New Jersey's Medical Billing Problem: When "Reasonable and Customary" Costs You a Fortune
Showing posts sorted by date for query knee. Sort by relevance Show all posts
Showing posts sorted by date for query knee. Sort by relevance Show all posts
Thursday, January 22, 2026
Wednesday, October 1, 2025
Workers' Compensation Lien Secures Damages
In a negligence action arising from a motor vehicle accident, the court found the defendants were 85% at fault, and the plaintiff, Antonio Lorenzo-Noda, was 15% at fault. The court determined that the plaintiff's negligence, at 15%, was less than the 51% threshold under the New Jersey Comparative Negligence Act, which allows him to recover damages.
Wednesday, December 25, 2024
Attempt to Inflate Jury Award by a Workers' Compensation Lien Rejected
In a recent New Jersey appellate decision, the court addressed an interesting intersection of personal injury law, workers' compensation, and jury verdict interpretation. The case Todd v. Bauder highlights the importance of precise jury instructions and the limits of judicial authority to modify jury awards.
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.
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.
Tuesday, March 26, 2019
Medical Treatment is an Exclusive Remedy Not a Reasonable Accommodation
The NJ Supreme Court has held that the provision of medical treatment does not equate to a "reasonable accommodation", therefore an employee cannot claim under the Law Against Discrimination [LAD] that failure to provide medical care was actionable. The provision of medical treatment is an exclusive remedy of the Workers’ Compensation Act.
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.
Friday, December 28, 2018
Knee Replacements: An Over Sold Procedure
The following post is shared from Kaiser Health News authored by Liz Szabo:
"Research suggests that up to one-third of those who have knees replaced continue to experience chronic pain, while 1 in 5 are dissatisfied with the results. A study published last year in the BMJ found that knee replacement had “minimal effects on quality of life,” especially for patients with less severe arthritis.
"Research suggests that up to one-third of those who have knees replaced continue to experience chronic pain, while 1 in 5 are dissatisfied with the results. A study published last year in the BMJ found that knee replacement had “minimal effects on quality of life,” especially for patients with less severe arthritis.
Saturday, June 30, 2018
Insufficient Evidence: When "A Lot" is Not Enough
A Judge of Compensation's opinion must be supported by objective medical evidence and not merely based upon an inadmissible net opinion of a medical expert.
Wednesday, February 21, 2018
Standing Desks at Work Deemed Not Beneficial
Before employers buy standing workstations and/or even treadmills to prevent repetitive motion claims, they ought to take heed of a recent study that considers them a useless fad. The newest marketing craze is work at standing desks, some even equipped with treadmills and marked as ergonomically safer for an employee’s health.
Friday, March 18, 2016
NJ Judge Orders Psychotherapy Sessions In Conjunction With Pain Management
A NJ Workers' Compensation Judge Ordered the continuation of medical services to an injured worker who has been struggling for years because of chronic knee pain depression and anxiety despite the objection of the employer who sought to terminate care. The Judge Philip A. Tornetta, Administrative Supervisory Judge of Compensation, adopted an innovative approach in attempt to reduce or eliminated prescribed drugs including, "Oxycontin for her knee pain, Lexapro for depression and Xanax, which helps her sleep."
Monday, February 8, 2016
Defense Firm Prohibited From Seeking Unfettered Medical Discovery
A defense firm, that had a “custom” of seeking unlimited medical discovery in workers’ compensation claims, was barred from utilizing that litigation tactic. The NJ Appellate Division affirmed the trial level decision of The Honorable Emille R. Cox, Supervising Judge of Compensation that prohibited requests for unlimited medical data.
Saturday, February 7, 2015
Blue Cross North Carolina’s Price Tool Could Shake Up Medical Industry
Leslie Goldfarb of Charlotte had been talking to two surgeons about knee surgery and worrying about her out-of-pocket costs.
When she recently read about a new online database from Blue Cross and Blue Shield of North Carolina, she checked the average reimbursement for those surgeons. One of them averaged about $1,500 less in total costs associated with the arthroscopic surgery she’s having. And Blue Cross pays about twice as much if the same doctors do the procedure in a hospital – costs that pass through to her with a high-deductible plan.
She used that data to schedule her surgery.
“You don’t have to legislate medical costs to come down,” Goldfarb said. “All you have to do is make the information available.”
That’s the idea.
Until recently the cost of medical care had been a closely guarded trade secret and patients had little reason to care when health insurance covered most of the expense. Now, however, as patients become responsible for more of their medical costs, such information is seeping out through online tools.
How that will play out in the medical marketplace remains to be seen, but Blue Cross’ North Carolina disclosure is creating national buzz. A recent post on Forbes.com said it could “represent the dawn of a new age in health care.”
“Transparency in general is a good thing,”...
