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.
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
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
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 |
Thursday, November 7, 2019
Employer-reported non-fatal injury and illness rate unchanged 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.
Tuesday, December 4, 2012
Obesity Is Weighing Down The Workers' Compensation System
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| 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.
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."
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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[Click here to see the rest of this post]
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
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 ...
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
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.
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Tuesday, October 6, 2009
NJ Commissioner of Labor Adopts Rules for Emergent Medical Motions in Workers Compensation Matters
David J. Socolow, Commissioner of Labor and Workforce Development, on September 3, 2009, formally adopted the pending Rules for Emergent Medical Motions. The new Rules became effective on Monday, October 5, 2009 and a notice published in the NJ Register on that date, 41 NJ Register 3807(a).
A public hearing concerning the pending Rules was held on June 2, 2009 and there were no attendees. A written comment was submitted by Kenneth A. Stoller, Senior Counsel, American Insurance Association, Washington, DC. One comment concerned the assessment of fines against an insurance carrier for activities of the employer. The Department declined to modify the pending Rules, but stated, “…the insurance carrier would not be fined or penalized where it is in no way culpable for the violation.”
A typographical correction was recognized. “Upon review, the Department has noticed a typographical error, which it would like to correct through a change on adoption. Specifically, the reference within proposed N.J.A.C. 12:235-3.3(r) to, "the decision and order rendered under (o) above," should read, "the decision and order rendered under (q) above..." Consequently, the Department is substituting "(q)" for "(o)" within N.J.A.C. 12:235-3.3(r).”
The Honorable Peter J. Calderone, Director and Chief Judge of the Division, will discuss the new Rules in an upcoming academic seminar sponsored by the NJ Institute for Continuing Legal Education on Wednesday, October 7, 2009.
………
The Rules:
12:235-3.2 General motions for temporary disability and/or medical benefits
(a)-(i) (No change.)
12:235-3.3 Motions for emergent medical care pursuant to N.J.S.A. 34:15-15.3
(a) With or after the filing of a claim petition, a petitioner may file a motion for emergent medical care directly with the district office to which the petition is or will be assigned (See N.J.A.C. 12:235-3.1 for claim petition filing and assignment).
(b) The notice of motion for emergent medical care shall be on a form prescribed by the Division and shall contain or be accompanied by the following:
1. A statement by the petitioner or the petitioner's attorney of the specific request(s) for medical treatment made by the petitioner or the petitioner's attorney to the employer and/or the employer's insurance carrier, including the name of the person(s) to whom the request(s) was/were made;
2. Medical documentation, including a statement by a physician indicating that the petitioner is in need of emergent medical care, that the delay in treatment will result in irreparable harm or damage to the petitioner and the specific nature of the irreparable harm or damage;
3. All medical records relating to the requested medical care, which are in the possession of the petitioner or the petitioner's attorney;
4. Copies of the claim petition and answer.
i. If no answer to the claim petition has been filed, the notice of motion shall include the following information if known by the petitioner: the telephone number and the fax number of the employer, the name of the employer's workers' compensation insurance carrier and the insurance carrier or self-insured employer contact person's telephone number and fax number, as required to be maintained under N.J.A.C. 12:235-3.4; and
5. Proof of service under (c), (d) and (e) below.
(c) Where an answer to the claim petition has been filed by the respondent, the notice of motion and supporting papers shall be served on respondent's attorney by fax and by a one-day delivery service.
(d) Where no answer to the claim petition has been filed by the respondent, the notice of motion and supporting papers shall be served on the employer and, if known by the petitioner, upon the employer's insurance carrier.
1. Service on the employer under this subsection shall be either by personal service or by fax and a one-day delivery service.
2. Service on the insurance carrier under this subsection shall be by fax and a one-day delivery service to the contact person listed pursuant to N.J.A.C. 12:235-3.4.
(e) Where the employer is uninsured or where the employer's insurer is not known by the petitioner, the notice of motion and supporting papers shall, in addition to the requirements under (c) or (d) above, be served on the Uninsured Employer's Fund by fax and by a one-day delivery service.
(f) The date of the personal service, the date of the fax service or the date of receipt of the one-day delivery service, whichever is latest, shall be considered the date of service under (c), (d) and (e) above.
(g) No later than five calendar days after receiving service of the petitioner's notice of motion for emergent medical care, the respondent shall file with the district office an answer to the motion.
