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(c) 2010-2024 Jon L Gelman, All Rights Reserved.
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Showing posts sorted by date for query rico. Sort by relevance Show all posts

Monday, December 10, 2012

Federal court denies motion to add Medicare secondary reimbursement claims to a pending class action

A United States District Court handling Vioxx litigation has denied as application to add Medicare reimbursement claims to the pending application. 

"The Court has reviewed the briefs and finds that denying leave to amend is appropriate because the proposed joinder of these new Defendant Law Firms is not the most expeditious way to dispose of the merits of these matters. First, the Court finds that the proposed amendment violates Federal Rule of Civil Procedure 20. The Court previously granted a motion to sever the Plan Plaintiffs' claims pursuant to Rule 21(a). See AvMed II, 2008 WL 4681368, at *5–8. As the Court held in AvMed II, the Plan Plaintiffs' bring different claims pursuant to different health benefit plan language to pursue liens over funds owed to different claimants in different factual circumstances. See id. This diversity between the claims of the individual Plan Plaintiffs meant that the rights to relief asserted did not arise out of the same transactions or occurrences and did not present common questions of law or fact. See id. (citing Fed.R.Civ.P. 20(a)). Therefore, the Court recognized the risk of “transform[ing] this litigation into an action against approximately 15,000 defendants, each of whom has entered into a separately negotiated health plan contract and each of whom has received medical benefits under highly individualized factual circumstances.” See id. at *8. Accordingly, the Court exercised its discretion to sever the improperly-joined claims of the individual Plan Plaintiffs."
....
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).  

In re Vioxx Products Liab. Litig., MDL 1657, 2012 WL 6045910 (E.D. La. Dec. 4, 2012)
Read more about Medicare Reimbursement Claims
Mar 17, 2009
A private suit, brought by a consortium of plaintiff entities and individuals seeking reimbursement of Medicare for the failure of the tobacco companies' to repay The Centers for Medicare and Medicaid [CMS] for benefits, was ...
Oct 01, 2010
The 11th Circuit Court of Appeals has held that Medicare is not entitled to reimbursement under the Medicare Secondary Payer Act (MSP) when the the surviving children's allocated share of proceed is the result of a wrongful ...
Dec 01, 2012
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 ...
Nov 22, 2011
The 6th Circuit Court of Appeals has ruled that The Center for Medicare and Medicaid Services (CMS) is entitle to complete reimbursement of Medicare payments under the Medicare Secondary Payer Act (MSP) from a liability ...

Thursday, November 29, 2012

A Single Payer System Will Solve the Fiscal Cliff

As time marches on to yet another US fiscal crisis, the politicians continue to attempt to direct public attention between the nation's rich and the poor. It has become yet another well produced political campaign of sound bites with no real substance.

The most important issue is not whether the country has "guns or butter," for in the end it will have both. 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 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 relief.

Robert Reich clearly stated the issue today in a posting on his blog:

"What worries me most about the tactical maneuvers over the "fiscal cliff" and "grand bargain" is that official Washington seems to be losing sight of the larger picture: We still have a huge number of unemployed, and many of those who have jobs continue to lose ground. If we were a sane society, we'd raise taxes on the rich in order to afford a first-rate system of public education for all our people, starting with early-childhood and extending through four-year college or technical; we'd borrow at historically-low rates (the yield on the ten-year Treasury is still below 1.4 percent) to put millions to work upgrading our crumbling infrastructure; and we'd turn our extraordinarily inefficient and costly healthcare system -- the single biggest driver of future budget deficits -- into a single-payer system focused on prevention and on healthy outcomes. Instead, we're locked into a game of chicken over the budget deficit, and preparing to cut public investments and safety nets.
....
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).  

Read more about "single payer systems" and workers' compensation
 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 ...
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 ...
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 ...
Mar 05, 2011
The legislation " proposes to set forth a strategic plan for creating a single payer and unified health system. It would establish a board …. ; establish a health benefit exchange for Vermont as required under federal health care ...

