Trump Administration Proposes Elimination of the Reverse Offset

The Trump Administration in its proposed FY 2020 Budget has proposed elimination of the workers’ compensation reverse offset. The elimination will act as a cost saving measure and will level the playing field for all workers’ compensation system throughout the United States.

Watered down NJ supplemental benefits heads to the Governor

A watered-down version of the original NJ supplemental workers’ compensation benefits bill has been approved by the Legislature. It now heads to the NJ Governor Murphy for review.

Legislation to Reduce Violence in Workplace

Congressman Joe Courtney (CT-02), a senior Member of the House Education and Labor Committee, introduced legislation this week to curb rising rates of workplace violence facing health care and social service employees such as nurses, physicians, emergency responders, medical assistants, and social workers.

NJ Senate Passes Increase to Supplemental Benefits for Injured Workers

The NJ Senate adopted legislation (S.1967) to increase supplemental benefits to certain injured workers receiving workers' compensation. On October 29, 2018 the NJ Senate voted (26-12) to pass the legislation. The Assembly version A3635 awaits action.

Totally Injured Workers Maybe Getting an Increase in Benefits

The proposed Trump Administration 2019 Budget (p. 115) may allow NJ workers’ compensation beneficiaries to receive an increase in benefits. By eliminating the Social Security “reverse offset,” totally and permanently injured NJ workers will receive a triennial annual COLA increase.

“The Budget includes a re-proposal to eliminate reverse offsets in fifteen states where Workers' Compensation (WC) benefits and temporary disability insurance benefits (TDI) are offset instead of DI benefits."

NJ Mandates Reporting of Medicare Conditional Payments

The NJ Division of Workers’ Compensation has now mandated the reporting of pending workers’ compensation claims possibly eligible for reimbursement of conditional medical payments to the US Centers for Medicare and Medicare Services  (CMS) as a condition precedent to the settlement of a pending claim for benefits.  The directive was outlined in a memorandum issued by Russell Wojtenko, Jr., Director and Chief Judge of Compensation on April 18, 2018.

2018 Social Security Changes - COLA Increases

The Social Security Administration has announced based on the increase in the Consumer Price Index (CPI-W) from the third quarter of 2016 through the third quarter of 2017, Social Security and Supplemental Security Income (SSI) beneficiaries will receive a 2.0 percent COLA for 2018.

Some Surprising 2016 SSA-DIB Statistics

Size and Scope of the Social Security Disability Program

1. Disability benefits were paid to almost 10.2 million people. 
2. Awards to disabled workers (706,448) accounted for 88 percent of awards to all disabled beneficiaries (799,330). 
3. In December, payments to disabled beneficiaries totaled more than $11.3 billion. 
4. Benefits were terminated for 820,372 disabled workers. 
5. Supplemental Security Income payments were another source of income for about one out of six disabled beneficiaries. 

 Profile of Disabled-Worker Beneficiaries 

1. Workers accounted for the largest share of disabled beneficiaries (87 percent). 
2. The average age was 54. 
3. Men represented less than 52 percent. 
4. The largest category of diagnoses was diseases of the musculoskeletal system and connective tissue (32.3 percent). 
5. Average monthly benefit received was $1,171.15. 
6. Supplemental Security Income payments were another source of income for about one out of eight. 

Preface

Since 1956, the Social Security program has provided cash bene ts to people with disabilities. This annual report provides program and demographic information about the people who receive those benefits. The basic topics covered are— beneficiaries in current-payment status;

• workers’ compensation and public disability benefits; 
• benefitts awarded, withheld, and terminated; 
• disabled workers who have returned to work; 
• outcomes of applications for disability bene ts; and 
• disabled beneficiaries receiving Social Security, Supplemental Security Income, or both. 

Chaos for Workers' Compensation Programs--The Elimination of Social Security Numbers?

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security Numbers (SSN) from Medicare cards to help combat identity theft and safeguard taxpayer dollars. The question remains whether the elimination will cause chaos in state workers' compensation programs since the SSNs have historically been utilized as personal identifiers.

The limits on a total permanent disability award

The New Jersey Supreme Court recently heard oral argument concerning the mathematical limits of a workers’ compensation total disability case. At the heart of the case is the issue of whether an injured worker could have an increase in a pre-existing permanent partial disability [PPT] claim, that existed prior to the last compensable injury which was to another part of the body. The last compensable claim rendered the worker totally and permanently disabled.

