Anyone collecting Worker’s Compensation benefits or that is pursuing a liability/negligence case (including motor vehicle accidents, slip and fall cases, product liability cases, medical malpractice cases and any other types of personal injury cases) for damages and are also enrolled in Medicare through the Social Security Administration must notify the Centers for Medicare and Medicaid Service (CMS) under the Medicare Secondary Payer (MSP). This is because Medicare (CMS) has certain reimbursement rights (MSP).
Concerning Worker’s Compensation benefits, if an employee collecting Worker’s Compensation benefits, because of an injury, settles his or her Worker’s Compensation case including settling the medical benefits or closing out the medical benefits with the settlement, the employee must report the settlement to CMS and put together a Medicare set-aside fund (MSA) regarding the payment of future medical benefits necessitated by the work related injury. In Rhode Island the Worker’s Compensation Court has two ways of settling Worker’s Compensation cases. One way would include leaving the medical benefits open for payment of future medical benefits and another way is in which the medical benefits are closed. If the medical benefits are left open, meaning that Worker’s Compensation will continue to pay medical benefits after the case is settled, then there is no Medicare set-aside requirement. Likewise, in Massachusetts the Worker’s Compensation case can be settled with the medicals left open. If the medicals are left open in Massachusetts, likewise there is no Medicare set-aside requirement.
Concerning liability/negligence cases, it must be noted that after CMS is notified of the case documents will be forwarded including Conditional Payment Information that will indicate the amount that Medicare is owed for reimbursement regarding the injuries suffered in the liability/negligence case to date. Thereafter, once the liability/negligence case is settled CMS must be forwarded a copy of the release and a Final Payment letter will be sent indicating how much Medicare is owed regarding the injuries suffered in the liability/negligence case that Medicare has paid. In addition, in certain circumstances there are Medicare set-aside requirements in liability/negligence cases.
Karns Law Group, with offices in Cranston, East Providence and Middletown, Rhode Island is extremely experienced in representing Worker’s Compensation clients and liability/negligence cases including motor vehicle accidents, slip and fall cases, product liability cases, medical malpractice cases and any other type of personal injury case along with interacting with Medicare to make certain that the Worker’s Compensation client or personal injury client is totally compliant with Medicare requirements and that their future Medicare is protected.
Anyone with any issues concerning their Worker’s Compensation case and/or personal injury case regarding Medicare responsibilities should contact Karns Law Group immediately.
Robert T. Karns
Attorney at Law
Member RI & MA Bars
Worker’s Compensation Clients and Personal Injury Clients – Recent Changes in Medicare Reporting Requirements and Reimbursement Requirements
November 1, 2011
Clients collecting Worker’s Compensation benefits and all clients pursuing personal injury cases including motor vehicle accidents, slip and fall cases, product liability cases, medical malpractice cases and any other type of personal injury matter must notify Centers for Medicare and Medicaid Service (CMS) of their claims. Medicare, through CMS, has certain rights to be reimbursed under the Medicare Secondary Payer Program (MSP) which is why the notifications are required.
Recently, there have been changes regarding these reporting requirements concerning personal injury cases as follows:
- CMS extended the implementation of the Section 111 reporting requirements for liability settlements. Under the new timeline the reporting requirements will begin to be phased in on January 1, 2012. www.cms.gov/MandatoryInsRep on the Additional NGHP Alerts section page.
- CMS issued a new policy on the types of exposure, ingestion or implantation (typically mass tort) situations where Medicare will not assert a recovery claim against settlements, judgments or awards and Section 111 reporting requirements do not need to be followed. This policy will improve the reimbursement process for cases that meet CMS criteria. www.cms.gov/MandatoryInsRep NGHP Alerts section page and www.cms.gov/COBGeneralInformation.
- CMS also issued another new policy that establishes a safe harbor for settlements where a physician attests that no future medical care is needed. In any case where a physician attests that no future medical care is needed, the beneficiary would have finality on their Medicare reimbursement. www.cms.gov/COBGeneralInformation.
- CMS has also exempted Qualified Settlement Funds (QSFs) from Section 111 reporting requirements for certain payments to qualified trusts where the payment took place before 10/1/11. www.cms.gov/MandatoryInsRep MMSEA 111 Alerts section
Karns Law Group, with offices in Cranston, Rhode Island, East Providence, Rhode Island and Middletown, Rhode Island serving all of Rhode Island and Southeastern Massachusetts, is well versed in handling Worker’s Compensation cases and personal injury cases regarding these Medicare requirements. Anyone with any questions regarding their case and Medicare should immediately contact Karns Law Group.
