Wednesday, December 30, 2015
There are several factors that are important when selecting an attorney. First, you want someone who is knowledgeable and experienced in handling injury cases (versus an attorney who is a "jack of all trades, and master of none"). Just as you would not go to your family doctor for back surgery; you should not trust any attorney with your Hartford, Connecticut area Workers’ Compensation claim. James Aspell concentrates on Connecticut workers' compensation. We have handled and successfully resolved hundreds of personal injury and workers' compensation through trial, arbitration and mediation. The Workers’ Compensation Section of the Connecticut Bar Association has created the Workers’ Compensation Certification Program to help the public to identify attorneys who are competent, experienced, and skilled in the area of workers’ compensation law and to raise the level of practice in this area of the law. Jim Aspell is a Board Certified Workers’ Compensation Specialist. He has been so designated since the project's inception in 2005 and he was one of the first lawyers in the State named to this honor. This is an honor reserved for attorneys who demonstrate the highest knowledge of and commitment to the practice of Workers’ Compensation Law. Currently, in Connecticut, there are less than 60 attorneys who have achieved this designation. The Legal Specialization Screening Committee and the Rules Committee of the Superior Court have approved the CBA’s certification program. This approval process insures that our program has met the court’s strict standards. See the links below for more information. Attorneys who have attained the designation "Board Certified Workers’ Compensation Specialist" have satisfied the following requirements: demonstrated that no less than twenty-five percent of their total practice has been in the area of workers’ compensation law; engaged in the practice of law in Connecticut for at least five years and been a member in good standing of each bar in which the attorney is admitted; maintained a malpractice policy with minimum limits of $300,000 per occurrence; have a satisfactory disciplinary and malpractice history; participated in a minimum of thirty-six hours of continuing legal education activities in the area of workers’ compensation law in the three years prior to filing the application; have a minimum of five references from other attorneys knowledgeable regarding the applicant’s practice and competence; and have passed a rigorous one-day written examination. Only attorneys who have been formally certified may use the designation "Board Certified Workers’ Compensation Specialist" on business cards, letterhead, and other printed advertisements. See, www.ctbar.org/general/custom.asp?page Certification You should feel comfortable with your attorney’s abilities as well as the attention paid to you and your case. At The Law Offices of James F. Aspell, P.C. you can be confident that we have the experience and also know that you can call the attorney at any time if you have a question or problem. We promise to work hard to get you the maximum benefits the law allows so that you can get back to the life you enjoy.
Tuesday, December 22, 2015
The IRS has issued the 2016 optional standard mileage rates used to calculate the deductible costs of operating an automobile for business, charitable, medical, or moving purposes. Beginning on Jan. 1, 2016, the standard mileage rates for the use of a car (also vans, pickups, or panel trucks) are: 54 cents per mile for business miles driven (down from 57.5 cents in 2015) 19 cents per mile driven for medical or moving purposes (down from 23 cents in 2015) 14 cents per mile driven in service of charitable organizations (unchanged from last year) The drop in rates for 2016 reflects lower gas prices. Workers’ Compensation Travel Reimbursement Rates Connecticut workers’ compensation law requires employers to furnish or pay for transportation for an injured employee traveling to and from medical care. If the claimant uses a private vehicle, he or she must be reimbursed for mileage at the federal mileage reimbursement rate set by the General Services Administration. The GSA and IRS rates are often very close or the same, so it is likely that the workers’ compensation travel reimbursement rate will drop in 2016. The GSA typically publishes its new rates in the Federal Register the last week of December; those rates are effective Jan. 1.
