Illinois Lawyer Blog

Starting in 2008, if your surgeon neglects to remove that sponge from your abdomen, Medicare won't pay for the subsequent procedure to retrieve it. Under some new rules just issued, Medicare will no longer pay for the costs associated with "preventable" conditions acquired in the hospital. Some examples include hospital-acquired infections, bed sores and transfusions of the wrong blood type. The hospitals themselves will have to pay the associated costs. Thankfully, the hospitals are prohibited from passing the costs onto the patients. Some health care specialists believe the change in the rules will give hospitals a stonger incentive to prevent mistakes from happening in the first place. In particular, hospitals will now have a real incentive to focus on preventing patients from developing infections. The CDC estimates that 2 million people get hospital infections each year - resulting in 100,000 deaths and an additional $27 million dollars in medical expense.

Posted by Mark P. Loftus | Permalink | Email This Post

Posted In: MEDICARE

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Pretty low, if the allegations made by an Atlanta couple prove to be true. Bill and Leandra Pitts, the couple in question, were injured in a 2004 auto accident. According to an recent article in the Atlanta Journal-Constitution, the insurance company involved, Progressive Insurance, established a new low while "investigating" the claims made by Mr. and Mrs. Pitts. According to the article, investigators for Progressive snuck into the Pitts' church in August of 2005, posing as prospective members. Then they slimed their way into a private confessional meeting at a church member's home, hoping to overhear a damaging admission from the Pitts about the auto case. After the Pitts learned of Progressive's tactics, they filed a lawsuit claiming invasion of privacy and fraud. Progressive's President and CEO, Glenn Renwick issued a statement acknowledging that the story appeared to have merit and apologizing for the actions of the investigators. Interestingly, Renwick's statement didn't mention what disciplinary action, if any, were taken against the investigators in question.

Posted by Mark P. Loftus | Permalink | Email This Post

Posted In: INSURANCE

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Senator Trent Lott, the powerful Republican Senator from Mississippi, has seen the light. Lott, who, until very recently, was a longtime defender of insurance companies, is no longer. Senator Lott lost his home to Hurricane Katrina in 2005. He filed a claim with his insurer, State Farm. The "Like a Good Neighbor" people denied coverage on Lott's claim, as well as the claims of tens thousands of other homeowners. State Farm claimed Lott's home, and the other homes, were actually damaged by flooding, a non-covered risk under the policies Lott filed suit, litigated the case over a year, and only recently settled. That experience caused Lott to re-think his allegiance to insurance companies. He has now concluded that the insurance industry needs some reforms[gasp!!!]. To quote Senator Lott: "I'm like a woman scorned. I'm prepared to to continue to kick their fanny until the last day I'm alive on this Earth because they have mistreated too many people." Better late than never Senator.

Posted by Mark P. Loftus | Permalink | Email This Post

Posted In: INSURANCE

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I recently had a situation with an Illinois Healthcare provider that I had managed to avoid for the last twenty years. Represented an older man for injuries he had received in an automobile accident. The client was a very nice guy who had come here from another country decades ago, worked hard and raised his family. Didn't have much education, but always worked. He got pretty smashed up in the collision and had a fairly substantial hospital bill. He didn't have any insurance at the time, so the hospital agreed to issue a lien for the outstanding amount, to be paid out of any settlement. Typically, [at least in my experience] the healthcare provider will usually accept a discounted amount in FULL AND FINAL SETTLEMENT OF ANY OUTSTANDING BILL. The reduction is an implicit acknowledgement that but for the efforts of the attorney, the medical bill would not have been paid.

Getting back to my client, his bill was outstanding for a long time, so the hospital sent it out to collection. Collection agency contacts me and advises that after payment of the lien, they will pursue the client for any outstanding amount. I call the hospital and speak to personnel in management who agree that normally, after payment of the reduced amount, they forget about the balance. I pass this onto the collection agency, who insists on pursuing the client for any amounts outstanding. So although the hospital has conceded that their custom and practice is to accept the discounted amount in full settlement, the collections bloodsuckers refuse to budge. The inmates have apparently taken over the asylum.

My only option is to bring a Motion to Adjudicate the Lien, which isn't a particularly good option. Under 770 ILCS 23/45, healthcare providers are entitled to go after the entire amount. Hopefully the judge will recognize the unfairness of the collection agency ignoring hospital policy, and give my client a break. To be continued...

Posted by Mark P. Loftus | Permalink | Email This Post

Posted In: HEALTHCARE LIENS

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The Fourth District Appellate Court of Illinois[Champaign County] recently came down with an opinon that will make Illinois personal injury attorneys check their complaints a little more closer. In Grady v. Machini[opinion filed on July 31, 2007] the plaintiff filed a complaint to recover damages for injuries she suffered in an auto accident. The complaint did not have an affadavit, as required by Supreme Court Rule 222, stating whether the damages sought did, or did not exceed $50,000. The case went to trial and the jury awarded $97,700. The defendant brought a post-trial motion to reduce the damages to $50,000. The trial court did so and the plaintiff appealed.

The Appellate Court felt that Rule 222 was very clear - in effect, it requires that a party to attach an affadavit stating whether the damages sought did or did not exceed $50,000. The rule goes on to say any judgment that exceeds $50,000 shall be reduced to $50,000 if the damages sought do not exceed the $50,000 mark. The court ruled that as plaintiff did not file an affadavit asying she was seeking more than $50,000 she could not recover more than that amount. Ouch.

Posted by Mark P. Loftus | Permalink | Email This Post

Posted In: CIVIL PROCEDURE

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The United States Court of Appeals for the Seventh Circuit, located in Chicago, Illinois, recently discussed the proof a plaintiff must offer when prosecuting a retaliatory discharge case. In McCoy v. Maytag, Thomas McCoy brought a retaliatory case against his former employer, Maytag, for firing him after he filed a Workers Compensation Act. The Court, in the course of its opinion, set forth the elements a Illinois plaintiff must prove: 1) that he was the defendant's employee before the injury; 2) that the employee exercised a right granted by the Illinois Workers' Compensation Act and 3) that he was discharged from his employment with a causal connection to his filing the Workers' Compensation claim. The hard part in these cases is the third element - causation. The Court noted that "The element of causation is not met if the employer has a valid basis, which is not pretextual, for discharging the employee." So what does that mean in English? The Court explained that in order to show pretext, "...a plainitff must offer evidence to indicate that the employer did not honestly believe the reasons it gave for its action and is simply lying to cover its tracks." Pretext "...means more than a mistake on the part of the employer; pretext means a lie, a specifically a phony reason for some action." In short, the plaintiff has to show the employer's reason for discharge was a lie. Not an easy thing to prove, as Mr. McCoy found out. The Seventh Circuit upheld the Trial Court's decision to grant summary judgment against plaintiff, ruling that the plaintiff's failure to provide regular updates to justify his absence from work[required under the Collective Bargaining Agreement]was a non-pretextual reason for the termination.

Posted by Mark P. Loftus | Permalink | Email This Post

Posted In: RETALIATORY DISCHARGE

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Illinois Governor Rod Blagojevich recently legislation that will permit successful plaintiffs to receive jury awards for grief, sorrow and mental suffering in Wrongful Death cases. The new law finally allows the surviving spouse and next of kin to recover for their anguish over the loss of their loved one. Prior to passage of the law, family members couldn't even mention their grief at trial, as any such mention just might be grounds for reversal of the verdict. Illinois has now joined with 23 other states that allow such damages.

Posted by Mark P. Loftus | Permalink | Email This Post

Posted In: WRONGFUL DEATH

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