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Thursday, November 8, 2012

Workers’ Compensation Is About Relationships

Today's post comes from guest author Ryan Benharris (MA) from Deborah G. Kohl Law Offices.

Prevention of accidents should be the first step in establishing a successful workers’ compensation system. If an employer were truly concerned about the health and safety of the employee there would be no need for workers’ compensation.

Unfortunately the profit motive of the employer sometimes corrupts the process, and shortcuts are taken at work to increase production at an anticipated lower cost to the employer.

Employers need to understand that the human and financial costs of industrial accidents and exposures can be devastating. Injured workers, through the workers’ compensation process, may seek the payment of medical benefits, lost time payments and permanent disability awards. 

Hopefully, the relationship between employees and employers can improve, and the workplace can become a safer environment.
....
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 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.

More About Workers' Compensation and Medical Benefits

Jul 30, 2011
The just published, Issue 3 of the Workers' Compensation Resources Research Report (WCRRR) provides 23 years of information on cash benefits, medical benefits, and total (cash plus medical) benefits per 100,000 workers ...
Mar 21, 2012
The implementation of the Act will ultimately have far reaching consequences of the overall operation of both the delivery of workers' compensation medical benefits and the ultimate assessment/apportionment of permanent ...
Nov 13, 2008
Now that Barach Obama is a going to be at the helm of the US, greater attention is being focused on the need for a national health care system incorporating workers' compensation medical coverage. With private insurance ...
Aug 29, 2011
The medical issue remains open usually and medical benefits remain the responsibility of the employer. The medical issue becomes a complication when costs are attempted to be shifted to collateral medical carriers or ...

Tuesday, November 20, 2012

Constitutional Challenge to Texas Workers' Compensation Domain Name--The Forbidden Words

The Fifth Circuit Court of Appeals has remanded, for additional review, a complaint filed by a Texas Workers' Compensation attorney who alleges that his constitutional rights were infringed upon by a Texas statute prohibiting misleading advertising. The attorney was cited by the State of Texas for using a domain name that contain the words "Texas" and "Workers' Compensation." The site is named, TexasWorkersCompLaw.com

The Court stated that the use of the domain maybe constitutionally protected:

"A domain name, which in  itself  could  qualify  as  ordinary  communicative  speech, might  qualify  as commercial speech if the website itself is used almost exclusively for commercial purposes."


Friday, November 21, 2014

Govt wants more clinical trial results made public

Today's post was shared by Take Justice Back and comes from hosted.ap.org

WASHINGTON (AP) -- Doctors and patients may soon find it easier to learn if clinical trials of treatments worked or not, as the government proposed new rules Wednesday expanding what researchers are required to publicly report.
Thousands of Americans participate in clinical trials every year, to test new treatments or diagnostics, compare which older therapies work best, or help uncover general knowledge about health.
Many of the studies are reported in scientific journals or trumpeted in the news. But researchers don't always publicly reveal their results, especially when the findings show a treatment doesn't work as initially hoped, said Dr. Francis Collins, director of the National Institutes of Health.
Collins cited one recent analysis that found less than half of studies had been published in a peer-reviewed scientific journal within 30 months of completion.
"This is simply not acceptable," Collins said. "This dissemination of trial results is the way in which medical progress occurs."
Wednesday's proposals aim to change that by increasing information available on a public database - http://www.clinicaltrials.gov - that already is a major source for patients and doctors seeking to find the latest studies that need volunteers.
That site lists basic registration information - what's being studied, in whom - about more than 178,000 clinical trials here and abroad. Some are enrolling participants; some already are completed. By NIH's count, just 15,000 of...
[Click here to see the rest of this post]

Friday, December 28, 2012

Legislation Goes to President Obama on CMS Condition Payment Procedures

The US House (H.R. 1845) and US Senate has passed legislation to modify procedures for processing conditional payments under the Medicare (S. 1718) Secondary Payer Act. It establishes parameters for repording, processing and appealing issues concerning conditional payments.

Under the proposed legislation time periods for reporting by parties to CMS (The Center for Medeicare and Medicaid Services) are eased, penalities for insurance carriers are reduced, and a 3 year statute of limitations is established.

