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Wednesday, July 18, 2012

Workers Compensation Rates in New York to Decrease

Mario Cuomo,
Governor of the State of New York
Governor Cuomo Announces First Reduction in Workers' Compensation Rates Since 2008

After Compensation Board Recommends Rate Increase, Administration Review Determines No Increase is Needed, Helping NY Businesses to Remain Competitive

Governor Andrew M. Cuomo today announced that for the first time in four years, New York State employers will see a reduction in workers' compensation premium rates. The Governor asked for a reconsideration of the original recommendation in order to find ways to reduce the proposed increase.

Rates to policyholders will actually see a decrease of 1.2 percent – the first reduction in rates since 2008. The Governor also announced that the last measures of the 2007 Workers' Compensation Reform Law, which secured necessary benefit increases for injured workers and cost reductions for businesses, have now been fully implemented by the state. The rate reduction and the expedited implementation of the reforms are a result of efforts by the Governor's administration over the past 18 months to modernize, improve efficiency and decrease waste in the workers' compensation system.

"To create jobs and get our state's economy back on track it is essential that New York's businesses remain in a competitive position to succeed in the global marketplace," Governor Cuomo said. "For years, the workers' compensation system has been too costly for businesses and ineffective for injured workers. With the new measures implemented by the state, and our continued work together with the business and labor communities, we will remain on track to create a system that works better for both employers and employees."

This year, the New York Compensation Insurance Rating Board, a non-governmental rate service organization, recommended a cost increase in their annual loss cost filing. After reviewing all filings and written submissions, the administration deemed the rate increase was not to be necessary. As a result of the decision, workers' compensation rates will actually decrease in the upcoming policy year. The rates are determined on an annual basis, and are informed by a variety of factors, including but not limited to experience in the marketplace, implementation of any cost cutting measures, and implementation of any new policies and procedures. 

Benjamin M. Lawsky, Superintendent of Financial Services, said, "Under the Governor's leadership, New York has taken dramatic steps that ultimately will benefit workers' compensation insurers, claimants, and businesses -- both large and small -- throughout the state. At a time when many states are gutting their workers' compensation systems, New York is working to continually improve our workers' compensation system for employers and employees. This is the right decision on rates at the right time."

The DFS decision was due in part to a variety of developments which are altering the workers' compensation landscape, including the completion of the workers' compensation reforms. Last year, Governor Cuomo directed the Workers' Compensation Board to deliver on the components of the reforms and implement any outstanding provisions. Although the savings from the reforms were immediately realized by businesses, the implementation of the measures supporting those savings proceeded at a slower pace. The January 1, 2012 release of the Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity and the recent adoption of diagnostic testing network regulations marked the completion of the reform.

Having finished the process for capping the number of years certain benefits are paid, instituting medical treatment guidelines and improving the calculation of loss-of-wage earning capacity, the Workers' Compensation Board will now focus on creating comprehensive guidelines for the treatment of chronic pain and modernizing its systems using technology and industry best practice to speed benefit delivery, improve service to injured workers, and reduce waste, fraud, and abuse by employers, medical providers, and employees in the system. 

Mario Cilento, President of the New York State AFL-CIO, said, "The Labor Movement's priority in the 2007 Workers' Compensation reform was to ensure that workers who suffer injury or illness while at work receive the timely treatment they need and adequate benefit levels to support themselves. The reform led to the indexation of the benefit at two-thirds of the state's average weekly wage so that never again would injured workers suffer an erosion of their benefits through inflation. I thank Governor Cuomo for finally implementing these reforms thereby ensuring that the benefit levels remain indexed and injured workers receive essential care. The New York State AFL-CIO will continue to work with the Administration to ensure that the system is appropriately funded and administered to serve injured workers and pay their benefits."

Heather Briccetti, President and CEO of the New York State Business Council, said, "The 2007 legislation was a good faith effort to balance benefit increases, reduced employer cost, and improved claims administration. Five years after the 2007 reforms, we need to evaluate its actual impacts on both benefits and costs. The cost of workers' compensation coverage remains a significant competitiveness issue for New York State business, and we look forward to working with the Administration and other stakeholders on next steps in improving the system."

Robert Beloten, Chair of the Workers' Compensation Board, said, "Prior to the reform, lost wage benefits were insufficient for injured workers yet the system has had uncontrollable medical and indemnity costs. It was an unsustainable system that did not work for the employer or the injured worker. Working with business and labor we have put this system on a more sustainable path. We will continue to work with our key stakeholders to improve benefit delivery and weed out waste, fraud, and abuse in the system."

