The recently enacted emergency coronavirus Federal funding legislation will offer some support to ease the burden of the epidemic on the workers’ compensation benefit system. Since the containment phase has been hampered by the lack of valid test kits, the US is now entering the mitigation phase. The additional resources to treat and eliminate the credible COVID-19 virus epidemic will prove beneficial.
Showing posts sorted by relevance for query universal health care. Sort by date Show all posts
Showing posts sorted by relevance for query universal health care. Sort by date Show all posts
Sunday, March 8, 2020
Friday, March 18, 2011
Industry Coalition Wants to Cut CMS Conditional Payments
A group of about 50 employers, insurance carriers and vendors have formed a coalition to endorse legislation (H.R.1063) introduced this week that would ease reporting requirements and reimbursement procedures of the Centers for Medicare and Medicaid (CMS). The organization, the Medicare Advocacy Recovery Group [MARC], contends that the proposed legislation will:
- "Empowering Medicare to provide settling parties with the amount of their MSP repayment obligation during the settlement process, will allow taxpayers to settle quicker, and repay the Medicare Trust Fund faster.
- "MSP Reform will provide a more affordable and less intrusive MSP system that protects beneficiaries and the Medicare Trust Fund, but does not waste limited judicial and other resources or needlessly confuse parties trying to settle a claim resulting from an injury to a beneficiary.
- "MSP Reform will also eliminate the required use of Social Security Numbers (SSNs) and Health Insurance Claim Numbers (HICNs) in the reporting process, create a basic right of appeal for all parties to resolve a CMS MSP determination, clarify the statute of limitations, and require the CMS Actuary to determine a threshold below which the recoveries are so small it makes no sense to apply the complex MSP laws.
Theoretically it sounds like the change would create a more efficient system to establish: time limits for claim reimbursement; a statute of limitations for liability (3 years); an avenue for redress directly to the judicial system; and a threshold amount for reimbursement. However, the proposal would actually defeat the basic philosophy of the workers' compensation act.
The convoluted logic of the employer/insurance group just makes no sense. It is like saying that I didn't bother buying enough postage on a timely basis so I will just mail my letter at half-price. The universal legislative intent of workers' compensation act mandates that the employer is responsible for medical care of its injured workers. The insurance industry has tried other gimmicks before to continue its long history of cost shifting, and those have rightly failed as Congress wouldn't buy into them.
While employers and insurance carriers delay and deny compensation benefits, shifting the cost to the taxpayers through depletion of the Medicare system, is both offensive and repugnant. If the coalition wants to ride the carousel of "it's not how long, but how much," in doling out benefits, then they should not blame CMS for delays and penalties, caused by the coalition's own failure to report on a timely basis in the first place.
Related articles
Tuesday, August 11, 2020
Virus Sequencing Useful to Establish Causal Relationship
A recently reported technique maybe prove extremely helpful to establish causal relationship in workers’ compensation cases. Whether a healthcare worker’s severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is community or hospital acquired affects establishment of compensability of a claim.
Tuesday, September 20, 2011
Asbestos Victims in Libby Settle Case for $43 Million
The asbestos victims in Libby, Montana, have settled their case against the State of Montana for $43 Million. The case alleged that Montana had failed to take proper action to curb the asbestos production at the WR Grace vermiculite plant.
Asbestos is a known carcinogen causally related to asbestosis, lung cancer and mesothelioma. WR Grace manufactured asbestos containing vermiculite as an insulation product. The production process contributed to the toxic contamination of the geographical area and both the workers and the residents developed asbestos related illness on a massive scale. The US Environmental Protection Agency designated Libby, MT, as a Superfund Site for cleanup and remediation.
Additionally, the Obama health care reform legislation, extended universal medical care (Libby Care) through Medicare to all residents of Libby who were exposed to fiber. This innovated medical insurance program can be extended to other areas designated as a national health emergency areas. Eventually all occupational disease claims in workers' compensation could be encompassed by the program.
