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(c) 2010-2026 Jon L Gelman, All Rights Reserved.

Wednesday, May 18, 2011

Federal Court Enjoins CMS From MSP Recovery Procedures

A US District Court Judge in Arizona has certified a putative class, composed of a nationwide class of Medicare recipients challenging the recovery procedures utilized by The Centers for Medicare and Medicaid Services (CMS). The Court also issued an Order enjoining CMS from certain collection activities.

This follows a broad discovery ordered issued by the Court a year ago. Haro v. Sebelius, 2010 WL 1452942 (A. Ariz.) CV 09-134 TUC DCB, Decided April 12, 2010.The plaintiffs were permitted discovery beyond the administrative record. The class action is challenging the recovery procedures of CMS under the Medicare Secondary Payer Act (MSP). The discovery permitted will included depositions and expert evidence .

The Court Order enjoins CMS from certain actions:
"IT IS FURTHER ORDERED that Defendant's demand for payment of her MSP reimbursement claims, under threat of collection actions before there has been a resolution of an appeal regarding the amount of the Defendant's MSP claim or a waiver request, exceeds her authority under the Medicare statute, and Defendant is enjoined from demanding payment of a MSP reimbursement claim with threats of commencing collection actions before there is a resolution of an appeal or waiver request. 
"IT IS FURTHER ORDERED that the Defendant's demand that attorneys withhold liability proceeds from clients pending payment of amounts claimed by the Defendant as MSP reimbursement exceeds her authority under the Medicare statute, and Defendant is enjoined from demanding that attorneys withhold liability proceeds from their clients pending payment of disputed MSP reimbursement claims.
In reaching its decision to allow discovery, the Court held that the putative class, that is challenging the recovery methods of Medicare, is permitted to extend discovery beyond the limited administrative record action without the necessity of the exhaustion of administrative remedies since constitutional and due process were collateral to any individual claim.

The issues reviewed by the court were:
"1) whether Defendant [CMS] can require prepayment of an MSP recovery claim before the correct amount is determined through the administrative appeal procedures, and
2) whether Defendant [CMS] can make plaintiffs' attorneys financially responsible if they do not hold or immediately turn over to the Defendant [CMS] their clients' litigation proceeds.

These questions involve a due process analysis, which consists of a three part balancing test:
1) the private interest affected;
2) the risk of erroneous deprivation and probable value of additional safeguards, and
3) the government or public interest in current procedures. "


Haro v. Sebelius, (A. Ariz.) CV 09-134 TUC DCB

Tuesday, May 17, 2011

Workers Compensation Act Does Not Bar A Negligence Action Against A General Partnership

In a recent court decision, an injured worker was permitted, in addition to her workers' compensation claim, to file an action against the general partnership for negligent conduct. The Court found that even though the workers' compensation is no-fault, the employee has a right to proceed and recover damages directly against the general partnership.

The injured employee was employed by Time Warner Entertainment Co., L.P. and slipped on black ice in the parking lot. The employee filed and claimed benefits from the employer in workers' compensation. Additionally, the employee filed a civil action against, among others, the Time Warner EntertainmentAdvance/Newhouse Partnership.

The court held that the employee could pursue an action in negligence against a general partnership after receiving workers' compensation benefits from her employer.

Whitfield v. Bononno Real Estate Group, et al., 2011 WL 1798874 (N.J.Super. A.D.) Decided May 12, 2011.

For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.


Related articles

Monday, May 16, 2011

FDA Orders Surveillance of Hip Implants

FdaImage via Wikipedia
Hip replacements are utilized through the workers' compensation medical delivery system in an effort to cure and relieve medical conditions arising out of employment injuries and exposures. The US Food and Drug Administration (FDA) has recently announced that it is widening its roll in monitoring the hip implants. This follows a recent recall of defective hip implants.
"The FDA is continuing to gather and review all available information about currently marketed metal-on-metal hip systems, including information related to adverse events that may be associated with increase levels of cobalt and chromium in the bloodstream. To that end, on May 6, 2011 the FDA issued orders for postmarket surveillance studies to manufacturers of metal-on-metal hip systems. The FDA sent 145 orders to 21 manufacturers. Manufacturers will be required to submit a research protocol to the FDA that addresses specific safety issues related to these devices. Data from the studies conducted will enable the agency to better understand these devices and their safety profiles.

Friday, May 13, 2011

Court Orders Workers Compensation Insurance Carrier to Comply With OSHA Subpoena

The workers’ compensation insurance company, who provided coverage to an employer where a double fatality occurred when a grain elevator exploded, has been order by a US Federal Court Judge, to comply with a subpoena issued by The Occupational Safety and Health Administration [OSHA] directed to obtain information about the safety of the facility. The opinion entered by Judge Philip G. Reinhard, adopts the report and recommendation of the magistrate judge, requires that custodian of records of the workers’ compensation insurance company testify and present documents concerning inspections and reports it prepared as to the employer, Haasbach LLC.


