LexisNexis Workers' Comp Free eNewsletter: State Workers' Comp Ball of Confusion

Vol 2, Issue 28

Find Solutions & Strategies July 11, 2011

State Workers' Comp Ball of Confusion

Analysis of AIA's positions on medical costs, AMA Guides, State Funds, and "Left Coast Litigation"

In This Issue

-WORK COMP CONFUSION

-MEDICARE ADVANTAGE

-1 MILLION PAGE VIEWS

-LARSON'S SPOTLIGHT: 5 RECENT CASES: FELA, Malicious Prosecution, Tort Action Against Employer, Jones Act, Retaliatory Termination

-BLOGS @ LEXISNEXIS WORKERS' COMP COMMUNITY: Fraud, DE case

-MSP COMPLIANCE BOOK

-NATIONAL NEWS

-STATE NEWS

-eNEWSLETTER ARCHIVES

A Note From Our Guest Editor

Dear WC Professionals:

Thanks to Karen Yotis, Esq. for her article examining AIA's positions on key workers' comp issues.

Last week the LexisNexis Workers' Compensation Law Community surpassed one million page views! We appreciate everyone's support.

If you haven't signed up yet for this free enewsletter, simply send your full name and email address with your request for the national enewsletter.

Sincerely,
Robin E. Kobayashi, JD

LexisNexis Editorial Content & Product Development

robin.e.kobayashi@lexisnexis.com

State Jurisdiction & Reciprocity

Did the Florida Legislature Fumble in Trying to Limit Workers' Comp Coverage for Pro Football Players?

The Florida legislature thought it had found a way to keep players in Florida from scoring in the California workers' compensation end zone. But there could be a potential flaw in Florida's new reciprocity statute.

To purchase the article at the LexisNexis Bookstore, click here.

workers' comp ball of confusion

The AIA's Positions on Workers' Compensation Medical Costs, AMA Guides Sixth Edition, State Funds, and California's Left Coast Litigation: Taking a Hard Look at the Ball of Confusion, by Karen Yotis, Esq.

When Norman Whitfield and Barrett Strong penned "Ball of Confusion (That's What the World Is Today)", they could hardly have anticipated that the political anthem the Temptations recorded in 1970 would mirror the state of our country's workers' compensation system 41 years later. But in a nation with 50 states -- and 50 different workers' compensation systems (not to mention D.C. and the federal workers' comp system) -- the ball of confusion analogy is, well, right on.

The American Insurance Association cuts through some of the morass in its article "States of Confusion," published in the winter 2011 edition of AIA Advocate. The piece describes the new and unique challenges that most states face and outlines the ways that AIA (which is in many respects the Great Googa-Mooga of the P&C industry) fights to keep the workers' compensation rules simple for insurers and employers.

Like the lyrics to the song, workers' compensation has lately been all about 'aggravation, demonstration and obligation to our nation', but the AIA article narrows the whole hot mess down to two main employer-specific issues: rising medical costs and legislative raiding of the "surplus" money in state funds to address budget shortfalls. Read more.

medicare advantage plans

Medicare Advantage (MA) Plans: Exploring Recovery Rights & Recent Court Decisions, by Mark Popolizio, Esq.

An emerging area of focus on the Medicare Secondary Payer compliance landscape relates to Medicare Advantage (MA) plans. Interest in this topic has been generated by the claim industry's heightened sensitivity to Medicare compliance issues in general, and in light of the fact that MA plans are taking a more aggressive posture in the claims context.

Over the past several months, questions concerning MA plans have also been the subject of three important court opinions, including the recent decision of In Re Avandia Marketing, Sales Practices and Products Liability Litigation, Nos. 7-md-01871, 10-6733, 2011 WL 2413488 [2011 U.S. Dist. LEXIS 63544] (D. Pa., June 13, 2011) issued by the United States District Court for the Eastern District of Pennsylvania. Read more.

one million page views & counting

Fireworks The LexisNexis Workers' Compensation Law Community is pleased to announce that is has reached an important milestone: 1,000,000 page views! A million thanks to all of our eNewsletter subscribers for clicking through to our web community, and to all of our bloggers, the Larson's National Workers' Compensation Advisory Board, the LexisNexis California Workers' Compensation Editorial Board, the LexisNexis California WCAB Noteworthy Panel Decisions Advisory Board, the LexisNexis Benefits Review Board Service - Longshore Reporter Advisory Board, the Work Comp Analysis Group on LinkedIn, and the entire workers' compensation community. We appreciate your support!

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

5 spotlight Larson'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.

> Read the summaries & court decisions.

1. US: Supreme Court Says FELA Does Not Use Common Law Concept of "Proximate Cause"

2. MA: Insurer Not Immune From Malicious Prosecution Claim Filed by Injured Employee

3. DE: Truck Driver's Injuries Sustained While Sleeping In Berth of Truck Were Within Course of Employment; Tort Action Against Employer Barred

4. LA: State-Employed Seaman May Sue State of Louisiana Under Jones Act

5. US: Firing Not Retaliatory Where Termination Was Based on Injured Worker's Statement That He Might Not Pass Drug Test

blogS at the lexisnexis workers' comp law community

Workers' Comp Fraud Blotter - Recent Arrests, Charges, Convictions, and Investigations (7/7/2011) - Pill Mill Doctor Prescribed Unneeded Narcotics and Improperly Billed Workers' Compensation, by LexisNexis Workers' Compensation Law Community Staff. Read it.

Two Out of Three Ain't Bad -- A Little Ditty About Course and Scope in Delaware, by Cassandra Roberts, Esq. Read it.

how to achieve medicare secondary payer compliance

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.