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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

Saturday, April 12, 2014

Too Big To Pay For: Workers' Compensation's Struggle To Cover Medical Care

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com. It highlights the growing concerns about infectious disease and burden it adds to an incredibly bogged down workers' compensation program. Ironically a recent report today in the NEJM (advanced publication) concerning a potential, but very expensive cure for Hep C (Therapy for Hepatitis C — The Costs of Success, Jay H. Hoofnagle, M.D., and Averell H. Sherker, M.D., April 12, 2014DOI: 10.1056/NEJMe1401508), mirrors this issue on an ever increasing trend. The question continues to arise as to whether the delivery of medical care is just too big and complicated of an issue for the aged workers' compensation system to handle any longer. JL Gelman


Political machinations create the complexity we know as workers' compensation law.

California is the prime example, with several bills moving around the legislature that bestow special treatment to certain classes of workers.

One bill, Assembly Bill 1035 by House Speaker John A. PĂ©rez, D-Los Angeles, would allow dependents to file claims for deaths caused by cancer, tuberculosis, methicillin-resistant Staphylococcus aureus infections and other bloodborne infectious diseases up to 420 weeks from the date the disease is diagnosed.

Similar bills in the past had made it through the legislature but Gov. Jerry Brown had vetoed them ostensibly because he was waiting for reports from the National Institute for Occupational Safety and Health and the California Commission on Health Safety and Workers' Compensation.

AB 1373, which passed in 2013 and AB 2451, which passed in 2012 differed in that both extended the limitations period to 480 weeks.

And the new bill includes a sunset provision that would allow the governor and Legislature to revisit the appropriateness of the new time frame in five years.

Supporters say AB 1035 is necessary because with advances in medical science, safety officers who develop cancer and other diseases through their employment are living longer.

The emotional appeal is that these brave public servants fight for their lives, only to succumb to the disease after the death benefits limitation period expires so dependents can not collect the benefits.

Of...
[Click here to see the rest of this post]

Related stories:
Apr 07, 2014
CATHERINE HAYLEY, whose diabetes was diagnosed when she was 9, describing the digital insulin pump that helps keep her alive." data-mediaviewer-credit="Luke Sharrett for The New York Times" ...
Sep 19, 2013
Medical Costs Still Treading Upward. The cost of medical treatment in workers' compensation claims, despite a resumed trend in lower claims, is continuing to increase. View complete report: NCCI Workers Compensation ...
Nov 20, 2013
A major component of the Workers' Compensation benefits system is now the cost of medical care. Workers' Compensation insurance is not alone in experiencing this phenomena. Soaring medical costs pervades the entire ...
Nov 01, 2012
Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers' compensation medical treatment. Proposed changes to the Federal program will indirectly ...

Wednesday, June 26, 2013

NJ Workers Compensation Companies Pay More for Hospital Fees

NJ workers' compensation insurance companies pay more for hospital charges than group health plans, according to a recent study published by the WRCI. NJ workers' compensation statute mandates a closed panel system were the the company must authorize the medical provider.

"The average workers' compensation payment for shoulder surgery in New Jersey was $7,323. Group health plans paid only $4,583 on average, a difference of $2,740, or 37 percent less.

For knee surgery the workers' compensation insurers' cost was $5,547, 42 percent higher than amounts paid through group health plans, which included the co payments and deductibles paid by the patients."

Click here to read: "Study: NJ workers comp insurers pay higher fees to hospitals than group insurers" The Record

Read more about medical treatment and workers' compensation:
Proposed Medicare Payment Reductions Will Impact Workers
Jun 17, 2013
A government Medicare advisory panel reported on Friday that sweeping changes should be implemented to reduce increasing medical costs, including higher costs associated with hospital purchased physician practices.
http://workers-compensation.blogspot.com/


NJ Bayonne Medical Center - Highest Priced Medicine in the Nation
May 18, 2013
The cost of medical care has increased tremendously according to a recently issued report. The NCCI (National Council on Compensation Insurance Inc.) reports an increase in medical costs from 40% in the early 1980s to .
http://workers-compensation.blogspot.com/


Workers' Compensation Jeopardy: Romney and Medical Costs
Nov 01, 2012
Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers' compensation medical treatment. Proposed changes to the Federal program will indirectly ...
http://workers-compensation.blogspot.com/


