The US Centers for Disease Control and Prevention [CDC] has issued an interim guidance based on what is currently known about the Coronavirus Disease 2019 (COVID-19). The guidance sets out a plan of containment initially, and if that fails, mitigation of the spread of this very contagious and potentially fatal disease. If employers follow the guidance, in all likelihood workers' compensation issues will arise as to the payment of temporary and medical benefits following from occupational exposure at work to the COVID-19.
Showing posts with label medical benefits. Show all posts
Showing posts with label medical benefits. Show all posts
Tuesday, February 25, 2020
Tuesday, May 7, 2019
Fundamental Fairness
Workers’ Compensation matters are adversarial in nature and must furnish all parties with due process, a concept that embodies fundamental fairness[1]. There are two sides, at least, to very story, and the justice requires that the hearing official balance the facts to determine an appropriate result within the confines of the rule of law.
To ascertain the truth parties have the right to cross-examine witnesses. If that right is denied, the concept of fundamental fairness is suppressed.
A judge of compensation ordered stem cell medical treatment. Presented with evidence by way of expert opinion the judge was held to have denied the parties fundamental fairness by not allowing a medical expert to be cross-examined and failing to go on the record to memorialize the proceeding.
The issue arose in a workers’ compensation matter where the injured worker moved for stem cell medical treatment to relieve a shoulder injury. The compensation judge held an off the record conversation with the parties in chambers and spoke to the medical expert on the telephone. The compensation judge ruled, without taking medical testimony, that the proposed controversial treatment, not FDA approved, was approved.
The Appellate Division in reversing the compensation judge’s decision, stated:
“Where an important issue is discussed in chambers, “a record must be made or a summary placed on the record as to what transpired in chambers. Only then is effective appellate review insured.” Klier v. Sordoni Skanska Const., 337 N.J. Super. 76, 86 (App. Div. 2001). We see no reason why the same caution should not apply where the motion for medical benefits is contested and a hearing is necessary.
“ We recognize that under the Act, “hearing evidence, exclusive of ex parte affidavits, may be produced by both parties, but the official conducting the hearing shall not be bound by the rules of evidence.” N.J.S.A. 34:15-56. We also have held that “[w]hile the technical rules of evidence may be relaxed at workmen’s compensation proceedings, they may not be relaxed to the point of infringing on the parties’ due process rights or other fundamental rights.” Paco v. Am. Leather Mfg. Co., 213 N.J. Super. 90, 95-96 (App. Div. 1986) (citing 3 Larson, The Law of Workmen’s Compensation, § 79.25(c) (1983)). This includes the right of cross-examination. See id. at 96; see also California v. Green, 399 U.S. 149, 158 (1970) (describing cross-examination as “the greatest legal engine ever invented for the discovery of truth” (quoting 5 Wigmore on Evidence § 1367 (3d ed. 1940))); State v. Castagna, 187 N.J. 293, 309 (2006) (emphasizing importance and efficacy of cross-examination).
"Crothall opposed stem cell treatment because it was not FDA approved. Dr. Krone’s testimony in chambers was not recorded and it was not taken under oath, yet it was found to be credible by the judge without affording Crothall the opportunity for cross-examination. We find that the procedures lacked fundamental fairness. We reverse the order and remand the motion for medical benefits to the workers compensation division for further proceedings consistent with this opinion. We do not express an opinion in support of or against petitioner’s claim for stem cell treatment in light of the inadequacy of this record.
Even though the rules of evidence may be relaxed in a workers' compensation proceeding, the concept of fundamental fairness requires that the parties have the right to cross examine expert witnesses and that a formal record be made of the proceedings, even if conducted in chambers.
Haggerty v. Crothall Service Group, Docket No. A-4478-17T4, 2019 WL 1975907 (Decided May 3, 2019) UNPUBLISHED OPINION. CHECK COURT RULES BEFORE CITING. NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION. This opinion shall not “constitute precedent or be binding upon any court.” Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3. Superior Court of New Jersey, Appellate Division.
