Medicare and Your Injury Claim

See that dog? I normally get that look from my clients when I try to explain this. Bear with me…

When you receive Medicare, and when you have a third party that might also be responsible for your medical bills (like when you have an injury claim that results in an offer of money, part of which reimburses you for medical expenses), then the law requires that you pay Medicare back.

But like anything dealing with government, the process isn’t straight forward. Not the end of the world, of course, it’s just more hoops to jump through. What are those hoops? I’m so glad you asked:

First, you’ll need to notify Medicare of the third party claim. As your attorney, I’ll do that for you, but I’ll first get you to sign a MSPRC/Medicare Proof of Representation form. That allows them to talk to me.

Second, Medicare will send what they call a Conditional Payment letter that indicates what they’ve paid in relation to your claim. This is NOT the final number that you’ll owe them, but it is IS what you have to work with in negotiating the claim with the third party.

Of course, if there are things listed in that summary of the Conditional Payments that you don’t think are related, we can ask them to amend it. They often will, which is nice.

AFTER we settle the claim (yes, AFTER) we then submit a form to Medicare indicating what the claim settled for, what the attorney’s fees were, AND what else we have to pay out of the settlement (other bills, costs, etc.). About a month or two later (that depends…years ago it was an 8 month turnaround, but as of this writing, they’ve been doing it in 1 – 2…) they send the Final Settlement letter, telling us what they want back. In calculating that number, they take into account the fees/costs/etc. that we reported, so often times this number is less than the Conditional Payment amount, but not always (as some payments can occur after the CP $…).

More complicated than it needs to be? Probably. But it’s what we have to work with for now, and it’s all the more reason to NOT handle your case on your own. Failure to take Medicare’s interest into account can jeopardize your coverage. Call me! 919-929-2992.

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Your Health Care Providers – Gotta Catch Em All!

When you have an injury claim – auto accident, slip and fall, dog bite, whatever – you’re probably going to have to see one if not several health care providers.

If you have an attorney helping you with your claim, it’s ABSOLUTELY VITAL that you make sure your attorney is aware of ALL of your health care providers related to your injury claim!

Why is this important? Think about it: As your attorney, what I’m trying to do is paint the most detailed and accurate picture of your treatment as possible. If you’ve left out a health care provider, I don’t have a complete picture to paint! I would be totally ignorant of those bills and records, and they may be a very important part of your story.

I can’t tell you how many times, despite my constant questioning and request for updates, I’ve gotten to the end of a client’s treatment period and requested all of the records/bills and gotten what I asked for, only to go over them with the client who then asks me, “Why don’t you have such and such in there?” Then I have to answer, “You didn’t tell me about such and such and I’m not telepathic.” This leads to at minimum a delay in your claim and also possibly a very frustrating conversation.

Don’t let this happen! Tell your attorney EVERY time you go to a provider and tell them about EVERY bill you get. Even better, SEND THEM EVERY BILL YOU GET! That doesn’t mean don’t pay them, it just means make sure your attorney has a picture of them. This way things won’t be left out.

Details matter. Don’t let them slip through the cracks. Call me at 919-929-2992.

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NC Traffic Tickets – Why Hiring a Lawyer Makes Sense

Traffic Attorney

We all get tickets. None of us are perfect. We all speed from time to time, we all make mistakes. But as I’ve said for years, it’s not if we mess up, it’s how we handle our mess ups that define us.

So you got a ticket. How are you going to handle it?

On one hand, you might feel comfortable going to court and winging it. You’ve heard about the “PVJ” or whatever it is, so you figure you waive that around and it will probably work out, right?

YOU ARE PROBABLY WRONG! Negotiating a traffic ticket successfully involves knowledge of State Law as well as local practice and rules. This is not the type of thing that’s easy to just do on the fly. The consequences are harsh, too. Your insurance can go up astronomically for 3 years, and you might even lose your license.