Workers' Compensation: Medical Costs Soar in Workers ...
Dec 11, 2008
The cost of medical care has increased tremendously according to a recently issued report. The NCCI (National Council on Compensation Insurance Inc.) reports an increase in medical costs from 40% in the early 1980s to ...
http://workers-compensation.blogspot.com/


Related articles

Saturday, May 6, 2017

CMS Prohibited From Collecting for Unrelated Conditions

A Federal Court in California has prohibited the Center for Medicare and Medicaid Services (CMS) from seeking reimbursement of conditional payments when the medical codes for the conditions are unrelated or not related even if the primary code was for a work-related medical condition. The court made the following ruling in a motion for partial summary judgment in a declaratory judgment action.

Tuesday, January 8, 2008

It's All About the Medical

As the new political and legislative year unfolds, stakeholders are keeping their eye on the prize, medical benefits, in the workers' compensation arena. Recent court decisions continue to emphasize the major significance of medical care and continue to question the ability of the presently crafted system to deliver medical benefits in an efficient and effective manner.


The New Jersey Appellate Court declared that medical providers have standing to seek reimbursement for the full amount of medical fees from a the workers' compensation carrier. Failure to attempt to pay or negotiate an obligation that it denied by implied "refusal to treat" actions resulted in an employer being obligated to pay the full freight, medical bills, and a counsel fee for recovery. Villanueva v. Federal Express, Inc. DOCKET NO. A-4342-06T24342-06T2 Medical liens remain a critical issue in workers' compensation. Legislation is pending to centralize the chaotic and disruptive process.


In another decision the NJ Supreme Court insulated the insurance carrier from an employee's medical malpractice claim, but did not permit the exclusivity doctrine to extend to the workers' compensation medical expert for a deviation from practice action. This dramatically increases the potential recovery for failure to provide adequate care in a workers' compensation claim. Barbara Basil, etc. v. Frank A. Wolf, et al. (A-80-05/A-110-06)


Universal medical remains a critical factor in 2008 politics. While Hilary lost Iowa, the exit poles demonstrate that people who wanted a change voted for Obama. "Obama won huge among those who cared most about change -- 51-19." The New Hampshire poles reflect while health care is a a critical issue to most Americans the major questions remains over what the action should be taken to fix the ailing system.


Compounding the problem is the fact that workers' compensation carriers have continued to shift the burden on to others. Whether it be private carriers or CMS the situation has now been inflamed by those who attempt to legislatively again limit the workers' compensation carriers' responsibility even in contested situations. This short sighted shell game will merely add even more outrage by taxpayers as Medicare fails to be able to pay its own bills.




Sunday, February 7, 2021

Investigative Report Raises Issues

The tension between public pension systems and workers' compensation programs was highlighted in a recent investigative report by the NJ State Comptroller. The report raises additional critical issues common to other state and national collateral social insurance programs challenged by current fiscal limitations.

Wednesday, December 7, 2011

It is Time To Do The Right Thing



A recent decision by the NJ Courts illustrates the weaknesses of the present workers' compensation system when dealing with occupational exposures. The social remedial system called workers' compensation was designed before recognition of the compensability occupational illnesses. 


The initial system was to furnish benefits without fault and in a summary and remedial fashion to injured workers. For the most part, that system worked from 1911 until the 1950's when the legacy of asbestos, used in World War II to insulate ships, came back to haunt the American worker by the manifestation of latent asbestos diseases including mesothelioma, a rare and fatal cancer.


Recently a NJ court denied the compensability of an asbestos related condition based upon the claimant's own knowledge of the causal relationship of an asbestos related medical condition and his own occupational exposure. Additional the court held that medical expert testimony was not required to support a motion to dismiss for the failure to meet the requirement of the statute of limitations.


In the 1970's the US Department of Labor was concerned with the same weaknesses and unavailability of benefits. The US DOL commissioned the Environmental Sciences Center at the Mt. Sinai School of Medicine under the leadership of the late Irving J. Selikoff, MD to study and analyze the problem. The weaknesses of the system, even though less dramatic than present, led to the conclusion that the workers' compensation systems just didn't work for occupational disease conditions. Additionally, costs for medical treatment of asbestos related conditions were being shifted at an estimated $10 Billion dollars, at that time, to the Medicare system.


