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Municipality Not Entitled to Reimbursement for Workers' Comp Outlay When Firefighter Injured Assisting Another Town's Fire Department

In May 2004, a significant fire broke out within a complex of apartments and condos in West Hartford. The West Hartford fire department responded to the call and soon realized that the size and ferocity of the blaze was beyond its resources. The officer on the scene requested assistance from the City...

California Department of Industrial Relations Regulations: Update and Comments

The development and implementation of regulations is a complex and time consuming process. However they are just as important as the laws when it comes to making the system work well and reducing unnecessary expenses. I recommend that you as an individual or your organization (or its system representatives...

California: Presiding Judge Clarke of Salinas WCAB Issues Guidelines—Appropriate Reimbursable Amounts for Deposition Attorneys Fees

California: Presiding Judge Thomas Clarke of the Salinas WCAB Has Issued Guidelines Regarding Appropriate Reimbursable Amounts for Deposition Attorneys Fees Under Labor Code §5710 Effective December 13, 2010 Every few years, the presiding judge of the Salinas WCAB issues new voluntary guidelines...

TX: Division Of Workers' Comp Proposes Revisions To Request For Reimbursement Form

Dallas, TX (CompNewsNetwork) - The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) has proposed revisions to the DWC Form-026, Request for Reimbursement of Payment Made by Health Care Insurer. Health care insurers and/or their authorized representative are required to...

New MSP Reform Bill Proposed in Congress - The SMART Act (H.R. 1063) Proposes New Amendments To the Medicare Secondary Payer Statute

By: Mark Popolizio, Esquire On March 14, 2011, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) ( H.R. 1063 ) was introduced in the U.S. House of Representatives by Tim Murphy (R-PA) and Ronald Kind (DWI). This legislation proposes major amendments to the Medicare...

California: Somebody Else Did It! A Primer on Third Party Cases

THIRD PARTY REMEDY The employee and employer each have an independent cause of action for damages against a negligent third party. Lab. Code § 3852 ; Buell v. CBS, Inc . (1982) 136 Cal. App. 3d 823, 825, 186 Cal. Rptr. 455 . The employee may simultaneously proceed against the third party for...

Medicare Advantage (MA) Plans: Exploring Recovery Rights & Recent Court Decisions

By: Mark Popolizio, Esquire, V.P. of MSP Compliance, NuQuest/Bridge Pointe An emerging area of focus on the Medicare Secondary Payer compliance landscape relates to Medicare Advantage (MA) plans. Interest in this topic has been generated by the claim industry's heightened sensitivity to Medicare...

Workers' Comp Fraud Blotter (8/11/2011) – Police Officer Made a Mint Running His Memorabilia Business While On Disability

Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, convictions and investigations. Workers' Comp Fraud...

No Change in California Workers’ Comp Medical Mileage Rate For 2012 Travel

The mileage rate that workers’ comp claims administrators pay injured workers for travel related to medical treatment or evaluation of their injuries will remain at 55.5¢ per mile for travel on or after January 1, 2012, regardless of the date of injury. California Labor Code §4600 ...

Four Reasons to Avoid the CMS Approval Process for MSAs

By Teddy Snyder, Esq., Ringler Associates - Beverly Hills, CA 1. MMSEA reporting makes approval unnecessary for Medicare beneficiaries. Reporting under the Medicare, Medicaid and S-Chip Extension Act, aka “section 111 reporting”, started January 1, 2010 for workers compensation claims...

Four Reasons to Avoid the CMS Approval Process for MSAs

By Teddy Snyder, Esq., Ringler Associates - Beverly Hills, CA 1. MMSEA reporting makes approval unnecessary for Medicare beneficiaries. Reporting under the Medicare, Medicaid and S-Chip Extension Act, aka “section 111 reporting”, started January 1, 2010 for workers compensation claims...

Take Medicare Off That Check: Court Rules That Medicare Not Required to be on Settlement Check

By: Mark Popolizio, Esquire, Crowe Paradis Services Corporation In Hearn v. Dollar Rent A Car, Inc., et. al. , 2012 Ga. App. LEXIS 338 (Ga. Ct. App. March 26, 2012), the Georgia Court of Appeals was called upon to address whether the court could enforce a settlement agreement without Medicare being...

California: Court of Appeal Reverses W.C.A.B. Ruling on Res Judicata

Attention Lexis Online Subscribers: The cites in this article link to lexis.com. The bracketed cites link to Lexis Advance. The 2nd Appellate District has ordered publication of an opinion previously issued as unpublished which provides important clarification of the rights of the California Insurance...

NC: Commission Erred in Refusing Retroactive Attendant Care Services Reimbursement to Spouse

In a divided decision, the Supreme Court of North Carolina recently held that the state’s Industrial Commission may not bar family members from receiving compensation for attendant care services provided to an injured employee before obtaining approval for those services from the Commission pursuant...

California: Self-Procured Medical Marijuana

Are applicants entitled to reimbursement for self-procured medical marijuana both pre- and post-SB 863? In Cockrell v. Farmers Insurance , 2015 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel has once again rescinded the WCJ’s finding that the applicant was entitled to reimbursement (as opposed...

Pennsylvania: Waiver of Future Subrogation Rights Must Be Clear and Explicit

Where the employer joined into a third-party settlement agreement that stated the employer agreed to a payment of a sum certain “in full satisfaction of the defendant/employer’s (and its workers’ compensation insurance carrier’s) right to subrogate against the third party settlement...

No Evidence That Insurer Issued Written Notice of Reinstatement or Issued New Policy After Cancellation: Cal. Comp. Cases June Advanced Postings (6/18/2015)

Here’s the fourth batch of advanced postings for June 2015 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2015 LexisNexis. All rights reserved. 2K Fabrications, Inc., Petitioner v. Workers'...

New Mexico: Medical Marijuana Constituted Reasonable and Necessary Medical Care

In its third decision on the issue of requiring an employer and/or insurer to reimburse the injured worker for the cost of medical marijuana provided to an injured worker under New Mexico’s “Compassionate Use Act,” a state appellate court again found the order requiring reimbursement...

The Case of the Mega-Credit: A New Take on Fund Reimbursement in Delaware

In my capacity as your (hopefully) favorite local legal pundit, I am always looking for the unexpected, the clever, the savvy and the edgy. And perhaps the following case represents something savvy defense counsel have been doing in their own practices for years, but today’s case struck me as the...

Applicant Shot at Illegal Marijuana Growing Business Suffered Compensable Injury: Cal. Comp. Cases December Advanced Postings (12/16/2015)

Here’s the latest batch of advanced postings for the December 2015 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2015 LexisNexis. All rights reserved. Christine Baker, Director of Department...

New Hampshire: Home Health Services Provided by Worker’s Spouse Should Be Compensated

Where a worker sustained serious injuries and, after a period of hospitalization, was discharged to his home and prescribed medication and follow-up care, which included home health services—physical and occupational therapy, a home health aide, and nursing services—it was reasonable to reimburse...

Virginia: Arbitrator’s Award of Lien Reimbursement to Comp Insurer Need Not Be Shared With Injured Worker

Where an arbitrator ordered an auto insurance carrier to reimburse a workers’ compensation insurer (“comp insurer”) for the full amount of its workers’ compensation lien ($4,060.19), the comp insurer need not share the lien proceeds with the injured worker on a pro rata basis;...