Sean Callagy - Attorney and Entrepreneur

Wednesday, July 27, 2016

PIP Claims—The Initial Steps When Involved in an Auto Accident

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

If you are involved in an auto accident, the steps you take or do not take can affect your ability to be reimbursed properly from your auto insurance company. First, seek medical attention, as injuries that may seem minor initially can end up being a very serious condition in the long run. Next, inform your automobile carrier of the accident, and fill out whatever paper work is required to have your claim processed. Finally, take detailed notes on the injuries and medical treatment obtained. Save all of the medical bills and receipts.

Consider a personal injury attorney, if warranted by the circumstances of the accident and the nature of your injuries, but realize that under the New Jersey No Fault laws, it is your auto insurance company that, in the first instance, is responsible for paying your medical bills. It is critical that you contact your automobile carrier, whenever you are involved in an automobile accident, whether your vehicle was involved in the accident or not.

When considering a personal injury attorney, look for one experienced in dealing with these auto claims and one who is aware of the rights of the patient. In personal injury cases, it is common to come across tons of paperwork and confusing legal and medical terms. An attorney with experience in these matters is able to sift through documents and records and initiate a resolution. It is also important to choose a personal injury attorney who cares about you and your claim, beyond simply the monetary aspects of the claim. You have been injured—perhaps very seriously—and you should have an attorney that is sensitive to the pain, discomfort and inconvenience that accompanies the misfortune of an auto accident.

As these incidents are quite common, following these steps can make the process easier and less stressful.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $200,000,000 for medical providers, and that number grows daily. Our team of knowledgeable PIP Arbitration attorneys are ready to help you. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

PIP Claims—The Initial Steps When Involved in an Auto Accident

Monday, June 27, 2016

PIP Claims: Fee Shifting Allows for Arbitration at No Charge to the Medical Provider

The state-imposed fee schedules under the New Jersey No Fault laws, otherwise known as Personal Injury Protection or PIP, result in reimbursements to medical providers at levels that tend to be less than the usual and customary rates charged by those medical providers. This disadvantage, however, is offset, to some degree, by the fee-shifting provisions of the No Fault laws, which afford medical providers a tremendous benefit by enabling the provider to pursue arbitration without having to pay an attorney to do so. With very limited exception, discussed further below, the No Fault laws allow providers to pursue denied or underpaid claims at literally no cost to the provider—legal services and all.

PIP arbitrations are conducted before Dispute Resolution Professional or DRP’s. To bring a dispute before a DRP requires the payment of filing fees, in excess of $200 per claim. Although not mandatory, the hiring of legal counsel also accompanies the pursuit of a medical claim in arbitration. An attorney experienced with PIP and medical revenue recovery is almost a requisite to success in this arena. The good news is that most law firms that pursue PIP arbitration pay the filing costs for the provider and pursue the arbitration on the provider’s behalf without first having been paid anything. If the claim is successful and additional reimbursement is awarded to the provider, the insurance carrier pays the attorney separately for the expended filing costs and reasonable attorneys’ fees. If the arbitration fails, the provider pays the attorney nothing and the attorney is generally not reimbursed for the filing costs.

The one exception to this involves claims brought against PLIGA. PLIGA is the state-sponsored “fall-back” automobile “insurer” for those who do not have other automobile insurance. The fee-shifting provisions of the No Fault laws do not apply to PLIGA claims. Accordingly, law firms that pursue PLIGA claims for medical providers usually look to recover a contingent fee percentage, as well as the filing costs, from the provider’s awarded reimbursement.

Learn More About Callagy Law Here:

PIP Claims: Fee Shifting Allows for Arbitration at No Charge to the Medical Provider

Tuesday, June 21, 2016

Callagy Law - Who We Are - What We Do

Callagy Law is fundamentally changing the way medical providers recover their money from the medical carriers, one case at a time.

We truly believe that providers need “an aggressive champion of the cause of proper reimbursement” on their side that fights for them with CARE, URGENCY and AGGRESSION and our amazing results are a direct reflection of this relentless pursuit.

Since 2006 we have recovered more than $200 million dollars and resolved more than 50 thousand claims for our providers such as physicians, hospitals and ASC’s as well as other types of medical providers. .

We take particular pride in the uniqueness of the Callagy law client experience in that we remain hands on with our clients through the

entire process of recovery.

