Medicare Overhauls Section 111 Reporting for Workers’ Comp Settlements
- Beginning in February 2026, the Centers for Medicare & Medicaid Services (CMS) will conduct quarterly random audits of Section 111 records to ensure workers’ compensation reporting compliance.
- Self-insured employers and insurers are required to report settlements involving Medicare beneficiaries that close future medical rights, regardless of the settlement amount.
- Failure to report these events within one year may result in civil monetary penalties of up to $357 per day.
- These reporting changes are intended to prevent the transfer of injury-related medical costs from primary payers to Medicare.
Delaware General Assembly Mandates Joint Liability for Workers’ Comp
- The Delaware General Assembly recently overrode a gubernatorial veto to enact Senate Bill 63, which targets worker misclassification.
- Under this new law, general contractors can now be held jointly liable if their subcontractors fail to pay required workers’ compensation premiums.
- Businesses found in violation face steep penalties, including the potential revocation of their state certificate of registration.
- This legislative shift aims to ensure all workers are properly covered while preventing companies from gaining an unfair advantage by skipping insurance costs.
Court Rules Workers’ Comp is the Only Way to Handle Denied Benefit Disputes
- In Ledoux v. Bristol Community College, a Massachusetts court affirmed that an injured worker could not sue for emotional distress caused by an insurer’s denial of benefits.
- The court ruled that the Workers’ Compensation Act provides the exclusive remedy for injuries arising from the claims-handling process.
- Because the law already includes penalties for insurer misconduct or delays, independent lawsuits for bad faith are barred.
- Consequently, the plaintiff’s civil claims against the college and its workers’ comp administrators were dismissed.