Heath Concerns About the Misuse of Pesticides for Bed Bug Control

Hotel workers as well as consumes are being cautioned cautioned about exposure to pesticides to control bed bugs.
The Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC) are alerting the public to an emerging national concern regarding misuse of pesticides to treat infestations of bed bugs and other insects indoors. Some pesticides are being applied indoors even though they are approved only for outdoor use. Even pesticides that are approved for indoor use can cause harm if over applied or not used as instructed on the product label.
There has been a dramatic increase in the number of bed bug-related inquiries received by the National Pesticide Information Center (NPIC) over the past several years, with many involving incidents of pesticide exposure, spills, or misapplications. From January 2006-December 2010, NPIC reported 169 calls to their hotline where residents, homeowners, or pesticide applicators sprayed pesticides indoors to treat bedbugs. These cases involved pesticides that were misapplied, not intended for indoor use, or legally banned from use. Of those, 129 resulted in mild or serious health effects (including one death) for persons living in affected residences.
ATSDR warns that outdoor pesticides should not be used indoors under any circumstances. Homeowners and applicators should always carefully read the product label to make sure that:
it has an EPA registration number
  • it is intended for indoor use
  • it is effective against bed bugs (the label should say it is meant to be used to treat your home for bed bugs) and
  • you know how to properly mix the product (if a concentrate) and where and how to apply it safely within the home.
  • ....
    Jon L.Gelman of Wayne NJ, is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson).  
More About Pesticides
Aug 22, 2012
Based on reports from the United States Centers for Disease Control (CDC) arial spraying of pesticides has been mandated in Texas because of the number of reported cases of West Nile Flu. Questions are now being raised ...
Feb 14, 2012
Consistent with an enforcement trend by the EU to reduce agricultural pesticides used by 50% between 2008-2018, a French court on Monday declared U.S. biotech giant Monsanto guilty of chemical poisoning of a French ...
Aug 11, 2010
A US District Court in NJ is allowing a claim of injured agricultural worker to proceed against an employer directly for an intentional tort flowing from a pesticide spraying. The workers, residents of Puerto Rico, were employed ...
Jul 02, 2009
A recent study by the McLaughlin Centre for Population Health Risk Assessment of the University of Ottawa finds that an increased risk of childhood leukemia is associated with the mother's exposure at work to pesticides.

Friday, November 16, 2012

NY Worker's Compensation Board Proposes New Medical Treatment Guidelines

New York Worker’s Compensation Board’s proposed new medical treatment guidelines that will modify 2010 previously implemented.

  1. Adopt the new carpal tunnel syndrome (CTS) medical treatment guidelines (MTG) as the standard of care for the treatment of injured workers with carpal tunnel syndrome;
  2. Modify current MTGs to include new maintenance care recommendations; and
  3. Implement consensus changes to simplify the process, reduce litigation and speed dispute resolution.

Carpal Tunnel Syndrome (CTS)
The new CTS MTG provide evidence based guidelines for the treatment of carpal tunnel syndrome, the most common occupational disease experienced in the workers’ compensation system. Like the other MTGs, the CTS MTG should improve the quality of care, speed access to the most beneficial treatment, and control the use of ineffective treatment.

Maintenance Care
The original four MTGs primarily address treatment for the acute and sub-acute phases of injury, with limited recommendations for the management of chronic conditions and chronic pain. As part of its effort to develop chronic pain guidelines, the MAC re-evaluated those recommendations that relate to maintenance care, recognizing that in certain situations maintenance care (chiropractic and occupational/physical therapy) should be available. The revised MTGs will authorize an ongoing maintenance program that can include up to 10 visits per year for those who have a previously observed and documented objective deterioration in functional status without the identified treatment. To be eligible for maintenance care, injured workers with chronic pain must have reached maximum medical improvement (MMI), have a permanent disability, and meet the requirements of the maintenance care program. No variance is allowed from the 10 visit annual maximum.

The new recommendations address a major concern of both providers and payers: the high number of variance requests. To date, more than three quarters of the variance requests are for maintenance care for those with chronic pain. Injured workers will now have access to important maintenance care while payers and providers will be relieved from the administrative burden of handling individual variance requests for this care. The remainder of the chronic pain guidelines is expected to be completed by early 2013.

