For years personal injury insurance companies have been claiming fraud is getting more and more out of hand. Over the past several years, even with an incredibly poor economy we've seen companies like State Farm have record setting profits of $800 Million in 2009 and $1.2 Billion in 2010.
So with these claims come suspicion as to their motivation. Why would a company and an industry that's doing so well and so profitable claim fraud is killing their profits and causing greater losses to their company??
Profits. Pure and simple.
According to some, the claims of fraud are a "smokescreen to hide padded profits".
This wouldn't be the first time the public trust has been compromised, politicians in hand in order for corporate profits (anyone remember Fannie & Freddie??).
Read more in this great article entitled: Claude Hanuschak: PIP fraud is exaggerated
So when the politicians start with the TV and Radio ads blaming your local doctors and attorneys, remember this blog post and Claude's words... PIP Fraud Is Exaggerated; all because they want to charge YOU higher premiums!
Friday, January 20, 2012
Monday, August 29, 2011
New Insurance Tactics: Intimidating Doctors that Supports Plaintiffs’ Injuries
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| Mark Bello |
The lawsuit alleges that New York medical professional corporations were fraudulently incorporated using the names of licensed physicians although laypersons actually owned and controlled the corporations; it is a violation under New York law for non-medical professionals to own a medical company. Allstate also contends that the laypersons submitted fraudulent insurance claims for unnecessary medical tests. The claims were filed under patients' insurance policies as "no-fault” which would allow Allstate to quickly pay injured policyholders for their injuries without going to court. Since 2003, Allstate has filed 31 fraud lawsuits in New York, seeking more than $170 million in damages.
Allstate would have us believe that New York is in an insurance fraud crisis and no-fault fraud is costing New Yorkers hundreds of millions of dollars each year. Krista Conte, spokesperson for Allstate's New York office, said “we need lawmakers to enact meaningful “insurance reform” (buzz word for another corporate bailout for billion dollar insurance companies) that puts the citizens of New York first."
Not so fast, ladies and gentlemen; the problem is that Allstate has no credibility on these issues. Since when has this anti-citizen company ever put citizens first? Allstate has always put its’ profits over the interest of its policy holders, ALWAYS. What Allstate is attempting to do here is to intimidate those doctors who have the audacity to actually put the interests of injured citizens first and Allstate profits second. This is the same “delay, deny, confuse and refuse” tactic that Allstate has used for years in defending personal injury claims. Instead of taking on its citizen/policy holders directly in litigation (where it usually loses), to “delay, deny, confuse and refuse”, it is now attacking those doctors who treat (rather than whore their services to Allstate so that claims can be denied) patients who happen to be insured by the “good hands people”. Those in the know call the company “Allsnake”.
Was Allstate dealt the same “bad hand” they deal their policy holders? Unlike what Allstate wants the general public to believe, fraud in the insurance industry in not a one-way street. While claims fraud should be addressed, Allstate’s “good hands” need to be thoroughly washed to clean the filth of unreasonableness and dishonest claims handling perpetrated on its own policy holders and those its policy holders seriously injure.
This is how Allstate’s (and other insurance companies’) deceptive tactics work: A policy holder files a no-fault claim or an injury victim files a tort claim. Allstate hires its own doctors, which the company calls Independent Medical Examiners (IMEs) to perform an examination of the plaintiff and review medical records and tests. The IME will also testify at trial, if necessary. If these physicians were truly “independent”, this might be a reasonable way to evaluate the validity of a claim. Unfortunately that is not the case; Allstate (and its ilk) retain the services of the same doctors in communities all across the country and instruct them to perform “cursory” evaluations of injury victims, typically lasting no more than 15 minutes to a half hour. These doctors are rarely in current practice (often retired), often do only defense exams, and are paid millions of dollars a year to produce negative results. Millions of dollars added to the cost of litigation (instead of toward the compensation of the victims) are used to pay doctors for hire, whose sole purpose is to provide test results and testimony that plaintiffs have not suffered injuries or that the accidents at issue did not cause their health problems. This tactic gives Allstate “cover” when it denies a claim and forces litigation. A “win at all cost” mentality exists, even if it means mistreating its own policy holders.
Allstate has made an art form of manipulating the justice system to rake injury victims and its own policy holders out billions of dollars, first through denying, delaying, and defending legitimate lawsuits, then low-balling the victims that its tactics have made financially desperate. And now, its new tactic is to claim that insured’s and their treating doctors are defrauding the company.
If you are injured in an auto accident, Allstate will likely challenge your claim, drag you into court, and take as long as possible, often years, before making an offer; an offer that is usually significantly less than the value of your claim. You are in “Greedy Hands with Allstate”; this is a company that believes its money is better spent dragging innocent victims through court rather than helping them in a time of need. Remember, the bottom line for Allstate is profit, profit, and more profit.
Tactics like this “fraud lawsuit” are designed to intimidate treating doctors and send a message that cases are “frivolous” and claims are “fraudulent”; the reality is that the tactics of Allstate and other insurance companies that engage in similar claims avoidance conduct are far more costly to the litigation process than anything done on the claimant side. Politicians should be screaming about “frivolous defenses”, not about so-called “frivolous lawsuits”. One case at a time, one jury at a time, a trial lawyer can attack these tactics, expose corporate greed, and show each jury that bought and paid for medical testimony is, simply, not credible. Trial results often reflect that. But public spectacles like the effort in New York put “fraud” and “frivolous” in the minds of the public (prospective jurors) and it is hard to compete, financially, with billion dollar insurance companies and other industries that would rather spend profits on phony “lawsuit abuse” campaigns that pay seriously injured accident victims. And until the general public wakes up and realizes the wool is being pulled over its eyes, access to justice for our fellow citizens will continue to be denied.
Imagine being seriously injured; you visit an emergency room or your family doctor. You are referred to a specialist and incur thousands of dollars in medical treatment expenses. You submit the claim to your own insurance company (the one you have been paying premiums to for years, despite a spotless claims record) only to have the claim denied because the company sent you to its so-called “expert”, and paid this “independent doctor” a significant amount of money to favor the insurance company’s position on the claim. The defense exams are for the sole purpose of a “little or nothing is wrong” diagnosis. My friends, what is your definition of “fraud”?
Using phrases like “lawsuit abuse”, “citizens against lawsuit abuse”, “tort reform”, “liability reform”, “frivolous lawsuit”, “jackpot justice”, and “insurance reform”, these companies and their lobbying arm, the U.S. Chamber of Commerce are falsely linking personal injury litigation to the cost of health care in this country. In reality, litigation is an irrelevant percentage of the overall cost of healthcare. Google ™ any legitimate, independent, study (not one by trial lawyers, insurance companies, or corporate interests), those conducted by or for Public Citizen, for example, on this issue and you will find that industry claims of any kind of litigation crisis in America is an absolute myth. You will find that the cost of litigation in relation to health care is miniscule. Corporate interests are pumping millions (instead of paying appropriate benefits to policy holders) in a deceptive marketing campaign and into the political campaigns of conservative politicians like Rick Perry and Mitt Romney to say that “corporations are people” and need our assistance against the “greedy trial lawyers”. This, of course, is nonsense, but it has had some success, especially in the political arena, where some politicians will cozy up to the devil himself if it means a steady flow of campaign dollars.
So, how do you stop this corporate takeover of our civil justice system? How do you prevent insurance companies from deceiving its policy holders? How do you prevent corporate interests and their political hacks from trampling on your constitutional rights? With you voice and with you vote; that is how you must beat them. And you should act before you become an accident victim, forced to go toe to toe with an insurance company that will use its economic power (achieved with your premium dollars) to crush you. Contact your local, state and federal elected representatives; find out where they stand on these important issues. If they stand with the corporations and the tort reformers, tell them they can’t have your vote. And if they refuse to see things your way, vote for the “other guy”. Together, we must combat and put an end to the deceptive corporate takeover of our precious civil justice system.
Reference: http://southfield.injuryboard.com/miscellaneous/new-insurance-tactics-intimidate-doctors-who-provide-reports-and-treatment-that-supports-plaintiffs-injuries.aspx?googleid=293730
Mark Bello has thirty-three years experience as a trial lawyer and twelve years as an underwriter and situational analyst in the lawsuit funding industry. He is the owner and founder of Lawsuit Financial Corporation which helps provide legal finance cash flow solutions and consulting when necessities of life litigation funding is needed by plaintiffs involved in pending, personal injury litigation. Bello is a Justice Pac member of the American Association for Justice, Sustaining and Justice Pac member of the Michigan Association for Justice, Business Associate of the Florida, Tennessee, and Colorado Associations for Justice, a member of the American Bar Association as well as their ABA Advisory Committee, the State Bar of Michigan and the Injury Board.
Monday, August 8, 2011
Florida PIP; One Newspaper Call For Repairs - Not Replacement.
The Orlando Sentinel weighs in on the upcoming battle that will surely pit the big business auto insurers against your local doctor and, if you drive a car, against you.
Pointing out that if you "Remove the PIP requirement, motorists will pay substantially more for their health insurance, which increasingly would cover auto injuries. More deadbeats also will drive without insurance, forcing others to pay for their care after accidents".
The Orlando Sentinel is calling for repairs of the PIP system, not replacing the system with something else. "Where it looks like you'll save on auto insurance, you'll end up paying more for health insurance", points out the newspaper.
