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Showing posts sorted by relevance for query federalization. Sort by date Show all posts

Friday, March 4, 2011

Public Meeting Held On Zadroga Health Compensation Fund

A public hearing, sponsored by the National Institute for Occupational Safety and Health (NIOSH), was held Thursday in New York City concerning the James Zadroga 9/11 Health and Compensation Act of 2010 (Pub. L 111-347). The purpose of the government sponsored meeting was to solicite comments on how to implement the Federal benefit program that was signed into law at the end of last year by President Obama.

Victims, their families and representatives were among the presenters at the day-long hearing. A major area of concern at the hearing was whether the program will cover cancer claims and claims for anxiety based diseases that resulted from the World Trade Center attack on September 11, 2001. The toxic cloud of dust and fumes that emanated from the site is of serious concern to medical professionals because of the known pulmonary irritants and carcinogens, including asbestos, that it contained and transported.

The law provides for additional benefits to those who worked near the site during the months following the disaster. Not only are first responders permitted to file for benefits, but the program provides coverage to those who were utility workers, who were involved in the restoration of services, ie. telephone and power, and it also includes those who were involved in the clean-up of the area and local residents.

Comments will accepted until 5:00pm EDT on April 29, 2011 and an implementation plan will be formalized by July, 2011. 

Sunday, January 8, 2012

PROTECT America's Injured Worker Medical Rights



Why This Is Important
The goal of this petition is to garner the support and representation of the American Civil Liberties Union in a due process lawsuit against the State of New York and/or other states within the United States under violations of the civil rights law pertaining to “Deliberate Indifference”, against injured worker’s legal rights to timely and qualified medical treatment thereof.
American workers were improperly stripped of their rights to sue their employer or the state for damages sustained in workplace accidents in 1917 before most of us were even born. Workers Compensation laws, in direct conflict with employee due process rights, quickly spread nationally. Only one lawsuit resulted, ironically, on behalf of employer due process rights. Despite the fact that this contract which lives in infamy violates both employer and employee rights, it has survived for 95 years.
Meanwhile, the "contract" has become so inequitable that millions of American workers are defrauded of life, liberty and the pursuit of happiness, after being thrown into an adversarial court system, where their $5.00 lawyers fight against six figure slingers who represent insurance companies that are raping America.
Injured workers are forced to obtain treatment from an inadequate, unspecialized list of providers, often with disastrous long term results and are barred from both timely and appropriate medical treatment through a complex paper trail of denials for basic medical care.
Further, their lifetime awards are severely limited, and their income reduced to nothing. Paid Independent Medical Examiners with little or no experience with the injury at hand are allowed to pass judgment on degrees of life time injury, literally whisking away damages for the benefit of the insurance providers who pay them. It's only a matter of time until Claimant’s are completely penniless and wind up on welfare, which lets the insurance company off the hook, but leaves the taxpayers holding the tab for social programs such as food stamps and medical coverage or social security disability, as the statutorily promised income protection and medical coverage is non-existent.
Additionally, Injured Workers who are legally entitled to lifetime medical benefits are finding these benefits are unavailable when they relocate from one state to another unless an out of state provider is willing to take on complex paper processes and pathetic reimbursement rates. Once injured in New York, you will never leave New York, or, in essence, you forfeit your right to coverage.
Due to low reimbursement, high medical malpractice risk (due to lack of timely treatment and authorization), and complex paper processes, the list of available providers is shrinking rapidly from year to year. Often, professional review processes are not employed by State government, and substandard physicians are the only ones left on the medical provider list.
Americans are being defrauded and led to believe they will be dealt with fairly, but all fairness has been removed from the system. Ultimately, Corporations are paying the highest insurance rates in history, while the Claimants are getting next to nothing. Meanwhile, the insurance industry makes a killing. The Workers Compensation contract is inequitable.
PROTECT AMERICAN INJURED WORKERS by repealing the 1917 Workers Compensation Act. In varying degrees, this violation of civil rights due process laws is creating a “deliberate indifference” situation, due to unrealistically low provider rates, medical malpractice risk, and shrinking provider lists. Provider fees and attorney fees haven’t been updated for years, and medical guidelines are being employed which haven’t even been ratified by the State, with each new guideline taking another chunk out of what little the injured worker is currently entitled to.
Before long, we’ll have to pay our employers when we’re injured, rather than the other way around.
The failure of Workers Compensation to meet the needs of injured workers is leading to lifetime injuries which were originally treatable and the collapse of American families.
Additionally, America’s social systems are picking up the tab as injured workers flock to obtain early social security, food stamps, and Medicaid due to their lack of coverage under Workers Compensation laws.
Ironically, while American workers are being ignored, American prisoners are getting free medical treatment. In fact, American prisoners are successfully being represented by civil rights lawyers across this country in order to obtain the same quality of care that Americans have come to expect, and that American Injured Workers desire.
If prisoners have rights under “Deliberate Indifference” guidelines to fair treatment, why not the American Worker?
Under current laws, Deliberate Indifference in relation to prisoners medical or safety rights is defined as a “a failure to act where prison officials have knowledge of a substantial risk of serious harm to inmate health or safety.” Crayton v. Quarterman, 2009 U.S. Dist. LEXIS 103709 (N.D. Tex. Oct. 14, 2009) (Wikipedia, 2011)
Deliberate indifference is defined as requiring (1) an "awareness of facts from which the inference could be drawn that a substantial risk of serious harm exists" and (2) the actual "drawing of the inference." Elliott v. Jones, 2009 U.S. Dist. LEXIS 91125 (N.D. Fla. Sept. 1, 2009). (Wikipedia, 2011)
In short, failure to provide timely and appropriate medical care resulting in damage is considered a civil rights violation.
Injured American Workers should never have been deprived of their constitutional right to a fair trial, representation, justice, humanity, and freedom. They should not be restricted to substandard medical care, any more than their legal representatives or medical providers should be asked to work for free.
Enough is enough. PROTECT AMERICAN INJURED WORKERS. It is clear based on hundreds of advocacy websites across the country that Workers Compensation does not work. Therefore, the band-aid approach needs to stop. We need real change, and a new system, which is fair and equitable to the American Worker.