The Promise of State Initiatives to Prevent Long Term Work Disability

Every year, millions of Americans suffer from medical conditions that affect their ability to work. This puts them at risk of losing their jobs or being forced to rely on Social Security Disability Insurance (SSDI). States could help many of these workers stay in their jobs, but promising options for doing this remain largely untested. The five states with state-mandated short-term disability benefits— California, Hawaii, New Jersey, New York, and Rhode Island—are promising settings for such tests.

Chaos in Workers' Compensation - Raising Medicare's Eligibility Age to 67

A new issue for workers' compensation programs is  emerging as  the Republicans push forward on their legislative agenda to reform Medicare. Uncertainty over the impact of raising the eligibility age for Medicare from 65 to 67 may seriously and adversely impact the nation's network of fragile workers' compensation schemes. Furthermore, looming in the background is also the elimination of The Affordable Care Act and the consequence of a large pool of uninsured again seniors.

Declining Earnings Capacity - A Retrogressive Penalty for Ill Workers

The decline of the earning capacity of ill workers prior to stopping work has an impact on both workers' compensation benefits as well as Social Security disability benefits. It is  a retrogressive penalty for chronically ill workers.

The Social Security Administration in a recent report objectively reports this phenomena.

Social Security Disability Trending Downward

Both Social Security Disability Applications and Social Security Disability Awards are now trending downward. Additionally, terminations from Social Security Disability Awards are now trending upward (8.62%) according to November 2016 statistics released by the Social Security Administration.

Cybersecurity is an imminent and costly threat to lawyers and their clients

Cybersecurity is a critical issue in handling the workers’ compensation claims process. Regulatory authorities and clients are mounting an increased concern that the legal profession must employ adequate measures to protect data from cyber attacks. The fragmented century old social insurance system is complex and expensive to operate and is now confronted with security measures that are more time consuming, cumbersome and expense to implement.

The progress of technology and the Internet of Things (IoT) is advancing logarithmically. The participants in the present workers’ compensation system need to be aware of the seriousness of cyber vulnerabilities as well their responsibilities to maintain the confidentiality of client’s interests and protect the legal strategies of the case.

US Department of Labor Urges Major Changes in the Nation's Workers' Compensation System

As The Path to Federalization of the US workers' compensation system broadens, the US Department of Labor has published a report urging expansion of the Federal role in reforming the entire patchwork of state systems. As the Presidential Election Cycle moves ahead, the ultimate outcome will impact the the nation's struggling workers' compensation scheme. Based on historical statements both "Hillarycare" or "Trump Medical," (lead by his advisor, Former Speaker Newt Gingrich,  will focus on this issue. See  my prior blog posts below.

CMS 2016 Recovery Thresholds for Workers’ Compensation Settlements, Judgments, Awards or Other Payments

2016 Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, Judgments, Awards or Other Payments 

As required by section 1862(b) of the Social Security Act, the Centers for Medicare and Medicaid Services (CMS) has reviewed the costs related to collecting Medicare’s conditional payments and compared this to recovery amounts.

The Social Security Financial Report: An Insight Into the Future

Change is coming to the Social Security Disability program based upon the The 2016 Trustees Report that was published this week. It projects that the future finances of the Social Security Disability Trust Fund will require additional funding to remain solvent.

The State of Medical Care in California’s Workers’ Compensation System

Katherine Roe

Todays' guest post is authored by Katie Roe*  of the California Bar and was originally published at rivercityattorneys.com/blog (Fraulob & Brown).

When you’re injured at work, you expect that your employer’s insurance carrier will dutifully provide you with proper medical treatment for your injury. After all, future medical care is one of the “benefits” injured workers are entitled to in California. Denial of medical treatment is the number one frustration we hear from our clients on a daily basis.

What injured workers quickly discover is that their medical treatment is strictly controlled by the insurance carrier and their medical fate is in the hands of a doctor who has never treated them and may not even have their complete medical records. This process is called Utilization Review (UR). Under UR an outside physician gets to decide whether or not the insurance company should authorize the medical treatment prescribed by your primary treating physician. This doctor doesn’t even have to be licensed in California.

