Here’s the full article: https://www.reuters.com/legal/blue-cross-blue-shield-agrees-pay-28-bln-settle-us-health-provider-class-action-2024-10-14/?utm_campaign=north-carolina-advocates-for-justice-eclips&utm_source=membercentralpublications&utm_medium=email&utm_content=october-15-2024

But in summary, Blue Cross Blue Shield has agreed to pay $2.8 billion to settle antitrust class action claims brought by hospital administrators, doctors, and other healthcare providers who claim they were not paid properly for reimbursements. What? An insurance company didn’t pay what they should have?!? Gasp! This settlement, announced in a federal court filing in Alabama, is the largest healthcare antitrust settlement to this date. Of course, BCBS denied the allegations and stated that the settlement is just an effort to resolve years of litigation and includes operational changes. Reading between the lines, you don’t doll out nearly $3 billion just for the sake of moving on; obviously, there’s some truth to the allegations as it would have cost much less to prove otherwise if that wasn’t the case. The proposed agreement will purportedly transform the BlueCard program for claims submission and enhance transparency and efficiency within what many may argue is a system. It also promises more contracting opportunities for providers and requires Blue Cross to invest hundreds of millions of dollars in implementing non-monetary aspects of the settlement. The settlement covers healthcare providers serving Blue plan patients from July 2008 to October 2024 and is subject to approval by U.S. District Judge R. David Proctor.

Knowing how to handle yourself if you’re pulled over by law enforcement can help you manage the situation and potentially reduce the consequences. Here are a few tips to keep in mind:

1. Stay calm and composed. If you’re pulled over, remain calm and take several slow, deep breaths. Safely pull over to the side of the road, turn off your engine, and keep your hands visible on the steering wheel. Wait patiently for the officer to approach your vehicle.
2. Be polite and respectful. Your attitude can really impact the outcome of the stop. Greet the officer respectfully, answer questions honestly and succinctly, and avoid making excuses BUT DO NOT ADMIT GUILT.
3. Know your rights. You have the right to remain silent beyond providing necessary information like your driver’s license, registration, and proof of insurance. If you feel uncomfortable, you can politely ask if you are free to leave.
4. Don’t argue with anyone with a gun. If you disagree with the reason for the stop or the ticket, let’s fight it in court, not on the street. You won’t win that one. Arguing can escalate the situation and won’t change the officer’s mind. Save your fighting spirit for court.
5. Consider legal representation. Talk to an attorney. It’s almost NEVER a good idea to pay a ticket. The best of us will tell you exactly what to do and what to expect.

I hope this has been helpful. If you have any questions or need assistance with a traffic-related matter or other legal issues, please don’t hesitate to call me at 919-929-2992.

Senate Bill 452, which was passed in NC in October 2023, made several changes to insurance laws in North Carolina that were already in N.C.G.S. 20-279.1(11) and N.C.G.S. 20-309(a2). The biggest changes for people injured in car collisions pertain to the minimum coverage requirements for auto liability insurance. The increases take effect in January 2025.

Previously, the minimum limit of liability insurance you had to have in NC was $30,000 per person. The new law raises the minimum coverage limits to $50,000 per person and $100,000 per accident for bodily injury claims. It also raises the coverage requirements for property damage from $25,000 to $50,000 to repair or replace damaged vehicles and other property. This was a change that was a long time coming.

I can’t tell you how often I had clients whose cases could have been 6 figures but they were stuck with only getting $30,000. That’s immensely unfair and frustrating.

Of note, this new bill changes the law so that those who have Underinsured Motorist coverage can now collect the full face value of their underinsured motorist policy. An insurance company will no longer be able to reduce the amount of UIM coverage available by subtracting the liability payment. The victims who could previously only collect a total of $50,000 in benefits can now collect $100,000 if the numbers are right.

If you’ve been injured in an accident, call me at 919-929-2992.

Insurance adjusters have about 4 arguments other than the plain old, “Nu uh!” that they’ll use to try to devalue your claim. One of them is the old chestnut, “gap in treatment.”

What they’re referring to is a perceived delay between the accident and seeking treatment, or a period during your recovery where you aren’t treating for some reason. The long and short of it is that they believe that if you were hurt, you’d be in treatment. The problem with this is that potential jurors who might have to decide the value of your claim might buy this! This sort of folksy “logic” is just the sort of non-scientific but reasonable-sounding drivel that gets Republicans elected to this day, so we have to take it seriously. So how do we combat it?

The best way to combat it is NOT have a gap in treatment. As soon as you’re hurt, seek treatment. Don’t stop your treatment until you’re all better. Boom! No gap in treatment, no BS argument to deal with.

