Cherry Hill, New Jersey Personal Injury Lawyer - Insurance

Medical Malpractice Reform: A Doctor’s Perspective

Camryn Hansen — Wed, 28 Oct 2009 18:58:59 GMT

If you’re getting mad about the mainstream media’s perpetual refusal to fact-check, telling you that So-and-So says X while another So-and-So says Y but refusing to tell you whether X or Y is in fact true, you will appreciate the recent Salon.com article by Rahul K. Parikh, M.D.—“I'm a doctor. So sue me. No, really.”

In this article, Dr. Parikh thoughtfully and rigorously examines the evidence that tort reformers have been touting for years as reasons why states should limit patient compensation for medical injuries. He finds that:

· We do not have an epidemic of malpractice suits in this country, and the numbers are not growing. Studies show that between 1996 and 2006, the number of suits has actually declined eight percent.

· Capping medical malpractice claims would not translate to significantly lower health care costs. Currently, malpractice costs amount to two percent of our $2 trillion total.

· Contrary to tort reformers’ claims, the cost to the system of “defensive medicine” is marginal at best.

· Although tort reformers claim that “junk lawsuits” account for the majority of malpractice claims and clog up the legal system, and have cherry picked misleading study statistics to back up their arguments, a comprehensive Harvard study in the New England Journal of Medicine found that a full 2/3 of malpractice cases involve errors made by doctors. Of that 2/3, 73% resulted in payments to plaintiffs. Of the suits that did not involve an actual doctor error, 72% did not result in payments. As Parikh says, “Those conclusions do not paint the picture of a medical-legal system burdened by ambulance-chasing lawyers and their litigious clients.”

· The cost of malpractice insurance does not drive doctors out of business in rural areas. Rural areas have always had a shortage of doctors relative to highly populated areas, and “with or without tort reform, access to care is likely to stay tight outside of big cities.”

The real culprit for high costs, according to Parikh, are the malpractice insurance companies, who are simply adhering to the tradition of making up for declining investments by increasing their premiums:

Public Citizen…notes "that a historical pattern has been established that insurance rates rise also based on the investment market...Earlier 'crises' (in 1975-6 and 1985-6) similar to today's 'crisis' were due to declining investment fortunes and failed pricing practices of the insurance industry rather than an increase in medical malpractice filings and awards. Then, as now, the insurance industry covered its losses by raising rates dramatically, then blamed the lawyers of innocent patients rightfully seeking compensation for negligence-related injuries." -Salon.com

Most importantly, as Parikh points out, no amount of malpractice reform will help doctors save the lives of more patients. Any humanitarian discussion of health care reform will need to pay a lot more attention to the issue of patient safety.

Originally posted at InjuryBoard by Camryn Hansen

Huge Medical Malpractice Study: Liability Should Not be More Limited.

Mike Ferrara — Thu, 23 Jul 2009 21:50:12 GMT

Americans for Insurance Reform released a study earlier this week showing that in recent years, doctor premiums and medical malpractice claims have overwhelmingly dropped, while the profits of the medical malpractice insurance industry have soared. Significantly, the study concludes that placing further limits on the liability of negligent doctors and unsafe hospitals would be unjustifiable, and would put almost no dent in our country’s health care costs.

AIR’s report, True Risk: Medical Liability, Malpractice Insurance and Health Care, is by Gillian Cassell-Stiga and Joanne Doroshow of the Center for Justice & Democracy, and actuary J. Robert Hunter, who is Director of Insurance for the Consumer Federation of America (CFA), former Commissioner of Insurance for the State of Texas, and former Federal Insurance Administrator under Presidents Carter and Ford.

In describing the study’s findings, Hunter said, “Thirty years of inflation-adjusted data show that medical malpractice premiums are the lowest they have been in this entire period. This is in no small part due to the fact that claims have fallen like a rock, down 45 percent since 2000. The periodic premium spikes we see in the data are not related to claims but to the economic cycle of insurers and to drops in investment income. Since prices have not declined as much as claims have, medical malpractice insurer profits are higher than the rest of the property casualty industry, which has been remarkably profitable over the last five years. -AIR

The findings apply equally to states that have placed major tort restrictions on victims of medical malpractice and to states that have not.

