The Texas Prompt Pay Act and Pharmacies

Posted by on Dec 23, 2014 in Insurance Laws | 0 comments

The Texas Prompt Pay Act (TPPA) took effect in 2003, but it wasn’t until eight years later in 2011 that the issue of delayed payments to contracted pharmacies was addressed.

The TPPA is a piece of legislation that was four years in the making, beginning in 1999 when the first bill was passed to the state’s House of Representatives. Several revisions later, it was finally signed by Texas Governor Rick Perry which effectively made it a law on September 3, 2003. It addressed the issue of timely payments made to health service providers by Health Management and Preferred Provider Organizations (HMOs and PPOs), or rather the lack thereof.

HMOs and PPOs are health insurance companies that typically contract with third-party providers to do the actual service and in exchange the companies would pay the service providers. Unfortunately, as stated on the website of law firm Williams Kherkher, it became common practice for these carriers to delay payments for claims, and the service providers lobbied for legal leverage to use against these carriers to discourage them from stretching the gap between the service rendered and actual payment.

But the TPPA did not specifically include pharmacies in the list of covered service providers. It wasn’t until House Bills 528 and 2292 were passed in 2011 that it was finally clarified that not only pharmacies but Pharmacy Benefits Managers contracted with HMOs were eligible for protection under the TPPA. Under the clarified TPPA, insurers had 18 days after a clean claim was electronically filed by the pharmacy to pay or explain why a claim is denied. The sanctions for late payments are similar to those for doctors and hospitals except that the late periods are 19-63 days, 64-108, and 109- up.

If you believe that you are eligible for TPPA protection, you need to determine if you are correct in your belief. Consult with an experienced prompt pay lawyer in your area before filing a complaint.

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Domestic Violence Laws in Texas

Posted by on Nov 6, 2014 in Crime | 0 comments

Domestic violence is considered a crime in the state of Texas and it is applicable to any acts of violence committed against any member of a family, a household, or someone who the offender is dating or have dated in the past. These include:

  • Current or past spouse
  • A person with whom the offender lives with
  • A member of the family, whether by blood, adoption, or marriage
  • A child of a past or current partner
  • Someone whom the offender has a child (or children)
  • The offender’s foster parent or foster child
  • Anyone with whom the offender has a present romantic relationship or is currently dating

The state of Texas recognizes three types of domestic violence: domestic assault, aggravated domestic assault, and continuous violence against the family. According to the Texas Penal Code § 22.01., anyone can be guilty of domestic assault when they (1) threatening another person with impending physical harm intentionally or knowingly, (2) knowingly or intentionally committing physical contact a person with whom the offender reasonably is aware that the victim would find offensive or provocative, and (3) causing physical injury to a person intentionally, knowingly or recklessly.

Mark Lassiter, Attorney at Law explains on its website that a person can be charged with a Class A misdemeanor for domestic assault if he or she does not have any prior domestic assault convictions, and they can be charged with a third degree felony when they have been convicted of domestic assault in the past.

Reckless acts account for accounts for anything that is not intended to cause harm but was done without regard of the other person’s safety. Likewise, a provocative or offensive physical contact constitute to an act that does not necessarily cause physical pain or injury to the victim but has upset or left caused a feeling of being violated.

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Wind is a Roof’s Greatest Enemy

Posted by on Sep 2, 2014 in Roofing | 0 comments

When a storm makes landfall, the main concern is not usually water but the wind. This is because when the wind is strong enough, it can wreak a lot of havoc such as damage to persons and property from debris, some of which may very well be parts of your roof.

Ironically, while wind may do the initial damage, the real problem is that it leaves your property exposed to water, ranging from small leaks to true downpours. It is not unusual for an entire roof to be carried off, such as in 2008 when Hurricane Ike capped the property damage to Texas which had been besieged that year with other record storms including Hurricane Hanna and Gustav. When this happens, it is important to get emergency roof repair done to minimize damage to the property and its contents as well as to secure the safety of the people.

Delaying emergency repairs to a badly-damaged roof is a bad idea even if the storm had already passed. One could come along at any time, and even ordinary rainfall can ruin appliances, machines, walls, carpets, electrical systems…the list goes on and on when it comes to water getting in. The cost of emergency roof repair will seem like chump change when considering the alternative.

Not all roofing companies offer emergency roof repair services, however. This is because it requires a lot of dedication to be available with little or no notice to undertake what may be a dangerous situation. When a roof fails, there is the danger of collapse, electrocution, and a host of other accidents-waiting-to-happen even with an experienced technician.

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Miranda Rights Explained

Posted by on Aug 7, 2014 in Crime | 0 comments

You hear it often in cop shows when a person is about to be arrested: “You have the right to remain silent…” This is the Miranda warning, and it is designed to explain to a person their rights when they are in police custody. However, it is important to understand that just because you have not yet been arrested and Mirandized that what you say can’t be held against you in a trial.

