TRUTH IN DAMAGES IN PERSONAL INJURY CASES

Transcription

1 TRUTH IN DAMAGES IN PERSONAL INJURY CASES Marc Salm Vice President Risk Management Publix Super Markets, Inc. Florida Chamber of Commerce 6 th Annual Insurance Summit

2 TRUTH IN DAMAGES Personal injury awards should not be based on inflated medical bills.

3 Workers Compensation Customer Claims Consumer Litigation Insurance

4 Publix is sued a lot: In 2010, Publix was sued 405 times. In 2011, Publix was sued 442 times. Through September 30, 2012, Publix was on track to get sued 464 times. Publix pays a significant amount of money to defend and resolve these lawsuits: 2010 $30,768, $32,987, $39,185,285( Estimated). About 80 % of these suits and costs are in Florida.

5 EXAMPLES OF PHANTOM MEDICAL COST IN FLORIDA

6 Description: Slip and fall in 2 or 3 drops of water Diagnostics: X rays, 2 MRIs Treatment: ER visit 28 physical therapy visits Lumbar Percutaneous Discectomy and disc repair Interbody fusion with anterior cage and hardware.

7 Total medical charges billed: $247,169 (all under LOPs). Medical Bill Review Conclusion: Total recommended payments for all bills combined $107, (50 th percentile as usual and customary).

8 CASE #2 Description: Slip and Fall in a 3 to 4 inch puddle of water with splatter. Diagnostics: CT Scan; 2 MRIs Treatment: ER visit Neuro consult Physical therapy Pain Management 1 visit Lumbar fusion with laminectomy and discectomy at L5 & S1

9 CASE #2 Medical charges billed for Neurosurgeon and Hospital only: $138, Medical Bill Review Conclusion: Adjusted Fee $54,105.75

10 Description: Diagnostics: Slip and Fall on a saucer sized amount of brown liquid (thought to be soda). MRI cervical Arthrogram/MRI shoulder 2 CT scans (hand & abdomen) Treatment: Urgent care - 23 Chiro visits Ortho consultation Injection (Right shoulder) Cervical discogram under fluoroscopy, anterior cervical discectomy with graft, fluoroscopy and laser assisted discoplasty at C3/4

11 Total medical charges billed: $146,488 Medical Bill Review Conclusion: Total recommended payments for all bills combined $49,438 (50 th percentile as usual and customary)

12 CASE #4 Description: Slip and Fall on some water drops on floor. Diagnostics: Multiple MRIs Treatment: Chiropractic manipulations under anesthesia Epidural injections 5 level lumbar discectomy

13 CASE #4 Total medical charges billed: $186,504 Medical Bill Review Conclusion: Total recommended payments for all bills combined $55, (50 th percentile as usual and customary)

14 Description: Slip and Fall in chunks of banana Diagnostics: X-ray cervical, thoracic, lumbar MRIs cervical, lumbar, brain EMG/NCV upper and lower extremities Treatment: 2 trigger point injections Cervical discectomy with decompression and arthroplasty

15 Total medical charges billed: $90,124 Medical Bill Review Conclusion: Total recommended payments for all bills combined $38,632 (50 th percentile as usual and customary)

16 CASE #6 Description: Slip and Fall in large pool of liquid Diagnostics: X-ray s of left hip, left knee and lumbar MRI of lumbar spine. Treatment: Spinal interbody fusion (PEEK Cage implantation) Autograft

17 CASE #6 Total medical charges billed: $381,398 Medical Bill Review Conclusion: Total recommended payments for all bills combined $171, (50 th percentile as usual and customary)

18 Publix s Study In the fall of 2011, Publix reviewed 174 Florida liability files comparing charges billed for Plaintiffs medical care to usual and customary fees in the relevant area. These 174 liability files involved the analysis of over $11 million in billed medical charges and the review of over 1000 invoices.

19 Our conclusion: For these 174 files the average amount of excess billing was 88%. This equals over $5,440,000 in phantom damages or $31,256 per file.

20 $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $ Excess billing amount Plaintiff Medicals Usual & Customary Fees

21 WHAT ARE WE ASKING FOR? We want to change the law so that when the Plaintiff has health insurance, the evidence the Jury sees reflects the amount the medical care provider actually received for the care he or she provided.

22 WHAT ARE WE ASKING FOR? In situations where the Plaintiff does not have health insurance, we want to limit recovery for past and future medical care by Plaintiffs in all personal injury cases to what is customarily accepted for such care.

23 WHAT ARE WE ASKING FOR? Change the law so that a party may present valid evidence that treatment was not medically necessary.

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