Tag Archives: medical treatment

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A Dismantling of the Grand Bargain That Created Workers’ Compensation

Today’s post comes from guest author Catherine Stanton, from Pasternack Tilker Ziegler Walsh Stanton & Romano.

This week marks the official start of the holiday season. It is a time for family and loved ones, and a time to reflect on the blessings that we have received in our lives. This week marks the countdown to a number of holidays including Christmas, Hanukah and Kwanzaa. Unfortunately for some people, however, the holiday season is fraught with anxiety, depression, illness and injury. Many people who sustain work-related injuries find that without their weekly salary, the holidays are a stark reminder of how their lives have changed dramatically. The inability to provide for even the basic necessities, let alone splurge on holiday presents, is a prescription for depression.

The Grand Bargain Premise of Workers’ Compensation laws in this country is that the employer, through their insurance carrier, is responsible to pay for injured workers’ medical treatment, lost wages, and permanent disability in exchange for injured workers giving up their rights to sue their employers for negligence. During the last couple of decades, Workers’ Compensation benefits have been under the continuous scrutiny of the Business Council, which has been alleging that the cost of benefits to injured workers is at the root of their increase in costs and reduction in profits.

However, a report from the National Academy of Social Insurance (NASI) indicates otherwise. Benefits as a percent of payroll declined in 46 states between 2010 and 2014, continuing a national trend in lower benefits relative to payroll that began in the 1990s. Costs to employers, on the other hand, continue to climb. Between 2010 and 2014, employer costs associated with Workers’ Compensation – such as insurance premiums, reimbursement payments, and administrative costs – grew at a rate nearly five times faster than benefits. Instead of using employers’ money to provide benefits for injured workers, insurance companies pay a host of businesses, including insurance medical examiners, nurse case managers, vocational rehabilitation companies and defense counsel, all of which profit from the system at the expense of workers and reap record profits for themselves. Meanwhile, the insurance industry and the Business Council falsely blame the claims of disabled workers so they can continue to increase profits by slashing benefits and shifting costs to taxpayer-funded programs instead of employer-paid insurance.

Benefits in New York have decreased under the current Workers’ Compensation system. The changes in the law in 2007 allowed higher wage earners to benefit in the short term as the amount of their weekly benefits has increased. However, these benefits are only available for a fixed period of time. If injured workers are able to return to work after a short period of lost time and a limited period of medical treatment, then some may say the system is a success. Unfortunately for many severely-injured high and low wage earners, the Grand Bargain wasn’t so grand. Medical providers’ hands are tied by Medical Treatment guidelines that limit the amount of treatment authorized based upon “best practices” or cookie cutter treatment, as opposed to what is recommended by the treating doctor. Now there is the prospect of limiting prescription medications as well, all in the name of cost reduction.

The reduction of medical treatment based on the treatment guidelines to injured workers should not imply they are fully recovered. Also, they don’t all return to work once they reach their indemnity cap. The cost of providing monetary benefits and medical treatment are shifted to the taxpayers to pick up the tab. Injured workers don’t expect that the very act of working will forever alter their lives in a negative way. Workers’ Compensation benefits are not a charitable donation, but an entitlement based upon a compromise between workers and their employers. Unfortunately, it is clear that these benefits have been gradually eroded. We should not allow any legislation that further erodes these benefits. While the holidays will continue to bring depression and despair for some injured workers, it should not be as a result of our treatment of them afterward.

 

Catherine M. Stanton is a senior partner in the law firm of Pasternack Tilker Ziegler Walsh Stanton & Romano, LLP. She focuses on the area of Workers’ Compensation, having helped thousands of injured workers navigate a highly complex system and obtain all the benefits to which they were entitled. Ms. Stanton has been honored as a New York Super Lawyer, is the past president of the New York Workers’ Compensation Bar Association, the immediate past president of the Workers’ Injury Law and Advocacy Group, and is an officer in several organizations dedicated to injured workers and their families. She can be reached at 800.692.3717.

What’s Happening to North Carolina’s Workers’ Compensation Act? (Part III)

Today’s post comes from guest author Leonard Jernigan, from The Jernigan Law Firm.

In Part I and II of this series we discussed the legislative power shift in 2010 and identified four significant changes.  Here are some more legislative changes, all imposed after 2010: 

 

    5.   Even If The Claim is Denied the Employer Can Still Get An IME

Before 2010, although an employer might be able to get the employee’s medical records once the claim was filed, if the claim was denied the employee took the position that the employer had no right to force the employee to go to an insurance-selected physician for an IME.  That has now changed. 

