Showing posts with label sean callagy. Show all posts
Showing posts with label sean callagy. Show all posts

Thursday, June 9, 2016

Attorney perseveres despite debilitating vision loss











A local lawyer is fighting both in and out of the courtroom, as he deals with a genetic disease that is causing him to lose his eyesight.



Sean Callagy, owner of Callagy Law in Paramus, suffers from Retinitis Pigmentosa, a rare disease that causes certain cells in the retina to start to die; he has been slowly losing his vision over the past five years. According to the National Eye Institute, the disease progresses, impairing vision, when proteins in the cones that make up the retina stop producing and the cells die. Because of this, Callagy, a River Vale resident, has a hard time seeing important details of the things in front of him, and at this point can only see the blurry silhouette of them.


“It’s like looking through a straw,” Callagy explained. “My peripheral vision is a lot better, but things that are in front of me are usually very blurry.”


Callagy was diagnosed with the disease when he was five years old, but didn’t begin to notice problems with his sight until he was a teenager. Over time, the disease continued to impair his vision, and he is now classified as legally blind. But despite the heartache that comes with losing his vision, Callagy has learned not to take anything in life for granted, and pushes himself further to be the best he can be, and make a difference in other people’s lives – perseverance he said comes because of the hand he’s been dealt.


The disease progresses


The attorney has recently had to give up driving and can no longer read court documents without assistance. But he says the worst part of the disease has been the way his lack of vision has hurt his ability to watch his kids grow.


“It hurts when I’m trying to watch my kids play soccer,” Callagy said. “I have to just focus on them. If they kick the ball, I have no idea where it goes, so I try to just follow them. I tend to lose track of them with everything that goes on, but I try my best to keep up. To me, that’s been the hardest part. I can’t enjoy watching them grow up the way I would love to.”


Callagy also talked about how his vision has hampered his ability to scuba dive and some of the other activities that he does with his family. He praised his family for their understanding and patience, and expressed how much help they have been.


“Vacations can be rough too,” he said. “There might be 50 fish right in front of you, but I can only see five. My family is amazing though, they are just so understanding and supportive. I couldn’t do this without their support.”


Callagy grew up as a baseball player in Emerson. He played baseball for Columbia University in 1992 and was even told that he could be drafted in the Major League Baseball draft. During his senior year, however, the disease started to really affect his play, causing him to lose track of fly balls in the outfield. In a game against Army, Callagy dropped a fly ball with the bases loaded, causing his team to lose the game. The MLB took notice, and Callagy never got his chance to play in the majors.


“On a cloudy day, it was hard to track the ball,” Callagy explained. “I would drop like one of every 50 balls, but in the majors, that’s still too much.”


Callagy explained that sitting through the draft was one of the hardest things that he had to do.


“It was really rough,” he said. “Imaging sitting there by the phone for three days waiting for a call, knowing that you won’t ever get one, but you’re just hopeful you will. It was hard for sure.”


Inspired to take a chance


After his baseball career was over, Callagy went into banking, working for a bank in New York for a year. He then decided to go to law school, hoping that he would be able to use his law degree to help people. He started working for a big firm, but left shortly after starting because he didn’t like how the firm treated their clients. After leaving the firm, Callagy sought counsel from doctor and friend Dr. Charles Berg, who prompted Callagy to read “Awaken the Giant Within” by Tony Robbins. The book explains how we all have something special inside of us, and gives tips on how to bring that special something out of us.


“That book changed everything,” Callagy said. “It gave me the inspiration to start doing my own thing, and to take a chance.”


Callagy started his own law firm in 2003 and had 40 people working for him. He also started his own educational company that year, after he realized how much he loved coaching and teaching people. In 2006, he started Callagy Law, with the company’s foundation built around the principle of education.


Since the disease has really begun to take hold over the past five years, Callagy said he’s had to memorize everything from his trials, and credits his lack of vision for making him an even better lawyer.


“My situation created a sense of urgency for me,” he explained. “Despite my disability, I knew I was the best lawyer in the room. What’s even better is the fact that everyone in the room knew it as well. That’s how my situation has been a benefit. We’ve won some really big cases in the past few years, and it’s all thanks to the dedication of my entire staff. We’re all growing and learning from this, which is really great.”


Callagy Law has won over $27 million in verdicts during the past two years, during the same time that Callagy’s vision started to take a turn for the worst.


Retinitis Pigmentosa will skip the next generation, but one of Callagy’s daughters most likely carries the trait. If she has a son, he most likely will get the disease, just like Callagy and his grandfather, the lawyer said. According to the United States Library of Medicine, Retinitis Pigmentosa typically affects more males than females and males’ symptoms are usually more severe. Callagy explained that the disease has no cure, but researchers are making huge strides in three areas.


“Right now there’s no cure but there are options out there,” he said. “The three big areas where research is going towards are the bionic eye, gene research, and stem cell research. It’s all about continuing to spread the word about the disease and continue to get funding for it.”


Despite the disease, Callagy has stayed positive throughout his journey and thinks that the situation has led him to help people even more than ever.


“Every day I ask myself the same question,” Callagy said. “How can I do more? What else can I do to help? I’ve learned to appreciate the little things, and that’s always been my message to others. We always take things for granted. I don’t do that anymore.”


Email: carroll@northjersey.com




Attorney perseveres despite debilitating vision loss

Wednesday, June 8, 2016

FAA Wins Bergen County Charity Classic in Final Appearance

FAA Family,


The FAA Phoenix won the Bergen County Charity Classic 16u Club Division in its final all-time appearance in the tournament.


Thank you to all the people who run this great tournament that raised over 100,000 for charitable causes. As always, it is a ton of fun to play a quality tournament in our home county.


It wasn’t our most impressive offensive effort, but we finished the job with a 2-1 victory over the LIB Expos.


Missing four outstanding players last night, including Joey Parsons and Johnny Apogar, who had big days with a hit and rbi and a save respectively, to help Waldwick reach the state finals for the Group 1 State Championship.


