This document discusses strategies for handling workers' compensation liens in third-party settlement negotiations. It notes that the carrier's statutory lien includes all paid and future medical expenses, but future expenses can be waived through a "clincher." When settling a third-party case, all parties including the third-party defendants, workers' compensation carrier, and claimant should be involved. Diminishing client expectations about the effect of the lien and resolving any ongoing workers' compensation claims are also discussed. The document explores options for funding Medicare set-asides and settling even when the settlement is less than the lien amount.
Arbitration in Insurance Coverage Disputes: Pluses and MinusesNationalUnderwriter
Arbitration in Insurance Coverage Disputes: Pluses and Minuses By Peter A. Halprin
Deciding whether to proceed with arbitration, either after the denial of a claim or when procuring the placement of a policy,requires an understanding of arbitration and its advantages and disadvantages. This article analyzes the perceived advantages and disadvantages of arbitration.
Policyholders may be surprised to find that their insurance policies contain an arbitration provision. Deciding whether to proceed with arbitration, either after the denial of a claim or when procuring the placement of a policy, requires an understanding of the advantages and disadvantages of arbitration.
Fallout from McVey v MLK Enterprises LLC - Cogan's CornerAnthony Roth
Plaintiff attorneys will be forced to recalibrate their risk assessment when it comes to taking a case with liability challenges and trying to reconcile their ideals with the fiscal reality of running a legal practice.
Dealing With Clients In Financial DistressArthur Howe
This presentation identifies issues that law firms and lawyers should consider when dealing with clients in financial distress. It is focused on Illinois law.
This presentation does not create an attorney-client relationship or provide legal advice. It may be deemed to be “Advertising Material.”
Arbitration in Insurance Coverage Disputes: Pluses and MinusesNationalUnderwriter
Arbitration in Insurance Coverage Disputes: Pluses and Minuses By Peter A. Halprin
Deciding whether to proceed with arbitration, either after the denial of a claim or when procuring the placement of a policy,requires an understanding of arbitration and its advantages and disadvantages. This article analyzes the perceived advantages and disadvantages of arbitration.
Policyholders may be surprised to find that their insurance policies contain an arbitration provision. Deciding whether to proceed with arbitration, either after the denial of a claim or when procuring the placement of a policy, requires an understanding of the advantages and disadvantages of arbitration.
Fallout from McVey v MLK Enterprises LLC - Cogan's CornerAnthony Roth
Plaintiff attorneys will be forced to recalibrate their risk assessment when it comes to taking a case with liability challenges and trying to reconcile their ideals with the fiscal reality of running a legal practice.
Dealing With Clients In Financial DistressArthur Howe
This presentation identifies issues that law firms and lawyers should consider when dealing with clients in financial distress. It is focused on Illinois law.
This presentation does not create an attorney-client relationship or provide legal advice. It may be deemed to be “Advertising Material.”
Home Inspector's Insurance & Risk Management - July 19, 2013Gerald Brunker
Home Inspector professional liability, general liability and other applicable insurances for home inspectors. Risk management tips and hints and home inspector claim information.
Dear students get fully solved assignments
Send your semester & Specialization name to our mail id :
“ help.mbaassignments@gmail.com ”
or
Call us at : 08263069601
Negotiating a Personal Injury Claim Vs. Filing a LawsuitAngela M. Deisley
Negotiating a personal injury claim and filing a lawsuit are different because there really is very little risk to someone in bringing a claim, while there is risk in filing a lawsuit.
Legal Ethics issues for State Attorneys GeneralKathleen Clark
examines the key legal ethics issues facing state Attorneys Generals, including
1) identifying their client
2) determining decision-making vis-à-vis their clients
3) conflicts of interest
Fischetti Law Group is here to provide you with the legal guidance and resources needed for a variety of practice areas, no matter what happened. Our experienced professionals are qualified in a range of services, from car accidents to nursing home abuse, personal injury protection payouts, and homeowners insurance claims. Rest assured that your case will be handled by an expert. Take advantage of our broad list of services today!
Our attorneys primarily litigate cases related to homeowner’s insurance claims, personal injury protection (PIP), insurance claims, and bodily injury and/or harm caused by negligence. This includes car accidents, nursing home abuse, and slip-and-fall accidents. If you’re not sure if we can help you with your case, contact us today to find out more information. We’re available every Monday through Friday from 8:30 am to 6:00 pm. We can also schedule a time to meet with you on the weekends if that’s preferred.
