The Division of Workers’ Compensation (DWC) has posted proposed changes to the existing Medical Treatment Utilization Schedule (MTUS) regulations to the online forum where members of the public may review and comment on the proposals. “These changes to DWC’s evidence-based medical treatment guidelines provide a critically needed framework describing best practices for providing medical care for work-related illnesses and injuries,” said DWC Executive Medical Director Dr. Rupali Das. The proposed updates to the MTUS were developed in cooperation with the multidisciplinary Medical Evidence Evaluation Advisory Committee (MEEAC). The proposed amendments to the MTUS regulations modify regulatory definitions, which includes a definition for Evidenced Based Medicine, and adds new definitions for terms used in the strength of evidence methodologies. The regulations clarify the role of the MTUS in accordance with Labor Code section 4600 and set forth the process to determine if medical care is reasonable and necessary when the MTUS is inapplicable. |
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Showing posts sorted by relevance for query medical treatment. Sort by date Show all posts
Showing posts sorted by relevance for query medical treatment. Sort by date Show all posts
Monday, August 26, 2013
CA DWC Posts Proposed Changes to the Medical Treatment Utilization Schedule Regulations Online for Public Comment
Monday, March 28, 2011
Colorado Court Allows RICO Case to Proceed Against Wal-Mart
A partial summary judgment motion was denied by Judge Robert E. Blackburn in a pending Colorado case against Wal-Mart where the plaintiff alleged that the employer, working in concert with other defendants "dictated and interfered unlawfully " with employees who were entitle to medical treatment flowing from occupational accidents.
The Court stated that, "The plaintiffs allege that the defendants improperly required, and continue to require, treatment providers to follow protocol notes that improperly direct and/or restrict the medical treatment provided to injured Wal-Mart workers under the Act. The plaintiffs allege that the policies implemented by the defendants result in delays in the injured workers' receipt of treatment, denial of prescribed medical treatment, withholding of benefits, and/or the inability of the injured workers to obtain prescribed medical treatment."
The case involves a certified class of plaintiffs. The defendants had sought to limit the number of claimants by shortening the statute of limitations for the viability of the claims under the Racketeer Influenced and Corrupt Organizations Act (RICO), 18 U.S.C. § 1961-1968. Since the relevant time periods were not evident on the face of the complaint, and the defendants did not offer proof to establish it, the Court denied the motion.
Gianzero v. Wal-Mart Stores Inc., 2011 WL 1085647 (D. Colo. 2011) Decided March 24, 2011.
Related articles
- RICO Issues Can Be Cured With A Single Payer Medical System (workers-compensation.blogspot.com)
- Professional Athletes Deserve Fair Workers Compensation (workers-compensation.blogspot.com)
- The RICO Consequences of Managing Health Care in Workers Compensation (workers-compensation.blogspot.com)
- Injured Workers Assert Class Action Claiming Wal-Mart Violated RICO Act (workers-compensation.blogspot.com)
- Stay Lifted in RICO Class Action Against Wal-Mart (workers-compensation.blogspot.com)
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.
Tuesday, July 23, 2013
Hospitals May Soon Be Reaching For The Stars
Should injured workers have the opportunity to select the "best rated" medical provider? The Federal government is looking forward to providing outcome base rating information. The workers' compensation system should utilize that information and allow injured workers to be able make an educated choice in seeking medical care. Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
Star wars may be coming to a hospital near you.
Medicare is considering assigning stars or some other easily understood symbol to hospitals so patients can more easily compare the quality of care at various institutions. The ratings would appear on Medicare’s Hospital Compare website and be based on many of the 100 quality measures the agency already publishes.
The proposal comes as Medicare confronts a paradox: Although the number of ways to measure hospital performance is increasing, those factors are becoming harder for patients to digest. Hospital Compare publishes a wide variety of details about medical centers, including death rates, patient views about how well doctors communicated, infection rates for colon surgery and hysterectomies, emergency room efficiency and overuse of CT scans.
