Category Archives: Workers Comp
Medicare Liens and Workers Comp Claims
The next lien type I will be discussing in this set of sites will be Medicare. Medicare is a benefit under federal law which, generally, is provided to individuals reaching 65 years old or when that person is determined to be eligible for Social Security Disability benefits.
I work in workers comp/ssd/Medicare. For the side Mick Mulvaney is defending. I raise fraud defenses for 1 in maybe every 400 cases filed. Stop it. https://t.co/Dc7Ex2f6C1
— Saeedo, Esq. 🇵🇸🇺🇸 (@Classic_Man5) March 11, 2019
Social Security Disability recipients are eligible for Medicare in the majority of instances following a two-year waiting interval. Medicare has the right under national law to recover some money they pay for medical treatment that they believe is something which should have been paid with a workers’ compensation insurance carrier.
When Medicare is concerned it is completely necessary at the very start of a claim which the worker tell her or his attorney they are Medicare eligible. Most attorneys now ask that issue at the beginning, however if they do not it is totally essential for the employee to tell the lawyer so that steps can be taken.
The first step the lawyer will take would be to notify Medicare throughout the Centers for Medicare and Medicaid Services, otherwise called CMS. Upon notice from a lawyer CMS will start a file and supply the attorney with advice as to any obligations claimed to be produced by Medicare for injuries covered by Workers’ Compensation. The obligations Medicare wants to recover are called conditional obligations.
With the participation of Medicare, liens can arise without the worker’s knowledge and with no worker specifically requesting therapy from Medicare. As an example, even a employee who is covered by therapy by means of a workers’ compensation carrier may see their family physician for unrelated problems. The employee might mention the simple fact they have compensation claim, and in several situations the doctor notes injury and someone in that doctor’s clerical personnel will record it as a code and submit an application to Medicare together with the non-work related troubles. Bingo, Medicare has a lien.
Accordingly, when an injured worker has been treated for non-work relevant conditions through their family physician or other physicians for an unrelated non-work condition it is absolutely crucial that no mention be made of the job accident in such a manner that might get the doctor to remember that in his or her chart.
Apparently, it is absolutely necessary that Medicare liens be determined and honored. Sometimes it is possible to reduce or eliminate them completely. Nevertheless, in no circumstance should they be disregarded.
Medicare, like ERISA from the very first blog in this show , is covered by federal legislation and they can have national enforcement of such a lien. Other items Medicare can perform would be to stop gains until the repayment was reached. That is something nobody would like to happen. Accordingly, it is absolutely crucial that if cure, for that reason, be compensated by Medicare the necessary steps are required to manage that situation.
I didn't vote for him! I am on medicaid, will be on social security and Medicare soon… or maybe not with what he is doing. All of this is after fighting with the insurance company for workers comp checks and the medical care I am supposed to have.
— Davromega (@omegamidnight13) March 12, 2019
One unfortunate characteristic of dealing with Medicare liens is the fact that a last quantity of conditional payments sought to be recovered isn’t given until later a workers’ compensation situation evolves. This absolutely does not make sense, and everybody understands that, however under Medicare guidelines, when a workers’ compensation situation is going to settle the attorney will contact Medicare for an overview of up-to-date amounts paid.
Medicare and Workers Comp fraud. It is as bad as Medicaid, welfare, a and child support fraud. I see it every day. Fix the system, don't just put a bandaid on it.
— NormaM (@TheAbbyNormal1) March 12, 2019
Unfortunately, Medicare won’t offer a complete”final-final” amount when they have been served with a copy of the purchase shutting the workers’ compensation case. Employees should be aware that even when money is taken from a settlement to be reimbursed to Medicare there’s still an opportunity, even though slim, which Medicare may come back with a bigger number.
That is the reason why a lot of orders have a provision that although they are shut the court retains jurisdiction should Medicare problems arise.
Up to 18% of injured workers not returning to work after one year
Between 11% and 18% of injured workers in 15 states do not return to work within a year of their accident, a range that is in line with previous studies, according to reports released Tuesday by the Workers Compensation Research Institute.
