Exhaust Administrative Remedies Before Challenging Medicare Conditional Payment Claims

A new case out of Missouri reaffirms this important principle: When challenging Medicare conditional payment claims, parties must exhaust Medicare administrative appeals before filing an action in federal court. This issue recently reappeared in Fortner v. Price (Secretary of Health and Human Services), 2017 WL 117712 (E.D. Missouri, March 30, 2017), a case in which […]

Arkansas passes bill affecting future medical benefit settlements for Medicare beneficiaries

The Arkansas Legislature quickly moved a relatively unknown bill addressing workers’ compensation settlements in the final days of its 2017 legislative session, passing it on March 31. Senate Bill 760, now referred to as Act 1058, initially sought to clarify the Workers’ Compensation Death and Permanent Total Disability Trust Fund. However, Senator David Sanders revised […]

Break the Logjam of Zero MSAs in Development

Zero WCMSA submissions are getting mired in a cycle of CMS development letters and responses, as the CMS Workers’ Compensation Review Contractor (WCRC) becomes increasingly meticulous about formatting requirements for submitted pay histories. Many of the current WCRC reviewer requests are not even listed requirements in either the WCMSA reference guide or the CMS operating […]

April 2017 Preview: Historical Catastrophe Activity

April is an active month for violent tornadoes, though overall tornadic activity typically peaks in May and June. We saw more violent tornadoes—EF4 and EF5—in April than any other month from 1950 through 2013. The past decade saw an average of 267 U.S. tornadoes in April. The April 2011 tornado outbreak is ranked as the […]

What now for soft tissue injury claims

On 23 February 2017, less than seven weeks after the government consultation aimed at reducing whiplash claims ended, the Ministry of Justice published part 1 of their response to the consultation. It’s said that part 2 will be published in due course, relating to the implementation of the recommendations made by the Insurance Fraud Taskforce […]

March 2017 Preview: Historical Catastrophe Activity

Property Claim Services® (PCS®) has designated 32 weather-related catastrophe events for the month of March between 2007 and 2016. Those events caused approximately $14.3 billion in insured losses and resulted in 2.2 million claims. The largest designated March event in the past ten years was CAT 67, a 2012 winter storm. The catastrophe involved six […]