Personal Injury Primer

A Medical Provider Billing Scam to Avoid https://personalinjuryprimer.com/wp-content/uploads/2024/10/Ep-349-A-Medical-Provider-Billing-Scam-to-Avoid.mp3 I’m Katelyn Holub, an attorney focusing on personal injury law in northwest Indiana. Welcome to Personal Injury Primer, where we break down the law into simple terms, provide legal tips, and discuss personal injury law topics. Today’s question is prompted by a call from a client. A physical therapist persuaded a client to sign a form directing the therapist not to bill his health insurance but to authorize the provider instead to assert a lien on his personal injury claim. We thought we’d bring this to your attention because it’s a common scam, and many people do not know how to handle it. Here is what the patient was asked to sign: I, the patient, hereby instruct my treater to submit my charges to any liable third-party insurance company and file a lien on my personal injury case instead of billing my health insurance company. I am aware that by doing this, my health insurance company may later deny the claim for untimely filing under their guidelines for claim billing. I am also aware that I will be personally liable for any balance remaining on my account should the third-party coverage not be sufficient to pay the full cost of my treatment. A representative of my treater has explained all of this to me, and I am directing my treater not to bill my health insurance carrier. By agreeing to this directive, the patient is potentially giving up their health insurance benefit. The patient has most likely paid premiums for health insurance so that their bills will be paid. There is no reason to give up insurance benefits that you’ve paid hard-earned dollars to purchase. Here’s what fuels the scam. Most medical providers have agreements with health insurance carriers to accept a lower dollar amount in payment on any bill that they submit. In other words, when the provider bills $1000, they likely have an agreement with the health insurance carrier to accept $330 in full payment. Of course, if you issued a bill for a thousand dollars and you had an agreement that you would accept $330 in full payment, you’d probably look for ways to bypass the agreement and get the full $1000. But by signing such a document, the patient is essentially agreeing to pay the full $1000 bill. Unless they take steps on their own to file a timely claim with their health insurance, they will have wasted their money buying health insurance. This means they not only have to pay the bill in full themselves, but they also lose the benefit of having the bill deemed paid in full had the health insurance carrier paid the negotiated rate. So, the injury victim who falls for this scam is victimized by their treater as well as the wrongdoer who injured them. Instead of getting the treatment that they need at a reasonable price covered through their own health insurance, which they paid for, by the way, they are now left with having to pay full freight for treatment. Moreover, any treater who tries to pull this scam is raising a big red flag that they cannot be trusted as to treatment and care and should be fired immediately. If you have an attorney and a medical provider requests that you sign such a document, immediately bring it to the attention of your attorney. Do not sign it. Instead, insist that the medical provider bill your insurance company. If the provider refuses, fire the provider. I hope you found this information helpful. If you are a victim of someone’s carelessness, substandard medical care, product defect, work injury, or another personal injury, please call (219) 736-9700 with your questions. You can also learn more about us by visiting our website at DavidHolubLaw.com. While there, make sure you request a copy of our book “Fighting for Truth.”The post Ep 349 A Medical Provider Billing Scam to Avoid first appeared on Personal Injury Primer.

What is a Dram Shop Claim? https://personalinjuryprimer.com/wp-content/uploads/2024/10/Ep-348-What-is-a-Dram-Shop-Claim.mp3 I’m David Holub, an attorney focusing on personal injury law in northwest Indiana. Welcome to Personal Injury Primer, where we break down the law into simple terms, provide legal tips, and discuss personal injury law topics. Today’s question comes from a caller concerned about a relative who was hit by a drunk driver who had no car insurance. She said the family knows the drunk was served at a local bar. She wanted to know if the bar could be sued for serving alcohol to someone who others at the bar said was clearly intoxicated before he got behind the wheel. The victim of a drunk driver cannot only sue the drunk driver, but the victim may also have a civil claim for damages against the party that served alcohol to the drunk driver. A lawsuit against the party who served alcohol to an intoxicated person is called a dram shop case. In Indiana, there is a dram shop statute that imposes liability for furnishing alcohol to a visibly intoxicated person. The statute provides that someone who sells, provides, delivers, or otherwise furnishes alcohol to someone else is liable for damages caused by that person’s impairment or intoxication only if the person who furnished the alcohol actually knew that the person to whom they furnished it was visibly intoxicated at the time. The statute also provides that the intoxication of the person to whom the alcohol was furnished must have been a proximate cause of the injuries or damage suffered by the plaintiff. Indiana Courts have confirmed that the requirement of actual knowledge of visible intoxication applies even to cases involving minors. The statute applies to social hosts, such as family members, friends, or acquaintances, serving intoxicated people. If a victim is successful in making a case under the dram shop statute, the victim may be able to recover expenses like medical bills, the costs of future medical care, and lost income and earning capacity, as well as compensation for subjective harm like pain and suffering and emotional distress, even if the drunk driver has no insurance. As part of the licensing requirement to serve alcohol, the operators of a bar, restaurant, or other business must have a procedure in place to ensure that visibly intoxicated individuals are not served alcohol. Often, it is difficult to prove that someone was already intoxicated when they were at the bar or other business seeking to be served more alcohol. The proof was a bit easy in one case we handled years ago. The deceased drunk driver’s phone had a message on it from a bartender who served him. The message said: just checking that you made it home ok, Bob. You were pretty much out of it when I served you before locking up last night. I hope you found this information helpful. If you are a victim of someone’s carelessness, substandard medical care, product defect, work injury, or another personal injury, please call (219) 736-9700 with your questions. You can also learn more about us by visiting our website at DavidHolubLaw.com – while there, make sure you request a copy of our book “Fighting for Truth.”The post Ep 348 What is a Dram Shop Claim? first appeared on Personal Injury Primer.

