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Re: The Rogak Report: The Most Useful Publication In The InsuranceClaims Industry RE: The Rogak Report: The Most Useful Publication In TheInsurance Cla ims Industry The Rogak Report: 09 Aug 2009 ** No Fault - 45 DayRule - Reasonable Excuse **

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  • jam0220@optonline.net
    Then why are insurers held to a strict interpretation of the rules---45 days seems to be more then ample and reasonable time to figure it out. I have never
    Message 1 of 16 , Aug 11, 2009
      Then why are insurers held to a strict interpretation of the rules---45 days seems to be more then ample and reasonable time to figure it out. I have never seen a medical provider have this same issue with private medical insurance (not a plug for Obama Care).

      I thank you for acknowledging my fairness; and I think I am being nothing but fair here. The rules are the rules; if I had my way I would demand 30 day billing--they always bill me within 10 days when I was self pay!! Why does there only seem to be an issue with PIP bills???

      So if an insurer is to establish the ground rules for "reasonableness" will the AAA and the courts allow us any leeway?? I think not, and that is what is wrong with this decision.

      Let's set some fair rules, make sure everyone understands them and properly compensate EIP's--that is what the law was meant to do. I truly believe that if the rules are simple and understandable and not complicated and convoluted by my friends at both sides of the bar; the truly innocent EIP's may experience the legislative intent of law.

      Juan

      Sent from my BlackBerry® wireless device



      Juan, your post brings up the philosophical question of "What is fair?" To some people, something is only "fair" if they get the result they want. So if their team doesn't win the game, that's not fair. Other people -- myself included -- believe that "fair" is when everybody is judged by the same objective criteria which is appropriate to the game. If the contest is to guess the number of jelly beans in a big jar in order to win a million dollars, and your guess is just one number off, is it unfair that you didn't win?

      Let me share the following with all my readers: On 21 March 1962, President John F. Kennedy said the following: "There is always inequality in life. Some men are killed in a war and some men are wounded, and some men never leave the country, and some men are stationed in the Antarctic and some are stationed in San Francisco. It's very hard in the military or in personal life to ensure complete equality. Life is unfair."

      Eighteen months later, this great man was shot and killed by a disgruntled misfit.

      So what was that about the 45-day rule being unfair?

      Larry Rogak

    • pete francis
      Even though I can fully empathize with Labot Scott, I must respond to Garcia Girls (for the record, in all my time in group, this is the first issue I have
      Message 2 of 16 , Aug 11, 2009
        Even though I can fully empathize with Labot Scott, I must respond to Garcia Girls (for the record, in all my time in group, this is the first issue I have ever commented on).

        First, I have also seen many instances wherein the arbiter rendered a decision that went against the evidence, regulation, and/or logic but this is not one of them. The arbiter's decision was clearly in-line with the prescribed rules and regulation. ATIC was required to acknowledge and respond to the explanation provided by the provider but they did not.

        Second, language was NOT an excuse in present case. Can we please stop referencing language. The provider did not use that as an excuse so let's not even go there.

        Third, please do not say the police report excuse could not apply. I am not saying it did or should apply in the present case but in certain instances, it may just be applicable.  I can personally tell you a police report in NYC is not ALWAYS available in two week. I have personally sent someone to pick-up a police report in Queens 24 days post MVA and it was still not ready.

        Last, you are right in writing that a hospital personnel will request insurance information from a patient or guardian but if you don't have it, you just don't have it.  How do you get the torfeasor's information if you are transported to the hospital or if the driver just won't voluntarily release the information?  Once the hospital get the driver plate number, police report, or insurance information it can already be well past 45 days.  Why should the hospital be penilized if they took prudent steps to get the insurance info. but came back unsuccessful. The statute was implemented to curtail fraud not to deny benefits to a party well deserving.  The fact is ATIC did not acknowledge or respond to the delay and their lax attitude resulted in a just award.   That's all folk. 

