Teleconference Event for Mandatory Reporting for
Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers’ Compensation
Date: April 9, 2009
Time: 1:00 PM – 3:00 PM Eastern Time
Participation is by telephone only. (The Centers for Medicare & Medicaid Services (CMS) will not have space for individuals/entities to participate onsite at CMS).
Call-in Line: 800 779 4354
Pass Code: SECTION 111
Please begin dialing in approximately 20-30 minutes before the call due to the large number of participants.
Click here for Notice and Agenda
Wednesday, April 8, 2009
AIG Workers' Compensation Under Investigation Again
American International Group Inc. (AIG) is reportedly now under investigation by the insurance regulators of 50 states who are reviewing whether the company violated rate setting rules. AIG in 2006 agreed to a payment of $300 Million in a Federal law suit for mistaking premiums. The company has also been the subject to multiple Federal bailout attempts.
Tuesday, April 7, 2009
Candy Makers Found to Have Popcorn Lung - Flavoring Illness
It has been reported by, Andrew Schneider, investigative reporter, that severe cases of "popcorn lung" caused by exposure to diacetyl butter are now being reported in candy makers as well. Five cases of severe lung disease have been identified by physicians. Those cases involved workers who made candy.
NJ Issues a Procedural Alert for Medicare Elligible Petitioners
The New Jersey Division of Workers' Compensation has issued a procedural alert to attorneys handling claims of Medicare Elligible Petitioners. Peter J. Calderone, Director and Chief Judge of the NJ agency issued a Memorandum in an effort to establish a formalized and smooth transition with the integration of the mandatory reporting requirements to be initiated this year by The Centers for Medicare and Medicaid Services (CMS).
1. "...parties should not send unsigned settlements to CMS";
2. "...settlements signed by a judge which are not based on a transcribed court record would violate our law since judges must find a settled case resolution fair and just on the court record presented";
3. "Up to date Medicare information must be obtained prior to the entry of a signed workers' compensation order that needs final CMS approval";
4. "When a case is settled, the parties can agree on language in the settlement that a party, usually the petitioner, will be responsible for any additional CMS reimbursements. The petitioner is generally identified since only the petitioner can petition CMS for a waiver from additional payments on hardship or equity grounds. We are advised that such waivers when supported are most often granted;" and
5. "As an alternative, the parties can agree in Orders Approving Settlements (but not Section 20 Orders [lump sum payments in lieu of compensation]) and the judge can insert language in judgments that the parties have the right to reopen the case ifthere are additional Medicare reimbursements and a dispute as to which party is responsible for the payment."
The memorandum goes on to caution the parties that if the parties and the Court are uable to agree upon settlement terms, then a trial and judicial resolution will be required.
1. "...parties should not send unsigned settlements to CMS";
2. "...settlements signed by a judge which are not based on a transcribed court record would violate our law since judges must find a settled case resolution fair and just on the court record presented";
3. "Up to date Medicare information must be obtained prior to the entry of a signed workers' compensation order that needs final CMS approval";
4. "When a case is settled, the parties can agree on language in the settlement that a party, usually the petitioner, will be responsible for any additional CMS reimbursements. The petitioner is generally identified since only the petitioner can petition CMS for a waiver from additional payments on hardship or equity grounds. We are advised that such waivers when supported are most often granted;" and
5. "As an alternative, the parties can agree in Orders Approving Settlements (but not Section 20 Orders [lump sum payments in lieu of compensation]) and the judge can insert language in judgments that the parties have the right to reopen the case ifthere are additional Medicare reimbursements and a dispute as to which party is responsible for the payment."
The memorandum goes on to caution the parties that if the parties and the Court are uable to agree upon settlement terms, then a trial and judicial resolution will be required.
Domer on Wisconsin Workers' Compensation Law Published
Thomas and Charles Domer have authored an exhaustive and authoritative analysis of Wisconsin Workers' Compensation Law. Their volume provides excellent practical insight on how to handle the simplest case to the most complex litigation. Wisconsin Workers' Compensation Law furnishes compensation lawyers with historical information and a current analysis of the law. The treatise skillfully identifies trends to aid the practitioner in crafting winning legal arguments in critical and cutting edge issues.Wisconsin Workers' Compensation Law, 2009 ed. (Vol. 17, Wisconsin Practice Series) By Charles F. Domer, Thomas M. Domer
Petition Filed to Re-Consider California AMA Guide Decision
The California Workers' Compensation Appeals Board (CAWCAB) has decided to review its prior decision of February 27, 2009, challenging the AMA Guidelines. The CAWCAB has issued an Order granting reconsideration and inviting mucus briefs to be filed.
"We also will give any interested person or entity until 5pm on Friday, May 1, 2009 to file an amicus curiae brief and to serve that brief on all counsel in both the Almaraz and Guzman cases."
Alvaraz v. Environmental Recovery Services, et al.
"We also will give any interested person or entity until 5pm on Friday, May 1, 2009 to file an amicus curiae brief and to serve that brief on all counsel in both the Almaraz and Guzman cases."
Alvaraz v. Environmental Recovery Services, et al.
CMS Publishes Memo on Pricing Future Prescription Drug Treatment
The Centers for Medicare & Medicaid Services' (CMS) has published a memorandum outlining the methodology of pricing future prescription drug treatment costs/expenses in Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) proposals.
"The CMS will begin independently pricing future prescription drug treatment costs/expenses in WCMSA proposals beginning June 1, 2009. Effective with complete WCMSA submissions received by CMS’ Coordination of Benefits (COB) Contractor on or after June 1, 2009, where the WC related injury warrant(s) the need of prescription drugs for the ongoing treatment of the WC related injury, CMS’ independent pricing of the prescription drug amount will be calculated and priced using average wholesale price (AWP). The CMS will not use or recognize any other pricing, discounting, or calculation methods when determining the adequacy of the prescription drug amounts in WCMSA proposals. "
"The CMS will begin independently pricing future prescription drug treatment costs/expenses in WCMSA proposals beginning June 1, 2009. Effective with complete WCMSA submissions received by CMS’ Coordination of Benefits (COB) Contractor on or after June 1, 2009, where the WC related injury warrant(s) the need of prescription drugs for the ongoing treatment of the WC related injury, CMS’ independent pricing of the prescription drug amount will be calculated and priced using average wholesale price (AWP). The CMS will not use or recognize any other pricing, discounting, or calculation methods when determining the adequacy of the prescription drug amounts in WCMSA proposals. "
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