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Medical insurance expert witnesses may opine on health insurance, medical insurance, managed care, and more. In Managed Care Fact Sheets, experts at the health care publisher MCOL describe provider payment arrangements:

Other types of risk sharing include withholds, when a portion of the provider payment is held back and only paid later if certain criteria are met. Also, there are shared risk funds, where physician groups share in a portion of the financial risk and potential profit of hospital or prescription costs.

How shared risk funds work: Typically, in a shared risk arrangement, a fund gets “paid” the capitation rate. Medical expenses are paid from this fund, and periodically, profits or losses are distributed to the participants.

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Health insurance expert witnesses may opine on health insurance, medical insurance, managed care, and more. In Managed Care Fact Sheets, experts at the health care publisher MCOL describe provider payment arrangements:

In Managed Care Organization (MCO) provider contracts, providers often bear some level of financial risk. In paying providers, capitation and salaries involve the highest levels of provider risk, and are usually just allowed under HMOs. Episode of Care payments also involve some risk, as costs could exceed the case payment.

Capitation: Capitation means paying a fixed amount of money per person (per capita). Capitation puts a lid on payments per person that otherwise might change under a fee-for-service system. Providers are at full financial risk for the services capitated. The provider is paid a fixed amount per member enrolled, regardless of the number of services delivered to that member.

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In a March 23 press release, wood products experts at the Western Wood Products Association write NEW LUMBER FORECAST PREDICTS SLOW, STEADY RECOVERY FOR SAWMILLS.

Mills are starting to emerge from the worst downturn in the history of the industry and recovery will be slow yet steady, according to a new forecast released by Western Wood Products Association. The lumber trade association’s forecast calls for modest gains in housing, lumber consumption and U.S. production this year after setting modern lows during 2009. While markets are expected to improve in the coming years, lumber demand and housing construction will remain far lower that what the industry saw in the mid-2000s.

Demand for lumber in the U.S. is expected to increase 6.1 percent in 2010 to 32.9 billion board feet, ending consecutive 20-percent-plus declines recorded the previous two years. WWPA anticipates lumber demand to rise to 36.1 billion board feet in 2011, up 9.7 percent.

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In Building A Box Around Murphy’s Law, risk management expert witness Donald Bendure writes on how to approach the transactional transfer of operational risk.

Always include insurance requirements of your sub-contractors.

Be aware and satisfy imposed insurance requirements in contracts you sign.

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In When the Phone Rings … Twelve Questions for Prospective Expert Witness Assignments, insurance claims expert witness Kevin M. Quinley, CPCU, ARM, AIC, writes:

(9) Is there a trial date yet? If so, when? This also gives you a sense of the expected pace and timeline of the case. This can be highly relevant, especially if you are in a busy phase and juggling many engagements. You may have conflicting trial dates on other cases, or be scheduled for a deposition or attending a conference for which you have pre-registered. An imminent trial date may portend, “Fire Drill!” A futuristic or unset trial date may suggest that you will have ample time to analyze and digest the requisite materials without a crisis atmosphere. Some people thrive on crises; others have a hard time functioning effectively in this atmosphere. The proximity of the trial date may suggest the degree of “juggling” you may or may not have to do with other assignments and obligations.

Kevin M. Quinley is a leading authority on insurance issues, including risk management, claims, bad faith, coverages and litigation management. He is the author of more than 600 articles and 10 books. You can reach him through http://www.insuranceexpertnetwork.com/.

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In When the Phone Rings … Twelve Questions for Prospective Expert Witness Assignments, insurance bad faith expert witness Kevin M. Quinley, CPCU, ARM, AIC, writes:

(8) Is this a rebuttal report? Has the other side disclosed its experts? If you are being asked to provide a rebuttal report, odds are that there is already an opposing expert who has weighed in on the issue for which your view is being sought. There may be situations that present not an outright conflict, but a potentially awkward situation. If the opposing expert is a good friend, business colleague, mentor, etc., you may be uncomfortable in opposing him or her. You may want to know the identity of the opposing expert before agreeing to take the case. Maybe the person has some business tie to you. Maybe she is a friend or mentor. Perhaps he is an industry guru whom you do not feel comfortable contradicting. Maybe he is a buffoon and you relish the chance to go head-to-head. It’s best to know up front before saying yes or no to the engagement.

Kevin M. Quinley is a leading authority on insurance issues, including risk management, claims, bad faith, coverages and litigation management. He is the author of more than 600 articles and 10 books. You can reach him through http://www.insuranceexpertnetwork.com/.

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In the Paige Report: Digest of Important Decisions from 2009, insurance broker expert witness David H. Paige writes:

Life insurance agents’ client held to be insured CEO, and agent held not liable to investor in CEO’s company.

Part 2 -Implications for Agent/Broker Liability: Policyholder’s should not assume that they have a right to legal recourse if an insurance broker who is placing insurance to their benefit makes an error. In many situations, the court will only allow a legal remedy to those who the court considers to be the direct “client” of the insurance agent or broker. This decision is an example of the limitations that many courts place on the range of individuals who may seek compensation for what they believe to be insurance agent or broker misconduct.

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In 2003, Racine County requested bids for a consultant to upgrade its software and train its employees in using it. Oracular Milwaukee, Inc. was awarded the contract. But the project didn’t go as planned, and Racine sued Oracular for breach of contract and statutory misrepresentation. In a case decided April 2, the Wisconsin Supreme Court concluded that the issues at stake were not so complex as to require testimony from a contracts expert witness.

The court wrote: “[W]e do not close the door to the possibility that expert testimony may later assist the trier of fact in evaluating Racine County’s breach of contract claim. Our point is only that in the posture of summary judgment, Racine County was not required to name an expert witness as a matter of law.”

For more, see wislawjournal.com.

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Medical expert witnesses at Medical Opinions Associates write on tort reform:

Let’s clarify the issue. Advocates of “tort reform” are really arguing for lower incidence of medical malpractice awards, smaller dollar awards, and lower medical malpractice insurance premiums for physicians. They also hope to reduce the level of “defensive medicine”, the result of which is higher medical cost in response to the fear of being sued.

According to the National Practitioner Data Bank, the number and dollar value of medical malpractice award payouts has been flat since 1991, and have actually declined since 2001.The figures presented by the National Association of Insurance Commissions back this up. Public Citizens’ Congress Watch in Washington, D.C. reports that medical malpractice award payments declined 13.6% from 2001 through 2004 (the latest data available). Award payments of $1 million or more actually fell 56% from 1991 through 2004. According to a Harvard University study, very few medical errors ever result in legal claims – only one claim per 7.6 injuries ever results in legal action. Of those claims, plaintiffs drop 9 of every 10 that are initiated. Let’s at least admit that a case made solely on the basis of the “exploding incidence” of medical malpractice claims and awards has its problems.

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A major revision to the federal rules governing expert witness reports is on track to take effect in December. No longer would Rule 26 of the Federal Rules of Civil Procedure allow full discovery of draft expert reports and require broad disclosure of any communications between an expert and trial counsel, as has been the case ever since the rule’s revision in 1993.

Instead, under proposed amendments to Rule 26, those communications would come under the protection of the work-product doctrine. The amendments would prohibit discovery of draft expert reports and limit discovery of attorney-expert communications. Still allowed would be full discovery of the expert’s opinions and of the facts or data used to support them.

For more, see ipFrontline.com.