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

Wednesday, July 31, 2019

Governor Murphy Signs Legislation to Dramatically Reform New Jersey's Medical Marijuana Program, Expand Patient Access

Governor Phil Murphy on July 2, 2019 signed the Jake Honig Compassionate Use Medical Cannabis Act to dramatically reform New Jersey’s Medicinal Marijuana Program (MMP) and expand patient access to medical marijuana.

Saturday, October 21, 2017

Guidelines for Medical Provider Claims - A Valuable Approach

While the vast majority of jurisdictions in the US have the guidance of mandatory workers' compensation medical fee schedules, New Jersey remains one of the very few with no such structure. As I reported earlier, this generates multiple issues in the claims process and creates costly delays in the adjudication of disputes.

Saturday, May 18, 2013

NJ Bayonne Medical Center - Highest Priced Medicine in the Nation

While workers' compensation insurance carriers may set approved fees or contract with providers, hospitals have huge disparities in the cost for medical care provided. Additionally, there appears to be no difference in the ultimate outcome based on cost for medical service provided.

Compromising fees for medical services has become a big business in the US. Regulatory agencies provide a forum for the re-evaluation and determination of the cost for medical service. Many companies have emerged that provide representation in assisting in compromising fee. NJ Workers' Compensation have been mandated with the jurisdiction to evaluate the need and reasonableness of medical care provided to injured workers and establish the reimbursable value of the medical services rendered.

The highest priced medicine does not yield the best result according to published data released by the US Government. The NY Times has analyzed  data and found that the NJ Bayonne Medical Center was the highest priced hospital in the nation.

"Until a recent ruling by the Internal Revenue Service, for instance, a hospital could use the higher prices when calculating the amount of charity care it was providing, said Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins. “There is a method to the madness, though it is still madness,” Mr. Anderson said."

Friday, September 14, 2012

NJ Legislature to Discuss Workers Compensation Reforms

The NJ Legislature will be discussing potential major changes to the NJ Workers' Compensation Act during Senate Labor Committee hearings next week. 

The Senate Labor Committee will meet on Thursday, September 20, 2012 at 10:00 AM in Committee Room 6, First Floor, State House Annex, TrentonNew Jersey.

The following bills will be considered:

Prohibits payment of temporary disability benefits to incarcerated individuals.

Prohibits requirement to provide information for access to account on social networking website by employer.

Prohibits requirement to disclose user name, password, or other means for accessing account or service through electronic communications device by employers.

Prohibits requirement to disclose user name, password, or other means for accessing account or service through electronic communications devices by institutions of higher education.

Bans charging workers' compensation claimants for medical expenses, gives Division of Workers' Compensation sole jurisdiction over work-related medical claims. (Binding arbitration)

A-2652 (1R)
Bans charging workers' compensation claimants for medical expenses, gives Division of Workers' Compensation sole jurisdiction over work-related medical claims.

Memorializes Congress and the President to enact the "Team USA Made in America Act of 2012."

A-2878 (1R)
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

May 11, 2012
By John H. Geaney and Jon L. Gelman "Medical expenses in contested workers' compensation cases are now a significant and troublesome issue resulting in uncertainty, delay and potential future liability. Th recent NJ ...
May 11, 2012
By John H. Geaney and Jon L. Gelman "Medical expenses in contested workers' compensation cases are now a significant and troublesome issue resulting in uncertainty, delay and potential future liability. Th recent NJ ...
May 11, 2012
May 11, 2012
By John H. Geaney and Jon L. Gelman "Medical expenses in contested workers' compensation cases are now a significant and troublesome issue resulting in uncertainty, delay and potential future liability. Th recent NJ orkers' Compensation: Collecting Unpaid Medical Bills in Workers ...
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 ...

Related articles

Tuesday, January 21, 2020

Medical Marijuana and the Supremacy Clause

“Change is the law of life. And those who look only to the past or present are certain to miss the future.” -John F. Kennedy

An unsettled area of the law has emerged between, the widespread adoption by the states to permit prescribed marijuana to relieve certain medical conditions and the strict federal law mandating the substance as a Schedule 1, Controlled Substance [CSA]. With an estimated 43.3 million Americans using the elicited drug, and the challenges of the “opioid epidemic” creating massive addiction and fatal results, the nation’s workers’ compensation system has been challenged to provide adequate authorized medical treatment.

Tuesday, April 13, 2021

NJ Supreme Holds Employers Responsible for Workers' Compensation Medical Marijuana Costs

The NJ Supreme has recognized that the workers’ compensation system has a legislative mandate to provide the safest medical care to cure and relieve occupational injuries. The Court acknowledged both state and Federal trends to provide non-addictive and non-fatal pain relief in place of the dangerous opioids. 


