The workers’ compensation system nationally has been challenged over the last two plus years of the COVID Pandemic. The multi-state administered workers’ compensation program is based on a litigious patchwork of state programs with varying degrees of eligibility, procedures, and benefits.
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Sunday, June 19, 2022
Sunday, June 23, 2013
NJ Workers' Compensation Judge Looses Her Own Case
A NJ Workers' Compensation judge was denied benefits after sustaining injuries as a result of a motor vehicle accident while traveling from her home to a NJ workers' compensation district courthouse that she was supervising.
The Appellate Court, affirming a trial court dismissal, ruled, that even though the judge was afforded mileage reimbursement. The Court stated that there was no proof that her commute to work was part of her actual work day. It also reasoned that there was no "special hazards" incurred by the travel, nor was it considered a "special mission." Therefore, the denial of benefits was affirmed under the "coming and going" rule.
Audrey Kernan v. State of NJ, Docket A-4261-11T4 (Decided June 19, 2013)
Read more about "The Coming and Going Rule" and workers' compensation:
The Appellate Court, affirming a trial court dismissal, ruled, that even though the judge was afforded mileage reimbursement. The Court stated that there was no proof that her commute to work was part of her actual work day. It also reasoned that there was no "special hazards" incurred by the travel, nor was it considered a "special mission." Therefore, the denial of benefits was affirmed under the "coming and going" rule.
Audrey Kernan v. State of NJ, Docket A-4261-11T4 (Decided June 19, 2013)
Read more about "The Coming and Going Rule" and workers' compensation:
Wednesday, November 20, 2013
Why does health care cost so much in America? Ask Harvard's David Cutler
| The cost of medical treatment continues to increase yearly. A major component of the Workers' Compensation benefits system is now the cost of medical care. Workers' Compensation insurance is not alone in experiencing this phenomena. Soaring medical costs pervades the entire Insurance industry and are a major concern of both Medicare and Medicaid solvency. Over the next two decades, the United States will have to reinvent the wheel I am determined what limitations on the cost of medical care must be imposed. The entire delivery system will ultimately experience change. It is more likely than not that Congress will again, "kick the can down the road, and delay implementation of significant change until after the baby boomer generation. Without a creative approach being offered now, the options will be limited, and will probably result in the universal medical care delivery system under a federal umbrella. The American health care system is structured differently from systems in other countries, making it more expensive. Paul Solman: Harvard's David Cutler is among the country's foremost health economists, famous for -- among other research -- a controversial paper arguing that even our exorbitant health care industry, in terms of increased productivity and life span outcomes, delivers more than what we pay for it. Cutler, who was profiled by Roger Lowenstein in the New York Times Magazine in 2005,
Paul Solman: Why does health care cost so much in America? David Cutler: Let me give you three reasons why. The first one is because the administrative costs of running our health care system are astronomical. About one quarter of health care cost is associated with administration, which is far higher than in any other country. Paul Solman: What's the next highest? David Cutler: About 10, 15 percent. Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks. Single-payer systems have fewer administrative needs. That's not to say they're better, but that's just on one dimension that they clearly cost less. What a lot of those people are... |
Wednesday, March 21, 2012
Health Benefits, US Supreme Court and Workers Compensation
U.S. Supreme Court building. (Photo credit: Wikipedia)
On Monday, the US Supreme Court will hear oral arguments concerning the validity of the 2010 Patient Protection and Affordable Care Act. Whatever the US Supreme Court decides in the pending matters, the nation's patchwork of workers' compensation systems will ultimately feel the impact. The implementation of the Act will ultimately have far reaching consequences of the overall operation of both the delivery of workers' compensation medical benefits and the ultimate assessment/apportionment of permanent disability.
Workers' Compensation systems have been struggling with the delivery of medical benefits. As more cases are denied initial compensability determinations, and alterate medical care is sought for the prevention, identification and treatment of underlying, co-existing and pre-existing medical conditions will be even more significant issues in workers' compensation matters.
