Callagy Law Arizona: workers comp

Showing posts with label workers comp. Show all posts

Friday, March 25, 2016

Workers’ Compensation Coverage Required for New Jersey Employers

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

The State of New Jersey Department of Banking and Insurance requires that New Jersey employers post notice of workers’ compensation insurance coverage or qualification as a self-insured employer. The only New Jersey employers except from the requirement of workers’ compensation coverage or the qualified self-insurance are those covered by Federal programs. Moreover, this requirement extends to out-of-state employers under certain circumstances. These situations include out-of-state employers who hire employees to perform work in New Jersey. Also included are out-of-state employers who have entered in employment contracts in the state of New Jersey. Finally, New Jersey employers must provide information to their employees regarding the procedures to be followed in the case of a worker related incident. Such information must include the following: (1) Where to seek medical treatment; (2) The proper procedure for reporting an injury while working; and (3) Information explaining workers’ compensation insurance coverage and benefits. Employees and managers should be made aware of this information upon being hired and during the course of employment.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $185,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Workers’ Compensation Coverage Required for New Jersey Employers

Thursday, March 10, 2016

How does third-party liability affect a New Jersey Workers’ Compensation claim for a medical provider petitioner?

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

N.J.S.A. 34:15-40 (“Section 40”) provides that

Where a third person is liable to the employee or his dependents for an injury or death, the existence of a right of compensation from the employer or insurance carrier under this statute shall not operate as a bar to the action of the employee or his dependents, nor be regarded as establishing a measure of damage therein. In the event that the employee or his dependents shall recover and be paid from the said third person or his insurance carrier, any sum in release or in judgment on account of his or its liability to the injured employee or his dependents, the liability of the employer under this statute thereupon shall be only such as is hereinafter in this section provided.

* * *

(b) If the sum recovered by the employee or his dependents from the third person or his insurance carrier is equivalent to or greater than the liability of the employer or his insurance carrier under this statute, the employer or his insurance carrier shall be released from such liability and shall be entitled to be reimbursed, as hereinafter provided, for the medical expenses incurred and compensation payments theretofore paid to the injured employee or his dependents less employee’s expenses of suit and attorney’s fee as hereinafter defined.

(c) If the sum recovered by the employee or his dependents as aforesaid is less than the liability of the employer or his insurance carrier under this statute, the employer or his insurance carrier shall be liable for the difference, plus the employee’s expenses of suit and attorney’s fee as hereinafter defined, and shall be entitled to be reimbursed, as hereinafter provided for so much of the medical expenses incurred and compensation payments theretofore paid to the injured employee or his dependents as exceeds the amount of such difference plus such employee’s expenses of suit and attorney’s fee.

Simply, Section 40 prevents double recovery by workers’ compensation claimants by allowing the respondent carriers to assert a lien against a potential third-party lien. A petition is prohibited from recovering from both the respondent carrier and a liable third-party, thereby allowing the respondent carrier to subrogate against the third-party.

A Section 40 lien is limited to medical treatment costs and disability payment (temporary and permanent), as it does not cover the respondent carrier’s medical examination defense costs, such as Independent Medical Examinations. A respondent carrier’s recovery from a third-party under Section 40 is limited to the amount paid less petitioner’s counsel fees, which are typically one-third. Therefore, the carrier will likely be allowed to recover two-thirds of the total payments from the third-party.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $185,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Wednesday, February 3, 2016

Workers’ Compensation Safety Nets: NJPLIGA and UEF

A closer look into NJPLIGA and EUF

New Jersey’s Workers’ Compensation Act, N.J.S.A. 34:15-1 et seq. requires all New Jersey employers to have workers’ compensation coverage. This coverage must provide medical treatment and wage and disability benefits for workers who are injured on the job. Unfortunately, in some instances, employer funded insurance coverage is not available. An injured workers’ recourse in such cases may include seeking benefits through NJ PLIGA, or the UEF.

NJ PLIGA is a private, non-profit, unincorporated legal entity established according to the New Jersey Property-Liability Insurance Guaranty Association Act, N.J.S.A. 17:30A-1 et seq. NJ PLIGA administers claims involving insolvent carriers. The UEF, Uninsured Employer’s Fund, also provides benefits where the employer was uninsured. N.J.A.C. 12:235-7.1 et seq. The UEF only provides for medical treatment and temporary disability benefits.

