Understanding When HIPAA Applies One of the most common questions in workers’ compensation subrogation practice is whether HIPAA requires a signed release before medical records can be obtained or shared. The short answer is that HIPAA seldom prevents the exchange of records between medical providers and workers’ compensation carriers for the purpose of administering or…
For years, Alaska remained one of the last holdout states which had not provided any caselaw decisions to declare whether and what evidence of medical bill charges or payments could be introduced by the parties in a personal injury suit. In a personal injury case, was the “reasonable value” of medical bills incurred by the…
Bayham v. State of Louisiana, Through the Office of Group Benefits, 2019 WL 4073410 (La. App. 2019). In a line from the History Channel’s television series Vikings, Viking chieftain Ragnar Lothbrok looks down at the village of Kattegat with his son and gives some advice regarding power: Power is always dangerous. It attracts the worst and…
Recovery of Medical Expenses in Personal Injury Actions Generally To recover damages for past medical expenses in a personal injury lawsuit, a plaintiff must present evidence and prove that the medical expenses incurred were both “reasonable” and “necessary.” For more than 100 years, this simple formula was the least complicated aspect of a plaintiff’s personal injury…
A Philadelphia jury handed down a roughly $28 million verdict against Johnson & Johnson and Bayer AG on Tuesday, December 5, giving hope to tens of thousands of Xarelto plaintiffs after a series of defense verdicts in the federal multidistrict litigation (MDL) currently pending in the Eastern District of Louisiana. This is also very good news for…
After considering a motion brought by the plaintiffs in 46 actions pending in nine federal districts across the country, the Judicial Panel on Multidistrict Litigation (MDL) entered an order on Tuesday, transferring those actions to the Northern District of Ohio for coordinated or consolidated pretrial proceedings. Those cases represent only a fraction of the cases filed…
Some states, including Missouri, are known as “anti-subrogation” states. Missouri’s public policy prohibits the assignment of a personal injury claim, whether it is called an assignment, subrogation interest, or agreement to reimburse. Hays v. Missouri Highways and Transp. Comm’n, 62 S.W.3d 538 (Mo. App. 2001). This means that in Missouri, a health insurance company who…
A recent 2nd Circuit Court of Appeals decision interpreted New York’s General Obligations Law § 5-335, which provides that personal injury settlements “shall be conclusively presumed” not to include “any compensation for the cost of health care services, loss of earnings, or other economic loss[es]” that “have been or are obligated to be paid or…
In a highly anticipated decision, the U.S. Supreme Court has finally weighed in on the issue of FEHBA subrogation and federal preemption of state laws in Coventry Health Care of Missouri, Inc. v. Nevils, 137 S.Ct. 1190 (April 18, 2017) (Coventry II). The verdict is that state law must yield to FEHBA contracts’ subrogation provisions.…
On August 8, 2016, the 11th Circuit issued its opinion in Humana v. Western Heritage, 15-11436 (11th Cir., August 8, 2016). It is a major victory for Medicare Advantage Organizations (MOAs) and a major blow to liability insurers. Matthiesen, Wickert & Lehrer (MWL) attorney, Ryan Woody, filed an amicus brief for America’s Health Insurance Plans…