Tag Archives: subrogation

Will Medicare beneficiaries see faster settlements?

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“How much will my case settle for ?” and “When will I get my settlement?” are two of the biggest questions asked by clients in a workers’ compensation or personal injury case. Medicare beneficiaries will soon better know the answers to these questions.

As of April 1, the Centers for Medicare and Medicaid Services will allow conditional payments to be made electronically. The change to an electronic payment system will allow all authorized users to view the updated demand status of CMS and track electronic payments in the “Electronic Payment History” tab.

This change should allow Medicare beneficiaries who have a workers’ compensation or personal injury claim to have their cases settle sooner and receive their settlement proceeds sooner.

A Medicare conditional payment is a payment made by Medicare in a disputed workers’ compensation or personal injury case. In a conditional payment situation Medicare will pay on a medical expense but demand that they be paid back from the proceeds of a settlement or judgment.

In substance a conditional payment issues is like any other subrogation issue where some form of health insurance pays for an injury that should be covered under workers’ compensation or a liability policy. In all cases, the plaintiff needs to know how much can be repaid so they can settle a claim and know what they might receive in a settlement.

In a Nebraska workers’ compensation case, under Neb. Rev. Stat. 48-120(8),a judge can order that a third-party who paid for medical care that was related to be a work injury be reimbursed for payments made on behalf of an injured worker.

The problem with Medicare is that the conditional payment process is often more burdensome than determining a subrogation or repayment interest from other types of insurers – it often takes longer as well. Hopefully electronic payment and tracking of payments will simplify and speed up settlements involving Medicare beneficiaries.

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Medicare, Nebraska, subrogation, Workers Compensation and tagged , , , , .

Three “mega” issues with “mega” claims

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An increase in driving jobs and use of mobile devices has lead to more “mega” workers’ compensation claims.

The cost of workers compensation insurance and the total number of work injuries has been in a long-term decline as industrial jobs decrease and service jobs increase.

But even as overall claims and costs decline, the workers’ compensation insurance industry is focusing on higher value “mega”  claims involving serious or fatal injuries. These claims often involve auto accidents which are made more prevalent by the 1) increase in delivery jobs through online commerce and 2) the expansion of mobile technologies that turn vehicle into mobile offices. (I drafted the first two paragraphs of this post on my IPhone in my car at a car wash)

The increased focus on so-called mega claims will likely bring increased attention to litigation over 1) when an injury arises out of and in the course and scope of employment 2) employee fault and so-called safety violations and 3) fights over how much an insurer/employer should be paid back when they paid workers’ compensation benefits for an injury that was the fault of a third-party. In legalese, this is called a subrogation interest.

Arising out and in the course and scope of employment

For an injury to be covered by workers’ compensation, it has to take place within the time and spatial boundaries of work and the injury has to be caused by a risk related to employment. At least under Nebraska law, the issue depends on the facts of the case. The Nebraska Court of Appeals recently heard oral arguments in a workers’ compensation case involving the survivor of a sheriff’s deputy who was killed in a car accident on his way home from work.

Normally such work would not be covered under workers compensation under the so-called going and coming rule. But in this case the sheriff’s deputy was talking to another deputy who was covering the next shift about a work-related event when accident occurred. The family of the employee argued that since the employee was talking on their cell phone about work with a coworker when the accident happened, that the accident should be covered by workers compensation. In that case the trial court disagreed.

I agree with the family.  Mobile technology is changing the scope of what constitutes the workplace. It also changes expectations for when an employee is expected to be working. Covering employees injured offsite and/or off the clock while using mobile technology by workers compensation adapts workers compensation to a modern workplace.

Safety violations

Using mobile devices in moving vehicles poses safety risks. Employers have the discretion to make reasonable safety rules. In some cases, violation of a safety rule gives employers to paying workers compensation in Nebraska. Many other states have similar rules. In a recent Virginia case, serious injuries to a bus driver injured in a motor vehicle accident were found not to be covered by workers’ compensation because the driver was violating an employer rule requiring that he wear a seat belt. A death or serious caused by a worker who was texting or emailing while driving in violation of company rules on would be vulnerable to being dismissed in Nebraska.

Third Party cases

Many cases involving auto accidents on the job involve the negligence of a third party that is neither the fault of the employee or employer. In such a case, the employer has a right to be paid back for workers’ compensation benefits out of any recovery from that third party minus some attorney fee. This is called a subrogation interest. Nebraska law allows a court to equitably determine the amount of the subrogation interest.

But Nebraska courts have taken a view of equitable subrogation in third party cases that is favorable to employers. The fact that an employer deceased the value of the personal injury case by aggressive defense of the workers’ compensation claim  does not given courts the authority to reduce an employer’s subrogation interest. Nebraska courts have also held that giving employers robust repayment rights in third party cases effects the purpose of the workers compensation act because it encourages the prompt payment of benefits.

 

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Nebraska, Workers' Compensation and tagged , , , , , .