Today's post is different from the series I started a few weeks ago. I heard a story about pending litigation, and I can't let it pass without comment. I will not disclose the name of a lawyer or a party to protect innocent and less innocent people!
For ERISA programs, medical malpractice cases are often complex. In most cases, there is a period of medical care, the date the medical incident occurred, and more treatments to resolve the medical incident. It is usually not difficult to determine the date of a medical incident and separate the medical expenses associated with the medical incident from the unrelated medical expenses.
But sometimes, the plaintiff's lawyers try to defend the defense lawyers. For example, $50,000 in medical expenses is related to medical expenses, and then the health plan related to medical expenses of only $5,000 is hurt, trying to debate their two sides. .
We have done a good job in dealing with this approach for many years, citing the Klapperich case we won in the USC in the northern part of Illinois in the late 1990s.
However, another case I have heard recently makes me laugh at the absurd position taken by health plan lawyers. The case also reminds me that HR representatives and risk managers understand the importance of your health care subrogation case. I bet that no one really knows the positions taken by these lawyers.
In this case, the program paid $95,000 in medical expenses before the medical incident and $5,000 in medical expenses after the medical incident. The plaintiff always argued in the litigation and reconciliation discussions with the doctor that only $5,000 was relevant.
The health plan intervened in the federal court's medical malpractice lawsuit. In the end, the plan was told that expert testimony must be provided to prove that the wrongful act was relevant. Do you think that the lawyers of the program can determine the medical expenses incurred before the medical accident occurred? Neither do I. [By the way, I am not saying that the health plan has no time to retain expert testimony, and these testimonies may be more effective than the experts employed by the members, but not such cases].
In one of the speeches, the lawyer of the program, after accepting the challenge of his method, allegedly said "but we are ERISA"! "I thought we just said ' ERISA' we got paid"! No, it won't work that way! He will learn the lesson soon.
Orignal From: Medical malpractice and health care subrogation: You can't just say "ERISA" and get healthy
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