Wednesday, November 3, 2010

The Election Validates A New Approach to Workers Compensation

The recent election results confirm that a new approach to handling the century old workers' compensation is needed and that some definite trends are developing.

Washington State: The insurance industry initiative for privatization was defeated.

New Jersey: The constitutional amendment to prohibit raiding the Second Injury Fund revenue was passed.

California: Jerry Brown was elected governor and the Republican assault on the state compensation system rejected.

Nevada: Harry Reid was re-elected validating the innovated "Libby Health Care" Plan for medical care for occupational illness and the Federalization of the program and the US Senate's initiative.

New York: Andrew Cuomo was elected governor and revision is likely of the administrative assault on workers' rights.

Nationally, the soaring US deficit, and a State system that continues to fail to deliver health care to occupationally injured workers, will eventually need to be addressed by Congress. The 2008 strong Democratic mandate has not evaporated. The Democrats still control the Senate (51-D v 46-R) and downtown at White House. The newly acquired House Republican majority (234-R v 180-D) is instilled with the chaos of an unsettling newly emerging third party, Tea Party, alliance.

The course ahead still remains promising for enacting a unified and coordinate program to help injured workers obtain medical care for occupational diseases on a timely and effective basis without breaking the bank. The vision of a coordinated epidemiological research program to prevent occupational disease and  insure safe working conditions remains hopeful.


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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.

Tuesday, August 14, 2012

CMS Rules Out TENS Units for Low Back Pain

"TENS is not reasonable and necessary for the treatment of CLBP under section 1862(a)(1)(A) of the Social Security Act."

The Centers for Medicare and Medicaid (CMS) has issued a ruling that will impact on the payment of proceeds in Workers' Compensation Medicare Set Aside Agreements (WCMSA). CMS has ruled out the use of TENS (Transcutaneous Electrical Nerve Stimulation) units for the treatment of chronic low back pain.


