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(c) 2010-2026 Jon L Gelman, All Rights Reserved.

Sunday, January 12, 2014

OSHA will hold live Web chat on its proposed silica rule

The U.S. Department of Labor's Occupational Safety and Health Administration will host a live Web chat to discuss the agency's proposed rule on occupational exposure to respirable crystalline silica from 1 p.m. - 3:30 p.m. EST, Tuesday, Jan. 14. Visit http://www.osha.gov/silica/webchat.html to participate.

The Web chat will provide participants the opportunity to ask questions, get clarification from OSHA on the proposed silica rule and learn how to participate in the regulatory process. OSHA staff will be available to clarify the proposed standards related to silica for general industry, maritime and construction. Staff will also answer questions on OSHA's underlying analysis of health risks, potential costs and benefits, and economic impacts associated with the proposed rule and how to submit comments to the rulemaking record.

The deadline to submit written comments and testimony on the proposal is Monday, Jan. 27. Members of the public may submit comments by visiting http://www.regulations.gov.

Additional information on the proposed rule can be found at http://www.osha.gov/silica.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit www.osha.gov.

Saturday, January 11, 2014

DWC's IMR Meetings Premature

The noise over the volume of Independent Medical Review requests and Maximus' inability to cope with that volume is at top level and the California Workers' Compensation Institute's latest research paper is certainly going to add to the fury.

The Division of Workers' Compensation has scheduled round table meetings with interested groups for Monday and Tuesday. CWCI's release couldn't be more timely.

CWCI says that basically IMR (and underlying Utilization Review) are working as intended.

The say that only 5.9% of requested medical procedures are delayed, denied or modified through utilization review, and that three out of every four medical treatment requests are approved by claims adjusters without the need for additional oversight.

Moreover, CWCI found 76.6% of the 919,370 treatment requests it evaluated that were sent out for physician review were approved, 6.6% were modified and 16.9% were denied.

One-in-four treatment requests being sent for physician review and one-in-four of those physician-reviewed requests denying or modifying the recommendation means that 94.1% of treatments are approved and 5.9% are denied.

CWCI also reviewed 1,141 independent medical-review decisions that had been issued as of Jan. 2 and found 78.9% of denials are upheld by the administrative review and 21.1% are overturned.

Of the 919,370 medical treatment requests reviewed by CWCi researchers, "pharmacy" garnered fully 43% of all events - this is an astounding number and debunks quite a...
[Click here to see the rest of this post]

Ex-NJ Mayor and Insurance Agent Sentenced On Charges Involving Workers' Compensation Insurance Scheme

Insurance Broker, Former Toms River, N.J., Mayor, Sentenced In Separate Schemes Involving Toms River Officials

TRENTON, N.J. — A New Jersey insurance broker and the former mayor of Toms River, N.J., were each sentenced today for offenses arising from separate schemes involving officials of Toms River and the former insurance broker for the Toms River Regional School District Francis X. Gartland, U.S. Attorney Paul J. Fishman announced.

Frank Cotroneo, 63, of Chester, N.J., an insurance broker with an office in Morristown, N.J., was sentenced to 37 months in prison and ordered to pay more than $12.4 million in restitution to the Toms River School District and in forfeiture to the United States. Cotroneo previously pleaded guilty before former Chief U.S. District Judge Garrett E. Brown Jr., to one count each of bribery and tax evasion arising from his participation in a scheme to pay hundreds of thousands of dollars in bribes to Michael J. Ritacco, 67, of Seaside Park, N.J., the former superintendent for the Toms River Regional School District, in exchange for his official assistance.

Carmine C. Inteso Jr., 47, of Toms River, was sentenced today to six months in prison and six months of house arrest for evading his income tax obligations. Inteso, who was arrested in July 2012 after returning from Afghanistan where he had been working as a contractor, pleaded guilty in December 2012 before U.S. District Judge Joel A. Pisano to one count of tax evasion.

From 2002 through 2007, Inteso held the positions of Township Committee member, mayor, deputy mayor, and councilman for the Township of Toms River, formerly known as Dover Township. 

Inteso allegedly took a job in Afghanistan after learning he was the target of the tax investigation and, after returning to the United States, was taken into custody at New York’s John F. Kennedy International airport.

Judge Pisano imposed the sentences today in Trenton federal court.