Process Changes
The regulations also include several changes to simplify the process, reduce conflict, and speed dispute resolution. These consensus changes are the result of suggestions from stakeholders. The changes will achieve the following:

  • enable parties to more easily choose resolution by the Medical Director’s Office, which provides faster and less costly dispute resolution;
  • clarify and simplify transmission requirements that were resulting in rejection of thousands of variance requests for technical violations;
  • allow carriers to partially grant variance requests, thereby expediting care and reducing litigation;
  • eliminate submission of duplicate variance requests;
  • reduce the number of procedures requiring C-4 Authorization, and
  • authorize submission of variance requests through a web-based portal or other technology in the future, should it become available.
  •  
In addition, several changes to the Forms C-4 AUTH, C-8.1, MG-1 and MG-2 forms that have been agreed upon with stakeholders will be implemented.  Comments on the draft forms may be sent to formsdepartment@wcb.ny.gov and will be considered if received by Monday, November 26, 2012. Final versions of the forms will be posted in early December. The parties will be expected to begin using the new forms after February 1, 2013. Old forms cannot be used to initiate new requests after March 15, 2013.

Complete copies of the proposed regulations, new and revised guidelines, complete description of the process changes, draft versions of the new forms, and other information are available on the Proposed Changes to New York Medical Treatment Guidelines page of the Board’s website. The regulations will be published in the November 21, 2012 State Register.

More about workers’ compensation medical treatment

Our Journey Forward on Occupational Medical Care
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 ...
http://workers-compensation.blogspot.com/

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

Workers' Compensation: Loss of Health Insurance Access: The ...
Nov 05, 2012
On the flip side, the worker's compensation insurance company is supposed to pay for reasonable medical treatment expenses related to the injury; however, the carrier usually hires an “independent” medical doctor to deny ...
http://workers-compensation.blogspot.com/

RICO Case Against Wal-Mart & CMI Settles for $8 Million
Nov 14, 2012
The claim, on behalf of 7,000 Colorado Wal-Mart workers charges conspiracy with: Claims Management Inc., American Home Assurance Co. and Concentra Health Services Inc., to control medical treatment, who may have .
http://workers-compensation.blogspot.com/

Thursday, June 14, 2012

National Experts Call Workers Compensation System Irrational and Unjust

National workers' compensation experts, Law school Dean Emily A. Spieler and Professor John F. Burton, in a recently published article in the American Journal of Industrial Medicine conclude that the present that the present  workers' compensation systems is "irrational" and "unjust." 

Characterizing the program as "....dizzying and frustrating in its complexity, and apparent irrationality,"   they conclude that "a substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits." They review such alternatives as universal medical care, "providing healthcare to workers regardless of the source of injuries or disease."


Related Articles on Alternative Compensation Programs
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Feb 15, 2011
In December 2010 US Congress passed and President Obama signed, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program.
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...
Jul 13, 2010
As The Path To Federalization expands, this debate will expand. A recent study by the Center for American Progress addresses these concerns. "Health threats from the oil spill may linger unseen, perhaps for more than a ...

Mar 16, 2011
Historically The Federal government's role has been to rise to the occasion and walk further down a path to federalization. On a smaller scale than the potential consequences of the Japanesse debacle, the US was first in line ...
Mar 05, 2011
Nationally, advocates to improve the delivery of medical benefits to injured workers have urged federalization of the medical delivery system into a single payer approach through universal health care. ... Compensation Claim Draws Major Public Attention (workers-compensation.blogspot.com); Vermont Governor Sets Out to Lead U.S. to True Universal Coverage (huffingtonpost.com); The World Trade Center Health Program Expands The Path to Federalization ...

Wednesday, June 13, 2012

Court Rules Site of Accident Invokes Exclusivity Rule

English: Motor vehicle accident following a ve...
A NJ appeals court ruled that a motor vehicle accident cause by a co-worker in the emplyers' parking lot, before work had commenced for the day, limited the injured workers' recovery to workers' compensation benefits.  The "Exclusivity Rule" embodied in the Workers' compensation Act barred a separate cause of action by the injured worker against the co-employee.


