Fast changing and complicated laws relating to self-insured employers’ responsibilities under the Medicare Secondary Payer Act make it difficult for employers to keep up with the latest changes and regulations. There is one thing that is easy to understand – the Centers for Medicare and Medicaid Services (
CMS) are aggressively pursuing recovery of payments they have made from any viable source including self-insured employers.
Employers need to be aware of the risk involved when an injured employee is also a Medicare or Medicaid beneficiary. Any expense paid by CMS for workers compensation-related medical care can be recovered from the self-insured employer, even if the workers compensation claim has been settled and closed. Therefore, if the injured employee is collecting Medicare benefits for non-work-related medical expenses, the self-insured employer should verify that CMS has been paid for any medical cost they have incurred due to work-related medical care.(WCxKit)
In routine workers compensation claims, the employee treats with the medical provider and the medical provider submits the medical bills to the claims office or medical fee schedule reviewer where they are processed and paid. The workers compensation claims where the self-insured employer gets into trouble are long-term claims where the employee is treated by more than one medical provider and often for both a work-related injury and non-work related medical issues. It is almost a certainty that sooner or later the employee gives his/her Medicare or Medicaid card to the workers compensation medical provider, resulting in CMS paying for the medical care.
It is not enough to accept the employee's statement they have not used their Medicare benefits or they have reimbursed Medicare or will reimburse Medicare. All known workers compensation medical bills should be paid directly to the medical provider. When settling the claim with an employee who has Medicare or Medicaid benefits, as a part of your pre-settlement procedure, run a query with CMS. Guidelines on how to submit a query are a part of the CMS Secondary Payer Act guidelines published on the CMS website:
https://www.cms.gov/MandatoryInsRep/Downloads/NGHPUserGuideV3.1.pdf
It will not do the self-insured employer any good to include wording in the Compromise and Release, or Release and Settlement Agreement that the claimant will be responsible for the repayment to CMS for any medical expenses they have paid as a result of the workers compensation claim. The agreement is between you and the employee. CMS is not a part of the agreement. They can still enforce their recovery rights and will do so. It is also much easier for CMS to go after the deep pockets of the employer than the employee who has already spent the money that was supposed to cover any medical bills that were not previously paid by the workers compensation insurance.
CMS must be protected or you are not protecting your self-insured workers compensation program from paying the cost twice. Intentional misrepresentation by the employee or an honest mistake on your part will not prevent you from having to reimburse CMS for the medical care for which they have paid. CMS takes the position that it is your responsibility to know the requirements of the Secondary Payer Act and to comply with them.
While the CMS manual is difficult and takes
some time to read, learn, and understand, if you are going to be involved in processing workers compensation, you must read the manual. Become acquainted with the
CMS guidelines. Most importantly, this is a very specialized area of workers compensation, so it's best to work with a firm that has expertise in this area. Let's the experts do what they do best – making sure all of the bases are covered.
Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Australia’s WorkSafe is reminding workers engaged in high-risk work they needed to obtain a current license by June 30, 2011, to remain in legal compliance.
According to WorkSafe, due to the National Standard for Licensing Persons Performing High Risk Work, replacing National Certificates of Competency in 2007, some workers will have been required to have the license by June 30 this year.
Everyone performing high-risk work will require a license by June 30 2012, but the date by which individuals need to have the license depends upon when their Certificates of Competency were issued, according to WorkSafe.
Workers holding a WA Certificate of Competency or OHSCertificationAustralia card issued between Jan.1, 2002, and Dec. 31, 2004, needed to convert to the high-risk work license before June 30.
The remaining conversion deadline is June 30, 2012, for certificates issued between Jan. 1, 2005, and Sept. 30, 2007.
Acting WorkSafe WA Commissioner Lex McCulloch urged people involved with high-risk work to check on the issue date of their Certificates of Competency and act to replace them with the new licenses as soon as possible.
“In agreeing to adopt the national licensing standard back in 2007, we acknowledged the important role high-quality training plays in helping provide workers with the skills to perform high-risk work safely and competently,” McCulloch said.
“These licenses apply to anyone engaged in work considered to be high risk, including scaffolding, dogging, and rigging work and the operation of cranes, hoists, and pressure equipment,” he added.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
A study from the Workers Compensation Research Institute’s (WCRI) report cites narcotic overuse as a major national public health problem. WCRI reports, “Medical treatment guidelines recommend that patients who receive ongoing narcotics prescriptions be actively monitored by the physician using urine tests and given psychological evaluations.”
