#Medical indemnity legal staff

[medtalksblog]

Indemnity Insurance: A Vital Shield for Healthcare Professionals

In India, Doctors have been the equivalent of gods since Vedic times. However, with rapid advancements in the complex and high-stakes world of healthcare, the role of doctors has become more demanding and fraught with risks. Furthermore, the growing population and sedentary lifestyle have strained healthcare infrastructure and medical professionals. 

Every day, numerous cases emerge where patients requiring hospitalization face severe consequences, including death or suffering, due to inadequate equipment, overworked medical staff, and lack of proper oversight. This highlights the urgent need for healthcare professionals to safeguard themselves against potential liabilities, making it crucial for them to ensure proper protective measures and adherence to best practices in their field.

Indemnity Insurance for Doctors

Indemnity insurance, or professional liability insurance, is a type of coverage designed to protect doctors and other healthcare professionals from financial losses arising from claims of negligence or malpractice. It provides coverage for legal costs and any compensation awarded to the patient if the doctor is found liable for an error or omission during their professional duties.

Medical Negligence Insurance Insights

Medical professionals are expected to bring a reasonable degree of skill, knowledge, and care in their daily practice. However, human errors are unavoidable. Thus, it is important to obtain indemnity insurance to protect oneself from financial liability due to negligence.  

The benefits of indemnity insurance are: 

Protection Against Medical Negligence Claims/Financial Stability: Medical negligence is a serious issue that can have far-reaching consequences for the patient and the doctor involved. It is an economic safeguard, ensuring doctors are not personally liable for the high costs of defending against these claims.

Peace of Mind: The threat of legal action can be a constant source of stress for doctors. Peace of mind allows doctors to focus on providing the best possible care to their patients without the fear of financial liability in the event of a lawsuit.

Compliance with Legal and Professional Requirements: In Western Countries, it is not just a recommendation but a legal requirement for practicing doctors. Failure to comply with these requirements can result in disciplinary action, including suspension or revocation of the license.

Factors to consider while choosing Indemnity Insurance

Coverage Limits: Ensure the policy provides sufficient coverage for legal costs and compensation awards. The coverage should reflect the risks associated with the specific medical specialty.

Scope of Coverage: Review the policy to understand what is covered, including specific acts of negligence, errors, wrongful acts, omissions, and exclusions. Some policies may offer additional benefits, such as cover for defamation or breach of confidentiality.

Claims Process: Understand the claims process and the level of support the insurer provides during a claim. A responsive and efficient claims process is crucial during stressful times.

Premium cost: While cost should not be the only factor, ensuring that the premiums are affordable and offer value for the coverage provided is essential.

Conclusion Indemnity insurance for doctors is a tool that protects against the financial risks associated with medical negligence claims and provides peace of mind and security in an increasingly litigious environment. Remember, doctors can safeguard their practice, reputation, and future by choosing the right indemnity insurance, allowing them to continue their essential work confidently.

[runacresinsurance]

The Ultimate Guide to Public Liability Insurance for Small Businesses

Starting and running a small business involves a myriad of responsibilities and risks. Among the essential aspects of business management is securing the right insurance to protect your enterprise from unforeseen events. Public Liability Insurance (PLI) is one such critical component.

This guide will delve into what PLI is, why it’s vital for your small business, how it works, and what you should consider when choosing a policy.

What is Public Liability Insurance?

Public Liability Insurance is designed to protect your business against claims made by the public for incidents that occur in connection with your business activities.

These incidents could include bodily injury or property damage. For instance, if a customer slips and falls at your store, PLI covers the legal and medical expenses that may arise from the claim.

Why Public Liability Insurance is Essential?

Legal Requirement: In some industries and regions, having PLI is a legal requirement. Even if it’s not mandated, it’s often required by clients and business partners.

Financial Protection: Lawsuits and claims can be financially crippling. PLI covers the costs associated with defending against claims and any compensation you may be required to pay.

Business Credibility: Having PLI demonstrates to clients, customers, and partners that you are responsible and prepared for unforeseen events. This can enhance your business's credibility and trustworthiness.

Peace of Mind: With PLI, you can focus on growing your business without the constant worry of potential accidents and the resultant financial consequences.

How Public Liability Insurance Works?

Public Liability Insurance covers a range of scenarios where a third party (such as a customer or a member of the public) claims injury or damage due to your business activities. Here’s how it typically works:

Incident Occurrence: An incident occurs where a third party suffers injury or property damage.

Claim Filed: The injured party files a claim against your business for compensation.

Insurance Notification: You notify your insurance provider about the claim.

Assessment and Investigation: The insurance company assesses the claim and conducts an investigation to determine its validity.

Settlement: If the claim is valid, the insurance company negotiates a settlement with the claimant. This includes covering legal costs and any compensation agreed upon.

What to Consider When Choosing Public Liability Insurance?

Choosing the right PLI policy involves several considerations to ensure comprehensive coverage and value for money. Here are some key factors to consider:

Coverage Amount: Evaluate the level of coverage you need. This depends on the nature of your business, the number of people you interact with, and the potential risks involved. Higher coverage amounts provide more protection but come at a higher premium.

Policy Exclusions: Understand what is not covered by the policy. Some common exclusions might include deliberate acts, contractual liabilities, and professional negligence (which is often covered under professional indemnity insurance).

Premium Costs: Premiums can vary significantly based on the coverage amount, the nature of your business, and your claims history. Compare different policies to find one that offers the best balance between cost and coverage.

Excess: This is the amount you pay out of pocket before the insurance kicks in. Policies with lower excess amounts typically have higher premiums, and vice versa.

Claims Process: A straightforward and efficient claims process is crucial. Look for insurers with a good reputation for handling claims promptly and fairly.

Additional Benefits: Some policies offer additional benefits such as legal advice, risk management support, and coverage for temporary staff. Assess these extras to determine if they add value to your business.

Conclusion

Public Liability Insurance is a vital safeguard for small businesses, offering protection against potentially devastating financial losses from third-party claims.

By understanding what PLI covers, why it’s important, and how to choose the right policy, you can ensure your business is well-protected. Investing in the right PLI policy not only safeguards your financial health but also enhances your business’s credibility and provides peace of mind, allowing you to focus on what you do best—growing your business.

Take the time to assess your business’s specific needs and risks, and consult with insurance professionals to find the best policy tailored to your requirements. Remember, the right coverage today can save your business tomorrow.

Source - https://liability-insurance-cover.blogspot.com/2024/06/the-ultimate-guide-to-public-liability.html

[heritage-instrument-insurance]

What Insurance Policies Do Musicians Need?

Being a musician involves a lot more than just creating and performing music. It is a career path with its own set of perks and risks. And having the right plan can mean the difference between bouncing back from a setback or facing financial collapse.

Here's a breakdown of the key insurance policies musicians should consider to protect their instruments, their livelihood, and themselves from the aftermath of an uncertain event. Let's get started!

Public Liability Insurance (PLI)

It is a fundamental coverage for any musician, especially those who perform live and are surrounded by people. PLI or public liability cover safeguards you financially if a third party (audience member, venue staff, etc.) gets injured or their property is damaged due to your actions or equipment during a performance, rehearsal, or even while setting up. Most importantly, such scenarios are not rare.

Imagine a rogue cymbal stand topples over and injures a guest at your gig. Public liability musicians' insurance would cover the medical expenses or any legal fees that arise. Many venues require performers to have PLI before they can take the stage. So, make sure you have it before you hit the stage.

Musical Instrument and Equipment Insurance

Your instruments are your voice, and their value can range from a few hundred dollars to priceless heirlooms. Isn't it? Equipment coverage protects your gear from theft, accidental damage, loss, and even damage during travel (in case you check your guitar on a flight and it gets mishandled). This plan can be obtained as a standalone policy or added to your PLI for a comprehensive musician's package.

Business Property Insurance

Do you have a dedicated music studio or practice space? A business property plan protects the physical location and your belongings inside it. It covers damage from fire, theft, vandalism, and natural disasters.

Inland Marine Insurance

This type of policy is specifically designed for items that are frequently moved around. It's particularly relevant for touring musicians who transport their instruments and equipment from gig to gig. Inland marine insurance bridges the gap between coverage provided by your business property policy (which applies at your studio) and your equipment cover (which might not extend to certain situations while traveling).

Personal Accident and Health Insurance

A musician's career can be physically demanding. We know you know it the best. Repetitive strain injuries, hearing loss, and even accidents on stage are potential risks. Personal accident and health coverage provide financial protection in case of an injury that prevents you from performing or working in your musical capacity.

Professional Indemnity Insurance

This protects you from legal claims related to negligence in your professional services. While uncommon, a situation could arise where a client sues you for a perceived error or omission in your work (e.g., a missed deadline for a commissioned composition). A professional indemnity plan would cover the legal costs associated with defending yourself in such a case.

Legal Expenses Insurance

Lawsuits can be expensive, even if you're ultimately found not guilty. Legal expenses protection covers the legal fees you incur if you're sued in a non-performance-related matter. This can be helpful in situations like contract disputes or copyright infringement claims.

Business Interruption Insurance

If an unforeseen event disrupts your ability to perform or teach music lessons for some time, business interruption musicians insurance can help offset lost income. This could be due to a natural disaster, illness, or even venue closure.

Choosing the Right Coverage

The specific protection needs of a musician will vary depending on factors like the type of music they play, whether they perform live, the value of their instruments, and their business structure. It's wise to consult with an insurance agent who understands the music industry to create a personalized coverage plan. Also, you can visit online portals to compare different plans from various insurance providers to find the most suitable option.

[mysticalgalaxycollection-blog]

How to Find the Right Consulting Insurance

If you are working with a team of people, you will need to have the right consultant insurance. There are many things that you might need coverage for and this type of insurance is designed specifically for those needs. Your company insurance policy is meant to cover your needs only. Whether you work in the IT field, sales, HR or finance, all individuals share some common characteristics. Good consultant insurance can ensure that an individual has your back even while you are serving your customers.