See also:
….
Jon L. Gelman of Wayne NJ is the author
of NJ Workers’ Compensation Law (West-Thomson-Reuters)
and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters).
For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900jon@gelmans.com has been representing
injured workers and their families who have suffered occupational accidents and illnesses.
Tuesday, November 7, 2017
Changes Urged for NJ Workers' Compensation System
The NJ 2017 Gubernatorial election results have not even been reported and major changes to the NJ Workers' Compensation system are already being urged. A leading practitioner in the workers' compensation arena is urging the adoption of a pure wage-loss system to replace the scheduled and time-limited disability benefits now embodied in the Act, and an employee choice of physician statute to replace the present employer directed system.
Sunday, February 26, 2017
The limits on a total permanent disability award
The New Jersey Supreme Court recently heard oral argument concerning the mathematical limits of a workers’ compensation total disability case. At the heart of the case is the issue of whether an injured worker could have an increase in a pre-existing permanent partial disability [PPT] claim, that existed prior to the last compensable injury which was to another part of the body. The last compensable claim rendered the worker totally and permanently disabled.
Thursday, November 12, 2015
Emerging Concepts for Future Workers' Compensation Benefits: Portability Now
Workers' Compensation as a benefit program is beginning to evolve under the concept of "The Shared Economy." Attacked from within and without, challenged by abuse and fraud, drained by the cottage industries and vendors, national lawmakers, labor leaders, insurance companies, governmental agencies, and the media, are speaking out to change the century old system that fails to integrate with current social, political, economic and medical programs.
"We need a portable vehicle for worker protections and benefits.Traditionally, benefits and protections such as workers compensation, unemployment insurance, paid time off, retirement savings, and training/development have been, largely or partly, components of a worker’s employment relationship with an employer. The Affordable Care Act has disrupted that model, providing more independent workers a different avenue of access to health insurance. Another new model is needed to support new ways of work. We believe this model should be:
● Independent: Any worker should be able to access a certain basic set of protections as an individual regardless of where they source income opportunities.
● Flexible and pro-rated: People are pulling together income from a variety of sources, so any vehicle should support contributions that can be pro-rated by units of money earned, jobs done, or time worked, covering new ways of micro-working across different employers or platforms.
● Portable: A person should be able to take benefits and protections with them in and out of various work scenarios.
● Universal: All workers should have access to a basic set of benefits regardless of employment status.
● Supportive of innovation: Businesses should be empowered to explore and pilot safety net options regardless of the worker classification they utilize.
A recent letter from national labor leaders has called for a "portable" system of benefits that will replace the current patch-work of systems called "workers' compensation programs.":
"We need a portable vehicle for worker protections and benefits.Traditionally, benefits and protections such as workers compensation, unemployment insurance, paid time off, retirement savings, and training/development have been, largely or partly, components of a worker’s employment relationship with an employer. The Affordable Care Act has disrupted that model, providing more independent workers a different avenue of access to health insurance. Another new model is needed to support new ways of work. We believe this model should be:
● Independent: Any worker should be able to access a certain basic set of protections as an individual regardless of where they source income opportunities.
● Flexible and pro-rated: People are pulling together income from a variety of sources, so any vehicle should support contributions that can be pro-rated by units of money earned, jobs done, or time worked, covering new ways of micro-working across different employers or platforms.
● Portable: A person should be able to take benefits and protections with them in and out of various work scenarios.
● Universal: All workers should have access to a basic set of benefits regardless of employment status.
● Supportive of innovation: Businesses should be empowered to explore and pilot safety net options regardless of the worker classification they utilize.
