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Tuesday, December 10, 2013

Delay Or Deny At Your Risk

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

There are so many reasons why both employers and workers feel that workers' compensation is "broken" or doesn't work.

Peter Rousmaniere, who is beginning work this week for WorkCompCentral, suggests in his column reviewing two studies on perceived delays in medical treatment that delay may arise as much from indifferent doctoring skills as days elapsing on the calendar.

An employer consultant relayed to me a factual scenario indicating another cause of this perception - standard claims administration protocol, which is defensive in nature as opposed to being aggressively pro-active.

Rousmaniere cites a couple of studies in his column. A Texas Department of Workers' Compensation survey of injured workers documents wide discrepancy in perceptions, but also notes that up to 50% of all survey respondents complained of some delay in receipt of treatment.

Another study cited by Rousmaniere conducted by Harbor Health, which specializes in designing workers’ compensation provider networks, looked for differences in claims outcome, including medical cost and litigation rates, and if surgical treatment happened early or late in the course of treatment.

Harbor Health found that early surgery in carpal tunnel cases (earlier than recommended by treatment guidelines) produced slightly more cost in medical expense but much less cost in indemnity expense.

Let's put these findings into context.

Assume a 28 year old male worker who complains of "...

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Friday, December 6, 2013

Keeping privacy in focus

Confidentiality has been the hallmark of Workers' Compensation since the inception of the program. Has been challenged federally through the portability act concerning the privacy of medical records. All that reach was bad enough, a data breach from and a governmental site is even worse. It is becoming more than obvious, but the weak financial infrastructure, of the patchwork of worker's Compensation systems for the country are creating serious challenges. Instead of attempting to run 50 different programs throughout the country, it is probably A good idea to start looking inward, and establishing a single solid system that can meet the needs required to run A multibillion-dollar benefit system the rep country and also maintain the confidentiality and privacy that the parties participating in it require. Today's post shared from therepublic.com

Hackers gained access to the personal information of about 26,000 Pennsylvanians who use debit cards to receive jobless and workers' compensation benefits, the Pennsylvania Treasury Department said Thursday.
The incident was part of a wider security breach affecting 465,000 holders of JPMorgan Chase & Co. prepaid cash cards nationwide.
The breach affects only cardholders who used the JPMorgan Chase UCard Center website between mid-July and mid-September, the Treasury Department said. Michael Fusco, a spokesman for JPMorgan, said the bank found no evidence any information was used improperly.
JPMorgan first contacted the Pennsylvania Treasury Department on Tuesday, agency spokesman Gary Tuma said.
JPMorgan has referred the matter to law enforcement and would not explain details of how the breach occurred, the Treasury Department said.
The Pennsylvania agency wants details from JPMorgan Chase about the bank's response to the breach, including an explanation for any delay in notifying it and the additional measures it will undertake to protect against a recurrence.
The department said most of the personal information that might have been viewed includes card numbers, dates of birth, user IDs, email addresses. Information on external bank accounts might have been exposed, as well, if a cardholder completed a transaction to it, the department said.
Cardholders are being contacted by letter with instructions and are being urged by JPMorgan Chase in the meantime to...

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Thursday, December 5, 2013

The Road toward Fully Transparent Medical Records

Privacy of medical data in the workers' compensation system does not exist. Federal portability act excluded worker's Compensation claims. In some jurisdictions, claimants are able to seek declaratory relief to shield the records. The processes costly, onerous, and incompatible with the underlining summary and remedial legislative intent of a viable Worker's Compensation program. Today's post was shared by NEJM and comes from www.nejm.org

Perspective
Jan Walker, R.N., M.B.A., Jonathan D. Darer, M.D., M.P.H., Joann G. Elmore, M.D., M.P.H., and Tom Delbanco, M.D.
December 4, 2013DOI: 10.1056/NEJMp1310132

Article: Forty years ago, Shenkin and Warner argued that giving patients their medical records “would lead to more appropriate utilization of physicians and a greater ability of patients to participate in their own care.”1 At that time, patients in most states could obtain their records only through litigation, but the rules gradually changed, and in 1996 the Health Insurance Portability and Accountability Act entitled virtually all patients to obtain their records on request. Today, we're on the verge of eliminating such requests by simply providing patients online access. Thanks in part to federal financial incentives,2 electronic medical records are becoming the rule, accompanied increasingly by password-protected portals that offer patients laboratory, radiology, and pathology results and secure communication with their clinicians by e-mail.
One central component of the records, the notes composed by clinicians, has remained largely hidden from patients. But now OpenNotes, an initiative fueled primarily by the Robert Wood Johnson Foundation, is exploring the effects of providing access to these notes.3 Beginning in 2010, at Beth Israel Deaconess Medical Center (which serves urban and suburban Boston), Geisinger Health System (in rural Pennsylvania), and Harborview Medical Center (Seattle's...