Our present locations include Fort Pierce Attorney Office (satellite offices) and Boynton Beach Florida Attorney Office (central hub and primary office location). However, we’ve taken cases throughout the entire state of Florida.
Howard Ankin Presentation at ITLA Workers' Compensation SeminarAnkin Law Office, LLC
Howard Ankin gave a presentation at the Illinois Trial Lawyers Association workers’ compensation seminar on November 3, 2017. The Illinois Trial Lawyers is an association of lawyers who advocate on behalf of injured people.
A PowerPoint overview of New York No-Fault Law, including the background of the law and regulation, an explanation of the scope of coverage, exclusions and benefits, and exploration of several issues, including notice and claims handling.
Independent healthcare in house lawyers' forum, March 2018, LondonBrowne Jacobson LLP
In our first independent healthcare in house lawyers' forum for 2018 we cover the following topics:
- claims and liabilities update - including vicarious liability for the acts of non-employees and the post Paterson inquiry
- inquests and other regulatory liabilities
- capacity, consent, and how to not get sued.
Home Inspector's Insurance & Risk Management - July 19, 2013Gerald Brunker
Home Inspector professional liability, general liability and other applicable insurances for home inspectors. Risk management tips and hints and home inspector claim information.
Dear students get fully solved assignments
Send your semester & Specialization name to our mail id :
“ help.mbaassignments@gmail.com ”
or
Call us at : 08263069601
Negotiating a Personal Injury Claim Vs. Filing a LawsuitAngela M. Deisley
Negotiating a personal injury claim and filing a lawsuit are different because there really is very little risk to someone in bringing a claim, while there is risk in filing a lawsuit.
Legal Ethics issues for State Attorneys GeneralKathleen Clark
examines the key legal ethics issues facing state Attorneys Generals, including
1) identifying their client
2) determining decision-making vis-à-vis their clients
3) conflicts of interest
Fischetti Law Group is here to provide you with the legal guidance and resources needed for a variety of practice areas, no matter what happened. Our experienced professionals are qualified in a range of services, from car accidents to nursing home abuse, personal injury protection payouts, and homeowners insurance claims. Rest assured that your case will be handled by an expert. Take advantage of our broad list of services today!
Our attorneys primarily litigate cases related to homeowner’s insurance claims, personal injury protection (PIP), insurance claims, and bodily injury and/or harm caused by negligence. This includes car accidents, nursing home abuse, and slip-and-fall accidents. If you’re not sure if we can help you with your case, contact us today to find out more information. We’re available every Monday through Friday from 8:30 am to 6:00 pm. We can also schedule a time to meet with you on the weekends if that’s preferred.
Our present locations include Fort Pierce Attorney Office (satellite offices) and Boynton Beach Florida Attorney Office (central hub and primary office location). However, we’ve taken cases throughout the entire state of Florida.
Howard Ankin Presentation at ITLA Workers' Compensation SeminarAnkin Law Office, LLC
Howard Ankin gave a presentation at the Illinois Trial Lawyers Association workers’ compensation seminar on November 3, 2017. The Illinois Trial Lawyers is an association of lawyers who advocate on behalf of injured people.
A PowerPoint overview of New York No-Fault Law, including the background of the law and regulation, an explanation of the scope of coverage, exclusions and benefits, and exploration of several issues, including notice and claims handling.
Independent healthcare in house lawyers' forum, March 2018, LondonBrowne Jacobson LLP
In our first independent healthcare in house lawyers' forum for 2018 we cover the following topics:
- claims and liabilities update - including vicarious liability for the acts of non-employees and the post Paterson inquiry
- inquests and other regulatory liabilities
- capacity, consent, and how to not get sued.
The Affordable Care Act: Taking a New Approach to DamagesRachel Hamilton
Presented at ACI's 13th Annual Advanced Forum on Obstetric Malpractice Claims by Caryn L. Lilling Mauro Lilling Naparty LLP and Thomas R. Shimmel Kitch Drutchas Wagner Valitutti & Sherbrook.
Commercial Payor Behavioral Health Audits: How to Avoid Getting Wiped OutEpstein Becker Green
The number of commercial payor audits of behavioral health facilities has been steadily rising, forcing closures of multiple treatment facilities, straining resources, and setting up an increasingly contentious conflict between treatment providers and payors.
