Attorneys to docs: Cut your fees PLEEZE!

[Guest guest]

Here's a question designed to stir your hearts:

If a lawyer asks you to cut your fees by a modest amount (i.e. 2/3), because

the patient didn't get the hoped for settlement, should you do it?

Could it be because the attorney wouldn't take a reasonable settlement offer

and the jury awarded less that hoped for amount and of course, now there are

trial costs including lawyer litigation fees.

Dan said in a seminor that we should say,

" Cut my fees? Sure 'nuff. Just send me a certified letter, notorized while

you're at it, showing who else including you, Mr//Ms. lawyer, cut their fees

by the same amount.

When they start wetting themselves about confidentiality, tell them for that

amount of savings, the patient will be happy to release the information.

He NEVER gets that letter.

Can you imagine a neurosurgeon whacking the fees by 2/3; better yet, a

hospital? Stop! Stop! My HMO doesn't cover split sides inflicted by

laughing!!!

Of course, one must remember, their work is important.

Is there any way to track which attorneys fish for reduced fees on almost

every case? Think about it: Crank out a boilerplate letter and get another

couple of grand on a claim. No malfeasance committed. No hard feelings

either.

E. Abrahamson, D.C.

[Guest guest]

Doctors:

I got this one forwarded to me and thought it would be potentially

beneficial to you to get an insiders view on this one.

Before I start, I got a good mention in Freeman's e-mail,

likely because of my firm's policy to take a cut on my fees in any case

where I ask a physician to take a reduction in fees. So, in regards to

the Dan thing, I do agree with this concept. I would hope that

the doctors who have worked on the same cases as I have, know that I

recognize the work that you doctors put into the treatment of these

patients is of significant value. Therefore, I see no reason why a

doctor should be asked for a reduction when the lawyer isn't willing to

do that on his / her fees. We are both professionals, and I clearly

recognize the importance of what you are doing.

With that said, while you may think it is a joke that any hospital or

medical doctor would agree to cut bills, it is a reality that they will

do that in cases. Most often, this is because there is insufficient

insurance (which occurs in about 25% of my cases) and no tangible

assets. As an example, I had a case with a bankrupt defendant, 100K in

insurance and $170,000 in health care bills. OHSU, and several other

area hospitals, medical doctors, and other variety of doctors had to

take a pretty substantial reduction as a result of there not being

enough money. We all cut our fees (me included) and there was little

left at the end for someone serious injured. Some providers simply

waived their bill. Unfortunately, a scenario like this isn't

particularly unusual in my practice because I handle a high percentage

of serious cases. Dan 's idea is pretty similar to what I am

seeing from OHSU when I request a reduction - I have to put in writing

that I am taking a reduction and then it goes to the OHSU legal desk

and they consider the requested reduction. I have the respect for all

providers that I don't ask for a reduction unless the reduction is

truly necessary. Even when it is, OHSU, who is probably the most

conservative about reducing bills, will only reduce by about 20-25%.

I think it is appropriate here to discuss why the amount might not be

sufficient to cover 100% of the bills, and that typically comes down to

six main factors: insufficient coverage, bad facts you may not know

about, bad lawyers, a conservative jury, failure to appreciate the

economic realities of the case, or substantially more treatment

provided on a particular type of case by yourself or another provider.

I'll try to briefly address these issues so that you can consider them

as those ongoing requests for reduction keep rolling in.

Often there is a case scenario that isn't fully understood by a

treating doctor, that results in there being problems obtaining what

might be a " reasonable " or even typical outcome in a case. Some of

this has to do with prior injuries that weren't fully investigated by

the treating doctor (same complaints shortly before the collision),

problems with the wage loss claim because people didn't file their

taxes, a prior drug history or psychological history, the collision

occurring in a very conservative jurisdiction, and a long list of other

problems which result in lower case outcome than you might think

appropriate. The fact is that you do not frequently see the " warts " of

a case as the doctor. My guess is that you then sit back, as I did

when I was practicing as a DC, and think " How the heck did that case

come out so poorly? " It may be due to factors the patient never told

you about.

Then there is the insufficient coverage problem. With $25,000 minimum

coverage on most insured vehicles in Oregon, a serious injury can't be

appropriately compensated. Unfortunately, I see it happen all the

time. I also see it where the negligent party is uninsured and the

injured party only has $25,000 of UIM insurance. They never thought

that they would be hit by someone who had minimum coverage, even though

that is all they carried themselves. Often the bills will approach or

even exceed the $25,000, and in such a case, you can appreciate why a

lawyer needs to ask for a reduction in the bills. Not that you have to

give it, but you are going to be going after the patient for it if you

don't. If they already lost a few internal organs and got no

settlement, it might not be a good idea to pursue the money, but that

is up to you.

There certainly is a problem with attorneys who don't do a good job,

have a bad reputation with the insurer, or who are afraid of going to

trial. There are also a notable group of law firms who will take cases

to see if they can settle them, and then dump them if they can't settle

the case. For those of you familiar with my writings in this area, you

know that attorneys are tracked by Federal Tax ID # by many insurers,

particularly in terms of an attorney's jury verdict history, and so if

you are working with an attorney with a $3,000 trial average, (or more

scary, a $3000 settlement average) don't expect the insurer to make a

$50,000 offer. It won't happen unless it is a really unusual case.