If the medical treatment prescribed by your physician is denied, your only recourse is to appeal the decision to an Independent Medical Reviewed (IMR). In California, MAXIMUS is the company contracted to conduct IMR reviews. Like UR doctors, the IMR doctor deciding your fate, has never met you or treated you and does not need to be licensed in California. In fact, their identity is protected. If your medical treatment is denied by UR, your chances of IMR overturning the decision are not good. California Workers’ Compensation Institute, an insurance research group, found that 91% of IMR decisions uphold the UR denial. If the treatment is denied by IMR, absent a change in circumstances, the denial will be in effect for one year.

While an injured worker has the right to appeal an IMR determination to the Workers’ Compensation Appeals Board, the only legal bases on which to appeal are fraud, conflict of interest, or mistake of fact. However, even if your appeal is successful the WCAB still cannot overturn the IMR doctor’s decision. If an appeal is granted, the remedy is referral to a different IMR for another review. Yes, you read that right, your award is to go through the IMR process again!

Many injured workers end up seeking treatment for their work related injuries through private insurance, Medicare or Medi-Cal. A study by J. Paul Leigh, a health economist at the University of California, Davis, estimated that only 1/3 of necessary medical treatment and lost wages is being paid for by workers’ compensation insurers.

The lack of adequate medical care for injured workers today is the result of Senate Bill 863, which was passed on August 1, 2012 and signed into law by Governor Brown on September 18, 2012. This law was the result of lobbying by big businesses and insurance companies, who have influence over the State Legislature and the Governor of California. We remind our clients that you also have a political voice. We recommend you go to Voters Injured at Work (www.viaw.org) for information on how to become involved with fixing this broken system.

To read more about the dismal state of medical treatment for injured workers all over America I encourage you to read Insult to Injury by Michael Grabell athttps://www.propublica.org/article/the-demolition-of-workers-compensation.

*Katherine Roe is originally from the San Francisco Bay Area. She attended University of St. Thomas, Saint Paul Minnesota for her undergraduate degree in Sociology with a minor in Criminal Justice. She earned her Master in Public Administration from University of Notre Dame de Namur, Belmont, CA. Katie graduated from University of the Pacific McGeorge School of Law in Sacramento where she received the Witkin Award for Health Law and Elder Law Clinic. She is a practicing attorney in the areas of Workers’ Compensation Law, Social Security Disability and Elder Law, including estate planning with wills, trusts, deeds, powers of attorney and health care directives.
While in college, Katie tutored grade school and high school students in low-income neighborhoods in Saint Paul and Minneapolis, MN and interned with the Oakdale, MN Police Department.
During law school, Katie interned with Legal Aid Society of San Mateo County, Human Rights Fair Housing Commission and the California Department of Insurance. While at McGeorge, she worked in the Elder and Health Law Clinic where she handled Medicare appeals, elder abuse cases, restraining orders, wills, trusts, consumer protection, special needs trusts, and powers of attorney.
While the Clinical Fellow at McGeorge she received the Cohn Sisters’ Scholarship for Patient Advocacy.

Related articles

• Google to Make Security Guards Employees, Rather Than Contractors (workers-compensation.blogspot.com)
• If Things Go Very Wrong (workers-compensation.blogspot.com)
• Insurance Carrier Subject to Lawsuit for Failing to Reimburse CMS (workers-compensation.blogspot.com)
• The Economic Benefits of Paid Parental Leave (workers-compensation.blogspot.com)
• The Plot Thickens As Uber Turns to Leasing Vehicles (workers-compensation.blogspot.com)
• California: WCIRB Report Shows Continued Increase in Claim Frequency (workers-compensation.blogspot.com)
• Mechanic can sue Ford for further damages in asbestos case (workers-compensation.blogspot.com)

Senator Patrick Leahy Calls For Greater Transparency by Asbestos Companies

Statement of Senator Patrick Leahy Ranking Member, Judiciary Committee Hearing on “The Need for Transparency in the Asbestos Trusts”

Today the Judiciary Committee meets to discuss legislation that purports to promote more transparency in asbestos trusts.  Before we get into a detailed discussion about the merits of the proposed legislation, I want to make sure we all remember why we are here today.  For decades, millions of American workers were secretly poisoned.  Men and women who worked in our Nation’s factories, shipyards, mines and construction sites, and service members in the military, unknowingly inhaled air that was laced with asbestos—a substance so harmful that an individual can become critically ill simply by breathing.