City Seeks Damages After Ship Takes Down a Bridge https://personalinjuryprimer.com/wp-content/uploads/2024/10/Ep-347-City-Seeks-Damages-After-Ship-Destroys-Bridge.mp3 I’m Katelyn Holub, an attorney focusing on personal injury law in northwest Indiana. Welcome to Personal Injury Primer, where we break down the law into simple terms, provide legal tips, and discuss personal injury law topics. Today’s question comes from a client asking out of curiosity if the City of Baltimore would be able to successfully sue the companies involved in the Frances Scott Key Bridge collapse that occurred not long ago. The ship that struck the bridge killed several workers and caused significant economic damage to the bridge itself and commerce in general. The city has lost tax revenue due to the slowdown in business generated by the use of the bridge, as well as revenue generated by the port authority. In a case such as that described, long-established principles of negligence would apply. The city likely will have a solid case against the owner of the ship, any company that chartered the ship, perhaps the shippers of the cargo, any entity operating the ship, the manufacturer of the cargo ship, and perhaps others. Most likely, all the listed entities have insurance. No question that the bridge collapse had inflicted a financial loss on the city and likely other regional governmental entities, as well as the state. Predicting the outcome of such a lawsuit is beyond the scope of this episode. But some things to consider include, examining evidence of the value of the loss. What was the value of the bridge before it collapsed? What was the expected useful life of the bridge? What will it cost to replace the bridge? These questions may seem simple but they are not. The bridge had value of course before it was destroyed, but what value? There is no market for used bridges. Another city could not have stepped in and purchased the bridge before it collapsed, for example. But of course, states have constructed and then sold or leased toll roads to private companies for millions if not billions of dollars. What if the ship owner and operator have insufficient insurance to cover all of the damage? The families of the workers killed will be suing for damages as well. Might the ship owner and operator file for bankruptcy to limit their responsibility for damages? Suppose there is sufficient insurance, will insurance carriers be driven out of business as a result of this event? Will insurance carriers and re-insurers seek to pool coverage? Will certain losses be able to be prioritized? As one can see, setting aside questions about fault, the question of damage is quite complex. As just another example, suppose a bridge maintenance company had a contract to paint the bridge. That company may now have no way to stay in business if compensation is not available. I hope you found this information helpful. If you are a victim of someone’s carelessness, substandard medical care, product defect, work injury, or another personal injury, please call (219) 736-9700 with your questions. You can also learn more about us by visiting our website at DavidHolubLaw.com – while there, make sure you request a copy of our book “Fighting for Truth.”The post Ep 347 City Seeks Damages After Ship Takes Down a Bridge first appeared on Personal Injury Primer.

