Jobs, Growth & Universal Healthcare

Robert Reich, in a 3 minute video, states the reasons why jobs, growth and universal healthcare are needed to expand the US economy. 

This is reflective of the issues plaguing the nation's workers' compensation system, especially soaring medical delivery costs (administrative, clinical and pharmaceutical).  

Read more about "universal healthcare" and workers' compensation:

Universal Medical and Workers' Compensation: It's Not

Feb 01, 2013

Medical care afforded by workers' compensation delivery systems will ultimately be merged into a universal national program, despite all the opposition along the way. My friend, and cycling inspiration, who keeps me trying to ...

http://workers-compensation.blogspot.com/

Our Journey Forward on Occupational Medical Care - Workers ...

Nov 09, 2012

Going forward it is imperative that a universal medical program be established to provide medical treatment for all work-related occupational injuries and exposures. The delay and denial of medical benefits to those who suffer ...

http://workers-compensation.blogspot.com/

Path to Federalization: A National Workers Compensation System

Jul 05, 2012

Those efforts demonstrate a commitment to bring the nation ever closer to a universal care medical program incorporating the entire patchwork of workers' compensation medical delivery systems. The US Supreme Court has ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Vermont Universal Health Care to Embrace ...

Mar 05, 2011

Vermont Universal Health Care to Embrace Workers Compensation. A two-stage bill in Vermont is geared to establishing a single-payer medical health care system that would include medical for workers' compensation ...

http://workers-compensation.blogspot.com/

HBO To Air Special About Triangle Shirtwaist Fire

The HBO special, "Triangle: Remembering The Fire" will air on HBO starting, March 21, 2011 at 9pm. The documentary will commemorate the 100th anniversary of the fire where 146, mostly young immigrant women, were killed in the New York City garment district. The tragedy galvanized public opinion and sparked the birth of the modern labor movement which lead the way for safety regulations in the workplace.

Related articles

• Television Review: Two Remembrances of One Deadly Day in 1911 (tv.nytimes.com)
• The Lingering Consequences of Smoke in the Workplace (workers-compensation.blogspot.com)
• Public Meeting on Implementation of the Zadroga 9/11 Health and Compensation Act (workers-compensation.blogspot.com)
• The World Trade Center Health Program Expands The Path to Federalization (workers-compensation.blogspot.com)

Asbestos Cement Factories Pose High Risk Mesothelioma

Mesothelioma of the left lower lung.
(Photo credit: Wikipedia)

An increased risk of developing asbestos related disease, including mesothelioma, was identified in a recent study. Asbestos exposure has caused an epidemic of claims for workers' compensation benefits in the United States decades following exposure because of the long latency period between exposure to asbestos fiber and the manifestation of disease.

Epidemics of malignant mesothelioma are occurring among inhabitants of Casale Monferrato and Bari never employed in the local asbestos-cement (AC) factories. The mesothelioma risk increased with proximity of residence to both plants.


To provide information on the intensity of environmental asbestos exposure, in the general population living around these factories, through the evaluation of the lung fibre
burden in mesothelioma patients.


A analysed by a scanning electron microscope equipped with X-ray microanalysis wet (formalin-fixed) lung tissue samples from eight mesothelioma patients who lived in Casale Monferrato or Bari and underwent surgery. Their occupational and residential history was obtained during face-to-face interviews. Semi-quantitative and quantitative indices of cumulative environmental exposure to asbestos were computed, based on residential distance from the AC plants and duration of stay.


 The lung fibre burden ranged from 110 000 to 4 300 000 fibres per gram of dry lung (f/g) and was >1 000 000 f/g in three subjects. In four cases, only amphibole fibres were detected. Environmental exposures had ceased at least 10 years before samples were taken. No patient had other definite or probable asbestos exposures. A linear relationship was observed between the lung fibre burden and all three indices of environmental cumulative exposure to asbestos.


Environmental exposure to a mixture of asbestos fibres may lead to a high lung fibre burden of amphiboles years after exposure cessation. The epidemiological evidence of an increased mesothelioma risk for the general population of Casale Monferrato and Bari, associated with asbestos contamination of the living environment, is corroborated.

....
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.

