See §127.755 of the Pennsylvania Workers Compensation Code for the full section of the code.  Be sure browse the website for other helpful tips on subjects like motor vehicle accidents, premises liability (slip and fall) accidents, and more.

My argument to the judge and the defense attorney is that it would be unusual if the patient did not experience low back pain one month post-accident.  Aside from the ridiculousness of the insurance company’s position, what is most important is that the provider in question was not aware that he had four years from the date of the accident, or from the last payment by the insurance company (whichever date is later) to initiate a lawsuit to get his money back.  Not knowing this fact, the chiropractor had essentially written off the monies as a loss.

In this regard, it should be noted that my office does this type of work on a contingent basis.  This means that if there is no recovery for the provider, there is no fee except the initial court filing fee.  (In Philadelphia Municipal Court, where these cases are most often filed, the filing fee ranges between $56 and $132.)  If you are having trouble getting paid by an insurance company, contact my office for a consultation.

With Full Tort coverage, a driver who has been in an accident is able to recover monies through litigation for both economic damages (i.e. property damage, lost wages, etc.) and pain and suffering.  This means that should the driver be injured in an accident through someone else’s negligence, they can potentially obtain a recovery representing the full extent of the damage done in the accident.  This type of coverage is especially helpful when an auto accident causes long-term chronic pain.

Limited Tort coverage is a bit more, well, limited.  In exchange for lower monthly premiums, a driver with Limited Tort insurance coverage gives up the right to sue for pain and suffering.  This means that a driver can only recover economic damages like damage to the vehicle, medical expenses immediately resulting from the accident, or lost wages.

There are, however, some exceptions that allow an accident victim to overcome the restrictions of Limited Tort coverage.  For instance, the Pennsylvania Motor Vehicle Financial Responsibility Law (MVFRL) allows drivers with Limited Tort policies to sue for pain and suffering if they have sustained a “serious injury” resulting in “death, serious impairment of body function or permanent serious disfigurement.” (75 Pa.C.S.A. § 1702)  In practice, this exception has generally not included soft-tissue injuries like sprains or even most bone or head injuries.

In recent weeks, however, there has been some indication that courts are willing to consider awarding monies for pain and suffering to individuals with Limited Tort coverage whose injuries do not, at face value, appear to meet the “serious injury” threshold described in the statute.  In Harlan v. Pennsylvania State Police, et al., (PICS Case No. 10-1506 (C.P. Pa. [Lawrence County] March 4, 2010), a judge ruled that a Limited Tort plaintiff’s case should not be dismissed, even though he did not suffer the types of injuries usually necessary to overcome the restrictions on Limited Tort.  According to Pennsylvania Law Weekly, the plaintiff “suffered injuries to his left arm, left shoulder, left wrist, neck, back, and head.”  Months after the accident, the plaintiff underwent three surgeries, missing a total of five months of work.  He continued to experience pain and loss of feeling on his left side, and as a result was limited in his ability to perform “daily tasks including driving and mowing the lawn.”  The court found that because the plaintiff’s household and recreational activities have been altered for the foreseeable future, it is up to a jury to decide whether or not this constitutes a “serious injury” under the MVFRL. (Pennsylvania Law Weekly, March 30, 2010, p. 17-18).

Because the potential for a major financial recovery is often diminished under the MVFRL, many attorneys are unwilling to pursue Limited Tort cases.  Jules Zacher, Esquire, however does accept Limited Tort cases, provided they have legal merit.  If you have been injured in an auto accident, please visit the Contact Us page of this website, and fill out a questionnaire.

At the March 10, 2010 rally, Obama emphasized the gravity of the initiative. “The health care system has billions of dollars that should go to patient care,” Obama said, “and they’re lost each and every year to fraud, to abuse, to massive subsidies that line the pockets of the insurance industry.”

If passed, the Improper Payments Elimination and Recovery Act (H.R. 3393) would require government agencies to hire auditors to investigate fraudulent claims. Administration officials have said that pilot programs run in three states between 2005 and 2008 recovered $900 million worth of fraudulent or incorrect claims.

But how can medical providers be sure they’re on the right side of these rules?

We at Jules Zacher, P.C. are pleased to announce that in an effort to provide fuller service to chiropractors, we have recently begun working with Jason Martin, an attorney with his own firm who has special expertise in health care law, to help medical providers navigate federal regulations on payment. Jason’s advice can help you avoid a costly and unpleasant audit in the face of complex regulations.

Make sure you and your practice aren’t on the wrong side of these regulations; contact Jules Zacher, P.C. today.

Know Your Rights: The Law of Automobile Accidents

Know Your Rights: The Law of Workers Compensation

Know Your Rights: The Law of Premises Liability

]]> http://www.juleszacher.com/2010/02/02/pamphlets-now-available-for-download/feed/ 0 http://www.juleszacher.com/2010/01/22/video-getting-providers-paid/ http://www.juleszacher.com/2010/01/22/video-getting-providers-paid/#comments Fri, 22 Jan 2010 22:10:06 +0000 jzacher http://www.juleszacher.com/?p=297 We at Jules Zacher P.C. are pleased to introduce a new feature to www.juleszacher.com, namely, informational videos concerning legal issues that affect the practices of medical providers.

The first such video, entitled “Getting Providers Paid” covers some of the basics of Act 6, and details some of the options available to providers who have been denied payment by insurance companies.

Please visit the following link to view the video:

Getting Providers Paid.

While this issue has not been the subject of a binding appellate decision in Pennsylvania, the better view is that Section 69.21 of the Insurance Code requires payment for necessary procedures within a provider’s scope of practice even if he would not be paid by Medicare. If an insurance company is refusing to pay you for radiological procedures, you do not need to accept that determination. Contact my office for information on how you can protect your rights.

Robin Perkins was struck by a car while she was walking in a grocery store parking lot. She was insured by State Farm (her motor vehicle insurance policy covered her even though she was a pedestrian) who refused to pay for her chiropractic care based on a peer review performed by another chiropractor well known to do this type of work.

The Court said, and it is correct, that there has been conflicting results in Pennsylvania as to whether Act 6 provides the exclusive remedy for the patient’s claim against State Farm, or whether she can bring a bad faith claim under the Bad Faith Statute (Section 8371), which provides for punitive damages.

Although the Pennsylvania Supreme Court has not weighed in yet to resolve the conflict, the U.S. District Court, following the Schwartz opinion in the Third Circuit, ruled that such care is in fact dependant to determine whether the patient can bring a bad faith action. In this case, the patient argued that the peer reviewer does substantial work for State Farm and therefore has a financial interest in providing a biased peer review. Further, the patient alleged that the peer reviewer repeatedly gave negative peer reviews to State Farm in order to maintain its relationship with State Farm. These allegations are not part of what Act 6 covers and therefore the patient could go forward with her bad faith claim.