Doctors refuse to take bitter no-gift medicine

Drugmaker freebies can lead to harm for patients, some say
By Bruce JapsenTribune staff reporterPublished April 26, 2007

Whether it be Subway sandwiches for the office staff or reimbursement for continuing education, gifts showered upon doctors by drug- and medical device-makers have become so pervasive that they are a standard part of virtually every U.S. physician's practice.

Despite self-policing initiatives launched by organized medical groups and the drug and device makers to curb the cozy relationship between physicians and industry, 94 percent "or virtually all" physicians have at least one type of relationship with the drug industry, according to a study scheduled to be published Thursday in the New England Journal of Medicine. The study indicates that those self-policing initiatives are not always followed. Consumers should care about such relationships because drug companies tend to market the latest and most expensive brand names, and gift-giving can influence prescribing behavior and therefore how much Americans spend on prescriptions, the authors said. Drug marketing and conflicts of interest between doctors and medical product companies have come under congressional scrutiny because of their impact on costs and because of safety issues involving heavily promoted drugs, including Vioxx, the painkiller that was pulled from the market in 2004, nearly two years after studies showed it increased risks of heart attacks."

Relationships with industry are a fundamental part of the way medicine is practiced today," said the study's lead researcher and co-author, Eric Campbell, an associate professor of medicine at the Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School. Campbell said consumers have reason to be concerned about the study's findings. "Would you care if this person was managing your 401(k) and you found out that they had financial relationships with mutual fund companies, or if an umpire was calling the World Series between the Cubs and White Sox would anybody care if the umpires were being paid by either of those two teams?" he asked. "If people would be very concerned that it was happening in a baseball game, you would be even more concerned if it was something like your health."

The findings arise from a survey of more than 1,600 practicing physicians in late 2003 and 2004. The survey was conducted at least two years after the American Medical Association launched a high-profile educational campaign for doctors to reinforce ethics guidelines that recommend that any gifts be of nominal value and benefit patients.

The AMA guidelines, which are voluntary, say any gifts should "primarily entail a benefit to patients and should not be of substantial value." Subsidies should not be accepted to pay for the "costs of travel, lodging or other personal expenses of physicians attending conferences or meetings, nor should subsidies be accepted to compensate for the physician's time." If physicians accept gifts, they should be worth less than $100 and "benefit patients," the guidelines say. Acceptable gifts include textbooks or drug samples.

The study suggests that many doctors do not always follow the AMA guidelines. It notes, for example, that 35 percent of respondents accept reimbursement for continuing medical education or for travel, food or lodging for medical meetings.

The drug industry lobby, Pharmaceutical Research and Manufacturers of America, said its member companies have worked to eliminate certain relationships and in 2002 established guidelines to curb such sales tactics as golf outings, entertainment and "dine and dash" dinners that drug companies order at restaurants for doctors to pick up for essentially doing nothing. Modest meals for the doctor at his office, however, are OK." The meals are recognition that the physicians are extremely busy [and] maybe the only time they have to meet is over a working lunch," said Scott Lassman, senior assistant general counsel for the lobby, which includes Abbott Laboratories, Pfizer Inc. and Merck & Co. in its membership.

Some doctors say, though, that free samples are needed, particularly in practices where there are a number of uninsured patients who cannot afford drugs. Take Dr. Kristin Coyle, a family physician in Sterling, Ill., who said her patients have been hit hard by unemployment. "We definitely have not only a physician shortage and a lot of people who cannot afford things like drugs -- we are a community trying to rebuild," said Coyle, who has accepted Subway, Applebee's and other drug-company-ordered lunches for herself and her office staff. Coyle said she allows reps to drop off free samples and that they are also allowed to make an educational presentation, such as explaining how a new drug or device works. "Basically, they are not allowed to interrupt my patient activity," Coyle said.

Some say, however, that doctors should at least let it be known to their patients that they have a relationship with drugmakers and why it exists. "People have no clue about this," said Jamie Reidy, a former Pfizer sales rep who wrote a book about his experiences selling Viagra and other Pfizer drugs. "They should care," Reidy said. "If they are getting a drug simply because the doc just got back from an advisory board and is pumped full of drug propaganda, that's a problem. But if the doc truly believes Drug X is best for that patient, fine."