Monday, December 21, 2015
Connecticut Workers compensation is a no-fault system. The worker doesn’t have to prove the employer was negligent to make a workers compensation claim, and a worker can make a claim even if he or she was negligent in some way and that negligence contributed to the injury. As long as the person suffered a type of work-related injury covered by the Workers Compensation Act, he or she can make a claim. Generally speaking, covered injuries are those that: Arise from the employment — Injuries must have a direct causal relationship with some danger or risk of the employment and must be job-related In the course of employment — Injuries have to happen while the employee is working, at a location the employee is at because of his or her employment, and under circumstances required by the employment When a claim is approved, available benefits can take a number of forms in Connecticut. Workers compensation can cover: Medical care related to the injury Temporary total or partial disability benefits when the injury leaves you unable to work or working light duty for some time period Permanent total or partial disability benefits if you are either permanently unable to work or have some permanent disability or disfigurement but can work Vocational rehabilitation benefits Death benefits for family members of workers who are killed in Connecticut work-related accidents Why Workers Compensation? The rise of industry is the foundation of much of the world we know today. In the late 19th and early 20th centuries as mechanization and mass production become increasingly more commonplace, jobs shifted from agriculture to factories, bringing people to cities for work. Places such as Hartford County boomed and expanded. But those early factories could be dangerous places for workers — and when a worker was disabled in those days, there was no safety net when that person could no longer do his or her job. Workers who were injured, maimed, or disabled in workplace accidents had to sue their employers and prove negligence to recover any kind of compensation for their injuries. Proving those cases was challenging, and an employer could counter that the injured worker was negligent or assumed the risk of doing the job, or that another employee was negligent. If the employer won, the disabled worker was left with nothing and no way to earn wages. If the worker won, there were no limits to the employer’s liability and one bad injury could put an employer out of business — perhaps costing hundreds of jobs. It was a system that was risky for both employer and employee. The workers compensation system came into being as a way to try to balance the needs of injured workers with those of employers. Laws governing workers compensation grew out of social and industrial reform movements in the late 19th and early 20th centuries. The idea was that workers who suffer disabling injuries in the workplace shouldn’t be financially ruined when an accident on the job renders them unable to work, but that employers also shouldn’t be driven out of business by a lawsuit verdict. The Role of an Attorney Even though workers compensation claims don’t typically involve lawsuits or courts, there is nonetheless a specific legal process involved in making a claim. There may be an opportunity to settle a claim with your employer, and an experienced workers compensation attorney can help ensure you get the best possible settlement. If you try to go it alone, you may end up with less than you deserve. If you need to attend a hearing on your claim, having a Board Certified Connecticut Worker's Compensation Specialist may gives you a better chance at the compensation you need and deserve. Sometimes your work-related injury will involve a third party who is not your employer, and you may have the option to pursue a claim against that third party in a civil court. An attorney experienced with Connecticut personal injury and workers compensation claims can discuss with you whether you might have a claim against someone other than your employer. Workers Compensation Workers Compensation Information Workers Compensation Overview How Do Workers Compensation Claims Work? Documenting & Proving a Workers Comp Claim Keeping Your Job Third-Party Lawsuits Third-Party Wrongful Death Claims Workers Compensation FAQs Types of Workers Comp Injuries Types of Workers Comp Benefits Earning your trust Finding an attorney can be overwhelming. You can trust the Hartford Connecticut Worker's Compensation injury team at The Law Offices of James F. Aspell, P.C.to handle your case with the compassion and respect you deserve.
