The Future of Spitzer’s NY Workers’ Compensation Reform Effort and the AMA Guides 6th ed.

With Governor Spitzer now embroiled in a major scandal that may end in his resignation as Governor of the State of New York, all eyes in the workers’ compensation arena are now focused on his reform efforts. On February 27, 2007 shortly after taking office he signed landmark legislation to overhaul the NY system.

The legislation mirrors the concerns of Labor and Industry throughout the country about a workers’ compensation system bogged down in administrative bureaucracy and failing to meet the medical and permanent disability needs of injured workers. The new NY act is a skeleton on a program that will be reconstructed by regulations and administrative memos.

Injured workers in NY, as in other parts of the country, are concerned of the implantation of the new AMA Guidelines as the criteria for determining disability. It has been remarked that the new AMA Guidelines 6th edition will eliminate at 60% of all findings of disability resulting in no benefits for those injured workers. The Business Council on NY has been advocating for their implementation.

It is doubtful that there will be a change of course in NY. The NY legislation was originally drafted under the Republication Administration of Governor Pataki and merely passed in the Democratic Administration of Spitzer in about 45 days after he took office. The political deal was struck NY long before the Spitzer Administration, but the legislation is only a skeleton that will require additional crafting and implementation.

NY mirrors the same issues of other jurisdictions. Unfortunately implementing the AMA Guidelines 6th edition will not solve the problem in NY or elsewhere. It is like taking a wheel off a vehicle with 2 flat tires already. Yes the system needs reform, but one that will be crafted as the fathers of workers’ compensation legislation intended, which is a system that provides expeditious and adequate compensation for injured workers.

Petition Filed to Re-Consider California AMA Guide Decision

The California Workers' Compensation Appeals Board (CAWCAB) has decided to review its prior decision of February 27, 2009, challenging the AMA Guidelines. The CAWCAB has issued an Order granting reconsideration and inviting mucus briefs to be filed.

"We also will give any interested person or entity until 5pm on Friday, May 1, 2009 to file an amicus curiae brief and to serve that brief on all counsel in both the Almaraz and Guzman cases."

Alvaraz v. Environmental Recovery Services, et al.

Computerized X-ray Interpretation to Evaluate Spinal Ligamentous Injuries

Diagnosing and quantifying spinal ligament pain in workers' compensation claims has historically been a challenge to both the medical and legal communities. Now a recently published study reports that through computer assisted analysis  a computerized measurement can be obtained that can assist in accurately diagnosing and grading of ligament injuries.

"Spinal Ligament injury is well documented to be one the most common injuries in a trauma. It is also well documented that, depending upon the grade (seriousness) of the injury, they can take up to 2 years to heal and have different treatment protocols. Yet it seems few doctors attempt to accurately grade the injury according to medical guidelines even where specific guidelines exist. The crude and varying methods to assess the injury provided little consensus. This study shows that precise accurate grading of spinal ligament injury can be best obtained by advanced computerized methods for measuring x-rays, while conforming to current AMA injury guidelines. One Hundred random cases of spinal injury were assessed by usual visual inspection of stress x-rays by radiologists, then re-assessed by computer measurement.  

"Significant spinal ligament injury was accurately revealed by computer measurement that was missed by the standard radiological reads. 

"Assessing spinal ligament injury by computer measurement significantly improves diagnosis and grading of ligament injury.

Click here to read Brownstein SP, Jefferey Cronk DC, Joseph Cioffi BA. Evaluation of Spinal Ligamentous Injuries using Computerized X-rayInterpretation. Orthop Rheumatol Open Access J. 2015;1(1): 555551. 

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NJ Bill Passes Assembly to Increase Awards for Hand and Feet Injuries

NJ Bill Passes Assembly to Increase Awards for Hand and Feet Injuries
The bill has been sent to Gov. Christie for signature.

NJ is one of the few state that does not follow the AMA Guidelines in determining disability. Disability is scheduled and based on complaints, functional loss and evaluation by the hearing official.

