Maryland Injury and Disability Law : Washington DC Metro Injury & Disability Lawyer & Attorney : Greenberg & Bederman : Accidents, Falls, Medical Malpractice : Maryland, DC, Virginia

“WARNING: The following show features stunts performed either by professionals or under the supervision of professionals. Accordingly, MTV and the producers attempt to recreate or re-enact any stunt or activity performed in this show.”

We can’t speak for anybody else, but we can’t imagine ever having the urge to try any of these stunts. But we are mindful that young people sometimes make poor decisions, so having that warning in place is the right thing to do.

It should be noted that the whole Jackass phenomenon is wildly successful. The three movies and multiple series of TV shows have generated hundreds of millions of dollars in advertising, DVD sales and ticket sales.

Sadly, Ryan Dunn died in a particularly bad car accident yesterday. Mr. Dunn, who was one of the featured players on Jackass, was driving at about 140 mph when his car tore through a guardrail and careened through a heavily wooded area. His car eventually hit a tree and burst into flames. Both Mr. Dunn and a man named Zachary Hartwell were killed instantly.

Mr. Dunn’s blood alcohol content was 0.196, which was 2½ times the legal limit in Pennsylvania. He also had a history of poor and reckless driving habits, racking up 23 total citations over the course of his driving career. Mr. Dunn’s cause of death might as well have been listed as “The Law of Averages.”

Nobody has their own personal highway or street. Any time you get in the car, you are sharing a public space with other drivers, motorcyclists, pedestrians and bicyclists. You aren’t just putting yourself at risk when you drink and drive or decide to speed. Zachary Hartwell serves as an unfortunate example of that fact. Please watch your speed, and please don’t drink and drive.

Greenberg and Bederman is a car accident injury law firm located in Silver Spring, Maryland. We are offering legal help to those who have been hurt in an automobile accident due to no fault of their own. If you or a loved one in Virginia, Maryland or Washington, D.C. has been injured in a car accident, contact Greenberg & Bederman for a free legal consultation.

As an example, let’s say for the sake of argument that you are walking across Wisconsin Avenue and you get hit by a car that ran a red light. The ambulance takes you to the hospital and you get treated. If you are like most injury victims, the last thing on your mind is sorting out which insurance company is going to pay for what. You simply hand over your insurance card and let them get on with it.

Once you recover and decide to pursue legal action against the person who hit you, that’s when things get tricky. If you end up winning a settlement or a judgment against the driver, your health insurance company will often place a lien on your personal injury settlement or judgment in order to recoup their costs for your medical treatment. The idea is that your insurance company rightly believes that since another party was at fault, they paid for medical services that they were under no legal obligation to pay for.

The legal term for this process is called subrogation, and it is a fairly common occurrence in injury cases. What is fortunate about the process is that insurance companies are only allowed to be reimbursed for what they paid for in medical expenses, and not all of what you received for medical expenses in your settlement or judgment. So if your insurance company paid $9,000 in medical expenses and you received $20,000 for medical expenses in your settlement, the insurance company is only allowed to file a lien for the $9,000 that they actually paid.

The question that many of you might be asking is “Why would I get a settlement for $20,000 in medical expenses if it only cost the insurance company $9000?” The answer to that question is that under Maryland law, there is an evidentiary rule that prohibits the admission of evidence that a victim will be compensated from a third party in a tort case. This prevents the person who was responsible for the injury from saying “What’s the big deal? He got his bills paid for. No harm, no foul, right?”

This part of Maryland law is known as the “Collateral Source Rule,” and it is a very important element of what the attorneys at Greenberg and Bederman are trying to do for our clients. When we represent an injury victim, our intention isn’t to simply get the bills paid and nothing more. The vast majority of our clients have been injured due to the negligence of someone else. They were hit by a driver that wasn’t paying attention, or their doctor made an easily preventable negligent error.

The Collateral Source Rule has been in place for as long as we can remember, and it is, of course, one of the main targets of tort reform organizations everywhere. They argue that it is unfair for a defendant to have to pay more for medical expenses that what the victim’s insurance companies paid, to which we say hogwash. For one thing, insurance companies carry negotiating weight that individuals do not. An insurance company that brings thousands of patients to hospitals and clinics can very easily ask for a lower price, while individuals carry no weight whatsoever. Nor do insurance companies negotiate lower prices on behalf of their patients. They do so on behalf of themselves. And again, a tort case is not simply a tit for tat accounting of dollars and cents. It is a legal way of both rectifying financial damages and bringing the responsible parties to account for their actions. It is important to remember that the driver hit you, not Blue Cross Blue Shield. And the Collateral Source Rule is the courts way of recognizing that.