As set forth above, NJ PLIGA and the UEF provide a necessary safety net for injured workers in cases where employers do not have the required workers’ compensation coverage or are insolvent. It is worth noting that employers who fail to obtain the required insurance may be directly liable for payments made in connection with workers’ compensation claims and may also be subject to criminal and monetary penalties.

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Workers’ Compensation Safety Nets: NJPLIGA and UEF

Wednesday, January 27, 2016

Medical Provider Applications In New Jersey Workers’ Compensation Courts

The Effect of the 2012 Amendment

The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

The New Jersey Workers’ Compensation courts provide a forum for healthcare providers to challenge inadequate reimbursements from workers’ compensation insurance carriers where the underlying claim is for a patient injured within the course of their employment. It was not until 2012 that the New Jersey Workers’ Compensation courts gained exclusive jurisdiction over these types of claims. The majority of cases that are filed in the Workers’ Compensation courts involve the injured worker’s (i.e. Petitioner) claim against his/her employer’s workers’ compensation insurance carrier (Respondent).

The 2012 Amendment to N.J.S.A. 34:15-15 effected a significant change in the rights of medical providers who have provided authorized treatment to injured workers in New Jersey. As a recent addition to the Workers’ Compensation Act, however, the language of the Amendment has not been interpreted in any prior decision in New Jersey. The full text of the Amendment provides:

Fees for treatments or medical services that have been authorized by the employer or its carrier or its third party administrator or determined by the Division of Workers’ Compensation to be the responsibility of the employer, its carrier or third party administrator, or have been paid by the employer, its carrier or third party administrator pursuant to the workers’ compensation law, R.S.34:15-1 et seq., shall not be charged against or collectible from the injured worker. Exclusive jurisdiction for any disputed medical charge arising from any claim for compensation for a work-related injury or illness shall be vested in the division. The treatment of an injured worker or the payment of workers’ compensation to an injured worker or dependent of an injured or deceased worker shall not be delayed because of a claim by a medical provider.

N.J.S.A. 34:15-15.

Prior to this Amendment, the state of the law in New Jersey with respect to medical provider claims in workers compensation matters was extensively reviewed by the New Jersey Supreme Court in Univ. of Mass. Mem’l Med. Ctr., Inc. v. Christodoulou, 180 N.J. 334 (2004). As discussed in Christodoulou, while the Workers Compensation Act with limited exceptions provides an exclusive remedy to employees injured the course of their employment, the Act “does not purport to establish an exclusive remedy for a hospital or physician that, pursuant to a contract, has provided medical services to a patient who may or may not have suffered a job-related injury.” Id. at 346. Thus, medical providers asserting claims arising from treatment provided to injured workers previously had the option to pursue their claims either in the Division of Workers Compensation, as authorized by N.J.S.A. 34:15-15, or in a common law collection action in Superior Court. Id. at 353. If a claim by a medical provider was asserted in Superior Court while a related claim by an injured worker was pending in the Division, the medical provider action was to be transferred to the Division to facilitate the resolution of all claims in a single forum. Id. at 352.

The 2012 Amendment to N.J.S.A. 34:15-15 changed existing law by vesting exclusive jurisdiction for any disputed medical charge arising from any claim for compensation in the Division, thus eliminating the option to pursue a common law collection action in Superior Court. The 2012 Amendment also changed existing law by providing that fees for treatments authorized by a workers’ compensation carrier shall not be charged against or collectible from the injured worker. Prior to the 2012 amendment, there was no statutory prohibition against a medical provider asserting its common law contractual right to payment for services provided. In the event the workers compensation carrier failed to make payment, or as is more common, made only a partial payment, and the petitioner settled its compensation claim without providing for payment of outstanding medical bills, the petitioner was exposed to potential liability for the balance. The 2012 amendment eliminated the practice of “balance billing” by requiring the medical provider to seek payment exclusively from the workers compensation carrier, with no contribution from the employee. With respect to medical provider claims covered by the 2012 Amendment, the statute thus significantly altered the medical provider’s rights by making a claim against the employer and its workers compensation carrier in the Division pursuant to N.J.S.A. 34:15-15 the exclusive remedy of the medical provider, supplanting its right to pursue its common law remedies in Superior Court.

