CMS 2016 Recovery Thresholds for Workers’ Compensation Settlements, Judgments, Awards or Other Payments

2016 Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, Judgments, Awards or Other Payments 

As required by section 1862(b) of the Social Security Act, the Centers for Medicare and Medicaid Services (CMS) has reviewed the costs related to collecting Medicare’s conditional payments and compared this to recovery amounts.

As of the date of this alert and for the remainder of 2016, CMS will maintain the $1,000 threshold for physical trauma-based liability insurance (including self-insurance) settlements. CMS will also implement a $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibly for medicals. 

This means that entities are not required to report, and CMS will not seek recovery on settlements, as outlined above. Please note that the liability insurance (including self-insurance) threshold does not apply to settlements for alleged ingestion, implantation or exposure cases. 

Information on the methodology used to determine the threshold is provided at https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-ofBenefits-and-Recovery-Overview/Non-Group-Health-Plan-Recovery/Downloads/Computationof-Annual-Recovery-Thresholds-2016.pdf

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Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  has been representing injured workers and their families who have suffered occupational accidents and illnesses.

Related:

Workers' Compensation: CMS Publishes Final Rule for MSP ... May 17, 2016 ... This final rule, effective June 16, 2016, specifies the process and timeline for expanding CMS' existing Medicare Secondary Payer (MSP) Web ... idoctor-health.blogspot.com

Workers' Compensation: CMS Implements SMART Act Functionality ... Dec 21, 2015 ... The SMART Act of 2012 codifies the process to comply with the Medicare Secondary Payer Act. CMS has now implemented an on-line process ... idoctor-health.blogspot.com

Workers' Compensation: CMS Posts WCMSA Self-Administration ... Apr 14, 2014 ... A new WCMSA Self-Administration page has been added to the Workers Compensation Medicare Set-Aside Arrangement section of CMS.gov. idoctor-health.blogspot.com

Hot Topics in Workers' Compensation Law Seminar 2016 - Available from NJICLE

This seminar is now available from NJICLE-Click here

Hot Topics in Workers' Compensation Law Seminar

Wed. Sept. 14, 2016  Ÿ Law Center, New Brunswick 5-8:35p

This year’s program will focus on professional and ethical responsibilities concerning disclosure and protection of client confidential information throughout the course of discovery and litigation, with specific emphasis on the pretrial conference.

The seminar +reviews the Professional Code of Responsibility and it’s integration with the Rules and procedures of The Division of Workers' Compensation, and The Health Insurance Portability and Accountability Act (HIPAA). 


Co-Moderators:
Jon L. Gelman, Esq,. Author of Workers' Compensation Law (Thomson-Reuters) (Wayne)
Nancy J. Johnson, Esq,, Certified by the Supreme Court as a Workers’ Compensation Law Attorney, Capehart & Scatchard (Mt. Laurel)

From the Bench:
Hon. Emille Cox, Administrative Supervising Judge of Workers’ Compensation (Camden)
Hon. Ashley Hutchinson, Administrative Supervising Judge of Workers’ Compensation (New Brunswick)

From the Bar:
Christopher Gargano, Esq., Certified by the Supreme Court as a Civil Trial Attorney (Jersey City)
Steve Secare, Esq. Certified by the Supreme Court of New Jersey as a Criminal Trial Attorney, District IIIA (Ocean County) Ethics Committee Secretary (Toms River)

Ralph Smith 3rd, Esq., Co-Chair, Labor & Employment Group, Capehart & Scatchard (Mt. Laurel)

From the Medical Profession:
Steven G. Crawford, M.D., Certified Medical Examiner (CIME) (Eatontown)

Time	Facilitator	Segment	Panel
Panel 1	Hon. Ashley Hutchinson, Steven G. Crawford, M.D., Christopher Gargano, Esq., Jon L. Gelman Esq., Esq., Nancy J. Johnson, Esq.,  Steve Secare, Esq., Ralph Smith 3rd Esq,		1
5:00 PM	Jon L. Gelman Esq. Nancy J. Johnson, Esq.	Introduction	1
5:01 PM	Ralph Smith 3rd, Esq,	Health Insurance Portability and Accountability Act (HIPAA): Protection of confidential client information and ethical responsibility of Workers’ Compensation practitioners.	1
5:23 PM	Ralph Smith 3rd, Esq,	Health Insurance Portability and Accountability Act (HIPAA): Proper protection of personal identifying information in pleadings, discovery and exhibits.	1
5:45 PM	Steve Secare, Esq.	Recognition of and dealing with conflicts of interest.	1
6:07 PM	Christopher Gargano, Esq.	How and when to withdraw and terminate client representation.	1
6:29 PM	Break
Panel 2	Hon. Emille Cox, Hon. Ingrid French, Hon. Philip Tornetta, Christopher Gargano, Esq., Jon L. Gelman Esq., Esq., Nancy J. Johnson, Esq., Steve Secare, Esq.		2
6:44 PM	Jon L . Gelman, Esq.	Meeting the challenge of cyber security.	2
7:06 PM	Hon. Emille Cox	Maintaining pretrial conference decorum and confidentiality of client protected information.	2
7:28 PM	Steve Secare, Esq.	Appropriate communication method with clients, adverse parties and the Court.	2
7:50 PM	Hon. Philip Tornetta	Representing minors and incompetents	2
8:12 PM	Hon. Ashley Hutchinson	Settling a claim with appropriate authority and enforcement of the settlement.	2
8:34 PM	Jon L. Gelman Esq. Nancy J. Johnson, Esq	Closing Remarks	2
8:35 PM	Adjourn

NJ CLE ETHICS: This program is approved for 4.0 credits (50 minute hour), including

 4.0 ethics/professionalism credits.

