February 2nd, 2010

Court Finds Insurance Covers Fireman in Own Car

This is the issue in a nutshell: If a volunteer firefighter is in an accident while responding to an emergency, and the insurance policy of the car that clobbered him is already exhausted, can he get the benefits of the fire department’s own Supplemental Uninsured/Underinsured Motorist Endorsement (a/k/a the SUM policy)?

In a matter of first impression, the trial court in American Alternative Insurance v. Pelszynski said yes. The matter came before Suffolk County Supreme Court Justice Mark Cohen when the fireman filed for arbitration on the policy and the insurance carrier brought an action in Supreme Court to stay the proceedings, claiming the fireman’s car was not part of the coverage.

Justice Cohen shot down that idea, relying on a New York State Insurance Department informal opinion, dated February 8, 2002, which interpreted the SUM policy as similar to one where a person drives his own car for a business. He wrote that:

The opinion found that an employee of the business operating their own vehicle during the course of employment and while acting within the scope of their duty would be covered under the SUM endorsement.

If the coverage was available to someone in their own car using it for a business, then it should likewise be applicable to the fire department.

If it was the fireman’s lawyers that found that insurance department opinion for the judge, then that was some good lawyering by his counsel, Kevin Grennan.

h/t NYLJ ($)

Addendum: More from Roy Mura in the comments and at Coverage Counsel

 

December 1st, 2009

NY Appellate Court Says OK to Sue No-Fault, Workers’ Comp and DME Physicians


Generally speaking, one can’t sue a doctor that does a medical-legal exam for the other side. These exams come up in the context of Workers’ Compensation trying to cut off a worker’s benefits, Defense Medical Exams for personal injury suits where too many doctors seem to claim that every injury under the sun is one that pre-existed the accident, or cutting off benefits under the wreck of legislation that we call No-Fault.

Historically, the bar to such suits takes place because there is no duty of care between the examiner and the examinee.

But last week New York’s Appellate Division First Department said that these doctors can, in fact, be sued, if three conditions are met. This is based on “an implied physician-patient relationship” if the examiner gives advice.

In Badalto v. Rosenberg, a unanimous panel of the First Department wrote that

“In the context of a physical examination conducted for the purpose of rendering an evaluation for a third party, such as an employer or insurer, an implied physician-patient relationship may arise if the physician either affirmatively treats the examinee or affirmatively advises the examinee as to a course of treatment.”

The three conditions set forth by the court are:

1. that the advice was incorrect,
2. that it was foreseeable that the plaintiff would rely on the advice, and
3. that the plaintiff detrimentally relied on the advice.

So if then, hypothetically, a doctor does an exam for a Workers Compensation carrier, and claims the worker can go back to work — advice for which the physician had previously been immune — and the worker relies on that advice to go back to work and is injured, the doctor can be held liable.

Can you see where this is going? All those 5-10 minute quickie exams done by doctors on behalf of insurance companies may now subject those doctors to liability. If a doctor is going to cut off benefits, s/he will now have to write that the worker can go back to work, but also write that the worker shouldn’t actually rely on this opinion. The physicians will have to write, essentially, that their opinions are actually worthless and should not be relied upon. If an injured party shouldn’t rely on it, why should a judge or jury?

Of course, there is the other option. Doctors can actually do legitimate exams instead of selling their souls to the insurance companies.

Links to this post:

Court Decision Protects Plaintiffs By Making Defense Doctors
Court-ruling-on-DME-doctor-liability Most people take it as a given that doctors are accountable for accurate, competent care of EVERY person whom they see in a professional capacity. It’s difficult to believe, but until just recently,

posted by Jim Reed @ December 30, 2009 11:15 AM

Around the web, December 3
All-New York edition: New York “ranks dead last in 18 of 28 legal categories” on litigation cost, per new Pacific Research Institute report [Lawrence McQuillan, “An Empire Disaster: Why New York’s Tort System is Broken and How to Fix
posted by Walter Olson @ December 03, 2009 12:09 AM

 

June 5th, 2009

New York Medical Malpractice Insurer Is Insolvent (Bumped and Updated)


Crain’s New York Business reports that Physicians’ Reciprocal Insurers, New York’s second largest medical malpractice insurer with 25% of the state’s doctors, is currently insolvent. The company is in the hole to the tune of $43M.

According to the article, while some insurers get taken over by the State Liquidation Bureau when they go bust, this isn’t the case for the medical malpractice insurers.

New York has been having troubles in recent years with rising malpractice rates. Was it because of an increase in claims? Nope. You can read the reason here: Why New York Medical Malpractice Insurance Jumped 14%, and match that with a freeze in further increases by former Gov. Eliot Spitzer during his brief time in office.

Likely contributors to the shorfall:

  • Artificially low malpractice rates while the market was soaring;
  • NY previously “appropriating” $691M of medical malpractice insurance reserves to balance the state budget ;
  • Sptizer caving in to the medical lobby to prevent rate increases.