If you’re debating hiring an attorney for your ticket, here are the reasons why you should:

  1. The fee is less than your time. We are generally charging between $100 and $200 to handle a ticket, depending on the circumstances. Is it worth you missing a whole day of work, or maybe several, to save that money? Maybe it is, but it probably isn’t. Pay us, and you go do what you’re good at and we’ll go do what we’re good at.
  2. The knowledge is worth the fee. You might not want to accept this, but traffic ticket law can be somewhat complicated. If you zig when you should have zagged, you can lose your license, or at minimum get huge increases (FOR THREE YEARS) on your insurance premiums. If you hire an attorney with experience in this area you’re much more likely to have an outcome that is favorable. You might think you can figure out how to do our job by reading a blog post or two. But I doubt it. Sorry.

Don’t hesitate to hire an attorney for your ticket. At least call one and talk about it. The best of us will tell you if you really don’t need us. Call me at 919-929-2992.

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Communication and Your Personal Injury Claim

We’re all part of this gigantic social experiment, so in a macrocosm communication is VITAL to our survival.

On a smaller scale, communication is also VITAL to the success of your personal injury claim.

Why is this such a big deal? Well, communication is about information. And information is knowledge, and as you well know, knowledge is power. For the good and for ill, as well. Check it out:

Communicating regularly and in detail with your attorney is important. The knowledge you share about your recovery, your health care situation, your questions, and concerns helps to make sure the attorney is using his/her skills to address each aspect of your claim. Knowing what your recovery looks like helps him/her to prepare your case for best results, and speaking with your attorney can help make sure you’re doing the best that you can be doing on your end to ensure the success of your claim. This cannot be overstated.

AVOIDING communication of the negative sort is also important. Social media and injury claims are oil and water; they do not mix. I have never seen social media posts help an injury claim, so it makes a lot of sense to totally avoid discussing your claim – or maybe taking a complete break from SM – after your accident. Also, everything you say to an insurance company representative can and will be used against you. Don’t. Talk. To. Them.

In summary, talk to your attorney. Respond to his/her attempts to contact you. Don’t talk to the insurance company unless specifically told to by your attorney. These things can be the difference between good and bad outcomes on your injury claim. Like a lot of other things in life, it’s super simple, but super important.

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Pedestrian v. Car Accidents

Here in Chapel Hill, we probably have a LOT more pedestrian activity than most towns in North Carolina. With 25,000-ish students centered around Franklin Street, and many of them living off of nearby roadways and walking to bus stops, pedestrian v. car accidents are very much a concern. So let’s talk about some issues with pedestrians and automobiles.

RIGHT OF WAY…A CONFUSING QUESTION

Look to the light to see who has the right of way. That will pretty much always set the stage. However, NC law is a little mushy on this, because once a pedestrian is in the roadway, drivers have a duty to yield, even if the pedestrian shouldn’t have been there. This sounds crazy, but it’s not when you think about it; we’re just not allowed to kill people simply because they’ve made poor decisions. Having said that, what we have to do is what a “reasonably prudent person would do in the same or similar circumstances.” So that means if I’m going the 65mph speed limit on I40 at night and a dude walks across the road and I don’t see him in time to stop, that ain’t my fault. Conversely, if I’m on a 35mph street and someone jay walks, I can’t speed up to run them over, either.

YOU, OTHER DRIVERS, AND PEDESTRIANS

One of the tricky issues I see come up is when there’s a multi-lane street with a pedestrian crossing. When you’re driving and the car in the lane next to you stops for a pedestrian, YOU have to STOP TOO! I know, I know. I loathe rules that allow other people to make decisions for me. But this one makes sense. Once someone has stopped for a pedestrian, it’s best to just let them get across safely and not have to play real life Frogger.