Jordan Issakedes and Travis Byrne combined to give up 1 run over 10 innings and a suicide squeeze by Jordan brought home the winning run in the 10th as Travis scored.


The FAA offense that had been roaring through the tournament was quieted in the 2-1 victory, but we did enough. Truth be told, we threatened in almost every inning but our normally clutch hitters weren’t getting our normal big hits.


In total, the FAA outscored our opponents 59-10 in the tournament over a 6-0 run through the BCCC. In addition to the above named, Chris Liriano scored a ton of runs, Tyler Callagy, Logan Butler, Travis Byrne and Anthony Rota (overall hit leader) led in hits with 29 combined, Andrew Rodriguez had some key hits and made a huge pick in a key spot in the championship at first, Luca Poliandro had big hits in the playoffs and picked off a runner in a huge spot in the championship game, Mike Roll picked up 2 wins in the playoffs, dominating in the semi-final, Ricky Lutz patrolled center field with his usual grace and ease, Brock Lombardi and Luke Lombardi chipped in with offensive and defensive help,


Many of our players have been playing in the BCCC since they were 10 years old. It is bitter sweet to have this one be over. The championship was terrific, but knowing that our boys are getting older and will never again play in the BCCC as it ends at 16u, brings both feelings of nostalgia and a bit of sadness.


The FAA parents were as always, terrific and supportive last night and throughout the tournament. However, we do need to unleash the Faa’s one and only Peter Poliandro who seems to have mellowed a bit in the 2016 campaign. We need a few “legs go, go, go, boys!”


I for one will be cherishing every pitch of every game all summer long. As my dear friend Bob Perry loves to say, “it doesn’t have to be this way.” We are so blessed and fortunate in the crazy cut throat world of club baseball to have built our FAA family, and I am so thankful for it.


This week, we take the FAA traveling road show to LBI. Friday afternoon and Saturday a.m. it will all be about body surfing and the beach. Saturday afternoon we take on the CK Cardinals, who have a typically strong program. We took second in LBI in the Fall, and we will be looking to change that this weekend.


Of course, good luck to Johnny, Joey, and yes, I guess Waldwick (lol, which is tough to say coming from Emerson–who did beat Waldwick for the league title this year guys!). Seriously though, bring it home for your team, your family, yourselves and the FAA program. You’re making incredible lifetime memories, and I hope this one has the perfect happy ending.


See you down the shore, where everything’s all right….


Coach Callagy



FAA Wins Bergen County Charity Classic in Final Appearance

How To Get A Big Jury Verdict from a Guy That Got 60 Million Total in 2 Years 

Lie, cheat, steal, swindle, manipulate and spin the facts. Yes, this is the picture most people have of lawyers and our legal system. Sadly, in many cases, those impressions are quite accurate.


However, that isn’t the way to truly win in our legal system. This article will briefly touch on the real keys.


My name is Sean Callagy, the founder and President of Callagy Law, a New Jersey, New York and Arizona law firm.


In 2014 I obtained a 33 million dollar verdict. In 2016 I obtained a 27.5 million dollar verdict. That puts me in a micro percentage group of attorneys who can make that statement.


Matt Damon, in the Rainmaker, makes a profound comment at the end of the movie when he decides to leave the law after an amazing victory of truth over lies. Essentially, Damon’s character muses that to keep doing it, he would likely need to become the evil he just defeated. The same evil he asked if he even remembered when he sold out.


Often, I feel that way in this profession. The amount of lies and gamesmanship that exist is enough to make any decent human being want to quit the human race. Then, you find your fair share of judges who let it go on, and even enable it.


So, if you can’t beat ’em, join ’em, right?


Wrong.


Integrity, authenticity and incredible hard work are the real secrets to success in our greatest system of lie detection on earth: the jury trial.


I believe that liars only win when they come up against the less skilled or hard working attorney.


The great benefit of dealing with liars in any case is that they don’t know when to stop lying. They lie so much that they begin to believe their own lies. Judges can become quite anesthetized to lying as well.


Juries, however, despise liars and lying. If you tell one lie as a lawyer, and the other guy approaches matters with integrity, then the liar is in huge trouble every time.


You see, juries, like all people, want to believe and find good in our system. They don’t expect to, but are very pleasantly surprised when they do. It restores their faith.


I believe that most attorneys don’t get this. They will try to hide, duck, dodge or flat out lie, to avoid problems in their cases. That may work for awhile, but it doesn’t work before a jury.


In both of these cases where I had the privilege of representing my clients, I believe the truth came shining through to the jury. That truth included acknowledging certain realities about the parties and the issues.


However, it is not enough to acknowledge a problem and gloss over it. Everyone says “draw the sting” from your problems. The real question is whether the jury believes what you believe. Your credibility, as a lawyer, is everything in front of the jury. Try to cheat on reality just a bit, and you are the lying lawyer they expected. Then, you better hope that the other man or woman is also seen as a lying lawyer and hope the jury believes you and your client is the lesser of two evils.


On the contrary, wouldn’t it be easier to be the voice of integrity, and therefore authority, in the court room?


It takes a ton of work to make this type of presentation. Like Matt Damon suggested though, would you want to do it any other way?


If you would ever want to discuss “how” to do this with a person who’s been blessed to do it, then please reach out and contact me. 


By the way, the jury awarded 8 and 16 million in punitive damages in these two cases. How do you think the juries perspective on integrity and authenticity factored into those verdicts?


Sean Callagy, Owner / Founder of Callagy Law  


“Fundamentally Changing the Way People Feel About Lawyers, One Client at a Time.”



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How To Get A Big Jury Verdict from a Guy That Got 60 Million Total in 2 Years 

Friday, May 27, 2016

Keeping Insurance Payments Flowing | Callagy Law

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. 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.



Billing insurance companies and collecting what you are entitled to collect can be a difficult process for medical providers. There are inevitably coverage issues, difficulties with navigating the ambiguities of policies, correct coding problems, and carriers will look for any discrepancy as a way to avoid payment.  Below are a few tips to help overcome or at least alleviate some of these issues.


