CA - Employers Asked to Pay as Mainstay Liabilities Near $50 Million
09/19/2017 | 743 | 0 | 0 min read
The $16.9 million security deposit posted by a tribe-owned professional employer organization was enough to pay claims only for a about a year-and-a-half after the self-insured PEO became insolvent, and now its former California clients may have to pick up a $30 million tab.
Mainstay Business Solutions went out of business in April 2011 as a result of what it called an unexpected $16.4 assessment from the Employment Development Department over unpaid taxes. At the time, the Self-Insurers’ Security Fund said it was taking responsibility for 481 open claims with an estimated future l.
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Plaintiff attorneys working on workers’ comp settlements have something new to worry about: Medicare Advantage Plans are now coming after them if a medical treatment conditionally paid for by Medicare is not reimbursed as required.
Heather Schwartz Sanderson
Medicare Advantage Plans, which are private companies that Medicare pays to provide benefits, have the right to pursue recovery for conditional payments from any party to a settlement, according to Heather Schwartz Sanderson, chief legal officer at Franco Signor. That includes plaintiff attorneys, insurers and providers, she said.
Labor advocates want Iowa Gov. Kim Reynolds to correct the record and concede that recent legislative reductions to workers’ compensation benefits had nothing to do with an 8.7% rate decrease for both the voluntary and assigned risk markets.
The Iowa Insurance Division approved the rate decrease on the recommendation of the National Council on Compensation Insurance, which attributed the drop to lower claims frequency in policy years 2014 and 2015.
Iowa claims frequency has dropped from 24.9 per $1 million of on-leveled, wage-adjusted premium to 14.7 in 2015, NCCI said.
The rate decre.
The Pennsylvania Supreme Court has accepted review of a case that could cost employers their ability to divert the money injured workers win in third-party negligence suits to pay for future medical care.
Employers who pay workers' compensation benefits have long enjoyed the right to recover the funds if a third party is found to have contributed to the injury. After an injured worker wins or settles with a third party, the employer can file a subrogation lien to recover the costs of any medical and wage-replacement benefits it has paid. Any money left over goes toward paying fu.
A New York appellate court ruled that a legally blind worker’s activities to support an amateur football team did not belie his representation that he was permanently and totally injured from a prior work accident.
Case: Matter of Eardley v. Unatego Central School District, No. 523948, 09/14/2017, published.
Facts: Bill Eardley worked for the Unatego Central School District as a janitor. He stopped working in June 2008 after suffering on-the-job injuries.
Eardley filed a claim seeking workers’ compensation benefits for injuries to his right shoulder and neck.
A workers’ c.
The West Virginia Supreme Court ruled that a worker may be entitled to an increased award of permanent partial disability benefits for an old shoulder injury, depending on the outcome of the independent medical examination ordered by the court.
Case: Lawrence v. West Virginia Office of the Insurance Commissioner, No. 17-0052, 09/15/2017, published.
Facts: Gregory Lawrence injured his back and shoulder in March 1993 while lifting a heavy coal nozzle. Over the years, he has received a 21% permanent partial disability rating for his lumbar spine, 14% permanent partial disability rating for his .
Sulivan On Comp
The Utah Court of Appeals is sticking to its determination that the state Labor Commission has been applying an overly strict standard for determining when a worker is entitled to benefits for the aggravation of a pre-existing condition.
Lavon Cox worked as a maintenance mechanic for the St. George Truss Co. He claims he felt a “burning, popping sensation” in his back while removing a brake drum from a semi truck on May 7, 2013.
Cox claimed he experienced the same sensation when he removed another brake drum the next day.
He continued to work but his pai.
A California appellate court ruled that a group of correctional officers were barred from suing their employer for discrimination based on race, ethnicity and national origin because they had already litigated their claims in pursuit of benefits for psyche injuries allegedly attributable to workplace harassment.
Case: Ly v. County of Fresno, No. F072351, 09/15/2017, unpublished.
Facts and procedural history: Va Ly, Travis Herr and Pao Yang worked for the County of Fresno as correctional officers.
All three men are Laotian, of Hmong ethnicity.
In August 2009, the officers filed a compl.
A Virginia Board of Medicine emergency regulation regarding opioid prescribing has been modified to address sensitivity to naloxone when buprenorphine-naloxone products are prescribed.
The regulation now says that buprenorphine without naloxone, also called buprenorphine mono-product, may be prescribed for addiction treatment in patients who have a demonstrated intolerance to naloxone. But such prescriptions for the mono-product should account for less than 3% of the buprenorphine prescriptions written by a particular prescriber, and the exception must be documented in the patient's .
Beginning Oct. 1, medical providers that treat injured workers have 12 months to bill an employer or its insurers for services, the Maryland Workers’ Compensation Commission reminded stakeholders in a recent notice.
Bills must be submitted within 12 months from the date the treatment was provided, the claim was accepted by the employer/carrier, or the commission determined the claim was compensable, whichever is latest.
The employer/carrier does not have to pay the bill after 12 months unless the medical provider files an application for payment, Form C-51, within three years from.
The Minnesota Department of Labor and Industry has adopted exempt permanent rules that update independent medical examination fees and workers’ compensation conversion factors.
Subparagraph 4.X was added to Minnesota Administrative Rules 5219.0500, Independent Medical Examination Fees, to adjust the fees upward by 0.2%, effective Oct. 1, according to Monday’s edition of the Minnesota State Register.
Under 5221.4010, Determining Fee Schedule Payment Limits, the conversion factors and maximum fee formulas beginning Oct. 1 are:
$69.62 for medical and surgical services identi.
The Buffalo law firm Lipsitz Green Scime Cambira LLP has named labor and employment attorney Joseph Guza as a junior partner, Livingston County News reports.
Guza represents unions on issues such as collective bargaining negotiations, arbitrations, agency hearings and corporate campaigns. He also works with the workers' compensation and personal injury departments.
Guza has been with Lipsitz Green for four years.
He holds a bachelor's degree from Nazareth College in Rochester, a master's degree from Boston College and a law degree from the State University of New York at Buffalo.
The Alabama Court of Civil Appeals overturned an order authorizing a worker’s continued receipt of medical care without determining whether the worker had suffered a compensable injury, or how the injury occurred.
Case: Ex parte West Fraser, No. 2160814, 09/15/2017, published.
Facts: Johnny Thomas worked for West Fraser Inc. He filed a workers’ compensation claim in April 2015, asserting he had suffered injuries while trying to dislodge a log that had become stuck on a conveyor belt.
West Fraser contested his claim, denying that the alleged accident had occurred. It said it.
The New York Department of Financial Services has approved changes to the document that outlines requirements for workers' compensation data reporting, the state's rate-maker announced Friday.
The New York Workers' Compensation Statistical Plan will undergo the following updates, effective Jan. 1:
Insurance carriers may submit replacement reports on documents other than the original report. The change will eliminate the need to submit official correction records.
Code 9, which is used to identify all permanent partial claims, will be eliminated. In its place will arise Code 10.
Costa Mesa, CA September 5, 2017: The .