If you are injured on the job in Connecticut, the Connecticut Worker's Compensation Act requires you to file a Notice of Claim (Form 30C) with your employer and the Connecticut Worker's Compensation Commission withing 1 year of an accidental injury. This important step can make or break you case. If you have any questions about what you must do if you are injured in Hartford Country or elsewhere in Connecticut, call me at 860-523-8783. The call is free and we offer free consultations in our West Hartford worker's compensation office. If more than a year has elapsed since you got hurt, please call us anyways. Ins some instances there are exceptions to the rule and if at all possible, we will take steps to protect your interests in your
Thursday, December 10, 2015
Workers' compensation in Connecticut pays for injuries when employees can prove that their injuries arose out of and during the course of their employment. Injured workers, in other words, must adequately show that a workplace injury accident was a substantial cause in the harm that they suffered. In a situation where it is unclear whether the employee's medical condition was caused by a workplace injury, medical testimony has to be presented. This expert testimony has to show that there was a reasonable probability that the condition was caused by an injury at work and must be based upon other competent evidence. Speculation and conjecture, however, cannot play a significant role in the expert's medical opinion. Expert testimony drawing a connection between the condition and a workplace accident has to be based upon other non-medical facts in evidence, such as what happened and the symptoms displayed by the claimant. There are no criteria on the facts that have to be considered if the facts are based upon proper evidence. The Connecticut Workers' Compensation Commissioner may choose to believe and choose differing accounts and evidence. In an opinion issued in September of this year, a Connecticut appeals court ruled that medical testimony was competent to find that the workers' compensation claimant suffered a work-related hearing loss even though an expert did not review medical records indicating that the worker did not complain of hearing loss and dizziness near the time of the accident. The expert in this case relied upon his own examination and medical tests. Other evidence included the claimant's description of the workplace accident and symptoms. Source: casetext, "Story v. Woodbury, AC 37111 (Sept. 15, 2015)," Accessed Oct. 19, 2015
Friday, October 9, 2015
Be wary of slick marketing ploys used by many attorneys. Just because a lawyer has a flashy website or a bus wrapped with his image does not mean his office has the experience and expertise to actually effectively represent you. You would be surprised how many of these marketing masters call or email, me every week to ask me a question about how I would handle a particular issue. We are the real deal. We have been helping injured workers in Connecticut since 1986. I am Board Certified by the Connecticut Bar Association in the field of workers compensation law---a designation that requires a significant amount of attention and success to maintain. I am also recommended by the A.M. Best Company as a Workers Compensation Insurance Attorney. Best is the leading rating agency for all things insurance. It's not a designation that can be bought. If you or a love one are injured on the job, don't fool around. Call the law firm the other lawyers call.
Tuesday, April 21, 2015
In Q1 of 2015 our office has resolved and settled a great number of high value worker's compensation claims. We have also been blessed to take on several important new cases both directly and on referral from other Connecticut Attorneys who trust us for our 30 years of experience in Connecticut worker's compensation law. If you have been hurt at work or suffered a heart attack or stroke that may be related to your job, I would be happy to speak with you at no charge. If I can help you, I will do so with all my ability. If i cannot, I will tell you that as well. That is my promise to you
In settlements where the future medical is going to be closed as part of the settlement the following must be considered: CLASS I BENEFICIARY Claimant is considered a Class I Medicare beneficiary if: a) Claimant is 65 years or older; b) Claimant has been on SSDI for 24 months or longer; or c) Claimant has End Stage Renal Disease (ESRD) As such, regardless of settlement value and including “compromise” settlements, you must consider Medicare’s interests. Medicare will need to review all Class I beneficiary settlements valued at $25,000 or greater. Class I beneficiary settlements below $25,000 in value do not require submission to and approval from Medicare. You are still required to consider Medicare’s interests and include future Medicare related medical costs in an allocation within the settlement. CLASS II BENEFICIARY with Settlement values greater than $250,000 Medicare approval is needed when settlement value is $250,000 or higher AND where an individual has a “reasonable expectation” of Medicare enrollment within 30 months. Situations that constitute “reasonable expectation” include but are not limited to: a) Claimant is on SSDI but not yet Medicare eligible; b) Claimant has applied for Social Security Disability Benefits; c) Claimant has been denied Social Security Disability Benefits but anticipates appealing that decision or is in the process of appealing and/or re-filing; e) Claimant is 62 years and 6 months old (i.e., may be eligible for Medicare based upon his/her age within 30 