The Essentials: Proposed New York 2018 Schedule Loss Guidelines

On September 1, 2017, the New York Workers’ Compensation Board issued draft guidelines and regulatory changes for 2018. The guidelines are intended to revamp the schedule process to align with modern medical practices. The drafts of both the guidelines and regulations appear to include possible errors, omissions, and ambiguities. Click here for a brief overview of the new proposed SLU process and for an idea of what to expect if the new guidelines are adopted.
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Denied Again! Bronx Civil Court Rejects Request of Out-of-State Providers to Re-Litigate Denied Medical Billing

One of the most basic and well-settled tenets of New York law is that the Workers’ Compensation Board maintains exclusive subject matter jurisdiction over all work-related claims and collection disputes. However, in 2015, a small law firm based out of Westbury, New York sought to disrupt the system by commencing several hundred lawsuits in Civil Court, Bronx County on behalf of out-of-state pharmaceutical and durable medical equipment providers arising out of payment disputes involving numerous insurance carriers. The firm touted
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North Carolina Governor Signs Bill Aimed at Protecting Employees from Misclassification

On August 11, 2017, North Carolina Governor Roy Cooper signed into law Senate Bill 407, which creates Article 82, Chapter 183 of the state’s general statutes — more commonly known as the Employee Fair Classification Act (the Act). Quite simply, the Act creates an Employee Classification Division (ECD) within the North Carolina Industrial Commission, led by Director Bradley L. Hicks. The legislation creating the ECD was introduced in 2015 but failed to become law. In response, former Governor Pat McCrory
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North Carolina Court of Appeals Holds Calculations of Average Weekly Wage Must Be “Fair and Just” to Both Employer and Employee

The North Carolina Court of Appeals ruled that when calculating the average weekly wage of an employee, the calculation must be “fair and just” to both the employer and the employee. In Ball v. Bayada Home Health Care, the plaintiff alleged to have suffered injuries to her left hand, bilateral knees, and right hip while employed as a certified nursing assistant (CNA) in February 2011. Her accident took place on the first day of work with a new patient — right
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Waging the War of Wages: Board Revises Employer’s Statement of Wage Earnings (Form C-240)

On June 19, 2017, the Office of the Chair of the Workers’ Compensation Board in New York issued an official Revision of Employer’s Statement of Wage Earnings — at parties, it simply goes by the Form C-240. For the most part, the Form C-240 has stayed true to its roots: it is still required where an injured worker may be entitled to compensation or death benefits, it still demonstrates the claimant’s wage earnings for the 52 weeks prior to the date
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Maryland on High Alert after Declaring State of Emergency

With communities nationwide struggling to address the booming opioid epidemic, Maryland is the first to declare a state of emergency in an attempt to rein in overdoses within its borders. In 2016, the Maryland residents suffered more than 2,700 fatal opioid overdoses; this figure is climbing at an alarming rate. The state of emergency declaration allowed Governor Larry Hogan discretion to allocate $50 million in funding to fight the epidemic without waiting for legislative approval. This funding is in addition
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The Center for Medicare & Medicaid Services Learns about Due Process: Amended Review of Approved Medicare Set-Asides and What it Means for Defense Bar

Recently, the Center for Medicare & Medicaid Services (CMS) promulgated a revised Medicare Set-Aside (MSA) Re-Review process. This “Amended Review” process is significant, as it actually provides those submitting MSAs for approval with an opportunity to revise and amend submitted MSA proposals upon an unfavorable determination from CMS. Previously, CMS has either been unwilling to re-review a submitted MSA or has limited its review following its determination. This has been true even in the face of a significant change in
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Can I Apportion to that Prior Injury/Condition?

Apportionment is an excellent mitigation strategy for carriers/employers. There are a couple of different scenarios to review when addressing apportionment; however, the threshold issue is permanency. Generally speaking, New York State Workers’ Compensation Law does not permit apportionment prior to permanency. The most common form of apportionment involves a prior compensable event. Under this scenario, there is no requirement that the carrier/employer prove an “active and symptomatic condition” at the time of the new/later injury. Addressing apportionment to a prior
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Missouri Governor Signs Bill Aimed at Reducing Workplace Injury Costs into Law

Throughout his campaign, Missouri Governor Eric Greitens promised to lead efforts to create a more business-friendly environment in Missouri. With only a short time remaining in the 2017 legislative session, the Missouri legislature approved Senate Bill 66, a measure focused at reforming Missouri’s worker’s compensation system.  On July 5, 2017, Governor Greitens made good on his promises and signed Senate Bill 66 into law. The bill contains several reforms that will help businesses better control the costs associated with workplace
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You Can’t Have Your Cake and Eat it Too — Maryland Court Interprets Controversial Phrase “Similar Benefits” and its Effect on Disability Pension Offsets

In Zakwieia v. Baltimore County, Board of Education, 231 Md. App. 644 (2017), the Court of Special Appeals of Maryland established the correct interpretation of LE § 9-610 and the controversial phrase “similar benefits.” As a result, the court’s holding provided a basis for the Board of Education of Baltimore County (the Board) to apply ordinary disability retirement benefits owed to the claimant as a credit against the claimant’s workers’ compensation benefits. Following a December 13, 2007 accidental injury, the
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