Category Archives: Workers’ Compensation

McCrory’s Fraud Statistics Questioned by Experts

Governor Pat McCrory

According to N.C. Governor Pat McCrory, workers’ compensation claims cause the state to spend about $150 million per year. He claims that research by CorVel, the state’s administrator for state employee claims, shows that roughly 40% of the workers’ compensation claims are related to abuse or fraud.

When attorneys, professors, and state employee representatives questioned this number, State Personnel Director Neal Alexander and McCrory spokesman Josh Ellis were unable to provide any statistical support for this claim.

It is uncertain why the Governor would make a serious allegation of this nature without the numbers to back it up, but if the goal is to cut fraud and abuse in the system he may want to start with evaluating why so many employers are “gaming” the system by misclassifying their employees as independent contractors, and not providing any workers’ compensation coverage at all. Taxpayers often end up footing the medical bills for disabled employees because the state has no uninsured fund.

An investigation by The News & Observer newspaper revealed last year that N.C. was losing approximately $467 million a year in lost tax revenue because of employer misclassification. That is real and tangible fraud, and legislation is needed to give state agencies the tools to go after these cheaters. 

For more information please read this article on WRAL by Mark Binker and Cullen Browder.

Being Mortal, a book about end-of-life medical care, by Atul Gawande

All of us need to talk honestly about matters that concern us. Talking honestly about end-of-life choices is essential, and Atul Gawande (a surgeon in Boston) makes that clear in his book Being Mortal. Are the desperate surgical procedures and expensive treatments, which usually reduce the quality of life of a terminally ill patient, worth it? If discussed openly and honestly early in the process, would the patient choose to die in a hospital or at home with his family under the care of hospice?

Once one becomes seriously ill, even at an early age, perceptions change. What becomes important are the people in your life. The same is true as you approach death as an older person, and those last few months or years can be highlights of dignity, or they can turn into medical nightmares. “It’s perception, not age, that matters most.”

Dr. Gawande gives examples including the death of his own father, to illustrate different scenarios and notes that, “25% of all Medicare spending is for the 5% of patients who are in their final year of life, and most of that money goes for care in their last couple of months and is of little apparent benefit.” He readily admits doctors don’t ask the hard questions and he is changing his ways as a surgeon, but he wants the patient and family to get there first. This book is worth reading in order to understand, to contemplate, and to help make wise decisions about end-of-life issues.

For a more in-depth analysis, go to NPR Frontline.

File a Workers’ Comp Claim – Get Fired

Today’s post comes from guest author Thomas Domer, from The Domer Law Firm.

A new study from the Workers Compensation Research Institute (WCRI) indicates trust or mistrust in the work relationship plays a significant role in the outcome of a workers’ compensation claim.  In a recent benchmark study in Iowa by WCRI, almost four out of ten workers interviewed reported they were concerned they would be fired or laid off after they were injured. 

The Iowa study reflects similar results in Wisconsin and other benchmark states.  All workers who were interviewed received workers’ comp benefits and experienced more than a week of lost work time.  Additional findings noted two-thirds of the injured Iowa workers had other health conditions (having smoked for ten years or had diabetes or lung conditions).  Obviously those with significant pre-existing conditions had predictably worse results.

Workers’ Compensation Medicare Set-Aside Accounts and Supplemental Coverage

When an injured worker is a Medicare beneficiary due to age or disability, a Workers’ Compensation Medicare Set-Aside (WCMSA) account will often be required as part of a settlement  of their workers’ compensation claim.  The funds in a WCMSA are set-aside in order to pay for future medical or prescription drug services related to the work related injury, illness, or disease that would normally be covered by Medicare. Once the funds in a WCMSA have been used appropriately, then Medicare can start paying for Medicare-covered services related to the work-related injury, illness, or disease. The WCMSA cannot be used to pay for any medical items or services that Medicare does not normally cover.

Workers’ compensation insurance provides 100% coverage of medical treatment for accepted medical conditions. Medicare, however, requires an 80/20 sharing of medical costs. Without a Medicare supplemental (also called “Medigap”) insurance policy, the injured worker would be required to pay significant co-pays and deductibles.  Supplemental insurance is not required by Medicare, but may be advisable to cover the cost sharing required by Medicare, especially if the beneficiary has other medical conditions that are not related to the work injury, illness or disease. However, the premiums for such supplemental coverage cannot be paid out of the WCMSA funds.

