The most dramatic factor in re-shaping the future of workers’ compensation is that we now have a sharing economy, Quietly, over the decades, “work” has been influenced dramatically by the Millennial Generation. As the sharing generation reinvents the economy, the element of “trust” will have the most important impact in the direction of social legislative programs such as workers’ compensation.
Showing posts sorted by relevance for query future. Sort by date Show all posts
Showing posts sorted by relevance for query future. Sort by date Show all posts
Wednesday, July 29, 2015
Friday, May 15, 2009
A Brokered Marriage: Medicare and Workers’ Compensation
The problems of old age are now worrying are beginning to influence decision makers on what to do with two major delivery system in the United States. Both the Medicare system and the workers’ compensation medical delivery system are now ailing. The fiscal remedy maybe their marriage.
The Medicare Hospital Fund will be insolvent by 2017. The Trustees of the program have indicated that the program has been paying out more than it has collected in taxes and interest over the last two years. This estimated date of insolvency is two years ahead of schedule and the shortfall will necessitate a deposit of $13.4 trillion.
Robert Pear reported in the NY Times this week, “’The financial outlook for the hospital insurance trust fund is significantly less favorable than projected in last year's annual report,’ the trustees said, adding, ‘Actual payroll tax income in 2008 and projected future amounts are significantly lower than previously projected, due to lower levels of average wages and fewer covered workers.’”
The workers’ compensation medical delivery system has been plagued with a set of its own difficulties including: cost shifting to Medicare and reimbursement issues, rising costs that now exceed the indemnity aspect of the program, lack of uniformity and delay in delivery of medical benefits, staggering litigation and administrative costs and uncertainty as to future premiums because of a failing economy.
The voice of change is now being heard in Washington as health care takes the stage front and center on the issues of affordability and choice. David Axelrod has indicated that the Administration is committed to "fix what's broken in the system and preserve what's good."
When the Social Security system was initial enacted, the country faced similar economic troubles. Employee medical coverage was not a consideration of the original program. The geriatric nature of both the Social Security system and the multiple workers’ compensation programs are now evidencing the problems of old age. A marriage of convenience maybe just what the future holds.
The Medicare Hospital Fund will be insolvent by 2017. The Trustees of the program have indicated that the program has been paying out more than it has collected in taxes and interest over the last two years. This estimated date of insolvency is two years ahead of schedule and the shortfall will necessitate a deposit of $13.4 trillion.
Robert Pear reported in the NY Times this week, “’The financial outlook for the hospital insurance trust fund is significantly less favorable than projected in last year's annual report,’ the trustees said, adding, ‘Actual payroll tax income in 2008 and projected future amounts are significantly lower than previously projected, due to lower levels of average wages and fewer covered workers.’”
The workers’ compensation medical delivery system has been plagued with a set of its own difficulties including: cost shifting to Medicare and reimbursement issues, rising costs that now exceed the indemnity aspect of the program, lack of uniformity and delay in delivery of medical benefits, staggering litigation and administrative costs and uncertainty as to future premiums because of a failing economy.
The voice of change is now being heard in Washington as health care takes the stage front and center on the issues of affordability and choice. David Axelrod has indicated that the Administration is committed to "fix what's broken in the system and preserve what's good."
When the Social Security system was initial enacted, the country faced similar economic troubles. Employee medical coverage was not a consideration of the original program. The geriatric nature of both the Social Security system and the multiple workers’ compensation programs are now evidencing the problems of old age. A marriage of convenience maybe just what the future holds.
Tuesday, December 17, 2013
Governor Cuomo Announces Significant new Protections for World Trade Center Workers
Governor Andrew M. Cuomo today announced World Trade Center workers who performed rescue, recovery and clean-up in the year after 9/11 now have significant new protections for workers’ compensation benefits. The World Trade Center Registry was reopened and the deadline for joining extended to September 11, 2014; certain previously time-barred World Trade Center claims are being reopened and considered timely; and qualifying health conditions were added to the law.
“New York State is committed to caring for those who stood up in the face of danger to assist in the rescue and recovery efforts during and after the horrific attacks at the World Trade Center,” Governor Cuomo said. “That is why we are providing new protections for the workers, including first responders, clean-up crews and volunteers, who answered the call for help and ensuring they have access to workers’ compensation benefits for the future. I urge those who worked at Ground Zero and other recovery sites to file a WTC-12 form today to apply for the benefits they deserve.”
Filing a WTC-12 form with the Workers’ Compensation Board preserves the workers’ compensation rights for those who performed rescue, recovery and clean-up after the World Trade Center attacks. The State again urges those who worked at Ground Zero, the Fresh Kills Landfill, on the barges, the piers and the morgues to file a WTC-12 form, no matter if they were injured or not and whether they were employed or volunteered.