Peter M. Rivera, Commissioner of Department of Labor, said, "Improvements in New York's workers' compensation system is a benefit to all the hard working people in the State of New York."

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Canada To Study the Health Effects of Wind Turbines

Noise exposure  has  resulted in many compensable hearing losses and compensable conditions for workers' compensation benefits. Canada is undertaking a major study to evaluate the noise generated by the emerging wind energy generating system using wind turbine engines.

Health Canada, in collaboration with Statistics Canada, will undertake a cross-sectional field study to evaluate these self-reported health impacts and symptoms of illness against objective biomarkers of stress and the sound levels generated by wind turbines, including low frequency noise. This data will be correlated with calculated wind turbine noise so that any potential relationship to reported health symptoms can be reliably determined. The research design includes a computer-assisted personal interview using a questionnaire consisting of modules that probe endpoints such as noise annoyance, quality of life, sleep quality, stress, chronic illnesses and perceived impacts on health. Following the 25-minute interview, the subject will be invited to participate in the health measures collection part of the study. This will include an automated blood pressure measurement and the collection of a small hair sample that will provide a 90-day retroactive average cortisol level. An objective evaluation of sleep will be undertaken using actigraphy for a period of 7 consecutive days, which will be synchronised with wind turbine operational data. Environmental sound level measurements, including low frequency noise, will be conducted inside and outside a sub-sample of homes in order to validate parameters ensuring accurate sound level modeling. The sample will consist of 2000 dwellings at setback distances ranging from less than 500 metres to greater than 5 kilometres from 8-12 wind turbine power plants. The results of the research study will contribute to the body of peer-reviewed scientific research examining the health impacts of wind turbine noise.


The last decade has seen a sharp increase in wind turbine generated electricity in Canada. As of May 2012, Canada's installed capacity was 5.4 Gigawatts, representing almost a 7-fold increase since 2005 and 2.3 percent of Canada's current electricity demands. The wind energy industry has set a vision that by 2025 wind energy will supply 20% of Canada's electricity demands. Development has been challenged by public resistance to wind farms based on various concerns, including the potential health impacts of wind turbine noise. The health effects reported by individuals living in communities in close proximity to wind turbine installations are poorly understood due to limited scientific research in this area. This is coupled with the many challenges faced in measuring and modeling wind turbine noise, in particular low frequency noise, which continue to be knowledge gaps in this area. The continued success and viability of wind turbine energy in Canada, and around the world, will rely upon a thorough understanding of the potential health impacts and community concerns that underscore public resistance.

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For over 3 decades the Law Offices of Jon L. Gelman1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.


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Thursday, July 12, 2012

NJ Division of Workers Compensation Modifying CMS Process Policy

The NJ Division of Workers' Compensation is modifying its policy concerning Conditional Payments and Medicare Set-Aside issues. The Division has announced flexibility in settlement formats to allow the utilization of alternate language when approving dispositions.


Click here to read the complete Memorandum of July 11, 2012. 

The High Price of Drugs: Upscale Pricing By Doctors

Source: NY Times
"Rules in some states that govern workers’ compensation insurance allow doctors to charge many times what pharmacies charge for some drugs when dispensed in their offices."


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Corporate Workers Compensation Fraud: California Targets Underground Economy

Sweep targets contractors operating in California's underground economy

Insurance Commissioner Dave Jones today announced that a statewide joint task force in the fight against California's underground economy has netted contractors allegedly operating illegally, resulting in 104 enforcement actions.

"Operation Underground took aim at the "off the books" activity of unscrupulous contractors allegedly operating illegally or without proper coverage for their workers," said Commissioner Jones. "In doing so, they not only failed to protect their employees, but they create unfair competition in California."

"Participants in the state's underground economy are harmful to everyone," said CSLB Registrar Steve Sands. "Anyone who neglects their responsibility to comply with state contracting, insurance, and payroll requirements drives up premiums. At the same time, legitimate licensed contractors are being underbid and struggle because of these illegal business practices."

Detectives from the California Department of Insurance (CDI), the Contractors State License Board (CSLB), Employment Development Department (EDD), and County District Attorneys' offices partnered for a series of sweeps at suspected illegal construction sites on June 20 and 21, 2012. Supplied with information in part from the State Compensation Insurance Fund (State Fund), sweeps were conducted in 11 counties, where enforcement actions were issued for violations including failure to carry workers' compensation insurance, under-reporting the number of workers to obtain cheaper insurance premiums and to pay less payroll withholding tax, and cash payment to hide unregulated practices. Uninsured, untaxed, unlicensed, and unregulated activity is referred to as the underground economy.