The auto insurers also would love to replace a diminished personal injury protection (PIP) system with one mandating more expensive — and more profitable — bodily-injury protection. Let's remember, this is big business and it's all about big profits. Under the current system, last year (2010) State Farm's profits surpassed the billion dollar mark, up from $900 million in 2009.
So, with profits so high why all the complaints? Well, quite frankly it's a chance to change the rules of the game to favor big insurance even greater than they do now.
The Orlando Sentinel has it right, don't scrap the current PIP program, rather have our legislators roll up their sleeves and fix what's broken in the current system. And, quite frankly it's not much. No matter what business, industry or profession, you will find a few bad apples. But to throw out an entire basket of good apples because there are a few bad ones seems like a waste of a lot of good apples. It's time for our legislature to pick out the bad apples and find out how they got there, then fix that part of the system.
If you had one bad employee would you close your business? or would you retrain or even re-hire a new one?
For more on the Orlando Sentenal's sentiments, click here for their entire article.
FPIB
Pointing out that if you "Remove the PIP requirement, motorists will pay substantially more for their health insurance, which increasingly would cover auto injuries. More deadbeats also will drive without insurance, forcing others to pay for their care after accidents".
The Orlando Sentinel is calling for repairs of the PIP system, not replacing the system with something else. "Where it looks like you'll save on auto insurance, you'll end up paying more for health insurance", points out the newspaper.
The auto insurers also would love to replace a diminished personal injury protection (PIP) system with one mandating more expensive — and more profitable — bodily-injury protection. Let's remember, this is big business and it's all about big profits. Under the current system, last year (2010) State Farm's profits surpassed the billion dollar mark, up from $900 million in 2009.
So, with profits so high why all the complaints? Well, quite frankly it's a chance to change the rules of the game to favor big insurance even greater than they do now.
The Orlando Sentinel has it right, don't scrap the current PIP program, rather have our legislators roll up their sleeves and fix what's broken in the current system. And, quite frankly it's not much. No matter what business, industry or profession, you will find a few bad apples. But to throw out an entire basket of good apples because there are a few bad ones seems like a waste of a lot of good apples. It's time for our legislature to pick out the bad apples and find out how they got there, then fix that part of the system.
If you had one bad employee would you close your business? or would you retrain or even re-hire a new one?
For more on the Orlando Sentenal's sentiments, click here for their entire article.
FPIB
Thursday, June 2, 2011
PIP Benefits Cannot Be Denied If Patient Doesn't Show for IME or EUO-Florida Supreme Court Denies United Auto Rehearing
Tuesday, May 24, 2011
On May 18, 2011, the Supreme Court of Florida entered an order denying United Automobile Insurance Company's ("UAIC") motion for rehearing and request for oral argument in Custer Medical Center v. United Automobile Insurance Company, 2010 WL 4340809 (Fla. Nov. 4, 2010) (Case No. Sc08-2036). The Court contemporaneously entered additional orders relating to ancillary motions and amici briefs. One of the Court's orders struck all amici briefs filed in the case, including briefs filed by numerous industry trade associations, insurance companies, and even the NCIB. Other orders denied motions filed in the case which were rendered moot by the court's denial of UAIC's motion for rehearing.
The Custer opinion, issued on November 4, 2010, contained language ancillary to the case's holding, known as dicta, that frustrates the purpose of the anti-fraud provisions of the personal injury protection ("PIP") statutes. The dicta opined that:
Florida Supreme Court Denies Rehearing of its Opinion in Custer Medical Center v. UAIC - United Automobile Insurance Company
The Custer opinion, issued on November 4, 2010, contained language ancillary to the case's holding, known as dicta, that frustrates the purpose of the anti-fraud provisions of the personal injury protection ("PIP") statutes. The dicta opined that:
- PIP policy provisions that do not directly mirror the PIP statutes may be unenforceable.
- Unless otherwise provided by statute, a PIP carrier may not deny payment of medical expenses incurred and submitted by the insured prior to the date of a scheduled independent medical exam ("IME"), even if an insured does not attend the IME.
- Unless otherwise provided by statute, a PIP carrier may only deny payment of an insured's medical expenses incurred and submitted after the date of the IME if the carrier can affirmatively prove the unreasonableness of an insured's failure to attend an IME. Thus, the burden of proving the unreasonableness of the insured's action/non-action rests with the insurer.
- Denial of benefits for an insured's failure to submit to an examination under oath without counsel ("EUO") may no longer be permissible, as the Court points out that EUOs are not expressly permitted under the PIP statutes.
Tuesday, April 12, 2011
PIP 'Reforms' Disguise Insurance Industry Profit Grab
Reprinted / reposted from: http://www.sunshinestatenews.com/story/pip-reforms-disguise-insurance-industry-profit-grab
Proposed legislation writes loopholes into the law to help insurers
Recently, I read a commentary on your site from yet another special-interest group funded by the powerful insurance industry, with a name that sounds as if they are looking out for the interests of Florida’s consumers.
Your readers need to understand, however, that these so-called “consumer groups” are part of the insurance industry’s public relations engine, which is using the seemingly admirable mantra of reducing PIP fraud to disguise their real intentions of making it easier to delay or deny payments on legitimate PIP claims.
The statistics that often are cited are misleading at best. Let’s be clear: PIP fraud is wrong and must be stopped; but Florida consumers are being blatantly misled by these various consumer groups proclaiming that PIP fraud is rampant and is costing all Floridians significantly in what they pay for PIP.
Insurance companies are continuing to earn record profits, and they are continuing to look for ways to reduce what they pay for legitimate PIP claims. And, contrary to representations made by the various consumer groups, PIP premiums have not gone up in years. Clearly, there is no shortage of insurers fighting for your business – just take notice of all the advertisements and solicitations consumers see every day.
To fuel the uproar, consumer groups keep telling us that PIP fraud is rampant because “questionable claims” in Florida are on the rise. But, has anyone ever stopped to ask what a questionable claim really is?
The term most frequently used is in conjunction with data from the National Insurance Crime Bureau (NICB). As the NICB would confirm, questionable claims are simply initial claims referred to them from their member insurance companies based on what those companies believe to be "questionable" or "suspicious." Such claims are not yet determined to be definitive acts of fraud.
In addition, it is significant to point out that when the number of PIP questionable claims in Florida, according to a March 22 NICB report, is compared to the total number of crashes in Florida (as compiled by the Florida Department of Highway Safety and Motor Vehicles), PIP questionable claims represent less than 1 percent of all crashes (2009: NICB – 2,347 PIP QCs/FLHSMV – 235,778 crashes). And, it is important to keep in mind that data from the Florida Division of Insurance Fraud show that only 4 percent of all reported possible PIP fraud claims it receives (about 5,500) result in prosecution.
So, is PIP fraud really as rampant as insurance companies want all of us to believe? No, it is not.
Some provisions in the proposed PIP legislation have nothing to do with fighting fraud and will instead create a potentially unreasonable burden for medical providers and policyholders to get legitimate bills paid and could lead to fewer medical providers willing to treat PIP patients.
One outrageous provision in the proposed legislation would require medical providers and policyholders to submit to deposition-like questioning, examinations under oath, before claims will be paid. Another provision would allow an insurance company to deny a claim if there is a simple typographical error on a bill or in the policyholder’s medical records. And, the law would limit the amount of legal fees the insurance company would have to pay if it is determined to have wrongly denied a claim. How do any of these provisions stop PIP fraud? They don’t.
If the proposed legislation becomes law, many insurance companies will take advantage of loopholes that will be created in order to make it expensive, time-consuming and frustrating for medical providers to treat PIP patients. That is not fair to consumers. Legitimately fighting fraud must be the real target. Please do not fall for the insurance industry rhetoric.
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Cris Boyar is president of Floridians for Fair Insurance. FFI seeks to reform policies in Florida known as “bad faith” insurance laws and to protect Florida’s small-business owners and consumers from the threat of lawsuit abuse.
Thursday, April 7, 2011
PIP fraud claims aren’t all they’re cracked up to be
From the Ft. Lauderdale Sun Sentinel
By Julie Patel, Sun Sentinel
Florida legislators are at work on laws, backed by major insurers and some consumer advocates, to combat what they say is “rampant” fraud by policyholders and health care providers filing PIP claims. The proposed legislation would, among other things, make it more difficult for people to file claims and for lawyers to collect huge fees.
Personal injury protection, or PIP, pays medical bills for policyholders injured in auto accidents, regardless of which driver is at fault. It’s intended to protect Floridians who don’t have health insurance and to avoid lawsuits and their costs for minor injuries. Florida drivers are required to carry $10,000 worth of coverage.
Lawmakers drafting legislation say there’s a “mountain of evidence” on PIP fraud, but most of the key data come from insurance industry groups, with some from the Department of Financial Service’s Division of Insurance Fraud.
Consider these points:
Florida legislators are at work on laws, backed by major insurers and some consumer advocates, to combat what they say is “rampant” fraud by policyholders and health care providers filing PIP claims. The proposed legislation would, among other things, make it more difficult for people to file claims and for lawyers to collect huge fees.
Personal injury protection, or PIP, pays medical bills for policyholders injured in auto accidents, regardless of which driver is at fault. It’s intended to protect Floridians who don’t have health insurance and to avoid lawsuits and their costs for minor injuries. Florida drivers are required to carry $10,000 worth of coverage.
Lawmakers drafting legislation say there’s a “mountain of evidence” on PIP fraud, but most of the key data come from insurance industry groups, with some from the Department of Financial Service’s Division of Insurance Fraud.
