Copyright

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

Sunday, November 29, 2015

Drivers' Protected From Being Forced to Violate Safety Regulations

The U.S. Department of Transportation’s Federal Motor Carrier Safety Administration (FMCSA) today announced the publication in the Federal Register of a Final Rule to help further safeguard commercial truck and bus drivers from being compelled to violate federal safety regulations.  The Rule provides FMCSA with the authority to take enforcement action not only against motor carriers, but also against shippers, receivers, and transportation intermediaries.

“Our nation relies on millions of commercial vehicle drivers to move people and freight, and we must do everything we can to ensure that they are able to operate safely,” said U.S. Transportation Secretary Anthony Foxx.  “This Rule enables us to take enforcement action against anyone in the transportation chain who knowingly and recklessly jeopardizes the safety of the driver and of the motoring public.”

The Final Rule addresses three key areas concerning driver coercion: procedures for commercial truck and bus drivers to report incidents of coercion to the FMCSA, steps the agency could take when responding to such allegations, and penalties that may be imposed on entities found to have coerced drivers.

“Any time a motor carrier, shipper, receiver, freight-forwarder, or broker demands that a schedule be met, one that the driver says would be impossible without violating hours-of-service restrictions or other safety regulations, that is coercion,” said FMCSA Acting Administrator Scott Darling.  “No commercial driver should ever feel compelled to bypass important federal safety regulations and potentially endanger the lives of all travelers on the road.”

In formulating this Rule, the agency heard from commercial drivers who reported being pressured to violate federal safety regulations with implicit or explicit threats of job termination, denial of subsequent trips or loads, reduced pay, forfeiture of favorable work hours or transportation jobs, or other direct retaliations.

Some of the FMCSA regulations drivers reported being coerced into violating included: hours-of-service limitations designed to prevent fatigued driving, commercial driver’s license (CDL) requirements, drug and alcohol testing, the transportation of hazardous materials, and commercial regulations applicable to, among others, interstate household goods movers and passenger carriers.

Commercial truck and bus drivers have had whistle-blower protection through the Department of Labor’s Occupational Safety and Health Administration (OSHA) since 1982, when the Surface Transportation Assistance Act (STAA) was adopted.  The STAA and OSHA regulations protect drivers and other individuals working for commercial motor carriers from retaliation for reporting or engaging in activities related to certain commercial motor vehicle safety, health, or security conditions.  STAA provides whistleblower protection for drivers who report coercion complaints under this Final Rule and are then retaliated against by their employer.

In June 2014, FMCSA and OSHA signed a Memorandum of Understanding to strengthen the coordination and cooperation between the agencies regarding the anti-retaliation provision of the STAA.  The Memorandum allows for the exchange of safety, coercion, and retaliation allegations, when received by one agency, that fall under the authority of the other.

For more information on what constitutes coercion and how to submit a complaint to FMCSA, see: www.fmcsa.dot.gov/safety/coercion.  Please note: the Final Rule takes effect 60 days following its publication in the Federal Register.
This rulemaking was authorized by Section 32911 of the Moving Ahead for Progress in the 21st Century Act (MAP-21) and the Motor Carrier Safety Act of 1984 (MCSA), as amended.

For a copy of today’s Federal Register announcement, see: www.federalregister.gov/articles/2015/11/30/2015-30237/prohibiting-coercion-of-commercial-motor-vehicle-drivers.
….
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.

Wednesday, November 18, 2015

NJ Medical Payments Stabilize - But Why?

A recent study by an insurance based data organization has reported that NJ is experiencing a leveling of medical costs. The real question is "why?" Are declining medical benefits caused by fewer claims based on a shift of challenging employment status in the shared economy or a shift of medical costs under Obamacare to the private sector? 
Medical payments per workers’ compensation claim in New Jersey were stable from 2010 to 2013, in contrast to rapid growth in the 2008 to 2010 period, according to a recent study by the Workers Compensation Research Institute (WCRI).
The report, CompScope™ Medical Benchmarks for New Jersey, 16th Edition, indicates results for New Jersey differed from those of other states WCRI studied, many of which experienced moderate to rapid growth in medical payments per claim.
The study found the following to be contributing factors: 
  • Increased use of networks, which may be linked to a decrease in prices paid for non hospital care. In recent years, two-thirds of total medical payments came from non hospital services.
  • Flat or decreasing trends in utilization of many non hospital services.
  • Slower growth in hospital outpatient payments per service.
  • A continued decrease in the percentage of claims that had hospital inpatient care.
“From 2010 to 2013, medical payments per claim with more than seven days of lost time rose less than 2 percent per year in New Jersey,” said Ramona Tanabe, executive vice president and counsel for WCRI. “From 2008 to 2010, payments rose nearly 10 percent per year.”
WCRI studied medical payments, prices, and utilization in 17 states, including New Jersey, looking at claim experience through 2014 on injuries that occurred in 2013 or earlier. WCRI’s CompScope™ Medical Benchmark studies compare metrics of medical costs and care from state to state and across time.

Monday, November 16, 2015

CMS MSP FInal Conditional Payments Portal To Open

Upcoming Updates to the Medicare Secondary Payer Recovery Portal (MSPRP) Modification for Inclusion of Final Conditional Payment (CP) Process Functionality

As part of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), the MSPRP will be modified to include Final CP process functionality by January 1, 2016.  This new functionality will permit authorized MSPRP users to notify CMS that a recovery case is 120 days (or less) from an anticipated settlement and request that the recovery case be a part of the Final CP process.
When the Final CP process is requested, any disputes submitted through the MSPRP will be resolved within 11 business days of receipt of the dispute.  Once all disputes have been resolved, and the case is within 3 days of settling, the beneficiary or their authorized representative will be able to request a Final Conditional Payment Amount on the MSPRP.  Once calculated, this amount will remain the Final Conditional Payment Amount as long as:
  1. The case is settled within 3 calendar days of requesting the Final Conditional Payment Amount, and
  2. Settlement information is submitted through the MSPRP within 30 calendar days of requesting the Final Conditional Payment Amount.

