No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces

Medicare is integrated with many aspects of state workers' compensation programs. From medical fee setting to reimbursement for conditional payments under the Medicare Secondary Payer Act. Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

While the Obama administration is stepping up efforts encouraging uninsured Americans to enroll in health coverage from the new online insurance marketplaces, officials are planning a campaign to convince millions of seniors to please stay away – don't call and don't sign up. (Photo credit: Wikipedia) "We want to reassure Medicare beneficiaries that they are already covered, their benefits are not changing and the marketplace doesn't require them to do anything," said Michele Patrick, Medicare's deputy director for communications. To reinforce the message, she said the 2014 "Medicare & You" handbook – the 100-plus-page guide that will be sent to 52 million Medicare beneficiaries next month -- contains a prominent- notice: "The Health Insurance Marketplace, a key part of the Affordable Care Act, will take effect in 2014. It's a new way for individuals, families, and employees of small businesses to get health insurance. Medicare isn't part of the Marketplace." Still, it can be easy to get the wrong impression. "You hear programs on the radio about the health care law and they never talk about seniors and what we are supposed to do," said Barbara Bonner, 72, of Reston, Va. "Do we have to go sign up like they're saying everyone else has to? Does the new law apply to us seniors at all and if so, how?" Enrollment in health plans offered on the marketplaces, also called exchanges, begins Oct. 1 and runs for six months. Meanwhile, the two-month sign-up period for private health plans for...

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Nuclear Operator Raises Alarm on Crisis

Nuclear energy has its safety issues for workers. Last weekn NJ's Salem Reactor was shut down due to a leak. Today's post was shared by WCBlog and comes from www.nytimes.com

The operator of Japan’s tsunami-hit nuclear power plant sounded the alarm on the gravity of the deepening crisis of containment at the coastal site on Friday, saying that there are more than 200,000 tons of radioactive water in makeshift tanks vulnerable to leaks, with no reliable way to check on them or anywhere to transfer the water. Fukushima I nuclear power plant before the 2011 explosion. (Photo credit: Wikipedia) The latest disclosures add to a long list of recent accidents, leaks and breakdowns that have underscored grave vulnerabilities at the Fukushima Daiichi nuclear power plant site more than two years after a powerful earthquake and tsunami set off meltdowns at three reactors. They come two weeks after the prime minister, Shinzo Abe, promised that his government would take a more active role in the site’s cleanup, raising questions over how seriously he has taken that pledge. Mr. Abe’s government has continued to push for a restart of the country’s nuclear power program, and he heads to the Middle East on Saturday to promote Japanese exports to the region, including nuclear technology. Mr. Abe also plans to lead Tokyo’s delegation to Argentina for the International Olympic Committee’s final vote, set for Sept. 7, on the host city for the 2020 Olympics. Tokyo, 150 miles south of the stricken nuclear power plant, is one of three finalists competing to host the games. The others are Istanbul and Madrid. Opposition lawmakers here have demanded that Mr. Abe stay home and declare a state of emergency. “The nuclear crisis is real and...

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Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 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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CA DWC Posts Proposed Changes to the Medical Treatment Utilization Schedule Regulations Online for Public Comment

Medical treatment guidelines are being proposed to providence evidential standards for the workers' compensation medical benefits. Today's post was shared by votersinjuredatwork and comes from www.workerscompensation.com

The Division of Workers’ Compensation (DWC) has posted proposed changes to the existing Medical Treatment Utilization Schedule (MTUS) regulations to the online forum where members of the public may review and comment on the proposals. “These changes to DWC’s evidence-based medical treatment guidelines provide a critically needed framework describing best practices for providing medical care for work-related illnesses and injuries,” said DWC Executive Medical Director Dr. Rupali Das. The proposed updates to the MTUS were developed in cooperation with the multidisciplinary Medical Evidence Evaluation Advisory Committee (MEEAC). The proposed amendments to the MTUS regulations modify regulatory definitions, which includes a definition for Evidenced Based Medicine, and adds new definitions for terms used in the strength of evidence methodologies. The regulations clarify the role of the MTUS in accordance with Labor Code section 4600 and set forth the process to determine if medical care is reasonable and necessary when the MTUS is inapplicable.