        --- And to that I post this question: where in the regs does it say that "lax attitude" by the insurer is a basis for excusing a late submission of a medical bill? -- Larry Rogak
      • garciagirls@yahoo.com
        Wow, you just hurt my feelings. I was actully enjoying the different views. Larry sorry that you are loosing such an opinionated individual. He added some
        Message 3 of 16 , Aug 11, 2009
          Wow, you just hurt my feelings. I was actully enjoying the different views. Larry sorry that you are loosing such an opinionated individual. He added some spice to the conversations.   


          On Aug 11, 2009, at 2:32 PM, Labott Scott <scott.labott@...> wrote:

           

          Larry. I'm getting way too many e-mails. I enjoy the publication and it has been helpful, however, this seems to have turned into a forum of sorts, and I'm really just not that interested in learning about how the Garcia girls etc think the former issue is unfair. Can you remove me from your distribution list? Thanks. Scott Labott.


          [Scott - I've edited your membership so you get only 1 email per day. -- Larry Rogak]

          From: TheRogakReport@ yahoogroups. com [mailto:TheRogakRep ort@yahoogroups. com] On Behalf Of insurancelawyer
          Sent: Tuesday, August 11, 2009 1:16 PM
          To: TheRogakReport@ yahoogroups. com
          Subject: Re: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry RE: The Rogak Report: The Most Useful Publication In The Insurance Cla ims Industry The Rogak Report: 09 Aug 2009 ** No Fault - 45 Day Rule - Reasonable Excuse **

           

          Here's a prediction. I'm not advocating this, I'm just saying it will happen. Print this out and put it in a time capsule that will be opened by a future generation:

          By the year 2050, everyone in the country will have a microchip implanted under their skin which contains all their basic identity and insurance information, and which can be read by a scanner.

          If you think that's far-fetched, imagine what people's reactions would be if you could time-travel back to 1959 and tell them all about the Internet; about bar-code scanning; about voice-recognition programs; and all the other nifty-but-intrusive technology we have today.

          Let me remind you all that just 50 years ago, the concept that people of different skin colors could use the same water fountain was so controversial that violence would sometimes break out over it.

          Fifty years before that, women could not yet vote.

          And fifty years before that, you could buy and sell human beings legally in a dozen U.S. States.

          Mull that over for a while while you consider what can change in 50 years.

          Larry Rogak

          This e-mail is confidential.  If you are not the intended recipient, you must not disclose or use the information contained in it.  If you have received this e-mail in error, please tell us immediately by return e-mail to Email.Control@sentry.com and delete the document.

          E-mails containing unprofessional, discourteous or offensive remarks violate Sentry policy. You may report employee violations by forwarding the message to Email.Control@sentry.com.

          No recipient may use the information in this e-mail in violation of any civil or criminal statute. Sentry disclaims all liability for any unauthorized uses of this e-mail or its contents.

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        • Matthew F. Guilbault [PIA]
          [Scott - I ve edited your membership so you get only 1 email per day. -- Larry Rogak] Please do the same for my account. Thanks. _____ Matthew F. Guilbault,
          Message 4 of 16 , Aug 11, 2009

            [Scott - I've edited your membership so you get only 1 email per day. -- Larry Rogak]

             

            Please do the same for my account. Thanks.

             

              _____ 


            Matthew F. Guilbault, Esq.
            Director of Government & Industry Affairs
            Professional Insurance Agents
            25 Chamberlain St.
            PO Box 997
            Glenmont, NY 12077
            Phone: (800) 424-4244
            Fax: (888) 225-6935
            http://www.pia.org/
            This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. If you prefer not to receive ANY e-mail communication from PIA click here

            -----Original Message-----
            From: Labott Scott [mailto:scott.labott@...]
            Sent: Tuesday, August 11, 2009 2:32 PM
            To: 'TheRogakReport@yahoogroups.com'
            Subject: [Spam] RE: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry RE: The Rogak Report: The Most Useful Publication In The Insurance Cla ims Industry The Rogak Report: 09 Aug 2009 ** No Fault - 45 Day Rule - Reasonable Excuse **

             

             

            Larry. I'm getting way too many e-mails. I enjoy the publication and it has been helpful, however, this seems to have turned into a forum of sorts, and I'm really just not that interested in learning about how the Garcia girls etc think the former issue is unfair. Can you remove me from your distribution list? Thanks. Scott Labott.