The Miranda warning first came about after a 1966 case Miranda v. Arizona when the court ruled that the defendant’s Fifth Amendment right against self-incrimination was violated upon interrogation because he was not aware of these rights. After that, law enforcement officers were required to explain these rights to a person during their arrest and before an interrogation can take place in order for the statements to be admissible.

However, when a person is just being interviewed and is not yet under formal arrest, the police can elicit information that may be consequently incriminating. They delay making an arrest declaration because they want to keep you talking and not ask for a criminal defense lawyer, who will definitely throw a spanner in the works. Most people want to explain themselves, thinking that the police will see it their way. They will not think about calling a lawyer until it is brought to their attention.

The police know that no verbal statement is admissible in court unless it is captured on video or other recording device, which is why police cars are now equipped with dash cams and interrogation rooms are wired for sound and video. Even if you are just being interviewed, whatever you say that is recorded can be used against you.

For example, if you are detained for whatever reason in Dallas, the only thing you are required to do is to provide identification and proof of insurance if you are driving. Your right to remain silent is always in force; you don’t have to wait to be Mirandized to “activate” it. A Dallas criminal defense lawyer will thank you kindly if you say nothing prior to legal consultation.

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Getting Both Veterans’ Disability and Workers’ Compensation Benefits

Posted by on Aug 6, 2014 in Disability Benefits | 0 comments

Veterans in the U.S. are accorded as many benefits as the government can offer in appreciation for their service to the country. One of these benefits is veterans’ disability, which comes into play when an injury or disability happens while a person is on active duty, even during peace time. In essence, it is similar to workers’ compensation, which is an insurance policy employers take out in case one of their workers is hurt on the job. According to the website of the Hankey Law Office P.C., what most veterans don’t realize is that they could be receiving veterans’ disability and workers’ compensation benefits at the same time in certain instances. Seeking both at the same time can be complex, but it is entirely possible.

There two basic types of veterans’ disability types: Individual Unemployability (IU) and scheduler. Under IU, the veteran sustained injuries of a type and severity that would keep them from getting “gainfully” employed. The vet can still work but not “gainfully.” Because this term can be interpreted quite loosely, most IU recipients choose not to risk losing it by taking on even the most minimal work.

Schedular disability, on the other hand, does not preclude the veteran from working full-time because their injuries do not render them unable to work. For example, if a veteran in Illinois suffers back injuries while on active duty that keeps them from doing any heavy lifting, he or she would qualify for schedular veterans’ disability. While they are receiving these benefits, they could be employed full-time as a data encoder and receiving any amount in salary; there is no ceiling for scheduler disability recipients. If that vet develops carpal tunnel syndrome, it is possible for him or her to claim workers’ comp with the help of a Champaign workers’ compensation lawyer while receiving vet disability. There would be no disqualification or reduction in benefits being received.

The above is a simplistic example; it is merely to illustrate that it is possible for these two benefits to co-exist. However, there are more complex issues in an actual case, and it would be important to first consult with a veterans’ disability lawyer in your state before making a workers’ comp claim to find out the consequences.

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Risperdal: Downplaying Medical Risks Cost Billions

Posted by on Aug 4, 2014 in Hospital Risks | 0 comments

Pharmaceutical giant Johnson & Johnson agreed to pay a total of $2.2 billion to settle criminal charges and civil liability claims for its products under subsidiary Janssen Pharmaceuticals which includes Risperdal, a top-selling anti-psychotic drug that proved to subject the elderly with dementia to an unacceptable degree of risk for stroke and other potentially fatal disorders.

Risperdal started out well when it was first approved in 1993 and prescribed for use in bipolar disorder, schizophrenia, and autism. It was considered safe enough to be administered to children, although there were well-publicized side effects that both doctors and patients were aware of and considered acceptable given the benefits, except in some occurrences of gynecomastia and increased suicidality. However, Risperdal was never approved for managing the behavior of the elderly diagnosed with dementia.

This is where J&J made a misstep; the drug was aggressively marketed for this purpose, and plaintiffs claim that the company knew about the medical risks it posed to that particular population segment.  And because many of these patients were using state health benefits to pay for the drug or for nursing home care that used the drug, states have also joined in the litigation fray with varying degrees of success.

The settlement is quite massive, considered the largest to date for any antipsychotic drug. However, since Risperdal was immensely popular with a wide market base, it had made the drugmaker a lot of money before product liability lawsuits started coming in. It is highly probable that the pharmaceutical giant can take it in stride with little trouble.

If you have had an elderly family member with dementia die of stroke or suffer serious injury while taking Risperdal, you may be able to prove causation. Hire a Risperdal lawyer to undertake an investigation in order to get compensation for your loss.