This webinar will examine the most common issues arising in payor audits (including medical necessity; patient financial responsibility; and other issues asserted to constitute fraud, waste, or abuse) and the common arguments used as grounds for the nonpayment or recoupment of fees by insurers. The presenters will also review responsive strategies in commercial payor audits and examine defensive strategies and best practices to avoid fraud, waste, and abuse.
Presented by:
Paul D. Gilbert – Member, Epstein Becker Green
John A. Mills – Partner, Nelson Hardiman
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/how-to-avoid-getting-wiped-out-by-the-wave-of-commercial-payor-behavioral-health-audits-medical-necessity-and-waivers-of-co-insurance-and-deductibles/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
2. Statutory Lien
• 42-1-560(b): the carrier’s lien is to the extent of the
total amount of compensation, including medical
and other expenses, paid or to be paid by the
carrier.
• Request an itemization.
• Review for payments to NCM’s, P.I.’s, or DME’s.
• Do the math yourselves.
3. Breeden and Future Medicals
• “The Clincher Enforcement Act.”
• Lien includes only those medical expenses
paid or accrued but not yet paid at the time
of the third party settlement, and does not
include future medical expenses.
• Future medicals are to be included in the
fund designated to pay future compensation
benefits under subsection (g).
4. Breeden and Future Medicals
• What does this mean for the third party case?
• For your client to receive any benefit from the
third party case, she must clincher or waive her
right to future medicals.
• Waiver or clincher of future medicals potentially
implicates Medicare and may require a MSA.
6. Have Lien in Mind Early
• When to file 3rd
Party Complaint?
– Don’t wait for the WC claim to resolve;
– WC and 3rd
party attorneys work in conjunction
• Include Loss of Consortium Claim
• Timely file and serve S-2 and S-4
– Harsh penalties if not: Callahan v. Beaufort Cty. (Court left open
whether dismissal without prejudice and refiling with S-2 prevents
election of remedies)
• Do not settle third party case while WC claim is pending without
explicit confirmation that Claimant has not elected his remedies.
• Meet with WC Defense attorney up front to discuss third party case
and any assistance the Employer can provide
7. Mediation
• Excellent method to resolve 3rd
party case
and workers’ compensation claim/lien
• Choose mediator familiar with workers’
compensation law/liens
8. Mediation – All Hands on Deck
• 3rd
party defendants and adjusters;
• WC Claimant attorney;
• WC Defense attorney and subrogation adjuster;
• Structured settlement broker;
• MSA proposal
9. Diminish Expectations
• Make sure clients understand WC lien will be
paid out of 3rd
party proceeds;
• If Client receiving lifetime meds, discuss effects
of continuing to receive benefits after resolution
of 3rd
party case v. clinchering meds;
• Do not wait until the day of mediation to explain
this to your client.
10. Posture of the WC Claim
• Ongoing WC claim with no indemnity
award, clincher, or future medicals
awarded;
• Clincher with no future medicals;
• Indemnity award in place with lifetime
medicals
11. Be Aware of Other Potential Liens
• STD/LTD;
• ERISA;
• Always request the Plan Documents.
13. Potential Methods of Resolution
• Apportion to Loss of Consortium claim;
• Upfront negotiation on a sliding scale repayment
of lien;
• Statutory reduction formula - Total cognizable
damages (42-1-560(f));
• Equitable reduction or waiver when employer
conduct contributed or WC defense IME hurts 3rd
party case
14. Ongoing WC Claim
• Consider two mediators;
• Negotiate settlement of WC alongside
third party case;
• Negotiate waiver of if third party case has
low value.
15. Ongoing WC Claim
• If recommended future surgery that client
may not get, consider waiving future meds
in return for waiver of lien;
• If client wants recommended surgery,
consider resolving lien but requiring carrier
to pay for specific surgery or treatment
under the Fee Schedule.
16. WC Lien and Lifetime Meds
• Must clincher or waive right to lifetime
meds for client to benefit from 3rd
party
case;
• MSA may be required;
17. MSAs Funding Options
• Carrier funds MSA and adds cost to lien;
• Carrier funds MSA after lien repaid;
• Client funds MSA using annuity or other
structured settlement vehicle;
• Client and Carrier jointly contribute to funding
MSA.
• Look at legal and economic benefits of each
option with your particular case.
18. Settling 3rd
Party Claim Without
Resolving WC Lien
• If settling for less than amount of WC lien,
carrier can continue to prosecute 3rd
party
claim (42-1-560(f));
• File Petition to have WCC determine total
cognizable damages and reduction of lien
– Helpful in 3rd
party cases with large damages
but weak liability