Sean Callagy - Attorney and Entrepreneur: legal facts

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Monday, January 18, 2016

A Closer Look into Amendments | Callagy Law

15 Million Civil Lawsuits Are Filed Each Year in the United States | More insight into amendments

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, and other procedures within business and commercial litigation. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

According to the latest polls, 15 million civil lawsuits are filed each year. That is one lawsuit for every twelve adults in America and one filing every two seconds. One overarching flaw that a majority of these complaints and their corresponding answers have in common is that they fail to name all the proper parties or assert all the proper claims or defenses. The mechanism to fixing these mistakes is called an amendment.

In the trial level court of New Jersey, called the Superior Court, one of the rules governing amendments is 4:9-1. Specifically this rule allows a party to amend their pleading once at any time before the opposing party responds. After a party a responds, there are then only two avenues to amend: one is by consent of the other party and the other is by leave of court which “shall be freely given in the interest of justice”

The phrase “in the interest of justice” is quite broad and may leave many readers wondering what courts will look to decide if an amendment fits into this phrase. While there a handful of factors that a court analyzes in reaching this conclusion, the overwhelming consideration is the prejudice that will be suffered by the other party if the amendment is granted.

In Keller v. Pastuch, the Plaintiff, who were husband and wife, brought suit against an automobile driver after the car the wife was riding in was struck by the Defendant. 94 N.J. Super. 499, 501 (App. Div. 1967). On the opening day of trial the defendant sought leave of court to amend his answer to include a new defense. Id. Subsequently, the court granted a mistrial and heard, later on that same day, oral arguments on whether the amendment should be granted. Id.

The plaintiffs argued that they would be substantially prejudiced due to the lateness of the defendant’s proposed amendment. Id. In response, the defendant argued that he did not know this defense was available to him until a recently conducted interview. Id. at 503. The court sided with the plaintiff and held that the defendant could have asserted the defense earlier, which in turn would have allowed the plaintiff’s to preserve their rights.

By contrast, in Sheppard v. Braun the court granted plaintiff’s motion to amend to add two new parties. No. ATL-L-1900-05, 2005 WL 2560782, at *1 (N.J. Super. Ct. Oct. 7, 2005). The plaintiff, a car accident victim, sought to add the Borgata Hotel after he recently learned that the hotel may have been serving alcoholic beverages that contributed to the accident. Id. The court summarily granted the motion, due to the fact that it was unopposed and no trial or arbitration date had been set. Id.

Thus, as a litigant it is important to act swiftly when amending a pleading, so as to ensure that the opposing party is not prejudiced and thereby causing the court to deny the amendment.

Sean Callagy, the owner and President of Callagy Law is an attorney, business coach, public speaker, and entrepreneur; and is dedicated to the personal and business growth. Please reach out to us here with any questions or comments regarding personal or business matters. We will to continue to provide daily updates with helpful information on our website and social media. Please feel free to contact Callagy Law at anytime. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube by clicking here.

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Thursday, January 14, 2016

Section 20 Settlements

The purpose of this post is to help assist healthcare providers and owners with questions they have concerning their business or relevant knowledge in the field. 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.

Section 20 Settlements

According to N.J.S.A. 34:15-20, the parties to a workers’ compensation claim petition may settle the claim where (1) jurisdiction, liability, causality and/or dependency are disputed; (2) the parties wish to resolve the claim with a lump sum settlement; (3) the parties consent to the settlement; (4) the parties are represented by Counsel; and (5) a judge of compensation determines that the settlement is fair and just under the circumstances. Notably, once the settlement is approved, it shall have the force and effect of a dismissal of the claim petition and shall be binding on the employee and employee’s dependants. Id. Such settlements are commonly referred to as “Section 20 Settlements” based on N.J.S.A. 34:15-20. In relevant part, N.J.S.A. 34:15-20 states:

34:15-20. Dispute; submission to division; order approving settlement.

