When Insurers Say “No” – Payment Protection for Health Care Professionals
Imagine working with a patient for several months or even years before they pay you for your services? It may sound unappealing, however, in cases involving motor vehicle accident victims, many health care professionals are often faced with that very situation.
In the vast majority of cases, patients cannot afford to pay for treatment if their insurance company refuses to pay for it or if the insurance coverage is exhausted. We are seeing more and more “MIG” cases where the patient still requires much needed treatment however they have exhausted the $3,500 coverage for medical/rehabilitation services.
Our firm has been dealing with this problem for many years and it is not uncommon. Law firms who specialize in personal injury law routinely work with health care professionals to ensure that clients/patients continue to receive much needed treatment and health care professionals are paid for their work.
There are several options available to accomplish these goals. First, as a legal representative, the lawyer should include all unpaid treatment accounts in any lawsuit the client initiates to ensure that all health care professionals are reimbursed for services rendered once the case settles. Second, an experienced lawyer can arrange to have their client protect their health care professional’s fee account out of the proceeds of any settlement. This protection is afforded by way of an Irrevocable Direction.
An Irrevocable Direction is a document the patient/client signs in favour of the health care professional. It is a contract between the health care professional and the patient and it binds the law firm that represents the client in their personal injury lawsuit. The Irrevocable Direction requires the law firm to pay the health care professional out of the proceeds of settlement, before the client receives their settlement funds. The law firm pays the outstanding treatment accounts directly to the health professional once the case settles. The Irrevocable Direction is worded such that the health care professional receives payment before the client receives their settlement funds. In other words, the amount owed to the health care professional is a “first charge” on the settlement funds. No one likes to wait months to get paid.
The Irrevocable Direction is often the health care professional’s best protection for receiving payment for services performed and not paid for by the patient’s auto insurer. Both options provide the health care professional with a measure of security when treating patients who have been injured in automobile accidents and their insurance companies have refused to pay for treatment or services. By working together, the lawyer and health care professional can ensure that clients continue to receive much needed treatment and at the same time the lawyer can assist the health care professional by stepping in when needed to ensure they receive complete payment for services rendered once the case settles.
Although suffering a concussion or a fracture are not the only ways of being excluded from the MIG, they are the simplest and least contentious routes. People who suffer a pre-existing condition may be excluded from the MIG too, however not all pre-existing conditions will have that effect. In fact, the revised definition of the MIG states that “it is intended and expected that the vast majority of pre-existing conditions will not exclude a person from the MIG”.
A pre-existing condition will operate to exclude someone from the MIG only if the health practitioner provides compelling evidence that the insured person has a pre-existing medical condition that will prevent them from achieving maximal recovery from the minor injury if they are subject to the $3,500. Given how difficult it is to be excluded from the MIG based on a pre-existing condition, a documented concussion within the medical record is often the easiest and quickest exit from the MIG in cases where the client has not sustained a fracture.
About the Authors
When Rob Durante was called to the bar in 1997, he had been articling for a year with a law firm that specialized in defending insurance companies in personal injury cases. “I developed a sense of wanting to right injustices,” he recalls. “I didn’t want to work for the insurance companies… For me, it’s all about achieving justice for clients, righting wrongs and arranging fair compensation.” Rob joined Oatley Vigmond that same year and has been advocating for seriously injured clients and their families ever since.