St. Cloud Personal Injury Lawyer - Spinal Cord Injuries

Medicare Is Delaying My Settlement

Mike Bryant — Sun, 18 Oct 2009 16:08:00 GMT

There have been new and old issues that have come up with recent changes in the Medicare rules. In July of 2009 a number of reporting requirements were added. Basically, in each settlement it must be determined if the plaintiff is Medicare eligible. If they are, then there are additional reporting requirements at the time of settlement. There also is a pay back requirement for money that was expended by the system that was caused by the defendant.

The concern has been if there is a requirement for a future set aside. In workers compensation claims, when there is a settlement that included future medicals, some of the money needs to be set aside so that the Medicare system doesn't pay for those items. The fear that was being pushed by some defendants was that the new rules require a set aside in all cases.

The American Association for Justice followed through on this issue and provided the following information:

... statements from CMS, and other federal entities, make clear that the agency does not require set-asides for liability claims. Since the MMSEA’s passage, CMS has held several Town Hall teleconferences to discuss the Section 111 requirements. During the March 24, 2009 call, Barbara Wright, CMS’ Acting Director of the Division of Medicare Debt Management, made several statements reiterating that Section 111 has no impact on liability MSAs.(2) For example:

In response to a question as to whether liability set-asides will be required under Section 111, she said “the point is the set-aside process is totally separate from the Section 111 reporting process. As we’ve said in more than one call we don’t anticipate changing our routine recovery process.” (Transcript, pg. 24)

When explaining that worker’s compensation agreements use a formal review process which makes set-asides recommended, she said that was in contrast to liability agreements. Liability “does not have the same formal review process although our regional offices will consider review of proposed liability set-aside amounts depending on their particular work load and whether or not they believe significant dollars are at issue.”
(Transcript, pg. 24).

In addition, CMS also has released several Alerts explaining Section 111, which do not indicate any intent to require MSAs for liability claims. For example:

“Unless you are a business entity which qualifies as [a required reporting entity (RRE)] for purposes of Section 111, you do not need to initiate any specific actions in connection with Section 111.” (CMS Alert, 2/23/09).(3)

“The new Section 111 requirements do not change or eliminate any existing obligations under the MSP statutory provisions or regulations.” (CMS Alert, 2/23/09).

Moreover, the Congressional Research Service (CRS) provided Congress with an “objective and non-partisan analysis” analysis of the MMSEA. As there was no legislative history regarding the bill, the CRS research report is the most reliable analysis of the MMSEA, including the Section 111 reporting requirements.

CRS’ analysis of the Section 111 reiterates that it is a reporting requirement, and makes no mention of the need for set-asides in liability cases. The Section 111 analysis states, in part:

This provision requires an insurer or third-party administrator for a group health plan (and in the case of a group health plan that is self-insured and self-administered, a plan administrator or fiduciary) to (1) secure from the plan sponsor and participants information required by the Secretary for the purpose of identifying situations where the group health plan is or has been a primary plan to Medicare, and (2) submit information specified by the Secretary. If an insurer or third-party administrator for a group health plan fails to comply, then a $1,000 per day civil monetary penalty will be imposed for each individual for which information should have been submitted.(4)

If CRS believed that the legislative language implies any Congressional endorsement of liability set-asides, it would have been included in this analysis.

It is still expected that with the reporting requirements many cases will be delayed if an amount needs to be determined for the payback. Early recognition of the claim and making sure all of the reporting is done right will make the biggest difference. Experienced attorneys are getting through the system as fast as possible, and will make a difference to clients who need to know their future Medicare coverage will not be put in jeopardy.

Originally posted at InjuryBoard by Mike Bryant

A True Story

Joe Crumley — Sat, 19 Sep 2009 18:48:00 GMT

A crisp and bright October Sunday morning. The kind of morning that inspires drives out of the city seeking clear air and crimson and amber leaves by roads and rivers.

First things first, though. Mom teaches Sunday School and starts her class prep an hour before. Dad is in charge of the kids until class starts, and when the weather is good, a nature walk along the creek fills the time. Today, however, something different.

It's the morning of the marathon. Dad has been drafted by best friend James to handle snack, first-aid, and petroleum jelly for socks at Milepost 18, which James won't reach for a couple hours. There will be plenty of time to reach Milepost 18 after Sunday School. The church is near Milepost 4, and a check of his watch tells Dad the race is just starting, a few miles away.

Dad shepherds the kids to a bridge where the marathon route crosses the creek. Beyond, the parkway is a broad, sweeping curve. Dad has done this before, and remembers the joy of clapping and cheering on the runners. But always in the middle of the course, arriving only in time to see the middle speed runners, like James. For once, he wants to see the first runners, and taste the excitement of the leaders. Dad has told the kids about this. But Dad has forgotten who usually leads the marathon.