Lots of data to process for Calif. lead paint judge

Lead exposure in the workplace continues due to decaying lead based paint in place. The complications of this environmental hazard are serious. Attention is now focussed on the Court's anticipated decision in the Lead Paint Litigation trial flowing from lead paint as a "public nuisance" that needs remediation.  Today's post was shared by Legal Newsline and comes from legalnewsline.com

Judge Kleinberg A watershed decision expected before the end of the year may come down to how one individual processes volumes of complex analyses of complex data relating to the use, promotion and manufacture of lead paint in the last century and its impact on children today. In a case that took six weeks to try after 13 years of litigation, Santa Clara County Superior Court Judge James Kleinberg also will measure the credibility of expert witnesses and their theories in The People of California v. Atlantic Richfield, et al. Not only do the plaintiffs have to prove that a public nuisance exists in pre-1978 built private residences in the 10 California cities or counties seeking abatement costs of more than $1 billion, they have to prove that paint companies promoted the use of white lead pigments in residential paint during the first half of the last century knowing it would create today’s alleged public nuisance.

OK's True Cost Control Feature

Counsel fees are a critical element to workers' compensation claims. David DePaolo's recent blog post highlights how counsel fees motivate some claim strategies in Oklahoma where a 30% fee prevails. Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

Most of the attention Oklahoma's reform is getting in the work comp world is about opt-out. But another minor provision of that law may be something more meaningful for traditional work comp systems to keep an eye on. Oklahoma for some time has had a "value added" provision on its books for attorney fees. In short, claimant attorneys fees are capped at 30%, but in the past that cap was available only if the employer admitted the claim, provided medical coverage and made a written settlement offer. Under Senate Bill 1062 all that is required now is that the employer make a written settlement offer, then the claimant attorney fee is capped at 30% of the difference between what the settlement offer is, and what the award actually ends up being. For instance, if an employer offers an injured worker a settlement of $10,000, the worker hires an attorney and obtains a $15,000 settlement, the claimant's attorney would only be entitled to attorney fees of up to 30% on the $5,000 difference between the two awards. Because the law in the past required admitting liability and providing medical services, many employers deferred making settlement offers, thus prolonging case adjudication, ergo expense. Since employers would have to admit the claim in order to invoke the cap on attorney fees, claimants' attorneys began adding additional body parts to increase the value of the case and make it more difficult for employers to admit the claim - employers were loath to admit to body parts that they...

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Nation’s Biggest Assisted Living Chain Agrees to Pay $2.2 Million to Settle Claims of Cheating on Wages

Wages in workers' compensation claims determine rates pf payment. The higher the wage usually, the higher the benefit payment. Today's post was shared by FairWarning and comes from www.fairwarning.org

Workers who care for frail seniors win settlement from Emeritus Senior Living. The chain, the country’s largest assisted living company, agreed to pay up to $2.2 million to settle claims that it routinely underpaid workers at dozens of California operations. Hands-on workers at Emeritus centers – non-salaried aides and support staffers who provide care and clean — alleged in a suit that the company had not only shortchanged them in their pay, but also violated state laws on mandated meal times and rest periods.

Report Recommends Raising Workers' Compensation Premiums

The California "too good to be true" reform effort, was just that, too good to be true. Rates are going up and benefits are going down. Today's post was shared by votersinjuredatwork and comes from www.californiahealthline.org

Workers' compensation premiums in California should increase by 3.4% in 2014, according to a report by the Workers Compensation Insurance Rating Bureau, the Sacramento Bee's "Capitol Alert" reports.The report represents a non-binding recommendation for insurers (Walters, "Capitol Alert," Sacramento Bee, 8/12). Background In September 2012, Gov. Jerry Brown (D) signed into law a bill (SB 863) that overhauled the state's workers' compensation system. The law -- by Sens. Kevin de León (D-Los Angeles) and Jose Solorio (D-Anaheim) -- changed the formula used to calculate benefits for injured workers, increasing their compensation by an average of 29%. It also eliminated benefits for certain health conditions that often are subject to lawsuits, such as psychiatric problems, sexual dysfunction and sleep loss.