Medical Legal - The Affordable Care Act: Palliative Care vs. Hospice Services - A Claims and Litigation Perspective on Today's Cost of Dying Comfortably
Medical Legal - Whistle While You Work - How to Prevent Activity Leading to Whistleblower Actions and Protect Health Organizations and Medical Practices from Whistleblower Threats
How well do the members of your organization or team work together? Are you a smooth, well-oiled machine or a fractured collection of in-it-for-yourself individuals? In a straight forward no-excuses style, Kevin Kush discusses eight traits that can turn any group or organization into a cohesive, high-performing team. Including; respecting everyone, handling adversity, adapting to change, and the importance of having high energy and being accountable. Coach Kush’s passion for performance is contagious and will help lead your team to greater productivity and success!
This advanced session will explore the use of Evidence Based Medicine as a key tool in the claims handling and Medicare compliance process by providing an objective basis for the determination of appropriate optimal care for injured workers with a focus on improved medical and functional outcomes. The application of the evidence for treatment and pharmaceutical options not only provides a more accurate basis for expediting claims handling, utilization review, authorization of medical treatment and cost projections reflecting appropriate quality care. When the objective evidence is presented to injured workers, treating physicians and involved stakeholders, agreement to the best treatment options can be obtained, resulting in elimination of the need for inappropriate suboptimal treatment excessive cost projections or, treatments which, in reality, are not in the best interests of the claimant and will or should never be rendered. Allocating for all medications prescribed over the two years prior to the MSA with dangerous drug interactions and contra indications, and life threatening combined dosages rather than the current appropriate medication regime supported by the treating medical providers is further counter-intuitive to best practices in claims handling and improving outcomes. The legal implications and effectiveness of the use of IMRs and other jurisdictionally based legal defenses in MSA submissions will also be detailed.
This session will address best practices for both counsel and claims professionals in managing the DC/Insurer relationship, making the team effort more efficient in working towards effective and economical claims resolution. The panel will address such elementary topics as efficient communication between and amongst the team, but also methods to enhance the coordination and execution of resolution action plans to minimize cycle time, defense spend, and indemnity payouts.
The topic of Diversity in the Legal Profession is complex. On the one hand, the progress in this area has been slow and frustrating. Everyone agrees that it is necessary and a value-add, however no one has truly figured out how to maximize it to their advantage. This panel will discuss their perspectives regarding how legal diversity can be leveraged to create an atmosphere where diverse ideas and viewpoints can exist as a result of hiring diverse outside counsel and how it can potentially improve claim handling and litigation management.
Claims/Litigation Management - SESSION 4 - EEOC Focus on LGBT Employment Matters: Expanding Title VII's Protections, Transgender Accommodations & the Effect of Marriage Equality
The EEOC is setting its sights beyond legislation and representation of LGBT employees to shaping the do’s and don’ts of the workplace. Discrimination based on sexual orientation and gender identity is only prohibited in some states and is not included within Title VII’s protections. However, the Commission’s strategic enforcement plan for 2016 specifically identifies, as an enforcement priority, coverage of LGBT individuals under Title VII's sex discrimination provisions. This exacerbates the existing tension between the EEOC guidelines and federal law. Between the EEOC’s guidelines and litigation on behalf of transgender employees and the current state of the law in this area, it is unclear how far employers must go to accommodate transgender employees. From bathrooms, bullying and accommodations, the potential for liability is real and education is necessary.
While there is no requirement to provide benefits to employees’ spouses, the EEOC takes the position that failing to offer benefits to same-sex couples that are offered to opposite-sex couples runs afoul of Title VII. This begs the question, what benefits must be extended in light of the Supreme Court’s decision in Obergefell v. Hodges?
Robert Keith, Engles, Ketcham, Olson & Keith, P.C.
