Rules Adopted to End NJ Pension Cost Shifting

The New Jersey Department of Labor and Workforce Development [DLWD] adopted Rules embracing the recommendations of  NJ State Comptroller concerning NJ State Pensions. A February 2021 investigative report by the NJ State Comptroller raised critical issues common to other state and national collateral social insurance programs challenged by current fiscal limitations. The rules are effective as of March 7, 2022.  54 N.J.R.448(a). The Rules were adopted without change and have retroactive application.

Investigative Report Raises Issues

The tension between public pension systems and workers' compensation programs was highlighted in a recent investigative report by the NJ State Comptroller. The report raises additional critical issues common to other state and national collateral social insurance programs challenged by current fiscal limitations.

New 911 Photos Dramatically Illustrate Toxic Cloud

The horrific tragedy of the attack on the World Trade Center on 911 and the toxic cloud of fumes and dust are vividly portrayed in newly released photos. The massive extend of the spread of toxic substances has given rise to resultant disease and illness to emergency first responders and residents of lower Manhattan.

ABC secured the release of the photos by a Freedom of Information Act Request to the New York Police Department (NYPD). The photos were taken  from an NYPD helicopter immediately following the attack when two large jet liners, loaded with fuel and passenger, were seized by terrorists and crashed into the buildings.

The fight to secure adequate medical care for medical conditions flowing from the exposures has been very problematic. While several local agencies have attempted to provide medical care, the lack of funds and a unified program has left many without appropriate medical care.

Click here to read more about 911 and medical care programs.

A Once-In-A-Generation Chance

The NY Times today called for passage of the Senate version of health care reform and salvage the opportunity for important change in the nation’s health care plan. More emphatically, the Senate version provides an opportunity for change in the way the nation’s century-old workers’ compensation system provides for the delivery of medical care in occupational disease claims.

The paper’s editorial rightly observes that one botched election in Massachusetts, a State that has already met the issue of universal health care, should not encumber the rest of country with horrors of a failed system. The Senate version of health care reform contains an opportunity to experiment and explore the opportunities on embracing the delivery of medical care and medical monitoring into a coordinated and national framework under the Medicare program. In the end it will be able to establish a unified epidemiological database to help prevent and treat occupational illnesses and lead the nation to a safer and healthier work environment.

The efforts of Senator Mat Baucus (D-MT) has made to craft an occupationally health care program has the potential for being the most extensive, effective and innovative system ever enacted for the delivery of medical care to injured workers. Libby Care [see Patient Protection and Affordable Care Act Sec. 10323 pp. 2222-2237] , and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations than any other program of the past. An ancillary benefit will be the integration of Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control (CDC) for the advancement of greater worker safety through organized data collection and research.

Caring for those who have been the victims of occupational disease has been an illusive goal of the nation’s patchwork of workers’ compensation systems for over a decade. Occupational diseases were a supplement to the compensation system that developed when Industry tried to shield itself from the emerging economic liabilities that silicosis was generating.

History reflects that the system just didn’t work. The longest running tort, asbestos reacted illness, plagued the workers’ compensation system and produced a  plethora of problems that only created more delay and denial of medical care for injured workers.

Economically the costs of direct costs for occupational illnesses and diseases continue to soar. Unfair cost shifting continues. A study in the year 2000 indicated that direct costs amounts to $51.8 Billion per year for hospitals, physicians and drugs. Workers’ compensation was reportedly covering only 27% of the costs and taxpayers were sharing un even share of the burden. The costs of occupational disease amounted for 3% of the gross national product.

The problems of under-reporting of occupational illnesses and disease even compound the reporting the true reality of the issue even further. The recent NY Times and Nebraska Appleseed investigative reports indicate that true numbers are hard to come by because of the fear and intimidation injured employees suffer in reporting claims.

Since the enactment of workers’ compensation in 1911, there has never been a greater opportunity to provide meaningful change to make the workplace healthier and safer. Congress and the President Obama should take advantage of this one-in-a-lifetime chance and make the Senate version of health care reform the law of the nation.

Click here to read more about health care and workers' compensation.

Workers Compensation Insurance Company and PBMs Liability for Drug Abuse

The Wall Street Journal reports today about a claim against  pharmacies as a result of customer drug abuse. In the State of Nevada a case is pending that may confer liability upon a drugstore for the consequences of an accident caused by patient drug abuse. A pharmacy dispensed narcotic painkillers to a Patricia Copening, 35 year old doctor's office receptionist, who killed a 21 year old man in a fatal Las Vegas accident. 


A case is pending against the seven pharmacies (Wal-Mart, Longs Drugs, Walgreen Co., CVS Pharmacy, Rite-Aid, Sav-On and Lam’s Pharmacy) that dispensed 4,800 tablets of the drug for Copening in the 13 months prior to the fatal accident. 