…

After a petition for compensation or dependency claims has been filed, seeking compensation by reason of accident, injury or occupational disease of any employee, and when the petitioner is represented by an attorney of the State of New Jersey, and when it shall appear that the issue or issues involve the question of jurisdiction, liability, causal relationship or dependency of the petitioner under this chapter, and the petitioner and the respondent are desirous of entering into a lump-sum settlement of the controversy, a judge of compensation may with the consent of the parties, after considering the testimony of the petitioner and other witnesses, together with any stipulation of the parties, and after such judge of compensation has determined that such settlement is fair and just under all the circumstances, enter “an order approving settlement.” Such settlement, when so approved, notwithstanding any other provisions of this chapter, shall have the force and effect of a dismissal of the claim petition and shall be final and conclusive upon the employee and the employee’s dependents, and shall be a complete surrender of any right to compensation or other benefits arising out of such claim under the statute.

Parties should be aware of the availability of Section 20 settlements when defending/pursuing workers’ compensation claims as an option to avoid protracted litigation. Indeed, Section 20 Settlements are particularly appealing where the costs of defending against or pursing a claim are not sensible in light of the value claim. However, when entering into a Section 20 settlement, the parties should be mindful of the fact that such a settlement will likely bar any subsequent claims by the petitioner and such employee’s dependants.

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 $175,000,000 for medical providers, and that number grows daily. 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.

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Tuesday, January 12, 2016

MAKING NO-FAULT NO PROBLEM | Callagy Law

A closer look into No-Fault, PIP and other important information

After searching various sources, we have found many people have questions when it comes to Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Do you have questions pertaining to reimbursement? Do you know what to do if problems arise? With articles written by Callagy Law’s law team, this blog will focus on many common questions and concerns surrounding legal matters which can arise in the field of healthcare law.

Car accidents can be overwhelming, one minute you’re on your way to work, the next minute you’re sorting through medical bills and trying to determine if you have enough insurance coverage for accident related injuries. This is why an understanding of medical benefit coverage under your New Jersey automobile insurance policy is crucial.

In the New Jersey No- Fault System, a patient’s medical claims are paid under the Patient’s First Party Policy, even if the motor vehicle collision is the patient’s own fault. All personal car insurance policies in New Jersey must contain No Fault coverage. These No- Fault Benefits are known as Personal Injury Protection or “PIP.”

The benefit of the PIP System is that the determination of liability has no bearing on the Insurance Company’s responsibility to pay the insured’s medical bills, which allows for a medical provider to receive payment prior to the underlying issue of liability being resolved. Basically, this system allows a patient to receive their necessary treatment, and a doctor to receive prompt payment.

As payment is made under the patient’s own policy, it is important that owners of private vehicles make prudent decisions when choosing their PIP Policy Coverage Limits.

The State of New Jersey allows for the election of PIP coverage in lesser amounts ($150,000.00, $75,000.00, $50,000.00 or $ 15,000.00).

Ideally, every patient would be insured under a $250,000.00 PIP Policy, meaning a patient’s medical bills would be covered up to a total of $250,000.00.

However, a patient may be enticed to select a Basic Policy, which provides only limited coverage in the amount of $15,000.00. While a limited policy may seem great at first glance, as the premiums are lower, if a patient is in a significant collision, their policy may be quickly exhausted leaving the patient on the hook for thousands in medical bills.

For example, subsequent to a motor vehicle collision, a patient may be transported to a Hospital for Emergency Room Treatment; thereafter, an extended period of chiropractic care for neck/back injuries will be recommended; and the patient may be further referred for MRIs, EMGs, pain management care and even surgery, which will easily exceed $15,000.00.

Additionally, in New Jersey, an automobile owner may choose a Health Insurance Primary Policy wherein a motor owner designates his/her health insurance policy is primary for a reduced premium.

When a patient is insured under a Health Insurance Primary policy it very important that the Medical Provider bill the Patient’s Health Insurance Provider first. After a denial is received from the Health Insurance Carrier, the Medical Provider must submit the Health Insurance Denial as well as the Providers bill to the patient’s PIP Carrier for payment.

