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Premature Satisfaction of a Third-Party Lien

Workers' Compensation

NJ Transit’s workers’ compensation insurance carrier notified Joseph of its legal right to recover all money paid on his workers’ compensation claim from the third-party potentially liable for his injuries. Joseph settled with his uninsured motorist (UM) insurance carrier for $14,000 in the underlying action.

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Not A Violation of Public Policy

Workers' Compensation

In addressing the public policy argument, the Court interpreted the insurance policy's language by the insurance carrier, who asserted that it had no duty to defend under the employer's liability insurance policy with Hartford Underwriters Insurance Company. 2024) Decided December 22, 2024.

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NH Case Remanded: Was MRSA Infection “Direct and Natural Result” of Work-Related Injury?

The Workcomp Writer

In a well-written opinion with careful analysis, the Supreme Court of New Hampshire reversed and remanded a decision by the state’s Compensation Appeals Board (CAB) that denied benefits to a teacher who sustained a serious MRSA epidural abscess following a work-related camping trip [ Appeal of Southworth , 2024 N.H. LEXIS 9 (Jan.

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PA Appellate Court Nixes Use of “Red Book” in Setting Reimbursement for Drug Costs in Comp Cases

The Workcomp Writer

Hearing Off.*), 2024 Pa. The appellate court agreed with the petitioning workers’ compensation insurance carrier that that the Red Book values did not reflect AWP as required by the Act. Summit Pharm. Bureau of Workers’ Comp. LEXIS 1 (Jan.

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New Health Plan Prescription Drug Reporting Mandate

AssuredPartners

For fully insured plans, health insurance carriers will be responsible for making the necessary reporting from a legal standpoint. For example, June 1, 2023 is the deadline for submitting 2022 data; June 1, 2024 is the deadline for submitting 2023 data. Thereafter, the data must be submitted annually every June 1.

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New Transparency Requirements for Health Plans

AssuredPartners

This rule, entitled Transparency in Coverage, requires group health insurance carriers and self-insured plans to disclose rates and cost-sharing information for all covered items and services. Effective January 1, 2024 , the online cost-sharing information must include all covered items and services.