A good insurance plan should be able to protect your clients and employees. For example, you may want to ensure that you are fully covered in case something were to happen to one or more of your staff members. You might also want to take advantage of the policies that cover employees' equipment for any reason. For instance, you may think it is too expensive to replace a laptop computer or an office chair that has been destroyed in a fire.

Even a staff member who works from home could suffer financially if they were to contract a disease or become ill. This type of coverage can help protect your employees. You can protect them against unexpected injury by providing a temporary income for the period of time they are hospitalized or recuperating. This can also provide an income during the days off that they would normally receive.

It is also important to find the right consultant insurance plan for your company. While you may think that a basic policy will do, your business may need different levels of coverage. You should know that your current employees may need special attention. You might also need to take care of employees who travel frequently to and from your location. Your consultants should be covered if they are working at a location that is remote, and they may need additional protection when they travel to remote locations, such as on business trips.

Your company can benefit from professional indemnity insurance if they are exposed to legal risks. You should have someone who is experienced in your industry in place of your legal affairs so you will be protected against potential lawsuits. For example, you might want to protect yourself from claims of negligence because of an employee's death or sickness, or an individual's sexual harassment or discrimination.

By having someone responsible for your legal obligations you can ensure that you are not held personally liable for paying out large amounts of money in lawsuits. If an individual has to pay out settlements for such occurrences, they will not be able to pay for their own medical bills or even the cost of a funeral.

[medinslegal]

Indemnity Insurance for Medical Professionals, Doctors, Medico Legal indemnity and Medical Establishment in Delhi NCR. Risk management services for medical professionals in Rajasthan and Punjab. Visit: https://medinslegal.com/services/

[careerplus7]

Virtual HR Customer Service Representative - Salem, VA 24153

Virtual HR Customer Service Representative - Salem, VA 24153

#HR #jobopenings #jobs #career #hiring #Jobposting #LinkedIn #Jobvacancy #Jobalert #Openings #Jobsearch

Description

Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Virtual HR Customer Service Representative with Work from Home you can be a part of an organization that is devoted to giving back!

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation.

Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.

Fertility and family building benefits through Progyny

Free counseling services and resources for emotional, physical and financial wellbeing

Family support, including adoption assistance, child and elder care resources and consumer discounts

401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)

Employee Stock Purchase Plan

Retirement readiness and rollover services and preferred banking partnerships

Education assistance (tuition, student loan, certification support, dependent scholarships)

Colleague recognition program

Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Would you like to unlock your potential with a leading healthcare provider dedicated to the growth and development of our colleagues? Join the Work from Home family! We will give you the tools and resources you need to succeed in our organization. We are looking for an enthusiastic Virtual HR Customer Service Representative to help us reach our goals. Unlock your potential!

The HR Service Center (HRSC) Customer Service Tier I Representative is a member of the HR Service Center team, responsible for providing front-line customer service and support to employees (active and inactive), managers, HR Field staff, and company vendors for questions, issues, and problems related to HR and Payroll Tier I. The HRSC Tier I Customer Service Representative will perform administrative, and data/records management activities in support of HR and HRIS functions, including interpreting life-cycle reports, onboarding, status change, compensation, separations, etc. The HRSC Customer Support Tier I Representative will work under direction from the HRSC Supervisor to ensure HR service delivery is consistently high-quality.

Provides customer service by answering HRAnswers calls, documents all customer inquiries and resolutions received via phone calls. Ask HR, Chat, mailboxes or alternative streams of input in order to identify, diagnose, and initiate research necessary to resolve customer issues in a timely manner, as needed

Provides support within a HR Line of Business

Cleary communicates problem symptoms and consults with CS Tier 2 representatives as necessary to aide in resolving customer issues/requests and ensure all pertinent information is included

Escalate unresolved issues as needed

Perform any other duties as needed

Provide assistance on navigating internal resources on self-service and HR technology tools

Strong Customer Service skills

1 year of experience in HR preferred

Virtual employees are required to have high speed interview with 60 MB download and 10 MB upload

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder

Be a part of an organization that invests in you! We are reviewing applications for our Virtual HR Customer Service Representative opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

This position is incentive eligible.

Apply Now: https://bit.ly/jumprecruiter

[searchworkerscompensation]

Workers Compensation Service

A workers compensation service offers advocacy and dispute resolution services to help injured workers navigate the process and receive the compensation they need. As a free service, the WCS provides representation exclusively for injured workers. With over 100 years of union experience, WCS is a great resource for injured workers. Its 24/7 nurse triage line makes it easy to get help for an injury, and it pays medical bills and provides indemnity benefits for lost wages. To find out more, visit the WCS website or call 1-800-411-WA workers compensation service. To  gather more awesome ideas, click here to get started oneforcewc.com.

The WCS is part of the Labour Program, which administers the Government Employee Compensation Act. Workers compensation programs provide medical care and salary protection for injured or sick employees. The Labour Program also administers claims submitted by certain merchant seamen. Its main mission is to help workers recover from work-related injuries. In addition to administering workers compensation claims, the WCS also provides advice to the insurance industry. Its members meet strict guidelines and abide by the law to ensure fairness and transparency. You can read more about workers compensation here. 

HM Insurance Group is dedicated to providing a seamless customer experience. Their service team works with clients to address all of their concerns and questions throughout the duration of their policy. This team is comprised of a marketing underwriter, account manager, loss control consultant, claims analyst, and medical case management coordinator. Their staff understands the nuances of the workers compensation system and will guide them through the claims process. In addition, their claims department is staffed with knowledgeable professionals who will work on the case to make it as easy as possible for their clients to recover.

It's important to make sure the doctor's diagnosis matches the claims of the insurance company. You'll need to file a Comprehensive Injury Report (CIR) if you are unable to work due to an injury sustained while at work. Your workers compensation insurance company will require that you undergo a certain diagnostic testing network. If you don't, you may lose access to workers compensation benefits. In addition, you may not be able to receive all of the benefits you're entitled to. Kindly�� visit this website  https://bizfluent.com/how-7690502-workers-comp-certificate.html  for more useful reference.

The DWC publishes the rules that regulate the Workers Compensation System. These rules govern the payment of income benefits and medical care to injured employees. A third-party claims administrator, such as Gallagher Bassett Services, performs the review conference. A case manager works with the company to coordinate medical services. This is the person who will be dealing with the case on behalf of the injured employee. A case manager is usually an experienced professional who has the expertise to resolve medical issues.

The benefits offered by a workers' compensation service include medical attention, lost wages, and income benefits. Moreover, the compensation service will also cover any other expenses related to an employee's condition. Workers compensation is a legal requirement in most states. However, in Texas, it is possible to opt out of a traditional workers' compensation program, but in Alabama, you only need it if you have five or more employees. For further information, please visit the WCSA website.

[medtalksblog]

Professional Indemnity Insurance for Doctors: Safeguarding Your Medical Practice

Doctors are the only professionals who face the risk of a financial liability in the course of practicing their profession. Professional Indemnity Insurance can protect them both financially and legally when they are sued for negligence.

For patients, doctors are healers who restore their health from critical medical emergencies. However, human errors are inevitable, leaving doctors vulnerable to claims from patients who experience loss due to perceived or actual negligence, mistakes, or oversights. While such claims can significantly threaten a medical practitioner's financial stability, medical insurance plays a crucial role in mitigating the risks and protecting the professional interests of doctors across the board.

What is Professional Indemnity Insurance?

Professional Indemnity Insurance, also known as Medical Negligence Insurance, is designed to financially safeguard medical practitioners against legal costs and claims for compensation. It provides:

Financial Protection: It relieves doctors from personal liability for compensation payments and settlement fees, allowing them to focus on providing quality care without fearing financial implications.

Financial Assistance: It also covers the cost of defending oneself in court (Cost of Decree), facilitating medical professionals with monetary support and economic stability in case of a lawsuit.

Regulatory Compliance: Professional indemnity insurance is a legal requirement for practicing medicine in some regions. 

What the Policy Covers?

The policy typically covers liabilities for a year from subscription, facilitating a predetermined sum insured, known as the Limit of Indemnity. This limit applies per accident and per policy period. Any expenses beyond this sum must be borne by the doctor. Indemnity insurance policies should be separately obtained for doctors and hospital staff and renewed annually to cover claims arising under the Consumer Protection Act (CPA).

Getting a Medical Insurance

Various organizations in India offer indemnity insurance policies for medical practitioners:

1. Indian Medicolegal Consulting Services or Professional Protection Groups: These services handle medicolegal issues and administrative problems. These organizations provide insurance coverage through nationalized companies and offer legal guidance and advisory support.

2. IMA National Professional Protection Scheme: This scheme offers legal aid to its members and aims to protect doctors from harassment or litigation during their professional practice. However, only life members of the Indian Medical Association (IMA) are eligible for the scheme. 

3. Professional Indemnity Policies by National General Insurance Companies: These policies are available for individuals, hospitals, and diagnostic centers. However, no short-period policies are allowed. 

4. Online Insurance Services: Comprehensive Professional Indemnity Insurance tailored to meet the individual needs of medical practitioners can be harnessed from online insurance aggregators. The easy-to-navigate online platforms allow doctors to compare different policies and select the one that best fits their needs.

Selecting the right Professional Indemnity Insurance policy requires careful consideration.  Policies tailored to specific specialties can provide more relevant coverage. Understanding the policy coverage and its exclusions is crucial before choosing the policy.

Conclusion

In a profession where the stakes are incredibly high, having the right insurance coverage is not just a precaution but a necessity. Doctors must be encouraged to consult with insurance experts to tailor a Professional Indemnity Insurance policy that best meets their needs and ensures comprehensive protection for their practice. 