----------bjapsen@tribune.com
Copyright © 2007, Chicago Tribune

Insurance Company Exec receives $22.5M salary

By Eileen Alt PowellApril 11, 2007

Martin J. Sullivan, who has been running insurance giant American International Group Inc. since the ouster of longtime chief executive Maurice "Hank'' Greenberg, received compensation valued at nearly $22.5 million (euro16.82 million) in 2006, according to a regulatory filing.
Sullivan, 52, who is president and chief executive of AIG, collected a salary of $1 million (euro750,000), a bonus of $10.1 million (euro7.55 million) and non-equity incentive plan compensation of $5.8 million (euro4.34 million), according to the proxy filed on Good Friday with the Securities and Exchange Commission.

His "other'' compensation totaled $703,432 (euro526,009) and included some $257,498 (euro192,550) for personal use of corporate aircraft, $135,014 (euro100,960) for a car and driver and $278,250 (euro208,068) for home security. The home security spending was "a result of implementing the recommendations of independent, third-party security studies,'' the filing said. It did not elaborate.

In addition, Sullivan also was awarded restricted shares under the 2006 performance program with an estimated value of $4.88 when they were granted.

The Associated Press calculations of total pay include executives' salary, bonus, incentives, perks, above-market returns on deferred compensation and the estimated value of stock options and awards granted during the year. The calculations don't include changes in the present value of pension benefits and sometimes differ from the totals released by the companies.

The proxy was filed in advance of AIG's annual meeting on May 16 in New York City.
AIG had a very profitable year in 2006, with net income totaling $14.05 billion (euro10.51 billion), or $5.36 per share, compared with $10.48 billion (euro7.84 billion), or $3.99 per share. Its fourth-quarter profit rose eight fold from the year-earlier period when the insurer spent $1.64 billion (euro1.23 billion) to settle the allegations of improper accounting practices.
Sullivan took over as head of the New York-based company in March 2005 after the AIG board removed Greenberg, who had led the company for nearly four decades, amid federal and state probes into accounting irregularities in AIG's property and casualty insurance business. Greenberg later resigned the chairmanship, too.

British-born Sullivan had served as AIG's vice chairman and co-chief operating officer before being named chief executive.
___
On the Net:
www.aig.com
Copyright 2007 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Senator looking for the truth on workers' comp rates

Published The Greenville News: Wednesday, March 28, 2007 - 2:00 am

By Frank Knapp Jr.

Recently many of us who are trying to address the rising costs of workers' compensation
insurance were shocked when the South Carolina Chamber of Commerce sent out a newsletter and e-mail to its members attacking specific state senators who they contended were deliberately delaying progress on workers' compensation reform legislation. This attack, reported in a March 14 GreenvilleOnline.com story, was not only unfounded but was revealing in its motivation.

As president and chief executive officer of the SC Small Business Chamber of Commerce (which is not affiliated with the state Chamber), I have been immersed in all factors driving the increase in workers' compensation premiums. The Small Business Chamber has successfully proposed systemic legislative reforms that have addressed fraud, provided resources needed to speed up the system and created an assessment of how rate-making data is processed. The Small Business Chamber successfully intervened in the most recent court hearing to have an insurance industry-proposed increase in workers' compensation reduced by about 44 percent. The Small Business Chamber was the only business organization that fought the insurance industry on this increase.

This legislative session, the state Senate is addressing workers' compensation cost drivers in two paths. The Senate Judiciary Committee looked at the costs of claims as a driving force. Insurance carriers collectively file medical and indemnity claim costs to the state Department of Insurance. Based on this data and often through a court hearing, the state determines allowable rate increases related to these costs. A bill dealing with this issue, S. 332, has been vigorously debated by parties representing business, attorneys, state agencies and workers.
It is in regard to the progress of this bill that the state Chamber fired off its "Thumbs Down" attack accusing four senators, including Greenville Sen. David Thomas, of being "Trial Bar-friendly" and delaying progress on S. 332.

