Case Strategies for Personal Injury Cases where Plaintiff has Inadequate Health Insurance or is Denied Coverage

Transcription

1 Case Strategies for Personal Injury Cases where Plaintiff has Inadequate Health Insurance or is Denied Coverage Help your Client get the medical care they need NOW! Help your firm fight to the finish! Author: Dean H. Chase HMR Funding, LLC 9211 Forest Hill Ave Richmond, VA SITUATION: You are a plaintiff-side personal injury attorney. Your client suffers from an injury resulting from a wreck with an 18-wheeler. The wreck was not the plaintiff s fault and he is in need of medical treatment. You soon discover your client has no health insurance, is under-insured or is denied coverage. Your practice needs quality providers that your client badly needs, you know you cannot (and should not) direct medical care, and/or you are in a state that prohibits you from paying for his medical services. Additionally, your firm needs capital for trial expenses, experts and your client is broke, which is exactly where the defense firm wants this this case to be as your client continues to suffer and is not getting what he deserves. QUESTIONS: 1. How can you best help your client get the care they require/deserve and also materially increase the value of the case? 2. How can you provide your firm the capital necessary to take this case to trial without putting undue pressure on your firm as well as on your personal finances? 3. How will your client and your firm best survive until this case is resolved? This is Happening More Often than You Realize Tens of Millions of Americans are Uninsured According to the 2012 U.S. Census, there are nearly 45 million Americans who have no health insurance. You may practice in a market where only 10% of your clients are in this predicament or you may be in an area where 30% or more of your clients fall into the uninsured/under-insured category. Regardless, your firm needs to have a strategies and protocols in place to make sure you are fully prepared to help these clients and increase the value of these cases, while also making prudent firm decisions for capital allotment. This article outlines a proven method of accomplishing this mission. 1

2 Avoid Gaps in Medical Treatment You are well aware of basic tactics the defense will often deploy: Disputing that your client is truly injured and asserting that he is attempting to garner a financial windfall by bilking the system. In short, the defense will often delay justice and therefore deny your client what he/she is entitled to. You have seen it over and over again. Your client is confused, broke, and scared. Your client is suffering from a wreck-related injury. Because your client has no health insurance they simply cannot afford to get the medical treatment they require so they do nothing. He copes with the pain and likely misses time from work. His inability to pay for required medical treatment results in a gap in medical care. This hurts your case. The Defense knows exactly how to use such a gap in medical treatment against you and your client. Additionally, as time goes on your client becomes more and more stressed as the bills pile up, with no solutions that make sound financial sense. Financial Stress on Your Law Firm Lastly, while you took an oath to help these poor clients, the cash that is often required to properly prepare the case is truly significant. Banks in general will not collateralize your case(s) and you may find your own firm strapped for the cash that is necessary to manage so many concurrent cases. But how do you solve these mountains of problems? You want to do the right thing as a Trial Lawyer for your clients and you also want to properly manage the cash flow of your practice. Below is a series of steps you can take to address all of these challenges: Step One: Start with your Case Intake Department Looking within the processes and personnel of your case intake department is step one to implementing this successful strategy. Are your personnel asking the right questions to determine if a client is in fact uninsured or under-insured? Be sure your organization has a programmatic means to let you know that this client falls into the uninsured category so you can jumpstart your new underinsured/uninsured client protocol. Step Two: Align with a Quality Medical Funding Company One that knows what to do and has the horsepower to get the case done correctly We all know of funding sources that can help your client with cost of living advances for managing household financial responsibilities while you manage the case. These companies serve their purpose well but they almost always fall well short when it comes to helping an uninsured client who is in need of surgery or other 2

3 expensive medical procedures and capital needed for the larger cases. Why? Because they often try to have your client take these loans, almost always with excessively high interest rates, which have proven to actually hurt the case due to end of case financial pressure when they are supposed to be helping. This often results in a messy case and an unhappy client, in which you now have to work extra hard to help you client manage the stress and confusion of a case that has a lower net result to the client. Also, the client will rarely be an excellent referral source for you and your firm as they have had a less than optimum experience. Until now see below. A quality funding company will first dive into the case to understand the merits of your case relative to causation, defendant liability and overall insurance coverage. They should have experienced underwriters on staff to analyze your case; you should be prepared to have your paralegal complete an application that may take 30 minutes or so. Once your case is reviewed by the funding company and is ultimately accepted, they will spring into action and help you manage your client s medical treatment plan while offering both your firm and your client a wide range of options that help you manage the case to a successful end result. When properly managed, you will have a stable of satisfied clients who will each be enthusiastic referral sources for you and your firm to others. Your next step in helping your client get the medical care he needs will be to align your firm with one of the funding companies that specialize in funding expensive medical procedures for uninsured and under-insured plaintiffs. HMR Funding (see is a company that specializes in supporting those cases that require everything from imaging, surgical procedures, physical and occupational therapy, prosthetics for amputation cases and even 24/7 TBI rehabilitation with associated medical bills often exceeding $100,000 or more. These firms also need to have sustainable options for other capital needs at rates that are reasonable, all with virtually no risk to you or your clients. Step Three: Audit of Medical Records Should Be Done Funding Should be Non-Recourse Additionally, quality funding companies will audit select medical estimates (pre-medical encounter) and bills to ensure there is no erroneous billing which the defense could use to put your case in jeopardy. This will benefit your case by not allowing the medical expenses to exceed the monetary level that the attributes of the case will support (see Funding Should Be Non-Recourse A quality funding company will risk their money right beside you. If the case is lost, the funding company loses its money on the case there is often no recourse against your client or your firm. If the case is either settled or won in trial, the funding company will be paid the value of the medical procedures as billed by the medical providers throughout the case. Be sure to select a funding company that has a solid track record, can audit the medical bills for competiveness and appropriateness and has a wide range of established provider options for your clients. 3