Friday, July 3, 2015
NJ Senate Passes Workers' Compensation Collective Bargaining Legislation
The NJ Senate passed an historic legislative proposal that will change the way benefits are delivered in work related injuries in NJ. S2447 provides for a collective bargaining arrangement that allows for delivery of benefits without the necessity of formal intervention before the NJ Division of Workers' Compensation, that will however remain an option in the process.
Wednesday, August 6, 2014
Doctor On Demand Raises $21 Million as Telemedicine Heats Up
Medical delivery is constantly changing in light of new technology. Workers' compensation insurance carriers could possibly implement thisdeliver system in an effort to contain costs. Today's post is shared from recode.net
[Click here to see the rest of this post]
| Doctor On Demand, one of the growing number of companies offering physician consultations via mobile video chat, has raised $21 million. Venrock led the Series A round, with participation from Shasta Ventures and Virgin Group Chairman Sir Richard Branson. On top of the financing news, Doctor On Demand said: Venrock Partner Bryan Roberts joined the company’s board, the $40-per-visit service is now available on desktop computers and Comcast will offer it to U.S. employees. (Comcast owns NBCUniversal, which is a minority investor in Re/code.) |
Thursday, July 10, 2014
Patient Access To Physicians Notes: An Experiment of Psychological Importance
| Today's post is shared from the NYTimes.com What would happen if all workers' compensation patients had access to all their treating physician's records including pschiatric care? Would such access assist in limiting and increasing litigation for continued medical care and the need for medical treatment? David Baldwin wasn’t sure how he had come across the other day in group therapy at the hospital, near the co-op apartment where he lives with his rescue cat, Zoey. He struggles with bipolar disorder, severe anxiety and depression. Like so many patients, he secretly wondered what his therapist thought of him. But unlike those patients, Mr. Baldwin, 64, was able to find out, swiftly and privately. Pulling his black leather swivel chair to his desk, he logged onto a hospital website and eagerly perused his therapist’s session notes. The clinical social worker, Stephen O’Neill, wrote that Mr. Baldwin’s self-consciousness about his disorder kept him isolated. Because he longed to connect with others, this was particularly self-defeating, Mr. O’Neill observed. But during the session, he had also discussed how he had helped out neighbors in his co-op. “This seems greatly appreciated, and he noted his clear enjoyment in helping others,” Mr. O’Neill wrote. “This greatly assists his self-esteem.” A smile animated Mr. Baldwin’s broad, amiable features. “I have a tough time recognizing that... |
Related articles
Wednesday, June 5, 2013
More Regulation Called for of State Opt-Out Plans
A recently published report by the New Street Group, sponsored by Sedgwick calls for the intervention of state regulation over workers' compensation opt-out plans. Recognizing the gray line between State and Federal insurance programs, the report concludes that the Federal and state courts may ultimately decide the direction of workers' compensation in the US.
Read more about "opt-out" plans and workers' compensation
Related articles
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| By Peter Rousmaniere and Jack Roberts |
Read more about "opt-out" plans and workers' compensation
May 07, 2013
Governor Mary Fallin today signed into law Senate Bill 1062, a bill that reforms the workers' compensation system in Oklahoma by removing it from the judicial system and making it an administrative process. The bill, by ...
Jun 03, 2013
The Electronic Privacy Information Center, or EPIC, filed a lawsuit against the Department of Homeland Security to establish that all air travelers have the right to opt out of airport body scanners. In additional to the privacy ...
Jan 19, 2013
The US Transportation Safety Administration (TSA) is following the lead on many other countries, including the European Community, and is removing all Backscatter machines from service. While not admitting to the radiation ...
Nov 16, 2012
An activist movement is encouraging individuals to opt-out of going through airport x-ray scanners during Thanksgiving travel. Health concerns have been raised over the use of machines. Many United States unions have ...