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Death and Bank Accounts

Posted by on Aug 3, 2014 in Estates | 4 comments

If you have an email account, chances are you have received an email from a purported Nigerian prince or bank officer who offers you a slice of a large bank account that has been “abandoned.” While such emails are most probably scams, abandoned accounts do exist, and there are ways for a legitimate heir to recover it legally through a probate or estate planning lawyer. It happens more often than people realize.

Many people fail to make provisions for what happens to their bank accounts when they die. This is especially true for people who have no expectations of dying in the near future i.e. car accident fatality, but even those who have the forethought to plan their estate neglect to appoint a beneficiary or leave other instructions regarding their active bank accounts. This can be a problem for the estate administrator or executor because the bank accounts will have to go through the probate process. It may also be an issue when it comes to distributing the funds.

There are many factors that come into play depending on what kind of bank account is in question. The simplest matter would be when the account is jointly held and at least one of the account holders is still alive. Upon presentation of the death certificate, the living account holder can have the name of the deceased removed and get full access to the funds. If the account is “held in trust for” a named person, that person can also get the funds upon presentation of the account holder’s death certificate.

In Illinois as in most states, if the account holder died intestate, the court will compile a list of people who are eligible to manage the estate from which the heirs choose one, and that person will be allowed access to bank accounts to pay for “last expenses” such as the costs of a funeral and burial. The remaining will be subject to probate and distributed according to state intestacy laws. Chicago estate planning lawyers will know what is due to legitimate heirs, so it would be wise to retain one if only to protect your rights.

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The Devastation of Motor Vehicle Accidents

Posted by on Aug 1, 2014 in Motor Vehicle Accidents | 0 comments

A recent three-car accident in Tulsa, Oklahoma claimed the life of a University of Oklahoma student, critically injuring 5 others. The accident occurred when one car collided head-on with another vehicle before crashing into a third one further down the road. The fatality was a 20-year old woman in the prime of her life.

When someone is killed unexpectedly in a car accident, it is always devastating because there is no warning. The effects radiate outwards to family and friends who are forced to confront the reality of how fragile life is. When young people die through no fault of their own, it is even more devastating. Oklahoma car accident lawyers deal with this type of tragedy more often than anyone would like.

The female driver who caused the accident by drifting down the center line of the road is suspected to have been driving under the influence, but the results of the blood test will confirm if this is so. If it is found to be true, she may be facing criminal charges and perhaps civil litigation for personal injury and wrongful death. The woman was also injured in the accident, but was able to answer questions from authorities.

In Chicago, instead of a young college student, a 71-year-old pedestrian loading groceries into a car was killed when a reckless driver plowed into him. Three other people were injured before the reckless 58-year-old male driver finally stopped. He was also critically injured and taken to the hospital. Investigation into the reason behind the reckless driving behavior is ongoing.

According to the website of Abel Law Firm, the devastation of motor vehicle accidents is indisputable regardless of whether you are young or old, and yet too many people continue to recklessly disregard the lives of other people around them by driving recklessly or when they are in no condition to do so. It is beyond reason, and these reckless individuals should be held accountable for their actions when they hurt innocent people.

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Protecting Your Intellectual Property

Posted by on Jul 28, 2014 in IP Laws | 0 comments

There have been many great ideas that have been translated into great business. Think Microsoft, cupcake bakeries, pet rocks…well, maybe most of them were great ideas. At any rate, in any start-up you want to be unique so you stand out in the crowd. It could be a code, a secret ingredient, or an innovative process. To protect your rights to these, you need to register them as intellectual property (IP). However, even if you do, people will still try to benefit off it without permission. As an IP owner, you have the right to take measures to protect it on your own. Here are some ways to do it.

Control Access

In any business, there are people who need to have access to confidential information that could impact on your core business if it leaks. According to the website of Cedar Rapids business attorneys Arenson Law Group, PC, employers can make sure that these people are bound by a legal contract that includes a confidentiality clause. This is a complex issue in business law that may vary from state to state. Businesses whose reach extends beyond the boundaries of a single state would be wise to take steps to ensure their confidentiality agreements comply with the each state’s laws. This will guarantee the protection of its intellectual property.

Include Non-Disclosure Agreements

When going into partnership or outsourcing some processes, you may have to impart some of your most jealously-guarded secrets. To ensure that these third parties respect your IP rights, have them sign a nondisclosure agreement, and if your IP involves a physical object, make sure that it is returned to you at the end of the relationship.

Act Quickly

When you discover that your IP rights have been violated, you should take legal action as quickly as possible to establish your position. When you act, make sure you act with teeth. If you simply send empty threats, you won’t get anywhere. A Dallas intellectual property lawyer, for example, would execute a cease and desist order on your behalf while preparing a case against the other company if they fail to do so. If it comes to the sticking point, make sure you have the ammunition to go through with litigation.

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