The truth is Sen. Thomas doesn't even serve on the Judiciary Committee and therefore he had absolutely no responsibility for the progress of that bill. There is no evidence Sen. Thomas has in any way wielded his influence on the committee's work. That bill has now moved to the full Senate.

So why would the state Chamber launch an attack on Sen. Thomas?

Because the senator has shown the willingness to investigate a second issue that certainly is driving up workers' compensation rates -- the little-understood and obscure-sounding "loss-cost multiplier." It is critical the public understand what this means and what is at stake. As chairman of the Senate Banking and Insurance Committee, David Thomas, does understand the significance of the "loss-cost multiplier."

Here is how this cost driver works:

After the state determines workers' comp rates related to the actual cost of claims, insurance companies themselves can add to the approved rate increase additional costs not related to the cost of claims. This additional charge is called the "loss-cost multiplier" and is easily manipulated to increase premiums because it is not regulated by our Department of Insurance.

The insurance companies do not even give the Department of Insurance documentation explaining what expenses they have included in the "loss-cost multiplier." South Carolina is the only state in the country that does not at least require insurance carriers to show how they arrived at their "loss-cost multiplier," let alone regulate this add-on charge.

Consequently, we do not know that the insurance carriers aren't driving up premiums on their own over and above covering their legitimate expenses. A rate increase they can't convince a judge to accept can simply be achieved by increasing their "loss-cost multiplier."
This is the issue that Sen. Thomas has bravely undertaken to investigate in his Banking and Insurance Committee. On this issue, the state Chamber also attacked the senator, accusing him of being unfriendly and presenting a "frosty demeanor" while insurance industry representatives answered questions about the "loss-cost multiplier."

It is this attack that tells the true motivation of the state Chamber's anger against Sen. Thomas. The state Chamber is representing the interest of its big dues-paying insurance company members. Because the state Chamber and the insurance industry cannot defend the practice of carriers manipulating workers' compensation rates through the "loss-cost multiplier," they indiscriminately throw mud at the bulldog investigating the issue.

The Small Business Chamber congratulates Sen. Thomas on his important work to uncover the real reason for rate increases and gives him two "thumbs up."

Frank Knapp Jr. is president, chief executive officer and co-founder of The S.C. Small Business Chamber of Commerce. For more information, visit www. scsbc.org or e-mail him at sbchamber@scsbc.org.

Consumer Groups Say Market Forces, Not Claims, Caused Med Mal Crisis

National News

March 29, 2007

A consumer coalition has released a new study that disputes insurers' contention that the most recent medical malpractice insurance crisis for doctors was caused by rising costs.

The study, Stable Losses/Unstable Rates 2007, by Americans for Insurance Reform (AIR) , a coalition of over 100 consumer and public interest groups, finds that the insurance crisis that hit doctors between 2001 and 2004 was not caused by claims, payouts or legal system excesses as the insurance industry claimed. Rather, the study of the industry's own data, found:
Inflation-adjusted payouts per doctor not only failed to increasebetween 2001 and 2004, a time when doctors' premiums skyrocketed, but they have been stable or falling throughout this entire decade.

Medical malpractice insurance premiums rose much faster in the early years of this decade than was justified by insurance payouts.

At no time were recent increases in premiums connected to actualpayouts. Rather, they reflected the well-known cyclical phenomenoncalled a ''hard'' market. Property/casualty insurance industry ''hard'' markets have occurred three times in the past 30 years.

During this same period, medical malpractice insurers "vastly andunnecessarily" increased reserves for future claims despite no increase in payouts or any trend suggesting large future payouts. The reserve increases in the years 2001 to 2004 could have accounted for 60 percent of the price increases witnessed by doctors during the period.

'This report is proof positive that the huge medical malpractice insurance rate increases between 2000 and 2003 were not related to a jump in claims," said study author J. Robert Hunter, director of Insurance for the Consumer Federation of America.

"'Rather, as in the mid-1970s and mid-1980s, they were simply the result of insurance industry economics, supplemented by insurer hype intended to divert attention away from the mismanagement by insurers that caused the crisis.''

Co-author Joanne Doroshow, executive director of the Center for Justice & Democracy, said the report shows the crisis was a function of market forces.

