Category Archives: Uncategorized

CMS Alert: New Contractor for NGHP Recoveries and Benefits Coordination in ORM

Today’s post was shared by WC CompNewsNetwork and comes from

Today, July 1, 2015, CMS issued an alert which states that come October 2015, the Benefits Coordination and Recovery Contractor will be transitioning some of its recovery caseload to a new contractor which will be known as the Commercial Repayment Center (CRC). The CRC will be handling conditional payment recovery where CMS is pursuing recovery directly from a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation (WC) entity as the identified debtor. The BCRC will continue to handle conditional payment recovery where CMS is pursuing recovery from the Medicare beneficiary.

CMS notes that webinars and town halls will be scheduled in the comings months to provide additional information on this new process.

The alert also provides that come January 1, 2016, CMS will be utilizing ORM information to determine whether Medicare is able to make payment for those claims. CMS further notes that insurers and workers’ compensation entities that notify Medicare that they have ORM are strongly encouraged to report accurate ICD-9 or ICD-10 codes and that Medicare’s claims processing contractors will use this information to pay accordingly.

The alert can be found here:

I am hopeful that the transition of some of the workload to the new CRC will streamline the conditional payment recovery process to…

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Opioid use decreasing in workers’ comp: What’s next?

Today’s post was shared by Workers Compensation and comes from

Hydrocodone acetaminophen—marketed as Vicodin—is one of the most over-prescribed and over-used opioid pain relievers. (Photo: Shutterstock/David Smart)
Hydrocodone acetaminophen—marketed as Vicodin—is one of the most over-prescribed and over-used opioid pain relievers. (Photo: Shutterstock/David Smart)

Chronic pain is by far the most debilitating—and for claims payers the most costlycompensable condition in workers’ compensation, according to a new special report from WorkCompCentral.

The report chronicles the way opioid use greatly expanded in workers’ comp over the last 20 years, then halted and is now in retreat as a result of increased criticism and research into its efficacy. The report also provides practical suggestions to rethink the approach to chronic pain—that is, pain that persists beyond expected healing time.

Opioids are defined as medications that relieve pain by reducing the intensity of pain signals reaching the brain, for example, hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine and fentanyl. Although some use the term “narcotics” to refer to these drugs, it’s a less precise term.

Startling statistics

Generally, most medical care for injured workers poses “trivial” or no iatrogenic risk (risk that medical treatment will inadvertently cause illness or death). This is not the case when opioids are used for ongoing treatment, however. According to the report, workers on a medium-to-high dose of opioids for a year experience about 1.75 deaths per 1,000 patients per year. By comparison, the riskiest jobs in the U.S., such as logging…

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Judge OKs settlements in World Trade Center cleanup

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World Trade Center Cleanup

(Reuters) — A federal judge has approved $53.8 million in settlements for 82 unionized cleanup workers who claimed they were made ill by exposure to toxic dust near the World Trade Center site, court papers showed.

The workers were among roughly 1,000 to seek compensation in federal court in Manhattan for alleged injuries stemming from their cleanup work at more than 100 privately owned buildings in downtown Manhattan.

While a few hundred other workers have also settled, the settlements approved on Tuesday night by U.S. District Judge Alvin Hellerstein in Manhattan offers a new window into the payouts, which typically have not been made public.

Payouts to the 82 workers will average $656,119, and range from $25,000 to $1.45 million. They reflect such factors as injury severity, lost earnings, age and smoking history. One worker still has claims against two related defendants.

Most litigation stemming from the Sept. 11, 2001, attacks has been completed. Judge Hellerstein has handled much of that litigation.

According to court papers, the latest settlement covers members of Laborers International Union of North America Local 78, which represents asbestos, lead and hazardous waste handlers in New York City, Long Island and New Jersey.

They claimed to suffer respiratory and digestive diseases, psychological injuries and cancer after the defendant building owners and contractors failed to provide equipment to keep them from inhaling toxic dust in about 71 buildings near Ground…

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South Carolina considers workers comp opt-out system

Today’s post was shared by Workers Compensation and comes from

Rep. David Hiott South Carolina

Photo by AP Republican South Carolina Rep. David Hiott.

South Carolina legislators have introduced a bill that would allow employers to create alternative benefit plans for injured workers rather than providing traditional workers compensation insurance coverage for employees.