Consider these points:
- The average payout for a personal injury protection claim increased over the past seven years — but not enough to keep up with the inflation rate for health care.
- The conviction rate for suspicious personal injury claims has dropped since mid-2007, even though the state beefed up its fight against fraud.
- Each Florida driver’s premiums were about $50 higher last year, the insurance industry says, to cover the cost of fraudulent claims, what insurers call the “fraud tax.”
Monday, April 4, 2011
Claims Of Personal Injury PIP Fraud Are Grossly Exaggerated
Brilliance in just a few words. As in all professions, those that commit fraud are an extreme minority. They are the proverbial "squeaky wheel" that gets the oil. That being said, the author of this article points out that PIP fraud accounts for less than 1% of all the insurance fraud relating to automobile accidents. Yest companies like United Automobile & State Farm continue to pound the legislature with ridiculous claims that fraud is the industry standard rather than the exception to the rule. Let's not forget that with all the alleged growing fraud, State Farm still posted record profits of $800 Million in 2009 and $1.8 Billion in 2010. Wow, who knew that fraud would increase their year to year profits so much ? I wonder how that happened.
Anyway, here's a link to a fresh little article about the often hidden truths - Click here, read & enjoy
Wednesday, March 16, 2011
Proposed Florida Legislation Calls For "Fraud Tax"???
Here in Florida, a House subcommittee this morning approved a controversial bill that would limit fees for attorneys who sue insurance companies in disputes about so-called PIP claims...and here we go again.
Insurance companies cry foul when it comes to fraud because they say they are losing so much money due to fraudulent claims. This year not only were they promoting their agenda regarding PIP fraud and staged accidents, but suddenly sink holes too.
Please realize that an insurance company is a business like any other. So they try to wield their political influence in such a manor as to gain any business advantage in their market. Remember, they are in business to make a profit. And, there's nothing wrong with that. But when you run a company like State Farm and constantly tell people you're losing money to fraud when in 2009 you made a paltry $800,000,000.00 profit (yes, that's 800 million) and then in 2010 you increase your profits to $1,800,000,000.00 profit (that's 1.8 Billion in profit)...yet you continue to cry to your legislatures that fraud is continuing to harm your business, who do you think you're fooling?
No doubt that fraud should be stopped for no other reason than it's fraud and it's wrong. But if the stated statistics are true, then it seem that with the increase in fraud comes an increase in insurance company profits. I'm not sure how that works, but it seems to be the case.
But with all of the efforts that have taken place, one of the biggest reasons for a change in legislation is because fraud costs the consumers just way too much money...AND it's taking money out of the consumer's pockets. Yet, with all the legislation, with all the hoopla, with all the incredible profits posted by these insurance companies, I have yet to see one of them lower their premiums. None!
When do the consumers get to save money? How much does someone like State Farm or the others have to profit by to get them to stop raising rates? Maybe $1.9 Billion and we get a discount? Excuse me but I won't hold my breath.
The real fraud is that this is a game to the insurance companies. They cry fraud, they get their PR companies to get article after article in the newspapers and stories on TV all to justify their raising your rates... Good luck to them, let's see if you can make a $2-Billion Dollar profit in 2011.
Seems like in a down economy, being an insurance company would have been the best bet. People pay you for insurance and you get to deny their claims until an attorney calls you on it. Now, they want to limit an attorney's ability to protect the rights of citizens. Assuring their ability to increase their profits and rake you over the coals on their way to the bank to deposit their profits.
http://www.healthnewsflorida.org/top_story/read/state_officials_target_fraud_tax
Insurance companies cry foul when it comes to fraud because they say they are losing so much money due to fraudulent claims. This year not only were they promoting their agenda regarding PIP fraud and staged accidents, but suddenly sink holes too.
Please realize that an insurance company is a business like any other. So they try to wield their political influence in such a manor as to gain any business advantage in their market. Remember, they are in business to make a profit. And, there's nothing wrong with that. But when you run a company like State Farm and constantly tell people you're losing money to fraud when in 2009 you made a paltry $800,000,000.00 profit (yes, that's 800 million) and then in 2010 you increase your profits to $1,800,000,000.00 profit (that's 1.8 Billion in profit)...yet you continue to cry to your legislatures that fraud is continuing to harm your business, who do you think you're fooling?
No doubt that fraud should be stopped for no other reason than it's fraud and it's wrong. But if the stated statistics are true, then it seem that with the increase in fraud comes an increase in insurance company profits. I'm not sure how that works, but it seems to be the case.
But with all of the efforts that have taken place, one of the biggest reasons for a change in legislation is because fraud costs the consumers just way too much money...AND it's taking money out of the consumer's pockets. Yet, with all the legislation, with all the hoopla, with all the incredible profits posted by these insurance companies, I have yet to see one of them lower their premiums. None!
When do the consumers get to save money? How much does someone like State Farm or the others have to profit by to get them to stop raising rates? Maybe $1.9 Billion and we get a discount? Excuse me but I won't hold my breath.
The real fraud is that this is a game to the insurance companies. They cry fraud, they get their PR companies to get article after article in the newspapers and stories on TV all to justify their raising your rates... Good luck to them, let's see if you can make a $2-Billion Dollar profit in 2011.
Seems like in a down economy, being an insurance company would have been the best bet. People pay you for insurance and you get to deny their claims until an attorney calls you on it. Now, they want to limit an attorney's ability to protect the rights of citizens. Assuring their ability to increase their profits and rake you over the coals on their way to the bank to deposit their profits.
http://www.healthnewsflorida.org/top_story/read/state_officials_target_fraud_tax
Wednesday, March 2, 2011
State Farm Profits Double in 2010; Yet Says Losing Money Due To Fraud
Each year insurance companies for whatever section of the insurance market cry foul when it comes to fraud. They wine & dine our legislators, contribute large amounts of money to their re-election campaigns, give donations to they favorite charities all to get them to introduce legislation to curtail "fraud". Yet, time and time again, it seems as if the insurance companies continue to win big with their profits.
According to ChicagoBusiness.com, & The Chicago Tribune; State Farm has doubled its profits last year. They hide these facts yet throw up smoke screens of fraud and every turn. Why? Because it enables them to justify raising your rates for insurance. For details, click here to read the full story.
Just remember, there's a difference between losing money and not making as much profit. And as we now see, in spite of alleged fraud claims, State Farm (and I'm sure others) are profiting nicely. Especially in an economic environment where half of their policy holders are probably having difficulty paying their premiums, holding a job and keeping a roof over their families head.
I hope someone in the state legislature sees this before trying to introduce more crazy legislation to stem insurance fraud that is but a minor blip on the screen. You see last year, State Farm only made $800 million profit. This year, State Farm made $1.8 BILLION in profit.
You think now maybe you can pay my doctor and fix that dent in my car?
According to ChicagoBusiness.com, & The Chicago Tribune; State Farm has doubled its profits last year. They hide these facts yet throw up smoke screens of fraud and every turn. Why? Because it enables them to justify raising your rates for insurance. For details, click here to read the full story.
Just remember, there's a difference between losing money and not making as much profit. And as we now see, in spite of alleged fraud claims, State Farm (and I'm sure others) are profiting nicely. Especially in an economic environment where half of their policy holders are probably having difficulty paying their premiums, holding a job and keeping a roof over their families head.
I hope someone in the state legislature sees this before trying to introduce more crazy legislation to stem insurance fraud that is but a minor blip on the screen. You see last year, State Farm only made $800 million profit. This year, State Farm made $1.8 BILLION in profit.
You think now maybe you can pay my doctor and fix that dent in my car?
Thursday, November 4, 2010
United Automobile Insurance Company Tactics Get The Boot By The Supreme Court of Florida & Set New Legal Precident
No longer can an insurance company use a "No-Show" at an IME as the basis to deny a claim. Since EUO's are not part of the PIP statute, one can argue that a "No-Show" at an EUO also cannot be used as the basis to deny a claim.
The decision is still hot off the presses as it came down earlier today. To see all the details click on this link Cluster Medical Center a/a/o Maximo Masis v United Automobile Insurance Company
Friday, October 1, 2010
Insurance Adjusters & Appraisers Committing Insurance Fraud in Miami.
5 Insurance adjusters and appraisers commit fraud by taking kickbacks and payoffs.
If you've ever wondered why your insurance rates keep going up, read this and you'll begin to understand the story.
Read: Insurance adjusters commit fraud
If the link doesn't work, copy and paste this into your browser: http://www.sun-sentinel.com/news/local/florida/fl-adjusters-appraisers-charged-20101001,0,6297211.story
And I'm sure if the arresting investigators poked around more, they'd find bigger fish at the top...
FLPIBlog
If you've ever wondered why your insurance rates keep going up, read this and you'll begin to understand the story.
Read: Insurance adjusters commit fraud
If the link doesn't work, copy and paste this into your browser: http://www.sun-sentinel.com/news/local/florida/fl-adjusters-appraisers-charged-20101001,0,6297211.story
And I'm sure if the arresting investigators poked around more, they'd find bigger fish at the top...
FLPIBlog
Wednesday, July 7, 2010
United Automoble Insurance Group & Others Only Telling Half The Story - Is There Another Side To Fraud?
Please do not fall prey to recent insurance industry propaganda. Insurance companies, like United Automobile Insurance Company, are planting stories about fraud that bear no relationship to reality. The public should realize the insurance industry has embarked on a strategic campaign designed specifically to poison the pool of potential jurors while at the same time filling its bloated coffers with premiums Florida citizens are legislatively mandated to pay. Insurance companies, like United Automobile Insurance Company, use business models that require their insureds to attend compulsory medical examinations (CMEs), also known as Insurance Medical Examinations (IMEs), and Examinations Under Oath (EUO) at alarming rates.