"The causal nexus between the accident and plaintiff's employment is manifestly established. It is inconsequential that she, like the plaintiff in Ramos, had arrived early to drink her morning coffee and ease into her workday before performing her work functions. The nexus to plaintiff's employment is more than sufficient here to conclude that the Act provides the exclusive means to compensate her for her injuries."



TAWANNA FLOYD v.CAROL VON NEUDECK, DOCKET NO. A–3855–10T2, Not Reported in A.3d, 2012 WL 2094063 (N.J.Super.A.D.) Decided June 12, 2012.


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Saturday, June 9, 2012

EPA Encourages the Public to Comment on Plan for Cleanup at Evor Phillips Superfund Site in Old Bridge, New Jersey


    The U.S. Environmental Protection Agency has proposed a plan to clean up contaminated ground water at the Evor Phillips Leasing Company Superfund site. The six-acre vacant site is in an industrial area of Old Bridge Township, New Jersey. Past industrial activities contaminated the ground water with volatile organic compounds, which can have serious health effects. The proposed plan calls for the ground water to be treated to break down the contaminants to protect people’s health and the environment.

    The EPA will hold a public meeting on June 19, 2012 to explain the proposed plan and is encouraging public comments. The meeting will be held at 6:00 p.m. at the Old Bridge Central Library, 1 Old Bridge Plaza, Municipal Center, Old Bridge, New Jersey. Comments will be accepted until July 9, 2012.

    Some volatile organic compounds can cause cancer. The extent and nature of potential health effects depend on many factors, including the level and length of exposure to the pollution.

    “The chemicals in the ground water at the Evor Phillips Superfund site pose health risks,” said EPA Regional Administrator Judith A. Enck. “Removing them is the best way to protect the health of people who live and work in the area. The EPA encourages the public to attend the June 19 meeting and share their views on the proposed plan.”

    From the early 1970s to 1986, the Evor Phillips site was used for industrial waste treatment and metal recovery operations. Liquid waste was treated on site and two waste disposal areas were used to neutralize acidic and caustic wastewater. The site also contained 19 small furnaces for incinerating photographic film and printed circuit boards to recover silver and other precious metals. The New Jersey Department of Environmental Protection closed down the liquid waste treatment operations in1975 after the operators failed to comply with state environmental requirements. All operations at the site stopped in 1986 with the shutdown of the metal recovery furnaces.

    The Evor Phillips site was listed on the EPA’s Superfund list of the nation’s most hazardous waste sites in 1983. Because of the nature and complexity of the contamination at the site, the cleanup is being conducted in three phases. The first phase, conducted by NJDEP, involved the removal of approximately 40 buried drums and soil contaminated by metals, and the construction of a ground water treatment system to prevent the contaminated ground water from moving off site. In 2002, several companies responsible for the contamination began operating the ground water treatment system, with NJDEP oversight. The companies also demolished office buildings and furnaces, and removed buried drums, contaminated soil and underground storage tanks.

    The EPA took the lead in overseeing the cleanup in 2008. The removal of contaminated soil, which will begin this summer, is the second phase of the cleanup. The third phase, which is currently proposed by the EPA, is the long-term treatment of the ground water using a process known as chemical oxidation. Chemical oxidation uses chemicals to destroy pollution in soil and ground water, breaking down the harmful chemicals into water and carbon dioxide. The oxidants are pumped into the ground water at different depths in the polluted area. Each injection is followed by monitoring to evaluate the effectiveness of the treatment. Samples of the ground water would be collected and analyzed to ensure that the technology is effective. The ground water will be monitored for several years after the cleanup goals have been met to demonstrate that the ground water is no longer a source of contamination.

    The Superfund program operates on the principle that polluters should pay for the cleanups, rather than passing the costs to taxpayers. After sites are placed on the Superfund list of the most contaminated waste sites, the EPA searches for parties responsible for the contamination and holds them accountable for the costs of investigations and cleanups. The cleanup of the Evor Phillips site is being conducted and paid for by the responsible parties with oversight by the EPA.

    Written comments may be mailed or emailed to:
    Rich Puvogel, Remedial Project Manager
    U.S. Environmental Protection Agency – Region 2
    290 Broadway – 19th Floor
    New York, N.Y. 10007-1866
    (212) 637-4410
    puvogel.rich@epa.gov

    For more information on the Evor Phillips Leasing Company Superfund site, go to:http://www.epa.gov/region02/superfund/npl/evorphillips/.