The intent that embraced the creation and development of the social insurance system has given the Court a rational and logical basis, consistent with public policy, to order medical marijuana for palliative care.

Sunday, January 20, 2019

Six-Year Statute of Limitations Governs Medical Claims

In a landmark decision the NJ Court of Appeals held that medical provider claims for expenses in workers’ compensation claims are subject to a contractual six-year statute of limitations. The ruling will have a major impact upon the overburdened state’s Division of Workers’ Compensation (NJDWC) system.

The NJDWC is already recognizing a soaring number of medical expense disputes and it lacks a standardized adjudication process. The Legislature should establish a medical fee schedule and create a separate alternate dispute resolution (ADR) system to adjudicate the medical provider claims.

Monday, November 24, 2014

When An Employer Should Not Deny Medical Care

It is always tricky slope for an employer to deny medical care based on a pre-existing medical condition. The employer must be absolutely certain that the proofs offered at trial will provide a credible basis for a ruling by the Court. Without that certainty, the employer could be subject to paying for uncontrolled medical care as well as for penalties.

Some employers avoid those dire consequences by providing medical care with reservation as the NJ Statute allows. The employer can then subrogate a claim against the correct primary medical provider should the claim be denied.

“The employer need not be asked to authorize medical care but may be responsible for payment for such care entirely in cases where the employer has disavowed compensability of a claim which is ultimately found to be compensable.” 38 NJ Practice §12.7, Workers’ Compensation Law, Jon L Gelman.

 An employer recently lost an appeal from such an adverse ruling. The employer who challenged compensability of a back injury and denied “legitimate” medical treatment based on an alleged pre-existing MRI.  The employer was held liability for medical treatment when the Court found the testifying radiologist on behalf of the petitioner to be a credit witness.

“Johnson [injured worker] presented extensive medical proofs, including the testimony of treating physicians and expert witnesses. This included the deposition testimony of Steven P. Brownstein, M.D., a practitioner of diagnostic radiology. Brownstein opined that the disputed MRI could not belong to Johnson because herniated discs and bone spurs do not spontaneously disappear. Brownstein also stated that the 1999 MRI films depicted a fifty-year-old man, while Johnson’s 2006 MRIs were of a man no older than thirty-five.

Additionally, the employee testified that he never had the prior MRI. The Court found the petitioner to be a credible witness.

The employer refused to pay for medical care following from a compensable accident at work. The Court ruled that the actions of the employer were incorrect and that the employer should be held responsible for paying for medical care since it was requested by the injured employee and subsequently denied by the employer. Following the rule in Benson v Coca Cola Co., 120 N.J. Super. 120 (NJ App. Div. 1972),  a NJ employer was responsible for medical care requested by the employee and denied by the employer as the accident was held compensable.

“The JWC also found, pursuant to Benson v. Coca Cola Co., 120 N.J.Super. 60 (App.Div.1972) , that Johnson “was well within his rights to seek outside treatment” based upon City’s denial of the April incident, the dilatory fashion in which it referred Johnson for treatment after the May incident, and its refusal to provide medical care even when recommended by its first medical examiner. He thus concluded the exception expressed in Benson  applied and that it would have been futile for Johnson to have continued to request coverage for medical expenses.

The Compensation Judge is giving a wide spectrum of discretion as to determine the credibility of the testimony of the witnesses:
“Our highly deferential standard of review is of particular importance in this case, where appellant’s principal points of error hinge on the JWC’s credibility determinations. See Hersh v. Cnty. of Morris, 217 N.J. 236, 242 (2014)  (quoting Sager, supra, 182 N.J. at 164).  The JWC has the discretion to accept or reject expert testimony, in whole or in part. Kaneh v. Sunshine Biscuits, 321 N.J.Super. 507, 511 (App.Div.1999) . The judge is considered to have “expertise with respect to weighing the testimony of competing medical experts and appraising the validity of [the petitioner’s] compensation claim.” Ramos v. M & F Fashions, 154 N.J. 583, 598 (1998 .

The Court went also reiterate the Belth Doctrine holding that the employer takes the employee as he finds him. While the Belth decision predates the 1979 Amendments to the NJ Workers’ Compensation Act it remains valid as to the exacerbation of an underlying medical issue. Belth v. Anthony Ferrante & Son, Inc., 47 N.J. 38, 219 A.2d 168 (1966).