More Blog Article on Mesothelioma

WHO Urges Worldwide Asbestos Ban: Mesothelioma Rates Surge

Oct 06, 2011

"In conclusion, malignant mesothelioma remains a rare form of cancer but the disease is on the rise, probably due to the spread of asbestos use over past decades. Our analysis shows that the disease burden is still ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Genetic Pre-Disposition to Mesothelioma

Aug 29, 2011

Scientists have found that individuals who carry a mutation in a gene called BAP1 are susceptible to developing two forms of cancer – mesothelioma, and melanoma of the eye. Additionally, when these individuals are ...

http://workers-compensation.blogspot.com/

Workers' Compensation: National Mesothelioma Awareness Day ...

Sep 19, 2010

National Mesothelioma Awareness Day September 26. A "National Mesothelioma Awareness Day" will be commemorated on September 26, 2010. Nearly 3000 individuals are afflicted yearly with this fatal disease associated...

http://workers-compensation.blogspot.com/

NJ Appellate Court Upholds $30.3 Million Mesothelioma Verdict

Apr 06, 2010

The court held that the standard of causation in a mesothelioma case permitted recovery where there was infrequent exposure to a small amount of fiber. History. "Mark Buttitta was born in December 1952. He worked as a ...

http://workers-compensation.blogspot.com/

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Undocumented Aliens Ensnared By Workers' Compensation

Peter Rousmaniere comments today about the problems, threats and fears that undocumented aliens confront with the nation's patchwork of compensation programs. Injured undocumented aliens in states than mandate the submission of a social security number to file an initial application for workers' compensation benefits are particular targets for criminal fraud enforcement.

"The eight million undocumented workers comprise about 6% of the total civilian workforce. By studying estimates of undocumented worker penetration by occupations ranked by injury risk, one can reasonably project that undocumented workers sustain one out of every ten work injuries. This high volume is invisible to almost everyone except for adjusters, case managers, lawyers and others who work directly with injured workers and have learned their work and life patterns. The rate varies greatly, from maybe 2% in West Virginia, a low foreign-born population state, to over half within the fruit and vegetable producing counties of southern California."

Reconciliation of this issue remains uncertain for a multitude of reasons. The future of immediate national reform of immigration laws this election cycle now looks bleak with Eric Cantor's recent primary defeat. States will continue to use Social Security information for tax collection and enforcement, in addition to the reconciliation of other programs such as Medicare and unemployment benefits. 

Ironically as Rousmaniere points out in his commentary, the power of the employer over the employee, is a huge challenge to the improvement of safety and health in the workplace. Shifting the burden from employers to US taxpayers is problematic. As the Affordable Care Act is fined tuned in the years ahead, the issue of undocumented aliens will become both a more dominate moral and legal issue in need of reform.

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• Medical Care Politics in Worker's Compensation (workers-compensation.blogspot.com)
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Workers Compensation Rates in New York to Decrease

Mario Cuomo,
Governor of the State of New York

Governor Cuomo Announces First Reduction in Workers' Compensation Rates Since 2008

After Compensation Board Recommends Rate Increase, Administration Review Determines No Increase is Needed, Helping NY Businesses to Remain Competitive

Governor Andrew M. Cuomo today announced that for the first time in four years, New York State employers will see a reduction in workers' compensation premium rates. The Governor asked for a reconsideration of the original recommendation in order to find ways to reduce the proposed increase.

Rates to policyholders will actually see a decrease of 1.2 percent – the first reduction in rates since 2008. The Governor also announced that the last measures of the 2007 Workers' Compensation Reform Law, which secured necessary benefit increases for injured workers and cost reductions for businesses, have now been fully implemented by the state. The rate reduction and the expedited implementation of the reforms are a result of efforts by the Governor's administration over the past 18 months to modernize, improve efficiency and decrease waste in the workers' compensation system.

"To create jobs and get our state's economy back on track it is essential that New York's businesses remain in a competitive position to succeed in the global marketplace," Governor Cuomo said. "For years, the workers' compensation system has been too costly for businesses and ineffective for injured workers. With the new measures implemented by the state, and our continued work together with the business and labor communities, we will remain on track to create a system that works better for both employers and employees."

This year, the New York Compensation Insurance Rating Board, a non-governmental rate service organization, recommended a cost increase in their annual loss cost filing. After reviewing all filings and written submissions, the administration deemed the rate increase was not to be necessary. As a result of the decision, workers' compensation rates will actually decrease in the upcoming policy year. The rates are determined on an annual basis, and are informed by a variety of factors, including but not limited to experience in the marketplace, implementation of any cost cutting measures, and implementation of any new policies and procedures. 

