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Daily Message Tuesday, May 14, 2002 Itemized Hospital Bill Legislation Held in Assembly NJHA successfully convinced Assemblyman Anthony Impreveduto (D-Secaucus) to hold his itemized hospital bill legislation from Assembly vote on Monday, May 6, to provide an opportunity to meet to discuss our concerns. The bill, A-1857, would require healthcare facilities to provide an itemized bill to a patient that details provided services in plain language. Postponing the vote gives NJHA an opportunity to discuss concerns that sending itemized bills to all patients would impose an unnecessary, increased administrative burden on healthcare facilities, billing departments and customer service staff. A-1857 was amended in the Assembly Health and Human Services Committee, March 4, to exempt healthcare facilities from providing itemized copies of bills to Medicare and Medicaid recipients and to change the effective enactment date from 60 to 180 days. NJHA will be meeting with the sponsor to discuss other potential amendments to the bill.
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The New Jersey Hospital Association - Press Releases
Press Releases
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Contact:
Ron Czajkowski , 609-275-4071
Betsy Ryan , 609-275-4241
March 14, 2002
SURVEY: TRIPLE-DIGIT MALPRACTICE PREMIUM HIKES
COULD HAVE LINGERING IMPACT ON HEALTHCARE SYSTEM
Princeton, NJ - New Jersey hospitals' medical malpractice insurance premiums jumped an average of 250 percent over the last three years, and 65 percent of facilities said skyrocketing insurance rates are driving some physicians out of the practice of medicine.
Those findings were among the results of a new survey by the New Jersey Hospital Association to gauge the effects of rising medical malpractice insurance rates on the state's healthcare industry. More than half of NJHA's 106 member hospitals responded to the survey, and their responses provided a sobering study of escalating costs, reduced availability of insurance, and ultimately, worries that patients may experience difficulty accessing certain healthcare services.
"We should consider this information a wake-up call," said Gary Carter, NJHA's president and CEO. "The fact that malpractice insurance is becoming more expensive is no great surprise. But we should be alarmed that these skyrocketing prices are driving many physicians out of medicine and threaten to have far-reaching effects on our state's healthcare system."
According to the survey, seven out of 10 New Jersey hospitals experienced increases in their professional liability insurance premiums last year. The average hospital saw its premium jump from $373,328 in 1999 to $942,539 this year, an increase of 252 percent.
In other findings, the survey showed:
78.2 percent of hospitals said their physicians had experienced sizeable increases in their medical malpractice insurance premiums.
74.5 percent of hospitals said they have had one or more physicians dropped from coverage entirely.
64.8 percent of hospitals said they have had physicians cease the practice of medicine or plan to leave practice because they were dropped from coverage or could not afford the premium increases.
Respondents said OB/GYNs and surgeons were the types of physicians who most often reported dramatic malpractice insurance price hikes.
Both hospitals and physicians maintain malpractice insurance coverage. Hospital professional liability insurance generally covers the institution, physicians employed by the facility and other direct care providers. The names of the physicians covered are generally listed in the policy, and there is a correlation between the cost of covering individual physicians and the overall policy cost for the hospital.
In this survey, only hospital executives were surveyed. Their responses included reports on malpractice insurance premiums for physicians within their facilities.
Respondents were asked about the impact rising rates have had on their hospitals. Many cited the overall fiscal impact on hospital budgets. One hospital administrator called the impact a "direct hit to the bottom line, which means less money for salaries, equipment, supplies, building maintenance, etc."
The survey also asked respondents' opinions on the potential future impact of skyrocketing medical malpractice insurance rates. The most common response? A loss of ability for hospitals to provide specialty services to their communities.
NJHA General Counsel Betsy Ryan shared the survey results Thursday with members of the state Senate Health, Human Services and Senior Citizens Committee, who held a hearing to gather testimony on the growing problem. NJHA praised the committee's co-chairmen, Sens. Joe Vitale (D-Woodbridge) and John Matheussen (R-Washington Township), for taking a proactive stand to confront this critical issue.
"These survey responses make it clear that what's at stake is much more than hospitals' bottom lines and physicians' earnings," said Ryan. "Without relief from these rapidly escalating premiums, more and more physicians will be driven out of healthcare, and hospitals will face difficult decisions about what services they will - and will not - be able to provide. It's the patient who will feel the ultimate impact. We look forward to working with Health Committee members and other state leaders to avert such a crisis."