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Wednesday, December 4, 2013

Coal industry pays lawyers, doctors to lie and let workers to die penniless

Today's post is shared from workerscomphub.org

Photo by Earl DotterIn a devastating must-read set of reports, the Center for Public Integrity and ABC News describe how coal companies have fought a cutthroat campaign of secrecy, misinformation, false diagnoses, and defiance of court orders to stop workers from getting workers’ compensation for black lung disease. The coal industry’s tactics mirror those of Big Tobacco, the lead and soda industries, the NFL, and pulp and paper giant Georgia-Pacific, which is conducting secret research and selectively withholding information to cast doubt on more than 60,000 legal claims filed by construction workers and others who Georgia-Pacific exposed to asbestos in the 1960s and ‘70s and are developing mesothelioma, a cancer nearly always caused by asbestos, today.
Black lung, a disease caused by inhaling coal dust over time, scars and shrinks the lungs and can be highly debilitating and deadly. In its severe form, black lung is supposed to automatically qualify miners for workers’ compensation. Yet in a series of three in-depth reports, the Center for Public Integrity reveals how the coal industry and its lawyers have fought tooth and nail to hide information on workers’ health from doctors, courts, and patients themselves in order to maintain doubt about people's’ eligibility for compensation.
ABC News interviewed Dr. Paul Wheeler, head of The Johns Hopkins Hospital’s black...

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Workers' Compensation Board hosts meetings to help improve services

New York state's Workers' Compensation Board has started a sweeping effort to examine the system, and look at how it could more effectively meet the needs of injured workers and employers. It's in the midst of holding sessions where injured workers can express their opinions.
The second of three sessions was held yesterday in Syracuse, and allowed injured workers to chime in on the discussion in central New York. Fidel, Alejandro Velacqueis Perez was among those telling stories.
His ankle was shattered on the job at a stone cutting company in Delaware County. While waiting four months for a Workers' Compensation hearing, he's basically homeless.
"I need help," Perez said. "I don't have any resources. I don't have money to buy food. I don't have money to get a phone and reach my family."
Interpreting for Perez is Rebecca Fuentes of the Workers Center of Central New York. She says immigrant voices especially need to be heard, but part of the problem is that many don't even know Workers' Compensation exists. An answer to that would be more outreach from the agency.
"People in this building need to get out," Fuentes said. "We want to see them out at events, tabling. We need to see them everywhere. Because workers are getting injured, and they're not having equal access to this right."
Fuentes says among other things, some immigrants lose their jobs after an injury because they apply for Workers' Compensation. She says it is a serious issue that the Workers' Compensation Board...

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Formaldehyde Spill At Southern Ocean Medical Center; Three Treated For Inhalation

A formaldehyde spill at Southern Ocean Medical Center on Monday caused three hospital employees to be treated for inhalation of the known carcinogen.

At 10:14 a.m., Stafford Township Police responded to a report of a hazardous material spill at SOCH on Route 72 in Stafford Township.

Investigation revealed that a small quantity of formaldehyde was spilled in a utility closet located in the Labor and Delivery area of the hospital. The spill was contained to the utility closet and no evacuations were necessary, police said.

No patients were injured in this incident but three hospital employees were treated for minor inhalation injuries and released, police said.

Responding agencies included the Stafford Township and Barnegat Township Volunteer Fire Companies as well as Stafford Township EMS.

The Berkeley Township Haz-Mat Unit responded and neutralized and contained the spill which is being cleaned up by a private contractor engaged by Southern Ocean Medical Center.

Questions concerning this release may be directed to Capt. Thomas Dellane at 609-597-1189 ext. 8299.

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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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Tuesday, December 3, 2013

Are Smokers Really the ACA’s Biggest Losers?

Smoking is a major pre-existing condition in workers' compensation claims and it is also a multiplier for medical conditions that result in malignancies. Penalizing smokers through the ACA (Affordable Care Act) will also have an effect on workers' compensation claims. Today's post was shared by The Health Care Blog and comes from thehealthcareblog.com

Facing thousands in extra insurance costs, smokers appear to be the Affordable Care Act’s (ACA) biggest losers. Employers are allowed charge smokers up to 50% more for their medical coverage than nonsmokers , starting in 2014.
On November 25, Fox News put it best: “Obamacare Policies Slam Smokers,” , noting that “smokers are the only group with a pre-existing condition that Obamacare penalizes.” THCB itself has headlined: Smokers Face Tough New Rules under Obamacare.

