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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...

Insurer Entitled to Credit for Third Party Recovery in Porta-Potty Injury Case: Cal. Comp. Cases May Advanced Postings (5/12/12)

Here’s the next batch of advanced postings for the May 2012 issue of Cal. Comp. Cases. Lexis.com subscribers can link to the cases to read the complete headnotes and summaries. © Copyright 2012 LexisNexis. All rights reserved. Pedro Gonzalez, Petitioner v. Workers' Compensation Appeals...

California Workers' Comp Case Roundup (6/9/2012)

CALIFORNIA COMPENSATION CASES Vol. 77 No. 5 May 2012 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2012 LexisNexis. All rights reserved...

Larson’s Spotlight on Recent Cases: Contribution/Indemnity Defense in Third Party Suit When Employer Hires Illegal Alien

Larson's Spotlight on Contribution, Firefighter's Rule, Safety Device, and Credit. Larson's surveys the latest case developments that you need to know about. Thomas A. Robinson, the staff writer for Larson's Workers' Compensation Law , has compiled the list below. NY: Employer...

Larson’s Spotlight on Recent Cases: Employee Sustained Psychic Injury When Told She Owed Tax on $100,000 of Travel Reimbursements

Larson's Spotlight on Psychic Injury, AMA Guides, Traveling Employee, and Subrogation. Larson's surveys the latest case developments that you need to know about. Thomas A. Robinson, the staff writer for Larson's Workers' Compensation Law , has compiled the list below. LexisNexis...

Ohio: $15,000 Settlement of Third-Party Claim Costs Injured Employee $61,500

Applying Ohio Rev. Code 4123.931(G), which provides in relevant part that if the injured employee settles with the third party without giving such notice, the employee and the third party are jointly and severally liable to pay the employer or carrier the full amount of the subrogation interest, an Ohio...

OK: Oklahoma Law Prohibiting Subrogation for Death Benefits Controls for Fatal Texas Accident

Under the provisions of 85 O.S.Supp.2005, § 44(b), applicable on the date the deceased worker, a resident of Oklahoma, was killed in a work-related accident while working in Texas, neither the employer nor the carrier had the right of subrogation to recover money paid for death claims or death benefits...

NJ: Small Dog Has Big Bite, Yet Subrogation Claim Fails Since Recovery Could Have Been Had Under State’s No-Fault Auto Law

In an unpublished decision, a New Jersey court recently held that a workers’ compensation insurer was not entitled to pursue a subrogation claim for $900 in medical bills associated with injuries a police officer sustained when he was bitten on the hand by a Chihuahua sitting in the lap of a driver...

NY: Divided High Court Awards Carrier Full Credit to Settlement Proceeds Where Worker Was Assaulted, Raped & Kidnapped

A workers' compensation carrier, who paid benefits to an aide at a juvenile detention center who was physically assaulted, raped, and kidnapped by a coworker, is entitled to take a dollar-for-dollar credit against future workers’ compensation benefits owed where the aide settled a federal civil...

Federal: Carrier’s Subrogation Claim May Not Be Removed to Federal Court

The Fifth Circuit Court of Appeals held the issue of whether a workers’ compensation insurance carrier was entitled to subrogation following a settlement between a third party and the insurance beneficiary employee arose under the Texas Workers’ Compensation Act and, therefore, the matter...

Texas: State Supreme Court Answers Complex Question as to Credit Allowed to Carrier in Third Party Action with Multiple Beneficiaries

Under Texas law, consistent with that in the large majority of states, a workers’ compensation carrier has a subrogation interest in a third-party civil action to the extent of its prior payments for benefits and to treat the amount recovered as an advance against the carrier’s future payment...

Wisconsin: Trial Court Can Compel Injured Employee to Accept Settlement of Third-Party Civil Action

The Supreme Court of Wisconsin affirmed a decision compelling a plaintiff/injured employee to accept a settlement offered in a third-party civil action he had filed against an alleged tortfeasor. The employee, who worked for the Village of Fontana, had filed a civil action against Northland Equipment...