Friday, November 13, 2015

Demolition of Paterson NJ Armory Highlights Present Danger of Asbestos

The emergency demolition of the decades old Paterson NJ Armory, an historic site, highlights that asbestos, a known carcinogen, remains a hazard to workers when older buildings require renovation or demolition.
asbestos remains a clear and present danger to workers. Despite the fact that asbestos may not be used as a new construction material,

Asbestos, a naturally occurring mineral, was used for years as a construction material because of its fire retardant and heat insulation properties.

The hazards of asbestos are well known. Exposure to asbestos may cause the latent development of: asbestosis, lung cancer and mesothelioma.

The Paterson NJ Armory caught fire several days ago and resulted in  a major North Jersey fire alarm requiring the participation of firefighters to be called in from multiple jurisdictions to be be brought under control. Unable to reach and extinguish some parts of the fire, the Paterson Fire Department ordered that the historic building be demolished on an emergency basis.

Despite the knowledge of the fatal hazards of asbestos use, it  has yet to be banned in the United States.
….

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.

Thursday, November 12, 2015

NY Corporate Workers' Compensation Fraud Leads to Criminal Charges

New York State Inspector General Catherine Leahy Scott announced today the arrests of four Central New York and Southern Tier business owners on fraud and theft charges as part of an ongoing series of investigations into employers and employees who defraud the State Workers’ Compensation system. Under State law, employers are required to maintain Workers’ Compensation coverage for their employees, and employees are expected to provide truthful information regarding their work activity to insurance carriers and the Workers’ Compensation Board during the time they are receiving benefits.

Today’s arrests are part of an ongoing coordinated effort by Inspector General Leahy Scott with local and State law enforcement partners involving multiple investigations across New York. Additional arrests are expected imminently. It also coincides with enhanced outreach efforts, including stakeholder trainings by the Inspector General, to increase public awareness of Workers’ Compensation fraud in the State.

“The Workers’ Compensation system is meant to assist and protect employees who are unable to work due to an illness or injury, and those who abuse the system should fully expect they will be caught,” said Inspector General Leahy Scott. “In these arrests today, the defendants are accused of using fraud and deceit to undermine their legal and moral responsibilities, and I will use the resources of my office to relentlessly pursue anybody who abuses the system at the expense of honest, hard-working New Yorkers.” Workers’ Compensation fraud impacts all New Yorkers, from increased insurance premiums to increased workloads for coworkers and an overall reduction in workforce productivity.

Arrested today were:

Douglas S. Griffen, 53, of 330 Halseyville Road, Ithaca, owner of Fingerlakes Excavating LLC, was charged with Grand Larceny in the Third Degree and Falsifying Business Records in the First Degree, felonies, as well as the Workers’ Compensation crimes of Fraudulent Practices, a felony, and Failure to Secure Compensation, a misdemeanor. Inspector General Leahy Scott’s investigation found that Griffen, last summer, provided a Tompkins County home building company false documents that purported to show that his own company had valid Workers’ Compensation coverage in order to qualify for two construction contracts with the home builder worth $72,000. Griffin had no Workers’ Compensation coverage and would not have been awarded the contracts if he had not provided the false documents to the home builder. Griffen was arraigned in Ithaca City Court and sent to Tompkins County Jail in lieu of $5,000 cash or $10,000 bond bail and is due back in court Tuesday, Nov. 17.

 Roger Camby, 60, of 1119 Teall Avenue, Syracuse, owner of an online retail candle business, was charged with the Workers’ Compensation crime of Fraudulent Practices, Insurance Fraud in the Second Degree and Grand Larceny in the Second Degree, all felonies. Inspector General Leahy Scott’s investigation found that Camby, a former truck driver out from work on a Workers’ Compensation claim since 2010, was operating several businesses while certifying to the Workers’ Compensation Board that he was not working in any capacity. Between early 2011 and the summer of 2013 he received more than $56,000 in Workers’ Compensation benefits while also running a candle business, Lovesoy Candles and Gifts, as well as working as a consultant for three multi-level marketing businesses.

Camby was arraigned in Town of Tully Court and is due to appear in Syracuse City Court tomorrow, Nov. 13. John A. Francher, 73, of 20 Vista Street, Auburn, owner of the Greenbriar Home for Adults in Homer, was charged with the Workers’ Compensation crime of Effect of Failure to Secure Compensation, a felony.

Inspector General Leahy Scott’s investigation found that Francher operated a business with more than five employees without obtaining required Workers’ Compensation coverage. He employed approximately 10 people at the Greenbrier Home. Francher was previously convicted in February 2014 of a misdemeanor charge of failure to secure compensation at Briarcliff Manor in Bath. Francher was arraigned in Town of Homer Court and is due back in court next Tuesday, November 17.

Steven M. Spratley, 58, of 179 Prospect Ave, Walton, owner of Spratley and Sons Tree Surgeons, was charged with Fraudulent Practices, a felony under the Workers’ Compensation Law. Inspector General Leahy Scott’s investigation found that Spratley falsely denied at a 2013 Workers’ Compensation Board hearing that a man who was severely injured while working for him in 2011 was actually an employee.

The investigation found that Spratley made the false statements to avoid liability for the employee’s claim for Workers’ Compensation due to the injury, which made him unable to work. Spratley is due to appear in the Town of North Norwich Court at a future date. Inspector General Leahy Scott thanked the Workers’ Compensation Board, the State Insurance Fund, Liberty Mutual Insurance and the Ithaca Police Department for their assistance during the investigations; the Ithaca Police Department and the New York State Police for their assistance with making the arrests; and Onondaga County District Attorney William J. Fitzpatrick, Tompkins County District Attorney Gwen Wilkinson, Cortland County District Attorney Mark D. Suben and Chenango County District Attorney Joseph A. McBride and their offices for prosecuting these cases.