Learning from others and seeking to find information is the first step to success. Whether you need questions answered about Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance., Callagy Law is here to assist you every step of the way. We are headquartered in Paramus, NJ and we are full service law firm that specializes in serving businesses, healthcare providers and individuals. Sean Callagy has assembled a team of attorneys that are exceptional leaders in their legal expertise and have been commended for providing exceptional legal services at every level. If you need a true hands of experience with a legal team, feel free to contact us at here and come meet with Sean Callagy himself. There is no substitute when it comes to working with a lawyer and law team that cares deeply about their clients. Feel free to search us on Facebook, Twitter or LinkedIn!

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Medical Provider Applications In New Jersey Workers’ Compensation Courts

Thursday, January 14, 2016

Section 20 Settlements

The purpose of this post is to help assist healthcare providers and owners with questions they have concerning their business or relevant knowledge in the field. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

Section 20 Settlements

According to N.J.S.A. 34:15-20, the parties to a workers’ compensation claim petition may settle the claim where (1) jurisdiction, liability, causality and/or dependency are disputed; (2) the parties wish to resolve the claim with a lump sum settlement; (3) the parties consent to the settlement; (4) the parties are represented by Counsel; and (5) a judge of compensation determines that the settlement is fair and just under the circumstances. Notably, once the settlement is approved, it shall have the force and effect of a dismissal of the claim petition and shall be binding on the employee and employee’s dependants. Id. Such settlements are commonly referred to as “Section 20 Settlements” based on N.J.S.A. 34:15-20. In relevant part, N.J.S.A. 34:15-20 states:

34:15-20. Dispute; submission to division; order approving settlement.

…

After a petition for compensation or dependency claims has been filed, seeking compensation by reason of accident, injury or occupational disease of any employee, and when the petitioner is represented by an attorney of the State of New Jersey, and when it shall appear that the issue or issues involve the question of jurisdiction, liability, causal relationship or dependency of the petitioner under this chapter, and the petitioner and the respondent are desirous of entering into a lump-sum settlement of the controversy, a judge of compensation may with the consent of the parties, after considering the testimony of the petitioner and other witnesses, together with any stipulation of the parties, and after such judge of compensation has determined that such settlement is fair and just under all the circumstances, enter “an order approving settlement.” Such settlement, when so approved, notwithstanding any other provisions of this chapter, shall have the force and effect of a dismissal of the claim petition and shall be final and conclusive upon the employee and the employee’s dependents, and shall be a complete surrender of any right to compensation or other benefits arising out of such claim under the statute.

Parties should be aware of the availability of Section 20 settlements when defending/pursuing workers’ compensation claims as an option to avoid protracted litigation. Indeed, Section 20 Settlements are particularly appealing where the costs of defending against or pursing a claim are not sensible in light of the value claim. However, when entering into a Section 20 settlement, the parties should be mindful of the fact that such a settlement will likely bar any subsequent claims by the petitioner and such employee’s dependants.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $175,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Section 20 Settlements

Wednesday, January 13, 2016

Section 40 Liens | Callagy Law

The purpose of this post is to help assist healthcare providers and owners with questions they have concerning their business or relevant knowledge in the field. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

Section 40 Liens

Under Section 40, a petitioner is obligated to reimburse the workers’ compensation insurance company two-thirds of whatever they paid you (temporary benefits, medical benefits and Perm benefits) less $750.00. The general theory is that an injured worker is not allowed to a “double recovery.” In Workers’ Compensation, when someone is injured on the job, the employer pays temporary disability benefits, provides medical care, and also provides permanent disability benefits based on the nature and extent of the injured worker’s permanent injuries. The employer pays this regardless of fault. However, when there is a liable third party, the law allows the employer to seek reimbursement of a portion of the benefits that they paid out from that third party.

Specifically, Section 40 (N.J.S.A. 34:15-40) provides in pertinent part: “Where a third person is liable to the employee or his dependents for an injury or death, the existence of a right of compensation from the employer or insurance carrier under this statute shall not operate as a bar to the action of the employee or his dependents, nor be regarded as establishing a measure of damage therein. In the event that the employee or his dependents shall recover and be paid from the said third person or his insurance carrier, any sum in release or in judgment on account of his or its liability to the injured employee or his dependents, the liability of the employer under this statute thereupon shall be only such as is hereinafter in this section provided.”