''This report shows that the real reasons medical malpractice insurance rates rose so dramatically for doctors during this decade was market forces and dropping interest rates, not because of a sudden increase in medical malpractice jury awards or payouts," Doroshow maintained.

She used the report to advocate for stronger regulation of the insurance industry.
"These periodic insurance crises will continue to occur unless lawmakers take steps to reform the insurance industry. State lawmakers must strengthen state insurance regulatory laws and Congress must repeal the decades-old McCarran Ferguson Act, which exempts the insurance industry from anti-trust laws," Doroshow argued.

The full study can be found at: http://insurance-reform.org.

Source: Center for Justice & Democracy

Workers' Compensation Insurance Reform

Senator John Land published an editorial in the Greenville News on March 1, 2007. The letter was great and is copied below:

Workers' compensation makes insurance companies richWe must find out what's causing premium increases and fix that problem to stop seller from setting his own price to a captive buyer.Published: Thursday, March 1, 2007 - 2:00 am
By John C. Land III

Business, and particularly small business, is paying too much for workers' compensation insurance. The insurance industry would have you believe the reason is that greedy injured workers are receiving too much for lost wages and medical care. The truth is that the insurance industry is getting filthy, stinking rich due to a change in the law that allows insurance companies to set their own premiums.

There are only two components to a workers' compensation premium in this state. The first is the "loss cost," which covers medical costs and wage replacement benefits, i.e., the true cost of the claim. Increases in this portion of the premium must be approved by our state Department of Insurance. As in health care, these costs have risen because of increased medical costs. The second factor for these increases is that the cost of living has increased, thus resulting in a number of higher paying jobs over that time.

The second component in pricing workers' compensation insurance is the "loss cost multiplier," or LCM. The LCM includes the insurance company's profit and overhead. Increases in this portion of the premium were similarly overseen by the Department of Insurance until a change in the law that occurred in 2003.

This change, which the insurance industry pushed, allowed insurance carriers to set their own LCM, and thereby set their own premiums, free from any oversight whatsoever. And finding out where the money is going is like trying to push a wet string -- it's frustrating with no oversight. Since that oversight was removed, the average LCM has increased almost 200 percent over the last six years. This is the runaway train in the Workers' Compensation system and is the cause of skyrocketing premiums.

The insurance industry will tell you that overhead is high because of the Second Injury Fund (SIF). I have heard the insurance industry lobbyists many times use the line that our SIF assessments are bigger than California's, and that sounds shocking. Do not fall for it. What they do not tell you is that the SIF does not keep the assessment money; rather, the SIF has to pay it back in reimbursements to the very insurance industry that paid it in. Once the reimbursements are accounted for, net assessments have actually decreased since 2002. In contrast, the loss cost multiplier, which is where assessments are accounted for in the premium, has seen an almost 200 percent increase since 2000, and the insurance industry has not told us why.

The insurance industry will also tell you that costs have increased because of inefficiency in the workers' compensation system. Nothing could be farther from the truth. In 2003-2004 the Commission handled almost 89,000 claims. Hearings were scheduled in less than 10 percent of the claims and actually held in less than 2.5 percent of the claims. The average time it takes to get a hearing from the date requested is less than four months and the average time it takes to get a review hearing of a decision is less than three months.

In 2004 there were only 262 appeals from the Commission to the Circuit Court. That means that out of all the claims filed, only 0.002 percent of the injured workers, the employers and the insurance carriers were dissatisfied with the Commission's review process.

I believe in the free market system. However, workers' compensation insurance is mandatory and the free market system does not work when the seller can name his own price to a captive buyer. We should focus on finding the real cause behind these premium increases and correct whatever that is. Otherwise, all we are going to improve is the size of the insurance executives' bank accounts.

Ownership, Maintenance, and Use of Automobile

South Carolina law mandates that all automobiles be covered by automobile liability insurance policies. The law is found at S.C. Code Ann. § 38-77-140. This statute provides, in part, as follows:

No automobile insurance policy may be issued or delivered in this Stateto the owner of a motor vehicle or may be issued or delivered by an insurer licensed in this State upon any motor vehicle then principally garaged or principally used in this State, unless it contains a provision insuring the persons defined as insured against loss from the liability imposed by law for damages arising out of the ownership, maintenance, or use of these motor vehicles ....

