HB 1869 Health insurance liens and subrogation in Texas – new law takes effect Jan 1, 2014

Finally! A bill passes in Texas creating a law that actually helps people who have sustained a personal injury. This blog post helps explain what the new law means to people who have used their health insurance to cover medical bills due to a personal injury.

House Bill 1869 (HB 1869) was signed by Governor Rick Perry in late May 2013.  It is known as the Subrogation Reform Bill.  It places a limit on the amount a health insurer (such as Blue Cross Blue Shield, Aetna, Humana, etc.) can recover out of a personal injury settlement in Texas, however the new law does not affect all types of health insurance plans, only certain types.

Let’s begin by talking about health insurance subrogation and health insurance liens: what they are and how they work.  Let’s say Paul Plaintiff is rear-ended at a stop light by Dan Defendant, suffers a serious neck injury and four months after the accident Paul has neck surgery.  Paul has health insurance with United Healthcare (UHC) and Paul uses his health insurance to pay the medical bills.  The total amount UHC pays for Paul’s neck surgery and all of Paul’s treatment related to the car accident is $37,000.  Dan Defendant has automobile insurance with Progressive, and Progressive reviews Paul’s injury claim and offers Paul a $50,000 settlement which is Dan’s policy limit for bodily injury.  UHC has a $37,000 lien (or “subrogation interest”) against Paul’s $50,000 settlement from Progressive. In other words, UHC has the right to be reimbursed $37,000 from Paul’s $50,000 settlement. Here’s why…

Buried somewhere in Paul’s UHC health insurance contract (which is probably a very long document) there will be subrogation language.  This contract language will say, essentially, if the person covered under the health insurance contract is injured due to a third party’s negligence or intentional act, and the injured person is going to get a settlement from the third party’s insurance company, then the health insurance company is entitled to be paid back up to the amount it paid out for medical treatment due to the accident.  So in Paul’s case, UHC has a $37,000 lien against Paul’s $50,000 settlement, essentially leaving $13,000 to compensate Paul for having neck surgery.

If that doesn’t seem fair to you, and if you think: “It’s health insurance, that’s what it’s there for…UHC shouldn’t get most of Paul’s money!” then I agree with you.  Thankfully so do State Representative Four Price (R-Amarillo) and State Senator Robert Duncan (R-Lubbock) who championed the Subrogation Reform bill.

HB 1869, the Subrogation Reform bill, places a limit on the amount certain health insurance plans can claim as a lien against a third party settlement. It is important to remember that not all health insurance plans are covered by HB 1869.  HB 1869 will take effect as a new law on January 1, 2014 and will be codified as Chapter 140 of the Texas Civil Practice & Remedies Code.

What types of health insurance plans are NOT covered by HB 1869  Medicare plans, Medicaid plans, CHIPS, workers compensation plans, and self-funded ERISA plans. 

The types of health insurance plans that ARE subject to the limitations created by HB 1869 are ERS plans (state employee coverage), insured ERISA plans and every other health insurance plan and every non-ERISA self-funded plan that is sold or issued in Texas.

What is the limit on how much a health insurance plan covered under the new law can take from a settlement? If the Plaintiff (insured person) is represented by an attorney, then the most the plan can take is 1/3 of the insured person’s settlement.  If the Plaintiff is not represented by an attorney, then the most the health insurance plan can take is 50% of the settlement.

So under the new law, using Paul Plaintiff’s accident as an example, if UHC’s lien was being dealt with on or after Jan 1, 2014 when the new law takes effect, the most UHC could get from Paul’s settlement is 1/3 of $50,000 which would be $16,666.66 (assuming Paul is represented by an attorney) or 50% of $50,000 which would be $25,000 (if Paul is not represented by an attorney).  Either way under the new law Paul is better off than if UHC’s lien was being resolved under current law (where UHC could insist on getting $37,000 of Paul’s $50,000 settlement).

This covers the high points of HB 1869, but of course there is more to it than I can include in this blog post.  For example, there are aspects of HB 1869 that affects whether a health insurance plan can attach its lien to first party insurance coverage for an automobile accident, such as PIP (Personal Injury Protection), UM (Uninsured Motorist) and UIM (Underinsured Motorist).