Identical Bill Number: S676     Last Session Bill Number: S639   (1R) A1581       This bill increases the amount of workers' compensation paid in certain cases for the loss of a hand, or thumb and first and second fingers (on one hand) or four fingers (on one hand) or a foot, as follows:      1.    If a loss of function of a hand is determined to be a 25% or more loss of use, the award of workers’ compensation shall be calculated based on a maximum of 300 weeks of compensation for a 100% loss of function; and      2.    If a loss of function of a foot is determined to be a 25% or more loss of use, the award of workers’ compensation shall be calculated based on a maximum of 275 weeks of compensation for a 100% loss of function.      Under current law, the maximum award for the loss of a hand is 245 weeks and the maximum award for the loss of a foot is 230 weeks. Egan, Joseph V.   as Primary Sponsor Evans, Elease   as Primary Sponsor Wisniewski, John S.   as Primary Sponsor Giblin, Thomas P.   as Primary Sponsor Spencer, L. Grace   as Co-Sponsor
9/16/2010 Introduced, Referred to Assembly Labor Committee 11/28/2011 Reported out of Assembly Committee, 2nd Reading 12/5/2011 Substituted by S676 Statement - ALA 11/28/11 - 2 pages PDF Format    HTML Format  Fiscal Estimate - 12/5/11; as introduced - 3 pages PDF Format    HTML Format  Introduced - 9 pages PDF Format    HTML Format  Committee Voting: ALA  11/28/2011  -  r/favorably  -  Yes {6}  No {2}  Not Voting {0}  Abstains {1}  -  Roll Call The legislation was previously approved by the NJ Senate. Identical Bill Number: A3166     Last Session Bill Number: S639   (1R) A1581  Sarlo, Paul A.   as Primary Sponsor Gill, Nia H., Esq.   as Primary Sponsor Egan, Joseph V.   as Primary Sponsor Evans, Elease   as Primary Sponsor Wisniewski, John S.   as Primary Sponsor Giblin, Thomas P.   as Primary Sponsor Scutari, Nicholas P.   as Co-Sponsor Spencer, L. Grace   as Co-Sponsor         1/12/2010 Introduced in the Senate, Referred to Senate Labor Committee 2/18/2010 Reported from Senate Committee, 2nd Reading 2/22/2010 Passed by the Senate (24-12) 2/25/2010 Received in the Assembly, Referred to Assembly Labor Committee 11/28/2011 Reported out of Assembly Committee, 2nd Reading 12/5/2011 Substituted for A3166 12/5/2011 Passed Assembly (Passed Both Houses) (59-15-4) Introduced - 9 pages PDF Format    HTML Format  Technical Review Of Prefiled Bill - 8 pages PDF Format    HTML Format  Statement - SLA 2/18/10 - 1 pages PDF Format    HTML Format  Fiscal Estimate - 3/1/10; as introduced - 2 pages PDF Format    HTML Format  Statement - ALA 11/28/11 - 2 pages PDF Format    HTML Format  Committee Voting: SLA  2/18/2010  -  r/favorably  -  Yes {4}  No {2}  Not Voting {0}  Abstains {0}  -  Roll Call ALA  11/28/2011  -  r/favorably  -  Yes {6}  No {2}  Not Voting {0}  Abstains {1}  -  Roll Call Session Voting: Sen.    2/22/2010  -  3RDG FINAL PASSAGE   -  Yes {24}  No {12}  Not Voting {4}    -  Roll Call

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NJ Governor Christie to Propose Workers' Compensation Reform

The NJ Workers' Compensation system is in for a change. Governor Chris Christie of NJ is taking aim at reforming the NJ system.

In the past, unsuccessful major attempts to reform the State's workers' compensation

system have come from interest groups from outside of the State, ie. 1980's national insurance Industry (AIA) concerns. Now the focus is changing, and the proposals for reform will be coming from the the State's Chief Executive, a major coalition builder who has successfully tackled major legislative changes during his term in office.

Historical efforts on workers' compensation reform in NJ have been:

-1974 Following the NJ State Commission on Investigation "Report of the NJ Workmen's Compensation System"
-1980's Following the WCRI Study attempt to adopt AMA Medical Guidelines

-1998 An attempt to increase the calculation of the State Average Weekly Wage, Dependency      Benefits and Legislative Oversight

-2008 Following the NJ Star Ledger expose ("How NJ Fails Workers") on temporary and medical benefit issues

“'We’re going to be coming up with a package of proposals that’s going to work both sides of that,' Christie told a caller on his monthly NJ 101.5 FM radio show tonight.

'The employers who may not be stepping up and meeting their obligations and also the employees who are committing fraud on the worker’s comp system,' he said."

Click here to read the complete article:  Christie to present plan to reform N.J. worker's compensation system (NJ.com)