The Nevada Prescription Controlled Substance Abuse Task Force had notified the pharmacies that Copening was “taking an unusual amount of these narcotics.” The vehicle causing the accident was commercially owned by a physician who was involved in a relationship with the driver.


The Nevada Supreme Court will be deciding whether the pharmacies, previously dismissed by the trial court, are liable because they dispense enormous amounts of drugs to Copening that resulted in drug abuse and resulting the fatal accident. 


Where the perimeter of liability may end is unknown. Workers' Compensation insurance companies and their integrated pharmacy benefit managers (PBMs) dispense many narcotics, on an ongoing basis, for pain relief, to injured workers.  The courts may ultimately deem them unprotected by the "exclusivity rule," and they, as ultimate wrongdoers, may become targets for these tragic yet foreseeable events.


To read more about drugs and workers' compensation click here.

Congressional Committee Moves to Reopen Victims Compensation Fund

Legislation has advanced in the US Congress to reopen the Victims Compensation Fund for those who may have been injured in the 9/11 attack.

NY Congresswoman Carolyn Maloney (D-NY) has sponsored H.R. 847 "James Zadroga 9/11 Health and Compensation Act of 2009." The bill amends the Public Health Service Act to establish within the National Institute for Occupational Safety and Health the World Trade Center Health Program (WTC program) to provide:

(1) medical monitoring and treatment benefits to eligible emergency responders and recovery and cleanup workers who responded to the World Trade Center terrorist attacks on September 11, 2001; and
(2) initial health evaluation, monitoring, and treatment benefits to residents and other building occupants and area workers who were directly impacted and adversely affected by such attacks. Requires the WTC program administrator to:
(1) implement a quality assurance program;
(2) establish the WTC Health Program Scientific/Technical Advisory Committee;
(3) establish the WTC Responders Steering Committee and the WTC Community Program Steering Committee;
(4) provide for education and outreach on services under the WTC program;
(5) provide for the uniform collection of data related to WTC-related health conditions;
(6) conduct research on physical and mental health conditions that may be related to the September 11 terrorist attacks; and
(7) extend and expand arrangements with the New York City Department of Health and Mental Hygiene to provide for the World Trade Center Health Registry. Authorizes the administrator to make grants to the Department to address mental health needs relating to the terrorist attacks.
Amends the Air Transportation Safety and System Stabilization Act to:
(1) make individuals eligible for compensation under the September 11 Victim Compensation Fund of 2001 for harm as a result of debris removal; and
(2) extend the deadline for making a claim for compensation.

The original legislation was a controversial benefit program that was to supplement applicable workers' compensation benefits. It did not provide for medical monitoring as well as treatment of latent medical conditions.

Building A Workers’ Compensation System That Works

State workers’ compensation systems are beginning to suffer from the impact of the national economic downturn. Economically induced factors are compounding the underlying issues that previously generated a growing level of critical stagnation. The combination of this dynamic now threatens the very core of the workers' compensation system and endangers its extinction.

Prior to the accelerated national economic downturn, the patchwork of State and Federal compensation programs were besieged by an assault of complex legal issues emerging during the last decade. These included: the reimbursement of collateral medical source issues, ie. CMS and MSP (Medicare Secondary Payer Act) ; greater difficulty in litigating complex scientific issues; a costly and inefficient medical benefits delivery system and a transition of “fault” into the administrative system.

As the national economy began to fail there was a surge of new administrative issues challenging the programs. These include: higher unemployment; self-imposed limitations on administrative cost by the States; and the increase of potential insolvency by the insurance industry. The filing of claims in NJ over the first 3 weeks of 2009 have already reflected a 27.5% decrease which is projected over the last reported year, 2007. Judicial salaries have been frozen and new State employees have been taken out of the State pension system. State budgetary freezes have caused a reduction of the hiring of critically needed new personnel such as the appointment of Deputy Attorney Generals to represent State funds, ie. Second Injury Funds. Hearing calendars have been reduced because of lack of personnel to appear.

Banking and investment house scandals continue. Insurance carriers have been threatened by insolvency including the giant AIG which has continued to require the infusion of “bail out” capital to float. Liberty Mutual has announced the plan to sell certain of its markets including the Wausau line of business.

As President Barack Obama reported, “The economic news has not been good.” The hope of a new beginning that prevailed at the recent inauguration signals creative opportunities for the reinvented and modernization of the entire workers’ compensation system. The implementation of technology and video conferencing initiated in Social Security hearings may be required to be utilized to lower expenses and increase efficiency. It is cheaper for the government to move electronic images rather than personnel. Technology advanced hearing systems and claims processing will be required to reduce costs and increase efficiency. Instead of hiring more personnel and establishing more offices, technologically advanced centralized hearing centers will be utilized. These will result in a lower carbon footprint and lower administrative costs.