(h) Within 15 calendar days after the petitioner has served the notice of motion for emergent medical care upon the appropriate party or parties under (c), (d) and (e) above, the employer or the employer's insurance carrier may have a medical examination of petitioner conducted.
(i) The petitioner is required to attend and cooperate with the medical examination process under (h) above.
(j) Motions for emergent medical care shall take precedence over all other court listings.
(k) The judge should use telephone conferences and afternoon hearings, as appropriate, to expedite the disposition of motions for emergent medical care and to avoid as much as possible the disruption of other court proceedings.
(l) Within five calendar days of the filing of an answer by respondent or, if no answer has been filed, within five calendar days from the date an answer should have been filed, an initial conference on the motion for emergent medical care shall take place.
(m) The district office shall provide notice of the initial conference to the following parties under the following circumstances:
1. Where an answer to the notice of motion for emergent medical care has been filed, the district office shall provide notice of the initial conference by telephone and fax to the petitioner's attorney or petitioner pro se and to the answering party using the telephone numbers and fax numbers indicated in the notice of motion for emergent medical care and the answer, respectively;
2. Where an answer to the notice of motion for emergent medical care has not been filed and where the employer is insured, the district office shall provide notice of the initial conference by telephone and fax to the employer and to the insurance carrier contact person listed in the notice of motion for emergent medical care; or
3. Where an answer to the notice of motion for emergent medical care has not been filed and where the employer is not insured or the insurer is not known, the district office shall provide notice of the initial conference by telephone and fax to the employer and to the Uninsured Employer's Fund.
(n) If the motion for emergent medical care has not been resolved at the initial conference and the employer or the employer's insurance carrier has not requested a medical examination of the petitioner under (h) above, the judge shall hold a hearing on the merits of the motion for emergent medical care as soon as is practicable, but no later than five calendar days from the date of the initial conference.
(o) If the motion for emergent medical care has not been resolved at the initial conference and the employer or employer's insurance carrier has requested a medical examination of the petitioner under (h) above, the judge shall hold a hearing on the merits of the motion for emergent medical care as soon as is practicable after the medical examination of the petitioner, but no later than five calendar days from the date of the medical examination of the petitioner.
(p) With regard to the hearing on the merits of the motion for emergent medical care, the judge may require a continuous trial or may use other procedures to ensure that the motion is expeditiously heard.
(q) The judge hearing the motion for emergent medical care shall render a decision and issue an order on the motion within one business day of the conclusion of the trial testimony.
(r) The judge may supplement the decision and order rendered under(q)above at a later date.
(s) If a motion for emergent medical care does not meet the requirements under this section, but does meet the requirements for a general motion for temporary and/or medical benefits under N.J.A.C. 12:235-3.3, the motion shall be listed and proceed as a general motion for temporary and/or medical benefits.
12:235-3.4 Insurance carrier or self-insured employer contact person procedures pursuant to N.J.S.A. 34:15-15.4
(a) Every insurance carrier providing workers' compensation insurance and every workers' compensation self-insured employer shall designate a contact person who is responsible for responding to issues concerning medical and temporary disability benefits where no claim petition has been filed or where a claim petition has not been answered.
(b) The contact person referred to in (a) above shall also receive notice of motions for emergent medical care under N.J.A.C. 12:235-3.3.
(c) The full name, telephone number, mailing address, e-mail address and fax number of the contact person referred to in (a) above shall be submitted to the Division utilizing the Division's contact person form in the manner instructed on the form.
(d) The Division's contact person form shall be made available on the Division's website and at the Division's district offices.
(e) Any changes of contact person or in information about the contact person shall be immediately submitted to the Division using the Division's contact person form.
(f) After an answer to a claim petition has been filed, the attorney of record for the respondent shall be the point of contact for issues concerning temporary disability and/or medical benefits.
(g) A contact person roster using the information provided under (c) above will be available on the Division's website.
(h) Failure to comply with the requirements of N.J.S.A. 34:15-15.4 or this section shall result in a fine of $2,500 for each day of noncompliance, which fine shall be payable to the Second Injury Fund.
1. The Division shall send notice of noncompliance and of the fine amount by certified mail, return receipt requested, to the business address of the insurance carrier or self-insured employer.