Policy Wordings PI Medical Practitioners. [Internet]. [cited 2024 Jun 18]. Available from: file:///D:/downloads/Downloads/7_Policy%20Wordings%20PI%20Medical%20Practitioners%20_%20Misc%2022_GEN074.pdf

 Kumar S, Haque MA, Tehrani HY. High stress in doctors. Indian J Psychiatry. 2020;62(5):458-463. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6951135/

[slempbrantsaundersinsva]

Reasons To Buy Homeowners Insurance in Abingdon and Bristol, VA

Small and big business owners want to remain protected ideally to operate their business and earn a livelihood without restraints. An insurance plan is the most standard type of security that provides compensation for damage to a person, goods, and property. Liability insurance in Abingdon and Bristol, VA is required in addition to safeguarding one’s interests and remain covered on all fronts, including a customer’s complaints. ​ Liability insurance can go a long way in providing protection from legal claims made by other individuals for damage to their property or causing physical/mental harm. Liability suits can drag on endlessly, causing monetary loss as well as affecting one’s peace of mind. It is not always easy to bear the expenses arising out of liability claims, though. Having adequate insurance coverage can certainly help take care of the financial burden, including paying compensation to the claimant and covering all associated legal expenses. One needs to carefully go through the terms and conditions before signing on the dotted line and agreeing to buy the required liability coverage. This type of insurance does not cover any intentional damage caused out of greed or malice, however. Criminal actions or protection for contractual liabilities do not come under the purview of such insurance plans either. Liability insurance is a part of auto insurance plans usually. Manufacturers of products and medical/legal professionals appreciate being covered for various liability claims made by dissatisfied clients. Insurance coverage for liabilities is not identical for every business owner or manufacturer. Instead, it makes sense to check one’s requirements and have the insurance company develop a tailor-made plan that covers all possible risks. It is essential to pick and choose from the available plans to create a comprehensive package that is enough to protect all the assets. Some of the main plans that are usually considered for liability coverage include:- · Business entities that utilize a team of staff for operations must be protected employers liability as well as workers compensation insurance · Companies that manufacture products for catering to the local market need to be covered with a product liability plan. · Indemnity insurance can enable the business owner to remain protected from negligence claims that resulted in financial loss due to error or inability to provide the required services. · The management consisting of a board of directors and top officials can protect themselves when the entire company is sued for liabilities. The Director and officer liability plan helps them to avoid heavy expenses Both the company owner and individuals may choose to buy an umbrella policy plan to ensure additional protection from liabilities. The plan comes into force when coverage for the other liability plans is exhausted. It is essential to have the assets at home protected as well. Having the right homeowners insurance in Abingdon and Bristol, VA can help one to safeguard against sudden damages without incurring heavy costs on repairs.

[zenruption]

Insurances to secure your business for a worry-free run 



Owning a venture does not come without its fair share of risks. Wisdom directs every entrepreneur to get some safety cover to save on bad days. And there cannot be a more effective protection program than having business insurance. 

What is it?

This form of commercial surety helps in the coverage and protection of your private enterprise from a diverse range of likely losses that take place suddenly. The various forms of this program include property damages, legal liabilities, and employee-related risks. 

The risks are primarily dependent on the operating environment and may vary from one trade type to the other. 

Why must you get it?

Apart from aspects of self-interest, it is actually in compliance with the law. Since it is a legal requirement, you can get sued too if you fail to keep any assurance. Having this form of a safety program increases your work's credibility and keeps it up and running at all times, irrespective of all the variables that can have the potential to harm your commerce. 

Why is safeguarding important?

Your work is of vital importance to you. You have invested a lot of money and effort into making it what it is today. Securing it is crucial to mitigate threats like thefts against people and property. 

Contrary to earlier times, today's burglars are educated, and they have easy access to various resources. That is why your indemnity measures should be well thought of so that your arsenal is the solution to detect and prevent prospective menaces. The best way is to get all the right kind of never-failing guarantees. 

1. Property insurance

It is a broad term for a series of policies and conditions that provide protective cover for the commercial property. It is responsible for providing financial reimbursement in case of a robbery or damage or to any person harmed on the premises. It usually takes into account appliances, furniture, catalogs, or any other utility of the interior and exterior space. 

2. Vehicle Insurance 

In case of an accident, having a special immunity against vehicle damage can help you cover the loss and medical expenses. According to the LoPriore Insurance Agency experts, any automobile that carries out business tasks is subjected to more risks compared to a personal motor wheel. 

Investing in the right auto protection policy will help you avoid any worries and always enjoy smooth rides. 

3. Professional Liability Insurance 

Also known as the E.O Protection cover, it provides provision for business harm that may have resulted from carelessness. It can be either caused by the company or the failure to act or perform to the optimum level. 

It also aims to resolve company queries in a specific and peaceful manner. This is something that can keep you away from being sued in a lot of common aspects. 

4. Workers Compensation Insurance

This suggestive name should give you a rough idea about what this may be. You guessed it right. This part of a full proof plan will help your employees with any emergency and health conditions. Adding this as compensation to your workforce will motivate and encourage your staff. 

This is a really good way of assuring them of their safe and secure future, which usually results in better output in work. This looks out for disability, death, therapeutic care, and any injury that happened while being at work. 

5. Fire Safety

Fires are the most unpredictable risk that always looms over any trade. The eruption of high flames causes everything to become gutted and into a rubble pile of ash. All the contents and the infrastructure greatly suffers on such an occasion. 

To ensure that your work is unhindered and remains afloat under any such conditions, it is wise to invest in a plan that offers safety against fires and any potential damages. 

Also, it not only makes up for the losses but also brings you in a position to claim for the replacement of some of the goods that suffered unfixable losing. Perils like explosions, implosions, lighting, bush fires are just some of the scenarios that can be taken care of with this form of a plan.

Conclusion

Meticulous planning is required to run any venture. That being said, various factors have the power to pose a threat to your company. The numerous advantages of these protection plans can help your work environment to stay protected against all kinds of threats. Hence, this wide range of policies will help you to secure your hard work a bit more. Good luck!

[edisonashley]

John Harrington, Erin Thomas and Barbara Hughes-Moore: Is there a Welsh Health Law? Values, Divergence and Devolution after COVID-19

Viruses can move the world and COVID-19 has unquestionably tested the United Kingdom’s constitutional settlement. This is not simply a matter of the generic allocation of powers as between London on the one hand, and Cardiff, Edinburgh and Belfast on the other. It also concerns the content of substantive law in discrete fields. Lawmakers, practitioners and scholars might thus ask: what has been the effect of the pandemic in the field of regulation central to official responses, namely health law? In this note we introduce a research project which aims to answer this question in relation to Wales, and, thus, contribute to evaluating some of the wider legal consequences of COVID-19 and the political contexts which shape and are shaped by them.

The UK nations’ divergent responses to COVID-19 highlight the interplay, interaction and negotiation between devolved governments and Westminster in legislating on public health matters. The diversity of devolved administrations has been illuminated through the regular announcement and amendment of public health regulations such as closing non-essential businesses and requiring face coverings to be worn in public indoor settings. Coordination between the four UK governments was a key aspect of the pandemic’s early stages, embodied in their joint Coronavirus Action Plan published on 3 March 2020 and their collective decision to institute a UK-wide lockdown on March 23. Weekly meetings between the four Health Ministers in these early stages were praised by Northern Ireland Health Minister Robin Swann for prioritising public health over political point-scoring. Small regional differences from May 2020 led to increasing divergences in lockdown rules, duration and substantive guidance.  However, co-ordination between the four governments of the UK is not an end unto itself; it is only desirable to the extent that it leads to better outcomes, and as the pandemic progressed the four governments began developing policy largely independently. If the pandemic has tested the UK’s devolution settlement, then the medium through which it has done so is law. It has highlighted the capacity for sub-state legislatures and executives to shape distinct responses to disease outbreaks and other health problems. COVID-19 has already been a site for contests over Welsh identity, Scottish independence, and Irish unity pursued through health law.

Health is a devolved policy area across the UK. Wales (like Scotland and Northern Ireland) has its own distinct public health and healthcare framework, comprised of legislation passed by Senedd Cymru (the Welsh Parliament) and Regulations laid down by Ministers of the Welsh Government. As the rate of infection increased dramatically in March 2020, the UK Parliament passed the Coronavirus Act which conferred new powers on devolved administrations to pass measures specifying emergency arrangements relating to the lockdown and other measures to prevent person-to-person transmission. Devolved ministers are empowered to provide an indemnity to medical staff for criminal negligence cases related to COVID-19, to temporarily close educational establishments and to alter the employment terms of health care workers.

COVID-19 has, thus, made the fact of devolution ‘present’ to citizens to an unprecedented degree, producing a distinctive ‘health space’ defined by the border between Wales and England. However, there has been more public confusion as regards substantive detail and scope of jurisdiction. Media sources have often neglected to indicate that measures imposed by the UK Parliament and ministers are specific to England only. This tendency is reinforced through the language of UK government ministers and in the paraphernalia of Downing Street briefings, e.g., displaying the Union flag. Given that people living in Wales are much more likely to receive information from these sources, uncertainty about operative rules has been inevitable. This confusion is troubling in terms of public health effectiveness given the need to secure general compliance across a given time and space. It also raises rule of law concerns, as Nason and Pritchard highlight in relation to administrative justice in Wales more generally. How can citizens, health workers and others know the limits placed on their basic rights and hold the devolved authorities to account legally and politically?

Looking forward, it is also worth noting that this scene of contest and confusion is likely to be exacerbated as a result of the UK’s departure from the EU. Economic commentators such as McHale, Speakman, Hervey and Flear have highlighted the potential implications for health and health care presented by customs barriers to imports from the EU and likely impediments to economic growth adding to the shock of the pandemic itself. Legal scholars like Kramer, Locke and Greene have also noted the implications in this context of the Internal Market Act, passed to ensure the barrier-free movement of goods between the four UK nations at the end of the Brexit transition period. Critically, Schedule 1 of the Act fails to set out a general public health exception to the mutual recognition principle. The Secretary of State has powers in the legislation to amend and remove the limited protections for public health that do exist through secondary legislation, thus preserving free trade across the UK by limiting the autonomy of devolved governments and restricting devolved administrations’ powers to raise public health standards unilaterally, for example in regard to the pricing of alcohol or level of salt content in food products. The narrow drafting of the Act undermines the ability of devolved governments to introduce key policies aiming to improve public health, potentially hindering the devolved administration’s innovation. This is potentially harmful when different nations move at different speeds in terms of public health, for example when Wales introduced a bespoke new law for minimum alcohol pricing in 2018. If COVID-19 has promoted centrifugal tendencies in devolution, by contrast the Internal Market Act may be the harbinger and agent of recentralization of power in Westminster.

