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The CMS Recovery Portal: helping put money in your pocket faster

December 2, 2015 by Brian Schachter Leave a Comment

ess- medicareEarlier this month, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited update and clarification on the conditional payment process for the Medicare Secondary Payer Recovery Portal (MSPRP or Recovery Portal). This is a significant development for us and our clients and the broader community of the plaintiffs’ bar because it affects the timeline and best practices that should be followed in resolving any case where Medicare has rights to receive reimbursement from the settlement proceeds.

CMS has been working for several years now to develop the Recovery Portal as a means for expediting the resolution of Medicare lien claims. Chronic delay from the Medicare bureaucracy in determining the final reimbursement amount has long been a cause of considerable frustration for plaintiff’s attorneys.

[Read more…]

Filed Under: lien resolution, Medicare Tagged With: lien resolution, Medicare, Medicare Liens

Getting the Most of Out of Your Next Mediation

November 17, 2015 by Brian Schachter 1 Comment

ESS ebook coverWith settlement season now in full swing, this week we are pleased to announce the publication of our new e-book: How to Get the Most out of Mediation. You can click here to download your free copy.

For those of you who are regular readers of our blog, you will find some familiar material here, as we have drawn on a number of articles that first appeared on the blog over the course of this past year. Our goal in putting the e-book together was to distill our experience and insights, gathered over the course of our participation in hundreds of mediations, and to present the material in one convenient place so you would have a practical and handy guide to use as you prepare for your next case settlement.
Key topics covered in the e-book include the following:

• How to identify which cases are ripe for mediation
• How to find the best mediator for your case
• How to make your initial demand
• How to develop a negotiation strategy
• How to maximize settlement value for you and your client

We hope you find the e-book a useful tool in your practice. And if you have a moment, please send us an email and let us know what you think. Feel free to let us know if you have any questions or pointers of your own you’d like to share with our readers, to help make this settlement season more productive for all of us.

 

Filed Under: Mediations Tagged With: guide to mediation, mediation, settlements

Open Enrollment: Time to Check Up on Your Clients’ Healthcare Coverage

November 10, 2015 by Brian Schachter Leave a Comment

open enrollmentNovember 1st is an important day on the calendar in contemporary American life. It’s nowhere near as festive occasion as Halloween, which comes the day before, nor is it a holiday for somber reflection as is Veteran’s Day, which follows only 10 days later. But is highly significant all the same as it marks the day on which the open enrollment period begins under the Affordable Healthcare Act, otherwise known as Obamacare. For those of us who represent and fight the good fight on behalf of personal injury victims, the open enrollment period provides an important opportunity to protect the interests of at least some of our clients.

Let’s face it. Many people are flummoxed when it comes to picking a policy on the healthcare exchanges. This is not at all surprising given the operational problems attendant on the rollout of Obamacare and the inherently confusing nature of most policy descriptions. This process can be even more of a challenge for people who formerly qualified for some form of government assistance and are unaccustomed to dealing with and analyzing the fine print on healthcare policies. All too often we have found situations where clients, left to their own devices, end up selecting policies with unreasonably high deductibles or other similar deficiencies, which effectively eviscerate the benefits of coverage.

[Read more…]

Filed Under: Affordable Care Act Tagged With: Affordable Care Act, Obamacare, open enrollment

Understanding the Real Value of a Structured Settlement

October 27, 2015 by Brian Schachter 4 Comments

Piggy bankLately I’ve been hearing a lot of concerns and objections from a lot of otherwise financially unsophisticated and inexperienced plaintiffs about the IRR on structured settlement proposals. While they are correct that the rate of return is currently low by historical standards, they are missing the bigger picture.

To start with, it’s important to remember that structured settlements are tax advantaged, in the same way a 401(k) plan works, with undistributed returns compounding on a tax-free basis. So a structured settlement product with a stated return of 3% provides closer to a 4% or more return on a tax-adjusted basis. Also, the first question I ask people who tell me that the rate of return is low is, “Compared to what?”