The defendants are presumed innocent until and unless proven guilty in a court of law.

For an audio file of Inspector General Leahy Scott’s remarks, click HERE

Emerging Concepts for Future Workers' Compensation Benefits: Portability Now

Workers' Compensation as a benefit program is beginning to evolve under the concept of "The Shared Economy." Attacked from within and without, challenged by abuse and fraud, drained by the cottage industries and vendors, national lawmakers, labor leaders, insurance companies, governmental agencies, and the media, are speaking out to change the century old system that fails to integrate with current social, political, economic and medical programs.

A recent letter from national labor leaders has called for a "portable" system of benefits that will replace the current patch-work of systems called "workers' compensation programs.":

"We need a portable vehicle for worker protections and benefits.Traditionally, benefits and protections such as workers compensation, unemployment insurance, paid time off, retirement savings, and training/development have been, largely or partly, components of a worker’s employment relationship with an employer. The Affordable Care Act has disrupted that model, providing more independent workers a different avenue of access to health insurance. Another new model is needed to support new ways of work. We believe this model should be:

Independent: Any worker should be able to access a certain basic set of protections as an individual regardless of where they source income opportunities.

Flexible and pro-rated: People are pulling together income from a variety of sources, so any vehicle should support contributions that can be pro-rated by units of money earned, jobs done, or time worked, covering new ways of micro-working across different employers or platforms.

Portable: A person should be able to take benefits and protections with them in and out of various work scenarios.

Universal: All workers should have access to a basic set of benefits regardless of employment status.

Supportive of innovation: Businesses should be empowered to explore and pilot safety net options regardless of the worker classification they utilize.

California Workers' Compensation $25 Million Medical Fraud: US Attorney Charges Providers

San Diego Nov 10 2015: Eight medical professionals and associates are charged in federal grand jury indictments with buying and selling patients in a bribery scheme involving $25 million in improper claims for medical services and devices which were then billed to California Workers’ Compensation insurance companies.

FBI agents along with investigators from the California Department of Insurance and the San Diego County District Attorney’s Office served five search warrants and three seizure warrants today at locations in San Diego, Chula Vista, National City, Murietta and Los Angeles. Authorities arrested five people, including a radiologist, a chiropractor, a medical equipment provider, a medical clinic administrator and a so-called medical marketer. An attorney and a medical service provider were summoned to appear in federal court on Thursday.  One indicted defendant, Gonzalo Paredes, remains a fugitive and a warrant has been issued for his arrest.

These defendants, plus six corporations, are charged in three federal grand jury indictments unsealed today with conspiracy and honest services mail fraud. The indictments allege that these players either paid or received tens of thousands of dollars to buy or sell hundreds of patients, without the patients’ knowledge - therefore depriving those patients of their right to their doctors’ honest services.

“Today’s indictments are only the first wave of charges in what we believe is rampant corruption on the part of some physicians and chiropractors in their dealings with the health care system in general, and California’s Workers’ Compensation System in particular,” said U.S. Attorney Laura Duffy. “A patient puts his trust, and his very life, into the hands of his physician. A doctor’s decisions should never, under any circumstances, be influenced by anything other than the patient’s best interest.”

“Today's indictments show how the defendants in this case allowed greed and corruption to influence their patient care decisions and treated their patients as a commodity to be bought and sold,” said FBI Special Agent in Charge Eric S. Birnbaum. “The FBI will continue to use our intelligence and investigative expertise to identify, disrupt and dismantle sophisticated criminal conspiracies that unlawfully enrich individuals at the expense of patient care. The FBI and our law enforcement partners are committed to rooting out corruption in our health care system.”

“This criminal network bought and sold patients like cattle,” said District Attorney Bonnie Dumanis. “They cashed in on people who trusted them with their health and they conspired to illegally game the system on a level that we’ve not seen before. But, the game is over.”

“Our detectives from the California Department of Insurance worked closely with the FBI, United States Attorney's Office and San Diego District Attorney's office to investigate and arrest these medical providers for insurance fraud, which adds crippling costs to California's workers compensation system,” said Department of Insurance Commissioner Dave Jones. “These are not victimless crimes. When medical providers defraud insurers, those costs are passed on to California businesses and consumers, who already are struggling to make ends meet.”

This is how the schemes worked:

Patients who said they were injured on the job filed a workers’ compensation claim with the state of California and sought treatment for their injury. In this round of indictments, the workers sought help from a chiropractor.

The chiropractors were the gateway to a wide-array of health care fraud. In these cases alone they prescribed medical equipment, referred the patients for MRIs and X-Rays, and ordered specialized treatments such as Shockwave therapy.

As alleged in one of the indictments, Los Angeles radiologist Ronald Grusd paid bribes to a San Diego chiropractor in exchange for patient referrals. The bribes were funneled to the chiropractor via Grusd’s corporation, Willows Consulting, a shell company. The checks were labeled “professional services,” but this was a sham.

In order to further hide the illegal kickbacks, checks were issued to intermediaries - defendants Alexander Martinez and his father, Ruben - through their front companies, “Line of Sight” and “Desert Blue Moon.” The Martinezes took their “cut” and then, in turn, paid off the chiropractor.
Grusd’s practice, California Imaging Network Medical Group, has clinics in San Diego, Los Angeles, Beverly Hills, Fresno, Rialto, Santa Ana, Studio City, Bakersfield, Calexico, East Los Angeles, Lancaster, Victorville and Visalia.