2. The insurance carrier or self-insured employer shall have 30 calendar days to pay the fine or to contest the fine.
3. Where the insurance carrier or self-insured employer contests the fine, the Division shall hold a conference in an attempt to resolve the dispute.
Recodify existing N.J.A.C. 12:235-3.3 through 3.13 as 3.5 through 3.15 (No change in text.)
12:235-3.16 Enforcement
(a) A party may, by written motion pursuant to N.J.A.C. 12:235-3.5(a) and (b), move against an employer, insurance carrier, petitioner, case attorney or any other party to a claim petition for enforcement of any court order or for the enforcement of the requirements of the workers' compensation statute or rules.
(b) The motion under (a) above shall identify the order, statute or regulation sought to be enforced.
(c) The party against whom the motion has been brought shall file a written response to the motion within 14 calendar days of the notice of motion.
(d) The response under (c) above shall include the reasons for any noncompliance and the manner and time period to ensure compliance.
(e) Any time after the 14-day period to respond under (c) above has elapsed and on notice to the parties, the judge shall hold a hearing on the motion.
(f) A judge on his or her own motion may at any time, upon notice to the affected parties, move to enforce a court order or to enforce the requirements of the workers' compensation statute or rules.
(g) Prior to ruling on a motion under (f) above, the judge shall provide the parties an opportunity to respond to the motion and to be heard on the record.
(h) Upon a finding by a judge of noncompliance with a court order or the workers' compensation statute or rules, the judge, in addition to any other remedy provided by law, may take any or all of the following actions:
1. Impose costs and simple interest on any monies due.
i. The judge may impose an additional assessment not to exceed 25 percent on any moneys due if the judge finds the payment delay to be unreasonable;
2. Levy fines or other penalties on parties or case attorneys in an amount not to exceed $5,000 for unreasonable delay or continued noncompliance.
i. A fine shall be imposed by the judge as a form of pecuniary punishment.
ii. A penalty shall be imposed by the judge to reimburse the Division's administrative costs.
iii. The proceeds under this paragraph shall be paid into the Second Injury Fund;
3. Close proofs, dismiss a claim or suppress a defense as to any party;
5. Take other appropriate case-related action to ensure compliance; and/or
6. Allow a reasonable counsel fee to a prevailing party, where supported by an affidavit of services.
(i) Upon a finding by a judge of noncompliance by a party with a court order or the workers' compensation law or rules, the judge, in addition to any other remedy provided by law, may hold a separate hearing on the issue of contempt.
(j) Following a hearing under (i) above and upon a finding by the judge of contempt, the successful party in the contempt hearing or the judge may file a motion with the Superior Court for contempt action.
(k) Any fine, penalty, assessment or cost imposed by a judge under this section shall be paid by the entity or party found to be in noncompliance and shall not be included in the expense base of an insurance carrier for the purpose of determining rates or as a reimbursement or case expense.
Recodify existing N.J.A.C. 12:235-3.15 and 3.16 as 3.17 and 3.18 (No change in text.)
12:235-7.1 Purpose; scope
(a)-(d) (No change.)
(e) A petitioner may move to relax or dispense with requirements under this subchapter.
1. After a hearing on the motion to relax or dispense with requirements under this subchapter, the judge may grant the motion upon a finding that the subject requirements under the particular facts of the case are unduly burdensome and that grant of the motion would not adversely affect the UEF.
(f) Where petitioner seeks current medical treatment and/or temporary disability benefits and the only issue is the cancellation or non-renewal of an insurance policy, the judge may order the insurance carrier to provide treatment and/or benefits without prejudice and subject to reimbursement by the employer or, if not paid by the employer, by the UEF, if it is subsequently determined that the policy was not in effect.
(g) (No change in text.)
12:235-7.4 Medical bills; physician's examination
(a) Any medical bills or charges for which petitioner seeks payment from the UEF must be timely submitted by the petitioner to the UEF and be supported by the following:
1. Related treating records, itemized bills and a physician's report, which reflects that the bills and charges were reasonable, necessary and causally related to the work accident or occupational exposure alleged in the claim petition; and
2. Other necessary medical documentation or information required by the UEF.
(b) Any dispute under this section concerning the treating records, bills, physician's report or UEF request for other medical documentation or information shall be determined by the judge after a hearing upon oral or written motion by the UEF or another party.
For more information concerning medical care and workers’ compensation click here.
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