Our office recently received several questions regarding the proposed Explanation of Benefits (“EOB”), as well as the current Department of Insurance Rules concerning electronic billing in Workers’ Compensation claims.

In Duncan v. Liberty Mutual Insurance Company, 2019 U.S. Dis. LEXIS 106265, the U.S. District Court for the Eastern District of Michigan found that a decedent’s Estate (“Plaintiff”) did not have standing to seek double damages against Liberty Mutual (“Liberty”), the decedent’s no-fault PIP carrier. 

Medicare Secondary Payer (MSP) compliance is a detailed, somewhat complicated, and often dynamic field. MSP law and regulations are constantly evolving and subject to some interpretation.

A Medicare Set-Aside (MSA) is a settlement tool used by parties to prevent a cost shift of future injury-related Medicare covered expenses to Medicare when the settlement terms close out liability for future medical.

Section 25.5 of the Illinois Workers’ Compensation Act (820 ILCS 305/25.5) governs workers’ compensation fraud in Illinois. 

On December 7, 2018, the Appellate Court of Illinois issued a Decision in William Pisano v. The Illinois Workers’ Compensation Commission (City of Chicago), 2018 IL App (1st) 172712WC, which sheds further light on awards for permanent partial disability in cases where multiple accidents and injuries are at issue, and a wage loss results as one of the cases.

On May 20, 2019, the Illinois Workers’ Compensation Medical Fee Advisory Board announced a Proposed Amendment to the Workers’ Compensation Commission’s Administrative Rules.

Prescriptions for compounded medications should be red-flagged and quickly assessed for more appropriate and cost-effective alternatives. Don’t wait until trial or settlement to address unnecessary use of these medications.

A few months ago, we submitted an MSA in a case where Lyrica was being prescribed “off-label” for a diagnosis of lumbar radiculopathy.  CMS included it in the MSA.  The inclusion of Lyrica inflated the MSA astronomically, and nearly prevented the case from settling.  I received this question:  “How can the rules just change like this?  Isn’t there some sort of advance notice required for changes like this?  This just isn’t right!”

On April 1, 2019, the Medicare Secondary Payer Recovery Portal (MSPRP) was updated with a new feature, offering primary payers to also pay conditional payment debts electronically.