Workers' Compensation News - December 1, 2004 Volume 2 Issue 242

 U.S. Department of Labor Assumes Responsibility For a New Energy Workers’ Compensation Program 
-2nd Annual Seminar: This Year in Workers' Compensation - The Top Issues and Cases - March 8, 2005 
-California Injured Workers File A Class Action to Keep Their Physicians 
-New Warning Issued for Remicade 
-Occupational Carcinogens Listed 
-CMS Assist (tm) Announced at NOSSCR Disability Law Conference 

For these stories and others visit our web site http://www.gelmans.com

***
NJ RECOGNIZES THAT CMS ISSUES HAVE CREATED A "CRISIS" AND "LOGJAM"
TASK FORCE PUBLISHES SUGGESTED GUIDLINES
The NJ Division of Workers' Compensation's Task Force on Liens evaluated the issues raised by the Medicare Secondary Payer Act and proposed guidelines so that beneficiaries, insurance companies, employers and the Court may determine how to satisfy claims asserted by The Centers for Medicare and Medicaid Services (CMS). The report acknowledges the need to comply with the with the 1980 Federal statute while recognizing that the administrative responsibilities imposed by the Federal requirements are increasing the delay and costs attributed to disposing of workers' compensation claims. Despite a national trend to go forward with State/CMS data matching and eventually insurance company/CMS data matching, the NJ Task Force suggested that the notification burden be shifted to the employee and the employee's attorney. 

Nationally, in an effort to reduce conditional payments by the Federal system and to reduce the pace of double digit medical expense increases, a focus of attention is newly enacted legislation in California that permits a "carve-out" system allowing the parties to opt-out of the traditional workers' compensation program and adopt a universal health care system. Alternatively, some have considered merging the Social Security Disability System and Medicare as an alternative to a State delivery system of workers' compensation benefits.. Advocates have suggested that the plans would reduce administrative and delivery costs. However, these alternatives would require an increase in the State temporary disability (TDB) rate to equalize with the present workers' compensation levels..

Full NJ report: http://www.nj.gov/labor/wc/forms/lien_taskforce_oct2004.pdf

Related - Integrated Health Care: Does the Workers’ Compensation System Need a Prescription Change?
http://www.gelmans.com/FrontEnd/ReadingRoom/vwArticle.asp?ArticleId=477&PracticeAreaId=-1

***
US SUPREME COURT DENIES CERT ON EXCESSIVE MED BILL ISSUE
Workers' Compensation: Excessiveness of insurer's $91,000 fine for refusing to pay $412 psychiatric bill -- Certiorari Denied.
The United States Supreme Court has denied certiorari in a case in which a Colorado appellate court, in an unpublished opinion, held that a penalty of $91,000 imposed by an administrative law judge (ALJ) on an insurer, for failing to pay a workers' compensation claimant's psychiatric bill totaling $412.40, was excessive. (Case below: (unpublished) (Colo.App.), cert. den. (Colo. 2004).)
Giddings v. Northern Telecom, Inc. 2004 WL 2071429

***
ATORNEY'S FAILURE TO ADVISE THE CLAIMANT OF DISMISSAL OF WC CLAIM LEADS TO SUSPENSION
The NJ Disciplinary Review Board of the NJ Supreme Court suspended the license of an attorney who committed multiple ethics infractions including the failure to advise the client of two cases that were dismissed because he ignored them.
http://www.app.com/app/story/0,21625,1115795,00.html

***
IS CONGRESS GOING TO ADDRESS THE NATIONAL CRISIS IN WORKERS' COMPENSATION?
Can the State systems continue to operate independently while the Federal system runs out of money?
"When the Feds March In..." by Peter Rousmaniere
Risk and Insurance
http://www.riskandinsurance.com/041015_column_2.asp

***
CALIFORNIA A WORKERS' COMENSATION BATTLE GROUND STATE

POSTS NEW DISABILITY RATING SCHEDULE GUIDLINES
The Legislature earlier this year overwhelmingly passed workers' compensation reforms to fix a system in which costs were out of control," said DWC Administrative Director Andrea Hoch. "For the first time, California's disability rating system will be based on objective medical conditions instead of subjective factors and work restrictions, which will result in cost savings. This new schedule represents a fundamental shift in the way disabilities are rated and promotes consistency, uniformity and objectivity."
The AMA Guides are used by evaluating physicians to determine the extent of an individual’s impairment.
http://www.dir.ca.gov/dwc/ForumDocs/Pdrs/PDRS.pdf

NEW LAW SUIT FILED BY CLAIMANTS ATTORNEYS AND THREATS FOR ANOTHER CHALLENGE
Injured workers and their advocates filed a lawsuit against the State of California for taking away their treating doctors.
http://www.signonsandiego.com/news/state/20041117-1848-ca-workerscompensation.html

