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
WACHP Congratulates Marcia Freeman
WACHP is pleased to announce that Marcia Freeman has been appointed to the GDLA Board of Directors.
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 […]
Adelman has been Selected to the Federation of Defense & Corporate Counsel
Please join us in congratulating our partner, Jonathan M. Adelman, for his selection to the Federation of Defense & Corporate Counsel, which is composed of recognized leaders in the legal community who have achieved professional distinction, is dedicated to promoting knowledge, fellowship, and professionalism of its members as they pursue the course of a balanced justice system and represent those in need of a defense in civil lawsuits.
Trevor Hiestand Secures Victory in the Eleventh Circuit Court of Appeals
Trevor Hiestand of the firm secured a victory in the U.S. Eleventh Circuit Court of Appeals in a multi-million dollar policy coverage issue. The district court granted summary judgment in favor of our insurer client in a declaratory judgment action involving complicated issues of leased commercial/motor carrier vehicles and overlapping policy definitions. The result was appealed by the respondents. After extensive briefing and oral argument, the federal appellate court upheld the lower court in a published decision. Grange v. Baisden et al, 1:16-cv-03058-SCJ (11th Cir. 2020).
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, […]
WACHP Continues Remote Work During the COVID-19 Pandemic
In compliance with Federal and State guidelines, the attorneys of Waldon Adelman Castilla Hiestand & Prout have transitioned to working remotely for the coming weeks. Our technology allows us full access to client matters. All attorneys are available by email and cell phone to assist with ongoing cases, accept new assignments, and advise clients as to the effect of the Georgia Supreme Court’s Statewide Judicial Emergency Order and Governor Brian Kemp’s Executive Order on pending claims and litigation. When possible and in the best interest of our clients, depositions and other meetings will be held via videoconference. A skeleton staff will be physically present on a rotating basis to process mail and execute essential in-office operations. Upon request, we will hold invoices for ninety (90) days on new litigation matters received during the pandemic in an effort to ease cashflow for existing and new clients. Waldon Adelman Castilla Hiestand & Prout is dedicated to protecting the health of our firm members, clients, and community. We look forward to seeing everyone back together as soon as we are assured it is safe to return.
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.
From 2018 thru 2019, WACHP closed 7,767 matters.
We recognize the desire of our insurance clients to move matters towards a conclusion in an efficient and expeditious fashion.
WACHP is pleased to announce that Brian McCarthy had been named a partner of the firm.