O'Malley Tunstall PLLC
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Offices in Raleigh, North Carolina, and Eastern North Carolina

April 2012 Archives

PI: Injured and now my Hospital wants to sue me rather than take my health insurance.

Often people first call our office out of concern over payment for large medical expenses as a result of an automobile collision that was not their fault.  The law in North Carolina after the passage of HB542 and SB 586 has changed and only a portion of any bill, that amount that is neccessary to satisfy a medical bill, is admissible to prove evidence of medical expenses. Rule 414 Evidence of medical expenses. Evidence offered to prove past medical expenses shall be limited to evidence of the amounts actually paid to satisfy the bills that have been satisfied, regardless of the source of payment, and evidence of the amounts actually necessary to satisfy the bills that have been incurred but not yet satisfied. In the real world, many clients debate whether or not to use their health insurance to pay their medical bills after an injury.  They don't want to use the insurance because it was not their fault, they are afraid of higher premiums and don't want to have the hassle of filing the insurance.  Often, many hospitals take that decision away from the patient by refusing to bill the health insurance regardless of whether the patient would like it billed or whether the patient has already paid for health insurance that should pay the bill. Many insurance companies, such as Medicare, are secondary payors.  That means they pay only if no one else pays.  However, even Medicare states that when a bill is left over 120 days it shall become primary and pay.  In these situations, insurance such as Medicare of the State Health Plan is entitled to obtain reimbursement for all the bills paid by them by the third party at the end of the case. Regardless of the reimbursement provisions (called subrogation) many hosptials take the decision away from the injured party and refuse to bill the person's health insurance hoping for a greater recovery from the at fault party in the collision.  However, the hospital doesn't take the risk of the patient recovering the amount from the at fault person's insurance, instead they often make claims against and sue the patient for the unpaid bill, even though they could have accepted the insurance. The Charlotte Observer has recently written a series of articles on these not-for-profit hospitals suing uninsured persons for their unpaid medical expenses.  Articles.  Another article by the Charlotte Observer even references a veteran with tri-care insurance whom they sued because they could not properly bill the insurance.  Article 2.  In another article Duke University failed to properly code an insurance bill and hired a collection agency to hound and call repediatly a couple who had proper insurance.  Article 3. Forbes Magazine has chosen to call this the Tort-Reform for Hospitals.  In their article they describe that not-for-profit hospitals are obtaining significant benefit from directly suing their patients rather than working with the insurance companies or using low paying health insurance such as Medicaid. Our clients, and many other persons injured through no fault of their own  should worry.  Just because you have been financially stable and smart, it will not prevent  

O'Malley Tunstall, PLLC: Gold Sponsors of the American Cancer Society's 16th Annual Edgecombe County Relay For Life Event

O'Malley Tunstall, PLLC is a  Gold Sponsor of the American Cancer Society's 16th Annual Relay For Life Event in Edgecombe County  to be held on May 4th and 5th, 2012 at the Tarboro High School football stadium. Relay For Life provides vital funding for the American Cancer Society to fund support for cancer survivors and their caregivers, education and awareness about the causes and effects of cancer, funding for scholarships, and funding for research programs. Last year's Relay For Life event raised $203,000 and the goal for this year is $216,500.00.   This is a great event and needs all of our support to reach their goal. This year O'Malley Tunstall, PLLC will be sponsoring the luminaries that will be on the visitor side bleachers that spell RELAY FOR LIFE at the Friday night luminary ceremony starting at 10pm. If you are interested in supporting, click Edgecombe County Relay For Life: or for MORE INFORMATION Join us in the fight Against Cancer!!

Automobile Injury in North Carolina: Types of Automobile Insurance

Most people are aware there is a requirement that to have an automobile in North Carolina you must carry at least minimum liability limits. The North Carolina Liability Insurance Requirements for Private Passenger Vehicles requires to meet the required minimum limits coverage that you must have at least the following amount of insurance protection: $30,000 of coverage for injuries or death involving one person in a single accident. $60,000 of coverage for injuries or deaths involving two or more people in a single accident. $25,000 of property damage coverage. This minimum liability coverage comes into play when you are the at fault driver in a motor vehicle collision in which there is bodily injury or property damage. With medical bills for a simple Emergency Room in the range of $1,500 to over $2,000.00 on average depending on the condition the $30,000.00 limit an be quickly exhausted. Many people also carry medical payment coverage. Medical payment coverage (med pay) is no fault insurance covering the owners or passengers in a vehicle regardless of fault reimbursing medical expenses and lost wages. It is often some of the cheapest and most useful insurance coverage and can be typically sold in amounts from $500.00 to $25,000.00. Higher amounts are sold by some companies. Joe Tunstall describes automobile insurance from an attorneys prospective. In North Carolina drivers and owners of vehicles are also required to carry uninsured motorist coverage. N.C.G.S. 20-279. Uninsured motorist coverage provides insurance when the at fault driver is driving a motor vehicle without current liability insurance. The limits for uninsured motorist coverage range from North Carolina minimum limits of $30,000.00 per person to $1million. Of course the price is dependent upon amount of coverage purchased. In case of a serious injury where the other person carries some amount less than the amount to reimburse for the damages, you can purchase underinsured motorist coverage. N.C.G.S. 20-279.21(b)(4). Underinsured motorist coverage is typically some amount between $50,000.00 and $1 million in coverage. Undersinsured motorist coverage is paid when the injury is greater than the amount of the defendants liability coverage and you have purchased an amount of coverage greater than the defendant's insurance coverage.  

How do I know if my back injury at work is a North Carolina workers' compensation claim?

Often our office receives calls from workers who are trying to determine if their hurt back is a workers' compensation claim.  Some are obvious, such as being in a car accident and having immediate back pain.  Many however are far less obvious.  An injury is compensable when the injury is by accident arising out of and in the course of the employment N.C.G.S. 97-2(6) (1991). However, in order to establish a compensable (related and payable under North Carolina Workers' Compensation) injury to the back, plaintiff must prove that the disabling back injury arose out of and in the course of the employment and was the direct result of either an accident or a specific traumatic incident of the work assigned. N.C. Gen. Stat. §97-2(6); Richards v. Town of Valdese, 92 N.C. App. 222, 224, 374 S.E.2d 116, 118 (1988). disc. review denied, 324 N.C. 337, 378 S.E.2d 799 (1989). Under the specific traumatic incident theory, plaintiff is not required to prove that the injury arose from an unusual occurrence or departure from ordinary duties. Fish v. Steelcase, inc., 116 N.C. App. 703, 707,449 S.E.2d 233, 237 (1994), cert. denied, 339 N.C. 737,454 S.E.2d 650 (1995).  Furthem10re, our courts have held that an injury is compensable if it is caused by an accident that arises out of employment. materially accelerates or aggravates a pre-existing condition. and proximately contributes to disability. N.C. Gen. Stat. ~97-2(6). Often clients call us after picking up something heavy or awkward at work and having immediate pain afterwards.  Clients also have compensable back injuries from turning landing gear on large trucks or twisting to put down something heavy.  In workers' compensation in North Carolina the compensable nature of an injury often turns on the smallest and least obvious facts such as how the doctor records your injury at the first visit or whom at work you report your injury. If you have any questions about the compensable nature of an injury give our office a call to discuss.

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