Friday, October 30, 2015

The Ten Commandments of Being a Quality Client Liaison in Medical Recovery

The purpose of this post is to help assist healthcare providers and owners with questions they have concerning their business. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

The responsibilities of a client liaison for medical provider revenue recovery are threefold:

To assist in the identification and assembly of claims to be pursued either in PIP (No-Fault) arbitration (injuries related to motor vehicle accidents), Worker’s Compensation (WC) litigation, or Commercial Insurance (CI) litigation.

To be a responsive and considerate supporter of the Firm’s attorneys and their staffs in the above areas.

To be an integral part of the customer service, sales and marketing efforts of the Firm.

To perform these functions at the highest level, client liaisons should always adhere to the following Ten Commandments.

To exhaust the file output of each and medical every provider as soon as possible. This ensures that providers will receive the most money possible as quickly as possible.

To do whatever is in your power to meet monthly goals, without sacrificing quality in any way, shape or form. Monthly goals are not an end in and of themselves. They are a measuring stick for your performance. Meeting goals in some artificial or manipulative way is not only dishonest, it is the opposite of effective performance.

If you do not have a sufficient number of medical providers to achieve monthly goals, to obtain additional providers as soon as possible in order to do so, and to speak with your supervisor about getting them. Seek out what you need in order to make your objectives. If it is a wider customer base, go get it.

To never lose a provider by virtue of anything you did or did not do effectively. A good liaison views losing any client as a shortcoming in his or her efforts. A liaison should always be looking to satisfy a client while at the same time managing expectations appropriately.

To minimize any inconvenience to your providers, and, accordingly, take care of office requests yourself as much as possible. A provider upset at being asked to perform functions they do not regard as their responsibility is not a good thing.

To never have a provider voice a single complaint about you or your performance. A provider complaint directed at you or your performance is never trivial, never petty, never excusable.

To do everything you can to make easier the job of other office personnel, so they can operate more efficiently. Treat those to whom you hand-off work as if they too are your customer. Colleagues are customers. Treat them with care and consideration.

To help the settling team as best you can to facilitate settlements. Settlements ensure the quickest recovery for medical providers and should always be regarded as a priority.

To assist the attorneys as best you can to facilitate awards. This is the bread and butter of the Firm. The Firm exists ultimately by virtue of the success of the attorneys.

To recognize and pursue sales and marketing opportunities wherever they exist. This is last but hardly least. All employees, but particularly liaisons, are ambassadors for the Firm and should at all times behave as such. Liaisons, moreover, are out in the field and should always be on the lookout for business development opportunities.

These Commandments have relevance for all people in the customer service / sales / marketing arenas, not just those attached to a law firm specializing in recovering money for medical providers against insurance carriers.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Feel free to search us on Facebook, Twitter or LinkedIn!

Learn More About Callagy Law Here:

The Ten Commandments of Being a Quality Client Liaison in Medical Recovery

Why Not #7 - Taking The Daily Test October 30, 2015

Happy Friday!!!!!!!!!!!!!! Let’s go!!!!!!!

Welcome to Halloween Eve!! We’ve got our Callagy Law Halloween Parade and Costume Contest today. Every year this is a big time highlight, and everyone in the office votes on the best costume. I always get a bit challenged by what to wear, but I think I’ve got something that will work for this year.

How about you? Dressing up? If you have children, are you ready for the Halloween parade and/or some trick or treating?

My last parade for my kids was last year. I miss it already! If you still have it, cherish it. It goes like “smoke through a key hole”. I never missed one. I loved them all. Now, it’s a new chapter in life.

So, Happy Halloween and enjoy!

As for today, let’s reinforce, very simply and clearly, “why” the “Why Not Huddle” is an indispensable part of our day.

When I was 28, I started my own law firm. I had no money. I started my firm on my credit card. My son was on the way. I was scared to death and stressed out of my mind every day. I wanted to quit literally every day!

Not only was I facing the stress of owning my own business and having to figure out a way to generate clients, make money and manage the business side of the firm, I also had to practice law just two years out of law school. I must have been out of my mind to quit my great job at a prestigious firm and do this! Well, sort of, but not really!!!!! I felt such of sense of being alone. I felt that I had no support and that I had nowhere to turn for the support I needed.

What support did I need? Hmmmmmm…… Well, after spending hundreds of days on an emotional roller coaster during that first year, reading hundreds of books, going to coaching school and building 4 successful businesses, I know precisely what I needed: a way to ground myself for being “At Cause”.

As we discussed yesterday, being “At Cause” means we are internally directing our thoughts, feelings and actions, which create our daily results, and destiny.

Where I was in my first year of owning my own law firm was greatly “At Affect”. This means, as opposed to being “At Cause” and internally controlling myself, the external world was dictating the vast majority of my thoughts, feelings and actions, leading to different results and a far inferior destiny to what I desired in my heart and soul.

This led me to reading many books, listening to tape programs, attending seminars and hiring coaches. All of this was terrific. However, none of it taught me the concept of being at cause, and none of it grounded me into that way of thinking on a daily basis.

I felt so alone. I had huge goals. I was going for it. Yet, every day I was all over the map with the quality of my thoughts, feelings and actions. When something good happened, I was feeling like King Kong. When something bad happened, I felt like a lost little boy who was being exposed as a pretender. I would vacillate through these feelings by the hour.

I was very hungry though. I had big dreams. As a result, I learned a lot of techniques that are so valuable that kept me in a far higher level of self-management WHEN I REMEMBERED to use them. AND, sometimes I didn’t use them just because I didn’t feel like it!

Is that nuts? Yes it is!!!! We are all emotional creatures that do ridiculous things to screw ourselves up all the time. I was no different.

Thankfully, I figured out ways to remain what I now call at cause at a very unique level most of the time. Thus, I produced some remarkable results building a 40 person law firm in two years. By the way, I’ve never heard of any other attorney ever doing that by his or her 30th birthday.

So, it is with that back drop that I give you my gift, the Why Not Huddles. These huddles are to give people something that everyone who wants more needs: daily knowledge, reinforcement, conditioning and FUN.

I am unaware of anything like this existing for free anywhere online. If something does, I have a high degree of certainty that our process here will be the most complete for helping you produce the goals and results of your dreams.

Again, I only ask that you keep sharing it. We’ve added 700 Facebook Likes this week, to take us over 10,000. Our goal by next Friday is to add 2,000 more folks. Please help us get there.

