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April 2011 Archives

Proposed legislation to help at fault drivers: Billed vs. Paid

As the tort reform debate continues in the North Carolina Legislature, one of the most controversial and seemingly difficult to understand issues for legislators is the concept of bill vs paid. What that involves is a push by the major automobile insurance companies to not allow a hurt person to put on evidence of ALL of their medical expenses if they have some additional way to pay the same or if they would not all have to be paid back. One easy example is when a state employee is injured in a car collision and goes to the emergency room and to their primary physician for several visits they have "incurred" $2,500.00 in medical expenses. Under bill vs. paid, the amount the State Health plan has negotiated as a reduction with the hospital and the other providers in exchange for the provider getting paid by the health plan would come out of the amount. Of the $2,500.00 20% would be "paid" or owed by the state employee as a deductible and 80% would be the responsibility of the state health plan. Due to the amount of bills that are paid by the state health play the plan may only have to pay 50% of the 80% to satisfy that debt in full. Under bill vs. paid the state worker would not be able to present the 30% reduction to the jury as an incurred medical expense as it would not be actually "owed", the state worker would STILL have to pay the state health plan back out of any recovery the 50% they "paid" for the medicals. Who benefits from the billed vs. paid option? Doesn't it make sense not to pay for what is not actually "owed"? In reality the only one who benefits is the at fault party and their insurance company. The not at fault party - the victim--gives to the defendant (the one who caused the problem in the first place) their benefit in having purchased insurance or had a good enough job to purchase insurance in exchange for nothing... The drunk that ran head on into the family of four on the way home from the circus gets the benefit of the parents having good jobs? Who of the two of them should get that benefit? If there is no health insurance then the bill is owed in full. Why is a system that rewards those who are at fault good for us? The short answer is that it is not good for the victim and quite frankly the only benefit is for the insurance company who represents the drunk driver and whose identity in North Carolina is never mentioned during trial. Yes, that is correct, if the defendant drunk driver has auto insurance who will pay his bill, it is illegal to mention that during a trial, but the fact that the injured person is hard working and has purchased their own insurance is admissible...

Serious Injury? Need NC Social Security, Workers' Compensation and Auto Accident lawyer?

Serious Injury? Need NC Social Security, Workers' Compensation and Auto Accident lawyer?

Changes to workers' compensation: Should an employer have contact with you doctors?

Having represented 100's of injured workers over the years, this years debate over workers' compensation in the North Carolina Legislature is painful. The number one thing to remember our injured workers is that they were by definition, workers.  Although they are being portrayed in the media and by Chamber of Commerce groups as slackers who are out for a handout, I cannot remember a single client that would have traded their good paying job for an injury and only 66% of their pay.  Add to that burden that these injured workers were on the job, doing what they were paid to do when something happened causing them to become injured, and now they are thrown into a system where they are told, that regardless of their pain level, you must be here or there to see a doctor of the employers choosing as often as the employer wants you to go and must then constantly have to worry whether your pay will be on time or just within the 15 day "window" for paying late each week allowed in the system and you have a no brainer --- don't get hurt here in North Carolina. Allowing the insurance companies who handle workers' compensation, whose adjusters are mostly overworked, underpaid and have a huge burnout and turn over level, to determine which physicians you can see with no recourse (what is currently being proposed) is almost as bad as allowing the inmates to run the prison... it may be easier, but it will be painful to someone.  The group who will be hurt by allowing the insurance companies to determine, contact directly and then and only then authorize treatment will be the workers of North Carolina - all in the name of attracting business.  Lets face it, if being allowed to ignore injured workers, or truly torture them (what the true result will be of this proposed legislation) is the cost of bringing in additional business, perhaps we should reevaluate our priorities.  Honestly, North Carolina has been consistently ranked as one of the top 5 states for emerging business and the proposed changes will NOT increase that ranking, will NOT reduce insurance premiums for North Carolina businesses, but will only HELP OUT OF STATE INSURANCE COMPANIES. Why then are our legislators fighting so hard for these out of state insurance companies?  Money, pure and simple is the root cause of this legislation.  The newly elected legislators took huge campaign contributions from out of state insurance companies and now owe them political capital.  Unfortunately this capital should not be the lives of our injured workers.  We have statutes in place that protect this contact.  Don't let our legislators throw away citizens rights for political capital.

Is the practice of Law more of a Business or Profession?

I read The New England Journal of Medicine, strange I know until you consider that 98% of my law firm's business involves medical-legal related issues. I have noticed a trend in which the largest read periodical for physicians and medical related workers has been debating a subject without actually naming the issue - whether they are a profession in which money is a by product or more of a business where the bottom line and thus cost benefit analysis must take over. These same articles are included along with articles on the cost/benefit of the new health care provisions and test cases on whether they will work. Essentially, whether increasing the number of people on insurance is worth the side problem of dealing with insurance companies for reduced prices. Let's face it, the business of medicine is just that, a highly complicated and ruthless business where if your not careful as an orthopedic surgeon or some other specialist, you become the employee of whatever major insurance company controls your state or area. Lawyers have long had this same issue, but we name it very succinctly although, much like other learned professions, we are not always sure how to handle whether as a professional we take a limited number of pro bono (for no fee) cases or whether we simply cannot afford to spend the time (really as attorneys all we have is our time and expertise to "sell").   My firm's mentor was always of the opinion that a gut check on most cases you were not sure whether to take would always tell you what to do... Not very scientific and hard to put on a balance sheet, but sometimes your professionalism requires that you spend your time on a case where little fee is expected or as with my law partner, sometimes you take the free Medicaid appeal because the client simply cannot afford for you not to help. Physicians cite as examples of their generosity the number of people they treat without insurance, as attorneys we are reluctant to plug ourselves for the number of "free" work we have performed as quite frankly we're afraid it may result in that service being required.  Most of the attorneys I associate with who handle medical-legal related issues give 1000's of dollars per week in free advice and free consultations... Perhaps the public will eventually realize that in the same light as physicians unbilled services.  One day you may even see a sign outside of a physicians' office that says - free consultations.

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