While Medicare does not provide coverage for prescription medications, WCMSA funds can be used to pay for medications related to the work injury, illness or disease. If there is a likelihood that the injured worker will exhaust the funds in their MSA, then purchasing a Medicare Part D prescription drug plan may be advisable to prevent the injured worker from having to pay full price for their medications once the MSA funds are exhausted. However, the financial benefit of having this coverage should be weighed against the cost of plan (2013 national average was $30.00 per month) since the MSA funds cannot be used to pay for the plan itself.

 

For more detailed information about workers’ compensation MSAs and supplemental coverage, visit www.Medicare.gov.

 

Are You Misclassifying Your Workers and Committing A Fraud?

To avoid misclassifying your workers follow these tips:

  • Don’t make assumptions. If you are a business owner you should consult a tax professional and an attorney to ensure you are complying with IRS and labor laws when hiring staff or contractors.
  • If contracting with staffing companies or labor brokers, make sure those agencies are properly classifying its workers as employees. Companies can be held responsible for labor violations of their contractors.
  • Consider filing a SS-8 Form (Determination of Worker Status) with the IRS and ask that agency to determine whether the worker is an employee or independent contractor.
  • Be aware that contractors set their own schedules and pricing, and perform the work as they see fit. If you want control over these areas, make sure you hire an employee.
  • Check the workers’ compensation policies of any subcontractor you hire. (Look out for “ghost policies,” which aren’t designed to cover known employees.)
  • Don’t rely on excuses such as “He only works a few days a week.” “She agreed to be an independent contractor.” “They use their own tools.” “He’s done this for so long he doesn’t need my supervision.”

Thanks to McClatchy DC!

 

Number of N.C. Work-Related Deaths Nearly Doubled in 2014

The number of workers killed last year on the job in North Carolina has nearly doubled according to the state Department of Labor. A total of 44 people were killed in work-related accidents, all but one of the workers was classified as male, and all of the deceased workers were classified as “laborers” by the Labor Department. In 2013, there were only 23 deaths.

Labor Commissioner Cherie Berry analyzed the deaths and found that many accidents occurred between 60 and 90 days on the job, and a few workers were killed on the first day of their employment. This is largely related to lack of proper safety training before starting construction jobs.

In order to combat this increasing statistic, Builders Mutual Insurance Company worked with Commissioner Berry to create public service announcements about common hazards on construction sites. These ads are aired on Univision, and will be aired through March of this year.

Original Article found here:  http://www.newsobserver.com/2015/01/22/4496586_number-of-nc-workers-killed-on.html#storylink=misearch

Help for Chronic Pain Patients

According to a recent news article by Rachel Noble Benner, a mental health counselor, chronic pain is defined as pain that lasts longer than three months. It affects more than 100 million sufferers in the United States alone, and for those who suffer from chronic pain caused by an illness or injury it may seem as if there is no end in sight to their misery.

Chronic pain is not merely one symptom or a limited experience like acute pain; it is usually accompanied by depression, fatigue, changes in appetite and trouble sleeping. It can hold sufferers back from wanting to socialize with family and friends, and it reduces their quality-of-life.

Chronic pain requires treatment by physicians using a holistic approach in order to relieve symptoms. Physical therapists should be able to reactivate injured muscles and retune a hyper-excited nervous system; exercise will help recover a patient’s nervous system by re-teaching nerves the difference between normal and harmful sensations, and counseling on a regular basis should help establish strengths, manage depression and anxiety, and develop relaxation techniques.

 

Original post in the Washington Post by Rachel Noble Benner

Reposted in News & Observer 1/20/15 http://bit.ly/1J3vquV

 

 

Medical Procedures: What do they cost?

Blue Cross Blue Shield has created an online pricing tool to help patients compare prices of about 1,200 non-emergency medical procedures. Patients can now search for the best financial deal for services offered within North Carolina.

 By exposing this previously undisclosed information, patients are now able to go and see services according to the databases average procedure costs. The pricing tool also reveals the most expensive and most affordable option for each procedure.

In order to look up costs and doctors available to preform your procedure, you first access the pricing tool at: http://www.bcbsnc.com/content/providersearch/treatments/index.htm#/ . Then, you enter the treatment or service you would like in the first blank, your current location, and how many miles you are willing to travel for the service. Once you have entered all of this information, you just click search and your results will be immediately displayed. You can organize your results by cost, provider name, or distance.

 

To see the original article by John Murawski in The News and Observer explaining the pricing tool, click below:

http://www.newsobserver.com/2015/01/31/4516241_blue-cross-pricing-tool-could.html#storylink=misearch