In Greene v. AIG Casualty Company, A-6287-11T4 (App.Div. October 16, 2013), the only published case on this issue, the Appellate Division provided that is does not matter that the compensation case is ultimately found non-compensable: the employer still can enforce its lien rights as to prior payments made. The Court went on to state that its holding is consistent with the remedial purpose of the Act by “making benefits readily and broadly available to injured workers through a non-complicated process.” Tlumac v. High Bridge Stone, 187 N.J. 567 (2006). The court said that this policy encourages employers to make prompt voluntary payments because it provides much needed medical and wage loss benefits to claimants while their claim is being investigated. In addition, the court said that its decision is consistent with the policy in New Jersey against double recoveries.

Parties should be aware of the availability of Section 40 liens when defending/pursuing workers’ compensation claims as an option to avoid protracted litigation.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $175,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Section 40 Liens | Callagy Law

Wednesday, December 16, 2015

Must Know Info For Medical Providers | Callagy Law

Providers Making The Most Out of Recovery

The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

Medical Providers are busy people, as are their patients. Doctors are (and should be) more preoccupied with treating their patients and increasing the quality of their lives, rather than dealing with administrative paperwork. That is why medical providers rely upon their office staff for assistance. In the hustle and bustle of day to day treatment of patients, some doctors pay less and less attention to the underlying business aspects of their practice. However, it is important that medical providers themselves stay informed as to how to optimally recover money for the treatment and procedures they provide.

Insurance carriers will deny a claim for many reasons – need for additional records, amended bills, etc. It could take over a year in some cases for a medical provider to be reimbursed. Obviously, this has a detrimental impact on a medical providers’ expected cash flow.

So what can a medical provider do to overcome these denials and delays? A medical provider should be aware which procedures are covered by the patient’s insurance policy. More information is also available on http://www.cms.gov and/or on the insurance carrier’s website. For instance, Medicare makes payment for an assistant at surgery when the procedure is authorized for an assistant and the person performing the service is a physician, physician assistant, nurse practitioner or clinical nurse specialist. A medical provider should try to get pre-authorization from the insurance carrier, while also being mindful of other denial issues, such as a perceived lack of medical necessity.

If a medical provider wants to proceed on a non-covered procedure, they should be aware in advance that the insurance carrier will deny payment. If a medical provider is considering charging the patient, they should be sure to have an agreement with the patient in writing prior to surgery. Billing after surgery is not always the best business policy for medical providers and may even be in violation of a contract if they are in-network with particular insurance carriers. Moreover, balance billing the patient in most cases is not permitted in PIP (Personal Injury Protection) and Medical Provider Workers’ Compensation claims.

The medical provider should specific services he or she performs in its operative report, ensuring that every CPT code in the bill correlates with the operative report. Insurance carriers will usually reference the operative report to confirm this information and will sometimes request the assistant surgeon’s medical records. A medical provider should be prepared to get involved and file multiple appeals in order to be reimbursed.

However, the most important step in the entire process occurs in the pre-surgery stage– don’t be afraid to communicate with the insurance carriers about what documents and information they need to efficiently and effectively process the claim, what procedures are authorized, and what is the expected reimbursement rate. Be sure to thoroughly document these conversations, or better yet, get it in writing.

Of course, it is very important to hire a law firm to review claims, handle appeals and proceed to litigation, as doctors are very busy with treating their patients – which is what matters most.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $175,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Must Know Info For Medical Providers | Callagy Law

Wednesday, December 9, 2015

The NJ Workers’ Compensation Act | Callagy Law

Examining the Exclusive Remedy Provision of New Jersey’s Workers’ Compensation Act

The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

In view of N.J.S.A. 34:15-8, it has been understood that the Division of Workers’ Compensation (“the Division”) is vested with exclusive jurisdiction over claims arising out of employment related injuries. In relevant part, N.J.S.A. 34:15-8 states:

34:15-8. Election surrender of other remedies. Such agreement shall be a surrender by the parties thereto of their rights to any other method, form or amount of compensation or determination thereof than as provided in this article and an acceptance of all the provisions of this article, and shall bind the employee and for compensation for the employee’s death shall bind the employee’s personal representatives, surviving spouse and next of kin, as well as the employer, and those conducting the employer’s business during bankruptcy or insolvency.

If an injury or death is compensable under this article, a person shall not be liable to anyone at common law or otherwise on account of such injury or death for any act or omission occurring while such person was in the same employ as the person injured or killed, except for intentional wrong.

