The Center for Medicare and Medicaid Services ("CMS) recently included generic versions of Oxycodone and Lyrica in its "Red Book". The "Red Book" is the pricing source for prescription medications utilized by CMS when evaluating whether an appropriate amount has been set aside to cover future medical expenses in a settlement of a workers' compensation … Continue reading Dust off That Medicare Set-Aside Evaluation-Oxycodone and Lyrica Prices Have Dropped
As we all know, to be compensable under Ohio Workers' Compensation law an injury must have occurred "in the course and scope of employment". Both parts of the test must be met. The Ohio Supreme Court developed a two part approach to the course and scope of employment analysis. To determine whether an injury occurred … Continue reading Are You Smarter Than a Workers’ Compensation Attorney?
Under Ohio law either the Bureau of Workers' Compensation or the Industrial Commission has the right to have an injured worker examined by a physician of their choosing in connection with any issue to be heard before the Industrial Commission. If the injured worker refuses to submit to the examination, their claim for compensation “is … Continue reading How Many Workers’ Compensation Examinations Must One Person Endure? More Than One, According to the Ohio Supreme Court
It is well settled law that the Industrial Commission cannot base its decisions on "equivocal" medical evidence. State ex rel. Eberhardt v. Flxible Corp. Equivocation occurs when a doctor: 1) repudiates an earlier opinion, 2) renders contradictory or uncertain opinions, or 3) fails to clarify an ambiguous statement. A Supreme Court case released last week, … Continue reading What Makes a Doctor’s Report Ambiguous for Workers’ Compensation Purposes? A New Supreme Court Case Attempts to Make That …Unambiguous
Legislation passed earlier this year by the Ohio House of Representatives funding the Bureau of Workers' Compensation also included a number of substantive changes to Ohio's Workers' Compensation laws. Those changes included: providing coverage for First Responders with Post-Traumatic Stress Disorder even in the absence of a physical injury; amending the First Report of Injury … Continue reading Ohio’s BWC Budget Bill Has Finally Passed. What’s Changed? Not Much.
This week, the Centers for Medicare & Medicaid Services (CMS) proposed to cover acupuncture for Medicare patients with chronic low back pain who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies. To read the proposed decision, visit the CMS website here. Acupuncture is not currently … Continue reading Medicare Is Considering Approving Acupuncture for Low Back Problems. Does It Have a Place in Workers’ Compensation Claims?
As regular readers know, the Ohio House and Senate are currently at odds regarding provisions contained within the most recent budget bill. The Senate rejected the bill passed in the House, and a stopgap spending measure was approved, funding the BWC through July 30, 2019. I addressed two controversial provisions in the House bill in … Continue reading What Else is at Issue in the BWC Budget Bill?
The Ohio House and Senate failed to reach agreement on the Bureau of Workers’ Compensation Budget Bill. On June 30th the chambers approved a 30-day budget extension for the BWC in the form of SB172. The House version of the BWC Budget Bill included a provision that would allow first responders to file claims for … Continue reading BWC Budget Bill Fails to Pass Due to Disputes About PTSD Claims and Citizenship Information on First Report of Injury Form
Two weeks ago I posted about a provision in Ohio's BWC budget bill to provide workers' compensation coverage for PTSD sustained by first responders in the line of duty. This week I'll address another provision in the bill, which would require injured workers to provide their citizenship status when applying for workers' compensation benefits. Specifically, … Continue reading Should the Ohio BWC Be Collecting Citizenship Information on a First Report of Injury?
Simply put, because Medicare is going broke. Fast. Based on the projections in the 2019 Medicare Trustee's report, the Medicare Hospital Insurance (Part A) trust fund will be depleted in 2026. No, that wasn't a typo: 2026 (that's 7 years from now). What is a Medicare Set-Aside? First things first. If you're new to this … Continue reading Why the Government Needs Medicare Set-Asides