National Edition Banner March 2010
Vol 2, Issue 20

Find Solutions & Strategies                               May 16, 2011

FaceInjured Worker Becomes First Person in U.S. to Receive Full Face Transplant

 

The 25-year-old construction worker suffered catastrophic electrical burns to his face

In This Issue
-FACE TRANSPLANT
-MEDICAL FOODS
-P&C INSURANCE
-LARSON'S SPOTLIGHT: 5 RECENT CASES: Firefighters and Cancer, Medical Causation, Fact Finder, Spider Bite, Fraud
-BLOGS @ LEXISNEXIS WORKERS' COMP COMMUNITY: Fraud, DE cases, MSP
-MSP COMPLIANCE BOOK
-NATIONAL NEWS
-STATE NEWS
-WHAT'S NEW IN LARSON'S: Tort claim
-eNEWSLETTER ARCHIVES
A Note From the Editor
Robin Kobayashi 2010

Dear WC Professionals:

 

Thank you to our eNewsletter subscribers who have been sending us news tips. We have more interesting articles on the way... 

Sincerely,
Robin E. Kobayashi, J.D.
LexisNexis Editorial & Content Development
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injured worker's face transplant

Utility LinemanAccording to The Perecman Firm, "A 25-year-old construction worker who suffered catastrophic electrical burns to his face became the first person in the U.S. to receive a full face transplant in March. Dallas Wiehs was operating a boom lift in 2008 when it came into contact with an overhead power line. The construction accident cost Wiehs' most of his face, including both of his eyes, nose and eyebrows. He spent three months following the accident in a coma and underwent more than 20 surgeries to try to repair some of the damage...." Read more.

medical foods & workers comp

Medical FoodNew Progressive Medical White Paper Addresses Medical Foods in Workers' Compensation. Progressive Medical, Inc. released a new white paper, "Managing the Medical Foods Dilemma." The white paper addresses the increasing role medical foods play in workers' compensation and the surrounding concern due to lack of conclusive clinical evidence to validate medical foods' effectiveness. The paper also offers insight to how payors can proactively control utilization of medical foods and manage expenses. Read more.

property & casualty insurance

P&C Insurance

Robert P. Hartwig, President, Insurance Information Institute, in a report entitled "Out of the Abyss: Growth, Challenges and Opportunities in the Post-Crisis World," at NCCI's annual issues symposium on May 5, 2011, presented a mixed picture of present and future conditions of the property and casualty insurance industry. Noting that uncertainty, risk, and fear abound, and citing natural disasters over the past year, the political upheaval in the Middle East, the recession and its long, slow recovery, among other challenges, Hartwig began by asking whether we are, in fact, crawling out of the abyss or falling into a new one. Read more

Larson's spotlight: 5 recent cases you should know about

5 spotlightLarson's Spotlight reports noteworthy workers' comp cases each week. This list was compiled by Thomas A. Robinson, a staff writer for Larson's Workers' Compensation Law, the nation's leading authority on workers' compensation law. 

 

Tom Robinson thumbnail 

 

 

 > Read the summaries & court decisions.

 

1. AZ: Firefighter Must Come Forward With Evidence That Carcinogen Was Reasonably Connected to Cancer in Spite of Statutory Presumption of Compensability

 

2. FL: Non-Physician Toxicologist's Testimony May Not Be Used to Establish (or Deny) Medical Causation

 

3. NC: Industrial Commission, Not the Deputy Commissioner Hearing the Case, is the Ultimate Fact-Finder

 

4. VA: Risk of Spider Bite Not Peculiar to the Work Environment-Claim Fails

 

5. US:  Licensed Message Therapist's Conviction of Workers' Compensation Fraud Upheld

blog round up at the lexisnexis workers' compensation law community
Fraud SignWorkers' Comp Fraud Blotter - Recent Arrests, Charges, Convictions, and Investigations (5/12/2011). Read it.
  
  
  
  
Cassandra RobertsThe Original Hoey Displaced Worker: Jewell Hoey Is Still Good Law Here In the First State, by Cassandra Roberts, Esq. Read it.
  
  
  
  
Mark PopolizioThe U.S. Attorney's Office for the Western District of New York Releases MSP Protocol for Liability Cases, by Mark Popolizio, Esq. Read it.
  
  
  
  

Cassandra RobertsChicken Little? Not in Delaware Where Blue Hen Case Rules MSA Commutation Enforceable, by Cassandra Roberts, Esq. Read it.

how to achieve medicare secondary payer compliance

MSP Red

 

The Complete Guide to Medicare Secondary Payer Compliance

Jennifer C. Jordan, Esq., Editor-in-Chief

To order, go to www.lexisnexis.com/Medicare.

 

Medicare Secondary Payer Compliance is an elusive area of law - tucked away in various public laws, statutes, regulations and CMS guidance materials.

 

Worse, many people don't realize that the CMS approval process for MSAs is voluntary-and carries an inherent cost.