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New Jersey Medical Malpractice Summary
NEW JERSEY
Statutes of Limitations Statutory Cap on Attorneys' Fees
Contributory or Comparative Negligence Periodic Payments
Joint and Several Liability Collateral Source Rule
Contribution Pre-Judgment Interest
Vicarious Liability Patient Compensation Funds
Expert Testimony Immunities
Damage Caps Arbitration
Statutes of Limitations
A medical malpractice action, like other personal injury actions, must be brought within two years from the date the cause of action accrued. N.J. Stat. Ann. § 2A:14-2 (West 1987). New Jersey courts have read a discovery rule into this statute, holding that a cause of action does not accrue so long as a party reasonably is unaware either that he has been injured, or that the injury is due to the fault of an identifiable person. Savage v. Old Bridge-Sayreville Medical Group , 260 N.J. Super. 417, 616 A.2d 1307 (App. Div. 1992). If, at the time the cause of action accrued, the claimant was under the age of 21 or insane, the time does not begin to run until the disability is removed. N.J. Stat. Ann. § 2A:14-21 (West 1987).
Wrongful death actions must be brought within two years from the date of death. N.J. Stat. Ann. § 2A:31-3 (West 1987).
Contributory or Comparative Negligence
New Jersey has adopted the doctrine of modified comparative negligence. N.J. Stat. Ann. § 2A:15-5.1 (West 1987). Under this doctrine, a claimant's action is barred if his negligence exceeds the combined negligence of all defendants. Otherwise, the claimant's recovery is diminished in proportion to his percentage of negligence. Id .
Joint and Several Liability
In a negligence action in New Jersey, the trier of fact must determine each party's negligence as a percentage of the combined negligence of all parties. N.J. Stat. Ann. § 2A:15-5.2 (West Supp. 1997). Any defendant whose negligence is 60 percent or more is jointly and severally liable for the claimant's entire damages. N.J. Stat. Ann. § 2A:15-5.3 (West Supp. 1997). One whose negligence is less than 60 percent is only severally liable for that portion of the claimant's total damages that is equal to his percentage of negligence. Id .
Contribution
The Joint Tortfeasors Contribution Law provides for contribution when one tortfeasor has paid more than his pro rata share of a judgment. N.J. Stat. Ann. §§ 2A:53A-1 to 2A:53A-5 (West 1987). The courts have held that the effect of comparative negligence on contribution is to change the measure from pro rata share to percentage of negligence. Dunn v. Praiss , 139 N.J. 564, 656 A.2d 413 (1995).
Vicarious Liability
While New Jersey courts generally hold that a hospital is not liable for the negligent acts of non-employed physicians, the doctrine of ostensible or apparent agency has been applied where the court thought it would be natural for a patient to assume that his treating physicians were employees of the hospital. Arthur v. St. Peters Hospital , 169 N.J. Super. 573, 405 A.2d 443 (App. Div. 1979).
Expert Testimony
In a medical malpractice case based on facts occurring on or after June 29, 1995, within sixty days of the commencement of the action plaintiff must file an affidavit by an appropriate licensed person stating that there exists a reasonable probability that the care, skill, or knowledge exercised in the treatment fell outside acceptable professional standards or treatment practices. N.J. Stat. Ann. § 2A:53A-27 (West Supp. 1997). Expert testimony is necessary proof in a medical malpractice action, unless the matters alleged are within a layman's common knowledge. Rosenberg v. Cahill , 99 N.J. 318, 492 A.2d 371 (1985).
Damage Caps
For actions filed on or after October 27, 1997, no defendant is liable for any punitive damages in any action for an amount in excess of five times the liability of that defendant for compensatory damages, or $350,000, whichever is greater. N.J. Stat. Ann. § 2A:15-5.14(b) (West Supp. 1997).
Statutory Cap on Attorneys' Fees
New Jersey has prescribed limits on attorneys' contingent fees for many years. Under the latest schedule, effective September 1, 1996, those fees may not exceed the following amounts: (a) 33 1/3 percent of the first $500,000, (b) 30 percent of the second $500,000, (c) 25 percent of the third $500,000, (d) 20 percent of the fourth $500,000, and (e) a reasonable amount approved by the court for the excess over $2 million. N.J. Ct. R. § 1:21-7 (West Supp. 1997). If the claimant is a minor or incompetent, no fee may exceed 25 percent of any pre-trial settlement. Id .
Periodic Payments
New Jersey does not provide for the use of periodic payments to satisfy judgments in medical malpractice actions.