From the introduction to our liaison members that assist the providers in gathering vital information for the litigation or arbitration process to our relentless settlement team that provide updates to the providers on regular bases through emails, calls, meetings and online database access.

We have created processes and set trends in the world of medical recovery over the years, specifically the PIP, Workers Compensation and the Commercial Insurance world while evolving into a successful multifaceted law firm, practicing business law, family law, wills, estates and trusts law and commercial / business litigation.

As published in the Star Ledger and The Record, Sean Callagy and the Callagy Law litigation team just returned home with their second 27 million dollar plus verdict in two years!

With “We believe good people deserve good things” as his motto, Sean Callagy shook the legal world. Despite of his visual impairment and being the underdog in this Arizona case, Sean and the Callagy Law team triumphed, making over 20 news publications.

Currently the Callagy Law family has nearly 80 professional and dedicated employees, operating out of New Jersey, New York and Arizona.

Whatever your situation, just know we are here to help. Please call us today: 201.261.1700.

Thanks for watching!

www.callagylaw.com

inquiries@callagylaw.com

201.261.1700

Callagy Law - Who We Are - What We Do

Thursday, June 16, 2016

Callagy Law – New Jersey, New York, Arizona | Lawyers Working For You!

Please subscribe on YouTube and spread the word.

Visit Callagy Law’s website for full details: www.callagylaw.com

We are skilled attorneys in several different practice areas which include: Medical Revenue Recovery / Healthcare Recovery (PIP, Workers Compensation, and Commercial Insurance), Business Law, Commercial and Business Litigation, Family Law, and Wills / Estates / Trust Law.

We’ve received several awards from AVVO as well.

Please contact us today: 201-261-1700 | inquiries@callagylaw.com | www.callagylaw.com

We are headquartered in Paramus, New Jersey (Bergen County). We have offices in New York and Arizona as well.

We also offer FREE consultations! Call today.

#Attorneys, #BusinessLaw, #CallagyLaw, #CommercialInsurance, #HealthcareRecovery, #Lawyers, #Litigation, #MedicalRevenueRecovery

Tuesday, June 14, 2016

Test Post from Callagy Law

Test Post from Callagy Law http://callagylaw.com

Monday, June 13, 2016

Palliative Care Under New Jersey PIP Laws

As a claimant attorney in New Jersey PIP arbitration, I often seek reimbursement for treatment that was denied by insurance companies because the treatment was “palliative.” My response is, the palliative nature of the care is not ipso facto grounds to deny such treatment. Just like curative medical treatment, palliative care is compensable when medically necessary and reasonable.

What is “palliative care”? Palliative care is treatment that provides relief for the patient without curing the underlying cause of the symptoms. Dispute Resolution Professional (DRP) Fannan explained the standard to determine if palliative care is compensable under the New Jersey PIP laws in the Forthright Arbitration matter 1595197, as follows:

“Further, after treatment to effectuate a cure or rehabilitation has ended and the patient’s condition has plateaued, medical expenses for palliative treatment may continue, but only to the extent that such expenses are deemed reasonable and necessary. The reasonableness and necessity of palliative expenses must be evaluated in the context of the quantum of pain involved, plaintiff’s tolerance of pain and the overall effect of the pain on plaintiff’s life. Perun v. Utica Mutual Insurance Company, 280 N.J. Super 280, 285-86 (Law Div. 1994). The services must be shown by competent medical testimony to be such as are reasonable and necessary for the particular patient, taking into consideration his individual condition and need. Howard v. Harwood’s Restaurant Company Rest. Co., 25 N.J.

72 (1957). In determining what is reasonable and necessary, the “touchstone is not the (patient’s) desires or what he (sic) thinks is to be most beneficial. Rather it is what is shown by sufficient competent evidence to be reasonable and necessary to cure and relieve him (sic).” Squeo v. Comfort Control Corp. , 99 N.J.588(1995).”

By way of background, medical providers are expected to generally follow Care Paths, which are suggested general treatment paths to address injuries. For example, a Care Path may allow for a certain period of time of conservative care, and if the patient is still symptomatic, it may be time to “move up” the Care Paths to the next level of care. Perhaps injection treatment would be the next level of care following conservative care. There may be medical reasons to deviate from the Care Paths, and the treating doctor should explain the reasons for the deviation.