Workers' comp is designed to provide medical treatment to recover from a work related injury or illness. https://t.co/X1TreS4BmT
— Keenan (@KeenanAssoc) June 21, 2017
VT Governor signs bill providing work comp presumption for firefighters, EMT's & paramedics suffering job related PTSD injury @IAFFNewsDesk
— Bradley Reed (@breed2934) June 19, 2017
Paterson council rejects $34,000 injury payment for retired police chief
In a split vote, the City Council on Tuesday night rejected a $34,857 workers-compensation payment for retired police Chief James Wittig, who claimed he hurt himself falling on the stairs at headquarters in 2011.
Wittig also had claimed he …
Immigrant benefit ban removed from Ohio workers’ comp budget
The Senate rejected on Tuesday a controversial provision that would have denied workers’ compensation benefits to undocumented workers who are injured on the job.
House Republicans added the amendment last month to the Bureau of Workers’ …
Milesburg business owner faces more than 800 felony charges
More than 800 felony charges??? This guy is S-C-R-E-W-E-D!!!
Robinson allegedly did not have workers’ compensation insurance coverage and was not exempted as a self-insurer.
An ex-employee’s injury on March 27, 2013, led to the charges, according to the affidavit.
Court documents do not specify how the former …
Two Very Important Steps When Managing A Catastrophic Injury Claim
Catastrophic injuries make up only a small fraction of the total number of workers’ compensation claims but account for a significant portion of the dollars spent on medical care and treatment of employees.
The proper management of these high dollar …
Records Detail Workers’ Comp History Of Trooper Charged With Assault
The state police trooper arrested after a bar fight last weekend in Groton has been on either workers’ compensation or leave from work 11 times since 2004, state records show.
Jeffrey Meninno was charged with second-degree assault after sources said he …
State Supreme Court says work-release inmates can’t get workers’ comp
The West Virginia Supreme Court of Appeals issued a decision, ruling that work-release inmates do not qualify for worker’s compensation.
The lawsuit involved a work-release inmate who injured his hand in a wood chipper.
The opinion was …
— Anesi Ozmon Law (@AnesiLaw) June 15, 2017
Bull rider claims workers compensation after severe injury at rodeo
From the age of nine, when his dad first plonked him on the back of a small calf, Mitchell Gajkowski loved rodeo life.
His dreams of a career as a bull rider …
Injured Workers’ Benefit Fund
Illinois state law requires employers to carry workers’ compensation insurance in order to protect any employee who suffers an injury on the job.
But what happens if your employer doesn’t carry the required insurance?
If my employer doesn’t have work …
Church Volunteer Allegedly Injured During Communion Was Limited to Workers’ Comp Benefits
A parishioner and volunteer Eucharistic Minister at a Roman Catholic church allegedly injured as she went to distribute Communion was limited to recovering workers’ compensation benefits, and could not sue for negligence, an appellate court in New York …
Injury from a fight at work. Do they get worker's comp? https://t.co/QtVOulKHjc
— ABC of West WA (@eventsatabc) June 16, 2017
Workers’ Comp: Represent Yourself, or Hire a Lawyer?
Employers can deny claims, and when this happens, over 70% of workers accept the denial.
An attorney will work to get your claim accepted and ensure you’re not in the majority of injured workers that accept a claim denial that should have been approved.
State Trooper on Workers’ Comp Arrested After Bar Fight
State comptroller records show that Meninno has been receiving workers’ compensation benefits since Sept. 16, the Courant reports.
The records do not indicate the nature of his injury. State police say Meninno’s police powers have been suspended, and …
Beverly Hills couple targeted as leaders of massive workers’ comp scam
The Orange County District Attorney has filed charges against 26 doctors, pharmacists and business owners in a crackdown on an alleged $40 million workers’ compensation fraud that involved overbilling for unnecessary compound creams and urine tests.
New Canaan Custodian Committed Worker’s Comp Fraud
Courtney Wills, 37, of Bridgeport collected more than $21,000 in worker’s compensation benefits after he suffered an injury in April 2016.
Wills is a custodian at New Canaan High School.
He was later observed installing carpets and said under oath he …
Modesto doctors accused in major fraud case plead not guilty; patients react
She was once a workers compensation patient of Dr. William Pistel at Stanislaus Orthopaedic.
“Whatever they were doing was doing me no good, but workers comp was getting billed,” Ozimek said.