Indeed, the administrations in Wales and Scotland refused to consent to the Act, and on 19 January 2021 Jeremy Miles, Counsel General for Wales, issued formal proceedings to legally challenge the Act by seeking permission for judicial review.

Though avoiding ‘devolution-determinism’, we can nonetheless affirm that there is a distinct body of health law in Wales into which relevant COVID-19 norms have been inserted. This is heterogenous as to source. The Labour-dominated parliament in Wales, looking to put ‘clear red-water’ between itself Conservative-led administrations at Westminster has legislated for a series of landmark initiatives since devolution in 1998. England functioned under an opt-in system until recently, while Wales introduced a ‘soft opt-out’ system of organ donation in 2015, the first UK nation to do so; the legislation is governed by the principle of ‘deemed consent’ in Wales, meaning that, if a person has not registered a decision, they are considered to have no objection to being a donor.

More fundamentally the National Health Service has been reoriented to remove market and quasi-market features retained in England, restoring cooperation in place of competition, it is claimed. The four nations of the UK have their own NHS services, funded via a block grant from the UK central government. Health services are divided into a series of organisations working at local and national levels. The structure of the NHS in Wales underwent major change in 2009, with a stronger emphasis now on public health and long-term planning, and a distinct public service ethos, following the creation of single local health organisations responsible for delivering all healthcare services within a geographical area, rather than the Trust and Local Health Board system in place previously.

Much of the law relating to health and health care in Wales nevertheless emanates from beyond Cardiff. Case law on everything from patient consent to treatment to the definition of death forms part of the common law of the unified jurisdiction of England and Wales, as the criminal law is not devolved to Wales. International law forms another important source, for example, human rights treaties ratified by the UK and, where relevant, directly incorporated into Welsh law like the Convention on the Rights of Children. Professional licensing and regulation of health care workers in Wales is a matter for the UK General Medical Council and equivalent bodies. The norms emanating from these sources are unlikely to sit side by side, as it were, capable of being applied discretely to discrete health-related issues. We can predict interaction in dynamic, even agonistic fashion, with norms qualifying and sometimes displacing each other and advancing rival jurisdictional claims. This suggests that we should study process as well as substance.

A properly descriptive approach might lead us to adopt the label ‘health law in Wales’ rather than ‘Welsh health law’. Nonetheless, we feel there is traction in the latter term too, in so far as it brings additional evaluative and predictive dimensions to the study. Our key question in that regard would then be: to what extent can there be principled coherence in Welsh health law? And, relatedly, where might the normative sources of such coherence lie? The practical needs of citizens, lawmakers, professionals, and administrators, for clarity and intelligibility has been made clear during COVID-19, as noted above. It will only grow in so far as the health-related output of Senedd Cymru expands in range, scope and volume. While discrete areas like the reform of organ donation rules have already been the subject of legal commentary, there has to this point been no systematic treatment capable of guiding new developments. Textbooks on UK health law now provide well-informed accounts of ‘divergence in the devolveds’, but this is by way of a supplement to the main story. This will become still more pressing should the recommendations of the Thomas Commission on Justice in Wales in 2018 in favour of the creation of a separate, autonomous jurisdiction be implemented. Moreover, such recommendations by Jeremy Miles, Huw Pritchard and Sarah Nason inform the future codification of Welsh law regarding Health and Social care.

What might provide the basis in principle for organizing an account of Welsh health law and for orienting and critiquing new developments? This challenge has been faced by health lawyers in other jurisdictions. Pioneering scholars like Brazier and Mason and McCall Smith prefaced their textbooks on UK health law with a review of relevant ethical values, for example the principles of autonomy, justice, non-maleficence, beneficence originally laid out by Beauchamp and Childress. With developing case law, dedicated legislation and the passage of the Human Rights Act 1998, some of these values and their specifications have been identified and thus grounded in positive legal material too. This UK health law made relatively little play of its ‘nationality’: Scots law precedents were and still are largely absorbed into a shared common law. Ethical values of the sort just mentioned are cast in universal terms.

The challenge is not to find (or more likely to invent) values which express an authentic Welsh national essence in the field of health. Rather our work needs to be wide-ranging and interpretive, drawing on legal analysis, political theory and historical scholarship to identify values which might underpin the emerging law. Many are likely to overlap considerably with principles and norms identified by the health law writers just mentioned. This is to be expected given the shared political, institutional and legal history across the UK. In other instances, though, we can expect distinct inflections and emphases. For example, the much-studied Well-Being of Future Generations Act seeks to put the UN Sustainable Development Goals and the concept of intergenerational justice into the heart of Welsh public administration. Public Health Wales and the wider NHS, through the creation of ‘hubs’ and ‘toolkits’ are monitoring and reporting progress in achieving strategic priorities and improving such health outcomes. Equally Aneurin Bevan’s work as founder of the UK-wide NHS was informed by the practical solidarity of mutual health provision in South Wales mining communities. We do well, however, to accept that values are plural, contingent and sometimes incompatible, and to articulate this rich Welsh, British and international corpus to highlight injustices in contemporary health law and policy. The work of Emmanuel Ogbonna and colleagues on the disparate impact of COVID-19 on black communities in Wales offers a powerful and topical impetus in this regard.

We will disseminate our findings and engage with our partners in health policymaking, professions, and academia in Wales, providing comprehensive and reliable information for policymakers and practitioners. This work will be useful currently for Welsh legislators, judges, policymakers, academics and other actors including professionals, doctors, patients, and citizens. Conducting our research will involve identifying, collating, and examining law and guidance applicable to Wales. Drawing on trends of health laws in Wales, we will source case law from Wales, the UK at large, and beyond, identifying areas where divergence is clear, and using cases from outside Wales to interpret secondary literature on these deviations in law and policy. Our analysis will be contextualised with reference to legal debates on the Welsh jurisdiction and to political science work on the impact of COVID-19 on the UK devolution settlement.

Supported by the Welsh Government’s Sêr Cymru programme, our project will construct an understanding of Welsh health law as a phenomenon which stands apart both from Westminster and its devolved counterparts. Employing a comparative and doctrine-focussed approach, we are investigating areas of clear divergence, drawing on trends in health legislation, for example in relation to organ transplantation. From our findings we will then consider the extent to which a devolved government may influence and have a say in decisions that affect the UK as a whole. We will use work in political theory to reflect on whether a set of distinct values underpins this developing legal corpus. More broadly, we aim to use our studies for reflection at another level: the question of whether devolution itself is creating a new field of Welsh health law.

John Harrington is Director of the ESRC Wales Doctoral Training Partnership and Professor of Global Health Law at Cardiff School of Law and Politics.

Erin Thomas is a Research Associate at Cardiff School of Law and Politics.

Dr Barbara Hughes-Moore is a Research Associate at Cardiff School of Law and Politics.

(Suggested citation: J. Harrington, E. Thomas and B. Hughes-Moore, ‘Is there a Welsh Health Law? Values, Divergence and Devolution after COVID-19’, U.K. Const. L. Blog (25th Jan. 2021) (available at https://ukconstitutionallaw.org/))

John Harrington, Erin Thomas and Barbara Hughes-Moore: Is there a Welsh Health Law? Values, Divergence and Devolution after COVID-19 published first on https://immigrationlawyerto.weebly.com/

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[davidslepkow]

Covid 19 and workers compensation in Rhode Island

Many Rhode Island workers who were infected with the Novel Coronavirus may need to seek workers compensation benefits to pay costs of hospitalization, prescriptions and lost wages. Families of workers who died as a result of Coronavirus will need to be compensated for the loss of future income for the remainder of the deceased’s life expectancy. This article addresses whether employees in Rhode Island, who were infected with Covid 19 at work can receive worker’s compensation benefits. Can the families, dependent children and spouse of a deceased worker obtain survivor compensation as a result of a death that arose out of the deceased’s employment? Does Workers’ Compensation in Rhode Island Cover Coronavirus (covid 19)?

Speak directly with an attorney on his cell phone, contact our Covid 19- Workers Compensation Hotline  24/7 at (401) 648-3580

This article was authored by Rhode Island lawyer, David Slepkow. David has 22 years of legal experience.

Questions that many Rhode Island workers are asking:

If I am infected with Covid 19 at work, can I get worker’s compensation benefits?

Can nurses and healthcare workers who tested positive for Covid 19 get workers compensation benefits in Rhode Island?

If a person contracts Covid 19 at work and later dies, can the family, spouse or children get survivor death benefits from a workers’ compensation claim?

Will workers infected by Coronavirus get workers compensation benefits?

This question has not been answered yet and will probably be litigated in the near future. Employees who contracted covid 19 during their employment should be entitled to workers compensation benefits in Rhode Island if they can establish that the virus infection most likely occurred at work. Healthcare workers and nurses with Beacon mutual  insurance will be provided worker’s compensation coverage. The State’s largest worker’s compensation company, Beacon mutual, has announced that they will expedite claims for nurses and healthcare workers and presume that their infection was contracted at work.

There are two primary issues concerning Covid 19 and workers compensation benefits:

Can an employee prove that their Covid 19 infection occurred in the course of their employment?

Is the Covid 19 virus a compensable “occupational disease” that is connected with or arising from the peculiar characteristics of the employment?

The Insurance companies may attempt to deny certain claims alleging there is no proof that a certain employee contracted Covid 19 at work.  The indemnity companies will also assert that Rhode Island law does not allow for payment of benefits in this type of situation because Covid 19 is not a disease that arises out of a particular type of employment.

