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Find Solutions & Strategies January 17, 2011 |
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Workers' Comp Waste & Gaming the System Alleged
U.S. Senator calls for thorough review of Federal Employees' Compensation Act | |
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A Note From the Editor |  | Dear WC Professionals:
If you would like to see more coverage of certain issues in our eNewsletter, please let me know. Sincerely, Robin E. Kobayashi, J.D.
LexisNexis Editorial & Content Development
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Workers' Comp Cost Reduction: Free Newsletter |
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Workers' Comp Profile |
Workers' Comp Insider, published by Lynch Ryan. Consistently at the top of the heap when it comes to workers' comp blogs, the Workers' Comp Insider is a rare combination of breadth and depth. Now in its eighth year, the Insider covers comp issues, risk management, business insurance, and workplace health and safety from Anchorage to Miami. It provides in-depth analysis concerning workplace legislation, occupational medicine, and best practices from Maine to Hawaii. It should be in the "favorites" folder of every comp attorney's web browser.
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Articles on AMA Guides |

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federal workers' comp |
Senator Collins suspects some recipients gaming the system, seeks reforms to bring overly generous federal system in line with states
WASHINGTON, D.C. - U.S. Senator Susan Collins, Ranking Member of the Homeland Security and Governmental Affairs Committee, has called for a thorough review of the program that provides federal employees with protection against loss of income from work-related injuries. The Federal Employee Compensation Act (FECA) pays benefits to roughly 49,000 federal employees to ensure that injured employees receive income while they recuperate pending their return to work. Senator Collins asked the Government Accountability Office to audit FECA and report on the length of time individuals remain on the program, the number of recipients who exceeded the standard federal retirement age, and how the federal program compares to state workers' compensation best practices. Senator Collins also asked GAO to compare records against the Death Master File and the civilian payroll database to search for deceased individuals receiving benefits or recipients "double dipping." > Read more |
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us supreme court: medical residents |
Medical Residents: Are They Workers Who Study or Students Who Work? by Thomas A. Robinson. Reconciling the definition of "employee" found in the Federal Insurance Contribution Act (FICA), which generally excludes any service performed in the employ of a school, college, or university "if the service performed is performed by a student who is enrolled and regularly attending classes at [the school]," [26 U.S.C.S. § 3121(b)(10)] and a 2004 Department of Treasury regulation providing that the services of a full-time employee-including an employee normally scheduled to work 40 hours or more per week-are not incident to and for the purpose of pursuing a course of study [26 CFR § 31.3121(b)(10)-2(d)(3)(iii)], the United States Supreme Court, on January 11th, affirmed a decision by the Eighth Circuit Court of Appeals and held that medical residents who generally work more than 40 hours per week are employees of the hospital or medical school where they perform their services and are not "students" for purposes of FICA, in spite of the fact that their services may have an educational, instructional, or training aspect. Accordingly, as their employer, the hospital or medical school must pay FICA taxes on their earnings. > Read more
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congressional hearing: ama guides |

Congress Holds Hearing on Developments in State Workers' Compensation Systems, Including Sixth Edition of AMA Guides to Permanent Impairment, by Mark A. Reinhalter, Counsel for Longshore, Office of the Solicitor, U.S. Department of Labor, Washington, D.C. Workers' compensation benefits are generally governed by state law and ordinarily draw little attention from the federal government. During the recent lame-duck session of Congress, however, a subcommittee of the House Education and Labor Committee held a hearing to address developments in state workers' compensation systems. The hearing explored matters of interest to workers' compensation practitioners of all types. Moreover, in addition to the hearing, Congress has requested a Government Accountability Office study which could spur federal action that could impact state compensation systems. > Read more |
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Larson's spotlight: 5 recent cases you should know about |
Larson's Spotlight reports noteworthy workers' comp cases each week. This list was c ompiled by Thomas A. Robinson, a staff writer for Larson's Workers' Compensation Law, the nation's leading authority on workers' compensation law.
#1 - OR: Oregon Supreme Court Approves Punitive Damage Award In Retaliatory Discharge Case That Was 30 Times Greater Than Compensatory Damages #2 - NY: Judge's Refusal to Allow Development of Record by Employer Was Prejudicial
#3 - OH: Employee Struck by Co-Worker's Vehicle in Company Parking Lot After Clocking Out May Not Sue Co-Worker for Negligence
#4 - PA: State Trooper's Post Traumatic Stress Disorder Associated With Investigation of Infant's Murder Was Not Abnormal Working Condition
#5 - NY: Child Support Investigator's Stress Claim Fails Where She Failed to Show Her Stress Levels Exceed That of Other Similar Workers
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top 10 must-reads in the blogosphere & beyond |
We recommend the following workers' comp-related articles recently posted in the Blogosphere and Beyond:
1. The Irrelevancy of Comp, by David DePaolo, WorkCompCentral.
2. Physician dispensing in work comp - worse than you think, by Joe Paduda, Managed Care Matters blog.
3. Five Commonly Asked Questions About Bipolar and Workplace Disability Benefits, by Robert Elliott, Workers' Comp Kit Blog.
