NJ Urged to Adopt Single Payer System for Workmens Comp

A coalition that has been formed in NJ is urging that the Garden State follow the lead of Vermont and establish a single-payer system.  Single-payer movements have already made important progress in California and Pennsylvania. The New Jersey One Plan One Nation coalition is leading the campaign in New Jersey.


Citing that in 1777 the Commonwealth of Vermont became the first sovereign state in the world to abolish slavery the coalition, the coalition is now advocating a similar nation adoption of Vermont legal precedence. On May 26, 2011. Vermont became the first state in the U.S. to commit itself to establishing a truly universal single-payer healthcare plan that includes workers' compensation medical care. 

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NIOSH Issues "Roadmap" Document Suggesting Asbestos Research Strategy

The National Institute for Occupational Safety and Health (NIOSH) announces the availability of “Current Intelligence Bulletin: Asbestos Fibers and Other Elongate Mineral Particles: State of the Science and Roadmap for Research.” The document contains NIOSH’s recommended framework for a national research strategy to address current scientific uncertainties about occupational exposure and toxicity issues relating to asbestos fibers and other elongate mineral particles.

The Current Intelligence Bulletin is available online at www.cdc.gov/niosh/docs/2011-159/.

It is well documented that asbestos fibers can cause lung cancer and other types of serious lung disease in workers when inhaled. Since the passage of the Occupational Safety and Health Act in 1970, considerable progress has been made in preventing harmful exposures and protecting workers from risks of illness. However, many scientific uncertainties remain as to the health risks associated with exposure to other elongate mineral particles, including those with mineralogical compositions identical or similar to the asbestos minerals and those that have already been documented to cause asbestos-like disease, as well as the physical and chemical characteristics that determine toxicity.

The new NIOSH document incorporates extensive public comment and scientific peer review, including review by an independent committee of the Institute of Medicine and the National Research Council. The document does not set any new NIOSH policy regarding asbestos fibers and other elongate mineral particles.

“The NIOSH roadmap outlines a strategic framework for designing, conducting, and applying the research that will best serve the need to address persistent scientific uncertainties about occupational health and elongate mineral particles,” said NIOSH Director John Howard, M.D. “We look forward to working with our partners to advance this research, building on today’s state-of-the-art scientific tools and methodologies.”

Priority areas for research, as proposed by the roadmap, include:

• Developing a broader understanding of the factors that determine the toxicity of asbestos fibers and other elongate mineral particles.
• Developing information and knowledge on occupational exposures to asbestos fibers and other elongate mineral particles, and related health outcomes.
• Development of improved sampling and analytical methods for asbestos fibers and other elongate mineral particles.
• Applying research outcomes to improve public policy.

NIOSH is the federal agency that conducts research and makes recommendations for preventing work-related injury, illness, and death. NIOSH has a longstanding program of research and health surveillance to prevent asbestos-related disease, and its scientific findings and recommendations have contributed significantly to national policies for eliminating or minimizing harmful exposures. Further information is available at www.cdc.gov/niosh/topics/asbestos/.

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 asbestos related disease.

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A Nuclear Workers' Compensation Disaster

As Japanese nuclear energy workers at the Fukushima Daiichi plant are being ordered to abandon efforts to contain the radiation emission, now at 1,000 times the safe limit, serious concern exists whether the US workers' compensation could handle a similar disaster, if not the consequences of the present event. The gut reaction in the US has been to lean on the Federal Government to bailout the ailing patch work of ailing state compensation systems. The lack of Federal preparation may not be adequate to permit an effective response this time around.


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 in other mass disasters including: Beryllium workers, coal miners compensation, 9-11 Victims Compensation and subsequent Zadroga Fund, and the Gulf oil spill program. In the past the Feds have even prepared to help with H1N1 flu compensation and in the preparation of a Smallpox compensation program.


The Japanese model of delay and denial has proved ineffective. The victims of the Sumitomo Metal Mining uranium processing plant disaster in 1999 were summarily denied benefits for their ensuing radiation health problems.


While similar reactors in the US pose identical design problems, preparation is lacking in the US to provide an adequate response, and even integrate or utilize, the best of the state workers' compensation programs. Those systems are universally struggling to handle the delivery of benefits for occupational exposures. The Federal government has even ignored the implementation of  legislation sponsored Senator Edward Markey (MA) for the prophylactic  distribution of potassium iodine (KI) pills to those who are in a potential radius of exposure near nuclear reactor sites.


One would think that we would have learned from the Three Mile Island Diaster decades ago or Chernobyl (prediction of fatal cancers of 9,000 to 28,000 between 1986 and 2056). Even the warnings of leaks of similar nuclear reactors like Oyster Creek in NJ or Shoreham in NY, all close to major population centers, have not seemed to create a momentum of urgency.


Notoriously late to react in situations of latent disease has become the classic US policy. We have seen this repeated public health policy in other toxic exposures such as asbestos and tobacco. It is not that we didn't know, it is merely that the government just chose to ignore the public health issues. Unfortunately, this policy has compounded the problems for ailing workers' compensation systems, and it maybe too little and too late to prevent a meltdown of the entire system. 

