Workers’ comp insurers have to prove negligence with possible intoxication

• Workers’ comp is generally a no-fault system designed to be a compromise between employers and employees to provide wage replacement benefits and medical treatment for workplace injuries.
• The viability of an intoxication defense to a workers’ compensation claim stemming from a truck accident therefore depends both on the circumstances of the accident and on state law.
• There must be proof that the driver was intoxicated and that intoxication was a cause of the accident and his injuries
• There must also be evidence that the driver’s intoxication was the sole cause of the accident and his injuries.
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Arrest for alleged workers’ comp fraud in NJ

• Christopher Angst and Michael McFadden for alleged insurance fraud in Morris County, New Jersey.
• McFadden is employed as an insurance agent with Insurance Associates in Hasbrouck Heights.
• Further investigation revealed McFadden had allegedly created false documents claiming Angst had a workman’s comp coverage policy, when in fact, the defendant did not have a workman’s comp insurance policy.
• The investigation revealed Angst had falsely presented his painting business to a client as being insured, and those documents were unknowingly submitted to an insurance carrier by the client.
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New York launches workers’ comp app

• The New York State Insurance Fund launched a new Claim Mobile App to improve communication with and help injured workers access real-time information about their workers’ compensation claims.
• The new app enables NYSIF claimants to easily access their claim number and status, case manager contact information, benefit payment dates and amounts, and a schedule of upcoming events important to their claim.
• The app also provides claimants with one-touch access to their current prescription card, and the ability to email or call their case manager and to sign up to receive benefit payments by direct deposit.
• The app is one of the few apps exclusively created and designed for workers’ compensation claimants.
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Medical payments continued to decline

• Medical payments per claim decreased more than 3 percent in most of the 17 study states for 2021 injuries with experience through March 2022, according to a new set of studies by the Workers Compensation Research Institute.
• The main driver of this was a decrease in utilization of medical services, likely the result of the pandemic.
• In Illinois, medical payments per workers’ compensation claim decreased by 3% per year between 2019/2020 and 2021/2022.
• In Indiana, utilization of most services decreased more in Indiana than in most other study states, but payments per workers’ compensation claim remained stable.
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