The last national Tell Us You Were There campaign ended with 41,094 filings received by the previous Sept. 13, 2010, deadline. As part of a new law signed by Governor Cuomo, any WTC-12 filings received after that date are now consider timely.
The Board will also review its files to locate any World Trade Center claims previously disallowed as “untimely” under Workers’ Compensation Law Secs. 18 and/or 28 or from failure to file a timely WTC-12 form. The Board will, under its own initiative, now reconsider those particular World Trade Center claims “timely.”
A detailed list of qualifying health conditions resulting from hazardous exposure for World Trade Center workers who participated in rescue, recovery and clean-up operations was also added. The categories are diseases of the:
“When New Yorkers needed their help, 9/11 rescue, recovery, and cleanup workers selflessly answered the call,” President of the New York State AFL-CIO Mario Cilento said. “It's incumbent upon us, as a state, to be there for them now and in the future as we continue to learn more about the growing impact of their exposure. We commend Governor Cuomo and the Legislature for ensuring that critical treatment and benefits will be available for the heroes who served in the aftermath of 9/11.”
“The enactment of this legislation is a major victory for those who worked in rescue, recovery and cleanup operations following the attack on the World Trade Center,” Executive Director Joel Shufro of the New York Committee for Occupational Safety and Health said. “By extending the deadline to register to file a claim for another year and reinstating those whose registrations were previously time barred, many workers who develop WTC related illnesses with long latency periods will be eligible to file for benefits under New York State’s Workers’ Compensation Law. The enactment of this legislation is an act of justice and equity and the legislature should be congratulated for passing the legislation and the governor for signing it.”
“As an injured worker as of the result of working at Ground Zero, I know firsthand what this important piece of legislation means to those who are sick or injured from their heroic actions. This will bill not only provides those sick or injured the opportunity to apply for benefits, but more importantly it gives them hope that our Governor still cares about yesterday's heroes,” John Feal, founder of the FealGood Foundation, said.
Governor Cuomo is committed to ensuring all World Trade Center workers receive the benefits and protections they are accorded under the law. To achieve this, at his direction the Board has:
Contacted previously untimely filers;
Translated the WTC-12 form into seven languages other than English;
Reopened a dedicated phone line for World Trade Center workers, 1 855 WTC-2014 (1 855 982-2014);
Relaunched the web page www.wcb.ny.gov/WTC12 for World Trade Center workers; and
Planned outreach to workers and groups representing World Trade Center workers.
All these worker protections were added to Workers’ Compensation Law Article 8-A.
The Board’s dedicated World Trade Center work groups and hearing parts have functioned continuously since September 2001.
….
“New York State is committed to caring for those who stood up in the face of danger to assist in the rescue and recovery efforts during and after the horrific attacks at the World Trade Center,” Governor Cuomo said. “That is why we are providing new protections for the workers, including first responders, clean-up crews and volunteers, who answered the call for help and ensuring they have access to workers’ compensation benefits for the future. I urge those who worked at Ground Zero and other recovery sites to file a WTC-12 form today to apply for the benefits they deserve.”
Filing a WTC-12 form with the Workers’ Compensation Board preserves the workers’ compensation rights for those who performed rescue, recovery and clean-up after the World Trade Center attacks. The State again urges those who worked at Ground Zero, the Fresh Kills Landfill, on the barges, the piers and the morgues to file a WTC-12 form, no matter if they were injured or not and whether they were employed or volunteered.
The last national Tell Us You Were There campaign ended with 41,094 filings received by the previous Sept. 13, 2010, deadline. As part of a new law signed by Governor Cuomo, any WTC-12 filings received after that date are now consider timely.
The Board will also review its files to locate any World Trade Center claims previously disallowed as “untimely” under Workers’ Compensation Law Secs. 18 and/or 28 or from failure to file a timely WTC-12 form. The Board will, under its own initiative, now reconsider those particular World Trade Center claims “timely.”
A detailed list of qualifying health conditions resulting from hazardous exposure for World Trade Center workers who participated in rescue, recovery and clean-up operations was also added. The categories are diseases of the:
- Upper respiratory tract and mucosae;
- Lower respiratory tract;
- Gastroesophageal tract;
- Psychological axis; and
- New onset diseases that develop in the future resulting from exposure.
“When New Yorkers needed their help, 9/11 rescue, recovery, and cleanup workers selflessly answered the call,” President of the New York State AFL-CIO Mario Cilento said. “It's incumbent upon us, as a state, to be there for them now and in the future as we continue to learn more about the growing impact of their exposure. We commend Governor Cuomo and the Legislature for ensuring that critical treatment and benefits will be available for the heroes who served in the aftermath of 9/11.”
