ymcgavin@socal.rr.com
Senior Member
Posts: 1351
Joined: Jun 2002
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Friday October 28, 2005 7:01 AM
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Hi David,
Thanks for the link to this poopchute's clearly biased article. Geez, without an IW having access to a lawyer in this adversarial system, while the insurer/TPA/PSI employer has an attorney, I guess he thinks that an IW does not need one --- after all, this is a no-fault system and the payor community is always just, fair, and honest about delivering benefits. Hogwash.
There is a very interesting article in this months edition of the CWCR addressing how the table is tilted in favor of the insurer/TPA/PSI employer because of the fact there is no limit as to how much a DA can charge. In contrast, the amount allowed the AA is limited by law. The author suggests that upping the fees for an AA would level the playing field.
I can recall a book put out by the automobile payor community addressing payment trends nationwide. The one result of that study that stands out is the reimbursement for BI vs. PD (Bodily Injury vs. Property Damage) in New Jersey.
The study concluded that NJ reshapes the bell curve for BI reimbursement when it comes to the no-fault system in NJ compared to the rest of the nation. The study also found that if a NJ auto insured was represented, the costs were greater because of an increase in diagnostic testing, treatment, and once the threshhold has been reached, the resulting lawsuit against the at-fault party.
It seems that once a claimant obtains representation, the costs for BI costs for the payor are increased significantly. No wonder the payor community wants lawyers out of the system --- they are ruining the payor's bottom-line.
On a daily basis, nationwide, I see payors refuse to authorize diagnostics and treatment that is reasonable. If the payor is able to deny authorization for diagnostic testing that reveals a need for further treatment, the payor saves money and the claimant suffers.
As much as I usually do not get along with attornies, they are indeed necessary to ensure the payor community is kept honest.
York McGavin
ymcgavin@socal.rr.com 
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