Sweeps took place in cities within Alameda, Butte, El Dorado, Kern, Los Angeles, Monterey, Orange, Riverside, San Bernardino, Santa Clara, and Yolo Counties. These actions resulted in 104 enforcement actions against contractors that failed to obtain the appropriate workers' compensation insurance coverage for workers, obtain the required contractor's license, or comply with payroll tax withholding requirements. Some received stop orders for the workers' compensation violations, which means they are not allowed to use employee labor until they obtained a policy for their workers and submit proof of that coverage to CSLB.

Highlights of the two-day operation, by county, are as follows:

  • Investigators issued two citations for workers' comp violations and stop orders in Pleasanton. One of them also faces contracting without a license charges. In Dublin, one was cited for workers' comp violations and received a stop order (Alameda County).
  • Investigators in Chico opened one insurance investigation; and two contracting citations are pending in Paradise (Butte County).
  • Six citations were issued for workers' comp violations, and three investigations and audits were opened in South Lake Tahoe (El Dorado County).
  • In Bakersfield, two insurance investigations and two EDD investigations were opened (Kern County).
  • One contractor caught in Inglewood and another in Santa Clarita will face tax audits (Los Angeles County).
  • One insurance investigation was opened in Salinas and four insurance investigations were opened in Monterey County; three were cited for workers' comp violations in Pebble Beach; one was cited in Carmel for contracting without a license and illegal advertising; and two were cited for workers' comp violations and received stop orders (Monterey County).
  • Two contractors caught in Riverside face EDD audits, along with one in Temecula (Riverside County). One contractor caught in Ontario received a citation for workers' comp violations and faces an EDD audit; one caught in Chino Hills faces an EDD audit; one contractor at a Fontana jobsite received a citation for aiding and abetting a non-licensee who was cited for contracting without a license and failure to carry workers' comp; and one EDD audit was opened in Upland (San Bernardino County).
  • Sixteen EDD audits were opened and one person was cited for workers' comp violations in San Jose; and one EDD audit was opened in Campbell (Santa Clara County).
  • In Woodland, investigators issued six stop orders for workers' comp violations and opened six investigations for insurance and tax fraud (Yolo County).

"This enforcement activity is a result of the partnership under the Joint Enforcement Strike Force which is made up of various state agencies including CDI, CSLB and EDD to aggressively combat the underground economy," said Jones. "Legitimate businesses that play by the rules are often forced to close their doors because illegal businesses are cheating the system."

Commissioner Jones offers the following tips for consumers when hiring a contractor:
Call the Contractors State License Board at 800-321-2752 or visit their Web site at www.cslb.ca.gov to check a contractor's license number or get further information on home and property repairs.



  1. Deal only with licensed contractors. Ask to see the contractor's "pocket license," together with other identification. If the person claims to be representing a contractor, but can't show you a contractor's license or home improvement salesperson registration card, call the contractor and find out if the person is authorized to act on the contractor's behalf.
  2. Do not do business with a contractor who does not carry the appropriate insurance coverage. If the contractor is not insured, you may be liable for accidents that occur on your property. Ask the contractor if he/she carries general liability and workers' compensation insurance. Request a certificate of insurance (COI) from the contractor that shows the name of the insurance company, policy number and policy limits the contractor carries. Contact the insurance company directly to verify information on the COI.
  3. Don't rush into signing a contract. Collect business cards, interview several contractors, and request multiple bids for comparison. Make sure to read the fine print on all estimates and contracts.
  4. Obtain estimates from at least three contractors before deciding which to hire.
  5. Beware of building contractors that encourage you to spend a lot of money on temporary repairs.
  6. Hire local, licensed contractors when possible, as it is easier to deal with a local contractor if problems develop. However, since it may not always be possible to deal with local contractor, be particularly careful to thoroughly check references for out-of-town contractors.
  7. Get everything the contractor discusses in writing. Also, if changes or modifications occur in the contract terms, they should be acknowledged by all parties in writing.
  8. Never sign a contract with blanks that have not been filled in. Unscrupulous contractors may fill in the blanks later with unacceptable terms.
  9. Never pay a contractor for the entire project in advance or before the work is completed. California law requires that the amount of the down payment for any one improvement project, other than for construction of a swimming pool, may not exceed $1,000 or 10% of the contract price, excluding finance charges, whichever is less.
  10. Be especially suspicious of door-to-door sales people who make unrealistically low estimates, refuse to leave a contract overnight, or try to sell their services by playing on your emotions.
  11. Federal law requires a three-day "cooling off" period for unsolicited door-to-door sales of more than $25.