“The enactment of this legislation is a major victory for those who worked in rescue, recovery and cleanup operations following the attack on the World Trade Center,” Executive Director Joel Shufro of the New York Committee for Occupational Safety and Health said. “By extending the deadline to register to file a claim for another year and reinstating those whose registrations were previously time barred, many workers who develop WTC related illnesses with long latency periods will be eligible to file for benefits under New York State’s Workers’ Compensation Law. The enactment of this legislation is an act of justice and equity and the legislature should be congratulated for passing the legislation and the governor for signing it.”
“As an injured worker as of the result of working at Ground Zero, I know firsthand what this important piece of legislation means to those who are sick or injured from their heroic actions. This will bill not only provides those sick or injured the opportunity to apply for benefits, but more importantly it gives them hope that our Governor still cares about yesterday's heroes,” John Feal, founder of the FealGood Foundation, said.
Governor Cuomo is committed to ensuring all World Trade Center workers receive the benefits and protections they are accorded under the law. To achieve this, at his direction the Board has:
Contacted previously untimely filers;
Translated the WTC-12 form into seven languages other than English;
Reopened a dedicated phone line for World Trade Center workers, 1 855 WTC-2014 (1 855 982-2014);
Relaunched the web page www.wcb.ny.gov/WTC12 for World Trade Center workers; and
Planned outreach to workers and groups representing World Trade Center workers.
All these worker protections were added to Workers’ Compensation Law Article 8-A.
The Board’s dedicated World Trade Center work groups and hearing parts have functioned continuously since September 2001.
….
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.
Tuesday, May 11, 2021
COVID-19: A lesson for the workers’ compensation industry
Michael Lewis’s new book, The Premonition, is about three characters and their struggle to alert the Nation about the COVID-19 pandemic. The book offers a shocking insight into the mismanagement of the public health care system. The workers’ compensation industry lacked adequate information to prepare for the epidemic properly. It must address this deficiency in the future.
Monday, October 16, 2023
Wayne NJ Contractor Fined $180K for Exposing Workers to Energized Power Lines
The U.S. Department of Labor has entered into a settlement agreement with a New Jersey building contractor who allowed their subcontractors' employees to work in close proximity to high-voltage power lines at a Paterson work site in 2021 and 2022.
Friday, September 30, 2011
CMS Announced Status Update and Future Changes
As part of the Centers for Medicare & Medicaid Service (CMS) efforts to continuously improve its Medicare Secondary Payer (MSP) program; CMS has posted the following information to the MSP websites:
1) An ALERT delaying the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) Section 111 MSP reporting requirement for certain liability insurance (including self-insurance) settlements, judgments, awards, or other payments is now posted at www.cms.gov/MandatoryInsRep.
2) Policy guidance related to Exposure, Ingestion, and Implantation issues, and December 5, 1980, is now posted at www.cms.gov/MandatoryInsRep and www.cms.gov/COBGeneralInformation.
3) An ALERT related to Qualified Settlement Funds, under Section 468B of the Internal Revenue Code, is now posted at www.cms.gov/MandatoryInsRep.
4) A policy memorandum, for liability insurance (including self-insurance), on the acceptance of the treating physician's certification, and its impact on the issue of protecting Medicare's interests with respect to future medicals is now posted at www.cms.gov/COBGeneralInformation.
In addition, on September 30, 2011, the MSPRC will implement a self-service information feature to its customer service line. This feature gives callers the ability to get the most up-to-date Demand/Conditional Payment amounts, and the dates that those letters were issued, without having to speak to a customer service representative. The self-service feature will be available for extended hours, and callers will have the option of requesting information on multiple cases during one phone call.
Beginning in October 2011, CMS will implement an option to pay a fixed percentage of certain physical trauma-based liability cases with settlement amounts of $5000 or less. Detailed information on this option will be posted as an ALERT, on or before October 21, 2011, on the MSPRC website at www.MSPRC.info.
Upcoming improvements to the MSP program, expected within the next 3-9 months, include the following:
• The implementation of a MSPRC portal, where the beneficiary/representative can obtain information about Medicare's claim payments, demand letters, etc., and input information related to a settlement, disputed claims, etc.
• The implementation of an option that allows for an immediate payment to Medicare for future medical costs that are claimed/released/effectively released in a settlement.
• The implementation of a process that provides Medicare's conditional payment amount, prior to settlement in certain situations.
1) An ALERT delaying the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) Section 111 MSP reporting requirement for certain liability insurance (including self-insurance) settlements, judgments, awards, or other payments is now posted at www.cms.gov/MandatoryInsRep.