The key provision of this liability insurance statute relates to the words, "arising out of the ownership, maintenance, or use" of the car. Thus, South Carolina automobile insurance policies must provide coverage when liability arises due to these activities.

Sometimes the scope of potential liability coverage arises in situations most people would not expect coverage. For example, we have recovered liability payments when the vehicle owner negligently left a part under some leaves in a parking lot. The part caused a passer-by to trip and fall. Since the fall arose out of the maintenance of the vehicle, the automobile liability policy applied and the person was able to obtain a recovery from the insurance company.

Other times, such as when a vehicle is used as a platform to commit an assault on a person, like a drive-by, gangland shooting, our law holds that such injuries do not "arise from the use" of the vehicle. Rather, the vehicle's involvement is just fortuitous and use of the vehicle bears no relationship to the intentional act. Then, the liability insurance policy may not apply to cover the wrong-doer.

Report Regarding Highly Skilled Immigrants (H1-B Visas)

The American Immigration Law Foundation issued a link to a recent report regarding quotas on visas for highly skilled immigrants. Surprisingly, the annual number of such visas allowed in the United States is now only 65,000. The report discusses the impact that this quota has on the international competitiveness of the United States in the global economy. The sumary of the report is set forth below.

U.S. Immigration Policy in Global Perspective:International Migration in OECD Countries
by David L. Bartlett, Ph.D.

REPORT SUMMARY

The United States possesses a number of competitive assets in the global war for talent: most notably, its huge and flexible labor market and an abundance of leading-edge multinational corporations and world-class universities. However, the United States also faces growing competition in the global labor market from other countries within the Organization for Economic Cooperation and Development (OECD), as well as from the expanding economic opportunities available in the home countries of Indian and Chinese professionals who constitute a vital talent pool for U.S. high-tech companies.

These trends underscore the need to revamp U.S. immigration policies to make them more responsive to the demands of an increasingly competitive global economy. Yet the quota-based immigration system of the United States diminishes the country’s ability to sustain, let alone expand, inflows of high-skilled immigrants.

The optimal remedy for this defect in U.S. immigration policy is to replace the H1-B visa program for highly skilled foreign professionals with a quality-selective regime along the lines of the point-based systems introduced in Australia, Canada, and New Zealand. The United Kingdom is moving in this direction, away from a work-permit regime to a multi-tiered system that would entitle high-skilled immigrants to work for any British employer or to set up their own businesses in the country. However, the political environment in the United States—where homeland security concerns remain acute five years after September 11th and the furor over undocumented immigration clouds the separate issue of skilled immigration—provides little cause for optimism that such a policy reform will soon materialize.

Among the findings of this report:

• The more educated share of working-age immigrants increased significantly in several OECD countries during the 1990s, especially Ireland, the United Kingdom, Luxembourg, and Finland.
• The success of educated immigrants in securing U.S. jobs commensurate with their skills varies widely by country of origin, ranging from 76 percent of educated men from India to 25 percent of educated Moroccan men.
• Between 2000 and 2005, the U.S. foreign-born population from India experienced the most dramatic increase (39.8 percent), followed by Peru and Honduras.
• Among immigrants arriving in the United States from 2000 to 2004, 12.1 percent held advanced degrees (compared to 10.3 percent of those arriving between 1990 and 1999), while 22.2 percent had bachelor’s degrees (compared to 17.3 percent of those arriving during the 1990s).
• While China, South Korea, and Japan have increased their funding for research and development (R&D) significantly, especially since 9/11, U.S. R&D funding in the physical sciences and engineering has declined or remained stagnant since the early 1990s.
• In 2004, Congress allowed the annual H1-B quota to revert from 195,000 to its 1990 level of 65,000, which represents just 1 percent of the U.S. science and engineering workforce and has been filled before the start of each fiscal year since it took effect.

Federal Jurisdiction--Diversity of Citizenship

South Carolina law applies in all traditional personal injury cases. This type of state law is under the broad legal category of civil wrongs called tort law. Even though South Carolina law governs a tort case, sometimes a Defendant will be allowed to have the case removed from South Carolina State Court to federal court based on diversity of citizenship between the parties.