Also, you can subscribe on YOUTUBE to the Why Not Videos. Please e-mail me any questions at scallagy@callagylaw.com. Be here everyday. We’re are creating. A movement here to help support people in the creation of their goals and dreams in a real and powerful way. Be a part of it and please help us by tuning in daily and spreading the word!!

Happy Halloween, don’t egg any houses tonight and check out an old classic: Abbot and Costello Meet Frankenstein with the actors who gave us our first horror movies rolling with the comedy legends. Have an awesome Friday and Weekend!

In Your Service,

Sean Callagy

You can see all of our WHY NOT – HUDDLE videos by clicking here and subscribing! If you have questions about any of the content you see or to have your questions answered on an upcoming show by Sean, please email your questions directly to him by clicking here.

Why Not #7 - Taking The Daily Test October 30, 2015

Thursday, October 29, 2015

Callagy Law Persuades the Third Circuit to Set Precedent in ERISA Cases

Callagy Law Persuades the Third Circuit to Set Precedent in ERISA Cases

In a precedent-setting victory, Callagy Law successfully argued that an ERISA plan administrator’s failure substantially to comply with a certain Department of Labor regulation results in annulling the plan’s contractual limitation on the period in which to bring a law suit in Federal Court.

Our client’s case was initially dismissed for filing his complaint after the plan’s one-year contractual limitation had run. But Callagy Law Counsel Matthew R. Major, Esq., persuaded the Third Circuit Court of Appeals that 29 C.F.R. § 2560.503-1(g)(1)(iv), a Department of Labor regulation governing the ERISA claims procedure process, “requires plan administrators to inform claimants of plan-imposed time limits for bringing civil actions in their adverse benefit determinations.” Clear and plain notice of the contractual time limit is necessary, Mr. Major argued, to effectuate ERISA’s remedial purpose in providing claimants with effective judicial review of such determinations.

Adopting Mr. Major’s reasoning, the Third Circuit held, for the first time ever in this Circuit, that plan administrators must include such notice in adverse benefit determination letters “and that the appropriate remedy” for failing to do so “is to set aside the plan’s time limit and apply the limitations period from the most analogous state-law cause of action—here, New Jersey’s six-year deadline for breach of contract claims.”

For our client, that means his suit will now be able to go forward on its merits. For all future ERISA clients within the Third Circuit’s jurisdiction—Pennsylvania, Delaware, and New Jersey— that means that plan administrators can no longer “hide the ball and obstruct access to the courts.”

That’s a victory for everyone.

For a copy of the court’s opinion, please visit: http://www2.ca3.uscourts.gov/opinarch/133535p.pdf

With offices in New York, New Jersey, and Arizona, Callagy Law is a multi-faceted law firm committed to providing legal representation and advice to individuals, medical providers, and business owners. For a full list of the firm’s practice areas, please click here. At Callagy Law, we are “Fundamentally changing the way people feel about lawyers, one client at a time.”

For more information about Callagy Law, visit our Website, Facebook, and Twitter.

Callagy Law Persuades the Third Circuit to Set Precedent in ERISA Cases

Law Library TV – Episode 1.4, ‪#‎AskSeanCallagy‬ October 29, 2015

Why Not #6 – Why Not Say Goodbye to Motivation? October 29, 2015

Why Not Say Goodbye To Motivation? And Hello To Something Infinitely More Powerful?

I had a game changing meeting with a friend of mine, Rey Rostami, the New Jersey Training Coordinator for AFLAC, yesterday. Rey has a tremendous life story, rising above some very challenging childhood years on the inner city streets of Los Angeles, to becoming a commission sales person for AFLAC, to becoming an award winner and leader, to now being the head of training for AFLAC, New Jersey.

Rey also uses a significant amount of my training principles for himself and his AFLAC trainees. So, when I asked Rey what he thought of our “Why No Huddle”, I was shocked to hear his answer.

Rey hesitated and looked uncomfortable as I waited to hear his thoughts. Finally, he said, “I haven’t seen it. In fact, I’m embarrassed to say that I didn’t even know it started yet.”

I actually felt a lot of excitement when Rey told me this. Our Callagy Law Facebook has already grown by 700 “likes” in just a few days. Now, I completely understand that out of our 10,000 “likes,” still only a fraction of the 10,000 has even seen the posts about “Why Not”. As more people see it, which we ask everyone’s help with changing that, we will watch the numbers grow like crazy. I’ll explain in a moment why that’s a good thing for everyone.

Something far more amazing happened though in the next stage of our conversation. Rey became very excited about the idea of his sales people having the ability to watch the “Why Not Huddle” everyday for motivation. He explained the obvious fact that sales is full of frustration and how important “motivational videos” are.

This is where our breakthrough moment occurred. After the next 10 minutes of our conversation, Rey was more blown away and excited than I’ve ever seen him.

I asked Rey to now explain what I had just shared with him as though he was speaking with sales people at AFLAC to help them understand how critical, unique and valuable the “Why Not Huddle” is for them.

Rey summarized our conversation as follows: “Motivation is for people who are ‘At Effect’. It means that you are riding external stimuli to move you.

The consequence of this is that if you receive negative stimuli, you are equally susceptible to stop acting. The key is to stay ‘At Cause,” which is the opposite of ‘At Effect’ and means that you are in control, through an entirely different philosophy, of your feelings, thoughts and actions. The value of ‘Why Not’ isn’t to motivate, is to keep you ‘At Cause’, which is so much more valuable it’s incredible.”

“Precisely my friend”, I shared with him. Rey added, “My entire philosophy of training and producing results has shifted in the last 10 minutes.” Rey also added some incredibly complimentary words for me, which I will leave out.

What??????!!!!!!!!! Yes, motivation is weak. Motivation is fleeting. When people call me a motivational speaker it bothers me.

During our conversation, Rey helped me clarify my burning “why”, or my drive, for doing all of this. I want to help people at an unprecedented level to improve the mental and emotional quality of their lives. I believe that it is so easy to lead a life of more passion, positive energy and results than most people do. This is why I do this.

Here is the key of all of this though: the “Why Not Huddle” is NOT about motivation!!!!!!! It is about changing your life philosophy so you don’t need external motivation. External motivation can be nice and fun, but it is fleeting and ineffective. It is like going from a car that has a one gallon gas tank, a person relying on motivation, to an oxygen powered car that is perfectly self sustaining as oxygen is everywhere, which is the equivalent of having a life philosophy of being “At Cause”.