In sum, it is important for a patient to research their options and be aware of the consequence that may follow when selecting PIP coverage for a reduced amount at a lower premium.

The Team at Callagy Law hopes the information in this article was helpful in either your personal or professional life. The legal world pertains to all walks of life and more specifically, various types of healthcare providers. Callagy Law, is a multidisciplinary law firm, headquartered in Paramus, NJ owned and operated by Sean Callagy. We are committed to providing legal representation and advice to our clients at additional law offices located across the United States. Please note that the information posted here should not be used as a legal argument of defense. If you find yourself needing legal advice pertaining to your unique situation, you can contact us at here. Feel free to search us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

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Friday, November 13, 2015

New AND FREE to Share - Why Not with Sean Callagy #16

Today’s Why Not Huddle with Sean Callagy:

Why Not Realize Defensiveness Destroys!

Dear Kindred Spirits, Welcome to our third “Why Not” Friday, and your 16th episode of the Why Not Huddle.

How are you doing so far?

We are here to support you. Send any questions or comments to scallagy@callagylaw.com if you need a private response or post your questions for a response.

Yesterday, we were discussing a very common challenge for all of us: when it’s us, we don’t think we can “do” much more to change things to increase the quality of our results.

When last we spoke, our friend from yesterday was believing she was doing “everything”. I have heard this more times than you can imagine over the past twenty years. One of the great destroyers of success is people’s defensiveness.

Most often, their defensiveness is rooted in a feeling that somehow their success, whether it be financial, sales, business, career, or whatever, is directly connected to who they are and their value as a human being.

We had a great comment from Paul C. yesterday describing the amazing compounding of a penny over one month. Check it out on Callagy Law Facebook. It is this concept that most people cannot grasp, in my experience, when it comes to them.

When I speak with business people who have big goals, but are challenged to reach them, they want to hear new “tricks”. What people become defensive and resistant when we begin to discuss the very simple shifts available that can create enormous benefits. In the situation with my friend, a real life example, she felt very successful in negotiating a $15,000.00 per month billing contract. I thought she got completely taken advantage of and her fear got to her.

She didn’t like hearing that. I am completely confident that a fair arrangement would have yielded one to two million dollars per year. She really didn’t like hearing that. Moreover, I shared that she didn’t have enough products to cover her clients’ full needs, and therefore, was losing sales. I also believed her marketing process to get to meetings was very weak, and therefore, tons of opportunities were being missed. Her response was that I thought I was smarter than her, and did I know how much she’s accomplished.

My answer: I don’t care. Well, I do care, but not enough for me to lie to her and tell her something different than the truth. The truth is, a few tiny changes, and the company will go from a one million dollar to ten million dollar company in less than three years. She still didn’t like it. Why? She was at affect.

She was also lacking the at cause ability to be completely self-aware and open to the turning of a couple of small screws to explode her business forward. After a few tears and some back and forth (that’s where my skills come in), we agreed to turn those screws. Here’s the challenge though: we all do this.

We all avoid the simple obstacles that will lead us to our results because we are often very emotionally committed to its meaning about us a smart, strong and competent person.

What? It goes like this: could a twenty dollar book or a free video really increase my income by thousands or even millions of dollars over time. Absolutely!!!!!!!!!! BUY, not if defensiveness and the need to prove how unique and impossibly unique your problems are. Let’s be open, self-aware and AT CAUSE! Have an amazing Friday and weekend.

Please share this, ask questions and post comments. We are over 11,000 Callagy Law Facebook Likes. Next stop: 50,000. Please help us get there. When we do, we are giving away a phenomenal gift worth over $1,000.00 to everyone.

Why Not?

In Your Service,

Sean Callagy

Please subscribe on YouTube and spread the word.

You can see all of our WHY NOT – HUDDLE videos by clicking here and subscribing! If you have questions about any of the content you see or to have your questions answered on an upcoming show by Sean, please email your questions directly to him by clicking here.

