Tag Archives: health insurance

Higher out of pocket costs in disputed comp. claims other COVID workers comp(lications)

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I had an awful realization summarizing medical bills in preparation for a workers’ compensation trial; injured workers who aren’t exposed to COVID-19 are in for a nasty surprise due to the resurgent pandemic: having to pay deductible in denied or disputes workers’ compensation.

Due to the COVID-19, many hospitals in Nebraska are delaying non-urgent surgeries because of lack of space in hospitals. Often times orthopedic injuries which are the most common workers’ compensation injuries are deemed to be non-urgent.

Of course, if workers’ compensation cases are accepted a worker doesn’t have to worry about medical expenses. However, many workers compensation case are disputed. In disputed case, many workers fortunate enough to still have health insurance pay for surgeries with private health insurance.

But private insurance requires you to burn through a deductible in order to have insurance start paying benefits. Your typical white-collar weekend warrior or Crossfit mom typically waits until the year to have surgeries as they don’t have to pay the deductible because it was spent down through out the year

But because of delays in non-urgent surgeries, more injured workers paying for surgeries in disputed workers compensation cases with private insurance will need to pay deductibles for procedures delayed into 2021.

So what options do workers have in this situation?

The first option is to get a lawyer and file a workers’ compensation lawsuit if you haven’t done so already. This may seem self-serving, but under Nebraska law, if a medical bill is related to a workers’ compensation claim a provider must delay collections efforts until the case resolves. (Of course, if you need a surgery and] your employer or their workers compensation insurer is denying medical care, you should get a lawyer even if you don’t have to pay a deductible)

Other problems with COVID delays

Higher out of pocket medical costs aren’t the only hitch for injured workers due to surgical delays to due to COVID-19. Workers who need to miss work due to a medical condition only have 12 weeks of job protected leave under the Family Medical Leave Act. (FMLA) Delays in surgery due to COVID may prolong treatment and return to work beyond 12 weeks.

Earlier in the pandemic, I thought the silver lining of medical delays could mean more temporary total disability (TTD) for injured workers waiting for medical treatment. I still think that could be true, but I can also see employers being more aggressive in return to work or voluntold community service light duty work to get around paying lost income benefits. Voluntold light duty assignments are full of pitfalls for injured workers

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Why it matters how your employer insures for workers’ compensation

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Does it matter whether workers’ compensation benefits are paid directly by an employer or by an insurance company? I think it does.

Here is what injured workers should know about self-insured employers in Nebraska and how self-insurance can affect their workers’ compensation claim.

What is self-insurance?

Self-insurance means an employer pays workers compensation benefits directly from company funds. Typically an employer pays premiums to an insurer who pays out benefits.

Because self-insureds bear the entire cost of a work injury they tend to be more hands on in managing workers compensation claims. Many self-insurers have internal workers compensation coordinators who communicate with doctors and go to medical appointments with workers.

How to know if your employer self-insured for workers compensation?

You can skip to the end of this post and check. You can also call the Nebraska Workers’ Compensation Court at 402-471-6468. But if you are calling an someone in a risk management department at your employer about benefits, your employer is probably self-insured

Some self-insureds contract out to third-party administrators such as Gallagher Bassett and Sedgwick. (Sedgwick was criticized for giving Iowa Governor Kim Reynolds a ride to an Iowa State bowl game in a company jet.)

How does self-insurance effect your claim?

Most employers who are self-insured for workers compensation are also self-insured for health insurance. Typically, health insurance will shift the costs of work injuries onto workers compensation insurance. But when an employer is paying for both health and workers compensation insurance, employers will try to shift the cost to the least expensive form of insurance. Usually it costs the employer more to pay through workers compensation than it would through health insurance.

More importantly employees often incur significant out of pocket costs of injuries are shifted onto health insurance.

Self-insurance may also impact settlement value. Any employer that is self-insured for both workers’ compensation and health insurance typically values future medical benefits less than an insurance company. Self-insureds argue that they will bear the cost of the injury either through workers’ compensation or health insurance.

Interaction with employment law

As mentioned earlier, self-insureds tend to be more hands on in managing claims. I believe this can make such employers more vulnerable to retaliation claims as terminations are often used as an excuse to reduce or not pay workers’ compensation benefits. Self-insureds are also more apt to ask for so-called global releases of workers’ compensation and employment law claims. Global releases often require the employee to resign their employment. Often times a resignation is the only way that an employee can get fair settlement value for future medical care if they are employed with a self-insured.

