Category Archives: health insurance

ACA Health Insurance Open Enrollment Begins November 1st

Today’s post comes from guest author Kit Case, from Causey Law Firm.

In Washington State, we have a healthcare exchange at www.wahealthplanfinder.org. If this is your first time obtaining health insurance through the WA State exchange, a little preparation and planning will help you through the process.  Gather the documents and information you will need to complete your online application.

Download a checklist of information you will need to apply.

Set aside time to work on your application.  Early morning or late evenings may be less busy and allow faster progress through the application program. Note that the website is down overnight from 10:00 pm to 2:00 am daily.  As you work through the application, save your work.  If you need, you can return to the application to complete it at a later time. 

Quick Tips for Completing the Application.

Workers’ Compensation Benefits are Not Taxable Income. Do NOT over-report your income by including time loss compensation in your in application.  You may qualify for insurance for you and your family at a much lower cost while you are receiving time loss compensation benefits.

Savings are based on your expected household income for the year you want coverage, not last year’s income. The exchange uses an income number called modified adjusted gross income (MAGI) to determine eligibility for savings. It’s not a line on your tax return.

See what’s included in MAGI and how to estimate it.

You can get free, in-person help from a navigator or broker. They can help you fill out the application and enroll in coverage. Search for a navigator or broker by your zip code or language preference. You can also call the Customer Support Center at 1-855-923-4633 for help with the application process.

Photo credit: ccPixs.com via Foter.com / CC BY

Shutdown Hurts Groups that Help Injured Workers

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

government-shutdownI can imagine few feelings worse than being hurt on the job, being unable to work and not getting benefits, and/or not being able to seek treatment. I get calls from my clients in that predicament frequently, and it is probably the worst part of my job. 

But the shutdown has made this situation even worse for injured workers with denied claims. The shutdown has endangered funding to community action programs that can help injured workers at least get short-term help with rent, housing utilities and food.

Please call your senator and representative and tell them to come to their senses and end this shutdown. Also, please consider donating to your local community action program, which you can find by doing an internet search.

Opioid Use in Worker’s Compensation

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Today’s post comes from guest author Tom Domer, from The Domer Law Firm.

Many of my back-injured clients use pain relief medication in the opioid family: Hydrocodone (Vicodin), Oxycodone (Oxycontin or Percocet), Fentanyl (Duragesic or Fentora), Methadone, and Codeine.  Many variations of opioids exist, each with a different level of potency. The worker’s compensation industry has labeled excessive opioid use “an epidemic, particularly targeting worker’s compensation.” The Center for Disease Control has noted the problem of opioid abuse as a national danger.

The CDC latest statistics show close to 40,000 drug overdose deaths each year in the United States, more than half of which involve prescription drugs. Deaths in which opioids are used now exceed deaths involving heroin and cocaine combined. The drug overdose deaths are more numerous that motor vehicle crash deaths and the numbers have gone up every year since the turn of the century. One contributing factor is that many work-related injuries are back injuries, for which doctors increasingly prescribe opioids for both short and long term to address pain. CDC medical epidemiologist Dr. Leonard Paulozzi recently noted worker’s compensation medical providers may be exceeding guidelines from the American College of Occupational Environmental Medicine regarding the use of opioids and how long they should be used. Dr. Paulozzi noted 42% of workers with back injuries had opioid prescriptions in the first year after the injury, most of them after their first medical visit, but 16% of those workers were still receiving opioids a year after the injury. He noted while opioids might be good for use as acute medication, for example within six weeks after the injury, continuation of opioids is not indicated beyond that short term use.

Prescription medication has become a bigger portion of medical expense in all States, especially if the worker becomes dependent or addicted to the opioid medication to control pain.  Opioids are generally prescribed for several reasons in worker’s compensation claims, including catastrophic injury with chronic pain and injury involving surgical treatment necessitating pain control and general pain control.

New Trend – Penalties For Not Participating In Your Employer’s Wellness Program

Today’s post comes from guest author Tom Domer, from The Domer Law Firm.

A new study by AON Hewitt indicates more employers will be using penalties to prompt participation in an employee wellness program. Many employers use incentives for participation in wellness and health management programs such as Health Risk Questionnaires, biometric screenings, and smoking cessation programs. Those incentives include health insurance premium increases and other penalties, and potential reward such as premium discounts, gift or cash cards. All these penalties and rewards are aimed at an effort to prompt employees to participate in wellness initiatives.

The connection to worker’s compensation for these wellness programs is interesting. For example, biometric screenings could be used against employees who may later file worker’s compensation claims for occupational exposures. Additionally, such pre-existing conditions that are revealed in the screening programs may prove an additional barrier to employees receiving worker’s compensation benefits for a later claimed injury or occupational disease.

The Problems with States Refusing Medicaid Expansion

Today’s post comes from guest author Brody Ockander, from Rehm, Bennett & Moore.

Medicaid expansion was a large part of the recent health care reform law under the Affordable Care Act. For reasons that seem to be solely based on politics, some state governors have made public their decision to reject the Medicaid expansion, and as a result, federal funding of the expansion.

Besides the obvious problems this rejection would cause for millions of uninsured Americans and the health care providers who treat these uninsured people, this rejection could have a negative effect on workers, especially injured workers, of these states.

Fellow workers’ compensation lawyer, friend and colleague Tom Domer of Wisconsin discussed the possible ramifications when an injured worker does not have access to health insurance. Mr. Domer discussed the following scenario that we see day in, and day out, in a previous blog post:

“The personal toll on the uninsured is devastating, especially for those dealing with work injuries.

As a worker’s compensation attorney, the following scenario plays out on a daily basis: A hard-working individual—who is lucky enough to have health insurance through the employer—is injured at work through no fault of his own. The injury is severe enough to not allow a return to work, or the employer simply terminates the employee (this insidious action happens far too often with far too little publicity). After termination, the injured worker is offered federal COBRA rights to continue paying the health insurance premiums at the full 100%, which of course, is near impossible when you are off work without income. Thus, the worker loses health insurance for himself and for his family.

On the flip side, the worker’s compensation insurance company is supposed to pay for reasonable medical treatment expenses related to the injury; however, the carrier usually hires an “independent” medical doctor to deny the worker’s compensation claim. The injured worker is then left out in the cold with an injury that requires medical treatment, but he has no ability to get that medical treatment without health insurance or workers’ compensation coverage. The worker then calls me and asks the emotionally-laden question: ‘What do I do?’”

Nebraska is one of the states that is “Leaning Toward Not Participating” in the Medicaid expansion, at least according to Gov. Dave Heineman’s public statements on the topic.

This can have a devastating effect on Nebraska workers who have suffered an injury.

As Mr. Domer further states:

“Access to health insurance alters this equation. If the worker had adequate access to health insurance, especially Medicaid, he could obtain the medical care that could allow a return to work, regardless of whether the worker’s compensation insurer accepted or denied the claim. Whether work-related or not, injured individuals should have the opportunity to get healthy in our country.”

So what can be done about this problem? Contact your government officials to encourage them to provide injured workers increased access by expanding Medicaid.