Help! This MPN Is Out To Get Me!

Help! This MPN Is Out To Get Me!
by Louis Larres, Esq. and Scott Rountree, JD 

I'm sure you've often wondered during a quiet moment alone, "Hey, are these Medical Provider Networks even constitutional?" Or perhaps you've worried, "If I litigate and lose on AOE/COE, have I waived the right to require applicant to treat in my MPN?"

You haven't? Good news! Someone else has wondered about, worried about, and litigated these issues for you–someone with too much time on his hands.¹

From the Fresno WCJ to the California Supreme Court, B&B recently defended against an applicant who was bound and determined to undercut your ability use your MPN. Applicant claimed MPNs could not be used in denied cases. Of even greater concern, applicant attacked the constitutionality of MPNs themselves. Applicant went down in flames.²

$$$$ Tens of Millions in Savings $$$$

$$$$ Tens of Millions in Savings $$$$

by Mark Fletcher, Esq.

Don Barthel recently announced that B&B's Rating Services "has literally identified tens of millions of dollars in savings for our clients." Per Don, "PTPs and medical-legal examiners in California continue to misapply the AMA Guides. Whether this represents simple mistakes is not always clear, but the result is. About eight out of ten of the reports we review overstate the true permanent disability value."

What is the largest saving identified in a single case? "We've seen reports that literally rated 100 percent. In one case, after a full analysis was performed, we were able to demonstrate that, per the AMA Guides, only 12 percent [PD] was justified. That's over a $1,500,000 swing!"

AD to Employers: "You're On Your Own!"

AD to Employers: "You're On Your Own!"
by Donald R. Barthel, Esq.

 

AME vs. QME? Which approach is preferable? The answer, of course, is: "It depends... on many things."

Prior to SB 899, represented cases typically involved either battling QMEs or an AME. Each side selected their own doctor (who, more often than not, would report in a manner reflecting the views of the party who made the referral). Applicant's selected QME was often wildly liberal; the defense physician tended to be more conservative. Alternatively, if the parties wished to "split the baby," one or more AMEs were used.

 

With the advent of SB 899, things have changed dramatically. No more battling QMEs. Options are now limited to:

• Living with the PTP's findings (in which case this article is irrelevant... read no further if you and your opponents always agree with the PTP's findings!)
• Agreeing to an AME
• Relying on a state-generated panel of QMEs¹

"Ten Years After" at B&B!

"Ten Years After" at B&B!¹
by Donald R. Barthel, Esq.

 

Congratulations are in order for B&B's Managing Partner, Mark S. Fletcher, and Tahmeena I. Ahmed, the Partner and Managing Attorney for our Tarzana office.

Mark recently celebrated his tenth year at B&B. In that time, Mark's skills, talents and hard work quickly moved him through the ranks from Associate, to Managing Attorney and Equity Partner, to his current position: Managing Partner. In that capacity, Mark oversees the day-to-day operations of the firm's thirteen offices. He has served in his current capacity since 2003. 

Tahmeena, too, will be celebrating her tenth anniversary with B&B in July. Originally hired as an Associate, Tahmeena soon distinguished herself as a top-notch attorney. She quickly earned the right to be the Managing Attorney in B&B's Tarzana office and was thereafter made an Equity Partner in April of 2002. During her tenure as the managing attorney, the Tarzana office has flourished, growing from 2 to 13 attorneys.

Mark & Tahmeena: You're not getting older, you're getting better! Congratulations!

Don Barthel is a Founding Partner of Bradford & Barthel, LLP and founder of B&B Rating Services.

¹ Apologies to the band, Ten Years After, who some of you will remember was founded by Alvin Lee and Leo Lyons, and who rocketed to fame on the strength of their breakthrough American appearance at Woodstock and their megahit "I'm Going Home."