Workers Compensation Countable as Income Despite Special Needs Trust

An injured worker was denied food stamps in NJ because money from a workers' compensation  award was countable as income despite the existence of a special needs trust.

"A special needs trust that effectively exempts assets or income from inclusion in Medicaid eligibility calculation can be established for the benefit of an individual deemed disabled pursuant to 42 U.S.C.A. § 1382c(a)(3). 42 U.S.C.A. § 1396p(d)(4)(A). The disability determination, however, can only be made by the Social Security Administration or the state disability review team, and only based on the definition set forth in the federal statute. See N.J.A.C. 10:71-3.10 to -3.12(a). Hence, the workers' compensation court judgment as to petitioner's disability, issued by a judge in the workers' compensation context, is not dispositive of whether she is "disabled" pursuant to the federal definition. See N.J.A.C. 10:71-3.10. As the Director of DMHS stated, unless and until petitioner is found to be disabled by the Social Security Administration or the state disability review team, she is not entitled to protect her assets through the use of a special needs trust. See Determining Disability and Blindness, 20 C.F.R. § 404.1504 (2009); Determining Disability and Blindness, 20 C.F.R. § 416.904 (2009)."

J.C. v. Division of Medical Assistance and Health Services, et al., Docket No.: a5632-07 Decided: 2010-02-08 
http://lawlibrary.rutgers.edu/courts/appellate/a5632-07.opn.html


Note: N.J.A.C. 10:71-3.10 Disability and Blindness Factors
For purposes of determining medical eligibility for the Medicaid Only program, the disability and blindness standards shall be the same as for the Supplemental Security Income program under Title XVI of the Social Security Act, as amended by Public Law 92-603. 42 N.J. Reg. No. 4.

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CMS Set-Aside Rules Raise Concern of Civil Trial Bar

At a recent continuing legal education program in Wisconsin members of the plaintiff and defense civil trial bar raised their concerns over the Rules governing CMS set-aside arrangements. While both sides recognized the need to reimburse Medicare, the methods being utilized by CMS to obtain reimbursement of future medical expenses caused deep concern by the lawyers.

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Secretary at Former Asbestos Plant Awarded $17.87 Million

A former secretary at an Illinois asbestos plant, Union Asbestos and Rubber Company (UNARCO) was awarded $17.87 Million as a result of contracting an asbestos related disease, mesothelioma. The woman was employed from 1967 to 1969 at UNARCO as a secretary.

The lawsuit alleged that Pneumo Abex LLC and Honeywell International Inc. and their corporate predecessors knew of the dangers of asbestos and failed to warn their employees and customers of the hazards.

UNARCO also operated an asbestos plant in Paterson NJ from 1942 through November, 1954. It produced asbestos pipe covering and textile material for US Navy ships and and others. The Paterson NJ group of workers, and their families, became the cohort group for sentinel studies conducted by the late Irving J. Selikoff, MD (1915-1992), who linked asbestos exposure to various disease including: asbestosis, lung cancer and mesothelioma. Those studies ultimately lead to a world renown conference in 1964 sponsored by The New York Academy of Sciences.

Asbestos is still mined in Canada. The use of asbestos in the United States has yet to be banned in the United States.

Disease caused by asbestos has resulted in an epidemic of disease and resulting massive amounts of workers' compensation occupational exposure claims and civil actions. Asbestos litigation has been deemed "The Longest Running Tort in American History."

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The Saga of Asbestos in LIbby Montana

The plight of the workers of Libby Montana may have been highlighted by efforts of Senator Harry Reid in the recent Senate Health Care Reform legislation, but it goes historically much deeper. While the hazardous of asbestos may have been studied for over a hundred years, it wasn't until a newspaper article 1999 did horrors of Libby become nationally recognized.

A a recent lecture Aubrey Miller, M.D. spoke on the plight of Libby and its people. An environmental epidemiologist and a captain in the U.S. Public Health Service board-certified in occupational medicine, Miller currently serves as the chief medical officer in the U.S. Food and Drug Administration (FDA) Office of the Commissioner's Office of Counterterrorism and Emerging Threats. Previously, he worked for the U.S. Environmental Protection Agency (EPA) and for the U.S. Department of Health and Human Services (DHHS) as a regional health administrator, coordinating multi-agency emergency responses, such as the Libby situation.

"It's the worst site in EPA history in terms of human health......Even though asbestos has been studied for 100 years," he added, "the science and regulations were developed from worker studies for workplace settings and thus were not very useful for environmental situations and non-worker exposures."

Eddy Ball, a reporter covering the Miller's lecture to a capacity audience concluded, "Politics and financial interests further complicate the regulation of such environmental hazards as Libby's. For instance, there was ample evidence accruing for many years that environmental asbestos contamination was hazardous and that the Libby situation was 'a predictable surprise.' Based on his experiences Miller is convinced that 'there must be other Libbys occurring under our noses' in the U.S. Miller stated we need to challenge dogma and preconceptions about environmental exposures and who is at risk in order to identify disease and provide honest and useful solutions for our communities."

