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Negligence, Even Gross Negligence, Will Not Bar a Worker’s Compensation Claim

The North Carolina Supreme Court has long recognized that an employee’s injury caused by their own negligence act, cannot, in itself, bar their workers’ compensation claim. This principle is outlined in Hartley v. N.C. Prison Department, 258 N.C. 287, 128 S.E.2d 598 (1962). In that case, Mr. Hartley, a prison guard, was on his way […]

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Newly Added Rule 26(b)(4)(D) of the South Carolina Rules of Civil Procedure

Excluding Expert Exchanges: Protecting Attorney-Expert Communications Recently, the South Carolina Rules of Civil Procedure were amended to add a protection that is already recognized by federal courts: the Attorney-Expert protection. The newly added Rule 26(b)(4)(D) of the South Carolina Rules of Civil Procedure, which is short-titled, “Trial-Preparation Protection for Communications Between a Party’s Attorney and […]

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Supreme Court Limits Compensability of Weight Loss Treatment Recommended for Injured Employees

On Friday March 22, 2024, the Supreme Court issued a favorable decision for the defense in Kluttz-Ellison v. Noah’s Playloft Preschool, No. 173PA22 (N.C. 2024).  Lindsay Wikle and Duane Jones from Hedrick Gardner represented Defendants. The Supreme Court provided a test to determine whether requested medical treatment is “directly related” to the original compensable injury, […]

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CMS to Demand Section 111 Reporting of Funds Set Aside for Future Medicals in Workers’ Compensation Settlements

The Centers for Medicare and Medicaid Services (CMS) is expanding the existing Section 111 reporting process to capture information on all workers’ compensation claims involving Medicare beneficiaries that receive a settlement (i.e., TPOC) and funding for a Workers’ Compensation Medicare Set-Aside (WCMSA), regardless of whether the workers’ compensation settlement was reported to CMS under the […]

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General Legislature Passes Significant Changes to Uninsured and Underinsured Motorist Law

By Allen C. Smith, Brooks P. Miller, Julianna Grant, and Austin R. Walsh On September 22, 2023, Senate Bill 452, An Act to Make Various Changes to the Insurance Laws of North Carolina, to Amend the Insurance Rate-Making Laws, and To Revise High School Interscholastic Athletics, was presented to Governor Roy Cooper for signature. Because […]

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Centers for Medicare and Medicaid Services (CMS) Maintains $750.00 “Low Dollar” Reporting Threshold

The SMART Act requires CMS to annually review the costs associated with the collection of Medicare conditional payments and set forth a threshold amount applicable to settlements, judgements, awards, or other payments (TPOC amount) for which it will not seek recovery. The threshold amount for 2023 was $750.00. On February 14, 2024, CMS announced the […]

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The Centers for Medicare and Medicaid Services (CMS) Confirms Civil Monetary Penalty (CMP) Rules Regarding Mandatory Insurer Reporting for Non-Group Health Plans (NGHP)

CMS held a webinar on January 18, 2024, where it provided clarification of the rules regarding the issuance of CMPs for late Section 111 reporting of the ongoing responsibility for medicals (ORM) and total payment obligations to a claimant (TPOC). The PowerPoint presentation should be posted on CMS’ website in two weeks. In sum, the […]

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CMS to Demand Section 111 Reporting of Funds Set Aside for Future Medicals in Workers’ Compensation Settlements

By Shannon Metcalf The Centers for Medicare and Medicaid Services (CMS) is expanding the existing Section 111 reporting process to capture information on all workers’ compensation claims involving Medicare beneficiaries that receive a settlement (i.e., TPOC) and funding for a Workers’ Compensation Medicare Set-Aside (WCMSA), regardless of whether the workers’ compensation settlement was reported to […]

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CMS Increasing Threshold for Liability Settlements – Fixed Percentage Option

The Fixed Percentage Option Threshold will Increase to $10,000.00 for Liability Settlements on October 2, 2023 says The Centers for Medicare & Medicaid Services (CMS) By Shannon Metcalf Since November 7, 2011, the Centers for Medicare and Medicaid Services (CMS) has permitted a Medicare beneficiary to elect to resolve his/her conditional payment claim in liability […]

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