Every year The Board of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Supplemental Medical Insurance Trust Funds makes an actuarial guess as to the future financial solvency of Medicare. The report creates an annual news frenzy in the workers’ compensation community since Medicare is both the safety net for injured workers and playground for employers and their insurance companies to use in cost shifting,
Showing posts sorted by date for query path to federalization. Sort by relevance Show all posts
Showing posts sorted by date for query path to federalization. Sort by relevance Show all posts
Friday, July 14, 2017
Thursday, June 15, 2017
Safeguarding Injured Workers From Cybersecurity Breaches
Under new Federal proposals, injured workers will be protected from cybersecurity breaches. The impact will be greater responsibilities and costs for law firms and, employers and their insurance companies.
Friday, October 7, 2016
US Department of Labor Urges Major Changes in the Nation's Workers' Compensation System
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, January 18, 2016
Sanders Proposes Universal Health Care: The Path to Federalization
Wednesday, September 30, 2015
Adult Club Dancer Is An Employee
An adult club dancer was held to be an employee in a recent NJ workers' compensation decision. The Court relied upon both, the Right to Control Test and the Relative Nature of the Work Test in making its determination of employment status.
The Honorable E. Elaine Voyles, Judge of Compensation, held:
The Honorable E. Elaine Voyles, Judge of Compensation, held:
"Although the parties were unable to enter into any stipulations, many of the relevant facts are not disputed. The Petitioner was employed as a dancer at the time of her accident. The Respondent, is an adult club wherein Petitioner, and other dancers, entertained patrons. Both parties agreed that Petitioner was required to fill out an application (P1) and audition for her position. Both parties agreed that Petitioner's schedule changed on a weekly basis and that the dancers could set their own schedule. There was further agreement that Petitioner was not paid a salary and that she worked for tips. According to the testimony of both sides, Petitioner did not have to share her tips except for when she performed a "couch dance". The cost for a "couch dance" was $20 of which $15 was given to the dancer and five dollars was retained by the Respondent.
"Petitioner testified that once the weekly schedule was set the dancers were required to appear at their designated times. She further testified that she could not leave the facility between dances and that she was required to finish out her shift.
****
"In assessing the degree of Respondent's right to exercise control over the Petitioner, the Court must examine the arrangements made between the Petitioner and Respondent. Despite the fact that Petitioner set her own hours I find the Respondent exercised a substantial degree of control over Petitioner. Petitioner was required to converse with patrons and perform both pole and couch dances. Petitioner was not free to come and go as she pleased. Once she arrived for her shift she was required to stay until that shift was completed. Dancers were chastised if they were found not to be entertaining the patrons.
****
"The court further finds that Petitioner was economically dependent upon the Respondent. Petitioner testified that she worked an average of five shifts per week and that the shifts averaged 8- 12 hours in duration. Additionally, Petitioner testified that her only source of income at the time of her assault was the money she earned working for the Respondent. As stated previously the Court found the testimony of the petitioner to be credible.
Decided July 14, 2014 - Posted by NJ DWC September 29, 2015
Monday, July 13, 2015
CMS Moved the Coordination of Benefits Secure Website (COBSW)
The Centers for Medicare and Medicaid Services has formally moved:
The URL for accessing the Section 111 Coordination of Benefits Secure Website (COBSW) has been changed to: https://www.cob.cms.hhs.gov/Section111//.
July 13, 2015 - Updated MMSEA Section 111 NGHP User Guide Version 4.7 - Chapters I-V Now Available
The URL for accessing the Section 111 Coordination of Benefits Secure Website (COBSW) has been changed to: https://www.cob.cms.hhs.gov/Section111//.
July 13, 2015 - Updated MMSEA Section 111 NGHP User Guide Version 4.7 - Chapters I-V Now Available
The updated MMSEA Section 111 NGHP User Guide dated July 13, 2015 has been posted to the NGHP User Guide page. Refer to Chapter 1-1 of each chapter for a summary of Version 4.7 updates.
Thursday, June 25, 2015
The Path to Federalization: US Supreme Court Again Validates the Affordable Care Act
The US Supreme Court again affirmed the validity of The Affordable Care Act. The Obamacare program, as it has been nicknamed, will continue to lead to a medical delivery program than eventually will have major repercussions on the antiquated and ineffective medical care system of the existing patch work of state workers' compensation insurance acts.