2) Policy guidance related to Exposure, Ingestion, and Implantation issues, and December 5, 1980, is now posted at www.cms.gov/MandatoryInsRep and www.cms.gov/COBGeneralInformation.
3) An ALERT related to Qualified Settlement Funds, under Section 468B of the Internal Revenue Code, is now posted at www.cms.gov/MandatoryInsRep.
4) A policy memorandum, for liability insurance (including self-insurance), on the acceptance of the treating physician's certification, and its impact on the issue of protecting Medicare's interests with respect to future medicals is now posted at www.cms.gov/COBGeneralInformation.
In addition, on September 30, 2011, the MSPRC will implement a self-service information feature to its customer service line. This feature gives callers the ability to get the most up-to-date Demand/Conditional Payment amounts, and the dates that those letters were issued, without having to speak to a customer service representative. The self-service feature will be available for extended hours, and callers will have the option of requesting information on multiple cases during one phone call.
Beginning in October 2011, CMS will implement an option to pay a fixed percentage of certain physical trauma-based liability cases with settlement amounts of $5000 or less. Detailed information on this option will be posted as an ALERT, on or before October 21, 2011, on the MSPRC website at www.MSPRC.info.
Upcoming improvements to the MSP program, expected within the next 3-9 months, include the following:
• The implementation of a MSPRC portal, where the beneficiary/representative can obtain information about Medicare's claim payments, demand letters, etc., and input information related to a settlement, disputed claims, etc.
• The implementation of an option that allows for an immediate payment to Medicare for future medical costs that are claimed/released/effectively released in a settlement.
• The implementation of a process that provides Medicare's conditional payment amount, prior to settlement in certain situations.
Friday, July 14, 2017
The Rise and Fall of Workers' Compensation - The Path to Federalization
Every year The Board of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Supplemental Medical Insurance Trust Funds makes an actuarial guess as to the future financial solvency of Medicare. The report creates an annual news frenzy in the workers’ compensation community since Medicare is both the safety net for injured workers and playground for employers and their insurance companies to use in cost shifting,
Friday, September 14, 2012
NJ Legislature to Discuss Workers Compensation Reforms
The Senate Labor Committee will meet on Thursday, September 20, 2012 at 10:00 AM in Committee Room 6, First Floor, State House Annex, Trenton, New Jersey.
The following bills will be considered:
S-1630
Bateman/Oroho
Prohibits payment of temporary disability benefits to incarcerated individuals.
S-1898
O'Toole/Allen
Prohibits requirement to provide information for access to account on social networking website by employer.
S-1915
Sweeney/Whelan
Prohibits requirement to disclose user name, password, or other means for accessing account or service through electronic communications device by employers.
S-1916
Sweeney
A-2879
Burzichelli/Greenwald/
Ramos/Conaway/Caride
Prohibits requirement to disclose user name, password, or other means for accessing account or service through electronic communications devices by institutions of higher education.
S-1926
Greenstein
Bans charging workers' compensation claimants for medical expenses, gives Division of Workers' Compensation sole jurisdiction over work-related medical claims. (Binding arbitration)
S-2022
Madden
A-2652 (1R)
Eustace/Singleton/Egan/
Benson/Coughlin
Bans charging workers' compensation claimants for medical expenses, gives Division of Workers' Compensation sole jurisdiction over work-related medical claims.
SCR-123
Scutari
Memorializes Congress and the President to enact the "Team USA Made in America Act of 2012."
A-2878 (1R)
Burzichelli/Greenwald/
Ramos/Conaway/Caride
Prohibits requirement to disclose user name, password, or other means for accessing account or service through electronic communications device by employers.
Read more about medical billing
Feb 17, 2012
Medical bills now account for almost 70% of the total of workers' compensation benefits paid, and the collection of those unpaid medical bills has exploded into a cottage business creating enormous procedural and ...
Aug 02, 2012
In 2007, Stancil filed a motion in the compensation court seeking an order compelling ACE to pay outstanding medical bills. During a hearing on the motion, the compensation judge commented that ACE had a history of failing...
Apr 09, 2009
Medical Bills of Smokers Reported to be Less Than Expected. It has been recently reported that smokers may actually cost society less for medical treatment than non-smokers. The CDC has reported that since smokers die on...
Jul 23, 2009
The number of disputes concerning the payment/reimbursement of medical bills have increased in workers' compensation claims in New Jersey. The State has proposed converting the Informal Hearing procedure into a new ...
Tuesday, April 7, 2009
CMS Publishes Memo on Pricing Future Prescription Drug Treatment
The Centers for Medicare & Medicaid Services' (CMS) has published a memorandum outlining the methodology of pricing future prescription drug treatment costs/expenses in Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) proposals.