"For those WC [workers' compensation]cases that were not settled prior to June 8, 2012, and where the  WCMSAs proposal includes funding for TENS for CLBP [chronic low back pain] as part of the WCMSA, CMS  will re-review the cases and remove pricing for TENS for CLBP. (Regional Offices shall  obtain from submitters requests for a case re-review, along with a signed statement  indicating a settlement had not occurred prior to June 8, 2012.)"

Case law throughout the country has been divided on whether TENS units should be authorized to cure and relieve low back pain. 

Click here to read: Decision Memo for Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain (CAG-00429N)

Click here to read: Impact of the Removal of coverage of Transcutaneous Electrical Nerve 
Stimulation (TENS) Units for Chronic Low Back Pain (CLBP) on Workers’ Compensation Medicare Set-Aide Arrangement (WCMSA) proposals – INFORMATION

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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 occupational accidents and illnesses.

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Wednesday, September 12, 2012

Health Care Continues to Eat Away at Employee Earnings

Family Health Premiums Rise 4 Percent to Average $15,745 in 2012, National Benchmark Employer Survey Finds


Throughout the nation Workers' Compensation systems have been impacted by health care costs that now take a large piece of the premium dollar. Traditional health care offered by employers mirrors the same problem of economic stress. Running two parallel systems creates added costs and  delays the delivery of medical care. The recent Kaiser Survey just released for 2012 reports that costs in the health care field continue to outpace employee compensation. 

Annual premiums for employer-sponsored family health coverage reached $15,745 this year, up 4 percent from last year, with workers on average paying $4,316 toward the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2012 Employer Health Benefits Surveyreleased today.

This year’s premium increase is moderate by historical standards, but outpaced the growth in workers’ wages (1.7 percent) and general inflation (2.3 percent). Since 2002, premiums have increased 97 percent, three times as fast as wages (33 percent) and inflation (28 percent).

“In terms of employee insurance costs, this year’s 4 percent increase qualifies as a good year, but it still takes a growing bite out of middle-class workers’ wages, which have been flat or falling in real terms,” Kaiser President and CEO Drew Altman, Ph.D. said.

“Premium growth is at historic lows, which greatly benefits workers. Continuing to ensure that Americans have coverage options that are affordable is vitally important for our nation’s health,” said Maulik Joshi, Dr.P.H., president of HRET and senior vice president for research at the American Hospital Association.

The 14th annual Kaiser/HRET survey of more than 2,000 small and large employers provides a detailed picture of trends in employer-sponsored health insurance costs and coverage. In addition to the full report and summary of findings being released today, the journal Health Affairs is publishing a Web First article with select findings, and Dr. Altman authored a “Pulling It Together” column reflecting on this year’s results.

The survey reveals significant differences in the benefits and worker contributions toward family premiums between firms with many lower-wage workers (at least 35 percent of workers earn $24,000 or less a year) and firms with many higher-wage workers (at least 35 percent of their workers earn $55,000 or more a year).

Workers at lower-wage firms on average pay $1,000 more each year out of their paychecks for family coverage than workers at higher-wage firms ($4,977 and $3,968, respectively). This occurs even though the firms with many lower-wage workers on average pay less in total premiums for family coverage than firms with many higher-wage workers ($14,694 and $16,427, respectively).

In addition, workers at lower-wage firms are also more likely to face high deductibles than those at higher-wage firms. Specifically, 44 percent of covered workers at firms with many low-wage workers face an annual deductible of $1,000 or more, compared with 29 percent of those at firms with many high-wage workers. Across all employers, a third of covered workers (34 percent) face a deductible of that size, including 14 percent with deductibles of at least $2,000 annually.

“This year’s survey suggest that working families at the low end of the wage scale face significant out of pocket costs for coverage,” said study lead author Gary Claxton, a Kaiser Vice President and director of the Foundation’s Health Care Marketplace Project. “Firms with many lower-wage workers ask employees to pay more out of pocket than firms with many higher-wage workers even though the coverage itself tends to be less comprehensive.”

