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Results for “WORKMAN'S COMPENSATION AND INSURANCE”

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At least 19 recordsLinked to original sources
PubMed1979

Medical records--legal perspectives.

Good documentation of medical diagnosis and treatment is not only a medical necessity, it is a legal one. Whether the physician is innocent or guilty of malpractice quickly becomes a side issue when it is discovered that he has tampered with the evidence, thereby attempting to perpetrate a fraud upon the court. And discovered it will be--the techniques are sophisticated and the motivation is high. Medical records are also important in workman's compensation cases, insurance claims, personal injury cases, and even in physician disciplinary hearings as well as their collection of bills. In creating and maintaining patient records, physicians and hospitals have several legal duties, including the duty to do so adequately, to safeguard the records' physical existence, and to prevent such use of the records as would violate the patient's right to confidentiality. Courts and legislatures are looking with increasing favor on the patient's interest in the content of his record, a phenomenon which is closely linked to the nationwide trend in favor of the patient's right to know and his right to determine his own physical destiny. For all these reasons, medical records no longer serve exclusively as the physician's private aid; medical records are increasingly becoming legal documents as well.

Confidentiality↗
PubMed1987

Profile of denials of durable medical equipment for SCI patients by third party payers.

The difficulty in obtaining approval for payment of durable medical equipment by third party payers has impeded the rehabilitation program and discharge planning of many spinal cord patients throughout the country for many years. To gain some insight as to the number and level of patients affected, the kinds of equipment denied, the reasons given for the denial, which third party payers were mostly involved and how the patient and his/her family managed to cope or resolve this problem, a survey was undertaken. Letters were sent to 259 members of the American Spinal Injury Association (ASIA) asking them to list representative cases where requests for equipment deemed necessary were denied. Twenty-eight responses from different institutions were received from sixteen states describing 110 patients and 180 pieces of durable medical equipment denied in 1984 and 1985. Manual wheelchairs, motorized wheelchairs, shower/commode chairs, and environmental control units were the four most common equipment items denied by the third party payers. Government agencies ie., Medicaid, Medicare, Vocational Rehabilitation Departments and State Crippled Children's Services were the most frequent deniers, comprising 54% of the total sample. They were followed by private insurance (31%) and Workman's Compensation (3%). By far, the two most common reasons given for denials were: it was not covered by the insurance policy (38%) and it was not medically necessary (30%). Ninety (90) pieces of equipment (50%) were eventually obtained, most often by charity, or through the patient's family resources.

Data Collection↗