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Thursday, June 23, 2011

OSHA Proposes New Reporting Rules for Amputations and Fatalities


OSHA's new proposed rule require employers to report to OSHA, within eight hours, all work-related fatalities and all work-related in-patient hospitalizations; and within 24 hours, all work-related amputations. The current regulation requires an employer to report to OSHA, within eight hours, all work-related fatalities and in-patient hospitalizations of three or more employees.

Additionally, OSHA is proposing to update Appendix A to Subpart B of its Injury and Illness Recording and Reporting regulation. Appendix A contains a list of industries that are partially exempt from maintaining records of occupational injuries and illnesses, generally due to their relatively low rates of occupational injury and illness. The current list of industries is based on the Standard Industrial Classification (SIC) system. In 1997, the North American Industry Classification System (NAICS) was introduced to classify establishments by industry. The proposed rule would update Appendix A by replacing it with a list of industries based on NAICS and more recent injury and illness data.

Accidents Caused by Fatiguing Employment Require a Remedy

Employees sometimes are directed to work long and stressful hours and then if they become injured they are left without a remedy.  A Court recently held that even though an employee who was killed as a result of fatigue related accident while driving home after working  22 hours straight on "Black Friday" for Wal-Mart was without a remedy.


The Court reasoned that the law barred any recovery. The Workers' Compensation Act is not an available remedy the Court held since the injured occurred off the premises of the employer and not under the employers control. Also a civil action was barred by the deceased's estate against Wal-Mart since the Court reasoned that, "...The imposition of a duty upon an employer for injuries sustained by an employee, arguably arising out of the fatiguing conditions of employment, yet occurring outside of the course of employment would alter the necessary balance struck by the New Jersey legislature when defining the scope of compensable injuries." 

Despite the changing economic times, the laws should keep pace with the growing momentum of making the workplace safer. Regressive employment practices are not the solution for a healthier workplace. It is more important than ever that the Legislature revisit working conditions and strike a balance to provide a regulatory response to injuries and accident caused by such adverse situations.

See: Aylward v Wal-Mart Stores Inc., CA No. 10-4799, 2011 WL 2357762 (D.N.J.) Decided June 9, 2011

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.

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Wednesday, June 22, 2011

Congress Told CMS Must Continue to Stop Work Comp Cost Shifting

At a House Oversight hearing today it was revealed that over the last decade the Centers for Medicare and Medicaid Service (CMS) has obtained over $50 Billion in reimbursement under the Medicare Secondary Payer Act (MSP). CMS has worked diligently to stop cost shifting from workers' compensation insurance carriers to the US taxpayer. 


Deborah Taylor, Chief Financial Officer and Director, Office of Financial Management Centers for Medicare and Medicaid Services, stated, "Any restrictions on existing MSP rights or recovery processes would adversely affect savings that would otherwise accrue to the Medicare Trust Funds through MSP recovery activities, as well as the $1 billion per year in cost-avoided savings that CMS is able to track. Proposals that would impose mandatory process changes may affect Medicare’s status as a secondary payer or its priority right of recovery, as well as CMS’ ability to prioritize its own workload. These changes may also have the unintended effect of undercutting the underlying intent of the statute, increasing costs, and reducing existing savings. " 

Ms. Taylor concluded by stating that, "...CMS is committed to a transparent MSP process that ensures that beneficiaries receive the care they need, while reducing Medicare payments for claims that are the legal responsibility of a group health plan, NGHP, or other responsible party. We understand that the MSP process can present challenges to all involved in coordination of benefits between Medicare and other payers. We are committed to maintaining a strong line of communication with beneficiaries, insurance and workers’ compensation plans, and other stakeholders on MSP policy in general, as well as the new Section 111 reporting requirements. Additionally, we will look to expand and strengthen our training and education opportunities where possible. CMS looks forward to working with our partners and beneficiaries in the future to preserve the integrity of the Medicare program and secure the Medicare Trust Funds for future generations. We look forward to working with Congress as well on these important goals."


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Tuesday, June 21, 2011

World Trade Center (Zadroga) Compensation Fund Rules Announced

Special Master Sheila L. Birnbaum has announced the publication of proposed rules to govern The Zadroga Act Health Claim Fund and the payment of $2.775 Billion of benefits over the next 6 years. The Special Master pledged a process: that is fair, transparent and easy to navigate; procedures that will not dilute the fund; and a full investigation of the response, clean-up and debris removal activities necessitated by the attacks and those injured.

"The James Zadroga 9/11 Health and Compensation Act of 2010 reopens the September 11th Victim Compensation Fund of 2001 to provide compensation to those who were physically injured or who died in the immediate aftermath of the terrorist attacks of September 11, 2001, including those who were injured during the clean-up and debris removal operations at a 9/11 crash site." This extension recognizes the considerable efforts of and effects on those engaged in or in the immediate vicinity of the response, recovery, and clean-up operations. The intent of the extension of the Fund is to provide fair and consistent compensation for those who are eligible and to do so in an efficient and timely manner.

"The regulations reiterate the expanded definition of the "9/11 Crash Site" to include both the crash site and contiguous areas of impact of the aircraft or subsequent fire, explosions, or building collapses. The Special Master will consider scientific evidence regarding the risks of physical harm resulting from the crashes. The routes of debris removal will be considered.