Thompson-Reuters News & Insight identifies some of the issues the US Supreme Court will consider:
"* Adult children remaining on their parents' insurance coverage through the age of 26.
* An end to lifetime limits on the dollar value of benefits available to people with serious medical conditions that can lead to astronomical treatment costs.
* Preventive healthcare benefits including free coverage for mammograms and birth control.
* For Medicare beneficiaries stuck in the prescription drug benefit coverage gap known as the "doughnut hole," a 50 percent discount on covered brand name drugs and 14 percent savings on generic drugs.
* A requirement that insurance companies justify unreasonably large healthcare premium increases.
* Tax credits for small employers with no more than 25 employees and average annual wages of less than $50,000 that provide health insurance for employees.
* Temporary insurance coverage programs for retirees who are over age 55 but not eligible for Medicare.
* Temporary insurance coverage for individuals with pre-existing medical conditions who have been uninsured for at least six months.
* A requirement that health plans report the proportion of premium dollars spent on clinical services, quality, and other costs, and provide rebates to consumers if the share of the premium spent on clinical services and quality is less than 85 percent in the large group market and 80 percent in the individual and small group markets.
National Federation of Independent Business v. Sebelius, No. 11-393; U.S. Department of Health and Human Services v. Florida, No. 11-398; and Florida v. Department of Health and Human Services, No. 11-400
Related articles
Monday, November 28, 2011
Fallout From The Failure of Super Committee May Cascade Into Workers Compensation Medical Delivery
USA Today Poll
The failure the Congressional Super Committee to reach an agreement on debit reform may result in a major readjustment of the Medicare premium system. That change, will possibly be a merger of the two ends of the political spectrum and result in a Newt Gingrich type privatization of the funding of medical delivery.
Similarly, and consistent with the Gingrich plan, the soaring medical costs of workers' compensation will need to be addressed. Lacking a more creative innovation from the workers' compensation arena, the changes may result in the peeling off of medical benefits from the workers' compensation menu and making it an a la carte item with deductibles as side dishes.
Read the article Support Builds for a Plan to Rein In Medicare Costs by Robert Pear (nytimes.com)
"WASHINGTON — Though it reached no agreement, the special Congressional committee on deficit reduction built a case for major structural changes in Medicare that would limit the government’s open-ended financial commitment to the program, lawmakers and health policy experts say."
Friday, October 25, 2013
mHealth: A Potential Player for Workers' Compensation
Delivery of workers' compensation medical care is one of the most costly items on the landscape of the social, remedial program. A recent article in the AMA Journal raises doubts that the delivery of medical care utilizing electronic mobile technology will be an advantageous solution to spiraling costs.
"mHealth technologies have the potential to change every aspect of the health care environment and to do so while delivering better outcomes and substantially lowering costs. For consumers, mHealth offers the promise of improved convenience, more active engagement in their care, and greater personalization. For clinicians, mHealth could lead to reduced demands on their time and permit them to instead refocus on the art of medicine. Much remains to be done to drive this transformation. Most critically needed is real-world clinical trial evidence to provide a roadmap for implementation that confirms its benefits to consumers, clinicians, and payers alike."
Click here to read the entire article appearing in the AMA Journal
"mHealth technologies have the potential to change every aspect of the health care environment and to do so while delivering better outcomes and substantially lowering costs. For consumers, mHealth offers the promise of improved convenience, more active engagement in their care, and greater personalization. For clinicians, mHealth could lead to reduced demands on their time and permit them to instead refocus on the art of medicine. Much remains to be done to drive this transformation. Most critically needed is real-world clinical trial evidence to provide a roadmap for implementation that confirms its benefits to consumers, clinicians, and payers alike."
Click here to read the entire article appearing in the AMA Journal
Wednesday, August 15, 2012
The Great California Trade Off 2012
Of critical importance is the fact that as goes California so goes the nation. Historically, changes made in California will slowly advance across the country and become adopted as a national wave of reform.