If you or a loved one has been injured in an accident, contact Greenberg and Bederman for a free legal consultation today.

The problem is that with health care, there is no such thing as a “Usual and Customary” rate. Big insurance companies are able to negotiate lower costs for services because of the volume of care seekers that they bring to hospitals, clinics and doctors’ offices. Once you go out of network, you no longer have the weight of your insurance company’s negotiating skill behind you. So the costs for your treatment vary wildly from place to place. A sprained ankle in Tacoma, Washington might cost much more than the same injury in Yuma, Arizona. It depends on who owns the hospital, whether the facility is independent or whether an HMO runs the facility, or what their billing policies are. Health care is quite literally wide open. There is no “invisible hand of Adam Smith” keeping the price of services up or down.

So for the sake of argument, let’s say you are on vacation in rural Vermont and you break your leg. The non-negotiated, out-of-network costs might be a lot higher than the costs of the same injury at the hospital you would go to in Bethesda, Maryland, Arlington, Virginia or Washington, D.C. So if you paid extra on your policy every month for out of network costs, you would probably assume that your insurance policy would pick up 80% of whatever the hospital in Vermont is charging you. But instead, your insurance policy is picking up 80% of what Ingenix decides is “Usual and Customary.”

And that’s exactly what the problem was. Attorney General Cuomo discovered that Ingenix was skewing its “Usual and Customary” rates so that everything was reported as much cheaper than it was in real life, which lowered the amount that insurance companies were obligated to cover. So if the guy with the broken leg in Vermont is presented with an out of network bill for $4000, the insurance company can say “According to our calculations, the Usual and Customary rate for your injury is $2500, of which we will pay $2000.” This leaves you on the hook for $2000, as well as all the extra money you had been paying each month for the out of network coverage, which was evidently completely useless due to Ingenix.

It wasn’t only the policyholders who were getting stuck with huge medical bills. Most people don’t have the amount of cash on hand that it takes to pay for enormous medical expenses (this is why they had insurance, after all,) so the providers end up selling their debt to bill collectors for nickels on the dollar just so they can recoup some of their losses. So both the policy holder and the healthcare provider lose out, but guess who doesn’t? The insurance companies that use Ingenix software for their out of market billing. Which is to say almost all of them.

All of this is bad enough, but what makes the whole scenario even worse is that Ingenix was actually a wholly owned subsidiary of United Health Care, one of the biggest health care insurance providers in the United States. This is like a professional football team being allowed to bring its own referees to the Super Bowl. Who do you think is going to win out?

We would like to say that this case of price fixing was an isolated incident, but we can’t for two reasons. The first reason is that this rigged software was used by practically the entire American health insurance industry. How “isolated” could something be if the entire system is using the same flawed data? The second reason is that this is not the first episode of big insurance using skewed data in their software to maximize profits at the expense of their policyholders. Auto insurance companies are still to this day using a program called “Colossus,” which uses skewed data to “average out” the costs of physical injuries. Just like Ingenix, Colossus also leaves policyholders on the hook for thousands of dollars worth of medical costs that should have been paid by the insurer in the first place.

While it’s a good thing that Ingenix was essentially forced out of business by Mr. Cuomo, and it is good that users of Colossus are facing similar investigations, these changes have come a little too late for the hundreds of thousands of patients and medical professionals who have been ripped off as a result of these skewed computer programs. We think that the country would be better served if the states or federal government were more proactive about examining healthcare billing software. It’s good that we have firemen, but we have more of a need for Smokey the Bear.

The data that these companies use to determine pricing should be open to review, not kept as a trade secret. Nor should any companies that develop similar software have any financial ties to insurance companies. The fact that Ingenix was owned by one of the biggest health care companies in America is a massive conflict of interest, and one that cost Americans millions of dollars.

Greenberg & Bederman is a personal injury law firm located one half block from the SIlver Spring metro station.  We have been handling personal injury law since 1985.  To learn more about our personal injury lawyers, please read about Andrew Bederman, Roger Greenberg, or Jason Fernandez, or watch some of our personal injury videos on Youtube.