Differences in regulation

Workers compensation insurance is regulated by the Nebraska Department of Insurance. Self-insureds are subject to regulation by the Nebraska Workers’ Compensation Court. The court regulates both claims practices and the solvency of self-insureds at NWCC Rules 69-76.

The risk of bankruptcy is another important difference between self-insureds and employers who carry outside insurance. If an employer goes bankrupt, the employee is still covered by workers’ compensation insurance. If a workers’ compensation insurer goes bankrupt, then a guaranty fund should pick up coverage. But if a self-insured goes bankrupt, the injured worker is less likely to get full compensation.

Who is self-insured for workers’ compensation in Nebraska?

Here is a list of approved self-insureds from the Nebraska Workers Compensation Court.

 

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Nebraska, Workers' Compensation and tagged , , , , .

Still getting medical bills after going to court and winning a workers’ compensation case?

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Getting a collection notice for a bill that was ordered to be paid by a judge is like a bad horror movie sequel

How can an injured worker go to trial, have the court order payment of disputed medical bills, have their employer pay the bills they were ordered to pay, but still be receiving medical bills? It’s like a horror movie or franchise where you think the villain is dead but keeps coming back to life.

Here’s the why and how it can happen in Nebraska.

Neb. Rev. Stat. 48-120(8) allows the court to order that an employer can pay bills through the so-called fee schedule or that employers reimburse other payors. Those payors are either the injured worker or a health insurer that paid a bill that was part of the workers’ compensation case.

Recently I encountered a situation where the court ordered the employer to reimburse a health insurer who had paid some bills in a disputed workers’ compensation case. The employer paid the health insurer, but then the health insurer decided that since the expense was related to a work injury that they could reverse the payment they made to the provider originally.

So, the medical provider attempts to collect the balance from my client. My client was confused and upset because they were getting collection notices for a case where the court had ordered that medical bill to be paid.

What is the solution for the client in this situation? In Nebraska the most leverage a plaintiff would have would be the penalty and fee provisions under Neb. Rev. Stat. 48-125. Once the employee gets the bill, thy should send to their attorney who will put the employer on notice that the medical bill remains unpaid after it was awarded. That puts the onus on the employer to pay within 30 days or be subject to an award of attorney fees under 48-125.

Medical providers and third-party payors don’t have standing to litigate in the Nebraska Workers’ Compensation Court, so I question whether the Nebraska Workers’ Compensation Court would have jurisdiction over them or what relief it could order against them even if it did.

The employee could have a case directly against their health insurer for breach of contract. Since health insurance payments are wages under the Nebraska Wage Payment and Collection Act, there could be a cause of action under that law as well. But in a case of relatively small-time graft by a health insurer, it might not be worth an attorney’s time or even filing fees to bring a case.

The best prevention for this situation would be to have the court order that bills be paid directly to the provider under the fee schedule. But there isn’t any Nebraska case law about when to pay bills under the fee schedule or when a payor should be reimbursed. I’ve had employers balk at being asked to pay at the fee schedule rate rather than to reimburse a third-party payor. In cases involving Medicare and Medicaid the reimbursement rate is generally much less than the workers’ compensation fee schedule rate, so paying at the fee schedule means the employer pays out more.

Injured workers’ may also want the faster reimbursement afforded to them when the court orders an employer to pay them back for any out of pocket medical expenses. If bills are paid under the fee schedule, then medical providers have to reimburse other payors. This can delay repayment and unscrupulous providers may try to pocket payments or double bill workers compensation and health insurance and/or the injured worker.

In the last legislative session, Nebraska passed bills that going forward will limit the ability to collect medical bills that are related to a workers’ compensation claim. However those protections only extend throhg final adjudication of a case. In a case where a health insurer reversed payment to a provider when they had been reimbursed through workers’ compensation after an awarded case, a provider would be free to collect an unpaid balance.

 

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Nebraska, Workers Compensation and tagged , .

Trump Policies Bad for Workers’ Compensation

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Dr. Richard Victor

Today’s post comes from guest author Thomas Domer, from The Domer Law Firm.