 

That's why you need this all-in-one handbook ...

 

Authored by the leading expert in the field of the MSP, "The Complete Guide to Medicare Secondary Payer Compliance" is the only available resource written by an industry insider with a deep understanding and practical knowledge about this highly complex and evolving area of the law.

 

For the first time, you'll find all relevant pieces of the law in one accessible place. And by understanding what CMS wants-and why it wants it-you'll be better able to:

Take control of your insurance settlements

Avoid pitfalls, delays and penalties

Comply with reporting requirements

 

You'll also learn that CMS' preference may not be the only way to achieve MSP compliance.

 

Attorneys agree! This is the first comprehensive resource for achieving Medicare Secondary Payer Compliance.

  

"Ms. Jordan and her contributors provide concise, practical analysis of the multiple layers and nuances of Medical Secondary Payer compliance. The Guide is a valuable resource for plaintiff and defense counsel, as well as insurance carriers, employers, and third party administrators."

 

- Ronald E. Weiss, Esq., Hamberger & Weiss, Rochester, New York. 

 

"The range of topics included in the book and updates is a beacon of wisdom in the confusing MSP compliance field."

 

- Tim Nay, Esq., Law Offices of Nay & Friedenberg, Portland, Oregon. Mr. Nay is a co-founder of the National Alliance of Medicare Set-Aside Professionals (NAMSAP). 

 

"I have a copy of Jennifer Jordan's book The Complete Guide to Medicare Secondary Payer Compliance and I am most impressed by same! I have recommended it to a number of attorneys here in Georgia."

 

- Richard C. Kissiah, Esq., Kissiah & Lay, Alpharetta, Georgia. 

 

"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."

 

- Brad Bleakney, Esq., Bleakney & Troiani. Read his complete review at Illinois Workers Compensation blog.
 

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.

 
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Implementation of the MMSEA reporting program is underway. Don't wait to order!

> Read more about the contents (1,350 pages). List Price: $179



 

national news

WCRI Releases New National Data on Medical Cost Containment Measures.

NCCI Posts Latest Gauging the Economy Newsletter.

NCCI Posts Annual Review of Legislation and Regulatory Developments.

Fibromyalgia Patients Fight Credibility Problem.

Expert Says Focus on Fitness, Not Weight, to Reduce Workers Comp Costs.

Accident Fund Holdings, Inc. Names Walsh Chief Claims Officer.

Employers Holdings Inc. Announces Management Changes.

SeaBright Holdings Declares Quarterly Dividend.

Sedgwick CMS Acquires Selective Settlements International Inc.

Domestic Workers Form Partnership With AFL-CIO.

state news

CA: Assembly Passes AB 1155 to Ban Discrimination Based on Race, Sex, Age.

CA: PERS Asks Bell to Investigate Disability Pensions, Workers Comp Settlements.

CA: WCIRB Informational Submission Under Review.

CA: Public Entities Say Bill to Create Presumption of Compensability for Nurses Would Increase Workers Comp Costs.

CO: Pinnacol Assurance Issues More Than $1.2M in Dividends.

DC: Mayor Vows to Reduce Workers Comp Costs With Return to Work Program.

FL: DWC Revises Employee Confidential Request Form.

FL: Legislature Passes Bill to Require Return-to-Work Programs for Specified Agencies.

IL: SB 1147 Workers Comp Crime Bill Awaits Governor's Signature.

IL: Judge Closes Case in Cincinnati Insurance Company Preferred Provider Organization Class Action.

IL: US District Court Upholds OSHA Subpoena in Grain Engulfment Case.

IL: IWCC Adds Review Motions to Online Case Information Screen.

IL: IWCC Welcomes New Administrators.

IL: House Speaker Renews Threat to Scrap Workers Comp System.

KS: Governor Signs HB 2076 Regarding Workers Comp Pools, Anti-Fraud, Surplus Lines.

MO: Lawmakers Disagree on How to Fix Second Injury Fund.

NE: Plan to Move Workers Comp Court to New Offices Almost Derailed by Lawmakers.

NH: Investigator Says LGC Improperly Retained Funds From Liability Programs to Subsidize Workers Comp Pool, Strategic Plan.

NJ: DWC to Hold Public Hearing for Readoption of Public Works Contractor Registration Requirements.

NC: Insurance Commissioner Asks Legislators to Support Fund for Volunteer First Responders.

OH: BWC to Cut Office Space at Youngstown Office, Not Staff.

OH: Senate to Vote Soon on Legislation to Regulate Pill Mills.

OH: BWC Reports 48% Reduction in New Claims Filings.

OH: BWC to Hold Public Hearing on Medical, Vocational Rehabilitation Rule Changes.

OK: Employer Coalition Calls for ERISA Injury Benefit Option as Alternative to Workers Comp.

OR: DCBS Searches for New Director.

OR: Medical Advisory Committee Discusses Proposed Pharmaceutical Clinical Justification Form.