Let’s say the patient has been treated through all levels of the Care Paths for the injury at hand, but the patient is still suffering. Is palliative care still permitted and compensable under the New Jersey PIP laws. As noted above, generally palliative care is held compensable when it is medically reasonable and necessary. Elkins v. New Jersey Mfrs. Ins. Co., 203 N.J. Super. 695, 701 (App. Div. 1990). The PIP insurance carrier has a duty to provide payment for treatment which results in the alleviation of pain to the patient, even without regard to the curative aspect of that treatment. Miskofsky v. Ohio Cas. Ins. Co., 203 N.J. Super. 400, 413-414 (Law Div. 1984).

For example, Forthright DRP Miller ruled as follows in the Forthright PIP Arbitration matter 1337517:

“Medically necessary” is defined as treatment or a diagnostic test that is “consistent with the clinically supported symptoms, diagnosis or indications of the injured person”. In addition, that treatment is “the most appropriate level of service that is in accordance with the standards of good practice and standard professional treatment protocols including the Care Paths” and is “not primarily for the convenience of the injured person or provider”. N.J.A.C. 11:3-4.2.

The term “clinically supported” is defined in N.J.A.C. 11:3-4.2 and essentially means that there must be sufficient medical evidence and analysis to justify the performance of the requested treatment. This includes a physical examination, a review of both subjective complaints and objective findings, prior tests and a record of these observations and conclusions.

In addition, the treatment must be palliative or curative of a condition, not simply something that was provided for the patient’s personal comfort. See, Perun v. Utica Mut. Ins. Co., 280 N.J. Super. 280 (Law Div. 1994). See also, Elkins v. New Jersey Mfrs. Ins. Co., 244 N.J. Super. 695 (App. Div. 1990); Miskofsky v. Ohio Cas. Ins. Co., 203 N.J. Super. 400 (Law Div. 1984); N.J.A.C. 11:3-4.2.

In sum, palliative care very well may be compensable under the New Jersey PIP laws. The treating doctor should explain the patient’s condition and the need for the medical treatment, whether curative or palliative.

Learn More About Callagy Law Here:

Palliative Care Under New Jersey PIP Laws #ClaimantAttorney, #NewJerseyPipArbitration, #Palliative, #PalliativeCare, #Pip, #PipArbitration

Friday, June 10, 2016

Divorce & Taxes | Callagy Law | Paramus, NJ | Bergen County

The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, the court system, and other procedures within the area of Family Law.

In the divorce context, all assets are not created equal and the Internal Revenue Service can alter what you thought were rather straight forward provisions for child support and alimony.

Consider the “child contingency rule” regarding alimony. IRS Publication 504 warns that if alimony payments are reduced or end around the same time as a child-related event, all alimony payments that were deductible to the payor and taxable income to the payee may be reclassified as child support instead of alimony. The payor would lose the deduction and pay retroactive taxes and the payee would receive a refund of taxes paid. A contingency relating to the child include (1) becoming employed (2) dying; (3) leaving the household; (4) leaving school; (5) marrying; or, (6) reaching a specified age or income level. This reclassification can be avoided if it can be established that any reduction in alimony was determined independently of a child-related contingency, which would be the normal circumstance. For example, if you can show that the period of alimony payments is customary in the local jurisdiction, such as a period equal to one-half of the duration of the marriage, you can overcome the presumption and may be able to treat the amount as alimony.

Also consider the income tax burden of certain assets that are being divided up as part of a divorce settlement. Investment accounts that hold stocks, mutual funds, etc., may carry different tax basis which may result in different unrealized gains or losses which can result in significantly different capital gains taxes. Investment assets must be viewed on a tax-neutral basis to assure an equal distribution and sharing of capital gains taxes. The $1 million dollar investment account, which may have unrealized gains that will subject to capital gains taxes is not equal to $1 million in cash and an straight up off-set would be an unequal distribution of the assets.

Your family lawyer should have a grasp and understanding of these tax concepts and be able to navigate you through such issues to assure that the distribution of assets is fair and equitable.

Learn More About Callagy Law Here:

Divorce & Taxes | Callagy Law | Paramus, NJ | Bergen County #Alimony, #Assets, #CallagyLaw, #ChildSupport, #Divorce, #FamilyLaw, #Irs