In another indictment, a second San Diego chiropractor, Dr. George Reese, with offices on El Cajon Boulevard, referred patients to a Los Angeles area medical service provider (controlled by attorney Lee Mathis and Fernando Valdes, president of Foremost Shockwave Solutions ) in return for bribes. The bribes were set by the conspirators at $100 per patient and paid through an intermediary. After taking a cut amounting to $25 per patient, the intermediary would pay the remaining $75 per patient to Reese.

Although disguised as “office rent” payments, the illegal bribes were paid in cash during clandestine exchanges in restaurants and parking lots. For example, $6,000 in cash was delivered to Reese in the parking lot of the Jolly Roger in Oceanside, hidden in a gift bag. Other times, it was passed in envelopes or stashed inside newspapers.

According to the indictment, Reese and his codefendants generated and submitted bills to insurers totaling in the tens of millions of dollars. Most of these treatments involved the providing of “Shockwave therapy,” which uses low energy sound waves to initiate tissue repair. Proceeds from the insurance claims generated through this scheme were paid to Mathis and Valdes.

In the final indictment, a San Diego chiropractor referred patients to a licensed provider of durable medical equipment, Julian Garcia. In return Garcia paid the chiropractor $50 for each patient – in cash, to disguise the kickbacks. Garcia then improperly billed Workers Comp insurers millions for hot and cold packs for patients who had been secured by bribes.

Tuesday, November 10, 2015

NJ Governor Chris Christie Vetoes Supplemental Benefit Bill

SENATE BILL NO. 929

(First Reprint)

To the Senate:

Pursuant to Article V, Section I, Paragraph 14 of the New

Jersey Constitution, I am returning Senate Bill No. 929 (First

Reprint) without my approval.




Workers’ compensation is an important program in New

Jersey, providing compensation to employees who suffer job related

injuries or illnesses through no fault of their own. It

is especially significant to families who receive benefits after

a loved one has died in the line of duty.




In 1979, the State made comprehensive changes to the

workers’ compensation law, resulting in higher payments for

workers totally and permanently disabled after December 31,

1979. The changes, however, created a disproportionate effect

on workers’ compensation payments made to those who sustained

total and permanent disability or death before the

implementation of those changes. In recognition of this

disparity, the Legislature established a cost-of-living

adjustment (“COLA”) for those injured on or before December 31,

1979 to align their payments with those injured after the new

reforms.




This well-intended bill would extend the workers’

compensation COLA benefit to total disability beneficiaries and

those receiving survivors’ benefits where the injury occurred

after December 31, 1979. The estimated yearly cost for the COLA

is at least $58 million and would be funded solely through an

increase in the annual surcharge on private-sector employers

paid into the Second Injury Fund (“SIF”).




Employers in New Jersey already pay the third highest

workers’ compensation rates in the Nation. This bill would

further raise those rates, putting even more of a burden on

private sector businesses. I have worked tirelessly with my

Administration to maintain a business environment that fosters

the growth of private-sector jobs in the State, and we have been

successful. This bill represents a step in the wrong direction

because an increase in the annual SIF surcharge would threaten

the State’s ability to keep existing employers in the State and

undermine efforts to attract new ones. I cannot sign a bill that

will pile yet another unacceptable financial burden on the

businesses of this State.




Accordingly, I am returning Senate Bill No. 929 (First

Reprint) without my approval.

Respectfully,

[seal] /s/ Chris Christie

Governor

Attest:

/s/ Thomas P. Scrivo

Chief Counsel to the Governor




................

S929 Aca (1R) Concerns certain workers' compensation supplemental benefits.

Received by the Senate




Identical Bill Number: A1908 (2R)

Last Session Bill Number: A4514 S613 (1R)




Sweeney, Stephen M. as Primary Sponsor

Madden, Fred H., Jr. as Primary Sponsor

Burzichelli, John J. as Primary Sponsor

Riley, Celeste M. as Primary Sponsor

Moriarty, Paul D. as Primary Sponsor




1/16/2014 Introduced in the Senate, Referred to Senate Labor Committee

3/17/2014 Reported from Senate Committee, 2nd Reading

3/17/2014 Referred to Senate Budget and Appropriations Committee

6/5/2014 Reported from Senate Committee, 2nd Reading

6/12/2014 Passed by the Senate (21-15)

6/12/2014 Received in the Assembly, Referred to Assembly Labor Committee

10/27/2014 Reported and Referred to Assembly Appropriations Committee

3/16/2015 Reported out of Assembly Comm. with Amendments, 2nd Reading

6/25/2015 Substituted for A1908 (2R)

6/25/2015 Passed by the Assembly (43-31-2)

6/25/2015 Received in the Senate, 2nd Reading on Concurrence

9/24/2015 Passed Senate (Passed Both Houses) (24-12)

11/9/2015 Absolute Veto, Received in the Senate




Introduced - 5 pages PDF Format HTML Format

Statement - SLA 3/17/14 - 3 pages PDF Format HTML Format

Fiscal Estimate - 3/26/14; as introduced - 8 pages PDF Format HTML Format

Statement - SBA 6/5/14 - 4 pages PDF Format HTML Format

Statement - ALA 10/27/14 - 4 pages PDF Format HTML Format

Statement - AAP 3/16/2015 - 3 pages PDF Format HTML Format

Fiscal Estimate - 4/8/15; 1R - 8 pages PDF Format HTML Format

Reprint - 3 pages PDF Format HTML Format

Veto - Absolute veto - 2 pages PDF Format HTML Format

Committee Voting:

SLA 3/17/2014 - r/favorably - Yes {3} No {1} Not Voting {0} Abstains {1} - Roll Call

SBA 6/5/2014 - r/favorably - Yes {8} No {2} Not Voting {2} Abstains {1} - Roll Call

ALA 10/27/2014 - r/favorably - Yes {6} No {2} Not Voting {0} Abstains {1} - Roll Call