The kids began to get bored after a few minutes, as the runners don't appear right away. They cavort and roll in leaves. A few more minutes and a whisper of clapping and cheering is heard in the distance, then builds. At Dad’s yell, the kids come running back to the bridge. They huddle by him at the curb, all leaning out over the pavement, squinting into the distance.

The clapping gets ever closer, as do indistinct yells of encouragement. My eight-year-old boy looks intently down the road. He often does not care or pay much interest in sport, and his attention span may again soon wander.

Suddenly, a small, low-to-the-ground form comes sweeping past the trees through the beginning of the curve. There is a moment of confusion, then recognition. Not a runner, but a man in a wheelchair ... and he's going fast.

Another man in a wheelchair is coming up the outside, gaining on him. They're almost neck and neck as they sweep through the turn, across the bridge toward us.

I look at my son and note the gradual recognition of what he's seeing. His eyes grow big. It’s a wheelchair. Eyes grow bigger.

His legs are really tiny. Atrophied, tucked almost like an afterthought into a pouch on the racing wheelchair beneath a paradoxically strong, rippling, upper body. He really can't walk or run.

My son is a sensitive boy, and his face begins to screw up at the immensity of what he's seeing. A man who cannot walk; a man who cannot run … is … flying. My boy’s eyes gleam and tears form at the corners of his eyes. Enviably large churning biceps, sweating forearms, and gloved hands literally beat power into the spinning rear wheels.

Men who cannot walk are going to win this marathon.

Misreading his expression, I move to comfort him but he brushes me back and responds quickly, almost as quick as the two men now sweeping by us tucked into their machines.

"Go, Wheelchair Guy, Go!” at the top of his lungs, his voice just cracking. I don’t know which of the two racers he is cheering, but it doesn’t matter. Both racers react immediately to the childish sincerity of that yell, which easily pierces the cheers of the other onlookers. The strain of their Herculean duel notwithstanding; both faces break into broad grins at the cheer.

In a moment they have swept around another corner, still neck and neck. Many more wheelchaired racers sweep by; men and women. Tears are streaming down my face, my son’s face, and his older sister.

A quiet interval, and the running men arrive. All their muscles are lean, and their strides rhythmic and effortless. They are some of the most impressive athletes in the world; some have crossed oceans to run and ‘win’ this race. But they are not so impressive as they might have been just a moment before.

The effort, the striving, indeed the full and complete meaning of sport, encapsulated in one innocent, sincere and robust cheer of an eight year old child. A simple expression of what we often struggle to explain in our closing arguments; the value of strength, the value of physical effort and competition. Not tears of sympathy for them, but a shout of encouragement and tears of joy and wonder.

The 2009 Twin Cities Marathon will be run October 4.

Go, wheelchair guy, go.

Originally posted at InjuryBoard by Joe Crumley

Is The Blue Mice Group Going To Help With Spinal Injuries?

Mike Bryant — Sat, 05 Sep 2009 16:56:00 GMT

Doctors are now looking to blue mice to deal with spinal injuries. Apparently, through the injection of Brilliant Blue G into injured mice, researchers are seeing substantial signs of healing. The tested mice are more active and moving about, as compared to the control group which showed no improvement and couldn't walk. The mice also turn blue.

It is thought that the Brilliant Blue G blocks the problem that creates inflammation in the injured spinal cord. Limiting or preventing the inflammation is understood to prevent extensive irreversible damage. The researchers from the University of Rochester will be continuing the research with clinical trials. The blue dye is found in M and M's, Jell-O, candy, and drinks thus is approved for human consumption.

In our practice we see a number of these types of injuries. It would be great if they could find more remedies to help these people. As lead researcher Maiken Nedergaard pointed out "Even a moderate improvement in functional performance of the patient is a big, big event for these patients,...They can control their bladder. If they can just take small steps instead of sitting in a wheelchair all the time, it's a tremendous benefit for these patients," Hopefully, this research will help a lot.

Originally posted at InjuryBoard by Mike Bryant

Americans Looking To Alternative Medicines

Mike Bryant — Tue, 18 Aug 2009 09:04:00 GMT

Last week, I wrote about the issues of pain killers and the advantages of chiropractic options. It's nice to see the recent study of the CDC’s National Center for Health Statistics (NCHS) which indicates that many Americans are looking other places than pain killers.