The costs for medical benefits extended to the residents of Libby will be reimbursed through the Medical Secondary Acts as directed by The Centers for Medicare and Medicaid Services. This concept is already in place throughout the US.
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.
Asbestos is a known carcinogen causally related to asbestosis, lung cancer and mesothelioma. WR Grace manufactured asbestos containing vermiculite as an insulation product. The production process contributed to the toxic contamination of the geographical area and both the workers and the residents developed asbestos related illness on a massive scale. The US Environmental Protection Agency designated Libby, MT, as a Superfund Site for cleanup and remediation.
Additionally, the Obama health care reform legislation, extended universal medical care (Libby Care) through Medicare to all residents of Libby who were exposed to fiber. This innovated medical insurance program can be extended to other areas designated as a national health emergency areas. Eventually all occupational disease claims in workers' compensation could be encompassed by the program.
The costs for medical benefits extended to the residents of Libby will be reimbursed through the Medical Secondary Acts as directed by The Centers for Medicare and Medicaid Services. This concept is already in place throughout the US.
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.
Thursday, July 23, 2020
Lessons from Asbestos Litigation Apply to COVID Claims
The rapid emergence of COVID-19 creates new challenges for the nation’s patchwork of state run workplace benefit delivery systems. This paper draws a comparison between COVID claims and asbestos claims, the “Largest and Longest” wave of occupational disease claims in the United States. The comparison offers insight into avoiding past economic, administrative and benefit delivery pitfalls. The lessons from asbestos claims provide an insight into maintaining a sustainable workers’ compensation system to meet the surge of COVID claims.
Wednesday, November 8, 2023
Toxic Flight Attendant Uniforms Result in a $1.1 Million Verdict
Wearing an employer-designated work uniform shouldn’t result in severe and debilitating occupational exposures. Unfortunately, some American Airlines flight attendants suffered injuries from wearing the flight uniforms prescribed by their employer. The lawsuit that they filed lawsuit resulted in a $1.1 Million award.
Monday, March 7, 2011
Maryland Awards Washington Redskins Football Player Benefits
Image via Wikipedia A Maryland Court of Appeals has awarded workers' compensation benefits to Tom Tupa, a Washington Redskins football payer. He was injured while warming-up for a football game to be played at FedEx Field in Landover, Maryland.
The Court held, "Considering the stipulated facts, we find that Tupa’s employment in Maryland was regular and not intermittent or temporary. Tupa was hired in Virginia, but the purpose of his employment was to play in professional football games at FedEx Field in Maryland and at various other stadiums around the country. We recognize that Tupa likely spends more time at the practice facility in Virginia than he spends playing in games at FedEx Field or elsewhere. As Hodgson suggests, however, the inquiry requires more than simply tallying up the quantity of time the employee spends in each jurisdiction. Here, it is clear that the purpose of Tupa’s employment was to play in games, not to practice. All of Tupa’s time in Virginia, whether practicing or attending team meetings, was geared towards improving his performance at the games. By way of contrast, a player signed to the practice squad would work entirely in Virginia because the purpose of a squad member's contract is to practice in Virginia."
Related articles
Sunday, February 17, 2013
The Missouri Compromise - 2013
It looks like Missouri is not going to ditch their Second Injury Fund (SIF) after all. The Missouri Senate did a turn around and passed legislation to fund the insolvent SIF.
Part of the compromise was to limit liability of occupational disease claims against employers and re-establish the exclusivity bar. Albiet, the SIF would provide additional monetary benefits to those exposed at work.
While it sounds nice on paper, the problem, of using a band-aide to permanently correct the overall concerns of both Industry and Labor, will not work in the long-run. Actually this has been tried before and already failed. Employers notoriously dodge the bullet and delay and deny occupational claims even though they are difficult to defend against.
When the going gets tough, down the road, Industry will end up further restricting the benefit flow to injured workers, and medical delivery will then remain non-existent. Consequentially, the end result is that the general taxpayer and not the consumer, ends up paying for the continued unsafe work practices of Industry.