According to documents filed and statements made in court:

Cotroneo admitted that from 2002 to April 2009, he and co-conspirators Gartland and Frank D’Alonzo, a former administrator at the Toms River Regional School District, paid bribes and other benefits to Michael J. Ritacco, who was then the superintendent of the district. The payments were made to allow Cotroneo and Gartland, 72, of Baltimore, Md., – insurance co-brokers for the school district – to obtain and keep the lucrative insurance brokerage contracts with the district. To facilitate the scheme, Ritacco, Gartland and Cotroneo agreed to have Ritacco approve a workers’ compensation insurance contract between Gartland and the school district, which yielded between $500,000 and $600,000 annually in excess fees. Those proceeds were to be used to make hundreds of thousands of dollars in bribes to Ritacco.

Cotroneo also admitted that for tax years 2005 to 2007, he evaded the assessment of hundreds of thousands of dollars of federal income taxes by concealing the illegal proceeds he received from Gartland and others during the course of the bribery scheme.

Ritacco and Gartland were ordered previously to pay $4,336, 987.91 in restitution to the school district. Judge Pisano today ordered Cotroneo to pay $3,275,677.65 in restitution, which represented the loss to the school district while he was an active participant in the scheme. In addition to ordering restitution, the court ordered that Cotroneo forfeit to the United States a sum of $9,126,200.16, which represented the proceeds derived from the scheme. D’Alonzo was ordered to pay $1,625,952.79 in restitution, and also ordered to forfeit a sum of approximately $4.3 million. Gartland was previously ordered to forfeit $11 million, which represented the total proceeds derived from the fraudulent scheme. Prior to his sentencing on Sept. 14, 2012, Ritacco forfeited to the United States $1 million, a 2010 Mercedes Benz, and $8,950 in cash.

In addition to the prison term and payments, Judge Pisano sentenced Cotroneo to serve three years of supervised release.

In a separate and unrelated scheme beginning in 2005 and continuing through 2008, Inteso accepted hundreds of thousands of dollars in payments from Gartland, an insurance broker whose companies provided insurance brokerage services for New Jersey municipal entities including the Brick Township Board of Education and the Township of Toms River. Inteso directed Gartland to make the payments to a company Inteso controlled and that had ceased operating by 2007. Gartland pleaded guilty to charges of mail fraud, conspiracy to defraud the IRS and perjury and was sentenced to 135 months in prison. 

Inteso used the funds to pay for his personal expenses and withdrew significant amounts of cash. Despite receiving approximately $291,000 in income from the insurance broker during calendar years 2006, 2007 and 2008, Inteso failed to file personal income taxes for those years. 

In addition to the prison term, Judge Pisano sentenced Inteso to serve two years of supervised release.

U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford; and IRS-Criminal Investigation, under the direction of Special Agent in Charge Shantelle P. Kitchen. The Office of International Affairs in the Justice Department’s Criminal Division and the Diplomatic Security Service’s Regional Security Office in Kabul, Afghanistan provided invaluable assistance in the Inteso case.

The government is represented by Assistant U.S. Attorney Lee M. Cortes Jr., of the U.S. Attorney’s Office Special Prosecutions Division in Newark. 

14-006 

Defense counsel:

Carmine Inteso: Scott A. Krasny Esq., West Trenton, N.J.
Frank Cotroneo: Howard Brownstein Esq., Union City, N.J.

Former Texas Workers' Compensation Director Pleads Guilty to $500,000 Fraud

Former Texas Association Of School Boards (TASB) Workers Compensation Claims Administration Director Pleads Guilty To Mail Fraud Charges

In Austin today, Herman G. Wilks, former Department Director of Workers’ Compensation Claims Administration for the Texas Association of School Boards, Inc. (TASB), pleaded guilty to stealing over $500,000 from the TASB’s Risk Management Fund announced United States Attorney Robert Pitman and Federal Bureau of Investigation Special Agent in Charge Armando Fernandez, San Antonio Division.