Dr. Richard Victor, an economist who founded the Workers’ Compensation Research Institute (WCRI) 35 years ago, just presented a paper at the WCRI National Conference in Boston.  He indicated that federal policies on immigration and health insurance promise to make worse the challenges the United States faces by an aging workforce and a widespread labor shortage. He noted that workers’ compensation claims could double and overall costs could expand by over 300% in the next dozen years, without any increase in benefits to workers.  External forces could bring far more cases into the system because of a number of forces, including an aging workforce, labor shortage, slowdown in immigration, and more shifting to workers’ compensation claims that should be paid by group health insurance. Dr. Victor projected current claims out a dozen years to 2030 indicating that claims should actually be down to about ¾ of today’s numbers, but external factors will more than overtake that favorable percentage. Labor shortages caused by baby boomers retiring will increase injury rates.  Research indicates that the older workforce will mean an increase in lost work days and more injuries and a real impact on labor shortage as more baby boomers retire. Dr. Victor indicated “These labor shortages, which will be longer and deeper than anything we have experienced, will lead to significant increase in workers’ compensation claims and longer durations of disability.” During a period of labor shortages, employers relax hiring standards and hire workers they would not have hired in a normal labor market, including workers who are less capable. The overall labor shortfall leads to more workers’ compensation claims.

The Immigration Factor:

Economists have seen immigration as a factor that mitigates against the impact of the labor shortage. The Trump Administration, changing federal immigration policy, will further tighten labor markets and prolong the duration of a labor shortage. Moreover, Trump’s “anti-immigration rhetoric” also discourages people to come to America.  In health care, Victor noted that one in six health care workers is foreign-born including 27% of physicians and surgeons, 15% of nurses, and 22% of home health aide, each of which effects the workers’ compensation system.

Health Insurance

A shortage of people with adequate health insurance is also a problem for workers’ compensation. Health insurance deductibles have risen from the hundreds to many thousands of dollars, and this new reality causes more workers to go without or delay getting medical care for an injury or illness. When they can no longer ignore their condition, many claim it as a work-related condition and seek workers’ compensation (he cited a Rand Research study indicating workers with high deductible or co-insurance plan postponed care in over one-third of cases of the most common kind of workers’ compensation claims – soft tissue injuries.” As the number of workers who lose their insurance grows (since the Trump Administration and Congress ended subsidies and other aspects of the Affordable Care Act) case shifting form health insurance to workers’ compensation could have a major effect, ballooning workers’ compensation claims by as much as 35% in the next dozen years.

Victor’s conclusion: “You end up with a 300% increase in workers’ compensation costs without increasing benefits to injured workers.”

 

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Government, Legislation, Workers' Compensation and tagged , , .

Examining Workers’ Compensation Costs to Employers

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Source: Bureau of Labor Statistics National Compensation Survey 1991 - 2014 (Credit: Sisi Wei/ProPublica)

Source: Bureau of Labor Statistics National Compensation Survey 1991 – 2014 (Credit: Sisi Wei/ProPublica)

Business and insurance interests are bombarding state legislatures every day of the week to take workers’ rights away by complaining how most states’ workers’ compensation systems are too expensive.

Recently, ProPublica and NPR produced a very detailed explanation of the state of workers’ compensation, focusing, rightly so, on injured workers. This article, which was the first in the series, included an interactive graphic that showed that even though business are complaining about rising premius, workers’ compensation insurance coverage is generally at its lowest rate in 25 years, “even as the costs of health care have increased dramatically,” according to the article.

As examples, using the average premium cost to the employer per $100 of workers’ wages, Nebraska employers paid $1.93 in 1988, while they actually paid $.15 less for the premium in 2014, for a total of $1.78 per $100 of workers’ wages, according to the chart. Iowa was more dramatic, with the price of workers’ compensation insurance $2.79 per $100 of workers’ wages in 1988. It went down $.91 to $1.88 per $100 of workers’ wages in 2014.

By scrolling down in the article, a person finds another graphic that shows how employer costs have risen for other categories, but have fallen for workers’ compensation. Most notably, the cost of workers’ compensation insurance coverage (per $100 of workers’ wages) went from $2.71 in 1991 to $2.00 in 2014. During the same timeframe, the cost of health insurance went from $8.55 to $12.52 and the cost of retirement benefits went from $5.50 to $7.29, all per $100 of workers’ wages, according to the chart in the article.

The offices of Rehm, Bennett & Moore and Trucker Lawyers are located in Lincoln and Omaha, Nebraska. Six attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 90 years of practice representing injured workers and truck drivers in Nebraska and Iowa in state-specific workers’ compensation systems. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers’ Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), and the Nebraska Association of Trial Attorneys (NATA).  We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Government, Iowa, Legislation, Nebraska, Workers' Compensation, Workers' Compensation Reform and tagged , , , .