Benjamin M. Lawsky, Superintendent of Financial Services, said, "Under the Governor's leadership, New York has taken dramatic steps that ultimately will benefit workers' compensation insurers, claimants, and businesses -- both large and small -- throughout the state. At a time when many states are gutting their workers' compensation systems, New York is working to continually improve our workers' compensation system for employers and employees. This is the right decision on rates at the right time."

The DFS decision was due in part to a variety of developments which are altering the workers' compensation landscape, including the completion of the workers' compensation reforms. Last year, Governor Cuomo directed the Workers' Compensation Board to deliver on the components of the reforms and implement any outstanding provisions. Although the savings from the reforms were immediately realized by businesses, the implementation of the measures supporting those savings proceeded at a slower pace. The January 1, 2012 release of the Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity and the recent adoption of diagnostic testing network regulations marked the completion of the reform.

Having finished the process for capping the number of years certain benefits are paid, instituting medical treatment guidelines and improving the calculation of loss-of-wage earning capacity, the Workers' Compensation Board will now focus on creating comprehensive guidelines for the treatment of chronic pain and modernizing its systems using technology and industry best practice to speed benefit delivery, improve service to injured workers, and reduce waste, fraud, and abuse by employers, medical providers, and employees in the system. 

Mario Cilento, President of the New York State AFL-CIO, said, "The Labor Movement's priority in the 2007 Workers' Compensation reform was to ensure that workers who suffer injury or illness while at work receive the timely treatment they need and adequate benefit levels to support themselves. The reform led to the indexation of the benefit at two-thirds of the state's average weekly wage so that never again would injured workers suffer an erosion of their benefits through inflation. I thank Governor Cuomo for finally implementing these reforms thereby ensuring that the benefit levels remain indexed and injured workers receive essential care. The New York State AFL-CIO will continue to work with the Administration to ensure that the system is appropriately funded and administered to serve injured workers and pay their benefits."

Heather Briccetti, President and CEO of the New York State Business Council, said, "The 2007 legislation was a good faith effort to balance benefit increases, reduced employer cost, and improved claims administration. Five years after the 2007 reforms, we need to evaluate its actual impacts on both benefits and costs. The cost of workers' compensation coverage remains a significant competitiveness issue for New York State business, and we look forward to working with the Administration and other stakeholders on next steps in improving the system."

Robert Beloten, Chair of the Workers' Compensation Board, said, "Prior to the reform, lost wage benefits were insufficient for injured workers yet the system has had uncontrollable medical and indemnity costs. It was an unsustainable system that did not work for the employer or the injured worker. Working with business and labor we have put this system on a more sustainable path. We will continue to work with our key stakeholders to improve benefit delivery and weed out waste, fraud, and abuse in the system."

Peter M. Rivera, Commissioner of Department of Labor, said, "Improvements in New York's workers' compensation system is a benefit to all the hard working people in the State of New York."

Related Blogs - New York

Exclusivity Rule Adopted in MDL Aviation Law Case

Jul 11, 2012

In a Multidistrict Litigation (MDL) case pending in New York, a Federal Court ruled that the New Jersey law governing exclusivity of claims barred an employee from proceeding with an intentional tort claim against the ...

http://workers-compensation.blogspot.com/

Workers' Compensation: 50 Cancers To Be Covered Under the 9-11 ...

Jun 08, 2012

The New York Times is reporting this afternoon that The National Institute for Occupational Safety and Health (NIOSH) has approved for compensation payments 50 types of cancers from the $4.3 Billion Zadroga 9-11 Fund.

http://workers-compensation.blogspot.com/

Workers' Compensation: OSHA Targets Fall at New Jersey Companies

May 23, 2012

"This is a call to action for every contractor in the state," says Robert Kulick, OSHA regional administrator in New York. "These incidents are tragic reminders of the dangers posed to workers when they are not adequately ...

http://workers-compensation.blogspot.com/

Workers' Compensation: WTC Health Program: First Year Anniversay

Jul 03, 2012

We will expand the Program so that through the nationwide network of providers both responders and survivors who live outside the New York City metropolitan area can receive monitoring and treatment benefits near to ...

http://workers-compensation.blogspot.com/

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The High Price of Drugs: Upscale Pricing By Doctors

Source: NY Times

"Rules in some states that govern workers’ compensation insurance allow doctors to charge many times what pharmacies charge for some drugs when dispensed in their offices."