The study adds that because medical malpractice premiums amount to less than 0.5% of overall health care costs, with medical malpractice claims amounting to 0.2% (yes, these are tiny decimals) of health care costs, limiting liability any more will simply not have a significant effect on these health care costs. “If Congress completely eliminated every single medical malpractice lawsuit,” it says, “including all legitimate cases, as part of health care reform, overall health care costs would hardly change, but the costs of medical error and hospital-induced injury would remain and someone else would have to pay.”

All of this only confirms the position we’ve been taking, which is that removing or further limiting medical liability would mean robbing patients of the only meaningful check and balance they have on the impossible monstrosity of a system that American health care has become. Limiting liability is not a way to save the country money, and it’s not fair for patients who are wrongfully injured or who lose their lives due to negligence.

Read AIR’s full study here.

Originally posted at InjuryBoard by Mike Ferrara

Just How Much do Malpractice Suits Raise Health Care Costs?

Mike Ferrara — Thu, 16 Jul 2009 22:22:45 GMT

A succinct op-ed in The New York Times earlier this week by UPenn Law School professor Tom Baker made some terrific points about medical malpractice, and the expensive malpractice insurance that everyone is always blaming for the skyrocketing costs of health care.

Eighty percent of malpractice claims involve significant disability or death, a 2006 analysis of medical malpractice claims conducted by the Harvard School of Public Health shows, and the amount of compensation patients receive strongly depends on the merits of their claims. Most people injured by medical malpractice do not bring legal claims, earlier studies by the same researchers have found.

In other words, patient claims, and accordingly, the malpractice insurance to cover them, are not that large unless patients can prove significant injury or death due to medical negligence. This means that claims are not draining our pocketbooks; medical negligence is.

On the other hand, medical liability has improved patient safety — by leading hospitals to hire risk managers, for example, and spurring anesthesiologists to improve their safety standards and practices. Even medical societies’ efforts to attack the liability system have helped, by inspiring the research that has documented the surprising extent of preventable injuries in hospitals. That research helped start the patient safety movement.

Disturbingly, findings have shown that hospitals in New Jersey, Pennsylvania, and in fact all over the country are still vastly underreporting preventable errors, even serious ones, that occur on their watch, despite state laws requiring them to do so. On the consumer level, patients have no way of knowing how well local hospitals are performing. State agencies do not release reports from individual hospitals regarding their rate of medical errors. Oftentimes, it is not until the health department cites a hospital for breaking state laws that the public even hears of the hospital’s failing.

Take away medical liability and you take away the only meaningful check and balance a patient has on the impossible monstrosity of a system that American health care has become.

As Baker notes, “there’s a better answer for doctors worried about high malpractice insurance premiums.” And this answer is:

…[m]edical providers should be required to disclose injuries, provide quicker compensation to deserving patients and — here’s the answer for doctors worried about their premiums — shift the responsibility for buying malpractice insurance to hospitals and other large medical institutions. Evidence-based liability reform would give these institutions the incentive they need to cut back on the most wasteful aspect of American health care: preventable medical injuries.

It’s so crazy it just might work.

Originally posted at InjuryBoard by Mike Ferrara

Dissatisfied with your Attorney? Some Lawyers are Suing the Bad Apples.

Mike Ferrara — Wed, 24 Jun 2009 21:31:29 GMT

Most of us know that lawyers can sue doctors, nurses, engineers, architects and other professionals for damages and deaths they’ve caused though what legal jargon calls deviating from the standard of care—the professional equivalent of running a red light.

What you may not know is that legal malpractice exists too. Just like any other professional, lawyers can make mistakes—sometimes major ones. Accordingly, lawyers carry malpractice insurance just like doctors, and some of them pay as much for it as doctors do. Every consumer should be aware that if your lawyer has made a mistake (for example, not filing a lawsuit on time), you have the option of consulting with another attorney to investigate whether your lawyer has committed malpractice.

