The latest edition of the annual Official Disabilities Guidelines (ODG) has been released, including the latest ODG volume on treating patients. ODG Treatment is the nationally recognized standard for medicine in determining the scope and duration of medical treatment in workers’ compensation.
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Thursday, March 28, 2013
Official Disabilities Guidelines Now Covers Diabetes
The latest edition of the annual Official Disabilities Guidelines (ODG) has been released, including the latest ODG volume on treating patients. ODG Treatment is the nationally recognized standard for medicine in determining the scope and duration of medical treatment in workers’ compensation.
Tuesday, September 10, 2013
Law Will Shift Demographics For Medicaid Toward Healthier Group, Study Finds
The health law is expected to change the face of Medicaid – literally. Using statistics from the National Health and Nutrition Examination Survey, the authors found that the group of newly eligible individuals is:
“It’s really a game changer,” said Dr. Tammy Chang, a lead author of the report. “A lot of providers think of Medicaid... |
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Monday, September 15, 2014
Thank You Truck Drivers!
Today's post is shared from cdc.gov and was authored by W. Karl Sieber, Ph.D.:
- What is the best way to get our information out to long-haul truck drivers?
- Who would long-haul truck drivers listen to?
- What health and safety topics are important to long-haul truck drivers?
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- NIOSH Safety Video MOVE IT! (workers-compensation.blogspot.com)
- Truck Drivers Not Revved Up About New Safety Rules (workers-compensation.blogspot.com)
- NIOSH Fact Sheet: NIOSH Approval Labels - Key Information to Protect Yourself (workers-compensation.blogspot.com)
- Big Judgement Against Carrier Over Deadly 2011 Nevada Train Crash (workers-compensation.blogspot.com)
- NIOSH to Establish a National Workers' Compensation Data/Analysis Center (workers-compensation.blogspot.com)
- NIOSH To Review Underreporting of Occupartional Injuries and Illnesses by Workers (workers-compensation.blogspot.com)
Friday, July 18, 2014
TOP 10 EVENTS IN CALIFORNIA WORKERS’ COMP 1ST HALF 2014
2014 is half done. What were the most significant events/themes in California workers’ comp in the first half of 2014? Here, in no particular order, are my top picks: 1. CONTROVERSY OVER UTILIZATION REVIEW AND INDEPENDENT MEDICAL REVIEW CONTINUES Utilization review and independent medical review continued to generate controversy during the first half of 2014. California injured workers, doctors, and applicant attorneys complained that it was increasingly hard to get consistent treatment for work injuries, as many adjusters used utilization review to deny treatments. Prominent attorney advocates called for reform of utilization review statutes and regulations. However, there were disputes about the raw numbers. A January 2014 study by CWCI (the California Workers’ Comp Institute) (http://cwci.org/research.html) claimed that only about 4.7% of treatment requests are ultimately denied or modified. According to the CWCI around 75% of treatment requests were approved without being sent to UR (“elevated review”). These numbers were in line with a 2011 study done by RAND. In response, a January 2014 analysis )of 2013 sample UR audit data prepared by CAAA consultant Mark Gerlach documented that some insurers were denying as much as two of every three treatment requests. Reviewing audit data, Gerlach noted that there was a wide range in approval rates of different claims administrators. Overall,... [Click here to see the rest of this post] |
Related articles
- CWCI and WCIRB: SB 863 Lowered Surgical Center Payments in California (insurancejournal.com)
- Move Over: Obesity as a medical condition is coming to workers' compensation (workers-compensation.blogspot.com)
- Cal/OSHA holds BART accountable for worker deaths, levies heavy fine (mysafetysign.com)
- CWCI Study Measures Claims Outcomes with Doctor-Dispensed Repackaged Drugs (claimsjournal.com)
- #WorkComp: It's The Greed. It's The Fraud. Is it 2014 or 1939? WHAT DIFFERENCE DOES IT MAKE? (askaboutworkerscompgravytrains.com)
- Another View: Workers' comp 'fixes' will result in more litigation (sacbee.com)
- California: Medical Delay and Denial Protested (workers-compensation.blogspot.com)
Wednesday, December 19, 2012
9/11 Rescue Workers At Increased Risk for Cancer
The study published in The Journal of the American Medical Association reported an increased incidence of prostate and thyroid cancers, plus multiple myeloma.
Benefits are available under The Zadroga 9/11 Victims Compensation Fund Benefit Program. The law was enacted by the US Congress and signed into law by President Barack Obama about 3 years ago.
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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 The Zadroga 9/11 Victim Compensation Fund Benefit Program
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Friday, March 15, 2013
The Painful Knee: A Genetic Issue
"But in the end, genetics, and the kind of cartilage you got from your parents, may play the biggest role. It is a little like buying tires, said Dr. Frederick M. Azar, chief of staff of the Campbell Clinic in Memphis and an official with the American Academy of Orthopaedic Surgeons. “You can get nice treads or you can get retreads,” he said."