Workers’ Compensation is not only an economic issue, it is also a human issue. Medical delivery and its associated costs remain problematic in the present workers’ compensation system. A single payer national medical insurance system program is a viable solution. Immediate delivery of medical benefits to injured workers will result in an administrative cost saving and allow for the introduction of medical monitoring, prevention programs and research grants to treat and cure industrial disease. The new system will require greater transparency and accountability.

The failing national economy is a catalyst for change. The ailing workers’ compensation program must obtain the course of treatment that it requires to rebound into a healthy and robust system once again.

Medical Costs Soar in Workers' Compensation

The cost of medical care has increased tremendously according to a recently issued  report. The NCCI (National Council on Compensation Insurance Inc.) reports an increase in medical costs from 40% in the early 1980s to almost 60% currently.

NCCI reports that the increase appears to be national, "....Furthermore, although there are differences in the medical share by state, the change in the relative mix of states has had very little impact on the estimated countrywide share of medical and indemnity benefits."

The national workers' compensation medical delivery system has now become a focus of attention in light of the prospects of an overhaul of national health care system as medical costs continue to put American businesses at a economic disadvantage with foreign competitors. James Kvaal, in his article, "The Economic Imperative for Health Reform," highlights that "...ever rising medical costs are threatening to drive an unsustainable explosion in the national debt." Higher insurance premiums result in lower wages or lack of medical coverage all together and the loss of preventive care.

The costly and inadequate workers' compensation medical delivery system provides a fragmented approach to medical care. The system's focus should treat current medical conditions and provide for preventive care. The administrative costs savings in providing global coverage will translate into reduced delivery costs and a healthier work force. Some of the extra savings could be well spent on much needed medical research to avoid the need for costly medical care.

A Time For Congress to Provide Compensation to 9-11 First Responders

The first responders to the horrific events of September 11, 2008 continue to be unsuccessful in obtaining NJ Workers' Compensation benefits. The Port Authority of New York and New Jersey (Port Authority), an agency formed as an Congressional Inter-State Compact, continues to prevail in the defense of claims brought by its employees, the first responders to the 9-11 tragedy.

Edward McQuade, a Port Authority police-officer, was assigned to the World Trade Center disaster site, "The Pit," for 8 weeks following the 9-11 event and allegedly developed symptomatically. Michael Ashton, also a Port Authority police-officer, worked at ground-zero for the 3 weeks (12 hour shifts) following 9-11, during the rescue and recovery phase complained of disability attributed to the post 9-11 tragedy.

The NJ Judge of Compensation denied their claims for benefits due to lack of objective evidence presented. NJ statutory language requires objective medical evidence to substantial the claims. The claims were denied without the benefits of medical monitoring being afforded for potentially latent medical conditions which are now being reported by medical investigators.

Unfortunately, the heroes of 9-11 continue to be caught in a Catch 22 situation. They lack the proof, based on scientific evidence, because the Federal government has not stepped up to the plate and done the responsible thing which is to adequately fund and co-ordinate medical monitoring, treatment and benefit programs for the 9-11 first responders and those caught the geographical web of the 9-11 scope of exposures.

These decisions scream out for Congressional oversight and advancement of legislation now pending in Congress to continue the program that the was started by the Mt. Sinai Hospital Environmental Sciences Laboratory and the NY City Fire Department. We owe our heroes nothing less than the care, concern and comfort that they gave to the victims and their families.

The Federal Government is Offering Funding for a World Trade Center Non-Responder Medical Program.

An announcement has been for applications for the provision of screening, referral and treatment services for residents, students, and others in the community, related to the September 11, 2001 terrorist attacks in New York City. The program is aimed at the ‘non-responder population.’ Since September 11, 2001, the Department of Health and Human Services, CDC, and NIOSH have been active in assessing the health impact of the World Trade Center disaster. There is currently a program in place to provide health assessment examinations, diagnosis, and treatment for first response emergency personnel (the responder population) in the New York City (NYC) area. The application deadline is August 25, 2008.

The grant awardee would be involved in the following activities:

1. Immediately provide for accessible health assessments, eligibility confirmation, diagnostic, referral and treatment services (including medications and durable medical equipment) to the non-responder population for health conditions associated with WTC dust/debris exposure.

2. Identify the organizational components required to support access to these services, including personnel, examination venues, maintenance of patient records, data platforms and management, compliance with applicable laws, assurance of quality care, coordination of healthcare benefits, and programmatic recordkeeping.

