Today’s post comes from guest author Leila A. Early from The Jernigan Law Firm.
Washington State can provide coverage for PTSD or similar mental injuries but only under certain circumstances. As the author points out, there are similar coverage provisions in North Carolina.
Post-Traumatic Stress Disorder (PTSD) is a type of anxiety disorder that can occur after a person has seen or experienced a traumatic event that involved the threat of injury or death. In civil war battles a soldier may be sitting next to his best friend when a cannonball takes off his friend’s head. The horror of such events put some soldiers out of action. Similarly, police officers have a higher incidence of PTSD/Anxiety Disorders than the general public due to the gruesome scenes and situations that they witness in their occupation. Classic symptoms of PTSD fall into three main categories: (1) reliving the event (such as nightmares and flashbacks); (2) avoidance (including feeling detached, numb, and avoiding things that remind them of the event); and (3) arousal (including difficulty concentrating, startling easily, and difficulty falling asleep).
Some of the police officers who responded to the shootings in Newtown, Connecticut are suffering from PTSD, calling it the worst crime scene they ever walked into. They are suffering from severe emotional distress and shock and have been unable to return to work due to the trauma they witnessed. Unfortunately, PTSD is not covered by workers’ compensation in Connecticut. Therefore they have been forced to use vacation and sick time to cope with the situation.
Our law firm has represented multiple police officers who have developed PTSD as a result of the gruesome scenes and situations they have been involved in at work. Fortunately, PTSD may qualify as an occupational disease under North Carolina workers’ compensation law. Hopefully the Connecticut legislature will amend their statutes in light of the school shootings to help these police officers get medical care and get back to work as quickly as possible.
By working together we can bring an end to gun violence in America
A man entered a Seattle bar late Sunday night, January 27, 2013, and confronted his ex-girlfriend, brandishing a gun. The gunman shot both his ex-girlfriend and the doorman before the gunman was fatally shot by Seattle police. Both the ex-girlfriend and the doorman were taken to Harborview Hospital with non-life-threatening injuries. Both were victims of senseless gun violence, but the doorman is also a workers’ compensation claimant due to this occurring while he was on-the-job.
2012 has been the worst year for these events in modern US history, with 151 victims injured and killed.
Quoting an article published by Mother Jones (Mother Jones Investigates: The NRA Myth of Arming the Good Guys), Washington CeaseFire shared that there have been at least 62 mass shootings in the last three decades, attacks in which the killer took the lives of four or more people (the FBI’s baseline for mass murder) in a public place—a school, a workplace, a mall, a religious building. Seven of them have occurred this year alone. Along with three other similar though less lethal rampages—at a Portland shopping mall, a Milwaukee spa, and a Cleveland high school—2012 has been the worst year for these events in modern US history, with 151 victims injured and killed.
On Tuesday, January 22nd, Washington CeaseFire presented the results of a statewide poll conducted by Alison Peters Consulting. The poll of 600 randomly selected registered Washington voters reveals a strong preference for stronger gun safety laws on both Eastern and Western sides of the state. The poll has a margin of error of plus or minus 4 percent. Findings included :
76% of state residents support tighter gun laws;
87% support a state law to require that everyone who buys a gun at a gun show undergo a background check;
66% support a state law to ban semi-automatic assault weapons;
68% are in support of a state law to increase mandatory penalties for youth firearm possession, starting with house detention at the first offense ;
68% would support a state law to limit ammunition clips on guns to 10 bullets; and,
66% of respondents are in support of a state law requiring the signature of local police on every concealed weapons permit application.
Washington CeaseFire states that it’s time to end gun violence in America, noting that gun deaths outnumber traffic fatalities in Washington and nine other states. Now is the time to make our voices heard. Please consider participating in a candlelight vigil and march on February 9, 2013 in Seattle, Washington, co-sponsored by CeaseFire. More than 1000 people attended a similar march held in January (see prior post for details) and it is hoped that the upcoming vigil and march will draw more attention to this issue.
Wal-Mart’s Vice President of “Ethical Sourcing” (irony noted here) said the company control could “only go so far” in preventing an unauthorized factory producing its goods. Wal-Mart said its Faded Glory clothing should not have been produced in the factory, which Bangladesh officials said was not safe.
Wal-Mart’s “factory certification” program focused on Bangladesh and China was allegedly “dedicated to improving the status of foreign labor.” Tell that to the families of the workers who died.
At a meeting last year where Wal-Mart’s Vice President of Ethical Sourcing was in attendance, the Bangladeshi Garment Workers Union proposed that producers such as Wal-Mart help ensure prices are high enough to provide for safety measures for their workers.