Highlights of the study include:

In 2007, 38 million adults made an estimated 354 million visits to CAM practitioners, at an estimated cost of almost $12 billion dollars.
Two-thirds of the out-of-pocket spending was for treatments that did not involve a practitioner, such as over-the-counter herbal therapies and other therapies, classes and materials. About $12 billion was spent on visits to practitioners such as chiropractors, acupuncturists, and homeopathic specialists.
The biggest single expenditure was for non-vitamin, non-mineral herbal supplements and other products (almost $15 billion) followed by practitioner visits ($12 billion), stretching and meditation-related classes such as yoga, tai chi, and qigong ($4 billion), homeopathic medicines ($2.9 billion) and relaxation techniques ($0.2 billion).

WebMD also noted some interesting findings about a type of injuries that we deal with a lot in the office:

Chronic pain, especially back pain, is by far the biggest reason that people turn to alternative treatments, Briggs said.

She cited previously released data from the 2007 survey showing that of the top 20 conditions for which CAM treatments are used, nine involve chronic pain.

“Americans turn to treatments like acupuncture, chiropractic care, and massage therapy to deal with these painful conditions,” she said, adding that groups like the American College of Physicians and the American Pain Society are on record as endorsing these therapies as useful options for the treatment of chronic back pain.

Briggs said assessing the safety and effectiveness of these and other alternative therapies used to treat chronic pain is a major focus of NCCAM’s research efforts.

“I think everyone would agree that we don’t know as much as we should, and need to know more, about how to manage back pain,” she said.

I see this as very good news. Hopefully, these numbers will be considered as the health insurance debate continues. People need to have options and deadly painkillers aren't the answer.

Originally posted at InjuryBoard by Mike Bryant

Minneapolis Man Critically Injured; Defendant Probably Drunk

Joe Crumley — Mon, 15 Jun 2009 09:53:03 GMT

Christopher Iverson, a 48-year-old south Minneapolis resident, was critically injured at a bus stop early Sunday morning, according to a Star Tribune report. Iverson was chatting with a woman at the bus stop, Cheryl Gouge, when the defendant driver drove up over the curb and literally knocked him out of his shoes. At least one witness reported the defendant smelled of alcohol, and Minneapolis Police department spokesman Sgt. William Palmer said alcohol was believed to be involved.

Iverson had ridden his bike out an errand, and had apparently just walked Ms. Gouge to the bus stop when the tragedy occurred.

Iverson, a 48-year-old south Minneapolis resident, was in critical condition Sunday at Hennepin County Medical Center with brain damage and other injuries, said his brother-in-law, Bill Breeggman. Family members expect to decide soon whether to remove life support.

The defendant has been arrested and taken into custody. Minneapolis police report that blood alcohol results will take a few weeks, probably because they are relying on blood or urine testing, which must be processed by the Minnesota Bureau of Criminal Apprehension (BCA). Breath Test results, which are quicker, have been put into legal limbo by Supreme Court rulings.

Early investigation wil be crucial. Police investigation will center around Criminal proof. A civil investigation would also look at the alcohol consumption. If a bar or liquor store illegally served alcohol to the defendant, there may be civil dram shop liability in addition to the fault of the drunk driver. Drunk drivers are often uninsured or underinsured, so an insurance investigation will also be important.

Our thoughts certainly go out to Mr. Iverson and his family.

Originally posted at InjuryBoard by Joe Crumley

Child Safety: Recent Studies Raise Concerns About Children And Snowmobiles

Mike Bryant — Wed, 21 Jan 2009 12:40:00 GMT

Last week, I blogged about general safety concerns while snowmobiling. Recent deaths up north have raised the concerns of more people. A recent study looked closer at the concerns of young riders.

A study by the Mayo clinic found that when young adults are injured,Orthopedic injuries predominate and lead to long-term disabilities. Helmet use significantly reduces injuries; however, vulnerable younger patients do not frequently wear helmets. As a result, the American Academy of Pediatrics and the Canadian Pediatric Society say that no one younger than 16 should be allowed to use a snowmobile.

In other states, the issue has been discussed, with New Hampshire requiring children older than 12 who don't have a driver's license to take a safety course and in Maine a child must be 10 or older to snowmobile on land other than that owned by a guardian or parent and a child must be at least 14 years old to operate a snowmobile across a public way.

There are many months of winter in front of us locally. Hopefully all snowmobiles will ride safety and where children are concerned, make sure that extra precautions are taken.

If you are in a snowmobile accident , it's important that you get medical help right away. If you have questions, contact an experienced Personal Injury lawyer who has dealt with these type of cases. As always, make sure you talk to someone knowledgeable before you sign off on a claim or give away the rights of your children.

Originally posted at InjuryBoard by Mike Bryant