4. Political Battle on Illegal Immigration Shifts to States, by Julia Preston, The New York Times.
5. Wii-habilitation Therapy - A Growing Trend, by Yvonne Guibert, Work Comp Complex Care Blog.
6. The Unusual Coalition [Compound Drugs in California], by Julius Young, WorkersComp Zone blog.
7. Are Fusion Surgeries Costing Workers and Employers More Than They're Worth? by Philip J. Fulton, Columbus Workers' Compensation Law Blog.
8. Are Fusion Surgeries Costing Workers and Employers More Than They're Worth? Part 2, by Philip J. Fulton, Columbus Workers' Compensation Law Blog.
9. New Drug May Be Effective Against Mesothelioma, by Jon L. Gelman, Workers' Compensation blog.
10. Can Sitting Too Much Kill You? by Travis Saunders, Scientific American guest blog. |
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blog round up at the lexisnexis workers' compensation law community |
Workers' Comp Fraud Blotter - Recent Arrests, Charges, Convictions, Investigations - 1/13/2011. Read it.
 Keep 'em Comin' - Fines in Delaware Now on a Roll..., by Cassandra Roberts. Read it. Texas 82nd Regular Legislative Session Proposed House Bill and Senate Bills Affecting Workers' Compensation, by Stuart Colburn. Read it.
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how to achieve medicare secondary payer compliance
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Take Control of Your Insurance Settlements With A Brand New Resource From LexisNexis!
"Finally, someone delivers a clear, concise reading in this area, with some definitive answers for both lawyers and claims specialists and accurate reporting dealing with MSP compliance and MSA allocations with all of the necessary resources found in one place."
"An excellent new book ... a one-of-a-kind resource ... [Jennifer C. Jordan's] straight-talk is much appreciated when it comes to this illusive area of the law."
- Rebecca Shafer, JD, President, Amaxx Risk Solutions, Inc. Read her complete review at Workers Comp Kit Blog.
There are many people who don't understand that the Centers for Medicare and Medicaid Services' approval process of a Medicare set-aside arrangement is voluntary and carries an inherent cost. In fact, many of the decisions that need to be made in a settlement negotiation are risk management decisions rather than being truly Medicare Secondary Payer-oriented. Once you understand why CMS wants what it wants, you will realize that its preference may not be the only way to achieve MSP compliance. The Complete Guide to Medicare Secondary Payer Compliance, Jennifer C. Jordan, Editor-in-Chief, will help you take control of your insurance settlements. > Read more about the contents (1,350 pages). List Price: $179
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workers' comp waste (CONTINUED) |
"I am increasingly concerned that individuals with no intention of returning to work continue to receive these benefits," said Senator Collins. "At the U.S. Postal Service, for example, 1,000 employees currently receiving federal workers' compensation benefits are 80 years or older. Incredibly, 132 of these individuals are 90 and older and there are three who are 98. This abuse may extend across the government where the Department of Labor regularly pays benefits to employees in their 70s, 80s, 90s, and even 100s. The lack of benefit caps and requirements for regular third-party certifications of continued need further expose the FECA program to possible fraud. If recipients are gaming this crucial benefit at taxpayers' expense, they must be exposed and the underlying program must be reformed."
FECA is more generous than federal retirement since on average employees on FECA receive nearly three quarters of their gross pay, tax-free. Under FECA, there also is an annual cost-of-living adjustment. By comparison, a federal employee with 30 years of service would retire under CSRS with an average of just over 56 percent of his or her gross pay, which is taxed. Under this scenario, a retired federal employee would receive 27 percent less annually than a comparable federal employee on FECA. FECA has no limits on the amount of time spent in the program or the amount of money given to recipients. FECA has no caps or cut-off periods, which is why there are reported cases of recipients in their 90s and 100s still receiving workers' compensation benefits.
Source: Office of Senator Susan Collins (ME) |
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what's new in larson's workers' compensation law |  Lexis.com subscribers to Larson's Workers' Compensation Law can link to the chapter discussion below. Find out more about how to become a Larson's online subscriber by contacting: Robin.E.Kobayashi@lexisnexis.com.
No Compensation For Mental Injury Caused by Student's Practical Joke. In Delrie v. Peabody Magnet High School, 2010 La. App. LEXIS 837, a Louisiana appellate court affirmed a decision by the state's Office of Workers' Compensation which found in favor of the employer and dismissed the claim of a high school teacher who claimed to have sustained a compensable mental injury when a student, as a practical joke, entered her room, claiming that people were shooting inside the school. [See Ch. 56, § 56.04[2] n22.1]
Bank Employee Awarded Benefits for Mental Injury Following Robbery. An Ohio bank employee, who was present at the time of an armed robbery, who did not sustain any physical injury as a result of the incident, but who claimed psychological injuries resulting from witnessing a police officer being shot to death, may recover workers' compensation benefits in spite of the restrictive rule in Ohio regarding mental injuries, indicated an Ohio appellate court. [See Rader v. Fifth Third Bancorp, 2010 Ohio 1327, 2010 Ohio App. LEXIS 1110; Ch. 56, § 56.04[1] n19.1]
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