Family Makes the Difference

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

Mom and Dad are late in their years. Mom is 89 and has moderate dementia. Dad just turned 91 and was in excellent physical health despite a history of heart disease and bypass surgeries. "Was" is the critical verb in the prior sentence. Dad is the decision maker, always has been. A retired dentist who had a successful practice, he is a leader and is used to being in charge. Also a faithful husband and family man, Dad made a personal commitment to himself years ago to take care of his wife to the end. He will also admit that he is the world's worst planner ... except for when it came to vacations. He didn't count on disability. Having elderly parents, seeing their travails on a weekly basis (my commitment to them was to visit at least once a week), and watching them sunset physically and mentally, provides some awareness of the disabled state. Dementia is a terrible disease. It progresses gradually, taking elements of memory away from daily functioning in a cruel manner. At Mom's stage, she forgets sometimes just how to walk, so she falls and then can't get back up. Dad thought he could deal with this. He thought wrong. Dad has sciatica and pain radiates down his leg. This started a few months ago. A shot of cortisone every once in a while alleviates the symptoms and he goes about his days with good energy and strength. But when he has to wait because of dosing issues, or just access issues, he can't move much without a walker. This past week was a seminal week in my father's...

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NJ Police Officer Indicted for Misclassification and Workers' Compensation Fraud

Today's post was shared from www.trentonian.com

A Trenton police officer and his father were indicted last week on charges of false swearing and workers compensation fraud. Trenton Police officer Gaetano Ponticiello, 42, and his father Filippo Ponticiello, 65, were indicted last week by a Mercer County grand jury on fourth-degree charges of false swearing and workers compensation fraud. Each offense carries a maximum penalty of 18 months in prison and a $10,000 fine. According to prosecutors in the case, on Feb. 23, 2009, both Gaetano and Filippo made false statements under oath regarding workers compensation claims. Prosecutors say the false or misleading statements included a misclassification of employees for the purpose of evading the full payment of benefits or premiums. Both father and son are scheduled to appear in Mercer County Superior Court Oct. 25. Gaetano Ponticiello has been with the Trenton Police Department for at least 15 years. Lt. James Slack of the Trenton Police Department internal affairs told The Trentonian in July that Ponticiello has been suspended without pay.

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California limits workers' comp sports injury claims

Today's post shared from The LA Times.

After more than a year of intense lobbying by professional sports leagues, California has slammed the door on most athletes looking to file injury claims in the state, including those with serious brain injuries. Gov. Jerry Brown on Tuesday signed legislation that significantly limits workers' compensation claims by pro players. It's a significant victory for the National Football League, which has been trying to reduce its financial exposure to concussions and other brain injuries that former players allege are the result of repeated blows to the head. In August, the league agreed to a $765-million settlement with more than 4,500 former players. They had sued the NFL in federal court over the lasting effects of concussions, which have been linked to dementia and other debilitating illnesses. That landmark deal was viewed as a bargain for the league, considering the gravity of the injuries and the bad publicity the lawsuit generated for the sport. The NFL's legislative win in Sacramento could be far more valuable over the long term. It allows the league to sidestep exposure to thousands of serious head and brain trauma claims by out-of-state players who are no longer eligible to file in California. The bill, signed without comment by the governor, was the subject of nearly 18 months of lobbying by the NFL, Major League Baseball and other major sports leagues and workers' compensation insurers. It ultimately found the backing of nearly every member of the Legislature;...

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UN rights expert urges EU to focus on migrants' rights

Today's post is shared from Jurist.org The UN Special Rapporteur on the human rights of migrants [official website] Francois Crepeau urged [press release] the EU on Monday to adopt a new approach to migration that focuses on the rights of migrants. The discussion was centered around last week's sinking of the Lampedusa [BBC report] off the coast of Italy, which claimed the lives of 194 Eritrean and Somali migrants. Crepeau visited Italy in May to study the external border management of the EU and its impact on human rights of migrants and urged [JURIST report] EU member states to prioritize human rights in the development of their migration policies. "This tragedy reminds us of the importance of that recommendation," Crepeau stated. "If countries continue to criminalize irregular migration, without adopting new legal channels for migration, especially for low-skilled migrants ... the number of migrants risking their lives on dangerously overcrowded and unseaworthy vessels over perilous sea routes can only increase." Last month UN High Commissioner for Human Rights Navi Pillay [official profile] called on governments [JURIST report] to create human rights-based policies addressing migration. In May Crepeau visited both sides of the border in Turkey, Greece, Tunisia and Italy [official reports] to... [Click here to see the rest of this post]

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Federal Court Deems CMS Interpretation of the MSP Act Impenetrable

A UD District Court has denied a health provider's challenge to CMS's interpretation of the to the Medicare Secondary Act. CMS's formula for reimbursement was upheld.