We will talk more about this on today’s “Why Not Huddle” and tomorrow’s article. For today though, please try and get this into your heart, soul and

brain: you are the only person or thing that can make you feel how you feel.

Remember, your feelings control your thoughts, your thoughts control your actions, your actions give you your results and your results create your destiny. Thus, the difference between living in motivation versus living “At Cause” is a completely different destiny.

Please, please, please, read tomorrow’s article as we will explain this enormous distinction. For today, understand that living “At Cause” is about you being in charge of how you feel, think, act and produce results minute to minute, day to day, week to week, month to month and year to year. The “Why Not Huddle” will help you achieve this level of mastery of your life and yourself AND it will be FUN!

This applies for peak athletes, business owners, sales people, stay at home moms and dads, teachers, lawyers, accountants, politicians, celebrities or whatever. The “why” behind “Why Not” is to make your life better and the world a better place through leaving behind negative emotional reactions, thoughts, feelings and behaviors.

AND just so this doesn’t sound like I’m suggesting we become weird robots, let me illustrate a point I made to Rey about the importance of feeling even sad feelings versus having those feelings produce negative outcomes. I used my grandfather, who passed away in 1999, as an example.

I miss my grandfather very much. I loved him with all my heart, and he was amazing as a source of support, love and teaching for me. He was incredibly positive when it came to him telling me who I am and how great I could be.

“When I think of him”, I explained to Rey, “I feel certain and confident, and I want to live an amazing life of balance, fulfillment, giving and success in tribute to all that he was and all that he taught me.”

This is a simple example of feeling very real feelings of missing my grandfather, but having those feelings serve my life as opposed to depress me because my beloved grandfather isn’t here anymore. All of that is a choice with tools to help make that choice a reality, all of which we will cover over time on our “Why Not Huddle”.

As we begin to touch on these topics, you may start to feel a bit challenged or even irritated by these concepts, or me. A natural human response is:

“you don’t know my problems. Mine are worse. This wouldn’t work for me!” All I can say is, yes, many people suffer from horrible challenges and trauma.

I’m sure some people exist that need some additional help. I simply believe that way more people can be masters of their own destiny that most people believe.

AND, I will close with this: medical science says I’m going blind from a hereditary eye disease that my beloved grandfather had and was blind from.

I’ve stopped driving and watching TV has become incredibly difficult as I pretty much see double, plus have huge contrast problems and blind spots. I need help telling me what’s happening on the TV screen pretty often if I watch a show like my favorite, “Walking Dead”. Yet, I have zero fear. I don’t feel fear and get rid of it. I don’t feel it in the first place. I have absolute certainty that I will be cured AND before I am, I will cope and adapt perfectly and enjoy additional advantages from my disease. One of those advantages is keeping me “At Cause” at an accelerated rate to take advantage of the vision I have.

So, while many people have worse disability challenges than I do, 95 percent of the population DOES NOT. Thus, I can speak from a place of absolute certainty when I tell you that you, with whatever challenges you have, can live an amazing life of being “At Cause” and enjoying life’s wonder, beauty, amazement, abundance, joy and passion.

Carpe Diem and enjoy your day “At Cause”!!!!!!!!

In your service,

Sean Callagy

Why Not #6 – Why Not Say Goodbye to Motivation? October 29, 2015

Wednesday, October 28, 2015

Medical Provider Applications In New Jersey Workers’ Compensation Courts

What is “Usual, Reasonable and Customary” When There is No Fee Schedule for Healthcare Providers?

The following article was written by Callagy Law’s Legal Team and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

Many may not be entirely aware, but the New Jersey Workers’ Compensation courts provide a forum for healthcare providers to challenge inadequate reimbursements from workers’ compensation insurance carriers where the underlying claim is for a patient injured within the course of their employment. When a healthcare provider files its application with the Workers’ Compensation court, it seeks to obtain additional payment for treatment that was authorized and provided to the injured worker. However, there is no fee schedule in place for workers’ compensation healthcare providers. In these medical provider claims, the issue typically is not a contractual one; instead, the issue often is what constitutes the usual, customary and reasonable charges (or “UCR”) and the payment that should be made for a given medical service rendered to an injured worker. When determining UCR, it is appropriate to look at a myriad of factors including but not limited to paid fees and all payments made to the carrier by commercial and non-commercial carriers.

The New Jersey Workers’ Compensation Court recently issued an opinion in the matter of Burn Surgeons of St. Barnabas v. Shop Rite concerning the payment of medical treatment in the context of a New Jersey workers compensation case. In adopting the reasoning in Coalition for Quality Healthcare v. New Jersey Department of Banking and Insurance, 358 N. J. Super. 123 (App. Div. 2003), Judge Dietrich in Burn Surgeons accepted that it is appropriate to use paid fees rather than billed fees to make a determination as to the usual and prevailing fees in billing. Judge Dietrich also accepted that there is a “balancing act between the attempts to contain costs while providing for a fair level of reimbursement for services rendered.”

Further, according to Task Force Report on Medical Provider Claims submitted on November 5, 2010, there are many factors that a Judge may consider in determining the UCR of a given medical treatment and the appropriate payment for said treatment. While the following is not exhaustive, the Report provided that considering the following can act as a useful guide for the parties to consider in presenting proofs and likewise, to the jurist, in deciding a case: the fees customarily paid for like services within the same community; the fees paid to the same physician or medical provider by other payers for like treatment; the fees billed and the accepted payments for such bills by a given provider; the disparity in payments accepted from different sources (i.e. Medicare vs. PIP and commercial carriers); using commercial and/or private databases such as Ingenix’s Prevailing Healthcare Charges System (“PHCS”); the Medical Data Resource (“MDR”) database, and; Wasserman’s Physician Fee Reference (“PFR”) database to name a few.

As also promulgated by the Medical Provider Committee Report on December 9, 2014, UCR can be determined by looking to many programs: Fair Health Allowed Module, New Jersey Personal Injury Protection Fee Schedule, Provider/Carrier Commercial Payments, CMS, Wasserman Fee Schedule, , Pennsylvania Workers Compensation Fee Schedule, the New York Workers Compensation Fee Schedule, Federal Workers Compensation Fee Schedule, and any other probative evidence of paid charges received and accepted by the Medical Provider or paid by the carrier.

