Athletico presentation


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Athletico presentation

  1. 1. ATHLETICOHamburger University Oak Brook, Illinois January 11, 2013 Howard H. Ankin Ankin Law Office LLC162 West Grand Avenue Chicago, IL 60654 312-346-8780
  2. 2.  A liability accident which most commonly is an automobile accident or slip and fall accident provides for money for medical bill, lost monies, loss of a normal life and pain and suffering. Cases are customarily assessed by looking at:  1. Liability.  2. Damages.  3. Ability to pay. The ability to pay a judgment often is based on insurance available. The minimum insurance coverage in IL is 20/40. This means $20k per person and $40k no matter how many people are to divide the $40k with no single person recovering more than $20k. The typical “full coverage” policy is 100/300.
  3. 3.  An automobile policy holder can insure themselves for additional coverage where an at- fault driver may not have enough coverage. A driver can insure against an uninsured motorist for whatever exposure it feels necessary/can afford. Typically capped at 1M A driver can insure for the difference between the underinsured driver’s policy and theirs. Example: Defendant driver has 50/100 policy. The driver has a 100/300 policy. Driver could potentially collect $150K from the defendant and $50K from driver’s policy.
  4. 4.  Typically a defendant and/or its insurance carrier will not pay any medpay until the close of the claim. Exception = property damage. An injury victim typically has 3 options for payment of medical bills:  1. Automobile medical pay coverage.  2. Health insurance.  3. Self Pay/Doctor’s lien.
  5. 5.  Medical pay coverage on a typical standard policy is $5K but can be purchased in many denominations. This payment is paid regardless of fault. Typically, it is paid on a “first come, first served” basis. “Grabbing the med pay.” If an injury victim could pay all of his medical bills by group health insurance and use the med pay for out-of-pocket co-payments, potentially they could have no medical bills outstanding for care and treatment.
  6. 6. Sec. 10. Lien created; limitation. (a) Every health care professional and health care provider that renders any servicein the treatment, care, or maintenance of an injured person, except services rendered under the provisions of theWorkers Compensation Act [820 ILCS 305/1 et seq.] or the Workers Occupational Diseases Act [820 ILCS 310/1 etseq.], shall have a lien upon all claims and causes of action of the injured person for the amount of the health careprofessionals or health care providers reasonable charges up to the date of payment of damages to the injured person.The total amount of all liens under this Act, however, shall not exceed 40% of the verdict, judgment, award,settlement, or compromise secured by or on behalf of the injured person on his or her claim or right of action.(b) The lien shall include a written notice containing the name and address of the injured person, the date of the injury,the name and address of the health care professional or health care provider, and the name of the party alleged to beliable to make compensation to the injured person for the injuries received. The lien notice shall be served on both theinjured person and the party against whom the claim or right of action exists. Notwithstanding any other provision ofthis Act, payment in good faith to any person other than the healthcare professional or healthcare provider claiming orasserting such lien prior to the service of such notice of lien shall, to the extent of the payment so made, bar or preventthe creation of an enforceable lien. Service shall be made by registered or certified mail or in person.(c) All health care professionals and health care providers holding liens under this Act with respect to a particularinjured person shall share proportionate amounts within the statutory limitation set forth in subsection (a). Thestatutory limitations under this Section may be waived or otherwise reduced only by the lienholder. No individuallicensed category of health care professional (such as physicians) or health care provider (such as hospitals) as setforth in Section 5 [770 ILCS 23/5], however, may receive more than one-third of the verdict, judgment, award,settlement, or compromise secured by or on behalf of the injured person on his or her claim or right of action. If thetotal amount of all liens under this Act meets or exceeds 40% of the verdict, judgment, award, settlement, orcompromise, then:(1) all the liens of health care professionals shall not exceed 20% of the verdict, judgment, award, settlement, orcompromise; and(2) all the liens of health care providers shall not exceed 20% of the verdict, judgment, award, settlement, orcompromise;
  7. 7.  provided, however, that health care services liens shall be satisfied to the extent possible for all health care professionals and health care providers by reallocating the amount unused within the aggregate total limitation of 40% for all health care services liens under this Act; and provided further that the amounts of liens under paragraphs (1) and (2) are subject to the one-third limitation under this subsection. If the total amount of all liens under this Act meets or exceeds 40% of the verdict, judgment, award, settlement, or compromise, the total amount of all the liens of attorneys under the Attorneys Lien Act [770 ILCS 5/0.01 et seq.] shall not exceed 30% of the verdict, judgment, award, settlement, or compromise. If an appeal is taken by any party to a suit based on the claim or cause of action, however, the attorneys lien shall not be affected or limited by the provisions of this Act. (d) If services furnished by health care professionals and health care providers are billed at one all-inclusive rate, the total reasonable charges for those services shall be reasonably allocated among the health care professionals and health care providers and treated as separate liens for purposes of this Act, including the filing of separate lien notices. For services provided under an all-inclusive rate, the liens of health care professionals and health care providers may be asserted by the entity that bills the all- inclusive rate. (e) Payments under the liens shall be made directly to the health care professionals and health care providers. For services provided under an all-inclusive rate, payments under liens shall be made directly to the entity that bills the all-inclusive rate.
