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(c) 2010-2024 Jon L Gelman, All Rights Reserved.

Saturday, May 29, 2010

CMS Claims No Statute of Limitations May Exist in a Recovery Action

The Centers for Medicare and Medicaid Services (CMS) have filed a reply brief in US v Strickler, et al, now pending in the US District Court in Alabama, alleging that the government’s recovery action was valid and filed within the six years Statute of Limitations. “The answer is clear: the United States’ claim, which seeks reimbursement based on a statutory right to recover monies conditionally paid by Medicare, is contractual and implied in law. Therefore, the six-year limitations period applies.”

The government states that the question for the question is whether the recovery action falls within a contract express or implied in law or fact, which subjects the United States to the six-year limitations period in § 2415(a), or in tort where a 3 year statute would apply.

Alternatively the government advances the proposition that if the could determines that none of the above categories apply then no statute of limitations would apply. “As noted in the United States’ Omnibus Response (at 20 n.10), if the Court were to decide that this claim falls into none of these categories, then no limitations period applies. See, e.g., United States v. Palm Beach Gardens, 635 F.2d 337, 341 (5th Cir. 1981) (holding that cause of action under the Hill-Burton Act was neither tort nor contract, and therefore the United States could pursue its cause of action at any time).”

Should the six year statitute apply, this it would accrue when, “…MSP claims accrue when the United States can “demonstrate” that a primary plan, or an entity that received money from a primary plan, was “required or responsible” to make payments under a primary plan. 42 U.S.C.§ 1395y(b)(2)(B)(ii) and (iii); see also Glover v. Liggett Group, Inc., 459 F.3d 1304, 1309 (11th Cir. 2006) (noting that defendants have no obligation to reimburse Medicare until the defendants’ responsibility to pay a beneficiary’s expenses has been demonstrated).”


Breast Cancer Linked to Occupational Exposures

A recent article in Occupational and Environmental Medicine causally links certain occupational exposures to breast cancer. 
"Odds ratios (ORs) were increased for the usual risk factors for breast cancer and, adjusting for these, risks increased with occupational exposure to several agents, and were highest for exposures occurring before age 36 years. Increased ORs were found for each 10-year increment in duration of exposure, before age 36 years (OR<36), to acrylic fibres (OR<36=7.69) and to nylon fibres (OR<36=1.99). For oestrogen-positive and progesterone-negative tumours, the OR doubled or more for each 10-year increase in exposure to monoaromatic hydrocarbons, and to acrylic and rayon fibres. The OR<36 also doubled for exposure to organic solvents that metabolise into reactive oxygen species, and to acrylic fibres. A threefold increase was found for oestrogen- and progesterone-positive tumours, with exposure to polycyclic aromatic hydrocarbons from petroleum sources.
"Certain occupational exposures appear to increase the risk of developing postmenopausal breast cancer, although some findings might be due to chance or to undetected bias. Our findings are consistent with the hypothesis that breast tissue is more sensitive to adverse effects if exposure occurs when breast cells are still proliferating. More refined analyses, adjusting for hormonal receptor subtypes and studies focusing on certain chemical exposures are required to further our understanding of the role of chemicals in the development of breast cancer.



Employer Responsible For Payment of Counsel Fees On Penalty

"... a judge of compensation must award counsel fees in addition to a penalty when an employer fails to make timely payment of temporary disability benefits and the appropriate standard to fashion the reasonable attorneys' fees allowed by statute. We hold that an award of attorneys' fees is mandatory and the judge of compensation is not limited by the statutory formula governing fee awards following an award of benefits. See N.J.S.A. 34:15-64.


"...a petitioner who resorts to section 28.1 to force payment of temporary disability benefits receives not only the 25% penalty but also reasonable legal fees incurred "as a result of and in relation to [the] delay[ ] or refusal[ ]." The fee is not subject to the 20% limitation of section 64, and shall be calculated in accordance with the standard factors for constructing a fee award.


Petitioner was represented by NJ Super Lawyer, David Tykulsker, Esq.

Thursday, May 27, 2010

Amended Complaint Filed in CMS Recovery Action Against Law Firms


The Secretary of Health and Human Services (HHS) [The Centers for Medicare and Medicaid Services (CMS)] has filed a first amended complant Stricker case now pending in the US District Court in Alabama for recovery of Medicare Secondary Payments (MSP). 