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Filed Under: Financial Planning, structured settlements Tagged With: financial planning, structured settlements

The Deadline Looms for New Medicare Billing Codes

September 22, 2015 by Brian Schachter Leave a Comment

We’ve written before on the blog about the looming revisions to the Medicare billing codes, which are about to expand almost ten-fold from the 17,000 current treatment codes to more than 155,000 treatment codes under the new scheme. This issue is in the news again because the new coding scheme, referred to as ICD-10, is set to go into effect in less than 2 weeks on October 1st. (Click here to read our prior blog post.)

Medicare codingThe New York Times recently ran a story about the significant impact the new coding scheme is likely to have on the medical profession, describing it as “a sea change for physicians”. Apparently, the pending changes are triggering extensive anxiety among doctors as a result of the anticipated the difficulties of compliance and the disruption it’s expected to cause in revenue and cash flow. The article highlights some extreme examples of the new coding scheme, such as the requirement for doctors to specify a distinct code depending on whether a patient was bitten by a horse, a shark or a crocodile (newly designated as Code W58.13) or suffered injury as a result of being sucked into a jet engine (new code V97.33). In a somewhat more serious vein, the article also reports how doctors groups are scrambling to line up new lines of credit on the assumption that confusion and non-compliance are going to result in extensive payment delays. (Click here to read the full story in the Times.)

[Read more…]

Filed Under: lien resolution, Medicare, Uncategorized Tagged With: lien resolution, Medicare Liens, medicare set asides

Dealing with Future Damages in the Settlement of a Personal Injury Lawsuit

July 20, 2015 by Brian Schachter Leave a Comment

future damagesWhen it comes to determining and paying damages in a personal injury or medical malpractice lawsuit, it’s important to remember that there are some special rules and statutory provisions that come into play, depending on what state you’re litigating in. Here in New York we most frequently deal with Articles 50-A and 50-B of the CPLR, which set forth the basis for calculating and paying future damage awards. Under these provisions of New York law, which have been in effect since the 1980’s, a judgment for future damages is to be paid out in a series of future periodic payments funded by an annuity purchased by the defendant, as opposed to being converted to present value and paid in a single lump sum.

The determination of future damages usually presents the largest challenge in the courtroom since there are so many practical and economic factors that must be considered, giving rise to the risk that the award will end up being either oversized or insufficient for the plaintiff’s future medical needs. The approach for calculating and paying future damages varies widely from state to state, with some states, such as Georgia, legislating a specific discount rate of 5% that is to be used in reducing the amount of future lost earnings, benefits and household contributions to a present value, compared to states such as Connecticut, which provide no case law or statutory guidance, but merely invites testimony from economists based on whatever discount methodology seems appropriate at that time as a basis for calculation. (Click here if you would like to see a 50 state survey on the basis of calculating future damages prepared by the National Association of Forensic Economics.)

The New York rule, which we are most familiar with, presents something of anomalous approach inasmuch as there is no discounting of future losses whatsoever undertaken by the jury. The calculations used for discounting the award of future damages are quite complicated, together with additional provisions for determining a lump sum portion of the award, as well as adjustment for attorneys fees and litigation expenses, all of which is laid out in the provisions of NY-CPLR Articles 50-A and 50-B. The net result is of this determination is entry of a final judgment pursuant to which the plaintiff is entitled to receive a single lump sum payment consisting of the past damages portion of the award plus the first $250,000 of future damages. The defendant pays this lump sum in cash and then is obligated to buy a structured annuity to fund the remaining portion of the future damages award for the amount above the $250,000 included in the lump sum payment. These annuity payments are intended to cover the future awards for pain & suffering, medical expenses and lost earnings.

Over the years these provisions of New York law have received repeated criticism from both plaintiffs and defendants bar, and there have been continuing calls for further revision or repeal. As Dennis P. Glascott of Goldberg Segalla, and Lisa Diaz-Ordaz , counsel at Liberty Mutual Insurance, wrote in a recent issue of the New York Law Journal: “While the Legislature intended CPLR articles 50-A and 50-B to benefit both plaintiffs and defendants, the end result has been confusion and discontent to all parties, including judges.” The feature of the New York statute that is perhaps most disliked by the plaintiffs’ bar is the provision that requires in most cases that payment of future damage awards are discontinued when a plaintiff dies, rather than having the remainder of the annuity paid out to the plaintiff’s heirs or estate. This strikes us as anomalous and completely out of step with the approach in other jurisdictions, by requiring a plaintiff to forfeit a substantial portion of a damages award simply because the injuries sustained prove to be fatal sooner than anticipated.

