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, hospital, nursing, and rehabilitative services, including, but not limited to, attendant care services prescribed by …Continue Reading
Category: Medical Expenses
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 exceeded the current 58 cents on one occasion, and it was only a temporary, mid-year …Continue Reading
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, their representative and the health provider). Unfortunately, if the objection is late or improperly …Continue Reading
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 50 percent loss of wage earning capacity, entitling the claimant to 300 weeks of …Continue Reading
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 payments are payments made by Medicare before a beneficiary has obtained settlement, judgement, award or …Continue Reading
WCB Announces Proposals to Improve Medical Care for Injured Workers (At the Cost of Everyone Else?)
Last month, the New York State Workers’ Compensation Board (WCB) announced various proposals to improve medical care for injured workers (Subject Number 046-1058). While these proposals appear to be reasonable improvements for injured workers, if approved, they will come at an increased cost for employers, insurance carriers, and third-party administrators. This cost will not only be felt financially, but also in the ability to defend claims.
First, the financial cost is easily seen and will be felt by the WCB’s proposal to increase medical fees …Continue Reading
Appellate Division Provides Clarity: Medical Expenses are Recoverable by Workers’ Compensation Carriers under Section 40
The Appellate Division issued a published decision on August 24, 2016 confirming the right of workers’ compensation insurers to recover medical expenses from the proceeds of any recovery the worker obtains from a third-party tortfeasor under Section 40 of the Workers’ Compensation Act, N.J.S.A. 34:15-40. The decision, Lambert v. Travelers Indemnity Co. of America, No. A-1073-14T3, __ N.J. Super. __, __ (App. Div. 2016), offers welcome clarity concerning reimbursement of medical payments under Section 40.
Following the unpublished 2013 decision of Dever v. …Continue Reading