On January 17, 2025, CMS issued Version 4.2 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, linked here. This guide provides guidance to the industry on the process used by CMS for approving proposed WCMSAs. Version 4.2 provided several important updates. Effective July 17, 2025, CMS will no longer accept or review WCMSA […]
The North Carolina Supreme Court issued a broad opinion in North State Deli v. Cincinnati Ins. Co. on December 13, 2024, where it broke from the vast majority of jurisdictions and determined that COVID shutdown orders constituted a “direct physical loss” triggering first-party property coverage and recovery of supplemental business income. Importantly, “direct physical loss” […]
On Friday, December 13, 2024, our Supreme Court issued a decision in Sturdivant v. N. Carolina Dep’t of Pub. Safety, which affirmed what the North Carolina Legislature has already confirmed: the “total loss of wage-earning capacity” required for an employee to qualify for extended disability benefits (beyond 500 weeks) means “the complete elimination of the capacity […]
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 2024 was $750.00. On December 16, 2024, CMS announced the same […]
The North Carolina Industrial Commission has released updated instructions for employers, carriers, and third party administrators completing the IC File Number Field when filing documents electronically. This new protocol streamlines the filing process, allowing documents to be submitted even without an assigned IC file number. The Industrial Commission has advised that Employers/Carriers/TPAs/Counsel should now: The […]
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 […]
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, […]
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 […]
NC Industrial Commission Unveiling New Integrated Case Management System
January 2024 — Hedrick Gardner Kincheloe & Garofalo LLP is proud to announce Rob Wilson has been appointed as the firm’s new managing partner of its Raleigh office, effective January 1, 2024. Wilson will succeed Patricia Shields, who has served as managing partner since 2021. In his new role, Wilson is committed to continue the […]