months); f) Claimant has an End Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD. Note: The Social Security Administration may use the following indicators when approving a claimant for SSDI benefits: Claimant has been deemed permanently and totally disabled; or Provider states that claimant cannot return to any reasonable gainful employment for a period of 12 months or longer. CLASS II BENEFICIARY with Settlement value less than $250,000 Although Medicare approval is not needed for settlement value of under $250,000, when an individual does not have a “reasonable expectation” of Medicare enrollment within 30 months most insurers, self insurer, third party adjusters, and attorneys require a Medicare Allocation be completed for all cases greater than $25,000 to be certain Medicare’s interests are considered for future medical associated with a Liability or Workers Compensation settlement. An appropriate portion of the total settlement needs to be identified as the Medicare Allocation. Additional services such as Structured Settlement, Custodial Medical and Indemnity Accounting, and Special Needs Trusts should be considered for complete administration, and to assure the client that the case will remain closed and appropriately managed according to the terms of settlement. CLASS II BENEFICIARY with Settlement value less than $250,000 Although Medicare approval is not needed for settlement value of under $250,000, when an individual does not have a “reasonable expectation” of Medicare enrollment within 30 months most insurers, self insurer, third party adjusters, and attorneys require a Medicare Allocation be completed for all cases greater than $25,000 to be certain Medicare’s interests are considered for future medical associated with a Liability or Workers Compensation settlement. An appropriate portion of the total settlement needs to be identified as the Medicare Allocation. Additional services such as Structured Settlement, Custodial Medical and Indemnity Accounting, and Special Needs Trusts should be considered for complete administration, and to assure the client that the case will remain closed and appropriately managed according to the terms of settlement. Article provided by James J Moore, AIC, MBA, ChFC, ARM. All articles are original content. .
Monday, April 6, 2015
An injury at work can happen suddenly, such as lifting a heavy object, a blow to the head, a fall from a ladder, or a construction site accident. Usually there is little question that these types of injuries should be covered by workers’ compensation. However, workers’ comp insurance companies frequently deny valid work injuries and occupational disease claims by trying to blame an injury and/or disability on non-work related activities or a pre-existing health condition. The workers comp. attorneys at The Law Offices of James F. Aspell, P.C. and our Board Certified Specialist in Connecticut Workers’ Compensation Law know how to investigate your claim, negotiate with the workers’ comp insurance company, and present a strong case at a workers’ compensation hearing, if needed. We are committed to protecting your rights as a hard-working employee who was injured on the job. We can also provide valuable advice on how potential Social Security Disability benefits, Medicare benefits, and/or disability insurance benefits interact with your workers’ compensation case. Comprehensive Representation Throughout the Work Comp Claim Process The workers’ compensation claims process is complicated. Jim Aspell will provide personal services to our clients throughout the course of their claims. Our attorneys stand up for your rights by filing your claim (a Form 30C), guiding you through your medical treatment, working toward a possible lump sum settlement, fighting a denial of benefits or medical treatment if necessary, and presenting your case at workers’ comp hearings and appeals. Our goal is to make sure you receive all of your workers’ compensation benefits in as timely a manner as possible. Do not sign anything about your Worker’s Compensation claim unless you speak with an attorney.
Saturday, April 4, 2015
There are times you may be hurt on the job and you don't need a lawyer. Really. Sometimes your employer and their insurer will do the right thing and your claim will go quite smoothly. Othertimes, unfortunately it will not. My general rules of thumb as to whether or not you need a lawyer are: 1. Have you missed more than 3 consecutive days of work? If so, it is probably in your best interest to retain counsel to oversee your claim, get you a "voluntary agreement" and make sure your rights are protected. 2. Are you lookin at surgery? If yes, you need a lawyer. The insursance company is going to challenge your need for surgery, possibly force you to return to work sooner than you are able, or make you work harder following surgery than your doctor says you can. I repeat. If you are looking at surgery you need a lawyer. 3. Do you want to settle your case? If so, I promise you you will see more in your pocket if you hire an experienced and respected Connecticut worker's comp lawyer to negotiate a settlement. 4. If you dont live in Connecticut. If you are out of state and have a Connecticut claim, you need a lawyer. call me and I'll tell you why. For free. 5. You have more than one job. Concurrent employument is complicated. You need an experienced lawyer to get your wages from both jobs and make sure you get every penny you deserve. If you ever have any questions, call me. The call is free. If you need me and i can help you, I will tell you. If you dont need me, I promise you I will tell you that too.