June 23, 2016 3:25 PM
A product failure occurs involving a trailer’s wheel assembly causing a traumatic injury to an innocent bystander. Law enforcement initiates an investigation, impounds the tractor and trailer and performs an inspection to determine whether the owner/operator violated any part of the Federal Motor Carrier Safety Regulations. A large claim is going to be asserted on behalf of the injured party and the owner/operator’s equipment has been impounded. Steps need to be taken to protect the interests of the owner/operator.
The presentation will give owner/operators, their insurers and their attorneys’ guidance via a real example of product failure as to how to protect the interests of all involved. The presentation will focus on the development of a rapid response investigation including identifying the scope an role law enforcement will play in the investigation; what to do when the product is returned to your custody and how to get it back in service as quickly as possible; reviewing applicable regulations to determine your investigative strategy; identifying and preserving key pieces of evidence; retaining a “custom” witness; and preserving witness information and statements.
This interactive seminar will create collaborative conversations to aid all in developing better techniques into product failure investigations that will aid all members of the industry, client, insurance and legal, in being better prepared when catastrophe strikes.
How well do the members of your organization or team work together? Are you a smooth, well-oiled machine or a fractured collection of in-it-for-yourself individuals? In a straight forward no-excuses style, Kevin Kush discusses eight traits that can turn any group or organization into a cohesive, high-performing team. Including; respecting everyone, handling adversity, adapting to change, and the importance of having high energy and being accountable. Coach Kush’s passion for performance is contagious and will help lead your team to greater productivity and success!
Samuel Shapiro, Aaronson Rappaport Feinstein & Deutsch, LLP
June 23, 2016 9:15 AM
The Health Care industry is on the precipice of a brave new world. The Affordable Care Act has challenged the medical industry to find effective and cost efficient ways of providing medical treatment. The advent of innovation in medical technology has already changed the face of medicine with telemedicine leading the charge. Telemedicine has the potential to create efficiencies in healthcare and extend the reach of existing providers but can create issues of safety and privacy.
The panel includes representatives from underwriting, claims and the defense bar and they will examine the benefits and potential issues associated with the use of telemedicine including the various applications. They will discuss potential claim drivers, underwriting questions, regulatory considerations and litigation concerns. Additional topics will include the potential for data security, fraud & abuse and HIPPA issues.
While the law is still unsettled in many states regarding the Affordable Care Act (ACA), there is no doubt that life care plans based on the ACA are dramatically different than traditional life care plans and, if jurors accept these newer life care plans, damages may be greatly reduced in states allowing testimony on the ACA. However, do jurors accept arguments regarding the ACA? And if the law is so unsettled and the jurors may not accept ACA arguments, does it make sense from an insured’s perspective to pay for the discovery and experts associated with the ACA?
This presentation will briefly examine the state of the law surrounding the ACA, the differences in life care plans with and without the ACA, and jurors’ comments and reactions to the ACA using clips from mock trials and focus groups. In addition, a claims industry representative from a national insurance carrier will give her perspective on when it makes sense to pay for the costs associated with an ACA defense.
The session explores the progression of breaches in healthcare IT security, leading to recent cyber attacks in major medical facilities across the United States. The mega breaches of today are devised by criminal masterminds and include the threat of violation of patient privacy affecting millions of patients; the tampering of critical medical equipment to provide false readings, leading to life-threatening medical mismanagement; to the recent trend in monetary ransom attacks, causing a lockdown of computers and patient files, forcing the closure of healthcare facilities. This session will focus on theories lodged as to the weaknesses in security, creating vulnerability to these cyber attacks; the target groups of such attacks; the ways to improve security for prevention; how to respond to and defend against a hacker; and the legal ramifications to the victimized institution.
