Medicare Advantage Organization Allowed to Sue Law Firm and Lawyer Over Conditional Payments

A Federal Court has ruled that a Medicare Advantage Organization (MAO) is permitted under the law to sue a law firm and a lawyer for the failure to reimburse conditional medical expenses arising out of an accident. 

US District Court Judge, Henry E. Hudson, ruled that the Medicare Secondary Payer statute created a private cause of action to pursue recovery for conditional payments that it made on the beneficiary's behalf for medical expenses resulting from an automobile accident.

"Although not binding precedent, this Court finds persuasive the Third Circuit's determination that a MAO may pursue recovery pursuant to the private right of action in § 1395y(b)(3)(A). Section 1395y(b)(2)(A)'s plain language establishes a private right of action to recover double damages where a primary plan fails to pay. Absent from the plain language of the statute is any restriction upon who may utilize that private right of action."

Humana Insurance Co. v Paris Blank LLP, 197 F. Supp. 3d 676 (E.D. Virginia 2016)

NJ Braces For Winter Weather --- Snow

Workers traveling the NJ highways tonight and tomorrow need to stay informed of the weather service announcements closely as an urgent Winter Weather Message has been issued for an anticipated winter storm.

URGENT - WINTER WEATHER MESSAGE 

NATIONAL WEATHER SERVICE MOUNT HOLLY NJ 

355 PM EST THU JAN 5 2017 

 ...LIGHT SNOW TO AFFECT THE AREA TONIGHT...FOLLOWED BY A POTENTIAL FOR A MORE SIGNIFICANT WINTER STORM PARTICULARLY NEAR THE COAST IN SOUTHERN PORTIONS OF DELAWARE AND NEW JERSEY LATE FRIDAY NIGHT INTO SATURDAY..."

OSHA has made the following suggestions to employers and employees to prepare for winter weather hazards:

Winter Driving

Although employers cannot control roadway conditions, they can promote safe driving behavior by ensuring workers: recognize the hazards of winter weather driving, for example, driving on snow/ice covered roads; are properly trained for driving in winter weather conditions; and are licensed (as applicable) for the vehicles they operate. For information about driving safely during the winter, visit OSHA's Safe Winter Driving page.

Employers should set and enforce driver safety policies. Employers should also implement an effective maintenance program for all vehicles and mechanized equipment that workers are required to operate. Crashes can be avoided. Learn more at: Motor Vehicle Safety (OSHA Safety and Health Topic’s Page).

Employers should ensure properly trained workers' inspect the following vehicle systems to determine if they are working properly:

• Brakes: Brakes should provide even and balanced braking. Also check that brake fluid is at the proper level.
• Cooling System: Ensure a proper mixture of 50/50 antifreeze and water in the cooling system at the proper level.
• Electrical System: Check the ignition system and make sure that the battery is fully charged and that the connections are clean. Check that the alternator belt is in good condition with proper tension.
• Engine: Inspect all engine systems.
• Exhaust System: Check exhaust for leaks and that all clamps and hangers are snug.
• Tires: Check for proper tread depth and no signs of damage or uneven wear. Check for proper tire inflation.
• Oil: Check that oil is at proper level.
• Visibility Systems: Inspect all exterior lights, defrosters (windshield and rear window), and wipers. Install winter windshield wipers.

An emergency kit with the following items is recommended in vehicles:

• Cellphone or two-way radio
• Windshield ice scraper
• Snow brush
• Flashlight with extra batteries
• Shovel
• Tow chain
• Traction aids (bag of sand or cat litter)
• Emergency flares
• Jumper cables
• Snacks
• Water
• Road maps
• Blankets, change of clothes

Work Zone Traffic Safety

Workers being struck by vehicles or mobile equipment lead to many work zone fatalities or injuries annually. Drivers may skid, or lose control of their vehicles more easily when driving on snow and/or ice covered roads. It is therefore, important to properly set up work zones with the traffic controls identified by signs, cones, barrels, and barriers, to protect workers. Workers exposed to vehicular traffic should wear the appropriate high visibility vest at all times, so that they can be visible to motorists (OSHA Letter of Interpretation, dated, August 5, 2009).

Learn more at: Work Zone Traffic Safety* (OSHA QuickCard™) and Highway Work Zones and Signs, Signals, and Barricades (OSHA Safety and Health Topics Page).

