Synopsis: Illinois Docs Go After WC Insurance Carriers Over 12% Annual Interest on Unpaid Medical Bills. Gene’s Vote is Rotsa Ruck With This Litigation—Go Back to the Legislature.
Editor’s comment: Every doctor I know gets irate/mad/sad to see the 2011 Amendments to the IL WC Act
- Cut their reimbursements for the second time under the 2011 Amendments to the IL WC Medical Fee Schedule;
- Expanded on the areas being cut and
- Supposedly provided them with 1% per month interest on unpaid medical bills.
The fighting/litigation over the 1% per month interest on unpaid medical bills erupted into the Circuit Court of Cook County where our judiciary noted the remedy had no provision to allow it to be enforced by the doctors, hospital and other caregivers. Ooops.
Last week, a federal judge refused to dismiss a class-action lawsuit that alleges IL workers' compensation carriers engaged in a conspiracy to avoid the 1% monthly interest on late medical bills payments. This class-action lawsuit was brought against more than 80 insurance carriers, including some of the largest U.S. and international work comp carriers and claims-management firms. As the claim survived, it will now proceed to discovery. As part of the discovery process, Plaintiffs' attorneys hope to shed light on the practices of ignoring the statutory fiat that appears to require payment of such interest..
U.S. Federal District Judge Nancy Rosenstengel denied a defense motion to dismiss. She ordered Plaintiffs to restate the complaint's fraudulent concealment allegations with more specificity. The amended complaint is due by Aug. 2. If you want her order, send a reply.
The problem I feel is present is our nutty IL legislators who repeatedly create laws that seem effective but without any penalty or path to enforce them. Please note in Indiana it is possible for a caregiver or hospital to start a work comp claim in their own right—they don’t need or want the help of the patient. The IN WC Board can and will get involved to require the insurance company to properly pay a medical bill. The IL WC system has no such concept or remedy—all benefits flow through Claimant and Claimant’s attorney. If Claimant and their attorney isn’t concerned about an unpaid medical/hospital bill, the caregiver can and does routinely get stuck negotiating for less money and losing the statutory interest ostensibly due.
Of very recent vintage, the Illinois Appellate Court in Marque Medicos v. Liberty Mutual Insurance rebuked Liberty Mutual Insurance for their alleged failure to pay medical bills for treatment of a number of injured workers. The Appellate Court confirmed IL doctors were provided no recourse to force reimbursement or interest payments, because the IL WC Act does not provide standing to seek payment to medical providers.
In a move to close that loophole in the law, the Illinois legislature this year passed Senate Bill 904, which would allow doctors to bill employers directly, require insurers to pay interest at 2% monthly on overdue medical bills and authorize providers to sue in court to collect payment. You will note that bill isn’t law just yet. The bill is awaiting action by Republican Gov. Bruce Rauner, who has not indicated he plans to sign it into law. The Illinois State Medical Society, long outraged by insurers' alleged stalling tactics, lobbied for the bill and has aggressively urged Rauner to sign.
Plaintiffs in the Beatty claim are taking a different tack than in previous suits. Instead of relying solely on the provisions of the IL WC Act, the lead Claimant Beatty argues the IL WC insurance companies engaged in a pattern of “fraud” prohibited by the Illinois Consumer Fraud and Deceptive Business Practices Act.
The complaint alleges insurance WC carriers fraudulently concealed their failure to pay the statutory interest due Plaintiff and the proposed class by employing a number of tactics, including:
- ◾Providing false information on the name of the insurance company, which prevents doctors from pursuing payment from the correct carrier.
- ◾Transmitting false information in explanations of benefits (EOBs). "Such false information is transmitted for the purpose making it appear on the face of the EOB that payment was timely, and concealing that the payment was outside the time limits proscribed" by law.
- ◾Failing to provide EOBs at all in settlements or rulings by the Workers' Compensation Commission, which makes it impossible to determine if payments were made in a timely fashion.
- ◾Sending payments without including interest.
- ◾Giving false information to the worker on when the request for payment was received.
The federal complaint also charges IL WC insurers did not act in isolation, but were part of what is claimed to be an industry-wide effort to thwart payments of reimbursements and statutory interest to doctors. Yawn. The IL WC carriers are alleged to have participated in trade associations that developed such practices and purchased software that magically does not calculate interest payments due to physicians.
Please note the practice of “balance billing” is similarly illegal under the IL WC Act. No penalty or proscription is assigned; in my view, balance billing continues by medical providers on occasion. Hard to imagine a class action about a “conspiracy” in by doctors’ balance-billing would go anywhere.
I don’t agree with this litigation and I predict it will be eventually dismissed; that may happen in the Seventh Circuit Court of Appeals or U.S. Supreme Court in several years. Enjoy the interminable wait. We will continue to report progress and see where it goes.
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Synopsis: Amended Illinois Supreme Court Rule Requires Additional Phrase for All Civil Summons. Analysis by our GL team leader, Brad Smith.
Editor’s comment: A recently-amended Illinois Supreme Court Rule requires the following language to be added to all civil summons:
E-filing is now mandatory for documents in civil cases with limited exemptions.
To e-file, you must first create an account with an e-filing service provider. Visit https://efile.illinoiscourts.gov/service-providers.htm to learn more and to select a service provider. If you need additional help or have trouble e-filing, visit http://www.illinoiscourts.gov/FAQ/gethelp.asp or talk with your local circuit clerk's office.
The language, "or talk with your local circuit clerk's office" was added to the Rule on July 19. The amended Rule takes effect immediately.
The new requirement also applies to the following rules:
• Rule 108 Notice to Heirs and Legatees
• Rule 110 Rights of Interested Persons During Independent Administration
• Rule 113 Notice of Entry of Default and Judgment of Foreclosure; Special Notice of Surplus Funds
• Rule 291 Proceedings Under the Administrative Review Law
• Rule 292 Form of Summons in Proceedings to Review Orders of the Illinois Workers' Compensation Commission
For further information contact Brad Smith at email@example.com.