What has been leaked to the media, and some stakeholders, by a coalition of Labor and Industry management representatives, is yet another bandaid attempt to to control medical delivery in an effort to reduce both treatment costs, and ultimately reduce the number of cases utilizing the system.
While on the books it looks great that injured workers may get a potential increase of $700 million in increased permanent disability benefits, the trade-off is the imposition of a stringently controlled, speeded-up, and rationed medical benefits.
For employers to truly benefit from a Workers' Compensation program that works, employees need to receive the best medical treatment available to cure and relieve their work related medical conditions, and an adequate program of disability payments.
The proposed reforms limit medical choice, limit medical protocols, take away disability modifiers and impose penalties for out of network medical care in the name of expediency.
The problems facing California are not unique to that state. The entire nation, both within the workers' compensation system, and without, are facing similar issues.
One would hope that California would set a high standard for the nation, such as it attempted to do with heightened requirements for automobile emission testing and safety. However, to eliminate treatment options available to injured workers merely for the purpose reducing costs is a fast track program that ignores the need to achieve the best medical result and provide adequate compensation to injured workers.
Wednesday, May 13, 2020
A Federal Heroes Compensation Fund
The COVID-19 pandemic has the potential of generating an enormous number of occupational illness claims from health care workers [HCW] and first responders [FR]. Several governmental leaders have called for a nationalized workers’ compensation benefit program to handle the surge of claims.
Tuesday, June 30, 2009
Labor and Industry Join Forces to Change the Path of Health Care Delivery
The United States is now facing a crucial change, necessitated by economics, to the health care delivery system. Not since the movement initiated in the early 1900’s to embrace a national workers’ compensation system, has the nation faced such a critical turning point in health care and the identical parties expressed such a keen interest in change.
The nation’s largest private employer, Walmart (non-union), and the nation’s largest union representing health care workers, SEIU, as well as the influential policy think-tank, the Center for American Progress, delivered a letter to President Obama today, endorsing a mandate for employer and employee contribution for a health care plan.
Citing the Senate Finance Committee (Max Bacus (D-Montana, Chairman) that “health care expenditures are expected to consume nearly 20 percent of the GDP” by 2017, the collation seek, “…an employer mandate which is fair and broad in its coverage.”
While the debate is being to flow in the direction of the adoption a “public plan” option, the “single payer system” has not yet been ruled out entirely. Funding continues to remain a concern.
It is anticipated that if a “public plan” is adopted, the workers’ compensation system will probably be targeted as an economic engine to contribute generated revenue through various reimbursement mechanisms in addition to outright payment reform including incentive based medicine. It is estimated that the plan's cost may amount to a $2 Trillion cost.
Cost shifting enforcement could be more strictly pursued. Additional fines, penalties and user fees, maybe assessed under the Medicare Secondary Payer Act. Even taxing workers’ compensation benefits may become an option if other employer provided health care benefits are also subject to tax.
The nation’s largest private employer, Walmart (non-union), and the nation’s largest union representing health care workers, SEIU, as well as the influential policy think-tank, the Center for American Progress, delivered a letter to President Obama today, endorsing a mandate for employer and employee contribution for a health care plan.
Citing the Senate Finance Committee (Max Bacus (D-Montana, Chairman) that “health care expenditures are expected to consume nearly 20 percent of the GDP” by 2017, the collation seek, “…an employer mandate which is fair and broad in its coverage.”
While the debate is being to flow in the direction of the adoption a “public plan” option, the “single payer system” has not yet been ruled out entirely. Funding continues to remain a concern.
It is anticipated that if a “public plan” is adopted, the workers’ compensation system will probably be targeted as an economic engine to contribute generated revenue through various reimbursement mechanisms in addition to outright payment reform including incentive based medicine. It is estimated that the plan's cost may amount to a $2 Trillion cost.
Cost shifting enforcement could be more strictly pursued. Additional fines, penalties and user fees, maybe assessed under the Medicare Secondary Payer Act. Even taxing workers’ compensation benefits may become an option if other employer provided health care benefits are also subject to tax.