Collateral Source Rule
In New Jersey, collateral benefits received by the claimant must be deducted from the claimant's recoverable damages. N.J. Stat. Ann. § 2A:15-97 (West Supp. 1997). Any amounts paid for such benefits by the claimant or the claimant's family must be added to such damages, however. Id .
Pre-Judgment Interest
New Jersey requires the award of interest calculated from the date the action was commenced or six months from the time the cause of action accrued, whichever is later. The rate floats on the basis of an index and was equal to 5.5 percent in 1997. N.J. Ct. R. § 4:42-11(b) (West Supp. 1997). In exceptional cases, the court may suspend the accrual of such interest. Id .
Patient Compensation Funds and Physician Insurance
New Jersey has not established a patient compensation fund, and it does not require its licensed physicians to carry liability insurance.
Immunities
New Jersey has waived sovereign immunity for itself and its counties, municipalities, and other political subdivisions to the extent set forth in the New Jersey Tort Claims Act. N.J. Stat. Ann. § 59:1-1 et seq . (West 1992 & Supp. 1997). Public entities retain their immunity from liability for, inter alia , the following: (1) failure to provide a medical facility or mental institution; (2) failure to provide sufficient equipment, personnel, or facilities in a mental institution or medical facility; (3) a decision to perform or not to perform any act to promote the public health of the community; (4) failure to make an adequate physical or mental examination of any person for the purpose of determining whether such person has a disease or physical or mental condition that would constitute a hazard to the health or safety to himself or others, unless such examination or diagnosis was for the purpose of treatment; (5) failure to diagnose that a person is afflicted with a mental illness or is a drug- dependent person; (6) the decision whether to confine a person for mental illness or drug dependence, including the terms and conditions of such confinement; and (7) injury caused by an escaping or escaped person who had been confined for mental illness or drug dependence. N.J. Stat. Ann. §§ 59:6-2 to 59:6-7 (West 1992).
Public entities are not liable for pre-judgment interest or punitive damages. N.J. Stat. Ann. § 59:9-2 (West 1992). In addition, public entities are not liable to claimants for damages for pain and suffering, unless the claim involves the loss of a bodily function, permanent disfigurement, or dismemberment, and the medical treatment expenses are in excess of $1,000. Id . No action may be brought against a political subdivision unless notice of the claim has been given within 90 days from the date the cause of action accrued. The court has discretion to extend this to one year absent prejudice to the political subdivision. N.J. Stat. Ann. §§ 59:8-8 and 59:8-9 (West Supp. 1997). Moreover, a complaint must be brought within two years from the time the cause of action accrued. N.J. Stat. Ann. § 59:8-8 (West Supp. 1997). A claimant's minority or mental incapacity tolls these periods. Id .
In addition, the New Jersey Tort Claims Act provides that "nothing contained in this supplementary act shall inure to the benefit of any insurance company which has issued a policy of liability insurance or to any person who is obligated to indemnify a public entity or public employee." N.J. Stat. Ann. § 59:10-9 (West 1992). Thus, to the extent a public entity carries applicable liability insurance, the limited immunities provided in the act do not apply.
New Jersey also provides non-profit entities organized exclusively for, inter alia , hospital purposes, immunity as to claims made by the hospital's intended beneficiaries for damages in excess of $250,000. N.J. Stat. Ann. §§ 2A:53A-7 and 2A:53A-8 (West Supp. 1997). A hospital's agents or servants, however, are not exempt from liability. Id . The increase in the maximum liability from $10,000 to $250,000 applies prospectively only to claims accruing on or after July 31, 1991. Schiavo v. John F. Kennedy Hospital , 258 N.J. Super. 380, 609 A.2d 781 (App. Div. 1992), aff'd mem. , 131 N.J. 400, 620 A.2d 1050 (1993).
Arbitration
New Jersey requires the reference of personal injury claims to an arbitrator if the amount in controversy is $20,000 or less. N.J. Stat. Ann. § 2A:23A-20 (West Supp. 1997). The arbitrator's decision is inadmissible and non-binding. Assembly Ins. Comm. Statement, Senate, No. 2709-L.1987, C.329.
Copyright © 1990-1998 McCullough, Campbell & Lane. All Rights Reserved.
Revision Date: February 6, 1998
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insure.com - insurance in New Jersey - New Jersey OKs new business plan for state's largest medical malpractice insurer
New Jersey OKs new business plan for state's largest medical malpractice insurer
By Vicki Lankarge insure.com
The New Jersey Department of Banking and Insurance has approved the state's largest medical malpractice insurer's plans to stop renewing policies and to file a proposal for a successor company.
"Doctors covered by MIIX will be entitled to their full coverage limits."