Delaware: Affiliation Between Insurance Companies Is Insufficient to Block Insurer’s Right to Join in Third-Party Action

A Delaware court has allowed the employer’s workers’ compensation insurer to intervene in a personal injury action filed by an injured employee against the firm that provided janitorial services to the employer, finding that the insurer has a subrogation interest in any recovery by the injured...

Texas Workers' Compensation: A Model of Stability Now on the Verge of Possible Change

Entering 2014, the Texas workers’ compensation system seemed to be a model of stability; something that would have been impossible to imagine only ten years ago. There was little controversy in the system and no major administrative rule changes were needed. In fact, other states began to look...

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...

Missouri: Commission Exceeded Authority in Ordering Subrogation Payment

A Missouri appellate court held that the state’s Industrial Relations Commission’s power to order an employee (and his spouse) to repay some $41,000 in medical benefits following the successful settlement of a third-party civil action for an amount far exceeding the subrogation lien could...

Missouri: Court Takes Away a Subrogation Credit

The Commission went too far to resolve a subrogation dispute after a third party settlement and violated due process of the claimant’s spouse when she was not a party to the comp claim. Graham v. Latco Contractors , 2015 MO App. Lexis 379 (lexis.com), 2015 MO App. Lexis 379 (Lexis Advance) (April...

Pennsylvania: Work Comp Insurer May Not File Subrogation Action in its Own Name

The Supreme Court of Pennsylvania held that notwithstanding the strong subrogation rights conferred upon employers or their workers’ compensation insurers, they have no direct right of action against a third-party tortfeasor under 77 Pa. Cons. Stat. § 671, where the injured employee has taken...

Georgia: Employer’s Subrogation Lien Fails Where No Proof That Injured Employee Had Been Made Whole

Unlike the situation in many other states, the subrogation lien of a Georgia employer and/or its insurer attaches to third-party recovery by the injured employee only after the injured employee has been fully and completely compensated for his economic and noneconomic losses [see OCGA § 34–9–11...

Massachusetts: Employer’s Subrogation Rights Do Not Extend to Worker’s Pain and Suffering Recovery

The Supreme Judicial Court of Massachusetts held that while an employer is entitled to a lien on an employee’s recovery from a third party for work-related injuries under Mass. Gen. Laws ch. 152, § 15, the lien does not attach to damages paid by a third party for an employee’s pain and...

West Virginia: Insurer Has No Subrogation Interest Since Benefits “Paid” Under Policy Were Less than Employer’s Large Deductible

Under the West Virginia subrogation statute [W. Va. Code § 23–2A–1], a party is entitled to a lien only to the extent that it has actually paid a sum of money. Accordingly, where a mining electrician suffered catastrophic injuries when he was struck and run over by an underground shuttle...

Illinois: In Third Party Action, Employer Owes 25 Percent Attorney Fee on Value of Future Medical Care

Where attorneys for an injured worker bring a successful action against a third party to recover damages for personal injuries sustained by the worker in the course of his employment, thereby enabling the worker’s employer to obtain reimbursement of the compensation benefits that it is obligated...

Montana: Oklahoma Employer May Not Intervene to Recover its Lien Until Worker is Made Whole

Relying upon § 90 of the Restatement (Second) Conflict of Laws, a divided Supreme Court of Montana held that because of the strong public policy against subrogation in the state, courts in Montana will not entertain actions involving workers’ compensation subrogation prior to an injured worker’s...

Idaho: Negligent Employer is Not Entitled to Subrogation Rights Involving Employee’s Third-Party Tort Claim

Idaho’s 1987 adoption of comparative negligence [see Idaho Code § 6–801] and the abrogation of joint and several liability did not affect the rule established in Liberty Mutual Insurance Company v. Adams , 91 Idaho 151, 417 P.2d 417 (1966), that an employer who is concurrently negligent...