Wal-Mart’s Vice President indicated Wal-Mart could not support such a program because of the high cost. Consider that next time you buy a cheap shirt at Wal-Mart.
Today’s post comes from guest author Jon Gelman from Jon Gelman, LLC – Attorney at Law.
Monthly Social Security and Supplemental Security Income (SSI) benefits for nearly 62 million Americans will increase 1.7 percent in 2013, the Social Security Administration announced.
The 1.7 percent cost-of-living adjustment (COLA) will begin with benefits that more than 56 million Social Security beneficiaries receive in January 2013. Increased payments to more than 8 million SSI beneficiaries will begin on December 31, 2012.
Some other changes that take effect in January of each year are based on the increase in average wages. Based on that increase, the maximum amount of earnings subject to the Social Security tax (taxable maximum) will increase to $113,700 from $110,100. Of the estimated 163 million workers who will pay Social Security taxes in 2013, nearly 10 million will pay higher taxes as a result of the increase in the taxable maximum.
Information about Medicare changes for 2013, when announced, will be available at www.Medicare.gov. For some beneficiaries, their Social Security increase may be partially or completely offset by increases in Medicare premiums.
Based on the increase in the Consumer Price Index (CPI-W) from the third quarter of 2011 through the third quarter of 2012, Social Security and Supplemental Security Income (SSI) beneficiaries will receive a 1.7 percent COLA for 2013. Other important 2013 Social Security information is as follows:
Tax Rate:
2012
2013
Employee
7.65%*
7.65%
Self-Employed
15.30%*
15.30%
NOTE: The 7.65% tax rate is the combined rate for Social Security and Medicare. The Social Security portion (OASDI) is 6.20% on earnings up to the applicable taxable maximum amount (see below). The Medicare portion (HI) is 1.45% on all earnings.
* The Temporary Payroll Tax Cut Continuation Act of 2011 reduced the Social Security payroll tax rate by 2% on the portion of the tax paid by the worker through the end of February 2012. The Middle Class Tax Relief and Job Creation Act of 2012 extended the reduction through the end of 2012. Under current law, this temporary reduction expires at the end of December 2012.
Maximum Taxable Earnings:
2012
2013
Social Security (OASDI only)
$110,100
$113,700
Medicare (HI only)
N o L i m i t
Quarter of Coverage:
2012
2013
Earnings needed to earn one Social Security Credit
$1,130
$1,160
Retirement Earnings Test Exempt Amounts:
2012
2013
Under full retirement age
NOTE: One dollar in benefits will be withheld for every $2 in earnings above the limit.
$14,640/yr.
($1,220/mo.)
$15,120/yr.
($1,260/mo.)
The year an individual reaches full retirement age
NOTE: Applies only to earnings for months prior to attaining full retirement age. One dollar in benefits will be withheld for every $3 in earnings above the limit.
There is no limit on earnings beginning the month an individual attains full retirement age.
The Department of Labor & Industries(L&I) provided the following information in a press release on January 11, 2013. L&I noted that it has cited the Department of Natural Resources (DNR) for 15 worker-safety violations following an investigation into the drowning death of a DNR diver last summer. The citation carries a proposed penalty of $172,900.
The deceased diver, David Scheinost, age 24, was one of a four-person dive team from the DNR Aquatic Resources Division that was collecting geoduck samples to test for paralytic shellfish poisoning from the Manzanita and Restoration Point geoduck harvest tracts off Bainbridge Island on July 24.
Two SCUBA (self-contained underwater breathing apparatus) divers had deployed on their third dive of the day when the victim surfaced in distress and called out that he couldn’t breathe. The others were unable to reach him before he slipped below the surface and was gone. His body was found three days later.
The L&I investigation into the dive-safety policies and practices at DNR found:
370 occurrences over a six-month period in which divers were deployed without carrying a reserve breathing-gas supply.
DNR did not ensure a designated person was in charge at the dive location to supervise all aspects of the diving operation affecting the health and safety of the divers.
L&I concluded that these were “willful” violations, which means they were committed with intentional disregard or plain indifference to worker safety and health regulations.
“Commercial diving involves risks that unfortunately lead too often to tragedies like this incident,” said Anne Soiza, assistant director of L&I’s Division of Occupational Safety and Health. “These significant risk factors require advance planning, properly maintained equipment and strict adherence to procedures to ensure the protection of workers’ lives on each and every dive.”