The six local doctors charged in a $40 million fraudulent …
Massive workers comp fraud ring uncovered in California
More than two dozen doctors, pharmacists and business owners in California are facing insurance fraud charges in an alleged $40 million fraudulent workers compensation medical billing and kickback operation uncovered by federal, state, and local …
Appeals Court Affirms Texas Physician’s Workers’ Comp Fraud Conviction
Douglas was convicted and sentenced to five years’ imprisonment for overbilling Texas Mutual for medical evaluations performed on injured workers.
Before the 2014 conviction, Texas Mutual had investigated Douglas and Western Medical Evaluators, …
Modesto doctors mum on allegations of large fraud, kickback scheme
The news release claims the Kings purchased the creams from Steven’s Pharmacy for $15 to $40 per tube, but workers compensation insurance carriers were billed $250 to $700 for each tube.
The Kings also are accused of a scam involving the purchase …
Golfing leads to workers comp fraud conviction
A Montana man who was videotaped lifting furniture and playing golf while collecting workers compensation benefits pleaded guilty to a charge of criminal theft and will have to pay back nearly $27,500, according to a statement issued Thursday by …
Former Amsterdam employee admits to workers’ compensation scam
A former city of Amsterdam employee has pleaded guilty to scamming the workers’ compensation system.
The state inspector general says 51-year-old William Forte was working for the city when he claimed he wasn’t working at all.
He’s also seen using an …
Auburn man gets jail time for using a fake name in $114K workers’ comp scam
Thurston County Superior Court Judge Chris Lanese on April 5 sentenced Pablo Francisco Castillo Murguia, 40, for felony first-degree theft and ordered him to repay $114,752 for cash benefits and medical and vocational services he wrongfully received …
Owners of California Hotel Cleaning Firm Plead Guilty to Workers’ Comp Fraud
They were accused of concealing the existence of 800 employees over nearly a decade to avoid paying millions in payroll taxes and workers’ compensation insurance.
Steven Kwon pleaded guilty to felony charges related to fraud and employment tax …
Workers’ Compensation Legislation Heads to Iowa Senate
Thursday, the Iowa House of Representatives passed a bill to scale back workers’ compensation benefits in Iowa along party lines.
A similar bill is now under consideration in the Iowa Senate.
During this hour of River to River, host Joyce Russell talks …
Does everyone remember that Jurassic Park's inciting incident is a workers comp lawsuit? And… https://t.co/dlzGHiRiDT
— Asher Novek (@ashernovek) March 21, 2017
Work Injury Compensation Bill Moves Through Iowa House
Republicans in the Iowa House have voted to alter the system that governs how employers compensate workers who are injured on the job.
Bill backers say the system has become a bonanza for some of the attorneys who file lawsuits for injured workers and …
— goodassurance (@good_assurance) March 17, 2017
Workers comp lawsuit against alleged Berkshire Hathaway units can proceed
A class-action lawsuit against purported Berkshire Hathaway Inc. units that alleges breach of contract and unjust enrichment in a workers compensation scheme will be allowed to move forward after a federal judge denied parts of a motion to dismiss the …
Lawsuit: Defective robot killed factory worker; human error to blame
He said that a workers compensation claim also is in dispute right now and that Holbrook’s family has been denied benefits.
“When we were denied access to the facility, we knew we had to file the lawsuit,” Wikander said.
“There may be other players …
— Aaron Allison Law (@AaronAllisonLaw) March 20, 2017
New Jersey Devils “wrongfully withheld” medical records
The New Jersey Devils reportedly withheld medical records in a recent workers’ compensation case involving former NHL enforcer Mike Peluso.
Peluso filed for …
See how prices paid for medical professional services for injured workers in California compare with other states. https://t.co/vatTXlIQgw
— CCWC (@CCWCworkcomp) December 22, 2016
New Year, New Workers’ Comp “Opt Out” Rule For Execs
New legislation effective 2017 will expand California workers’ compensation coverage by requiring coverage for certain high-level individuals unless they affirmatively opt out and waive coverage, thereby reversing the prior rule by …
Ninth Circuit Sides With Growers Against California
Two Fresno-based farm companies have plausibly argued that a California workers’ compensation law denies them equal protection, because the Legislature may have targeted them in a law to court support from the United Farm …
PPJ Healthcare Enterprises Inc. Closes Billing Contracts in California Workers Compensation Compounding Pharmacy
TAMPA, FL / ACCESSWIRE
PPJ Healthcare Enterprises Inc. (OTC PINK: PPJE) has announced today that it closed two billing agreements with compounding pharmacies to provide Workers Comp. billing and lien collection.