In a recent case, the New Jersey Supreme Court found that the Superior Court had jurisdiction to make a threshold determination as to whether an injured worker was an employee or an independent contractor. See: Estate of Kotsovska v. Liebman, 221 N.J. 568 (2015). The Liebman case involved a wrongful death action brought by the estate of the deceased worker. At issue was whether the decedent was an employee or independent contractor. Significantly, the estate had not filed a petition with the Division. The Court held that when “there is a genuine dispute regarding the worker’s employment status, and the plaintiff elects to file a complaint only in the Law Division of the Superior Court, the Superior Court has concurrent jurisdiction to resolve the dispute.” In its analysis, the Court emphasized that “there was no claim pending before the Division over which it could assert jurisdiction.” The Court further reasoned that the doctrine of primary jurisdiction was inapplicable on the grounds that the question of a worker’s employment status is often determined by trial judges and juries, the Division is in no better position than the Superior Court to determine a worker’s employment status, and there was no risk of inconsistent rulings because a petition had not been filed with the Division.

It is expected that this decision will result in increased filings of workplace injury lawsuits in the Superior Court where the worker is claiming to be an independent contractor to avoid some of the limitations on redress in the Division.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Feel free to search us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

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The NJ Workers’ Compensation Act | Callagy Law

Wednesday, December 2, 2015

A History of Workers’ Compensation: Part II | Callagy Law

The 1900’s.

Click Here to Read Part I.

Although Workers’ Compensation reform took root in Europe during the late 19^th century, it would take several decades later before the United States adopted the concept. During the 1900s, a group of authors known as the “muckrackers” focused their writing on the experiences of the common man, government and business corruption, and social change. One of these muckrackers, Upton Sinclair, wrote The Jungle. The novel detailed the deplorable working conditions of a slaughterhouse in Chicago. Although the intention of the book was to call attention to the need to improve working conditions, its immediate effect on the public led to the passage of the Food and Drug Act of 1906.

Nevertheless, public support for workers’ compensation reform continued to increase during the 1900s. Several states made attempts to pass comprehensive workers’ compensation acts. In 1908, President Taft put into law the United States’ first workers’ compensation system for workers involved in interstate commerce. The decentralization of labor law in the United States created a barrier to nationwide reform. Manufacturers argued that although they were ready for change, state by state regulation would create unfair competitive advantages. In 1910, a conference was held in Chicago to address this issue. Representatives from all industrial states gathered to create a uniform set of compensation laws. The first of these laws was passed in Wisconsin in 1911 and expanded to most other states shortly after.

In its inception, workers’ compensation received criticism from medical professionals as an attempt to control fees. However, this opinion changed when Social Security Disability Insurance was created during the 1930s. The program generated a greater demand for medical services and proved to be profitable for the medical profession.

The workers’ compensation system in the United States follows the Prussian model of the late 19^th century. It is a no fault system that provides security for employees and shields employers from tort liability. An injured worker may sue third parties responsible for their injuries, but recovery from these suits must compensate the workers’ compensation carrier. Workers’ compensation plans are either funded by the employer through an insurance carrier or self-insurance account. Although the Workers’ Compensation system has remained largely unchanged through the decades, in 1990, the American with Disability Act (ADA) required employers to provide “reasonable accommodation” for disabled workers.

The Team at Callagy Law hopes the information in this article was helpful in either your personal or professional life. The legal world pertains to all walks of life and more specifically, various types of healthcare providers. Callagy Law, is a multidisciplinary law firm, headquartered in Paramus, NJ owned and operated by Sean Callagy. We are committed to providing legal representation and advice to our clients at additional law offices located across the United States. Please note that the information posted here should not be used as a legal argument of defense. If you find yourself needing legal advice pertaining to your unique situation, you can contact us at here. Feel free to search us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Click Here to Read Part I.

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A History of Workers’ Compensation: Part II | Callagy Law

Wednesday, November 18, 2015

When is an Injury Covered by Workers’ Compensation?

New Jersey Workers’ Compensation and the New Jersey Division of Risk Management | Helpful Information from the Callagy Law Team

The State of New Jersey is self insured for Workers’ Compensation pursuant to N.J.S.A. 34:15 and all such matters are handled by the “Division of Risk Management”. Workers’ Compensation is legislation to insure that employees injured on the job will be paid without regard to fault. The effect of the compensation statute on the covered “employee” is to take away the employee’s common-law remedies against the “employer” and to substitute in a remedy that requires the employer to pay the compensation benefits stipulated in the statute. The right to pay the compensation is the covered employee’s exclusive remedy against the employer.

