Ever since the Workers Compensation Guidelines were released, becoming effective on December 1, 2010, providers & their attorneys alike took a deep breath, as they knew exactly what would happen next; arguments with the insurance carriers on the applicability of the guidelines. The Guidelines encompass a set of medical guidelines to be used in the treatment of neck, low back, knee and shoulder injuries, which the Worker's Compensation Board notes accounts for "40% of injuries and 60% of medical costs." These are not new fee schedules, but guides to the application of certain modalities in certain situations. Of course as with anything new done by Worker's Comp Board without specificity as to who /when it doesn't apply; comes the inevitable question of whether these guidelines apply to no fault and when they apply.
Insurance carriers are constantly trying to delay payment of claims by sending verification requests. This is a clever tactic because until a provider complies with these requests, an action to recover payment on the claims will not be ripe. Therefore, whether in court or arbitration, these cases will be dismissed without prejudice until the insurance verification requests are complied with or at least responded to. The purpose behind this is supposed to be to ensure the carriers have all the relevant information in front of them when deciding whether to pay or deny a claim.
One too many times a client has come to the firm with a personal injury settlement they are unhappy with. For some reason, they signed a release settling their claim for much less than it is worth; Maybe they really were short changed in the deal, maybe their previous representation did a bad job of negotiating on their behalf, maybe they feel their lawyer forced them into signing it or they didn't understand what they were signing; Whatever the case may be, only in the most rare situation will Court allow a settlement to be undone. The fact of the matter is, the Court wants finality, they want the matter to be disposed of and thus if there is a valid release with your signature on it, it is likely the end of the road for you on that matter. Unfortunately, there is no room for Buyer's remorse in the area of personal injury settlements.
When you've been injured in a car accident and it becomes time to retain a lawyer, many questions may cross your mind. Typically, many of our clients have same questions and concerns regarding our fee. We felt it was important to take this time out to answer some of those reoccurring questions so that you may know the answers before deciding to retain us.
Good old Regulation 68, enacted in 1974, in order to ensure that all reasonable and necessary medical treatment following a motor vehicle accident was paid for, which was revised in 2002, is once again up for revision. The original proposed revisions were released in November 2009; subsequently, a second proposed revision released for comment on March 3, 2011. As idealistic as ever, the Insurance Department vows that somehow these revisions will cause less confusion and less fraud.
Recently, our firm has seen a rise in No Fault arbitrations circulating around a procedure known as Manipulation under Anesthesia. One would assume that any advance in medicine is always a positive thing, but they would be wrong. As with anything new, there is always a transitional period, where guidelines are being developed and the lack of guidance causes chaos. Sometimes it can take some time before we come away with consistent decisions from the arbitrators or guidance from the Workers Comp Board, which puts both providers and attorneys in a tough spot. During this transitional period, insurance companies used this chaos in order to create new reasons why providers shouldn't be paid. And trust me, during these arbitrations, we have heard it all. The good news is, we are one step ahead of the insurance companies, and have already had our fee schedule calculations confirmed. (Please see Flatbush Chiropractic P.C. a/a/o Ude Ofuru v. Nationwide Insurance Co. 17 1991 R 25758 10; Flatbush Chiropractic, AAA Case No. 412010014919 at 31-32 [Skelton, Arb.])
The answer, without the necessity for the question first, is that there are profound and significant breakages in the real estate market, and the administration of solutions to fix it are collapsing and show difficult short falls for the new callers and clients in our law firm.