RI Law:  Coronavirus must ‘arise out of and in the course of employment.’

Eligibility for comp. benefits under the Rhode Island workers compensation law is premised on the injured worker establishing that a diagnosed illness arose out of their employment. The worker must establish that a diagnosed illness was not as a result of exposure from other non-work related sources. Pursuant to Rhode Island workers compensation law, an employee’s injury must arise out of and be and in the “course of his or her employment, connected and referable to the employment” (7)(i) Employees who are comp. claimants must retain a Rhode Island workers compensation lawyer to prove that the novel corona virus infection took place at the workplace and resulted from work for the employer.

What type of benefits are available in workers compensation court for Covid 19 victims?

medical expenses

replacement of lost wages

disability benefits for workers who cannot work as a result of the disease or injury

death benefits to the families who lost loved ones

Speculation that Coronavirus infection occurred at work is not enough

If an essential frontline employee is infected with Coronavirus, in all likelihood the infection occurred at the employees’ workplace. However, speculation, guesswork and common sense will not win a Rhode Island workers’ compensation case. The Rhode Island workers compensation attorney must establish in Court by competent evidence that the Coronavirus infection occurred at the workplace. “As a general rule, an employee’s injury is compensable if the particular facts and circumstances presented establish a “nexus” or a “causal relationship” between the injury and the employment.” Frank P. TAVARES v. A.C. & S. INC., 462 A.2d 977 (1983), Bottomley v. Kaiser Aluminum & Chemical Corp., R.I., 441 A.2d 553, 554 (1982); Knowlton v. Porter Trucking Co., 117 R.I. 28, 30, 362 A.2d 131, 133 (1976).

A matter of proof

A worker may have difficulty proving that they were infected while at work. The insurance company could argue that the disease did not arise from work. The insurance company could assert that the worker contracted the virus while they were shopping for their own groceries, from a family member, at a friend’s house or out in the community. An employee who is infected by the Covid 19 virus should hire one of the best workers compensation lawyers in Rhode Island. The RI workers’ comp lawyer will fight to get justice for the victim and hold the insurance company accountable.

What is the standard of proof to establish that Coronavirus infection took place at work?

The Rhode Island workers compensation lawyer must establish by a fair preponderance of the evidence that the Covid 19 infection took place at work. This means it was more probably than not that the infection took place in the course of employment. In order to prove that the employee was infected by the Novel Coronavirus in the course of the worker’s employment, the RI workers compensation lawyer may need to retain a virologist, infectious disease expert, epidemiologist, or occupational disease specialist. Preponderance of the evidence is the standard of proof used in Providence Workers Compensation Court. Preponderance of the evidence is also the standard of proof utilized in the vast majority of civil cases in Rhode Island.

The workers compensation judge would have to make a determination whether the expert was competent to testify. The seminal case in Rhode Island for the admissibility and reliability of expert testimony is the RI Supreme Court case of Dipetrillo v Dow Chemical Company. The Dipetrillo Court adopted the reasoning and decision of the United States Supreme Court case of Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993)

“Faced with a proffer of expert scientific testimony, then, the trial judge must determine at the outset, pursuant to Rule 104(a) whether the expert is proposing to testify to (1) scientific knowledge that (2) will assist the trier of fact to understand or determine the fact in issue.  This entails a preliminary assessment of whether the reasoning or methodology underlying the testimony is scientifically valid and of whether the reasoning or methodology properly can be applied to the facts in issue.” Daubert , 509 U.S. at 592-93, 113 S.Ct. at 2796, 125 L.Ed.2d at 48

Applicable Rules of evidence

Providence Workers Compensation Court utilizes the RI rules of evidence in all trials and testimonial hearings. “Rule 104(a) of the Rhode Island Rules of Evidence provides that the court shall determine “[p]reliminary questions concerning the qualification of a person to be a witness * * * .” Rule 702 of the Rhode Island Rules of Evidence provides as follows with respect to expert witnesses: “Testimony by experts. — If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of fact or opinion.”  https://www.courts.ri.gov/Courts/SupremeCourt/OpinionsOrders/orders/09-355.pdf

Will workers’ compensation insurance companies attempt to deny Covid 19 claims for employees who worked during the pandemic?

Only time will tell what positions the insurance companies will take as to whether they will accept liability for the occupational disease claims for Rhode Island residents who worked during the pandemic of 2020. There may be a legislative solution in Rhode Island. A legislative solution may include a presumption, in all cases, that all workers infected with Covid 19 arose during the course of the employee’s employment. Rhode Island worker’s compensation insurers may do the right thing and capitulate to political and social pressures to accept accountability for Covid comp. claims.

Will nurses and medical professionals who test positive for Coronavirus qualify for workers compensation benefits?

One of the largest workers comp. insurers, Beacon Mutual Insurance Company, recently announced that they will presume that all healthcare workers who worked during this pandemic, who were infected with Covid 19, were injured in the scope of employment. The vast majority of workers in Rhode Island are insured by Beacon. Beacon mutual insures over 60 percent of the workers in Rhode Island. Beacon’s move was a nice gesture of social responsibility in the face of a statewide crises causing thousands of deaths. However, Beacon’s policy does not go far enough. Beacon’s policy does not address the plight of non-healthcare workers such as grocery store workers, Walmart employees,  nursing home staff, hotel workers, delivery drivers, construction workers and others who were exposed to Covid 19 virus at the workplace.

Rhode Island’s largest workers’ compensation insurance provider, Beacon mutual, stated:

“In order to be eligible for workers’ compensation benefits under the Rhode Island Workers’ Compensation Act, claimants need to prove that their diagnosed illness arose out of and in the course of their employment, and not through other potential sources of exposure.  In an attempt to expedite any workers’ compensation claims by those providing treatment and care for COVID-19 patients, Beacon intends to recognize the heightened risk of COVID-19 exposure to policyholder health care workers and to presume that those health care workers diagnosed with COVID-19 have an occupational disease, thereby making them eligible for workers’ compensation benefits.  Specifically, throughout the declared state of emergency in Rhode Island, Beacon will address any such claims as follows:…”

The State of Rhode Island issued a press release stating:

“Workers Compensation: Beacon Mutual Insurance Company, which insures 12,000 Rhode Island businesses, will be allowing frontline healthcare workers to file for workers compensation under the presumption that they contracted the virus in the course of doing their jobs – and will expedite those claims….” Press release

Go local Providence covered Governor Raimondos press conference and Governor Raimondo stated, “I have said all along there have been so many companies in Rhode Island that have been fantastic…I want to recognize Beacon Mutual who insures over 12,000 Rhode Island businesses. I’m announcing on their behalf that Beacon will be allowing frontline healthcare workers to file for workers’ compensation under the assumption they contracted it while on the job….This is an additional benefit on top of [Temporary Disability Insurance, Unemployment Insurance, and Pandemic Unemployment Assistance]…. There’s a number of different benefits available if you’ve lost your job or contracted the disease…”

Can I be denied workers compensation coverage because Coronavirus is not technically an injury?

Under RI law, both an injury and an “occupational disease” is covered by workers compensation benefits. Coronavirus infectious disease illness does not fall in the four corners of any RI workers comp. laws. However, the Novel Coronavirus pandemic is an unprecedented and unanticipated global pandemic. The law in Rhode Island may categorize Coronavirus as an “occupational disease” not an injury. An occupational disease which arises out of work may be treated the same way as an injury in Rhode Island Workers Compensation Court.

“The Legislature enacted G.L. 1956 (1979 Reenactment) Chapter 34 of title 28 in order to protect the worker who was exposed to conditions that resulted in disability because of an occupational disease. Evidently the Legislature recognized that an occupational disease is set apart from accidental injuries in that it is not unexpected — because it is incident to a particular employment — and it is gradual in development.” Frank P. TAVARES v. A.C. & S. INC., 462 A.2d 977 (1983)  See Morgan v. Stillman White Foundry Co., 87 R.I. 408, 414, 142 A.2d 536, 538-39 (1958); Perez v. Columbia Granite Co., 74 R.I. 503, 507, 62 A.2d 658, 660 (1948); see also 1B Larson, The Law of Workmen’s Compensation § 41.31, at 7-357 to -358 (1982).

“Section 28-34-1(c) defines the term “occupational disease” as “a disease which is due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation, process or employment.” Disability arising from silicosis or asbestosis is listed in § 28-34-2(32), as amended by P.L. 1982, ch. 32, art. 1, § 8, as a compensable occupational disease and is therefore treated as a personal injury. Moreover, § 28-34-3, as amended by P.L. 1982, ch. 32, art. 1, § 8, and § 28-34-4, as amended by P.L. 1979, ch. 151, § 1, provide that a disabled employee is entitled to compensation if the occupational disease is due to the nature of the employment and was contracted within that employment. Furthermore, when a worker has contracted an occupational disease from being exposed to a harmful substance over a period of years and in the course of successive employment, § 28-34-8 specifies that the employer who last exposed the worker to the harmful substance is liable to pay the entire compensation.” Frank P. TAVARES v. A.C. & S. INC., 462 A.2d 977 (1983) See also Esmond Mills, Inc. v. American Woolen Co., 76 R.I. 214, 219, 68 A.2d 920, 923 (1949).

Is Covid 19 an Occupational disease that you can get compensation benefits?

Rhode Island General law § 28-34-1 defines an occupational disease as “a disease which is due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation, process, or employment.” Pursuant to Rhode Island Law 28-34-3 occupational diseases that are set forth in Rhode Island General Law § 28-34-2 are treated the same way as other injuries in workers compensation court. The problem is that 28-34-3 does not list a respiratory virus such as Covid 19 as  a compensable injury. RI law 28-34-3 lists a “Disability arising from any cause connected with or arising from the peculiar characteristics of the employment” as a compensable occupational disease.