Stranded in a Vehicle

If you are stranded in a vehicle, stay in the vehicle. Call for emergency assistance if needed, response time may be slow in severe winter weather conditions. Notify your supervisor of your situation. Do not leave the vehicle to search for assistance unless help is visible within 100 yards. You may become disoriented and get lost in blowing and drifting snow. Display a trouble sign by hanging a brightly colored cloth on the vehicle’s radio antenna and raising the hood. Turn on the vehicle's engine for about 10 minutes each hour and run the heat to keep warm. Also, turn on the vehicle's dome light when the vehicle is running as an additional signal. Beware of carbon monoxide poisoning. Keep the exhaust pipe clear of snow, and open a downwind window slightly for ventilation.

Watch for signs of frostbite and hypothermia. Do minor exercises to maintain good blood circulation in your body. Clap hands and move arms and legs occasionally. Try not to stay in one position for too long. Stay awake, you will be less vulnerable to cold-related health problems. Use blankets, newspapers, maps, and even the removable car mats for added insulation. Avoid overexertion since cold weather puts an added strain on the heart. Unaccustomed exercise such as shoveling snow or pushing a vehicle can bring on a heart attack or make other medical conditions worse.  

Shoveling Snow

Shoveling snow can be a strenuous activity, particularly because cold weather can be tasking on the body. There is a potential for exhaustion, dehydration, back injuries, or heart attacks. During snow removal in addition to following the tips for avoiding cold stress, such as taking frequent breaks in warm areas, there are other precautions workers can take to avoid injuries. Workers should warm-up before the activity, scoop small amounts of snow at a time and where possible, push the snow instead of lifting it. The use of proper lifting technique is necessary to avoid back and other injuries when shoveling snow: keep the back straight, lift with the legs and do not turn or twist the body.

Using Powered Equipment like Snow Blowers

It is important to make sure that powered equipment, such as snow blowers are properly grounded to protect workers from electric shocks or electrocutions. When performing maintenance or cleaning, make sure the equipment is properly guarded and is disconnected from power sources.

Snow blowers commonly cause lacerations or amputations when operators attempt to clear jams with the equipment turned on. Never attempt to clear a jam by hand. First, turn the snow blower off and wait for all moving parts to stop, and then use a long stick to clear wet snow or debris from the machine. Keep your hands and feet away from moving parts. Refuel a snow blower prior to starting the machine; do not add fuel when the equipment is running or when the engine is hot.

Clearing Snow from Roofs and Working at Heights

Employers must evaluate snow removal tasks for hazards and plan how to do the work safely. Workers should be aware of the potential for unexpected hazards due to the weather conditions, for example, layers of ice can form as the environmental temperature drops, making surfaces even more slippery. A surface that is weighed down by snow must be inspected by a competent person to determine if it is structurally safe for workers to access it, because it may be at risk of collapsing. Snow covered rooftops can hide hazards such as skylights that workers can fall through. Electrical hazards may also exist from overhead power lines or snow removal equipment.

Employers can protect workers from these hazardous work conditions, for example, by using snow removal methods that do not involve workers going on roofs, when and where possible. Employers should determine the right type of equipment (ladders, aerial lifts, etc.) and personal protective equipment (personal fall arrest systems, non-slip safety boots, etc.) for the job and ensure that workers are trained on how to properly use them. For more information, see OSHA's Hazard Alert: Falls and Other Hazards to Workers Removing Snow from Rooftops and Other Elevated Surfaces*.

Preventing Slips on Snow and Ice

To prevent slips, trips, and falls, employers should clear walking surfaces of snow and ice, and spread deicer, as quickly as possible after a winter storm. In addition, the following precautions will help reduce the likelihood of injuries:

• Wear proper footwear when walking on snow or ice is unavoidable, because it is especially treacherous. A pair of insulated and water resistant boots with good rubber treads is a must for walking during or after a winter storm. Keeping a pair of rubber over-shoes with good treads which fit over your street shoes is a good idea during the winter months.
• Take short steps and walk at a slower pace so you can react quickly to a change in traction, when walking on an icy or snow-covered walkway.

Repairing Downed or Damaged Power Lines

Repairing and/or replacing damaged power lines in severe winter weather conditions are especially hazardous. A major hazard is snow, because the moisture can reduce the insulation value of protective equipment, and could cause electrocution. In these conditions de-energized work is safer, but if energized work must be done, qualified workers and supervisors must first do a hazard analysis that includes evaluating the weather conditions and identifying how to safely do the job.

