Another reason for Health Insurance Reform

It is no secret that the current Health Insurance system in America is not working. Whether you agree or disagree with the tenets of the Affordable Care Act that is now in front of the US Supreme Court, nobody can argue that the current health care system isn’t broke. It is.

Here is another example of why we need reform – a report from the News & Observer that non-profit hospitals which are supposed to be providing “charity care” to the poor, aren’t.

Charity care is health care that is provided to poor patients who lack health insurance. In return for their non-profit status, the hospitals are expected to write off the bills of patients who lack insurance and are financially needy. However, nearly 2 out of every 3 patients that would otherwise qualify for charity care are not even informed that is exists.

And when charity care is offered, it is often in the form of promissory notes with steep consequences if the patient fails to pay on time. In this report, the patient profiled was offered a promissory note in which 1/2 of her $5,000 debt would be forgiven if she made payments on time and paid off the other half of the balance. If she failed to pay, the entire balance would immediately become due, along with collection costs and legal fees. Where I’m from, those unconscionable contracts are illegal forms of “usury” agreements. The patient in the article refused to sign the agreement and is still being hounded by collections agencies.

It is my hope that articles like this will draw attention to these “non-profit” hospitals, such as Person Memorial Hospital in Roxboro, so that the state can take a closer look at their non-profit status.

Additionally, in my opinion, this is just another glaring example of why we need an individual mandate. If this patient had health insurance, all of a sudden she does not have a huge medical bill looming that she cannot afford to pay. Additionally, the hospitals will save money on collection efforts and unpaid medical bills, which are ultimately passed on to those of us that DO have health insurance.

Finally, the individual mandate would eliminate shady businesses such as AccessOne, a credit card company that offers interest free options to pay off medical bills. However, when payments are missed, rates will rise sharply. Interestingly, this company was started by a doctor who wanted to solve the problem of patients who can’t pay their medical bills.

 

Principal shot on way to work suffered a compensable injury

On April 9, 2009, James Hunt, a principal at Fairmount Middle School in Lumberton, was shot on his way to work. Earlier this month, the Court of Appeals affirmed a decision determining that Mr. Hunt suffered an injury that arose out of and was within the scope of his employment. (A full copy of the opinion can be found here).

The central issue in this case was something called the “coming and going rule”. Generally speaking, if you are in some type of accident while driving to or from work, it is not a compensable “injury by accident”, the standard required to have a compensable workers compensation injury in North Carolina. However, there are exceptions to this rule, and it appears that the Court of Appeals has carved out another exception in this case.

The Court of Appeals looked at several things in coming to this conclusion. First, evidence was presented to suggest that the shooting was related to Mr. Hunt’s anti-gang activities at the school. Second, the Court of Appeals found evidence that Mr. Hunt was on his cell phone with a school staff member at the time of the shooting. In addition, the phone he was using was paid for by the school district.

Finally, the Court of Appeals looked to the exceptions to the coming and going rule, one of which is called the “contractual duty” exception. Under this exception, if the employer provides transportation or allowances to cover the cost of transportation, than an exception applies. Because Mr. Hunt was provided a travel allowance, then this exception applied.

I find this to be an extremely interesting case that shows just how complicated the workers compensation laws in this state can be. Very few cases are so black and white that they are either compensable or not. There are many shades of gray – and the facts of these cases are all too important.

 

 

Workers’ Comp Mileage Rates in NC

Did you know that if you have to travel farther than 20 miles roundtrip to attend an appointment for medical treatment, you are entitled to reimbursement from the workers’ comp insurance carrier?

Per the North Carolina Industrial Commission, the IRS mileage rate for January 1, 2011 through June 30, 2011 is $0.51 per mile. On July 1, 2011, the IRS mileage rate was increased to $0.555 per mile and applies to travel for medical treatment on or after July 1, 2011.

Click here to review a copy of the Form 25T that is used to submit your mileage for reimbursement. If you are a client of The Hart Law Firm, please email or fax the completed form to our office and we will submit the form for reimbursement on your behalf.