“Under Rhode Island Workers’ Compensation Law, an occupational disease is set apart of accidental injuries in that it is not expected because it is incident to a particular employment, and it is gradual in development. Accordingly, R.I. Gen. Laws § 28-34-1(3) defines the term “occupational disease” as “a disease which is due to causes and conditions which are characteristic or peculiar to a particular trade, occupation, process of employment.” Disability arising from any cause connected with or arising from the peculiar characteristics of the employment is noted in, R.I. Gen. Laws § 28-31-1(33) as a compensable occupational disease and is therefore treated as a personal injury. Moreover, disabled employees are entitled to compensation if the occupational disease is due to the nature of the employment and is contracted within that employment. See R.I. Gen. Laws § 28-34-3 and §4.” JD Supra

“Rhode Island has yet to address acute instances of contraction of infectious diseases in the workplace. The state is notable for having limited case law, not just in the realm of workers’ compensation, but we anticipate this issue may be litigated in the coming years, given the widespread nature, and great impact of COVID-19. It is arguable that for employees such as cashiers, waitstaff, or other individuals who work closely with the general public, that contraction of COVID-19 is a condition that is characteristic or peculiar to the particular trade, occupation or employment. We anticipate claimants’ attorneys will argue that the conditions of such particular employment, makes workers suspectable to communicable diseases. This is the argument we anticipate will be made to ensure contraction and perhaps even simple exposure of COVID-19 is determined a compensable injury.’ JD Supra

The insurance company may try to deny claims asserting that Covid 19 is not due to causes peculiar to certain types of employment

The workers compensation insurance defense lawyers may argue in certain types of employment that Covid 19 does not arise from a peculiar characteristic of the employment as described in §28-34-3. In other words, infection with Covid 19 does not arise out of a peculiar characteristic of being a construction worker or pizza delivery driver. Furthermore, RI workers comp defense lawyers are likely to argue that Covid 19 is not an occupational disease as described in § 28-34-1 because it it is not’a characteristic and peculiar to a trade, occupation or process of employment. It will be more difficult for the insurance defense lawyers to assert that contraction of  a disease such as Covid 19 would not arise out of the characteristics of working as a doctor, nurse, medical provider or nursing home staff. This reality may have been Beacon’s rationale for accepting accountability for workers’ comp. claims of nurses and medical providers who contacted Covid 19.

A unique and unprecedented challenge

Covid 19 infection presents a unique challenge to the workers compensation statutory scheme in Rhode Island. RI workers’ comp laws, clearly, did not and could not have anticipated a pandemic to this extent affecting the workforce in Rhode Island. The four corners of the workers compensation statute, case law and regulations are not directly referring to infections of workers caused during a pandemic of this nature and proportion.

Will lawmakers revise and update the RI workers compensation statute to provide coverage to employees?

There is a real possibility that the Rhode Island legislature amends the Rhode Island worker’s compensation to specifically include the Novel Coronavirus as a specific occupational disease that may arises out of employment and for which workers will be potentially entitled to benefits. The second issue would be whether the legislature creates a presumption for certain types of workers that Covid 19 infection ws contracted by employees during the course of their employment.

Will legislation be enacted in Rhode Island creating a presumption that a worker who tested positive for Coronavirus was infected at work?

There is a possibility of the Rhode Island Legislature enacting specific legislation to definitively create a legal presumption that all worker infections occurred at work. If the Rhode Island legislature creates a presumption, they must specifically state that it applies retroactively to Covid 19 victims. “As a general rule a statute is presumed to operate prospectively and not retrospectively, unless it appears by clear, strong language or by necessary implication that the Legislature intended to give the statute retroactive force and effect State v. Healy, 410 A. 2d 432 – RI: Supreme Court 1980,Langdeau v. Narragansett Insurance Co., 96 R.I. 276, 279, 191 A.2d 28, 30 (1963); Capobianco v. United Wire & Supply Co., 78 R.I. 309, 312, 82 A.2d 170, 172 (1951).

Fault or the failure of employers to follow safety protocol is not required

Even though an employer has good intentions, an employee could still be infected with Covid 19 at work. Despite an employer following the law and instituting proper safety protocols to protect their employees, members of their workforce can still be infected with the Novel Coronavirus. Fault and negligence of the employer is not an element of a workers’ compensation claim in Rhode Island and Providence Plantations. In other words, if an employee is injured or is infected with a virus at work, the employer is required to pay workers comp. benefits even if the employer did nothing wrong.

Workers compensation law in Rhode Island is relatively simple. If you are injured in the course of your employment, you are usually eligible for benefits. An employee is not required to show that his or her employer was negligent. An injured worker is not required to prove that negligence caused their injury.

Frontline workers- the heroes of this war

The heroes of the Covid 19 pandemic crises are now the frontline workers in Rhode Island. Frontline workers are providing essential services and goods to the public during these difficult times. The State of Rhode Island and the United States are effectively at war with an unconventional enemy, Covid 19. The frontline to this war is not soldiers. The frontline is the grocery store worker who check you out at Shaws / Stop and shop, delivery drivers and clerks at CVS providing your necessary and life-saving medications.

Essential frontline workers include: nurses, health care workers, first responders, EMT workers, medical providers, deliver drivers, physicians, store clerks, cashiers at the supermarket and other heroic workers in Rhode Island. Many employers are not providing their employees proper masks and personal protective equipment (ppe) Employees in Rhode Island face a substantial risk of exposure to the Novel Coronavirus.

Nurses and the workforce selflessly endangering their health and safety

Governor Gina Raimondo, local municipalities and the RI Department of Health have issued many safety protocols for Rhode Island employers. Thankfully, the vast majority of employers are instituting proper precautions for their employees and workers.  However, many employers are not following CDC and State of Rhode Island Department of Health Covid 19 rules and recommendations. The employees, nurses and workforce are selflessly endangering their own health and safety by doing their jobs. These workers are risking their lives to allow Rhode Island residents to get essential services such as food, medication, toiletries, health products and necessary legal services.

Insurance hardball tactics

Insurance companies are well known for their hard ball litigation strategies and tactics that involve insurance companies denying, delaying and deflecting liability and responsibility for an injured employee’s injury.

Which Rhode Island employees have workers compensation available to them?

Rhode Island law mandates very stringent workers’ compensation requirements for the vast majority of employers and companies in Rhode Island. In certain cases, municipal employees are not covered by workers compensation.

House Labor Committee Chairwoman Anastasia Williams will introduce legislation in Rhode Island

“House Labor Committee Chairwoman Anastasia Williams will introduce legislation in Rhode Island which would create a presumption for all frontline workers that their Covid 19 infections are presumed to be work related. “A veteran state lawmaker is calling on Gov. Gina Raimondo to issue an executive order requiring that all front-line workers directly affected by coronavirus will have the illness presumed to be a work-related injury…House Labor Committee Chairwoman Anastasia Williams formally made the request on Monday in an email to the governor’s office, including a draft copy of the executive order. She told WPRI 12 she will introduce legislation with the same provisions if the governor does not take action herself….Under Williams’ proposal, the front-line workers category should include public safety personnel, government workers, janitors, public transit employees, grocery staff, retail clerks, truck and freight drivers, among others. Any of those workers who contract, have symptoms of or otherwise become affected with coronavirus shall have their medical condition or incapacity to work presumed to be work-related,” the draft order says. WPRI

“These selfless workers deserve to know that if the worst should happen and they become infected with COVID-19, that we recognize their sacrifice for our greater good, and their infection and recuperation should be deemed work-related,” Williams, D-Providence, said in a statement…In addition, Williams argues that public safety employees who are “incapacitated or unable to perform their duties as a result of the COVID-19 infection or exposure” shall have the time they spend hospitalized or quarantined classified as on-duty time, rather than being required to use paid time off such as sick days or vacation.” WPRI

“State Rep. Evan Shanley, D-Warwick, said he supports Williams’ proposal…Immediate action is required to support these courageous workers by affording them the basic protections afforded to injured workers under the Rhode Island Workers Compensation Act,” Shanley said in a statement. “The least we can do is tell these workers that their medical bills and families will be taken care of in the event they contract COVID-19.” https://www.wpri.com/news/politics-government/rep-classify-covid-19-infections-as-work-related-injuries-for-front-line-employees/

Can a spouse, child or family member file a wrongful death lawsuit against the employer as a result of a Covid 19  infection at work causing a fatality?

An employee subject to workers compensation law in RI cannot file a wrongful death lawsuit against their employer.

An employee cannot file a wrongful death lawsuit against one of his co-workers who caused him to be infected.

“In all cases where an employer and employee have elected to become subject to the provisions of chapters 29 – 38 of this title, the provisions of chapter 7 of title 10 shall not apply while those chapters are in effect.” § 28-29-21. Wrongful death law inapplicable.

Workers with Coronavirus cannot sue their employer seeking pain and suffering

An employee covered under workers compensation insurance cannot file a lawsuit seeking pain and suffering and other damages against their employer in Superior Court. “The right to compensation for an injury under chapters 29 – 38 of this title, and the remedy for an injury granted by those chapters, shall be in lieu of all rights and remedies as to that injury now existing, either at common law or otherwise against an employer, or its directors, officers, agents, or employees; and those rights and remedies shall not accrue to employees entitled to compensation under those chapters while they are in effect, except as otherwise provided in §§ 28-36-10 and 28-36-15.” 28-29-20. Rights in lieu of other rights and remedies.

What types of death benefits are available in workers compensation court to compensate surviving family members, spouse and dependent children?

Sadly, many nurses (RN and LPN), doctors, medical providers, anesthesiologist and nursing home employees died as a result of exposure to patients who had Cornavirus.  Rhode Island General Law§ 28-33-12 sets forth the compensation available to family members from the employer, if a worker dies as a result of Coronavirus which occurred at work.

“(a)(1) If death results from the injury, the employer shall pay the dependents of the employee wholly dependent upon his or her earnings for support at the time of his or her injury or death, whichever is the greater in number, a weekly payment equal to the rate that would have been payable for total incapacity to the deceased employee under the provisions of § 28-33-17, except as provided in this section in case the dependent is the surviving spouse or child under the age of eighteen (18) of that employee.