Related articles
Wednesday, April 3, 2013
Student Athletes Should be Covered by Workers' Compensation Policies
Student Athletes Should be Covered by Workers' Compensation Policies
They call them "student players" and the schools, televisions companies and advertisers make the money. The "students" get injured and no benefits are available for medical (except when over $90,000 on medical has been expended then an NCAA policy kicks in), no temporary disability or permanent disability are afforded. The student suffer lifetime and carrer altering injuries as they play their hearts out for the schools and they do so without adequate compensation.
There is major inequality going on in College sports which indeed is a BIG business.
The coaches hammer at the student players and entice them to play too many games in a growing TV broadcast season where one conference add up upon another expanding to greater proportions and placing serious physical demands upon the player resulting in accidents and injuries.
Additionally bullying by coaches as revealed by Rutgers Basketball Coach Rice physically assaults the students and berates them with indecent name calling.
Where is the accountability? The students are actually employed by the schools to earn profits for the educational institutions and corporate sponsors. The student players are being exploited. Student athletes should be covered by workers' compensation policies.
Thursday, June 14, 2012
National Experts Call Workers Compensation System Irrational and Unjust
National workers' compensation experts, Law school Dean Emily A. Spieler and Professor John F. Burton, in a recently published article in the American Journal of Industrial Medicine conclude that the present that the present workers' compensation systems is "irrational" and "unjust."
Characterizing the program as "....dizzying and frustrating in its complexity, and apparent irrationality," they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits." They review such alternatives as universal medical care, "providing healthcare to workers regardless of the source of injuries or disease."
Related Articles on Alternative Compensation Programs
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Feb 15, 2011
In December 2010 US Congress passed and President Obama signed, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program.
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...
Jul 13, 2010
As The Path To Federalization expands, this debate will expand. A recent study by the Center for American Progress addresses these concerns. "Health threats from the oil spill may linger unseen, perhaps for more than a ...
Mar 16, 2011
Historically The Federal government's role has been to rise to the occasion and walk further down a path to federalization. On a smaller scale than the potential consequences of the Japanesse debacle, the US was first in line ...
Mar 05, 2011
Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. ... Compensation Claim Draws Major Public Attention (workers-compensation.blogspot.com); Vermont Governor Sets Out to Lead U.S. to True Universal Coverage (huffingtonpost.com); The World Trade Center Health Program Expands The Path to Federalization ...
Sunday, July 11, 2010
CMS to Rely on New Life Tables for Workers Compensation Set Aside Agreements
In 2006, the overall expectation of life at birth was 77.7 years, representing an increase of 0.3 years from life expectancy in 2005. From 2005 to 2006, life expectancy at birth increased for all groups considered. It increased for males (from 74.9 to 75.1) and females (from 79.9 to 80.2), the white (from 77.9 to 78.2) and black populations (from 72.8 to 73.2), black males (from 69.3 to 69.7) and females (from 76.1 to 76.5), and white males (from 75.4 to 75.7) and females (from 80.4 to 80.6).
Click here to read more about Medicare Secondary Payer Act and workers' compensation.
Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon Gelman or call 1-973-696-7900.
Tuesday, July 6, 2010
Temporary Benefits Due During Period of Unrelated Medical Condition
An asthma flare up, that delayed surgery for a compensable back injury, was not a reason to halt the payment of workers' compensation temporary disability payment. The Court held:
"....when treatment for the original work related injury is delayed due to unrelated
conditions, the claimant was entitled to continued disability benefits during the entire period."
"The compensation judge correctly ordered continued temporary disability benefits from November 9, 2006 through February 17, 2007, "the period of time when [Schock] was unable to proceed with an authorized anterior fusion at C5-6 and C7 because of asthma flare-ups unrelated to the work accident." Schock did not refuse treatment, there is no evidence that she was able to return to work or that she was at maximum medical improvement during the brief delay in her neck surgery. Her asthma condition was temporary and beyond her or her doctor's control."
"....when treatment for the original work related injury is delayed due to unrelated
conditions, the claimant was entitled to continued disability benefits during the entire period."