In understanding this rule, the State of New Jersey is self-insured for Workers’ Compensation pursuant to N.J.S.A. 34:15-1, et. seq. All matters regarding case management and investigations are handled by the Division of Risk Management. All workers’ compensation obligations, including payments for medical treatment, temporary and permanent disability, are approved and processed by N.J.S.A.34:15-7 and N.J.S.A.34:15-43.

In order to be eligible for worker’s compensation, the first inquiry by the Division of Risk Management is whether the injury arose out of or in the course of the employee’s employment. If the injury is deemed compensable in nature, the injured worker is entitled to the full benefits of worker’s compensation. When medical treatment is warranted, the treatment is fully governed by the State of New Jersey, through the medical management facility, Horizon Casualty Services, Inc. If the injury results in lost time from work, the employee could receive monetary benefits through worker’s compensation, as well. The benefit is based on 70% of the employee’s base salary at the time the injury occurred, however, cannot exceed the rate that is allotted for the year, in question. The amount of the award is based on the percentage of disability that governs the injured body parts in question.

A reported injury is covered under workers’ compensation if the injury is a direct result of the employee’s employment and falls under the guidelines pursuant to N.J.S.A. 34:15-1, et. seq. A work related injury is an injury which occurs out of and in the course of State employment. “In the course of employment” is defined as when “employees are at their place of work, during the hours that they are expected to be there and engaged in doing the task that they were employed to do.” The employee could be traveling outside of the office. Overtime is also included. Moreover, the accident must result in “bodily injury.” Finally, the injury must be the proximate result of the accident the employee sustained. The employee may not recover benefits if there is no such causal relationship.

Under the Workers’ Compensation Statute (34:15-17), unless the employer shall have actual knowledge of the occurrence of the injury, or unless the employee, or someone on his behalf, or some of the dependents, or someone on their behalf, shall give notice thereof to the employer within fourteen (14) days of the occurrence of the injury, then no compensation shall be due until such notice is given or knowledge obtained.

You must notify the Division of Risk Management with your report of incident/accident within 24 hours of such knowledge, especially if there is a direct need for medical treatment. If no medical treatment is warranted, you are required to keep the report on file.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Feel free to search us on Facebook, Twitter or LinkedIn!

Learn More About Callagy Law Here:

When is an Injury Covered by Workers’ Compensation?

Wednesday, November 4, 2015

Don’t Let Your Claims Expire: Statute of Limitations on Workers Compensation Medical Provider Claims

In 2012, N.J.S.A. 34:15-15 was amended to give the Workers Compensation Court exclusive jurisdiction over medical provider claims. Prior to 2012, it was clear that the statute of limitations for a medical provider’s claim was the six-year statute set forth in N.J.S.A. 2A:14-1, which applies to all actions of a contractual nature, express or implied, and all actions to recover on an account. Although it is unclear whether a two-year statute of limitation applies to medical provider claims filed after 2012, medical provider claims arising from events prior to the establishment of exclusive jurisdiction should carry a six-year period. The Appellate Division clearly held that the six-year period applied to the medical provider’s claim in Medical Diagnostic Assocs. v. Hawryluk, 317 N.J. Super. 338, 349 (App. Div. 1998), certif. denied, 160 N.J. 89 (1999), stating:

Finally, we deem it appropriate to discuss the statute of limitations issue in the event the Division determines that the employee’s claim is not compensable. Plaintiff asserts that if medical providers are not allowed to bring suit in the Law Division, there is the potential that their claims will be barred by the statute of limitations. The statute of limitations is six years. See N.J.S.A. 2A:14-1. We note that there is no statutory provision tolling the statute of limitations on the medical provider’s claim while an employee’s claim is pending in the Division. We are satisfied, however, that if a medical provider’s suit is transferred to the Division, as we hold today, the complaint will have been timely filed. In future cases in which the medical provider proceeds directly in the Division the statute of limitations will be tolled during the period that the matter is pending in the Division. Ibid. (emphasis added)

In Hawryluk, the Appellate Division transferred the medical provider’s claim to the Division and held that the statute of limitations for the claim was six years. In Univ. of Mass. Mem’l Med. Ctr. v. Christodoulou, 180 N.J. 334, 345 (2004), the Supreme Court overruled Hawryluk on the necessity of transferring the medical provider’s claim to the Division for a judgment of non-compensability before a Superior Court action could be filed, but did not alter its holding with respect to the statute of limitations. Although the Legislature subsequently amended N.J.S.A 34:15-15 to give exclusive jurisdiction to the Division for medical provider claims, eliminating the Superior Court option, there is no reason to suggest that the Legislature also intended to change the statute of limitations. The statute remains six years, as it does in all collection cases of a contractual or quasi-contractual nature.