But that’s best case scenario, I get it. Here are some other suggestions to help you mitigate your problems with a gap in treatment:

• If you don’t get treatment immediately following your accident, hurry up and do it now. If “now” is more than a month after the accident, do what you want for your healthcare, but talk to an attorney about how this is going to impact the claim.
• If you can’t get treatment immediately, document what you’re suffering from in a pain journal. That way you’re at least documenting that you were suffering, and you can explain the need for the delay (travel, family obligations, work, etc.). THEN get to treatment as soon as you can.
• If you’re going to have to interrupt treatment for some reason, same thing, use your pain journal to kind of bridge the gap. Ideally, maybe you could seek treatment elsewhere if the delay is caused by travel.

This stuff is hard, which is why people get attorneys. If you have an injury claim and want help, call me at 919-929-2992.

With summer here a lot of us may be spending time on watercraft. It’s a good time to think about the importance of boating safety and the possibility if Boating Under the Influence.

Much as operating a car while intoxicated, operating a boat while intoxicated or under the influence of alcohol or drugs poses serious risks to anyone on the water. Compromised coordination, impaired judgment, and slowed reaction times significantly increase the likelihood of accidents and injuries.

• Impairment by Drugs: Boating under the influence isn’t just limited to alcohol. Operating a boat while under the influence of drugs, whether prescription, over-the-counter, or illegal substances, is also considered BUI.
• Blood Alcohol Concentration (BAC) Limits: In most states, operating a boat with a blood alcohol concentration (BAC) above 0.08% is considered BUI.
• Penalties and Consequences: Just like DUIs, BUIs can lead to severe penalties. These might include fines, license suspension, and even jail time. Moreover, if a BUI accident results in injuries or fatalities, the legal consequences can be catastrophic, not to mention the personal devastation associated with harm to others.

Remember, safety first!

• Designate a sober operator before setting out on the water.
• Never consume alcohol or drugs while operating a boat.
• Wear a life jacket, follow navigation rules, and be mindful of weather conditions to ensure a safe and enjoyable experience for everyone aboard.

If you have any questions or concerns about boating under the influence, especially if you were injured by someone operating a boat under the influence, or any other legal matters, please don’t hesitate to reach out.  Call me at 919-929-2992.

First, you need to know what Med Pay (maybe). So read this.

Now that you know that med pay if first party coverage that you have on your auto policy, you’re wanting to know why you can’t/shouldn’t use it right now to pay your bills.

Here’s the trick answer to the trick question: You can. But it might come back to haunt you.

There’s the age-old adage: Do you want it done fast or do you want it done right? That sort of applies here. You can do whatever it is you want with your med pay. You can process it now and pay bills. You can process it now and bet on sportsball or make a Tik Tok or whatever people do with money these days. The problem is that this may have consequences down the road.

In the context of an automobile injury claim, you have your liability claim – the claim against the bad guys who hit you – and you have (potentially, if you bought it) first party coverage in the form of med pay. You may have a few bills, you may have a ton of bills. Some of those bills might be protected by a lien. You may have health insurance, or you may not. You may have a health plan that expects to get paid back from some or all of those settlement proceeds, or you may not. The problem is YOU probably don’t know enough to avoid shooting yourself in the foot by using that med pay early on in the process. I might not even know, but that’s why I don’t process that med pay until I DO know what all you have and what I need to protect.

In other words, you might have a contractual and/or legal duty to preserve that med pay to pay some other medical bills, so if you process it too soon, you may create more problems for yourself than you are solving.

This is yet another example of how these complicated issues should be addressed by a seasoned, experienced personal injury attorney. If you have such issues, call me at 919-929-2992 and I’ll see if I can help.

This is some inside baseball kind of stuff, but it’s important info if you’re injured in an automobile accident in North Carolina.

Generally speaking, I tell people that in these situations (auto accident injury claims in NC) you want to use use your health insurance. It’s there for that reason, so use it!

There are exceptions to every rule, though, and one of those exceptions is treatment with chiropractors. Those folks often offer to treat you on a lien basis. Read this article for more explanation on what a lien is, but in short, it means they don’t bill your health plan, or you for that matter; they just wait until the case gets settled and then expect to get paid then.

But what happens if your claim falls apart, or something else wacky happens? How do you know what to do? Well, sadly, there’s rarely a one size fits all answer for these situations. For that reason, I broke down the good and bad of health insurance v. liens…

Lien

Good: No out of pocket up front, no co-pays.  Hopefully the at-fault carrier pays for it through the settlement.  When it works, it’s great.  But what if it doesn’t?  