According to WCRI study, Interstate Variations in Use of Narcotics, narcotic-prescribing physicians are not monitoring use, abuse, and diversion. The study is based on nonsurgical workers compensation claims with more than seven days missed work and prescribed pain medications.(WCxKit)
In some states, WCRI found prescribed narcotic use was more likely to turn into a long-term habit. These states are: California, Louisiana, Massachusetts, New York, North Carolina, Pennsylvania, and Texas. WCRI looked at 2006 injuries and the subsequent prescriptions through spring of 2008.
According to the abstract, other findings include:
1. The amount of narcotics per claim was the highest in Louisiana, Massachusetts, New York, and Pennsylvania among the 17 states studied.
2. In the other 13 states, there were large differences in the amount of narcotics received by injured workers.
3. A higher than typical percentage of claims that received narcotics may signal overuse of narcotics for some states.
4. The proportion of nonsurgical cases with narcotics that were identified as longer-term users of narcotics was substantially higher than typical in California, Louisiana, Massachusetts, New York, North Carolina, Pennsylvania, and Texas. (WCxKit)
5. Few longer-term users of narcotics received the recommended services for monitoring, contrary to medical guideline recommendations.
For more information, the complete report is available for purchase
here.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
It is not easy being an adjuster – worried claimants, demanding plaintiff attorneys, state forms, overly concerned employers, totally unconcerned employers, constant phone calls, tons of emails, mediations and hearings, medical providers who do not report, and medical providers billing above fee schedule all make for a stressful job with too many things to do. In such an environment, it is easy to make mistakes – mistakes that cost the insurer money. These costs are passed on to the employer in the form of higher workers compensation premiums.
8 costly mistakes the adjuster can make:
1. Failing to Investigate
It is way too easy for the adjuster to rationalize that if the employer reported the work comp claim, then it must be compensable. Monday morning claims (that usually happen away from work over the weekend) and claims that were not reported when they occurred are two of the most common types of work comp claims that need to be thoroughly investigated. But often there is no investigation. The failure to investigate results in payment of work comp claims that were not owed and should not have been paid.(WCxKit)
2. Not Recognizing Subrogation
Work comp adjusters are trained in workers compensation claim handling. The work comp adjuster is usually not trained to handle liability claims and therefore will often not recognize a third-party liability situation where there is a right of recovery from another party. Every work comp adjuster should learn to ask, “What caused the injury?” and, “Was anybody else involved?” This is such an issue that some insurers have set up a separate subrogation department with staff trained to recognize liability situations and opportunities for recovery of the amount paid on the workers compensation claim.
3. Letting the Defense Attorney do the Adjuster's Job
When the employee's attorney files for a hearing or a mediation and the adjuster has not properly investigated the claim or does not have the claim file properly organized, defense attorneys and their paralegals will not have a word of complaint – they will simply charge their hourly rate. If the claimant's recorded statement was never taken, no problem, they will take a deposition. If medical records are not organized, they will be put into order by whoever the treating physician was or by the chronological occurrence date. Of course, the paralegal or junior partner, who does what the adjuster should have done, will bill the insurer for time spent doing the adjuster's job.
4. Not Reading the Medical Reports
A work comp adjuster will often scan the treating physician's report but skip reading the diagnostic records, nurse's notes, and various other additional documentation, especially in long, complicated cases with extensive medical information. This can be a costly mistake because buried deep in the medical documents will be information on pre-existing medical conditions or intervening causes – such as another accident. This information will change who is responsible for medical care and the amount of time an employee is away from work.
5. Ignoring Unofficial Information
The employee with the “severe back injury” is seen at the bowling alley by one of his co-workers. The co-worker tells a supervisor, who tells the work comp coordinator who tells the adjuster. The adjuster has read the medical report in which the claimant told the orthopedic doctor he could not bend over. The adjuster dismisses the information from work comp coordinator as gossip or hearsay and has “too much other work to be chasing rumors.” The claimant stays off work and perfects his bowling game while the adjuster continues to pay medical bills and weekly indemnity checks.
6. Failing to Direct the Defense Attorney
Often the overworked adjuster will give the claim to the defense attorney and say, “You handle it.” The proper course of action is for the adjuster to work in partnership with the defense attorney. In this situation the adjuster advises the defense attorney on when to litigate and when to settle. Many defense attorneys will go through the motions of depositions and hearings, and after months or years recommend the claim be settled. The adjuster should have discussed the claim early on with the defense attorney and instructed the defense attorney to defend or settle the claim. Too often unnecessary legal cost is incurred because the adjuster did not specify a course of action on the claim.
7. Not Utilizing Medical Case Management
Different insurers and different third-party administrators have varying guidelines on when the adjuster should utilize medical case management. Neither the extreme of using a nurse case manager on every work comp claim (unless a senior nurse reviewer is utilized on all claims) nor the extreme of never utilizing medical management should be the adjuster's norm. The wise adjuster will save the insurer money by bringing in a nurse case manager on every surgical intervention, every compound fracture, and every hospitalization. When the adjuster does not have medical management involved in the file, the medical providers practicing defense medicine will have optional medical procedures performed that would have been avoided with a nurse case manager controlling the medical care.