“ Employers are responsible for treatment of a preexisting condition which is exacerbated by a work accident. Sexton v. Cnty. of Cumberland, 404 N.J.Super. 542, 555 (App.Div.2009) . The burden is on the employer to prove that the compensable accident was not the cause of the exacerbation. In this case, City did nothing more than attempt to prove that Johnson was lying about his 1999 medical conditions.  Even if City is correct, in the judge’s opinion, Johnson objectively established that the May 2006 accident caused him significant cervical and psychiatric injuries from which he currently suffers.

Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thompson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson-Reuters). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Friday, January 24, 2020

Medical Providers Prohibited From Reporting to Credit Agencies

NJ Governor Murphy has signed legislation (S.3036) that prohibits a provider to an injured worker of medical, surgical, other treatment, or hospital service pursuant to the workers' compensation law, R.S.34:15-1 et seq., from reporting any portion of their charges which are alleged to be unpaid, to any collection or credit reporting agency, bureau, or data collection facility.

Friday, February 3, 2017

AMA Urges Trump Administration to Clarify Immigration Executive Order

A major element of workers' compensation benefits is medical treatment and that will be impacted the Donald Trump's recent ban on immigration. An adequate number of physicians must be available to provide medical care to cure and relieve  a work related medical condition. The American Medical Association (AMA) sent the following letter today to the U.S. Department of Homeland Security regarding the Administration’s executive order issued last week,“Protecting the Nation from Foreign Terrorist Entry into the United States:”

Tuesday, May 21, 2013

Just Go to The Emergency Room

Emergency room medicine is becoming an easy avenue for work-related medical care as employers and insurance carriers keep restricting traditional medical care access. Over the past decades it is becoming increasingly difficult for workers who have suffered occupational accidents or diseases to obtain quick, efficient and authorized diagnostic services and medical treatment.

A recent RAND study now validates that an alternate route is increasingly being used to access the medical care system, the emergency room. Few restrictions exists to enter an emergency room door. The red tape imposed by insurance carriers is eliminated, and the concept of deny and delay are non-existent in emergency room medicine.

Hospital emergency departments play a growing role in the U.S. health care system, accounting for a rising proportion of hospital admissions and serving increasingly as an advanced diagnostic center for primary care physicians, according to a new RAND Corporation study.

While often targeted as the most expensive place to get medical care, emergency rooms remain an important safety net for Americans who cannot get care elsewhere and may play a role in slowing the growth of health care costs, according to the study.

Emergency departments are now responsible for about half of all hospital admissions in the United States, accounting for nearly all of the growth in hospital admissions experienced between 2003 and 2009.

Despite evidence that people with chronic conditions such as asthma and heart failure are visiting emergency departments more frequently, the number of hospital admissions for these conditions has remained flat. Researchers say that suggests that emergency rooms may help to prevent some avoidable hospital admissions.

"Use of hospital emergency departments is growing faster than the use of other parts of the American medical system," said Dr. Art Kellermann, the study's senior author and a senior researcher at RAND, a nonprofit research organization. "While more can be done to reduce the number of unnecessary visits to emergency rooms, our research suggests emergency rooms can play a key role in limiting growth of preventable hospital admissions."

Thursday, January 25, 2018

NJ Governor Murphy Signs Executive Order Mandating Review of Medical Marijuana Policy

NJ Governor Phil Murphy today signed an Executive Order directing the New Jersey Department of Health and the Board of Medical Examiners to review the state’s existing medical marijuana program. The goal of the review is to eliminate barriers to access for patients who suffer from illnesses that could be treated with medical marijuana.

Tuesday, January 1, 2013

Workers’ Compensation 2013 – What Happens on the Other Side of The Fiscal Cliff?

The fiscal reality is that workers’ compensation is in greater jeopardy than ever before as the debate in Washington is not about the deficit at all. The debate is about government spending which includes health care.

Overall health care devours 18 percent of the US economy and amounts to 25% of the Federal budget.

Medical treatment for injured workers continues to be delayed, denied and limited under current workers’ compensation programs. Medical costs continue to be shifted to other programs including employer based medical care systems and the Federal safety net of Medicare, Medicaid, Veterans Administration and Tricare.

While a trend continues to emerge to offer “Opt Out” and “Carve Out Programs,” they are not global enough to solve the critical budget deficit issues. The latest emerging trend is for employers to utilize ERISA based medical care plans to efficiently delivery medical care. In NJ a limited alternate dispute-resolution procedure between unions and employers has been introduced. See “NJ Care Outs –Another Evolutionary Step” authored by David DePaolo.

The US economy continues to be very weak. This in an ominous signal for the nation’s workers’ compensation program which is starved for premium dollars. Premiums are based upon salaries and real median incomes continued their dramatic decline over the last decade from $54,841 in 2000 to $50,054 in 2011. There just may not be enough dollars available in the workers’ compensation programs to pay for present and lifetime medical care.