An examination under oath is where the insurance company demands the insured go to the office of the insurance company to answer questions about a claim. A compulsory medical examination (CME) is where the insured is compelled to be physically examined by a doctor selected by the insurance company. A CME is supposed to be used by insurance companies to determine if future care is needed. Under Florida law, an insurance company can only cut off care if the insurance company obtains a report from a doctor stating no further care is medically necessary. These insurance doctors are supposed to be independent, fair and neutral.
In reality, insurance companies will immediately schedule these examinations, even before the insurer receives a single bill. Insurance companies know that a certain percentage of people will not attend these examinations if requested. This “no show” results in a basis for the insurance company to deny care. Additionally, many of the doctors used by the insurance companies are far from independent, fair and neutral. Typically, these doctors generate reports stating no more care is needed in the vast majority of times the doctor examines the patient at the request of an insurance company. Many of these doctors earn the majority of their income by working for the insurance companies. These doctors know that the insurance companies want the patient to be cut off. This saves the insurance company money. Alternatively, the insurance companies use doctors to do paper reviews of the medical records and opine that the only care that is reasonable will fall under the patient’s deductible. This means the insurance company would not have to make a payment. Accepting premiums and denying claims is a very profitable business model.
For some reason, the stories posted by the insurance industry, including United Automobile Insurance Company, fail to inform the public of this practice of scheduling compulsory medical examinations knowing a percentage of insureds will not appear so that the “no show” can be a basis to deny care as well as the practice of using doctors to cut off care the vast majority of time. It true there is a small percentage of fraudulent claims. However, it is just as true that insurance companies fail to act in their insured’s best interest, as opposed to protecting their own greedy profit motives. For this reason, virtually every jury trial results in a verdict for the patient or the doctor and against the insurance company. Jurors are smart and have more common sense than the insurance companies give them credit for having.
Thursday, March 18, 2010
Insurer Targeted HIV Patients to Drop Coverage
Does Anyone Remember The Movie "The Rainmaker"?? Read on...
Murray Waas
WASHINGTON
Wed Mar 17, 2010 1:40pm EDT
WASHINGTON (Reuters) - In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance.
U.S. | Health | Healthcare Reform
Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that.
So he hired an attorney -- not because he wanted to sue anyone; on the contrary, the shy African-American teenager expected his insurance was canceled by mistake and would be reinstated once he set the company straight.
But Fortis, now known as Assurant Health, ignored his attorney's letters, as they had earlier inquiries from a case worker at a local clinic who was helping him. So Mitchell sued.
In 2004, a jury in Florence County, South Carolina, ordered Assurant Health, part of Assurant Inc, to pay Mitchell $15 million for wrongly revoking his heath insurance policy.
In September 2009, the South Carolina Supreme Court upheld the lower court's verdict, although the court reduced the amount to be paid him to $10 million.
By winning the verdict against Fortis, Mitchell not only obtained a measure of justice for himself; he also helped expose wrongdoing on the part of Fortis that could have repercussions for the entire health insurance industry.
Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.
The revelations come at a time when President Barack Obama, in his frantic push to rescue the administration's health care plan, has stepped up his criticism of insurers. The U.S. House of Representatives is expected to vote later this week on an overhaul of the health system, which Obama has said is essential to do away with controversial and unpopular industry practices.
Insurance companies have long engaged in the practice of "rescission," whereby they investigate policyholders shortly after they've been diagnosed with life-threatening illnesses. But government regulators and investigators who have overseen the actions of Assurant and other health insurance companies say it is unprecedented for a company to single out people with HIV.
In his previously undisclosed court ruling, the judge in the Mitchell case also criticized what he said were the company's efforts to cover its tracks.
Assurant Health said that as a matter of policy it did not comment on individual customer claims.
"We disagree with certain of the court's characterizations of Assurant Health's policies and procedures in the Mitchell case," it said in a statement provided by spokesman Peter Duckler, adding: "The case continues to progress through the appellate process."
"REPREHENSIBLE" CONDUCT
Much of the trial record of the Mitchell case is bound by a confidentiality order and not available to the public. But two orders written by the presiding judge, Michael G. Nettles, a state circuit judge for the 12th Judicial District of South Carolina, of Florence County, describe the case in detail. Judge Nettles wrote the orders in response to motions by Assurant that the jury's verdict be set aside or reduced.
In the motions, Nettles not only strongly denied Fortis' claims but condemned the corporation's conduct.
"There was evidence that Fortis' general counsel insisted years ago that members of the rescission committee not record the identity of the persons present and involved in the process of making a decision to rescind a Fortis health insurance policy," Nettles wrote.
Elsewhere in his order, Nettles noted that there were no "minutes of actions, votes, or any business conducted during the rescission committee's meeting."
The South Carolina Supreme Court, in upholding the jury's verdict in the case in a unanimous 5-0 opinion, said that it agreed with the lower court's finding that Fortis destroyed records to hide the corporation's misconduct. Supreme Court Chief Justice Jean Hoefer Toal wrote: "The lack of written rescission policies, the lack of information available regarding appealing rights or procedures, the separate policies for rescission documents" as well as the "omission" of other records regarding the decision to revoke Mitchell's insurance, constituted "evidence that Fortis tried to conceal the actions it took in rescinding his policy."
In affirming the trial verdict and Nettles' order, Toal was as harsh in her criticism of the company as Judge Nettles had been. "We find ample support in the record that Fortis' conduct was reprehensible," she wrote. "Fortis demonstrated an indifference to Mitchell's life and a reckless disregard to his health and safety."
Fortis canceled Mitchell's health insurance based on a single erroneous note from a nurse in his medical records that indicated that he might have been diagnosed prior to his obtaining his insurance policy. When the company's investigators discovered the note, they ceased further review of Mitchell's records for evidence to the contrary, including the records containing the doctor's diagnosis.
Nettles also suggested that Fortis should have realized the date in the note was incorrect: "Not only did Fortis choose to rely on one false and unreliable snippet of information containing an erroneous date to the exclusion of other information which would have revealed that date to be erroneous, Fortis refused to conduct any further investigation even after it was on notice the evidence which aroused its suspicion to be false," the judge noted.
Fortis "gambled" with Mitchell's life, Nettles wrote.
Their motive, according to the judge, was obvious: "The court finds that Fortis wrongfully elevated its concerns for maximizing profits over the rights and interest of its customer." In upholding Nettles' verdict, the South Carolina Supreme Court similarly ruled that "Fortis was motivated to avoid the losses it would undoubtedly incur in supporting Mitchell's costly medical condition."
While declining to comment on specific cases, Assurant said in the statement: "All insurance companies have processes to review claims to ensure their accuracy, completeness and compliance with policy provisions and we evaluate all claims on an individual basis."
Click here to read the full/original article
Murray WaasWASHINGTON
Wed Mar 17, 2010 1:40pm EDT
WASHINGTON (Reuters) - In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance.
U.S. | Health | Healthcare Reform
Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that.
So he hired an attorney -- not because he wanted to sue anyone; on the contrary, the shy African-American teenager expected his insurance was canceled by mistake and would be reinstated once he set the company straight.
But Fortis, now known as Assurant Health, ignored his attorney's letters, as they had earlier inquiries from a case worker at a local clinic who was helping him. So Mitchell sued.
In 2004, a jury in Florence County, South Carolina, ordered Assurant Health, part of Assurant Inc, to pay Mitchell $15 million for wrongly revoking his heath insurance policy.
In September 2009, the South Carolina Supreme Court upheld the lower court's verdict, although the court reduced the amount to be paid him to $10 million.
By winning the verdict against Fortis, Mitchell not only obtained a measure of justice for himself; he also helped expose wrongdoing on the part of Fortis that could have repercussions for the entire health insurance industry.
Previously undisclosed records from Mitchell's case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.
The revelations come at a time when President Barack Obama, in his frantic push to rescue the administration's health care plan, has stepped up his criticism of insurers. The U.S. House of Representatives is expected to vote later this week on an overhaul of the health system, which Obama has said is essential to do away with controversial and unpopular industry practices.
Insurance companies have long engaged in the practice of "rescission," whereby they investigate policyholders shortly after they've been diagnosed with life-threatening illnesses. But government regulators and investigators who have overseen the actions of Assurant and other health insurance companies say it is unprecedented for a company to single out people with HIV.
In his previously undisclosed court ruling, the judge in the Mitchell case also criticized what he said were the company's efforts to cover its tracks.
Assurant Health said that as a matter of policy it did not comment on individual customer claims.
"We disagree with certain of the court's characterizations of Assurant Health's policies and procedures in the Mitchell case," it said in a statement provided by spokesman Peter Duckler, adding: "The case continues to progress through the appellate process."
"REPREHENSIBLE" CONDUCT
Much of the trial record of the Mitchell case is bound by a confidentiality order and not available to the public. But two orders written by the presiding judge, Michael G. Nettles, a state circuit judge for the 12th Judicial District of South Carolina, of Florence County, describe the case in detail. Judge Nettles wrote the orders in response to motions by Assurant that the jury's verdict be set aside or reduced.
In the motions, Nettles not only strongly denied Fortis' claims but condemned the corporation's conduct.
"There was evidence that Fortis' general counsel insisted years ago that members of the rescission committee not record the identity of the persons present and involved in the process of making a decision to rescind a Fortis health insurance policy," Nettles wrote.