Let’s begin with coding.  Employing a certified coder is a start.  It is best these days to hire a professional, who will stay educated on the latest coding practices and information, rather than simply someone who has general knowledge.  Coding has grown and continues to grow more and more complicated.  A certified coder reviewing the National Correct Coding Initiative (NCCI) tables will ensure that bundling errors do not hold up payments. A professional coder can navigate the labyrinth of codes so as to limit the carriers’ ability to delay payments for coding deficiencies.


Insurance policies too can be problematic.  Whenever possible a medical provider should obtain as much information about the insurance policy relevant to the treatment as possible.  This might mean the declaration page of an automobile policy or the health benefit plan description for a commercial insurance patient.  Knowledge of the policies and plans will help reduce, if not, eliminate unknown coverage pitfalls, and provide a better knowledge base of likely reimbursement levels.  Too often providers render services having little or no real knowledge as to what the reimbursement levels will be or whether or not they are even likely to be reimbursed.


The medical documentation also can raise issues.  A medical provider must make sure the supporting documentation matches the diagnosis codes, and should be very specific.  It is self defeating to be cavalier about explaining the need for and the medical necessity of all aspects of the treatment.  It is important to be aware of codes that need specific explanations for payment and ensure your documentation has the necessary explanations.


Finally, confronting denials as and when they happen, as well as having a competent and aggressive legal time at your disposal, will pay big dividends. You need collection personnel with tenacity and organization skills to pursue relentlessly the frequent follow up calls that are necessary.  Knowing payer systems and rules and asking the right questions of claims adjusters is also important.


These are some simple suggestions to combat the revenue roller coaster many providers face.  As a liaison for Callagy Law, I have seen some of my providers struggle with insurance payments, and these basic steps can help alleviate that struggle.



We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $200,000,000 for medical providers, and that number grows daily. Our team of knowledgeable PIP Arbitration attorneys are ready to help you. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.



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Keeping Insurance Payments Flowing | Callagy Law

Wednesday, May 18, 2016

To Start Up a Start-up | Callagy Law - Business Law Blog

In this blog post, Callagy Law will focus on topics to help people better their businesses. Clients often come to Sean Callagy’s team with questions about their businesses, ranging from contracts, disputes, and other common legal issues in the business world. We hope to answer some common questions with business owners their teams. Our mission is to answer any litigation and business law questions. Our goal is to help you avoid litigation and give you the necessary tools to run a successful business.



Approximately  90% of start-up companies fail.   With such a high failure rate, it is no surprise that the relatively few businesses that succeed tend to thrive—at least for awhile.  So, is there a secret to success?  Success is probably simpler than the statistics might suggest, but, as with anything, an entrepreneur must pay attention to what works and what does not.  There are about twenty-eight million small businesses in the United States.  Most will not succeed much longer, but a small percentage will thrive and continue to thrive.


 


One trait of a successful business—and it might seem obvious–is to create a product that fits the current market.  The most common reason new companies fail is that they make a product no one actually wants.  The owner/businessman might think he or she is offering a desirable product or service, but in reality it is a product or service he thought the public wanted.  In other words, it was a product or service he or she wanted and then they assumed the rest of the buying public thought the same way.


 


It is also important for the owner to work on the business, rather than in the business. Successful entrepreneurs understand that doing everything themselves might be necessary at the very beginning of a start-up, but business growth comes with proper staffing. An entrepreneur/owner acts as the captain of the ship and steers it in the right direction.  If the business owner works too much in the business, he or she will not be working on the business, that is, they will fail to ready the business for future success.


 


With a team of determined personnel, with a leader setting the direction and steering the company toward the goals set, a new business has a much greater of chance success. Versatility among the personnel is also important, because versatility involves mindset. Startup teams that are ready to change products, adjust plans, market differently, study other industries, or even start from scratch, are the ones that will make it.



We hope you found the information provided in this article helpful to your everyday life and business. Please free to reach out to Sean Callagy or the Callagy Law team at any time for questions you may have concerning personal and business matters. Callagy Law’s headquarters is located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of business legal practice and business coaching, if you need help with anything, please reach out to us by calling 201-261-1700 or by emailing us here. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube by clicking here.



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To Start Up a Start-up | Callagy Law - Business Law Blog

Monday, May 16, 2016

Callagy Law"s 27.6 Million Dollar Jury Verdict - NOT BAD!



Dear Client and Friend,


I hope this Monday Morning finds you doing well.  This is the first in what will be an ongoing communication from me to our client and other friend base.


One of my goals has been, for a long time, to build a sense of community around Callagy Law. The idea is to find likeminded people of integrity, empathy, caring, urgency, aggression and a desire to grow and live a life of passion and positive energy. We want this in the people with whom we work as both clients and business teammates.


As you may know, we post videos on our callagylaw.com website, our Facebook page, our LinkedIn page and throughout our social media. Please join us there to receive our videos and other content that is designed to foster that sense of community, fun, adventure and growth for you and your career.


Today’s Why Not message was about one of my favorite quotes: “The unexamined life is not worth living.” The challenge is to examine our lives and really determine in which areas we want growth and change.


The key though, is to focus as much on the feelings we want as the “things” we want. Peace, for example, is a critically important feeling for our life. Joy, fulfillment, adventure and many other feelings are also critically important for most of us. If we only focus on “things” or tangible outcomes (e.g., winning a trial), then we can miss many of the critical feelings we NEED in our life.


So, the quick message for today: examine your life and set your goals. I did this on Thursday, and it led to me on Friday ending up a half mile off shore in 50 feet of water free diving by myself in another country. While that’s a story for a different day, it was the result of this process, and a tremendous boost to my energy level and mind set!


By the way, for those that don’t know, we just obtained an over 27 million dollar jury verdict for our client Marc Wichansky. It has been a five year odyssey, which will be the subject of other videos and articles, but I want to thank our entire team for once again putting Callagy Law, and me personally, in America’s top 100 verdicts, as well as putting us in the running for Arizona’s highest verdict of 2016. The American jury system is the great equalizer and human lie detector. I am so appreciative for the work of Michael Smikun, Chris Miller, Robert Solomon, Sam Saltman, Taylor Gallo, Dally Shala and everyone at Callagy Law and outside the firm, who helped make this result a reality.