(2) If the dependent is a surviving spouse, or surviving spouse upon whom there is dependent one or more children of the deceased employee including an adopted child or stepchild under the age of eighteen (18) years or over that age but physically or mentally incapacitated from earning, the employer shall pay the surviving spouse the weekly rate for total incapacity the deceased employee would have been entitled to receive under the provisions of § 28-33-17 plus forty dollars ($40.00) per week for each dependent child. § 28-33-12″Death benefits payable to dependents” Rhode Island General Law§ 28-33-12

Can the employer blame the victim for contracting Covid 19 and refuse benefits as a result?

If an occupational illness occurred at the workplace, pursuant to RI law 28-29-3, the employer cannot deny comp benefits alleging that the employee did not take proper precautions In an action to recover damages for personal injury sustained by an employee arising out of and in the course of his or her employment, connected with and referable to the employment, or for death resulting from personal injury so sustained, it shall not be a defense:

(1) That the employee was negligent;

(2) That the injury was caused by the negligence of a fellow employee;

(3) That the employee has assumed the risk of the injury. 28-29-3. Defenses abrogated as to injuries in course of employment.

Can a Coronavirus victim’s family, spouse or children file a wrongful death lawsuit against a third party for a work related death?

The victims’ survivors, spouse and family member can file a wrongful death lawsuit against third parties who are not their actual employees

In order to win a wrongful death lawsuit in Rhode Island for a work related Covid 19 infection against a third party entity, the victims’ family must prove that the third party was negligent.

The executor of the estate must retain a Rhode Island wrongful death lawyer.

Reported news stories across the United States:

“A longtime Sonoma County nurse first felt sick in March, starting with a sore throat and stuffy nose, followed by a deep fatigue. Nearly two weeks later, a confirmation: she had contracted COVID-19, the respiratory disease caused by the coronavirus. But where did she get it? At the hospital where she works? Or somewhere else in the community? For her and other health care workers on the front lines, the answers to those questions are critical. They determine whether their treatment is covered by a limited bank of paid sick days and health insurance or by workers’ compensation, an employer-funded system that offers expanded benefits ­— including lost wages, job protection guarantees and death benefits — to workers who are hurt on the job.” North Bay Business journal https://www.northbaybusinessjournal.com/industrynews/healthcare/10902138-181/sick-nurses-must-prove-coronavirus?ref=mostsection

You need to retain a top Rhode Island workers compensation lawyer to represent you in your workers’ comp claim. In the event of a death arising out of employment, contact a top Rhode Island wrongful death lawyer.

[bigyack-com]

Imran’s paradox: Legal wins, political troubles - analysis

Pakistan Prime Minister Imran Khan has warded off strong challenges from his political opposition, including a stiff one from Maulana Fazlur Rehman, who launched a march to Islamabad last month to topple the Tehreek-e-Insaf government. But, for Khan, the challenges posed by the recent judicial decisions are proving to be much bigger political headaches. First came the suspense over the extension of the Chief of the Army Staff (COAS), General Qamar Javed Bajwa’s tenure during the last week of November. General Bajwa’s three-year tenure was to end on November 28. However, a notification signed by Khan on August 19 stated that General Bajwa was “appointed for another term of three years from the date of completion of current tenure”. The decision was justified on the basis of the “regional security environment”. On November 26, a three-judge bench of the Supreme Court, headed by chief justice Asif Saeed Khosa, rejected an application to withdraw the petition, questioning the extension, declaring that it fell in “the domain of public interest”. During the hearing, Attorney General (AG) Anwar Mansoor Khan failed to explain how the PM had issued the notification when the appointing authority is the president. A presidential order described it as “extension” while the PM had mentioned “reappointment”. Further, since only 11 Cabinet members out of 25 were present when the decision was taken, how had the views of the other members been ascertained? Dismissing the AG’s defence, citing “clerical error”, the bench suspended the extension order. Law minister Farogh Naseem resigned to appear as defence lawyer for General Bajwa. The following day, questions regarding the tenure of the COAS, the terms and conditions, retirement perks and precedents could not be answered. The bench dismissed a second notification produced by the AG, declaring that it failed to meet the test of law, procedure and justifiable grounds for extension.Finally, on November 28, the court approved a third notification “appointing General Bajwa as COAS under Article 243(4)(b) of the Constitution for a period of six months with effect from 28.11.2019”. The government provided an undertaking that parliament will pass legislation to determine “tenure” and “terms and conditions of service”. The judgment has diminished the army by exposing the COAS’s untrammelled powers, as well as the ineptness of the civilian government. The second judicial decision to pose a challenge came on December 17 when a special court, headed by Peshawar High Court chief justice Waqar Ahmed Seth, convicted former COAS General Pervez Musharraf of high treason, awarding him a death sentence. The treason case pertains to the declaration of a state of emergency on November 3, 2007, following his showdown with the judiciary. After the election of a Pakistan People’s Party government in 2008, a deal was brokered for President Musharraf to step down in return for promised indemnity. The situation changed when Nawaz Sharif came to power in 2013 and charged him with treason. The trial began after the indictment on March 31, 2014.Despite being summoned repeatedly, General Musharraf never testified and left the country for medical treatment in March 2016. The then army chief, General Raheel Sharif, made it clear that the army was not going to disown one of its own, stating that “the army will preserve its own dignity and institutional pride”. After General Musharraf was declared an absconder and following the apex court’s direction, the special court moved forward with the trial. Nervous about the outcome, the government sacked the prosecution team on October 23, and got a restraining order from the Islamabad High Court to prevent the pronouncement of judgment on November 28. On December 5, a new prosecution team asked that former PM Shaukat Aziz, law minister Zahid Hamid and chief justice Abdul Hameed Dogar be included as suspects for advising General Musharraf. The special court advised prosecution to file fresh indictments against the three and proceeded to announce its verdict. Major General Asif Ghafoor, director-General, Inter Services Public Relations Pakistan, questioned how Musharraf could be named a traitor, and said that the decision “has been received with a lot of pain and anguish by the rank and file”. In the detailed judgment, Justice Seth had added that if found dead, the fugitive’s corpse “be dragged to the D-Chowk (in front of the Parliament House) and be hanged for three days”.Having won the case, Imran Khan’s government is backing off furiously from its victory. It has decided to file a case against Justice Seth before the Supreme Judicial Council. AG Mansoor has said that the government will appeal against its “victory” in the Supreme Court.For Imran Khan, who owes his elevation to the tacit backing of the army, legislating rules governing tenures of army chiefs in Pakistan is a politically charged exercise, and he would want support from Zardari and Sharif. However, having been treated harshly by the government, Zardari and Sharif may have other ideas, and use the growing tensions between Imran Khan and the army to their advantage. Both judgments strengthen civilian authority, but for Imran Khan, these are serious political headaches.Rakesh Sood is a former diplomat and currently distinguished fellow, Observer Research FoundationThe views expressed are personal Read the full article

[plancover-blog]

7 Reasons Why Your Company Needs Business Insurance

The Journal of IDCRO, a dentistry-related online magazine’s research, revealed that more than 50% of dental practitioners were not aware of the Professional Indemnity Insurance, 20% felt that it was not mandatory and 9.5% did not feel there was a need to purchase the insurance. The research concluded that there was a severe lack of awareness about this insurance despite rising cases of claims against dentists by patients.

This is just one example of a disturbing lack of awareness about the need and the importance of insurance for small businesses and individual professionals.

There are numerous ways in which insurance can help protect and cover businesses, which business owners may fail to consider. This article will detail a few of the many reasons why your company needs tailormade business insurances.

1. You want to be able to deal with uncertainties

Your assets such as the office space, vehicle, inventory are indispensable and extremely valuable to the success of your business. However, natural disasters, machinery breakdown, burglary, or lawsuits arising out of negligence, are risks that cannot be ascertained and have the potential to cripple your business. Hence, it only makes sense to protect these precious assets.  

Thus it’s essential for any company to have business insurance that can cover these losses. Large corporations can face lawsuits running into millions. SMEs might not be able to sustain the crushing financial losses that arise in fighting out legal battles or out-of-court settlements. Individual professionals and consultants, too, could face the risk of legal suits. Thus, opting for suitable business insurance, that serves as an umbrella to cover all kinds of company assets, is a wise decision for every kind of business.

In a nutshell, it would be okay to say that risks and dangers are always growing. Global warming has made natural calamities a more frequent occurrence. Your office premises may be physically protected but your business data faces the risk of cyber attacks What would happen if your customers file a lawsuit against you for losing their personal data to a cyber attack?, Would you have the financial resources to help your business stay afloat in such a scenario? This is where business insurance can help you live another day.

2. You want to get all aspects of your business covered

Every business is made of various components – employees, electronic assets, raw material, inventory, vendors, customers, third parties, and more. Events and happenings may affect any or all aspects of the business. This brings us to business insurance. Insurance cannot reduce the incidents of risk but it can be a financial tool to protect against expenses and losses.

The kind of insurance a business may need depends on the industry it operates in and the nature of the business. For example, a fintech company would require Cyber Risk Liability Insurance, whereas an SME that is into manufacturing clothes may not need it, if none of its business activities are online. Commercial General Liability, Professional Indemnity Insurance, and Directors & Officers Liability Insurance are among the most prevalent insurance plans in India and cover a whole range of business liabilities.

Business owners need to give a deep thought as to which are the areas of their business that require the purchase of business insurance plans. From the office building to equipment to inventory to business reputation – when one plans an insurance portfolio, there are many complex decisions and components to be considered.

3. You want to ensure your business is up and running after a loss

A bustling café had to shut down due to an outbreak of a disease caused by the eggs that were being served in the café. However, Business Interruption Insurance covered all their losses and expenses – staff salaries, vendor payments, and losses.  

Businesses are akin to a pack of cards. Building a business involves a lot of effort, time and monetary investments but the slightest error or negligence can bring the whole edifice crashing down. And if you don’t have the right insurance policies to protect you, you could be in for a severe heartache. Most businesses collapse in the event of not having insurances policies at the time of unexpected distress.