Medical Legal - SESSION 4 - The Affordable Care Act: Palliative Care vs. Hospice Services - A Claims and Litigation Perspective on Today's Cost of Dying Comfortably
There is an upcoming election, but the Affordable Care Act (ACA) is here to stay. The ACA has the potential to provide mediators, arbitrators and courts enough objective information to cap a Plaintiff’s future medical needs to the recovery of premiums and out-of-pocket expenses. Such an application may eventually create an overall reduction in indemnity payments for medical malpractice carriers, and their insureds. This presentation will provide an overview of the ACA, obstacles within litigation, summaries of recent defense favorable case law and orders, and initial recommendations for how to develop an affirmative defense for those complex medical malpractice cases which involve extensive palliative care. Although laws vary amongst states we recommend making similar, continuous and consistent efforts across state lines in order to reach the ultimate goal of all courts automatically allowing and applying the objective costs provided by the ACA as evidence towards mitigation of Plaintiff’s future damages.
While Ralph Nader is frequently credited with coining the phrase "whistleblower" in the 1970’s, informants have been a part of the justice system in the U.S. since at least the Civil War, when the government embraced whistleblower information relating to government contracts. That trend has increased exponentially since then, and it is not expected to slow any time soon. To the contrary, the government has greatly enhanced rewards to whistleblowers in a number of areas and the perception of whistleblowers has sometimes turned from that of a snitch to an American hero.
Whistleblowers, both real and purported, have become a part of everyday business life. Failing to prepare for complaints about illegal and/or unethical activities, and ignoring or minimizing these complaints is a recipe for disaster. This presentation is intended to help organizations identify whistleblowers generally, identify the sources of whistleblower complaints, handle complaints appropriately, manage the substantial risks associated with responding to complaints and make recommendations for steps companies can take to prepare and protect the organization before a complaint is made.
How well do the members of your organization or team work together? Are you a smooth, well-oiled machine or a fractured collection of in-it-for-yourself individuals? In a straight forward no-excuses style, Kevin Kush discusses eight traits that can turn any group or organization into a cohesive, high-performing team. Including; respecting everyone, handling adversity, adapting to change, and the importance of having high energy and being accountable. Coach Kush’s passion for performance is contagious and will help lead your team to greater productivity and success!
Nonprofit organizations rely on volunteers to implement their mission, but inevitably, volunteers can also comprise a source of significant liability for the organization. This session is intended to review and address prospective liability to volunteers and caused by volunteers. This includes outlining the types of claims that can result from use of volunteers (ie personal injury, auto, outrage, attempts to create an employment relationship, D & O liability), identifying claims trends based on national statistics, reviewing relevant law regarding duties to supervise and to protect, establishing criteria to enable reasonable care in the selection of volunteers, clear communication establishing training and status, steps to disengage or terminate the volunteer if necessary, and developing methods to reduce or share liability (effective releases, volunteer handbooks).
This session will include a survey of LGBT issues related to employment, accommodations/business services/civil rights and insurance. The session will start with a brief overview of terminology and definitions. Panelists will summarize the development of LGBT legal protections in the workplace, including the EEOC’s current efforts to pursue LGBT discrimination claims under Title VII, OSHA’s stance on restroom access, and court cases addressing the collision of LGBT issues and religious accommodation/religious organizations. Panelists will discuss court cases involving LGBT issues related to public, customer, and client services, and civil rights. Panelists will also address how different insurance policies cover these legal issues.
Religious employers have a number of unique risks and defensive strategies available to them in employment litigation. This session will seek to “remind” religious employers what they should be doing to place themselves in the best defensive posture possible in the unfortunate event of an employment claim. The panelists will discuss applicable law, case studies, recent developments, hot litigation/enforcement areas, and best practices. The session will be interactive and attendees will have the opportunity to ask questions of the panelists regarding any situations they might face.