AAP 3/16/2015 - r/Aca - Yes {6} No {1} Not Voting {1} Abstains {1} - Roll Call




Session Voting:

Sen. 6/12/2014 - 3RDG FINAL PASSAGE - Yes {21} No {15} Not Voting {4} - Roll Call

Asm. 6/25/2015 - SUBSTITUTE FOR A1908 Aca - Yes {0} No {0} Not Voting {80} Abstains {0} - Voice Vote Passed

Asm. 6/25/2015 - 3RDG FINAL PASSAGE - Yes {43} No {31} Not Voting {4} Abstains {2} - Roll Call

Sen. 9/24/2015 - CONCUR ASMB AMEND - Yes {24} No {12} Not Voting {4} - Roll Call






RELATED ARTICLES

Governor Christie Vetoes First Responder Workers' Compensation Bill (workers-compensation.blogspot.com)
NJ Senate Passes Law To Help Injured Workers (workers-compensation.blogspot.com)
Christie, Cuomo veto N.J.-N.Y. Port Authority overhaul (workers-compensation.blogspot.com)
NJ COLA Bill Passed by Senate (workers-compensation.blogspot.com)

Monday, November 9, 2015

CMS Has a New Play Book for Conditional Payments - The Time Factor

The Centers for Medicare and Medicare Services  (CMS) has invoked the element of time to encourage workers' compensation settlements to be finalized. After almost 15 years has lapsed from the Patel Memo of July 11, 2001,  CMS is encouraging compensation claims to be resolved in a timely fashion when conditional payments are at issue.

Recently enacted Federal debt collection legislation has set the tone to encourage repayment of conditional payments in a timely fashion. 

Adding the element of a time deadline in any negotiation results in an acceleration  or resolution. CMS announced today:

"...Upcoming Updates to the Medicare Secondary Payer Recovery Portal (MSPRP) Modification for Inclusion of Final Conditional Payment (CP) Process Functionality"

"As part of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), the MSPRP will be modified to include Final CP process functionality by January 1, 2016. This new functionality will permit authorized MSPRP users to notify CMS that a recovery case is 120 days (or less) from an anticipated settlement and request that the recovery case be a part of the Final CP process.

"When the Final CP process is requested, any disputes submitted through the MSPRP will be resolved within 11 business days of receipt of the dispute. Once all disputes have been resolved, and the case is within 3 days of settling, the beneficiary or their authorized representative will be able to request a Final Conditional Payment Amount on the MSPRP. 

"Once calculated, this amount will remain the Final Conditional Payment Amount as long as:

  • The case is settled within 3 calendar days of requesting the Final Conditional Payment Amount, and
  • Settlement information is submitted through the MSPRP within 30 calendar days of requesting the Final Conditional Payment Amount.

Wednesday, October 21, 2015

Sanders, Pocan Introduce Legislation to Strengthen Workers’ Rights

Sen. Bernie Sanders (I-Vt.) and Rep. Mark Pocan (D-Wis.) introduced legislation today that would make it easier for workers to join unions and bargain for better wages, benefits and working conditions.

“Millions of Americans who want to join unions are unable to do so because of the coercive and often illegal behavior of their employers,” Sanders said. “The benefits of joining a union are clear: higher wages, better benefits and a more secure retirement. If we are serious about reducing income and wealth inequality and rebuilding the middle class, we have got to substantially increase the number of union jobs in this country.

The Workplace Democracy Act will make it easier for workers to join a union by allowing the National Labor Relations Board to certify a union if a simple majority of eligible workers sign valid authorization cards. The bill also requires companies to begin negotiating within 10 days after certification. If no first contract is reached after 90 days, either party can request compulsory mediation. After 30 days of mediation, the parties will submit the remaining issues to binding arbitration.

“For years, the ability of workers to unionize has given employees the opportunity to bargain for better wages and benefits. And unions have been one of our nation’s strongest voices for workplace safety and fairness. But over time, employers have steadily undermined workers’ ability to organize through nefarious tactics,” said Sen. Sherrod Brown (D-Ohio). “By allowing the use of the majority sign-up process and ensuring a timely contract negotiation, we can help restore this fundamental right to form a union.”

“The Workplace Democracy Act strengthens the middle class by restoring workers' rights to bargain for better wages, benefits, and working conditions,” said Pocan. “One of the root causes of declining wages is that workers’ ability to join together and bargain for higher wages and better working conditions has been has been severely undermined. This bill would make it easier for workers to have a voice in the workplace, providing a bigger paycheck to middle class families trying to pay the mortgage and find a way to send their kids to college.”

Joining Sanders and Pocan at the news conference outside the Capitol were workers who have faced retaliation for trying to organize their fellow workers. “Working moms shouldn’t have to strike and face threats just to join a union,” said Kellie Duckett, a federal contract worker at the U.S. Capitol. We should be able sign up for the union just like we sign up for the PTA.”

“I’m here to say that current labor laws don’t protect workers,” Mayra Tito, a federal contract worker, added. “I should know – I was fired from the Pentagon Starbucks after I went on strike for $15 and a union. That’s why we need the Workplace Democracy Act.”

“I was fired for speaking out in my workplace to improve patient care conditions by organizing a union,” Allysha Almad, a registered nurse from Pasadena, said. “My case is not unique. There are thousands of nurses and other workers who face retaliation when they try to raise their voices collectively to address unsafe condition – conditions that in hospitals and other workplaces actually endanger lives."

According to Bureau of Labor Statistics data released earlier this year, union workers’ wages are 27 percent greater than for non-union workers. Seventy-nine percent of unionized workers receive health insurance from their employers, compared to only 49 percent of non-union workers. Seventy-six percent of union workers have guaranteed defined-benefit pension plans, compared to only 16 percent of non-union workers. Eighty-three percent of union workers receive paid with sick leave compared to only 62 percent of non-union workers.