If you have suffered a personal injury, either in Houston or somewhere else in Texas, and you would like to better understand your legal rights, contact me for a no-charge consultation.  I am Board Certified by the Texas Board of Legal Specialization in Personal Injury Trial Law and I have dedicated my legal career to representing injured Texans.

Visit my web site here

Driver killed on North Loop when pickup truck rear-ends Monte Carlo

A pickup truck rear-ended a Chevrolet Monte Carlo at 9:45 p.m. last night, Thursday May 30th, killing the driver of the Monte Carlo and injuring his female passenger.  According to Channel 2 News Houston, the Monte Carlo and the white-colored Ford Ranger pickup truck were both heading westbound on the North 610 Loop when the pickup struck the car, causing major rear-end damage.  As the photograph shows, the trunk of the Monte Carlo is completely collapsed.  The driver and passenger of the Monte Carlo were both trapped inside the vehicle, probably because the rear-end impact pushed the rear panels forward jamming shut the driver and passenger doors.  The driver of the Monte Carlo was taken to the hospital where he died. Police say the pickup truck driver was not intoxicated at the time of the crash and no charges are anticipated (surprising...not even a traffic citation?).

Photo credit: Channel 2 Houston and KHOU

Personal injury resources and information

Cody Wayne Lewis charged with sexual assault at Massage Envy

Cody Wayne Lewis, 40, formerly a masseuse at a Massage Envy in Spring, Texas has been charged with sexually assaulting two women and is being investigated in connection with a third alleged sexual assault.  According to Channel 2 Houston, the third woman came forward stating Lewis had touched her inappropriately at Massage Envy. Lewis is currently charged with one count of sexual assault, since a Montgomery County grand jury did not find enough evidence to indict him for the first sexual assault charge. Channel 2 determined that Lewis is not licensed by the State of Texas as a massage therapist.

Massage Envy's corporate office in Arizona informed Channel 2 that the spa where Lewis was working did not comply with company protocol.  Massage Envy corporate terminated the franchise's license for the Spring location, which is now operating under new management.  Lewis is represented by an attorney with respect to the criminal charges.

While acknowledging that Mr. Lewis is innocent until proven guilty in a court of law, in my opinion Massage Envy shares in the blame for the (alleged) incident involving the third woman.  I have been to a Massage Envy in Houston: assuming the Spring location operates the same way at the spa I visited, unless you request someone specific the customer is assigned a masseuse.  Massage Envy should make sure that their clients are protected and that their employees are properly licensed and conduct background checks.

Daragh Carter, Houston Personal Injury Attorney

Massage Envy, Spring, Texas

Cody Wayne Lewis

Insurance Claims: How Personal Injury Cover Works

Accidents are very much unpredictable and moreover an accidental death or a serious injury is something which will put you and your family in serious financial trouble. Insurance claims also known as personal injury cover or personal accident insurance are a great way to deal with such difficult circumstances as they provide you the necessary financial help when it is needed the most. 

 

Buying a personal injury cover

In many cases, the personal injury cover is often added to the insurance policies like car, auto, travel, home, sports, and business. If not, then you can ask the insurance company and get them attached to any of these policies. Getting injured as a result of any of these factors might offer you and your loved ones with cash money which will help you a lot in coping with the immediate and day to day expenses. 

Buying this policy separately offers more benefits compared to what it offers when attached to some other type of insurance claim. This is true because of the fact that, when tied to some other policy the benefits are restricted to accidents that take place in certain specific conditions, for example, if tied to a car accident insurance claim then you will get the benefits if and only if the injury has resulted from the accident. Conversely, if you buy a standalone personal injury cover you receive protection in numerous conditions.

Furthermore, the benefits the nature of the benefits that you receive depends on the severity of the injury. If the nature of your injury is very serious or if there is loss of life then the insurance agency offers a lump-sum amount, no sooner than the policy terms and conditions are met. On the other hand, if the injury is minor or if you suffer from a non-fatal accidental injury then the monetary benefits might be offered in a number of smaller payments over a certain period of time.

It is inevitable to understand the seriousness and importance of insurance claims and how the personal injury cover works so as to safeguard future financial needs.

