CMS Schedules Another Teleconference to Address Mandatory Reporting

CMS has scheduled yet another teleconference to address questions about mandatory reporting requirements in workers' compensation matters. The program is in preparation ofImplementation of Medicare Secondary Payer Mandatory Reporting Provisions in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007  (See 42 U.S.C. 1395y(b)(7)).

Participation is by telephone only:Wednesday October 29, 2008 1:00 PM – 2:30 PM Eastern Time - Call-in Line: 800-988-9534 -Pass Code:  NGHP 

A Time For Congress to Provide Compensation to 9-11 First Responders

The first responders to the horrific events of September 11, 2008 continue to be unsuccessful in obtaining NJ Workers' Compensation benefits. The Port Authority of New York and New Jersey (Port Authority), an agency formed as an Congressional Inter-State Compact, continues to prevail in the defense of claims brought by its employees, the first responders to the 9-11 tragedy.

Edward McQuade, a Port Authority police-officer, was assigned to the World Trade Center disaster site, "The Pit," for 8 weeks following the 9-11 event and allegedly developed symptomatically. Michael Ashton, also a Port Authority police-officer, worked at ground-zero for the 3 weeks (12 hour shifts) following 9-11, during the rescue and recovery phase complained of disability attributed to the post 9-11 tragedy.

The NJ Judge of Compensation denied their claims for benefits due to lack of objective evidence presented. NJ statutory language requires objective medical evidence to substantial the claims. The claims were denied without the benefits of medical monitoring being afforded for potentially latent medical conditions which are now being reported by medical investigators.

Unfortunately, the heroes of 9-11 continue to be caught in a Catch 22 situation. They lack the proof, based on scientific evidence, because the Federal government has not stepped up to the plate and done the responsible thing which is to adequately fund and co-ordinate medical monitoring, treatment and benefit programs for the 9-11 first responders and those caught the geographical web of the 9-11 scope of exposures.

These decisions scream out for Congressional oversight and advancement of legislation now pending in Congress to continue the program that the was started by the Mt. Sinai Hospital Environmental Sciences Laboratory and the NY City Fire Department. We owe our heroes nothing less than the care, concern and comfort that they gave to the victims and their families.

The Politics of Asbestos – US Government Failed the People Declares Senator Baucus

At a recent hearing of the US Senate Committee on Environment and Public Works, Senator Max Baucus presented a report revealing that the Federal government failed to take the appropriate action to declare Libby, Montana a public health emergency in 2002. The disregard of the federal government led to a lack of funding and manpower in cleaning up the asbestos contamination according to the Senator.

“EPA was going to let people know, but they were changed from their direction. A Public Health Emergency definitely would have helped--- it would have provided media and public attention. Without a Public Health Emergency, asbestos has not become a public health issue. That’s the politics of asbestos."

Libby Montana was the former vermiculite mine site of W.R.Grace & Company. Vermiculite is a form of asbestos, a known carcinogen. Grace recently agreed to globally settle all of its asbestos claims for $3 Billion.

The exposure to asbestos has been long linked to several disease including, asbestosis, lung cancer and mesothelioma. Asbestos exposure occurs when the toxic particles are ingested or inhaled into the body. When asbestos articles attach themselves to the lining of the lung, pleural mesothelioma, a fatal disease, results. The fibers may also attach themselves to the mesothelioma linings surrounding the heart and abdomen.

Libby Montana was declared a Federal Superfund site in 1999. Following that declaration, the Federal government has poured millions of dollars into cleaning up the asbestos-contaminated site. The failure to declare the site a public health emergency limited the Federal government’s role in providing even more extensive cleanup operations and healthcare to those residents who innocently suffered the avoidable exposure to asbestos.

Proposed CMS Legislation Cannot be Resuscitated Following the Wall Street Bailout

The efforts of the insurance industry to revive the previously fatally ill CMS reform legislation can be declared over and the life support disconnected following the Congressional actions to bailout Wall Street. The bill had been given a bounce, like a dead cat thrown against the ground, by the insurance industry, and some misinformed stakeholders, but economics and public opinion will not support the effort any longer.

The combination of the nationalization of AIG and the need for the US government to raise $700 Billion, makes it extremely doubtful that the Federal government is going to give the insurance industry another break other than to reinforce the country's need to insure banks and their spreadsheets.

CMS made it absolutely clear on a national teleconference on October 1st that it was holding workers’ compensation insurance carriers as sole Responsible Reporting Entities (RRE) and it wasn’t going to let them just walk away and re-delegate responsibility to others. CMS declared that workers’ compensation conditional medical payments remained a “pay and chase” proposition and that CMS was not allowing the responsibility of reporting to be shifted by the insurance industry.

The tightening of governmental scrutiny is now a predominate theme as the socialization of the insurance industry becomes more apparent and the existence of workers' compensation as a State based program becomes ever more threatened. Both sides of the political aisle are now being encouraged to look at insurance programs in a new light and make major adjustments as the economic viability of the country remains threatened. Giving the insurance industry another break by allowing them to shift responsibility back to CMS just isn't on the horizon and the idea can be finally buried.

Liberty Mutual's Rating Falls as the Workers' Compensation Industry Continues to Tremble

Standard and Poor's has announced that Liberty Mutual's rating has been lowered from A to A-. This happened as another rating agency, Fitch, placed Liberty Mutual Inter-company  Pool (on "Rating Watch Evolving" status. 

CMS Begins to Roll Out Details of The Mandatory Insurance Carrier Registration Progress-Teleconference Oct. 1, 2008

Implementation of the mandatory insurance company reporting process mandated pursuant to Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (See 42 U.S.C. 1395y(b)(7)&(b)(8) have now been unveiling by CMS. The process will require identification of Responsible Reporting Entities (RRE). A telephone conference call has been scheduled for October 1, 2008.

A Hurricane Over Florida Fees

The Supreme Court of Florida is about render a decision that may change the course of Florida workers’ compensation practice dramatically. In 2003 limitations were placed upon the attorney fee structure in Florida severely limiting the fees that claimant’s attorneys were authorized to receive. Murray v. Mariner, argued in April 2008, raises the issue that such limitations are denial of constitutional rights.