Even the present Federal system leaves much to be desired. Whether Federal rationing medical care becomes a reality is unknown. Physicians are under economic scrutiny as the “Doc Fix” to limit provider fees continues as a cloud over all medical programs. The agreement reached by Congress still does not resolve the 26.5% percent cut reimbursement cut to physicians who treat Medicare patients. The law merely "freezes" payment to physicians.

Workers’ compensation programs presently structured provide no real economic incentive to monitor and compensate for more favorable medical outcomes. On the other hand, the Federal government, with broad and sweeping regulatory ability, is able to continue to make strides in many areas including present incentives to hospitals and proposed incentives to physicians to provide medical treatment with fewer complications and ultimate better outcomes

Steven Ratner in the NY Times points out the dramatic increase in the nation’s health care costs. He wrote, “…no budget-busting factor looms larger than the soaring cost of government-financed health care, particularly Medicare and Medicaid.”

Solving the economic gridlock of the country will require an approach to re-invent a medical program for injured workers. A global single-payer program under Federal control will eliminate duplicative administrative State and private efforts. The Federal government has the clout to provide efficient enforcement and co-ordination.

Now that we are on the other side of the fiscal cliff, the opportunity to be creative is possible. The US needs to transition to a single-payer health care system subsuming a medical care program for injured and ill workers who suffer both traumatic and occupational conditions.

Read more about the "single-Payer System" and workers' compensation

Workers' Compensation: A Single Payer System Will Solve the ...
Nov 29, 2012
The question is whether the nation will recognize that the US needs tol take the bold step previously taken by the European Community, finally adopt a single payer medical care program. The perpetual cost generator that ...

NJ Urged to Adopt Single Payer System for Workmens Comp
Jun 06, 2011
NJ Urged to Adopt Single Payer System for Workmens Comp. A coalition that has been formed in NJ is urging that the Garden State follow the lead of Vermont and establish a single-payer system. Single-payer movements ...

Vermont Single Payer System Called the Dawn of A New Era
Apr 03, 2011
The proposed state based Vermont Single-Payer health care system, that would embrace workers' compensation medical care, is gaining momentum. A recent article in the New England Journal of Medicine, citing increased ...

RICO Issues Can Be Cured With A Single Payer Medical System
Mar 22, 2011
Vermont's proposed single payer system would seperate medical care from indemnity. Vermont's single proposed single-payer system would likely also provide a primary care doctor to every resident of Vermont. This would ...
Related articles

Thursday, October 24, 2013

California: Medical Delay and Denial Protested

Sedgwick vs. The People
Round 4: Sedgwick v. Debbye Mazzucca

Operating Room Nurse’s Injury no Emergency to Kaiser, Insurer: Defy Judge’s Order, Refuse to Provide Urgent Medical Care Injured Workers’ Advocates to Seek Penalties, Investigation

Injured Kaiser OR nurse Debbye Mazzucca tells how Sedgwick defied a judge's order to provide careThe California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today held a news conference outside Kaiser Foundation Hospital with Debbye Mazzucca, a former operating room nurse who was injured while working there. They called for sanctions against Sedgwick Claims Services, Kaiser’s workers’ compensation insurer, for defying a judge’s order to provide Ms. Mazzucca urgently needed medical care, causing her to lose her teeth. On February 11, 2013, the Workers’ Compensation Appeals Board (WCAB) ordered that Sedgwick “shall” provide dental treatment to Ms. Mazzucca. After eight months, Sedgwick and Kaiser have still refused to do so. Sedgwick faces a relatively small monetary penalty for ignoring the court order, which means little to a huge corporation.

Operating Room Nurse Debbye Mazzucca, of La Mesa, has thirty-five years’ experience, and worked for Kaiser for 12 years. She was injured in 1998, when she tripped and fell over a parking lot barrier while at work. Kaiser treated her injured knee, but ignored multiple doctors’ reports that she had also injured her neck and back. In spite of four doctors reports confirming that fact, Kaiser denied that those injuries were from the fall. Now, due to complications from medications, and delays in approving medical care, Ms. Mazzucca has lost her teeth.

CAAA President Jim Butler said, “Insurers’ Utilization Review (UR) routinely delays and denies doctors’ legitimate requests for appropriate medical treatment. This is unnecessary and expensive, and has got to change. We’ve seen the evidence of out-of-control delay and denial in the 15,000 denials of recommended medical care in just the month of August. It’s time to bring UR to heel, and stop insurance carriers from using it as a routine roadblock.”