Click here to read the complete article:  Paying Much More in the Doctor’s Office (NY Times)

Workers' Compensation: The Complex World of Workers ...

Nov 18, 2011

Prescription drugs have become an increasingly important issue in workers' compensation law. Their use in workers' compensation claims has resulted in both a major direct financial cost to the system, and has had ...

http://workers-compensation.blogspot.com/Workers' Compensation: Federal Pre-emption Of Pain Drugs

Jun 20, 2012

As state workers' compensation reformers continue to be sidetracked with alleged prescription drug pain-killer abuse, the US Congress has entered the fray with proposed Federal legislation. It has been reported today by ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Sidetracked By Drugs

May 04, 2012

To use the prescription drug abuse issue to attack workers' compensation generally is merely sidetracking the real problem with the medical delivery system which is the global denial of compensability of workers' ...

http://workers-compensation.blogspot.com/

Workers' Compensation: Drugs, Alcohol and Mauling Bears

Mar 30, 2011

Many states, including Wisconsin, hold that if an injury results from intoxication (by alcohol or drugs) benefits are not denied, but reduced (usually by 15%) as an employee safety violation, but intoxication is not evidence of a ...

http://workers-compensation.blogspot.com/

The Top 10 Drugs Prescribed For Workers Compensation Claims

Sep 14, 2011

The Top 10 Drugs Prescribed For Workers Compensation Claims. A recent study by NCCI Holdings, Inc. reports the top 10 most popular drugs prescribed for workers' compensation claims. OXYCONTIN®; LIDODERM ...

http://workers-compensation.blogspot.com/

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The James Zadroga 9/11 Health & Compensation Act of 2010

It Is A Guest Blog Featuring Troy G. Rosaco.......

On January 2, 2011, President Obama signed 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 Zadroga Act accomplishes two goals important for individuals who suffered injuries or illnesses related to either the actual attacks or the subsequent cleanup.. First, Title I of the Zadroga 9/11Act establishes a comprehensive health plan to monitor and treat injuries suffered by first responders and survivors—including firefighters, police officers, EMT’s, rescue workers, construction workers, cleanup workers, local residents, local area workers, and school children—as the result of the exposure to toxic dust and debris around Ground Zero and other specified areas. Second, Title II of the Zadroga 9/11 Act reopens and expands a number of elements of the September 11th Victim Compensation Fund of 2001.

Title I - Health Benefits 

There are a number of health programs funded under the Zadroga Act. The new law establishes a new WTC responders medical monitoring and treatment program to provide medical evaluation, monitoring, and treatment benefits (including prescription drug benefits) to emergency responders and clean-up workers who were impacted by the WTC attack on September 11th. The benefits are delivered through medical “Centers of Excellence”.

The Zadroga Act also establishes a medical monitoring and treatment program to pay for medical monitoring for WTC responders who performed rescue, recovery, demolition, debris clean-up, and related services. If the responder meets the eligibility criteria and is accepted into the program, the responder is entitled to receive treatment if two conditions are met: (1) the condition is among those identified WTC-related listed conditions including a number of “aerodigestive” disorders, listed mental health conditions, and musculoskeletal disorders occurring during the rescue or recovery efforts, and (2) a physician at a Clinical Center of Excellence determines that a condition was caused or contributed to by exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 11th attacks.

The Zadroga Act also establishes a “survivor program” for non-responders who lived, worked, went to school or were otherwise in a defined area of lower Manhattan (and parts of Brooklyn) for a certain time period after the September 11th attacks. The criteria and medical eligibility determinations for survivors are the same as those that apply to the responders program. The survivor program is the “secondary payor” to any applicable public or private health insurance for the conditions that are not work-related.

Title II - The Re-Opened Victim Compensation Fund of 2001

The Zadroga Act also reopens and significantly expands a number of aspects of the September 11th Victims Compensation Fund of 2001. The Zadroga Act amends the original September 11th Compensation Fund by extending the time in which a claim may be filed for a period of five years from the date that Special Master (who has not yet been appointed) updates the regulations under the Zadroga 9/11 Act. The Victims’ Compensation Fund was originally closed on December 22, 2003.