And these headlines are absolutely accurate — meaning that, with the possible exception of the e-cigarette, ACA is the best thing that has happened to employed smokers ever.

Here is how we arrive at this conclusion. The data is mixed on whether smokers incur much higher healthcare costs or just slightly higher healthcare costs during their working ages than non-smokers do. None of the data shows that their costs are lower, but let’s say there is no impact on health spending.

Nonetheless, the following is incontrovertible: smokers take smoking breaks.
Remarkably, there are no laws specifically governing smoking breaks, and like most other quantifiable human resources issues, no one has quantified them. But we all observe these breaks, and about a fifth of us participate in them. They reduce productivity. By definition, if you are outside smoking, you are not inside...

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NJ COLA Bill - Legislative Hearing Scheduled

The NJ Senate Budget and Appropriations Committee will hold a public hearing on a pending COLA bill S613 to increase benefits on 12/5/2013 1:00:00 PM.

The Senate Labor Committee report

The Senate Labor Committee reports favorably and with

committee amendments Senate Bill No. 613.

As amended by the committee, this bill provides, from July 1, 2013

forward, an annual cost of living adjustment (COLA) in the weekly

workers' compensation benefit rate for any worker who has become

totally and permanently disabled from a workplace injury at any time

after December 31, 1979 and for the surviving dependents of any

worker who died from a workplace injury after December 31, 1979.

The COLA would be an amount such that, when added to the

workers' compensation weekly benefit rate initially awarded, the sum

will bear the same percentage relationship to the maximum benefit rate

at the time of the adjustment that the initial rate bore to the maximum

rate at the time of the initial award, except that:

1. The bill reduces the amount of the adjustment as much as

necessary to ensure that the sum of the adjustment and the amount

initially awarded does not exceed the amount which would cause any

reduction of disability benefits payable under the Federal Old Age,

Survivors and Disability Act; and

2. The bill reduces the supplemental workers’ compensation

benefits (but not regular workers’ compensation) for claimants injured

after 1979 by the amount of any Social Security benefits (other than

Social Security disability benefits and any increases in Social Security

benefits due to federal statutory changes after May 31, 1980), Black

Lung benefits, or the employer’s share of disability pension payments

received from or on account of an employer, except that if the worker's

original workers' compensation award was already reduced under

current law, there would be no further reduction of the supplemental

benefits under the bill.

These reductions parallel the reductions provided under current

law for claimants who were injured before 1980. The bill also

provides that no supplemental benefits would be paid in any case

where they are calculated to be less than $5 per week.

Current law requires such annual adjustments in the rate of

workers' compensation benefits for death and permanent total

disability to be paid from the Second Injury Fund (SIF), but only for

cases of injury or death occurring before January 1, 1980. The bill

extends the adjustments paid from the SIF to claims originating after

December 31, 1979, although the adjustments would apply only to

benefits paid on those claims after July 1, 2013, thus avoiding a

backlog of retroactive benefits.

The bill provides that supplemental payments will commence only

after SIF assessments are sufficient to pay them without using General

Fund money. The supplemental benefit payments would start on July

1, 2013 and the Department of Labor and Workforce Development is

required to take into account the supplemental benefits when

calculating the amount of the Second Injury Fund assessment which

starts on January 1, 2013, thus avoiding the need for any General Fund

appropriation.

To avoid an abrupt fiscal impact on the workers’ compensation

system, the bill provides that one third of the supplemental benefit rate

be paid during the first year, two thirds of the rate be paid during the

second year and the full amount be paid during the third and

subsequent years.

The bill sets time limits for workers’ compensation insurers and

self-insured employers to notify the SIF when supplemental workers’

compensation benefits are required under the bill. An insurer or selfinsured

employer is required to provide the notice not more than 60

days after the supplement is awarded or voluntary payment is to begin.

If a failure to notify results in the payment of an incorrect amount of

benefits, the liability for the payment of the supplemental benefits is

transferred from the SIF to the insurer or employer until the required

notice is provided.

The bill makes no change in the provisions of sections 1 and 9 of

P.L.1980, c.83 (C.34:15-95.4 and 34:15-95.5), which provide for the

reduction of certain portions of workers' compensation benefits by the

amount of Social Security disability benefits paid. In addition, the bill

expressly states that the supplemental benefits shall not be paid in a

manner which in any way changes or modifies the provisions of those

sections. The bill, therefore, will have no effect on existing provisions

of State and federal law regarding offsets between workers'

compensation and federal Social Security disability benefits.

The committee amendments provide that the application of the cost

of living adjustment commence on July 1, 2013, instead of July 1,

2011.