The Daily Why Not Huddle is for you if you want more money, time, or fulfillment. The Why Not Huddle with business coaching expert, successful entrepreneur, and attorney Sean Callagy provide the essential daily ingredients for you to create and achieve your destiny.

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Tuesday, November 10, 2015

Callagy Law Library TV - Episode #12, #‎AskSeanCallagy‬

Callagy Law Library – TV is an original series from Sean Callagy, President and Founder of Callagy Law; to help the general public with every day legal questions and information. For more information about Sean Callagy, Callagy Law, or any questions you have, please email scallagy@callagylaw.com

If you’d like to have your legal questions answered on the show, email Sean: scallagy@callagylaw.com

See more here: www.callagylaw.com/blog

In this article / video, Sean Callagy will focus on topics to help people better their legal knowledge of vital information. Clients often come to Sean Callagy’s team with questions about their businesses, ranging from contracts, disputes, and other common legal issues in the business world. Our mission is to answer any legal questions and provide information to anyone who may need it. If you have questions about any of the content you see or to have your questions answered on an upcoming show by Sean, please email your questions directly to him by clicking here.

Callagy Law Library TV - Episode #12, #‎AskSeanCallagy‬ #AskSeanCallagy, #BusinessLitigation, #CallagyCoaching, #CallagyLaw, #GoalSetting, #LawLibraryTv, #LawOfficeOfSeanRCallagy, #LegalFacts, #LegalNews, #LegalQuestions, #Litigation, #NjLawFirm, #ParamusLawFirm, #SeanCallagy, #SeanRCallagy, #Youtube

Tuesday, October 27, 2015

Beware of the Finality Clause of a PPO Agreement

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, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

Under the New Jersey No-Fault laws, medical providers who treat patients injured in motor vehicle accidents can arbitrate PIP claims against No-Fault insurance carriers. Some of these medical providers have entered into PPO agreements with various insurance companies. These “preferred provider” contracts govern how the provider will be paid by the carrier. Generally speaking, the provider is willing to accept a lower reimbursement amount in exchange for faster reimbursement as well as inclusion in a network of preferred medical providers.

Unfortunately, medical providers may not be aware of some of the pitfalls in a PPO contract. One issue that can be troubling in a New Jersey PIP arbitration is what is commonly referred to as the “finality clause.” The “finality clause” is a provision in the PPO contract that typically states that the medical provider will “accept” whatever amount the insurance company pays, unless they dispute the amount in a certain period of time. We often see the dispute period as ninety-days. A typical finality provision reads something like the following:

“Neither the Medical Provider nor the Payor may dispute the amount billed or paid more than ninety (90) days after payment.”

“The payment made under this Agreement may not be disputed after ninety (90) days from payment.”

For example, suppose a provider provides a medically necessary service to a PIP patient, and then bills an insurer $1,000.00 and is entitled to that amount under the New Jersey PIP regulations. The insurer responds by issuing a payment in the amount of $500.00. Let’s say the PPO contract provides for payment at 90% of the amount billed. In such case, the provider should have been reimbursed $900.00. Let’s also say the provider does not dispute the payment, in the form of an official appeal, until six months later when it wishes to seek redress. Let’s also say that the carrier denies any additional payment as a result of the appeal. The provider then files a Demand for arbitration in New Jersey. The insurer will likely raise the finality provision as a defense against having to pay any additional money, and will argue that the provider may no longer dispute the amount paid, having waited beyond the contractual period to appeal. This defense may prove successful for the insurer.

The provider should pay attention to the provisions of its PPO contracts. If a finality clause is contained in the contract, the provider should file its objection to the amount paid in a timely basis and in accordance with any other requirements in the agreement. It is advisable to limit the defenses that may be prevent a hearing on the merits of the provider’s right to redress.

We do have arguments to make to overcome the defense of a finality provision, but the most effective arsenal we can have to prevail is an appeal (with proof of delivery) demonstrating the medical provider indeed did timely dispute the payment in accordance with the PPO contract.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Feel free to search us on Facebook, Twitter or LinkedIn!

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