Drunk driver causes head-on crash on Washington Avenue

Unfortunately this is a fairly typical event for a holiday weekend in Houston.  A drunk driver caused a head-on crash at around 2:15 a.m. on Memorial Day (Monday) morning.  The male driver was heading westbound on Washington Avenue when he veered over into the center lane at Snover Street, hitting another car head-on, pushing that car backwards into a third vehicle.  A female driver in the vehicle that was struck head-on was transported to the hospital.  The suspected drunk driver was arrested at the scene: his name has not been released.  Washington Avenue was temporarily shut down in both directions as police worked the scene.

Drunk driving accident attorney; car accident attorney.

Top 4 Tips for Personal Injury Claims

Dealing with a personal injury claim can be a tedious and stressful task, as there are so many things which you need to take care of during such painful situation. To help you out is such difficult time and to simplify your claims procedure, here are the top 10 tips to prepare you for filing a lawsuit for personal injury claims:

1. Seek medical care immediately

Be it a slip and fall accident or an injury due to motor vehicle accident or any other type of personal injury, the very first step is to seek first aid immediately. Failure in treating your injuries at the right time may result in complications. Hence, to avoid further damage, make sure that you do not neglect this point.

2. Summon the Police and the Insurance Company

After you finish with the initial medical treatment, summon the police about the injury, if applicable. By doing this, you may get a great help in collecting information about those who were responsible for the injury and those who were present when the incident took place.

In addition to this, it is also important to inform the insurance company about the injury, since there is statute of limitations on the time period within which you can file a claim. Any delay in reporting the insurer about the injury may put your compensation in trouble.

3. Watch your words

Most of the insurance agencies send their lawyers to negotiate the claim to a minimal amount. They record your statements and then manipulate it for the benefit of themselves. Therefore, be careful when communicating with insurer and try not to disclose each and every minute details of what had happened on the day of mishap. It is advisable to exercise discretion so as to avoid any conflict with the at-fault party and the insurance company.

4. Keep track of all the expenses

In order to determine the rightmost claim for the injury it is essential to keep track of all kinds of expenditures related to injury. For example, collecting hospital bills, rehabilitation bills, bills related to property damage are some of the costs which you can seek remuneration for. If possible, try to pen down all the major facts and events related to the injury before time fades them.

The list does not end here. There are many more aspects which you must take heed of when handling personal injury claims. Consulting personal injury lawyers will surely help you in protecting your rights down the road.

Motorcyclist injured in crash with garbage truck on Briar Forest

A motorcyclist was seriously injured in an early morning crash today.  The rider was heading down Briar Forest near the West Sam Houston Parkway around 3:00 a.m. when he struck the rear of a garbage truck that was pulling out of a business.  Houston Police Department representative Javier Tapia told Channel 2 News that the motorcycle rider wound up underneath the garbage truck and sustained head injuries, including a fractured skull.  He was rushed to the hospital.

In some of the comments to Channel 2's story readers seem quick to blame the motorcyclist for the accident, but they may well be rushing to judgment.  For example, the timing of when the trash truck pulled out into the main lanes is relevant to fault.  Also based on Channel 2's photograph (see below) the area where the accident happened does not appear to be particularly well-lit. Maybe the garbage truck had it's lights on, maybe it didn't.

Photo credit: Channel 2 News

Motorcycle accidents, truck accidents.

Giovanna Caruso Chooses Phoenix College of Law

Giovanna Caruso, daughter of Mark and Judy Caruso of Caruso Law Offices in Albuquerque announced today that she will be attending Phoenix College of Law beginning August 2013.

By:  Mark Caruso, Personal Injury and Wrongful Death Attorney (Albuquerque, NM)

 

Giovanna Caruso is a 2013 graduate of a Bachelor of Arts in English Literature from Baylor University in Waco, Texas. She chose Phoenix College of Law from the list of 15 law schools who had accepted her as a first year law student. The law school is one of three ABA approved law schools in Arizona.
 

Among the factors that influenced Giovanna Caruso to choose Phoenix College of Law were the beautiful new one year old complex in downtown Phoenix on the top floors of One North Central Avenue. The law school has state of the art classrooms, courtrooms, library and other facilities.  Other factors included the proximity of Phoenix College of Law to Albuquerque, a substantial scholarship from the law school, and Indian Law courses she will take at the law school.
 

