This follows a recent US District Court ruling enjoining CMS's collection procedures. Haro v. Sebelius, (A. Ariz.) CV 09-134 TUC DCB
Wednesday, May 25, 2011
Halted: Medicare Secondary Payer Recovery Contractor Demand Letters
The Medicare Recovery Contractor (MSPRC) has now posted a notice on its web site that, "...Issuance of the Rights and Responsibilities (“RAR”) and Demand letters has been temporarily suspended while these letters are under review. The MSPRC is still working cases, and the RAR and Demand letters will be mailed out once appropriate revisions have been made."
This follows a recent US District Court ruling enjoining CMS's collection procedures. Haro v. Sebelius, (A. Ariz.) CV 09-134 TUC DCB
This follows a recent US District Court ruling enjoining CMS's collection procedures. Haro v. Sebelius, (A. Ariz.) CV 09-134 TUC DCB
Employers Face a Triple Legal Threat for Distracted Driving Claims
Employers usually make an "after the fact" reaction to cell phone use that the result in distracted driving accidents. The mounting liability for employers, a triple economic threat, may soon change their attitude to adopt an improved cell phone safety culture.
Employers who have no policy in-place or enforcement protocol, passive or active, seem to be in the majority according to a recently released survey conducted by ZoomSafer Inc. The company offers several products to actively stop cellphone use while driving. Their survey of over 500 business managers reveals that 32% of companies have knowledge or evidence of vehicle cashes that have occurred as a result of distractions stemming from employee use of cell phone while driving. Of the 54% of the companies with a defined cell phone policy, more than half, 27.3%, created that policy only after an incident occurred.
Employers are now faced with a triple threat of legal actions including: workers' compensation claims from their employees, liability law suits from the innocent individual who was injured, and now an OSHA fine. It is anticipated that these economic factors will have a major impact in creating an improved cellphone safety culture.
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.
NJ Pension System Not Permitted to Deduct Counsel Fee From Workers Compensation Recovery
The NJ State Police Retirement System is not permitted to deduct the workers' compensation counsel fee allocation from the worker's accidental disability retirement allowance.
"We are persuaded that the Board cannot offset petitioner's accidental disability retirement allowance under N.J.S.A. 53:5A-38.1(b) by the amount of the attorney's fee payment credit to petitioner because that payment does not constitute a compensation benefit under our workers' compensation law. The fact that petitioner may have received the attorney's fee payment from his employer in the form of a credit does not change the legal status and convert that payment into a periodic benefit subject to triggering the application of N.J.S.A. 53:5A-38.1(b)."
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"We are persuaded that the Board cannot offset petitioner's accidental disability retirement allowance under N.J.S.A. 53:5A-38.1(b) by the amount of the attorney's fee payment credit to petitioner because that payment does not constitute a compensation benefit under our workers' compensation law. The fact that petitioner may have received the attorney's fee payment from his employer in the form of a credit does not change the legal status and convert that payment into a periodic benefit subject to triggering the application of N.J.S.A. 53:5A-38.1(b)."
Baracia v. Board of Trustees of the State Police Retirement System, A-3611-09T2, 2011 WL 1885937 (NJ Super AD 2011) Decided May 13, 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.
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Tuesday, May 24, 2011
IARC To Issue Report on Cell Phones
The use of cell phones in the course of employment is a major concern as it results in distracted driving accidents. The new report will determine if employer mandated cell phone use can be causally connected to occupational cancer claims.
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.
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.
Court Permits Deduction of Procurement Costs From Medicare Set-Aside in Liability Claim
Following the guidelines of the CMS Management Memo entitled "Medicare Secondary Payer - Workers Compensation (WC) Information" dated May 7, 2004, and the interpretation of 42 CFR 411.37, a NJ Court granted an attorney the deduction of procurement costs from a Medicare Set-Aside Trust.
"This court's decision to apply 42 C.F.R. § 411.37 to funds obtained in a civil action and placed in a Medicare set aside is also in line with general principles of equity. Where a plaintiff is, or will within a short time become, a Medicare recipient, the plaintiff's attorney also works on behalf of Medicare to secure funds to pay future medical expenses Medicare would otherwise pay. To allow Medicare to avoid paying an equitable share of the procurement fees for a judgment or settlement amount, forcing the plaintiff to cover all the fees, would be unfair to plaintiffs. In some situations, a plaintiff may end up getting nothing after creating the set aside and paying attorneys' fees or may even have to pay money out of pocket to his attorney after a lengthy trial. Such a result would not only be inequitable, it would deter persons on Medicare who are injured by the tortious acts of others from bringing claims."
Hinsinger v. Showboat Atlantic City, L-3460-07, 2011 WL 1885980 (NJ Super Law Division 2011), decided May 19, 2011.
"This court's decision to apply 42 C.F.R. § 411.37 to funds obtained in a civil action and placed in a Medicare set aside is also in line with general principles of equity. Where a plaintiff is, or will within a short time become, a Medicare recipient, the plaintiff's attorney also works on behalf of Medicare to secure funds to pay future medical expenses Medicare would otherwise pay. To allow Medicare to avoid paying an equitable share of the procurement fees for a judgment or settlement amount, forcing the plaintiff to cover all the fees, would be unfair to plaintiffs. In some situations, a plaintiff may end up getting nothing after creating the set aside and paying attorneys' fees or may even have to pay money out of pocket to his attorney after a lengthy trial. Such a result would not only be inequitable, it would deter persons on Medicare who are injured by the tortious acts of others from bringing claims."
Hinsinger v. Showboat Atlantic City, L-3460-07, 2011 WL 1885980 (NJ Super Law Division 2011), decided May 19, 2011.
Monday, May 23, 2011
CMS Announces Review is Only a Recommended Process for Set-Aside Agreements
The Centers for Medicare and Medicaid Services (CMS) has just announced a clarification of its prior memos concerning the review of Workers Compensation proposed Set Aside Agreements and also indicates that submission is an elective process.
"Submission of a WCMSA proposal to CMS for review and approval is a recommended process. There are no statutory or regulatory provisions requiring that a WCMSA proposal be submitted to CMS for review. However, if an entity chooses to use the WCMSA review process, CMS requests that it comply with the established policies and procedures referenced on its Web site. Claimants, employers, carriers, and their representatives should be encouraged regularly to monitor this dedicated workers’ compensation Web site for changes in policies and procedures."
CMS indicated that, "A WCMSA should not be submitted to CMS when the resolution of the workers’ compensation claim results in the medical portion of the claim is being left open." In the memo, CMS reiterates the threshold levels and eligibility for review criteria.
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