Friday, October 17, 2014
Path to Federalization: Obama May Name ‘Czar’ to Oversee Ebola Response
DALLAS — President Obama raised the possibility on Thursday that he might appoint an “Ebola czar” to manage the government’s response to the deadly virus as anxiety grew over the air travel of an infected nurse.  Schools closed in two states, hospitals and airlines kept employees home from work, and Americans debated how much they should worry about a disease that has captured national attention but has so far infected only three people here.A federal official said that the Centers for Disease Control and Prevention had broadened its search for contacts of Amber Joy Vinson, the second nurse infected with Ebola at Texas Health Presbyterian Hospital here, after interviewing family members who gave a different version of events from Ms. Vinson’s. The nurse had said she had a slight fever before boarding a flight from Cleveland to Dallas on Monday. But family members said she had appeared remote and unwell during her trip to Ohio over the weekend. The C.D.C. said it was now tracking down passengers on Frontier Airlines Flight 1142 from Dallas to Cleveland, which Ms. Vinson took last Friday. It had already been tracing passengers on her Monday flight.Ms. Vinson’s case raised flags for investigators because the day after she arrived home in Dallas, she reported substantial symptoms. Health experts say those would be unlikely to develop in just one day. Seven people in Ohio were voluntarily quarantined because they had contact with Ms. Vinson... |
Read more about the "The Path to Federalization"
Jul 05, 2012
United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation's workers' compensation system. By it's recent decision, upholding the mandate for insurance care under the ...
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 ...
Jun 14, 2012
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 .
May 17, 2013
and will put greater control and more choice in the hands of individuals and small businesses." Read more about "Federalization" and workers' compensation: Path to Federalization: A National Workers Compensation System.
Sunday, September 21, 2014
Income inequality last year rose in 15 states
The nation became more unequal last year. Alaska was the only state to see its Gini Index score decline, while 15 states posted increases. D.C. and the remaining 34 states saw no change. The 15 states that saw income inequality rise last year were: Arizona, California, Delaware, Hawaii, Illinois, Indiana, Iowa, Maryland, Nebraska, New Jersey, New York, North Carolina, Pennsylvania, Texas and Washington. Those results reflect a multi-year trend: Earlier this month, the Federal Reserve reported that “[o]nly families at the very top of the income distribution saw widespread income gains between 2010 and 2013.” And income inequality can have cascading effects. In a Monday analysis, credit ratings agency Standard & Poor’s concluded that income inequality acted as a drag on state tax collections. “The findings from our research indicate that tax revenue growth slows as income inequality rises, especially for the sales tax-dependent states,” the report’s authors wrote. “This suggests to us that inequality is having a detrimental effect on economic growth.”... |
Saturday, September 6, 2014
NH Governor Hassan Creates Workers’ Compensation Commission for Reform
In order to help reduce workers’ compensation costs that are a burden on New Hampshire businesses and ensure that injured workers have access to high-quality care, Governor Maggie Hassan today issued an Executive Order creating the Commission to Recommend Reforms to Reduce Workers’ Compensation Medical Costs.
“Employers and workers have done their part to increase workplace safety, but New Hampshire has become one of the most expensive states in the nation for workers’ compensation, a burden on businesses across the state,” Governor Hassan said. “By bringing together business leaders and experts from insurance, health care and labor, the Commission to Recommend Reforms to Reduce Workers’ Compensation Medical Costs provides an opportunity for stakeholders to identify ways to reduce workers’ compensation medical costs and ensure that injured workers have access to quality care. With these reforms, our businesses will be able to re-invest these dollars in growing their companies, creating new jobs and keeping our economy moving in the right direction.”
Tasked with making recommendations to reform New Hampshire’s workers’ compensation system, the commission will review the data behind New Hampshire’s high workers’ compensation costs; analyze efforts by other states to successfully reduce workers’ compensation costs; review how other states ensure continued access to quality care for injured workers; and develop comprehensive reforms that will reduce costs and premiums and improve New Hampshire’s workers’ compensation system while ensuring that injured workers have access to quality care.
According to the Oregon Workers Compensation Rate Ranking Study, New Hampshire rose from the 14th-most expensive state for workers’ compensation coverage in the country in 2008 to the ninth-most expensive in 2012. In addition, data from the National Council on Compensation Insurance shows that workers’ compensation surgical procedures in New Hampshire are 83 percent more expensive than those in the region and more than twice as expensive as they are nationally. For more information on New Hampshire’s workers’ compensation costs, visit www.nh.gov/insurance/media/pr/2014/documents/052214.pdf
.
“New Hampshire is among the most expensive states for workers’ compensation, an unnecessary disadvantage for businesses that operate here,” said New Hampshire Insurance Department Commissioner Roger Sevigny. “I look forward to working with the commission to improve our workers’ compensation system by making recommendations to reduce costs and premiums while ensuring that workers have access to quality care.”