Sunday, June 23, 2013
Single Payer A Possibility for New York City Employees
The single payer medical benefit system, a program that brings workers compensation into a universal care program, maybe the future for NY City employees. Anthony D. Weiner, a Democratic Candidate, is proposing the change.
"Vowing to “make New York City the single-payer laboratory in the country” if he is elected
mayor, Anthony D. Weiner on Thursday presented an ambitious plan to create a Medicare-like system for the coverage of municipal workers, retirees and uninsured immigrant residents left out of the Affordable Care Act."
Click here to read: "Weiner Wants City to Test Single-Payer Health Care" The NY Times
"Vowing to “make New York City the single-payer laboratory in the country” if he is elected
Click here to read: "Weiner Wants City to Test Single-Payer Health Care" The NY Times
Friday, December 10, 2021
Is the Workers' Compensation System Prepared for Omicron (Updated 12/10/21)
As this holiday season approaches, employers, insurance companies, and employees will be facing what may be the biggest COVID challenges of the year. The highly infectious disease variant Omicron detected initially in South Africa is spreading worldwide, including reported cases in the US.
Saturday, July 13, 2019
Surveillance drones: Coming soon to Nebraska workers’ compensation?
Today's guest author is Jon Rehm, Esq. of the Nebraska bar.
Last summer Brody posted about the possibility of drone surveillance in workers’ compensation cases in Nebraska. Some new developments lead me to believe that drone surveillance of injured workers in Nebraska may be coming soon.
Last summer Brody posted about the possibility of drone surveillance in workers’ compensation cases in Nebraska. Some new developments lead me to believe that drone surveillance of injured workers in Nebraska may be coming soon.
Thursday, June 14, 2012
National Experts Call Workers Compensation System Irrational and Unjust
National workers' compensation experts, Law school Dean Emily A. Spieler and Professor John F. Burton, in a recently published article in the American Journal of Industrial Medicine conclude that the present that the present workers' compensation systems is "irrational" and "unjust."
Characterizing the program as "....dizzying and frustrating in its complexity, and apparent irrationality," they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits." They review such alternatives as universal medical care, "providing healthcare to workers regardless of the source of injuries or disease."
Related Articles on Alternative Compensation Programs
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Feb 15, 2011
In December 2010 US Congress passed and President Obama signed, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program.
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...
Jul 13, 2010
As The Path To Federalization expands, this debate will expand. A recent study by the Center for American Progress addresses these concerns. "Health threats from the oil spill may linger unseen, perhaps for more than a ...
Mar 16, 2011
Historically The Federal government's role has been to rise to the occasion and walk further down a path to federalization. On a smaller scale than the potential consequences of the Japanesse debacle, the US was first in line ...
Mar 05, 2011
Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. ... Compensation Claim Draws Major Public Attention (workers-compensation.blogspot.com); Vermont Governor Sets Out to Lead U.S. to True Universal Coverage (huffingtonpost.com); The World Trade Center Health Program Expands The Path to Federalization ...
Wednesday, February 1, 2012
Merit-Based Workers Compensation: The Romney-Gingrich Plan
Of course, missing from the debate is that fact that the US has changed, in tandem, with the rest of the world. The nation's manufacturing sector left the auditorium, and with it went jobs and premiums for supporting a viable workers' compensation system. What it left was a legacy of industrial illness and disease that is fatally affecting the nation's medical delivery system and burdening the taxpayers of our nation.
If the political debate is to become credible, the medical treatment delivery system must be addressed rather than just throwing around meaningless political rhetoric. While the safety net is slowing deteriorating, there remains still an opportunity to re-design and advance a credible workers' compensation system. If the debate continues along the present path, the opportunity will be lost and the nation will loose.
See The Republican Myth Of Obama’s “Entitlement Society” By Robert Reich
"But they have cause and effect backwards. The reason for the rise in food stamps, unemployment insurance, and other safety-net programs is Americans got clobbered in 2008 with the worst economic catastrophe since the Great Depression. They and their families have needed whatever helping hands they could get."