"The compensation judge correctly ordered continued temporary disability benefits from November 9, 2006 through February 17, 2007, "the period of time when [Schock] was unable to proceed with an authorized anterior fusion at C5-6 and C7 because of asthma flare-ups unrelated to the work accident." Schock did not refuse treatment, there is no evidence that she was able to return to work or that she was at maximum medical improvement during the brief delay in her neck surgery. Her asthma condition was temporary and beyond her or her doctor's control."
Shock v Morristown Memorial Hospital/Atlantic Health Systems, Docket No, A-1658-09T2, (NJ Ap. 2010), Decided July 2, 2010
Thursday, July 1, 2010
Federal Government Launches HealthCare Insurance Website
"
The Federal Government has launched a new web site to provide information to consumer of health care insurance.
"HealthCare.gov launches today. It’s a website designed to help you take control of your health care – by putting the power of information at your fingertips.
"It’s the first website to collect both public and private health insurance options across the nation in a single place. Even better, our insurance options finder automatically sorts through this huge catalog of options to help you identify the ones that may be right for you.
"Other highlights of the site include extensive information about your rights as a consumer, how to navigate the health insurance marketplace, and how the Affordable Care Act can help you – all tailored to you.
The Federal Government has launched a new web site to provide information to consumer of health care insurance.
"HealthCare.gov launches today. It’s a website designed to help you take control of your health care – by putting the power of information at your fingertips.
"It’s the first website to collect both public and private health insurance options across the nation in a single place. Even better, our insurance options finder automatically sorts through this huge catalog of options to help you identify the ones that may be right for you.
"Other highlights of the site include extensive information about your rights as a consumer, how to navigate the health insurance marketplace, and how the Affordable Care Act can help you – all tailored to you.
Tuesday, May 11, 2010
The Declining Euro and US Workers Compensation
This past week has been hectic on the news front. Internationally, the financial riots in Greece, and the British election results have sounded an alarm that the Euro is going south. The impact on the world’s financial markets on Thursday reverberated across the globe. On the home front, Saturday night last, a car bomb was parked in Times Square as news media merely focused instead for 3 desperate hours on Presidential humor at the White House Correspondents' Dinner. Even the US workers’ compensation system generated gloomy news as the NCCI reported dismal findings and a lack of a positive direction for the patchwork of State systems. NY State has joined the ranks of closing down 20% of its workers’ compensation agency. Unemployment rates in the US continue to grow and the rebound of the past is unlikely and the nation’s workers’ compensation continues to struggle.
One should not loose sight of the fact that the US workers' compensation system had its birth in Europe at the turn of the 1900’s. It was imported into the United States and the program flourished in tandem for decades with the late industrial revolution.
The international economic system now is challenged. The unemployment rate fails to rebound. Thomas L. Friedman (NY Times) brings into question, how to adapt the workers' compensation system to fit in the world market. He points out that, under Greek law workers in “hazardous jobs” can retire on full pension at age 50 for women and 55 for men. In Britain everyone over the age of 60 can ride the bus for free.
Everyone knows that a “free ride” just doesn’t exist any longer. Some commentators place doubt even on the $1 Trillion European bailout package as merely “kicking the can down the road,” and not a definitive solution.
The pension and benefit program in Europe is just one element of the failed workers’ compensation system. A larger question will be the adaptation of a medical benefit delivery system that works efficiently and is sustainable. As Friedman points out, "The Tooth Fairy is Dead." New concepts and ideas are desperately needed. Those looking to the past for solutions, now need to look to the future and be prepared to adapt to the future. It is necessary to grasp a vision of the horizon and beyond. The change going forward may be an entirely different approach to a present troubled workers’ compensation system.
..........
Jon L. Gelman Wayne NJ author of NJ Workers' Compensation Law and contributory author Modern Workers' Compensation Law.
Saturday, May 8, 2010
NCCI Reports Gloomy Outlook for Workers Compensation
While claims continued to decline medical costs continued to grow at a fast rate. In 2009 costs increased 5.0% while the medical CPI (Consumer Price Index) rose only 3.2%.
