Category Archives: Workers Comp

Medicare Liens Attached to a Workers’ Compensation Claim

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.

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.

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.

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

Up to 18% of injured workers not returning to work after one year 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.

The …

Get more info

Paterson council rejects $34,000 injury payment for retired police chief, NJ
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 …

Get more info

Immigrant benefit ban removed from Ohio workers’ comp budget 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’ …

Get more info

Milesburg business owner faces more than 800 felony charges 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 …

Get more info

Two Very Important Steps When Managing A Catastrophic Injury Claim 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 …

Get more info

Records Detail Workers’ Comp History Of Trooper Charged With Assault 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 …

Get more info

Workers Comp Developments Around The Country

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 …

More info

Bull rider claims workers compensation after severe injury at rodeo 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 …

More info

Injured Workers’ Benefit Fund 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 …

More info

Church Volunteer Allegedly Injured During Communion Was Limited to Workers’ Comp Benefits 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 …

More info

Workers’ Comp: Represent Yourself, or Hire a Lawyer? 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.

More info

State Trooper on Workers’ Comp Arrested After Bar Fight 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 …

More info

Massive workers comp scams are still as popular as ever

Beverly Hills couple targeted as leaders of massive workers’ comp scam 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.

Original article

New Canaan Custodian Committed Worker’s Comp Fraud 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 …

Original article

Modesto doctors accused in major fraud case plead not guilty; patients react 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 …

Original article

Massive workers comp fraud ring uncovered in California 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 …

Original article

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, …

Original article

Modesto doctors mum on allegations of large fraud, kickback scheme 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 …

Original article

Golfing leads to workers comp fraud conviction 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 …

Original article

Former Amsterdam employee admits to workers’ compensation scam 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 …

Original article

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 …

Original article

Owners of California Hotel Cleaning Firm Plead Guilty to Workers’ Comp Fraud 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 …

Original article


Workers' Compensation Legislation Heads to Senate

Workers’ Compensation Legislation Heads to Iowa Senate, 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 …

Original story

Work Injury Compensation Bill Moves Through Iowa House 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 …

Original WNAX story

Workers comp lawsuit against alleged Berkshire Hathaway units can proceed 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 …

Original story

Lawsuit: Defective robot killed factory worker; human error to blame 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 …

Original story

Workers Comp Changes Ringing in With The New Year

New Jersey Devils “wrongfully withheld” medical records New Jersey Devils reportedly withheld medical records in a recent workers’ compensation case involving former NHL enforcer Mike Peluso.

Peluso filed for …

See full article on The Comeback

New Year, New Workers’ Comp “Opt Out” Rule For Execs

Seyfarth Synopsis:
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 …

Read the original article on Lexology

Ninth Circuit Sides With Growers Against California FRANCISCO
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 …

See Court House News for the full story

PPJ Healthcare Enterprises Inc. Closes Billing Contracts in California Workers Compensation Compounding Pharmacy

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 …

See the original article on Yahoo Sports

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 …

See Insurance Journal’s full article

Recent Changes Happening With Workers Compensation

Workers’ Comp Bill Draws Fire at House Committee Hearing 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 …

For the original article, click here

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 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 …

Click here for the whole story

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 …

Click here for the full article

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.

Original article is here

Auto mechanic owes BWC $132,000 for workers comp fraud – 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 …

The original article can be found here

Circuit judge voids workers comp increas 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 …

Original article

Judge halts workers comp rate hike over Sunshine issues, 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.

Click here for the full post

Is Assault at Work Compensable Under NJ Workers Comp?

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.

Read the full National Law Review story

Workplace injuries fall to all-time low in Indiana 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 …

Click here for the full story

OSHA Clarifies Discipline, Retaliation and Drug Testing Commentary 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,

Read the full OSHA ruling here


WORK INJURY 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


$12.5M Suit Filed Three Years After Fatal Industrial Accident

$12.5 M Suit Filed 3 Years After Deadly Industrial Accident
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 …

Read the full story here

See all stories on this topic Barrick Gold Corp. Reaches$140 Million
Settlement Agreement In Claim Reaches$140 Million Settlement Arrangement In Claim … Barrick Gold Corp to pay $140 million in investor suit over shuttered Pascua-Lama …

SC bill aims to cover PTSD under workers’ compensation

SC costs aims to cover PTSD under employees’ payment
A bipartisan group of South Carolina senators have introduced a costs, S429, that would permit some first responders to declare employees’ payment …

Falls man dealing with workers’ comp fraud charges
“This defendant tricked the Workers’ Payment system to take advantages indicated for employees who are really not able to work,” stated Inspector …
California bucks trend as workers comp claims increase
California workers compensation claim frequency increased 3 % from 2010 to 2014 in spite of an 11 % fall in claim frequency in the majority of other states throughout …