Hear what our attorneys are saying

18
Aug 2020

Section 111 Total Payment Obligation to Claimant Reporting and Bifurcated Settlements

By Rasa Fumagalli     

  I recently wrote about Section 111 Total Payment Obligation to Claimant (TPOC) reporting in bifurcated settlements. Given the ambiguity in the NGHP User Guide, claims handlers have reported TPOC in indemnity only settlements that kept future medical rights open. When medical closed at a later date, the Section 111 Ongoing Responsibility for Medical (ORM)
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04
Aug 2020

Managing Opioids in a Workers’ Compensation Case

By Rasa Fumagalli     

  Although our nation is currently focused on the COVID-19 pandemic, the opioid abuse epidemic continues to claim many lives.  According to data from the Centers for Disease Control and Prevention (CDC), almost 70% of the 67,000 deaths from drug overdoses in 2018 involved a prescription or illicit opioid.  Attempts to curb opioid abuse have
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29
Jul 2020

Answers by Amy

By Amy Bilton     

  Prescription drugs can make up a large part of a Medicare Set-Aside.  Since Medicare prices future prescription drugs using average wholesale price, the ultimate cost of the drugs through a pharmacy benefits manager (PBM) is often less than the average wholesale price.  The question posed is: “I would like to price out the future
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29
Jul 2020

Diagnostic Studies in the Allocation: Guiding Principles

By Julie A. Garrison     

  Almost every Workers’ Compensation Medicare Set-Aside (WCMSA) includes future diagnostic imaging studies, usually x-rays and MRIs.  For most work injuries, and especially orthopedic ones, diagnostic imaging studies are commonly done early in treatment.  They may be done on an emergent basis.  And it is not unusual for repeat studies to be conducted for more
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29
Jul 2020

Timing Your Total Payment Obligation to Claimant (TPOC) Report Under Section 111

By Rasa Fumagalli     

  Most workers’ compensation claims adjusters would agree that the best claim is a closed one.  Although the ideal settlement closes all aspects of the claim at once, this is not always feasible.  The unique circumstances of a claim may result in an indemnity only settlement with future medical rights remaining open.  The settlement terms
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