Consumers with questions or concerns regarding insurance, or who feel they have been a victim of insurance fraud, are urged to contact the California Department of Insurance at 800-927-HELP (4357) or online at www.insurance.ca.gov.

Wednesday, July 11, 2012

Former CEO for Missouri Employers Mutual and Attorney Sentenced for Misappropriation of Funds

Seal of Missouri.
Seal of Missouri. (Photo credit: Wikipedia)

Roger B. Wilson was sentenced to two years probation, a $5,000 fine, $5,000 restitution and 100 hours of community service.  Edward Griesedieck III was sentenced to one year of probation, a $5,000 fine, $5,000 restitution and 100 hours of community service.  Both were sentenced involving their misappropriation of funds from an insurer.

Wilson was CEO of Missouri Employers Mutual (MEM),  a provider of workers compensation insurance.  Douglas Morgan, now deceased, was the Chairman of the Board of Directors of MEM.  Edward Griesedieck III was a partner with the St. Louis law firm of Herzog Crebs and provided legal services to MEM.  In July 2009, Griesedieck made a $5,000 contribution to the Missouri Democratic Party at the direction of Douglas Morgan and then billed the contribution to MEM on his legal bill as "cost advanced."  The MEM Board of Directors was unaware of the political contribution or the falsity of the legal bill.  Without permission from the Board, Wilson, at the direction of Morgan, approved the payment of Griesedieck’s legal bill, including the reimbursement of $5,000 for the political contribution.  As a result, the public campaign disclosure records for the State of Missouri falsely reflected the contributions from Griesedieck’s law firm.  

In December of 2009, Morgan again directed Griesedieck to make a contribution to the Missouri Democratic Party, this time for $3,000, but with the promise that he, Morgan, would personally reimburse Griesedieck for the contribution.  Later, when Morgan ran into financial problems, he then directed Griesedieck to bill MEM for the contribution.  However, when in-house counsel for MEM discovered in a routine review that the "cost advanced" related to a contribution to the Missouri Democratic Party, Wilson then reimbursed Griesedieck from his personal funds. 

Rodger Wilson, Columbia, MO; and Edward Griesedieck III, Town & Country, MO, both entered guilty pleas in April to one misdemeanor count of misappropriation of funds from an insurer. They appeared today for sentencing before U.S. Magistrate Judge Mary Ann Medler. 

As part of his plea, Griesedieck agreed to surrender his law license for 18 months.  Further, both Wilson and Griesedieck entered into consent orders with the Missouri Ethics Commission and paid fines of $2,000.  Both have also made restitution to MEM for the funds used to reimburse Herzog Crebs for the political contributions.
           
This case was investigated by the Federal Bureau of Investigation.  Assistant United States Attorney Hal Goldsmith handled the case for the U.S. Attorney’s Office.  Missouri Employers Mutual fully cooperated and provided assistance in the investigation.

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Exclusivity Rule Adopted in MDL Aviation Law Case

Continental Connection Bombarder Q400 operated by Colgan Air
Photo Credit: Wikimedia Commons
In a Multidistrict Litigation (MDL) case pending in New York, a Federal Court ruled that the New Jersey law governing exclusivity of claims barred an employee from proceeding with an intentional tort claim against the employer. Despite the fact that the fatal plane crash occurred in New York, the Court adopted New Jersey law since the the employer was based in New Jersey, the employee was based in New Jersey and workers' compensation benefits were being paid under New Jersey law by a New Jersey based and claims unit in New Jersey.


The Exclusivity Doctrine bars an employee from filing a claim against his or her employer outside of workers' compensation. There are some limited exceptions to that rule such as intentional actions by the employer such as concealment of medical information and gross negligence. The workers' compensation act in the overwhelming majority of claims supersedes common law actions in tort and is the exclusive remedy for an injured worker against an employer. Dudley v. Victor Lynn Lines, Inc., 32 N.J. 479, 161 A.2d 479 (1960).  Kristiansen v. Morgan et al., 153 N.J. 298, 708 A.2d 1173 (1998).




The Court reasoned that under a New York conflict-of-laws analysis, the State of New Jersey, rather than New York, had a greater interest in the case. since the plaintiff failed to meet the two prong NJ test to circumvent the NJ exclusivity rule, the case was dismissed. 


In re Air Crash Near Clarence Center New York on February 12, 2009 v. Colgan Air, Inc., et al., # 09-md-2085, 10CV-10078, 2012 WL 1029530 (W.D.N.Y.) March 26, 2012

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For over 3 decades the Law Offices of Jon L. Gelman1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.


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