You Down With 13(d)? Yeah, You Know Me: Responding to Health Insurer Reimbursement Requests

Occasionally, when a workers’ compensation claim is initiated, medical bills are paid by the claimant’s private health insurance. If this happens, you may receive correspondence from the health insurer asking for reimbursement. What should you do in that situation?

The short answer is that you have no obligation to respond to a direct demand for reimbursement. However, there is a process for reimbursement. This is where the Health Insurer Match Program (HIMP) comes into play.

Per the Board, “health insurers may submit information regarding payments …

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Is the Labor Market Attachment Forever Over?

As of 2017, a claimant with a permanent partial disability (PPD) who is entitled to awards when they are classified does not have to demonstrate ongoing labor market attachment (LMA). The mentality since the change in 2017 has been that if a claimant is entitled at classification then there is no way to bring up LMA in the future.

Prior to the 2017 reform, from December 23, 2010 through February 1, 2012, the Third Department Decision in the matter of Zamora (12/23/10), controlled labor market …

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What Did You Know and When Did You Know It? The Meaning and Impact of Knowledge in Occupational Disease Claims

There are statutes of limitation relating to occupational diseases which reference the claimant’s knowledge of their condition and other factors. Generally, I find that people tend to misinterpret the meaning of knowledge in these contexts; as such, I will endeavor to provide you with a general idea of what this means in a workers’ compensation context in New York claims.

The first reference I’ll discuss comes from New York Workers’ Compensation Law Section 28. This section governs the timely filing of claims and limits filing …

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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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New York’s 2017 Workers’ Compensation Reforms: What They REALLY Mean for Employers and Carriers

When New York’s 2017 budget recently passed — bringing some significant changes to the state’s Workers’ Compensation Law with it — a great deal of misinformation as to how those changes would impact employers and insurers followed in its wake.

Importantly, the passage of reforms as part of the budget did not include Senate Bills S4014, S4554, S4520, or S4345. Rather, changes were made as part of the budget bill S2009, and they are substantially different from these prior bills.

Goldberg Segalla’s Workers’ Compensation team …

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