AIG’s announcement yesterday, of yet another loss of $5.4 Billion brings their total loss to $18.5 Billion in the last 3 quarters, shook Wall Street. The announcement caused the 5th largest daily decline in the value of its stock. Yesterday alone, AIG stock fell 18% in value as the NYSE fell 224.64 points.
Since AIG is a major component of the national workers’ compensation scene, the devaluation of the company will most probably have financial repercussions thought the workers’ compensation sector. If AIG is unable to meet its obligation in some jurisdictions then an automatic insolvency procedure will be implemented. The ultimate cost will flow into the system itself.
Compounding this issue is the fact that workers’ compensation premiums that are to be collected are heading south. Also announced yesterday was that the job market in the US had become further restricted as unemployment claims rose to 455,000 last week which is a 6 year high.
The NCCI also reported recently that claims nationally were down 2.5% in 2007. These factors may demonstrate that reforms to restrict access to the system are becoming effective, but the massive infrastructure that has been amassed for handling the dwindling claims will need to be ramped down at even a faster rate that anticipated because of the declining economic base signaled by the AIG announcement.
Friday, August 8, 2008
The Odd Lot Doctrine Springs New Life
In 1921 Justice Cardoza while sitting on the Court of Appeals of the State of New York introduced The Odd Lot Doctrine into workers’ Compensation. The Doctrine has been brought to life again in New Jersey.
The “Odd Lot Doctrine” had its genesis in England where a claimant's search for work was fruitless since his physical defects in combination with his lack of skills made him an unmarketable unit. Various States, including New Jersey, have embodied the concept statutorily. In New Jersey where at least 75% of total disability can be attributed to medical reasons, then the other personal handicaps may be considered in combination with the medical conditions in reaching a determination of unemployability.
The Appellate Division remanded a total disability award for failure of the petitioner to provide adequate notice of the assertion of the Odd Lot Doctrine. 06T14598-06T1 JOYCE R. RAMBOUGH, Respondent, v. C.V. HILL REFRIGERATION "Under the ["odd-lot"] doctrine, the worker is viewed in the [context] of the competitive market place, where his inability to sell his labor may be traceable to his [personal] background superimposed upon his physical disability." Id. at 540; see Barbato v. Alsan Masonry, 64 N.J. 514, 526-28 (1974)
See also: "The pretrial memorandum should specify that total permanent disability under the odd-lot doctrine is an issue in the claim so that the respondent can be prepared to meet it at the time of trial. In addition, the ability to perform limited service in one's own enterprise, or a family enterprise, may not of itself be sufficient to negate industrial employability for workers' compensation purposes; the question in such a case is the worker's ability to sell his services in a competitive job market. Germain v. Cool-Rite Corporation, 70 N.J. 1, 355 A.2d 642 (1976)." 38 NJ Practice Sec. 12.12
The “Odd Lot Doctrine” had its genesis in England where a claimant's search for work was fruitless since his physical defects in combination with his lack of skills made him an unmarketable unit. Various States, including New Jersey, have embodied the concept statutorily. In New Jersey where at least 75% of total disability can be attributed to medical reasons, then the other personal handicaps may be considered in combination with the medical conditions in reaching a determination of unemployability.