CONTRIBUTORY NEGLIGENCE

This is the worst. Watch this vid for a more detailed description, but the short version is if a victim is even 1% at fault, they can’t get ANYTHING from the person who is 99% at fault. This is NOT the case is 46 other States in this fine Union, but here we are. This is a huge problem for most pedestrian claims in that there’s often an allegation that the pedestrian may have had the right of way, but they could have avoided the accident. There’s a counter to this, usually, but it’s all silly. This, however, is the NUMBER ONE REASON YOU SHOULD GET AN ATTORNEY IF YOU HAVE AN ACCIDENT!

Call me for help with any injury claim. 919-929-2992.

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Med Pay and Your Liability Policy

Sometimes we have to make a liability claim against our own liability policy. This happens most often in inter-family claims where, perhaps, hubby was driving, screws up, causes a wreck, and wife is injured. Well, that’s what you have liability insurance for, so there’s no need to be shy. Make the claim!

But there is a little surprise lurking in that process for people who have opted to pay extra for medical payments coverage, or “med pay” as we call it in the business.

Let’s say your overall claim was worth $6000. Cool. Let’s also say that you have $2000 in Med Pay. That means your policy will pay out your $2000 in Med Pay, and your liability policy will then cover the remaining $4000. In other words, the liability policy gets a credit for Med Pay! But you’ve paid extra for that! Is that fair?

Well, it depends on your perspective. It’s allowed, so we’re stuck with it, so fair doesn’t really matter. But from the POV of the insurance companies, the claim is “worth” $6000, so why should they pay more? From our POV, though, they should pay the $6000 because that’s what the liability policy is on the hook for, and they should pay the $2000 because you’ve paid for it.

The current rule for the credit stands as of this writing. However, it is worth noting that if the liability policy pays out its limits, then it does not get a credit for Med Pay, in which case you’d get the limits PLUS the Med Pay. So there’s that.

This stuff is wacky, and you probably don’t have time to figure it all out, which is precisely why you should call me. If you have an injury claim call me at 919-929-2992.

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Medicare Advantage Plans and your Injury Claim

By now, you probably know that if you have an injury claim that you get money from, and Medicare paid for some of your treatment, you MUST pay Medicare back. There’s a whole process for this that your attorney can help you with. If you’re not an attorney trying to handle that, heaven help you.

What you might not know is that if you have a Medicare Advantage plan you might have a similar issue.

Many of these Medicare Advantage plans have what’s called a “right of reimbursement” or “subrogation” claim.  That means that in a situation where we obtain for you payment in compensation for incurred medical expenses from an at-fault party, then your health plan may have a right to get paid back what they paid out.  Normally if this is the case, they or a company they hire, reach out to you to investigate this.  If you get a letter about this, YOU MUST NOT IGNORE IT! IF YOU HAVE AN ATTORNEY YOU MUST BRING THIS TO THEIR ATTENTION! Your attorney probably can’t effectively investigate this for you with your plan. 

If you have a Medicare Advantage plan it would be most wise for you to contact your health plan, make this inquiry – does the plan have a right of reimbursement for third party claims? – and let your attorney know the response.  Failure to do so can leave you owing them after your settlement money is gone, and can impact your coverage as well. 

This is not the type of thing you want to ignore. You can end up thousands of dollars in debt and lose your coverage. You’ve been warned.

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Personal Injury AND Worker’s Comp Claims

Oh, lort. This stuff can get really complicated…but here it goes:

Most of you are familiar with the idea of a worker’s comp claim…you get hurt at work, you have the right to certain protective benefits. Most of you are familiar with auto accident injury claims…someone runs into you and you hope to be able to recover what you lost as a result of their negligence.

But what happens if you have an auto accident claim WHILE you’re working? Can you have a worker’s comp claim AND a personal injury claim at the same time? YES! But be careful how you handle them.

I could write FOR DAYS on what you are entitled to with each of these claims and how they might intersect, but that would make for a long blog post that no one would want to read. So let’s just summarize:

What should you get from worker’s comp? Mostly just three things: Payment for your time out of work due to your injury, payment of your medical expenses, and to the extent that you have permanent impairment, payment for that. There are lots of little nuances in there, and they aren’t quite as nice as they sound, but they’re something.