The Missouri Compromise 2013 is only a first step in recognizing a problem exists. It demonstrates that legislators from different parties can reach a compromise. The real fix would be even greater OSHA enforcement of safety procedures, new Federal regulation and, a universal health care system.
Part of the compromise was to limit liability of occupational disease claims against employers and re-establish the exclusivity bar. Albiet, the SIF would provide additional monetary benefits to those exposed at work.
While it sounds nice on paper, the problem, of using a band-aide to permanently correct the overall concerns of both Industry and Labor, will not work in the long-run. Actually this has been tried before and already failed. Employers notoriously dodge the bullet and delay and deny occupational claims even though they are difficult to defend against.
When the going gets tough, down the road, Industry will end up further restricting the benefit flow to injured workers, and medical delivery will then remain non-existent. Consequentially, the end result is that the general taxpayer and not the consumer, ends up paying for the continued unsafe work practices of Industry.
The Missouri Compromise 2013 is only a first step in recognizing a problem exists. It demonstrates that legislators from different parties can reach a compromise. The real fix would be even greater OSHA enforcement of safety procedures, new Federal regulation and, a universal health care system.
Monday, October 1, 2018
Rand Study Urges National Workers’ Compensation Reforms
A national study by the Rand Corporation is urging changes to the workers’ compensation system. The study was commissioned by the US National Institute for Occupational Safety and Health (NIOSH) and approaches necessary improvements inorder to make the nation’s workplaces safer.
Monday, May 2, 2011
Atlantic Mutual Placed into Liquidation
The Court converted the rehabilitation proceeding into a liquidation action by the filing of the Order. The companies were previously the subject of a Rehabilitation Order that was entered on September 16, 2010. AMIC was found to be insolvent and efforts to rehabilitate the company were deemed futile.
Click here to view The Order of Liquidation.
http://www.nylb.org/Documents/AMIC-L.pdf
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.
Tuesday, September 28, 2010
Atlantic Mutual Insurance Co Placed into Rehabilitation
The NJ Division of Workers' Compensation has responded to an Order of Rehabilitation of Atlantic Mutual Insurance Company and Centennial Insurance Company entered by the New York Supreme Court entered on September 14, 2010. The NJ Division of Workers' Compensation has directed that 120 active cases now pending are stayed until further notice.
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.
Related articles
- American Mutual Ordered into Liquidation (workers-compesation.blogspot.com)
- Obama Care for All (workers-compensation.blogspot.com)
- Vermont Universal Health Care to Embrace Workers Compensation (workers-compensation.blogspot.com)
- Employer Fraud is Alive and Well (workers-compensation.blogspot.com)
- Washington Workers' Compensation Reform (workers-compensation.blogspot.com)
- Memo from Director/Chief Judge Calderone - NJ DWC (http://lwd.dol.state.nj.us/)
Saturday, February 26, 2011
Using the Forbidden Words-Texas Workers Compensation
The Texas Workers Compensation Agency has sent a cease-and-desist letter to to the author of the Texas Workers Compensation Law Blog requesting that he stop using the term(s), "Texas Workers Compensation" in his blog. The Lubbock, Texas workers compensation lawyer has filed a lawsuit in federal court alleging violation of his First Amendment rights have been violated.
The Texas Labor Code s 419.002 prohibits “any impersonation, advertisement, solicitation, business name, business activity, document, product or service.” The Texas blog author, who has sought declaratory relief, has alleged that the statute is overly broad and violates his Right to Free Speech. The blogger is certified in Workers' Compensation Law from the Texas Board of Legal Specialization.
The Texas Labor Code s 419.002 prohibits “any impersonation, advertisement, solicitation, business name, business activity, document, product or service.” The Texas blog author, who has sought declaratory relief, has alleged that the statute is overly broad and violates his Right to Free Speech. The blogger is certified in Workers' Compensation Law from the Texas Board of Legal Specialization.