In its proposed rules for hospitals in the fiscal year starting Oct. 1, the Centers for Medicare & Medicaid Services asked for ideas about "how we may better display this information on the Hospital Compare Web site. One option we have considered is aggregating measures in a graphical display, such as star ratings."
Private groups such as Consumer Reports, the Leapfrog Group and US News and World Report already issue hospital guides that boil down the disparate Medicare scores -- along with their own proprietary formulas -- to come up with numeric scores, letter grades or rankings.
But even before it's formally proposed, the possibility of the government rating...
[Click here to see the rest of this article]Medicare is considering assigning stars or some other easily understood symbol to hospitals so patients can more easily compare the quality of care at various institutions. The ratings would appear on Medicare’s Hospital Compare website and be based on many of the 100 quality measures the agency already publishes.
The proposal comes as Medicare confronts a paradox: Although the number of ways to measure hospital performance is increasing, those factors are becoming harder for patients to digest. Hospital Compare publishes a wide variety of details about medical centers, including death rates, patient views about how well doctors communicated, infection rates for colon surgery and hysterectomies, emergency room efficiency and overuse of CT scans.
In its proposed rules for hospitals in the fiscal year starting Oct. 1, the Centers for Medicare & Medicaid Services asked for ideas about "how we may better display this information on the Hospital Compare Web site. One option we have considered is aggregating measures in a graphical display, such as star ratings."
Private groups such as Consumer Reports, the Leapfrog Group and US News and World Report already issue hospital guides that boil down the disparate Medicare scores -- along with their own proprietary formulas -- to come up with numeric scores, letter grades or rankings.
But even before it's formally proposed, the possibility of the government rating...
...
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.
Read more about "medical treatment" and workers' compensation:
Apr 15, 2013
The main difference is in Nebraska, as long as the worker elects a prior treating doctor to treat their injury (for example, the worker's family doctor), that doctor can dictate the medical care and refer them to others for treatment.
May 18, 2013
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 ...
Nov 16, 2012
New York Worker's Compensation Board's proposed new medical treatment guidelines that will modify 2010 previously implemented. Adopt the new carpal tunnel syndrome (CTS) medical treatment guidelines (MTG) as the ...
Jul 03, 2013
Read more about The Affordable Health Care Act: Workers' Compensation: Protecting Healthcare Workers. May 06, 2013. Kerri A. Thom, MD, MS, Assistant Professor of Medicine at the University of Maryland School of ...
Related articles
- NJ Workers Compensation Companies Pay More for Hospital Fees
- Proposed Medicare Payment Reductions Will Impact Workers' Compensation Costs
- CMS Consolidates Web Portals for Coordination of Benefits & Recovery
- Privacy: Workers' Compensation Health Data Heading for Electronic Storage
- Infectious Disease: Cyclospora Infection Becomes More Widespread
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.
Sunday, September 21, 2014
Medical Treatment Denials
Medical treatment denials are SOP now thanks to the workers’ compensation reforms signed into law by Governor Brown. Currently, there is no appeal to an independent judge for denied treatment. The medical reviewing companies are making millions of dollars to deny necessary care. As a consequence, if injured workers have other insurance coverage, Medicare or MediCal, these programs are the only hope; and even then many other coverage plans may deny the treatment because they think it is work related medical cost. Injured workers and their families are caught in a vicious Catch 22. Anyone who is denied treatment should write the Governor and demand an end to these unconstitutional and unconscionable laws. Read the article here. http://https://www.caaa.org/index.cfm?pg=URDenied_Kathryn_Donahue#.U_SzwAC8jLU.facebook |
Related articles
- California Applicants' Attorneys Association Announces New Legislative Team (workers-compensation.blogspot.com)
- California: Medical Delay and Denial Protested (workers-compensation.blogspot.com)
- Criminal Charges Urged Against Sedgwick (workers-compensation.blogspot.com)
- 2 Workers Injured By Sulfuric Acid At Tesoro Refinery Near Martinez (workers-compensation.blogspot.com)
- California's Independent Medical Review System Unreasonably Denies Injured Workers Benefits (workers-compensation.blogspot.com)
- Top 10 Events in California Workers' Comp 1st Half 2014 (workers-compensation.blogspot.com)
- Claims Adjuster, TPA Could Face Criminal Charges for Worker Fatality (workers-compensation.blogspot.com)
- California Applicants' Attorneys Association Affiliates With Labor (workers-compensation.blogspot.com)
Thursday, November 7, 2019
Employer-reported non-fatal injury and illness rate unchanged in 2018
The US Bureau of Labor Statistics reported that the rate of nonfatal occupational injuries and illnesses among private industry employees was unchanged for the first time since 2012 at 2.8 cases per 100 full-time equivalent workers in 2018. Workers in private industry incurred 2.8 million injuries or illnesses in 2018.