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The World Trade Center Health Program Expands The Path to Federalization

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 funded and administered program provides for medical evaluation and treatment of occupational medical conditions that have been neglected or ignored by other benefit programs.


The legislation specifically provides for medical monitoring and treatment to eligible emergency responders and recovery and cleanup workers, including those who are Federal employees, who responded to the September 11, 200, terrorist attacks. Furthermore, the program will provide initial health evaluations, monitoring, and treatment to residents and other building occupants and area workers in New York City who were directly impacted and adversely affected by the attacks.


H.R. 847 Health and Compensation Act of 2010
Click Here for C-Span Video http://tinyurl.com/2ax3htq

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USPS May Declare Bankruptcy Citing High Workers Compensation Costs

The Washington Post reported Saturday that the US Postal Service (USPS) may declare bankruptcy and cited high combined benefit costs as a major cause for its financial instability.  The quasi-governmental agency is running into problems it claims because of its requirement to to pre-fund $5.4 billion to a retiree health benefit fund and pay $2.5 billion to the federal workers' compensation fund.

The USPS's troubles mirror that difficulties stangulating the nation's network of state workers' systems caused by the inability to fund soaring medical costs enhanced by complications caused by duplicate administrative costs engulfed by a multiplicity of collateral programs. In contested claims injured workers are shifted to other benefit programs to pay for medical costs. Those secondary programs ultimately seek reimbursement from the primary benefit program, workers' compensation coverage, and literally clog up administrative dockets and create greatly enhanced processing costs and monumental delays.

While the USPS will seek assistance from the Republican majority in US Congress, it is uncertain what financial aid will be forthcoming, or whether Congress will take a deeper look at the nation's workers' compensation entirely. The last time the Republican's dominated Congress proposals were suggested by the former Speaker, Newt Gingrich, to over haul the national system entirely.

The medical component is now in critical condition. It remains uncertain if it will addressed in the next congressional term, or whether it will be the can that is kicked down the road to be dealt with in the future. The growing trend remains, that Federalization of the medical delivery component is the probable  solution to both the USPS's compensation difficulties as well as the the nation's.
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For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

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New Jersey Issues Workers Compensation Guidance on Evaluating Disputed Medical Provider Claims

A NJ Workers' Compensation Task Force report has been published that provides guidance to the parties in evaluating disputed medical provider claims. While declaring that, "certainly there are no overnight solutions," the report provides a manual type of suggestions for negotiation, litigation and resolution.

1. The new WCRI report, Benchmarks for Designing Workers’ Compensation Medical Fee Schedules. Fee schedules vary dramatically from state to state and based upon the type of payer;

2. The fees customarily paid for like services within the same community;

3. The fees paid to the same physician or medical provider by other payers for like treatment;

4. The fees billed and the accepted payments for such bills by a given provider. The Court may wish to consider the disparity in payments accepted from different sources (i.e. Medicare vs. PIP and commercial carriers);

5. A review of the Health Insurance Claim Forms (“HCFA”) submitted by the provider to the claim payer and the Explanations of Benefits (“EOB”) that that claim payer sends to the provider. The EOB provides the amount billed for a given procedure or service performed on a particular date of services. The EOB also provides the amount paid and, where applicable, identifies the reason why a disparity may exist in the amount billed and the amount paid. The use of certified professional coders may be employed to review the bill along with the medical records to be sure that it is consistent with CPT coding standards;

6. The HCFAs or EOBs from other medical providers in the same geographic area or community for the same medical treatment provided;

7. Using commercial and/or private databases such as Ingenix’s Prevailing Healthcare Charges System (“PHCS”); the Medical Data Resource (“MDR”) database, and; Wasserman’s Physician Fee Reference (“PFR”) database to name a few;

8. The type of facility where the procedure was performed. For example, was the services provided at a Level 1 trauma center versus a community hospital;

9. Consideration of whether there was a contract between a claim payer and the medical provider, such as a PPO network, in which case the contract would be controlling;

10. Consideration ofMedicare/Medicaid reimbursement rates;

11. Testimony from medical office personnel as to what services were billed for, the payments received and how the bill was formulated;

12. Consideration of state sanctioned PIP fee schedules;

13. Consideration of commercial carrier authorized payments.
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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 work related accident and injuries.

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US Workers Compensation Centennial Commission

This  10-minute video was created for the National History Day contest by students at Nimitz High School in Houston, Texas.

The Workers’ Compensation Centennial Commission was formed to celebrate the first constitutional workers’ compensation law in the United States which was signed on May 3, 1911 and took full effect on Sept. 1, 1911.  It was a recognition of society’s responsibility to the workplace, establishing workers compensation as the first form of social insurance in American history.  Today, workers’ compensation stands as a pillar within our economic system that benefits all Americans.

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 work related accident and injuries.

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Designing the New Federal Workers Compensation Program

Designing the New Federal Workers Compensation Program

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 sweeping concept of inclusiveness is more than obvious.