Friday, April 8, 2016
The Difficult Task of the Florida Supreme Court
The Florida Supreme has before it a constitutional challenge once again concerning workers’ compensation. The scope of the controversy remains undefined and the ultimate impact equally uncertain. I have found over the years that one cannot predict the outcome of a case by merely watching an oral argument.
Thursday, March 3, 2011
US Postal Service May Fail to Deliver Workers Compensation Benefits
Image via WikipediaPatrick R. Donahoe, US Postmaster General stated, "Even as we continue to fulfill our commitment to service, we must address one particular area of concern – our liquidity. I would like to discuss this in more detail, to provide a clear picture of our situation and to give some background, especially for the new committee members. Without changes in applicable laws, at the close of this fiscal year, in seven months, the Postal Service will be insolvent, as we will be unable to meet all of our financial obligations."
Related articles
Friday, January 30, 2009
Commissioning The Federal Government for a New Workers' Compensation System
Legislation was recently introduced in Congress to re-establish a National Commission on State Workers’ Compensation Laws [Commission]. This attempt to recreate the almost 4 decades ago effort to evaluate uniformity of benefits, was introduced by a sole legislator, Representative Joe Baca [CA-43] and lacks any co-sponsorship or a duplicate effort in the US Senate.The initial Commission I, 1972 Report of the National Commission on State Workmen's Compensation Laws, chaired by Professor Emeritus John Burton, looked the national patchwork of chaotic programs to provide uniformity of benefit delivery in the program almost 4 decades ago.
The 1972 report concluded: “We have concluded that there is a significant role for a modern workmen's compensation program and that the States' primary responsibility for the program should be conserved. We also agree that the protection furnished by workmen's compensation to American workers presently is, in general, inadequate and inequitable. Significant improvements in workmen's compensation are necessary if the program is to fulfill its potential.”
The bottom line is that the national system is a hodgepodge of state workers’ compensation laws that are not at all functional in today’s economic/medical market. The times changed since the original enactment of multiple state enactments in 1911. The present program has indeed out lived its usefulness. Over the decades many stakeholders have become preoccupied with economic considerations that have far seriously degraded human considerations.
A national review at the Federal level is a welcome sign that The Administration is using a thoughtful approach to change. This path must embrace the workers’ compensation medical delivery system into universal health care.
Friday, March 25, 2011
Grizzly Bear Attack Does Not Deter Benefits Even Though Employee Was Using Marjuana
The Montana Supreme Court ordered the Uninsured Fund to pay workers' compensation benefits to an employee who was mauled by an grizzly bear even, though the worker was under the influence of marijuana at the time of the accident.
The Court held that the marjuana was not a major contributing cause of the employee's injuries.
"Non-prescription drug consumption will preclude an injured employee’s benefits if consumption was the leading cause contributing to the result, when compared to all othersSection 39-71-407(4), and -407(13), MCA. No evidence was presented regarding Hopkins’ level of impairment. The WCC [Workers' Compensation Court] aptly noted, “Hopkins’ use of marijuana to kick off a day of working around grizzly bears was ill-advised to say the least and mind-bogglingly stupid to say the most.” However, the WCC further noted that grizzlies are “equal opportunity maulers,” without regard to marijuana consumption. Without evidence of Hopkins’ level of impairment, the WCC correctly concluded that marijuana was not the major contributing cause of Hopkins’ injuries."
The majority of states permit the payment of workers' compensation benefits where the use was not the sole cause of the accident. Usually Uninsured Funds are able to obtain reimbursement directly for the employer who failed to carry workers' compensation benefits.
The Court held that the marjuana was not a major contributing cause of the employee's injuries.
