Callagy Law Arizona: workers compensation

Showing posts with label workers compensation. 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

Friday, March 4, 2016

Worker"s Comp Claims|Statute of Limitations (Part I)

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.

Typically, under New Jersey Worker’s Compensation law, most claim petitions filed on behalf of an injured worker must be filed within either two years from the date of the injury or two years from the last payment of compensation, whichever is later. Payments of compensation can also include payment to a medical provider for authorized medical services. So, if an employee is injured in a work related accident and receives treatment authorized and paid for by the employer [or its insurance carrier], or receives disability benefits from the employer [or its insurance carrier] the Workers’ Compensation Claim Petition has to be filed within two years of the last payment or the last treatment received from the medical provider which was paid for by the employer or its carrier. Simply put, if an employee is injured on the job, the claim has to be filed within two years of the date of the accident or filed within two years from the last date of treatment or the last payment of disability.

In those other cases where an employee alleges that they developed an injury or illness developed over time as a result of the conditions of their employment, otherwise known as an “occupational injury”, ie: the law provides that these claims must also be filed within two years, but two years from when the employee knew or should have known that the injury or illness was connected to their employment. So for example, if an employee was to develop mesothelioma, which often may not appear for 20-50 years after exposure to asbestos, and the exposure was connected to the employee’s job, then the employee would have two years from diagnosis to file a claim.

In sum, injured employees generally have either two years from the date of an accident, or two years from the last payment of compensation to file a worker’s compensation claim, and employees who suffer an occupational injury have two years from when they knew or should have known that they developed an illness or injury related to their 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.

Learn More About Callagy Law Here:

Worker"s Comp Claims|Statute of Limitations (Part I)

Wednesday, February 24, 2016

Establishing Usual/Customary Rates in Workers Compensation

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.

In New Jersey, the Department of Labor and Workforce Development oversees Workers’ Compensation. Petitioner medical providers may file a claim to recover payments denied by the insurance carrier, a self-insured corporation, or a third party administrator.

Pursuant to N.J.S.A. 34:15-15, Medical and hospital service, “… All fees and other charges for such physicians’ and surgeons’ treatment and hospital treatment shall be reasonable and based upon the usual fees and charges which prevail in the same community for similar physicians’, surgeons’ and hospital services.” Because there is no workers’ compensation fee schedule in New Jersey, establishing usual, customary and reasonable fees are central to seeking additional reimbursement in a workers’ compensation claim.

Under New Jersey law, a medical provider, not an insurance carrier, “establishes [the provider’s] own customary rate.” Cobo v. Market Transition Facility, 293 N.J.Super. 374, 389 (App. Div. 1996). While an insurance carrier may review the medical provider’s fee to ensure that it has billed at its usual and customary rate, the provider is entitled to its billed rate so long as it is reasonable. (See: Id. at 386). (emphasis added) In determining the reasonableness of a medical provider’s fee, courts look to a number of factors, including the following: 1) the subject provider’s billing history, 2) disparity in charges to different insurance carriers, 3) what other providers are charging for the service. (See: Id. at 387).

The Court in Cobo, citing 24 NJR 1348 further stated, “The provider, in submitting the billings, makes the initial determination as to what his or her usual, customary and reasonable fee is….thus, the scheme envisions that the health care provider will set its own customary fee, not the insurer or the insurer’s auditor.”

One way for a medical provider to establish usual, customary and reasonable fees is with exemplar Explanation of Benefit forms from insurance carriers and third party administrators indicating the usual and customary rate billed by the petitioner medical provider (and other medical providers) for the appropriate CPT Codes which had been reimbursed at 100%. Specifically, the Explanations of Benefit forms demonstrate the consistency of a petitioner medical provider’s billing practices by documenting, regardless of insurance carrier or third party administrator, the usual and customary rates charged for the CPT Codes at issue. Providing such Explanation of Benefit forms may expedite settlement negotiations.

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Establishing Usual/Customary Rates in Workers Compensation

Wednesday, February 10, 2016

The Issue with Time | Callagy Law

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 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 time period / 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 in a time 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 time 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 / time period 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 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.

Learn More About Callagy Law Here:

The Issue with Time | Callagy Law

Monday, January 18, 2016

Upcoming Shortage of Physicians | Callagy Law

Difficulties Facing the American Healthcare System – What You Need To Know!

