Challenges to PIP Payments

We have noticed an increasing number of challenges to personal injury protection (PIP) payments by use of mere medical records reviewing companies. These companies are sometimes based in Arizona, Las Vegas, Florida or other places. They often hire individuals who purport to be DC’s or MD’s who, for a price, supposedly review the records produced by the treating DC and then write a report. The report usually determines that the volume of care is insufficiently documented and/or was unnecessary due to improper or insufficient diagnostic coding. Often, the reviewing agency will also suggest that the prices for the individually CPT-coded treatment modalities exceeds the “usual and customary” rate for such services. Many times we have seen no reference to the Relative Value Study in such a conc…

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Utah health insurers post healthy profits

The recession was short-lived for Utah’s health insurance companies.
Despite halting economic recovery, all but one of the state’s five largest insurers posted robust profits last year.
Some paid fewer medical claims than they expected due to cost-conscious patients delaying or forgoing medical care. Others captured new customers. All benefitted from a rebounding stock market and higher returns on investments.
Yet the companies — including the nonprofits SelectHealth and Regence BlueCross BlueShield, Utah’s two largest insurers — continue to hike premiums while sitting on large reserves.
They defend double-digit increases in rates that they charge as a means to prepare for the unknowns of federal health reform and the likelihood that people will spend more on health care when family fi…

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Slip and Fall Injuries

Larson Law represents clients in slip and fall injuries.
However, these cases are difficult to bring in Utah. Some people believe that all that is necessary for someone to have a lawsuit is for an injury to occur on someone else’s premises. That is not true! Utah law explains that a victim of a slip-and-fall event can recover only with one of three options:

First, the business, homeowner or landlord has a permanently unsafe condition due to having chosen a mode of operation that foreseeably could result in an inherently dangerous condition, or if the premises violate some aspect of the building code that directly led to the unsafe condition.

Second, if there is a temporary unsafe condition created by a business, one of its employees, a homeowner or landlord. Even if the creators did…

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Successful Surgery and Healing

Check out http://www.lorimertz.com/ for the wonderful new book “Successful Surgery and Healing”. Lori Mertz has written an incredible book with amazing ideas for successfully getting through surgeries and the healing process. It is a practical guide for patients, caregivers, and advocates. You can go to the website for a copy or contact us for a special discounted copy. Her website also has great tools for patients, which you should definitely check out.

Lori Mertz

 

 

 

 

 

 

 

 

Successful Surgery and Healing is your definitive guide, no matter where you are in the surgical process – beginning, middle or end. There is information here to help you! Simple, direct, easy to understand and follow.

The ideas, checklists, templates and worksheets are intended to aid and support anyone preparing for or recovering from surgery. The information is also applicable for anyone taking on a supportive, caregiving or advocacy role such as a spouse, partner, family member, relative or friend.

Is it Soup Yet?

In handling the numerous cases we currently have, we make every effort to try to get your patient’s case resolved as soon as practical. It’s important to remember that you, the treating physician, and we, the law firm, are in this together since neither one of us can get compensated (once PIP is exhausted) until the matter is settled or resolved through mediation, arbitration, or trial.

In the usual case, there are a number of “moving pieces” to consider. The most important factor that causes a delay in resolving a case is the length of time it takes the patient to get to the point of resolution of his injuries so that we can be able to effectively evaluate his case. We only get one resolution, and we have to make sure that the settlement is for an appropriate amount, given the best knowledge available as to the extent of your patient’s injuries. Many times new injuries or complications develop or crop up during the course of treatment that are not initially known. In many instances, a case that begins as what appears to be a non-surgical case ends up with our client requiring surgery causing additional frustrating complications or recovery time needed for the surgery.

Although it is not necessary for the patient to be 100% completed with all of his care and treatment, it is necessary for us to know the extent of any necessary future treatment. We are in frequent, although not constant, contact with each of client’s treating physicians. However, many times treating physicians do not respond to our inquiries quickly or tell us when treatment is completed. Sometimes the physician assumes that we know when treatment is completed, possibly thinking that the patient will tell us. However, many times the patients, our clients, do not always tell us when their treatment is completed, assuming that we have heard from the physicians.

We want to get your patient’s case settled or resolved. We want to get it settled or resolved as soon as possible. Therefore, please tell us when his treatment is completed or if or when new developments have occurred that changes the course of his treatment. For example, if you suggest that your patient see a different physician or obtain a MRI, tell us so we can obtain those records and be able to include the cost of that additional treatment and the outcome of that treatment or diagnostic care in our evaluation of the case. Finally, get us the records and bills. Send them to us before the patient is through treating. Send us the rest as soon as the patient is done.