Obviously, this concept is not popular with lawyers. But to be fair, lawyers who mess up should be held personally responsible for the wrongs they commit, just like doctors.

Originally posted at InjuryBoard by Mike Ferrara

Most Bankruptcies Caused by Medical Bills of Americans with Health Insurance

Camryn Hansen — Mon, 08 Jun 2009 20:26:16 GMT

A recent Harvard University study found that in 2007, a full 62% of all bankruptcies filed in the US were caused by medical problems that led to overwhelming medical bills.

Tough luck, you say. Those people should’ve had insurance. But wait! Seventy eight percent of them did. And more than 60% of them were not using Medicare or Medicaid, but private insurance. Most were also middle-class, well-educated homeowners.

"For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments, and deductibles that illness can put you in the poorhouse," said lead author Himmelstein. "Unless you're Warren Buffett, your family is just one serious illness away from bankruptcy." –Catherine Arnst, Business Week

As anyone who has had a long, expensive illness can probably tell you, the care that is necessary to treat long, expensive illnesses is simply not covered by private insurance. Patients are strangled by loopholes in the form of co-pays, deductibles, and uncovered prescriptions and services. The somewhat shocking numbers underscore this quite clearly:

[M]edically bankrupt families with private insurance reported average out-of pocket medical bills of $17,749, while the uninsured's bills averaged $26,971. Of the families who started out with insurance but lost it during the course of their illness, medical bills averaged $22,658. –Business Week

In other words, when it comes to the infeasibility of funding extended care, there is not a huge difference between having health insurance, having insurance and losing it due to illness, and not having insurance at all. In this country, sick and middle class means sick and bankrupt.

President Obama recently noted that if we allow the current course of health care to continue, in a few years, every American will be paying one out of every five dollars he or she earns on health care. That’s 20% of our income—and that’s if you’re lucky and aren’t stuck by a debilitating disease that leaves you penniless, whether or not you have private health coverage. This is horrible.

We must attack the root causes of skyrocketing health care costs. Some of these costs are the result of unwarranted profiteering that has no place in our health care system, and in too many communities, folks are paying higher costs without receiving better care in return. And yet we know, for example, that there are places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions that offer some of the highest quality of care in the nation at some of the lowest costs in the nation. We should learn from their successes and promote the best practices, not the most expensive ones. That’s how we’ll achieve reform that fixes what doesn’t work, and builds on what does. –Barack Obama, Address to Congress

We absolutely need to pass legislation on health care reform immediately. Please contact your Congresspersons to express your overwhelming support of their re-election, contingent on their cooperation with President Obama on this issue.

Originally posted at InjuryBoard by Camryn Hansen

Horizon Blue Cross to Expand Benefits for Eating Disorder Patients

Camryn Hansen — Tue, 21 Apr 2009 20:40:23 GMT

Today, US District Judge Faith Hochberg approved a class action settlement in Drazin v. Horizin Blue Cross which will require Horizon Blue Cross of New Jersey to expand benefits for 1.5 million patients with eating disorders. 566 Horizon patients whose coverage for eating disorders was previously limited will now recover about $1.2 million for treatment they received.

Horizon also agreed to treat any future eating disorder claims the same way it treats biologically-based mental illnesses (BBMI) such as schizophrenia—a move that will cost it an estimated $17.8 million. In so doing, the company will have to give up its current restrictions limiting treatment to 20 outpatient visits per calendar year and 30 days of hospitalization.

Medical experts have been saying for years that the long-term treatment Horizon has agreed to fund, particularly on an outpatient-basis, is necessary to address the physical and psychological causes of the illness. Most of the patients are young women.

Hochberg said the settlement, besides being fair, adequate and reasonable as required by law, will help "young people caught in a world they do not understand." -Henry Gottlieb, New Jersey Law Journal

In January 2010, when the U.S. Mental Health Parity Act goes into effect, all carriers will have to provide BBMI coverage for eating disorders to patients in employer-sponsored group health plans when employers have 51 or more employees. Small group and individual plans will be exempt from this requirement.