“A doctor, agreed to by the company and their insurer, determined this Kaiser operating room nurse’s injury was a result of her work accidents. The insurer still refused to provide urgent medical care. A judge ordered the insurer to provide urgently needed medical care. But Sedgwick continues to refuse medical care and Debbye lost all her teeth during the months of delay,” said Alicia Hawthorne, the president of CAAA’s San Diego chapter, and Ms. Mazzucca’s attorney. “This nurse has been in pain, and in need of medical treatment. Yet, the insurance company defied a judge’s order to provide care. Kaiser and its insurer have spent years fighting their responsibility to treat these injuries. Why does the State of California allow workers’ compensation insurance companies to further damage patients through delaying and denying medical care and disability compensation?”

 “Kaiser has failed to provide the care needed to heal my injuries,” Mazzucca told a news conference outside Kaiser Foundation Hospital in San Diego. “For years, all they would approve were painkilling drugs. These drugs’ side effects have caused more medical problems, including ‘dry mouth syndrome,’ which is insidious and dangerous. The drugs prevent your saliva glands from working properly, causing your teeth and gums to deteriorate.  Mine became infected, abscessed and threatened my health and my life. In 2010, my teeth started cracking and breaking off at the roots. I lost seven of my teeth this way.”

Sedgwick denied the dental treatment I needed, so Ms. Mazzucca took them to court.  In February 2013, the judge ordered Sedgwick to provide this urgent medical treatment. To this day, they have refused to do so. “It has been more than a year and a half since the medical expert the insurer agreed upon said I urgently needed dental care. The pain and infection became so unbearable in July that my doctor sent me to the emergency room, and 25 of my teeth were removed. I then spent the entire month of July in the hospital, in agony, and on painkillers. Kaiser and their insurance company are defying a judge’s order to provide urgently needed medical care,” said Mazzucca.

Today’s release is the fourth in CAAA’s series of cases spotlighting the abuse of Utilization Review (UR) and other methods for delaying and denying legitimate medical care and disability compensation in the workers’ compensation claims handling practices of insurers like Sedgwick Claims Management Services.

Wednesday, April 10, 2019

An Employer Must Provide Accommodation for Off-Hours Use of Medical Marijuana

An employee licensed to use medical marijuana under the New Jersey Compassionate Use Medical Marijuana Act may proceed with a the New Jersey Law Against Discrimination (LAD) action ageist his employer for unlawful termination. 

The employee, who was suffering from cancer, received a license from his medical doctor to obtain and use medical marijuana. The employee was involved in a motor vehicle accident and the employer termination his employment upon learning he was using marijuana. 

While the court did not address the effect of medical marijuana on job performance or during the employment, it did opine: 

“In considering the relationship between the Compassionate Use Act and the LAD, we start by rejecting plaintiff’s argument that these enactments are in conflict. We reject that assertion because the Legislature plainly said there was no conflict; the Legislature’s actual words bear repeating: “Nothing in this act shall be construed to require ... an employer to accommodate the medical use of marijuana in any workplace.” N.J.S.A. 24:6I-14. These words are unambiguous; they require no interpretation and permit no deviation. See DiProspero v. Penn, 183 N.J. 477, 492, 874 A.2d 1039 (2005). Those words can only mean one thing: the Compassionate Use Act intended to cause no impact on existing employment rights. The Compassionate Use Act neither created new employment rights nor destroyed existing employment rights; it certainly expressed no intent to alter the LAD. Just as the Compassionate Use Act imposes no burden on defendants, it negates no rights or claims available to plaintiff that emanate from the LAD.” 

“….To rephrase what we said earlier, just because the Legislature declared that “[n]othing in [the Compassionate Use Act] shall be construed to require ... an employer to accommodate the medical use of marijuana in any workplace,” N.J.S.A. 24:6I-14, does not mean that the LAD may not impose such an obligation, particularly when the declination of an accommodation to such a user relates only to use “in any workplace.” Ibid. Judging this argument solely by reference to the pleadings and the statutes in questions, we repeat that plaintiff did not allege he sought an accommodation for his use of medical marijuana “in [the] workplace”; he alleged only that he sought an accommodation that would allow his continued use of medical marijuana “off-site” or during “off-work hours.” 

Case law is developing in medical marijuana and how it integrates with the Workers’ Compensation Act (WCA) is yet to be determined. 

WILD v. CARRIAGE FUNERAL HOLDINGS, INC., DOCKET NO. A-3072-17T3, 2019 WL 1371206 (N.J. App. Div. 2019) 

See also: 
US FDA Moves to Further Regulate Marijuana Products (WorkersCompensationBlog 4/9/19) 

Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 has been representing injured workers and their families who have suffered occupational accidents and illnesses