This bill was pre-filed for introduction in the 2012-2013 session

pending technical review. As reported, the bill includes the changes

required by technical review, which has been performed.

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As Hospital Prices Soar, a Single Stitch Tops $500

Medical delivery costs continue to soar and workers' compensation claims costs are running out of ontrol. Cost for emergency medicare are not usually regulated by workers' compensation prorams, eve where balance cillig is removed from the equation. Todays post is shared from the NYTimes.org

With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center’s tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.

On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. “It was great — they had good DVDs, the staff couldn’t have been nicer,” said Emer Duffy, Orla’s mother.
Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11. Orla’s forehead was sealed with a dab of skin glue for $1,696. “When I first saw the charge, I said, ‘What could possibly have cost that much?’ ” recalled Ms. Singh. “They billed for everything, every pill.”
In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care...

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Wednesday, November 27, 2013

Workers’ Comp will cover hijacked UPS driver with PTSD

Risks associated with employment are usually covered under Workers' Compensation claims. Assaults usually are traumatic in nature and having a component of psychological stress manifested in post traumatic stress disorders.Today's post is shared from wvrecord.com
The state Supreme Court has ruled that a UPS driver’s post-traumatic stress disorder stemming from a hijacking is a compensable injury in the Workers’ Compensation system.
The court made the decision Oct. 25 in UPS’ appeal of a Board of Review decision in Jay Hannah’s case.

Justices of the state WVSupreme Court

Hannah had his UPS truck hijacked by a man with a rifle on Aug. 11, 2010. The events of the hijacking are summarized by the court in the opinion as follows:
“The gunman fired a shot in the air near Mr. Hannah’s driver side door. He then threatened Mr. Hannah’s life and forced Mr. Hannah to drive him towards the police station. On the way to the police station, the gunman saw a police cruiser parked at a gas station and forced Mr. Hannah to pull over.
“The gunman then took the keys to the truck, stepped out of the passenger side door, and fired a shot at the ground. As the gunman was getting out of the truck, Mr. Hannah was able to escape and hide behind a nearby store. The gunman was subsequently fatally shot by law enforcement.”
According to a 2012 report in the Parkersburg News and Sentinel, the hijacking occurred in Elizabeth by Joseph Dennis...

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Tuesday, November 26, 2013

NJ Workers Compensation Rates 2014

Revision of Rates and Rating Values – Effective January 1, 2014

The Commissioner of Banking and Insurance (“Commissioner”) has approved a 3.6%
increase in rates and rating values applicable to New Jersey workers compensation and employers
liability insurance effective January 1, 2014 on a new and renewal basis. The rating components of the increase are summarized below.

PREMIUM AND LOSS EXPERIENCE

Analysis of data for the latest two complete policy years and the latest calendar-accident
year, following adjustment to present premium and benefit levels, using paid and incurred losses
separately, indicates a premium level adjustment factor of 0.979 (-2.1%) due to experience.

A trend factor of 1.055 (+5.5%) is included to recognize changing exposures and losses.

BENEFIT CHANGES

Effective January 1, 2014, the maximum weekly benefit with respect to all types of injuries,
except permanent partial disabilities, will be changed from $826 to $843. The minimum weekly benefit will be changed from $220 to $225. In cases involving permanent partial disabilities, the present maximum weekly benefits ranging from $220 to $826, varying on the basis of duration of disability, will be changed to $225 and $843, respectively. The minimum weekly benefit for permanent partial injuries will remain at $35. The effect of the changes to the minimum and maximum weekly benefits results in a premium level adjustment factor of 1.007 (+0.7%) due to benefits.
EXPENSES

There is need for decreases in the provisions for Loss Adjustment Expense, the Security
Fund and Bureau Expense. The changes to the expense provisions result in a premium level adjustment factor of 0.996 (-0.4%).

OVERALL PREMIUM/RATE LEVEL CHANGE

The combined effect of the above adjustment factors results in an indicated premium level
adjustment factor of 1.036 (+3.6%). The rate level adjustment is also an increase of +3.6%.

CATASTROPHE PROVISIONS

A Terrorism Premium Charge of $0.03 per unit of exposure applies to all policies except
for the exclusions in 3:9-2 and 3:9-5 of the Manual. Upward deviation from the $0.03 rate is
permissible.

A Catastrophe (Other than Certified Acts of Terrorism) Premium Charge of $0.01 per
unit of exposure applies to all policies except for the exclusions in 3:9-9 and 3:9-12 of the Manual.