Dr. Selikoff studied two major cohorts in analyzing the inadequacies of the  workers' compensation system. One group were insulators, and another group were 933 former plant workers at The Union Asbestos and Rubber Company of Paterson NJ who worked in war production between 1942 and 1944. Strikingly, the dormant medical conditions caused by the occupational exposure to asbestos fiber, and the latent condition of the disease for decades, caused major problems in filing claims. Those included the statute of limitation and diagnosis by medical professionals. Some professional were Grade B readers certified by The National Institute of Occupational Safety and Health (NIOSH) and even those experts in the field were challenged in Court. 


The report, that was submitted to the US Congress, concluded that the failure of the workers' compensation system to provide benefits to many who were exposed to asbestos, and the inadequate benefits to others. Their low rates were based on extremely low wages at the time of exposure. For these and other reasons, the report concluded, that the workers' compensation had failed to adequately provide treatment and other benefits. Since workers' compensation was not meeting the needs, claimants flocked to the tort system in epidemic proportion resulting in "the longest running tort" in American judicial history, "asbestos litigation." That litigation continues to this day. Even scores of companies that have reorganized under bankruptcy to avoid liability exposure are now providing benefits under a claims procedure.


While the NJ Court's decision may have been on point with regard to the Rules adopted to govern workers' compensation cases, it is time to revisit whether the Rules are too strict and defeat the social and remedial goals of the system that was envisioned by the creators in 1911. On a global scale, the failure of the workers' compensation to provide benefits results in the inequitable shift of responsibility to the general taxpayer. 


To meet the needs of those exposed occupationally, Congress needs to act now upon a global and unified solution. One path to the goal of correcting inequities of the system is to advance a system of universal medical care.  The US government must do the right thing. The medical delivery system for occupational diseases must come under a national universal medical care program. Additionally Congress must meet its moral and social responsibility and finally ban asbestos use in the US once and for all.


Read the decision: Russo v. Hoboken Board of Education, A-1861-10T4 (App. Div. November 29, 2011)

"...the WCJ found that he knew asbestos could cause lung disease and other medical problems as early as "the 70s." She noted that Russo "made complaints about the exposures to harmful substances . . . while still teaching." The WCJ further found that Russo "was well aware of the potential harmful effects of asbestos exposure," and she rejected his claim that the petition was not time-barred "because he was never informed by any of his treating physicians that his cancer was related to this exposure."

...
For over 3 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Thursday, July 5, 2012

Path to Federalization: A National Workers Compensation System--US Supreme Court Validates

United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation's workers' compensation system. By it's recent decision, upholding the mandate for insurance care under the Affordable Health Care for America Act (ACA) 2009, it has set the precedent to federalize the nation's fragmented and chaotic workers' compensation medical delivery system.

John G. Roberts Jr.,
Chief Justice US Supreme Court
Validating Mechanism
In a 5 to 4 ruling, Chief Justice Roberts validated the individual mandate as a permissible exercise of congressional power under the Taxing Clause of the US Constitution. Under 26 U.S.C. Section 5000A. The law requires that: (a) an individual must maintain minimum essential coverage for each month beginning after 2012; and (b) if there is a failure to maintain minimum essential coverage, a "penalty" is imposed "on the taxpayer" of $695 per year or 2.5% of family income, whichever is greater. The penalty "shall be assessed and collected in the same manner as taxes."

The Chief Justice, writing for himself, stated, "Every reasonable construction must be resorted to in order to save a statute from unconstitutionality." If it is "fairly possible" to interpret the statute as merely imposing a tax on those who've failed to purchase insurance. Writing for the majority, the Chief Justice stated, that the penalty is not a tax for anti-injunction act purposes. The Court, he wrote, needs to look beyond the label when assessing the constitutionality. For constitutional purposes Justice Roberts reasoned that the penalty may be considered as a tax when: it is not so high that there is no choice; and it is not limited to willful violations; and the penalty is collected by the IRS through normal means.

Constitution of the
United States
The Court indicated that the assessment is not really a "penalty." "Taxes that seek to influence conduct are nothing new," the Chief Justice wrote. He reasoned for the Court that there are no negative legal consequences to not buying health insurance, because beyond requiring a payment to IRS, Congress anticipated that some 4 million people would pay the penalty, and Congress did not treat them as "outlaws."