8. Working on Autopilot
It takes a minute of the adjuster's time each week to verify employee's medical treatment and return-to-work status. It is easy to put indemnity checks on autopilot –they are computer issued each week without the adjuster's approval. What often happens is the employee returns to work while the indemnity checks continue to go out. Some honest employees will return the overpaid indemnity benefit, but many will keep the extra money rationalizing it is for their pain or inconvenience. Other examples of autopilot on the claim file is placing the claim on a "long diary," with the adjuster figuring everything will be resolved by the time the adjuster sees the file again on their diary (calendar).
If you see your workers compensation adjuster making any of these mistakes, politely bring it to their attention. Advise the adjuster not to allow an insurer to make unnecessary payments on your claims.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Marcelo Ponciano, a representative with Toronto-based Asbescan Environmental Co., Inc., was recently fined $15,000 for violating the Occupational Health and Safety Act, after refusing to cooperate with Ministry of Labor inspectors.
According to the Ontario Ministry of Labor, Feb. 17, 2009, a ministry inspector visited a house renovation project in Toronto and found live electrical wires, poor housekeeping, and debris that could potentially contain asbestos.(WCxKit)
The inspector issued stop-work orders on the project, including one requiring the project owner to produce a designated substance report. Two days later, ministry inspectors visited the site after they were notified that the house interior had been cleaned, a violation of the stop-work order. They were approached by Ponciano, who said he was called in to handle the asbestos concerns. Inspectors told him as a result of the cleanup, a ministry hygienist would need to take samples the next day at the worksite and no work was to be done without the hygienist present.
The following morning, ministry inspectors found Ponciano with two other workers. An inspector told Ponciano that no work was to be performed until the hygienist arrived. Ponciano then reached over the stop-work barrier to take a sample. The inspectors told him he was breaching the stop-work order and told him to stop. Ponciano proceeded to take another sample. The inspectors asked Ponciano to identify himself. He refused, despite being told he was required to do so by law. The inspectors also approached one of Ponciano's co-workers to request identification. Ponciano told the worker not to cooperate.(WCxKit)
After a trial, Justice of the Peace Alice Napier fined Ponciano $15,000 for failing to cooperate with ministry inspectors. In addition to the fine, the court imposed a 25 percent victim fine surcharge, as required by the Provincial Offenses Act. The surcharge is credited to a special provincial government fund to assist victims of crime.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
This week at Workers Compensation Roundtable we surpassed 2,000 members! Read more about it
here. Bob Wilson, congenial host of the group writes, “Two of the reasons for this group’s success are the high quality of it's membership, and the success of specialized subgroups to help manage the flow of information. We appreciate your interest and support, and hope you continue to participate while we "march on" to top the 3,000 member level and beyond.”
On this discussion, read comments such as Steven Dlott, who says, “While I am happy not to lay claim to first place in this contest, Ohio also does not allow the employer any opportunity to manage or direct medical treatment. Let's just say chiropractors do very well in Ohio.”
Read more to find out why member Christopher Brigham thinks t
he most “dysfunctional” states are California and New York.
Join us at Linkedin's Workers Compensation Roundtable right now and
right here! Better yet,
invite your friends so they too can become informed on hot topics in the Workers Compensation industry. (WCxKit)
Workers Compensation Roundtable is jointly managed by people dedicated to the concept that workers compensation is a manageable line on your expense ledger, and that informed professionals are empowered achievers. Workers' compensation is not simply a cost of doing business, it is a cost that can be controlled. Beginning with an assessment of cost drivers, benchmarking data, and integrating the solutions, employers can reduce workers' comp costs 20 to 50 percent. With proper information, professionals managing compensation claims can reduce costs and improve outcomes for all stakeholders in the process. This group is for employers, business owners, risk managers, HR managers, insurance executives, and brokers to discuss the obstacles and strategies to overcome them.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The number of work-related deaths in North West England has risen by 35 percent in the past year, new figures from the Health and Safety Executive (HSE) show.
HSE said 23 people in the region were killed at work in the year to April 2011, compared to 17 the previous year. (WCxKit)
A total of 142 people across England died in the workplace. Most were in construction and manufacturing. Alongside Yorkshire, the North West had the highest figure anywhere in the country, the HSE said.
HSE chairwoman Judith Hackitt, said the number of deaths in England was "disappointing" after an all-time low last year. However, the figures remain among the lowest in Europe.
"It is a stark reminder of the need to ensure that health and safety remains focused on the real risks, which exist in workplaces not on trivia and pointless paperwork," she added.