Financially beleaguered MIIX Insurance Co. will be allowed to immediately stop writing malpractice insurance for out-of-state physicians, to continue existing policies through expiration, and, after 90 days, to stop renewing policies in New Jersey. Additionally, MIIX plans to form another company to cover its clients, subject to the department's approval.
New Jersey Banking and Insurance Commissioner Holly C. Bakke calls MIIX's situation a "solvent runoff" rather than an insolvency that would force doctors and hospitals currently covered by the company to seek alternate coverage under the state's Property-Liability Insurance Guaranty Association, where coverage is capped at $300,000. This limit is much less than doctors typically need to stay in practice, and some might have stopped treating patients in order to avoid personal exposure to a malpractice lawsuit.
"If our doctors cannot practice because they can't get insured, New Jersey's patients lose," says Bakke. "Doctors covered by MIIX will be entitled to their full coverage limits, and this will help them keep serving patients in New Jersey."
According to the commissioner, actuarial reports ordered by the department show that MIIX currently has sufficient assets to pay claims on existing policies as they come due. MIIX has about 7,000 New Jersey policies in force, or about 37 percent of the state's medical malpractice insurance market.
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Results from search: http://www.njatty.com/tips/medmal-claim.html
Lawyers in New Jersey: Tips: What is a Medical Malpractice Case?
What is a Medical
Malpractice Case?
To determine if a potential
malpractice case has merit Blume Goldfaden suggests a prospective
plaintiff ask these questions:
Have I or a
member of my family suffered a severe, permanent injury while under
the care of a physician or medical facility?
If so, was this
injury more severe or devastating than would be expected from the
original medical condition or trauma?
Has it come
to my attention, perhaps through another physician, that the treatment
received was inappropriate, or that the outcome was unusual.
Do I have strong
doubts about the competency of a physician, or the appropriateness
of the care received?
Have I been
kept in the dark about a medical situation?
Has my insurance
company questioned the appropriateness of specific procedures, tests
or diagnoses?
Do I have concerns
that a medical device may have seriously affected my health?
If the answer to any
of these questions is yes, contact Blume Goldfaden to review your
medical records. Our attorneys can then determine whether there is a basis
for a malpractice claim at no cost to you.
There are, however,
situations that do exist where malpractice or medical negligence has
been committed by a physician, dentist, nurse or other health care provider.
In such situations, the services of a law firm experienced in the handling
of medical malpractice cases is the only way in which a victim may expect
to have a chance to recover money damages for his or her injuries. Physicians
and their insurance companies never attempt to settle malpractice claims
voluntarily before the injured party has obtained the services of an
attorney.
There are several
reasons for this. Medical malpractice insurance policies, as distinguished
from most liability insurance policies, contain a provision that the
physician must consent to any settlement. Often a physician who has
been guilty of medical malpractice, out of a misguided sense of pride
in his ability, will not admit even to himself that he might have been
wrong in the manner in which he rendered treatment or advice to a patient
let alone report the incident to his insurance company so it could attempt
a settlement. Physicians and their insurance companies know that in
order to be successful in almost all medical malpractice claims, the
injured party or plaintiff must have expert testimony indicating that
there was medical malpractice by a qualified physician with the same
specialty as that of the physician who committed the malpractice. Although
such testimony is not as hard to obtain as it has been in the past,
there is still a reluctance on the part of physicians to testify against
their fellow practitioners and it is most often necessary to obtain
the required expert testimony from physicians who practice in other
states. To be effective, however, such physicians must be highly qualified,
usually with medical school affiliations. Physicians willing to testify
are not only hard to find, but usually charge very highly for their
services.
In actual practice,
most medical malpractice claims which go through a full trial are lost
by plaintiffs. Only 20% or fewer result in verdicts for the plaintiffs.
This poor ratio on behalf of plaintiffs may be attributed to several
causes, such as the fact that many of the cases being tried should not
have been brought because they are of questionable merit, the skill
or lack of skill of the attorneys involved, and the natural reluctance
of juries to render verdicts in favor of plaintiffs against physicians
either because of the mystique that surrounds practitioners of the healing
arts or fear that verdicts in favor of victimized patients would result
in higher medical costs.
From the point of
view of the trial lawyer, medical malpractice cases are probably the
most difficult to pursue. Not only are they bitterly contested, but
the litigants become personally involved. The patient because he feels
let down or betrayed by the physician in whom he placed not only his
trust but his body, and the physician who regards a medical malpractice
claim as a challenge to his integrity and skill as a healing artist.