While certain taxes are prohibited under the U.S. Constitution, the penalty under the Affordable Health Care for America Act 2009 is not barred. The Court reasoned that the Constitution states, "No Capitation, or other direct, Tax shall be laid, unless in Proportion of the Census or Enumeration herein before directed to be taken." The majority of the Court held that a tax on "going without health insurance" does not fall within any recognized category of direct tax since it is triggered by certain specific circumstances.


The US Supreme Court previously validated compulsory workers' compensation programs. Compulsory compensation systems have been held not to be an arbitrary classification contrary to the equal protection clause of the United States Constitution, 14th Amendment.  The state-enacted systems were created for the protection of the lives, health and safety of the employees.  The systems provide payment of compensation through a state mandated system for injuries to employees or for the death of employees resulting from injuries related to work, regardless of fault.  The compensation systems are held as a simple, inexpensive and expeditious method of providing recovery to employees who are injured in a highly organized and modern industrial employment environment.  New York Central Railroad Company v. White, 243 U.S. 188, 37 S.Ct. 247, 61 L.Ed. 667 (1917). See also, Lower Vein Coal Co. v. Industrial Board of Indiana, 255 U.S. 144, 41 S.Ct. 252, 65 L.Ed. 555 (1921) and In re Asbestos Litigation, 829 F.2d 1233 (3d Cir.1987), cert. denied 485 U.S. 1029, 108 S.Ct. 1586, 99 L.Ed.2d 901 (1988).

Medical Delivery & Fees
Generally, the ACA provides a much needed national structure for the regulation, delivery, and enforcement of medical coverage. The ACA contains significant fraud and abuse provisions. In 2010 the law significantly expanded the government's authority to prosecute Faults Claims Act (FCA) cases. In 2011-2012 the ACA triggers increased provider screening, oversight and reporting. The ACA also establishes the Independent Payment Advisory Board to evaluate fee schedules and expands the scope of Medicaid and CHIP payments. 


Unlike most State compensation systems that presently struggle with both expeditious medical delivery as well the value and responsibility of medical care, the ACA provides a uniform system and expeditious system. The fragmented network of complex, dilatory and inconsistent results in the State programs have been described recently by national experts as "irrational" and "unjust."  They characterize the present compensation programs as "....dizzying and frustrating in its complexity, and apparent irrationality,"  and  they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits," and in need of a better format. 

Non-Traditional Revenue Stream
In addition to the widely publicized tax for non-compliance, the ACA contains several other innovative revenue provisions that will provide additional funding from collateral sources without burdening al employers globally. In 2010 an indoor tanning service tax was implemented. In 2011 annual fee was instituted on pharmaceutical companies as well as  an increased penalty for early withdrawal from health savings accounts. In 2013 the following provisions go into effect: the Medicare payroll tax will increase for high-income individuals, an excise tax on medical device manufacturers, limits on Flexible Spending Accounts, and the elimination of the deduction for Employer Part D subsidy. In 2014 there will be an annual fee on health insurance plans. In 2018 there will be an excise tax and high-cost plans commonly referred to as the "Cadillac tax."





"Libby Care"--Universal Care 
Center for Asbestos Related Disease
Libby, MT.
A provision of the Act, that has already been implemented, provides for the treatment of medical conditions, including asbestosis & mesothelioma, arising out the Libby, Montana asbestos contamination. The industrially caused   catastrophe in Libby has resulted in widespread illness and death. The ACA provides medical attention to those exposed to occupational toxins. The Center for Asbestos Related Disease is now operating in Libby, MT. The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. This type of program, minimally, needs to be expanded to include all occupational illness nationally.



The Future: Universal Health Care
Landmarks on the Path to Federalization
It is very doubtful that ACA repeal legislation, to be offered by the Republicans in the House will pass Congress, nor will the President sign it.. There may be some technical and substantive revisions to the ACA in the next Congress. If there is a mixed political government after the next election,  the ACA will be implemented and go forward as the law of the land.


History reveals that a series of efforts have been made by the Federal government  to federalize medical care for industrial accidents and illnesses. 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 accelerated the nation down that promising path.
....
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). 

More on improving the medical delivery system

Jun 14, 2012
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally .
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Feb 15, 2011
In December 2010 US Congress passed and President Obama signed, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program.
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...