    For a Google Earth aerial view of the Evor Phillips Leasing Company Superfund site, go to:http://www.epa.gov/region02/kml/evor_phillips_leasing.kml. (You must have Google Earth installed on your computer to view the map. To download Google Earth, visithttp://earth.google.com/download-earth.html).

Thursday, May 24, 2012

Whose to Blame for Opioid Abuse in Workers' Compensation Claims?

English: From: United States Department of Jus...
(Photo credit: Wikipedia)
A recent Texas case  holding an employer liable holding an employed liable for a fatal opioid overdose arising out of work-related event highlights again that, the workers' compensation medical delivery system just isn't working. Efforts by Industry to "reform" the system. by limiting benefits. is a misdirected knee-jerk reaction, and not one that will address the symptoms of the problem, a failed medical delivery system.

Click here to read more: Opioid death liability falling on employers--Court rulings compel benefits payments

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Friday, May 11, 2012

Law to Ban Medical Expense Claims Proposed

Legislation (A-2652) [introduced May 10, 2012] has been proposed in NJ that would ban charging workers’ compensation claimants for medical expenses and gives the Division of Workers’ Compensation sole jurisdiction over work-related medical claims. The law would be a positive initiative for all parties as it will subject medical provider claims to an exclusive remedy and consolidate the claims before a single administrative agency for resolution.


The legislation will be the subject of consideration by the NJ Assembly Labor Committee on Monday, May 14, 2012.


Click here to read: Clearing the Workers' Compensation Benefit Highway of Medical Expense Land Mines

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 Supreme Court decision, University of Mass. Memorial Hospital v. Christodoulou, 180 N.J. 334 (2004) has left the question of how to adjudicate medical benefits that were conditionally paid or paid in error. Presently there is no exclusively defined procedure to determine the allocation, apportionment of primary responsibility for unauthorized medical expenses and reimbursement."



Statement of the Bill

"This bill prohibits the charging of workers’ compensation 
claimants for medical expenses that have been authorized by the 
employer or its carrier or its third party administrator, that have 
been paid by the employer, its carrier or third party administrator 
pursuant to pursuant to the workers’ compensation law, or which 
been determined by the Division of Workers’ Compensation to 
be the responsibility of the employer, its carrier or third party 
administrator.  The bill gives the division sole jurisdiction over 
disputed work-related medical claims, and directs the division to 
provide procedures to resolve those disputes, including procedural 
requirements for medical providers or any other party to the 
dispute.  Finally, the bill provides that the treatment of an injured 

worker or the payment of workers’ compensation to an injured 

worker or dependent of an injured or deceased worker shall not be 
delayed because of a claim by a medical provider. "


Further Reference:
NJ Task Force Report on Medical Provider Claims
"During our meetings, it came to the attention of the Task Force that “balance billing” is a 
problem. This is the practice wherein authorized medical providers accept fees paid by the
carrier and then issue a bill to the petitioner for any remaining balance. In an effort to eradicate
this practice, the Task Force recommends an amendment to N.J.S.A. 34:15-15. Section 15 of the
Act requires that employers furnish and pay for physicians, surgeons and hospital services for the
injured worker. Having reviewed the statute and the case law, the Task Force believes that there
is a need to clarify that balance billing in the workers’ compensation setting is inappropriate.

Accordingly, the Task Force recommends the following amendment to N.J.S.A. 34:15-15 which
we would propose would appear as a paragraph between the final two paragraphs of that section.

This additional language would read as follows:
“Fees for treatments that have been authorized by the employer or
its carrier or its third party administrator, or which have been
determined by the court to be the responsibility of the employer, its
carrier or third party administrator, shall not be charged against or
collectible from the injured worker. Sole jurisdiction for any
disputed medical charge arising from a workers’ compensation
claim shall be vested in the Division of Workers’ Compensation.”