Duty to Control Personal Body Movements https://personalinjuryprimer.com/wp-content/uploads/2024/10/Ep-346-Duty-to-Control-Personal-Body-Movements.mp3 I’m David Holub, an attorney focusing on personal injury law in northwest Indiana. Welcome to Personal Injury Primer, where we break down the law into simple terms, provide legal tips, and discuss personal injury law topics. Not too long ago there was a news report of a person injured when a costumed character at an amusement park knocked him over. The injured party sued and alleged that while he was bent over, tying his child’s shoelaces, a park employee dressed in a costume knocked him to a concrete sidewalk leading to broken teeth and a neck injury. This type of injury is not as unusual as it might seem. A person has a legal duty to use reasonable care to control their body movements to avoid slamming into another person and knocking them down. The duty is similar to the obligation to use reasonable care to control a motor vehicle to avoid colliding with someone. A person moving about near other people as a pedestrian must use similar due care to avoid striking another person and knocking them to the ground or otherwise hurting them. A person employed by an amusement park to walk around in a costume and entertain has no less of a duty to exercise reasonable care to avoid colliding with and harming others in their immediate vicinity. Wearing a costume, especially one that might interfere with the wearer’s vision, is not an excuse to injure someone. Quite likely in the case described in the news, the amusement park that employed the costumed character would have an equal duty to manage the person employed to wear a costume. That duty would include the obligation to train the individual wearing the costume and to make sure that they can see their surroundings (or supply someone to act as a spotter for them) so that they do not inadvertently strike others, or bump into them, or knock them over accidentally. Frequently amusement parks will have a non-costumed individual spot for a costumed individual. The spotter will be tasked with assisting the employee in the costume to keep aware of his or her surroundings and help them avoid hurting someone. If the spotter fails to prevent an injury, the spotter might also be held responsible for injuries caused by the person in the costume. The obligation to use reasonable care would apply not only in the setting of an amusement park but also in cases where, for example, a restaurant chain might choose to have someone dress up as a chicken and walk around holding a sign suggesting that customers should eat more beef or fish. I hope you found this information helpful. If you are a victim of someone’s carelessness, substandard medical care, product defect, work injury, or another personal injury, please call (219) 736-9700 with your questions. You can also learn more about us by visiting our website at DavidHolubLaw.com – while there, make sure you request a copy of our book “Fighting for Truth.”The post Ep 346 Duty to Control Personal Body Movements first appeared on Personal Injury Primer.

Machine Calculation of Pain and Suffering https://personalinjuryprimer.com/wp-content/uploads/2024/10/Ep-345-Machine-Calculation-of-Pain-and-Suffering.mp3 I’m Katelyn Holub, an attorney focusing on personal injury law in northwest Indiana. Welcome to Personal Injury Primer, where we break down the law into simple terms, provide legal tips, and discuss personal injury law topics. With the rise of AI machines it’s likely that insurance companies have secured the services of such a computer and are using it, or will soon use it, to try to calculate pain-and-suffering damages relating to injury claims. When there is an injury claim, some types of damages are easily calculable. These damages are traditionally referred to as special damages. What exactly are special damages? Things that you can calculate such as medical bills, income lost from being unable to work, property repair costs, and other out-of-pocket expenses. General damages are different from special damages. General damages include such things as pain-and-suffering, physical and mental discomfort, emotional distress, anxiety linked to the accident or injuries. The question is can a computer be used to accurately place a dollar value on pain? And if you did have such a computer, what information would you feed into the computer to make such a calculation? What insurance companies often attempt to do to value pain and suffering, is to plug-in information about special damages into a computer system, and have the computer calculate a projection of what value a jury might assign to a claim. Keep in mind, in many cases special damages have no logical correlation to pain and suffering. For example, consider a 30 year old woman who has to have a leg amputated below the knee due to an injury. It might cost $5,000 to amputate the leg, but the lifetime pain and suffering and inability to function as normal, likely would be valued by a human on a jury in the millions of dollars. Nevertheless, using a computer programmed to use special damage figures to calculate general damages may appeal to an insurance company that wants to make a simple evaluation of a claim. But, what numbers get fed to a computer? Is the computer told to look at the medical bills charged? Or, should the computer consider what was paid on the actual bills after write-offs? Most medical bills get reduced by the result of a health insurance contract reduction provision, or a government imposed reduction. For example Medicare might see a bill from the surgeon for $100,000, but pay the surgeon only $5000. A health insurance provider might look at a $100,000 surgery bill, and through some written agreement, pay the surgeon only $25,000. Another number that this type of computer system will examine is a daily dollar rate assigned to the number of days a person experiences pain, or the number of days they could not work. What happens next is the computer program adds up all the numbers and tries to project from those numbers what a jury might decide is the value of the claim. For example, let’s assume that the numbers in the categories we just discussed add up to $15,000. Whoever programs a computer may decide that pain should be considered to be 1.5 times the total, and another computer system might be programmed to decide that 3.5 times that total is what could be expected to be awarded by a jury. Neither computer may be right, and neither computer system will be even remotely close to what a human jury would decide. After these types of calculations are made other factors come in. Another typical factor would be to look at the projection of fault for the accident that resulted in the injury. Another factor might be whether the injuries are objectively observable, or whether the injuries are subjective and rely only on the report of the injured party. If a person suffered a scar or they are permanently damaged for life, such factors come into play. The problem with a computer program like this is that there is no mechanism to take into effect all the factors that a human being would take into effect as that human being sits on a jury and listens to all of the evidence and evaluates the witnesses. I hope you found this information helpful. If you are a victim of someone’s carelessness, substandard medical care, product defect, work injury, or another personal injury, please call (219) 736-9700 with your questions. You can also learn more about us by visiting our website at DavidHolubLaw.com – while there, make sure you request a copy of our book “Fighting for Truth.”The post Ep 345 Machine Calculation of Pain and Suffering first appeared on Personal Injury Primer.