PA: Senate Considers Workers Comp for Business Owners, Sole Proprietors.

PA: BWC Posts Chapter 61 Rule Changes Effective 2/12/2011.

TX: TDI Order Updates Workers Comp Rate Criteria.

WA: Governor Drafts New Workers Comp Reform Plan for Lawmakers' Consideration.

WA: Governor Signs Health Care Reform Package.

WV: State Seeks Bids on Workers Comp Insurance Coverage for State Agencies.

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what's new in larson's workers' compensation law 
Larson Volumes ResizedLexis.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.
  

Employee Tort Claim Against Employer and Coworker for Improper Dissemination of Medical Information Not Barred by Exclusivity. Finding that an employee's "injuries" resulting from improper dissemination of employee's HIV status did not arise out of her employment, a Tennessee court recently held the employee's tort action against her employer, a manager, and a coworker were outside the workers' compensation law and not barred by exclusivity [Doe v. Walgreens Co., 2010 Tenn. App. LEXIS 734 (Nov. 24, 2010)]. [See Ch. 100, § 100.04 n16.1]

P&C insurance, continued...

PC Terrorism Risk Insurance

Specifically, in light of the killing of Osama bin Laden, Hartwig addressed the question of whether we still need the terrorism risk insurance program.  His view is that it would be a serious mistake to allow the program to lapse, as currently scheduled, at the end of 2014.  Listing the numerous thwarted terrorism attempts against the U.S. in 2009 and 2010, he suggested that the "domestic/home grown terror risk looms larger today than in 2001."  He also noted that the 9/11 attacks constituted the largest workers' compensation loss-$2.2 billion-in U.S. history, and he pointed out that, in the event of a chemical, nuclear, biological, or radiation terrorist attack, or a truck bomb terrorist attack, on a major U.S. city, workers' compensation will likely amount to the largest single category of claims.

 

Natural Disasters

Turning to natural disasters, Hartwig stated that the recent earthquake/tsunami in Japan will probably turn out to be "among the most expensive in world history in terms of insured losses," amounting to around $30 billion.  While unlikely to have any direct impact on the U.S. workers' compensation markets, the Japanese disaster is simply one among many recent natural disasters, including record floods in Australia, earthquakes in Haiti, Chile, and New Zealand, unprecedented tornadoes in the U.S., and (although too recent for Hartwig to have discussed) the present flooding of the Mississippi River, that have resulted, or will result, in major catastrophe losses.  These losses, no matter where they occur, will have significant impacts on global reinsurers.

 

Recession

Hartwig reviewed the impact of the recession on the property and casualty lines, pointing out that "massive job losses sapped the economy and p/c exposure," but that the "trend is improving."  The workers' compensation premium volume began dropping, two years before the recession began, and the recession augmented that trend, with the result that net premium written fell by 29.3 percent between 2005 and 2010, from $47.8 billion to $33.8 billion.  Despite recent employment gains, stubbornly high unemployment and underemployment continue to constrain growth in workers' compensation premium.

 

With regard to the economy as a whole, Hartwig pointed out that far too few new small businesses are being created and that far too many small businesses are filing for bankruptcy, another trend that impedes growth in workers' compensation premium.  Similarly, as long as the construction industry, formerly a major source of workers' compensation premium, remains in the doldrums, premium will stagnate.  In general, of course, the insurance markets are tied to the larger economy, and, until that economy achieves sustained growth, relevant insurance premium growth will be limited.  Hartwig identified several industries "poised for growth" in which many insurers do not write.  Among these are health care, energy (both traditional and alternative), agriculture, natural resources, environmental, technology (including biotechnology), light manufacturing, export-oriented industries, and shipping.

 

Conclusion

In summary, Hartwig foresees marginally better performance for property and casualty insurers, including workers' compensation insurers, with the performance of insurers' investments being a key driver of profitability.

 

Read the complete report: https://www.ncci.com/Documents/AIS-2011-Robert-Hartwig.pdf

ENEWSLETTER ARCHIVES
Take a deep dive into our past eNewsletters for 2011 and prior...warning - some links to articles may not work...report any linking problems to Robin.E.Kobayashi@lexisnexis.com.

May 9, 2011: State of the Line; Workers Comp Trends

http://archive.constantcontact.com/fs077/1102828640660/archive/1105406865560.html 

May 2, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1105306219674.html 

April 25, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1105243933380.html

April 18, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1105151454598.html 

April 11, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1105054845597.html 

April 4, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104945262995.html

March 28, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104894130984.html 

March 21, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104811663296.html 

March 14, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104742747659.html 

March 7, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104678900034.html 

February 28, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104610168211.html 

February 21, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104523576536.html 

February 14, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104442568785.html 

February 7, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104372668124.html 

January 31, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104299196240.html 

January 24, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104266393145.html 

January 17, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104223885217.html
January 10, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104176109384.html 

January 3, 2011

http://archive.constantcontact.com/fs077/1102828640660/archive/1104102646819.html 

 

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