By the way, I think we are America’s only trial team to have two verdicts in excess of 27 million dollars within the past two years.  Not a bad team to have helping you with your legal challenges….


Also, we have added a Family Law team to our world of Callagy Law. Chris Cavalli and Brian McCann have joined the firm as partners and hold the special designation of Certified Matrimonial Attorneys. If you have any divorce, child custody or other family law issues, please call us, we are here to help.


Please also be on the lookout for live events we will be doing at the firm to help educate, inspire and even network as we continue to grow the Callagy Law community with awesome like-minded people.


I am so thankful to work with you, and I look forward to seeing you soon.


In your service,


Sean Callagy


Please subscribe on YouTube and spread the word.


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.


The Daily Why Not Huddle is for you if you want to exponentially increase your money, time, or fulfillment. The Why Not Huddle with business coaching expert, successful entrepreneur, and attorney Sean Callagy provide the essential daily ingredients for you to create and achieve your destiny.



Callagy Law"s 27.6 Million Dollar Jury Verdict - NOT BAD!

Friday, May 6, 2016

Success Is Easy—All It Takes Is Hard(er) Work | Callagy Law

Cael Sanderson is currently the head wrestling coach at Penn State.  Since he began coaching there, Penn State has won 5 National Team Championships in the past 6 years.  After winning 4 National Championships his first 4 years there as head coach, Penn State lost the year before last, and re-gained the title this past season.


I had heard stories about Cael Sanderson over the years—how he trained incessantly year after year–and was struck by one story my son told me when he was wrestling in high school.  My son’s high school coach, in an attempt to inspire his wrestlers at St. Joseph’s Regional High School in Montvale, New Jersey, showed a video about Cael Sanderson.  Cael Sanderson was undefeated in college, with a record of 159-0 and won 4 National Championships.  In the video the St. Joseph’s coach showed his wrestlers, Cael Sanderson, shortly after winning one of his National Championships, apparently had a bite to eat—well-deserved of course—and then immediately started training for the next season.  I thought to myself, “Relax a little.  Go see a movie.  Play some video games.”  But then I realized, it was no accident or coincidence, nor was it fate or destiny, nor luck, serendipity, or any other name for good fortune that brought him the success he achieved, and continues to achieve.  It is pure, unmitigated hard work and dedication, always beyond even the most dedicated wrestlers around him.  He took nothing for granted.  He believed he had room for improvement, no matter how successful he had been, and simply worked, and worked, and worked some more, and continues to do so, knowing there is always more room for more improvement.


So, what are we to make of this?  Okay, Cael Sanderson was a great wrestler and now a great wrestling coach, and he achieved his success through a great deal of hard work.  We are not all as dedicated as he is or perhaps as crazy to be so obsessed with something as to dedicate our entire being to it the way did and does.  Tell me something that is not obvious!


Well, you might come away from this with the moral that hard work and dedication pay off or are important to success.  You might think it is necessary to always strive to improve.  And both of those are noble lessons to have learned from the example of Cael Sanderson.


I have a slightly different take.  I come away from his example not thinking that success is hard, but that success is easy!  But by easy I am not suggesting you can be lazy and succeed.  Success is easy because, for the most part, all you need to do is work harder than everybody else, and, in most instances, that is not difficult to do.  I understand that Cael Sanderson had more going for him with wrestling than simple hard work.  So many things go into the level of success he enjoyed—the very highest level, a level that Sports Illustrated regarded as the second greatest college athletic achievement in history, behind Jesse Owens who set four world records in one afternoon.  But for the great majority of us, achieving success among our peers requires simply an increment over and above their performance.  It need not be a very great increment either.  It only needs to be enough to enable us to stand out.  We stand out by performing beyond those around us.  Perform over and above and you will succeed over and above.  It really is that simple.


Too often, people follow the pack, falling in line with the expectations of their peers, and succumbing to the pressures not to do too much.  That is fine if you do not want to succeed.  In fact, that is a sure-fire formula for not succeeding.  But if you do want to succeed and, indeed, excel, just raise the bar above the expectations of your peers and colleagues, not even necessarily by much, and success will come swifter than you can imagine, perhaps not in the form of 4 National Championships and an undefeated record, but at least enough to earn a raise or a promotion or your supervisor’s recognition.


Success is easy—all it takes is hard(er) work.  After re-capturing the National Championship for Penn State this past season, Cael Sanderson was quoted as saying, “We’re happy, but we leave here ready to improve, and build . . . .  We’re happy we won, but we are excited about the future also.”  I wonder how many other coaches at his level say that. My guess is that virtually any other coach would savor the moment, enjoy the high note he was on, and pay no mind to the next season for awhile.  Not Cael Sanderson.



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 you can subscribe to our daily videos on YouTube.



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Success Is Easy—All It Takes Is Hard(er) Work | Callagy Law

Thursday, May 5, 2016

Uninsured Employer’s Fund for New Jersey Workers’ Compensation Claims

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. 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 New Jersey Workers’ Compensation Law established the Uninsured Employer’s Fund (UEF) in order to provide benefits for any employee injured while working for an employer who did not have the required workers’ compensation insurance coverage.  Benefits from the Uninsured Employer’s Fund also paid to an injured employee when an uninsured employer does not pay the benefit payments awarded by the Division of Workers’ Compensation.  The benefits provided by the Uninsured Employer’s Fund include payment of medical expenses and temporary disability benefits.  These benefits are administered by The Office of Special Compensation Funds (OSCF).


When a Petitioner files a Claim Petition, the insurance carrier or the approved self insurance of the employer is indicated on the application.  If none is provided, then a search is performed with the Compensation Rating & Inspection Bureau to identify the whether the employer is uninsured.  In the employer is determined to have no workers’ compensation coverage, then an attorney for the Uninsured Employer’s Fund will be assigned to the claim and will appear at the scheduled court proceedings.



We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $200,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.