Mike MacDonald from Prospect, the union which represents many HSE workers, said: "As the economy comes out of recession, as new staff go into the workforce it is likely workplaces will become more risky.
"At the same time government has cut back funding of the HSE by 35 percent."
MacDonald said the HSE's enforcement role would continue but he was concerned that its advisory role would be run down. (WCxKit)
"In an industrial sector, if an inspector visits company A … our experience is that the companies around know the HSE is around and pick up their performance. As whole sectors of the economy see pro-active inspections disappear then that deterrent and advisory impact is lost,” he said.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
U.S. Transportation Secretary Ray LaHood announced that the U.S. Department of Transportation (DOT) and Better Business Bureau (BBB) will collaborate to educate consumers and businesses about the dangers of distracted driving.
The DOT and BBB are calling on businesses nationwide to adopt distracted driving policies as part of their employee culture. A strong distracted driving policy assists companies in saving lives, decreasing time lost from work because of accidents and injuries, reducing insurance premiums, and saving money. (WCxKit)
“Distracted driving has become a deadly epidemic on America’s roads,” LaHood said. “We know educating people about the risks of distracted driving works, and we are pleased to be working with BBB to raise awareness and help businesses and consumers fight this problem.”
“BBB is very pleased to help the DOT spread the word about the dangers of distracted driving," added Stephen Cox, president and CEO of the Council of Better Business Bureaus. "Raising awareness about the dangers of multi-tasking while driving is vital. We are pleased to help promote this good work of the DOT.”
The national BBB website features a link to a free tool kit that provides employers with suggested distracted driving policies to help keep their employees safe. The kit, created by DOT and the Network of Employers for Traffic Safety (NETS), contains materials such as a sample company policy, a sample memo to employees on the policy, and a sample company press release.
Additionally, the website features videos from DOT’s “Faces of Distracted Driving” video series. The videos include heartbreaking stories from family members who have lost loved ones due to distracted driving accidents. BBB also provides a link to www.distraction.gov, a complete resource on everything about distracted driving.
Close to 5,500 people in the United States died and nearly 500,000 were injured in accidents related to cases of distracted driving in 2009. Eighteen percent of these fatal accidents involved the use of a cell phone.
The U.S. Department of Transportation’s campaign against distracted driving is a multi-modal effort including automobiles, trains, planes, and commercial vehicles. In 2009 President Obama signed an executive order directing federal employees not to engage in text messaging and not to use electronic equipment supplied by the government while driving government-owned vehicles or driving privately-owned vehicles when on official government business.
The order also encourages federal contractors and others doing business with the government to adopt and enforce their own policies banning texting while driving on the job. The Federal Motor Carrier Safety Administration (FMCSA) banned commercial truck and bus drivers from texting while driving in September 2010, and proposed a ban on the use of cell phones by commercial drivers in December of that year.
In September 2010, the Pipeline and Hazardous Materials Safety Administration (PHMSA) proposed a ban on the use of electronic devices by drivers operating a motor vehicle containing hazardous materials, in conjunction with the proposed FMCSA ban.
The Federal Railroad Administration (FRA) banned rail employees from using cell phones or other electronic devices on the job following a September 2008 Metrolink crash in Chatsworth, California that killed 25 people. (WCxKit)
After a Northwest flight crew distracted by a laptop overshot their destination by 150 miles, the Federal Aviation Administration (FAA) advised air carriers to create and enforce policies that limit distractions in the cockpit and keep pilots focused on safely transporting passengers.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com .
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
In an effort to increase safety for attendants at gas stations, the Ministry of Labor (MoL) in Ontario is considering imposing a prepaid policy following an attendant’s death in a “gas and dash” incident.
According to the Canadian OH&S News, gas attendant Hashem Atifeh Rad, was hit by a vehicle leaving the station without paying for the gas. The attendant was found on the roadway with severe injuries and died in hospital the next day according to a Peel Regional Police statement, which also revealed the driver reportedly was seen covering up his license plates prior to leaving the scene. (WCxKit)
In an effort to increase the pressure, the Ontario Association of Chiefs of Police (OACP) in Toronto is slated to vote on a resolution requesting the province to legislate mandatory prepaid services at gas stations. The resolution, provided by the Hamilton Police Service, was voted on at the annual general meeting in Huntsville, Ontario June 29.
Ontario is not the first province to consider prepaid systems. British Columbia put in place a pay-then-pump system in 2008 after the death of a young gas attendant. Grant's Law, named after Grant DePatie who died in a gas theft incident in March of 2005, requires mandatory prepayment for gasoline, and safe work practices and protection for gas station workers.
According to a Ministry of Labor representative, "Employers are required to assess risks and to have measures and procedures in place to control those risks. For gas stations, one of those risks needing to be addressed is gas-and-dash."
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
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