The recovery action is based upon an alleged failure of the attorneys to honor a claim that CMS had filed in an underlying bankruptcy claim filed in 2003. The settlement provided for distributions to be paid from 2004 through 2013 by the defendants.

The initial complaint alleges that the US may initiate a claim for recovery of Medicare conditional payments when it "learns that payment 'has been or could have be made' under a liability insurance policy of plan. 42 C.F.R. Sec 411,24(b)."

The case is now under a briefing schedule for a pending Motion to Dismiss filed by the defendants. Plaintiff's response is due May 27, 2010 and the Defendant's reply is due June 10, 2010.

Federal Challenge to NJ Workers Compensation Delays Unsuccessful

The claim of an injured who brought a Federal Court action pro se for “unwarranted delays” of his NJ workers’ compensation claim was dismissed by a Federal Court. The action was based on a violation of: The Americans with Disabilities Act, the Universal Declaration of Human Rights, the Convention on the Rights of Persons with Disabilities and 42 U.S.C. sec. 1983 for violation of the First, Ninth and Fourteenth Amendments.






The worker suffered an alleged work related accident on January 29, 2008 as an employee of NJ Transit. He alleged that the Judge of Compensation from October 24, 2008 through January 7, 2010, on numerous occasions imposed delays through cancellation or postponement of his hearings.






The Court held that the Younger Abstention Doctrine, that prohibits unwarranted federal interference in an ongoing state judicial proceeding, bars the claims. Younger v. Harris, 401 U.S. 37 (1971). The doctrine is imposed when there is an ongoing state proceeding that involves an important state interest and the state proceedings afford an adequate opportunity to raise any constitutional issues. O’Neill v. City of Philadelphia, 32 F.3d 785 (3rd Cir. Pa. 1944).






The legislative intent of the Workers Compensation Act, originally enacted in 1911, was to provide a summary proceeding through an administration system utilizing the concepts of a no-fault system. The compensation program has been severely challenged over the decades by a growing burden of collateral and complex issues that now need resolution as part of the compensation process. Nationally, the state administered systems have become critically impaired by the growing state economic difficulties that have resulted in the availability of fewer resources to operate a system whose responsibilities and magnitude of demands are constantly increasing.






Townsend v. The Hon. Peter J. Calderone and the Hon. William Lake, in their official capacity as members of Labor and Workforce Development Workers’ Compensation, Civil Action No. 09-3303 (GEB), 2010 WL 19999588 (D.N.J.) Slip Copy, Unpublished Opinion.






To read more about delay and workers' compensation.


Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon Gelman or call 1-973-696-7900.

Workers Compensation Beneficiary Challenges to ERISA Setoff Allowed

A US District Court has held that a workers’ compensation claimant is allowed to go forward with his challenge of a delayed setoff of workers’ compensation benefits. The ERISA plan administrator originally, in October 2004 determined that no offset of workers’ compensation benefits would be permitted based upon a specific loss date. In December 2007 the beneficiary was by the plan administrator that the date offset had been changed and that an offset would be required.

The injured worker instituted the action claim that the plan was estopped by the late chance of plan determination of the disability date.

Luppino v. Sedwick Claims Management Services, Inc., et al., Civil Action No. 08-cv-5315 (DMC-MF), 2010 WL 1999316 (D.N.J.), Slip Copy, Unpublished Opinion.


Friday, May 21, 2010

Cell Phone Use and Occupational Cancer: The Jury is Still Out

study by a 13-country team of experts concludes that it is unable to reach a definitive conclusion on the causal relationship between cell phone use and cancer. That is not necessarily a good thing. The experts were able to agree that the interpretation of the data was disputed, and does point to the conclusion that a long-term brain tumor risk may exist.

Cell phone use has disturbingly has become ingrained in the work environment. Distracted driving caused by cell phone use has been identified as major cause of accident.

Unfortunately, if there is further delay in reaching a definitive conclusion on the association of cancer with cell phone use, then any necessary precautions will not be invoked and potential malignancies will continue. 

To read more about cell phone use and occupational accidents.

Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon  Gelman or call 1-973-696-7900.