Category Archives: Workers Compensation

Medicare Updates Guidance on Submission of Proposed Set-Asides

The Set Aside Reference Guide (WCMSA Ref. Guide Vers. 3.5) was updated on January 10, 2022 to state that Medicare no longer gives “non submit” set aside allocations the same deference as “submitted and approved” set aside allocations. This will have a big impact on workers’ compensation settlements.

This is new and conflicts with other guidance issued by the Center for Medicare & Medicaid Service regarding both required pre-approval and the review thresholds. Two key questions emerge.

First, the new Guide states throughout that submission of a set aside for pre-approval by CMS is not required. All of the language in the Guide that confirms that pre-approval is not required is the same.

Second, the new statement, that CMS will not give deference to “non-submit” allocations conflicts with the fact that many allocations can not be submitted for review, according to Medicare’s own rules.

Greg Lois is hosting a live Q & A session on what this change in guidance from the CMS means for carriers and self-insured employers resolving workers’ compensation claims via “full and final” settlement. Register here: https://attendee.gotowebinar.com/register/2523205883375673614

Risk Transfer & Subrogation: New York Workers’ Compensation Webinar

Join Us for This Live Webinar on Monday December 20, 2021 at 12PM EST or 3PM EST

In this LIVE webinar on Monday, December 20, 2021, Greg Lois leads a discussion on reimbursement from the proceeds of third party claims as well as the carrier/employer’s right to subrogate. This webinar is offered at two different times, always on the Third Monday of the month, at 12:00 PM and 3:00 PM EST.

We will discuss:

  • What rights the carrier or employer has to the proceeds of a third-party settlement pursuant to Section 29.
  • Overview of how reimbursement is calculated.
  • What types of cases are “red flags” for reimbursement or risk transfer.
  • Answers to common risk transfer questions.

To register for our New York Workers’ Compensation Webinar Series, a monthly discussion offered at your choice of time in two sessions, click the buttons below (or register here).

Continue reading Risk Transfer & Subrogation: New York Workers’ Compensation Webinar

Year-End Review of Construction Case Law: Construction Defense Webinar

Join Us for This Live Webinar on Monday, December 6, 2021 at 12PM EST

In this live webinar, “Year-End Review of Construction Case Law,” Tashia Rasul, partner at Lois Law Firm, looks back at the important case law decisions of 2020 which will have an impact on how we defend claims in the future! Join us for this live discussion and Q & A.

Tashia will discuss the following:

  • Most important Workers’ Compensation construction accident trial and appellate decisions.
  • New case law impacting civil litigation.
  • A look ahead at how these case decisions will impact the practice in 2021.

To register for our Construction Litigation Webinar Series, a monthly discussion of recent case law developments and best practices for handling construction accident claims in New York, click the button below (or register here).

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Evaluating Cases for Permanency Exposure: New York Workers’ Compensation Webinar

Join Us for This Live Webinar on Monday November 15, 2021 at 12PM EST or 3PM EST

In this LIVE webinar on Monday, November 15, 2021, Greg Lois leads a discussion and answers questions on evaluating claims for permanency exposure in New York. We will focus on the recent case law and practical advice on how to minimize the employer’s exposure in Loss of Wage Earning Capacity awards. This webinar is offered at two different times, always on the Third Monday of the month, at 12:00 PM and 3:00 PM EST.

We will discuss:

  • Definition of “Loss of Wage Earning Capacity,” including what classes of injuries may qualify for this type of award.
  • Overview of how awards are calculated.
  • The use of IMEs and Disability Duration Guidelines to challenge impairment ratings in LWEC awards.
  • Answers to common Loss of Wage Earning Capacity questions.

To register for our New York Workers’ Compensation Webinar Series, a monthly discussion offered at your choice of time in two sessions, click the buttons below (or register here).

Continue reading Evaluating Cases for Permanency Exposure: New York Workers’ Compensation Webinar

Video: Impact of New Jersey’s Creating New “Preference” For Rehiring Permanently Disabled Employees

In this video, Greg Lois discusses the new “rehiring preference” for permanently disabled employees added to New Jersey’s Workers’ Compensation Law on September 30, 2021 .  This video is from a live webinar provided to clients on October 25, 2021.

