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Commonwealth Court Enhances Medical Providers’ Rights Against Workers Compensation Carriers

Attorney Dan Siegel Was Lead Counsel in Decision Affirming That Medical Providers Have a Right to Payment Under the Pennsylvania Workers’ Compensation Act

The Commonwealth Court today affirmed that insurance companies and their attorneys may not take actions that prevent medical providers from being paid for care for injured workers. The decision, in Workers First Pharmacy Services, LLC v. Bureau of Workers’ Compensation Fee Review Hearing Office (Cincinnati Insurance Co.), disallowed a procedure used by an insurer and its counsel intended to prevent a pharmacy not only from being paid, but also from having a hearing about its right to payment.

Havertown workers’ compensation and appellate Attorney Daniel J. Siegel, whose cases have dramatically expanded the protections available to medical providers caring for Pennsylvania’s injured workers, was counsel and argued the case before the Court.  Before this and other decisions in which Siegel was counsel, Pennsylvania courts had never ruled that doctors, physical therapists, orthopedic surgeons and other medical caregivers cannot be cutout from payment without a hearing.

“I am proud that this case, and others my office has handled, have expanded the rights of every medical professional in Pennsylvania. My firm’s recent cases have extended the rights of more injured persons and their medical providers than any other firm’s,” said Siegel, founder of the Law Offices of Daniel J. Siegel, LLC. He also credited attorneys Christa Frank High and Nicole A. Kratzer, who also handled the case.

In this case, a workers’ comp claim settled, and the insurance company’s lawyer included a provision in the settlement saying that (1) the injured worker was not obligated to pay for medicine he received, and (2) the insurer agreed to be bound by the separate fee review process used by medical providers to assert and protect their right to payment.  As soon as the settlement was approved, the carrier’s lawyer argued in the fee review that the pharmacy was not entitled to any payment because the insurer had never “admitted” that the worker was injured. The Fee Review Officer agreed and dismissed the matter, barring the pharmacy from any compensation. The Commonwealth appeals Court disagreed, stating: “Employer accepted full liability for the debt to Pharmacy. Employer’s counsel told Claimant that even if Employer was found not liable, Pharmacy could not hold Claimant responsible for the debt. Stated otherwise, Employer accepted “responsibility” for the debt to Pharmacy when it released Claimant from any obligation to pay Pharmacy in the C&R Agreement. Accordingly, the Hearing Office has jurisdiction to decide the three fee review contests.”

Click here to read the decision authored by President Judge Leavitt.

 

OSHA – No One’s Minding the Store – A Dangerous Position for Workers

All too often we discover that our injured clients have worked – often for many years – in factories and other facilities where the conditions are unsafe, and often extremely dangerous. All because their employers don’t care about their safety. All because the government doesn’t enforce the laws designed to assure worker safety.

That’s why the latest report about OSHA, the Occupational Safety and Health Administration, is troubling – but not at all surprising. Over 5,000 workers were killed on the job in 2017, and nearly 3 million were injured. Where was OSHA? They weren’t doing their job because they didn’t have anyone to do the job of inspecting workplaces.

As of January 2018, OSHA had only 764 inspectors, that’s 15 per state. The number has been dropping every year since 2016. In fact, enforcement actions – when OSHA inspects workplaces and prosecutes dangerous jobsites – have dropped to record low levels. It’s not surprising under the current administration, which does not value workplace safety. Former OSHA policy adviser Debbie Berkowitz estimates that it will take more than 160 years for the agency to inspect every workplace under its jurisdiction just once at current staffing levels.

This news is troubling because it means that if employers know that they don’t have to maintain a safe workplace, they won’t. And they don’t.

So, what does that mean for you? It means that you need to be careful, hope that your employer cares about you and maintains a safe work environment. It also means that if you get hurt, you need a law firm that will fight for you – whether it’s pursuing your workers’ compensation claim or assuring that any negligent parties are held legally responsible for your injuries and damages. At the Law Offices of Daniel J. Siegel, LLC, we are prepared to help you if you get hurt or a loved one is killed at work. No one should have to experience this hardship, but if you need a lawyer, call us 610-446-3457 to set up a free consultation.

 

Social Security Administration Slows Down the Disability Application Process by Adding More Red Tape

Two years. That is how long it can take for an individual to make his or her way through the social security disability application process. For individuals with significant physical or mental health impairments who desperately need income, that is an eternity. Now, the Social Security Administration has added three to six more months to the application processing time by requiring applicants to file for Reconsideration.

The Social Security Administration has reinstated Reconsideration as a step in the disability adjudication process. As of April 1, 2019, Pennsylvania applicants whose initial applications were denied, which is nearly everyone, must seek Reconsideration.

If the Social Security Administration denies your initial application, you have 60 days from the date you receive the notice to submit a request for reconsideration. After you submit your reconsideration request, the Disability Determination Services will do a second review of your records. Unfortunately, if there are no changes from your initial application, you can expect another denial. And, if the reconsideration request is not submitted within 60 days, you will have to start over and resubmit your initial application. Only after you receive the reconsideration denial, then you can request a hearing.

