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

Thursday, September 26, 2013

Work Comp Steps Up to ACA

The Affordable Care Act's impact on workers' compensation is going to take many forms. David DePaolo points out in his shared blog today some of the aspects as the ACA is close to launch. Whether the ACA is going to emasculates the workers' compensation system is yet unknown  It is sure heading that way in the new less litigious and aging society.

One of the big questions I have had since the Affordable Care Act became law was how the workers' compensation underwriting market would react since it seemed that there would be a broadening in the class of health care workers coming into the scene.

That question was given some evidence yesterday when ProAssurance, a writer of medical professional liability insurance based in Birmingham, Ala., announced a proposed acquisition of Pennsylvania-based workers' compensation writer Eastern Insurance Group for $205 million.

Eastern offers workers’ compensation to employers with generally 1,000 employees or less that traditionally pay an average premium per policy of $21,956, according to filings with Securities & Exchange Commission. Also, Eastern concentrates on low- to middle-hazard classes of businesses, primarily in the Mid-Atlantic, Southeast, and Midwest regions. In 2012, it reported workers comp premiums written of $182.9 million.

Among those employers Eastern counts as policy holders are small hospital systems, long-term care facilities, physician and dental practices and home health care providers....
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Wednesday, September 25, 2013

Chart of the Day: Hands-Free Talking Is as Bad as Talking on a Handset. Maybe Even Worse.

Distracted driving doesn't get better by the use of hands free technology. Today's post was shared by Mother Jones and comes from www.motherjones.com


Michael O'Hare points us this morning to a study of cell phone usage in cars that confirms the obvious: it's dangerous. More dangerous than driving drunk, in fact. What's more, as the chart on the right shows, hands-free talking doesn't help. In fact, for certain
tasks it makes things even worse. O'Hare explains what's going on:
To understand the reason, consider driving while (i) listening to the radio as I was (ii) conversing with an adult passenger (iii) transporting a four-year-old (iv) sharing the front seat with a largish dog.
Why are the first two not dangerous, and the last two make you tense up just thinking about them? 
The radio is not a person, and you subconsciously know that you may miss something if you attend to something in the road ahead, but also that you won’t insult it if you “listen away”, and it won’t suffer, much less indicate unease. The adult passenger can see out the windshield and also catch very subtle changes in your tone of voice or body language. 
If you stop talking to attend to the car braking up ahead, the passenger knows why instantly, and accommodates, and because you know this, you aren’t anxious about interrupting the conversation. The dog and the child, in contrast, are completely unaware of what’s coming up on the road or what you need to pay attention to; the former is happy to jump in your lap if it seems like a good idea at any moment, and the child demands attention on her own schedule and at...
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Judge again asks sides to settle in Calif. lead paint case

Lead paint litigation is facing a sentinel decision that will set the direction for the future of environmental and occupation litigation. Today's post was shared by Legal Newsline and comes from legalnewsline.com


Santa Clara County Superior Court Judge James Kleinberg on Monday ended proceedings in a 13-year-old case against paint companies by admonishing both sides, again, to settle.
Kleinberg

Kleinberg made his remarks after closing arguments in The People of California v. Atlantic Richfield Co. et. al., which seeks to hold five defendant paint companies liable for an alleged lead paint public nuisance in 10 county and municipal jurisdictions in the state.

“Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passion, they cannot alter the state of facts and evidence,” Kleinberg said, quoting John Adams who defended British soldiers in the Boston Massacre trial of 1770.

Kleinberg also recalled a one-word response made by a judge in a civil case he tried as a lawyer. The judge, he said, asked the plaintiff’s lawyer how his clients felt about their prospects, to which the lawyer responded “Very confident.”

“Why,” asked the judge.

Kleinberg said the case settled a few days later.

Saying it is “never too late to settle,” Kleinberg encouraged the sides to bring an end to the litigation that has spanned more than a decade and could put the defendants – Atlantic Richfield Co., ConAgra, DuPont, NL Industries and Sherwin Williams – on the hook for more than $1.4 billion to abate lead paint in pre 1978-built homes. Kleinberg said it takes He said it...
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Prescription-Drug Coupons — No Such Thing as a Free Lunch

The cost of pharmaceuticals prescribed in workers' compensation claims remains a seriously advancing cost to the system.  Employers blame injured workers for the cause and the demand. Is the actual demand being driven by the pharmaceutical industry? The following is shared from The New England Journal of Medicine www.nejm.org.

Visit nearly any official website for a brand-name drug available in the United States and, mixed in with links to prescribing and safety information, you'll find links to drug “coupons,” including copayment-assistance programs and monthly savings cards.

Most offers are variations on “Why pay more? With the [drug] savings card, you can get [drug] for only $18 per prescription if eligible” or “Get a free 30-capsule trial of [drug] with your doctor's prescription and ask your doctor if [drug] is right for you.” Why do manufacturers offer drug coupons? Are they good for patients in the long run? Are they even legal?

