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Wednesday, August 10, 2011

Qui Tam Action for MSP Results in Costs to Plaintiff

Federal court ruled that a plaintiff acted with an improper purpose and in bad faith by filing seven different putative qui tam actions against various health care providers under the Medicare Secondary payer Act (MSP). The Federal Court imposed sanctions against plaintiff pursuant to court's inherent power.

The Court reasoned that there was no legal support for plaintiff's claim that MSP was a qui tam statute, Court of Appeals had previously determined that plaintiff's claims were “utterly frivolous” and “unreasonable and vexatious,” and plaintiff had already filed dozens of almost identical cases across the country with similar results.

Stalley ex rel. U.S. v. Mountain States Health Alliance, 644 F.3d 349, C.A.6 (Tenn.), 2011, decided July 08, 2011

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Employee Penalized For Not Following Safety Rules

An employee's workers' compensation award maybe be reduced for failing to follow an employer's safety rules. A Missouri Court ruled that reducing an injured employee's award by 25% to 50% for failing to follow an employer's safety rules was not unconstitutional.

This ruling may have widespread application in many situations including distracted driving claims, where an employee sustains an accident while using a cell phone in violation of an employer's cell phone policy. The employer woud still remain responsible for the reduced award and, of course, subject to a 3rd part law suit by a potential 3rd party.

The reduction rule actually places fault back into the workers' compensation system which both violates the intent of the Act . Such a policy does not compensate for the reduced values (awards) anticipated and prescribed under the workers' compensation act. While the the logic seems to rational, the application further emasculates the intent of workers' compensation. It would be far more logical to put the cart before the horse, and work to prevent the unsafe work condition in the first place. Shifting responsibility to the injured worker is not consistent with the act's intent.

Thompson v. ICI American Holding, 2011 WL 3444008 (Mo.App. W.D.) Decided, August 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.


Medical Providers Barred From Lawsuits Against Employers for Benefits

A NJ Appellate Court, in an unreported decision, ruled that medical providers are barred from filing a civil action against an employer for medical services provided to an injured worker. The medical provider must bring the claim before the Division of Workers' Compensation which has exclusive jurisdiction over benefits.

This decision, while permitting contractual issues to be decided in a civil action, is consistent with a prior NJ Supreme Court ruling barring a collection action outside of workers' compensation directly against an injured worker for medical treatment.

The Valley Hospital v L.Q. Management, 2011 WL 3425591 (N.J.Super.A.D.) Decided August 8, 2011. (Not Approved for Publication)

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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Monday, August 8, 2011

Workers' Compensation Medicare Set-Aside Web Portal (WCMSAP) Webinar


Please read below an invitation to Submitters to attend a CMS Workers' Compensation Medicare Set-Aside Web Portal (WCMSAP) Webinar.

WCMSAP Submitters Webinar - August 10, 2011

Event Description: This Webinar will review the Workers' Compensation Medicare Set-Aside Portal (WCMSAP), a new web-based application that allows for the electronic submission and tracking of WCMSA proposals submitted to CMS for review. This Webinar will also review the current WCMSA proposal submission process, the new submission process on the WCMSAP and the WCMSAP screens that will be used to enter and submit a proposal.

Enrollment Information: To receive your Webinar access information simply send an email to Techi@nhassociates.net and include the following information. To ensure that you receive webinar access information, future notifications and announcements regarding the Webinar, please add this e-mail address (Techi@nhassociates.net) to your "Safe Sender" list in your e-mail client.

Note: Due to limited seating we will need to hold attendance to an 85 user maximum. So please reserve
your seat as soon as possible, we apologize for any inconvenience.

Information Required for WCMSAP Webinar Registration:

Name (first and last):
Email Address:
Company Name:
Tel. Number:
Receipt of invitation which reserves space in Outlook Calendar (i.e. an iCal) (Yes/No):

Saturday, August 6, 2011

Text To Join Our Mailing List - Workers Compensation Law

Stay up to date on current developments in workers' compensation benefit programs. Join our monthly newsletter Workers' Compensation Law mailing list today. Text WORKCOMP to 22828.