In addition to the two willful violations, L&I cited DNR for eight “serious” and five “general” violations for not complying with standard safe-diving practices and procedures, including failure to:
Have an effective safety and health accident prevention program and training program.
Ensure that divers maintained continual visual contact with each other.
Inspect and maintain equipment.
Have a stand-by diver available while divers are in the water.
In Washington, state and local governments must provide safe workplaces for their employees just like private businesses, including following the minimum workplace safety and health rules. L&I is responsible for workplace safety and health and investigating workplace deaths for all private, state and local government worksites.
DNR will have 15 working days to appeal the citation. As with any citation, penalty money paid is placed in the workers’ compensation supplemental pension fund, helping workers and families of those who have died on the job. For a copy of the citation, please contact L&I Public Affairs at 360-902-5413.
Not mentioned in the L&I notice sent out today is the information from Bainbridge Island police, reported by the Seattle Times on September 4, 2012, that Mr. Scheinost was also suffering from “acute cocaine intoxication” at the time of his salt-water drowning, according to the death certificate. It is not clear whether this was factored into the penalty ordered by L&I.
The SMART Act will modify the process through which the Medicare program is reimbursed when another payer (for example, a liability insurer) is responsible for a beneficiary’s medical costs.
As reported by Medivest Benefits Advisors, President Obama signed the Strengthening Medicare and Repaying Taxpayers (Smart) Act into law as part of H.R. 1845, on January 10, 2013. This bill represents one of the most significant changes in the Medicare Secondary Payer (MSP) conditional payment recovery process since the MSP Statue was enacted in 1981.
The SMART bill is the result of over four years of effort from the Medicare Advocacy Recovery (MARC) Coalition, which represents virtually every group of stakeholders impacted by the Medicare Secondary Payer (MSP) statute. The Congressional Budget Office estimated that the SMART Act would save Medicare $45 million from 2013-2022 by making it easier for payers to reimburse Medicare.
The Smart Act amends the Medicare Secondary Payer Statue by adding a new clause at the end of the existing statute that provides for the following:
Section 201 – Expedited Repayment, Web Portal and Right of Appeal. This section requires CMS to maintain and make available a timely updated website so settling parties can determine how much is owed to CMS for conditional payments, during the settlement process. It also requires CMS to provide a timely appeals process and to promulgate related regulations, if the settling parties believe there is a discrepancy in the conditional payment statement.
Section 202 – Threshold. Establishes that an actuarial single threshold amount be set for exemption from conditional payment reimbursement, where the expected recovery amount is less than the cost to recover.
Section 203 – Section 111 Penalties. Makes the $1,000 per day Mandatory Insurer Reporting (MIR) non-reporting penalty prevision discretionary by changing the statutory language from “shall be subject” to “may be subject to”. Also, this section requires CMS to publish formal regulations specifying situations where the penalty will not be imposed due to good faith efforts to comply.
Section 204 – Social Security Number. Directs CMS to modify the MIR reporting requirements so that reporting of social security numbers are not required.
Section 205 – Statute of Limitations. Creates a three-year statute of limitations for conditional payment recovery actions brought by the government.
The changes made to the provisions for penalties should come as a relief to carriers, patients, and their lawyers and doctors who were previously under threat of stiff penalties in any case of mis-reporting or under-reporting to CMS. Changing the language to “may be subject to (penalties)” allows for penalties to be ordered in cases of fraud or misrepresentation but does not require penalties in cases where mistakes are made.
CFO Jeff Atwater and Broward Sheriff Al Lamberti announced multiple arrests in Operation Dirty Money.
Today’s post comes from guest author Leonard Jernigan from The Jernigan Law Firm.
Over the past few years, many states have aggressively gone after workers’ compensation fraud (whether it’s the employee or the employer) and the amount of employer fraud being discovered continues to be staggering, notwithstanding these efforts. Legitimate business owners that pay for workers’ compensation, as required by law, are at a competitive disadvantage with those who cheat the system, and when people suffer a workplace disability and have no insurance local businesses that provide goods and services feel the pain along with health care providers who cannot get properly paid for their services. The cost of medical care and disability ends up being shifted to the taxpayer through Social Security, Medicare and Medicaid, and in states where compliance is not vigorously enforced a culture of cheating continues. The top ten cases for 2012 are listed below.
