A Brokered Marriage: Medicare and Workers’ Compensation

The problems of old age are now worrying are beginning to influence decision makers on what to do with two major delivery system in the United States. Both the Medicare system and the workers’ compensation medical delivery system are now ailing. The fiscal remedy maybe their marriage.

The Medicare Hospital Fund will be insolvent by 2017. The Trustees of the program have indicated that the program has been paying out more than it has collected in taxes and interest over the last two years. This estimated date of insolvency is two years ahead of schedule and the shortfall will necessitate a deposit of $13.4 trillion.

Robert Pear reported in the NY Times this week, “’The financial outlook for the hospital insurance trust fund is significantly less favorable than projected in last year's annual report,’ the trustees said, adding, ‘Actual payroll tax income in 2008 and projected future amounts are significantly lower than previously projected, due to lower levels of average wages and fewer covered workers.’”

The workers’ compensation medical delivery system has been plagued with a set of its own difficulties including: cost shifting to Medicare and reimbursement issues, rising costs that now exceed the indemnity aspect of the program, lack of uniformity and delay in delivery of medical benefits, staggering litigation and administrative costs and uncertainty as to future premiums because of a failing economy.

The voice of change is now being heard in Washington as health care takes the stage front and center on the issues of affordability and choice. David Axelrod has indicated that the Administration is committed to "fix what's broken in the system and preserve what's good."

When the Social Security system was initial enacted, the country faced similar economic troubles. Employee medical coverage was not a consideration of the original program. The geriatric nature of both the Social Security system and the multiple workers’ compensation programs are now evidencing the problems of old age. A marriage of convenience maybe just what the future holds.

Budget Crisis Triggers NJ DWC Closing

The NJ Division of Workers' Compensation will be closed on May 22, 2009. This closing is the result of a State mandated furlough because of the lack of revenue in the NJ State Treasury.

Hyper Technical Procedure Rejected

The NJ Appellate Division, while ruling against an injured worker in a claim where the worker exhibited "egregious conduct" in failing to keep numerous medical exams, in dicta, declared that hyper technical rules should not be enforced in workers' compensation. The Appellate forum declared that even though a notice of motion was "less than perfect," that alone should not be the basis for an adverse ruling.

Williams v, Family Choice, at al., Docket No. A-4474-07T3 (Decided May 2008) 2009 WL 1286895

RICO Case Goes to the US Supreme Court

A Petition for Certiorari has been filed in Brown v. Cassens Transport Co., 546 F.3d 347 (6th Cir. Oct 23, 2008) (NO. 05-2089), following the rehearing and rehearing en banc denied (Jan 05, 2009). 

NCCI Issues a “Guarded” Report of Health of Workers’ Compensation

A report that the short term was “guarded” and the long term “cautionary” was issued this week by NCCI Holdings, Inc. Medical care continues to lead the list of concerns as the costs continue to out pace wages. Medical continues to be problematic as CMS (The Centers for Medicare and Medicaid Services) continue to become more involved in the workers’ compensation process that the Sec. 111 Mandatory Registration process and the recovery efforts and monitoring of future care plans, ie. Workers’ compensation Medicare set aside arrangement.

Lead is Still Breaking the Learning Cycle

The book, "Lead Babies Breaking the Cycle of Learning Disabilities, Declining IQ, ADHD, Behavior Problems, and Autism" by Joanna Cerazy, MEd and Sandra Cottingham, PhD addresses this issue.

"This groundbreaking study reveals the continuing danger that lead contamination presents to health—particularly in the earliest stages of life. Disclosure about the lead content in house paint, gasoline, canned food, and tap water revolutionized the manufacturing of those products a generation ago, but lead-based products are still produced and pose a health hazard as lead remains in the environment years after its initial use."

Asbestos MDL Goal To Remand Cases To US District Courts

Asbestos cases pending in the Multi District Court Litigation (MDL 875) may be remanded to the US District Courts throughout the country. As of January 1, 2009, the inventory of cases pending amounted to 58,625 cases encompassing 3.3 milllion claims.

In an Order entered on April 30, 2009, Judge Eduardo C. Roberto stated that, "remanding cases to the transferor court at an early date remains as important administrative goal of the Court." The Court set up a procedure permitting the Plaintiffs to a file a motion requesting the entry of a "suggestion of remand." by the Court.