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
Continue reading...

The Importance of Safety in the Food & Beverage Industry

Restaurants and bars are susceptible to a variety of workers’ compensation claims based on their fast-paced nature. As attorneys, identifying areas of concern when walking into a restaurant or bar becomes second nature. We consider: how do you address an accident before it becomes one? How do you prevent injuries when working in an environment and an industry that is so susceptible to them? The clear and concise answer is
Continue reading...

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
Continue reading...

Connecticut Workers’ Compensation Commission Issues Important Update to Professional Guidelines Regarding One-Time Evaluations and Second Opinions

On August 29, 2019, Connecticut Workers’ Compensation Commission (WCC) Chairman Stephen M. Morelli issued Memorandum No. 2019-07 regarding updates to the Professional Guide for Attorneys, Physicians, and Other Health Care Practitioners Guidelines for Cooperation. Specifically, the memorandum highlights changes to the Professional Guide with respect to one-time medical evaluations and second opinions. By way of background, the Professional Guide is a guidance document produced by the Workers’ Compensation Commission intended
Continue reading...

Leveraging Compromises in the New York Workers’ Compensation System

Compromises are a vital and frequent part of the workers’ compensation litigation process. However, one should take care to avoid negotiating them out of habit. With two doctors giving irreconcilable opinions, parties will often agree to split benefits straight down the middle in lieu of litigation. Sometimes, such as when both parties concede partial disability and are within a close margin, this is a helpful way to allay costs of
Continue reading...

Missing Check: The Status of the Law

Oftentimes, when parties in a workers’ compensation matter agree to settle or when the claimant is entitled to certain indemnity benefits, the carrier sends payment to the claimant by mailing a check to an address provided by the claimant. There are situations, though, when the check goes missing or is stolen, perhaps in transit or at the address provided by the claimant. This begs the question – what are the
Continue reading...

Paying for Claimants’ Attorney Fees is the Exception to the Rule in D.C.

The D.C. Court of Appeals was recently presented with the opportunity to weigh in on the prerequisites for ordering employers and insurers to pay for claimants’ litigation fees and costs in workers’ compensation claims. In the case of Kelly v. D.C. Dep’t of Employment Servs., No. 18-AA-13, 2019 WL 4073672 (D.C. Aug. 29, 2019), the court refused to require the employer and insurer to bear the cost of the claimant’s
Continue reading...

Special Funds Liability Under the Board’s Special Funds Group

It has become apparent over the recent years that the New York Workers’ Compensation Board, along with the Special Funds Group, will go to great lengths to resolve themselves of liability for outstanding claims under NY WCL Section 25(a), as well as 15(8), particularly in consequential death claims. Under the 2007 reforms, the then-Second Injury Fund was closed to new claims with dates of injury on or after July 1,
Continue reading...

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),
Continue reading...

Due Process in the New Jersey Workers’ Compensation System

In an ideal workers’ compensation system, all parties would keep to the letter of the law. However, courts’ rules are oftentimes relaxed within our system and often not followed. In handling any New Jersey workers’ compensation claim petition, employers, employers’ attorneys and claims professionals must be diligent in making sure that employers’ fundamental rights are not violated by this relaxed approach. All parties, petitioners, and respondents have the right to
Continue reading...