Congress and Medicare

In June, 2011, congressional hearings were held in Washington D.C. to examine systems under the Medicare Secondary Payer Law.  Objectives included whether the systems adequately protect the interests of Medicare beneficiaries, businesses, taxpayers, and other interested parties. Particular focus has been on the conditional payment aspect of the MSP. The MARC Coalition’s H.R. 1063; “Strengthening

CMS Policy for Set-Aside Submission

As covered in previous Wiedner & McAuliffe Newsletters, CMS issued a Memorandum on May 11, 2011.  This was intended by CMS to “reiterate guidance provided in [prior procedure] Memoranda regarding CMS’ Workers’ Compensation Medicare Set‑Aside Agreement (WCMSA) proposal review threshold …” The Memorandum was a response, in part, to legislative efforts in some states to make

Record Review Reports Subject to Section 12

William Mulligan v. Illinois Workers’ Compensation Commission No. 1-09-2507WC William Mulligan suffered injuries on separate dates to his right knee and cervical spine which he claimed rendered him totally disabled from working.  His employer disputed this claim based on Mulligan’s long history of multiple knee surgeries, including a total knee replacement, and prior surgery to

Section 8j Credit Granted for Wages Paid in Lieu of TTD

Elgin Board of Education School District 4-26 v. Illinois Workers’ Compensation Commission, Et al., No. 1-09-3446WC Linda Weiler worked for the Elgin Board of Education School District U-46.  On November 13, 2002, she struck her right knee against a metal desk, aggravating an unrelated condition for which she had just one week before undergone surgery. 

MSPRC to Resume Issuance of Conditional Payment Demand Letters

Recall from prior Alerts that MSPRC suspended issuance of conditional payment demand letters in the wake of the Haro v. Sebelius decision.  This created additional delay in the already burdensome process of considering Medicare’s interests.  MSPRC has now announced that it has completed its review of its internal policies and procedures, and that it expects

What Is New With Conditional Payments?

Portman v. Goodson, et al.; Sullivan v. Farm Bureau Mutual Insurance Company of Michigan No. 2011 U.S. Dist. LEXIS 19491; 2011 U.S. Dist. LEXIS 35817 What is new with Conditional Payments? Case Law MSPRC Policy A previous Alert advised that MSPRC suspended issuance of conditional payment information while it reviews the implications of the recent

Workers Compensation Reform Passes Both Houses in General Assembly

In the final hours of the legislative session, the General Assembly voted to implement substantive changes to the Workers’ Compensation Act under HB 1698.  The legislation now awaits Governor Quinn’s signature.  Below is a summary of how the legislation unfolded over the past five days. Friday, May 27, 2011 After months of negotiations between all

Multiple Injuries to the Same Body Part Merit One Disability Award

The City of Chicago vs. The Illinois Workers’ Compensation Commission, et al. and Robert Baumgardner vs. Illinois Workers’ Compensation Commission, et al. No. No. 1-09-2320WC and No. 1-10-0727WC In two decisions issued on the same day, the appellate court has held that multiple injuries involving the same part of the body merit only one permanency

MSPRC Suspends Issuance

Greater delays in obtaining conditional payment information should be expected following MSPRC’s recent announcement that it has suspended issuance of Rights and Responsibilities letters and Conditional Payment Demand Letters.  This change in protocol is presumably in response to an Arizona federal court’s recent opinion in the case of Haro v. Sebelius, where the court ruled

Workers Compensation Reforms Advance in Springfield

Senate Amendment 3 to House Bill 1698 was introduced in the Senate on May 26, 2011.  The following represents the most substantive proposed changes: Compensability standard codified –an employee bears the burden of showing, by a preponderance of the evidence, that an accidental injury arose out of and in the course of the employment. Carpal