Elsewhere in his order, Nettles noted that there were no "minutes of actions, votes, or any business conducted during the rescission committee's meeting."
The South Carolina Supreme Court, in upholding the jury's verdict in the case in a unanimous 5-0 opinion, said that it agreed with the lower court's finding that Fortis destroyed records to hide the corporation's misconduct. Supreme Court Chief Justice Jean Hoefer Toal wrote: "The lack of written rescission policies, the lack of information available regarding appealing rights or procedures, the separate policies for rescission documents" as well as the "omission" of other records regarding the decision to revoke Mitchell's insurance, constituted "evidence that Fortis tried to conceal the actions it took in rescinding his policy."
In affirming the trial verdict and Nettles' order, Toal was as harsh in her criticism of the company as Judge Nettles had been. "We find ample support in the record that Fortis' conduct was reprehensible," she wrote. "Fortis demonstrated an indifference to Mitchell's life and a reckless disregard to his health and safety."
Fortis canceled Mitchell's health insurance based on a single erroneous note from a nurse in his medical records that indicated that he might have been diagnosed prior to his obtaining his insurance policy. When the company's investigators discovered the note, they ceased further review of Mitchell's records for evidence to the contrary, including the records containing the doctor's diagnosis.
Nettles also suggested that Fortis should have realized the date in the note was incorrect: "Not only did Fortis choose to rely on one false and unreliable snippet of information containing an erroneous date to the exclusion of other information which would have revealed that date to be erroneous, Fortis refused to conduct any further investigation even after it was on notice the evidence which aroused its suspicion to be false," the judge noted.
Fortis "gambled" with Mitchell's life, Nettles wrote.
Their motive, according to the judge, was obvious: "The court finds that Fortis wrongfully elevated its concerns for maximizing profits over the rights and interest of its customer." In upholding Nettles' verdict, the South Carolina Supreme Court similarly ruled that "Fortis was motivated to avoid the losses it would undoubtedly incur in supporting Mitchell's costly medical condition."
While declining to comment on specific cases, Assurant said in the statement: "All insurance companies have processes to review claims to ensure their accuracy, completeness and compliance with policy provisions and we evaluate all claims on an individual basis."
Click here to read the full/original article
Sunday, February 14, 2010
United Automobile Insurance Company Fighting Fraud??? Are You Kidding Me???
How is it that an insurer that has been caught denying most claims without any justification is now fighting fraud? This is like the fox guarding the hen house. Many doctor refuse to treat those insured by United because United Auto blindly denies so many claims (Go dig through your DVD library and re-watch the movie: The Rainmaker with Matt Damon and you'll understand what we're talking about). For no good cause, United Auto forces their insured to go to “their doctors” to be examined. Their "I.M.E." doctors almost always say care is not needed. Don't your find it funny that people get into car accidents and are ALMOST ALWAYS are deemed to be 'okay' and their benefits cut off. Tell me that’s not fraud...
United Auto forces most of their insured to go to the home office of United Auto to give a recorded statement simply for making a claim. UAIG does this because when an insured does not go to their doctor or to their statement, United Auto can use this "failure to attend" as a basis to deny their claim and deny their insurance benefits. United Auto is great at taking money from the hard working insured people of Florida, but they have not figured out how to pay claims without putting up hurdle after hurdle to deny claims......
For those that they (UAIG and others) legitimately catch perpetrating fraud - well, kudos to them. But we'll reserve the kudos for UIAG and others, and give them out on a case by case basis. Although there's the appearance of fighting fraud on the surface, it's all about not paying out benefits as the foundation of their efforts. For some not to strange reason, we're still thinking about that fox and the hen house thing. That being said, the stance of the Florida Personal Injury Blog is that all fraud should be stamped out. We'd like to see those with real injuries have their rights protected under the law and the terms of their insurance contracts; and their injuries treated until they are back to "normal" or at least until they've reached maximum medical improvement - with only necessary treatments and diagnostic tests done.
Post your comments & stories below
United Auto forces most of their insured to go to the home office of United Auto to give a recorded statement simply for making a claim. UAIG does this because when an insured does not go to their doctor or to their statement, United Auto can use this "failure to attend" as a basis to deny their claim and deny their insurance benefits. United Auto is great at taking money from the hard working insured people of Florida, but they have not figured out how to pay claims without putting up hurdle after hurdle to deny claims......
For those that they (UAIG and others) legitimately catch perpetrating fraud - well, kudos to them. But we'll reserve the kudos for UIAG and others, and give them out on a case by case basis. Although there's the appearance of fighting fraud on the surface, it's all about not paying out benefits as the foundation of their efforts. For some not to strange reason, we're still thinking about that fox and the hen house thing. That being said, the stance of the Florida Personal Injury Blog is that all fraud should be stamped out. We'd like to see those with real injuries have their rights protected under the law and the terms of their insurance contracts; and their injuries treated until they are back to "normal" or at least until they've reached maximum medical improvement - with only necessary treatments and diagnostic tests done.
Post your comments & stories below
Friday, February 12, 2010
Tips For Doctors On How To Fly Under The Radar
So, you want to treat personal injury patients & want to stay out of trouble right???...(say yes)... Then Here are some important points on how to fly under the radar:
►Confirm coverage on the first date of treatment. Make sure the insured listed all residents on the application for insurance and the insured does not use the vehicle for business purposes
►Disclosure & acknowledgment must be properly filled out. Put on line one a minimum of “initial consultation” or what you always do on the first day so you do not forget. You can always add more services if needed but this keeps you from leaving line one completely blank. This line must be accurate.
►CMS (formally HCFAs) must be properly filled out. Make sure your credentials, license number, signature and tax ID are on every form (double check).
►Have patient sign an assignment of benefits. Please use the one provided after putting your full legal name and address on top.
► Keep a patient log and it would be best if the patient initialed each service provided
►Make sure your patients go to all IMEs and EUOs and if they cannot/ failed to attend send a letter by mail or fax to the insurer with a reasonable excuse and ask for it to be rescheduled in writing. Keep a copy. Have patient bring the ledger to the EUO. Do NOT rely on a telephonic conversation or message.
►Don’t waive co-pays or deductibles unless part of a 3rd settlement
►If you do everything right, you do not have to accept reductions, IME cut offs, or negotiate your bills with the PIP insurers. You can file a PIP suit.
►Medical records must be well written and clearly and legibly provide proper documentation as required by Florida law. See below. Justify ordering any tests, order prior medical records, be careful where there is limited property damage and gaps in treatment. If there is an IME note in your records the patient was informed of the suspension, the current complaints and findings and that the patient wants to keep treating.
►In your initial report explain the benefits of the therapies you order
►Do not indicate the patient has a lawyer in your letters. Avoid using the express attorney, lawyer, or esquire. Send letters to the patient and “cc” the lawyer. That can be easily crossed out if needed. A letter to the lawyer hurts you.
►Put your impairment ratings on a separate report
►Respond to all requests made by the insurer. Read their explanations of benefits.
►Avoid using a level 5 office visit (Evaluation and management codes) unless you can justify that high code. It should be avoided, especially by Chiropractors, unless you meet the time requirements and properly document the notes as stated in the CPT book. If it is time based you MUST state it in the records.
►Don’t send your PIP suits to anyone that asks for one. You may be responsible if you lose for the insurers fees and costs.
►Remind patients that PIP pays for household services
►Stay properly licensed and procure a masage establishment license.
►Remember to protect the patient’s privacy. Don’t allow surprise inspections by insurers when you have patients in your office. You can tell them to make an appointment to come back at another time. If they don't like it, too bad!
►Out of State, out of car, out of luck - tell your patients if they leave the State of Florida and leave their car at home PIP will most likely not follow them.
►Multiple accidents - if a person is involved in more than one accident in a short period of time you cannot bill under two separate claim numbers unless the injuries and treatment is distinguishable. You should bill under ONE claim number unless you can differentiate the injuries. If you can then you bill for the injuries that were attributable to each injury without double billing.
►Avoid having your bills for therapy from becoming excessive otherwise the insurers will send all of your patients for an IME. Insurers keep track of providers they deem to over utilize treatment.
►Use proof of mail when sending in bills and know what dates of service are in the envelope.
►30 day pre-suit demand letters are not sent to the adjuster. You must go on line and send it to the correct person. Use the attached form and try to be as detailed as possible. The more specific as to the amount at issue the better.
►Do not cash checks that say full and final unless you are positive you are being paid in full. If you cash the check you waive the right to suing for the balance.
►At a deposition or trial never state what percent of your business is car accident or accident of any kind related.
►Keep a copy of the police report and patient’s identification in the file
►Have a note in the file stating your office cleared coverage with the adjuster
►Always show improvement otherwise stop treating after a reasonable time.
►Do not have a cookie cutter treatment plan (or cookie cutter SOAP notes) for your patients. State Farm sued a group of doctors and recovered $3.9 million for using this practice.
OK, now have at it...
Tips from: http://www.floridapersonalinjuryblog.net/
►Confirm coverage on the first date of treatment. Make sure the insured listed all residents on the application for insurance and the insured does not use the vehicle for business purposes
►Disclosure & acknowledgment must be properly filled out. Put on line one a minimum of “initial consultation” or what you always do on the first day so you do not forget. You can always add more services if needed but this keeps you from leaving line one completely blank. This line must be accurate.
►CMS (formally HCFAs) must be properly filled out. Make sure your credentials, license number, signature and tax ID are on every form (double check).