Other potential hazards include:

• Electrocution by contacting downed energized power lines, or contacting objects, such as broken tree limbs, in contact with downed energized power lines.
• Fires caused by an energized line or equipment failure.
• Being struck or crushed by falling tree limbs, collapsing poles, etc.

When working on downed or damaged power lines, electrical utility workers should use safe work practices, appropriate tools and equipment (including personal protective equipment (PPE)). Extra caution should be exercised when working in adverse weather conditions. Learn more at: Contact with Power Lines (OSHA Construction eTool).

Working Near Downed or Damaged power lines

Assume all power lines are energized and stay clear of any downed or damaged power lines. Establish a safe distance from power lines and report any incidents to the responsible authority. Only properly-trained electrical utility workers can handle damaged power lines. Learn more at: Contact with Power Lines (OSHA Construction eTool) and Working Safely Around Downed Electrical Wires* (OSHA Fact Sheet).

Removing Downed Trees

Clearing downed trees is a critical job during severe winter weather conditions. It is usually urgent to remove downed trees that block public roads and damage power lines. Emergency crews are often tasked with clearing downed trees.

Potential hazards include:

• Electrocution by contacting downed energized power lines or contacting broken tree limbs in contact with downed energized power lines. Learn more at: Line Clearance Tree Trimming Operations (OSHA Electric Power eTool).
• Falls from heights.
• Being injured by equipment such as chain saws (Chain Saw Safety* (OSHA QuickCard™)) and chippers (Chipper Machine Safety* (OSHA QuickCard™)).

Workers should wear PPE that protect them from the hazards of the tree removal tasks. Workers using chainsaws and chippers to clear downed trees should use: gloves, chaps, foot protection, eye protection, fall protection, hearing protection and head protection.

Only powered equipment designed for outdoor and wet conditions should be used. Use all equipment and tools (saws, chippers, etc.) properly and for the purpose that they are designed for. Ensure that equipment is always maintained in serviceable condition and inspected before use by a knowledgeable person that can identify any problems with the equipment. Do not use equipment that is not functioning properly. Equipment must have proper guarding (as applicable); safe guards must never be bypassed.  All controls and safety features must function as designed by the manufacturer. Learn more at: Tree Trimming and Removal* (OSHA QuickCard™).

OSHA cites Jersey City Medical Center (St Barnabas) $174,393

OSHA investigation of Jersey City Medical Center worker's fatal fall finds facility exposed employees to dangerous electrical hazardsCitations issued: On Dec. 21, 2016, the U.S. Department of Labor's Occupational Safety and Health Administration issued citations to the medical center for one willful and four serious safety violations.

OSHA began its inspection on June 28, 2016, after the employer notified the Agency that a worker needed to be hospitalized after falling from a ladder as he changed an overhead ballast in a light fixture. The worker later died from his injuries on July 17, 2016.

The agency cited the willful violation because the facility required employees to change ballasts without the proper lockout/tagout training on practices and procedures necessary to disable machinery or equipment to prevent hazardous energy release, as well as other safety hazards and related unsafe practices.

The serious violations involved the medical center's failure to ensure de-energized circuits were locked out, maintain an electrical lockout/tagout program, ensure that only qualified persons worked on live circuits, provide personal protective equipment, and ensure workers did not work on live parts.

"This worker's tragic death was preventable. Jersey City Medical Center did not have basic lockout/tagout safeguards in place to prevent exposure to electrical hazards, and failed to train its maintenance workers on these safeguards. As a result, the worker sustained an electrical shock while changing the ballast, fell approximately 6 feet off a ladder and died from his injuries," said Kris Hoffman, director of OSHA's Parsippany Area Office.

Proposed penalties: $174,593

The citation can be viewed at: https://www.osha.gov/ooc/citations/JerseyCityMedicalCenter_1158589.pdf

The employer has 15 business days from receipt of its citations and proposed penalties to comply, request a conference with OSHA's area director or contest the findings before the independent Occupational Safety and Health Review Commission.

To ask questions; obtain compliance assistance; file a complaint; or report amputations, eye loss, workplace hospitalizations, fatalities or situations posing imminent danger to workers, the public should call OSHA's toll-free hotline at 800-321-OSHA (6742) or the agency's Parsippany Area Office at 973-263-1003.