The bill is cosponsored in the Senate by Sens. Patrick Leahy (D-Vt.), Patty Murray (D-Wash.), Sherrod Brown (D-Ohio), Martin Heinrich (D-N.M.), Elizabeth Warren (D-Mass.), Kirsten Gillibrand (D-N.Y.), Debbie Stabenow (D-Mich.), Mazie Hirono (D-Hawaii) and Sheldon Whitehouse (D-R.I.).

Click here to read the bill.

Click here to read a summary of the bill.

Click here to read Sanders’ prepared remarks.
….

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.

Related articles
The New Push for Paid Family Leave (workers-compensation.blogspot.com)
Senator Gillibrand: We Have a Moral Obligation to Care for 9/11 Heroes, Survivors & Their Families (workers-compensation.blogspot.com)
National Census of Fatal Occupational Injuries in 2012 (preliminary Results) (workers-compensation.blogspot.com)
New Testing Reveals Hidden Dangerous Chemicals in Popular Halloween Costumes and "Trick or Treat" Bags (workers-compensation.blogspot.com)
McDonald's charged with abusing workers over wage protests (workers-compensation.blogspot.com)

Tuesday, October 13, 2015

OSHA: NJ Fragrance Manufacturer Fined for Exposing Workers

Ambrosia Fragrance LLC fined more than $67K for federal workplace violations
Employer name: Ambrosia Fragrance LLC, 7 Turner Place, Piscataway, New Jersey.
Citations issued: On Sept. 30, the Occupational Safety and Health Administration cited the company for 19 serious violations.
Investigation findings: OSHA inspectors cited the company for lack of procedures and training related to preventing equipment from starting up during service and maintenance, a procedure known as lockout/tagout*. Citations were also issued for fire hazards and obstructed exits.
Proposed penalties: $67,200
Quote: "Machines that start up suddenly can seriously injure workers, or even kill them," said Patricia Jones, director of OSHA's Avenel Area Office. "These dangers are preventable, and the solution starts with training and implementing safe processes. Fixing these hazards isn't just the law - it's a vital step toward protecting workers' lives and limbs, and it's a step that Ambrosia Fragrance needs to take."

Monday, October 5, 2015

And they didn't see it coming........

Rafael Gonzalez authored a very helpful, and spot on, post today that summarizes the new approach of The Centers for Medicare and Medicaid Services (CMS) to recoup benefits under Medicare Secondary Payer law (42 U.S.C. § 1395y(b)) (MSP) before a final determination is made in the underlying workers' compensation claim.
Rafael Gonzalez

With multiple reporting trigger points CMS is new able to capture data quickly and with the implementation of the expedited US Treasury debt collection procedures, the Digital Accountability and Transparency Act (DATA Act). the process will now  ignore the sluggish/delayed workers' compensation program/adjudication.

CMS has now operationalized a new procedure, "As part of the continuing efforts to improve the Coordination of Benefits & Recovery (COB&R) program and claims payment accuracy in Medicare Secondary Payer (MSP) situations, the Centers for Medicare & Medicaid Services (CMS) will be transitioning a portion of the Non-Group Health Plan (NGHP) recovery workload from the Benefits Coordination & Recovery Center (BCRC) to its CommercialRepayment Center (CRC)."

Ironically, this process cuts through the red tape and cottage industry's interests of the State programs and moves the claims to the goal of Federalization of the entire system based also on a uniformity of processing, coding and determinations at the Federal administrative level. See also, D. Torrey, The Federalization Standards Issue, A Short History Before and After NFIB v. Sebelius (2012), ABA, 2013. "These views speak loudly to the expectation of educated observers that state-based workers’ compensation will endure and that federalization is unlikely."

Additionally, the cottage industries (lawyers, insurance carriers & employers, ie. MARC) who lobbied for The Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2011, never saw the forest from the trees as they tried to stake out their territory.

Perhaps, the very next step may be an effort to follow the liability program models, wherein pre-disposition, alternate resolution, is possible early in the process, ie. the mass tort specialized programs for resolution. 

Of course, workers' compensation (WC) insurers and employers would then need to really expedite WC claims. But then, wasn't that the intent of the now antiquated 1911 system anyway?

Click below to read the post on LinkedIn:
New Process for Primary Payers Resolving Medicare Conditional Payments Begins Today

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:

"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

Friday, September 25, 2015

Employees exposed to dangerous workplace hazards at Pennsauken aluminum
 services plant

A aluminum company fined $308K
 OSHA's investigation found 44 safety violations, including one willful:

Employer name: Aluminum Shapes LLC, 9000 River Road, Delair, New Jersey.

Citations issued: On Sept. 21, 2015, the Occupational Safety and Health Administration cited the company for one willful, three repeat, 35 serious, and five other-than-serious violations.
Investigation findings: OSHA launched an investigation April 16, 2015, after being notified that an employee suffered a broken leg on March 24 while operating a crane and was hospitalized. The company failed to report the incident to the agency within 24 hours, as required.

The willful citation involved electrical equipment with damaged parts that could adversely affect the safe operation or mechanical strength of the equipment. In addition, pendant control boxes for a crane were damaged, malfunctioning and not clearly marked; damaged slings were not removed from service; and metal saws were not guarded to prevent employee exposure, resulting in the repeat citations. Unguarded floor openings, lack of machine guarding and confined space training were among the serious violations.

The other-than-serious violations included the employer's failure to report the hospitalization and an inadequate hazard communication program.

Proposed Penalties: $308,000

Quote: "The number of safety violations found at Aluminum Shapes' plant is completely unacceptable. This employer blatantly ignored known safety requirements, causing a preventable worker injury," said Robert Kulick, OSHA's regional administrator in New York. "This company is now paying a hefty price for its negligence. The hazards identified in the investigation should be immediately addressed to prevent future incidents and ensure worker safety."