►Have patient sign an assignment of benefits. Please use the one provided after putting your full legal name and address on top.
► Keep a patient log and it would be best if the patient initialed each service provided
►Make sure your patients go to all IMEs and EUOs and if they cannot/ failed to attend send a letter by mail or fax to the insurer with a reasonable excuse and ask for it to be rescheduled in writing. Keep a copy. Have patient bring the ledger to the EUO. Do NOT rely on a telephonic conversation or message.
►Don’t waive co-pays or deductibles unless part of a 3rd settlement
►If you do everything right, you do not have to accept reductions, IME cut offs, or negotiate your bills with the PIP insurers. You can file a PIP suit.
►Medical records must be well written and clearly and legibly provide proper documentation as required by Florida law. See below. Justify ordering any tests, order prior medical records, be careful where there is limited property damage and gaps in treatment. If there is an IME note in your records the patient was informed of the suspension, the current complaints and findings and that the patient wants to keep treating.
►In your initial report explain the benefits of the therapies you order
►Do not indicate the patient has a lawyer in your letters. Avoid using the express attorney, lawyer, or esquire. Send letters to the patient and “cc” the lawyer. That can be easily crossed out if needed. A letter to the lawyer hurts you.
►Put your impairment ratings on a separate report
►Respond to all requests made by the insurer. Read their explanations of benefits.
►Avoid using a level 5 office visit (Evaluation and management codes) unless you can justify that high code. It should be avoided, especially by Chiropractors, unless you meet the time requirements and properly document the notes as stated in the CPT book. If it is time based you MUST state it in the records.
►Don’t send your PIP suits to anyone that asks for one. You may be responsible if you lose for the insurers fees and costs.
►Remind patients that PIP pays for household services
►Stay properly licensed and procure a masage establishment license.
►Remember to protect the patient’s privacy. Don’t allow surprise inspections by insurers when you have patients in your office. You can tell them to make an appointment to come back at another time. If they don't like it, too bad!
►Out of State, out of car, out of luck - tell your patients if they leave the State of Florida and leave their car at home PIP will most likely not follow them.
►Multiple accidents - if a person is involved in more than one accident in a short period of time you cannot bill under two separate claim numbers unless the injuries and treatment is distinguishable. You should bill under ONE claim number unless you can differentiate the injuries. If you can then you bill for the injuries that were attributable to each injury without double billing.
►Avoid having your bills for therapy from becoming excessive otherwise the insurers will send all of your patients for an IME. Insurers keep track of providers they deem to over utilize treatment.
►Use proof of mail when sending in bills and know what dates of service are in the envelope.
►30 day pre-suit demand letters are not sent to the adjuster. You must go on line and send it to the correct person. Use the attached form and try to be as detailed as possible. The more specific as to the amount at issue the better.
►Do not cash checks that say full and final unless you are positive you are being paid in full. If you cash the check you waive the right to suing for the balance.
►At a deposition or trial never state what percent of your business is car accident or accident of any kind related.
►Keep a copy of the police report and patient’s identification in the file
►Have a note in the file stating your office cleared coverage with the adjuster
►Always show improvement otherwise stop treating after a reasonable time.
►Do not have a cookie cutter treatment plan (or cookie cutter SOAP notes) for your patients. State Farm sued a group of doctors and recovered $3.9 million for using this practice.
OK, now have at it...
Tips from: http://www.floridapersonalinjuryblog.net/
Cookie Cutter Notes? Cookie Cutter Treatment Plan? You Better Read This...
$3.9 Million Verdict Sends Strong Anti Fraud Message
Facts at a glance:
•An Orlando jury returned a verdict yesterday ordering Irving Colvin, M.D., Robert Colvin, and Physicians Injury Care Center (PICC) to pay State Farm Mutual Auto Insurance Company® $3.9 million in compensatory damages and $750,000 in punitive damages.
•The State Farm lawsuit claimed PICC (and owners Dr. Irving Colvin and Robert Colvin) created a pre-determined treatment protocol for auto accident patients with a one-size-fits-all application in order to maximize payment to the clinic.
•The unanimous jury found Robert Colvin, Dr. Irving Colvin, and PICC liable for Fraud, Unjust Enrichment, and violations of Florida’s Deceptive and Unfair Trade Practices Act.
•Insurance fraud costs the property-casualty insurance industry--and its customers--about $30 billion a year according to the National Insurance Crime Bureau (NICB).
Read the original press release by clicking here
Helpful Links
http://www.statefarm.com/insurance/claim_center/ins_claims_fraud.asp - for more information from State Farm about reporting fraud.
Full Story
Florida - In a verdict yesterday, an Orlando jury ordered Irving Colvin, M.D., Robert Colvin, and Physicians Injury Care Center (PICC) to pay State Farm Mutual Auto Insurance Company® $3.9 million in compensatory damages and $750,000 in punitive damages. The court also released State Farm and its customers from any obligation to pay outstanding medical bills from PICC.
According to State Farm’s lawsuit, PICC (and owners Dr. Irving Colvin and Robert Colvin) created a pre-determined treatment protocol with a one-size-fits-all application for patients who came into their office following an automobile accident. The treatment protocol was rarely altered to meet the individual recovery needs of the patient. The protocol was designed to maximize payment to the clinic.
In returning the verdict in favor of State Farm, a unanimous jury found Robert Colvin, Dr. Irving Colvin, and PICC liable for Fraud, Unjust Enrichment and violations of Florida’s Deceptive and Unfair Trade Practices Act.
"We hope this verdict sends a loud and clear message to those who choose to commit insurance fraud,” said Russ Kile, State Farm Special Investigative Unit Claim Section Manager for Florida. “State Farm is committed to fighting insurance fraud.” Nationally, State Farm has more than 1,300 employees in 160 special units who investigate suspicious claims and work with law enforcement, the NICB and state fraud bureaus to combat the insurance fraud problem.
Fraud drives up the cost of insurance, and can add $200 to $300 to insurance premiums paid by the average American household. Insurance fraud costs the property-casualty insurance industry--and its customers—more than $30 billion a year, according to the National Insurance Crime Bureau (NICB). The NICB works with law enforcement to curb insurance fraud and organized vehicle theft.
Contact: Michal Connolly, State Farm Public Affairs Specialist, (863) 318-3088
______________________________________________
Do you have some important information regarding the medical/chiropractic/legal practice of personal injury in the State of Florida? News on Legislation in Tallahassee? New Findings From The Courts? IME Doctors playing games? Insurance company not paying bills? Please submit it to us for posting. Click here to email us your Florida Personal Injury Blog News
Facts at a glance:
•An Orlando jury returned a verdict yesterday ordering Irving Colvin, M.D., Robert Colvin, and Physicians Injury Care Center (PICC) to pay State Farm Mutual Auto Insurance Company® $3.9 million in compensatory damages and $750,000 in punitive damages.
•The State Farm lawsuit claimed PICC (and owners Dr. Irving Colvin and Robert Colvin) created a pre-determined treatment protocol for auto accident patients with a one-size-fits-all application in order to maximize payment to the clinic.
•The unanimous jury found Robert Colvin, Dr. Irving Colvin, and PICC liable for Fraud, Unjust Enrichment, and violations of Florida’s Deceptive and Unfair Trade Practices Act.
•Insurance fraud costs the property-casualty insurance industry--and its customers--about $30 billion a year according to the National Insurance Crime Bureau (NICB).
Read the original press release by clicking here
Helpful Links
http://www.statefarm.com/insurance/claim_center/ins_claims_fraud.asp - for more information from State Farm about reporting fraud.
Full Story
Florida - In a verdict yesterday, an Orlando jury ordered Irving Colvin, M.D., Robert Colvin, and Physicians Injury Care Center (PICC) to pay State Farm Mutual Auto Insurance Company® $3.9 million in compensatory damages and $750,000 in punitive damages. The court also released State Farm and its customers from any obligation to pay outstanding medical bills from PICC.
According to State Farm’s lawsuit, PICC (and owners Dr. Irving Colvin and Robert Colvin) created a pre-determined treatment protocol with a one-size-fits-all application for patients who came into their office following an automobile accident. The treatment protocol was rarely altered to meet the individual recovery needs of the patient. The protocol was designed to maximize payment to the clinic.
In returning the verdict in favor of State Farm, a unanimous jury found Robert Colvin, Dr. Irving Colvin, and PICC liable for Fraud, Unjust Enrichment and violations of Florida’s Deceptive and Unfair Trade Practices Act.
"We hope this verdict sends a loud and clear message to those who choose to commit insurance fraud,” said Russ Kile, State Farm Special Investigative Unit Claim Section Manager for Florida. “State Farm is committed to fighting insurance fraud.” Nationally, State Farm has more than 1,300 employees in 160 special units who investigate suspicious claims and work with law enforcement, the NICB and state fraud bureaus to combat the insurance fraud problem.
Fraud drives up the cost of insurance, and can add $200 to $300 to insurance premiums paid by the average American household. Insurance fraud costs the property-casualty insurance industry--and its customers—more than $30 billion a year, according to the National Insurance Crime Bureau (NICB). The NICB works with law enforcement to curb insurance fraud and organized vehicle theft.