"The Court finds this line of argument unpersuasive for several reasons. Most significantly, Allina's heavy reliance on the above-cited cases is unavailing because none of those decisions directly dealt with the precise issue before this Court–i.e., the phrase “entitled to benefits under Part A.” Rather, all of those courts were called upon to interpret the other component of the Medicaid fraction's numerator–the requirement that patients be “eligible” for Medicaid. For this very reason, our Court of Appeals “declined to follow” those same cases, characterizing those courts' discussion of the phrase “entitled to benefits” as dicta. Northeast Hosp., 657 F.3d at 12 n.7. This Court agrees with that assessment and follows the lead of our Circuit. Those decisions do not lend any meaningful support to Allina's arguments here. Moreover, the D.C. Circuit has rejected the substance of this “eligible” versus “entitled” argument as unpersuasive in any event, observing in Northeast Hospital that “the fact that the DSH factions speak of ‘eligibility’ for Medicaid but ‘entitlement’ to Medicare” was not “enlightening.” Id. at 12. Instead, as the Circuit went on to state, “the Secretary's interpretation of ‘entitled’ as ‘meeting the statutory criteria for entitlement’ ... does not actually collapse the terms.” Id. (explaining that an individual could be “ ‘eligible’ for, but not ‘entitled’ to, Part A benefits because one has not yet ‘enrolled’ in the program”). This Court concurs. The Secretary's reading of the statute at issue here does not equate these two terms, and Allina's insistence otherwise lacks merit."

Allina Health System v. Sebelius,

--- F.Supp.2d ----, 2013 WL 5530609, D.D.C., October 08, 2013 (NO. 09-CV-1889 (RLW))

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Case Remanded to Compensation Court to Determine Employment Status

A NJ Appellate Court has remanded a negligence case from Superior Court to the Division of Workers' Compensation to determine when an employee held joint employment and subject to the Exclusivity Bar.

" It is well settled in this jurisdiction that for workers ' compensation  purposes

an employee may be simultaneously employed by more than one employer, either because

of the employee's separate contracting with multiple employers or because

his general employer has “lent” him to a special employer. The question to be

determined in the dual employment situation is whether, at the time of the injury,

the petitioner was, as a factual matter, the employee of one or the other

or both of the employers.

In determining which among multiple employers are liable for workers ' compensation ,

this court has noted the indicia of employment that ordinarily require

evaluation, including the existence of a separate agreement between the employee

and each employer, the determination of whose work is being done at the time of

the compensable injury, which has the right to control the details of the work,

which pays, and which has the power to hire, discharge or recall the employee.

The relative weight to be accorded these factors and the manner in which they

are to be balanced are not, however, ... subject to mechanical or automatic application.

Rather, the criteria determinative of the employment relationship

must be “rationalized and applied so that each case may be considered and determined

upon its own particular facts.” And, ...in the dual employment situation,

the most significant inquiry is the determination of “whose interest the

employee was furthering at the time of the accident. ”

CHALMERS and FRED CHALMERS, Plaintiffs–Appellants,

v.

STEPHEN J. SWARTZ

--- A.3d ----, 2013 WL 5525694 (N.J.Super.A.D.) October 9, 2013

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When It Comes To Brain Injury, Authors Say NFL Is In A 'League Of Denial'

Today's post was shared by The Health Care Blog and comes from www.npr.org

The casket bearing the body of former Pittsburgh Steelers center Mike Webster is surrounded by flowers, after funeral services in Pittsburgh in September 2002. Mark Fainaru-Wada and Steve Fainaru, authors of League of Denial, point to Webster's autopsy as one of the most significant moments in the history of sports.

When the Pittsburgh Steelers won four Super Bowls in the 1970s, you could argue that no one played a bigger role than Mike Webster. Webster was the Steelers' center, snapping the ball to the quarterback, then waging war in the trenches, slamming his body and helmet into defensive players to halt their rush.

He was a local hero, which is why the city was stunned when his life fell apart. He lost all his money, and his marriage, and ended up spending nights in the bus terminal in Pittsburgh. Webster died of a heart attack, and on Sept. 28, 2002, came the autopsy.

"His body ends up in the Allegheny County coroner's office," ESPN investigative reporter Mark Fainaru-Wada tells NPR's David Greene. "And there's a young junior pathologist there named Bennet Omalu. He makes this decision sort of on the spur of the moment to study Mike Webster's brain."

Fainaru-Wada and his brother, Steve Fainaru, have written a new book called League of Denial, which was also turned into a Frontline documentary on PBS. They take an exhaustive look at how the NFL has dealt with allegations that playing football can lead to brain damage. They interviewed...

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