Commissioner Sevigny will be the chairman of the Commission to Recommend Reforms to Reduce Workers’ Compensation Medical Costs. He will be joined on the commission by New Hampshire Department of Labor Commissioner Jim Craig or a designee from the department, as well as a diverse group of experts representing workers, employers, insurance professionals and the health care sector.
The Commission’s final report is due to the Governor on December 1, 2014.
Other members of the commission are:
Brian Allen, Vice President of Government Affairs at HELIOS (formerly Progressive Medical/PMSI)
Donald F. Baldini, AVP and State Affairs Officer at Liberty Mutual Insurance
Pamela Bronson, Administrator at Access Sports Medicine & Orthopedics
Paul W. Chant of Cooper Cargill Chant
Tammy Denver, Director of Claims & Coverage Programs at NH Public Risk Management Exchange (Primex3)
Edward Dudley, Executive Vice President/CFO of Catholic Medical Center
Mark Erdody, Director of New England Claims for Cove Risk Services, LLC
Marc Lacroix, New Hampshire Physical Therapy Association and Director of Specialty Services at Concord Hospital
David Lang, President of Professional Firefighters of NH
Mark Mackenzie, President of NH AFL-CIO
Peter McNamara, President of NH Automobile Dealers Association
Dr. Gregory Soghikian of New Hampshire Orthopaedic Center
Ben Wilcox, President & General Manager of Cranmore Mountain Resort
Full text of the Governor’s Executive Order
“Employers and workers have done their part to increase workplace safety, but New Hampshire has become one of the most expensive states in the nation for workers’ compensation, a burden on businesses across the state,” Governor Hassan said. “By bringing together business leaders and experts from insurance, health care and labor, the Commission to Recommend Reforms to Reduce Workers’ Compensation Medical Costs provides an opportunity for stakeholders to identify ways to reduce workers’ compensation medical costs and ensure that injured workers have access to quality care. With these reforms, our businesses will be able to re-invest these dollars in growing their companies, creating new jobs and keeping our economy moving in the right direction.”
Tasked with making recommendations to reform New Hampshire’s workers’ compensation system, the commission will review the data behind New Hampshire’s high workers’ compensation costs; analyze efforts by other states to successfully reduce workers’ compensation costs; review how other states ensure continued access to quality care for injured workers; and develop comprehensive reforms that will reduce costs and premiums and improve New Hampshire’s workers’ compensation system while ensuring that injured workers have access to quality care.
According to the Oregon Workers Compensation Rate Ranking Study, New Hampshire rose from the 14th-most expensive state for workers’ compensation coverage in the country in 2008 to the ninth-most expensive in 2012. In addition, data from the National Council on Compensation Insurance shows that workers’ compensation surgical procedures in New Hampshire are 83 percent more expensive than those in the region and more than twice as expensive as they are nationally. For more information on New Hampshire’s workers’ compensation costs, visit www.nh.gov/insurance/media/pr/2014/documents/052214.pdf
.“New Hampshire is among the most expensive states for workers’ compensation, an unnecessary disadvantage for businesses that operate here,” said New Hampshire Insurance Department Commissioner Roger Sevigny. “I look forward to working with the commission to improve our workers’ compensation system by making recommendations to reduce costs and premiums while ensuring that workers have access to quality care.”
Commissioner Sevigny will be the chairman of the Commission to Recommend Reforms to Reduce Workers’ Compensation Medical Costs. He will be joined on the commission by New Hampshire Department of Labor Commissioner Jim Craig or a designee from the department, as well as a diverse group of experts representing workers, employers, insurance professionals and the health care sector.
The Commission’s final report is due to the Governor on December 1, 2014.