2012 TOP TEN WORKERS’ COMPENSATION FRAUD CASES Total Fraud: $97,466,500.00
Multiple arrests were announced in Florida’s joint task force’s ‘Operation Dirty Money,’ which led to the arrest of alleged ringleader Hugo Rodriguez, owner of the Oto Group, Inc., and seven other individuals. Mr. Rodriguez was the facilitator of 10 known shell companies that funneled in excess of $70 million in undeclared and undetected payroll through different money service businesses. By using shell companies, Rodriguez was able to run a large construction operation and avoid paying the cost of workers’ compensation coverage, leaving employees at risk and scamming legitimate businesses.
Ohio: May 13, 2012 Thousands of Ohio companies violated state law by not paying their most recent workers’ compensation premium, which can drive up insurance costs for businesses that follow the rules, a Dayton Daily News analysis found. The bureau identified about 41,247 private employers in the state that failed to report their payroll data and submit premium payments by the deadline. As of May, more than 12,200 accounts remain outstanding, and those companies owe an estimated $5.6 million in premiums.
$4,466,500.00 was awarded in a Texas court against a staffing agency and its workers’ compensation insurance company. Jackson Brothers Hot Oil Service hired Business Staffing, Inc., (BSI) in 1999 and required BSI to have workers’ compensation insurance for its leased employees. BSI had 150 client companies with 2,000 employees. BSI bought a policy from Transglobal Indemnity for a total premium of $4,100.00 to cover all its employees. After failing to pay the medical bills of a 27-year-old oil field worker who was in an explosion and had 18 surgeries, the employee and Jackson Brothers sued BSI and Transglobal for fraud. Neither Transglobal (who had its corporate headquarters in the Turks and Caicos Islands) nor BSI had a license to conduct insurance business in Texas.
George Osumi was indicted on numerous felony counts.
Construction business owner George Osumi of Irvine, California was indicted on numerous felony counts of misrepresenting facts to the State Compensation Insurance Fund, among other charges. From December 2001 to March of 2006, Mr. Osumi committed workers’ compensation premium fraud by reporting his payroll to SCIF at just over $1 million, under-reporting over $3.5 million in payroll. This fraud resulted in a loss of over $814,000.00 in premium owed to the insurance fund.
Newton Contracting Company misclassified half of its workforce as subcontractors.
The Massachusetts Insurance Fraud Bureau discovered that the company, Newton Contracting Company, Inc., owned by Shaun Bryan and Antoinette Capurso-Bryan, misclassified half of its workforce as subcontractors, as well as failing to disclose to auditors more than $3.4 million of their company’s misclassified subcontractor payroll during its annual workers’ compensation audits.
Steven Morales, 65, of Wildomar, CA was convicted and sentenced to seven years in prison for his part in a $3.1 million workers’ compensation scheme. His son Brian was also convicted and sentenced to 4 years in prison. Morales and his son had set up a sophisticated system of shell companies to hide payroll and avoid paying workers’ compensation premiums.
Randall Seltzer, president of Navarre Industries, Inc., was charged with multiple felony counts, including workers’ compensation fraud. An investigation by Florida’s Department of Financial Services’ Division of Insurance Fraud revealed that Seltzer systematically and intentionally under-reported his corporation’s true payroll to his insurance carrier. The department’s Division of Workers’ Compensation issued the company two stop-work orders within a five-year period. Seltzer allegedly established a shell corporation in 2011 to intentionally violate the stop-work orders and continue operating his construction business illegally. If convicted, Seltzer could face up to 30 years in prison and pay over $2.8 million in restitution.
Yucet Batista allegedly used a shell company to commit large-scale fraud.
Yucet Batista was arrested for allegedly creating more than 250 fraudulent certificates of insurance to help uninsured contractors avoid $2.1 million in workers compensation premiums. Batista created the company and obtained the workers’ compensation insurance policy for the purpose of “renting” it, or making it available to dozens of uninsured subcontractors for a fee.
In 12 audits conducted by the Joint Enforcement Task Force on the Underground Economy and Employee Misclassification and the Executive Office of Labor and Workforce Development, it was discovered that there were $584,249.00 in misclassified 1099 wages and $584,287 in unreported W-2 earnings, for a total of $1,171,536.00 in unreported wages by subcontractors on the Marriot renovation project. Six companies misclassified workers as contractors rather than employees, and seven companies failed to report wages. Among the worst of the offenders were one company that misclassified 28 workers and failed to report over $410,000.00 in wages; another failed to report $462,081 in W-2 wages.
Owners of the historic Brookdale Inn and Spa are facing trial on charges of falsifying wage information to obtain lower insurance premiums.