            [Scott - I've edited your membership so you get only 1 email per day. -- Larry Rogak]


            From: TheRogakReport@ yahoogroups. com [mailto:TheRogakRep ort@yahoogroups. com] On Behalf Of insurancelawyer
            Sent: Tuesday, August 11, 2009 1:16 PM
            To: TheRogakReport@ yahoogroups. com
            Subject: Re: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry RE: The Rogak Report: The Most Useful Publication In The Insurance Cla ims Industry The Rogak Report: 09 Aug 2009 ** No Fault - 45 Day Rule - Reasonable Excuse **

             

            Here's a prediction. I'm not advocating this, I'm just saying it will happen. Print this out and put it in a time capsule that will be opened by a future generation:

            By the year 2050, everyone in the country will have a microchip implanted under their skin which contains all their basic identity and insurance information, and which can be read by a scanner.

            If you think that's far-fetched, imagine what people's reactions would be if you could time-travel back to 1959 and tell them all about the Internet; about bar-code scanning; about voice-recognition programs; and all the other nifty-but-intrusive technology we have today.

            Let me remind you all that just 50 years ago, the concept that people of different skin colors could use the same water fountain was so controversial that violence would sometimes break out over it.

            Fifty years before that, women could not yet vote.

            And fifty years before that, you could buy and sell human beings legally in a dozen U.S. States.

            Mull that over for a while while you consider what can change in 50 years.

            Larry Rogak

            This e-mail is confidential.  If you are not the intended recipient, you must not disclose or use the information contained in it.  If you have received this e-mail in error, please tell us immediately by return e-mail to Email.Control@ sentry.com and delete the document.

            E-mails containing unprofessional, discourteous or offensive remarks violate Sentry policy. You may report employee violations by forwarding the message to Email.Control@ sentry.com.

            No recipient may use the information in this e-mail in violation of any civil or criminal statute. Sentry disclaims all liability for any unauthorized uses of this e-mail or its contents.

            This e-mail constitutes neither an offer nor an acceptance of any offer. No contract may be entered into by a Sentry employee without express approval from an authorized Sentry manager.

            Warning: Computer viruses can be transmitted via e-mail. Sentry accepts no liability or responsibility for any damage caused by any virus transmitted with this e-mail.

          • garciagirls@yahoo.com
            I am touched that you took the time. I posed this question to you. When the carrier issued a properly and timely denial and they stand by the denial in
            Message 5 of 16 , Aug 11, 2009
              I am touched that you took the time. I posed this question to you. When the carrier issued a properly and timely denial and they stand by the denial in question based on the submission of the provider what guide lines should the arbitrator use in order to determine if the excuse is valid or not? Maybe carriers should not issue denials based on the 45 day rule if you can be penalized by an arbitrator based on what they feel is reasonable or not. Just a thought.  I thank you in advance for your reply. 



              On Aug 11, 2009, at 3:12 PM, pete francis <mrclaims2001@...> wrote:



              The truth is, there are no guidelines. What is a "reasonable excuse"? The dog ate it? The range of what people consider to be a reasonable excuse is as varied as people's personalities. Excuses can range from "I forgot" to "I was in a coma for six months." And everything in between. -- Larry Rogak

               

              Even though I can fully empathize with Labot Scott, I must respond to Garcia Girls (for the record, in all my time in group, this is the first issue I have ever commented on).

              First, I have also seen many instances wherein the arbiter rendered a decision that went against the evidence, regulation, and/or logic but this is not one of them. The arbiter's decision was clearly in-line with the prescribed rules and regulation. ATIC was required to acknowledge and respond to the explanation provided by the provider but they did not.

              Second, language was NOT an excuse in present case. Can we please stop referencing language. The provider did not use that as an excuse so let's not even go there.

              Third, please do not say the police report excuse could not apply. I am not saying it did or should apply in the present case but in certain instances, it may just be applicable.  I can personally tell you a police report in NYC is not ALWAYS available in two week. I have personally sent someone to pick-up a police report in Queens 24 days post MVA and it was still not ready.