The Appellate Division remanded a total disability award for failure of the petitioner to provide adequate notice of the assertion of the Odd Lot Doctrine. 06T14598-06T1 JOYCE R. RAMBOUGH, Respondent, v. C.V. HILL REFRIGERATION "Under the ["odd-lot"] doctrine, the worker is viewed in the [context] of the competitive market place, where his inability to sell his labor may be traceable to his [personal] background superimposed upon his physical disability." Id. at 540; see Barbato v. Alsan Masonry, 64 N.J. 514, 526-28 (1974)
See also: "The pretrial memorandum should specify that total permanent disability under the odd-lot doctrine is an issue in the claim so that the respondent can be prepared to meet it at the time of trial. In addition, the ability to perform limited service in one's own enterprise, or a family enterprise, may not of itself be sufficient to negate industrial employability for workers' compensation purposes; the question in such a case is the worker's ability to sell his services in a competitive job market. Germain v. Cool-Rite Corporation, 70 N.J. 1, 355 A.2d 642 (1976)." 38 NJ Practice Sec. 12.12
CMS Gearing Up for Mandatory Insurance Reporting
CMS will implement mandatory insurance company reporting: GHP January 1, 2009 and liability insurance carriers (workers’ compensation) on July 1, 2009. Mandatory reporting announcements will be posted on the CMS web site and e-mail notices may be requested by e-mail
The new provisions for Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation found at 42 U.S.C. 1395y(b)(8):
Add reporting rules; do not eliminate any existing statutory provisions or regulations. The new provisions do not eliminate CMS' existing processes if a Medicare beneficiary (or his/her representative) wishes to obtain interim conditional payment amount information prior to a settlement, judgment, award, or other payment.
Include penalties for noncompliance.
Who must report: "an applicable plan." "…[T]he term 'applicable plan' means the following laws, plans, or other arrangements, including the fiduciary or administrator for such law, plan or arrangement: (i) Liability insurance (including self-insurance). (ii) No fault insurance. (iii) Workers' compensation laws or plans."
What must be reported: the identity of a Medicare beneficiary whose illness, injury, incident, or accident was at issue as well as such other information specified by the Secretary to enable an appropriate determination concerning coordination of benefits, including any applicable recovery claim.
When/how reporting must be done:
• In a form and manner, including frequency, specified by the Secretary.
• Information shall be submitted within a time specified by the Secretary
after the claim is resolved through a settlement, judgment, award, or other
payment (regardless of whether or not there is a determination or
admission of liability).
• Submissions will be in an electronic format.
The new provisions for Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation found at 42 U.S.C. 1395y(b)(8):
Add reporting rules; do not eliminate any existing statutory provisions or regulations. The new provisions do not eliminate CMS' existing processes if a Medicare beneficiary (or his/her representative) wishes to obtain interim conditional payment amount information prior to a settlement, judgment, award, or other payment.
Include penalties for noncompliance.
Who must report: "an applicable plan." "…[T]he term 'applicable plan' means the following laws, plans, or other arrangements, including the fiduciary or administrator for such law, plan or arrangement: (i) Liability insurance (including self-insurance). (ii) No fault insurance. (iii) Workers' compensation laws or plans."
What must be reported: the identity of a Medicare beneficiary whose illness, injury, incident, or accident was at issue as well as such other information specified by the Secretary to enable an appropriate determination concerning coordination of benefits, including any applicable recovery claim.
When/how reporting must be done:
• In a form and manner, including frequency, specified by the Secretary.
• Information shall be submitted within a time specified by the Secretary
after the claim is resolved through a settlement, judgment, award, or other
payment (regardless of whether or not there is a determination or
admission of liability).
• Submissions will be in an electronic format.
Wednesday, July 30, 2008
The Asbestos Debate is Over
Almost 45 years following the historic 1964 NY Academy of Medicine conference in New York experts continue to memorialize the history of asbestos related disease. Now enters, defense expert John E. Craighead, who has written his viewpoint on the subject.Asbestos is one of the modern world’s most historic occupational medical disasters. Not only is it well documented, it continues not to be banned in the US , in fact, the incidence of asbestos related disease reported has turned upward, according to recently released NIOSH data (1979-2003.
In a recent review of the Craighead volume, the New England Journal of Medicine, has called it, “….highly personalized with strong individual viewpoints. It is less authoritative as a source for risk assessment and litigation issues.”
Yet others have including: Victor L. Roggli (Pathology of Asbestos-Associated Diseases), Barry I. Castleman (Asbestos: Medical and Legal Aspects, Fifth Edition) and Paul Brodeur (Outrageous Misconduct) have followed in the historic footsteps of the late, Irving J. Selikoff, MD and have guided us to seek a remedy and cure for wrongdoings of the past.