The owners of historic Brookdale Inn and Spa, Sanjiv and Neelam Kakkar, are facing trial on charges that they falsified wage information to obtain lower insurance premiums. According to records, the couple paid approximately $800,000 less in insurance premiums than they should have over a period of several years.
Today’s post comes from guest author Tom Domer from The Domer Law Firm.
Access to health insurance is under attack. President’s Obama’s comprehensive health care reform law, intended to increase health care coverage for millions of Americans, faced extreme scrutiny by the U.S. Supreme Court last week. Congressman Paul Ryan’s federal budget plan is a cynical and careless proposal that would slash Medicaid programs, while providing tax cuts for the wealthy. In Wisconsin, Governor Walker and his fellow Republicans also propose gutting funds to the state’s vital Medicaid program. The ultimate goal is hard to deny: certain politicians and interest groups actually want a country with more uninsured citizens. The personal toll on the uninsured is devastating, especially for those dealing with work injuries.
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.
On December 14, 2012 the shooting carried out by Adam Lanza in Newtown, CT awakened the American people to issues of gun control, school safety and mental health care. The nation mourned the loss of so many innocent lives and lauded the heroic actions of the teachers and staff at the school.
I was on vacation in downtown Manhattan the morning of the shooting. Everywhere my family and I went we heard the same topic, over and over. On the subway, we heard conversations lamenting that children are no longer safe, even at school. In restaurants and throughout the Christmas markets in the parks – in any public gathering – the overheard conversations were on the same topic: how to prevent this from happening again. Our own community in West Seattle held a candlelight vigil on Alki Beach, as many, many other communities across the nation did, to gather together and, by sharing the loss and fear, lessen the pain, together.
All of the adults killed at Sandy Hook Elementary were on the job; all were victims of gun violence in the workplace.
Another issue raised by this tragedy, one that has not been mentioned in the media, is workplace safety. All of the adults killed at Sandy Hook Elementary were on the job; all were victims of gun violence in the workplace. The families of the adult victims are now workers’ compensation claimants. In Connecticut, death benefits are paid to surviving spouses at the rate of 75% of after-tax income, paid for life or until remarriage. There is a $4,000.00 funeral allowance. These benefits hardly compensate for the loss of a loved one. An astounding 20% of all violent crime in the United States occurs in the workplace, injuring more than two million workers annually. Approximately 500 fatalities occur in the American workplace annually. According to the Department of Labor, nearly 78% of all workplace homicides were caused by shootings.1 The financial protection afforded by the workers’ compensation system does nothing to protect our safety and our lives from gun violence. Only we, as a society, can take action to protect ourselves. The change must begin with us, individually and collectively.
For the past 30 years, Washington CeaseFire has been the only statewide organization in Washington dedicated to reducing gun violence. The organization was formed in 1983 by citizens who had been directly affected by gun violence. From a small group meeting in private homes, it has grown to an organization with more than 6,000 members across the state. Washington CeaseFire is now one of the most respected gun safety organizations in the nation and continues to work to reduce gun violence in communities throughout Washington State.
Washington CeaseFire is sponsoring a march and rally on Sunday, January 13, 2013 at 1:30 p.m. in the wake of the tragic shooting at Sandy Hook Elementary School in Newtown, Connecticut. Washington CeaseFire is turning Anger into Action, as supporters march from Westlake Park to Seattle Center Mural Amphitheater. The rally, called StandUp Washington, will include speakers, music and remembrance for those lost. Most importantly, there will be a call to action on this day before the opening of the 2013 Legislative session. Washington CeaseFire will join with thousands of other concerned citizens in demanding a ban to semi-automatic assault weapons, similar to those used in the Newton shooting.
Beth Flynn, Executive Director of Washington CeaseFire, says, “We want to send a clear message to our legislators that we want to ban semi-automatic assault weapons.”
Supporters are encouraged to bring their families and join civic, religious and education leaders in this show of support for sensible gun legislation and for the victims of all gun violence, from Newton to Seattle. Please use the hashtag #StandUpWA to spread the news on Twitter of the rally and march. A website has been set up at www.standupwa.org with further details.
“In our glorious fight for civil rights, we must guard against being fooled by false slogans, such as ‘right to work.’ It is a law to rob us of our civil rights and job rights. Its purpose is to destroy labor unions and the freedom of collective bargaining by which unions have improved wages and working conditions of everyone…Wherever these laws have been passed, wages are lower, job opportunities are fewer and there are no civil rights. We do not intend to let them do this to us. We demand this fraud be stopped. Our weapon is our vote.”—Martin Luther King, speaking about right-to-work laws in 1961