LAWSUIT BLOCKED BY COURT
Appeals court refuses to block regulations limiting choice of doctors. A state appeals court Thursday refused to block the Schwarzenegger administration from implementing regulations Jan. 1 that would limit injured employees' choice of doctors, saying the challenge by workers' attorneys was premature.
http://www.mercurynews.com/mld/mercurynews/news/local/states/california/northern_california/10218020.htm

AIA RESPONDS THAT LAWSUIT WILL DAMAGE REFORMS
http://www.aiadc.org/dochandler.asp?file=/outbound/pubaffairs/PA_13794_17115.htm&root=\\webdb1

INSURANCE COMMISSIONER THREATENS INSURANCE COMPANY REGULATION
"There is a growing concern that insurers have not passed along all of the potential savings to employers in the form of reduced premiums," Garamendi said in a statement. "It is clear that unless the savings are given to employers soon something will be done to require insurers to do so."
http://www.sacbee.com/content/business/story/11459743p-12373772c.html

CALIFORNIA WC JUDGES SIX TIMES MROE LIKELY TO FILE CLAIMS
The Sacramento Bee newspaper found that 15.8 percent of 184 working or recently retired workers' comp judges had filed claims for workers' compensation benefits, This was a higher rate than other Judges.
http://www.nctimes.com/articles/2004/11/23/news/state/11_22_0419_32_00.txt

REFORM MEDICAL REGUALTIONS APPROVED IN CALIFORNIA
The California Division of Workers’ Compensation (DWC) received approval from the Office of Administrative Law on the first set of regulations implementing SB 899, workers’ compensation reforms passed by the Legislature and signed by Governor Schwarzenegger last April. The emergency regulations became effective November 1 and will be used by employers or insurers to establish medical provider networks (MPNs).
http://www.santapaulatimes.com/news/fullstory.php/aid/7730/Division_of_Workers?_Compensation_reform_regulations_approved_by_Office_of_Administrative_Law.html

***
PA LEGISLATION PROPOSE TO EXPAND WORKERS' RIGHTS
State Rep. W. Curtis Thomas, (D-Phila.), recently outlined his proposed legislation that would change Pennsylvania's workers' compensation law to allow workers or their families to hold an employer financially liable for death or permanent injuries suffered while on the job, even if they accept a workers' compensation agreement. 
http://www.stevenspublishing.com/Stevens/OHSPub.nsf/frame?open&redirect=http://www.stevenspublishing.com/stevens/ohspub.nsf/d3d5b4f938b22b6e8625670c006dbc58/a281c1dffb46232286256f4a00562f15?OpenDocument

***
NY AG TARGETS CALIFORNIA BROKER
Spitzer Sues Broker Used for Workplace Insurance
The New York attorney general's investigation into abuses in the insurance industry escalated yesterday with a lawsuit accusing a California broker of fraudulent practices that led to higher premiums for employees at some of the nation's leading companies.
http://www.nytimes.com/2004/11/13/business/13insure.html?oref=login

***
$38 BILLION PAID TO VICTIMS OF 911 FROM FEDERAL FUND
Families of emergency responders who were killed or seriously injured in the Sept. 11, 2001, attacks each received about $1 million more than other victims of the terrorist strikes, although most of that difference was from large donations from charities, according to a study released Monday. 
Feinberg states that next time there should be a fixed compensation payment in such circumstances, but the right to sue for recovery above that amount. Thirteen families filed no claims and Feinberg concludes that is was due to "grief." They just couldn't
emotionally fill out the forms.
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2004/11/09/MNGPA9OC2S1.DTL

***
FREE ACCESS TO THE INTERBNATIONAL LABOUR ORGANIZATION RESEARCH
ILO Encyclopedia and CIS database for free on the Web
The English version of the ILO Encyclopedia of Occupational Health and Safety and the CISDOC bibliographic database on OSH are available to the world for free on the ILO Web site. 
http://www.ilo.org/encyclopaedia/ and 
http://www.ilo.org/dyn/cisdoc/index_html

***
CANADA CONTINUES TO DEFY THE WORLD HEALTH ORGANIZATION AND EXPORTS ASBESTOS
"Every hour, another American dies from asbestos-related cancers" Barry Castleman. "But Canada continues to use its international prestige to market asbestos." 
Canada's Deadly Export, Washington Post, 11.19.04
http://www.washingtonpost.com/wp-dyn/articles/A61372-2004Nov18.html

Ban Asbestos in America Act of 2003 H.R.2277
http://thomas.loc.gov/cgi-bin/query/D?c108:1:./temp/~c10860wbzq::

***
WORK-RELATED MULTIPLE FATALITIES
Multiple-fatality work-related incidents claim the lives of 1 out of 10 fatally injured workers and include some of the worst occupational catastrophes: air crashes, bombings, fires, and explosions; using multiyear data, the Bureau of Labor Statistics takes a first-time-ever look at this infrequently occurring phenomenon 
http://www.bls.gov/opub/mlr/2004/10/art2full.pdf