View the citations: https://www.osha.gov/ooc/citations/Aluminum_Shapes_LLC_1059368_Sept_23_2015.pdf

NATIONAL CENSUS OF FATAL OCCUPATIONAL INJURIES IN 2014 (PRELIMINARY RESULTS)

A preliminary total of 4,679 fatal work injuries were recorded in the United States in 2014, an increase of 2 percent over the revised count of 4,585 fatal work injuries in 2013, according to results from the Census of Fatal Occupational Injuries (CFOI) conducted by the U.S. Bureau of Labor Statistics. The preliminary rate of fatal work injury for U.S. workers in 2014 was 3.3 per 100,000 full-time equivalent (FTE) workers; the revised rate for 2013 was also 3.3. Revised 2014 data from CFOI will be released in the late spring of 2016. Over the last 5 years, net increases to the preliminary count have averaged 173 cases, ranging from a low of 84 in 2011 (up 2 percent) to a high of 245 in 2012 (up 6 percent).

Key preliminary findings of the 2014 Census of Fatal Occupational Injuries:

 The number of fatal work injuries in private goods-producing industries in 2014 was 9 percent
higher than the revised 2013 count but slightly lower in private service-providing industries. Fatal
injuries were higher in mining (up 17 percent), agriculture (up 14 percent), manufacturing (up
9 percent), and construction (up 6 percent). Fatal work injuries for government workers were
lower (down 12 percent).

 Falls, slips, and trips increased 10 percent to 793 in 2014 from 724 in 2013. This was driven
largely by an increase in falls to a lower level to 647 in 2014 from 595 in 2013.

 Fatal work injuries involving workers 55 years of age and over rose 9 percent to 1,621 in 2014 up
from 1,490 in 2013. The preliminary 2014 count for workers 55 and over is the highest total ever
reported by CFOI.

 After a sharp decline in 2013, fatal work injuries among self-employed workers increased
10 percent in 2014 from 950 in 2013 to 1,047 in 2014.

 Women incurred 13 percent more fatal work injuries in 2014 than in 2013. Even with this
increase, women accounted for only 8 percent of all fatal occupational injuries in 2014.

 Fatal work injuries among Hispanic or Latino workers were lower in 2014, while fatal injuries
among non-Hispanic white, black or African-American, and Asian workers were all higher.

 In 2014, 797 decedents were identified as contracted workers, 6 percent higher than the
749 fatally-injured contracted workers reported in 2013. Workers who were contracted at the time
of their fatal injury accounted for 17 percent of all fatal work injury cases in 2014.

 The number of fatal work injuries among police officers and police supervisors was higher in
2014, rising from 88 in 2013 to 103 in 2014, an increase of 17 percent.

NJ Supplemental Benefits Bill Goes to The Governor

Identical Bill Number: A1908    (2R)
Last Session Bill Number: A4514   S613 (1R) 

Sweeney, Stephen M.   as Primary Sponsor
Madden, Fred H., Jr.   as Primary Sponsor
Burzichelli, John J.   as Primary Sponsor
Riley, Celeste M.   as Primary Sponsor
Moriarty, Paul D.   as Primary Sponsor

1/16/2014 Introduced in the Senate, Referred to Senate Labor Committee
3/17/2014 Reported from Senate Committee, 2nd Reading
3/17/2014 Referred to Senate Budget and Appropriations Committee
6/5/2014 Reported from Senate Committee, 2nd Reading
6/12/2014 Passed by the Senate (21-15)
6/12/2014 Received in the Assembly, Referred to Assembly Labor Committee
10/27/2014 Reported and Referred to Assembly Appropriations Committee
3/16/2015 Reported out of Assembly Comm. with Amendments, 2nd Reading
6/25/2015 Substituted for A1908 (2R)
6/25/2015 Passed by the Assembly (43-31-2)
6/25/2015 Received in the Senate, 2nd Reading on Concurrence
9/24/2015 Passed Senate (Passed Both Houses) (24-12)

Introduced - 5 pages PDF Format    HTML Format 
Statement - SLA 3/17/14 - 3 pages PDF Format    HTML Format 
Fiscal Estimate - 3/26/14; as introduced - 8 pages PDF Format    HTML Format 
Statement - SBA 6/5/14 - 4 pages PDF Format    HTML Format 
Statement - ALA 10/27/14 - 4 pages PDF Format    HTML Format 
Statement - AAP 3/16/2015 - 3 pages PDF Format    HTML Format 
Fiscal Estimate - 4/8/15; 1R - 8 pages PDF Format    HTML Format 
Reprint - 3 pages PDF Format    HTML Format 


Committee Voting:
SLA  3/17/2014  -  r/favorably  -  Yes {3}  No {1}  Not Voting {0}  Abstains {1}  -  Roll Call
SBA  6/5/2014  -  r/favorably  -  Yes {8}  No {2}  Not Voting {2}  Abstains {1}  -  Roll Call
ALA  10/27/2014  -  r/favorably  -  Yes {6}  No {2}  Not Voting {0}  Abstains {1}  -  Roll Call
AAP  3/16/2015  -  r/Aca  -  Yes {6}  No {1}  Not Voting {1}  Abstains {1}  -  Roll Call

Session Voting:
Sen.    6/12/2014  -  3RDG FINAL PASSAGE   -  Yes {21}  No {15}  Not Voting {4}    -  Roll Call
Asm.  6/25/2015  -  SUBSTITUTE FOR A1908 Aca   -  Yes {0}  No {0}  Not Voting {80}  Abstains {0}  -  Voice Vote Passed
Asm.  6/25/2015  -  3RDG FINAL PASSAGE   -  Yes {43}  No {31}  Not Voting {4}  Abstains {2}  -  Roll Call

Symposium: Celebrating Dr. Irving J. Selikoff

Friday, October 16, 2015, 8:00 AM - 12:30 PM
Location: Davis Auditorium, Hess Building, 1470 Madison Ave (between 101st and 102nd Sts)

Program Overview
: This symposium will examine the lasting impact of the legacy of Dr. Irving J. Selikoff (January 15, 1915-May 20, 1992) on occupational health and safety in the United States. Considered the father of occupational medicine, he is remembered for his seminal research on asbestos-related illnesses, his tireless advocacy for worker safety and health protections, and his contributions to the establishment of federal asbestos regulations. 




