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

Saturday, August 31, 2013

Cost Shifting vs. Cost Fixing

Cost shifting is a major credibility issue in workers' compensation schemes. Insurance carriers, employers and even employees have been implicated in such conduct. Unless it is resolved it will ultimately jeopardize the entire program. Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com.au

There have always been allegations of cost shifting either to or from workers' compensation and general health. Now Massachusetts is going to study just whether or not this is true, and if so, by how much.

The Massachusetts Department of Public Health is expected to release a report to the state Workers' Compensation Advisory Council in October or November on practices that regulators warned last May may be shifting costs from workers' compensation carriers primarily to MassHealth and to some private health care providers.The alleged problem seems to be three-fold:


  • Employers pressure workers not to report injuries as job-related.
  • Employees use private insurance because of fears they will lose their jobs or suffer some form of retaliation for filing a workers' compensation claim.
  • Some doctors check for secondary insurance and send out bills to all carriers to ensure they get paid.

    • At a meeting of the Advisory Council last May, Massachusetts Department of Industrial Accidents Deputy Director George Noel said the regulatory agency had indications that some workplace injuries are being processed through MassHealth and that community health centers reluctant to accept workers' compensation claims are shifting cases to "other places."Mickey Long, a member of the advisory council and an attorney for the Massachusetts AFL-CIO, said "There are an increasing number of anecdotes going back a decade involving contractors, where a worker is told by the owner of a company to handle...
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    Is Big Sugar the Next Liability Target?

    Today's post was shared by The Health Care Blog and comes from thehealthcareblog.com

    By Vik Khanna

     Growing paranoia is the hallmark of the aging process for me.  Although I am a generally affable sort (I know, it doesn’t always seem that way from my writing), I am also a fairly suspicious person.  I am starting to think that all the food industry’s sweet talk about the innocence of sugar is really just icing on a toxic cake and that we’ve all been sold a bill of goods.  In particular, I wonder — and part of me hopes — that Big Sugar might soon replace Big Tobacco as the favorite target of our most underappreciated and misunderstood national resource…the plaintiff’s bar.

     There is no question we eat way too much sugar and that the increase in consumption has coincided nicely with both our rise in obesity and decline in health status even though we are living longer.

    Not that I think the Tobacco Settlement (TS) was great social policy.  You can read my full view here; but, to summarize, as an immigrant and a person of color, a part of me resents the TS because all it did is push the burden of fulfillment of the financial terms into the hearts and lungs of people in Africa, Asia, and Latin America.  The smug satisfaction of tobacco opponents in the US and their glib dismissal of the impact on predominantly poor people of color around the world is first order racism.
    Any analogous move against Big Sugar (BS) could be quite interesting.  There is, of course, the delectable duality of...
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    Second Circuit to consider petition to reassign federal judge in Chevron RICO case

    Today's post was shared by Legal Newsline and comes from legalnewsline.com

    Kaplan
    Kaplan
    The U.S. Court of Appeals for the Second Circuit will consider a petition to reassign a federal judge overseeing a case stemming from a $19 billion judgment against oil giant Chevron Corp.

    In a notice filed Aug. 14, the Second Circuit set Sept. 26 for oral argument on the petition to reassign Judge Lewis Kaplan for the U.S. District Court for the Southern District of New York.

    Kaplan is currently presiding over a RICO lawsuit that Chevron filed against a group of Ecuadorians and their lawyers. The fraud case was filed by the company in the New York federal court in 2011.

    New York attorney Steven Donziger and Ecuadorian plaintiffs Javier Piaguaje and Hugo Camacho filed a petition for writ of mandamus with the federal appeals court in June. They want the judge to be removed from the case for his alleged bias.

    In a rare move, the court asked Kaplan for a legal brief in his defense. However, the judge “respectfully declined” the court’s invitation, according to a letter last month.

    The U.S. Chamber of Commerce has filed an amicus brief in the case.

    “The Chamber is concerned that improper resolution of Petitioners’ tactical use of a request for judicial reassignment could set a dangerous precedent with long-standing effects,” former U.S. Attorney General Michael Mukasey wrote in the brief, filed July 29.

    The Chamber’s Institute for Legal Reform owns Legal Newsline.
    This week, Donziger and the Ecuadorian...
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    Defense bar files brief to U.S. SC in support of insurer

    Today's post was shared by Legal Newsline and comes from legalnewsline.com


    drilogo
    DRI: The Voice of the Defense Bar this week filed an amicus brief with the U.S. Supreme Court, saying the terms of an Employee Retirement Income Security Act-covered plan must be upheld.

    Heimeshoff v. Hartford Life & Accident Insurance Co. et al. is expected to settle differences among the courts of appeals regarding the extent to which the terms of an ERISA-covered plan can establish the date on which the statute of limitations to file a claims for benefits complaint in federal court will begin to run.

