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Centers for Medicare and Medicaid Services (CMS) Maintains $750 Reporting Threshold

The SMART Act requires CMS to annually review the costs associated with the collection of Medicare conditional payments and set forth a threshold amount applicable to settlements, judgments, awards or other payments (TPOC amount) for which it would not seek recovery. The threshold amount for 2017 was $750. On November 3, 2017, CMS announced the […]

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SC Court of Appeals Affirms Rescission of Workers’ Compensation Policy Procured by Fraud

The South Carolina Court of appeals recently affirmed a decision by the South Carolina Workers’ Compensation Commission that allowed an insurance carrier to rescind a workers’ compensation policy of insurance that was fraudulently obtained with the intent of covering an injury that occurred earlier the same day but was not disclosed by the employers. In […]

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New Taxpayer ID & Mailing Address for the North Carolina Industrial Commission

New Taxpayer ID & Mailing Address for the North Carolina Industrial Commission New Taxpayer Identification Number Effective November 1, the NCIC’s Taxpayer Identification Number will be 56-1401519. Please make any checks to the Industrial Commission payable to Department of Insurance-Industrial Commission. New U.S. Mail Address Changes to NCIC Effective November 1, the NCIC’s Mail Service Center […]

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North Carolina Industrial Commission Makes Changes To Sanction Amounts

North Carolina Industrial Commission Changes Sanction Amount for Late Filing of Forms 60, 61, or 63 The North Carolina Industrial Commission has just announced that: Effective December 1, 2017, the following changes will go into effect for sanctions issued pursuant to N.C. Gen. Stat. § 97-18(j): The amount sanctioned upon Carriers/Employers for failing to file […]

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Legislature Amends § 97-82 to Clarify Which Injuries Are Accepted Pursuant to A Form 60

The North Carolina Legislature and Governor Roy Cooper have passed a law clarifying that an employer’s acceptance of the compensability of a specific injury on a Form 60 or Form 63 Section 1 shall not extend the “Parsons presumption” to injuries and conditions other than those specifically listed on the Form 60 or Form 63 Section 1. The North Carolina Legislature enacted […]

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The Supreme Court Expands The Parsons Presumption

The Supreme Court has issued the much anticipated decision which impacts the application of the Parsons presumption in claims accepted on a Form 60.  In Wilkes v. City of Greenville, 368PA15 (June 9, 2017), the Employee was involved in a work related motor vehicle accident.  The defendant accepted the claim via a Form 60, and […]

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Medicare Beneficiaries Cannot Rely on Estimated Conditional Payment Amounts in Making Settlement Decisions

On March 23, 2017, a decision from the South District of Florida, Shapiro v. Secretary of HHS, 2017 U.S. Dist. LEXIS 42278, confirmed Medicare beneficiaries cannot rely on estimated conditional payment amounts from the Centers for Medicare and Medicaid Services (CMS) in making settlement decisions. The Medicare beneficiary Plaintiff, Shapiro, was injured in an automobile […]

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CMS Announces Changes Coming to the Re-Review Process of Approved WCMSAs

The Centers for Medicare & Medicaid Services (CMS) just announced it has been reviewing its process for addressing requests for CMS to “re-review” approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) amounts and plans to make a change in 2017.  CMS expects to update its existing re-review process to address situations where CMS has provided an […]

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