We regularly represent individuals seeking Social Security benefits and can assist you throughout the application process. You can call our office at 610-446-3457 to set up a consultation with one of our attorneys. We will explain the process, guide you and fight to get you the benefits you need.

 

Estate Planning – Have You Considered Your Digital Assets?

Today, I was reminded by Facebook that I had been friends with a colleague for seven years. What Facebook didn’t seem to know is that he had been gone for about three years. Interestingly, this week also saw the publication of the latest issue of The Philadelphia Lawyer, in which I write the Technology and the Ethics columns, and this colleague was mentioned in my Tech column, “Digital Estate Management – Your Clients May Be Dead, But Their Facebook Accounts Live On.”

At the Law Offices of Daniel J. Siegel, LLC, we focus on our clients by doing things a little different, but with the goal of providing cutting edge client services in an affordable manner. Our estate planning services are a great example, as highlighted by this Technology Column in The Philadelphia Lawyer, which is published by the Philadelphia Bar Association. The article addresses one such area – dealing with your electronic, Internet, and online assets when you or a loved one is no longer with us – and it highlights how we do things a bit differently. We understand that estate planning can be stressful, but we try to take some of the stress away with our “Pay Once, Revise for Life Estate Planning Program,” and our comprehensive interview. But most importantly, we focus on drafting documents that meet our clients’ needs.

Most of our clients need a Will, a Living Will (also called an “Advanced Healthcare Directive”) and a Power of Attorney. Our non-traditional family clients may need Hospital Visitation forms and an Authorization that permits a non-related loved one to handle your remains.

As stated above, we focus on today’s lifestyle issues. We are one of the very few law firms that considers and advises clients about disposition of their digital assets, and will address whether you need a Digital Executor – a person who understands and can assure that all of your electronic information is finalized. The bottom line is that while we all should deal with our inevitable futures, estate planning today is different from estate planning just a few years ago. We need to address digital assets, such as computers, websites, and social media. What happens to your Amazon account? Or what should happen to your Facebook page? Do you really want reminders of your “friendship” going out years after you are gone. And how about your Dropbox account, your email, and all of those other things that go along with our mobile economy? That is digital estate planning, we do it, and we help clients recognize the need for digital executors, a term many lawyers have never heard.

Finally, no one wants to pay a lawyer. We understand. We don’t want the pressure of fees to prevent clients from planning for the future. With our “Pay Once, Revise for Life Estate Planning Program,” clients only pay a fee once – when clients initially draft and sign their estate planning documents. We never charge for revisions, so clients feel comfortable calling us to make changes at any time, and know that the meter won’t be running. Last week, one of our clients was having surgery and wanted to change his Will, for the sixth time, and we handled the revisions the same day.

We know of no other law firm that has a similar focus on clients’ peace of mind. Read my article, and perhaps you can understand why one colleague – a business law professor – thought it was satire. But for those of us who recognize the realities of a 21st century lifestyle, they are not laughing. They are looking for, and hiring, a law firm that understands their lives, their needs and their goals.

 

Attention Doctors, Pharmacies & Medical Providers Treating Pa. Workers’ Compensation Patients

Pennsylvania Appeals Court Eliminates Defense That Prevented Countless Workers’ Compensation Providers From Getting Paid

Doctors and every other entity providing medical care or services to injured workers under the Pennsylvania Workers’ Compensation Act will benefit from the Commonwealth Court Opinion today in Armour Pharmacy v. Bureau of Workers’ Compensation Fee Review Hearing Office. The unanimous court eliminated the ability of insurers and employers to simply allege a few “magic words” to halt the process used to determine how much they should be paid for caring for injured workers. Attorney Dan Siegel of the Law Offices of Daniel J. Siegel, LLC represented the medical provider in the case.

In the case, the Court ruled that that “where the employer challenges a fee determination of the Medical Fee Review Section for the stated reason that the medical service was not rendered by a ‘provider’ within the meaning of the Act, the threshold question must be decided by the Hearing Officer.” This means that insurers and employers must now provide evidence why they are disputing a medical bill, eliminating the often-bogus defenses that have prevented a Hearing Officer from deciding how much they are owed.

This case applies to every doctor, hospital, chiropractor, medical equipment company, pharmacy and any other entity providing medical care or services to workers injured and receiving benefits under the Pennsylvania Workers’ Compensation Act. This case also affirms that these medical providers have a due process right to compensation, as established in Armour Pharmacy I, another case handled by Attorney Dan Siegel.

Our office regularly represents medical providers and other entities seeking to be paid for treatment to injured workers. In the past week, Attorney Dan Siegel has received numerous honors for his work: (1) Philadelphia Inquirer Influencer of Law (Personal Injury) award, (2) voted Delaware County’s #1 personal injury attorney by Delaware County Daily Times readers, and (3) honored as a Pennsylvania Best Lawyer in workers’ compensation law, based upon voting by other attorneys.

When you need an attorney, contact our office. Over half of our clients are attorneys; that’s why we’re known as the Lawyers Other Lawyers Call for Advice.

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