The legislation was merged into another pending bill for medical services and was rushed to a favorable vote in both the House and Senate in the last moments before Christmas.

What remains to be determined are the regulations that will be established to implement the legislation. In the past, such regulations usually set boundries for such legislation and may in the end further complicate and even prolong resolution of the issues.

Read more about "The Medicare Secondary Payer Act" and workers' compensation


Oct 01, 2012
US Supreme Court Denies CMS-MSP Case - Hadden. 2012 WL 1106757. Supreme Court of the United States. HADDEN, VERNON V. UNITED STATES. No. 11-1197.Oct. 1, 2012. Opinion. The petition for writ of certiorari is ...
Apr 03, 2009
CMS/MSP Requires Deceased Beneficiary Information. CMS has announced that workers' compensation information concerning deceased beneficiaries must be reported by insurance carriers. "We received another question ...
May 18, 2011
"IT IS FURTHER ORDERED that Defendant's demand for payment of her MSP reimbursement claims, under threat of collection actions before there has been a resolution of an appeal regarding the amount of the Defendant's ...
Dec 23, 2008
A formal process exits to obtain a waiver of an Overpayment Recovery request from The Center for Medicare and Medicaid Services [CMS]. If SSA advises you or your client that it has made an overpayment, ie. Medicare ...


Saturday, December 1, 2012

Hospital Controlled Physician Access and Workers' Compensation

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

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

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

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

Read more about "medical Costs" and workers' compensation

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



Wednesday, May 7, 2014

Employers Eye Moving Sickest Workers To Insurance Exchanges

Today's post is shared from Kaiser.org
Can corporations shift workers with high medical costs from the company health plan into online insurance exchanges created by the Affordable Care Act? Some employers are considering it, say benefits consultants.
"It's all over the marketplace," said Todd Yates, a managing partner at Hill, Chesson & Woody, a North Carolina benefits consulting firm. "Employers are inquiring about it and brokers and consultants are advocating for it."


Health spending is driven largely by patients with chronic illness such as diabetes or who undergo expensive procedures such as organ transplants. Since most big corporations are self-insured, shifting even one high-cost member out of the company plan could save the employer hundreds of thousands of dollars a year -- while increasing the cost of claims absorbed by the marketplace policy by a similar amount.
And the health law might not prohibit it, opening a door to potential erosion of employer-based coverage.
"Such an employer-dumping strategy can promote the interests of both employers and employees by shifting health care expenses on to the public at large," wrote two University of Minnesota law professors in a 2010 paper that basically predicted the present interest. The authors were Amy Monahan and Daniel Schwarcz.
It's unclear how many companies, if any, have moved sicker workers to exchange coverage, which became available only in January. But even a few high-risk patients could add...
[Click here to see the rest of this post]

Thursday, December 7, 2023

Potential Impact of the Purdue Pharma Bankruptcy Case

The Purdue Pharma bankruptcy case will significantly impact workers’ compensation cases nationally. The US Supreme Court heard oral argument this week, and the potential consequences are far-reaching.

Tuesday, June 21, 2022

US Supreme Declines to Review Medical Marijuana Reimbursement Issue

The US Supreme Court (SCOTUS) declined to review 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 was denied today.  Musta v. Mendota Heights Dental Center, et al., No. 21-998. Therefore, the individual States will remain the authority on whether reimbursement for medical marijuana will be permitted in a workers' compensation claim.

Friday, March 28, 2014

Nurse Ratched Comes To Workers' Compensation or Why Workers' Compensation Should NOT be Involved in Criminal Drug Enforcement

State officials and legislators are increasingly concerned with the over-prescription of opiates and other controlled substances for pain management in the workers’ compensation program.

A bill pending in...

[Click here to see the rest of this post]

Related Story:
Workers' Compensation: Physicians Petition to Limit Opioid Abuse
Jul 27, 2012
The efforts to reform pharmacuetical use is a tough balancing act. The ulterior motive of cost savings and profits generates sensationalism, but what makes good medical sense and what benefits the patient should not go ...
http://workers-compensation.blogspot.com/

Tuesday, July 29, 2014

Medical pot covered by workers' comp, says appeals court

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

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.

Thursday, December 27, 2012

Who Calls The Shots, Your Employer-Selected Doctor Or The Insurance Company?