Jul 13, 2010
As The Path To Federalization expands, this debate will expand. A recent study by the Center for American Progress addresses these concerns. "Health threats from the oil spill may linger unseen, perhaps for more than a ...
Mar 16, 2011
Historically The Federal government's role has been to rise to the occasion and walk further down a path to federalization. On a smaller scale than the potential consequences of the Japanesse debacle, the US was first in line ...
Mar 05, 2011
Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. ... Compensation Claim Draws Major Public Attention (workers-compensation.blogspot.com); Vermont Governor Sets Out to Lead U.S. to True Universal Coverage (huffingtonpost.com); The World Trade Center Health Program Expands The Path to Federalization ...
Apr 03, 2010
The recent health care reform legislation provided for the Libby Care which will provide universal medical care for victims of asbestos related disease. The plan is a pilot program for occupational disease medical care fully ...
May 19, 2010
The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. Potential pilot programs will now be available to ...

Related articles

Tuesday, April 9, 2019

US FDA Moves to Further Regulate Marijuana Products

US Food and Drug Administration [FDA] announced a public hearing to obtain scientific data and information about the safety, manufacturing, product quality, marketing, labeling, and sale of products containing cannabis or cannabis-derived compounds.

Saturday, September 27, 2008

Is It Time For A Delay Of Game Penalty in Workers' Compensation?

Delay has always been a problem when injured workers need medical treatment. Traditionally, insurance companies, especially in hard economic times, have sought to hold onto their money and not distribute benefits. In a recent New Jersey workers' compensation case, the Appellate Division refused to allow the insurance company to "snow" the court with excuses on why it should not provide medical care to an injured worker.

A worker was seriously injured when he was struck by a forklift and was pinned against the wall by the machinery. An MRI indicated that the injured worker suffered a right hip anterior labral tear and the worker was conservatively treated with injections and chiropractic care. After nine months lost time he was able to return to work part time with a restricted limit to lifting of 20 pounds..

Six months after his return to work while merely walking through deep snow and he suffered a re-occurrence of the right hip pain and limitation of motion of the limb. Arthroscopic hip surgery was required. Prior to surgery, the workers' compensation carrier denied responsibility and refused to provide medical care.

The worker was required to file a notice of motion to seek reimbursement for medical treatment and temporary disability benefits. The respondent denied causal relationship raising the defense of an intervening superseding event. The respondent also claimed that the motion was moot since medical treatment had already occurred. The Division Workers' Compensation, issued a written decision in December 2007, 22 months after the respondent refused to provide medical treatment. An appeal was taken in nine months later, before the Appellate Division of the state New Jersey and the trial court decision was affirmed. The process took 29 months.

The Appellate Division in its decision did not address the issue of why the system takes a long, but it did comment upon the fact that the defenses raised by the respondent did not meet the threshold level to reverse the trial ltrial court's decision. The Appellate Division indicated that the motion was not moot merely because the medical treatment was subsequently rendered and that the employer did not establish that the injured workers suffered an independent and subsequent injury in February of 2006.

This case highlights the fact that the workers' compensation process has a major failing. While the State of New Jersey has perennially attempted to address these issues legislation has not been enacted to improve the system. The process itself is fraught with problems and does not keep up with the advancements in medical science and delivery of modern medical care in an expeditious and efficient manner.

The hurdles that the injured worker has to j navigate provide substantial barriers for injured workers and their advocates. In a system that was supposed to be remedial, efficient and summary, has now turned into a dilatory litigation machine utilized by employers in an effort to defeat claims. The same employers who complain that reimbursement of medical benefits through secondary payers such as the Centers for Medicare and Medicaid Services, have now made a simple process into a complex and painfully slow remedy. The practice of snowing the court with meritless defenses, without penalty, i.e. pre-judgment interest, contributes to further destruction in workers’ compensation program.

Cuccineillo v Sports Authority, 2008 WL 4329874 (N.J. Super. App. Div.) Decided September 24, 2008.

Saturday, December 1, 2012

Hospital Controlled Physician Access and Workers' Compensation

As hospital consolidation of physician practices by acquisition continues, the question of the impact on control of the cost workers' compensation medical delivery remains uncertain.

Hospitals, supported by private equity, are now buying physician practices at a greater pace than ever before making choices for physician care more limited and at a higher cost. The New York Times reports that physicians who sell their practices hospitals find that they are under pressure to meet economic challenges of hospital targeted fees and are restricted in the referral of patients.