OK, that was the past. Filled with lousy public policy. Now to the present. Does this mean that the company is in imminent danger of demise? Not according to the company. From the article:

PRI President Anthony Bonomo says that while his company has a “negative surplus” of $43 million, making it insolvent under the state Department of Insurance’s accounting rules, it is far from going out of business.

“This is no Ponzi scheme,” Mr. Bonomo said. “DOI actuaries will always say the sky is falling.” Mr. Bonomo is lobbying for a Senate bill that would allow insurers to switch to a cash-flow basis of accounting.

Also, previously, Eliot’s Mess: The Ramifications for Medical Malpractice “Reform” in New York (3/12/08)

Originally published 5/21/09 – Bumped and updated on 6/5/09
—————————————————-
Update – 6/5/09: From the PopTortReport Shows No Link Between Medical Malpractice Suits and Insurance Rates for NY Docs:

A new report released today and endorsed by a coalition of consumer organizations (including CJ&D!) shows that “despite rising malpractice insurance premiums over the past several years there has actually been a drop in medical malpractice payouts made by New York doctors.”

 

May 10th, 2009

Doctors Are Still Tops in Pay (But Complain About Malpractice Premiums Anyway)

Another year, another survey, and once again physicians are found to take home the biggest paydays in America. In fact, out of the ten top paying jobs, nine go to medical professionals.

It’s something to think about when doctors complain about malpractice premiums. Complaining about an expense is OK, but it is only relevant if the complainers also disclose their income. Saying an insurance premium is 20K means one thing if a person nets out 45K, but it means something else entirely when the person nets out 150K.

This is not to say that doctors don’t deserve the big paychecks. Some do, some don’t, it depends on the individual. And many doctors do carry extra debt from four years of medical school and low-wage residencies.

But if a medical professional is going to complain about an expense of working, they should nevertheless be prepared to also disclose their income. Because expenses have no context without knowing what it means in terms of income.

Links to this post:

doctors’ salaries and medical malpractice
forbes provides the top paying jobs in the united states. here are the top 5: 1. surgeons (>06770) 2. anesthesiologists (<97570) 3. orthodontists (<94930) 4. obstetrician and gynecologists (<92780) 5. oral and maxillofacial surgeons

posted by @ May 11, 2009 12:49 PM

doctors’ salaries and medical malpractice
forbes provides the top paying jobs in the united states. here are the top 5: 1. surgeons (>06770) 2. anesthesiologists (<97570) 3. orthodontists (<94930) 4. obstetrician and gynecologists (<92780) 5. oral and maxillofacial surgeons
posted by @ May 11, 2009 12:08 PM

 

April 8th, 2009

Sham Medical Exams for Litigation (A Round-Up)

Last week the New York Times ran a huge piece on phony medical exams that were used to deny injured people benefits in Workers Compensation exams. (Exams of Injured Workers Fuel Mutual Mistrust) I didn’t blog it then as I was starting a trial in New York, a trial made more difficult due to the Astor trial starting the same day and sucking all the jurors out of the system since it was in the same courthouse.

But this was the lede from the Times:

Dr. Hershel Samuels, an orthopedic surgeon, put his hand on the worker’s back. “Mild spasm bilaterally,” he said softly. He pressed his fingers gingerly against the side of the man’s neck. “The left cervical is tender,” he said, “even to light palpation.”

The worker, a driver for a plumbing company, told the doctor he had fallen, banging up his back, shoulder and ribs. He was seeking expanded workers’ compensation benefits because he no longer felt he could do his job.

Dr. Samuels, an independent medical examiner in the state workers’ compensation system, seemed to agree. As he moved about a scuffed Brooklyn office last April, he called out test results indicative of an injured man. His words were captured on videotape.

Yet the report Dr. Samuels later submitted to the New York State Workers’ Compensation Board cleared the driver for work and told a far different story: no back spasms, no tender neck. In fact, no recent injury at all.

“If you did a truly pure report,” he said later in an interview, “you’d be out on your ears and the insurers wouldn’t pay for it. You have to give them what they want, or you’re in Florida. That’s the game, baby.”

Dr. Edward Toriello feels that workers’ doctors are often biased. “I think it’s human nature to help your patient. I think a lot of doctors say: ‘I don’t need the aggravation. It doesn’t hurt to keep him out of work.'”

The Times also has a related article from March 31st: For Injured Workers, a Costly Legal Swamp.

The problem of so-called “Independent” medical exams, or IMEs, that are dismissive of the injuries suffered by their fellow human are, of course, not limited to Workers’ Comp cases. They show up routinely in personal injury cases, especially auto cases where insurance companies and their attorney seek a report claiming that there is no “serious injury” (See: New York’s No-Fault Law Problem With “Serious Injuries”) and that therefore the case should be dismissed. The plaintiff’s bar calls these “defense medical exams,” since they are anything but independent.

These sham medical exams have also been the subject of litigation, including RICO suits. My posts on that subject has generated a tremendous amount of page views and commentary, some of which is from those involved in the exams and/or litigation:

The article and subject matter has also been the subject of commentary in the blogosphere: