Are you ready for Section 111, Medicare Secondary Payor? If you are a self insured responsible for paying workers compensation benefits or a carrier paying workers compensation benefits, you must register with CMS. This requirement also applies to No-Fault Insurance and Liability Insurance. General Health Insurance has already gone through the transition for mandatory reporting.
CMS has begun mandatory reporting so they can create a database to know when they do not have primary responsiblity for medical payments.
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CMS has just recently extended the deadline for mandatory reporting. They have moved the date from April 1, 2010 to January 1, 2011.
For more information about Medicare Secondary Payor reporting, visit CMS website at http://www.cms.hhs.gov/MandatoryInsRep/
Feel free to contact us if you have questions about Section 111 in regards to Workers' Compensation. |
Probably the most recent item to cross our path is the emphasis that the Workers Compensation Bureau is taking with medical bills. They are basically saying take some action on the medical bill within 30 days of receipt of the bill and records. It is important to either pay it, deny it or respond in writing to the bill with those 30 days. They are working with certain medical providers to track payment on bills. If they are not paid within the 30 days, you may face the possiblity of up to 50% penalties.
Attempted suicide can be grounds for suspending benefits. In Curtis Vs. Burley Electric Company the employer filed a Suspension Petition alleging that the claimant had recovered sufficiently from his work injury to return to light duty. While this litigation was pending, the claimant shot himself in the head, attempting suicide. He was unsuccessful.
The employer, however, filed another Suspension Petition alleging that he voluntarily withdrew from the workforce and refused reasonable medical treatment by this attempt at ending his life. Initially, the Workers Compensation Judge denied the Petition, but on remand from the Board an Order was issued granting the Petition.
Several physicians testified who treated the claimant for drug, alcohol and marital problems. The Workers Compensation Judge then issued his ruling that the claimant, by attempting suicied, revealed his intent not to continue medical treatment which would have resolved that work-related injury. The claimant, then in a vegetative state, appealed through his wife and legal guardians.
The Appeal Board affirmed the decision. On the day in question, the claimant was engaged in a domestic dispute with his girlfriend (not the claimant's wife) after consuming a large quantitiy of beer and cocaine. During the argument, the claimant took out a gun, loaded it with one bullet, and pulled the trigger twice. The Board affirmed the Judge's finding that the claimant intended to bring harm to himself and consequently voluntarily removed himself from the workforce.
The claimant's widow has appealed to Commonwealth Court.
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In the future it may be more difficult to settle claims when an injured worker is also receiving Social Security benefits. The Social Security Adminitration is proposing to modify its rules on disability payment which could ultimately lower the benefits for injured workers accepting workers' compensation lump sum settlements.
Attorneys and inurers involved in negotiating compensation settlements are currently manipulating the way settlement amounts are prorated for the calculation of the social security offset, enabling the injured worker to take advantage of the sysstem and obtain more Social Security benefits. Consequently, the Social Security Administration wants to stiffen the rule for prorating higher settlements or more difficulty in settling claims because injured workers would have less social security disability benefits on which to rely.
Presently, attorneys and insurers are using life expectancy to calculate the equivalent monthly rate which results in a low amount and Social Security pays more than it would if another basis were used.
The Social Security Administration is proposing to return to the method it used prior to 1971 in which a lump sum award would be reduced by the amount of excludible expenses prior to proration. They claim that this would provide both unifmity and consistency for all claimant.s
In addition, the Social Security Administration proposal would also effect how legal, medical and related expenses are treated in calculating the social security disability offset.
We will keep you informed of the status of this proposal.
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