There are many difficulties facing the American healthcare system, but perhaps chief among them is a possible shortage of physicians. The Association of American Medical Colleges (AAMC) predicts that an approximate shortage of 90,000 – 130,000 physicians will occur in the US by the year 2025. There are many factors contributing to this problem, including inadequate enrollment in medical schools.

Many new allopathic (M.D. granting) and osteopathic (D.O. granting) medical schools have been established in recent years, with overall medical school enrollment expected to increase by 30% by 2019. New Jersey has recently started Cooper Medical School of Rowan University and Seton Hall School of Medicine to help meet the health care needs and many other states are following suit.

While increasing the number of medical schools would help to alleviate this shortage, perhaps a more important and overlooked issue is reduction in the fund of residency positions. A residency is a multi-year education program medical school graduates must complete before they can become practicing physicians or surgeons. In 1997, Congress capped the number of Medicare-supported residency positions. In other words, even if we add medical school graduates by increasing the number of medical schools, we will not add to the number of practicing physicians unless we also add to the number of residency training programs. A bill was introduced that would increase residency positions in 2012, but Congress has yet to act on the bill.

The AAMC urges all Americans to rally for support of this bill, and while it will not entirely fix the projected physician shortage, it seems to be a step in the right direction.

Sources

http://www.ama-assn.org/ama/pub/news/news/2015/2015-03-05-ama-applauds-congress-modernize-graduate-medical-education.page

https://www.aamc.org/newsroom/newsreleases/305476/120928.html

https://www.congress.gov/bill/112th-congress/house-bill/6562

https://www.aamc.org/newsroom/newsreleases/431036/20150430.html

Photo Credit: www.vox.com

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:

Upcoming Shortage of Physicians | Callagy Law

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 6, 2016

Section 20 Settlements | Callagy Law

Section 20 Settlements

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

…

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 | 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.

Learn More About Callagy Law Here:

The NJ Workers’ Compensation Act | Callagy Law

Wednesday, November 25, 2015

A History of Workers’ Compensation: Part I

Workers’ Compensation, Defenses and the History Behind It All

The history of workers’ compensation law has its roots in Sumaria, circa 2050 B.C., where the laws of King Ur-Nammu compensated workers for injuries to specific body parts. Many ancient civilizations such as the Babylonians, Greeks, Romans, Arabs and Chinese followed suit and also provided scheduled compensation for worker injuries. Under these systems, compensation was commensurate to the injured body part.

During the middle ages, the ancient systems of workers compensation gave way to the whim of the feudal lord. Payment for injury was left entirely to the discretion of the noble class. The development of the common law system in the 17^th century provided workers with some reprieve, however, they were still subject to three anti-worker defenses: 1) Assumption of Risk; 2) Fellow Servant Rule and; 3) contributory negligence.

Under the “assumption of the risk” defense, employees assumed the risks inherit in their jobs. Although, employers were required to provide industry standard safety measures, worker safety was an afterthought in many industries prior to the 20^th century. Furthermore, many workers were forced to sign “worker’s right to die” contracts as a condition of employment. These contracts forfeited the worker’s right to sue for injury. The “fellow servant rule” held employers not liable if the injury was caused in part by the negligence of another worker. Under the contributory negligence defense, an employee was not liable if the injury was caused by any negligent act on the part of the injured worker. These defenses were known as the “unholy trinity” and made recovery practically impossible. Additionally, a worker’s only recourse was through an expensive court system that was out of reach for the common man.

The framework of the modern worker’s compensation system does not come about until the late 19^th century from an unexpected source. Otto von Bismarck was chancellor of the Prussian empire during the latter half of the 19^th century. His political policies led to the persecution of opposition parties such as the Marxists and Socialists. However, in order to prevent rebellion, Bismarck adopted some socialist programs that expanded protection for workers. In 1884, he created Workers’ Accident Insurance. An important advancement in Bismarck’s reform was that the system was the exclusive remedy for workers’ compensation matters.

By the end of the century, other European nations adopted the Prussian workers’ compensation model. In the 1880s, the United Kingdom abolished the unholy trinity of defenses. However, “right to die” contract still prevented significant progress. It was not until 1894 that the United Kingdom adopted the Prussian no fault system. Change in the United States was still a decade away.

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.

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A History of Workers’ Compensation: Part I