In fact, as a matter of practice in New York, very few verdicts are actually paid in accordance with the provisions of CPLR 50-A and 50-B. As commentators have noted, “the paucity of reported cases under Articles 50-A and 50-B indicates that settlements are commonplace, notwithstanding the numerous opportunities these articles present for disagreement.” Thomas F. Gleason, Practice Commentaries to CPLR Article 50-A & Article 50-B (McKinney 2007).

Nonetheless, familiarity with Articles 50-A and 50-B is important to settlement discussions where future damages are involved, because a verdict is generally the best or worst case scenario (depending upon which side), and it is vital to know, at least in general terms, what winning or losing would entail. In our experience, in certain cases, it can be highly advantageous for a plaintiff to come to a mediation armed with a 50-A or 50-B analysis. That’s because in determining a settlement value at mediation, parties will often look at future damages as set out by an expert, and use a present value of those numbers as a basis for settlement value. And in fact, depending on a variety of factors, such as the applicable discount rate, the cost of funding the structured annuity under CPLR Rule 50-A or 50-B can actually be significantly higher than the present value of the future damages. This analysis can thus sometimes help provide a substantial financial incentive to the defendant to settle.

Some day these problematic provisions of New York law may end up being revised or repealed. But in the meanwhile, they remain one more important arrow in the quiver that we can and do use as part of our effort to drive settlement value for plaintiffs and their counsel.

Filed Under: Mediations Tagged With: future damages, litigation, mediations, NYCPLR

What Types of Cases Should You Mediate?

June 30, 2015 by Brian Schachter Leave a Comment

oliver w. holmesThere’s an old Oliver Wendell Holmes maxim we remember from law school – great cases like hard cases make for bad law. Not to quibble with the venerable Justice Holmes, but in our experience as settlement consultants, we have found that this observation is not so true, at least when it comes to mediation. Great cases and not so great ones both make for good mediations, at least when measured by that all-important yardstick of positive financial outcomes.

Of course, whether your case is a strong one or not will shape your strategy and goals as you head into mediation. With a strong case you will be much less inclined to compromise; your settlement range will be much narrower and you will likely insist on adhering closely to what you think of as full value for the claim. To the extent that you are fully confident about the law and facts of the case, though, there are still significant advantages to be realized from participating in mediation, as we have written in a previous blog post. It’s also important to remember, as we previously discussed here, that whenever you mediate a strong case, you must make sure you’re trial ready before mediation, so the defense fully appreciates how prepared you are to crush them at trial.

But let’s face it – not every case in your office is a sure winner. Every trial lawyer takes on matters where investigation and research turn up potential vulnerabilities in the plaintiff’s case – bad facts turn up in discovery; perhaps the defense has taken a surveillance video that shows your client playing touch football despite a claim of chronic back pain; or maybe you’ve learned that your client will be unfit to take the stand due to his prior history as a child abuser. When any such weakness surfaces in the course of developing your case, mediation becomes more attractive as a means to sidestep jury trial while nonetheless providing a means to secure some settlement value for your client.

From the lawyer’s point of view, mediation provides a means to cull some of the weaker cases from your docket so you can focus your firm’s resources on higher value opportunities. This is why we recommend to our clients that they undertake a periodic review of all pending matters, in order to identify those cases, where a material weakness makes going to trial problematic in some way. From the client’s point of view, mediation may provide a shorter route to recovery, albeit one that is smaller but more certain. Oftentimes, this is a tradeoff that clients are ready to make in the interest of putting a sum certain into their pocket now rather than risking a larger upside in front of a jury.

