Two Common Myths About Medicare Set Asides

When settling a workers’ compensation claim in any state, carriers and self-insured employers often make one of two crucial errors based on two commonly accepted compliance myths. Most focus solely on $25,000 and $250,000, the two threshold markers for determining if the Centers for Medicare and Medicaid Services (CMS) approval is required (the former if the claimant is Medicare enrolled, the latter if the claimant is expected to be enrolled
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Timing Negotiations Where Claimant Has a Third Party Action

Clients frequently seek advice on how to resolve workers’ compensation claims. Often, as attorneys, we are in the best position to negotiate a settlement when we have some leverage on issues impacting a claimant’s entitlement to benefits, such as cases where labor market attachment has been raised or a client’s consultant is of the impression that a claimant has no further causally related disability. In short, timing is everything in
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Expanded Provider Legislation; Implications for Insurance Carriers

As part of Gov. Cuomo’s 2019-20 executive budget, a new law was passed expanding the types of medical providers that can apply to be authorized to treat injured workers under the New York State Workers’ Compensation System. The law will be effective January 1, 2020. Prior to the legislation taking effect, only physicians, chiropractors, podiatrists, and psychologists could apply to be board-authorized to treat injured workers while nurse practitioners (NPs),
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North Carolina Court of Appeals Affirms Industrial Commission’s Denial of Bellwether Cases

The North Carolina Court of Appeals recently affirmed the Industrial Commission’s denial of claims, collectively known as the bellwether cases, that constituted a small portion of 144 consolidated workers’ compensation claims. Specifically, Walter Hinson, decedent-employee, worked for Continental Tire the Americas at its factory in Charlotte, North Carolina. The decedent’s estate alleged that his employment exposed him to levels of harmful airborne asbestos sufficient to cause asbestos-related disease. In addition
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The Importance of Investigating a Petitioner’s Medical History and How It Can Help Employers Save Money

Upon the filing of a New Jersey workers’ compensation claim petition, it is extremely important to thoroughly investigate the history of the alleged injured worker to ensure you attain the best possible outcome and to prevent unnecessary expenses. This is a relatively well-known strategy.  However, in a rush to close or settle a matter, this strategy can sometimes be overlooked, which can result in significant costs to an employer. In
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Directing Medical Treatment in Compensable Claims in North Carolina

An increasingly litigated issue involves an employer’s right to direct and provide medical treatment. As a reminder, when an employer accepts a claim as compensable, it is the employer’s right to direct medical treatment. This has long been established by North Carolina precedent and statutes, including N.C. Gen. Stat. Section 97-25. Medical treatment, or medical compensation, is broadly defined by N.C. Gen. Stat. Section 97-2(19). Medical compensation includes “medical, surgical,
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2019 Mileage Rates Reach Second Highest in 20 Years

The Internal Revenue Service (IRS) has issued its annual mileage rates for 2019. This year, the mileage rate has increased from 54 cents per mile to 58 cents per mile, which reflects a 6.42 percent increase from 2018. A review of the mileage rates from 1997 to present show rates as low as 31 cents (1999) and as high as 58 cents (July to December 2008). The rate has only
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Do it Right or Pay the Price (of Medical Bills)

When an injured worker receives a medically necessary treatment, the employer or insurance carrier is responsible for payment of the treatment when the claim has been accepted or established. See NYCRR section 325-1.25. However, when the treatment is not medically necessary or under the Medical Treatment Guidelines, the carrier can object by filing the New York State Workers’ Compensation Board C-8.1 form (a copy should go to the WCB, the employee,
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New York Workers’ Compensation Full Board Issues Decision Regarding WCL Section 15(3)(w) and the Classification Caps

The New York State Workers’ Compensation Board recently issued a decision in Matter of Jacobi Med. Ctr., No. 00825967, 2019 WL 645558 (N.Y. Work. Comp. Bd. Feb. 11, 2019) ruling that a claimant is only entitled to benefits for the duration of the capped period, regardless of surgeries subsequent to the time of classification. In this case, the claimant was classified pursuant to a February 8, 2012 decision at a
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Settlement with the U.S. Department of Justice on outstanding conditional Medicare payments is a stark reminder to look before you leap when settling a claim.

On June 18, 2018, the United States Department of Justice (DOJ) issued a press release regarding a settlement involving claims that a personal injury law firm failed to properly reimburse conditional medical payments to Medicare. This press release is a stern warning that Medicare is required, by statute, to seek reimbursement for conditional payments made as a secondary payer — and it will. See 42 U.S.C. Section 1395y (6). Conditional
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