What This Means for Healthcare Providers

Under the Burn Surgeons case, when determining the amount of money to be charged for authorized medical treatment in a work-related injury, healthcare providers should use universally adopted databases, codes, and modifiers in order to determine whether the payments conform to UCR standards.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Feel free to search us on Facebook, Twitter or LinkedIn!

Learn More About Callagy Law Here:

Medical Provider Applications In New Jersey Workers’ Compensation Courts

Why Not #5 - Learn The Secret of Small WHY NOT?! October 28, 2015

Good Morning to you and Happy Wednesday!!!!!!!!

How did the Mets do in Game 1 of the World Series?!?!?!?! Did the Dark Knight Rise?!

For some thoughts, watch today’s Why Not Video discussing the Mets AND our Challenge!

For today, let’s focus on the “Secrets of Small”.

The basic premise of Why Not, is to say yes instead of no, where you should.

To act, instead of not act, where you should. To do what is going to support your happiest and most fulfilled life as opposed to doing the opposite, or nothing at all.

I believe that we are born happy and outside conditions and forces change that. Do I believe people have biological issues that impact happiness, absolutely!

However, I believe that for the vast majority of the population, there is a science and process that will lead to our success and fulfillment.

The goal of Why Not is to support you in this endeavor in a world full of negativity, cynicism and obstacles to our best life and version of us.

For today, let’s look at the power of small. My favorite word to discuss small is “distinctions”. Distinctions are small differences. Our success and failure is decided in very small differences.

The challenge for us though, is we make the differences feel and seem BIG.

This impacts us emotionally, so we don’t take action.

Remember the truth about our ultimate dream destiny: it flows from our daily results, which flow from our daily actions, which flow from our daily thoughts, which flow from our daily feelings. Thus, one terribly important tiny distinction is to know that reality and to remember it!

Let’s take a very simple story to show the power of distinctions and how it impacts our results.

In 1987, 28 years ago, I had a conversation with my mom’s friend Joan. I told Joan that I would always maintain a size 32 waist. Joan told me that her husband believed the same thing, that he exercised and took great care of himself, but it was impossible to do.

I didn’t like the idea of being told I couldn’t do something, especially when it was as simple as maintaining a size 32 waist.

I bet her 100 dollars that I could still have a size 32 waist on my 30th birthday. Well, I’m now 45 years old, and guess what? I still have a size 32 waist.

Well, that must mean I do A LOT to keep it that way. I must really be on a major diet and crazy work out routine. WRONG!!!!!

Here is my magic weight maintenance formula: 1. I weigh myself every day: 2.

I eat 3 meals a day, and I have substantial amounts of ice cream a couple of time per week: 3. I lift weights, do abs and run, and I love it!!!!!!!

If I see my weight creep up, I don’t have any sugar drinks, I don’t have dessert for a few days, and I make sure I don’t miss doing cardio.

If my calf bothers me, which it does at times when I run, then I shift to following an indoor cardio 45 minute work out that I learned from buying a Tae Bo video.

Tiny, small, simple distinctions. The key distinction within the distinction, is that I have a process I follow, with simple contingencies, that allows me to maintain my results.

BUT, I recently had a BIG problem. I was at my friends home in Arizona. I hadn’t weighed myself in about 3 months because my vision had worsened to the point that I couldn’t see the numbers on the scale anymore (I have a hereditary eye disease that medical science says will cause me to go completely blind-i say differently, but that’s a story for another day).

SO, I stopped weighing myself.

My friend said I looked heavier. I told him no way that I always knew how much I weighed. He challenged me to get on the scale. When I did, sure enough, I was 15 pounds heavier.

How did this happen? One distinction, and a very small one at that: I had stopped weighing myself.

Now I had a BIG problem, right? Nope. I needed to make a “small shift”. I needed to begin weighing myself daily again and flow my process.

In a month, without completely eliminating desert, I had lost 15 pounds and returned to a size 32 waist. No pain, no stress, no overwhelm and very simply got the results I wanted.

Another crucial tiny distinction is the distinction of managing ourselves.

Too often people believe that managing ourselves is a BIG process. It is not. Success also doesn’t require major disciple. Instead, it requires some very simple beliefs.

One of the simple, small beliefs success requires is this: my results are within my control, AND I am confident and powerful enough to produce all of the results I want for a happy and fulfilled life.

The distinction within this distinction is that how we interpret information is critical. If you receive negative feedback, people mock your goals or dreams or your not hitting your interim goals, do you make BIG changes?!?

NO! You stay the course and make SMALL changes.

The amazing book the Millionaire Next Store discusses the idea that as of about 10 years ago, the vast majority of American millionaires had never made more than $100,000.00 in income in a single year of their lives. How the heck did they do it? Small distinctions in savings and using the power of compounding was the answer.

I’ve touched on a lot of topic answers so far today, BUT do not be overwhelmed, as they were only illustrations. The sole point for today is

this: if you want to be in great shape, become a millionaire, have amazing confidence, obtain a college scholarship, buy a beach house, retire at a younger age, have the greatest marriage in the world, master sales or public speaking, the result lies in mastering the power of small distinctions.

We all are on an endless journey of growth and development. There are unavoidable and very specific rules to that process though. One of them is small distinctions and another is loving the process of growth itself.

Look for those two things today, e-mail me your thoughts, questions about this Why Not video, which will elaborate on this topic of the Secrets of Small!

In your service,

Sean Callagy

You can see all of our WHY NOT – HUDDLE videos by clicking here and subscribing! If you have questions about any of the content you see or to have your questions answered on an upcoming show by Sean, please email your questions directly to him by clicking here.

Why Not #5 - Learn The Secret of Small WHY NOT?! October 28, 2015

Law Library TV – Episode 1.3, ‪#‎AskSeanCallagy‬ October 28, 2015

What Are 3 Key Things To Look For From Your Attorney? Key Ingredient 2: Caring

Law Library TV – Episode 1.3, ‪#‎AskSeanCallagy‬ October 28, 2015

Tuesday, October 27, 2015

Law Library TV – Episode 1.2, #AskSeanCallagy

Beware of the Finality Clause of a PPO Agreement

The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

Under the New Jersey No-Fault laws, medical providers who treat patients injured in motor vehicle accidents can arbitrate PIP claims against No-Fault insurance carriers. Some of these medical providers have entered into PPO agreements with various insurance companies. These “preferred provider” contracts govern how the provider will be paid by the carrier. Generally speaking, the provider is willing to accept a lower reimbursement amount in exchange for faster reimbursement as well as inclusion in a network of preferred medical providers.

