bless you.  God bless America.  (Applause.)

Wednesday, December 4, 2013

Coal industry pays lawyers, doctors to lie and let workers to die penniless


Today's post is shared from workerscomphub.org

Photo by Earl DotterIn a devastating must-read set of reports, the Center for Public Integrity and ABC News describe how coal companies have fought a cutthroat campaign of secrecy, misinformation, false diagnoses, and defiance of court orders to stop workers from getting workers’ compensation for black lung disease. The coal industry’s tactics mirror those of Big Tobacco, the lead and soda industries, the NFL, and pulp and paper giant Georgia-Pacific, which is conducting secret research and selectively withholding information to cast doubt on more than 60,000 legal claims filed by construction workers and others who Georgia-Pacific exposed to asbestos in the 1960s and ‘70s and are developing mesothelioma, a cancer nearly always caused by asbestos, today.
Black lung, a disease caused by inhaling coal dust over time, scars and shrinks the lungs and can be highly debilitating and deadly. In its severe form, black lung is supposed to automatically qualify miners for workers’ compensation. Yet in a series of three in-depth reports, the Center for Public Integrity reveals how the coal industry and its lawyers have fought tooth and nail to hide information on workers’ health from doctors, courts, and patients themselves in order to maintain doubt about people's’ eligibility for compensation.
ABC News interviewed Dr. Paul Wheeler, head of The Johns Hopkins Hospital’s black...
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