Friday, March 27, 2015
Pursuant to Section 31-280b, Chairman John A. Mastropietro has appointed Commissioners Randy L. Cohen and Stephen M. Morelli to sit as panel members on appeals before the Compensation Review Board for the calendar year beginning January 1, 2015.
Wednesday, March 25, 2015
Is your lawyer a "known commodity?" When pursuing a work injury claim in Connecticut it goes a long way if your employer's worker's comp insurance company is familiar with the track record of you lawyer. I have been handling worker's comp claims in Connecticut since 1986. I am known to worker's compensation defense attorneys throughout the State as an aggressive advocate for my client and one that is willing to litigate a case if necessary. That results in a biggerConnecticut Worker's Compensation A.I.A.C. AIG Allstate Atlanta Casualty AMEX Insurance Amica Insurance Chubb CIGNA CNA Colonial Penn Covenant Crum & Forster Electric Insurance Esurance Fireman’s Fund Geico General Accident Great American Hanover The Hartford Home Insurance Infinity Insurance Integon Kemper Liberty Mutual Maryland Casualty Metropolitan Middlesex Mutual Nationwide Northland Ohio Casualty One Beacon Patriot General Peerless Preferred Mutual Progressive Prudential Reliance Royal Insurance Safeco Sentry St. Paul Fire & Marine State Farm TIG Insurance Transamerica The Travelers U.S.A.A. U.S.F. & G. Wausau Windsor Worcester Zurich America
Monday, March 16, 2015
March 9, 2015 - WorkCompWire Hopkinton, MA – Researchers with the Liberty Mutual Research Institute’s Center for Injury Epidemiology have concluded that individuals who work multiple jobs – approximately 14 million U.S. residents – have a greater likelihood of injury than those holding a single job. According to the findings published in the American Journal of Public Health, multiple jobs holders have a 27 percent higher rate of work-related injury and a 34 percent higher rate of non-work-related injury compared to single job holders. Principal researcher Dr. Helen Marucci-Wellman said the elevated injury rates suggest greater risk exposures for those who work multiple jobs. “Factors that may contribute to higher injury risk could include a disruptive work week structure, job inexperience, hurried behavior – physical and mental stressors related to alternating between different jobs, and fatigue,” said Dr. Marucci-Wellman. Researchers used 15 years of data from the National Health Interview Survey (NHIS), an in-household survey administered annually by the U.S. Census Bureau, to gather nationally representative data on a broad range of health topics. Representing more than a quarter of a million households, the NHIS is the only dataset that supports linking multiple job holding and injury. “To better understand the association between multiple job holding and injury risk, we need to look at a whole array of risk factors. We need to understand with greater specificity employment situations and the circumstances surrounding injuries. This way, we can determine where changes need to be made to enhance safety for those at increased risk,” added Dr. Marucci-Wellman. A subsequent Liberty Mutual Research Institute study (PDF) using data from the U.S. Census Bureau’s annual American Time Use Survey compared the work and lifestyle activities of single job holders and those holding multiple jobs during a one week period. Twenty-seven percent of multiple job holders worked 60 plus hours versus only six percent of single job holders. On average, multiple job holders worked 2.25 to 2.75 additional hours per day, worked odd hours, had longer commutes and had 45 minutes to an hour less sleep per day than single job holders. “In addition to significant differences in work schedule and time use patterns for workers with multiple jobs, they also had less time for household and leisure activities,” noted Dr. Marucci-Wellman. “These time use pattern findings suggest that working multiple jobs may result in heightened risk of fatigue, increasing the likelihood of injury. A better understanding of the factors that contribute to increased risks would help identify ways – such as changing daily routines or work scheduling practices – to reduce the injuries associated with holding multiple jobs.” Source: Liberty Mutual
Tuesday, February 17, 2015
