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Showing posts sorted by relevance for query knee. Sort by date Show all posts
Showing posts sorted by relevance for query knee. Sort by date Show all posts

Tuesday, December 3, 2013

As Hospital Prices Soar, a Single Stitch Tops $500

Medical delivery costs continue to soar and workers' compensation claims costs are running out of ontrol. Cost for emergency medicare are not usually regulated by workers' compensation prorams, eve where balance cillig is removed from the equation. Todays post is shared from the NYTimes.org

With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center’s tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.

On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. “It was great — they had good DVDs, the staff couldn’t have been nicer,” said Emer Duffy, Orla’s mother.
Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11. Orla’s forehead was sealed with a dab of skin glue for $1,696. “When I first saw the charge, I said, ‘What could possibly have cost that much?’ ” recalled Ms. Singh. “They billed for everything, every pill.”
In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care...
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Sunday, October 26, 2014

Quarantined nurse to CNN: 'My basic human rights' are being violated

Today's post is shared from cnn.com
Kaci Hickox, a nurse placed under mandatory quarantine in New Jersey, went on CNN on Sunday and criticized the "knee-jerk reaction by politicians" to Ebola, saying "to quarantine someone without a better plan in place, without more forethought, is just preposterous."
Hickox, an epidemiologist who was working to help treat Ebola patients in Sierra Leone, has tested negative twice for Ebola and does not have symptoms, she said.
"This is an extreme that is really unacceptable, and I feel like my basic human rights have been violated," Hickox told CNN's Candy Crowley on "State of the Union."
She described herself as "physically strong" but "emotionally exhausted."
"To put me through this emotional and physical stress is completely unacceptable," she said.
She slammed New Jersey Gov. Chris Christie for describing her as "obviously ill."
"I'm sorry, but that's just a completely unacceptable statement in my opinion. For him -- a politician who's trusted and respected -- to make a statement that's categorically not true is just unacceptable and appalling," Hickox told Elizabeth Cohen, CNN's senior medical correspondent, in a separate interview.
Hickox told Crowley that mandatory quarantine is "not a sound public health decision" and that public health officials -- not politicians...
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Monday, July 27, 2009

Jury Awards $70,000 to Injured Employee For Discrimination & Retaliation

A corrections officer in Hudson County NJ was awarded $70,000 by a jury for violation of her workers' compensation rights and discrimination charges flowing from her accident at work.

The employee, who had suffered an injury to her knee and subsequent surgical intervention, received a disciplinary notice from her employer alleging that she was "faking her injuries."

NJ law permits a common law action for wrongful discrimination based upon an alleged retaliatory firing attributed to the filing of a workers' compensation claim is also available to an employee. The judicial remedies include: loss of wages and reinstatement of employment, as well as other compensatory and punitive damages.

Monday, March 25, 2013

Ciba, Toms RIver NJ and a Cancer Epidemic

Early in my workers' compensation career, during the 1980's, I was asked by a local attorney to participate in the prosecution of 3 brain cancer workers' compensation claims. The cases arose out of an alleged exposure to toxic substances while working at the Ciba-Geigy's chemical plant in Toms River, NJ. 

Being a notoriously zealous attorney, I undertook the claims. They were being defended personally by named partner in a mega-NJ liability firm. After several hearing dates, and my motion being granted for an on-site inspection of the premises with Judge being present, the claims were ended to the satisfaction of my clients.

The story of Ciba-Geigy and the plight of the employees and the community is now the subject of an insightful book, Toms River, A story of Science and Salvation authored by Dan Fagin.

Click here to hear the NPR Story - For Toms River, An Imperfect Salvation

Thursday, September 7, 2023

Lawsuit Proceeds Against Amazon For Scheme to Obstruct a Workers’ Compensation Claim

An injured Amazon fulfillment center worker brought an action against Amazon.com Service LLC [AMAZON] for acts of its Third-Party Administration (TPA), Sedgwick CMA-Philadelphia [SEDGWICK], among other allegations, in interfering with the authorized workers’ compensation physician. The claim arose from a December 2019 knee accident the worker sustained at the AMAZON warehouse. 