Medical costs and the efficient and delivery of medical benefits continue to be a major issue in the functioning of the workers' compensation system nationally. National Health Care reform may provide an opportunity to address this issue in a meaningful fashion through transfer of occupational disease medical costs to Medicare.
To read more about health care and workers' compensation click here.
Sunday, April 18, 2010
Is The Virtual Doctor a Cure for Workers' Compensation
One of the primary benefits under the Workers' Compensation Act is that of medical benefits. Medical benefits are mandated by the Act, and require the employer to furnish the injured worker with medical, surgical and other treatment and hospital services as are necessary "to cure and relieve the worker of the effects of the injury and to restore the functions of the injured member or organ" if possible. The injured worker's exclusive remedy to receive medical treatment is in accordance with the provisions of the Workers' Compensation Act. The employer can be compelled to provide prompt and adequate medical treatment, and an action at common law against the workers' compensation insurance carrier is barred. The employee's right to medical benefits is independent of other remedies available under the Workers' Compensation Act. The injured worker need not wait until final adjudication of his claim for permanent disability in order to proceed with a claim for medical benefits.
This year OptumHealth is about to launch NowClinic. The site is compatible with Internet Explorer, Firefox and Safari. Using Chrome will not allow you to access the site. The planned cost, according to AAARP is $45 for a ten minute dialog.
Will this trend be adaptable to workers' compensation programs is a major question. With so much paranoia concerning fraud on both sides of the program involving into RICO claims, many employers and insurers might be apprehensive in launching such a system. On the other hand, the cost savings benefits to employers and insurance companies maybe monumental. Clinical care, diagnostic testing and pharmaceutical dispensing may also become incorporated into the program. Some delays maybe eliminated for claims that are not contested or denied. Once into the "system" the chance for straying to unauthorized medical care could be reduced.
As technological expands in the health profession, the use of virtual care system will probably become more available. Tailoring them to the needs of the workers' compensation program will remain a challenging opportunity to improve the benefit system.
To read more about health care and workers' compensation click here.
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Saturday, April 3, 2010
Libby Care Launches - Center for Asbestos Related Disease Ground Breaking
The recent health care reform legislation provided for the Libby Care which will provide universal medical care for victims of asbestos related disease. The plan is a pilot program for occupational disease medical care fully funded under the Medicare program.
This week Senator Max Baucus, instrumental in crafting and enacting he program, participated in the ground breaking for ceremony for the expansion of the Center for Asbestos Related Disease (CARD).
“Today was a great day for CARD and the people of Libby,” Baucus said at the groundbreaking. “We’re all in this together, and it’s really through team work that we’re able to get this expansion done. It’s also great day because now the people of Libby will get the health care they need and deserve.”
Baucus said that the EPA designation, along with the new legislation, “has triggered over $300 million [in health aid for Libby] over the next 10 years. This is going to be bigger and better than the aid that was given to victims of 9/11.”
Saturday, March 20, 2010
Workers Compensation Insurance Company Ordered to Pay For Gastric Bypass
Treating medical conditions that are necessary to relieve and cure a medical condition is the responsibility generally of workers' compensation programs throughout the United States. Now a Court has ordered that an insurance company must treat a persons obesity as an extension of its medical benefits so that weight reduction can occur and the underlying work related condition can be addressed.
In affirming the decision the Supreme Court, Appellate Division, Third Department, New York held:
"Claimant slipped and fell at work in 2002, and his ensuing workers' compensation claim presently encompasses, among other things, injuries to his head, neck, back and knees. His morbid obesity has contributed to his knee and back problems and, in an effort to combat those problems and counter a broader threat to his survival, claimant sought authorization to undergo gastric bypass surgery. The Workers' Compensation Law Judge granted his request. Upon review, the Workers' Compensation Board affirmed, holding that the surgery was causally related to the compensable injuries.