The Court reasoned that OSHA had the authority under Federal law to conduct inspections and investigation including requesting attendance and testimony of witnesses. 29 U.S.C. 657(b). The Court also held that OSHA’s request for loss control reports for 4 years prior to the accident were reasonably related to the investigation. The workers’ compensation insurance company will also be required to produce: site safety inspections, applications for insurance coverage for the site, and correspondence between the insurance carrier, Grinnell Mutual Reinsurance Co., and the the employer, Hassbach, concerning the site.

OSHA had issued 25 citations ($555,000 penalty) to the Illinois grain elevator operator, Haasbach LLC, following an investigation into the deaths of two young workers, Wyatt Whitebread and Alex Pacas (ages 14 and 19 years old, respectively), at the company’s grain elevator in Mount Carroll, Illinois. A third worker was injured at the time of the accident, when they were “walking down the corn” to make it flow while while machinery used for evacuating the grain was running.

Grain entrapments kill workers. All employers, especially those in high-hazard industries, must prevent workers from being hurt or killed as a result of recognized hazards,” said Assistant Secretary of Labor for Occupational Safety and Health Dr. David Michaels. “There is absolutely no excuse for any worker to be killed in this type of incident.”

OSHA Assistant Secretary Dr. David Michaels praised the decision. “The court affirmed OSHA’s authority to obtain relevant information from an employer’s workers’ compensation insurance company. This is not surprising legally, but it does illustrate that workers’ compensation and OSHA are not separate worlds divorced from each other,” he said. “Workers’ compensation loss control activities overlap with OSHA’s efforts to bring about safe and healthful workplaces, and in order to achieve a safe and healthful working environment for all Americans, all efforts of business, insurance, labor and government must move forward together.”

Judge Reinhard held that disclosure of the information into the public domain was permissible unless a federally recognized attorney-client privilege existed due to a pending state court action. If such a privilege was to be asserted as to certain materials that would be required to be produced, then the parties may submit a privilege log to the magistrate judge for consideration.

Solis v. Grinnell Mut. Reinsurance Co., 2011 WL 1642534 (N.D. Ill) Decided May 2, 2011
Related articles

· OSHA Anniversary April 21, 2011 10:00am C-Span Event (workers-compensation.blogspot.com)

· OSHA To Fine Employers for Distracted Driving Accidents (workers-compensation.blogspot.com)

· Video of The History of US OSHA (workers-compensation.blogspot.com)

· OSHA at 40 (workers-compensation.blogspot.com)

· US OSHA Warns Workers of Brazilian Blowout Formaldehyde Hazards (workers-compensation.blogspot.com)

Common Themes, The Green Mountain System & Newt Gingrich


Editors note: This is a re-post of yesterday's blog. Google had a systemwide issue and during their maintenance they did not restore this post.

Common themes of a single payer medical system are emerging. History can repeat itself. The announcement by NewtGingrich to run for the presidency in 2012, and the anticipated signing of the Vermont Single Payer medical care legislation, may set the stage for "the perfect storm" to gather impetus for a system that brings workers' compensation care into a unified system.

As the Vermont legislation goes to Governor Peter Shumlin for signing in a couple of weeks, the eyes of the nation will switch focus to the debate in Washington and the presidential race of 2012. Congress and the new administration will be required to focus on the issue of waivers that will be effective in 2014. 

Newt Gingrich had advocated in the past to move the cost occupational medical care onto the backs of employees. He would relieve employers from contributing to workers' compensation medical care and Medicare.

Workers' Compensation is a summary and remedial system that affords injured workers medical care to cure and relieve medical conditions that result from occupational exposures and accidents. In most instances employees find it necessary and prudent to retain the professional assistance of an attorney to assist them in obtaining medical treatment for work related accidents and occupational exposures.

For over 3 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.


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Wednesday, May 11, 2011

Common Themes, The Green Mountain System & Newt Gingrich

Common themes of a single payer medical system are emerging. History can repeat itself. The announcement by Newt Gingrich to run for the presidency in 2012, and the anticipated signing of the Vermont Single Payer medical care legislation, may set the stage for "the perfect storm" to gather impetus for a system that brings workers' compensation care into a unified system.

As the Vermont legislation goes to Governor Peter Shumlin for signing in a couple of weeks, the eyes of the nation will switch focus to the debate in Washington and the presidential race of 2012. Congress and the new administration will be required to focus on the issue of waivers that will be effective in 2014. 

Newt Gingrich had advocated in the past to move the cost occupational medical care onto the backs of employees. He would relieve employers from contributing to workers' compensation medical care and Medicare.

Workers' Compensation is a summary and remedial system that affords injured workers medical care to cure and relieve medical conditions that result from occupational exposures and accidents. In most instances employees find it necessary and prudent to retain the professional assistance of an attorney to assist them in obtaining medical treatment for work related accidents and occupational exposures.

For over 3 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Related articles

Recommendations Released for Use of Spirometry in the Occupational Setting

The Occupational and Environmental Lung Disorders Committee of the American College of Occupational and Environmental Medicine (ACOEM) has published a report making recommendations equipment performance (Specifications,Validation, Accuracy and Error Avoidance); how to conduct tests; comparing results with reference vales; and evaluating results over time.


Click here for the Complete Reporthttp://tinyurl.com/6h8pqkk