    The Employee Retirement Income Security Act protects the assets of millions of Americans so that funds placed in retirement plans during their working lives will be there when they retire.
    According to the U.S. Department of Labor, ERISA is a federal law that sets minimum standards for pension plans in private industry.

    For example, if an employer maintains a pension plan, ERISA specifies when an employee must be allowed to become a participant, how long they have to work before they have a non-forfeitable interest in their pension, how long a participant can be away from their job before it might affect their benefit, and whether their spouse has a right to part of their pension in the event of their death.
    Most of the provisions of ERISA are effective for plan years beginning on or after Jan. 1, 1975.
    On Aug. 22, 2005, Julie Heimeshoff, a Walmart employee, submitted a claim for long-term disability benefits under the ERISA-covered...
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    AMA President Optimistic About A Fix For Medicare’s Doctor Payment Formula

    Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org


    Dr. Ardis Dee Hoven
    Debated and despised, the Medicare physician payment formula may finally be on the way out – at least that’s what AMA President Ardis Hoven believes.

    Known as the “sustainable growth rate” or SGR, the formula routinely threatens double-digit payment reduction to doctors until Congress steps in at the last minute to stop the cuts. Currently a 25 percent cut looms Jan. 1 unless Congress takes action again.

    An admitted optimist, Hoven says she sees plenty of evidence to support her view that Congress is prepared to pass a permanent SGR fix this year. The AMA president points to wide bipartisan support in both chambers.

    She notes that the House Energy and Commerce Committee passed SGR legislation before the August break — well before the usual end-of-the-year scramble that has been the usual path to a short-

    term SGR fix. The House Ways and Means and Senate Finance panels are also actively working on a solution. “This is different. This is palpably different,” Hoven says in an interview.

    According to the Congressional Budget Office, replacing the SGR would cost about $140 billion, down from earlier estimates as high as $300 billion.  But in this era of deficit reduction, it’s unclear where Congress can find that much cash for anything, let alone to pay for the doc fix.

    Expect a big battle if lawmakers, as they have in the past, turn to other Medicare providers, such as hospitals, home health...
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    CDC: Public Health Practices to Include Persons with Disabilities

    Today's post was shared by WCBlog and comes from www.cdc.gov

    This is another in a series of occasional MMWR reports titled CDC Grand Rounds. These reports are based on grand rounds presentations at CDC on high-profile issues in public health science, practice, and policy. Information about CDC Grand Rounds is available at http://www.cdc.gov/about/grand-rounds.

     "Persons with disabilities" is a vague designation that might not always be understood.

     Persons with disabilities are persons with limitations in hearing, vision, mobility, or cognition, or with emotional or behavioral disorders. What they have in common is that they all experience a significant limitation in function that can make it harder to engage in some activity of daily living without accommodations or supports.

     According to the World Health Organization, disability has three dimensions: 1) impairment in body function or structure, such as loss of a limb or loss of vision; 2) limitation in activity, such as difficulty seeing, hearing, walking, or problem solving; and 3) restriction in participating in normal daily activities, such as preparing a meal or driving a car. Any of these impairments, limitations, or restrictions is a disability if it is a result of a health condition in interaction with one's environment (6).

    These limitations all relate to health conditions experienced within the environment in which persons live, as well as to other personal factors. Environmental barriers can be physical barriers, such as stairs; communication barriers, such...
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    New Jersey court rules texting a driver creates liability

    Today's post was shared by WCBlog and comes from jurist.org


    The New Jersey Superior Court [official website] ruled [opinion, PDF] Tuesday that knowingly sending a text message to someone who is behind the wheel creates liability for any causes of action that result from a potential collision. Previously, liability was only assigned to the driver that was texting. Defendant Shannon Colonna was sued for texting a driver who collided with a motorcyle less than 10 seconds after responding to her message.

      The trial court dismissed [Bloomberg report] the plaintiff's theory of proximate cause, aiding and abetting illegal activity and joint liability against Colonna in a summary judgment. However, the plaintiffs appealed and the appellate court validated all of the theories of liability against her as trial-worthy arguments. However, the court found that the plaintiffs did not procure enough evidence to indicate that Colonna knew or had special reason to know that the recipient of her message was driving, and thus again dismissed the case for her liability:
    [W]e also reject defendant's argument that a sender of text messages never has a duty to avoid texting to a person driving a vehicle. We conclude that a person sending text messages has a duty not to text someone who is driving if the texter knows, or has special reason to know, the recipient will view the text while driving.
    In response to this crash and several others, the New Jersey legislature enacted the Kulesh, Kubert, and Bolis Law [press release] to increase penalties...
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