CLASSIFICATION RATES

The adjustment of classification rate relativity is based on the policy experience for 2006
through 2010, as reported through the Statistical Plan. The changes in the rates for the individual
classifications including those in the Admiralty and Federal Employers Liability Act coverage are
supported by, and derived from, the experience.

There are 572 classifications in the Manual effective January 1, 2014 including the codes to
accommodate Federal employments. Eight classifications carry no rate assignment. Of the remainder, 381 will experience increased rates, the rates for 167 classes will decrease, and 16 are unchanged. There are no changes to the annual policy charges for private estate or residence employees as set forth in 3:5-12 of the Manual.

In order to comply with the decision of the Commissioner, changes in manual rates for any
classification have been limited to an increase of 15% from last year’s rate. The increase percentage applicable to non "F" classifications when coverage is provided under the United States Longshore and Harbor Workers Compensation Act remains unchanged at 50%.

MINIMUM PREMIUM FORMULA

The minimum premium multiplier is increased from 100 to 150 and the maximum
minimum premium is increased from $850 to $900. The change to premium resulting from the new
rating values in the minimum premium formula is minimal and does not impact the overall rate level.
Special minimum premiums applicable to private residence classifications and to classifications subject to Maritime or Federal Employers Liability Act coverage are not affected.

SURCHARGES

New Jersey law mandates application of separate policyholder surcharges to finance the
Second Injury and Uninsured Employers’ Funds. Based on the Department of Labor and Workforce
Development’s estimate of 2014 Fund requirements, the policyholder surcharge percentages effective January 1, 2014, on a new and renewal basis to be applied to the modified premium are:
Second Injury Fund 6.56%
Uninsured Employers’ Fund 0.00%

The Next Wave: N.H.L. Players Sue League Over Head Injuries

Occupational illness claims have been a traditional battleground in workers' compensation for larger and more significant lawsuits and dynamic changes in the safety of the workplace induced by economics.

From the lack of the incorporation of occupational claims in the 1911 model workers' compensation acts, in the 1950's, employers and their insurance companies sought refuge under the "exclusivity bar" of the. workers' compensation act to shield themselves from negligence actions for silicosis and asbestosis claims.

The creativity of claimant's lawyers, and the blatant intentional tort acts of unscrupulous asbestos companies, brought forth a sweeping change in the economic balance as claimants used the civil justice system to establish an avenue for adequate compensation for asbestos victims (lung cancer, asbestosis and mesothelioma claims).

Asbestos litigation, "longest running tort, continues today and is the perfect example of the societal benefits of a working civil justice system. In fact, the same dynamic existed in: tobacco litigation, lead paint litigation, latex litigation and has been repeated many times over.

The civil justice system, not the workers' compensation system, established an economic incentive establishing a safer workplace for workers and their families.

It is more than obvious that contact sports are seeing the next wave of litigation as the employers and their insurance companies accelerate the cycle, by barring professional athletic players from even seeking workers' compensation benefits, ie. California.

Since it appears that no safe helmet can be manufactured to protect the mayhem of some contact sports, the business of sports will be the next "industry" to experience economic incentives to make the workplace safer. The higher education system will just have to find another economic engine to fund colleges and university and stop luring students to play dangerous sports in hope of winning the professional sports lottery.

First football, now hockey, are emerging targets of the civil justice system as the economics of safety takes hold and the need for safety takes hold. Today's post is shared from the nytimes.com.

Ten former N.H.L. players sued the league Monday for negligence and fraud, saying the sport’s officials should have done more to address head injuries but instead celebrated a culture of speed and violence.

The players, who were in the league in the 1970s, ’80s and ’90s, filed their suit in federal court in Washington. One of the lead lawyers is Mel Owens, a former N.F.L. player who has represented scores of other retired players in workers’ compensation cases.

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Copyright

Tuesday, December 10, 2013

Delay Or Deny At Your Risk

Friday, December 6, 2013

Keeping privacy in focus

Thursday, December 5, 2013

The Road toward Fully Transparent Medical Records

Wednesday, December 4, 2013

Coal industry pays lawyers, doctors to lie and let workers to die penniless

Workers' Compensation Board hosts meetings to help improve services

Formaldehyde Spill At Southern Ocean Medical Center; Three Treated For Inhalation

Tuesday, December 3, 2013

Are Smokers Really the ACA’s Biggest Losers?

NJ COLA Bill - Legislative Hearing Scheduled

As Hospital Prices Soar, a Single Stitch Tops $500

Wednesday, November 27, 2013

Workers’ Comp will cover hijacked UPS driver with PTSD

Tuesday, November 26, 2013

NJ Workers Compensation Rates 2014

The Next Wave: N.H.L. Players Sue League Over Head Injuries

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