Contact: Michal Connolly, State Farm Public Affairs Specialist, (863) 318-3088
______________________________________________
Do you have some important information regarding the medical/chiropractic/legal practice of personal injury in the State of Florida? News on Legislation in Tallahassee? New Findings From The Courts? IME Doctors playing games? Insurance company not paying bills? Please submit it to us for posting. Click here to email us your Florida Personal Injury Blog News
Wednesday, February 3, 2010
New Case Law on Balance Billing of HMO Subscribers
35 Fla. L. Weekly D257b
Insurance -- Health maintenance organizations -- A hospital-based, but non-contracted provider of health care services to the subscribers of a health maintenance organization plan may not balance bill subscribers for unpaid portion of its statements for medical services that have not been paid by the health maintenance organization
THE JOSEPH L. RILEY ANESTHESIA ASSOCIATES, ETC., Appellant, v. AMANDA STEIN AND FLORIDA HEALTH CARE PLAN, INC., Appellee. 5th District. Case No. 5D08-2162. Opinion filed January 29, 2010. Appeal from the Circuit Court for Volusia County, Randell H. Rowe, III, Judge. Counsel: Jamie Billotte Moses, of Fisher, Rushmer, Werrenrath, Dickson, Talley & Dunlap, P.A., Orlando, and C. Anthony Schoder, Jr., of Smith, Schoder & Bledsoe, L.L.P., Daytona Beach, for Appellant. Karina P. Gonzalez, of Law Offices of Steven M. Ziegler, P.A., Hollywood, for Appellee.
(MONACO, C.J.) One of the appellees, Florida Health Care Plan (“Florida Health Care”), a health maintenance organization, pre-authorized surgical procedures for each of its subscribers, the remaining appellees, through Florida Hospital Fish Memorial in Orange City (“Florida Hospital”). The appellant, Joseph L. Riley Anesthesia Associates, P.A., d/b/a JLR Medical Group (“JLR”), provided anesthesia services to the subscribers/patients in conjunction with their surgical procedures. JLR, however, did not have a contractual agreement with Florida Health Care regarding the amounts to be paid for the medical services it provided to subscribers of Florida Health Care. The issue presented to us for determination is whether a hospital-based, but non-contracted, provider of health care services to the subscribers of a health maintenance organization plan may balance bill the subscribers for the unpaid portion of its statements for medical services that have not been paid by the health maintenance organization. We agree with the trial court that in light of section 641.3154, Florida Statutes (2007), the provider may not balance bill the subscriber, and affirm.
The plaintiffs/appellees are a group of 52 medical patients who are subscribers to Florida Health Care.1 All 52 had surgical procedures at Florida Hospital. The hospital and all of the surgeons involved had contractual arrangements with Florida Health Care regarding insurance payment for their services. Moreover, the contract between Florida Health Care and Florida Hospital provided that the hospital was empowered to direct hospital-based physicians to provide medical services that were pre-authorized by Florida Health Care.
JLR had an exclusive contract with Florida Hospital to provide anesthesia services for surgeries performed there, but had virtually no contact with any of the subscribers prior to the surgeries. What complicated the relationship between the parties further was that although JLR provided anesthesia services to each of the subscribers, it had not contracted with Florida Health Care regarding reimbursement for services.
After each surgery JLR submitted a statement for its medical services to Florida Health Care, but in each instance Florida Health Care paid a reduced amount in full payment of the bill. JLR received and retained each payment, but denied that the payments fully satisfied its statements, and then sent bills to the subscribers for the balance not paid by Florida Health Care. JLR refers to this as “balance billing.”
The patients brought suit seeking a declaratory judgment that JLR's balance billing violated section 641.3154, Florida Statutes (2007), and that balance billing violated Florida's Unfair Trade and Deceptive Practices Act under Chapter 501, Florida Statutes. The trial court bifurcated the proceedings and set the declaratory judgment action for trial. At the conclusion of the trial the court held that although JLR did not have a contract with Florida Health Care, it did have a contract with Florida Hospital and with the various surgeons who provided health care services to the 52 subscriber/ patients. The final judgment noted that each pre-scheduled surgery performed at Florida Hospital went through an authorization process during which Florida Health Care would decide if each subscriber/patient was eligible, and whether the requested surgery was a covered benefit. Once approved, an authorization number was issued for use by all involved providers in order for them to submit bills to Florida Health Care for payment. The trial court noted that JLR billed Florida Health Care using the assigned authorization number for each subscriber, and that because Florida Hospital had a contract with Florida Health Care, it was empowered to authorize or direct the provision of JLR's anesthesia services to Florida Health Care members pursuant to section 641.3156(1).
When the trial court reviewed section 641.3156(1), it found that under that statute a health maintenance organization was liable for services to a subscriber/patient by a provider, regardless of whether a contract existed between the health maintenance organization and the provider. It concluded further that in those circumstances the health maintenance organization would be liable for payment to the provider, but a subscriber/patient would not. Thus, JLR was prohibited from balance billing the appellees.
A trial court's rulings on its interpretation of statutes and contracts are, of course, reviewed de novo. See Health Options, Inc. v. Palmetto Pathology Servs., P.A., 983 So. 2d 608 (Fla. 3d DCA), review denied, 994 So. 2d 1104 (Fla. 2008); Lukacs v. Luton, 982 So. 2d 1217 (Fla. 1st DCA 2008); see also Jones v. Utica Mut. Ins. Co., 463 So. 2d 1153, 1157 (Fla. 1985); Contreras v. U.S. Sec. Ins. Co., 927 So. 2d 16, 20 (Fla. 4th DCA 2006), review denied, 954 So. 2d 28 (Fla. 2007). We agree with the trial court that pursuant to Florida's “Health Maintenance Organization Act,” section 641.17-.3923, Florida Statutes (2007), a health maintenance organization is liable for services rendered to a subscriber/patient by a provider, regardless of whether a contract exists between the HMO and the provider. The statute is quite specific in providing that a health maintenance organization is liable for payment of fees to the provider, and that a subscriber is not liable for payment of fees to the provider. See § 641.3154, Fla. Stat.
More specifically, section 641.3154(4) reads as follows:
A provider or any representative of a provider, regardless of whether the provider is under contract with the health maintenance organization, may not collect or attempt to collect money from, maintain any action of law against, or report to a credit agency a subscriber of an organization for payment of services for which the organization is liable, if the provider in good faith knows or should know that the organization is liable. This prohibition applies during the pendency of any claim made by the provider to the organization for payment of the services and any legal proceedings or dispute resolution process to determine whether the organization is liable for the services if the provider is informed that such proceedings are taking place. It is presumed that a provider does not know and should not know that an organization is liable unless:
(a) the provider is informed by the organization that it accepts liability;
(b) a court of competent jurisdiction determines that the organization is liable;
(c) the office or agency makes a final determination that the organization is required to pay for such services subsequent to a recommendation made by the Subscriber Assistance Panel pursuant to s. 408.7056; or
(d) the agency issues a final order that the organization is required to pay for such services subsequent to a recommendation made by a resolution organization pursuant to s. 408.7057. (Emphasis supplied).
The highlighted first sentence of this subparagraph seems to us to be dispositive. The Legislature specifically informs us through this statute that a provider, even one not under contract to the health maintenance organization, may not balance bill a subscriber to the health maintenance organization. As counsel for Florida Health Care agreed during the oral arguments associated with this case, while JLR retains all of its common law remedies against Florida Health Care, it may not collect or attempt collection against the patient if the provider knows that the health maintenance organization is liable.2
In the present case there is little doubt that JLR knew that Florida Health Care was liable. Florida Hospital and the surgeons were pre-authorized by Florida Health Care for each surgery; Florida Health Care issued an authorization number; JLR submitted its bill for each patient/subscriber to Florida Health Care using the appropriate authorization number; Florida Health Care paid some part of the bill directly to JLR; and JLR retained the payments. Thus, JLR was forbidden by section 641.3154(4) to balance bill the patient/subscribers.
JLR argues, however, that the second sentence of section 641.3154(4) modifies the first, so that the prohibition against balance billing only applies “during the pendency of any claim made by the provider to the organization for payment of the services and any legal proceedings or dispute resolution process” resulting from the claim. We read the paragraph differently. The second sentence, we believe, simply assures that the provider will not balance bill during the time when there may be attempts to resolve the issue of whether a health maintenance organization is liable. The second sentence is not a limitation on the first. Rather, it is a stand-still provision. It holds everyone in place while any dispute over liability is pending.
Our reading of the statute is bolstered by a number of factors. First, we see no ambiguity in the statute. JLR's reading of it is strained, at best. Had the Legislature intended it “only” to apply during the pendency of legal or dispute resolution proceedings, it would surely have begun this critical sentence by saying, “This prohibition only applies during the pendency of any claim. . . .” Accordingly the plain reading of the statute convinces us of this interpretation.
Second, we have previously held with respect to section 641.315, a precursor to section 641.3154, that the statute
provides that only the HMO is liable for services rendered, not the subscriber or insured. The providers are prohibited from collecting funds from a subscriber for services provided and covered by the HMO.
The Fla. Physicians Union, Inc. v. United Healthcare of Fla., Inc., 837 So. 2d 1133, 1135 (Fla. 5th DCA 2003); see also Shands Teaching Hosp. & Clinics, Inc., v. Humana Med. Plan, Inc., 727 So. 2d 341, 346 (Fla. 1st DCA 1999). In the same case we also commented that section 641.315, Florida Statutes (1997), was designed to protect and safeguard subscribers, and that while providers are viewed as essential to the overall plan of prepaid medical service, “they are not focused on as parties needing protection.” Fla. Physicians Union, Inc., 837 So. 2d at 1135. Nothing has been brought to our attention that would suggest that the Legislature intended to modify our statutory reading of the earlier statute by its amendment.