Available for purchase

This seminar is now available from NJICLE-Click here

New Jersey Institute for Continuing Legal Education A Division of the NJSBA

One Constitution Square, New Brunswick, NJ 08901

Phone: (732) 214-8500 · Fax: (732) 249-0383 · CustomerService@njsba.com

ICLE is a fully accredited CLE provider in NJ, NY & PA. 

Updated: September 20 2016

Workers' Compensation "Demise of the Grand Bargain" Seminar Papers Online

The 2016 workers' compensation "Grand Bargain" seminar sponsored by the Pound Civil Justice Institute has posted the draft seminar papers online in PDF format and are available for download. The 2016 Academic Symposium is entitled, "The Demise of the Grand Bargain: Compensation for Injured Workers in the 21st Century."

View/Download the 2016 Symposium Papers

PANEL I:  Work Injury and Compensation in Context,1900 to 2016
                 Emily Spieler, Northeastern University School of Law

                 Commentary by Charles R. Davoli, Workplace Injury Law & Advocacy Group

PANEL II: Workers’ Compensation at a Crossroads: Back to the Future or Back to the Drawing Board?
                 Alison Morantz, Stanford Law School

                 Commentary by John F. Burton, Jr., Rutgers School of Management and Labor Relations

                 Commentary by James Lynch, FCAS MAAA, Chief actuary, Insurance Information Institute

PANEL III:  ​Can State Constitutions Block the Workers'-Compensation Race to the Bottom?
                   Robert F. Williams, Rutgers Law School

PANEL IV: Outside the Grand Bargain: The Persistence of Tort
                  Robert L. Rabin, Stanford Law School  (Rabin draft introduction)

                 Towards a Less-Grand Bargain for Injured Workers
                  Adam Scales, Rutgers Law School

A live webcast is available via registration at: LIVE WEBCAST registration

Background
Workers’ compensation systems arose as one of the great political compromises of the Progressive Era: workers injured on the job gave up the right to sue their employers for personal injury damages in return for less generous but more certain benefits. This exchange became known as The Grand Bargain.

This bargain has survived over the ensuing century despite frequent political battles in the states, often fought below the national radar screen. Over the past 25 years, the attacks on these systems have escalated. Most recently, a politically powerful coalition has proposed further constraints on benefits through implementation of “opt-out” systems, which allow employers to substitute self-designed and self-implemented programs for the traditional statutory system. Remedies have become so constricted in some states that courts have questioned whether a quid pro quo still supports the Grand Bargain.

This conference will re-examine The Grand Bargain in light of evolving legal doctrine, a changed labor market, and changing politics. How well is the workers’ compensation system serving its original purposes of swift, sure, and efficient remedies? Does an employer-based insurance scheme for workplace injuries supplanting tort remedies remain desirable? How does the common law command of a remedy for every legal wrong affect the architecture of workers’ compensation systems? What responsibilities should employers and employees bear in this system? What are the ramifications of a move towards universal health insurance? Responses to these questions can inform debates occurring now in courts and legislatures across America.

Panels

• The Challenges of the Changing Legal Structure of Workers’ Compensation and the Changing Workforce
• Compensating Injured Workers in the U.S.: Back to the Future or Back to the Drawing Board?
• Workplace Injuries as a Constitutional Law Issue
• Alternative Structures for Addressing Workplace Injuries: Tort Law and Beyond

Paper Writers* and Discussants
Leslie I. Boden, Boston University School of Public Health
John F. Burton, Jr., Rutgers School  of Management and Labor Relations (emeritus)
George W. Conk, Fordham University School of Law
Charles R. Davoli, practitioner; Workers’ Injury Law & Advocacy Group
Michael C. Duff, University of Wyoming College of Law
Price V. Fishback, University of Arizona, Department of Economics
Hon. Dan Friedman, Maryland Court of Special Appeals
Monica Galizzi, University of Massachusetts Lowell, Department of Economics
Justin R. Long, Wayne State University Law School
James Lynch, Chief Actuary, Insurance Information Institute
*Alison D. Morantz, Stanford Law School
*Robert L. Rabin, Stanford Law School
*Adam Scales, Rutgers Law School
*Emily A. Spieler, Northeastern University School of Law
Hon. David B. Torrey, Workers’ Compensation Judge, Commonwealth of Pennsylvania
*Robert F. Williams, Rutgers Law School