"The CMS will begin independently pricing future prescription drug treatment costs/expenses in WCMSA proposals beginning June 1, 2009. Effective with complete WCMSA submissions received by CMS’ Coordination of Benefits (COB) Contractor on or after June 1, 2009, where the WC related injury warrant(s) the need of prescription drugs for the ongoing treatment of the WC related injury, CMS’ independent pricing of the prescription drug amount will be calculated and priced using average wholesale price (AWP). The CMS will not use or recognize any other pricing, discounting, or calculation methods when determining the adequacy of the prescription drug amounts in WCMSA proposals. "
"The CMS will begin independently pricing future prescription drug treatment costs/expenses in WCMSA proposals beginning June 1, 2009. Effective with complete WCMSA submissions received by CMS’ Coordination of Benefits (COB) Contractor on or after June 1, 2009, where the WC related injury warrant(s) the need of prescription drugs for the ongoing treatment of the WC related injury, CMS’ independent pricing of the prescription drug amount will be calculated and priced using average wholesale price (AWP). The CMS will not use or recognize any other pricing, discounting, or calculation methods when determining the adequacy of the prescription drug amounts in WCMSA proposals. "
Tuesday, April 26, 2022
What is our COVID-19 Future?
Over the last two years, chaos has reigned in the workplace as workers, employers, and insurance companies attempted to adjust to the emergence of COVID and its multiple variants. While infectious diseases have impacted occupational environments in the last century, the lack of preparation was totally inadequate.
Friday, August 9, 2013
Debtors’ in asbestos bankruptcy case appeal estimation decision to Third Circuit
Today's post was shared by Legal Newsline and comes from legalnewsline.com
Fitzgerald
But then came Fitzgerald’s 50-page May 20 memorandum opinion in which the Delaware-based jurist estimated the liabilities of Specialty Products Holding Corp. and Bondex International to be in the neighborhood of $1.1 billion, many millions of dollars higher than what the debtors contended the true figure to be.
An expert working for the bankrupt companies – they are referred to as ‘debtors’ in bankruptcy proceedings as opposed to ‘defendants’ in the tort system – had estimated total future liabilities at between $465 million to $700 million nominal or $300 million to $575 million net present value.
In the end, Fitzgerald, who retired from the bench shortly after rendering her decision in the case, estimated the liabilities to be closer to the figures thrown out by attorneys representing the Official Committee of Asbestos Personal Injury Claimants and the Future Claimants’ Representative, numbers that were in the billion-dollar range.
Appropriate estimateIn her May decision, Fitzgerald wrote that after considering all of the evidence in the case, exhibits and arguments presented to the court during a weeklong estimation hearing in Pittsburgh earlier this year and during subsequent briefs and other legal filings, she considered an appropriate estimate for mesothelioma claims, pending and future, to be $1.1 billion net present value.
The judge also determined that an additional six percent, or $66 million, would have to be...
[Click here to see the rest of this article]
Friday, July 25, 2008
The Future of Workers' Compensation: Navigating the New Benefit Highway
The Future of Workers' Compensation: Navigating the New Benefit Highway
The past and present will predict the future of the new workers' compensation benenfit highway. This Power Point presentation is available in a PDF format and for the next 14 days may be securely downloaded from https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE at no cost to the first 500 requests.
Link available at:
https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE
The past and present will predict the future of the new workers' compensation benenfit highway. This Power Point presentation is available in a PDF format and for the next 14 days may be securely downloaded from https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE at no cost to the first 500 requests.
Link available at:
https://www.yousendit.com/transfer.php?action=download&ufid=Smp1Q3QzTWNtUUZFQlE
Sunday, March 28, 2021
Permanent Disability: The post-acute COVID-19 sequelae
The residuals of post-acute residuals of COVID-19 (Sars-CoV-2) may result in compensable permanent disability for many individuals (long haulers). A recent study outlines the potential compensable sequelae.
Thursday, January 10, 2008
CMS Hammers Work Comp Carriers with Major MSP Reporting Requirements
A new law on the books introduced in the Senate on Dec. 18, 2007 and signed by the President on December 29, 2007 is going to have significant impact on how the workers' compensation system operates in the future concerning Medicare Secondary Payer (MSP) issues. Robert E. Taren, Esq. of California, a national expert on the subject, has alert me to the new legislation.