The subject matter
of these suits is medicine, which has at least 25 recognized specialties
which require, in addition to medical school training, internships and
residencies of four to six years. No attorney, no matter how knowledgeable
in medical matters, can possibly match the knowledge of the defendant
physician and his expert witnesses. This means the proper preparation
of any medical malpractice case on the part of a plaintiff requires
extensive help from physicians, medical researchers, medical illustrators
and the like, all of which are readily available to the defense, usually
with minimal or no charge. The actual out-of-pocket costs required to
pursue even the simplest, if there is any such thing, of medical malpractice
cases can range from $10,000 to $50,000 and more.
Minute and complete
examination of hundreds of pages of hospital and other records is often
required to detect where the medical care provider has gone astray in
his professional obligation to the patient. Although there are certain
situations that even a lay person can see as probably malpractice, such
as operating on the wrong limb, leaving an instrument in a person's
body, or failing to see an obvious tumor on an X-ray, most medical malpractice
claims require careful evaluation by competent medical experts to determine
whether, in fact, malpractice was committed or was there merely a bad
result which occurred which was not the fault of the health care provider.
It is obvious that
the key to bringing a successful medical malpractice claim is in the
choice of law firms representing the injured party. To have a reasonable
chance for success, the lawyer chosen by the injured party must have
certain qualifications:
Experienced
in handling medical malpractice matters.
Adequate support
staff. At Blume Goldfaden , we have one physicial, two physician
attorneys, one nurse paralegal, two nurse attorneys and a full time
reference librarian, all on our medical malpractice team.
Substantial
financial resources to be able to advance the funds necessary to pursue
the matter. Demonstrated skill by actual success in court so that
the insurance company will be aware of the firm's ability which is
a great stimulation to settle.
The ability
to expend all necessary resources of money, personnel and time to
properly prepare the matter.
Overall, the
firm must be dedicated.
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This website has basic information
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Insurance Doctors grapple with costly malpractice premiums More doctors in Florida are finding innovative ways to get around horrendous medical malpractice insurance bills. HCA-owned Fawcett Memorial Hospital is contemplating allowing its doctors to "go bare," or practice without medical malpractice insurance.
Sarasota Herald-Tribune, May 13, 2002
FULL STORY | SEND TO FRIEND | POST OPINION Hospitals, doctors say self-insurance for state not wise Arizona hospitals and doctors are wary about a state plan to drop Cigna HealthCare of Arizona as its sole insurer and become self-insured.
The Business Journal of Phoenix, May 13, 2002
FULL STORY | SEND TO FRIEND | POST OPINION Malpractice insurance ails Birmingham docs, hospitals Medical malpractice insurance premiums are skyrocketing in pockets all across the United States. The crisis hasn’t hit yet in Birmingham, but doctors and hospitals say they are starting to feel the pinch.
Birmingham Business Journal, May 13, 2002
FULL STORY | SEND TO FRIEND | POST OPINION New Jersey study faults Cigna for late payments New Jersey regulators say Cigna Healthcare of New Jersey failed to pay claims on time in more than 84,000 cases, and had a 26% error rate in handling claims.
Hartford Courant, May 14, 2002
FULL STORY | SEND TO FRIEND | POST OPINION Pennsylvania docs examine Highmark reserves Highmark Inc. is used to defending its $2.3 billion reserve fund. Now the Pennsylvania Medical Society says it is examining the issue of health insurers' reserve funds. In particular, the society is studying reserve amounts and requirements for insurers, where the money in the reserve funds is going, how it's being used and premium costs.
Pittsburgh Business Times, May 13, 2002
FULL STORY | SEND TO FRIEND | POST OPINION
Insurance Health insurance could be hurting consumers' credit ratings New York Times, May 12, 2002
QualChoice dropping MedicareGold plan Piedmont News-Record, May 10, 2002
Doctors: Insurance premiums forcing obstetricians out of Pennsylvania Pittsburgh Post-Gazette, May 10, 2002
Flak greets plans to overhaul Michigan Blue Cross Detroit Free Press, May 10, 2002
New Jersey insurer is leaving many doctors scrambling New York Times, May 10, 2002
The Cost of Quality Balanced Scorecarding in Six Sigma – Part 7. 5-10-2002 Healthcare Marketing The impact of the Baby Boomers on healthcare marketing. 5-8-2002 HealthLeaders EXTRA! Shortage of healthcare leaders means premium deals. 5-3-2002 Healthcare Real Estate Maximizing value by conducting a design competition. 5-1-2002
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