Unfortunately, medical providers may not be aware of some of the pitfalls in a PPO contract. One issue that can be troubling in a New Jersey PIP arbitration is what is commonly referred to as the “finality clause.” The “finality clause” is a provision in the PPO contract that typically states that the medical provider will “accept” whatever amount the insurance company pays, unless they dispute the amount in a certain period of time. We often see the dispute period as ninety-days. A typical finality provision reads something like the following:

“Neither the Medical Provider nor the Payor may dispute the amount billed or paid more than ninety (90) days after payment.”

“The payment made under this Agreement may not be disputed after ninety (90) days from payment.”

For example, suppose a provider provides a medically necessary service to a PIP patient, and then bills an insurer $1,000.00 and is entitled to that amount under the New Jersey PIP regulations. The insurer responds by issuing a payment in the amount of $500.00. Let’s say the PPO contract provides for payment at 90% of the amount billed. In such case, the provider should have been reimbursed $900.00. Let’s also say the provider does not dispute the payment, in the form of an official appeal, until six months later when it wishes to seek redress. Let’s also say that the carrier denies any additional payment as a result of the appeal. The provider then files a Demand for arbitration in New Jersey. The insurer will likely raise the finality provision as a defense against having to pay any additional money, and will argue that the provider may no longer dispute the amount paid, having waited beyond the contractual period to appeal. This defense may prove successful for the insurer.

The provider should pay attention to the provisions of its PPO contracts. If a finality clause is contained in the contract, the provider should file its objection to the amount paid in a timely basis and in accordance with any other requirements in the agreement. It is advisable to limit the defenses that may be prevent a hearing on the merits of the provider’s right to redress.

We do have arguments to make to overcome the defense of a finality provision, but the most effective arsenal we can have to prevail is an appeal (with proof of delivery) demonstrating the medical provider indeed did timely dispute the payment in accordance with the PPO contract.

Learn More About Callagy Law Here:

Beware of the Finality Clause of a PPO Agreement

Why Not #4, October 27, 2015

Quick thought: What are you thankful for in your life? For a moment, close your eyes, see it, make it large, colorful and moving. Feel the feelings of gratitude you have for this person, place, thing, opportunity or whatever it is, in your life.

Do this for 60 seconds.

This is one of just so many ways we can rapidly shift ourselves into a more resourceful, less stressed, more happy and joyful, and if relevant, more productive place.

If this sounds cheesy to you, then ask this question to that part of you: what is more cheesy and foolish, feeling overly stressed, angry, frustrated, defeated or overwhelmed by things we are capable o feeling differently and better about OR simply employing techniques to feel better?

A quick example of this is how most people feel on Monday mornings, albeit it’s a Tuesday. Most people “make it through” the week. I used to feel that way too. Then, one day, I realized that I was wishing 5 out of 7 days of my life away. Who wants to do that?????!!!!!!! It was a life changing moment.

Tomorrow’s article will discuss how different reality is for people than reality actually is.

To answer today’s question though, the first missing step for the achievement of our dreams for most people is……..THE FAILURE to have WRITTEN GOALS!

It amazes me the number of people that fail to have written goals. It also amazes me to see the amazing power that having written goals has.

So, your mission, should you choose to accept it, is to create written goals for every area of your life. This includes: family, financial, spiritual, health, fitness, relationship, career, joy, adventure, skill development and any other areas in which you desire something in your life.

Even if you set goals, here is a quick example of a possible way you haven’t taken advantage of goal settings amazing power:

Goal:

Family: help my daughter walk onto the soccer field feeling 10 feet tall and possessing a complete and perfect level 10 of confidence by November 15, 2015.

We will discuss the nuances of goal setting and goal attainment in future articles and programs. Simply writing your goals down in all of these areas, with numbers, and time sensitivity, is the first essential step!

Take up your life’s mission, write your goals down, feel gratitude and have an amazing day because you, like everyone, deserve it!!!!!!!!!

In your service,

Sean Callagy

Why Not #4, October 27, 2015

The Litigation Funding Business: A Closer Look

The litigation funding business consists of hundreds of companies throughout the country which purchase portions of the anticipated recoveries of plaintiffs in pending lawsuits. In return for these cash advances, the funding company receives a contingent interest in the potential post-judgment proceeds of the plaintiff’s case. The nonrecourse nature of these transactions distinguish litigation funding from traditional loans, which require absolute repayment— i.e., in litigation funding, if the plaintiff fails to recover, the funding company receives nothing in return for its cash advance. It is only in scenarios where a plaintiff recovers on his or her claim, that litigation funding companies receive any return on its investment.

In Opinion 691 of “Referral of Personal Injury Client to Third-Party Factor Which Will Purchase an Interest in the Case,” Referral of Personal Injury Client to Third-Party Factor Which Will Purchase an Interest in the Case, 2001 WL 169754, the Supreme Court’s Advisory Committee on Professional Ethics (the “Committee”), explains the fundamental purpose of the litigation funding business and how it operates. The Committee explains that the purchase of a portion of a “potential personal injury settlement or judgment” involves a great degree of risk being assumed by the possibility that a plaintiff’s claim could fail completely, or yield insufficient awards unable to cover the original investment. Id. at p. 2. Further, litigation funding companies often represent the only option available to plaintiffs, to address their immediate personal financial needs, and relieve the pressure “to accept a settlement offer not in the client’s best interests simply in order to survive financially.” Id. at p. 3. The Committee concludes that, “… a lawyer may ethically refer a client to a factor concerning a possible advance against an anticipated personal injury judgment or settlement, provided that the standards and limitations [as to independence of the lawyer’s judgment, etc., were] followed. Id. at p. 6.

Opinion 691 also acknowledges that litigation funding companies have been visible and accepted in the legal setting for years. By providing such funds, litigation funding and the pre-settlement finance industry as a whole, helps to level the playing field in many cases where cash-strapped plaintiffs would otherwise be forced to accept inadequate and unfair settlement offers made by large companies that have the resources to out-litigate and ultimately out-last individual victims of their insured’s’ tortious conduct. On a final note, while some may be skeptics of the litigation funding business, pre-settlement finance companies take great risks in these business ventures and are often a plaintiffs only opportunity to maintain personal financial viability while his or her case works itself through the legal system to a fair and just resolution.