Sunday, December 19, 2010
Medical Witness Cannot Be An Advocate - Knee Replacement Surgery Authorized
A workers' compensation medical witness is not permitted to be become an advocate. A Judge of Compensation disregarded an insurance company medical witness when the medical expert "crossed the line from being a medical witness to an advocate."
In reaching her decision, Diana Ferriero, Judge of Compensation, rationalized that the insurance company's medical expert by the "convoluted cover letter sent by respondent counsel," along with medical records on the injured worker.
The injured employer suffered two work related accidents as a mechanic for American Airlines. The first accident in to the right knee occurred in July 2004 and resulted in a partial menisectomy and no prolonged sequelae. The worker was symptom free until a second accident in January 2007when he slipped and fell on both knees and hands. The insurance company authorized 28 medical office visits, 15 Hyalgan injections, 14 aspirations and physical therapy for treatment to his right knee. A diagnosis was made by the treating physician and the insurance company refused the injured worker a total knee replacement claiming that the medical condition was unrelated to the 2nd accident of January 2007.
The workers' compensation Judge ordered an independent medical evaluation by a renowned specialist in knee and hip replacements, Mark A, Hartzband of the Hackensack University Medical Center. The judge concluded that, "Dr, Hartzband opined that petitioner's need for a right total knee replacement was directly and causally related to the accident of January 17, 2007."
The court also found that the insurance company's treating physician, who opined that the 2nd accident was unrelated to the need for a knee replacement, was "disingenuous given the contents of his office chart," and reasoned that the insurance company's authorized treating physician did not have an understanding of arthritis and its progression.
The court granted the injured workers' motion for medical treatment, evaluation and scheduling of the right knee replacement, and ordered the payment of temporary medical benefits.
Pepe v. American Airlines, CP No. 2008-5878, NJ DWC 2010), Decided November 11, 2010.
Related articles
- Defective Artificial Hips Maybe a Costly problem for Workers' Compensation (workers-compensation.blogspot.com)
- Hot Topics in Workers' Compensation Law 2011 Seminar (workers-compensation.blogspot.com)
- Insurance Company Liable in Tort for Delay of Medical Treatment
- The Health Reform Act Charts a New Course for Occupational Health Care
Tuesday, December 4, 2012
Obesity Is Weighing Down The Workers' Compensation System
The "fat" gene |
Medical delivery now needs to deal with: weight reduction, delay of medical care and complex treatment protocols , due obesity issues. The resulting consequences of this pre-existing / coexisting issues, are increasing the economic burden on the entire program.
Recent discoveries in human genome project reflect that obesity may actually be controlled by genetic propensities. In other words, the so-called "fat gene" programs whether the human body will gain weight.