The Special master will "...maintain and publish a list of presumptively covered conditions that resulted from the air crashes or debris removal, and that this list shall consist of the physical injuries and conditions that are found, under the WTC Health Program, to be WTC-related health conditions."
Click Here to View Proposed Rules.

 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.

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Sun Exposure, Prevention and Workers Compensation

The first day of summer brings attention to working outside, sun exposure and the risk of skin cancer. Workers Compensation coverage offers a unique opportunity to provide affirmative action to prevent, detect and treat high risk workers before the disease takes a fatal course.

While working outside has the connotation of working in a clean air and healthy environment, the reality is quite the opposite. With a reduction of the world's ozone layer, workers exposed to the sun are at an increase risk of developing skin cancer at an even shorter exposure time. 

The US Food and Drug Administration (FDA) just published recommendations for sunscreens. This initial first step will most likely expand the government's roll in getting skin cancer under control. In the meantime, exposed and diagnosed workers must rely upon the workers' compensation programs for treatment and benefits as a result of occupational induced skin cancer resulting from the occupational exposure to the the sun.

Workers' Compensation insurance companies and employers would do well to heed the government's recommendations and take affirmative action to protect  employees and provide medical evaluations for medical monitoring and surveillance. That action may include: avoiding exposure to the sun,  seek regulation medical monitoring and mandating the use of sunscreens in the workplace. The risk of sun exposure is well known and employers should be encourage to protect workers from such obvious and deadly common place exposures.

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.

Monday, June 20, 2011

CMS Recovery Contractor Publishes New Rights and Responsibilities Letter

The Centers for Medicare and Medicaid Services (CMS) has now posted its newly revised Rights and Responsibilities letter. The letter complies with the Court's Order in Haro v. Sebelius which restrict the application of interest while an appeal is pending. The letter no longer demands that an attorney withhold settlement proceeds from a case.

CMS employs outside contractors to collect conditional payments that Medicare has paid and for which it is only secondarily responsible

"The Medicare Secondary Payer Recovery Contractor (MSPRC) protects the Medicare trust fund by recovering payments Medicare made when another entity had primary payment responsibility. The MSPRC accomplishes these goals under the authority of the Medicare Secondary Payer (MSP) Act. The MSPRC identifies and recovers Medicare payments that should have been paid by another entity as the primary payer either under a Group Health Plan (GHP) or as part of a Non-Group Health Plan (NGHP) claim which includes, but is not limited to Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation. The MSPRC does not pursue supplier, physician, or other provider recovery'." 


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.


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Thursday, June 16, 2011

US Supreme Court Advances the Rights of Injured

Workers who become ill from defective medications prescribed to treat occupational conditions will now be afforded the opportunity to seek compensation by way of State class action lawsuits against pharmaceutical companies who manufacturer drugs that make them sicker. The Court expanded the rights of the injured today when it held that State class action law suits were not prohibited even though a Federal Court denied class certification in a pending similar case.

Workers' Compensation benefits are notoriously inadequate to compensation ill workers adequately from the harms resulting from the adverse effects of  defective medications. Third party actions by the employees against the ultimate wrongdoers, in this case the pharmaceutical manufactures, have become a vehicle to receive supplemental benefits.

The Supreme Court's decision afford the workers an opportunity to proceed with a class action in a State Court even though a similar clase may have not received class action certification in Federal Court.

"Respondent (Bayer) moved in Federal District Court for an injunction ordering a West Virginia state court not to consider a motion for class certification filed by petitioners (Smith), who were plaintiffs in the state-court action. Bayer thought such an injunction warranted because, in a separate case, Bayer had persuaded the same Federal District Court to deny a similar class-certification motion that had been filed against Bayer by a different plaintiff, George McCollins. The District Court had denied McCollins’ certification motion under Fed. Rule Civ. Proc. 23.

"The District Court’s injunction was independently improper because Smith was not a party to the federal suit and was not covered by any exception to the rule against nonparty preclusion. Generally, a party “is ‘[o]ne by or against whom a lawsuit is brought,’ ” United States ex rel. Eisenstein v. City of New York , 556 U. S. ___, ___, or who “become[s] a party by intervention, substitution, or third-party practice,” Karcher v. May , 484 U. S. 72 . The definition of “party” cannot be stretched so far as to cover a person like Smith, whom McCollins was denied leave to represent. The only exception to the rule against nonparty preclusion potentially relevant here is the exception that binds non-named members of “properly conducted class actions” to judgments entered in such proceedings. Taylor v. Sturgell , 553 U. S. 880 . But McCollins’ suit was not a proper class action. Indeed, the very ruling that Bayer argues should have preclusive effect is the District Court’s decision not to certify a class. Absent certification of a class under Federal Rule 23, the precondition for binding Smith was not met. Neither a proposed, nor a rejected, class action may bind nonparties. See id., at 901. Bayer claims that this Court’s approach to class actions would permit class counsel to try repeatedly to certify the same class simply by changing plaintiffs. But principles of stare decisis and comity among courts generally suffice to mitigate the sometimes substantial costs of similar litigation brought by different plaintiffs. The right approach does not lie in binding nonparties to a judgment. And to the extent class actions raise special relitigation problems, the federal Class Action Fairness Act of 2005 provides a remedy that does not involve departing from the usual preclusion rules.

Amith v Bayer, No. 09-1205 (Decided June 16, 2011)