              Last, you are right in writing that a hospital personnel will request insurance information from a patient or guardian but if you don't have it, you just don't have it.  How do you get the torfeasor's information if you are transported to the hospital or if the driver just won't voluntarily release the information?  Once the hospital get the driver plate number, police report, or insurance information it can already be well past 45 days.  Why should the hospital be penilized if they took prudent steps to get the insurance info. but came back unsuccessful. The statute was implemented to curtail fraud not to deny benefits to a party well deserving.  The fact is ATIC did not acknowledge or respond to the delay and their lax attitude resulted in a just award.   That's all folk. 

              --- And to that I post this question: where in the regs does it say that "lax attitude" by the insurer is a basis for excusing a late submission of a medical bill? -- Larry Rogak


            • jam0220@optonline.net
              JFK was right-- I always tell my daughter life sucks and then you die not meant as a negative but as a reason to fight every day for what is right/fair;
              Message 6 of 16 , Aug 11, 2009
                JFK was right-- I always tell my daughter "life sucks and then you die" not meant as a negative but as a reason to fight every day for what is right/fair; luckily I kept her away from insurance.

                I agree with Larry fair is when the playing field is level--sometimes you win, sometimes you lose, sometimes it rains (to steal a line from "Bull Durham"); at least we all know where we stand.

                Sent from my BlackBerry® wireless device


                From: jam0220@...
                Date: Tue, 11 Aug 2009 19:05:11 +0000

                Your daughter is going to make some lucky guy a great wife! :-)

                Larry Rogak

              • jam0220@optonline.net
                Maybe AAA should be forwarded this exchange so they can share it with their arbitrators???? Sent from my BlackBerry® wireless device ... From:
                Message 7 of 16 , Aug 11, 2009
                  Maybe AAA should be forwarded this exchange so they can share it with their arbitrators????

                  Sent from my BlackBerry® wireless device



                  There are over 1,000 people who receive these emails. The odds are, someone will take you up on that. -- Larry Rogak


                  From: jam0220@...
                  Date: Tue, 11 Aug 2009 19:05:11 +0000
                  To: <TheRogakReport@yahoogroups.com>
                  Subject: The Rogak Report: The Most Useful Publication In The Insurance Claims Industry Re: The Rogak Report: The Most Useful Publication In The InsuranceClaims Industry RE: The Rogak Report: The Most Useful Publication In TheInsurance Cla ims Industry The Rogak Report: 09 Aug 2009 ** No Fault - 45 DayRule - Reasonable Excuse **

                   

                  Then why are insurers held to a strict interpretation of the rules---45 days seems to be more then ample and reasonable time to figure it out. I have never seen a medical provider have this same issue with private medical insurance (not a plug for Obama Care).

                  I thank you for acknowledging my fairness; and I think I am being nothing but fair here. The rules are the rules; if I had my way I would demand 30 day billing--they always bill me within 10 days when I was self pay!! Why does there only seem to be an issue with PIP bills???

                  So if an insurer is to establish the ground rules for "reasonableness" will the AAA and the courts allow us any leeway?? I think not, and that is what is wrong with this decision.

                  Let's set some fair rules, make sure everyone understands them and properly compensate EIP's--that is what the law was meant to do. I truly believe that if the rules are simple and understandable and not complicated and convoluted by my friends at both sides of the bar; the truly innocent EIP's may experience the legislative intent of law.

                  Juan

                  Sent from my BlackBerry® wireless device



                  Juan, your post brings up the philosophical question of "What is fair?" To some people, something is only "fair" if they get the result they want. So if their team doesn't win the game, that's not fair. Other people -- myself included -- believe that "fair" is when everybody is judged by the same objective criteria which is appropriate to the game. If the contest is to guess the number of jelly beans in a big jar in order to win a million dollars, and your guess is just one number off, is it unfair that you didn't win?

                  Let me share the following with all my readers: On 21 March 1962, President John F. Kennedy said the following: "There is always inequality in life. Some men are killed in a war and some men are wounded, and some men never leave the country, and some men are stationed in the Antarctic and some are stationed in San Francisco. It's very hard in the military or in personal life to ensure complete equality. Life is unfair."

                  Eighteen months later, this great man was shot and killed by a disgruntled misfit.

                  So what was that about the 45-day rule being unfair?

                  Larry Rogak

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