workers compensation - Solutions for Workers' Compensation and Liability Settlements

Natt Reifler, Esq., CMSP, VP of MSP Compliance

19/Dec/2020

The Centers for Medicare & Medicaid Services provided an alert on November 25, 2020 that it reviewed the costs related to collecting Medicare’s conditional payments and compared the cost to CMS recovery amounts, and decided to leave the threshold for physical trauma-based liability insurance settlements (including self-insurance settlements) at $750. Additionally, CMS indicated it will keep the $750 threshold for No-Fault insurance and Workers’ Compensation settlements, where the No-Fault insurer or Workers’ Compensation entity does not otherwise have ongoing responsibility for medicals (ORM). Otherwise, once ORM reaches $750 for either No Fault or Workers’ Compensation plan claims, those payments need to be reported for Medicare beneficiaries via Section 111 Reporting. These described reporting thresholds do not apply to settlements for alleged ingestion, implantation, or exposure cases.

Take Aways:

Those settlements falling under any of the above described categories of insurance or self-insurance commonly referred to as Non-Group Health Plans (NGHP) will not need to be reported under the Medicare Secondary Payer Act (MSP) via Section 111 and will also not be subject to recovery claims by Medicare under the MSP.

See this web link for the CMS Alert regarding these NGHP reporting thresholds: https://www.cms.gov/files/document/2021-recovery-thresholds-certain-liability-insurance-no-fault-insurance-and-workers-compensation.pdf

Medivest

17/Apr/2020

On March 20th, we discussed what actions Washington State’s Workers’ Compensation Agency was taking that would allow medical providers and injured workers to file claims for work related/industrial exposure to COVID-19. Since then, other states have also taken action and created new policies in regards to the COVID-19 outbreak.

Kentucky

Last month, Kentucky was one of the States that adopted policy to provide workers’ compensation benefits to healthcare workers and first responders exposed to COVID-19. On April 9th, 2020 Governor Andy Beshear of Kentucky extended the provision of those benefits to additional types of employees. In his executive order, Gov. Beshear ordered that an employee could receive temporary total disability (TTD) payments for the period of time that the employee was quarantined if that employee met certain criteria.

The burden of proof lies with the employee to show that the COVID-19 exposure was caused by the work conditions. The employee’s removal to quarantine has to be ordered by a physician. If the employee can show the connection and removal by a physician, TTD payments can now be received for the quarantine period even if the employer denies liability.

The expanded list of those now eligible for TTD payments includes healthcare workers, first responders, corrections officers, members of the military, activated National Guard, domestic violence shelter workers, child advocacy workers, rape crisis center staff, Department for Community based Services workers, grocery workers, postal service workers, and child care workers permitted by the Cabinet for Health and Family Services to provide child care in a limited duration center during the State of Emergency.

Florida

Florida followed Washington and Kentucky, and as of the end of March, Florida Chief Financial Officer Jimmy Patronis ordered the state’s Division of Risk Management (DRM) to review workers’ compensation claims submitted by state workers “required to interact with potentially infected individuals.” Those workers includes those employees known in Florida as “Frontline Workers“: law enforcement, firefighters, EMTs, paramedics, correctional officers, health-care workers, child safety investigators and Florida National Guardsmen.

The Florida League of Cities also announced in March that the Florida Municipal Insurance Trust would cover municipal first responders’ COVID-19 claims.

Illinois

This week, Illinois has taken a progressive step with the introduction of an emergency amendment to the Illinois Workers’ Compensation Commission’s rules of evidence under Part 9030 titled Arbitration, establishing a rebuttable presumption of a causal connection between employment and contraction of COVID-19 for both First Responders and Frontline Workers who contract COVID-19 as a result of their employment.

This is different than any other state in terms of the burden of proof. In most states, the burden is on the injured or ill worker to prove the causal connection. In Illinois, at this time, the burden will be on the employer to rebut this presumption that the causation exists.

In Illinois and other states, attorneys representing injured workers should evaluate whether there may be new expanded coverage in their state for their clients who contract COVID-19 as a result of employment-related activities. They should consider whether such coverage may exist under the respective state’s Workers’ Compensation statutes or any other state law that may apply.

Some states, like Illinois, also have an Occupational Diseases Act which could be applicable, and if so, would pay benefits based on rates established under the applicable version of Illinois’ Worker’s Compensation Act.

Changes in Workers’ Compensation and Liability Cases

COVID-19 has driven changes that affected both the Workers’ Compensation and Liability industries outside of state and local government regulation. For additional information how the Workers’ Compensation industry has been affected please click here, and to find out how the Liability industry has been affected follow this link.

We hope each of you stays safe at this time. Medivest is fully functional during this period and ready to assist parties with MSP compliance and lien resolution services. For assistance in these matters please call us at 1.877.725.2467 or contact us here.

Medivest

21/Mar/2020

The state regulated Workers’ Compensation agency for Washington State has already set up online methods for medical providers and injured workers to file work related/industrial exposure claims for COVID-19/Coronavirus, and even added a hotline for injured workers to call to be able to report likely exposure to COVID-19/Coronavirus. Because COVID-19/Coronavirus is so new and so contagious, it is hard to predict how likely it will be that claims of work related exposure will be accepted by Workers’ Compensation carriers or Boards that hear appeals of denials of exposure claims. Some factors the Washington State Department of Labor & Industries listed that should be considered before filing a claim are:

Was there an increased risk or greater likelihood of contracting the condition due to the worker’s occupation (such as a first responder or health care worker)?
If not for their job, would the worker have been exposed to the virus or contracted the condition?
Can the worker identify a specific source or event during the performance of his or her employment that resulted in exposure to the new coronavirus (examples include a first responder or health care worker who has actually treated a patient with the virus)?

The Washington State online message suggests that “if the above criteria are not met, it is not necessary to file a Workers’ Compensation (WC) claim; however, a claim may still be filed if requested by the worker or if the provider is uncertain if the case meets the criteria.” The site goes on to explain that instances where contraction of COVID-19 is only incidental to the workplace or common to all employment, giving an example of an office worker contracting the condition from a fellow employee, a claim for WC exposure to and contraction of COVID-19 would be denied.

Because WC is governed by state law, while the factors considered will likely be similar, the decision making resulting from the evaluation could vary state by state.

We hope the curve of exposure associated with this pandemic will flatten soon and we can get back to our ordinary lives, but in the meantime, we send positive thoughts and healthy wishes to all of our first responders, healthcare workers, service industry employees, and everyone else affected by this fast spreading virus!

For further questions regarding Workers’ Compensation settlements please contact Medivest for a consultation.