"Obesity is a chronic metabolic disorder affecting half a billion people worldwide. Major difficulties in managing obesity are the cessation of continued weight loss in patients after an initial period of responsiveness and rebound to pretreatment weight. It is conceivable that chronic weight gain unrelated to physiological needs induces an allostatic regulatory state that defends a supranormal adipose mass despite its maladaptive consequences. To challenge this hypothesis, we generated a reversible genetic mouse model of early-onset hyperphagia and severe obesity by selectively blocking the expression of the proopiomelanocortin gene (Pomc) in hypothalamic neurons. Eutopic reactivation of central POMC transmission at different stages of overweight progression normalized or greatly reduced food intake in these obesity-programmed mice. Hypothalamic Pomc rescue also attenuated comorbidities such as hyperglycemia, hyperinsulinemia, and hepatic steatosis and normalized locomotor activity. However, effectiveness of treatment to normalize body weight and adiposity declined progressively as the level of obesity at the time of Pomcinduction increased. Thus, our study using a novel reversible monogenic obesity model reveals the critical importance of early intervention for the prevention of subsequent allostatic overload that auto-perpetuates obesity."
Workers' Compensation needs to address obesity as a medical condition requiring, not only with co-existence medical attention, but also extend preventive medical treatment and medical monitoring to that the conditio Then obesity will not become a major factor in an employee's lifetime. Identification of this genetic abnormality early on appears critical to addressing weight control and behavior leading to its elimination.
This is yet another reason why the incorporation of the workers' compensation program into a universal medical system is so very important to the health of workers, and the solvency of workers compensation going forward.
....
Jon L.Gelman of Wayne NJ, helping injured workers and their families for over 4 decades, is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson).
Read more about obesity and workers' compensation
Jun 21, 2012
"The statistical analysis shows that claimants with a comorbidity indicator pointing to obesity have an indemnity benefit duration that is more than five times the value of claimants who do not have this comorbidity indicator but ...
Sep 23, 2011
We thought it was a fitting topic for our workers' law blog because NFL linemen must embrace this condition in order to stay in peak performance. It's called chronic obesity. These days, to be an NFL lineman, you not only have ...
Nov 15, 2012
In 2010, an NCCI study found that claims with an obesity comorbidity diagnosis incurred significantly higher medical costs than comparable claims without such a comorbidity diagnosis. Relative to that study, this study ...
Mar 20, 2010
His morbid obesity has contributed to his knee and back problems and, in an effort to combat those problems and counter a broader threat to his survival, claimant sought authorization to undergo gastric bypass surgery.
Related articles
- The Costs and Complications of The Other Disease on Workers' Compensation Claims (workers-compensation.blogspot.com)
- Hospital Controlled Physician Access and Workers' Compensation (workers-compensation.blogspot.com)
- The Hidden Cost of Jobs - Selling Fear (workers-compensation.blogspot.com)
- US Supreme Court Hears Oral Argument on Workplace Harassment Case (workers-compensation.blogspot.com)
- The Devil is in the Details California Style (workers-compensation.blogspot.com)
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."
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."
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Treatment,
Universal Medical Care,
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Friday, February 16, 2018
Defense Employer Ordered to Pay Medical for Lung Disease Caused by Burn Pit Exposure
In a decision that will have significant impact on potentially thousands of injured workers, a Court has ruled that a private military contractor for the US Defense Department during the Iraq and Afghanistan conflicts is responsible for the payment of employee’s medical treatment required after manifesting lung disease (bronchiolitis) from exposure to burn pits maintained during the war.
Saturday, December 14, 2019
Top NJ Workers' Compensation Decisions of 2019
It has been an active 2019 for workers’ compensation decisions in New Jersey. There have been two NJ Supreme Court opinions and three reported Appellate Court opinions that are noteworthy. From a review of the pending docket the NJ Supreme Court will be reviewing at least 3 very significant issues in 2020 invoking workers’ compensation issues.
Sunday, May 5, 2019
Correct Way to Contest a Lien
Attorneys should follow the correct procedures to contest a lien asserted by a workers’ compensation insurance carrier. A recent case provides instructions on the appropriate techniques.
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
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/
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, April 12, 2014
Too Big To Pay For: Workers' Compensation's Struggle To Cover Medical Care
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. Pérez, 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... |
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 ...