South Carolina is the fourth state to weigh opt-out legislation. The Texas nonsubscription system was established more than 100 years ago, Oklahoma passed opt-out legislation in 2013, and a Tennessee opt-out bill is on hold until 2016.

The legislation, introduced Tuesday, also called the South Carolina Injury Benefit Plan Alternative, states that minimum benefit requirements must be “interpreted and applied in a manner so that the benefit plan is comparable to” the South Carolina workers compensation law.

Republican South Carolina Rep. David Hiott, who introduced the bill, said in a statement that “markets operate best and participants receive the most benefit possible when competition exists … The (bill) will also require high benefits levels, which is a win for hardworking South Carolina workers.”

According to the bill, total disability benefits must be at least 75% of a worker’s average weekly wage and no less than $75 per week. Workers eligible for temporary partial disability benefits will receive at least 75% of the difference between their pre- and post-injury average weekly wages. And death benefits are to be paid when death results from an accident or within two…

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My Concern With Oklahoma Opt Out in One Word – Transparency

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"Those who do not understand their history are doomed to repeat it”

I will admit to being in unfamiliar territory here. As a conservative businessman who normally identifies with employer challenges and issues, I find myself on the opposite side of the aisle from many in the growing debate over Opt Out from traditional workers’ compensation in this nation. However, my concerns are what they are, and they center around one very simple concept: There is a tremendous lack of transparency in the actual claims management process of companies who have opted out and are now handling workplace injuries under their own “private label” systems.

It is that lack of transparency that threatens not just employees within those programs, but the employers themselves as well as the communities in which they operate. I believe all are at increased risks that are either unappreciated or unrecognized by many.

I must clarify a few points. First and foremost, I absolutely understand an employer’s desire to escape the workers’ compensation system as it exists today. It is on many levels an expensive, bloated, burdensome and inefficient system that sometimes fails to meet the desired results, particularly where permanent injury or impairment is concerned. I also believe that most people are decent and honest, and at a high level view employers want to do the right thing for both company and crew. However, I would also posit that employers have long forgotten…

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Health Hazards in Nail Salons

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Nail salons are mostly small businesses that employ or contract with trained professionals to provide clients with nail services including, but not limited to, nail filing and polishing, artificial nail application, and other hand- and foot-care treatments.

The more than 375,000 nail technicians working in salons across the United States face possible health hazards every day. The hazards include exposure to chemicals from glues, polishes, removers, and other salon products; muscle strains from awkward positions or repetitive motions; and risk of infection from contact with client skin, nails, or blood.

Information on nail salon hazards and preventing illness and injury is also available for workers in OSHA’s publication "Stay Healthy and Safe While Giving Manicures and Pedicures: A Guide for Nail Salon Workers" (PDF* | EPUB** | MOBI**)

This publication is also available in:

A flier and wallet card including information on worker rights and health effects are available from the US Department of Labor’s OSHA and Wage and Hour Division.

This web page gives important information about these hazards and the steps that nail salon workers and employers can take to prevent injuries and illnesses.

Nail polishes, glues, and other products used in nail salons may contain the following chemicals, among others:

  • Toluene
  • Formaldehyde
  • Dibutyl Phthalate
  • Methacrylate compounds

Without taking the correct safety precautions each day, these chemicals can cause breathing…

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Roofing Contractor’s Willful Disregard of Fall Prevention Standards Leads to Death of Worker Who Fell Through Skylight

Today’s post was shared by WC CompNewsNetwork and comes from

Jacksonville, FL ( – Skylights are a useful way to allow sunlight into a room or other space, but without safety guards or covers, they can expose rooftop workers to catastrophic falls, serious injury and death.

Atop a warehouse on Powers Avenue in Jacksonville, roofer John W. Miles III crashed through a skylight without an adequate safety cage and plunged more than 24 feet to the ground below. He was admitted to an area hospital in critical condition and later died of his injuries.

Skylight with protective system installed

U.S. Department of Labor Occupational Safety and Health Administration inspectors responded to the scene to investigate. They found Pinnacle Roofing Contractors Inc., Miles’ employer, had failed to install protective cages over the skylights and cited the Jacksonville-based company for two willful and two serious violations. OSHA has proposed that the company be placed in the Severe Violator Enforcement Program.