This presentation will address best practices for handling what may be among the most difficult of claims – allegations of child sexual misconduct by individuals in positions of leadership and authority. The panelists bring a wealth of experience and perspective on this controversial and challenging area. Initial response is pivotal and can be complicated by the often high profile of the institutions and individuals involved. Initial investigation presents a crucial opportunity to shape the claim and achieve necessary understanding and insight regarding the validity and viability of the claim. The panelists will discuss best practices for identification and preservation of applicable privileges and immunities. Hear tips on conducting an effective investigation which recognizes the sensitive nature of the claims while fulfilling the need for a thorough review of the allegations. Those involved in the claims process have an obligation to uncover illegitimate claims but need to try and do so without compounding or further antagonizing the situation. Claims handlers and counsel must recognize mandatory reporting requirements and potential criminal issues and be prepared to properly advise those involved regarding their obligations. These claims often involve significant time gaps between the alleged misconduct and filing of a claim. The panelists will address complications presented by unavailability, often due to death, of those involved and the absence of records. The discussion will cover issues including statutes of limitation and bankruptcy, which may provide defenses for the individuals and institutions involved.
How well do the members of your organization or team work together? Are you a smooth, well-oiled machine or a fractured collection of in-it-for-yourself individuals? In a straight forward no-excuses style, Kevin Kush discusses eight traits that can turn any group or organization into a cohesive, high-performing team. Including; respecting everyone, handling adversity, adapting to change, and the importance of having high energy and being accountable. Coach Kush’s passion for performance is contagious and will help lead your team to greater productivity and success!
This panel presentation will discuss the important role that the first party adjuster plays in the subrogation process. We will explain the critical nature of early and frequent communication between the first party adjuster and the subrogation specialist while the first party claim is being adjusted. Additionally, we will provide concrete examples of the type of documentation necessary to establish a subrogation claim, and discuss how the first party adjuster can help to collect and deliver a winning package of information to the subrogation specialist.
Subrogation Pitfalls – Navigating the Difficult Insured is a presentation focused on recognizing potential problems that may arise when dealing with a difficult insured during the subrogation process. The presentation will include real-life examples to emphasize some of the common issues and their potential impact that arise in subrogation matters when the insured does not wish to cooperate and/or wishes to put his/her own interest ahead of the subrogated carrier. The presentation will also provide suggested methods for both preventing potential pitfalls and addressing problems when they arise.
We have all been there. You have a solid liability case that should resolve for a high percentage of the paid claim, but the subrogation target’s carrier is challenging every aspect of your damages. With so much effort and expense put into proving liability, we sometimes overlook the importance of developing “provable recoverable damages,” which are necessary to secure large subrogation recoveries.
This intermediate-to-advanced presentation for subrogation representatives and attorneys will focus on the aggressive strategies and tactics that subrogation professionals, front-line claims adjusters and attorneys can pursue to maximize the provable recoverable property and related damages.
Recommendations and discussions will cover the full scope of recovery efforts: from the initial claims adjusting; through effective and persuasive pre-suit presentation of damages; to the appropriate measure of recoverable damages and how to negotiate; right on up to the best logistics for maximizing your damages at trial.
Throughout the presentation we will be interacting with the audience about their past and present cases, and how they may have handled them better, and how they can be more proactive going forward.
The presentation will emphasize the importance of a prompt and thorough subrogation investigation for property claims- fire, water and structural. The presentation will address considerations in the retention of expert(s), interaction with public authorities, what information and documentation needs to be gathered immediately, recognition of potentially responsible parties, proper notice to those potentially responsible parties, securing the loss scene and any artifacts associated with the loss, and potential defenses to be considered in conducting the investigation.
The Consumer Product Safety Commission (CPSC) regulates the sale and manufacture of various consumer products within the United States and is charged with protecting the public from unreasonable risks of injury or death associated with the use of the thousands of types of consumer products under the agency's jurisdiction. The CPSC is charged with ensuring that proper minimum safety standards are developed and identifying those products that fail to meet those standards. While violations of CPSC standards do not necessarily create private rights of action, those entities pursuing product liability claims against manufacturers, distributers and sellers can use the materials and standards generated by the CPSC to help them more effectively litigate their cases to a successful conclusion. This presentation will provide a background on the how the CSPC operates, what information is available for a subrogation litigant, and how that information can be used to produce a successful recovery.