  8. 8.  Amy Stanton v. Carolyn Rea & Robert Roe, 2012 il App 5th 110187, Decided November 2, 2012, In order to ensure that plaintiff receives 30% of the judgment as intended by the Act it is necessary that computation of the 40% [allotment for medical providers and professionals] does not begin until costs associated with bringing the case to trial and securing payment of the judgment have been deducted from the amount of the original verdict. In the instant case, the trial court should have begun its calculations of 40% for the lienholders after payment of attorney fees and costs necessary in securing the judgment.”
  9. 9.  A statutory right of recovery providing for payment of medical bills, lost time, permanency recovery and other benefits. Medical bills paid have to be reasonable and necessary. Necessity is a fact question. Petitioners want to rely on doctor’s opinion. Respondents want to rely on IMEs and Utilization Review.
  10. 10.  Law is in flux. Must dispute UR and place dispute in client file. Client will need an attorney. This weeks dispute: Dept. of Financial Regulation requiring in-state UR providers. Strength of the doctor customarily wins medical necessity dispute.
  11. 11. Who is responsible for payment of transportation services to medical appointments? In Gen. Tire & Rubber Co, the Illinois Appellate Court held that the Respondent would be responsible for the payment of transportation services as long as they are reasonable. 211 Ill. App. 2d 641, 651 (Ill. App. 1991). In that case, the Petitioner incurred $1,588.00 in travel expenses to treat with his physician. The Petitioner lived in Mt. Vernon and sought treatment with a doctor who practiced in Evansville, Indiana, which was approximately 100 miles from his home. The court held that because his doctor was the most familiar with the Petitioner’s condition and medical history, it was reasonable that he travel to this doctor. As such, the court found that it was the Respondent’s responsibility to pay those expenses and awarded the Petitioner costs of $1,588.00.Who is responsible for payment of translation services at medical appointments? Similarly, the Respondent is responsible for the payment of reasonable medical services which can include translation services at medical appointments. The court held that pursuant to section 8(a) of the Act, whatever is “reasonably required to cure or relieve from the effects of the accidental injury” is the Respondent’s responsibility. Id. at 649- 650. If the translation services are necessary to facilitate the doctor’s appointment and treat the patient, the Respondent can be responsible for the charges incurred. Gen. Tire & Rubber Co. v. The Indus. Comm., 211 Ill. App. 3d 641 (Ill. App. 1991).
  12. 12.  An injured worker can maintain a host of causes of action at the same time. It is not uncommon to have a delivery driver who is injured in an auto accident or a laborer on a construction site bring an action against a general contractor or an office worker fall down on another’s premises while working. The injured party can maintain both a workers’ compensation case and a third party liability case. The recovery of both involving sophisticated subrogation issues and is covered under Section 5 of the Illinois Workers’ Compensation Act. Beyond these two cases you could also have a Social Security Disability case, products liability suit or medical malpractice cause of action arising out of one incident.
  13. 13.  52 year old woman is in an auto accident and sustains injuries to her hand, neck and arm. First seeks treatment with family physician then hand and spine specialists. Important issues to note:  1. Therapist does good job of documenting loss of normal life activities. (collosis software)  2. There is no follow up letter to Dr. Haak.  3. Is there a difference between occupational v. physical therapy?  4. Why no close out report or bill for close out?  5. Billed to BC/BS with no bill to med pay.
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