Considering the relatively higher costs of individual health insurance plans for women, it seems absurd that individual plans will not be required to offer this kind of coverage for patients (mostly young women) with eating disorders. If for years, medical experts have been deeming it necessary for these patients to receive prolonged outpatient treatment to recover, why is this kind of treatment not covered by insurance carriers except in special employer-sponsored circumstances?

Originally posted at InjuryBoard by Camryn Hansen

AIG = Abetting Irresponsible Gamblers. $165 Million in Bonuses to Execs Who Caused This Mess.

Camryn Hansen — Tue, 17 Mar 2009 12:23:25 GMT

So how we should be feeling about AIG’s decision to pay out more than $165 million in employee bonuses and perks, some to the very employees who designed the risky credit schemes that ultimately brought the insurance giant down, ostensibly because it is “legally obligated” to do so.

Furious, that’s how.

“It's hard to understand how derivative traders at AIG warranted any bonuses, much less $165-million in extra pay,” Mr. Obama complained at the White House. “How do they justify this outrage to the taxpayers who are keeping the company afloat?” -Mimi Hall et al., USA Today.

How indeed. The $165 million is only available for the company to hand out because it took $170 billion in bailout money from the federal government. Last December, in a letter to the White House, AIG Chairman Edward Liddy (former CEO of noted insurance cheat Allstate) vowed with his tail between his legs that he would be cutting bonuses this year. Now that they’ve got the money in hand, they’re unrepentantly—I daresay flagrantly—dolling it out to the very executives who got us into this mess, at as much as $6.5 million a pop.

What should really gall us is that after playing (and losing) irresponsible high stakes games with the financial stability of the entire world, these guys are defending their outrageous bonuses with a responsible nod of the head to their “legal responsibilities” in the matter.

In the letter to Geithner, Liddy said the unit's 25 highest-paid contract employees will reduce their salaries to $1 this year and all other officers in the unit will reduce their salaries by 10 percent. Other "non-cash compensation" will be reduced or eliminated. But he told Geithner that some bonus payments are binding legal obligations of the company, and "there are serious legal, as well as business consequences for not paying." -CNN

Barack Obama has promised to pursue “every legal avenue” possible to keep AIG employees from pocketing the bonuses. If federal laws have somehow made it possible for this company to gamble away taxpayer money without any legal recourse, and yet protect itself with the law when it turns a bailout sponsored by the taxpayers into bonuses for the unruly gamblers themselves, we really, really have a problem on our hands.

To quote Rep. Barney Frank, “Maybe it's time to fire some people. We can't keep them from getting the bonuses, but we can keep them from continuing in their jobs.”

Originally posted at InjuryBoard by Camryn Hansen

Anthem Blue Cross Pays $1 Million Fine for Dropping Customers With Expensive Bills

Camryn Hansen — Wed, 11 Feb 2009 21:31:23 GMT

As part of its recent settlement with the state of California, Anthem Blue Cross has agreed to pay a $1 million fine and take back 2,330 insurance customers it had dropped for submitting expensive hospital and doctor bills (i.e. for asking that their claims be paid by their insurance company). The company has also agreed to reimburse its dropped customers for the medical expenses they were forced to assume when their insurance quit on them.

According to Anthem Blue Cross estimates, the latter costs will total about $14 million.

“The settlement is a significant step toward ending rescission practices that can devastate consumers already weakened in their battle against illness,” Insurance Commissioner Steve Poizner said.

The settlement was far smaller than the $10 million settlement the company paid last July to a different state regulator, the Department of Managed Care, for another 1,770 members with health maintenance organization policies who were dropped for similar reasons.

Anthem said the consumers would be welcomed back within the next 90 days without strings attached. -AP

Anthem Blue Cross will still have to reckon with individual and class-action lawsuits on the part of dropped and no doubt indignant insurance customers, whether or not they’re welcomed back.

Originally posted at InjuryBoard by Camryn Hansen

Allstate is Cooking the Books.

Mike Ferrara — Sun, 08 Feb 2009 22:42:07 GMT

Allstate is already well known for collecting exorbitant premiums and simultaneously refusing to pay reasonable claims to customers, forcing them instead to either endure years of litigation while their bills go unpaid, or settle for a fraction of the claims they deserve.