NJ Workers' Compensation Rates Increase in 2017 - Max $896.00

The NJ Workers' Compensation Rating and Inspection Bureau (NJCRIB) reported today 2017 rates effective January 1, 2017.

The Commissioner of Banking and Insurance (“Commissioner”) has approved a 3.0% decrease in rates and rating values applicable to New Jersey workers compensation and employers liability insurance effective January 1, 2017 on a new and renewal basis. The rating components of the decrease are summarized below.

OSHA cites NJ roofing contractor for exposing workers to falls, other hazards $112K

Hackensack Roofing Co. Inc., 83 First St., Hackensack, New Jersey was cited for OSHA

violations.Citations issued: On Dec. 16, the U.S. Department of Labor's Occupational Safety and Health Administration issued citations to the company for one serious and three repeat safety violations.

Investigation findings: As part of the agency's Local Emphasis Program focused on falls, OSHA began the East Rutherford inspection on Oct. 18, after inspectors observed employees working on a roof without fall protection. The Wallington inspection was opened in response to a complaint alleging fall hazards on the site.

Inspectors issued citations for repeat violations due to a lack of fall and eye protection. The company was previously cited for similar violations in 2014.

A serious citation was issued because workers were throwing roof shingles from the roof without the use of a container to catch the materials.

Quote: "The fact that Hackensack Roofing allowed employees to work without basic fall protection on two separate sites is problematic and indicates a breakdown in their safety and health program," said Lisa Levy, director of OSHA's Hasbrouck Heights Area Office. "Falls in construction continue to be the leading cause of workplace fatalities. By repeatedly failing to comply with OSHA regulations, this employer continues to put its workers at risk, leaving them vulnerable to falls that could permanently injure or kill them."

Proposed penalties: $112,487

The citation can be viewed at:

https://www.osha.gov/ooc/citations/HackensackRoofingCoInc_1188195_1191691.pdf

The employer has 15 business days from receipt of its citations and proposed penalties to comply, request a conference with OSHA's area director or contest the findings before the independent Occupational Safety and Health Review Commission.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit http://www.osha.gov.

Related:

Workers' Compensation: OSHA Fine NJ Contractor $43,000 for Fall ... Feb 26, 2016 ... OSHA finds Middlesex contractor exposed workers to fall hazards after investigation of roofer's death at Parsippany jobsite S&S Roofing Inc., ... workers-compensation.blogspot.com

Workers' Compensation: OSHA finds Clifton company again ... Aug 17, 2016 ... Investigation findings: OSHA initiated an inspection on April 25, 2016, after a compliance officer observed Furia Roofing employees working on ... workers-compensation.blogspot.com

Workers' Compensation: Supreme Court Decided Not to Decide ... Mar 8, 2011 ... Feb 9 2011, DISTRIBUTED for Conference of February 25, 2011. Feb 16 2011, Reply of petitioner Vaughan Roofing & Sheet Metal, LLC filed. workers-compensation.blogspot.com

Workers' Compensation: Misclassification Fraud Across the Country May 20, 2013 ... For example, a roofing company may have 30 roofers doing the actual work but these workers are classified as "independent contractors" ... workers-compensation.blogspot.com

Zika: The Next Compensable Infectious Disease - Benefit Challenges Begin

Workers' Compensation insures for the consequences of infectious diseases arising out of and in the course of employment. Is the system ready for a potential onslaught of Zika claims?

The line in the sand has been drawn in the State of Florida, where an infected Miami Beach police officer has been denied benefits. The union has actively supporting the municipal employee in an effort to rule the claim compensable.

The NJ Supreme Court in establishing compensability in an occupational disease cited Justice Learned Hand, “Few adults are not diseased … an infection mastered, though latent, is no longer a disease, industrially speaking, until the individual's resistance is again so far lowered that he succumbs.” Bober v. Independent Plating Corp., 28 N.J. 160, 145 A.2d 463 (1958).

Lung-sparing surgery for patients with advanced mesothelioma results in prolonged survival, new study shows

Patients with advanced malignant pleural mesothelioma (MPM) treated with a combination of surgery to remove the cancer but save their lung, plus photodynamic therapy and chemotherapy, had a median survival of nearly three years, with a subset of patients living longer than seven years, according to new research published in the Annals of Thoracic Surgery.