Photo Exhibit
  In conjunction with the symposium, there will be an exhibit by photographer Earl Dotter on display titled Badges: A Memorial Tribute to Asbestos Workers. Guggenheim Pavilion Atrium, 1468 Madison Avenue.



Who should attend?
 This symposium is open to the public and intended for faculty, residents, students, and members of the occupational health and safety community.



Mount Sinai Organizing Committee  
Madelynn Azar-Cavanagh, MD; Philip J. Landrigan, MD, MSc; Roberto Lucchini, MD; John D. Meyer, MD, MPH; Barbara J. Niss; Robert O. Wright, MD, MPH



Registration
 There is no fee to attend this event. Click here to register for this event or email carla.azar@mssm.edu. Please note that space is limited and early registration is encouraged. 

Special Needs
The Icahn School of Medicine at Mount Sinai is in full compliance with provisions of the Americans with Disabilities Act (ADA) and is accessible for individuals with special needs. If you would like to attend this conference and require any special needs or accommodations, please contact carla.azar@mssm.edu.




Agenda

 

8:00 AM 
Breakfast and Check-in



9:00 AM 
Welcome Remarks

Robert O. Wright, MD, Chair, Dept. of Preventive Medicine, Icahn School of Medicine at Mount Sinai

Philip J. Landrigan, MD, Dean for Global Health, Icahn School of Medicine at Mount Sinai

David Michaels, PhD, MPH, Assistant Secretary of Labor for Occupational Safety and Health and Director, Occupational Safety and Health Administration (OSHA)

John Howard, MD, MPH, LLM, Director, National Institute for Occupational Safety and Health

Program Moderator

Roberto Lucchini, MD, Director, Division of Occupational and Environmental Medicine, Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai



9:30 AM
 Irving J. Selikoff in History

Albert Miller, MD, Director of the Pulmonary Function Laboratory, Albert Einstein College of Medicine and Emeritus Clinical Professor of Medicine, Icahn School of Medicine at Mount Sinai 



9:50 AM
 Asbestos and Selikoff’s role in the Reconception of Responsibility for Chronic Disease in a pre-OSHA era

David K. Rosner, PhD, MPH, Ronald H. Lauterstein Professor of Sociomedical Sciences and Professor of History, Graduate School of Arts and Sciences, Columbia University Mailman School of Public Health



10:10 AM 
Break



10:25 AM
 Update of the Selikoff’s Insulators’ Asbestos Cohort

Steven Markowitz, MD, DrPH, Barry Commoner Center for Health and the Environment, Queens College and Graduate Center, City University of New York



10:45 AM
 Pneumoconiosis and Autoimmune Disease from an Historical Perspective

Paul D. Blanc, MD, MSPH, Professor of Medicine and Endowed Chair, Occupational and Environmental Medicine, University of California San Francisco



11:05 AM 
Perspectives on Dr. Selikoff’s Contributions to Public Health and Safety Laws

Neil T. Leifer, Esq., Neil T Leifer, LLC, Auburndale, MA




11:25 AM
 Trends Today: Global Spread of Asbestos to Developing World

Barry I. Castleman, ScD, Author of Asbestos: Medical and Legal Aspects



11:45 AM 
Q&A



12:05 PM 
Introduction of Photo Exhibit

 Linda Reinstein, President/CEO, Asbestos Disease Awareness Organization 



12:10 PM
 Closing Remarks

Madelynn Azar-Cavanagh, MD, Medical Director, Mount Sinai Selikoff Centers for Occupational Health



Symposium: Celebrating Dr. Irving J. Selikoff
Sponsored by the Selikoff Centers for Occupational Health, Division of Occupational and Environmental Medicine, Dept. of Preventive Medicine, Icahn School of Medicine at Mount Sinai



Thursday, September 10, 2015

John Burton Reports Private Sector Costs Down For 9th Year

Professor Emeritus, John F. Burton, Jr., reports in the Workers' Compensation Research Report that for the ninth consecutive year there have been declining costs.

Issue 10 of the Workers’ Compensation Resources Research Report (WCRRR) examines the employers’ costs of workers’ compensation. Part I relies on data from the Bureau of Labor Statistics (BLS) to examine national trends from 1986 to 2014. For private-sector employers, costs dropped for the ninth consecutive year and represented 1.77 percent of payroll in 2014, the lowest figure since 1986. For all non-federal employers, which includes state and local government employers in addition to private sector employers, employers’ costs of workers’ compensation were 1.76 percent of payroll in 2014, which was the ninth consecutive year of declining costs and the lowest figure since the data series began in 1991.

The National Academy of Social Insurance (NASI) also publishes estimates of the employers’ costs of workers’ compensation for all non-federal employers. The results of the two estimates diverge after 2010, with the NASI data showing three years of increases in employers’ costs from 2011 to 2013 (the latest year with NASI data) while the BLS data show nine years of declines through 2014.

Part II provides information based on the BLS data on the variations among employers’ costs of workers’ compensation in 2014 depending on the employers’ region, industry, the occupations of the firms’ employees, firm size, and union status. The variations among industries were significant, ranging from 4.71 percent of payroll in construction to 0.57 percent of payroll in the financial industry.

Download WCRRR Issue 10 Order Form