When a hungry person has been invited to dinner, he will often wonder when the soup will be completed. Hence, the cry “Is it soup yet?” is often the age-old question that the hungry partakers wonder. We are hungry to get your patient’s case settled or resolved. We do our best not to interfere in the course of health care treatment, but we need your help to let us know what is going on. You might be telling us things we already know, but that’s okay. Likewise, we need to know if your patient (our client) has repeatedly missed appointments or simply stopped going in for treatment. Letting us know when any changes in treatment occur will help us get your patient’s case moving quicker. Just give us a call and let us know.

It complicates our handling of the case if we do not know how much chiropractic care is involved or what progress is being made. Please do not wait until the case is completed before sending us what records you have.

Email us if you’d like or give us a call. Our office number is 801-601-8323.

Research Sheds Light on the Truth about Lawsuits and the Medical Profession

A recent USA Today article by Carl T. Bogus shed some interesting light on the truth about the way the civil justice system affects the cost of health care in our country. We have all heard the recent furor of skyrocketing malpractice premiums driving physicians out of business. Naturally, the thought of a shortage of doctors to treat those with injuries and illnesses makes us a little uncomfortable. We have been told by insurers that the cause of these sky-high premiums is unjustified lawsuits by people trying to make a buck from their doctor.

As we all know, there are problems in the health care industry. But Carl Bogus shows that cause of these problems is not what we have been told it is.
The article points to research by the National Association of Insurance Commissioners to show that, from 1995 to 2000, new medical malpractice claims declined by about 4%.

We also see that jurors are not “overly sympathetic to patients with unfortunate medical outcomes regardless of whether anyone is to blame.” The truth shows nearly the opposite. Research by Valerie Hans and William Lofquist shows that more than 80% of people beginning jury duty say they believe there are too many frivolous lawsuits. According to the researchers, only a third believes that most plaintiffs have legitimate grievances.

From a study done by the National Center for State Courts, we learn how difficult it is for plaintiffs to win. The rate of victory for a plaintiff in a medical malpractice case is 30%. That is lower than any other category of litigation. Strong evidence is needed to be victorious in such a case.

Even in such cases where plaintiffs are victorious, studies have shown that large “out of control” and “runaway” verdicts we hear so much about are not an accurate picture of reality. According to a study in the Annals of Internal Medicine, when a plaintiff is successful, 15% of verdicts are above $1 million, but of that percentage, 75% or more are decreased by the judge or appellate courts.

Bogus points out what likely is a key factor in the crisis: the downturn of the stock market, which only recently has been reversed. This down turn significantly reduced insurance company reserves and investment income. He uses the example of when one of the largest malpractice insurers, The St. Paul Companies, caused havoc in four states by halting the writing of malpractice policies. This problem was the result of major investment losses, including at least $70 million in Enron.

The dark reality of medical malpractice still looms large. According to the Institute of Medicine, 44,000 to 98,000 hospital patients die every year from preventable accidents. It is natural that some physicians will make mistakes, no one is perfect. However, the disciplinary system is lax and few doctors who have multiple malpractice claims against them are ever disciplined. According to Public Citizen and reports filed by the National Practitioner Data Bank, about 5% of physicians account for the majority of all medical malpractice claims. Also, only 13.3% of doctors who have paid five or more malpractice claims have been subject to professional discipline. Little is done to motivate change in malpracticing physicians.

We all know there are problems with our health care system. If we want to solve these problems, we must know the source of the problems.
Following:

(a) a copy of the operators valid:

(i) insurance policy;
(ii) binder notice;
(iii) renewal notice; or
(iv) card issued my an insurance company as evidence of insurance;

(b) a certificate of insurance issued under Section 41-12a-402;
(c) a certified copy of a surety bond issued under Section 41-12a-405;
(d) a certificate of the state treasurer issued under Section 41-12a-406;
(e) a certificate of self-funded coverage issued under Section 41-12a-407, or
(f) information that the vehicle or driver is insured from the Uninsured Motorist Identification Database Program created under Title 41, Chapter 12a, Part 8.
(8) A person is guilty of a class B misdemeanor, and shall be fined not less than $100, who:
(a) when requested to provide security information under Subsection (1), or Section 41-12a-303.2, provides false information;
(b) falsely represents to the department that security required under this chapter is in effect; or
(c) sells a vehicle to avoid the penalties of this section as applicable either to himself of a third party.

When should I refer a personal injury lawyer to my patients?

When Should I refer a Personal Injury Lawyer to my Patients?

As I travel around and talk with chiropractors across the state, there is one question that almost always comes up: How soon should I refer my personal injury patients to a lawyer? The answer is simple: Right now.