"....the consolidation of health care may be coming at a hefty price. By one estimate, under its current reimbursement system, Medicare is paying in excess of a billion dollars a year more for the same services because hospitals, citing higher overall costs, can charge more when the doctors work for them. Laser eye surgery, for example, can cost $738 when performed by a hospital-employed doctor, compared with $389 when done by an unaffiliated doctor, according to national estimates by the independent Congressional panel that oversees Medicare. An echocardiogram can cost about twice as much in a hospital: $319, versus $143 in a doctor’s office."

Read the complete article:  A Hospital War Reflects a Bind for Doctors in the U.S.

Read more about "medical Costs" and workers' compensation

Nov 01, 2012
Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers' compensation medical treatment. Proposed changes to the Federal program will indirectly ...
Nov 22, 2012
A report issued by NCCI concludes that medical costs in Workers' Compensation were higher in some instances than in Group Health Plans. The main findings were: For comparable injuries, when WC pays higher prices than ...
Nov 15, 2012
“While the average medical cost for a workers compensation claim is approximately $6,000, the medical cost of an individual claim can be a few hundred dollars or millions of dollars. In 2010, an NCCI study found that claims ...
Nov 29, 2012
The perpetual cost generator that continues to rage out of control in workers' compensation programs is the medical component. Medical costs are crashing the system to failure across the country, with no hope in sight for ...



Tuesday, July 29, 2014

Medical pot covered by workers' comp, says appeals court

If undefined by statute, workers' compensation provides for an almost limitless delivery of medical benefits. What ever "cures and/or relieves" is authorized and is paid for by the employer/insurance carrier. Today's post is shared from hr.blr.com
The New Mexico Court of Appeals recently ruled that an employer must pay for an injured worker's medical marijuana. This appears to be the nation's first appellate court ruling in a workers' compensation case in which an employer has been ordered to pay for medical marijuana prescribed by an employee's healthcare provider to treat a workplace injury.
George Vialpando injured his back in a workplace accident in 2000 while he was employed by Ben's Automotive Services in Santa Fe. For years, he was unable to find pain relief through conventional drugs and treatment. His physician said Vialpando had "some of the most extremely high intensity, frequency and duration of pain, out of all of the thousands of patients I've treated within my seven years practicing medicine."
In 2013, Vialpando was certified by his healthcare providers to participate in the New Mexico medical marijuana program. The program, authorized by the Lynn and Erin Compassionate Use Act, permits an individual to purchase marijuana after receiving certification from a medical practitioner licensed in New Mexico that states he has a debilitating medical condition and the potential health benefits of the medical use of cannabis would likely outweigh the health...
[Click here to see the rest of this post]

Monday, April 21, 2014

Generic Drug Manufacturers Get a Favorable Signal From The US Supreme Court

The US Supreme Court has given generic drug manufacturers a favorable signal by not staying the mandate of the Court of Appeals for the Federal Circuit in an ongoing battle over a patent infringement. The decision of Chief Justice John Roberts will allow Teva's Copaxone drug to continue to be manufactured in genetic format, and resulting lower cost, during the pendency of the appeal.

A lack of competition among drug manufacturers in United States has resulted in a huge escalation in pharmaceutical costs. The resulting impact has increased medical delivery costs in workers' compensation, and burdened the system substantially. The cost for medical delivery far exceeds indemnification for temporary and permanent disability benefits.

The court's action, albeit temporary in nature, maybe a signal of forthcoming judicial intervention in the pharmaceutical arena that will result in a more realistic cost for pharmaceutical benefits in workers' compensation.

Teva Pharmaceuticals USA, Inc., et al., Petitioners v.Sandoz, Inc., et al. No. 13-854

….
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 four 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.

Related articles:

Too Big To Pay For - Workers' Compensation - Blogger
Apr 12, 2014
Medical Costs Still Treading Upward. The cost of medical treatment in workers' compensation claims, despite a resumed trend in lower claims, is continuing to increase. View complete report: NCCI Workers Compensation .
http://workers-compensation.blogspot.com/

Even Small Medical Advances Can Mean Big Jumps in Bills
Apr 07, 2014
CATHERINE HAYLEY, whose diabetes was diagnosed when she was 9, describing the digital insulin pump that helps keep her alive." data-mediaviewer-credit="Luke Sharrett for The New York Times" ...
http://workers-compensation.blogspot.com/

Workers' Compensation: Medical Costs Still Treading Upward
Sep 19, 2013
Medical Costs Still Treading Upward. The cost of medical treatment in workers' compensation claims, despite a resumed trend in lower claims, is continuing to increase. View complete report: NCCI Workers Compensation ...
http://workers-compensation.blogspot.com/

Compensation Jeopardy: Romney and Medical Costs
Nov 01, 2012
Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers' compensation medical treatment. Proposed changes to the Federal program will indirectly ...
http://workers-compensation.blogspot.com/

Saturday, January 24, 2009

2009 Supplement to Workers' Compensation Law - Order Now

Jon L. Gelman's 2009 supplement to the 3 volume hard bound practice series has been published. Now available for order.