Read the complete report: Why Do My Knees Hurt? (NYTimes 3.15.13)
Wednesday, August 21, 2013
Senate fails to revive workers' comp bill for first responders
The bill would have required the employer to challenge any work-related injuries and illness, shifting the burden away from nurses, firefighters, police officers, rescue squad members and other first responders who have to prove how and when they were hurt or sickened under the current system.
Wages and medical benefits would be paid if "any death or disability, including post traumatic stress disorder, arises from the physical or psychological impact of stress or injury experienced by the public safety worker during response to a terrorist attack, epidemic or other catastrophic emergency," according to the bill sponsored by Sen. Linda Greenstein (D-Middlesex).
Christie said while the state is grateful for the heroic work of its first responders, New Jersey can't afford this legislation.
Tuesday, August 13, 2013
Garlock trial winds down; judge closes courtroom again
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- Governor Christie Vetoes First Responder Workers' Compensation Bill (workers-compensation.blogspot.com)
- Move Over: Obesity as a medical condition is coming to workers' compensation (workers-compensation.blogspot.com)
- NJ Workers Compensation Companies Pay More for Hospital Fees (workers-compensation.blogspot.com)
Friday, December 13, 2013
How Clinical Guidelines Can Fail Both Doctors and Patients
Guidelines came about after generations of physicians wanted to bring something more than “opinion and experience” to the patient’s bedside. In the late 1960s legislation for the U.S. Food and Drug Administration was amended to call for a demonstration of efficacy and an assessment of benefits and risk as prerequisite to the licensing of any pharmaceutical. Modern clinical science resulted, first slowly and now with an avalanche of clinical trials, each pouring forth outcome data galore. The Burden of Clinical Data Clinicians are expected to stay current with this wealth of information. The modern medical curriculum instructs all budding physicians on how to evaluate the quality and the clinical relevance of all such contributions to the body of clinical science. Because some (or perhaps many) find this exercise overwhelming, there are organizations—many academic and some without any discernible relationships with purveyors that could pose... |
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Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
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Tuesday, September 30, 2014
Working Long Hours Tied to Diabetes Risk
Working long hours may increase the risk for Type 2 diabetes, a new review has found, but the risk is apparent only in workers of lower socioeconomic status.
Long working hours are associated with diabetes risk factors — work stress, sleep disturbances, depression and unhealthy lifestyle, and some studies have found long hours associated with increased risk for cardiovascular disease.
Researchers combined data from 19 published and unpublished studies on more than 222,000 men and women in several countries.
The analysis, published in The Lancet Diabetes & Endocrinology, found no effect of working hours in higher socioeconomic groups. But in workers of lower socioeconomic status, working more than 55 hours a week increased the risk for Type 2 diabetes by almost 30 percent. The association persisted after excluding shift workers and adjusting for age, sex, obesity and physical activity.
The study is observational, and the lead author, Mika Kivimäki, a professor of epidemiology at University College London, said there were no intervention studies that could establish cause and effect.
“My recommendation for people who wish to decrease the risk of Type 2 diabetes,” he said, “applies both to individuals who work long hours and those who work standard hours: Eat and drink healthfully, exercise, avoid overweight, keep blood glucose and lipid levels within the normal range, and do not smoke.”
[Click here to see the rest of this post]
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Monday, September 2, 2013
Media Portrays Social Security as an Avenue to Benefits for the Unemployed - WRONG! It's Not That Simple...
The Social Security Administration turns down many worthy applicants when they first apply.
Photo credit: Thomas Hawk / Foter.com
/ CC BY-NC
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So I work with the program’s rules - yes, there are rules for deciding these cases – it is not enough just to claim to be disabled. And I come face to face with individuals who are struggling, sometimes with a major health issue such as cancer, or rheumatoid arthritis, or Multiple Sclerosis.
Other folks have multiple health problems that have combined to force them from the labor market. All of them have medical records, often reams of them, documenting diagnoses, chronicling surgeries and other treatment regimens. This is one big thing I think the general public does not know: a person must have one or more diagnoses from a qualified physician that could account for the symptoms and limitations he or she is reporting to Social Security.
Sunday, November 13, 2016
Weighing Genetic Factors in Cardiovascular Cases
Saturday, May 28, 2022
NJ Senate Confirms Judicial Nominations
Wednesday, June 8, 2022
Common Law Discrimination Complaint Fatally Flawed
One of the remedies available to injured workers who have been discharged in retaliation for filing a workers’ compensation claim is a common law action. The failure to adequately plead a retaliation action in the complaint will result in the dismissal of the action.
Monday, April 12, 2010
The Health Reform Act Charts a New Course for Occupational Health Care
Wednesday, August 14, 2013
Anti-Smoking Battle Moves Outdoors
City parks, public beaches, college campuses and other outdoor venues across the country are putting up signs telling smokers they can't light up. Outdoor smoking bans have nearly doubled in the last five years, with the tally now at nearly 2,600 and more are in the works.
But some experts question the main rationale for the bans, saying there's not good medical evidence that cigarette smoke outdoors can harm the health of children and other passers-by.