"While some skylights on the warehouse roof had safeguards installed, workers were not protected from fall hazards sufficiently. If Pinnacle Roofing had been more diligent, John Miles would be with us today," said Brian Sturtecky, OSHA’s area director in Jacksonville.

OSHA issued two willful citations to the company for allowing employees to work at heights greater than 6 feet without guardrails or fall protection and for not installing protective systems on the skylights. Two serious citations were issued for failing to ensure the edge of the roof was…

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Exploding Exclusive Remedy

Today’s post was shared by Jon L Gelman and comes from

What’s better than exclusive remedy in workers’ compensation?

Let’s be honest, if you’re an employer, not much.

Sure, one may quibble about the cost of acquiring the status of exclusive remedy, but when the claim hits the file, and the exposure is revealed, there is nothing quite as warming to Business as the doctrine that provides the basic guidance to workers’ compensation.

We’ve all seen the reports this past year (more to follow) about the erosion of benefits to injured workers, and some legal challenges. Some are offended, some are circumspect – most don’t know what to think.

The context of the challenges to exclusive remedy protection is that the balance that represented the Grand Bargain is no longer in the center, and that reform after reform in the various state systems has deteriorated benefits to the point that there is no longer a reasonable compromise.

That’s the argument being played out in Nevada in the face of legislation recently introduced that would reshape one of the cheapest work comp states into, perhaps, an even cheaper state. Nevada ranked 46th out of 50 in Oregon’s most recent cost survey.

Assembly Bill 229, introduced by the Assembly Committee on Commerce and Labor, seeks more than a dozen changes to Nevada’s workers’ compensation law, including when an employer can terminate benefits, changing from the 5th edition AMA Guides to the 6th, and the time for filing a claim from 90 days to 30.

Other changes proposed by the bill would:

  • Expand the prohibition…

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On Trade, Don’t Leave Workers Behind

Today’s post was shared by Jon L Gelman and comes from

Boeing employees in Renton, Wash., watched Secretary of State John Kerry speak about the Trans-Pacific Partnership on May 19. Credit Pool photo by Saul Loeb

International trade typically produces winners and losers. Consumers benefit when they pay less for imported goods than similar domestic products. Some American workers are clearly hurt when foreign competition leads factories to shut down or move overseas. That’s why economists have long argued that government should help those displaced by the dynamics of freer trade.

But to hear some Republicans tell it, trade only produces winners. Even as President Obama and Congress vigorously debate major trade agreements with Asia, Australia, Europe and Latin America, these legislators are trying to cut back on the few benefits that the government provides to workers hurt by foreign competition.

A longstanding program known as Trade Adjustment Assistance gives displaced workers training for new jobs, extended unemployment benefits, reimbursement for relocation expenses and so on. But the program is quite modest, helping just 84,529 people in the 2013 fiscal year, and less than half of those people received any training.

Congress made it harder for workers to qualify for T.A.A. last year. It is now available only to manufacturing workers; people laid off from service businesses like call centers cannot get help. And it assists only people affected by trade with a country that has a trade agreement with the United…

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4 Ways to Avoid the Most Common Warehouse Incidents

Today’s post was shared by Workers Comp Brief and comes from


Employees working in a warehouse are exposed to a number of strenuous activities that can threaten their well-being. According to OHSA, the number of forklift-related accidents reaches close to 100,000 per year (100 fatal accidents, 34,900 serious injury accidents, and 61,800 non-serious accidents). As a result, those who handle heavy material handling equipment such as forklifts need to take special precautions to ensure that the materials they transport are properly handled. Here are four most common warehouse incidents you can easily avoid to prevent injuries and increase workplace productivity.

Slips & Trips
The warehouse is a place with lots of stuff. Its narrow aisles, tall stacks of goods, and poor lighting are the exact ingredients that can compromise visibility. Slipping and tripping over materials or spilled liquid are common accidents that can be avoided if the warehouse maintains adequate lighting and equips dark corners with special lights that can be easily switched on and off. Remove unnecessary steps or ridges and encourage employees to never leave any cargo, box, and goods unattended on the floor.

If a warehouse worker needs to temporarily leave the floor, it is important for him or her to move materials away from the center of the aisle while keeping lights on. In cases when something is spilled, employees should take the proper steps to close the area with visible signs and clean up as soon as possible.

Duties in the warehouse sometimes take…

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