A recent case we were involved in illustrates how mediation provides a good alternate route to recovery as potential difficulties at trial begin to emerge. The plaintiff in this case was a construction worker who had been injured on the job. The case had to be brought in Westchester County – a jurisdiction not generally favorable to plaintiffs. The plaintiff had filed a motion for summary judgment on liability and the defendant had filed a motion to dismiss. Our client assessed the probabilities as a 30% percent chance for winning the motion for summary judgment as against a 35% probability that defense’s motion to dismiss would be granted. In any event the defense only carried $1 million of insurance coverage. Given the limited upside and the various weaknesses in the case, this was easy to identify as a good candidate for mediation. The plaintiff went into mediation with an initial target of $700,000 to $800,000 but ended up settling at $550,000. This made sense because we were able to provide a structured settlement that enhanced the lifetime value of the plaintiff’s recovery, and brought the financial settlement value into an acceptable range.

When mediation works, everyone walks away happy. In this case, the defense was pleased to cap their expense and exposure at a level well below the full amount of the insurance coverage. At the same time, the plaintiff was happy to achieve finality and closure, avoiding the risk of trial, with a recovery enhanced by a structured settlement. By definition that’s a successful outcome.

Filed Under: Mediations, Uncategorized Tagged With: mediation

How to preserve your clients’ medical coverage while settling a case

June 8, 2015 by Brian Schachter Leave a Comment

esq - affordable careWhen it comes to the settlement phase of personal injury litigation, plaintiffs and their counsel will typically be focused on the bottom line – how close to their settlement demand has the defendant’s offer come? But quite often a proposed personal injury settlement will introduce a host of additional complications, which make it important to evaluate more than just the bottom line number. The most important such complicating factor is determining how your client is going to get medical coverage once the settlement is done.

All in all, there are lots of ways a client may end up forfeiting the right to continue receiving subsidized medical coverage after receiving a large monetary damages award, so analyzing your client’s health care needs post-settlement is a vital part of any personal injury settlement process. Unfortunately, many lawyers fail to pay heed to this issue, as a result of which their clients end up needlessly squandering some of the significant benefits of the eventual settlement.

[Read more…]

Filed Under: Affordable Care Act, Mediations Tagged With: ABLE ACT 2014, Affordable Care Act, Health care, health insurance, healthcare, Medicaid, Medical Law, Medicare, Medicare Set Aside, settlements, Special Needs Trust, worker's compensation, workers comp

Why It’s Important to Push Back if an Insurance Company Pushes You

May 26, 2015 by Brian Schachter Leave a Comment

round or square tableAs with any negotiation, mediations typically start out with the parties addressing preliminary matters and trying to set the ground rules for negotiation, or trying to agree on how to agree. Sometimes these preliminary matters seem a little frivolous, dealing more with matters of style than substance, as the parties come to the table, jockeying for position. One of my favorite examples of this is the famous Vietnam Peace Conference that began in 1968 but stalled for many months as the parties haggled about the shape of the negotiating table. The North Vietnamese favored a round table whereas the South Vietnamese insisted on a rectangular table.

Unimportant as such preliminary matters may seem, they can actually make a big difference in the ultimate outcome of a mediation. Not that we have a strong preference for using either a round or rectangular table but after picking a mediator, it’s important to pay attention to a few other details that will also be included in your mediation agreement, as it establishes the framework for all that follows.

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Filed Under: Mediations, structured settlements Tagged With: mediations, mediator, structured settlements

Mediator I Choose You!

May 11, 2015 by Brian Schachter Leave a Comment

ess - picking a mediatorSo, you’re going to mediation. Now how are you going to pick a mediator? This can be one of the most important factors in determining whether your mediation is going to be successful so it’s worth giving some attention to the factors worth considering in making your choice.

Of course, neither plaintiff nor defendant alone can dictate which mediator to choose. The mediator must be a mutual choice. But that being said, the question is what sort of mediator is likely to do the best job in any given case?

It really makes no difference which company a mediator is affiliated with, as far as we’re concerned.  What’s important is the mediator him or herself – what knowledge and background does he or she possess and how well suited will they be to help guide the parties towards a resolution of the case?

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Filed Under: Uncategorized Tagged With: litigation, mediation, mediations, mediator, Mediators, plaintiff, plaintiffs

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