The Zadroga Act also expands the 9/11 Victim Compensation Fund (VCF) in several important respects. The original VCF provided a right to file a claim only to those individuals injured while “present at the site” of the disasters or in the “immediate aftermath” of the September 11th attacks. “Present at the site” was originally defined by the VCF as physically present at the time of the crashes in the buildings, portions of the buildings that were destroyed as a result of the airplane crashes or any contiguous area that was sufficiently close to the crash site that there was a demonstrable risk of physical harm from the impact of aircraft or any subsequent fire, explosions, or collapse of buildings. As a result, rescue and clean-up workers injured at the buildings or areas not adjacent to the site were not originally eligible to file a claim as they were not “present at the site”.

The original VCF regulations defined the “immediate aftermath” of the crashes for claimants, other than rescue workers, as from the time of the crashes for a period of 12 hours after the crashes. For rescue workers the period of time defined as the “immediate aftermath” was extended to include the period from the crashes until 96 hours after the crashes. Again, rescue and recovery workers who arrived more than 96 hours after the crash and were injured were excluded from filing a claim under the original VCF.

The Zadroga Act expands the definition of “immediate aftermath” to well beyond the 12 and 96 hour post-crash periods defined in the original law. “Immediate aftermath” is redefined by the Zadroga Act to mean “any period beginning with the terrorist-related aircraft crashes of September 11, 2001, and ending on May 30, 2002.” The expansion of what was considered the “immediate aftermath” of the terrorist attacks significantly broadens the pool of claimants in the VCF to include the rescue, construction, an other clean-up workers who suffered injures during the ongoing rescue and clean-up efforts that persisted for many months after the September 11th attacks.

The Zadroga Act also expands definition of the “crash site.” The term “9/11 crash site” is defined by the Zadroga Act to mean: ‘‘(A) the World Trade Center site, Pentagon site, and Shanksville, Pennsylvania site; (B) the buildings or portions of buildings that were destroyed as a result of the terrorist-related aircraft crashes of September 11, 2001; (C) any “area contiguous to a site of such crashes that the Special Master determines was sufficiently close to the site that there was a demonstrable risk of physical harm “ resulting from the impact of the aircraft or any subsequent fire, explosions, or building collapses (including the immediate area in which the impact occurred, fire occurred, portions of buildings fell, or debris fell upon and injured individuals); and (D) any area related to, or along, “routes of debris removal”, such as barges and the Fresh Kills landfill. on Staten Island.

One major issue that is unclear at the time of this writing is whether the residents, workers, and others in lower Manhattan who were sickened by the toxic fallout from the 9/11 attacks are eligible claimants under the VCF. The broadened language of the Zadroga Act amendments would suggest that the area residents and nearby workers are eligible claimants under the reopened VCF.

Within two weeks of the signing of the of Zadroga Act, however, Senator Kirsten Gillibrand’s staff announced that lower Manhattan residents and workers were not covered by the Fund, only to be contradicted by Rep. Jerrold Nadler (a co-author of the Zadroga Act) the next day, declaring that such area residents/workers were in fact covered. Resolution of this issue will need to be decided by the Special Master and the new rules implemented under the Zadroga Act. As of February 11, 2011, no Special Master has been appointed,

The Zadroga Act places sharp limitations on attorneys’ fees. The Zadroga Act amended the original Victim Compensation Fund law to place a “cap on attorneys’ fees of no more than ten percent” of an award made on a claim. The ten percent attorneys’ fee cap is further limited by fees previously received by attorneys representing VCF claimants who were also part of any settled civil action, including the recently settled litigation in the Southern District of NewYork. The Zadroga Act also prohibits an attorney from charging a legal fee in the case of an individual who was charged a legal fee in connection with the settlement of a prior civil action, except if the legal fee charged in connection with the settlement of a civil action is less than 10 percent of the aggregate amount awarded by a subsequent Victim Compensation Fund.

Bottom Line - attorneys who represented the over 10,000 9/11 responders in the recently settled actions against New York City cannot “double dip”. If their fees in the NYC litigation were higher than the 10% attorney fee cap in the Zadroga Act, they cannot charge any fee for the Zadroga VCF claim. New attorneys who represent the claimant solely in the Zadroga VCF claim are also limited by the 10% aggregate cap, which may dissuade some attorneys from taking claims where claimants previously paid attorneys a 25% fee under the NYC settlements. In some cases, the result might be that the attorney fee on the Zadroga Victim Compensation Fund claim could be significantly less that 10%, and could be offset completely.