The asbestos debate is over. It is no longer time to profit from the debate and sell controversy. It is no longer time to allow this product to be sold anywhere in the world for profit. It is time to direct attention to provide medical treatment to those who suffer from asbestos related illness and draw our attention to find a cure for this disease.
Friday, July 25, 2008
The Future of Workers' Compensation: Navigating the New Benefit Highway
The Future of Workers' Compensation: Navigating the New Benefit Highway
The past and present will predict the future of the new workers' compensation benenfit highway. This Power Point presentation is available in a PDF format and for the next 14 days may be securely downloaded from https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE at no cost to the first 500 requests.
Link available at:
https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE
The past and present will predict the future of the new workers' compensation benenfit highway. This Power Point presentation is available in a PDF format and for the next 14 days may be securely downloaded from https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE at no cost to the first 500 requests.
Link available at:
https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE
The Federal Government is Offering Funding for a World Trade Center Non-Responder Medical Program.
An announcement has been for applications for the provision of screening, referral and treatment services for residents, students, and others in the community, related to the September 11, 2001 terrorist attacks in New York City. The program is aimed at the ‘non-responder population.’ Since September 11, 2001, the Department of Health and Human Services, CDC, and NIOSH have been active in assessing the health impact of the World Trade Center disaster. There is currently a program in place to provide health assessment examinations, diagnosis, and treatment for first response emergency personnel (the responder population) in the New York City (NYC) area. The application deadline is August 25, 2008.The grant awardee would be involved in the following activities:
1. Immediately provide for accessible health assessments, eligibility confirmation, diagnostic, referral and treatment services (including medications and durable medical equipment) to the non-responder population for health conditions associated with WTC dust/debris exposure.
2. Identify the organizational components required to support access to these services, including personnel, examination venues, maintenance of patient records, data platforms and management, compliance with applicable laws, assurance of quality care, coordination of healthcare benefits, and programmatic recordkeeping.
3. Provide referral and treatment services with grant funds only as the Payor of Last Resort. Private health insurance (self-funded or employer-funded), workers’ compensation insurance (employer-funded), and government-funded health insurance (Medicare and Medicaid) shall be used first before grant funds are used. Applicants should demonstrate their capacity to determine insurance status and to seek reimbursement from outside payers. Funds shall not be used to supplant existing activities or for the treatment of the responder population.
4. Establish service information and patient management systems as needed in order to accommodate intake, referral, prompt healthcare services, and reporting of the services provided to the non-responder population. In carrying out these activities, collaborate with other WTC-related healthcare providers, as appropriate and needed.
5. Develop a written Management and Prioritization Plan which identifies the projected service delivery area, explains how the assessment of potential non-responder patient needs will be determined, provides a strategy to ensure meeting those needs, and provides a section focused on ensuring prioritization and management of this program’s health services delivery to meet those needs, within the broader context of all organizational activities and responsibilities. The applicant should state an estimate for the number of non-responders to be served with the requested funds and provide a justification based on an estimation of the projected costs to provide health assessment examinations, and the costs to provide treatment for the expected World Trade Center-related conditions that will be identified.
6. Provide patient encounter reporting on health assessment examinations and treatment to NIOSH for quality assurance. 7. Establish and maintain information and data management systems that will ensure the provision to NIOSH of electronic data in a uniform fashion
Complete Announcement
Thursday, July 24, 2008
New Chemotherapy Treatment Reported "Responsive" to Mesothelioma
A new set of drugs has been reported responsive in treating mesothelioma, a tumor caused by exposure to asbestos fiber. The British Journal of Cancer has reported that cisplatin and vinorelbine effective in the treatment of mesothelioma. “Cisplatin and intravenous vinorelbine is a highly active regimen in MPM with a response rate and survival comparable to the most active regimens so far reported.”
The report appears in the June 10, 2008 edition of The British Journal of Medicine.
The report appears in the June 10, 2008 edition of The British Journal of Medicine.
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