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In the event you are planning on contacting any
attorney
regarding medical
malpractice, negligence, wrongful death or anything non emergency
related
please:
- Gather your medical records - Order them
immediately from Kaiser
following
your states request for medical records procedures.
Instructions
and sample forms are at: http://www.harp.org/recordmethod.htm
- Do not tell Kaiser or let them know what your
intentions are. You
may be taking a chance of having your medical records altered by Kaiser
Medical Legal Department before you receive them if you do.
- Calmly and with as little emotion as possible
write out a concise
statement
of what took place. If possible also write out a
timeline.
- Your first question to any attorney should
be: Do you or have you
ever represented an HMO? If the answer is yes then ask
questions
about the attorney's involvement with the HMO to satisfy yourself that
if you hire him/her you will feel comfortable with the arrangement.
- Realize that all victims of the Kaiser system
feel that their case is
unique
and will be the one that will make change. The truth is that
only
by having all cases made public will any change be made. The
Kaiser
arbitration system will not as a rule make this information available
to
the general public.
- Read:http://legalstuff.kaiserpapers.info/surarib.html How To Survive A Kaiser Arbitration. This page is not well
written
but it certainly presents the truth. Make sure you go into
this
with
open eyes. A Kaiser Arbitration costs more money than a
conventional
court proceeding. Whether the client foots the bill or the
attorney
initially it is rare to do much more than recoup your
expenses.
True
justice in this form of legal proceeding is rare. No one can
bring
back your health or a loved one's life. This is a closed
civil
proceeding
that probably will never see the light of day - realize that from the
start.
- The hardest part as a victim of
medical negligence or malpractice
or as a survivor of a loved one wrongfully killed is being told that a
persons financial worth is based upon their potential earning
capacity.
If you are very young and die or if you are elderly that is not very
much
money. It is not fair nor is it morally correct but it is
what
the
law says and none of us can do anything about that.
The following is extremely important as Kaiser hopes that you will not
learn about it.
A Calif. appellate
court has ruled
that a mandatory arbitration agreement is not binding on adult children
suing for
wrongful
death of a
parent.
The
case is Buchner
v. Tamarin,
Calif. 2d Appellate Distr. #B149385
Who
WILL be bound by
the patient's
agreement to arbitrate?
1.
an agent can bind
a principal
-
2.
spouses can bind
each other
-
3.
a parent can bind
a Minor child.
If
you have Kaiser
insurance
through your employer, it is an ERISA plan, and effective January 1 of
this year, 2003, you cannot be forced into arbitration.
Government at all
levels and Church
employees are not subject to ERISA.
New
regulations make it clear
that ERISA plans may not require mandatory arbitration.
However,
Kaiser is likely to ignore these regulations and refer
to the
contractual provisions
that require arbitration, so it is important that you be very clear
about
your ERISA rights so that you can enforce
them.
The Department of
Labor can clarify
any questions about under ERISA plans. Their hotline is
866-275-7922
The specific
regulation section
is 29 CFR 2560.503-1:
(c) Group health
plans.
The
claims procedures
of a group
health plan will be deemed to be reasonable only if, in addition to
complying
with the requirements of paragraph (b) of this section-
.
. .
(4) The claims
procedures do not contain any provision for the mandatory arbitration
of
adverse benefit determinations, except to the extent that the plan or
procedures
provide that:
(i) The arbitration is conducted as one of the two appeals described in
paragraph (c)(2) of this section and in accordance with the
requirements applicable
to such
appeals; and
(ii) The claimant is not precluded from challenging the decision under
section 502(a) of the Act or other applicable law.
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