"But they have cause and effect backwards. The reason for the rise in food stamps, unemployment insurance, and other safety-net programs is Americans got clobbered in 2008 with the worst economic catastrophe since the Great Depression. They and their families have needed whatever helping hands they could get."
.....
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.
Wednesday, February 11, 2009
Paying for Medical Performance in Workers' Compensation Claims
The workers' compensation medical delivery system is a target of much controversy over its effectiveness. The extensive delays in the delivery of medical benefits because of bureaucratic stagnation, and the massive employee dissatisfaction over the results of industry managed care are a rising chorus of concern.
Paying for medical performance in Workers' Compensation might be just what the doctor ironically ordered so that the disabled population receives appropriate and timely care that so justly deserve.
Thursday, May 24, 2012
Whose to Blame for Opioid Abuse in Workers' Compensation Claims?
 |
| (Photo credit: Wikipedia) |
Click here to read more: Opioid death liability falling on employers--Court rulings compel benefits payments
Related articles
Friday, October 12, 2007
Recrafting the Delivery of Workers' Compensation Benefits
It has been reported SaltLakeTribune: Few lawyers willing to represent injured workers that fewer lawyers are now representing injured workers. The situation is critical in many areas of workers' compensation law including the delivery of medical benefits.
This situation is rather contagious. While claims have dropped nationally, the number of attorneys representing injured claimants have also fallen, but at an alarming rate. This phenomenon is not reflective of a safer work environment, but one in which the Industry has squeezed lawyers out of the process intentionally, through many aspects including: regulatory action, philosophical strategy, and legislative tactics. It has been difficult, to say the least, for stakeholders to seek benefits. The failure to mount a defense against these disruptive and destructive practices is partly based upon the inability of stakeholders to maintain a united front.
Yet the CMS (Medicare reimbursement issue) challenge is one that should be a new beginning for injured workers, Labor, lawyers and other groups to creatively employ tactics and strategy to reconstruct the benefit program, albeit periodic payments, rather to merely adopt a program and jump on the band wagon of Industry to deconstruct the program of "lump sum" reductions in benefits including medical care. A good start would be to propose to Congress a legislative package meaningful to injured workers and one that would preserve the integrity of the periodic benefit system and continued provision of full and complete medical benefits. The convoluted system proposed, yet again, by Industry fails to meet those goals.
This situation is rather contagious. While claims have dropped nationally, the number of attorneys representing injured claimants have also fallen, but at an alarming rate. This phenomenon is not reflective of a safer work environment, but one in which the Industry has squeezed lawyers out of the process intentionally, through many aspects including: regulatory action, philosophical strategy, and legislative tactics. It has been difficult, to say the least, for stakeholders to seek benefits. The failure to mount a defense against these disruptive and destructive practices is partly based upon the inability of stakeholders to maintain a united front.
Yet the CMS (Medicare reimbursement issue) challenge is one that should be a new beginning for injured workers, Labor, lawyers and other groups to creatively employ tactics and strategy to reconstruct the benefit program, albeit periodic payments, rather to merely adopt a program and jump on the band wagon of Industry to deconstruct the program of "lump sum" reductions in benefits including medical care. A good start would be to propose to Congress a legislative package meaningful to injured workers and one that would preserve the integrity of the periodic benefit system and continued provision of full and complete medical benefits. The convoluted system proposed, yet again, by Industry fails to meet those goals.
Monday, June 23, 2014
On-Demand Labor - Is Workers' Compensation Ready for Flex-Time Employment?
Today President Obama announced the expansion of flexible hours for governmental employees. This major trend, already exists in private industry as companies seek to expand on-demand employment.
This appears to be an expansion of the President's remarks made Saturday in his weekly address: "Then there’s the issue of flexibility – the ability to take a few hours off for a parent-teacher conference or to work from home when your kid is sick. Most workers want it, but not enough of them have it. What’s more, it not only makes workers happier – studies show that flexibility can make workers more productive and reduce worker turnover and absenteeism. That’s good for business."