Bad: IF we don’t settle or get enough money, then you’re possibly on the hook for some or all of it with no health insurance discounts.  VERY unlikely in most cases that I’m involved in (not because of me, but because I can normally pick cases that work!). Then again, we can never really know and it depends on the facts of your case. Did you have really big balances at a hospital?  

Health Insurance

Bad: Paying co-pay every time you go, gets expensive out of pocket.  That’s right, depending on your plan, you’ll probably have to fork out like $50 every time you go, so that can add up and might make you treat less than you should. Also, sometimes you have to pay your plan back! That depends on the plan, but it happens! Not the end of the world, but something to consider.

Good: You don’t have to worry about being on the hook for the whole bill (remember, you get discounts with health insurance) if this whole thing goes to heck. 

I can never tell you anything is a sure thing.  But then again, it’s very rare for me to have a case that simply doesn’t work out and the client gets left holding the bag.  Does it happen?  Yes.  Does it happen often?  No.  I personally see this maybe 3 times a year, if that, out of maybe 100 cases or so, but I can’t say if you’re going to be that unlucky 3% or not.  

TLDR: Attorneys are really bad at saying “yes” or “no” to questions.  There are good and bad points to both.  You’re probably fine to do a lien with most chiropractic claims in auto accident cases but I can’t say anything is for certain!  As always, seek educated and experienced advice. Call me at 919-929-2992.

I don’t do a lot of premises liability claims, but I thought it might be a good idea to remind folks about a few safety ideas concerning pool use…

CONSTANT VIGILANCE!

Do your best Mad Eye Moody here. Always have an adult supervising kids in the pool (even the big kids with the alky drinks!). Just having someone who is responsible watching for trouble can be immensely helpful.

SAFETY EQUIPMENT

Have several floats, poles, and/or ropes available in case of emergency. Having something quickly at hand can be the difference between a good and a bad outcome.

AROUND THE POOL A PERIMETER CREATE!

That’s a Yoda reference for y’all not in the know. In most states you’re required to have a locking gate and fence around a pool. Self-locking is best. The idea is to avoid unauthorized entry, especially by little ones.

YOUR POOL, YOUR PROBLEM

Having a pool can be awesome, but with great power comes great responsibility. Check your homeowner’s insurance (talk to your agent!) and make sure you’re covered. Also, if you have a pool, you darn well better have an Umbrella policy. Try to avoid trouble, but have a plan in place in case there is trouble.

I hope all of that is helpful but not necessary advice for you this Summer. As always, if you have any injury claim questions, give me a ring at 919-929-2992. Enjoy!

Personal injury cases in North Carolina are normally based on a theory of negligence, meaning someone failed to act reasonably in a particular situation. Most of the negligence claims I handle are from automobile accidents, but sometimes I handle slip-and-fall incidents, dog bites, and occasionally medical malpractice. Each of these scenarios normally involves a negligence claim.

To establish a good negligence claim, four fundamental elements must be present: duty, breach, causation, and damages. This is not the case for intentional torts, but that’s for another post. Here’s a breakdown of the elements of negligence.

Element 1: Duty

This is the legal obligation to act as a reasonable person would under similar circumstances. This can mean a lot of different things. For example, all drivers have a duty to follow State traffic laws and exercise due caution to avoid harming others on the road. Businesses have a duty to discover and warn of dangerous conditions.

Element 2: Breach of Duty

A breach of this duty occurs when the responsible party fails to meet the standard of care referenced above. This can mean a lot of different things, obviously. An example might be a driver texting while driving and causing an accident. 

Element 3: Causation

Causation is where the rubber meets the road in these claims. Plaintiffs have a duty to prove that the breach (above) caused the damages (that we’ll explain below). Remember, in a North Carolina civil claim, the burden of proof is a preponderance of evidence, meaning “more likely than not,” or reduced to numbers, 50.1% more likely to be true. That’s not impossible, but it can be hard.

Element 4: Damages

Damages in personal injury cases are often categorized as economic and non-economic. Economic damages are the “hard numbers,” like costs incurred by the plaintiff, while non-economic damages cover more subjective things such as pain and suffering, or whatever you might call that.

As always, this stuff can be complicated. If you’re hurt in North Carolina, call me at 919-929-2992.

Whatever you do for a living, I guarantee you that you’re better at it than I am. So why would you think you’re better than me at doing my job?

If you have an injury claim in North Carolina and want to handle it on your own, you’re welcome to do so. To me, it makes sense to hire a professional to do what they’ve been trained to do well rather than you trying to figure it out on the fly. For serious claims, there’s just to much riding on it.

If you have a North Carolina injury claim, before you decide to become an amateur personal injury attorney, call me at 919-929-2992 for a free consultation.