This is not a surprising turn of events. It is entirely consistent with a broad pattern to sweep the ailing and fragmented patch work of state programs into a unified Federal program. In an era of economic depression, national health care reform and major workforce changes this approach is consistent with the underlying bipartisan national philosophy.

Columnist and an expert in the field, Peter Rousemaniere, recently concluded an analysis of system’s failures that have literally pushed workers’ compensation into a federalized program. “The states and workers' compensation insurers have for decades weaseled on the promise to protect workers from occupational illnesses and to honor their claims.” 

The knee jerk reaction, one would think, would be this could never happen because of interested stakeholders. In reality, they have been silently distracted by more far reaching issues and have been economically drained of resources to the point where they’ll take anything the Federal Government can offer to save them from extinction.

The Federal government is not unfamiliar with the administration and distribution of benefits. Since 1882 the federal government has been providing benefits to injured workers and their widows:  in 1900 the postal workers compensation system was established; in 1908 the Federal government established a program for those who work in hazardous environments; and, in 1932 the Social Security Administration was established. However, the Social Security Act did not embrace workers’ compensation in 1932 since the primary goal of the law was to reduce unemployment. 

The federal programs have produced a dismal result over the last few years.  The Federal Victims Compensation Fund, enacted following the horrific tragedy of September 11^th, 2001, has a very strict eligibility criteria and a limited recovery scheme.  The Smallpox Emergency Personnel Protection Act of 2003 (SEPPA) was enacted following an aborted vaccination program after the government reluctantly disclosed available medical research concerning potential fatal cardiovascular reactions.  A risk analysis demonstrated that this program may not have been needed at all but was merely implemented to sway public opinion.  Ultimately, the federal government halted the Smallpox Vaccination Program and funded $100 million for the purpose of cleaning up the legacy of adverse medical reactions and to ease the burden placed upon the victims and their estates that were struggling to obtain benefits under State compensation programs.

The Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA) (P.L.106-398) was enacted into law in October, 2000 with strong bipartisan support. EEOICPA established a program to provide compensation to employers of the Department of Energy (DOE), its contractors and subcontractors, companies that provided beryllium to DOE, and atomic weapons employers.

The Federal health care reform is a big Federal deal for workers’ compensation as it establishes the Libby Health Care Plan with far reaching impact by involving Medicare to deliver health care. The ongoing integration of conditional payments (Medicare Secondary Payer Act and mandatory reporting) as well as the review of all compromises concerning  the provision of future medical care (Workers Compensation Medical Set-aside Agreements) is already anther Federal foot in the door to prevent what in the past was a tradeoff of medical care to US taxpayer without consideration.

While federalization may not be the panacea, the target remains to limit the cost of medical expenses and provide an efficient and remedial benefit delivery system at minimal cost for administration and to hold the appropriate parties financial responsible.  The costs of maintaining duplicate medical delivery systems for workers, major medical and workers’ compensation, continues to represent an unnecessary and costly duplicate expenditures in administration and management.

The BP-Federal Oil Compensation Plan is yet another attempt to find a solution. While it may not be perfect, hopefully it will be guided successfully and will learn from past Federal trials and errors dabbling in workers’ compensation. It is obviously not the perfect solution, but that may only exist as an unattainable goal. The first step is a comprehensive and integrated Federal workers’ compensation program. A step in the right direction would be for the Federal Government to take primary responsibility for all occupational workers’ compensation claims. This would be an innovated initial approach to implement a new Federally administered Workers’ Compensation system.

To read more about federalization and workers' compensation click here.

Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon  Gelman or call 1-973-696-7900.

Designing a BP Oil Spill Compensation Fund

As the Obama Administration debates the format for an Gulf Oil Spill Compensation the critical factors of funding, administration and longevity of the program remain unresolved. Tonight The PBS News Hour provided only a limited insight into the major issues involved in such a program.

Essential to the program is the adequacy and efficiency of the delivery of benefits to injured and exposed workers. While comparisons continue to be drawn to the the longest tort in American history, asbestos, and the Victims Compensation Fund of 911, sight continues to be lost of the injured and exposed workers who have been faced with a basic workers' compensation system that for the most part, failed to adequately miss their needs.

Daniel Farber, Director of the environmental law program at the University of California, Berkeley's Law School highlighted some of the design failures of the past in Federal programs when he stated, "Well, I don't know if we need a custom-built scheme for BP, but I think that this has shown a genuine problem, both here, but also with other kinds of environmental disasters, with public health disasters, which is that we have a very long litigation process, and people may need help right away."

Missing from the discussion, yet again, are the injured workers, the employers, the workers' compensation insurance carriers and their advocacy groups discussing the essential issue of compensating oil spill workers. History teaches us that in the past Federal programs have missed the mark in creating adequate programs to meet the needs of compensating injured workers. Hopefully, the opportunity will not be lost this time to create a viable, fair and exemplary program.

To read more about petroleum exposure and workers' compensation.

Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon  Gelman or call 1-973-696-7900.