Thursday, November 13, 2014

MEDICAL PAYMENTS PER CLAIM IN FLORIDA WERE TYPICAL OF STUDY STATES AND GREW AT A MODERATE RATE FROM 2007 TO 2012, SAYS NEW STUDY


CAMBRIDGE, MA, November 12, 2014  Medical payments per claim in Florida were typical of the 16 study states and grew moderately over the study period. The WCRI report, CompScope™ Medical Benchmarks for Florida, 15th Edition, said the average cost of a Florida claim with more than seven days of lost time that occurred in 2012 was $11,519, fairly close to the 16-state median at $12,167.  
From 2007 to 2012, medical payments per claim in Florida grew 2.9 percent per year, less than the median growth of the 16 states WCRI studied, 4.5 percent.  
Hospital outpatient care was used less frequently in Florida compared to other study states. Both the percentage of claims with hospital outpatient services and the average number of visits per claim billed by hospital outpatient providers were among the lowest of the 16 states. However, for claims receiving hospital outpatient care, the average payment per service of Florida’s hospital outpatient services was higher than any other study state, 60 percent higher than the 16-state median.  
While the average payment per outpatient service was the highest of all states, the number of outpatient services performed per claim was the lowest. The two measures largely offset, giving an average hospital outpatient cost per claim near the 16-state median.  
WCRI observed that the average payment per service for hospital outpatient services in Florida grew rapidly at 7.5 percent per year from 2007 to 2012. This trend may be related to some features in the percent-of-charge-based fee schedule in the state. For example, the average payment per service for hospital outpatient operating rooms grew 12 percent per year over the study period, closely following the increase of 13 percent per year in charges per service. 
Among other major findings:
  • Florida had higher percentages of outpatient shoulder and knee surgeries done in ambulatory surgery centers (ASCs), and the average ASC payment per episode for those surgeries was in the middle group of study states.
  • Prices paid for professional services in Florida were among the lowest of the study states, while utilization of nonhospital care was relatively higher. Both metrics remained fairly stable over the study period.
The Cambridge-based WCRI is recognized as a leader in providing high-quality, objective information about public policy issues involving workers' compensation systems. 
Click on the following link to purchase a copy of this study:http://www.wcrinet.org/result/csmed15_FL_result.html

Sunday, May 5, 2019

Correct Way to Contest a Lien

Attorneys should follow the correct procedures to contest a lien asserted by a workers’ compensation insurance carrier. A recent case provides instructions on the appropriate techniques.

Thursday, February 28, 2013

E-Filing Is A Good Thing

Workers' Compensation attorneys need to adapt to new technology. A case in point is electronic filing.

The Bob Cummings Show
January 2, 1955 to September 15, 1959
Two jurisdictions recently have sparked efforts for adaptation to new procedures designed to implement more expeditious and cost savings measures.

Over fifty years ago, there was a sit-com on TV, The Bob Cummings Show. The program mocked a GrandPa's ability to adopt to new technology. The aging parent used gifts of an electric blanket as a bread warmer, and an electric rotisserie as a sock dryer.

NJ has adopted e-filing of motion practice that speeds docketing and service of pleadings in the vast majority of cases. While not mirroring the stellar Federal Court Case Management Electronic Filing System with compete exhibit PDF submissions permitted, it does make major improvements to the process.

Florida has reported, that despite offerring an e-filing, parties are still entrenched in their old and wasteful habits of using USPS Certified Mail for process.

Friday, November 29, 2013

US manufactures try to stop carcinogen classification

Friday, March 8, 2013

Jobs....a long way to go

The workers' compensation market/business is dependent on employment. The newly released statistics, while appearing encouraging, might not be so after all.


Despite today's promising numbers report from the US Bureau of Labor Statistics, some believe that the US has a very long way to go to get to full employment. Repeating the golden years is a very difficult road.