Robert T. Karns
Attorney at Law
Member RI & MA Bars
Longshore & Harbor Workers’ Compensation – Onshore Injuries
November 1, 2011
The Longshore and Harbors Workers’ Compensation Act provides workers’ compensation benefits for maritime workers who are not seamen. The benefits the statute provides, like a state workers’ compensation scheme, do not depend on finding that the employer was at fault. These benefits include disability payments and rehabilitation services. The act also provides benefits to survivors when a maritime worker dies from work-related injuries.
The Longshore and Harbors Workers’ Compensation Act is a comprehensive workers’ compensation scheme for maritime workers. The law fills a gap that exists between the Jones Act, which protects seamen, and state workers’ compensation, which covers injuries occurring within a particular state. And injured workers who qualify for coverage are entitled to disability benefits. Under the Longshore and Harbors Workers’ Compensation Act the right to receive benefits does not depend on a finding that the employer was at fault for the worker’s injuries much like state Workers’ Compensation law.
The Longshore and Harbor Workers’ Compensation Act covers injuries that occur during maritime employment. Maritime employment includes the loading/unloading of vessels, repairing vessels and building a vessel. A worker who is injured on a pier, wharf, dry dock or terminal, can be compensated under the Act. Areas near a pier or wharf can also be included such as areas for loading, unloading, repairing, or building vessels.
The Longshore and Harbors Workers’ Compensation Act provides medical and disability benefits as well as rehabilitation services. The medical services must relate to the injury or illness sustained on the job. Occupational diseases that “arises naturally” from maritime employment are also included such as a welder who worked in a shipyard who develops a chronic illness as a result of handling asbestos at work. The Act also provides wrongful death benefits to survivors of a worker who is killed on the job.
An employee who is injured on the job has just 30 days to give the employer notice of the injury. When the employee develops a disabling condition or illness that is work related, notice also must be provided. A formal Longshore and Harbor Workers’ Compensation Act claim for benefits must be filed with the Department of Labor within one year from the date of injury. An employer can dispute the claim or begin voluntary payment within fourteen days of the accident. If an employer disputes the claim there is a conciliation procedure designed to help the parties come to an agreement about how the dispute should be resolved. If the parties cannot resolve the problem, an administrative law judge (ALJ) working for the Department will conduct a hearing and render a decision.
The Longshore and Harbors Workers’ Compensation Act also allows an injured worker to sue persons or entities, other than the employer or co-worker, whom the worker believes to be at fault for his or her injuries. Such when a worker is injured on a vessel, there may be a claim of negligence against the vessel and its owner. However, the worker is not permitted to allege a claim of unseaworthiness, because that claim is reserved to seamen.
Karns Law Group is extremely experienced in handling Longshore and Harbor Workers’ Compensation cases and anyone with a claim regarding this should immediately contact Karns Law Group. Karns Law Group has offices in Cranston, Rhode Island, East Providence, Rhode Island, and Middletown, Rhode Island and serves all of Rhode Island and Southeastern Massachusetts.
Robert T. Karns
Attorney at Law
Member RI & MA Bars
Maritime Injuries – Injuries on Navigable Waters
November 1, 2011
Anyone injured in the scope of their employment while working at sea or on the water falls within the category of maritime injuries. This is governed by a United States Federal Act known as the Jones Act and is also governed by Federal Case Law known as Admiralty utilizing Jones Act and the concepts of unseaworthiness.
Maritime injuries include anyone injured on navigable waters. This can be the open ocean, bays and harbors and lakes and rivers. The class of injured people includes fisherman, and workers on all types of ships, boats, barges and watercraft. Benefits under the Jones Act and the concepts of unseaworthiness are paid instead of normal Worker’s Compensation and include maintenance and cure (maintenance is the weekly amount the injured worker will receive and cure is the payment of his or her medical bills). In addition to the benefits of maintenance and cure, the law of maritime injuries also allows the injured worker to sue his employer under the Jones Act and the concepts of unseaworthiness for damages.
Injured workers must fit the definition of seaman and must be injured on navigable waters.
These benefits pay the injured worker’s medical bills and provide him or her with weekly income. In addition, as stated, the injured has a right to sue for damages and either go to trial for a recovery or eventually settle the case.
