NJ, a State that elected not to data match with CMS, is now reporting a drop of 46% of its backlog from the cases designated "waiting for CMS approval," MCARE matters. In a memo to all judges and attorneys, the Director and Chief Judge reported the drop in the cases so designated.

Occupational lead exposure, especially to lead paint, has been a well known hazard in the workplace you decades. Recent epidemiological studies demonstrate the causal relationship of exposure to impaired brain function, over time, in adults, results in early aging. Employers and insurance carriers should brace themselves for a wave of claims.

The distractions caused by cell phone use and other electronic gadgetry are increasing the exposure of employers to monetary exposure well beyond those benefits that employers are covered for under their workers’ compensation policies. A fatal accident contributed to by the employee’s use of a cell phone while driving resulted in a recent settlement of $5.2 million.

Workers' Compensation medical benefits continue to be up for grabs as the US Presidential Primaries continue. The problematic medical compensation delivery system continues to provide little cost containment, high administrative costs and continues to drain the system by endless delay hampering the delivery of effective medical care.

A new law on the books introduced in the Senate on Dec. 18, 2007 and signed by the President on December 29, 2007 is going to have significant impact on how the workers' compensation system operates in the future concerning Medicare Secondary Payer (MSP) issues.

As the new political and legislative year unfolds, stakeholders are keeping their eye on the prize, medical benefits, in the workers' compensation arena. Recent court decisions continue to emphasize the major significance of medical care and continue to question the ability of the presently crafted system to deliver medical benefits in an efficient and effective manner.

WCRI has been “researching” or generating data for the Industry for 24 years. The introductory remarks were offered by Robert Steggert, Marriott International, Inc., Chair WCRI Bd or Directors. The central topic of the entire program has been medical costs and how to contain them and the consequential effect upon medical claims, temporary benefits and permanent benenfits.

INSURANCE INDUSTRY AGAIN OFFERS MSP LEGISLATION THAT WOULD DISCOURAGE WORKERS' COMPENSATION PERIODIC PAYMENTS
After a failed attempt in the last Congress, the Insurance Industry has again offered similar legislation to encourage "lump sum" settlements in Workers' Compensation hearings, H.R.2549, and circumvent reimbursement of the ailing Medicare program. This legislation failed to gain acceptance in the last Congress as it did not receive the support of interest groups involved in preserving the Medicare system and Labor who continues to support a periodic benefit system in Workers' Compensation.

FLORIDA EXPANDS INTENTIONAL TORT EXCEPTION

 

Employee's injury was substantial certainty from employer's failure to respond to requests for new ladder did not require proof that employer concealed danger.

 

"Even though case law on the intentional tort exception to workers' compensation immunity is devoid of any defined test that will establish substantial certainty as a matter of law, it is evident that concealment of the dangerous condition is only one of several factors in a nonexclusive list. "

 

Bakerman v The Bombay Company, ___So. 2d____, 2007 WL 1774420 (Fla.), decided June 21, 1007

American Bar Association Establishes The College of Workers' Compensation Lawyers. Jon Gelman, Author and Litigator, Installed as Fellow. NAPLES, FL.,March 2, 2007 – The College of Workers’ Compensation Attorneys announced today that Jon L. Gelman has been inducted as a fellow of the national organization at its first annual induction dinner.

NYC CONNECTS AN EXPOSURE TO 911
For the First Time, the City Connects a Death to 9/11 Dust 
New York City’s chief medical examiner, Dr. Charles S. Hirsch, has for the first time directly linked a death to exposure to dust from the destruction of the World Trade Center. 

Medical expenses in contested workers’ compensation cases are now a significant and troublesome issue resulting in uncertainty, delay and potential future liability. The recent NJ Supreme Court decision, University of Mass. Memorial Hospital v. Christodoulou, 180 N.J. 334 (2004) has left the question of how to adjudicate medical benefits that were conditionally paid or paid in error. Presently there is no exclusively defined procedure to determine the allocation, apportionment of primary responsibility for unauthorized medical expenses and reimbursement.

CLEARING THE WORKERS' COMPENSATION BENEFIT HIGHWAY OF MEDICAL EXPENSE LAND MINES 
Medical expenses in contested workers’ compensation cases are now a significant and troublesome issue resulting in uncertainty, delay and potential future liability. The recent NJ Supreme Court decision, University of Mass. Memorial Hospital v. Christodoulou, 180 N.J. 334 (2004) has left the question of how to adjudicate medical benefits that were conditionally paid or paid in error. Presently there is no exclusively defined procedure to determine the allocation, apportionment of primary responsibility for unauthorized medical expenses and reimbursement. By John H. Geaney and Jon L. Gelman

FEDERAL LAWSUIT ALLEGES ABUSE OF MEDICARE SYSTEM BY THE STATE OF CALIFORNIA & SEEKS TO RECOVER $20 MILLION IN DAMAGES
Plaintiff claims cost-shifting of workers compensation obligations to Medicare created "work comp reform bubble" that is about to burst  

RICO CLAIMS RESULTS IN AWARD OF $2.2 MILLION AGAINST INJURED WORKERS
Federal RICO action arising from WC claims results in $2,264,690. Award Against Workers
"The Complaint alleges that the defendants committed violations of the Racketeer Influenced and Corrupt Organization Act, 18 U.S.C. 1962, violations of the New Jersey State Racketeer Influenced and Corrupt Organization Act, N.J.S.A. 2C:41-2, violations of N.J.S.A. 34:15-57.4(b) (workers’ compensation fraud), common law fraud and conspiracy in connection with the filing and prosecution of fraudulent workers’ compensation petitions against Plaintiff...'
Bath Unlimited, Inc. v Ginarte O'Dwyer, et al., Case 2:04-cv-03919-SRC-RJH Filed 3.14.07 Civ Ac No 04-3919 (SRC) (USDCT NJ 2007)

 The Mercer County Bar Association will be sponsoring a seminar on workers' compensation at two locations this spring.Samuel Gaylord and Michael R. Paglione will join Jon Gelman for a seminar for workers' compensation attorneys.

STATE PREMIUM RANKINGS ANNOUNCED 
1. Alaska 
2. California 
6. Florida (down from 3) 
10. New York (up from 18) 
23 New Jersey (up from 29) 
51. North Dakota 
Source: State of Oregon 

 STATE PREMIUM RANKINGS ANNOUNCED  1. Alaska  2. California  6. Florida (down from 3)  10. New York (up from 18)  2...

NEW MEDICARE RECOVERY PROCEEDURE – Medicare Secondary Payer. The Centers for Medicare & Medicaid Services (CMS) is consolidating all of the functions and workloads related to Medicare Secondary Payer (MSP) post-payment recoveries into one MSP recovery contract. The contract for the new national MSP Recovery Contractor (MSPRC) will be implemented on October 2, 2006. 

PUTTING "FAULT" BACK INTO WORKERS' COMPENSATION. A bill has been introduced into the NJ Legislature in an attempt to legislatively reverse the recent NJ Supreme Court ruling in Tlumac v. High Bridge Stone which reaffirmed the long standing rule that intoxication must be the "sole cause" of an accident in order to deprive an employee of workers' compensation benefits. The proposed legislation, S2166, amends the workers' compensation law to provide that it in employee was intoxicated when the injury or death occurred, it is presumed that the injury or death was caused by the intoxication and the employee will be barred from receiving workers' compensation.