    6.   In Second Opinion Rating Evaluations Certain Medical Evidence Can Be Ignored.

An employee has an absolute right to get a second opinion about the extent of a permanent injury, if dissatisfied with the impairment rating given by the insurance-selected treating physician.  Occasionally, this new physician, who was selected by the employee, would make a medical finding that the employee needed further medical treatment or would diagnose another medical condition that had not been evaluated by the treating physician.  This new information would be the basis of a motion to the Industrial Commission for additional medical care.  New legislation states that as to any opinions unrelated to the rating the Commission “must either disregard or give less weight” to these medical opinions.

    7.   Restrictions on the Ability to Change Physicians.

Before 2010, the employee had the right to petition the N.C. Industrial Commission to change physicians.  Occasionally there were personality conflicts between the employee and the insurance-selected physician, or the physician would be ignoring certain complaints, or not reporting the complaints in the medical records.  When these matters were brought to the attention of the Executive Secretary’s Office, the Commission had the discretion to authorize a change of physician.  New legislation now requires that the Plaintiff prove by a “preponderous of the evidence” that a change is necessary. 

     8.   Greater Difficulty for Getting Second Opinion for Employee.

Before 2010, the employee could select a physician for a second opinion examination and request the Industrial Commission to approve this physician.  Now the employee must first request approval “in writing” from the employer and attempt to jointly agree on a new physician.  If this effort fails, then the employee can seek approval from the Industrial Commission.  This new procedure is a roadblock to allowing the employee quicker access to a different medical provider.

 

Part IV of the series will discuss other changes, including administrative changes, to the Act.  Stay tuned.

 

 

 

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Workers’ Compensation 2013 – What Happens on the Other Side of The Fiscal Cliff?

Today’s post comes from guest author Jon Gelman from Jon Gelman, LLC – Attorney at Law.

The fiscal reality is that workers’ compensation is in greater jeopardy than ever before as the debate in Washington is not about the deficit at all. The debate is about government spending which includes health care.

Overall health care devours 18 percent of the US economy and amounts to 25% of the Federal budget.

Medical treatment for injured workers continues to be delayed, denied and limited under current workers’ compensation programs. Medical costs continue to be shifted to other programs including employer based medical care systems and the Federal safety net of Medicare, Medicaid, Veterans Administration and Tricare.

While a trend continues to emerge to offer “Opt Out” and “Carve Out Programs,” they are not global enough to solve the critical budget deficit issues. The latest emerging trend is for employers to utilize ERISA based medical care plans to efficiently delivery medical care. In NJ a limited alternate dispute-resolution procedure between unions and employers has been introduced. See “NJ Care Outs –Another Evolutionary Step” authored by David DePaolo.

The US economy continues to be very weak. This in an ominous signal for the nation’s workers’ compensation program which is starved for premium dollars. Premiums are based upon Continue reading

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If You’re Going Out To Eat Check Out “Behind The Kitchen Door”

Today’s post comes from guest author from Jon Gelman, LLC – Attorney at Law.

For many celebrating the holiday season is inggo out to eat for an enjoyable experience. Unknown to many restaurant patrons are the problems of restaurant workers and include:  low wages, occupational stress and lack of medical benefits that requires restaurant workers to go to work sick.

Behind The Kitchen Door exposes the working conditions in the restaurant industry.

“How do restaurant workers live on some of the lowest wages in America? And how do poor working conditions—discriminatory labor practices, exploitation, and unsanitary kitchens—affect the meals that arrive at our restaurant tables? Saru Jayaraman, who launched a national restaurant workers organization after 9/11, sets out to answer these questions by following the lives of ten restaurant workers in cities across the country – New York City, Washington DC, Philadelphia, Houston, Los Angeles, Houston, Miami, Detroit, and New Orleans. Blending personal and investigative journalism, Jayaraman shows us that the quality of the food that arrives at our restaurant tables is not just a product of raw ingredients: it’s the product of the hands that chop, grill, sauté, and serve it, and the bodies to whom those hands belong.

“Behind the Kitchen Door “ is a groundbreaking exploration of the political, economic, and moral implications of eating out. What’s at stake when we choose a restaurant is not only our own health or “foodie” experience, but the health and well-being of the second-largest private sector workforce—the lives of 10 million people, many immigrants, many people of color, who bring passion, tenacity, and important insight into the American dining experience.

Download the 2012 National Diners Guide – See how your favorite restaurant ranks