A serious issue will be whether the century old workers' compensation system be able to adapt to the irregular work hours. Workers' compensation is a patchwork of systems that evolved 100 years ago in a tradeoff of benefits and legal duties. It's fiscal structure is based on premiums paid for hours worked, ie. audited payrolls.
A new dynamic now exists in both the delivery of both wage loss benefits and medical benefits. This new frontier will have a profound effect upon the national workers' compensation program.
Wages historically form the basis of establishing rates for both temporary and permanent disability benefits. Some of those benefits are subject to reconstruction based on limited/reduced wages, ie. temporary disability benefits. Some wages not reconstructed, ie. permanent disability benefits.
The cost of medical benefits is an escalating challenge to the entire system. Medical benefits are paid entirely by the employer. As medical/pharmaceutical benefits continued to soar in cost, and the Federal medical care program continues to expand, the Affordable Care Act, workers compensation program will become less stable.
Over the decades the concept and ethic of work, as we have know it to exist, has changed. Adding the processes of, the expansion of flexible work hours and on-demand employment on a global basis, will require readjustment of the workers' compensation delivery system.
….
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.
Friday, January 30, 2009
Commissioning The Federal Government for a New Workers' Compensation System
Legislation was recently introduced in Congress to re-establish a National Commission on State Workers’ Compensation Laws [Commission]. This attempt to recreate the almost 4 decades ago effort to evaluate uniformity of benefits, was introduced by a sole legislator, Representative Joe Baca [CA-43] and lacks any co-sponsorship or a duplicate effort in the US Senate.The initial Commission I, 1972 Report of the National Commission on State Workmen's Compensation Laws, chaired by Professor Emeritus John Burton, looked the national patchwork of chaotic programs to provide uniformity of benefit delivery in the program almost 4 decades ago.
The 1972 report concluded: “We have concluded that there is a significant role for a modern workmen's compensation program and that the States' primary responsibility for the program should be conserved. We also agree that the protection furnished by workmen's compensation to American workers presently is, in general, inadequate and inequitable. Significant improvements in workmen's compensation are necessary if the program is to fulfill its potential.”
The bottom line is that the national system is a hodgepodge of state workers’ compensation laws that are not at all functional in today’s economic/medical market. The times changed since the original enactment of multiple state enactments in 1911. The present program has indeed out lived its usefulness. Over the decades many stakeholders have become preoccupied with economic considerations that have far seriously degraded human considerations.
A national review at the Federal level is a welcome sign that The Administration is using a thoughtful approach to change. This path must embrace the workers’ compensation medical delivery system into universal health care.
Tuesday, October 16, 2007
Federal Court Grants Class Certification to Federal Express Driver Case - Independent Contractor Status at Issue
In a pending MDL (Multi-District Litigation) claim against Federal Express, US Federal Judge Robert Miller (US DCT Northen District of Indiana), granted class certificationto the claims of potentiall 14,000 current FedEx Ground/Home Delivery drivers and up 10,000 former drivers.
An important issue confronting the litigation is the determination of the existence of an "independent contractor" relationship between FedEx and its present and former drivers.
Full decision:
Judge Robert Miller of U.S. District Court for Northern Indiana, today granted class certification on behalf of approximately 14,000 current FedEx Ground/Home Delivery drivers – as well as upwards of 10,000 former drivers - across the nation who are challenging the company’s embattled independent contractor model.
“This is a landmark decision for workers everywhere serving
An important issue confronting the litigation is the determination of the existence of an "independent contractor" relationship between FedEx and its present and former drivers.
Full decision:
Judge Robert Miller of U.S. District Court for Northern Indiana, today granted class certification on behalf of approximately 14,000 current FedEx Ground/Home Delivery drivers – as well as upwards of 10,000 former drivers - across the nation who are challenging the company’s embattled independent contractor model.
“This is a landmark decision for workers everywhere serving
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