CMS Lists How to Avoid 10 Top WCMSA Errors

The Centers for Medicare and Medicaid Services has now posted the 10 top errors on Workers' Compensation Set Aside Agreement submissions and how to avoid them:

1. No medical records for the last two years of treatment

2. Claims payment history missing or undated

3. Response to development requests incomplete

4. Calculation method stated as fee schedule when state does not have a fee schedule

5. Calculation method not stated for the medical set-aside

6. Total settlement amount missing or unclear

7. No rated age statement from submitter confirming that all rated ages obtained on the claimant have been included

8. Payout amount not used in annuity situations

9. Proposed medical set-aside amount is missing, unclear, or inconsistent with other information

10. Proposed prescription drug set-aside amount is missing, unclear, or inconsistent with other information

Click here for the solutions.

Congressional Action on Workers’ Compensation

From coast to coast, the patchwork of state workers’ compensation systems remains under constant scrutiny for change. The problems seem global in character as the frustrations continue to rise. The fate of the entire system may hinge on efforts to enact or defeat legislation establishing a new national commission on workers’ compensation.

NIH Defense Asbestos Expert Pleads Guilty to Lying

A physician who was working full time in a senior position with the National Institutes of Health (NIH) pleaded guilty to lying about moonlighting as an expert in litigation at $425.00 per hour. Dr. Jack Snyder pleaded guilty recently and was convicted of a felony.

Study Reveals The Decline in Occupational Injuries Caused by Loss of Manufacturing Sector

A recent report in the American Journal of Industrial Medicine links the decline of occupational injury rates to the loss of manufacturing jobs. The study reviewed statistical data from 1976 to 2000 and concludes that the 18% in occupational injuries is a direct result of the decline in manufacturing sector jobs.

American Journal of Industrial Medicine 10.1002/ajim.20742

Administrative Rules in Workers’ Compensation May Not Infringe Upon The Right to Due Process Court Holds

The right to cross examination medical experts, in a bifurcated claim cannot be extinguished by administrative rules, according to a decision rendered by a NJ Appellate Court.

A total disability claim involving the Second Injury Fund [SIF] was the subject of a bifurcated trial. At the first phase of the trial only the injured party and employer participated. After hearing the matter ,including medical evidence, a total disability award was entered.

In the second phase the trial court heard testimony as to allocation of the award between the employer the SIF. The barred the re-introduction of additional testimony from the injured workers’ medical expert. The SIF objected and on appeal prevailed.

The Court stated, “… administrative regulations cannot be ‘construed to infringe upon the substantive rights of either party’…..the employer's ‘fundamental right to due process which includes the right to present and cross[-]examine a witness, must be respected.’"

Nisivoccia v. County of Essex, et al., Docket No.. A-1864-07T21864-07T2, 2009 WL 2589480 (N.J.App. Div. 2009)

NIOSH Schedules Conference on Safety of Nanoparticles

NIOSH announced a conference in July 2010 to discuss the safety concerns that have been raised concerning workers and nanotechnology.

“NIOSH research has shown that some nanoparticles, including certain types of carbon nanotubes and metal oxides, can be toxic to the heart and lung in mice and rats in laboratory experiments. Other research has demonstrated various other adverse effects of nanoparticles. Through its Approaches to Safe Nanotechnology, NIOSH recommends that specific precautions be taken to protect workers who might be exposed to any level of nanoparticles or nanoparticle-containing materials. A big question left unanswered is, can nanoparticles cause the same types of disease in humans?”

Concern intensified on this issue following the publication of the September issue of the “European Respiratory Journal, the first medical case series of workers with serious disease that the study authors associate with exposure to nano-sized particles has been published.”

A New Test for Mesothelioma Reported

A team of scientists at Oxford University have reported a more accurate and less invasive test to diagnose mesothelioma. The findings have been reported in a recent edition of the American Journal of Respiratory and Critical Care Medicine.

The test is claimed to be quicker and more accurate in testing for mesothelioma. Since it involves pleural fluid cytology the serum mesothelium is utilized as a bio marker to establish a diagnosis of mesothelioma.

The scientists indicate that the quick test will allow injured workers to file claims with greater reliability. Dr. Helen Davies, who participated in the research project stated, "Claims for worker's compensation may also be instigated once the diagnosis is confirmed."

Mesothelioma is a fatal disease that is associated with exposure to asbestos fiber. It is tumor that grows on the linings of the lungs or abdomen. Many workers have been exposed over the decades to asbestos and have developed mesothelioma in epidemic proportions.

Exposure to asbestos may occur as a result of both direct exposure to asbestos in the workplace or though a secondary exposure as a bystander or even a household contact of an asbestos workers. The disease has a very long latency period of the date of exposure to the date of manifestation. Asbestos, a known human carcinogen, use has not yet been banned in the United States.

For more information about treatment options, potential claims for benefits and the history of asbestos production, please visit out web site www.gelmans.com.