A two-year statute would unfairly prejudice medical providers who rendered services to injured employees and were entitled to rely on the six-year statute in managing collection activity on their unpaid accounts. It would deprive medical providers of their property interests without any basis in a duly enacted statute. It would also unjustly enrich insurance carriers who collected premiums to pay for patients’ medical bills, then deliberately underpay for services rendered to those patients.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $175,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally Callagy Law has some great reviews and is working hard to be a leader in multiple fields of the legal profession.

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Don’t Let Your Claims Expire: Statute of Limitations on Workers Compensation Medical Provider Claims

Wednesday, October 28, 2015

Medical Provider Applications In New Jersey Workers’ Compensation Courts

What is “Usual, Reasonable and Customary” When There is No Fee Schedule for Healthcare Providers?

The following article was written by Callagy Law’s Legal Team and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

Many may not be entirely aware, but the New Jersey Workers’ Compensation courts provide a forum for healthcare providers to challenge inadequate reimbursements from workers’ compensation insurance carriers where the underlying claim is for a patient injured within the course of their employment. When a healthcare provider files its application with the Workers’ Compensation court, it seeks to obtain additional payment for treatment that was authorized and provided to the injured worker. However, there is no fee schedule in place for workers’ compensation healthcare providers. In these medical provider claims, the issue typically is not a contractual one; instead, the issue often is what constitutes the usual, customary and reasonable charges (or “UCR”) and the payment that should be made for a given medical service rendered to an injured worker. When determining UCR, it is appropriate to look at a myriad of factors including but not limited to paid fees and all payments made to the carrier by commercial and non-commercial carriers.

The New Jersey Workers’ Compensation Court recently issued an opinion in the matter of Burn Surgeons of St. Barnabas v. Shop Rite concerning the payment of medical treatment in the context of a New Jersey workers compensation case. In adopting the reasoning in Coalition for Quality Healthcare v. New Jersey Department of Banking and Insurance, 358 N. J. Super. 123 (App. Div. 2003), Judge Dietrich in Burn Surgeons accepted that it is appropriate to use paid fees rather than billed fees to make a determination as to the usual and prevailing fees in billing. Judge Dietrich also accepted that there is a “balancing act between the attempts to contain costs while providing for a fair level of reimbursement for services rendered.”

Further, according to Task Force Report on Medical Provider Claims submitted on November 5, 2010, there are many factors that a Judge may consider in determining the UCR of a given medical treatment and the appropriate payment for said treatment. While the following is not exhaustive, the Report provided that considering the following can act as a useful guide for the parties to consider in presenting proofs and likewise, to the jurist, in deciding a case: the fees customarily paid for like services within the same community; the fees paid to the same physician or medical provider by other payers for like treatment; the fees billed and the accepted payments for such bills by a given provider; the disparity in payments accepted from different sources (i.e. Medicare vs. PIP and commercial carriers); using commercial and/or private databases such as Ingenix’s Prevailing Healthcare Charges System (“PHCS”); the Medical Data Resource (“MDR”) database, and; Wasserman’s Physician Fee Reference (“PFR”) database to name a few.

As also promulgated by the Medical Provider Committee Report on December 9, 2014, UCR can be determined by looking to many programs: Fair Health Allowed Module, New Jersey Personal Injury Protection Fee Schedule, Provider/Carrier Commercial Payments, CMS, Wasserman Fee Schedule, , Pennsylvania Workers Compensation Fee Schedule, the New York Workers Compensation Fee Schedule, Federal Workers Compensation Fee Schedule, and any other probative evidence of paid charges received and accepted by the Medical Provider or paid by the carrier.

What This Means for Healthcare Providers

Under the Burn Surgeons case, when determining the amount of money to be charged for authorized medical treatment in a work-related injury, healthcare providers should use universally adopted databases, codes, and modifiers in order to determine whether the payments conform to UCR standards.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Feel free to search us on Facebook, Twitter or LinkedIn!

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Medical Provider Applications In New Jersey Workers’ Compensation Courts