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Uninsured Employer’s Fund for New Jersey Workers’ Compensation Claims

Wednesday, May 4, 2016

Supreme Court upholds Agreement terminating alimony upon showing of cohabitation



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 practice area of Family Law. Our mission is to answer any questions and give knowledge to many different aspects of these matters.



In the recently published opinion Quinn v. Quinn (A-5-14, decided May 3, 2016), the Supreme Court upheld the parties’ divorce settlement agreement which provided for a termination of alimony upon cohabitation.  The majority’s decision is not surprising given the strong public policy favoring agreements and, absent a showing of fraud, coercion or overreaching, agreements will be enforced as written.  The wrinkle in the dispute was that, absent the parties’ agreement calling for an outright termination of alimony upon cohabitation, cohabitation may not have resulted in a termination of the obligation and the court would have had the discretion to modify or suspend the obligation.  In fact, the trial court in Quinn v. Quinn did suspend the alimony obligation for the period of cohabitation, rather than terminating the obligation in total, reinstating the obligation as of the date the cohabitation ended.  The trial court’s decision was affirmed on appeal, but the Supreme Court reversed, finding that the trial court was bound to enforce the parties’ agreement, which was entered freely, voluntarily and with the advice of independent counsel.  By failing to enforce the terms of the agreement, the trial court effectively created a different agreement not contemplated or intended by either party.


Two (2) of the Supreme Court Justices dissented noting the severe financial consequences to Ms. Quinn as a result of the termination of the alimony obligation.  The dissent believed that the provision of the parties’ agreement mandating a termination of alimony upon cohabitation is contrary to public policy and would effectively “pauperize” the ex-wife.  The dissent cites a lack of evidence of any financial or economic benefit received by the ex-wife as a result of the cohabitation.  The dissent viewed the anti-cohabitation provision in the parties’ agreement “as a means to oppress an ex-spouse,” viewing the provision as requiring the ex-wife to choose between her right to alimony and her “desire to enter into a loving relationship.”


The majority opinion, in addressing the dissents concern regarding the economic consequences, acknowledged the “serious” financial consequences to the ex-wife resulting from the termination of alimony.  However, the majority clearly felt that the ex-wife understood without doubt that her conduct could result in a termination of the alimony obligation, yet she proceeded to cohabit anyway.  Interestingly, Ms. Quinn stopped cohabitating just after her ex-husband sought to terminate the alimony obligation.  Yet, the majority found that the cessation of cohabitation was of no moment and irrelevant.  Will this open the door for similar applications to terminate or modify alimony obligations based upon cohabitation that existed months or maybe even years earlier, but subsequently ended?


The Quinn v. Quinn decision exemplifies the clash of equities often experienced in family law disputes.  Certainly Mr. Quinn believes that enforcement of the bargained for agreement was equitable and the majority of the Supreme Court agreed.  If nothing else, the Quinn decision should serve as a reminder that notions of equity and fairness are subject to judicial interpretation.



The Team at Callagy Law hopes the information in this article was helpful in either your personal or professional 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 additional law offices located across the United States. 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 here. Feel free to search us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.



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Wednesday, February 24, 2016

Establishing Usual/Customary Rates in Workers Compensation

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. 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.



 


In New Jersey, the Department of Labor and Workforce Development oversees Workers’ Compensation. Petitioner medical providers may file a claim to recover payments denied by the insurance carrier, a self-insured corporation, or a third party administrator.


 


Pursuant to N.J.S.A. 34:15-15, Medical and hospital service, “… All fees and other charges for such physicians’ and surgeons’ treatment and hospital treatment shall be reasonable and based upon the usual fees and charges which prevail in the same community for similar physicians’, surgeons’ and hospital services.” Because there is no workers’ compensation fee schedule in New Jersey, establishing usual, customary and reasonable fees are central to seeking additional reimbursement in a workers’ compensation claim.


 


Under New Jersey law, a medical provider, not an insurance carrier, “establishes [the provider’s] own customary rate.”  Cobo v. Market Transition Facility, 293 N.J.Super. 374, 389 (App. Div. 1996).  While an insurance carrier may review the medical provider’s fee to ensure that it has billed at its usual and customary rate, the provider is entitled to its billed rate so long as it is reasonable.  (See: Id. at 386). (emphasis added)  In determining the reasonableness of a medical provider’s fee, courts look to a number of factors, including the following: 1) the subject provider’s billing history, 2) disparity in charges to different insurance carriers, 3) what other providers are charging for the service.  (See: Id. at 387).


 


The Court in Cobo, citing 24 NJR 1348 further stated, “The provider, in submitting the billings, makes the initial determination as to what his or her usual, customary and reasonable fee is….thus, the scheme envisions that the health care provider will set its own customary fee, not the insurer or the insurer’s auditor.”


 


One way for a medical provider to establish usual, customary and reasonable fees is with exemplar Explanation of Benefit forms from insurance carriers and third party administrators indicating the usual and customary rate billed by the petitioner medical provider (and other medical providers) for the appropriate CPT Codes which had been reimbursed at 100%.  Specifically, the Explanations of Benefit forms demonstrate the consistency of a petitioner medical provider’s billing practices by documenting, regardless of insurance carrier or third party administrator, the usual and customary rates charged for the CPT Codes at issue.  Providing such Explanation of Benefit forms may expedite settlement negotiations.



 


We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $185,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.



 


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Establishing Usual/Customary Rates in Workers Compensation

Tuesday, February 23, 2016

Interlaminar vs. Transforminal Injections | Callagy Law

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. 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.



 


When disputing the use of a Transforaminal Injection as opposed to an Interlaminar Injection, Transforminal Injections have proven to present less risk to the patient and be more cost effective for a provider.


 


Specifically, regarding the differences between Interlaminar and Transforaminal Injection Approaches, studies have clearly established the following:


 


The interlaminar approach is the most common way of performing an epidural injection for all indications in anaesthesia […]This can be done with or without fluoroscopic guidance, but one of the many queries with regard to the varying efficacy of epidural steroid in studies has been the uncertainty of whether, by caudal or interlaminal route, the steroid has been accurately placed at the required site.


(See, “Epidural Steroids,” by Neil Collighan and Sanjeeva Gupta MD)


On the other hand:


 


The transforaminal approach is a selective injection aimed at a specific level and is always done under fluoroscopic guidance. […] Both the interlaminar and transforaminal approaches can be used at the cervical, thoracic, and lumbar levels. The benefits of the transforaminal approach, when performed by an experienced clinician, may include decreased risk for dural puncture with delivery of smaller volumes of steroid to the appropriate site of considered pathology. (emphasis added). [Id.]

 


In fact, in one recent study, the researcher concluded:


 


Transforaminal injection [is] superior in its ability to reach the site of pathology while being able to use even smaller doses of steroids. While the increased technical difficulties are noted to perform this method, his study showed better outcomes after a series of epidural steroid injections [with] the transforaminal approach followed by the caudal approach as a reasonable secondary approach.”[Id.]

 


Additionally, there is an established difference in cost effectiveness between the intralaminar method and the transforaminal:


 


Evaluation of the cost effectiveness of epidural injections including transforaminal steroid injections for the management of chronic low back pain revealed […] cost effectiveness of caudal epidural steroids at $3,635.00 and transforaminal steroids at $2,927.00 per year.


(See, “Transforaminal Lumbar Epidural Steroid Injections,” by Laxmaiah Manchikanti, MD)


 


Furthermore, with respect to the efficacy of the various injection methods:


 


the transforaminal epidurals appear to be clinically effective with a favorable outcome and cost effectiveness, compared not only to blind interlaminar epidural steroid injections and fluoroscopically directed caudal epidural steroid injections but also to numerous other modalities of treatment.”[Id.]

 


As stated above the Transforminal approach presents less risk of a dural puncture with the delivery of smaller volumes of steroid to the appropriate site of injury. The studies also showed better outcomes after repeat series of epidural injections via the Transforaminal approach as opposed the Interlaminar approach. Based on these recent studies and that fact that Transforminal injections represent a saving of up to $800 a year clearly demonstrate that the Transforminal approach is a better option for the health of the patient and for the treating provider.



 


We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $185,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.



 


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Interlaminar vs. Transforminal Injections | Callagy Law

Monday, February 1, 2016

Over-Specialization Can Adversely Affect American Healthcare

Is over-specialization creating more problems than good in our American Healthcare system? 




The purpose of this post is to help assist those with questions they have concerning their business or medical practice. 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.



Cardiologists, Oncologists, Urologists. One could go on and on naming the different types of specialists that comprise the medical profession. Although it is comforting to know that should a medical emergency arise there are dedicated professionals with years of specialized study and experience to help with nearly any particular ailment, there is a dangerous trend emerging in the United States healthcare system. Not only is there a projected physician shortage in the coming decades, but there is an even greater shortage of non-specialized, primary care physicians.


 


Primary care physicians, as the name suggests, are the doctors we rely on for check-ups, physicals, and other general medical care.  Alarmingly, fewer and fewer medical school graduates are choosing primary care for their residency training programs. To highlight this trend, between 1975 and 2010 the number of physicians in the United States has more than doubled, while during this same span there has been only a 10% increase in primary care physicians. This, coupled with a growing US population, has made it increasingly difficult to find a primary care physician.


 


There are a multitude of factors causing this trend.  One factor is earning potential. During residency training, there is not a significant pay difference. But, over a lifetime a specialist could earn upwards of $10 million more than a primary care physician. A second factor is quality of life and prestige. To many, the prospect of working and living in cities like New York or Boston, at a prestigious hospital like New York Presbyterian or Massachusetts General as a top surgeon, is surely more alluring than working in Des Moines or El Paso at a local, rural hospital as a geriatrician. While there are additional problems, including federal residency funding, that feed into the primary care shortage, unless there are critical changes made in the US healthcare system this alarming trend will continue.


 


Thankfully, there are efforts on the part of many schools and legislatures to address the problem of the primary care shortage. Medical schools at the University of Wisconsin and the University of Washington, for example, offer rural medicine programs that offer incentives such as reduced tuition and preferential admission. Many states are also empowering licensed nurse practitioners (LPNs) to provide primary care to ensure that all state citizens have access to medical care regardless of location. While these efforts represent the sort of action needed to tackle the problem of overspecialization, there is much more to be done.



 


We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $185,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.



 


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Over-Specialization Can Adversely Affect American Healthcare

Monday, January 18, 2016

A Closer Look into Amendments | Callagy Law

15 Million Civil Lawsuits Are Filed Each Year in the United States | More insight into amendments




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 business and commercial litigation. Our mission is to answer any questions and give knowledge to many different aspects of these matters.



 


 


According to the latest polls, 15 million civil lawsuits are filed each year. That is one lawsuit for every twelve adults in America and one filing every two seconds. One overarching flaw that a majority of these complaints and their corresponding answers have in common is that they fail to name all the proper parties or assert all the proper claims or defenses. The mechanism to fixing these mistakes is called an amendment.


 


In the trial level court of New Jersey, called the Superior Court, one of the rules governing amendments is 4:9-1. Specifically this rule allows a party to amend their pleading once at any time before the opposing party responds. After a party a responds, there are then only two avenues to amend: one is by consent of the other party and the other is by leave of court which “shall be freely given in the interest of justice”


 


The phrase “in the interest of justice” is quite broad and may leave many readers wondering what courts will look to decide if an amendment fits into this phrase. While there a handful of factors that a court analyzes in reaching this conclusion, the overwhelming consideration is the prejudice that will be suffered by the other party if the amendment is granted.


 


In Keller v. Pastuch, the Plaintiff, who were husband and wife, brought suit against an automobile driver after the car the wife was riding in was struck by the Defendant. 94 N.J. Super. 499, 501 (App. Div. 1967). On the opening day of trial the defendant sought leave of court to amend his answer to include a new defense. Id. Subsequently, the court granted a mistrial and heard, later on that same day, oral arguments on whether the amendment should be granted. Id.


The plaintiffs argued that they would be substantially prejudiced due to the lateness of the defendant’s proposed amendment. Id. In response, the defendant argued that he did not know this defense was available to him until a recently conducted interview. Id. at 503. The court sided with the plaintiff and held that the defendant could have asserted the defense earlier, which in turn would have allowed the plaintiff’s to preserve their rights.


 


By contrast, in Sheppard v. Braun the court granted plaintiff’s motion to amend to add two new parties. No. ATL-L-1900-05, 2005 WL 2560782, at *1 (N.J. Super. Ct. Oct. 7, 2005). The plaintiff, a car accident victim, sought to add the Borgata Hotel after he recently learned that the hotel may have been serving alcoholic beverages that contributed to the accident. Id.  The court summarily granted the motion, due to the fact that it was unopposed and no trial or arbitration date had been set. Id.


 


Thus, as a litigant it is important to act swiftly when amending a pleading, so as to ensure that the opposing party is not prejudiced and thereby causing the court to deny the amendment.



 


Sean Callagy, the owner and President of Callagy Law is an attorney, business coach, public speaker, and entrepreneur; and is dedicated to the personal and business growth. Please reach out to us here with any questions or comments regarding personal or business matters. We will to continue to provide daily updates with helpful information on our website and social media. Please feel free to contact Callagy Law at anytime. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube by clicking here.



 


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A Closer Look into Amendments | Callagy Law

Wednesday, January 6, 2016

Section 20 Settlements | Callagy Law

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



 


 Section 20 Settlements


 


According to N.J.S.A. 34:15-20, the parties to a workers’ compensation claim petition may settle the claim where (1) jurisdiction, liability, causality and/or dependency are disputed; (2) the parties wish to resolve the claim with a lump sum settlement; (3) the parties consent to the settlement; (4) the parties are represented by Counsel; and (5) a judge of compensation determines that the settlement is fair and just under the circumstances.  Notably, once the settlement is approved, it shall have the force and effect of a dismissal of the claim petition and shall be binding on the employee and employee’s dependants.  Id. Such settlements are commonly referred to as “Section 20 Settlements” based on N.J.S.A. 34:15-20.  In relevant part, N.J.S.A. 34:15-20 states:


34:15-20. Dispute; submission to division; order approving settlement.



After a petition for compensation or dependency claims has been filed, seeking compensation by reason of accident, injury or occupational disease of any employee, and when the petitioner is represented by an attorney of the State of New Jersey, and when it shall appear that the issue or issues involve the question of jurisdiction, liability, causal relationship or dependency of the petitioner under this chapter, and the petitioner and the respondent are desirous of entering into a lump-sum settlement of the controversy, a judge of compensation may with the consent of the parties, after considering the testimony of the petitioner and other witnesses, together with any stipulation of the parties, and after such judge of compensation has determined that such settlement is fair and just under all the circumstances, enter “an order approving settlement.” Such settlement, when so approved, notwithstanding any other provisions of this chapter, shall have the force and effect of a dismissal of the claim petition and shall be final and conclusive upon the employee and the employee’s dependents, and shall be a complete surrender of any right to compensation or other benefits arising out of such claim under the statute.


Parties should be aware of the availability of Section 20 settlements when defending/pursuing workers’ compensation claims as an option to avoid protracted litigation. Indeed, Section 20 Settlements are particularly appealing where the costs of defending against or pursing a claim are not sensible in light of the value claim. However, when entering into a Section 20 settlement, the parties should be mindful of the fact that such a settlement will likely bar any subsequent claims by the petitioner and such employee’s dependants.



 


 We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $175,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.



 


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Section 20 Settlements | Callagy Law

Monday, December 28, 2015

Promises and Failure to Perform | Callagy Law

Expanding the legal analysis beyond contract law limitations. 




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 business and commercial litigation. Our mission is to answer any questions and give knowledge to many different aspects of these matters.



 


When most lawyers are given a factual situation that includes a promise, their mind will undoubtedly begin to analyze it as a potential contract. Promises, in the legal world, are tricky things. Most first year law students spend the better part of a semester distinguishing when a promise is an enforceable contract vs. mere banter. As any of those first year law students will (hopefully) be able to tell you by the end of that semester, is that if the promise lacks “consideration” – or something of value (either a promise, an act or an object) that a promisor receives from a promisee in return for his promise – it is generally unenforceable as a contract. While this is a vast oversimplification of centuries of contract law, it is safe to say that issues involving a promise are almost always analyzed under theories of contract.


This tendency to analyze promises under a contract theory leads to several limitations. First, unless the court finds sufficient consideration, any claims arising from the promise will fail. Second, the damages one may recover under a contract theory are usually limited.


In certain situations however, a promise, and the subsequent failure to deliver on that promise, is still actionable. Instead of a contract, though, the promise is actually considered under a “tort” theory, specifically, a claim for fraud. For example, in Arizona,  to prevail on a constructive fraud claim, a plaintiff must prove: (1) Defendants had a fiduciary or confidential relationship with Plaintiffs that gave rise to a legal or equitable duty; (2) Defendants breached that duty; (3) the breach tends to deceive others, violates public or private confidences, or injures public interests; and (4) the breach induced detrimental and justifiable reliance.” Dawson v. Withycombe, Provided that the Plaintiff can prove the first three elements, a promise to perform, which is not ultimately fulfilled, can be used to satisfy  the fourth element.


It is the general law that to constitute a fraudulent misrepresentation, the representation must be relative to a present or preexisting fact and cannot be based on unfulfilled promises or statements as to future events. Law v. Sidney. However, a promise made without a present intention to perform the promise,  is considered to be a matter of fact which exists in the present. Starkovich v. Noye and Ahmed v. Collins. Many states in addition to Arizona provide for recovery under a similar set of facts and circumstances.


As such, a promise which does not meet the formalistic requirements of a contract cause of action can still be used as the basis of a cause of action under a constructive fraud theory. The limitations on damages which are present in a contract cause of action are also replaced by those applicable to a tort theory – which may include punitive damages.


We hope you found the information provided in this article helpful to your everyday life and business. Please free to reach out to Sean Callagy or the Callagy Law team at any time for questions you may have concerning personal and business matters. Callagy Law’s headquarters is located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of business legal practice and business coaching, if you need help with anything, please reach out to us by calling 201-261-1700 or by emailing us here. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube by clicking here.



 


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Promises and Failure to Perform | Callagy Law

Thursday, December 17, 2015

Uber-Important: Employee Contracts! | Callagy Law

The Difference between an Employee and an Independent Contractor and its Legal Ramifications



 


The following article was written by Samuel S. Saltman from Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the business and commercial litigation. Our mission is to answer any questions and give knowledge to many different aspects of these matters.



 


Uber is finding out the hard way that formal written employment contracts are … uber important.


The booming ridesharing company has lost recent legal battles over the classification of its drivers as either employees or independent contractors. The drivers sued for, among other things, unemployment benefits and outstanding business expenses. In these cases, whether Uber drivers are classified as employees or independent contractors makes all the difference: If the former, they are entitled to the compensation they seek; if the latter, nothing.


Clearly, the law treats employees much better than it treats independent contractors. Unlike independent contractors, employees are covered by a multitude of state and federal laws, including minimum wage, overtime, antidiscrimination, workers’ compensation benefits, and, of course, business expenses and  unemployment benefits. There are also significant tax withholding differences between the two.


So what distinguishes an employee from an independent contractor? While there is no bright-line rule, courts focus on a variety of factors, including:


  • whether the worker can earn a profit or suffer a loss from the work (if so, more likely an independent contractor);

  • whether the worker earns a wage or is paid per job/project (if the former, more likely an employee; if the latter, independent contractor);

  • whether the worker invests in equipment (if so, more likely an independent contractor); and

  • whether the worker provides services that are integral to the company’s day-to-day operations (if so, more likely an employee).

From a company’s perspective, both classifications have pros and cons. For Uber, having to pay, for example, overtime and worker’s compensation benefits to its thousands of drivers across the country is clearly an expense inimical to its business model – or so it thinks. But Uber does exert significant control over its drivers in the form of sole discretion over fares, the right to charge drivers a cancellation fee if they reject a passenger, prohibitions against picking up passengers without using the Uber app, and the right to suspend or deactivate drivers’ accounts. Uber drivers appear to be telling their “employer” – you can’t have our cars and drive them too.


Despite the recent Uber driver victories, states across the nation are split on the issue of their classification. Georgia, Pennsylvania, Colorado, Indiana, Texas, New York, Illinois, and California have found them to be independent contractors, although a recent case in California is challenging that. The lesson to be learned here is that whatever classification you decide is right for your business model, it’s best to put the terms of employment into a formal written agreement signed by the worker.


Even written agreements, however, are not fail-proof. The actual circumstances of the relationship matters more. Of course, a carefully worded written employment agreement should dictate those circumstances and will strongly support the company’s position in court. At Callagy Law, we have years of experience drafting such agreements and enforcing them in court, and can advise you every step of the way to ensure that you and your workers have an uber-clear understanding of your relationship.



 


We hope you found the information provided in this article helpful to your everyday life and business. Please free to reach out to Sean Callagy or the Callagy Law team at any time for questions you may have concerning personal and business matters. Callagy Law’s headquarters is located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of business legal practice and business coaching, if you need help with anything, please reach out to us by calling 201-261-1700 or by emailing us here. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube by clicking here.



 


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Uber-Important: Employee Contracts! | Callagy Law

Wednesday, December 16, 2015

Must Know Info For Medical Providers | Callagy Law

Providers Making The Most Out of Recovery



 


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.



 


Medical Providers are busy people, as are their patients.  Doctors are (and should be) more preoccupied with treating their patients and increasing the quality of their lives, rather than dealing with administrative paperwork.  That is why medical providers rely upon their office staff for assistance.  In the hustle and bustle of day to day treatment of patients, some doctors pay less and less attention to the underlying business aspects of their practice. However, it is important that medical providers themselves stay informed as to how to optimally recover money for the treatment and procedures they provide.


Insurance carriers will deny a claim for many reasons – need for additional records, amended bills, etc.  It could take over a year in some cases for a medical provider to be reimbursed.  Obviously, this has a detrimental impact on a medical providers’ expected cash flow.


So what can a medical provider do to overcome these denials and delays?  A medical provider should be aware which procedures are covered by the patient’s insurance policy.  More information is also available on http://www.cms.gov and/or on the insurance carrier’s website.  For instance, Medicare makes payment for an assistant at surgery when the procedure is authorized for an assistant and the person performing the service is a physician, physician assistant, nurse practitioner or clinical nurse specialist.  A medical provider should try to get pre-authorization from the insurance carrier, while also being mindful of other denial issues, such as a perceived lack of medical necessity.


If a medical provider wants to proceed on a non-covered procedure, they should be aware in advance that the insurance carrier will deny payment.  If a medical provider is considering charging the patient, they should be sure to have an agreement with the patient in writing prior to surgery. Billing after surgery is not always the best business policy for medical providers and may even be in violation of a contract if they are in-network with particular insurance carriers. Moreover, balance billing the patient in most cases is not permitted in PIP (Personal Injury Protection) and Medical Provider Workers’ Compensation claims.


The medical provider should specific services he or she performs in its operative report, ensuring that every CPT code in the bill correlates with the operative report.  Insurance carriers will usually reference the operative report to confirm this information and will sometimes request the assistant surgeon’s medical records.   A medical provider should be prepared to get involved and file multiple appeals in order to be reimbursed.


However, the most important step in the entire process occurs in the pre-surgery stage– don’t be afraid to communicate with the insurance carriers about what documents and information they need to efficiently and effectively process the claim, what procedures are authorized, and what is the expected reimbursement rate.  Be sure to thoroughly document these conversations, or better yet, get it in writing.


Of course, it is very important to hire a law firm to review claims, handle appeals and proceed to litigation, as doctors are very busy with treating their patients – which is what matters most.



 


We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $175,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.



 


 


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Must Know Info For Medical Providers | Callagy Law