At Phoenix School of Law Giovanna hopes to specialize in personal injury and wrongful death litigation for her future employment as an attorney at Caruso Law Offices.  Giovanna has worked as a legal assistant at Caruso Law Offices during her vacations away from Baylor University. She assisted attorneys with personal injury lawsuits from car, truck, motorcycle and pedestrian accidents and collisions. 

 

Caruso Law Offices is a personal injury and wrongful death law firm representing victims of vehicular, car, auto, truck, semi truck, tractor trailer, motorcycle, bus, bicycle and pedestrian crashes, wrecks, accidents and collisions. Mark and Judy Caruso have operated Caruso Law Offices in Albuquerque since 1987.  Caruso Law Offices can be contacted at mark@carusolaw.com or thru their web site at www.carusolaw.com

 

 

 

 

 

 

 

Tips on Personal Injury Claims in Toronto GTA

Whether you have suffered from a slip and fall accident or you have met with a motor vehicle accident, being a victim of any type of personal injury may be shocking and you may get confused about how to proceed with the personal injury claims procedure in order to obtain a fair claim for the damage done. Here are some tips on personal injury claims in Toronto GTA to guide you in the right direction which leads to the claim.

The most important step is to make sure that you get some first aid and visit a nearby clinic or hospital or a family doctor, as soon as possible, so as to avoid any complications. In case, you are a victim of car or any other kind of motor vehicle accident then report about the same to the police quickly. Besides this, it is equally important to inform the insurance company about the injury, since your claim may be constrained to inflexible time limits. If you fail to comply with this criterion you may be barred from taking any action for obtaining any kind of compensation. 

Remember that, it is inevitable to gather details of all the witnesses and parties involved in the accident like their names, telephone numbers, and residential or office addresses. All this information is very crucial and can benefit you a lot in establishing the claim without much difficulty. 

The next step towards commencing a personal injury claim is to find out what the injury owes you. Depending on the nature of the injury, you can claim for both economical and non-economical damages. Damages like cost of rehabilitation, lost wages, and cost of vehicle repair are grouped under economical whereas damages like inability to lead a normal life, pain, and distress are considered as non-economical damages. 

In addition to all these factors there are many other things you need to take a note of for obtaining a rightful claim. Therefore, it is highly recommended that you seek some legal advice from an expert personal injury lawyer. There are multitudes of personal injury lawyers in Toronto that offer legal assistance to families and victims of personal injury. You can consult any of these attorneys for obtaining your compensation.

More information on Hanson Duby is available by visiting the firm's web site at http://www.HansonDuby.com, or by calling (416) 588-9100.

Noah and Jack Melton E. Coli sickening traced to Coco Loco restaurant in College Station

Brazos County health officials have identified the source of an E. Coli outbreak that sicked at least five people in April as the Coco Loco restaurant in College Station, Texas. Noah Melton, the youngest victim of the outbreak, was released from Texas Children's Hospital on Tuesday. Noah's older brother Jack was also sickened: Jack had been previously released from hospital. Noah is 18-months old and Jack is 4-years old.

Dr. Eric Wilke with the Brazos County Health Authority spoke to the press and said the probably source of the E. Coli was ground beef that wasn't properly cooked. The county's health department will monitor the restaurant. Greg and Alissa Melton were unimpressed with one aspect of Dr. Wilke's press conference: apparently the doctor stopped at Coco Loco and bought a ground beef taco, which he took a bite of for the cameras in a rather lighthearted way.

I can understand the boys' parents being frustrated by the tone of the press conference: their children were in hospital for a month fighting serious illness. If it were one of my three young kids that had been poisoned, hospitalized and on dialysis, I'd feel the same way.  I have personally handled a food poisoning wrongful death case in the Houston area associated with a salmonella Saintpaul poisoning at a local Mexican restaurant.  People sometimes forget that food poisoning can cause serious long term effects or death, particularly to those with weakened immune systems, or patients who are very young or elderly.

I'm thankful for the Melton family that the boys have been discharged and they are back together again at home. In my opinion Coco Loco needs to take care of the damages their improperly prepared food has caused.

Update 1: Dr. Wilke has apologized, both publicly and to the Melton's directly. Good choice.

DaraghCarterLaw.com

Dr. Eric Wilke puts his foot a Coco Loco taco
in his mouth at the press conference

Greg and Alissa Melton, delighted to be leaving Texas Children's
Hospital with 18-month old son Noah.