The team at Callagy Law hopes the information in this article was helpful in either your personal or professional life. Businesses and people are multi-dimensional and at times may need a guiding light. The legal world pertains to all walks of life and businesses, therefore, we aim to provide information which will help you navigate through your life. Callagy Law, is a multidisciplinary law firm, headquartered in Paramus, NJ owned and operated by Sean Callagy. We are committed to providing legal representation and advice to our clients at our law offices located in New York, New Jersey and Arizona. Please note that the information posted here should not be used as a legal argument of defense. If you find yourself needing legal advice pertaining to your unique situation, you can contact us at by writing us here. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally Callagy Law has had some great reviews and is working hard to be a leader in multiple fields of the legal profession.

Related Blog: NY Litigation Funder Awarded $33.5M In Kickback Suit

The Litigation Funding Business: A Closer Look

Monday, October 26, 2015

Law Library TV - Episode 1.1, #AskSeanCallagy

Law Library – TV is an original series from Sean Callagy, President and Founder of Callagy Law; to help the general public with every day legal questions and information. For more information about Sean Callagy, Callagy Law, or any questions you have, please email marketing@callagy.com

Law Library TV - Episode 1.1, #AskSeanCallagy

Why Not, #3, October 26, 2015

Good morning and welcome to the week of October 26, 2015!!!!

Do you love Monday morning? Living in the northeast, in the great state of New Jersey, it is still dark at 5:45a.m. as I write today’s thoughts and messages and before shooting today’s Why Not video.

It was a challenging weekend in the world of blessed people’s problems.

What?

Blessed people’s challenges are challenges that we are blessed to even experience in the first place, or to feel challenged by in the second place.

This weekend I had a big weekend of youth sports with my children. I run a club baseball team and my daughters play club soccer, which all means a lot of traveling and intensity during the games.

We lost a tough quarterfinal baseball game and soccer went okay, but it had its own challenges for the kids

AND, the Jets lost to the dreaded Patriots.

AND, spoiler alert for all of those Walking Dead Fans out there. Skip this paragraph if you haven’t watched the episode from last night yet……………..okay, well, it appears as those Glenn, maybe the most beloved character on the show, and certainly one of the characters believed to be “un-killable” died last night. It was the most shocking and heart breaking moment on the show yet. However, I hold out hope that he isn’t dead. We’ll see….

All of that factors into, as silly as it may sound, a bit of a down and flat Monday morning wake up. Add to it the fact that I ate too much sugar for the past few days and have missed working out for 4 days. What does that all add up to? A morning of compromised state management where I am not at my best, most confident, most powerful, strong and ready to live a life on purpose and to be the leader of my 100 person Callagy Law Firm that I need to be.

What to do?!

Why do I share all this? Am I a narcissist reality show “wanna-be” celebrity blogger? I certainly hope not.

I share it because it’s life. We all have challenges. We all have things, big and small, which have the capacity to impact our daily joy, actions and results.

So what you say?

Here is the so what: our feelings dictate our thoughts. Our thoughts produce our actions. Our actions produce our daily results. Our daily results produce our destiny.

Our lives today, on every area, are nothing more than the sum total of our daily results, which stem from our daily actions, thoughts and feelings.

How are you doing today? Are you feeling powerful, ready to take massive zone action? Are you on track for the destiny of your heart and soul’s desire?

If you are, then congratulations!!!!! You are living in rarified and special air.

If you are feeling “okay”, “normal”, “average” or less than that, (e.g., sad, tired, frustrated, bummed, etc..), then you are living in the vast majority of the population.

I Am also here to help shift that with you, NOT FOR YOU.

With all of that said, what is the answer to our daily message question: why do I no longer hate our Callagy Law Facebook Page?

Well, first of all, I don’t believe in “hating” anything. I don’t believe that giving that much negative energy to anything helps us, no matter what.

Second, I really didn’t like our Callagy Law Facebook page because it was just “okay”. Each day we put up some information that I didn’t choose to send out to people. Some days we sent out a lot of content. Frankly, I don’t think it was very good, special or helpful. Maybe it was even annoying.

So, I decided to make a massive change to our Facebook page and MY LIFE.

I decided to truly help those people who believe in what I believe. Folks that want more, who actually do want to “suck the marrow out of life”.

This is for people, from executives of Fortune 100 companies to teens in school to moms and dads raising their children full time.

We will be here together everyday to support one another in living amazing lives “on purpose”. To creating our best daily feelings, thoughts and actions to create OUR amazing destines.

This is a place for people who desire more joy, passion, freedom, time, fulfillment, money, energy or whatever. Those are big words with very special meaning that can be easily misinterpreted. We will talk about all of it over the course of our days together.

Life is not perfect, but it can and should be perfectly amazing. It is within our power through our minds and bodies that we can make it so.

Practically, to accomplish all of this, I am going to do 4 things each day:

Post a daily Why Not video that will help people learn the ultimate process for producing their best lives possible;

Post a daily written message for those who prefer to read or supplement the video with a bit more information:

Post a daily video: “Ask Sean Callagy” to respond to legal questions and discuss issues of the law for those that are interested;

Have our firm produce daily write ups on interesting and helpful points about the law.

This is a massive undertaking. I am also proud to say, I am also giving massive value to people from the past 30 years I’ve spent acquiring knowledge in these areas through spending hundreds of thousands of dollars and pouring in thousands of hours of reading, listening, attending and studying.

What’s the catch? NONE.

All I ask is a small, very small, favor: please share the content and spread the word to others on social media or through text or e-mail.

I want to create a movement of people seizing the day and a community of folks who believe in living extraordinary lives that are full of belief and passion, as opposed to negativity and cynicism.

It takes very little to identify problems. It takes a lot to solve problems and live with passion.

So, I am now very happy with, and proud of, our Callagy Law Facebook Page where our daily links will be posted. Please share it and ask others to “like” the page, that’s all I ask.

Other people charge thousands of dollars for content that will be inferior to what you will receive here for free!

Thanks for reading, watch today’s video and say “Why Not!”

In your Service,

Sean Callagy

Why Not, #3, October 26, 2015

Many NJ Hospitals Still Missing Revenue Opportunities

In the current environment, hospitals are facing an inordinate amount of uncertainty about the future. Indeed, the Affordable Care Act, among other things, has redefined what it means to provide appropriate medical care. The transition from ICD-9 to ICD-10 has required extensive preparation in all areas of hospital billing, reporting, and revenue recovery. The mergers and acquisitions taking place nationally as well as in our home state of New Jersey compound the anxiety. As a result of these changes, hospitals are understandably preoccupied with the numerous issues surrounding compliance, information technology, and resource management. Perhaps because of this preoccupation, many New Jersey hospitals continue to miss revenue opportunities in the areas of MVA (PIP), Worker’s Compensation (WC) and even Commercial Insurance (CI), at a time when new revenue streams would help alleviate any financial pressures. While many New Jersey hospitals are reaping the financial benefit of having a law firm aggressively pursue their New Jersey PIP and out-of-network WC and CI claims, many still are not.

While it is impossible to predict the revenue potential at any particular hospital without first seeing the nature and extent of any un-pursued claims, it is safe to say that we are talking about hundreds of thousands and perhaps millions of dollars in revenue opportunities, and that is significant to any hospital’s bottom. The dollars at stake are sizable enough to make the issue worthy of any CFO’s attention.

Any hospital that has not historically pursued PIP arbitration and/or out-of-network WC and CI litigation against insurance carriers not only stands to gain significantly going forward, but also is likely to have a backlog of claims that are still ripe and can be pursued. These claims might even be written off. But as long as they are within the applicable Statutes of Limitation, and are otherwise not barred, they can be filed and aggressively pursued by Callagy Law.

The best news is Callagy Law will provide the resources necessary to do so. We will audit your claims, identify those worth pursuing, print and assemble all of the relevant records, front the filing fees and costs, and aggressively advocate on your behalf. You pay nothing out-of-pocket and only a contingent fee percentage when appropriate (NJ PLIGA, WC and CI), and even that does not have to be paid until you receive payment from the carrier.

Occasionally, something comes along that sounds too good to be true. This is one of them, but the difference is that this one is indeed true—just ask the New Jersey hospitals that utilize Callagy for their PIP and out-of-network WC and CI recovery. At times I hear about an upcoming hospital fund-raiser and the hospital’s hope that it will raise $5,000 or $10,000. The fact of the matter is that one ER PIP claim through arbitration or one settled out-of-network WC or CI claim could recover a similar amount at no risk whatsoever to the hospital.

Click here to see what makes Callagy Law different.

Learn More About Callagy Law Here:

Many NJ Hospitals Still Missing Revenue Opportunities

Friday, October 23, 2015

Why Not Number 2, October 23, 2015 - Why Not Say Why Not

Why Not #1, October 22, 2015 | Sean Callagy

Today I launched the “Why Not?” daily huddle, available on YouTube. The purpose of these 3- to 10-minute morning sessions is to reach those who believe there is, or should be, more to life and want more money, more time, or more fulfillment in their lives – which in my experience includes just about everyone! The concept of a daily huddle is one which I have used for several years in my own law firm and because it has proven so effective, I am confident you will find it to be just as valuable, especially if you make it an ongoing habit to tune in.

It’s been said that the way we start anything goes a very long way to determining how we finish. With that in mind, I ask you to consider how most people start their day. Typically, it’s by catching up on the news from the previous night and – even more typically – that news is deflating. Tragedy, conflict, and dysfunction served on a bed of negativity, followed by a few minutes of weather and sports, then topped with a cheery, “Have a great day!” “Ah,” some say, “but that’s what people want to see!” I strongly disagree. I believe that launching your day with joy, hope, passion, encouragement and clarity is an infinitely better way to begin your daily walk.

Make no mistake, this daily huddle is designed to set your day on that better trajectory from the very beginning – one that will serve your needs and desires – and that will result in a better destiny. You may wonder what it is that qualifies me to bring you this huddle and the high expectations I want you to have for it. Briefly, I have studied the art and science of producing optimal results for over 30 years. Beginning in high school to apply what I was learning, I excelled academically and, as captain of Columbia University’s baseball team, athletically before becoming an attorney and certified business coach. Within two years of leaving law school I had defied the advice of naysayers by leaving a position with a prestigious firm to start my own, and already had 40 employees. Today that number has grown to over 100, yet I also coach baseball and lead a very fulfilling, well-balanced life. I have achieved my dreams because of the daily decisions I have made, and those decisions are founded on three beliefs: 1) our destiny is driven by our daily actions, 2) our daily actions are driven by our daily thoughts, and 3) our daily thoughts are based on how we feel each day.

I want to hear from you, and specifically I want to know two things. First, what do you want? Better relationships? More business? Less stress? And second, what is keeping you from having what you want? You may find the second question a bit more difficult to answer, but give it a shot. Then email those answers to me at scallagy@callagylaw.com. The Why Not daily huddle is here to address those answers, just as I address them with clients and associates, some of whom own $30 million dollar businesses yet wrestle with all kinds of challenges and are searching for the answers that will put them back in control of their lives. Every huddle will be different (occasionally we will have guests) but their common denominator will be to provide another useful, positive launch to your day.

This will cost you nothing. You will simply be investing 3- to 10- minutes each morning, five days a week, as often as you can, for one year. Please be generous with your sharing of this opportunity via Facebook and other social media platforms. And last, feel very encouraged to send me not just what you want and what you think is blocking you from having it, but also your suggestions for the huddle, because I truly want to hear them. Let’s get started!

Why Not #1, October 22, 2015 | Sean Callagy

Wednesday, October 21, 2015

Callagy Law | Legal Fact of the Day

Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.

In Kansas, when two trains meet at a crossing, “both shall come to full stop and neither shall start up again until the other has gone.”

Callagy Law | Legal Fact of the Day

Tuesday, October 20, 2015

Callagy Law | Legal Fact of the Day

Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.

It is against Michigan state law to tie a crocodile to a fire hydrant.

Callagy Law | Legal Fact of the Day

Monday, October 19, 2015

Drafting Contracts To Avoid Litigation Later

Businesses need to be proactive in choosing vendors and drafting and finalizing contracts to protect themselves from expected and even far-fetched litigation risks. The risk of contracts leading to litigation may be the last thing on the minds of busy employees who are on deadline to get projects moving. However, businesses need to be mindful of avoiding unnecessary risk in writing contracts as well as monitoring the progress of these agreements.

Front-end or Back-end Investment

In drafting (or writing) contracts as well as negotiating contracts there are tradeoffs in how much time and effort the parties should expend in setting highly precise terms versus more generic or vague terms. While it may be easier to use more generic terms that can be applicable for multiple contracts, it is risky because those generic terms may lead to confusion and conflict between the two contracting parties.

To avoid litigation, it may be advantageous to put more time into negotiating and simply discussing terms up front to avoid confusion later between the two businesses. When parties use only vague terms they push issues into the back end which generally means that the disputes end up in litigation.

Businesses need to think long and hard about whether they are willing to take the potential risk of costly litigation in the event of contract litigation.

Litigation can be very time-consuming in addition to financially costly so business leaders need to take the overall inconvenience and risk of this into account when preparing contracts. So, investing in the front-end, while inconvenient and time-consuming, can more predictable than the risk, even if it is relatively unlikely, of litigation at some unknown time in the future.

Maintaining Good Records is Also Key

In addition, it is important to keep good records regarding business relationships and contracts. The contract itself with signed versions should be kept in a safe and accessible location whether that is in hard copy files or electronically.

Also, records showing invoices, payments made, and other relevant information about the contract are important to show whether or not your business, or the other party, is adhering to the terms of the contract. Even documents such as emails or notes from meetings between the two contracting parties can be helpful in determining what the parties actually meant in drafting contracts or how those obligations may have evolved over time. All of these records are potentially important in determining liability as well as damages.

Of course, keeping good business records is simply a good practice for all sorts of other reasons as well. Good business records are important for tax purposes as well as for monitoring revenue, costs, and the overall health of the business.

Contact a Knowledgeable Attorney Now for Guidance

In order to make sure that you are minimizing litigation risk and know exactly what you are getting into when you are negotiating a contract with another business partner, contact one of the knowledgeable lawyers at the Callagy Law firm.

Learn More About Callagy Law Here:

Drafting Contracts To Avoid Litigation Later

Callagy Law | Legal Fact of the Day

Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.

It is illegal in Tennessee for an atheist to hold office.

Callagy Law | Legal Fact of the Day

Friday, October 16, 2015

Help Us Help You: The Role of Medical Documentation in New Jersey PIP

Help Us Help You!

The Proof is in the Pudding. When a medical provider treats a patient for injuries caused by a motor vehicle accident, the medical documentation will often determine if reimbursement is required by the auto insurer. The provider has the burden to prove the treatment was medically necessary and reasonable. Miltner v. Safeco Ins. Co. of Am., 175 N.J. Super. 156 (Law Div. 1980). The provider must carry that burden by a preponderance of the evidence.

Pursuant to N.J.A.C. 11:3-4.2, “medically necessary” or “medical necessity” means that the medical treatment or diagnostic test is consistent with the clinically supported symptoms, diagnosis or indications of the injured person, and; (1) The treatment is the most appropriate level of service that is in accordance with the standards of good practice and standard professional treatment protocols including the Care Paths … as applicable; (2) The treatment of the injury is not primarily for the convenience of the injured person or provider; and (3) Does not include unnecessary testing and treatment.

Focus on the phrase “clinically supported.” This means the provider personally examined and evaluated the patient in making an assessment of the patient’s subjective and objective complaints, as well as considered prior test results and recorded all observations and findings.

It is imperative to recognize DOBI (the New Jersey Department of Insurance and Banking), the regulatory body for New Jersey PIP, has adopted Care Paths, which are “typical” courses of intervention in the treatment of a patient. DOBI recognizes the Care Paths may vary, depending on the medical needs of the patient. Deviations, however, must be properly documented to increase the likelihood of success at arbitration. For example, a patient may have co-morbidities or pre-existing conditions requiring more or different treatment that would otherwise be typically provided, but this must be explained in the documentation by the treating doctor.

For example, let’s say a “typical” course of treatment for someone injured in a motor vehicle accident is x weeks of conservative care, such as chiropractic care. If that patient has a co-morbidity that would require additional conservative care and the patient continues to improve with care, this additional care will generally be deemed medically necessary if the medical records support that position.

Similarly, let’s say the patient remains symptomatic after a “typical” period of conservative treatment, and the “typical” course of treatment at that stage would be surgical intervention. What if the patient does not want to undergo surgery at that time for reasons also explained in the medical record? That important information might provide a reasonable basis to continue with conservative care and/or injection treatment.

Check the Medical Denials. Auto insurers are required to have medical denials before they may properly deny treatment based on medical necessity. N.J.A.C. 11:3-4.7(c)4 provides, “All determinations on treatments or tests shall be based on medical necessity and shall not encourage over or underutilization of benefits. Denials of decision point review and precertification requests on the basis of medical necessity shall be the determination of a physician.”

Make sure medical denials address the requested treatment, and the insurer’s doctor is of the same specialty as the treating doctor.

Three day Rule. Auto insurers are required to respond to a provider’s pre-certification request in three business days. Check to see when the insurer responds to your request. (Make sure you can prove the day your request was sent, and that it was sent to the proper facsimile number, etc. of the insurer.) An untimely denial may be another way to show medical necessity of treatment.

In sum, the role of medical documentation in a New Jersey PIP arbitration is paramount. If the treating doctor documents all clinical findings made by thorough evaluation and examination, and then explains the medical basis for recommended treatment, our chances of success are increased significantly. As Jerry Maguire has so eloquently stated, help us help you.

For more information please visit:

www.callagylaw.com

www.callagycounsel.com

You may also be interested in reading our latest blog posts!

http://callagylaw.com/2013-pip-regulations-lower-reimbursements-for-ascs/

http://callagylaw.com/5-contract-tips-avoiding-litigation/

http://callagylaw.com/ppo/

Help Us Help You: The Role of Medical Documentation in New Jersey PIP

Callagy Law | Quote of the Day

Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.

“We need space to be productive, we need places to go to be free.”–Laure Lacornette

Callagy Law | Quote of the Day

Callagy Law’s Legal Fact of the Day

Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.

Most of the cases in the US courts are automobile cases.

Callagy Law’s Legal Fact of the Day

Thursday, October 15, 2015

Callagy Law | Quote of the Day

“When people are placed in positions slightly above what they expect, they are apt to excel.”- Richard Branson

Callagy Law | Quote of the Day

Callagy Law’s Legal Fact of the Day

Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.

In North California, you are not allowed to plow your field with an elephant.

Callagy Law’s Legal Fact of the Day