Please see the following email fowarded to Attorney Russo by Paul Gitnik:

August 4, 2009

Dear Mr. Grantz:

The amendment as offered by Congressman Barrow and Congressman Braley , specifically the inclusion of the Make Whole Doctrine is countervailing to any health care cost containment effort and in fact benefits the property and casualty insurers, automobile insurers and workers’ compensation carriers. I am certain that this language was crafted by either the American Association for Justice, formerly the Association of Trial Lawyers of America, or the property and casualty insurance industry. For year the American Association for Justice has inaccurately stated that subrogation/reimbursement potentially puts members in the middle of the insurance companies’ bickering or worse litigation. Most importantly, property and casualty insurers, automobile insurers and workers’ compensation carriers do want effective subrogation and injury coordination, because they have been economically benefiting at the cost of health plans, employers and consumers because health payors have been paying these third party accident related claims. Please see my written statement submitted at the Health Forum on June 29, 2009, that goes into detail on this issue.

Most importantly any amendment should contain the following with regard to subrogation/reimbursement and for accident-related claims:

1. Legislate the statutory right of subrogation/reimbursement for accident-related claims by a health payor.

2. The right of subrogation/reimbursement of accident-related claims should be consistent, regardless if you are an ERISA self-funded welfare benefit plan, Medicare, Medicaid, Federal Employees Health Benefit Plan, government sponsored plan or a fully insured plan.

3. Elimination of the Make-Whole Doctrine as it applies subrogation/reimbursement of accident-related claims paid for by a health payor.

4. Elimination of the Common-Fund Doctrine as it applies to subrogation/reimbursement of accident-related claims paid for by a health payor or establishing a statutory fee similar to recoveries on a workers’ compensation claim.

5. Require member’s legal counsel to provide written notice of a third party claim, that they protect, recover and remit the accident-related claims paid for by a health payor.

6. Permit the health payor to deny or suspend a claim that it identifies as an accident-related claim; and/or

7. Require property, casualty, motor vehicle and workers’ compensation insurance carriers to exchange information and coordinate with health payors to ensure that all accident-related claims are properly identified and recovered by said health payor.

I will be calling you today to further discuss the right of subrogation/reimbursement for accident-accident related claims and how if done effectively could result in savings of billions of dollars per year.

I am also copying my response to the executive team at SCIOinspire Corp., since I am certain that they too would like to provide you with their thoughts, comments and even proposed language for an amendment to be offered by Congressman Murphy.

Respectfully yours,

PAUL J. GITNIK & ASSOCIATES, LLC

Click here to see the Amendment

Click here to see the Health Forum Presentation

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This entry was posted by Adam V. Russo on Tuesday, August 4th, 2009 at 10:29 am and is filed under Subrogation. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.