Lehman Brothers Crisis May Meltdown State Workers’ Compensation Programs

The escalating financial crisis of Lehman Brothers [stock down 94% Jan-Sept 2008], may have a major impact on workers’ compensation throughout the US. Over this weekend the financial gurus scheduled meetings in an effort to avoid a complete crash of Lehman Brothers. In the meantime, the waves of this potential economic meltdown are sending hurricane type surges throughout the US workers’ compensation system.

Workers’ Compensation is an employer funded benefit program. Even self-insured companies purchase reinsurance for economic protection. The reliance upon insurance companies to operate workers’ compensation programs in the US is vital.

Major insurance companies such as AIG [stock down 79% Jan-Sept 2008], the nations largest insurer, are intricately involved in operating and funding the nation’s workers’ compensation program. AIG’s shares fell 30% on Friday as the Lehman Brothers fiscal crisis continued to escalate. Congress Waxman has expressed concern over AIG’s premium charges. AIG’s decline was based on their questionable credit default swaps, covering loses on securities based on mortgages.

As this economic crisis continues to domino the question will be whether State the insolvency mechanisms in place will be sufficient to react to keep the system afloat and provide an adequate benefit flow to the workers’ compensation system. It is doubtful that the beneficiaries of the compensation system, and its administrators, will think kindly of becoming creditor in a bankruptcy reorganization scheme paying ten cents on the dollar.

This unfortunate economic scenario brings new life to a call for the reevaluation of the entire failing US workers’ compensation program and the need to look at a Federal approach to co-ordination and delivery of benefits.

CMS Tightens Its Policy on Implant Devices and Restricts Early Termination of the WCMSAs

CMS, on August 25, 2008 issued its 11th Policy Memorandum on WCMSA (Workers’ Compensation Set Aside Accounts). If the pricing for implantable devices are NOT included in the WCMSA proposal then CMS will utilize its own pricing methodology. Additionally, CMS has rescinded its 7/11/05 memorandum and will no longer accept early termination of agreement requests.

The Integrity of Periodic Payments in Workers' Compensation

Yet again the basic theme of workers' compensation, "periodic payments," was reiterated by a Judge of Compensation. This philosophical premise, periodic payments, is the basic foundation upon which workers' compensation is structured and flies directly in the face of those who advance a legislative change to promote CMS workers' compensation set aside agreements.

In denying an application to commute an award, NJ Workers' Compensation Judge Philip A. Tornetta declared, "The essence of the scheme of the Workmen’s Compensation Act is to provide weekly compensation, in lieu of wages, to the injured employee during the period of disability and commutation of the payments is out of the normal course. Verra v. The Mayor and Council of the City of Hoboken, 70 N.J. Super. 422 (App. Div. 1961). In the exercise of his or her discretion when determining if commutation should be permitted or precluded, the compensation judge should be guided by the express language of N.J.S.A. 34:15-25. Harrison v. A & J Friedman Supply Co., 372 N.J. Super. 326 (App. Div. 2004). " See Piskoroz v. Beno Stucco Systems Corp. CP 2006-6559 (NJ Div of WC).

Note: Despite restrictions on confidentiality of records, the NJ DWC posts reserved, unpublished decisions on its web site.

Honoring Human Dignity in Workers' Compensation

In accepting the Democratic nomination for presidency of the United States, Barack Obama declared that he envisioned “….an economy that honors the dignity of work.” The State legislatures had many goals in mind when they crafted a system for compensating injured workers.

One of the goals was to relieve the injured worker of the burden of paying for their own medical care. The pendulum is swinging back to the 1911 era when the majority of workers are no longer covered for medical care. Uncompensated medical care is now a $42.9 Billion burden on governmental programs.

Generally speaking workers’ compensation was to provide a summary, efficient and economical administrative system of benefits for injured workers. One of the program’s major purposes was to avoid the tedious, costly and unpredictable results of the civil justice system. State laws created a system of a certain and reliable flow of benefits which gave support and dignity to the workforce that complemented their strong work ethic.

As the workers’ compensation expanded, salaries, pensions and benefits became unstable. The process became entangled into legalities and the assertion of a growing number of defenses became more troublesome. Consequently the system became entangled in the tedium of collateral issues and escalating delay.

This progression of events impacted the system with resulting frustration and the workers with a loss of self-esteem. It is time, that on this Labor Day, we reflect on the past and follow the vision of the future and embrace the concept, that the dignity of work and workers, should be honored.

NY Lowers Premiums 25% in Two Years!

Governor Patterson announced that premiums have been lowered 25% for workers' compensation in New York over the last two years. Just how did NY do it?

They claim reduced claims, reduced administrative costs and an increase in weekly benenfits for a few. What they didn't mention is that NY is probably delivering lower benefits with slower service than before.

The ultimate consequence is that line for benefits becomes longer and the ultimate benefit is still capped at an incredibly low rate of $550. per week. Additionally, the NY State system is now cracking down on liberal impairment ratings and medical providers, modalities and drugs for injured worker.

The New York Alliance for Injured Workers declared, "The admirable goal of the 'rocket docket' regs was to speed the resolution of disputed workers' compensation claims. However, the new regs would do just the opposite, and cause further delay in the in receipt of benefits by injured workers."

Lower premiums translate to a lower performance and benefits to injured workers. A studious change evaluation of changes should be required in advance of change is warranted. NY must become more relastic of the consequence of changes.

Rate Your Workers' Compensation Doctor?

The US Department of Health and Human Services (HHS) has initiated serveral programs to improve the delivery of medical care. HHS no longer wants to pay hospitals for "medical mistakes" and has now announced a program to rate the medical facilities.

“CMS’ goal for updating and enhancing the Hospital Compare Web site is to provide usable and accurate information about hospital performance to providers and communities that will encourage hospitals to excel in the quality of care they provide,” said CMS Acting Administrator Kerry Weems. “With these new enhancements, consumers and health care providers will be able to look at individual hospital mortality scores. We hope that this new information will cement the Web site’s role as a key driver in improving the quality and reliability of care in the nation’s hospitals.”

This interesting concept is one that may interest the workers' compensation insurance companies as well as governmental agencies that regulate the programs. The opportunity to provide a comparison of services may likely lead to the delivery of better medical care for injured workers.

Cosmetic Workers Suffer Exposures at Work

Nail salon workers are now reporting an increase in symptoms frequently sought in serious occupational exposure claims. In a series of news articles appearing in West coast publications, it has been reported that nail salon workers have been exposed to hazardous chemicals in cosmetic products.

Increasing evidence has become available that reflects that cosmetic workers had been exposed to hazardous and carcinogenic substances, in an unregulated environment, for prolonged periods of time, that may result in occupational asthma conditions and even breast cancer.

"Every day, nail salon workers are exposed to a wide array of carcinogenic chemicals," said Migden, a San Francisco Democrat chair of the Senate's Labor and Industrial Relations Committee. It has been reported that some of the substances used in US salon have been banned already in Europe.

The American Public Health Association will be holding some additional seminars on this subject this fall directed their attention to increase cancers that have been reported by former cosmetic workers. The APHA reported that 15% of the salon workers that were surveyed presented with complaints similar to asthma, eczema, and hives and 30% claimed they had hay fever.