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Workers' Compensation Blog

Key Differences in the Vocational Rehabilitation Process in Maryland and the District of Columbia

Friday, September 23, 2016

VOCATIONAL BENEFITS

The Workers’ Compensation Statutes in both the State of Maryland and the District of Columbia offer a benefit to injured workers called Vocational Rehabilitation, often called “Voc Rehab” for short. Vocational Rehabilitation arises in a workers’ compensation case when the injured worker’s medical treatment is complete, or near complete, and he/she is given restrictions from his/her doctor that prevent him/her from physically performing the work he/she was able to perform before the accidental work injury. During the Voc Rehab process, the injured worker receives assistance from a licensed vocational expert so that they can, together, strive towards getting the injured worker back to full-time work with another employer and within the injured workers’ permanent physical limitations. The injured worker receives pay from the workers’ compensation insurance company while he/she is applying for jobs, taking classes, or going through retraining.

One scenario in which an injured worker would be able to receive Voc Rehab benefits would be, for example, if the injured worker was employed as a security officer at the time of the work injury, and had work requirements of standing for 6 hours a day, and lifting up to 50lbs. Yet, because of his permanent back and right ankle work injuries he is now only able to stand for only 2 hours a day, and lift up to 20lbs. The injured worker in that example would be entitled to receive Voc Rehab benefits in both the District and in Maryland. By contrast, if that same security officer was released to full-duty work, and had no permanent limitations on his ability to lift or stand, then he would not be entitled to Vocational Rehabilitation and would be expected to return back to his pre-injury work, even if it was now physically harder to do that job and his work activities caused him some physical discomfort.

Often times, the permanent work limitations are given by the treating physician at the time the injured worker is being discharged from his doctor’s care. There is a test called a Functional Capacity Evaluation (FCE) that offers a more detailed analysis as to what the injured worker can and cannot do. The FCE usually takes place at a physical therapy facility, although not all physical therapy facilities perform FCE’s. The FCE typically lasts approximately 4 hours. Upon completion of the FCE, the FCE facility will issue a detailed report stating how much the injured worker can lift, push, pull, and carry, and for how long he can sit, stand, walk, and run. If the FCE evaluator feels the injured worker has permanent work restrictions that keep him or her from returning back to the job they had at the time of the work injury, then vocational rehabilitation will begin.

COMPARING MARYLAND AND THE DISTRICT OF COLUMBIA

There are several key differences in the Voc Rehab process in Maryland and the District of Columbia. For example, in Maryland the Workers’ Compensation Regulations state that the Parties to the Claim may agree on the Vocational Counselor that will be assisting the injured worker with getting back to full-time work within his/her permanent work restrictions. If no agreement is reached, the Commission will pick the Vocational Counselor from a list. In the District of Columbia, however, there is no such provision, and the vocational counselor is typically selected only by the workers’ compensation insurance company, or their attorney. Therefore, from the onset of the Voc Rehab process, injured workers in DC are at a disadvantage. The manner in which the injured worker is scrutinized in Maryland versus the District during the Voc Rehab process is vastly different. In Maryland, Voc Rehab is offered to injured workers typically at three-month increments. If the injured worker in Maryland is “compliant” during those first three months, the Vocational process will be extended for another three months, and another three months, until the Maryland workers’ compensation insurance carrier no longer wishes to offer Voc Rehab to the injured worker, or finds a reason to deem the injured worker as being “non-compliant” with the Voc Rehab process. One example of how noncompliance is alleged is by stating that the injured worker was not applying to enough jobs each week, or was showing up late to their weekly meetings with the Voc Rehab counselor. In the District of Columbia, however, vocational rehabilitation can go on for years without ever having to request or wait for an extension of time from the workers compensation insurance adjuster.

And so, while in Maryland the vocational process is evaluated on a monthly basis by the insurance adjuster, in the District of Columbia, injured workers who are receiving Voc Rehab benefits are often left to their own devices. The Rehab counselors typically do not write detailed monthly reports commenting on everything that was done and not by the injured worker, and so the injured workers’ level of participation during Voc Rehab in DC is not able to be scrutinized or judged as it is in Maryland. However, the same goes for the level of participation of the Voc Rehab counselor. If the counselor is not required to write monthly reports in the District as they are in Maryland, the counselor’s own level of involvement is not recorded. For example, were classes or re-training discussed and offered officially? If so, when? Was the counselor late to meetings as well? These details control the Voc Rehab process in Maryland, and determine the extent to which Voc Rehab will take place, and how much Vocational benefits are offered to the injured worker, whereas in the District of Columbia, those details are often lacking.

In sum, there are benefits and detriments to each jurisdiction’s workers’ compensation laws. There is no perfect system. The best thing for the injured worker to do is to follow the laws and procedures of the jurisdiction in which their injury took place, and to do so with the assistance of an attorney they trust. If additional information is needed as to the Vocational Rehabilitation process, I can be reached at: LPisano@bsgfdlaw.com, or on my direct work line of: 301-740-3304.

Medicare and Old Workers’ Compensation Claims

Monday, September 19, 2016

A letter from Medicare is in the mail. The envelope doesn’t look much different from others you have received from Medicare. You open it without thinking or much concern.

What it says shocks you.

Medicare (actually an outfit called MSPRC) is alerting you that it no longer will pay for treatment or wants money back for bills they have paid. Why?

Because you filed a Workers’ Compensation claim more than ten years ago - it makes no sense to you. The Workers’ Compensation claim was for your right leg, the treatment you now need is oxygen for your lungs!