Health Reform and Employers

The survey estimates that 2.9 million young adults are currently covered by employer plans this year as a result of a provision in the 2010 Affordable Care Act that allows young adults up to age 26 without employer coverage of their own to be covered as dependents on their parents’ plan. That’s up from the 2.3 million in the 2011 survey. Young adults historically have been more likely to be uninsured than any other age group.

The survey also finds that 48 percent of covered workers are in “grandfathered” plans as defined under health reform, down from 56 percent last year. Grandfathered plans are exempted from some health reform requirements, including covering preventive benefits with no cost sharing and having an external appeals process. To retain this status, employers must not make significant changes to their plans to reduce benefits or increase employee costs.

Employer Expectations for 2013

In addition to the comprehensive survey conducted in the spring, employers were asked in August whether they had information about the change in premiums (or total cost for self-funded plans) for their current health plan with the largest enrollment. The average increase reported by employers who had received information for their current plan is 7 percent.

These early reports may not match what employers and workers ultimately end up paying next year, as firms can raise deductibles or otherwise change the health benefits and plans they offer to lower premiums. This year, for example, more than half (54 percent) of employers who offer health benefits reported that they had shopped around for new coverage. Of that group, significant shares switched carriers (18 percent) or changed the type of plans they offer (27 percent).

Other findings from the study include:
Worker-only coverage. Premiums for worker-only health coverage increased 3 percent in 2012 to reach $5,615 annually. Workers on average pay $951 toward this coverage.
Offer rate. This year, 61 percent of firms offer health benefits to their workers – statistically unchanged from last year. 

Cost-sharing for office visits, emergency care and drugs. Covered workers facing co-payments for in-network physician office visits on average pay $23 for primary care and $33 for specialty care. For emergency-room visits, average co-pays are $118. For drug plans with three or more tiers, average co-pays are $10 for generic drugs, $29 for preferred brand-name drugs, $51 for non-preferred brand-name drugs, and $79 for specialty drugs.
Domestic partner benefits. In 2012, 31 percent of employers offer health benefits to same-sex domestic partners, up from 21 percent three years earlier. This year 37 percent of firms offer such benefits to unmarried opposite-sex partners, up from 31 percent in 2009.
Flexible Spending Accounts and Pre-Tax Premiums. Large employers are more likely than small ones to allow workers to pay their share of premiums with pre-tax income (91 percent, compared to 41 percent) and to contribute pre-tax dollars to Flexible Spending Accounts (76 percent, compared to 17 percent).

Now in its 14th year, the survey is a joint project of the Kaiser Family Foundation and the Health Research & Educational Trust. The survey was conducted between January and May of 2012 and included 3,326 randomly selected, non-federal public and private firms with three or more employees (2,121 of which responded to the full survey and 1,205 of which responded to a single question about offering coverage). A research team at Kaiser, HRET and NORC at the University of Chicago, led by Kaiser’s Gary Claxton, designed, conducted and analyzed the survey. For more information on the survey methodology, please visit the Survey Design and Methods Section at http://ehbs.kff.org.
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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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Tuesday, February 15, 2011

Agenda Announced for Public Meeting on Implementation of the Zadroga 9/11 Health and Compensation Act

An agenda for the a public meeting on March 3, 2011 to discuss the implementation of the James Zadroga 9/11 Health and Compensation Act of 2001 has been published by The National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC). The purpose of the meeting is to allow interested parties provide the agency with their perspectives to assist in developing a plan to meet the requirements of the Act.

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. 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 meeting will begin with a brief introduction by Federal officials, followed by presentations from attendees who register to speak. Each speaker will be limited to five minutes in order to maximize the number of presentations during the meeting. If all registered presentations are made before the end time, there will be an open session to receive comments from anyone who has not signed up on the speaker registration list who may wish to speak. Open session comments will also be limited to five minutes per person. After the last speaker or at 4:45 p.m., whichever occurs first, the meeting will be adjourned.



