Industry Insights
Medicare Set-Aside Agreements Must be Crystal Clear to all Sides | 05/13/2014 | ||
By: Eugene Keefe | |||
State: IL | Segment: | 0 | |||
We consider this article required reading for all claims adjusters, risk managers, defense lawyers, and workers' compensation hearing officers across the country. In Paluch v. United Parce...Read More | |||
May 2014 Case Law Update | 05/07/2014 | ||
State: CA | Segment: | 0 | |||
JURISDICTION AND SUBROGATIONIn Smith v. New York Giants, 2014 Cal. Wrk. Comp. P.D. LEXIS 109, the WCAB declined to exercise jurisdiction over a professional football player's claim because his last two employment contracts provided that exclusive jurisdiction for resolving workers...Read More | |||
March Case Law Updates | 03/10/2014 | ||
State: CA | Segment: | 0 | |||
JURISDICTION AND SUBROGATIONIn Randle v. Seattle Seahawks, 2013 Cal. Wrk. Comp. P.D. LEXIS 621, the WCAB held that it had jurisdiction over a professional football player's workers' compensation claim even though the employment contract selected the state of Washington for all su...Read More | |||
Move to the Center? | 02/26/2014 | ||
By: Eugene Keefe | |||
State: IL | Segment: | 0 | |||
It is no secret to veteran readers of this KCB&A newsletter that we have been known to wield a sharp pen over the years when it comes to our critique of the hearing officers of our Illinois Workers’ Compensation Commission. While perhaps harsh at times, much of our criticism was meant to p...Read More | |||
More on Nurse Case Manager Selection | 01/03/2014 | ||
State: CA | Segment: | 0 | |||
Nothing ruins a Friday for a cold-hearted workers’ compensation defense attorney more than having to side with the arguments of an applicant. Well, probably a few things could make a Friday worse (like realizing that it’s only Thursday), but that’s one of the bad ones. So it is, as...Read More | |||
Myths about Obamacare and Workers' Comp | 11/25/2013 | ||
State: NA | Segment: | 0 | |||
The Obama administration has said that the Patient Protection and Affordable Care Act, enacted into law in 2010 and scheduled to take effect on Jan. 1, will reduce workers’ comp claims because so many additional people will be covered under personal insurance policies. But there is reason to t...Read More | |||
Medicare May Seek Upfront Reimbursement of Conditional Payments | 09/20/2013 | ||
By: Heather Schwartz | |||
State: NA | Segment: | 0 | |||
Some of us in the industry may remember an interesting case back from May of 2011 where a class of Medicare beneficiaries successfully obtained an injunction against the Centers for Medicare and Medicaid Services (CMS) for certain conditional payment reimbursement practices. The two conditional paym...Read More | |||
Must the Adjuster Ask for Settlement Authority from the Insured? | 09/04/2013 | ||
By: James J. Moore | |||
State: NA | Segment: | 0 | |||
One of the most repeated comments we hear when reviewing claims-loss runs is an adjuster settled or agreed to accept a file without the insured agreeing to the settlement. We often hear that an adjuster increased the reserves to a very high level without consulting the employer.Almost al...Read More | |||
Medicare-Based Fee Schedules and Work Comp | 07/30/2013 | ||
By: Joe Paduda | |||
State: NA | Segment: | 0 | |||
Medicare bases the physician fee schedule, known as the Resource-Based Relative Value Scale, on estimates of how much time it takes docs to do specific things, plus their operating expenses adjusted for regional cost factors. That’s a gross oversimplification but close enough (more on the deta...Read More | |||
Medicare Secondary Payer Act Compliance: A WCEC Session Preview | 07/16/2013 | ||
By: Workers Compensation Institute | |||
State: NA | Segment: | 0 | |||
Editor’s Note: The 68th annual Workers' Compensation Educational Conference (WCEC) will be held Aug. 18-21 at the Orlando World Center Marriott. This article is pa...Read More | |||