FROM CTNEWSJUNKIE.COM Two bills under consideration this legislative session seek to expand the state’s workers’ compensation law to cover those who suffer severe mental or emotional distress after witnessing extreme workplace violence. One bill, SB 593, has been introduced by the Labor and Public Employees Committee. It would expand coverage under the Workers’ Compensation Act to those who have certain “mental or emotional impairments” due to witnessing the death or maiming of another person in the workplace. Similar legislation has failed in previous years. In the past, workers’ compensation claims could be filed by those who suffered emotional or mental distress even if they sustained no accompanying physical injury. But in 1993, amid cost concerns, the law was changed so that those with emotional or mental trauma could not file a claim unless they also were physically injured. Lawmakers on the Labor and Public Employees Committee introduced the bill this year because they have “learned over the years” that experiencing something traumatic can have a lasting effect on workers, said committee co-Chairman Sen. Gary Winfield, D-New Haven. The current law “does not reflect the reality” that many workers experience, according to Senate President Martin Looney, D-New Haven. “It is very possible to have severe, traumatic mental health issues that are not necessarily accompanied by a physical injury.” The law as it stands now “just seems to be unfair, just doesn’t seem to recognize the reality of the significant disabilities that can occur,” he said. Looney was among those who testified in support of the bill at a Jan. 29 public hearing. Andrew Matthews, president of the Connecticut State Police Union, also spoke in support of the bill, noting the trauma many police officers face on the job. Ted Scholl Jr., legislative representative for the Connecticut State Firefighters Association, testified in favor of the bill as well. Others opposed the measure. David Lowell, president of the Association of Ambulance Providers, said the group has “significant concerns” about the burden the bill would put on the ambulance industry. “Ambulance providers pay some of the highest workers’ compensation rates due to the nature of the employment,” Lowell testified. “This bill would cause an increasing hardship on all providers at a time when Medicaid and Medicare rates have been cut.” The bill stipulates that workers’ compensation coverage would apply to any worker who a licensed psychologist or psychiatrist diagnoses as suffering from extreme distress. The distress must be caused by witnessing the death or maiming of one or more people or witnessing the immediate aftermath, in some capacity connected to the worker’s employment. The Connecticut Conference of Municipalities opposes the bill, according to Bob Labanara, the group’s state relations manager. Cities and towns know how important it is to help municipal employees who suffer emotional distress from their jobs, and there already are measures in place to do so, he said. The bill, however, is too ambiguous. Words like “aftermath,” “impairment” and “maiming” have not been clearly defined, Labanara said, which would make it impractical to enforce. City and town leaders also worry about additional costs they would incur at a time when municipal budgets are already tight, he said. Several groups that submitted testimony at the public hearing — including the Connecticut Psychiatric Society, the Connecticut Education Association and the Connecticut AFL-CIO — support the measure but said workers’ compensation coverage should be expanded even further. Workers can be traumatized if they witness a violent act, even if no one is killed or maimed as a result, the Connecticut Psychiatric Society said in its testimony. The AFL-CIO also said in testimony the bill is a good step but “falls short.” Winfield acknowledged that lawmakers will have to wrestle with how best to implement any law expanding workers’ compensation coverage, but said it is an important undertaking. Looney also has introduced a related bill, S.B. 105. His bill focuses on a specific section of the Workers’ Compensation Act and seeks to expand the legal definition of “personal injury” so that it would include certain events in which a person suffers mentally or emotionally after seeing someone killed or maimed by another person on the job. Looney said he is optimistic about the potential to expand workers’ compensation coverage this session. “There is growing interest and support for it,” he said. Both bills to expand coverage are being spearheaded by Democratic lawmakers, who hold a majority in both the House and Senate.