How Could This Happen?

Insurance companies are now required to send Workers’ Compensation claim information to Medicare. If:

  • bills are coded incorrectly by a medical provider
  • a medical report erroneously says the treatment is for a job related injury
  • Medicare makes a mistake; or
  • who knows why

The letter you get may be a:

  • Rights and Responsibilities Letter (RAR) - The letter informs you that Medicare is aware you have filed a Workers' Compensation claim. Sixty-five days later a Conditional Payment Letter is sent to you (see below)
  • Conditional Payment Letter (CPL) – This letter specifies what Medicare has paid that it believes are related to your Workers’ Compensation claim.
  • Conditional Payment Notice (CPN) - This letter tells you what you should do if Medicare has paid bills and wants its money back.
  • Demand Letter (DL) – Medicare tells you that you must repay Medicare for the payments listed in the letter. A Demand letter is issued thirty days or more after the Conditional Payment letter.

If payments are not made within sixty days of the Demand Letter and Medicare does not agree to modify or waive the demand interest is charged from the date of the Demand Letter.

If no payments are made within 120 days of the Demand Letter, an "Intent to Refer" letter will be mailed to you. Medicare may send the matter to the Department of the Treasury for collection from 120 days to 240 days from the date of the Demand Letter.

You or your attorney can request a “waiver” after a Demand Letter is issued even if the treatment is related to your old Workers’ Compensation claim. To do so:

1) you must not be at fault for the overpayment; and

2) it would cause you financial hardship to repay Medicare .

There also is an appeal process for disputes over more than $130.00.

How to Solve the Problem

The only clear statement that can be made at this time about resolving Medicare/Workers' Compensation disputes is that there is no clarity. However, the first step is to call the Medicare number listed on the form and find out what the problem is. If there is a clear error by Medicare, your phone call may take care of the problem. It is also possible that some documentation from the Workers’ Compensation claim and/or your medical providers will be required. The issues will be more complicated if the new treatment is for the same part of your body that was the subject of your Workers’ Compensation claim. The argument is, for example, that a back strain of ten year ago could not possibly be related to a need for back surgery now. It is possible medical records will be required to support that position, and/or a hearing before the Workers’ Compensation Commission to determine whether the treatment is related. Even then, Medicare may not agree to be bound by a Commission decision.

The Bottom Line

The only sure thing to say about Medicare and Workers’ Compensation claims is that nothing is sure. Rules and procedures change. Simple issues may be resolvable without an attorney, more complex ones, perhaps not.

Medicare And Old Workers’ Compensation Claims

Thursday, May 10, 2012

A letter from Medicare is in the mail. The envelope doesn’t look much different from others you have received from Medicare. You open it without thinking or much concern.

What it says shocks you.

Medicare (actually an outfit called MSPRC) is alerting you that it no longer will pay for treatment or wants money back for bills they have paid. Why?

Because you filed a Workers’ Compensation claim more than ten years ago – it makes no sense to you. The Workers’ Compensation claim was for your right leg, the treatment you now need is oxygen for your lungs!

How Could This Happen?

Insurance companies are now required to send Workers’ Compensation claim information to Medicare. If:

  • bills are coded incorrectly by a medical provider
  • a medical report erroneously says the treatment is for a job related injury
  • Medicare makes a mistake; or
  • who knows why

The letter you get may be a:

  • Rights and Responsibilities Letter (RAR) – The letter informs you that Medicare is aware you have filed a Workers’ Compensation claim. Sixty-five days later a Conditional Payment Letter is sent to you (see below)
  • Conditional Payment Letter (CPL) – This letter specifies what Medicare has paid that it believes are related to your Workers’ Compensation claim.
  • Conditional Payment Notice (CPN) – This letter tells you what you should do if Medicare has paid bills and wants its money back.
  • Demand Letter (DL) – Medicare tells you that you must repay Medicare for the payments listed in the letter. A Demand letter is issued thirty days or more after the Conditional Payment letter.

If payments are not made within sixty days of the Demand Letter and Medicare does not agree to modify or waive the demand interest is charged from the date of the Demand Letter.

If no payments are made within 120 days of the Demand Letter, an “Intent to Refer” letter will be mailed to you. Medicare may send the matter to the Department of the Treasury for collection from 120 days to 240 days from the date of the Demand Letter.

You or your attorney can request a “waiver” after a Demand Letter is issued even if the treatment is related to your old Workers’ Compensation claim. To do so:

  1. you must not be at fault for the overpayment; and
  2. it would cause you financial hardship to repay Medicare .

There also is an appeal process for disputes over more than $130.00.

How to Solve the Problem

The only clear statement that can be made at this time about resolving Medicare/Workers’ Compensation disputes is that there is no clarity. However, the first step is to call the Medicare number listed on the form and find out what the problem is. If there is a clear error by Medicare, your phone call may take care of the problem. It is also possible that some documentation from the Workers’ Compensation claim and/or your medical providers will be required. The issues will be more complicated if the new treatment is for the same part of your body that was the subject of your Workers’ Compensation claim. The argument is, for example, that a back strain of ten year ago could not possibly be related to a need for back surgery now. It is possible medical records will be required to support that position, and/or a hearing before the Workers’ Compensation Commission to determine whether the treatment is related. Even then, Medicare may not agree to be bound by a Commission decision.

The Bottom Line

The only sure thing to say about Medicare and Workers’ Compensation claims is that nothing is sure. Rules and procedures change. Simple issues may be resolvable without an attorney, more complex ones, perhaps not.

By Ken Berman

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