“We have …
New Year, New Workers’ Comp “Opt Out” Rule For Execs https://t.co/fZcw4dTblh
— California Law News (@California_Laws) December 23, 2016
California’s Workers’ Comp Division Posts Adjustments to Medical Fee Schedule
California’s Division of Workers’ Compensation has posted an order adjusting the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) section of the official medical fee schedule to conform to the 2017 changes in the Medicare payment …
Workers’ Comp Bill Draws Fire at House Committee Hearing
Proposed changes to the state’s workers’ compensation system, backed by health care providers, drew fire from the insurance community and received a mixed review from the business community at a House Labor and Industry Committee hearing in …
TriMark Legal Funding LLC offers non-recourse pre settlement funding on state workers compensation cases in the following states: Alabama, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Mississippi, Missouri, Montana, New Mexico, South Carolina, South Dakota and West Virginia.
— Florida FAF (@FloridaFAF) November 28, 2016
Florida Workers Comp; We’re in One Heckuva Tight Spot
Sometimes stories in the news are simply that; stories. You read them, you ponder the significance for those strangers who are affected by the news, and then you move on. Other times, you find yourself directly affected by the news of the day, and it …
NCCI vows to appeal court ruling on workers compensation
TALLAHASSEE — The National Council on Compensation Insurance, which sets workers’ compensation rates, will appeal Wednesday’s ruling by Leon County Circuit Court Judge Karen Gievers to strike down a 14.5 percent increase in rates slated to take effect on …
Kentucky Judge Allows Bevin to Appoint Workers Comp Judges
A Kentucky judge has cleared the way for Republican Gov. Matt Bevin to appoint six administrative law judges to help ease a backlog of workers’ compensation.
Auto mechanic owes BWC $132,000 for workers comp fraud
COLUMBUS – A Southern Ohio man who collected injured workers’ benefits for four years while running an automobile repair shop out of his residence must pay $132,239 in restitution to the Ohio Bureau of Workers’ Compensation (BWC) and serve five …
Circuit judge voids workers comp increas
Update: Circuit Judge Karen Gievers of Florida’s 2nd Judicial Circuit in Leon County issued an order Wednesday voiding the 14.5 percent increase in state workers’ compensation rates. Gievers cited “multiple non-public, secret meetings held by (the …
Judge halts workers comp rate hike over Sunshine issues
TALLAHASSEE, Fla. – Little more than a week before businesses were slated to get hit with increased workers’ compensation insurance rates, a Leon County circuit judge Wednesday blocked the hike because of violations of Florida’s Sunshine Law.
— DailyBusinessReview (@dbreview) November 28, 2016
Is an Assault at Work Compensable Under the New Jersey Workers Comp Laws?
After considering the evidence the Judge found that the accident did not “arise out of and in the course of employment,” and stated that the injury was solely due to Mr. Joseph’s involvement in the non-work related pyramid scheme.
Bought budweiser for the first time. I think I'm finally an average adult male. Drinking cheap piss water nursing a work injury.
— Eric Brown (@EDexBrown) November 22, 2016
Workplace injuries fall to all-time low in Indiana
The injury and illness rate in the manufacturing sector dropped from 4.9 incidents per 100 workers in 2014 to 4.7 incidents per 100 in 2015.
Factories have historically been among the most dangerous places to work, but Indiana’s manufacturing sector …
OSHA Clarifies Discipline, Retaliation and Drug Testing Commentary
When the Occupational Safety and Health Administration (OSHA) released its 2016 final rule requiring the electronic reporting of workplace injury and illness reports, it included controversial provisions on discriminatory discipline, retaliation,
Are You Unhappy With How Your Work Injury Claim is Going?
Each year thousands of Iowans are hurt at work, but many are not treated properly by the insurance company because they fail to learn about their rights.
A New Book reveals the Injured Workers …
WORK INJURY – Mason City Globe Gazette
— Mayo Clinic (@MayoClinic) November 21, 2016
The administrator of a Virginia mechanic’s estate has actually filed a $12.5 million wrongful death claim versus the designer of the devices the man was …