I commented a few years ago (Is The Recovery Of The Workers’ Compensation System An Illusion?) that workers' compensation is not necessarily anti-cyclical, ie. does not necessarily do better in down markets. That has been reflected in decreased manufacturing and insurance carrier insolvencies.

Friday, December 12, 2014

The long history of GM’s ignition switch cover up

Today's post is shared from motleyrice.com/
GM’s ignition switch defect has now been linked to 38 deaths to date. The ignition switch problem was so obvious that customers, journalists and even GM employees were reporting the problem a decade before GM finally admitted the issue and recalled the cars.
Way back in 2005, one frightened customer wrote to both GM and the National Highway Traffic Safety Administration (NHTSA), stating that “This is a safety/recall issue if ever there was one . . . The problem is the ignition turn switch is poorly installed. Even with the slightest touch, the car will shut off while in motion. I don’t have to list for you the safety problems that may happen, besides an accident or death, a car turning off while doing a high speed must cause engine and other problems in the long haul . . . I firmly believe that this ignition switch needs to be recalled, reexamined and corrected.” Yet, GM did nothing.
That same year, New York Times journalist Jeff Sabatini commented on an odd issue with his Chevrolet Cobalt. His wife was driving on the freeway when she accidentally bumped her knee on the steering column and the car “just went dead.” On looking into the issue, he found another writer with the same problem. Journalist Gary Heller of Pennsylvania’s The Daily Item had also experienced “unplanned engine shutdowns [that] happened four times during a hard-driving test week” in his Cobalt. The...
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Friday, March 8, 2013

$8 Million Verdict: DePuy Defective Hip Implant

A jury in California awarded a retired guard $8 Million as a result of suffering from a defective hip implant. The defective product, an ASR hip implant,  was manufactured by Johnson & Johnson. Many additional cases are pending though-out the country.
DePuy Hip Replacement Claims

Read more about hip-implants and workers' compensation
Feb 27, 2013
4, 2013, DePuy issued an Urgent Medical Device Recall informing hospitals and surgeons of the problem and to immediately stop distributing or using the recalled lots. If a medical facility has the affected product in stock, it is ...
Dec 17, 2010
With an estimated 93,000 DePuy recalled artificial hips implanted worldwide, the workers' compensation benefit system will probably be paying for a vast amount of the remediation and treatment costs, and then having its ...
Aug 27, 2010
DePuy release a statement today that they two products being recalled were: the ASR XL Acetabular System, a hip socket used in traditional hip replacement, and the ASR Hip Resurfacing System, a partial hip replacement ...
Jan 17, 2013
Johnson and Johnson has recalled 2 Hip Implants because of failure. The two implants were made by the DePuy Orthopaedics unit of Johnson and Johnson. The decision to withdrawn the products was based upon the fact .

Friday, March 28, 2014

Nurse Ratched Comes To Workers' Compensation or Why Workers' Compensation Should NOT be Involved in Criminal Drug Enforcement

State officials and legislators are increasingly concerned with the over-prescription of opiates and other controlled substances for pain management in the workers’ compensation program.

A bill pending in...

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Related Story:
Workers' Compensation: Physicians Petition to Limit Opioid Abuse
Jul 27, 2012
The efforts to reform pharmacuetical use is a tough balancing act. The ulterior motive of cost savings and profits generates sensationalism, but what makes good medical sense and what benefits the patient should not go ...
http://workers-compensation.blogspot.com/

Wednesday, June 26, 2013

NJ Workers Compensation Companies Pay More for Hospital Fees

NJ workers' compensation insurance companies pay more for hospital charges than group health plans, according to a recent study published by the WRCI. NJ workers' compensation statute mandates a closed panel system were the the company must authorize the medical provider.

"The average workers' compensation payment for shoulder surgery in New Jersey was $7,323. Group health plans paid only $4,583 on average, a difference of $2,740, or 37 percent less.

For knee surgery the workers' compensation insurers' cost was $5,547, 42 percent higher than amounts paid through group health plans, which included the co payments and deductibles paid by the patients."