Friday, May 4, 2012

Sidetracked By Drugs

New York Mayor, Michael R. Bloomberg.
New York Mayor, Michael R. Bloomberg. (Photo credit: Wikipedia)
The core health care delivery problems that exist in workers' compensation are not being driven by the alleged excess prescriptions of pain relief medication. That is a symptom of a system that has been derailed.

The focus of major employer and insurance initiatives of so-called reform legislation in multiple jurisdictions has been to reduce the delivery of prescriptive pain relief. Actually, that is an enforcement issue only that globally exists in the health care industry. New York's Mayor Michael Bloomberg, is working diligently to identify and database the few prescribers and physicians involved.  A national effort modeled after the New York process would go a long way to curtain excessive and unorthodox prescriptions.

To use the prescription drug abuse issue to attack workers' compensation generally is merely sidetracking the real problem with the medical delivery system which is the global denial of compensability of workers' compensation claims by employers and insurance carriers merely to delay and avoid payment of medical benefits.

The recent decision in Federal Court recognizing RICO violations by an insurance carrier, the employer medical expert, and the employer itself, puts the real focus on the problem.  That decision demonstrates the need to get the workers' compensation train back on the tracks and redirect the system so that it pays benefits to injured workers in an efficient and timely basis.

Monday, April 23, 2012

Federal Court Dismisses Lawsuit to Preserve Missouri Second Injury Fund

A Federal Judge in Missouri dismissed a Federal lawsuit that was filed to forced the State of Missouri to fund its Second Injury Fund for workers' compensation beneficiaries.


The Court held:
“'Decisions over what programs to fund or not to fund generally represent a basic right and power possessed by the legislative branch....'  'Plaintiffs have cited no case law, and the Court is not aware of any, which stands for the proposition that a legislative decision to de-fund a program can represent a taking of a plaintiff’s entitlement.'”
Hon. Nanette Kay Laughrey


Click here to read the decision, Pettet v. May, No. 2:11-CV-04049-NKL (USDC W.D.Mo) Decided April 19, 2012


Click here to read the report in The Kansas City Business Journal

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NJ Supreme Court To Rule on Several Critical Issues

The NJ Supreme Court has before it three issues of critical importance concerning workers' compensation including: the standard of proof in a fatal heart claim; remedy for the failure of an insurance company to provide medical care, and the "exclusivity rule." These decisions have the potential to be landmark decisions.


1. Standard of Proof in a Fatal Heart Claim: Does the record support this workers' compensation claim under N.J.S.A. 34:15-7.2, which sets the standard of proof governing claims based on injury or death from cardiovascular causes?


Workers' Compensation benefits were awarded for a pulmonary embolism causally related to sedentary work activity. A NJ Appellate Court awarded benefits for the development of a pulmonary embolism precipitated by the inactivity of sitting long hours at a desk job.


Certification granted: 2/14/12
Posted: 2/14/12
A-71-11 James P. Renner v. AT&T (068744)

2.  Remedy for the Failure of the Insurance Company to Provide Medical Care:
May an employee who suffered a work-related injury pursue a common-law cause of action against a workers’ compensation carrier for willful failure to comply with court orders compelling it to provide medical treatment when the delay or denial of treatment causes the employee’s condition to worsen?

The NJ Supreme is going to review the procedure to bring bad faith claims against employers and insurance companies in workers' compensation actions. The Court accepted for review a case holding that workers' compensation bad faith claims are within the exclusive jurisdiction of the workers' compensation hearing official.

Certification granted 6/7/11
Posted 6/10/11
Argued: 3/26/12
A-112-10 Wade Stancil v. ACE USA (067640)


3. The Exclusivity Rule:

Under the circumstances of this case, which include a finding by the federal Occupational Safety and Health Administration that the accident was the result of a “willful violation” of its regulations, did the employer’s action constitute an “intentional wrong” that would preclude immunity under N.J.S.A. 34:15-8 of the workers’ compensation statute?

NJ Courts have held that trench accidents were not a mere fact of industrial life and were beyond intent of Act's immunity provision. A claim was permitted directly against the employer in addition to the workers' compensation action. 

Certification granted 1/27/11
Posted 1/28/11
Argued: 10/12/11
A-69-10 Kenneth Van Dunk, Sr. v. Reckson Associates Realty Corp. (066949)


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