What should you get from a personal injury claim? I’ve written on this previously, so check this post out. But suffice it to say you should be able to recover for whatever you can prove was proximately caused by the negligence of the other driver…normally this is full payment of your medical expenses, lost income, and something for pain and suffering. The main difference with worker’s comp is that there is NO PAIN AND SUFFERING IN WORKER’S COMP.

But here’s the big problem: The Worker’s Comp Lien. Whatever worker’s comp pays for, they’re going to want you to pay them back from whatever you get out of the related injury claim settlement (what they’ll call the third-party claim). This can result in the classic “Robbing Peter to pay Paul” metaphor, but there’s a lot that your attorney can do to help you navigate this issue. Sometimes we can help to limit the payment of the lien, and sometimes we can make it go away totally! What you DON’T want to do is handle your worker’s comp and personal injury liens claim without considering this, because you might end up just taking lots of money from one insurance company and giving it to another. And that’s not what any good-natured American wants now, is it?

Anyway, if you have a worker’s comp claim resulting from an auto accident, call me or another attorney before it gets too wacky. 919-929-2992.

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Is it expensive to hire an attorney for your ticket?

Traffic Attorney

I recently quoted my fee to a potential client for handling her ticket and she said, “That’s expensive!”

I thought that was an odd reaction. But being the self-reflective and awesome person I am, I didn’t argue with her. I just pointed out that I think it’s probably less expensive than risking the loss of her driver’s license or having her insurance rates go up for 3 years, but the choice was hers.

Maybe that wasn’t the best salesmanship in the world. While I admit that part of what I must do in my business is selling my service, I feel that there’s a line to be drawn. I’m not going to pander to you and beg for your business. I will, however, tell you what I charge for the valuable service I offer, and here I’ll tell you what you get for it:

  • If you hire me, YOU don’t have to go to court, I do that for you
  • I analyze your driving record and make a choice as to the preferred disposition of your ticket, as I can tell what impact each disposition might have on your record (prior tickets can impact this one, and vice versa!)
  • I use my knowledge and experience to get you the best deal available in order to minimize the impact this ticket will have on you
  • If your ticket isn’t handled appropriately, you could risk losing your license, or maybe having your insurance rates increase for three years! Sometimes that increase will be 100%

I can then only leave it up to you. Do you know how to do what I do? Do you want to bet on it? If you’re OK with the consequences of being wrong, then have at it! Maybe you keep your license! Maybe you don’t! If you’re not comfortable making that bet, then pay me a few bucks and let me do it right. I really don’t think you’ll regret it.

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Who is at fault in your auto accident?

Fault can be clear sometimes in automobile accidents. But sometimes, it’s really, really tricky to tell who is the responsible party.

Who had the right of way? Was anyone speeding? Were lights/blinkers in use? Should they have been? What were the conditions? There’s a ton to consider.

Can you tell from the accident report who the officer thought was at fault? Does that matter? Does the officer’s opinion control the issue? Can you read the semi-secret codes on the report? This is getting more and more complicated, which means it’s more likely you’re going to need help.

What makes that even more difficult in North Carolina is that we are a contributory negligence state. In short, that means if a person is even 1% at fault in their accident, then they can’t get anything from the person who is 99% at fault. This is crazy when you consider that in most states under those facts the 1% guy could get 99% of his damages from the other guy. That seems a lot more fair, but we have a really strong insurance lobby here, so they get to make the laws!

If you have a question about who is at fault in your auto accident in North Carolina, you’re probably in for an uphill battle. Call me for some advice and help. 919-929-2992.

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Contact Jeffrey

Jeffrey Allen Howard, Attorney at Law, PLLC
1829 E. Franklin St. - Bldg 600
Chapel Hill, NC 27514

(P) 919-929-2992
(F) 919-636-4779

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