Conclusion

The passage and enactment of the James Zadroga 9/11 Health and Compensation Act of 2010 was a huge victory for 9/11 first responders and survivors. Most importantly, it provides much needed medical monitoring and treatment to thousands of individuals who are now sick as a result of the 9/11 attacks and its aftermath. We are all aware now of the “toxic soup” that enveloped the area surrounding Ground Zero.

The Zadroga 9/11 Act also provides a second chance for many individuals, who were either ineligible or became sick after the closure of the original Victim Compensation Fund, to apply for a monetary award for their damages. As of February 11, 2011, President Obama has not selected the new Special Master of the Fund.

The original Special Master of the VCF was Kenneth Feinberg, who is now administering claims related to the BP Gulf oil spill. Mr. Feinberg has offered to act as Special Master in the reopened VCF on a pro bono basis. The Special Master must issue new regulations on Fund procedures within 180 days of enactment of the Zadroga 9/11 Act. Once these regulations are issued, attorneys will be in a much better position to counsel our clients on their rights and potential benefits under the new Zadroga Act.
......
Troy G. Rosasco is a Senior Partner at Turley, Redmond, Rosasco & Rosasco, LLP with offices in Nassau, Suffolk and Queens. He has been representing 9/11 victims and first responders since soon after the September 11th attacks. He authors the nationally recognized New York Disability Law Blog.

Daniel J. Hansen is a personal injury trial attorney with his own practice and offices in the Woolworth Building in Manhattan. They are jointly handling 9/11 Victim Compensation Fund claims.

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• The World Trade Center Health Program Expands The Path to Federalization (workers-compensation.blogspot.com)
• Our responsibility to all 9/11 victims | Lila Nordstrom (guardian.co.uk)
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Workers Compensation Fails to Cover Most Occupational Disease Claims

A just published study reports that only 25% of occupational disease claims are covered by US workers' compensation programs.

Click here to read the entire report: Economic Burden of Occupational Injury and Illness in the United States  Get PDF (611K)
"The medical and indirect costs of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Workers’ compensation covers less than 25 percent of these costs, so all members of society share the burden. The contributions of job-related injuries and illnesses to the overall cost of medical care and ill health are greater than generally assumed."

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The National Association of Workers’ Compensation Judiciary March 2016 Newsletter

I strongly urge you to read The National Association of Workers’ Compensation Judiciary March 2016 Newsletter for cutting edge information concerning national workers' compensation issues.

The Compensability of a Swine Flu Pandemic

The US Centers for Disease Control (CDC) has issued an alert for the spread of human swine flu virus. Employers and employees will now need to be alerted to preparations and the reactions that may occur.

In preparation for a Smallpox epidemic, the US government, several years ago, issued rules concerning illness flowing from the distribution of smallpox vaccine. Now the focus will switch from not only compensable conditions flowing from preparation to compensable and contagious diseases in the workplace.

The federal government established a no-fault program entitled the Smallpox Emergency Personnel Protection Act of 2003 (SEPPA) in an effort to provide benefits and/or compensation to certain individuals, including health-care workers and emergency responders, who are injured as a result of the administration of smallpox countermeasures including the smallpox (vaccinia) vaccine. The Department of Health and Human Services, under rule making authority, established a vaccine injury table and procedural process for filing a request for benefits and/or compensation under the Program.

Already the CDC reported today, "Human cases of swine influenza A (H1N1) virus infection have been identified in the U.S. in San Diego County and Imperial County, California as well as in San Antonio, Texas. Internationally, human cases of swine influenza A (H1N1) virus infection have been identified in Mexico."

The CDC has reported that Swine flu has impacted the US in the past: "Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death."

As new cases become suspect, concern will focuss on the spread of the disease in the workplace environment. Over 75 students are being tested in New York City. The Governor of California has issued an alert. As of now the Federal government is directing individuals to their local workers' compensation programs. Since a pandemic could be considered a challenge to Homeland Security, the federalization of prevention, treatment and compensation may ultimately result in expansion of a nationalization of the program.
......
To read more about compensation for the flu click here.

