Articles Posted in Public Benefits

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Felton, then employed by Hewlett-Packard, sustained a minor injury to his knee while volunteering on a Douglas County search and rescue team. Felton sought insurance benefits from Douglas County and its workers' compensation insurance carrier. The third-party claims adjustor, ASC, notified Felton that it had calculated his average monthly wage (AMW) for the purpose of determining the amount of benefits based upon the statutorily deemed wage of a search and rescue volunteer as set forth in NRS 616A.157, which is $2,000 per month. ASC awarded Felton a one-percent permanent partial disability (PPD) or whole person impairment (WPI). A hearing officer affirmed the award. Felton appealed only the determination that his AMW should be set at the statutorily deemed wage of a search and rescue volunteer. The appeals officer affirmed, holding that Felton was not entitled to an AMW that aggregated his statutorily deemed wage and his earned wage from his private employment. The Nevada Supreme Court reversed. The plain language of the statutes and regulations requires the aggregation of concurrently earned wages. View "Felton v. Douglas County" on Justia Law

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Plaintiff was a Medicare beneficiary who received his Medicare benefits through a plan offered by Respondents, health insurance businesses that specialize in health maintenance and/or managed care and are engaged in the joint venture of providing insurance. As a result of his treatment at a clinic, which was a contracted provider for Respondents, Plaintiff became infected with hepatitis C. Plaintiff subsequently sued Respondents alleging negligence in selecting their health care providers. The district court dismissed the complaint, concluding that Plaintiff’s claim was preempted by the federal Medicare Act. The Supreme Court affirmed, holding that state common law negligence claims regarding the retention and investigation of contracted Medicare providers are expressly preempted by the Medicare Act. View "Morrison v. Health Plan of Nev., Inc." on Justia Law

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From 2007 to 2008, Dorothy Rogers received Medicare benefits through Pacificare's federally-approved Medicare Advantage Plan, Secure Horizons. Rogers and Pacificare entered into separate contracts each year providing the terms and conditions of coverage. After receiving treatment from the Endoscopy Center of Southern Nevada (ECSN), a facility approved by Pacificare for use by its Secure Horizons plan members, Rogers tested positive for hepatitis C. Rogers sued Pacificare, alleging that Pacificare should be held responsible for her injuries because it failed to adopt and implement an appropriate quality assurance program. Pacificare moved to dismiss her claims and compel arbitration based on a provision in the parties' 2007 contract. The district court determined that the 2007 contract governed, but held that the arbitration provision was unconscionable and, thus, unenforceable. The Supreme Court reversed, holding (1) because the parties in this case did not expressly rescind the arbitration provision at issue, the provision survived the 2007 contract's expiration and was properly invoked; and (2) as the Medicare Act expressly preempts any state laws or regulations with respect to the Medicare plan at issue in this case, Nevada's unconscionability doctrine was preempted to the extent that it would regulate federally-approved Medicare plans. View "Pacificare of Nevada v. Rogers" on Justia Law