The meeting is scheduled for Wednesday, March 3, 2011 9 a.m to 4:45 p.m. EDT. The meeting will take place at the Jacob Javits Federal Building, 26 Federal Plaza, Broadway entrance, 6th Floor, Broadway entrance, 6th Floor Conference Room A/B, New York, NY 10278. While the meeting is open to the public, limited only by the space available. It is anticipated that the space can hold only 300 people. The USA toll-free dial-in number is 800–619–8873; pass code 8693287.


The James Zadroga 9/11 Health and Compensation Act of 2010 established a program known as the World Trade Center (WTC) Health Program within the US Department of Health and Human Services (HHS). The Act includes:

1. Medical Monitoring for Responders
2. Initial Health Evaluation for Survivors
3. Follow-up Monitoring and Treatment for WTC-Related Health Conditions for Responders and Survivors
4. Outreach
5. Clinical Data Collection and Analysis
6. Research on Health Conditions

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. Please contact our office if you require assistance in filing a claim under the newly enacted James Zadroga 9/11 Health and Compensation Act.


Thursday, August 2, 2012

Probable Link Sustains Claim for Renal Cancer & Pulmonary Disability

A NJ appellate court upheld a trial court's decision holding an employer liable for workers compensation benefits for renal cancer and pulmonary disability where a probable link could be demonstrated as a result on a worker's occupational exposure to known carcinogens including asbestos.

Johnson v Exxon-Mobile Chemical Co. (2012 WL 3064003 (N.J. Super. A.D.) Decided July 30, 2012

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Thursday, February 24, 2011

Zadroga Health Fund: Utility Workers Suffer Increased Anxiety

A recent study reveals that utility workers who were deployed at the World Trade Center (WTC) disaster site on 9/11 have an increased level of post traumatic stress disorders (PTSD) and depression. The study may significantly increase the potential benefits that utility workers may obtain under the James Zadroga 9/11 Health and Compensation Act (“Zadroga Act”) providing a total of $4.3 billion in health benefits and financial compensation for victims, responders, and other harmed by the attacks of September 11th and its aftermath. 


The report concludes that, nonrescue workers deployed to a disaster site are at risk for PTSD and depression. Extent of exposure affected the most vulnerable workers differently than the least vulnerable ones. These results suggest that the relationship among predictors of PTSD may be different for different vulnerability groups, and underscore the importance of screening, education, and prevention programs for disaster workers. 


Recent attention has begun to be focused on the effects of disaster recovery work on nonrescue workers. The study assesses the prevalence and predictors of posttraumatic stress disorder (PTSD) and related symptoms in a population of utility workers deployed to the World Trade Center (WTC) site in the aftermath of 9/11.  Utility workers deployed to the WTC site were screened at their place of employment between 10 and 34 months following the WTC attacks, utilizing both structured interviews and self-report measures.


Eligibility for benefits under the James Zadroga 9/11 Health and Compensation Act include those who were World Trade Center victims and First Responders. Under the law those who worked, attended school, childcare and adult day care, may be eligible. The program also covers some who were present in the area of the dust cloud or who lived in the the New York City disaster area. Certain cleanup and maintenance workers are included including tele-communications workers such as Verizon, AT and T and other employees.



Additionally, various respiratory and digestive diseases are being reported including:
1. Interstitial lung diseases.
2. Chronic respiratory disorder--fumes/vapors.
3. Asthma.
4. Reactive airways dysfunction syndrome (RADS).
5. WTC-exacerbated chronic obstructive pulmonary disease (COPD).
6. Chronic cough syndrome.
7. Upper airway hyperreactivity.
8. Chronic rhinosinusitis.
9. Chronic nasopharyngitis.
10. Chronic laryngitis.
11. Gastroesophageal reflux disorder (GERD).



Like the September 11th Victim Compensation Act of 2001, even if the exposed individuals are living in another state, but were exposed at the NY Disaster Area, the ill individuals may apply for benefits. 


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. Please contact our office if you require assistance in filing a claim under the newly enacted James Zadroga 9/11 Health and Compensation Act.



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