Why Cases Don't Settle in Washington State

Guest Blog
By Kit Case of Causey Law, Washington


The Size of the Check Points the Way
In Washington State, the majority of workers’ compensation claims are “State Fund” claims managed by the Department of Labor and Industries (Department), with perhaps a third are comprised of “self-insured” claims managed by third-party administration companies under the oversight of the Department. In “State Fund” claims, managed by State employees, benefits are paid from monies received from both workers and employers – - Washington is the only state where workers and employers each pay half of the medical insurance premiums. When a dispute arises in a claim, the aggrieved party can file an appeal to the Board of Industrial Insurance Appeals (Board), another State agency. When an appeal is filed with the Board, the Department is represented by the Office of the Attorney General, yet another State agency.


Since the economic crisis hit Washington, as it has in every other state in the union, the Department of Labor and Industries has become very cautious concerning any expenditures.


Since the economic crisis hit Washington, as it has in every other state in the union, the Department of Labor and Industries has become very cautious concerning any expenditures. After all, audits have found mis-spent money — nothing worthy of headlines, but the media loves a good fraud story as much as they love a government waste story. Fraud investigations and video surveillance have increased dramatically in recent years at great expense to the Department with minimal economic benefit. The Department was recently found to have spent a significant sum on no-show fees to independent medical examination companies without recouping those charges from the claimants who failed to attend the examinations or, in some of the cases, without properly notifying those companies to avoid the charges when a cancellation was known to have occurred. The end result of the Department’s caution is that benefits clearly payable to a claimant are being delayed or denied simply based on the amount of money at stake.


Payments of minor amounts can be made by Department claims managers at their discretion, based on the records on file. Amounts over a few thousand dollars, however, trigger the need for supervisor review and approval before payment can be made. Consequently, we are working much harder to obtain payment administratively because the Department increasingly requires proof of entitlement to benefits “beyond a reasonable doubt” rather than simply based upon the opinion of a treating physician. One doctor’s opinion of a worker’s inability to work seems no longer enough to establish entitlement to benefits. We increasingly face roadblocks to payment in cases where the Department concocts an issue over whether the inability to work is related to the covered injury or condition or is instead due to some pre- or post-existing condition, even if the disabling condition is clearly shown to be related to the original injury or the treatment procedures for that injury. If payment or authorization for treatment for a condition is denied, we are forced to demand an order be issued. We then file an appeal, and off to litigation we go.


In the current economic climate simply the amount of money involved increasingly drives the decision-making process at every administrative level.


The paralegals and attorneys at our firm work diligently to document the benefits we are seeking and the medical support for the claims we are making. In some cases, the monetary benefit at issue is a fairly significant amount. In the current economic climate simply the amount of money involved increasingly drives the decision-making process at every administrative level. Denials are much more common when a significant sum is at stake, regardless of the validity of the claim. We encounter a “make them prove it” attitude, forcing cases to go through time-consuming and expensive litigation rather than being resolved through mediation discussions or agreement between the parties.


Yesterday, I received phone call apology after a denial order had been issued, expressing condolences but the hope that we will be able to prevail on appeal. Today, I was told by an Assistant Attorney General that she would likely not be able to get authority from her client – the Department — to accept our settlement offer due to the amount of money at issue – “the case will just have to be litigated.”


I can accept these denials when there is a genuine dispute over the facts, over whether a claimant is entitled to the benefits or not. I cannot accept it when the answer is simply “it’s too much money.” I would prefer the other side tell me why my argument lacks merit, tell me that I am wrong in my belief that the claimant is entitled to the benefits at issue, tell me where the hole in my case is – anything – but, please, don’t just say that it’s too much money. That is not a reason for a State Agency which, unlike an insurance company, has no inherent profit motive, to deny benefits.


Consider the relatively low values in workers’ compensation claims: 60 – 72% of pre-injury wages as wage-replacement compensation; surprisingly small awards for permanent impairment, with no consideration given to the impact on lifestyle or earnings ability. If there is a significant sum at stake, it is because of YEARS of delay, or years of benefits at issue, not because the claimant is lucky or greedy. The claimant didn’t win the lottery; he or she was simply injured on the job and denied benefits when they were most needed. That required hiring an attorney, and in many cases expended large sums of money in efforts to support their case. The significant sums often at issue in these cases do not make claimants RICH, nor do they make them WHOLE. They only provide the limited measure of compensation that our workers’ compensation system allows.


Don’t add insult to injury.
My message to our State: Don’t add insult to injury. Show claimants the respect they deserve and promptly make decisions in their claims based on the merits of their arguments and the evidence presented, without being influenced simply by the amount of the check that may be issued.


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