How To Ensure Your IME is Compliant with Section 137

In order for an Independent Medical Examination (IME) report to be compliant with Section 137 of the Workers’ Compensation Law, a copy of each report must be submitted by the practitioner on the same day and to the Board, the insurance carrier, the claimant’s attending physician or practitioner, the claimant’s representatives, and the claimant themselves in the same manner (WCL Section 137(1)(a)). “If a practitioner who has performed or will be performing
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New Attachment for Schedule Loss of Use Stipulations

There are two types of permanency evaluations: Schedule awards for the impairment of extremities, vision loss, hearing loss, or facial disfigurement Non-schedule classification as a permanent partial or total disability. On October 4, 2019, in subject number 046-1211, the Board issued specific circumstances where a new attachment must be used when stipulating to schedule loss of use and non-schedule sites are also involved. The new stipulation must be used in
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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
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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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