WCC Official Hospital and Ambulatory Surgical Center Fee Schedule Memorandum - December 31, 2014 MEMORANDUM NO. 2014-06 TO: WCC Commissioners, Facility Fee Schedule Core Committee Members, District Administrators, Advisory Board, Legal Advisory Panel, Medical Advisory Panel, Medical Practitioners, Self-Insureds, Insurance Carriers, Medical Care Plans, Attorneys, and Unions. FROM: John A. Mastropietro, Chairman DATE: December 31, 2014 RE: Issuance of the Official Fee Schedule for Hospitals and Ambulatory Surgical Centers Pursuant to Public Act No. 14-167 (Senate Bill No. 61) Effective for Medical Treatment Rendered On and After April 1, 2015 Pursuant to Public Act 14-167 "AN ACT CONCERNING WORKERS' COMPENSATION AND LIABILITY FOR HOSPITAL AND AMBULATORY SURGICAL CENTER SERVICES", the Workers' Compensation Commission hereby establishes the following Facility Fee Schedule for the treatment of injured workers. RATES: 1. The hospital inpatient rate shall be 174% of the Medicare rate payable to that facility on the date of service. 2. The hospital outpatient and hospital-based ambulatory surgery rate shall be 210% of the Medicare rate payable to that facility on the date of service. 3. The non-hospital based ambulatory surgery rate shall be 195% of the hospital-based outpatient Medicare rate payable in the same CBSA (Core Based Statistical Area) on the date of service. 4. Where there is no Medicare rate for the procedure in an outpatient hospital setting, the parties shall negotiate the reimbursement rate. If negotiation is not successful, the parties may request a hearing with the Commission; however, treatment shall proceed pending same. RULES: In order to implement the above-referenced Fee Schedule the following rules shall apply: 1. Payors must remit payment within 60 days of receipt of appropriate documentation for compensable claims. Payment made after the 60th day must include interest payment at the rate of 1.5% per month. 2. Facilities have 60 days following receipt of payment to request a review by payor and such requests may be accompanied by additional supporting documentation. Any requests to review made after such 60 day period will not be considered unless parties agree otherwise. 3. Payment for implants, devices and hardware is included as part of the appropriate percentage above Medicare for the procedure (the applicable inpatient, outpatient or ambulatory surgery rate established by this Fee Schedule). Requests for additional reimbursement for implants, devices and hardware shall be by exception only. The exception is if the applicable percentage of Medicare amount for the implant, device and hardware does not cover the invoice cost, then the invoice cost can be presented and will be reimbursed at 130% of invoice less the applicable percentage of the Medicare amount for the implant, device and hardware already included in the fee. 4. The reimbursement rate for services rendered will be in accordance with this Fee Schedule unless a different rate is negotiated between the parties. 5. This Fee Schedule will apply to dates of service rendered on and after April 1, 2015. The Workers' Compensation Commission is working with a vendor to publish the applicable rates, rules and guidelines for implementation of this Fee Schedule. It is expected to be available in advance of the April 1, 2015 effective date. Notice of availability will be published on our website at http://wcc.state.ct.us.
By Robert Wilson at workerscompensation.com. Connecticut Work Injury, feel free to call me.
Friday, February 13, 2015
Federal Circuit Court Finds Employment Discrimination Settlement Lacking Medicare Details Binding, Leaving Parties Unprotected from MSP Viewpoint By Settlement Solutions, February 12, 2015 2:59 pm On February 11, 2015, the United States Court of Appeals for the Second Circuit published its opinion on Hoover v. New York State Department of Corrections and Community Supervision, Albion Correctional Facility, Sue Wojcinski, Sandra Durfee, Angie Maume, and Donna Baker, finding that if defendants considered plaintiff’s Medicare status to be critical in deciding whether to settle, they should have ascertained that status before agreeing to settle the case on November 5, 2012 for $750,000. As a result, the court affirmed the judgment of the district court, which had previously directed that judgment be entered in favor of plaintiff in the amount of $750,000 when the parties were unable to agree on the exact Medicare language in the settlement documentation. Plaintiff commenced this employment discrimination action on November 21, 2002. After several motions for summary judgment, and several changes in attorneys, at a conference on July 9, 2012, the court scheduled jury selection and trial to commence on November 7, 2012. On the morning of November 5, 2012, two days before the trial was scheduled to commence, counsel telephoned the judge’s chambers to report that the parties had reached a settlement. That afternoon, the material terms of that settlement were placed on the record. At that time, defendants’ attorney