4. You want to protect yourself and others, too

Apart from protecting yourself, it is important for you, as a business owner, to have insurances that protect the key stakeholders – customers, employees, vendors, and investors, among others. One of the most important insurances for a business is the Commercial General Liability Insurance (CGL) that protects enterprises. It covers major claims that any business may face:

Bodily injury and property damage

Personal and advertising injury

Medical expense payment

Moreover, there is a difference between the liabilities of the business and its owners. A business has limited liabilities, whereas the business owners or directors have additional liabilities.

5. You want to enhance business credibility, attract talented employees

Employees are an asset for a business. A business also has liabilities towards its employees. Employers may have to face losses and expenses related to employees. A legal case filed against the employer by the employee on the grounds of discrimination, an employee getting injured in the course of performing a business activity or an employee being sued by a third party. These are some of the ways in which a business is liable to its employees’ protection in times of risks.

Group Health Insurance, Workers Compensation, Professional Indemnity and Directors & Officers Liability Insurance are some of the most prevalent types of insurances that businesses should purchase to protect their employees.

Here’s an example: Company X was on the lookout for a new CEO. Most candidates that were pursued declined the offer on the grounds that the company did not have a Directors & Owners Liability Insurance policy. It’s possible. Insurances improve recruitment opportunities for director-level roles and also promote higher retention. Some industries could be more vulnerable to legal risks towards its directors. Thus these types of insurances are essential for companies to procure in order to recruit and retain strong leaders, directors and decision makers.

6. You want to expand your business

As a business grows, so does its needs. Having a strong and comprehensive business insurance portfolio can help the owners and directors take important decisions while not having to worry too much about the personal and business legal ramifications. Expanding business requires confidence. Insurances provide a fair bit of confidence.

In the current landscape of startups and entrepreneurial initiatives, business owners  have an increasing urge to expand their footprint across the country, and in some cases, globally. International markets bring with them, new risks, challenges, new rules and regulations, which if not followed to the tee, might leave businesses vulnerable to legal risks. Certain sectors such as IT, knowledge-based sectors, outsource-related industries, and individual consultants such as doctors, architects, brokers, and business consultants, among others, should definitely have insurances in place to be able to expand their business to new shores.

7. You want to improve your business credibility

Insurance policies could help in improving business credibility and reputation, and instill trust in customers and new partners. Companies that face legal charges could face a lot of problems such as interruption in daily business activity, loss of productivity or low morale of employees, among others. Having the right business insurance policies would ease the company’s stress and burden, allowing it to function smoothly.

Having the right kind of business insurance policies could also help in creating confidence and trust in customers, in turn, leading to higher revenue. For companies that aspire to expand its business in the foreign markets, having business insurance can ensure it is prepared for new kinds of risks, rules and regulations. Having business insurance would instill confidence in new partners and collaborations, especially when expanding to new geographies and markets. Those companies that aspire to expand their business should seek guidance from professional insurance companies that can offer the right insurance solutions.

To sum it up

Business insurance can leave you confused, with the many factors that need to be understood before making a decision. This is why it is important to get business insurance advice from competent insurance companies who can aid you.

PlanCover can address your concerns and queries with unbiased solutions that would benefit your business. Moreover, PlanCover’s approach of transparency at every stage of the policy’s life cycle ensures that you know what’s happening with your policy. For more details visit our website.

[pharm-studies-blog]

Study Guide

4 MCO (MANAGED CARE ORGANIZATION)

HMO (Health Maintenance Organization): Started out as closed systems; SELF MAINTAIN

Restricted: Patient couldn’t go outside the network or they have to pay out of pocket

Employers tend to prefer HMO: premiums + managed care costs are lower

As a result, it became the dominant form of MCO

Staff HMO: Owned by HMO in business

IPA (Individual Practice Association): Physician practices that come together and form an association that’s contracted with HMO

As a result of losing market shares to PPOS, MCO implemented the

POS (Point of Service): Allows you to have coverage when you need it, you pay it when you get it (Similar to PPO)

Requires referral

There was a drop in consumers in 2003-2005 because Medicare Part D came out

BUT If you have large amount of drugs, it’s cheaper to be in MA than part D

PPO (Preferred Provider Organization): consists of physicians, hospitals, labs that voluntarily come together to create their own managed care system

Open: Patient could go outside of network but just paying a little more but NOT out of pocket

If you stay within the network, you pay little to nothing

Don’t need referral

ABSOLUTELY CANNOT join Medicare part D

Private Fee for Service Plan (PFFs): Like old indemnity insurances where plan contracts health care providers and figure out how much they will contribute

NOT RESTRICTED

Doctors may refuse care, they do have network but all plans are different

Don’t need referral

Medicare Special Needs Plan (SNP): designed for particular disease groups

May NOT cover everything and it’s unique to ONLY THAT disease

Requires referral

GOVERNMENT PROGRAMS

MediCARE: healthcare funded by federal government for 65+/renal disease/disabled (Earned)

Consists of: Plan A, B, C (Managed Care/Medicare Advantage), D covering social services, medications, medical supplies, transportation to hospital

You must wait until you’re in the U.S. 5 years before you sign up for the application regardless age!

Part A (GOV PAYER/ UNIFORM/FLEXIBLE): Hospital care (Sitting in the ER is NOT hospital; inpatient HOSPITAL CARE

Missing enrollment period isn’t a big deal but if you don’t pay 40 quarters, you double the amount to pay

Can’t terminate unless you LOSE SS OR DIE

You get this AFTER you pay your 40 quarters but no copay, co-insurance

NO PREMIUM but DEDUCTIBLE if in hospital (worth 3-4 days)

Deductible Per Benefit Period: Benefit Period is how frequently the patient goes in and out of the hospital, if it’s within 60 days, it’s within the same benefit period

Life time reserve day: 60 days to cover your expensive (NOT RENEWABLE)

There are certain types of services attached per disease and not everyone can quality for PT/OT unless the doctor justifies

Nursing home admission: 3 requirements (day 21 no copay, 21-100 pay, 100+ out of pocket)

Have Part A coverage and days left

Admitted for at least 3 days in the hospital

Decided that you need daily care

Skilled nursing homes have earlier but smaller copays that lasts longer

Part B (GOV PAYER/UNIFORM/SICKNESS MODEL/FLEXIBLE):   Voluntary: Covers medical services and lab tests + equipment

Missing enrollment period IS A BIG DEAL b/c for every 12 month you’re out of the plan, you pay a 10% penalty forever unless you have CREDIBLE COVERAGE

Can terminate but have consequences and if you’re late for paying

You can’t sign up for part B UNLESS YOU HAVE part A

Must be a U.S. resident (Domestic residence issue) that’s lawfully admitted to the U.S.

ACA requires: preventative services (“Welcome to Medicare” free screening NOW FREE)

Flu + pneumonia immunizations are covered

Monthly premium comes from SS

Under Original Medicare plan, there is ALWAYS a 20% (co-pay, co-insurance) for the patient

Part C (Medicare Advantage INSURANCE PLANS WELLNESS MODEL/ restricted):

MUST HAVE A + B in order to apply for C

Get more coverage but more restricted TRADE OFF

Part D (INSURANCE PLANS/restricted): allowed consumers to stay in original Medicare plan and get drug plan (Managed care didn’t allow that)

Starts in JAN; NO set premium varying from plan to plan

When implemented, the numbers were very underestimated

Not every plan is the same and not every drug is covered

Used the star system and had the DONUT HOLE

Government sets a basis for each plan + classes of drug

Will only cover for people in the U.S. (Exception: IN TRANSIT: If you’re on your way to the U.S. and you’re sick, they will cover it)

Medicare card is connected to SS, violates their own rules for SS, no picture!

Usually pay nothing for Medicare approved services but 20% of most other medical services

PAYS FOR

Hospice care: Will NOT pay for treatments, out patient treatment, ambulance, room and board, 0 copay for hospice care and max $5 for drugs

Home health services: Covered in some part of B + A (24 hr care and home made services)

Custodial care (sleep, eat bathe): NOT covered

Private rooms: NOT covered unless necessary such as contagious disease

Clinical trials: May be covered

Mental health: Started to get covered (wasn’t covered before)

MediCAID (WELLNESS): funded by state + federal government for the poor (income too low) Give

There is a state and local component (Albany have different plans from that of NYC)

Locally: Can make Medicaid managed care mandatory and can only offer one insurance plan to choose from (LEGAL)

Not really a problem in NYC b/c 1 million people under Medicaid

Family could be all PEOPLE LIVING IN SAME ROOF

States can ask federal government to increase income so more people can qualify for Medicaid SUCH AS 150 + 200% increase

Based on MONTHLY basis of NET INCOME, MEDICAID INCOME, RESOURCE INCOME

Pregnant: 154% poverty level up to 1 year, 223% if pregnant again while baby is within 1y/o

Number in family for 1: ALWAYS higher because first person usually cover expenses for everybody but not enough to need TWICE as much for the next person

HEALTH CARE YELP

NCQA (National Committee on Quality Assurance): Founded to compare the quality of managed care plans that stand outside and have no connection with outside industry

Gathers outcomes research and provide database of HEDIS (Health plan employer data information set) now stands for Health care effectiveness data information plan

They ask a series of questions on each domain (same) to employers + patients on surveys

Medicare + Medicaid: must have to report HEDIS data!

Star system: for Medicare part D

Cut off is 3 stars of 3 year response, if quality is low, gov. notifies you/ window is cases by case

CHIP

CHILD HEALTH PLUS 1998: NY’s version of CHIP; ALL came from STATE taxes

For children whose parents make too much $$ to qualify for Medicaid

HEALTHNY: For employers of smaller businesses

BIGGER THE GROUP, SMALLER THE PREMIUM

Typically no premium unless the parents made more money but premim don’t go above 3

**CANNOT DOUBLE DIP, you either get MEDICAID OR SCHIP, NOT BOTH**

·       2008: SCHIP was not reauthorized but NY kept it running