Insurance companies sometimes tell doctors that they will not pay for procedures that the doctor says are medically appropriate.

Today's post comes from guest author Nathan Reckman from Paul McAndrew Law Firm.

In Iowa, employers have the right to control an injured worker’s medical care. This means that if you are injured at work, your employer gets to send you to a doctor of their choosing. The doctors chosen by the employer are called “authorized treating physicians.” In theory, after an employer chooses their authorized treating physician, they are required to pay for any care that doctor believes is necessary to treat the work injury. In practice, the employer and their workers’ compensation insurance company often try to interfere with the care the injured worker is entitled to by refusing to pay for procedures or tests recommended by their handpicked doctor.

Typically, when an authorized doctor suggests an expensive course of care (like surgery) the first thing the doctor will do is check with the insurance company to make sure the surgery is going to be paid for. Instead of immediately scheduling the needed surgery, the doctor will wait until the insurance carrier agrees to pay for the procedure. Doctors do this so they don’t have to worry about how they are going to be paid. Asking for this unneeded authorization from the insurance company means the insurance company now has a say in determining what individual procedures are proper for the care of the work injury.

We often see injured workers whose injury was initially accepted by the employer until the doctor requests authorization for an expensive surgery. When faced with the additional cost of surgery, the insurance carrier denies the work injury hoping the injured worker will either forego surgery or try to pay for the surgery through other means, such as their personal health insurance.

This situation may also arise when the authorized doctor recommends expensive diagnostic procedures, like CT scans, or refers the injured worker to a specialist, for example a psychiatrist for depression related to the work injury.

To make sure your rights are protected, it’s often helpful to have an experienced workers’ compensation attorney on your side if you’re facing a situation where your employer is trying to interfere with the decisions of their handpicked doctor. Injured workers should get the care that their doctor, not an insurance company, determines is medically appropriate.

Read more about "medical treatment" and workers' compensation.


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 ...
Nov 09, 2012
On Tuesday, the American people expressed its support for a unified medical care program that will embrace all aspects of life, including industrial accidents and diseases. They validated, as did the Supreme Court, the ...
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 ...
Jan 22, 2011
The court held that the failure of the employer/insurance carrier to provide medical care for out-of-state treatment, even though requested by the employee, was deemed a refusal of the employer to provide adequate medical ...

Related articles

Tuesday, November 13, 2012

NJ Workers Compensation Courts Reopen

Long Beach Island, N.J., Nov. 11, 2012 -- Utility crews are hard at work on Long Beach Island to help residents with their recovery. FEMA is working with local, state and other federal agencies to provide assistance. Steve Zumwalt/FEMA
Almost two weeks after Hurricane Sandy made landfall in NJ, the New Jersey Division of Workers' Compensation has announced the reopening of the Lebanon and New Brunswick offices.

"Power has been restored to the New Brunswick and Lebanon Workers' Compensation Court offices, both will be OPEN for business on Tuesday, November 13, 2012."

Read more about "Hurricane Sandy"

19 hours ago
As Hurricane Sandy recovery workers descend on NJ by land, sea and airlift, by the thousands, energized and fueled by caffeine, to work long and tiring hours, to do treacherous and hazardous tasks, they need to understand ...
Oct 25, 2012
The NJ Office of Emergency Management and the National Hurricane Center are closely monitoring Hurricane Sandy ("frankenstorm") as it has the potential to become an historic storm as it moves up the Eastern seaboard ...
Nov 05, 2012
The U.S. Department of Labor's Occupational Safety and Health Administration is urging workers and members of the public engaged in Hurricane Sandy cleanup and recovery efforts in New York, New Jersey and the New ...
Oct 28, 2012
The NJ Office of Emergency Management and the National Hurricane Center are closely monitoring Hurricane Sandy ("frankenstorm") as it has the potential to become an historic storm as it moves up the Eastern seaboard .

Thursday, October 25, 2012

Hexavalent Chromium Cleanup Progressing With Building Demolition in Garfield NJ

The U.S. Environmental Protection Agency today announced that it has demolished the E.C. Electroplating building at the Garfield Ground Water Contamination Superfund site in Garfield, New Jersey. Areas underneath the building, located at 125 Clark Street, are contaminated with hexavalent chromium that is reaching the basements of some area residences and businesses through the ground water. The EPA continues to assess and, if needed, clean up nearby basements. The demolition of the building will allow the EPA to remove contaminated soil that is a likely source of chromium contamination in the ground water.