Evidence in Allstate company reports shows that the American insurance giant has also been fudging its numbers to appear financially stronger in the crumbling economy than it actually is.

According to The Washington Post, Allstate has made at least two “account changes” adding erroneous funds to their assets: one for $347 million and another for $365 million.

In the economic crunch, Allstate and other insurers have been asking insurance regulators to either let them operate with less of a financial cushion than before, or simply approve “account changes” that make the cushion they have just look larger. The regulators have been more or less amenable.

Allstate's home regulator in Illinois approved one of the company's accounting changes during the fourth quarter of last year, retroactive to Sept. 30, Allstate reported.

The company made the other change anticipating that the National Association of Insurance Commissioners would later endorse the approach, Allstate spokeswoman Maryellen Thielen said. Instead, the NAIC executive committee rejected the proposal on Jan. 29, leaving the question for individual states to resolve, Thielen said in an e-mail.

In a Jan. 29 conference call with investment analysts, Allstate executives said they already had regulators' blessing.

“They look at it favorably because it's indicative of the strength of the company,” Allstate Controller Samuel Pilch said when an analyst asked about the approximately $700 million of capital the company generated through accounting changes. – David S. Hilzenrath, The Washington Post

The blatant refusal on the part of regulators to responsibly regulate Allstate or any other insurer means that individual states will be given the power to approve or reject insurance companies’ accounting practices, determining how successful each company appears to the public and in turn, how the public chooses insurers. Companies will soon be reporting their financial standing differently from state to state, and the already confusing process of choosing and keeping an insurance company will become virtually impossible from the standpoint of a company’s financial health—and accordingly, its likelihood of actually covering you in the event of an accident.

Originally posted at InjuryBoard by Mike Ferrara

For Majority, Losing a Job Means Losing Health Insurance – Economic Stimulus Package May Help

Camryn Hansen — Fri, 06 Feb 2009 20:53:34 GMT

The majority of low-income Americans who lose their jobs are also financially forced to go without health insurance, a new report by consumer health organization Families USA revealed this week.

According to the report, a full 54% of the country’s unemployed workers making about double the poverty level (about $44,100 for a family of four) cannot afford private health insurance, but are also not eligible for Medicaid.

Moreover, COBRA continuation coverage, a government initiative which allows laid-off employees to retain their employer-based insurance for a period of time at the employees’ own expense—this means laid-off workers can keep their formerly subsidized insurance plans if they assume the full cost of the premiums—is prohibitively expensive throughout most of the country. In 41 states, including New York and Pennsylvania, the cost of COBRA family coverage eats up a staggering three fourths the average amount of unemployment benefits.

“Most laid-off workers can't afford COBRA coverage and do not qualify for public health safety-net programs,” said Ron Pollack, executive director of Families USA. “As a result, millions of middle-class and lower-income workers become uninsured.”

In 43 states, Pollack said, Medicaid is simply unavailable for adults who don't have children — unless they are permanently disabled.

“Even if those adults are penniless, they are ineligible.” -AP

The House version of the economic stimulus package currently under consideration in Congress stands to offer some insurance relief to the recently unemployed and their families, by providing “a subsidy of 65 percent, almost two-thirds of the COBRA premium costs to families and workers who are seeking COBRA coverage. This assistance would be extended for a 12-month period,” according to Pollack. The House bill also would make the federal Medicaid health insurance program available to laid-off workers who meet particular income requirements. (The Senate version of the package only offers COBRA assistance for nine months, and does not make Medicaid available to laid-off workers.)

While some Americans who feel secure in their jobs and/or in their health insurance plans cling to the idea that these problems do not affect them, the skyrocketing cost of treating the uninsured ultimately forces many hospitals to cut the services they offer to all of their patients. Families USA has also calculated that the cost of medical services for uninsured Americans increases annual health insurance premiums by an average of $341 for individuals and $922 for families.

Originally posted at InjuryBoard by Camryn Hansen