Click here to read: "Study: NJ workers comp insurers pay higher fees to hospitals than group insurers" The Record

Read more about medical treatment and workers' compensation:
Proposed Medicare Payment Reductions Will Impact Workers
Jun 17, 2013
A government Medicare advisory panel reported on Friday that sweeping changes should be implemented to reduce increasing medical costs, including higher costs associated with hospital purchased physician practices.
http://workers-compensation.blogspot.com/


NJ Bayonne Medical Center - Highest Priced Medicine in the Nation
May 18, 2013
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 .
http://workers-compensation.blogspot.com/


Workers' Compensation Jeopardy: Romney and Medical Costs
Nov 01, 2012
Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers' compensation medical treatment. Proposed changes to the Federal program will indirectly ...
http://workers-compensation.blogspot.com/


Workers' Compensation: Medical Costs Soar in Workers ...
Dec 11, 2008
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 ...
http://workers-compensation.blogspot.com/


Related articles

Wednesday, April 28, 2010

Preventing Joint Replacement Surgery in Workers' Compensation Claims

Joint replacement claims are becoming more frequent in workers’ compensation and proving compensability remains challenging. As the aging working population has expanded so has been the need for workers’ compensation to pay for the cost of replacing aging joints.

The cost for a new hip or knee can cost as much as $30,000 to $40,000. for the surgery alone. Additionally, workers’ compensation companies maybe responsible for the payment of temporary disability benefits to injured workers who are required to undergo surgery. Should the medial procedure fail, the insurance company could possibly be liable for the payment of total disability benefits to the injured worker.

Historically workers’ compensation programs were only liable for specific traumatic injuries. The original acts enacted in 1911 were amended the 1940’ and 1950’s to cover occupational conditions and cumulative stress disorders.

Whether a joint replacement is required because of a work related condition sometimes becomes a difficult proof issue. Pre-existing conditions. ie. natural degeneration, may be considered as the sole or contributing factor for the need for replacement. . Ruhe v. Industrial Commission of Arizona, 2010 WL 1253527 (Ariz. App. Div. I), Raymer v. Interstate Brands Company, 2009 WL 277539 (Ky. App.). A prior condition may be ruled out as a con-contributory factor. Anheuser-Busch Co. Inc., 156 N.H. 677, 940 A.2d 1147 (N.H. 2008).

Even if there is a traumatic injury, there may be a need for joint replacement that can be anticipated in the future. Stevens v. Citizens Memorial Healthcare Foundation, 244 S.W.3d 234 (Mo. Ct. App. 2008). In such situations future medical care should be considered at the time of the initial judgment.

Avoiding the need for joint replacement is the best solution altogether. While 400,000 people a year have joint replacement surgery, taking the preventive route of  caring for your joints can save both lot of money and a lot of discomfort. The NY Times has reported some prevention methods that look promising.  Workers’ compensation courts should consider these concepts and order recognized preventive programs when adjudicating claims where potential joint replacement maybe anticipated.

To read more about workers' compensation click here.

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Thursday, May 24, 2012

Whose to Blame for Opioid Abuse in Workers' Compensation Claims?

English: From: United States Department of Jus...
(Photo credit: Wikipedia)
A recent Texas case  holding an employer liable holding an employed liable for a fatal opioid overdose arising out of work-related event highlights again that, the workers' compensation medical delivery system just isn't working. Efforts by Industry to "reform" the system. by limiting benefits. is a misdirected knee-jerk reaction, and not one that will address the symptoms of the problem, a failed medical delivery system.