Click here to read more about asbestos and Libby, Montana.

Quebec's The Selling of Asbestos Called "Immoral"

The Montreal Gazette has called for a ban on the sale of asbestos. Asbestos continues to be  mined in Quebec.

Asbestos is a long known carcinogen causally related to asbestos, lung cancer and  mesothelioma (a rare and fatal disease.) A major effort has been underway internationally to ban asbestos as the epidemic of asbestos disease continues to be rampant.  Injured workers and their families have inundated workers' compensation system throughout the US highlighting insufficiencies in the system to provide adequate benefits and straining the traditional tort system.

In an editorial the paper stated, "The day should be long gone when a civilized society such as Quebec's knowingly sells a carcinogenic substance - asbestos - to a poorer, developing country such as India."" In an interview with an Indian publication in December, New Democratic Party MP Pat Martin said, 'Asbestos and tobacco are the two industries where the industry knows well it is killing people, but it survives by junk science and aggressive lobbying of politicians.'"

"A coalition of more than 100 scientific experts from 28 countries sent a letter to Charest [Quebec's Premier] last week, on the eve of his trade-mission visit to India, pointing out that Quebec is facing an uspurge of asbestos-related illness. Asbestos is to blame, the province's workers' compensation board says, in 60 per cent of the 104 cases of Quebec workers who died from work-related causes in a seven-month period last year."

Click here to read more about asbestos and workers' compensation. 

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CMS Sues Lawyers Over MSP Reimbursement

The Secretary of Health and Human Services (HHS) [The Centers for Medicare and Medicaid Services (CMS)] has filed a recovery action in the US District Court in Alabama for recovery of Medicare Secondary Payments (MSP). 

The recovery action is based upon an alleged failure of the attorneys to honor a claim that CMS had filed in an underlying bankruptcy claim filed in 2003. The settlement provided for distributions to be paid from 2004 through 2013 by the defendants.

The complaint alleges that the US may initiate a claim for recovery of Medicare conditional payments when it "learns that payment 'has been or could have be made' under a liability insurance policy of plan. 42 C.F.R. Sec 411,24(b)."

Complaint: The United States of America v James J. Sticker, et al. Docket 1:09-cv-02423, filed 12.02.2009

Click here to read more about Medicare Secondary Payer Act and workers' compensation.

Ethnic Disparities in Workers' Compensation

Researchers from the National Institute for Occupational Safety and Health (NIOSH) have partnered up with researches from other agencies and organizations address the needs, challenges, and opportunities for improving workplace safety and health for underserved worker populations in a special February 2010 issue of the American Journal of Industrial Medicine, “Occupational Health Disparities.” 


NIOSH reports, " Low-wage, low-skilled, and immigrant workers face disproportionately high risks for work-related injuries and illnesses in comparison with the U.S. workforce in general.  They also encounter significant barriers in accessing training and education programs, health care systems, and legal protections that are critical for mitigating those risks."


“This special issue of the American Journal of Industrial Medicine adds to our knowledge by examining occupational health disparities and inequities immigrant and other workers face, and measuring the extent of the problem,” U.S. Secretary of Labor Hilda Solis states in a Foreword to the issue. “In addition to helping address the need for better data, this research promises to create new knowledge that can be used to improve the lives of our nation’s workers."

• Occupational health surveillance must be enhanced and improved to describe the nature and extent of disparities in occupational illnesses and injuries (including fatalities), identify priorities for research and intervention, and evaluate trends. This is a priority of NIOSH and its partners under the National Occupational Research Agenda (NORA). Serious shortcomings in current surveillance systems include an undercounting of what research suggests to be the true incidence of work-related injuries, illnesses, and deaths, and a lack of information in key datasets that would allow users to identify incidence and trends in cases by race, ethnicity, and place of birth.
  
• A case study under NIOSH’s state-based Sentinel Event Notification System for Occupational Risk (SENSOR) demonstrated the value of occupational health surveillance for protecting migrant farmworkers from risk of job-related illness. SENSOR’s pesticide-poisoning surveillance staff identified a birth-defects cluster among migrant farmworkers exposed to pesticides. Subsequent state legislation in North Carolina provided funding to strengthen surveillance, improve the quality of state inspections for compliance with pesticide regulations, increase and improve worker pesticide safety training, and broaden the coverage of state anti-retaliation rules to include agricultural workers.
  
• Questionnaires for worker health studies that ask questions in different languages are essential for identifying work-related injuries and illnesses, and trends in those cases, among the ethnically diverse U.S. workforce. Developing such questionnaires is complex, and literal translation often is not appropriate or accurate. More research should be focused on development of useful bilingual and multilingual research tools.

To read more about NIOSH and workers' compensation click here.