Thursday, September 25, 2014
The Domino Effect of Treatment Denials
Today's post was shared by CAAA and comes from myemail.constantcontact.com
When UR denies medical treatment, the real world consequences are many! Join us on September 20, 2014 for a practical examination of the "dominoes" that fall when an injured worker can't get the treatment they need. Specific practice tips and practical solutions will be offered by a superb panel of attorneys that are managing UR denials on a daily basis.
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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:”
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
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
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."
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."
Sunday, April 18, 2010
Is The Virtual Doctor a Cure for Workers' Compensation
The American Association of Retired People (ARRP) reports in May/June2010 edition of their magazine that the concept of online appointments is taking hold in the medical system. Doctors are making house calls by computer or phone. Patients will no longer have to sit in waiting rooms watching "Medical TV" or read magazines while waiting to see their doctor.
One of the primary benefits under the Workers' Compensation Act is that of medical benefits. Medical benefits are mandated by the Act, and require the employer to furnish the injured worker with medical, surgical and other treatment and hospital services as are necessary "to cure and relieve the worker of the effects of the injury and to restore the functions of the injured member or organ" if possible. The injured worker's exclusive remedy to receive medical treatment is in accordance with the provisions of the Workers' Compensation Act. The employer can be compelled to provide prompt and adequate medical treatment, and an action at common law against the workers' compensation insurance carrier is barred. The employee's right to medical benefits is independent of other remedies available under the Workers' Compensation Act. The injured worker need not wait until final adjudication of his claim for permanent disability in order to proceed with a claim for medical benefits.
This year OptumHealth is about to launch NowClinic. The site is compatible with Internet Explorer, Firefox and Safari. Using Chrome will not allow you to access the site. The planned cost, according to AAARP is $45 for a ten minute dialog.
Will this trend be adaptable to workers' compensation programs is a major question. With so much paranoia concerning fraud on both sides of the program involving into RICO claims, many employers and insurers might be apprehensive in launching such a system. On the other hand, the cost savings benefits to employers and insurance companies maybe monumental. Clinical care, diagnostic testing and pharmaceutical dispensing may also become incorporated into the program. Some delays maybe eliminated for claims that are not contested or denied. Once into the "system" the chance for straying to unauthorized medical care could be reduced.
As technological expands in the health profession, the use of virtual care system will probably become more available. Tailoring them to the needs of the workers' compensation program will remain a challenging opportunity to improve the benefit system.
To read more about health care and workers' compensation click here.
47ACVKNDVPAV
One of the primary benefits under the Workers' Compensation Act is that of medical benefits. Medical benefits are mandated by the Act, and require the employer to furnish the injured worker with medical, surgical and other treatment and hospital services as are necessary "to cure and relieve the worker of the effects of the injury and to restore the functions of the injured member or organ" if possible. The injured worker's exclusive remedy to receive medical treatment is in accordance with the provisions of the Workers' Compensation Act. The employer can be compelled to provide prompt and adequate medical treatment, and an action at common law against the workers' compensation insurance carrier is barred. The employee's right to medical benefits is independent of other remedies available under the Workers' Compensation Act. The injured worker need not wait until final adjudication of his claim for permanent disability in order to proceed with a claim for medical benefits.
This year OptumHealth is about to launch NowClinic. The site is compatible with Internet Explorer, Firefox and Safari. Using Chrome will not allow you to access the site. The planned cost, according to AAARP is $45 for a ten minute dialog.
Will this trend be adaptable to workers' compensation programs is a major question. With so much paranoia concerning fraud on both sides of the program involving into RICO claims, many employers and insurers might be apprehensive in launching such a system. On the other hand, the cost savings benefits to employers and insurance companies maybe monumental. Clinical care, diagnostic testing and pharmaceutical dispensing may also become incorporated into the program. Some delays maybe eliminated for claims that are not contested or denied. Once into the "system" the chance for straying to unauthorized medical care could be reduced.
As technological expands in the health profession, the use of virtual care system will probably become more available. Tailoring them to the needs of the workers' compensation program will remain a challenging opportunity to improve the benefit system.
To read more about health care and workers' compensation click here.
47ACVKNDVPAV
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