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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... |
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
Tuesday, November 4, 2014
Stryker Settles Suits by Hip Implant Patients for $1 Billion
Tiday's post is shared from nytime.com/
| Stryker, the major producer of artificial hip implants, said on Monday that it had reached a settlement of thousands of patient lawsuits involving now-recalled all-metal devices that is expected to cost the company about $1 billion. The Stryker deal, negotiated with lawyers representing the patients, would be one of the highest amounts paid in the last year by an implant manufacturer to resolve claims by patients who said they were injured by a hip replacement in which a device’s ball and cup components were both made from metal. Last November, the DePuy division of Johnson & Johnson agreed to pay about $2.5 billion to resolve lawsuits filed by 8,000 patients who said they were injured by an all-metal implant that it once sold, known as the Articular Surface Replacement or A.S.R. All-metal implants once accounted for about one of every three devices used in the estimated 250,000 hip replacement procedures that are performed annually in this country. The devices have been largely abandoned after evidence emerged several years ago that the metal components could rub together, creating tiny particles of metallic debris that could severely damage a patient’s tissue and muscle. In announcing the settlement, Stryker, which is based in Kalamazoo, Mich., said that it covered patients who had received the Rejuvenate Modular-Neck or the ABG II Modular-Neck and who underwent operations to have the implant replaced. Stryker recalled both models in 2012 as complaints... |
Sunday, October 26, 2014
Quarantined nurse to CNN: 'My basic human rights' are being violated
| 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... |
Tuesday, September 30, 2014
L.A. pays millions as police and firefighter injury claims rise
| Los Angeles Fire Capt. Daniel Costa liked to go all out on the racquetball court at the LAX fire station. A fellow firefighter described him as a "very competitive" player who "likes to win." Costa seemed in fine form after five spirited games in the fall of 2011. So his supervisor was skeptical when Costa, then 53, said he'd hurt his knee on the court and needed time off, according to a report by investigators for the city attorney's office. Costa was out on injury leave for a year, collecting his full salary, tax-free. In 2009, he took a nearly year-long paid leave after a run-in at the fire station with subordinates he described as "bullies." He complained of chest pain, high blood pressure and other symptoms, state records show.  Costa has been one of the biggest beneficiaries of an injury-leave program for Los Angeles police and firefighters that has cost taxpayers $328 million over the last five years, a Times investigation found. Total salaries paid to city public safety employees on leave increased more than 30% — to $42 million a year – from 2009 through 2013, the five-year period studied by The Times. The number who took leaves grew 8%, and they were out of work an average of nearly 9 weeks — a 23% increase compared with 2009. The increased frequency and cost of leaves has forced the Fire Department to spend millions of dollars a year in overtime and reduced the number of police officers on the... |
Sunday, September 21, 2014
Workers’ Compensation changes found unconstitutional in Florida and may effect California injured workers
| Anyone that has been following California Workers’ compensation over the last few years has seen medical care and wage replacement benefits slashed. It is to the point where the Workers’ Compensation system is causing more problems than it is fixing. The same thing is happening in several other states including Florida. Thankfully a judge has finally taken a stand and said the Workers’ Compensation system changes have gone to far. Workers’ Compensation has a purpose; it is supposed to get workers’ healthy and compensate them for the time they missed from work and the permanent disability they now suffer. The changes in Florida limited treatment, stopped workers’ from getting wage replacement, and did not compensate people that lost their ability to work. As judge Cueto stated “The purpose of a workers’ compensation act is not for it to be used as a weapon in an economic civil war, its purpose is to provide adequate compensation for on-the-job injuries in place of a worker’s ability to sue in civil court.” The same arguments made in Florida apply to California where a simple doctors request for treatment takes an average of 7 months to get approved. For example, a person that twists their knee at work may have to wait over 6 months for an MRI, where a person not hurt on the job will have that same MRI within a day, a week at the most. This delay slows down the recover of... |
Thursday, September 4, 2014
J&J’s Pinnacle Hips Face First Trial on Poisoned Patients
Johnson & Johnson (JNJ), which set aside $2.5 billion last year to resolve claims that 8,000 of its artificial hips were defective, faces a new round of lawsuits over another line of hip implants blamed for poisoning patients.
J&J’s DePuy unit is starting its first trial of allegations that the metal-on-metal version of the Pinnacle hip was defectively designed and caused metal debris to leech into patients’ bloodstreams. The cobalt-and-chromium material caused an infection that forced Kathleen Herlihy-Paoli to have her artificial hips surgically removed, she said in court filings.
Jury selection began today in Herlihy-Paoli’s suit, the first of more than 6,000 cases over the devices to be weighed by a jury. The cases have been consolidated before U.S. District Judge Ed Kinkeade in Dallas for pretrial information exchanges. Kinkeade will preside over Herlihy-Paoli’s trial.
“The first trials in any of these consolidated litigations set the tone for the following cases,” Carl Tobias, who teaches product-liability law at the University of Richmond in Virginia, said in an interview. “If J&J loses the first couple of these Pinnacle trials, they better start seriously thinking about coming up with a settlement similar to what they signed off on for the ASR hips.”
Ultamet Line
J&J said studies have shown the Pinnacle Ultamet line of devices restores mobility and reduces pain for patients in need of hip replacement.
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