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.

An Employer Is Responsible To Compensate For Pain

A NJ Appellate Court, in a dramatic reversal of a compensation judge's dismissal of a case, held that "an employer is responsible to compensate" an injured worker for pain.  The reviewing court held that, "...the judge misapplied some standards bearing upon this case."

The trial judge's conduct, in baring the treating physician from testifying, was also cited as "a discretionary lapse." The trial judge's ruling was reversed and the case remanded for a hearing.

The case involved a long standing injury that required prolonged treatment for a chronic medical condition. The injury occurred in June of 1989 and was the subject of an Order Approving Settlement in January 2004 for 20% of partial total. That award was entered by another trial judge.

Even thought an Order had been entered by the prior trial judge for continued medical treatment and medication, the insurance company unilaterally terminated provision of those benefits without a court order. The claimant's attorney, George Goceljak, was required to file two motions for continued medical treatment and medication benefits. The trial court dismissed the case for lack of prosecution and then subsequently restored the matter for trial and then marked it "not moved" when a minimal one-cycle (3 week) adjournment was requested. Customarily, NJ workers' compensation cases are tried in piecemeal, every 3 to 6 weeks.

The trial judge then mandated that the trial should begin immediately on January 15, 2010, commenting that she was, "...not going to wait" any longer for the the claimant to proceed with his case. She denied a reconsideration of the application of the injured worker to allow the treating physician to testify, and then proceeded in a 5 month stagnated trial ultimately dismissing the case.

The NJ Appellate Division found, "the judge erred is using, out of its context, the simple thought that 'an employer is not required to compensate and employee for pain,' as a basis for denying this petitioner's application. The larger principle...is that, to the extent that a petitioner experiences continuing pain as a result of his work-connected injury, the employer for whom he worked at the time of the injury remains responsible.'"

Noto v. Staples, Inc.,  Docket No. A-0237-10T1, 2011 WL 3273921 (NJ App. Div. 2011) Decided August 2, 2010 

Friday, August 5, 2011

Bad Faith Claims Maybe Going to the Jury

The NJ Supreme is going to review the procedure to bring bad faith claims against employers and insurance companies in workers' compensation actions. The Court accepted for review a case holding that workers' compensation bad faith claims are within the exclusive jurisdiction of the workers' compensation hearing official.

The case involves an injured worker who filed a civil action against his employer's workers' compensation insurance company for failing to comply with the Division of Workers' Compensation Order that medical treatment should proceed. The employee alleged that the delay and denial of medical care caused harm. The lower court had rejected the case and dismissed it holding that the jurisdiction for bad faith is exclusively within the purview of the Division of Workers' Compensation. Stancil v. ACE USA, 418 N.J. Super. 79, 12 A. 3rd 223 (App. Div. 2011), ___A.3d___, 2011 WL 3342730 (NJ). Decided June 7, 2011.

In another decision, the NJ Supreme Court held that bad faith, in a negligence action,  was a contractual issue giving rise to a factual question that could only be decided by a jury.

"We conclude that a Rova Farms claim that an insurer in bad faith failed to settle a claim within the policy limits, thereby in fact exposing its insured to liability for any excess, represents a traditional contract claim that the insurer breached the implied covenant of good faith and fair dealing and to which the right to trial by jury attaches." Wood v. New Jersey Manufacturers Insurance Company, 21 A.3d 1131, 2011 WL 2314954 (NJ), Decided June 14, 2011.

The Stancil
case highlights one of the most serious and costly issues in Workers' Compensation, both in NJ and the nation, the adequate and efficient delivery of medical care. While the courts are struggling with this issue that is compounded by arguments over reimbursement  and treatment paths, the compensation system continues to be bogged down and unresponsive to the urgency of the need to delivery medical care to injured workers.

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.