indicated he had offered and the plaintiff had accepted $750,000 total inclusive of damages, costs and fees to settle. Defense counsel also indicated he had advised plaintiff counsel that because of new Medicare and Medicaid laws, there would be some documents that would be forthcoming to determine how to word the stipulation. On the record, the judge asked whether the dismissal of the claims would be with prejudice in return for the payment of the settlement amount, and both counsel agreed. The judge further asked counsel to confirm the material terms of the settlement, and that although documentation needed to be executed to confirm the settlement, that the settlement would be effective November 5, 2012, notwithstanding any additional documentation which needs to be executed. Both counsel agreed. As a result, the court issued an order that same day indicating that because a settlement had been reached, the material terms of which were placed on the record, the jury trial scheduled to commence on November 7, 2012 was cancelled, as the parties would file an executed stipulation of dismissal. After spending the better part of a year attempting to finalize the language of the settlement documentation, the parties reached an impasse. Defendants then asked the court to compel plaintiff to execute their settlement agreement, and plaintiff asked the court to compel defendants to execute her version. On October 16, 2013, the United States District Court for the Western District of New York published its decision denying both motions and concluding instead that if the parties had not executed settlement documentation by November 8, 2013, the court would entertain a motion to enforce the settlement. Defendants insisted that plaintiff either provide a physician’s letter stating that she would not require further treatment, or else agree to a Medicare Set-Aside (MSA), whereby a certain amount of the settlement proceeds would be set aside to pay for future medical payments, in order to protect the parties against any potential liability to Medicare. The court however ultimately found that although defendants could have conditioned the settlement on plaintiff’s providing a physician’s letter or agreeing to a MSA, they did not do so. If defendants considered plaintiff’s Medicare status to be critical in deciding whether to settle, they should have ascertained that status before agreeing that the settlement was effective as of November 5, 2012. The court therefore ordered that if the parties had not executed settlement documentation by November 8, 2013, the court would entertain a motion to enforce the settlement. When the parties were unable to agree on the exact language of the settlement documentation, the court directed that judgment be entered in favor of plaintiff in the amount of $750,000. The State appealed that decision. On appeal here, the Circuit Court reiterates the fact that the parties expressed a clear intent to settle and placed the material terms of their settlement on the record, with neither party making any express reservation to be bound only by writing. As a result, the court agrees with the magistrate judge that “although defendants could have conditioned the settlement on plaintiff’s providing a physician’s letter or agreeing to a Medicare set-aside, they did not do so.” “If defendants considered plaintiff’s Medicare status to be critical in deciding whether to settle, they should have ascertained that status before agreeing that the settlement was effective as of November 5, 2012.” The court therefore affirms the judgment of the district court. We have all seen work comp and auto cases with MSP issues. And it is no longer unusual to read about medical malpractice or products liability cases with MSP issues. This however may be the first federal employment discrimination case dealing with MSP issues. More so however, this is yet another example of how waiting too long to prepare to protect Medicare’s interests in any type of settlement can end up affecting your agreement, provide you with unclear or unwanted language, or even worse, leave you unprotected from an MSP perspective. Over the last five years, there have been numerous state and federal cases concluding that despite Medicare’s guidance in workers compensation cases, and lack thereof in liability cases, courts will not disturb parties’ agreement to settle, even if it is clear both parties may be leaving the courtroom without appropriately taking Medicare’s interests into consideration. If you have questions concerning settling your Connecticut workers comp claim, call us at 860-523-8783.
Thursday, February 12, 2015
The mileage reimbursement rate for all travel expenses incurred on or after January 1, 2015 has increased to 57.5 cents per mile. This rate change applies to all claimants, regardless of injury date, and coincides with the federal mileage reimbursement rate pursuant to Section 31-312(a) of the Workers’ Compensation Act. Click here to read more about mileage reimbursement rates, including those for travel expenses incurred in past years.