For years it has been a dirty little secret in the Workers' Compensation Industry that the insurance carriers were shifting the medical liability from themselves to Medicare. Enacted in 1980 the Medicare Secondary Payment Act has had major enforcement problems and Medicare has continued to bleed dollars. Struggling with the issue and after major reports of a failing system, Medicare in 2001 issued the famous Patel Memorandum establishing a system where the workers' compensation industry would be required to obtain Medicare consent before future medical benefits could be compromised. Medicare also established a recovery program from benefits that were paid in the past and actually the responsibility of the workers' compensation system.
Plagued by the multiple network of workers' compensation programs and reluctant players in the system to provide data, Medicare has struggled to establish a efficient program. Attorneys, claimants, insurance carriers and the agencies themselves have been reluctant to provide information to Medicare and in turn Medicare has had to seek information through convoluted reporting procedures.
A stagnating system has caused those in the workers' compensation industry to complaint that that the process is too slow and that the workers' compensation has been placed on life support systems. Additionally the major stakeholders in the system, the insurance carriers and the employers have made failed attempts to cut Medicare off at the knees by eliminating and reducing the past due recoveries and the potential future medical payments.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 requires workers' compensation carriers to submit information to Medicare on a schedule prescribed by the Federal government or be subject to a $1,000 a day fine for each violation.
For years it has been a dirty little secret in the Workers' Compensation Industry that the insurance carriers were shifting the medical liability from themselves to Medicare. Enacted in 1980 the Medicare Secondary Payment Act has had major enforcement problems and Medicare has continued to bleed dollars. Struggling with the issue and after major reports of a failing system, Medicare in 2001 issued the famous Patel Memorandum establishing a system where the workers' compensation industry would be required to obtain Medicare consent before future medical benefits could be compromised. Medicare also established a recovery program from benefits that were paid in the past and actually the responsibility of the workers' compensation system.
Plagued by the multiple network of workers' compensation programs and reluctant players in the system to provide data, Medicare has struggled to establish a efficient program. Attorneys, claimants, insurance carriers and the agencies themselves have been reluctant to provide information to Medicare and in turn Medicare has had to seek information through convoluted reporting procedures.
A stagnating system has caused those in the workers' compensation industry to complaint that that the process is too slow and that the workers' compensation has been placed on life support systems. Additionally the major stakeholders in the system, the insurance carriers and the employers have made failed attempts to cut Medicare off at the knees by eliminating and reducing the past due recoveries and the potential future medical payments.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 requires workers' compensation carriers to submit information to Medicare on a schedule prescribed by the Federal government or be subject to a $1,000 a day fine for each violation.
Monday, August 12, 2013
Bloomberg Sees Higher Costs in a Union-Friendly Mayor
How government looks at the distribution of health care benefits is insightful as to predicting the future of workers' compensation. The change of delivery mechanism implied in the comments of NYC's Mayor, Mike Bloomberg, sketch out a potential future blueprint.Today's post was shared by Steven Greenhouse and comes from www.nytimes.com
Warning of the fiscal danger if New York City fails to rein in its spiraling pension and health care costs, Mayor Michael R. Bloomberg on Tuesday challenged his would-be successors to take a tough line in negotiations with the city’s unions, while worrying aloud that whoever is elected will be too beholden to labor.
“We can’t wake up tomorrow morning — the day after the election — and find that some candidate has made a back-room deal with one of the unions that sets the pattern for all the other unions that will eventually lead to stopping the growth in this city,” Mr. Bloomberg said, departing from his prepared remarks at the end of a speech in Brooklyn on the city’s economy and fiscal situation.
“We cannot afford certain things,” he continued. “It’s tough to say no. It’s particularly tough to say no when nobody wants anybody to get hurt. But the bottom line: this is the taxpayers’ money, and this is our future.”
Mr. Bloomberg’s speech, delivered at a former Pfizer manufacturing plant that is now home to some two dozen small companies, producing everything from 3D printers to kimchi, was in part an attempt to burnish his record of fiscal stewardship, which is hotly debated. He argued that he has determinedly tried to reform pensions and health care but has been stymied by unions.
Fiscal watchdogs note that his administration presided over a 40 percent increase in the city budget, and in his second term handed out raises without demanding concessions on pensions and...
Warning of the fiscal danger if New York City fails to rein in its spiraling pension and health care costs, Mayor Michael R. Bloomberg on Tuesday challenged his would-be successors to take a tough line in negotiations with the city’s unions, while worrying aloud that whoever is elected will be too beholden to labor.
“We can’t wake up tomorrow morning — the day after the election — and find that some candidate has made a back-room deal with one of the unions that sets the pattern for all the other unions that will eventually lead to stopping the growth in this city,” Mr. Bloomberg said, departing from his prepared remarks at the end of a speech in Brooklyn on the city’s economy and fiscal situation.