Commercial drug-insurance plans typically have tiered pharmaceutical formularies to guide prescription-drug use, requiring relatively small patient copayments (approximately $5 to $15) for inexpensive generic drugs and higher copayments (perhaps $25 to $100) for brand-name drugs. Manufacturers use coupons to reimburse patients for this difference in copayments when they buy brand-name medications, so that, for people with commercial insurance coverage, the out-of-pocket costs are the same as those for generic drugs.

Drug coupons are implemented through subsidies paid by drug manufacturers. Patients nearly always print coupons off...
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Joseph S. Ross, M.D., and Aaron S. Kesselheim, M.D., J.D., M.P.H.
N Engl J Med 2013; 369:1188-1189 September 26, 2013 DOI: 10.1056/NEJMp1301993

Prospect voters choose to abolish Fire Department

Residents of the Village of Prospect voted Tuesday to abolish its Fire Department.
The 82-46 vote comes as the village faces possible bankruptcy as it struggles to cope with a 2008 workers compensation claim from a volunteer firefighter that amounts in the hundreds of thousands of dollars.

As of 8 a.m. Wednesday, any fire in Prospect will be covered primarily by Barneveld’s department, and also by Remsen, Mayor Fran Righi said. The Prospect fire station likely will become a satellite station.

“As of right now, the village owns all their assets,” Righi said of the Prospect Fire Department. “As of 8 a.m., the tones will not sound, we will be changing the locks and taking an inventory.”

Late Tuesday afternoon, there was a slow but steady trickle of voters coming to the Prospect Village municipal building to vote.

The sky was clear, the scent of wood smoke hung in the air and the clock at the corner of Upper State and Summit streets pointed to high noon.

Of the roughly 175 people eligible to vote, 128 cast ballots. Few, however, would disclose to the media their decision.

“I’m for the Fire Department,” said resident Kim Fazekas. “I think there is a different solution.”
But George Zacek said he had voted to abolish the department.

“The way it is structured now, there’s just a small number of families that are liable for every comp case that arises,” he said. “It puts a tremendous burden on the...
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Questionable Workers Comp Claims Report: Fewer Claims and More Disputes

The National Insurance Crime Bureau (NICB) today released an analysis of workers’ compensation (WC) questionable claims (QC) referrals submitted from Jan. 1, 2011, through June 30, 2013. 

The report finds that while the total number of WC claims has been decreasing, the percentage that is deemed “questionable” has been rising. 

QCs are claims that NICB member insurance companies refer to NICB for closer review and investigation based on one or more indicators of possible fraud. A single claim may contain up to seven referral reasons.
 
California ranked first generating a total of 2,270 WC QCs. It was followed by Illinois with 689. New York was third with 688. 

In 2011, 3,349,925 WC claims were found in the Insurance Services Office (ISO) ClaimSearch® database. That number decreased to 3,244,679 in 2012, and is on track to decrease again in 2013 based on the 1,498,725 claims received in the first half of 2013. 
In 2011, 3,474 WC QCs were referred to NICB. That number increased to 4,460 in 2012 — a 28 percent rise. WC QCs accounted for 3.5 percent of the 100,201 QCs submitted in 2011, and increased to 3.8 percent of the 116,171 QCs in 2012.  

Through the first half of 2013, 2,325 WC CQs have been referred to NICB (3.7 percent of 62,352 total QCs), compared with 1,681 through the first half of 2011 and 2,174 through the first half of 2013.

The distribution of WC QCs follows a standard Monday–Friday workweek with...
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Join us for the 6th Annual Worldwide Photo Walk October 5, 2013

If you are going to be in South Florida for the WILG meeting in October 2013, I would like to invite you to join me for a photo walk that is absolutely for fun and FREE.


Bring any type of camera, from a camera-phone to a sophisticated DSLR.
Boca Raton, FL United States (Mizner Mall)
Join us for the 6th Annual Worldwide Photo Walk
Register for FREE now!
Registration is limited.
Sponsored by the National Association of Photoshop Professionals.

Photo Walk Description

Walk to Begin at E Boca Raton Rd & NE 1st Street, Boca Raton, FL. It will end at Starbucks at Mizner Park. Mizner Park is an upscale lifestyle center in downtown Boca Raton, Florida. Besides upscale shops, Mizner is also composed of rental apartments and offices. The Centre for the Arts at Mizner Park is a cultural center on the north end of the development, which is embodied by an amphitheater and the Boca Raton Museum of Art. The art museum, Victor’s Antiques & Fine Arts, Addison Gallery and the luxurious iPic movie theater are the center’s anchor stores, along with highly rated restaurants Max’s Grille, Villagio, and Truluck’s. Cooper Carry designed the architecture of Mizner as a Mediterranean revival town center.

Read more about the Worldwide Photo Walk