Click here to read more: Opioid death liability falling on employers--Court rulings compel benefits payments

Related articles

Monday, September 1, 2014

Court OKs workers' comp for kickball injury

Todays post is shared from blufftontoday.com
A man who was severely injured during the company kickball game he organized is entitled to workers’ compensation, the S.C. Supreme Court has ruled.
The justices reversed the Court of Appeals and the state workers’ comp panel in a Wednesday decision.
During a company-sponsored kickball game in 2007, Stephen Whigham jumped and landed awkwardly on his right leg, shattering his tibia and fibula.
“He was taken away in an ambulance and eventually underwent two surgeries. His doctor later informed him he would need a knee replacement in the near future,” according to Wednesday’s decision.
Whigham was the director of creative solutions at Jackson Dawson Communications in Greenville, described in court records as a marketing, advertising and public relations company.
During a meeting with other company leaders, Whigham came up with the idea of having a company kickball game as a team-building activity, and his superior at the company approved it. Supplies cost the company $440.
The event was called “Ballad Ball” and “paid tribute to the rock ballads of the 80s,” according to court records.
In its decision Wednesday, the Supreme Court focused on whether Whigham’s employer expected him to attend the game.
When asked if he would have considered it irresponsible of him not to show up, his boss replied: “I don’t know. I would have thought—he wouldn’t do...
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Friday, January 4, 2019

Landlord Held Not Liable for Injuries Of Tenant's Employee

A NJ Appellate Court has upheld the summary judgment dismissing the case where a commercial landlord was sued in a civil action for damages injured by a tenant's employee. The Court reasoned that the tenant had exclusive possession of the premises under the lease and the tenant had sole responsibility for the maintenance and repair of the premises.

Monday, February 3, 2014

Goodbye to the Doctor’s White Coat?

Today's post was shared by The New York Times and comes from well.blogs.nytimes.com

A scene from “Grey’s Anatomy,” ABC's long-running hospital drama.
A scene from “Grey’s Anatomy,” ABC's long-running hospital drama.
Ron Tom/ABC A scene from “Grey’s Anatomy,” ABC’s long-running hospital drama.
New recommendations on what health care workers should wear may mean an end to the doctor’s white coat.
The Society for Healthcare Epidemiology of America, a professional group whose mission is to prevent and control infections in the medical workplace, has issued guidance on what health care workers should wear outside of the operating room.
The paper, in the February issue of Infection Control and Hospital Epidemiology, suggests that to minimize infection risk, hospitals might want to adopt a “bare below the elbows” policy that includes short sleeves and no wristwatch, jewelry or neckties during contact with patients.
The authors also recommend that if the use of white coats is not entirely abandoned, each doctor should have at least two, worn alternately and laundered frequently. And even if they wear the coat at other times, they should be encouraged to remove it before approaching patients.
The authors emphasize that the recommendations are based more on the biological plausibility of transmitting infection through clothing than on strong scientific evidence, which is limited.
The lead author, Dr. Gonzalo Bearman, a professor of medicine at Virginia Commonwealth University, said that hand washing, bathing patients with antibacterial soap, and checklists for inserting...
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Saturday, March 9, 2013

Hospitals Are Become Even Deadlier Places for Sick People

The US Centers for Disease Control (CDC) has reported that lethal drug-resistance bacteria is making its appearance at a growing rate at health care facilites. What has now been called a "nightmare of bacteria," CRE infections may now become a very serious complication of a work-related injury

"Drug-resistant germs called carbapenem-resistant Enterobacteriaceae, or CRE, are on the rise and have become more resistant to last-resort antibiotics during the past decade, according to a new CDC Vital Signs report.  These bacteria are causing more hospitalized patients to get infections that, in some cases, are impossible to treat. 
CRE are lethal bacteria that pose a triple threat:
  • Resistance: CRE are resistant to all, or nearly all, the antibiotics we have - even our most powerful drugs of last-resort.
  • Death: CRE have high mortality rates – CRE germs kill 1 in 2 patients who get bloodstream infections from them.
  • Spread of disease:  CRE easily transfer their antibiotic resistance to other bacteria.  For example, carbapenem-resistant klebsiella can spread its drug-destroying weapons to a normal E. coli bacteria, which makes the E.coliresistant to antibiotics also. That could create a nightmare scenario since E. coliis the most common cause of urinary tract infections in healthy people.