Whether it is a long-term health issue for a lot of people "is still up in the air," said Neil Klepeis, a Stanford University researcher whose work is cited by advocates of outdoor bans.
Ronald Bayer, a Columbia University professor, put it in even starker terms.
"The evidence of a risk to people in open-air settings is flimsy," he said.
There are hundreds of studies linking indoor secondhand smoke to health problems like heart disease. That research has bolstered city laws and workplace rules that now impose smoking bans in nearly half of the nation's bars, restaurants and workplaces.
Tuesday, January 1, 2013
Workers’ Compensation 2013 – What Happens on the Other Side of The Fiscal Cliff?
Overall health care devours 18 percent of the US economy and amounts to 25% of the Federal budget.
Medical treatment for injured workers continues to be delayed, denied and limited under current workers’ compensation programs. Medical costs continue to be shifted to other programs including employer based medical care systems and the Federal safety net of Medicare, Medicaid, Veterans Administration and Tricare.
While a trend continues to emerge to offer “Opt Out” and “Carve Out Programs,” they are not global enough to solve the critical budget deficit issues. The latest emerging trend is for employers to utilize ERISA based medical care plans to efficiently delivery medical care. In NJ a limited alternate dispute-resolution procedure between unions and employers has been introduced. See “NJ Care Outs –Another Evolutionary Step” authored by David DePaolo.
The US economy continues to be very weak. This in an ominous signal for the nation’s workers’ compensation program which is starved for premium dollars. Premiums are based upon salaries and real median incomes continued their dramatic decline over the last decade from $54,841 in 2000 to $50,054 in 2011. There just may not be enough dollars available in the workers’ compensation programs to pay for present and lifetime medical care.
Even the present Federal system leaves much to be desired. Whether Federal rationing medical care becomes a reality is unknown. Physicians are under economic scrutiny as the “Doc Fix” to limit provider fees continues as a cloud over all medical programs. The agreement reached by Congress still does not resolve the 26.5% percent cut reimbursement cut to physicians who treat Medicare patients. The law merely "freezes" payment to physicians.
Workers’ compensation programs presently structured provide no real economic incentive to monitor and compensate for more favorable medical outcomes. On the other hand, the Federal government, with broad and sweeping regulatory ability, is able to continue to make strides in many areas including present incentives to hospitals and proposed incentives to physicians to provide medical treatment with fewer complications and ultimate better outcomes
Steven Ratner in the NY Times points out the dramatic increase in the nation’s health care costs. He wrote, “…no budget-busting factor looms larger than the soaring cost of government-financed health care, particularly Medicare and Medicaid.”
Now that we are on the other side of the fiscal cliff, the opportunity to be creative is possible. The US needs to transition to a single-payer health care system subsuming a medical care program for injured and ill workers who suffer both traumatic and occupational conditions.
Read more about the "single-Payer System" and workers' compensation
Workers' Compensation: A Single Payer System Will Solve the ...
Nov 29, 2012
The question is whether the nation will recognize that the US needs tol take the bold step previously taken by the European Community, finally adopt a single payer medical care program. The perpetual cost generator that ...
http://workers-compensation.blogspot.com/
NJ Urged to Adopt Single Payer System for Workmens Comp
Jun 06, 2011
NJ Urged to Adopt Single Payer System for Workmens Comp. A coalition that has been formed in NJ is urging that the Garden State follow the lead of Vermont and establish a single-payer system. Single-payer movements ...
http://workers-compensation.blogspot.com/
Vermont Single Payer System Called the Dawn of A New Era
Apr 03, 2011
The proposed state based Vermont Single-Payer health care system, that would embrace workers' compensation medical care, is gaining momentum. A recent article in the New England Journal of Medicine, citing increased ...
http://workers-compensation.blogspot.com/
RICO Issues Can Be Cured With A Single Payer Medical System
Mar 22, 2011
Vermont's proposed single payer system would seperate medical care from indemnity. Vermont's single proposed single-payer system would likely also provide a primary care doctor to every resident of Vermont. This would ...
http://workers-compensation.blogspot.com/
Monday, May 16, 2022
US Requests SCOTUS Not Review Medical Marijuana Reimbursement Issue
The US Government filed an amicus curiae brief requesting that the US Supreme Court (SCOTUS) not review the Minnesota Supreme Court’s decision prohibiting reimbursement of medical marijuana costs in a workers’ compensation claim. The US Government was invited to submit a brief by SCOTUS. Musta v. Mendota Heights Dental Center, et al., No. 21-998.
Tuesday, May 31, 2022
US Supreme Court to Conference Medical Marijuana Preemption Case
The US Supreme Court (SCOTUS) is scheduled to conference the Minnesota Supreme Court’s decision prohibiting reimbursement of medical marijuana costs in a workers’ compensation claim. The Petitioner for a Writ of Certiorari conference is listed for Thursday, June 16, 2022. Musta v. Mendota Heights Dental Center, et al., No. 21-998.