3. Provide referral and treatment services with grant funds only as the Payor of Last Resort. Private health insurance (self-funded or employer-funded), workers’ compensation insurance (employer-funded), and government-funded health insurance (Medicare and Medicaid) shall be used first before grant funds are used. Applicants should demonstrate their capacity to determine insurance status and to seek reimbursement from outside payers. Funds shall not be used to supplant existing activities or for the treatment of the responder population.

4. Establish service information and patient management systems as needed in order to accommodate intake, referral, prompt healthcare services, and reporting of the services provided to the non-responder population. In carrying out these activities, collaborate with other WTC-related healthcare providers, as appropriate and needed.

5. Develop a written Management and Prioritization Plan which identifies the projected service delivery area, explains how the assessment of potential non-responder patient needs will be determined, provides a strategy to ensure meeting those needs, and provides a section focused on ensuring prioritization and management of this program’s health services delivery to meet those needs, within the broader context of all organizational activities and responsibilities. The applicant should state an estimate for the number of non-responders to be served with the requested funds and provide a justification based on an estimation of the projected costs to provide health assessment examinations, and the costs to provide treatment for the expected World Trade Center-related conditions that will be identified.

6. Provide patient encounter reporting on health assessment examinations and treatment to NIOSH for quality assurance. 7. Establish and maintain information and data management systems that will ensure the provision to NIOSH of electronic data in a uniform fashion

Complete Announcement

http://www.cdc.gov/od/pgo/funding/OH08-801.htm

24 Hour Care Emerging as Good Medicine for the Ailing Workers Compensation System and CMS Conflicts

All the national political candidates are now framing the health care issue as a cure-all to the ailing American system. One must take a look back in time. History is known to repeat itself and turning the page back a decade in time reveals that the Clinton I plan considered a merger between the ailing workers' compensation system and a national health care proposal.

Insurance carriers are now rapidly moving into coalitions to unify under 24 hour care proposals.

The initially proposed Clinton II proposal lacks sufficient detail to determine whether the proposal is yet again included. One would think that the real answer to complexities brought about through reimbursement demand of CMS (Centers for Medicare and Medicaid Services) and long avoided reimbursement issues, would be the merger of both workers' compensation systems (all multiple and unmanageable entities) into a single payer system thus avoid the duplications of costs and litigation expenses. Congress already rejected proposals offered by some interested parties to circumvent the system last legislative term.

Integrated health care would put workers' compensation back on the track of maintaining its philosophical integrity of maintaining the concept 'of "periodic payments" for disability and thus avoiding the "buy outs" of medical services in "lump sum" packages thereby circumventing the periodic payment/wage replacement nature of workers' compensation payments. Injured workers would be able to continue to receive medical monitoring and evaluation through diagnostic care and observation.

The lump sum "buy outs," encouraged by insurance carriers, merely defeat the public policy issues of workers' compensation periodic payments and abrogate their responsibility and the integrity of the workers' compensation system(s) while shifting yet again the responsibility to the taxpayers and an overburdened Medicare/Medicaid system.

A program of 24 hour care will remove from controversy medical coverage and would eliminate unnecessary litigation and administrative costs while keeping benefits to workers on a periodic basis which was the foundation of the workers’ compensation systems.

NJ Permits Intentional Tort Claim Against Former Employer- PVC Exposure

While denying class action certification for a medical monitoringclass and a punitive damage class, the NJ App Div permitted an INTENTIONAL TORT action against the employer to go forward in a common law civil claim.

This case involved exposure to poly vinyl chloride at a Pantasote, a Paterson NJ plant, causing disease to former workers which is characteristic of Raynaud's phenomenon ( fingers blanch and numbnessand discomfort are experienced upon exposure to the cold), changes inthe bones at the bones at the end of the fingers [Known asacro-osteolysis (AOL)], joint and muscle pain, and scleroderma-likeskin changes (thickening of the skin, deceased elasticity and slightedema).

Inhaled vinyl chloride has been shown to increase the risk of a rareform of liver cancer (angiosarcoma of the liver) in humans. It is classified by the Environmental Protection Agency (EPA) as a Group A, human carcinogen.

Plaintiffs represented by: Jon Gelman (NJ), Ron Simon (DC), Herschel Hobson (TX) and Mark Cuker (PA)

Decision- Buynie v. Airco Co, NJ App Div 2007, Decided August 10, 2007

See related articles:
Misleading Statements Made By Vinyl Chloride Companies Held Valid Basis for Suit

Workplace Poison

Vinyl Chloride Conspiracy Documents: Part 4 (Jun 1974 - Dec 1974)

Vinyl Chloride Plants in New Jersey