Many good physicians are not sure, or just plain mistaken about what the right time is for a referral to a personal injury lawyer. Well-trained and experienced docs who have personal injury patients know that Utah law requires a claimant (your patient) to reach “Personal Injury Protection threshold” or $3,000 before they have a third-party bodily injury claim. Many doctors think they need to wait until that time to make the referral. On our side of the fence, many personal injury lawyers are not interested in talking to potential clients unless they have reached, or are certain to reach their Personal Injury Protection threshold. I’m here to tell you that thinking is wrong, and you are hurting your patient and yourself by waiting.

Here are three simple reasons (there are many more than three, but for the sake of time and space, let’s just keep it simple) why you should not wait to get a personal injury lawyer:

1. Personal Injury Lawyers help avoid gaps in treatment.

Well trained and experienced personal injury physicians know that treatment gaps can be deadly to a claimant’s case and their healing. For chiropractic care to be successful, it requires a commitment on the patient’s part. Additionally, a case is ultimately worth what a jury says it is worth. Jurors have a hard time believing a person is hurt if they don’t go to the doctor and get treatment. While reasonable explanations for gaps can be sold to a jury, we are only good for a few dozen miracles each month. Having a personal injury lawyer involved early will give the doctor’s office another voice of support to get their patients in for treatment without missing appointments. We help patients better understand the process, and rest assured that the Personal Injury Protection PIP carrier will be paying the bills they are obligated to pay.

2. Personal Injury Lawyers get the insurance companies moving.

There are always delays when insurance is involved. We have thousands of horror stories about adjusters behaving badly. Just last week I was in a good Doctor of Chiropractic office’s when a Personal Injury Protection adjuster called and made all kinds of ridiculous threats, all in an effort to keep the claim from being made. Lawyers know the right buttons to push to get an adjuster on track and paying bills. Also, we help your patients fill out the Personal Injury Protection application form correctly to ensure the doctor gets paid quickly.

On top of all of that, very few Personal Injury Protection adjusters inform claimants of all the various benefits that are available such as compensation for household services and lost wages. How many patients have you had that aggravate/reinjure because they were doing some household chores, or they went back to work too soon? A good Personal Injury lawyer will help your patients get ALL of the benefits they need to assist in their healing.

Once Personal Injury Protection is exhausted, the doctors usually face the choice of wrapping up care early, or keep treating and hope to get something out of the third party claim. Without a personal injury lawyer involved, the third party insurance carrier has little motivation to resolve the claim in a timely or reasonable manner. Injured people rarely know what their claim is worth and don’t know where to turn for help. However, having a personal injury lawyer involved will get the case settled faster. Having a personal injury lawyer who knows personal injury well will get the doctor full value for their services faster.

Personal Injury cases require a lot of work and documentation. Experienced and well trained Personal Injury lawyers know what documentation the adjuster will need. Personal Injury attorneys will be able to spot and deal with problems in the case early on, and will also know when to file suit. They will get the process started sooner and work faster and more effectively. While negotiating has great merits, in this economy, insurers are constantly worried about their bottom line. Sometimes valuable time is wasted sitting at the negotiating table without the insurance company burning money in litigation costs. Litigation certainly isn’t our only tool, but it is one we aren’t afraid to use when necessary. The earlier the attorney is involved, the sooner this whole process gets started.

3. You get a chance to choose which personal injury lawyer you work with when you refer early.

This may not sound like a big deal, but it really is. Many times, if the doctor isn’t making the referral, the patient will hire someone who either doesn’t know personal injury well or who does not give each case the time and attention it deserves. Some Personal Injury firms ask the Doctor of Chiropractic, as a standard operating procedure, to trim their bill every time. Worse yet, the patient may hire an attorney who does not understand Personal Injury or who is not pro-chiropractic. There are a lot of attorneys who do Personal Injury work “on the side.” Trust me; you don’t want one of them.

Personal Injury is complicated enough that the attorney needs to know what he or she is doing.

When you make the referral, you can send your patient to someone you know and trust. At Larson Law Firm, we do personal injury work exclusively. We have the original legal friend to Utah chiropractic in Bryan Larson. We know and understand chiropractic, and we use it! We have helped develop some of the personal injury laws in this state, and we have helped the chiropractors get a seat at the table against some fierce opposition. Perhaps best of all, we will only ask you to trim your bill on the rarest of occasions. If we do, there is a serious problem with the case, and we will always take an equal trim in our fees.

For the above reasons and for countless others, you need to refer your personal injury patients to an attorney at the beginning. Do it even if you don’t think they will reach threshold. If we sign them and they don’t reach threshold, it’s no big deal. We send them on their way healthy and happy, and we won’t charge them for our time. However, you don’t want to gamble on the chance that everything will work out if you don’t make the referral, or wait until after threshold is reached. You have nothing to lose. Protect the value of your treatment and care by making the referral today!