Other members of the commission are:
Brian Allen, Vice President of Government Affairs at HELIOS (formerly Progressive Medical/PMSI)
Donald F. Baldini, AVP and State Affairs Officer at Liberty Mutual Insurance
Pamela Bronson, Administrator at Access Sports Medicine & Orthopedics
Paul W. Chant of Cooper Cargill Chant
Tammy Denver, Director of Claims & Coverage Programs at NH Public Risk Management Exchange (Primex3)
Edward Dudley, Executive Vice President/CFO of Catholic Medical Center
Mark Erdody, Director of New England Claims for Cove Risk Services, LLC
Marc Lacroix, New Hampshire Physical Therapy Association and Director of Specialty Services at Concord Hospital
David Lang, President of Professional Firefighters of NH
Mark Mackenzie, President of NH AFL-CIO
Peter McNamara, President of NH Automobile Dealers Association
Dr. Gregory Soghikian of New Hampshire Orthopaedic Center
Ben Wilcox, President & General Manager of Cranmore Mountain Resort
Full text of the Governor’s Executive Order
Friday, September 5, 2014
9/11 Responders Urged To Register For Workers’ Compensation Benefits
| Next week marks the anniversary of the 9/11 tragedy. Many workers' who may be entitled to benefits have not yet enrolled. Today's post is shared from cbslocal.com Elected officials and union activists are urging Sept. 11 responders to sign up for New York workers’ compensation benefits. They say that those who worked around the World Trade Center site should enroll with the state Workers’ Compensation Board. Next Thursday, the 13th anniversary of the terror attacks, is the deadline to sign up. The officials said even people who are not sick should register because it preserves their right to get benefits in the future if they do fall ill. It also is open to workers who live in other states. Rep. Jerrold Nadler said that “those who have paid such a high price” deserve compensation. “This does not mean that you are injured or ill now, but it does preserve your ability to file a claim later,” Nadler said. Nadler was joined at Friday’s City Hall press conference by representatives of several unions, including DC 37 and the Laborers Local 78. As WCBS 880’s Jim Smith reported, Reverend Bill Minson spent months in and around ground zero working as a chaplain. He’s not sick now, but knows the air was like a ticking time bomb. “An incubation period for many of these cancers and things can’t be calculated,” he said. ... |
Thursday, September 4, 2014
More Big Firms Shifting To High-Deductible Health Plans
Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
The New York Times examines the movement among large employers towards high-deductible plans that shift more health care costs to workers. Meanwhile, The Wall Street Journal looks at how the ACA may affect job-based plans next year.
The New York Times: High-Deductible Health Plans Weigh Down More Employees
Just as employers replaced pensions with retirement savings plans, more large companies appear to be in the midst of a similar cost-sharing shift with health plans. Besides making workers responsible for more of their care, employers hope these plans will motivate employees to comparison-shop for medical services — an admirable goal but one that some say is hard to achieve. ... With high-deductible health plans, consumers pay for all their medical services — at the insurer's negotiated rate — until they meet their deductible. After that, consumers typically pay coinsurance, which is a percentage of each service — say 10 to 35 percent — until they reach the out-of-pocket maximum (Siegel Bernard, 9/1).
The Wall Street Journal: Get Ready For Health-Insurance Enrollment
If you get health insurance through your workplace, you'll probably have a chance this fall to make important decisions about your coverage and costs. Because many corporate health plans hold their annual open-enrollment periods in October and November, many employees can expect to get a packet of benefits, or instructions for... |
Thursday, July 24, 2014
Appeals Court Deals Major Blow to Implementation of Affordable Care Act
Today's post is shared by WSJ Law Blog and comes from blogs.wsj.com
A federal appeals court on Tuesday dealt a serious blow to the Obama administration’s implementation of its signature health-care law, striking down subsidies available to some consumers who purchase health coverage on insurance exchanges set up by the federal government.
WSJ’s Brent Kendall has more on the breaking legal development out of Washington:
The U.S. Court of Appeals for the District of Columbia Circuit, on a 2-1 vote, invalidated an Internal Revenue Service regulation that implemented a key piece of the 2010 Affordable Care Act. The regulation said subsidies for health insurance were available to qualifying middle- and low-income consumers whether they bought coverage on a state exchange or one run by the federal government.
The ruling potentially could cripple the Affordable Care Act by making subsidies unavailable in as many as 36 states where the federal government has run some or all of the insurance exchanges.
The court sided with challengers, four individuals and three employers, who argued the health law allowed subsidies only for insurance purchases made through state exchanges. The issue became an important one after the law was enacted because more than two-thirds of the states chose not to set up their own exchanges, relying on federally run exchanges instead.
[Click here to see the rest of this post]
Thursday, July 10, 2014
Workers’ Compensation: The Road Ahead
This article is another installment of my continuing series entitled, 'The Path to Federalization."
Historical analysis of corporate wealth provides insight as
to why the Nation’s workers’ compensation, conceived as a remedial social
insurance program, has become dysfunctional. The National interest that drives the program is a strong predictor of future coverage for injured workers' and their families.
Over a century ago, in 1911, the US adopted a patchwork of
programs to provide benefits to injured workers in a summary fashion. While
much has changed over the century, the majority of states continue with the
traditional programs, although they are seriously restricted in benefit delivery.