“We cannot afford certain things,” he continued. “It’s tough to say no. It’s particularly tough to say no when nobody wants anybody to get hurt. But the bottom line: this is the taxpayers’ money, and this is our future.”
Mr. Bloomberg’s speech, delivered at a former Pfizer manufacturing plant that is now home to some two dozen small companies, producing everything from 3D printers to kimchi, was in part an attempt to burnish his record of fiscal stewardship, which is hotly debated. He argued that he has determinedly tried to reform pensions and health care but has been stymied by unions.
Fiscal watchdogs note that his administration presided over a 40 percent increase in the city budget, and in his second term handed out raises without demanding concessions on pensions and...
Saturday, April 2, 2016
Is Social Insurance in Our Nation's Future?
The changing economy presents both new concepts and new challenges. Over 60% of today's
children will be employed in jobs that don't even exist now. An interesting article explores whether social insurance, of which workers' compensation is a part, will even exist the future.
Tuesday, July 11, 2023
EPA Seeks Reporting of Asbestos Fibers
The U.S. Environmental Protection Agency (EPA) announced a final rule to require comprehensive reporting on all six fiber types of asbestos as the agency continues its work to address exposure to this known carcinogen and strengthen the evidence that will be used to protect people from this dangerous chemical further. Historically asbestos, a known carcinogen, has been present in workplaces causing significant occupational exposures to workers, sometimes fatal, and has generated a long wave of workers’ compensation claims.
Wednesday, June 10, 2009
The Lack of Equality in the CMS Reimbursement Policy
The current debate on national health care has brought to the forefront some of the most glaring problems that are compounding the workers’ compensation medical delivery system. Since the enactment of The Medicare Secondary Payer Act (MSP) in 1980, the Federal Government has desperately tried to prevent cost shifting from the workers’ compensation system to the Federal Medicare program. The efforts of The Centers for Medicare and Medicaid Service (CMS) to seek medical reimbursement of past and future medical care costs from workers’ compensation beneficiaries, in a uniform fashion across the entire national spectrum, is plagued with equality issues.
In a very insightful article, Robert Pear of The New York Times on June 9, 2009 reported that costs of medical care were not uniform through out the nation and that an increase in expenditures for treatment did not improve the outcome. These “disparities,” as Pear points out demonstrate major fluctuations in the cost of Medicare payments for the same types of treatment. “Nationally, according to the Dartmouth Atlas of Health Care, Medicare spent an average of $8,304 per beneficiary in 2006. Among states, New York was tops, at $9,564, and Hawaii was lowest, at $5,311.”
The costs for medical care paid by Medicare based upon geographical jurisdictions are unequal. More specifically, higher costs states were reported to be: Florida, Massachusetts, New Jersey and New York. The lower cost states were reported as: Iowa, Minnesota, Montana, North Dakota, Oregon and Washington.
CMS has sought to seek reimbursement under the MSP Act for medical care, present and future, based on a nationally tailored program. Unfortunately, the benefits paid by each state program are not the same.
While the program to deter the shift of billions of dollars Medicare funds yearly to pay for work related injuries and disease is a noble goal and legitimate function, it is now unequally applied to beneficiaries across the country since all workers’ compensation benefit programs are not the same and the costs of medical treatment vary.
The need for uniformity and equality should be address by Congress as it debates the future of medical care legislation. The enactment of a single payer medical care system would be a good first step to leveling the playing field for both employers and employees.
In a very insightful article, Robert Pear of The New York Times on June 9, 2009 reported that costs of medical care were not uniform through out the nation and that an increase in expenditures for treatment did not improve the outcome. These “disparities,” as Pear points out demonstrate major fluctuations in the cost of Medicare payments for the same types of treatment. “Nationally, according to the Dartmouth Atlas of Health Care, Medicare spent an average of $8,304 per beneficiary in 2006. Among states, New York was tops, at $9,564, and Hawaii was lowest, at $5,311.”
The costs for medical care paid by Medicare based upon geographical jurisdictions are unequal. More specifically, higher costs states were reported to be: Florida, Massachusetts, New Jersey and New York. The lower cost states were reported as: Iowa, Minnesota, Montana, North Dakota, Oregon and Washington.
CMS has sought to seek reimbursement under the MSP Act for medical care, present and future, based on a nationally tailored program. Unfortunately, the benefits paid by each state program are not the same.
While the program to deter the shift of billions of dollars Medicare funds yearly to pay for work related injuries and disease is a noble goal and legitimate function, it is now unequally applied to beneficiaries across the country since all workers’ compensation benefit programs are not the same and the costs of medical treatment vary.
The need for uniformity and equality should be address by Congress as it debates the future of medical care legislation. The enactment of a single payer medical care system would be a good first step to leveling the playing field for both employers and employees.
