The Business of Not Paying Claims

December 28, 2007

Death by Profit Margin

Insurance companies make money by finding ways to not pay claims. That’s the truth of it. This past week, we sadly saw the result of this in the death of Nataline Sarkisyan. From the CA Nurses Association: On Dec. 11, four leading physicians, including the surgical director of the Pediatric Liver Transplant Program at UCLA, wrote to CIGNA urging the company to reverse its denial. The physicians said that Nataline “currently meets criteria to be listed as Status 1A” for a transplant. They also challenged CIGNA’s denial which the company said occurred because their benefit plan “does not cover experimental, investigational and unproven services,” to which the doctors replied, “Nataline’s case is in fact none of the above.”

The CA Nurses Assoc. organized a massive protest against Cigna’s spreadsheet-based decision, but the turnaround from Cigna came too late for Nataline, who passed away without ever receiving her transplant. C&L has news video on the story, and it is absolutely heartbreaking.

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PEACE!

December 24, 2007

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HAPPY HOLIDAYS!!!!!!!

December 24, 2007

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Not Such a Good News…

December 19, 2007

I often thought they were doing something right there in Madison County for them to remain constantly in the cross hair of the anti-consumer, anti-justice, anti-American-Justice-System and pro-business groups such as the American Tort Reform Association. I wonder what changes have been implemented for ATRA to let Madison County fall short of its Blue Ribbon position on the List… More on that later.

Group: South Florida top `judicial hellhole’; Ill.’s Madison County falls from list

On Tuesday, the American Tort Reform Association left Madison County off of its rankings of “judicial hellholes” for the first time in the list’s six years — big stuff for the local court system that once topped the rankings for three years in a row.”It’s a very upbeat time for all of us in Madison County,” said Callis, the seven-year circuit judge who became chief judge in May 2006. While cautioning she’d never put much stock in what the pro-business lobbying group considers the worst legal venues for lawsuit defendants, the newest rankings “indicate we continue to move forward, making progress.”

The newest list is topped by South Florida, followed by Texas’ Rio Grande Valley and Gulf Coast, Illinois’ Cook County including Chicago, West Virginia and Nevada’s Clark County that includes Las Vegas.

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More on Avandia

December 19, 2007

Nurse’s Family Files Avandia Wrongful Death Lawsuit against GlaxoSmithKline

Rogelio Larosa and his adult son, Eric, of National City, San Diego County, California, filed a lawsuit on Monday, December 17, 2007, against Philadelphia-based GlaxoSmithKline (“GSK”), the maker of Avandia (rosiglitazone maleate), in U.S. District Court, Southern District of California (San Diego) accusing GSK of causing the wrongful death of a Chula Vista nurse due to its negligence, fraud, breach of warranty and a failure to warn about the risks of its drug, Avandia.Milagros LarosaThe lawsuit alleges that Milagros Larosa, 65, over the course of one year, was hospitalized three different times for heart problems, classified as myocardial ischemic events (a painful heart condition caused by blockage or lack of blood flow to the heart) and ultimately suffered a fatal stroke, caused by the Avandia she was taking for her type 2 diabetes. She had no prior heart problems or any type of a heart condition before starting Avandia.

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In the Trenches Fighting for Justice

December 15, 2007

A Small Firm Wages ‘100 Years’ War’ on Tort Reform

Attorney Robert Peck and his nine law firm partners at the Center for Constitutional Litigation in Washington look like average plaintiffs lawyers when they walk into courtrooms around the country, but they’re not.

They are the lawyers to trial lawyers nationwide, fighting “tort reform.” The center’s attorneys are on retainer for the trial lawyers’ trade group, the American Association for Justice (formerly the Association of Trial Lawyers of America) and pursue cases to overturn state and federal laws that they allege rob Americans of legal redress.

The center’s attorneys have 40 cases pending across the United States in which they are helping plaintiffs challenge government limits on tort claims, such as state caps on medical malpractice damages and federal legal immunity for rental car companies and gun manufacturers.

“We are often in a case because there’s some impediment to having your day in court,” Peck said.

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How Accurate is a Mammogram?

December 13, 2007

Accuracy of Diagnostic Mammogram Interpretation Varies by Work Setting

Radiologists at academic medical centers are more likely to interpret diagnostic mammograms accurately than those at non-academic centers, according to researchers here.

So found a review
of 123 radiologists who interpreted 35,895 diagnostic mammography
examinations at 72 facilities that contribute data to the Breast Cancer
Surveillance Consortium, Diana L. Miglioretti, Ph.D., of Group Health
Cooperative, and colleagues reported online in the Journal of the National Cancer Institute.

After
controlling for patient characteristics, radiologists working in
academic medical centers achieved a median sensitivity of 88% (95% CI:
77% to 94%) versus a median sensitivity rating of 76% (95% CI: 72% to
79%) for non-academic radiologists.

So found a review
of 123 radiologists who interpreted 35,895 diagnostic mammography
examinations at 72 facilities that contribute data to the Breast Cancer
Surveillance Consortium, Diana L. Miglioretti, Ph.D., of Group Health
Cooperative, and colleagues reported online in the Journal of the National Cancer Institute.

After
controlling for patient characteristics, radiologists working in
academic medical centers achieved a median sensitivity of 88% (95% CI:
77% to 94%) versus a median sensitivity rating of 76% (95% CI: 72% to
79%) for non-academic radiologists.

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Another Recall

December 13, 2007

Merck Recalls Million Doses of Hib Vaccine

Merck has issued a voluntary recall of one million doses of its Haemophilus influenzae type b vaccine, an action that the CDC said does not threaten public health but will cause a serious vaccine shortage.

Merck decided to recall the vaccines after tests at a manufacturing plant in Pennsylvania identified a malfunction in the sterilization process that could have allowed microorganisms to survive the process.

Both the CDC and the FDA emphasized that they have no evidence of contaminated vaccine, nor have there been any reports of adverse events associated with use of the suspect vaccines.

Moreover, the recall does not affect potency so there is no need for revaccination of children who received vaccinations from the affected lots.

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