James Surowiecki authored an
article, “Moaning
Moguls,” in this
week’s New Yorker magazine that focuses on why the system has really changed:
“A
century ago, industrial magnates played a central role in the Progressive
movement, working with unions, supporting workmen’s compensation laws and laws
against child labor, and often pushing for more government regulation. This
wasn’t altruism; as a classic analysis by the historian James Weinstein showed,
the reforms were intended to co-opt public pressure and avert more radical
measures. Still, they materially improved the lives of ordinary workers. And
they sprang from a pragmatic belief that the robustness of capitalism as a
whole depended on wide distribution of the fruits of the system.”
***
“If
today’s corporate kvetchers are more concerned with the state of their egos
than with the state of the nation, it’s in part because their own fortunes
aren't tied to those of the nation the way they once were. In the postwar
years, American companies depended largely on American consumers. Globalizationhas changed that—foreign sales account for almost half the revenue of the
S&P 500—as has the rise of financial services (where the most important
clients are the wealthy and other corporations). The well-being of the American
middle class just doesn’t matter as much to companies’ bottom lines. And
there’s another change. Early in the past century, there was a true socialist
movement in the United States, and in the postwar years the Soviet Union seemed
to offer the possibility of a meaningful alternative to capitalism. Small wonder
that the tycoons of those days were so eager to channel populist agitation into
reform. Today, by contrast, corporate chieftains have little to fear, other
than mildly higher taxes and the complaints of people who have read Thomas
Piketty. Moguls complain about their feelings because that’s all anyone can
really threaten. “
As
income inequality continues to fan the stalemate in Washington, there is little hope for a rescue of the nation’s ailing workers’ compensation system from
extinction. Unless corporate greed yields to national interest, workers’
compensation as we now know it, will be subsumed into a program financed by
taxpayers instead of consumers.
….
Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thompson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson-Reuters). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
Click Here to Read More About "The Path to Federalism"
Click Here to Read More About "The Path to Federalism"
Monday, June 16, 2014
Undocumented Aliens Ensnared By Workers' Compensation
Peter Rousmaniere comments today about the problems, threats and fears that undocumented aliens confront with the nation's patchwork of compensation programs. Injured undocumented aliens in states than mandate the submission of a social security number to file an initial application for workers' compensation benefits are particular targets for criminal fraud enforcement.
"The eight million undocumented workers comprise about 6% of the total civilian workforce. By studying estimates of undocumented worker penetration by occupations ranked by injury risk, one can reasonably project that undocumented workers sustain one out of every ten work injuries. This high volume is invisible to almost everyone except for adjusters, case managers, lawyers and others who work directly with injured workers and have learned their work and life patterns. The rate varies greatly, from maybe 2% in West Virginia, a low foreign-born population state, to over half within the fruit and vegetable producing counties of southern California."
Reconciliation of this issue remains uncertain for a multitude of reasons. The future of immediate national reform of immigration laws this election cycle now looks bleak with Eric Cantor's recent primary defeat. States will continue to use Social Security information for tax collection and enforcement, in addition to the reconciliation of other programs such as Medicare and unemployment benefits.
Ironically as Rousmaniere points out in his commentary, the power of the employer over the employee, is a huge challenge to the improvement of safety and health in the workplace. Shifting the burden from employers to US taxpayers is problematic. As the Affordable Care Act is fined tuned in the years ahead, the issue of undocumented aliens will become both a more dominate moral and legal issue in need of reform.
Monday, May 26, 2014
I.R.S. Bars Employers From Dumping Workers Into Health Exchanges
| WASHINGTON — Many employers had thought they could shift health costs to the government by sending their employees to a health insurance exchange with a tax-free contribution of cash to help pay premiums, but the Obama administration has squelched the idea in a new ruling. Such arrangements do not satisfy the health care law, the administration said, and employers may be subject to a tax penalty of $100 a day — or $36,500 a year — for each employee who goes into the individual marketplace. The ruling this month, by the Internal Revenue Service, blocks any wholesale move by employers to dump employees into the exchanges. Under a central provision of the health care law, larger employers are required to offer health coverage to full-time workers, or else the employers may be subject to penalties. Many employers — some that now offer coverage and some that do not — had concluded that it would be cheaper to provide each employee with a lump sum of money to buy insurance on an exchange, instead of providing coverage directly. But the Obama administration raised objections, contained in an authoritative question-and-answer document released by the Internal Revenue Service, in consultation with other agencies. The health law, known as the Affordable Care Act, builds on the current system of employer-based health insurance. The administration, like many in Congress, wants employers to continue to provide coverage to workers and their families. “I... |
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