Third, our sister court in the Third District has arrived at the same conclusion in a somewhat similar case where the type of services, rather than the reasonableness of the amount of payment, was in dispute. There, a pathology group associated with a hospital brought a claim against the health maintenance organization for declaratory and other relief in an effort to recover additional payments for the disputed services. The court noted during the course of its opinion that:
As a “non-participating provider” of these services, [pathology group] was nonetheless prohibited (by section 641.3154(4), Florida Statutes (2007)) from directly billing [health maintenance organization] members if [pathology group] knew or should have known that [the organization] was liable for payment. As to the disputed services, therefore, [pathology group] was not being paid by the hospitals, could not collect from [health maintenance organization] members, and was not being reimbursed by [health maintenance organization].
See Health Options, Inc. v. Palmetto Pathology Servs., P.A., 983 So. 2d 608, 612 (Fla. 3d DCA), review denied, 994 So. 2d 1104 (Fla. 2008).
JLR contends, however, that because it did not specifically seek or obtain Florida Health Care's authorization prior to performing its medical services, its rights are governed not by section 641.3154(4), but by section 641.3156(1). That statute provides:
(1) A health maintenance organization must pay any hospital-service or referral-service claim for treatment for an eligible subscriber which was authorized by a provider empowered by contract with the health maintenance organization to authorize or direct the patient's utilization of health care services and which was also authorized in accordance with the health maintenance organization's current and communicated procedures, unless the provider provided information to the health maintenance organization with the willful intention to misinform the health maintenance organization.
JLR argues that it was either Florida Hospital or the surgeon of each subscriber/patient that was empowered by virtue of its contract with Florida Health Care to render services. Thus, according to JLR, because it did not follow the authorization procedures articulated by Florida Health Care, JLR was not in a contract position with the health maintenance organization, and section 641.3156 required Florida Health Care to pay whatever bill JLR sent them without diminishment. It would follow using this logic that if Florida Health Care did not pay the full amount of the bill, JLR could balance bill the remaining unpaid amount. The expansiveness of this argument is breathtaking, and we, of course, reject it.
As the Health Options court properly observed, and as the trial court here concluded, hospital-based providers like JLR are deemed authorized by virtue of their exclusive contract to provide anesthesia services at Florida Hospital, and thus fall within the hospital's authorization for services. There is no question but that anesthesia services were medically necessary for the surgeries, as they were requested by the surgeons, and the contract between Florida Health Care and Florida Hospital recognized this relationship. The authorizations issued to Florida Hospital for services to the Florida Health Care subscribers extended to the services rendered by JLR.
We conclude, accordingly, that any dispute over payment amounts for bills rendered by JLR for the services it rendered to the subscribers of Florida Health Care must remain a dispute between JLR and Florida Health Care. JLR is statutorily prohibited from balance billing the appellee/subscribers. While JLR makes other arguments in support of its position, we find none to be meritorious. We, therefore, affirm the final judgment rendered by the trial court.
AFFIRMED. (TORPY, J., and LAMBERT, B., Associate Judge, concur.)
__________________
1The trial court consolidated the 52 cases brought by the subscriber appellees.
2This subsection would not, of course, prohibit collection by the provider of co-payments, co-insurance or deductible amounts due the provider. See § 641.3155(8), Fla. Stat.
Friday, January 29, 2010
What To Do About “The I.M.E. Doctor”???
Whether you’re a physician or an attorney, you’ll have to agree, IME doctors are for the most part like the kids we all knew as a child who would throw a stick in your spokes when riding your bike. If they truly offered an “independent” decision, that would at least be fair and probably a miracle.
By now, most of you are well aware of one major South Florida IME doctor who was committing his own brand of fraud and was called to task on it.
After years of having IME hatchet-men prostitute their opinions for a few measly dollars, I decided to take matters into my own hands. I was tired of my patients coming back from an IME telling me “the insurance company doctor saw me for 4-5 minutes, made me bend and touch my toes and didn’t even touch me”….and then getting back a 4-5 page report with all kinds of physical examination & orthopedic testing on it. All of which, the patient said never happened.
So, what is a poor ole’ treating physician to do?
Documentation is the key. But this time, you’re going to involve your patient in the process.
Below is a form I give my patients when they go for an insurance medial examination (the word “independent” dropped intentionally). It allows them to take notes intelligently and in the sequence of events that they would typically occur. It allows them to document their experience with the “I’M.E. They are instructed to bring it back with them following the insurance exam and we go through it together. I will then follow up with an examination of my own and write a report of my findings. The completed form is kept in the file and sent on to the patient’s attorney.
When there is a major difference between the IME doctors report and the patients notes, well, let’s just say now we have a bone to pick with them.
To date, I’ve had 1 doctor render what I consider a good competent examination. I actually agreed with his conclusions, the patient’s form matched perfectly what the report said and I called him to thank him. The phrase “1 in a million” comes to mind.
Here’s a tool I use, try it and see if it works for your patients/clients. Please post your results here on the Florida Personal Injury Blog.
Dr. Todd Narson
Diplomate, American Chiropractic Board of Sports Physicians
Self Report of Medical / Chiropractic IME Evaluation
Patient's name: ____________________________________________ Date of Examination: _____________
Examining doctor: _______________________________ Address ______________________________________
What time did you arrive at the office? _______________ AM PM
How long did you wait to see the doctor? __________________
How long were you actually with the doctor? _______________
How much time was spent: answering questions? ______________, for the actual examination? ________________
What time did you leave the doctor's office? ____________AM PM.
Were you questioned by a nurse/staff member before seeing the doctor? YES NO
If yes, for how long? _______________
Were any x‑rays taken? YES NO If yes, of what part of the body? _______________
Please list any questions you remember the doctor asking you and your response to the question:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Please list any comments the doctor made to you about your case, your injuries or his (the doctor's) opinions:
_____________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Other comments or information: _________________________________________________________________
The Examination:
Please note if the insurance company’s doctor did any of the following orthopedic, neurological or chiropractic tests on you:
Did the doctor tap your reflexes
1. At your forearm? qYes qNo
2. At the inside of your elbow? qYes qNo
3. At the back of your elbow? qYes qNo
4. At your knees? qYes qNo
5. At your Achilles’ tendons (back of your foot/heel) qYes qNo
Did the doctor roll a mini-pinwheel on your arms? qYes qNo and/ or on your legs? qYes qNo
Did the doctor check the strength of the muscles in your shoulders, arms and forearms? qYes qNo
Did the doctor check the strength of the muscles in your shoulders, arms and forearms? qYes qNo
Did the doctor check the strength of the muscles in your legs? qYes qNo
Did the doctor have your bend your neck forward and backward? qYes qNo
Did the doctor have you bend your head/neck from side to side? qYes qNo
Did the doctor have you turn your neck from side to side? qYes qNo
Did the doctor use a device to check your range of motion? qYes qNo -or-
Did the doctor watch you as you bent through the various motions? qYes qNo
Did any of these tests cause you any pain? If yes, which one? ____________________________________________________
Did the doctor place his hands on your head and apply downward pressure into your neck? qYes qNo
· How did this make you feel? ______________________________
Did the doctor do this again while your head was bent to the right? qYes qNo or left? qYes qNo
· How did this make you feel? ______________________________
Did the doctor put his hands under the back of your head and gently traction or lift your head up qYes qNo
· How did this make you feel? ______________________________
Did the doctor have you bend over to try and touch your toes? qYes qNo
Did the doctor have you bend your torso(low back) backwards? qYes qNo
Did the doctor have you bend your waist to the right? qYes qNo and/or to the left? qYes qNo
Did the doctor use a device to check your range of motion? qYes qNo -or-
Did the doctor watch you bend through the various motions? qYes qNo
Did any of these tests cause you any pain? If yes, which one? ____________________________________________________
Did the doctor have you bend backward while turning to the right? qYes qNo And/or to the left? qYes qNo
Did the doctor have you lay down on your back and hold both of your legs in the air at the same time? qYes qNo
· How did this make you feel? ________________________________
While lying on your back, did the doctor stretch your left leg up? qYes qNo
· How did this make you feel? ________________________________
While lying on your back, did the doctor stretch your right leg up? qYes qNo
· How did this make you feel? ________________________________
While lying on your back, did the doctor bend your left or right leg in a figure 4? qYes qNo
· How did this make you feel? ________________________________
Did the doctor have you lay down on your stomach and lift your right leg backward? qYes qNo
Did the doctor have you lay down on your stomach and lift your left leg backward? qYes qNo
· How did this make you feel? ________________________________
Did the doctor have you lay down on your stomach and touch your right heel to your right buttock? qYes qNo
Did the doctor have you lay down on your stomach and touch your left heel to your left buttock? qYes qNo
Did the doctor have you lay down on your stomach and touch your right heel to your left buttock? qYes qNo
Did the doctor have you lay down on your stomach and touch your left heel to your right buttock? qYes qNo
· How did this make you feel? ________________________________
Did the doctor feel the muscles of your spine, back and neck? qYes qNo
Where there any tender areas when he felt your back and neck muscles? qYes qNo
Please use the reverse side of this paper for any other comments you have about the IME doctors exam or your experience at the IME doctor’s office. Please return this paper to our office ASAP.
Signed: ___________________________________________________ Date: ____________________
PS, if you highlight the 'q' at the Yes and No exam answers, select Wingdings font, it will change the 'q' into a check box.
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