State News : Pennsylvania

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Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.

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By Kevin L. Connors, Esquire

On January 10, 2013, theSmart Act was signed into Law by President Obama.

The Smart Act stands for “The Strengthening Medicare And Repaying Taxpayers Act”.

This legislation reforms several aspects of Medicare requirements for conditional payments.

Under Section 201 (Conditional Payment Final Demand and Use of Website), efficiencies have been approved in the conditional payment system, with the following reforms:

  • A Claimant or “applicable plan” may, at any time within one-hundred twenty (120) days prior to a settlement, judgment, or award, notify the Secretary of the expected date and amount;
  • The Secretary can then provide conditional payment information through a website, with that information being updated no later than fifteen (15) days after a payment is made;
  • Dependent upon certain conditions being met, the last statement downloaded from the website can be considered to be the final demand for conditional payment;
  • If there are disputes over conditional payment amounts, the Secretary is required to respond to resolve the disputes within eleven (11) days of the dispute, or the proposed resolution by the Claimant/applicable plan will be deemed accepted; and,
  • These procedures will go into effect ninety (90) days after passage of the Smart Act, essentially to establish an enactment date of April 9, 2013.

Under Section 202 (Thresholds for Reporting a Conditional Payment Reimbursement); by November 15th of every year, the Secretary will have to publish a threshold, wherein reporting conditional payment reimbursements shall not apply.

This procedure will not take effect until 2014.

Under Section 203 (Discretionary Fines for Non-Compliance of Mandatory Insurance Reporting):

Fines for non-compliance with Mandatory Insurer Reporting will now be discretionary, rather than mandatory.

The guidelines surrounding discretionary application have yet to be created.

Within sixty (60) days of the passage of the Smart Act, being signed into law as of January 10, 2013, CMS will seek proposed comments on which action/practices should or should not be sactionable, with publication of the proposed comments in the Federal Register.

This section established an enactment date of March 10, 2013.

Under Section 204 (Social Security Numbers); Social Security numbers will no longer be required on health identification claim forms. CMS has been given eighteen (18) months after the enactment date of theSmart Actto publish rules surrounding this declaration.

Under Section 205 (Statute of Limitations for Conditional Payment Recovery):

The statute of limitations for conditional payment recoveries is three (3) years after the receipt of notice of a settlement, judgment, award, or other payment made.

Effective as of January 1, 2014, certain liability claims will be exempt from reporting and reimbursement, if the claim falls below the annual threshold as calculated by the Secretary of Health and Human Services.

Civil penalties for non-compliance with mandatory insurance reporting requirements will be discretionary, and can be up to $1,000.00 for each day of non-compliance, with respect to each Claimant.

The Smart Act can be accessed online through several links, to include

Copies of the Smart Act are also available through our office.

This is long overdue reform, intended to simplify what has become a Sisphysian ordeal, more complicated than necessary, and fraught with both frustration and uncertainty.

ConnorsLaw LLP

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Defending workers’ compensation claims throughout Pennsylvania for employers, self-insureds, insurance carriers, and third party administrators, our 100+ years of cumulative experience defending our clients against compensation-related liabilities, empowers our workers’ compensation practice group attorneys to be more than mere claim denials, entrusting us to create the factual and legal leverage to expeditiously resolve claims, in the course of limiting/reducing/extinguishing our clients’ liabilities under the Pennsylvania’s Workers’ Compensation Act.

With every member of our workers’ compensation practice group being AV-rated, our partnership with the NWCDN magnifies the lens through which our professional expertise imperiously demands that we always be dynamic and exacting advocates for our clients, businesses, corporations, and insurance carriers, seeking our trial and compensation acumen, navigating the frustrating and form-intensive minefield pervasive throughout Pennsylvania workers’ compensation practice and procedure.