Hexavalent chromium is extremely toxic, may cause cancer and nervous system damage. Prior to the demolition of the structure, the EPA met with community members and local officials to keep them informed, coordinate activities and ensure public safety.

“The EPA has safely taken down the former E.C. Electroplating building, an important step in the agency’s work to protect the health of the Garfield community,” said EPA Regional Administrator Judith A. Enck. “Our next step is to assess the best way to address the chromium contaminated soil that is underneath the structure.

The EPA’s sampling had shown that the parts of the E.C. Electroplating building above the foundation slab were not contaminated with hexavalent chromium, but two basements and the soil under the structure were contaminated. The structure had to be demolished to access the contaminated soil underneath. The industrial materials and building debris left at the E.C. Electroplating site have been removed and disposed of at facilities licensed to receive the waste. Over 600 cubic yards of debris and over 325 drums of hazardous waste were removed from the site. The demolition work began on October 12, 2012 and was completed on October 22, 2012.

Throughout the demolition work, the EPA followed strict work procedures to protect public health. Dust was controlled and the air was monitored to ensure that contamination was not getting into the community during the demolition. Air monitoring data showed that there have been no hazardous levels of hexavalent chromium, total chromium, lead or cadmium.

As part of its longer-term work, the EPA has established a network of ground water monitoring wells to determine the extent of chromium contamination in the ground water. This in-depth investigation is ongoing and will allow the EPA to develop a proposed plan for the cleanup of chromium-contaminated ground water.

For a complete history of the EPA’s work at the Garfield Ground Water Contamination Superfund site please visit: http://www.epa.gov/region2/superfund/removal/garfield.
....
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 work related accident and injuries.

Read more about "Chromium Contamination"
Aug 09, 2012
The building, located at 125 Clark Street, is contaminated with hexavalent chromium that is reaching the basements of some area residences and businesses through the ground water. Hexavalent chromium is extremely toxic, ...
Oct 03, 2009
Chromium exposure has been associated with lung cancer. Breathing high levels of hexavalent chromium can irritate or damage the nose, throat, and lungs. Irritation or damage to the eyes and skin can occur if hexavalent ...
Jun 09, 2009
Soldiers Exposed to Chromium in Iraq File Suit. Soldiers who have been exposed to hexavalent chromium, a carcinogen, have filed suit against a government contractor. The present and former soldiers have brought a claims ...
Nov 23, 2010
EPA announced the release of the Toxicological Review of Hexavalent Chromium in the September 30, 2010, Federal Register. This draft assessment is provided for public viewing and comment. Public comments received on ...

Friday, April 22, 2016

22 million U.S. workers are exposed to hazardous occupational noise

The Centers for Disease Control and Prevention (CDC) released new data regarding injuries, deaths, and illness faced by millions every year in the workplace. This week’s Morbidity and Mortality Weekly Report (MMWR) issue is devoted to occupational health concerns, in acknowledgment of Workers Memorial Day (April 28th).

Thursday, October 24, 2013

FDA Proposes Changes in Pain Medication Prescriptions

The US FDA has announced proposed changes will be forthcoming in labeling for pain relief medication:
Consumers and health care professionals will soon find updated labeling for extended-release and long-acting opioid pain relievers to help ensure their safe and appropriate use.
"In addition to requiring new labeling on these prescription medications, the Food and Drug Administration (FDA) is also requiring manufacturers to study certain known serious risks when these drugs are used long-term.
"The new labeling requirements and other actions are intended to help prescribers and patients make better decisions about who benefits from the use of these medications.

They also are meant to reduce problems associated with their use," says Douglas Throckmorton, M.D., deputy director of regulatory programs in FDA's Center for Drug Evaluation and Research. "Altogether, the actions we're now announcing are part of FDA's efforts to make opioids as safe as possible for those who need them," Throckmorton adds.
"He noted that the actions come after careful analysis of new safety information, including reviews of medical literature, and consideration of input from patients, experts and many other interested parties.