In affirming the decision the Supreme Court, Appellate Division, Third Department, New York held:
"The employer is obliged to pay for claimant's medical care “for such period as the nature of the injury or the process of recovery may require” (Workers' Compensation Law § 13[a]; see Matter of Spyhalsky v. Cross Constr., 294 A.D.2d 23, 25-26 [2002] ). There is evidence in the record that claimant has gained a substantial amount of weight since 2002 due to the sedentary lifestyle imposed by the compensable injuries. Claimant's treating orthopedic surgeon opined that claimant's back and knee pain was exacerbated by his obesity and that such could be alleviated by weight loss. An independent medical examiner agreed, opining that weight loss would “certainly” help those conditions. While material in the record before us could support a different result, substantial evidence exists for the Board's determination that claimant's weight gain was caused by his compensable injuries and that gastric bypass surgery “would assist in [his] recovery” ( Matter of Bolds v. Precision Health, Inc., 16 A.D.3d 1007, 1009 [2005]; see Workers' Compensation Law § 13[a]; Matter of Spyhalsky v. Cross Constr., 294 A.D.2d at 25-26, 743 N.Y.S.2d 212).Laezzo v. New York State Thruway Authority, --- N.Y.S.2d ----, 2010 WL 812862, N.Y.A.D. 3 Dept., 2010, March 11, 2010.
Saturday, March 13, 2010
Yet Another Attempt to Shift CMS Costs
The American Insurance Association (AIA) and collateral Industry groups have banned together in a formal attempt to avoid the Federal mandate to reimburse Medicare for conditional medical payments. This is yet a third assault on the responsibility of employers to avoid payment of medical treatment of injured workers and shift the burden upon the ailing and financially strapped Medicare. Two prior legislative attempts to modify the Medicare Secondary Payer Act (MSP) have failed.
The proposal is embraced in recently introduced HR4796. It is an attempt to modify the Medicare Secondary Payment Act by reducing conditional payment responsibilities of Industry.
In the past, failures in the enforcement of reimbursement practices were highlighted in various investigative reports. Since the reporting of those failures, the Centers for Medicare and Medicaid Services (CMS) have enhanced its efforts to seek reimburse. The US Congress has also imposed compulsory employer/insurance carrier reporting requirements.
Recent studies presented at the National Association of Social Insurance (NASI) disclosed that the majority of conditional payment issues arise in occupational claims which traditionally are denied compensability initially by insurance carriers.
A proposal was made at the NASI meeting to provide more effective and efficient delivery of medical care to injured workers. It was suggested that medical coverage in occupational disease claims become the initial responsibility of US Medicare system who then could seek indemnification from insurance carriers and others who may be ultimately responsible. A pilot plan for this type of health care was embodied in the US Senate passed health care legislation.
Click here to read more about health care and workers' compensation.
The proposal is embraced in recently introduced HR4796. It is an attempt to modify the Medicare Secondary Payment Act by reducing conditional payment responsibilities of Industry.
In the past, failures in the enforcement of reimbursement practices were highlighted in various investigative reports. Since the reporting of those failures, the Centers for Medicare and Medicaid Services (CMS) have enhanced its efforts to seek reimburse. The US Congress has also imposed compulsory employer/insurance carrier reporting requirements.
Recent studies presented at the National Association of Social Insurance (NASI) disclosed that the majority of conditional payment issues arise in occupational claims which traditionally are denied compensability initially by insurance carriers.
A proposal was made at the NASI meeting to provide more effective and efficient delivery of medical care to injured workers. It was suggested that medical coverage in occupational disease claims become the initial responsibility of US Medicare system who then could seek indemnification from insurance carriers and others who may be ultimately responsible. A pilot plan for this type of health care was embodied in the US Senate passed health care legislation.
Click here to read more about health care and workers' compensation.
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