So, if you are working with a lawyer who gets average settlements of

$3,000 you probably shouldn't expect that they are going to cover your

$5,000 outstanding bill, because the money won't be there. The real

problem is when DCs make the referrals to lawyers who continually do

this to you. This goes into the " take advantage of me once, shame on

you, take advantage of me twice, shame on me " category. In other

words, if you are referring to someone who keeps asking you for 50%-66%

reductions, I guess that is your choice. If you don't like it quit

working with the law firm.

There are also problems in obtaining the right amount even when the

lawyer will go to trial. I have come to the realization, that due to

Oregon's low jury verdicts, a very small percentage of clients get what

their case should be worth. Sometimes this is because the jury awards

less than they should because they don't trust injured people and think

every injured person files lawsuits in hopes of a big outcome. That's

the picture the defense lawyers paint in almost every case -Jackpot

Justice. It is a bias that we seldom overcome despite our best efforts

as lawyers to get an impartial jury. I think that if you talk to trial

lawyers you will find that most of us are pretty amazed by the

decisions that juries make. I do the best job I can on every case, but

sometimes the jury bias against injured people is too much to overcome.

I want you to know that juries are handing out $0 outcomes in Oregon

even when the defendant admits fault. That is reality.

There is some economic reality that comes into play as well, and so

occasionally we are faced with either settling a case, or incurring

$3000-$20,000+ to try to get a jury verdict that may not even cover the

costs. Few lawyers are willing to risk the money necessary for solid

experts on a case, like myself and the others who do well at trial, and

this does affect case outcome. Also, since we have essentially no

established bad faith law in Oregon, insurers really can do whatever

they like (including spending more on litigating cases against their

own insured) rather than provide a reasonable settlement offer.

There is also some problem with overtreatment, and this is almost

always a topic that comes up in chiropractic cases. But I think a

larger problem is bad notes. I had a case which completed

approximately 6 months ago, which I had taken early in my career, where

there was a clear brain injury. The initial notes were difficult to

read and then the chart notes read either " better " or " patient returns "

for the next ten months. The narrative was totally bizarre. No

referrals to a neurologist or neuropsychologist for evaluation. Then

the doctor wonders why I can't get a great outcome on the brain injury

case, and why the $10,000 balance can't be paid in full. And,

unfortunately, there was no where else to look for that answer beyond

the chart notes which said absolutely nothing, the incoherent

narrative, and the failure to refer out. Bad notes kill a case, and it

certainly killed that one.

So, there are some of the reasons why I think you end up with lawyers

asking for 66% reductions in your bills.

With all this said, there is a GREAT deal of pressure made by judges,

and mediators who deal with the potential resolution of a claim, to ask

lawyers to negotiate with health care providers to see if costs can be

cut and the case can be resolved by lowering the outstanding amounts on

bills. I typically discuss with them the significant distaste the

providers are exhibiting toward the legal profession because of our

expectation that doctors should reduce bills in such a high percentage

of cases. Typically after that discussion the issue is dropped, but

frequently my cases do not resolve as a result and I carry forward to

trial. Then, it is a decision for the jury as to whether or not to

accept any or all of the bills resulting from the collision. And, if

you get a jury who doesn't like chiropractors, it is very evident that

all of the bills except the DCs have been provided in the verdict.

I've seen this happen even when the DC did the best job testifying and

provided most of the substantiation for the case. When the bills for a

few years of DC treatment amount to $10,000-$15,000 of a case with

$30,000 in total bills, and the jury deducts only the DC bills, we end

up with a situation where it is very hard to pay all of the bills at

100%. I really think that we are continuing to face the fall out of

the AMAs quackery campaign, and it may take us another 20 years before

we see juries who don't have bias caused by that.

Anyway, that is my 2 cents.

DeShaw, D.C., J.D.

>  

> Attorneys to docs: " Cut your fees PLEEZE! "

>

> Here's a question designed to stir your hearts:

> If a lawyer asks you to cut your fees by a modest amount (i.e. 2/3),

> because

> the patient didn't get the hoped for settlement, should you do it?

>

> Could it be because the attorney wouldn't take a reasonable settlement

> offer

> and the jury awarded less that hoped for amount and of course, now

> there are

> trial costs including lawyer litigation fees.

>

> Dan said in a seminor that we should say,

> " Cut my fees? Sure 'nuff. Just send me a certified letter, notorized

> while

> you're at it, showing who else including you, Mr//Ms. lawyer, cut

> their fees

> by the same amount.

> When they start wetting themselves about confidentiality, tell them

> for that

> amount of savings, the patient will be happy to release the

> information.

> He NEVER gets that letter.

>

> Can you imagine a neurosurgeon whacking the fees by 2/3; better yet, a

> hospital? Stop! Stop! My HMO doesn't cover split sides inflicted by

> laughing!!!

>

> Of course, one must remember, their work is important.

>

> Is there any way to track which attorneys fish for reduced fees on

> almost

> every case? Think about it: Crank out a boilerplate letter and get

> another

> couple of grand on a claim. No malfeasance committed. No hard feelings

> either.

>

> E. Abrahamson, D.C.

>

>

>

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