Ethical Boundaries of Discovery in Social Media

Today I gave a presentation for NBI on Ethics and Social Media.  Following is a link to my manuscript on the Ethical Boundaries of Discovery.

Ethical Boundaries of Discovery – Manuscript from presentation on December 15, 2011

Why do I need a lawyer for my Workers Comp case?

Lot’s of people believe that they have no need for a Workers Comp lawyer.  This could be for a number of reasons, including:  they don’t think they have a claim or don’t wish to file a claim, they believe that the system is “fair” and they they can handle their case on their own, or perhaps they just don’t like attorneys and don’t want to hire one.  Still others are scared of some sort of retaliation by their employer (which is illegal, by the way).

Obviously, I am a bit biased here, but if you have been injured at work, and there is any chance at all that you might miss a prolonged period of work, I strongly recommend that you contact a lawyer.  Here are a couple of reasons why:

  1. Worker’s Comp lawyers generally will not charge you for the initial consultation
  2. There are a lot of “issues” or “disputes” that might arise that would most people won’t fully comprehend
  3. A lawyer can help you the most when they have been involved from the very beginning – i.e. they can coach you through the recorded statement and other communications with the insurance company
  4. They can answer your questions so that even if you decide to proceed without a lawyer, you will have information you need

Although workers comp may appear to be fairly straight-forward and simple, there are a number of “disputes” that can arise during the course of your case.  One dispute might be as to the amount of your weekly average wage, another might be as to your right to be compensated at all.

When the employer has workers comp claims made against it, the insurance company will increase the insurance premiums it collects to cover the increased risk of future claims or payouts.  Accordingly, the employer has a substantial incentive to decrease the number of claims filed against it, and assist in getting them settled for as little as possible – leading to conflict between the worker and the employer when there is a potential claim.

On the flip side, the insurance company makes money by paying out as little money as possible.  They have lots of very smart attorneys working for them to interpret the rules and statutes in a way that most favors the insurance company – which leads to lots of “disputes”.

Many people feel that they don’t need an attorney if the insurance company accepts their claim.  However, even in those cases where liability is undisputed, the lawyers working for the insurance company will make sure that you are paid the least amount possible – sometimes much less than you would receive with competent counsel.

If you have been injured at work and aren’t sure about your rights, give us a call at (919) 460-5422 for a free consultation.

The Rehab Nurse – Who do they really work for?

If the insurance company decides to accept liability for your workers comp claim, then they are able to direct your care.  As part of that care, the insurance adjuster will assign you to what is called a Rehabilitation Nurse to manage your care.  According to the NC Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims, the purpose of these Rehabilitation Counselors is to provide for the “medical and vocational rehabilitation of the injured worker”.

The North Carolina Industrial Commission has also provided a brief summary of these “Rehab Rules” for the injured worker.

Although the Rehab Professional is supposed to be working to help you with your care, in reality they are working for and with the insurance company to assist in the effort to terminate your Worker’s Compensation benefits.  The Rehab nurse is an employee of the insurance company, and often times works side-by-side with the adjuster assigned to your case.  These nurses have a clear understanding of who signs their paychecks and how their company makes money.  No bones about it – they will do what they can to turn off your benefit checks.

While we encourage all of our clients to follow closely the instructions of the Rehab nurse very carefully, there are some things that you need to watch out for which are clear violations of the Rehab Rules outlined above.  If you nurse engages in any of the following behaviors, it is a violation of the Rehab Rules and you should contact an attorney immediately:

  1. They attempt to tell the doctor what to do or when to release you to return to work;
  2. They attempt to tell the doctor where to send you for an MRI or physical therapy, or they tell the doctor which specialist to refer you to;
  3. They attempt to give you legal advice regarding the merits of your claim or tell you what will happen if you go back to work;
  4. They are corresponding with doctors or other healthcare providers or to the insurance adjuster without copying you on those communications;
  5. They are talking to your doctor without you being present, or they insist on sitting in on your examination with your doctor; or,
  6. They try to get you to sign a release that authorizes them to talk to your doctor without you being present.

There is another type of rehabilitation specialist called a Vocational Rehab professional, whose job is to find you a new job.  The pitfalls related to these professionals will be discussed in a future post.