4 On other financial programs, such as capital needed for trial costs, experts, or even client living expenses that can be a nuisance for your firm, their terms should amount the most favorable in the ever-growing litigation funding market. There is no reason for your firm or your client to pay a premium for such services. Step Four: Prepare your Case/Build your Specials Every case is different, so it is impossible to follow the exact same strategy on each one. However, we all acknowledge that if the plaintiff has been responsible, if the medical treatment plan has been efficiently managed, the medical records support the medical necessity of the treatment, and the medical provider is a solid witness your chances for a favorable result are increased significantly. Below is an illustration of the same hypothetical case with an uninsured plaintiff one) with a quality funding company being involved (see Figure Scenario #1) and the other (see Figure 1 Scenario #2) not relying on the expertise of a quality funding company: Figure 1 For illustration only Scenario #1 Scenario #2 Necessary Medical Services Timing WITH Funding Co. WITHOUT Funding Co. Initial ortho consult Day 1 Yes No Image Day 3 Yes No Pain mgmt. injection Day 7 Yes No Physical therapy Days 7-21 Yes No Surgery Day 45 Yes No Physical therapy Days Yes No Occupational therapy Days Yes No Gap in medical treatment No Yes Total Medical Bills $60,000 $0 Case Result (increases significantly) $240,000 $60,000 (400%) Legal Fees (increase proportionately) $80,000 $20,000 (400%) Net to client (after meds) Plus 150% $100,000 $40,000 (250%) 4

5 Strengthen your Case By partnering with a quality funding company you mitigate several strategies the Defense will likely attempt to use against you. The inherent advantages include but are not limited to the following: - There is a thorough and well documented medical treatment plan with no gaps in medical treatment. - The medical service records, radiology, operative notes and other services clearly support the medical necessity of the treatment received. - The depositions of the medical providers support your causation and defendant liability arguments. - Your firm has the necessary capital to help cover your trial costs, your client has received living expense advances against their settlement to help them be more patient as you manage their case so settling cases short is simply not necessary. If the case needs to continue or go to trial it can. - Your client and your firm each knows that they have a quality funding company that understands BOTH the medical side and the legal aspects of your case to become part of your team and will risk their capital right beside you, your firm and the plaintiff so you can focus your full energy as a Trial Lawyer. The Economics are Compelling In referring to Figure 1 Scenario #1 above, the case built in partnership with a quality funding company has far more merit logic, responsible plaintiff behavior, and the appropriate and medically necessary expenses to help you maximize the value of the case. Conversely, when no medical treatment is provided, as illustrated in Scenario #2, the value of the case is severely diminished. Step 5: Be a Trial Lawyer By implementing this proven strategy, the defense will quickly recognize that you are a trial lawyer that is committed to achieving the optimum result for your client. You are strategic. You are patient. You are resourceful and you have your client s full confidence which all mean you are willing to try the case with confidence. Your client is patient too, because they are receiving what they need-now. 5

6 Illustration 2: Well-Managed Medical Treatment Plan ObamaCare is NOT Affordable Some attorneys indicate that when they have a new client who has no health insurance they advise their clients to get ObamaCare the Affordable Care Act. If this is your current advice to clients, you should reconsider the financial ramifications to your client. With ObamaCare, there are often significant deductibles and onerous co-pays built into these so called, affordable policies. In cases like the one illustrated in Figure 1 Scenario #1 in which the medical expenses in the case were $60,000, a typical policy may have a $2,500 deductible with 20% co-pay requirements resulting in costs to the plaintiff of $14,500. For most uninsured plaintiffs this amount simply cannot be afforded. And if you lose the case, the plaintiff is still responsible for these charges. Most plaintiffs would rather have a medical funding company assume the medical expense financial risks understanding that they will be required to pay the funding company at the end of the case if they prevail. 6

7 In Conclusion You have likely had cases similar to the Scenario #2 illustration found in Figure 1 where you only have few specials that simply do not justify the monetary result that plaintiff truly deserves. And your client deserves the medical care, not empty promises by the defense and inadequate healthcare due to this wreck. Do not penalize yourself or your client simply because they do not have - nor can they afford - health insurance. We all know that every case is different; therefore there is no one right solution for every case. Many of your fellow trial lawyers such as Don Keenan, John Romano, and the many hundreds of others have used our services and will validate the inherent benefits of working with a quality funding company. Trial lawyers who are working closely with the right funding company on uninsured and under-insured cases not only help their clients by helping them get them the medical care they require; but they also help dramatically increase the value of their cases, which benefits both client and your firm. About the author: Mr. Chase is Chief Marketing Officer of HMR Funding His is. 7

8 Dean H. Chase Biography/ HMR Funding Introduction Mr. Chase is Chief Marketing Officer of HMR Funding, LLC, a plaintiff-oriented medical funding company located in Richmond, VA and McKinney, TX presently serving 39 states. HMR has been in business for 24 years. Prior to leading HMR Funding, Mr. Chase had a 20 plus year career both in medical funding and medical device firms with positions in Finance, Management, and Sales & Marketing. Mr. Chase also spent several years as a business leader in Asia and Latin America completing expansion project for over 50 medical centers. Mr. Chase is a graduate of the University of California and is a frequent speaker at Plaintiff Trial Lawyer functions and throughout the United States. Mr. Chase is the father of two adult daughters and resides in the Dallas Metroplex area of Texas. Dean Chase, Chief Marketing Officer or (888)