ACA Sign-up Deadline Set for Sunday

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healthcaregov.pngSunday, Feb. 15, is the 2015 deadline to enroll for health insurance coverage through the Affordable Care Act’s process. The information that’s out there can be pretty overwhelming, and sometimes websites don’t work, especially when enrollment is time sensitive, as it now is. For procrastinators, here are some good places to start, hopefully help to beat the deadline, and most importantly, enroll in insurance coverage.

A good starting place is the healthcare.gov website. Be sure to use the .gov, as other places (.com, .net, etc.) aren’t actually the insurance exchange and at worst, can be scams. From there, if things get confusing, as insurance often does, another option is to call 800-318-2596 for help, according to healthcare.gov. Or, by clicking on “Find local help” and providing a zip code, there are more direct ways to get ahold of someone and ask questions.

The site itself answers such questions as what kind of coverage a person qualifies for when the marketplace application is filled out. Unfortunately, Nebraska is one of the states that has chosen to not expand Medicaid, so clicking on the link about what Medicaid expansion means will help explain how this affect people. However, many folks are qualifying for subsidies, which are automatically applied to specific plans, often the silver level, and help people afford more comprehensive coverage, with the subsidies based on income.

Why should a person go to the effort? Because there are actually financial and societal benefits to having health insurance, especially if something happens and a person has medical needs. That being said, the ACA coverage is not meant to take the place of employer-sponsored coverage for sick workers.

As has been mentioned before in this blog, folks having health insurance coverage benefits more than just the individual.

“You’ll be pulling your weight. Americans pick up the costs of caring for uninsured patients in the form of higher insurance premiums, higher taxes and more expensive care,” according to an editorial around this time last year in the Kansas City Star newspaper.

In addition to the benefits of having health insurance, there is a greater penalty for not enrolling this year than there was last year, according to healthcare.gov. “If you don’t have health coverage during 2015, you may have to pay a penalty. The fee in 2015 is higher than it was for 2014 – 2 percent of your income or $325 per adult/$162.50 per child, whichever is more.”

Just as it’s important for employers to have workers’ compensation insurance coverage, individuals – and their families – should have health insurance to try to plan for the unknown.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Affordable Care Act, health insurance, healthcare and tagged , , , .

Deadline for ACA Sign Up Is Monday

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Monday, March 31, is the deadline to enroll for coverage this year through the Affordable Care Act’s process. There’s a lot of information out there, and it can be extremely overwhelming. For procrastinators, here are some good places to start, hopefully help to beat the deadline, and most importantly, enroll in insurance coverage.

A starting place is healthcare.gov. Be sure to use the .gov, as other places (.com, .net, etc.) aren’t actually the insurance exchange and at worst, can be scams. From there, if things get confusing, as insurance often does, another option is to call 800-318-2596 for help, according to healthcare.gov. Or, by clicking on “Find local help” and providing a zip code, there are more direct ways to get ahold of someone and ask questions.

The site itself answers such questions as what kind of coverage a person qualifies for when the marketplace application is filled out. Unfortunately, Nebraska is one of the states that has chosen to not expand Medicaid, so clicking on the link about what Medicaid expansion means will help explain how this affect people. However, many folks are qualifying for subsidies, which are automatically applied to specific plans, often the silver level, and help people afford more comprehensive coverage, with the subsidies based on income. Note that the one-page guide recommends applying either online or by phone, as a paper application won’t be processed quick enough to meet Monday’s deadline.

Here’s an example of how the ACA affects people in one industry that the firm works with through the website www.truckerlawyers.com. The Smiths, who are strong advocates for drivers, recently had both a blog post and a podcast about options for truckers, so follow the links to explore those resources. This information also generally applies to those who aren’t truckers, too.

Why should a person go to the effort? Because there are actually financial and societal benefits to having health insurance, especially if something happens and a person has medical needs.

An editorial in the Kansas City Star recently argued a number of points about the wisdom of having insurance coverage. As has been mentioned before in this blog, folks having health insurance coverage benefits more than just the individual.

“You’ll be pulling your weight. Americans pick up the costs of caring for uninsured patients in the form of higher insurance premiums, higher taxes and more expensive care.”

Just as it’s important for employers to have workers’ compensation insurance coverage, individuals – and their families – should have health insurance to try to plan for the unknown.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Affordable Care Act, healthcare, trucker and tagged , , , , .