Longshore book is in final edits.

I am pleased to report that the Longshore book is in the hands of the publisher . . . I’ll be working with my editor to complete the final revisions over the next few weeks. A big thank you to Matthew P. O’Malley, editor extraordinaire.

From the Table of Contents:

Introduction 1
Who is a Longshoreman? 1
Who else qualifies for benefits under the LHWCA? 2
Who is specifically excluded from benefits under the LHWCA? 2
What benefits are available under the LHWCA? 3
About this Book 4
Citations and common usage. 5
Staying up-to-date! 5
Chapter 1: Initial Reporting 7
Overview 7
Forms & Procedure – Controverting claims. 8
Appeal. 9
DLHWC Forms 9
Notice in specific accident cases. 9
Giving the report of loss. 11
Notice as a defense. 11
Chapter 2: Jurisdiction 13
How is jurisdiction established under the LHWCA? 13
Time for Filing 13
Statute of Limitations in Traumatic injuries 13
Statute of Limitations in Occupationals 13
“Status” and “situs.” 14
Status. 14
Situs. 15
“Over water” 15
“Over land” 15
LHWCA v. Jones Act (The Merchant Marine Act, 1920) 16
Jurisdiction expanded under the Defense Base Act. 18
Exclusions to jurisdiction of the LHWCA. 18
Chapter 3: Employment 21
Who is an employee for LHWCA? 21
Agency 21
Right to control test. 22
Relative nature of the work test. 22
Volunteers. 23
Owners and corporate officers. 23
Chapter 4: Arising out of . . . 25
Defining “arising out of the employment . . .” 26
Assaults at work. 26
Punch-In, Punch-Out Claims 27
Personal Mission 28
Aggravation of prior conditions. 29
…In the course of employment. 29
Coming and Going Rule 30
Travel time exception 30
Parking Lots 31
Zone of Special Danger 31
Chapter 5: Defenses 33
Jurisdiction 33
Specific Exclusions 33
The Statute of Limitations 34
Waiver 34
Notice & Prejudice 34
Intentional Injuries 36
Suicide or self-harm. 36
Intent to harm another. 36
Intoxication. 36
Chapter 6: Medical Benefits 39
Exceptions to the claimant’s choice of physician 41
Emergencies 41
Changing doctors 41
Requesting treatment. 42
Judicial review of medical treatment 43
Independent Medical Examinations 45
The IME Process 46
If the claimant refuses to attend an IME 46
Chapter 7: Indemnity benefits 49
Waiting Period 49
Temporary Total Disability. 49
Temporary Partial Disability. 50
Death Benefits 50
Survived only by spouse. 51
Survived by spouse and children. 51
Survived by just children. 51
No spouse or children. 51
The special case of aliens. 52
Permanent Total Disability. 52
Permanent Partial Disability. 53
Scheduled loss of use – enumerated body parts. 53
Unscheduled disability. 54
What happens when a claimant dies while receiving permanent partial benefits? 55
What if the employer/carrier fails to pay benefits in a timely fashion? 56
Chapter 8: Wages and Rates 57
Defining Wages. 57
Calculating Wages. 58
Wages in Traumatics versus Occupationals 59
Traumatic Cases 59
Occupationals 60
Rates. 60
Chapter 9: Traumatic Injuries 63
Benefits 63
Medical 63
Permanent Partial Disability 63
Total Disability 64
Chapter 10: Occupational claims 65
Burden of proof in establishing a compensable occupational disease 65
“Last on the Risk” doctrine. 66
Chapter 11: Trial, Settlement & Dismissal 69
Trial 69
Evidence at Trial 69
Use of videotape surveillance at trial 70
Medical testimony 71
Witness credibility 71
Settlements 71
Approval. 73
Timing 73
Contents of a settlement agreement. 74
Withdrawal of claims 75
Time to Appeal 76
First Appeal – Benefits Review Board 76
Next – the Court of Appeals. 77
Enforcement of Orders. 78
Chapter 12: Defense Base Act 79
Jurisdiction 79
Arising out of the Course of Employment and the “Zone of Special Danger” 80
Filing Procedures 81
Region II — New York 81
Region IX — San Francisco 81
Chapter 13: Medicare Secondary Payer Act 83
Background 83
The Problem with Settlements 85
Pre-approval 85
Set-Asides 86
Failure to Obtain Approval for Section 20 Settlement 87
Conditional payments. 88
Just what does it mean to be “Medicare Eligible”? 89
What is a “Reasonable Expectation” for entitlement to Medicare? 90
Need for set-aside. 91
Best Practices for obtaining a Set Aside 91
The New Forms (Sept 2009). 91
FAQs 92
Chapter 14: HIPAA 97
A (very) Brief look at Title I: Portability and ‘Look Back’ 97
This topic in brief: “The Privacy Rule” 101
Effects on research 102
Effects on clinical care 103
Costs of Implementation 104
Effect on privacy 104
The Privacy Rule – What You Can Disclose and What You Must disclose 105
Dates & Deadlines 105
Notification & Enforcement 106
So, Who Is a ‘Covered Entity’? 106
Health Plans. 107
Health Care Providers. 107
Health Care Clearinghouses. 108
Business Associates 109
So, What is Covered? (What “PHI” do I have to watch out for?) 109
De-Identified Health Information. 110
When you CAN disclose PHI. 111
When you MUST disclose PHI. 113
In a Nutshell: The Privacy Rule “for Dummies” 113
Rules for Carriers 113
The “Enforcement Rule” or “Why Do We care?” 114
Civil Money Penalties. 114
Criminal Penalties. 115
But, do we care? 115
For Claims Adjusters: Applying the Privacy Rule to Workers’ Comp Claims 115
Other Types of Claims (non-workers’ comp) 117
For Carriers and their ‘Business Associates’ 118
Chapter 15: The Longshore and Harbor Workers’ Compensation Act. 119
About Tompkins McGuire 209
NAWW & Rates Chart 211
2000-2011 Information 211
About the Author 212

Greg Lois is the managing partner of LOIS LLC, a 19-attorney law firm dedicated to defending employers and carriers in New York and New Jersey workers' compensation claims. Greg is the author of a popular series of "Handbooks" on workers' compensation, and is the co-author of the 2016 Lexis-Nexis New Jersey Workers' Compensation Practice Guide. Greg can be reached at 201-880-7213 or glois@lois-llc.com