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Workers’ Compensation

Medicare Provides New Way to Terminate Ongoing Responsibility for Medicals (ORM)

The Centers for Medicare and Medicaid Services (CMS) issued an updated Section 111 NGHP User Guide – Version 6.4, on June 11, 2021. CMS will now allow the termination of ORM if the following criteria are met. Where there is no practical likelihood of associated future medical treatment, which is reflected by meeting ALL of the following: […]

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Are employees entitled to more than 500 weeks of benefits?

Before June 24, 2011, injured employees were eligible for lifetime Temporary Total Disability (TTD) benefits for the duration of their disability. In 2011, the North Carolina legislature passed revisions to the Workers’ Compensation Act. One of the revisions altered N.C. Gen. Stat. § 97-29(b), which now states: The employee shall not be entitled to compensation […]

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New Rule/Requirement to Provide North Carolina Industrial Commission with Email Address for Claim-Related Documents

The North Carolina Industrial Commission today, Monday, March 1, 2021, sent out the following notice: “Effective March 1, 2021, all carriers, third-party administrators, and self-insured employers are required to provide the Commission with an email address for receipt of claim-related documents. The designated email address shall be provided to the Commission at contactinfo@ic.nc.gov. The email […]

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AB5: A New Standard for Worker Classification – Part 2

In our last article, we discussed the status and potential impact of AB5, a law recently passed in California which went into effect on January 1, 2020, addressing the classification of certain workers. By way of review, prior to AB5’s passage, the decision on whether a worker should be classified as an employee or an […]

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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 will not seek recovery. The threshold amount for 2020 was $750.00. On November 25, 2020, CMS announced the […]

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NC Commission Revises Form 19 (FROI) Filing Requirement

Effective Dec. 1, 2020, the North Carolina Industrial Commission has revised the filing requirement that triggers the submission of a Form 19,  Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission.  Specifically, the Commission increased the Form 19 filing threshold for medical compensation paid from $2,000 to $4,000. The revised rule – 11 NCAC […]

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AB5: A New Standard for Worker Classification

One issue that has come up numerous times in the setting of the trucking and transportation industries is the classification of workers as either employees or independent contractors. Concerned with workers who werebeing misclassified as independent contractors and who were not getting the benefits afforded to employees, the State of California passed a law, which […]

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Handling COVID-19 Workers’ Compensation Claims in North Carolina

Proving a Compensable Occupational Disease in North CarolinaUnder the North Carolina Workers’ Compensation Act, generally speaking, there are two types of occupational diseases, each with their own standard of proof: Those specifically enumerated in N.C.G.S. §97-53; and Those covered by the statute’s “catchall” provision in N.C.G.S. §97-53(13): “Any disease, other than hearing loss covered in […]

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Medicare Liens: Another Concern Prior to Settlement?

In our last post, we discussed the issues posed by ERISA liens and how the presence of an ERISA lien can complicate a potential settlement. Another similar issue that complicates settlements is the potential presence of a Medicare lien. This applies to workers’ compensation and liability cases. The Medicare Secondary Payer Act (MSPA), 42 U.S.C. […]

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ERISA Liens: Another Concern Prior to Settlement?

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans. In the context of workers’ compensation claims or civil litigation, the subject of ERISA is usually raised when an […]

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