Saturday, August 28, 2010
There is No Good Asbestos -- It Is All a Killer
Chrysotile Asbestos and Mesothelioma
Assistant Surgeon General, U.S. Public Health Service (retired), National Institute for Occupational Safety and Health (retired), Canton, Georgia, E-mail: richard@ralemen.org
Citation: Lemen RA 2010. Chrysotile Asbestos and Mesothelioma. Environ Health Perspect 118:a282-a282. doi:10.1289/ehp.1002446
Online: 01 July 2010
Editor’s Note: We appreciate Lemen’s concern about the incorrect statement that was included in the original Editor’s Summary for Tse et al. (2010), and we regret the error. The Editor’s Summary has been corrected in the online version of the paper, and an erratum was published in the June issue of EHP [118:A240 (2010)]; the text of the erratum is included below:
The Editor’s Summary for the article “Are Current or Future Mesothelioma Epidemics in Hong Kong the Tragic Legacy of Uncontrolled Use of Asbestos in the Past?” by Tse et al. [Environ Health Perspect 118:382–386 (2010); doi:10.1289/ehp.0900868], has been corrected online: specifically, “(which has been implicated but not conclusively established as a cause of mesothelioma)” has been deleted.
The author testifies in asbestos litigation on behalf of plaintiffs.
The Editor’s Summary for the article by Tse et al. (2010) stated the following:
Assuming an average latency of 42 years, the authors predict that incidence rates will peak in 2009 and that diagnoses will peak in 2014. However, they caution that ongoing use of chrysotile asbestos (which has been implicated but not conclusively established as a cause of mesothelioma) and the release of asbestos fibers from older buildings during demolition or renovation may slow the projected decline.
The statement concerning chrysotile asbestos being “implicated but not conclusively established as a cause of mesothelioma” is inconsistent with current scientific opinion. I refer you to the most recent evaluation by the International Agency for Research on Cancer in which Straif et al. (2009) stated,
Epidemiological evidence has increasingly shown an association of all forms of asbestos (chrysotile, crocidolite, amosite, tremolite, actinolite, and anthophyllite) with an increased risk of lung cancer and mesothelioma. Although the potency differences with respect to lung cancer or mesothelioma for fibres of various types and dimensions are debated, the fundamental conclusion is that all forms of asbestos are “carcinogenic to humans” (Group 1).
In addition, opinions such as that expressed in the Editor’s Summary are advanced only by scientists with prochrysotile industry bias.
When I wrote the draft for the first IARC Monograph on asbestos in 1976, which the expert committee accepted and published in 1977 as IARC Monograph Volume 14, a similar conclusion was stated: “Many pleural and peritoneal mesotheliomas have been observed after occupational exposure to crocidolite, amosite and chrysotile.” Since then—more than 30 years—science has not changed its opinion that all forms of asbestos, including chrysotile, cause mesothelioma.
In fact, in the article that is the subject of the Editor’s Summary, Tse et al. (2010) did not indicate that chrysotile is not a cause of mesothelioma; on the contrary, they stated the following:
Although the mesothelioma incidence is anticipated to decline in the coming decades, it may not decrease to background risk levels given that chrysotile consumption has not been banned under the current legislation and that secondary asbestos exposure from the environment will likely continue. Nevertheless, the hypotheses generated from this ecologic study need further confirmation by subsequent analytic studies. The present study provides supportive evidence for an immediate and global ban on asbestos use.
I hope that future Editor’s Summaries will reflect the conclusions of the article and not put forth statements that are not supported by mainstream science. I also support the conclusion of Tse e al. (2010) for “an immediate and global ban on asbestos use.”
References Top
- 1977. Asbestos. IARC Monogr Eval Carcinog Risk Hum 14: 1–106. FIND THIS ARTICLE ONLINE
- 2009. A review of human carcinogens—part C: metals, arsenic, dusts, and fibres. Lancet Oncol 10: 453. –454. FIND THIS ARTICLE ONLINE
- 2010. Are current or future mesothelioma epidemics in Hong Kong the tragic legacy of uncontrolled use of asbestos in the past? Environ Health Perspect 118: 382–386. FIND THIS ARTICLE ONLINE
Click here to read more about asbestos related disease and claims 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 illnesses.
Tuesday, August 1, 2017
Termination and the lingering cloud over a disabled worker
Injured workers are in constant fear of losing their jobs as a result of absenteeism caused by injuries incurred at work. NJ Supreme Court Justice LaVecchia noted in a recent concurring opinion in a Law Against Discrimination (LAD) case, that termination based on absenteeism challenges the remedial social intent of the workers’ compensation act.
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