Topics discussed:

  • Who the New Law Applies To;
  • Employers EXEMPT from the Law;
  • The Impact on Employers;
  • Live Q & A on topic.

New Statute Creating “Hiring Preference”

On September 30, 2021, Governor Phil Murphy signed into law Assembly Bill A2617, which provides as follows:

Following a work-related injury, an employer shall provide a hiring preference to an employee who has reached maximum medical improvement (MMI) and is unable to return to the position at which the employee was previously employed for any existing, unfilled position offered by the employer for which the employee can perform the essential functions of the position.

Who The New Law Applies to

The law creating preference only applies to employers with more than 50 (fifty) employees.

Read on for all the exemptions (below). 

Who Is Exempted From the New Law

1) The Preference Does Not Apply to Employers with Less Than Fifty (50) Employees.

Employers with less than 50 employees are exempted b the clear terms of the new law.

2) The Preference Does Not Apply to Contractors Subject to Prevailing Wage Law

The law states that it “shall not include a contractor as defined in section 3 of P.L.1999, c.238 (C.34:11-56.50).” The referenced law,  N.J.S.A. 34:11-56.50, defines “contractor” as

a person, partnership, association, joint stock company, trust, corporation, or other legal business entity or successor thereof who enters into a contract which is subject to the provisions of the “New Jersey Prevailing Wage Act,” P.L.1963, c.150 (C.34:11-56.25 et seq.), and includes any subcontractor or lower tier subcontractor of a contractor as defined herein.

The New Jersey Prevailing Wage Act (N.J.S.A. 34:11-56.25 et seq.) establishes a prevailing wage level for workers engaged in public works. It applies to public projects which are defined as follows: 

3) The Preference Does Not apply to Athletes Employed by Professional Sports Teams.

The law states that employers of athletes of professional sports teams are exempted from the preference. 

Continue reading Video: Impact of New Jersey’s Creating New “Preference” For Rehiring Permanently Disabled Employees

Video: Impact of New Jersey’s Creating New “Preference” For Rehiring Permanently Disabled Employees

In this video, Greg Lois discusses the new “rehiring preference” for permanently disabled employees added to New Jersey’s Workers’ Compensation Law on September 30, 2021 .  This video is from a live webinar provided to clients on October 25, 2021.

Topics discussed:

  • Who the New Law Applies To;
  • Employers EXEMPT from the Law;
  • The Impact on Employers;
  • Live Q & A on topic.

New Statute Creating “Hiring Preference”

On September 30, 2021, Governor Phil Murphy signed into law Assembly Bill A2617, which provides as follows:

Following a work-related injury, an employer shall provide a hiring preference to an employee who has reached maximum medical improvement (MMI) and is unable to return to the position at which the employee was previously employed for any existing, unfilled position offered by the employer for which the employee can perform the essential functions of the position.

Who The New Law Applies to

The law creating preference only applies to employers with more than 50 (fifty) employees.

Read on for all the exemptions (below). 

Who Is Exempted From the New Law

1) The Preference Does Not Apply to Employers with Less Than Fifty (50) Employees.

Employers with less than 50 employees are exempted b the clear terms of the new law.

2) The Preference Does Not Apply to Contractors Subject to Prevailing Wage Law

The law states that it “shall not include a contractor as defined in section 3 of P.L.1999, c.238 (C.34:11-56.50).” The referenced law,  N.J.S.A. 34:11-56.50, defines “contractor” as

a person, partnership, association, joint stock company, trust, corporation, or other legal business entity or successor thereof who enters into a contract which is subject to the provisions of the “New Jersey Prevailing Wage Act,” P.L.1963, c.150 (C.34:11-56.25 et seq.), and includes any subcontractor or lower tier subcontractor of a contractor as defined herein.

The New Jersey Prevailing Wage Act (N.J.S.A. 34:11-56.25 et seq.) establishes a prevailing wage level for workers engaged in public works. It applies to public projects which are defined as follows: 

3) The Preference Does Not apply to Athletes Employed by Professional Sports Teams.

The law states that employers of athletes of professional sports teams are exempted from the preference. 

Continue reading Video: Impact of New Jersey’s Creating New “Preference” For Rehiring Permanently Disabled Employees