The TASB is a voluntary, non-profit, statewide educational association that serves and represents local Texas school districts, regional education service centers, community colleges, and tax appraisal districts. One of the products and services offered by TASB to its members is the TASB Risk Management Fund. The TASB Risk Management Fund provides specific coverage to members through their requisite financial contributions into the risk management pool. This coverage can then apply with regard to unemployment compensation claims, workers' compensation claims, auto, liability and property programs. Wilks’ TASB duties included the supervision of setting up member school districts' workers' compensation claims, adjudicating medical bills and carrying out the utilization, management and pre-authorization functions required by the workers' compensation statutes. Pursuant to his title and area of responsibility at TASB, Wilks had control over and direct access to the entire claimant pay process by which TASB accepted and paid workers' compensation claims for its contributing members by way of the TASB Risk Management Fund.

Appearing before U.S. District Judge Sam Sparks this morning, Wilks pleaded guilty to ten counts of mail fraud. By pleading guilty, Wilks admitted that from April 2008 until March 2013, he unlawfully obtained approximately $514,400 from TASB via the TASB Risk Management Fund by submitting fraudulent workers’ compensation claims on behalf of Medco Implantable Supply, a company he created for the sole purpose of carrying out his fraudulent scheme, for products and services that were never actually ordered, provided or rendered.

“Like many defendants, Mr. Wilks undoubtedly concocted his scheme of setting up a dummy company to steal hundreds of thousands of dollars from the TASB Risk Management Fund with full confidence that he would get away with it. This prosecution should remind would-be thieves like Mr. Wilks that their schemes will be discovered and they will lose not only their ill-gotten gain, but their livelihoods, reputations and quite likely their freedom as a result,” stated U.S. Attorney Pitman.

Wilks faces up to 20 years in federal prison per count. He is currently out on bond pending sentencing which has yet to be scheduled.

This indictment resulted from an investigation conducted by the Federal Bureau of Investigation. Assistant United States Attorney Ashley Hoff is prosecuting this case on behalf of the Government
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Friday, January 10, 2014

Using Workers’ Compensation Records for Safety and Health Research

NIOSH recently released Workers’ Compensation Insurance: A Primer for Public Health to help public health researchers and practitioners broaden their understanding of workers’ compensation insurance, relevant aspects of the insurance industry records, and the potential uses of that information for public health pur­poses. Read more on the NIOSH Science Blog.


NJ COLA Bill is passed by the State Senate

Identical Bill Number: A4514    
Last Session Bill Number: S935   

Sweeney, Stephen M.   as Primary Sponsor
Madden, Fred H., Jr.   as Primary Sponsor
Beach, James   as Co-Sponsor
Norcross, Donald   as Co-Sponsor
Greenstein, Linda R.   as Co-Sponsor
Weinberg, Loretta   as Co-Sponsor
Vitale, Joseph F.   as Co-Sponsor
 
   

1/10/2012 Introduced in the Senate, Referred to Senate Labor Committee
5/17/2012 Reported from Senate Committee with Amendments, 2nd Reading
5/17/2012 Referred to Senate Budget and Appropriations Committee
12/5/2013 Reported from Senate Committee with Amendments, 2nd Reading
12/19/2013 Senate Amendment (26-1) (Sweeney)
1/9/2014 Passed by the Senate (23-14)
1/9/2014 Received in the Assembly, Referred to Assembly Labor Committee

S613 ScaScaSa (3R) Concerns certain workers' compensation supplemental benefits. 
Labor 


Tuesday, January 7, 2014

NJ Senate to Vote on S613 - Workers Compensation Cost of Living Benefit Increase

On Thursday, January 9, 2014, the NJ Senate is scheduled to vote on S613, which is proposed legislation to increase workers' compensation benefits by implementing a cost of living allowance for some beneficiaries.
On December 19, 2013 the following amendments were adopted by the NJ Senate:
These Senate amendments provide:
1. That the periodic cost of living supplement that the bill
provides to an individual for total permanent disability or survivor’s
benefits under workers’ compensation will be reduced by the original
amount of that individual’s periodic Social Security survivor’s or
retirement benefits, but not reduced by subsequent cost of living
increases in those Social Security benefits; and
2. That, in the case of an individual who initially received Social
Security disability benefits and later receives Social Security
retirement benefits, or who dies and has dependents who receive
Social Security survivors’ benefits, the workers’ compensation
supplement will then be reduced by the amount of the Social Security
retirement or survivor benefits, exclusive of any cost of living increase
in those Social Security retirement or survivor benefits
S613:
1/9/2014 1:00:00 PM Senate
1000 AM  Committees at the Call of the Senate President
200 PM  Voting Session
Senate Chambers

http://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=S613