If you want to know why the business of medical coding should not be ignored when defending against personal injury claims, you should read this article by our own Alexandra Svoboda.
This article touches on the issues of billing practices of medical providers and discusses the reasons for hiring a medical billing expert. Billing Issues
KEEPING THEM HONEST: MEDICAL FUNDING COMPANIES, POTENTIAL FOR UNNECESSARY TREATMENT AND INFLATED BILLS, AND HIDING BEHIND THE COLLATERAL SOURCE RULE
A medical funding company (“MFC”) is an entity which pays for the medical treatment of injured plaintiffs. They are typically paid back when those plaintiffs settle or obtain a verdict in their favor. MFCs make their money by contracting with doctors in advance of the treatment provided to pay less than the amount the doctors charged the plaintiffs. For example, an MFC will agree to send patients to a surgery center and pay the surgery center less than 20% of the surgery center’s charged amount. The surgery center then releases any further claims it has for payments, although the patient is bound to pay the MFC the full “charged” amount. While MFCs take the position that they serve a legitimate and helpful purpose, an incentive exists to steer plaintiffs towards doctors who will provide unnecessary treatment at inflated prices with the intention of maximizing the MFC’s profit. The result is increased costs passed along to consumers in the form of higher insurance premiums, doctor’s bills, and legal fees. At present, there are no regulations or laws specifically relating to MFCs. Furthermore, MFCs have taken the position that the Georgia collateral source rule provides a blanket opportunity to hide the details of the involvement of MFCs in litigation. However, the collateral source rule does not necessarily shield evidence of MFC involvement from discovery. One does not have to think too hard to see why the relationship between doctors and an MFCs are ripe for abuse. MFCs’ profits depend on the amount […]
YOUR BUSINESS INTERRUPTION POLICY DOES NOT COVER LOSSES ASSOCIATED WITH COVID-19? THINK TWICE ABOUT SUING YOUR INSURANCE AGENT
By: Jonathan Adelman Most businesses are experiencing financial losses due to Covid-19 and shelter in place orders. Those with business interruption insurance are likely disappointed to have learned that “civil authority” clauses, which cover losses due to a government order, typically require corelating property damage or the threat of the same. Furthermore, business interruption polices routinely do not cover losses resulting from disease and/or pandemic. So, where does that leave you? Some companies might initially want to blame their insurance agents for not procuring an insurance policy which covers losses associated with what many businesses are now experiencing. However, in Georgia, prevailing on such a claim is an uphill battle. The Georgia Court of Appeals very recently clarified longstanding law and held the following: “In general, an insured has an obligation to read and examine an insurance policy to determine whether the coverage desired has been furnished . . . [,and] the policyholder[‘s] failure to examine the policy bars coverage against the insurer or its agent for failure to provide coverage.” Martin v. Chasteen, A19A1980, 2020 WL 1239488 (2020). There are, of course, exceptions to this rule. “[W]hen the agent has held himself out as an expert and the insured has reasonably relied on that agent’s expertise to identify and procure the correct amount or type of insurance,” a claim could exist. However, that exception is inapplicable if a review of the policy would have made it “readily apparent” that coverage did not exist. Traina Enterprises v. Cord & Wilburn, […]
Despite Testimony of Treating Physician, Cobb County Jury Returns Double Defense Verdict
On March 8 and March 9, 2020, Taylor Barnett successfully defended a case involving an admitted liability, rear-end accident. Both plaintiffs were transported from the scene via ambulance. Plaintiffs introduced the testimony of their treating chiropractor and orthopedist, both of whom related their alleged injuries to the accident. Both plaintiffs’ MRIs showed multiple bulging discs. Ultimately, plaintiffs presented evidence of approximately $49,000 in medical bills and $6,700 in lost wages, combined. In closing, they asked the jury for an award of $80,000. After a short deliberation, the jury returned a defense verdict as to both plaintiffs.
Claims Resulting from Autonomous or Semi-Autonomous Vehicle Failures Require Specialized Knowledge and a Different Approach.
WACHP Press Release – KDS 4.2018 (Edited Version 2)
Click the Link to Read the Daily Report Article about Dan Prout and Travis Meyers’ Defense Verdict
DCP Cobb County Win – Daily Report Article
Great CLM Article on Funding Companies
The Funding Company Predicament
Medical Funding Companies: A New Problem for an Old Rule
WACHP is pleased to post a new article written by Rachel Reed, Clay Knowles, and David Glustrom that was recently published in the GDLA newsletter. Medical Funding Companies: A New Problem for an Old Rule
Georgia Supreme Court Allows Non-Party Apportionment of Fault to Plaintiff’s Employer for Negligent Entrustment
On July 6, 2015, in the case of Zaldivar v. Prickett et al., No. S14G1778, 2015 WL 4067788, the Supreme Court of Georgia unanimously held that Georgia’s apportionment statute allowed a jury to apportion some fault for plaintiff’s damages to plaintiff’s employer. The case concerned an automobile accident between two drivers where the defendant alleged that the plaintiff’s employer was partially responsible for its employee’s injuries based on negligent entrustment. The defendant argued that the jury should be allowed to apportion some fault to the non-party employer based upon its allowing the plaintiff to drive a company truck on business, even though three complaints had been filed against him for poor driving. In ruling in favor of the defendant, the Court held that Georgia’s 2005 apportionment statute, O.C.G.A. § 51-12-33, requires the trier of fact to consider the fault of a non-party (i.e., the plaintiff’s employer) when the non-party is shown to have committed a tort against the plaintiff that was a proximate cause of the plaintiff’s injury. Specifically, the Court held that the apportionment statute contemplates the fault of every tortfeasor, regardless of whether he or she may have an affirmative defense or claim of immunity against liability to the plaintiff. The Court also explained that a non-party’s negligent entrustment of an instrumentality can be a proximate cause of an injury to the person to whom the instrumentality was entrusted. This is known as “first-party” negligent entrustment, which is typically not a workable legal theory of recovery available to […]
Consent to Settle Clause Upheld
On April 20, 2015, the Georgia Supreme Court held that an insured’s negligent failure to settle a claim against an insurance company was barred when the insured settled the underlying claim against it without the insurance company’s authorization. Piedmont Office Realty Trust v. XL Specialty Insurance Company, 771 S.E. 2d 864 (2015). There, the applicable insurance policy contained a “consent-to-settle” clause and a provision that there could be no action against the insurance company without full compliance with the provisions of the policy. The insurance company provided a defense to the insured in the underlying case. The insured consented to a settlement without the insurance company’s authorization and then attempted to recover the settlement amount from the insurance company. The Georgia Supreme Court held that the insured could not sue for bad faith refusal to settle. The Georgia Supreme Court recognized, however, that if the insurance company denied coverage outright and refused to provide any defense, the insured could enter into a settlement agreement without the insurance company’s authorization and then proceed with a potential bad faith action against the insurance company.