"Non-prescription drug consumption will preclude an injured employee’s benefits if consumption was the leading cause contributing to the result, when compared to all othersSection 39-71-407(4), and -407(13), MCA. No evidence was presented regarding Hopkins’ level of impairment. The WCC [Workers' Compensation Court] aptly noted, “Hopkins’ use of marijuana to kick off a day of working around grizzly bears was ill-advised to say the least and mind-bogglingly stupid to say the most.” However, the WCC further noted that grizzlies are “equal opportunity maulers,” without regard to marijuana consumption. Without evidence of Hopkins’ level of impairment, the WCC correctly concluded that marijuana was not the major contributing cause of Hopkins’ injuries."
The majority of states permit the payment of workers' compensation benefits where the use was not the sole cause of the accident. Usually Uninsured Funds are able to obtain reimbursement directly for the employer who failed to carry workers' compensation benefits.
Hopkins v. Uninsured Employers Fund, et al., Docket 2011 MT 49 (MT 2011) Decided March 22, 2011
Tuesday, January 8, 2008
It's All About the Medical
As the new political and legislative year unfolds, stakeholders are keeping their eye on the prize, medical benefits, in the workers' compensation arena. Recent court decisions continue to emphasize the major significance of medical care and continue to question the ability of the presently crafted system to deliver medical benefits in an efficient and effective manner.
The New Jersey Appellate Court declared that medical providers have standing to seek reimbursement for the full amount of medical fees from a the workers' compensation carrier. Failure to attempt to pay or negotiate an obligation that it denied by implied "refusal to treat" actions resulted in an employer being obligated to pay the full freight, medical bills, and a counsel fee for recovery. Villanueva v. Federal Express, Inc. DOCKET NO. A-4342-06T24342-06T2 Medical liens remain a critical issue in workers' compensation. Legislation is pending to centralize the chaotic and disruptive process.
In another decision the NJ Supreme Court insulated the insurance carrier from an employee's medical malpractice claim, but did not permit the exclusivity doctrine to extend to the workers' compensation medical expert for a deviation from practice action. This dramatically increases the potential recovery for failure to provide adequate care in a workers' compensation claim. Barbara Basil, etc. v. Frank A. Wolf, et al. (A-80-05/A-110-06)
Universal medical remains a critical factor in 2008 politics. While Hilary lost Iowa, the exit poles demonstrate that people who wanted a change voted for Obama. "Obama won huge among those who cared most about change -- 51-19." The New Hampshire poles reflect while health care is a a critical issue to most Americans the major questions remains over what the action should be taken to fix the ailing system.
Compounding the problem is the fact that workers' compensation carriers have continued to shift the burden on to others. Whether it be private carriers or CMS the situation has now been inflamed by those who attempt to legislatively again limit the workers' compensation carriers' responsibility even in contested situations. This short sighted shell game will merely add even more outrage by taxpayers as Medicare fails to be able to pay its own bills.
Saturday, December 1, 2012
Construction Injuries and Fatalities Cost California’s Economy $2.9 Billion Between 2008 and 2010
California Would Save Money by Using Its Buying Power to Reward Companies With Strong Safety Records
Occupational injuries and fatalities in the construction industry cost California residents $2.9 billion between 2008 and 2010, a new Public Citizen report shows.
The report, “The Price of Inaction: A Comprehensive Look at the Costs of Injuries and Fatalities in California’s Construction Industry,” quantifies the estimated costs of deaths and injuries in the state’s construction industry by considering an array of factors.
From 2008 to 2010, 168 construction workers were killed in workplace accidents in California. Additionally, the state recorded 50,700 construction-industry injuries and illnesses that required days away from work or a job transfer.
Drawing on a comprehensive 2004 journal article that analyzed the cost of occupational injuries, and combining the paper’s findings with updated fatality and injury data, Public Citizen determined that such incidents cost the state’s economy $2.9 billion during the three-year period.
“The economic picture is quite staggering,” said Keith Wrightson, worker safety and health advocate for Public Citizen’s Congress Watch division. “We now know that construction accidents impose huge economic costs in addition to tremendous pain for individual victims.”