Karns Law Group is extremely experienced in handling all injured workers under the Jones Act and unseaworthy doctrine. Anyone injured on navigable waters that qualifies as a seaman should immediately contact Karns Law Group for representation. Karns Law Group has offices in Cranston, Rhode Island, East Providence, Rhode Island and Middletown, Rhode Island and services all of Rhode Island and Southeastern Massachusetts.
Robert T. Karns
Attorney at Law
Member RI & MA Bars
Re: Can I still work if I bring a personal injury claim?
October 21, 2011
Due to the difficult economic times that our country is currently facing, people value their jobs more than ever. Many people ask if they will be able to continue working if they decide to bring a personal injury claim and the answer is always yes. Insurance adjusters understand the importance of employment and often look favorably on a claimant who continues to work when possible. Obviously, if you are physically unable to work after an accident you should not push yourself as we can help you to recoup money during your claim through temporary disability benefits. Treatment can be planned around your schedule making it possible for you to get therapy without jeopardizing your employment. Do not let the fear of not being able to work prevent you from holding the at fault party responsible for your injuries.
Sarah Karns Burman
Attorney at Law
Member RI Bar
The success of a personal injury claim lies heavily on the honesty of the client. If a client is dishonest about pertinent preexisting information such as their medical history or driving record, the claim can suffer greatly. In a personal injury case everything goes to the credibility of the witness and without a trustworthy witness an insurance company will try and seek out every reason to deny your claim. An attorney needs to be armed with as much information as possible in order to build the strongest case. Even if it seems unrelated to a personal injury claim, it is important to answer all of the attorney’s questions truthfully that way there are no surprises. Honesty is the best policy so let your attorney be the one to decide what information is relevant and what isn’t.
Sarah Karns Burman
Attorney at Law
Member RI Bar
RE: The Risks of Social Networking
September 30, 2011
Social Networking on sites such as Facebook, MySpace, and Twitter are great ways to communicate with friends and family however it is important to remember that everything on these sites is open to the public. With the increasing popularity of such sites, insurance companies now consider it standard practice to run computer searches and investigations to try and seek out any information about your personal life that could potentially be used against you later in the case. Since the law is unclear to what extent privacy laws apply, insurance companies have the ability to obtain information without your knowledge. Sites such as Facebook provide everything from pictures, conversations with friends, and contact information so if there is information that you don’t want insurance companies to see, then it is probably best to either remove it or to close it until your case is completely over. Although privacy settings can help make your information somewhat more secure, insurance companies have ways of getting a hold of such information so even with the highest setting possible keep in mind that social networking is still a very vulnerable form of online communication. Limiting your social networking and closely monitoring who has access to it, can help build the strongest case possible so it is important to keep in mind that until the case is over communication via the internet should be kept at minimum.
Sarah Karns Burman
Attorney at Law
Member RI Bar
Brain Injury Associations – Support Groups
September 29, 2011
Traumatic brain injury survivors and their family members will find great benefit in joining the state brain injury association where they live that is affiliated with the Brain Injury Association of America.
One of the most useful benefits of belonging to these brain injury associations are the support groups they offer that involve interaction with other brain injury survivors and their family members whereby very useful information is discussed that is quite beneficial for the brain injury survivor and family members. These support groups usually meet on a monthly basis.
In Rhode Island the state brain injury association is Brain Injury Association of Rhode Island – www.biaofri.org.
The support group meetings for the Brain Injury Association of Rhode Island are as follows:
For information on each state brain injury association contact the Brain Injury Association of America - www.biausa.org. The Brain Injury Association of America website will indicate the brain injury association of each state in order that the support group meetings in each state can be located.
In addition, for your convenience, the state brain injury associations are listed below:
The Karns Law Group is experienced in handling traumatic brain injury cases for survivors and family members, making sure their rights are protected and they are fully compensated.
Robert T. Karns
Attorney at Law
Member RI & MA Bars
Social Security and Heart Disease
September 29, 2011
Heart-related illnesses fall under the category of “cardiovascular system”, which includes such conditions as chronic heart failure, cardiomyopathy, ischemic heart disease, etc.
Despite modern medicine and efforts to educate people about cardiovascular and other heart-related diseases and conditions, risk factors, and preventive lifestyle changes, heart disease is still the number one killer in the United States.
Unfortunately, some people with heart disease are unable to accomplish the simplest daily tasks. This interferes with their quality of life and sometimes leaves the heart patients unable to work.
Many who find themselves unable to work seek financial relief from the Social Security Administration (SSA) in the form of Social Security Disability Insurance, also referred to as SSD or SSDI.
Rachel Karns Kerrison
Attorney at Law
Member RI & MA Bars