The newly enacted statutory changes to the New Jersey Workers’ Compensation Act permitting Emergent Medical Care Motions, new registration requirements for insurers, and new judicial enforcement powers of Judges of Compensation, including sanctions and contempt powers, are contained in this supplemental material.

The mandatory reporting requirements of the SCHIP Extension Act of 2007 are described as well as the appeal procedure under the reimbursement provision of the Medicare Secondary Payer Act.

These pocket parts provide information concerning the requirements for medical monitoring in workers’ compensation claims. It discusses. the Asbestos Fund, which has been established for those entities where workers’ compensation coverage cannot be established. The newly designed forms that need to be utilized in filing for benefits are included. Also, the recently modified Motion for Temporary and Medical Benefits, including a form Certification, is provided and discussed.

The newly revised Judgments for Total and Permanent Disability are provided in this pocket part. The Judgments include new refinements in offsets for pensions and Social Security disability benefits. Reviewed also is the “intentional wrong exception” to the Exclusivity Bar which has been the subject of new workers’ compensation insurance policy language and regulation.

The recently promulgated administrative rules governing the disposition of Temporary Disability Benefits are discussed. The non-duplication of benefits provisions are reviewed including the multiple agency adjudication process. An expansion of benefits available to Federal public safety officers is reviewed in this supplement.

Collateral medical benefit issues are discussed in light of the recent Supreme Court decision concerning this matter. The pocket parts include a Motion to Join the Collateral Health Carrier and provide sample Certifications to be used in support of the application.

Additionally, these pocket parts provide information concerning the new rules of the Division of Workers’ Compensation embodying electronic filing requirements and new procedures involving both formal and informal proceedings, motion practice, post judgment process, and judicial performance. The expanded Medicare secondary reporting requirements and the mandatory coordination of benefits are reviewed in this supplement. The recovery aspects of Medicare conditional payments as well as future medical provisions are updated and discussed. The new Child Support Lien distribution forms, computation worksheets and judgments are provided and explained in depth. The NJ Supreme’ Court ruling and the legislative enactments are discussed concerning same sex couples and the availability of workers’ compensation benefits.

This supplement reviews the newly promulgated Rules concerning the Uninsured Employers’ Fund and audio and video coverage of workers’ compensation proceedings. The horrific tragedy of September 11th, 2001 and the impact it has upon the Workers’ Compensation system is discussed. This supplement reviews the newly enacted Smallpox Emergency Protection Act as well as recent court decisions concerning acts of terrorism. The subsequent legislative changes enacted in response to potential terrorist threats are reviewed, including the Public Safety Officers’ Benefit Act as well as the liberalized legislative enactments involving rescue workers and medical personnel.

The impact of the newly promulgated Federal rules and regulations concerning medical record privacy and compliance with the Health Insurance Portability and Accountability Act (HIPPA) medical authorization requirements are reviewed in this supplement and model forms are furnished. The recently enacted statutory workers' compensation coverage options available to proprietors and partners are discussed. The supplement reviews the recent court decisions expanding the responsibility of the Second Injury Fund for pre-existing medical conditions in cases in which latent diseases become manifest during retirement. The statutory enactments concerning State Temporary Disability Benefits are reviewed. The recently amended Energy Employees Occupational Illness Compensation Act is explained in detail and forms are furnished and discussed.

The recent Supreme Court decisions concerning the high judicial threshold for evaluation of scientific evidence are analyzed. The requirements for proof of scientific evidence in complex workers’ compensation cases are discussed including the admissibility of testimony from non-physicians experts. Furthermore, the evolving and expanding issues concerning medical monitoring are reviewed.

This pocket part also discusses recent changes in the application for counsel fees. The supplement includes the newly promulgated administrative directive embodying those changes.