As a partial solution, the report proposes that California pass a law requiring companies to demonstrate adherence to safety standards in order to be eligible to bid for state contracts. Such a solution not only would ensure that public-sector projects are fulfilled by responsible contractors but also would provide incentives for companies to maintain clean records while working on private-sector sites.
The report notes that California already screens construction companies to ensure that they have met performance standards in the past and haven’t violated any laws. The state also incorporates some safety standards in its prequalification system. But the system should be expanded to require construction firms to put greater emphasis on demonstrating that they provide safety training to workers and site supervisors, and that they have not had serious safety violations.
“Implementing a stricter prequalification process for public construction projects would not address all of the industry’s safety problems,” Wrightson said. “However, such a step would help further protect workers while also yielding significant gains to the economy for minimal costs.”
The report can be viewed at http://www.citizen.org/price-of-inaction-california-construction-safety-report.
Read more about "occupational" conditions and workers' compensation
Nov 26, 2012
Physician Stress - An Occupational Hazard for Oncologists. Physicians who treat terminally ill patients are reporting occupational stress. A recent article on the NY Times blog describes the problem of oncologists who treat ...
Nov 09, 2012
Going forward it is imperative that a universal medical program be established to provide medical treatment for all work-related occupational injuries and exposures. The delay and denial of medical benefits to those who suffer ...
Nov 23, 2012
This exploratory population-based case–control study contributes to one of the neglected areas: occupational risk factors for breast cancer. The identification of several important associations in this mixed industrial and ...
Jul 05, 2012
The National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS) requests public comments to inform its approach ...
Monday, July 20, 2020
Coronavirus (COVID-19) - The workers' compensation community should support TTSI
The workers' compensation community should play an active role to contain the spread of COIVD-19. Labor, Industry and insurance companies must be encouraged to participate in contact tracing, testing and supported isolation [TTSI]. All reports of illness and incidents of COVID-19 should trigger reportable investigations that are co-ordinated with local and state health agencies. Communication with employees should be encouraged for testing, isolation and expansion of contact testing.
Tuesday, April 15, 2014
ND workers' comp agency sues over computer project
Yet another reason for a universal integratable workers' compensation docketing program. Today's post is share from http://www.sacbee.com/.
BISMARCK, N.D. -- North Dakota's workers' compensation agency has sued a Chicago company over a failed $17 million computer system overhaul. The Workforce Safety and Insurance agency filed its lawsuit last month in state court against Aon eSolutions Inc. to recoup costs associated with the system that was never delivered. WSI hired Aon eSolutions in 2007 for a software system upgrade. The work was to cost $14 million, but it was plagued by delays and cost overruns and was never finished. The contract with the company expired in 2012, and WSI did not renew it. The state Legislature last year gave WSI $750,000 for potential litigation. WSI, which provides coverage for businesses when employees are hurt or killed on the job, alleges, among other things, negligence, fraud and deceit against the company in court papers. The agency has requested a jury trial. "Aon promised to deliver a state-of-the-art integrated software package that would replace WSI's existing software system and meet all of the agency's business needs," said WSI Director Bryan Klipfel said in a statement. "WSI intends to prove that Aon did not follow through on its promise. We are acting in the best interest of our stakeholders as we try to recover the money that was spent on this desired product." Aon said in a statement that it is "disappointed that WSI chose this course. We delivered substantial value to WSI and we did nothing wrong. We look forward to telling our side of... |
Related articles:
Feb 08, 2009
While the regulations cover health plans, health care clearinghouses and certain other providers who use computers to transmit claims information, workers' compensation insurance carriers are exempted. The Institute of ...
Oct 28, 2010
"Nanotechnology has the potential to revolutionize countless products, create computers smaller and faster than once could be imagined, and fight diseases such as cancer. According to the Project on Emerging ...
Oct 21, 2010
In one implementation, the system may comprise a computer system, and the computer system may further host, interface with, or otherwise enable access to a billing management application for tracking information/contracts ...
Subscribe to:
Posts (Atom)