Saturday, April 21, 2012

Are there any reimbursements in Compensation?

Reimbursement for causally related prescription costs and mileage are available subject to limitations found in the WCL, WCB rules and case law. At the time of this writing,  mileage reimbursements are payable at 55.5 cents a mile.  Mileage reimbursement rates have changed over time and are controlled by the date of the service as documented in the rules and regulations of the WCL. You are permitted to receive such reimbursements for traveling to and from those health providers handling your case as well as for transportation costs associated with examinations conducted and set up by insurance companies monitoring your case. Transportation costs to and from the court or your attorney are not reimbursable.

Covered medical prescription costs may be reimbursable if you comply with the procedures set out in the act but primarily must be documented as "medically necessary".  Such products and devices must be requested by your health provider and are subject to challenge if not medically necessary. Routine procedures are detailed in the Medical Treatment Guidelines, WCL and WCB rules and regulations as well as procedures for obtaining such services but,  may be reimbursable  if approved by the insurance provider in advance or after board direction.

Health provider are not permitted to charge and receive payments for causally related medical services from workers' compensation claimants. If any such payment is made,  the payment is not reimbursable. If such a payment is made for a compensable claim, it is illegal and not enforceable.

If your employer has made advance payments for causally related care,  reimbursements can be directed by the WCB.  In addition, various payments made under contract or state law in certain circumstances and subject to contract documents may also be reimbursable to the entity making the payment. If a non-employer and non co-employee is negligent and the cause of the injury; then they could be found to be ultimately liable for all compensation costs in the case subject to the amounts contained in the negligent or malpractice action. This is known as a third party case. As such, the negligent party and its insurance provider can be compelled to reimburse the workers' compensation provider who has already paid or create a credit to the benefit of the compensation provider to future obligations equal to the amounts contained in the third party case subject to case law regarding apportionment issues. Detailed discussion on these issues are contained in the "Kelly" and "Burns" cases and their progeny. ( See standard disclaimer as noted below.)


Eliot S. Levine & Associates
Attorneys at Law
1455 Veterans Highway
Hauppauge, New York  11749
Telephone: (631) 234-5484
Fax: (631) 234-5561
Email: e.levine@redsail2.com
www.LongIslandWorkers.com
DISCLAIMER

Tuesday, April 3, 2012

How do I get my injuries treated ?

Under the present Rules and Regulations as promulgated by the WCB as exemplified by the latest Medical Treatment Guidelines ( MTG ) effective December 1, 2010 injuries effecting arms, knees backs and  necks are described in a detailed 200 page document available to all individuals participating in the workers compensation system . This document tries to provide and permit standard medical practices for many types of medical conditions. When treatment or conditions are not found or fully handled in the MTG, the health provider may file a variance to the MTG and then procedural requirements exist to eventually resolve any dispute. The question arises as to how these variances should be evaluated. The present system permits either medical arbitration or WCL judges review. When the question goes to a law judge, the difficulty develops as to what is the medical basis that the judge can use to review and decide such issues. On a simplified approach the judges can rule based upon whether the health provider has met their burden of proof. When this means is there any evidence submitted then the judge has no problem making a decision. When the issue  is comparing medical opinion on reasons for one type of medical form of treatment over another; a strong complaint can be made that the judge is not legally competent to give or evaluate such medical opinion.  They should be able to hear the reasons presented but do not have the medical expertise to weigh one opinion over another. If the procedure is not prohibited by the guidelines and a health provider can explain why such a procedure is appropriate consistent with present medical custom and usage then only an impartial medical expert should be used to resolve the dispute not a law judge. This is the very nub of the problem with the medical guidelines as they presently exist., The issue gets murkier when only one side provides a medical opinion from a licensed medical provider. We'll have to see how this develops as more cases are presented and litigated.


Eliot S. Levine & Associates
Attorneys at Law
1455 Veterans Highway
Hauppauge, New York  11749
Telephone: (631) 234-5484
Fax: (631) 234-5561
Email: e.levine@redsail2.com
www.LongIslandWorkers.com
DISCLAIMER