Articles Posted in Medical Claims

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There is nothing more agonizing to a family than making the decision to place a loved one in a nursing home, assisted living, or memory care.   The fear of having your loved one suffer an injury or dying in a nursing home has been heightened in recent times with the COVID-19 pandemic, where we have seen numerous outbreaks of the virus in nursing homes with people being forced to say good-bye to their loved ones through glass windows over cell phones. In Georgia, our elderly family members, parents, and grandparents are some of the most vulnerable members of society who deserve to be protected when we entrust nursing homes with their lives.  Unfortunately, it is too often that nursing homes are understaffed, staffed with unqualified employees, or lack the adequate policies and procedures and cause their elderly patients to suffer from falls, bed sores, COVID-19, abuse, or other injuries.

Like any personal injury claim, nursing home claims are based on the carelessness or negligence of the nursing home and/or its employees causing an injury or death to the patient.  Proving up a claim involves showing that the nursing home and/or its employees breached the standard of care (what would a reasonable nursing home in the same shoes would have done in the situation?) and that breach caused the patient to suffer from injuries.  These standards must be established by an “expert” who is willing to sign an affidavit as to how the nursing home breached the standard of care.  In the context of a nursing home, there are protocols that should be followed to protect patients from becoming injured, and every case is different.

For example, where a patient is considered a fall risk due to weakness, disease, inability to walk, or for any other reason, the facility should take precautions, such as identifying the fall risk, using bed rails, instructing the patient to not get out of bed without help, and turning on bed alarms to reduce the risk of falling.

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When you have a personal injury case, whether it be from a motor vehicle collision, a slip & fall, or truck accident, it is important to do everything that is in your control to preserve your claims and to make it difficult for the insurance company or the defense attorney to defend your case.  The following article will outline the “do’s and don’ts” of a personal injury case.

The Do’s of a Successful Personal Injury Case

  • Do call the police to the scene.
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Demanding Payment:  Timeline of Settlement

One of my clients recently asked me about how long it would take to settle her case from the date we sent off a demand to the insurance company in her car wreck case.  Before even sending a demand, a claimant in a personal injury case needs to complete his or her medical treatment, so that amount of time will vary according to the injuries and treatment.  After the treatment is completed and the medical bills and records are gathered (that normally takes at least 60 days), the timeline of settlement from the date of the demand also depends on the circumstances of each case.  Under Georgia law (O.C.G.A. Section 9-11-67.1), the minimal amount of time a claimant must give an insurance company or at-fault driver to settle a bodily injury claim based on personal injuries sustained in a motor vehicle collision prior to filing a lawsuit is 30 days from the receipt of the offer.

Preserving Bad Faith Claims:  Giving Insurance Company Reasonable Amount of Time to Settle

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Many people who are involved in car accidents seek medical care from chiropractors for their personal injuries. Each person’s injuries are different, so the decision as to where to seek medical care after a car accident depends on various factors such as:

  • The extent of the injuries. For example, if there are fractures or broken bones, you’ll probably go the emergency room via ambulance from the scene of the collision and follow up with an orthopedic doctor. If there’s a head injury that causes headaches or a traumatic brain injury, then it would be advisable to seek emergency car and follow up with a neurologist. On the other hand, if the injuries are “soft tissue,” meaning they are largely muscular and involve the pain caused by whiplash, then seeking care from a chiropractor or a primary care physician is probably okay.
  • Whether there is health insurance. If there is health insurance available to cover treatment for injuries related to the accident, absent a catastrophic or emergent injury, then starting with a primary care physician is probably ideal way to obtain treatment. Chiropractors normally work on a “lien” basis, where they get paid on the back end of the settlement. Any time you have available health insurance to cover the cost of medical care, no matter what kind of provider you use, it is better than treating on a lien care basis because using your health insurance will more than likely allow you to maximize your recovery.
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