In serious cases, Defendants will usually attempt this procedural removal maneuver whenever possible, because generally speaking, federal judges are much more prone to grant a Defendant "summary judgment." Summary judgment deprives the injured party of her right to a jury trial and results in a defense judgment. When summary judgment is granted, the case is just decided in favor of a defendant based on paperwork filed with the Court and no live testimony--such as would happen at a trial--is taken before the Court.

Unlike State courts which have broad jurisdiction over cases brought before them, federal courts are considered to be courts of limited jurisdiction. Therefore, the types of cases that can be presented to a federal trial court are limited by statutes passed by Congress.

There are a number of jurisdictional statutes, but for most State tort cases brought in State Court, the diversity jurisdiction statute is the law that governs a federal court's right to hear the case.

This statute is found at 28 U.S.C. § 1332. The statute states, in part, as follows:

(a) The district courts shall have original jurisdiction of all civil actions where the matter in controversy exceeds the sum or value of $75,000, exclusive of interest and costs, and is between — . . . citizens of different States;

The Supreme Court states that federal jurisdiction predicated upon 28 U.S.C. § 1332(a) requires complete diversity between all plaintiffs and all defendants. See Lincoln Property Co. v. Roche, 546 U.S. 81 (U.S. 2005) (citing Strawbridge v. Curtiss, 3 Cranch 267). When a corporation is a defendant, Section 1332(c)(1) states, “a corporation shall be deemed to be a citizen of any State by which it has been incorporated and of the State where it has its principal place of business.” 28 U.S.C. § 1332(c)(1).

A corporation, formed by paying fees and filing paperwork in a State Secretary State's office, is an organization whose primary purpose is to protect investors from personal liability, i.e., to help individuals evade personal responsibility for wrongs they commit. The law states that a corporation is considered a legal fiction or "an entity."

“For diversity purposes, a corporation maintains a dual citizenship. A corporation is a citizen of the state in which it was incorporated, and the state in which it has its principal place of business. 28 U.S.C. § 1332(c).” Clipper Air Cargo v. Aviation Products, 981 F. Supp. 956, 958 (D.S.C. 1997). Defense lawyers often make efforts to prove their corporate client's principal place of business is another state other than South Carolina.

Therefore, one tactic South Carolina Plaintiff attorneys follow to preclude federal jurisdiction before a case is removed, is to identify all South Carolina Defendants as parties to the lawsuit. By including a South Carolina Defendant in the legal action, a foreign corporate defendant will not be able to show the federal court that there exists "a complete diversity" of citizenship between the parties. As long as one of the legitimately named Defendants is a South Carolina citizen, the case, if removed, must be remanded to State Court because the Federal District Court would lack jurisdiction.

Immigration Reform: President Bush

On January 23, 2007, President Bush gave his State of the Union speech last night. In his speech, he addressed the issue of immigration reform. His proposed policy includes the following aspects taken from the White House web site:

To Secure Our Border, We Must Create A Temporary Worker Program

America's Immigration Problem Will Not Be Solved With Security Measures Alone. There are many people on the other side of our borders who will do anything to come to America to work and build a better life. This dynamic creates tremendous pressure on our border that walls and patrols alone cannot stop.

As We Tighten Controls At The Border, We Must Also Address The Needs Of America's Growing Economy. The rule of law cannot permit unlawful employment of millions of undocumented workers in the United States. Many American businesses, however, depend on hiring willing foreign workers for jobs that Americans are not doing.

To Provide A Lawful Channel For Employment That Will Benefit Both The United States And Individual Immigrants, The President Has Called For The Creation Of A Temporary Worker Program. Such a program will serve the needs of our economy by providing a lawful and fair way to match willing employers with willing foreign workers to fill jobs that Americans have not taken. The program will also serve our law enforcement and national security objectives by taking pressure off the border and freeing our hard-working Border Patrol to focus on terrorists, human traffickers, violent criminals, drug runners, and gangs.

The Temporary Worker Program Should Be Grounded In The Following Principles:

• American Workers Must Be Given Priority Over Guest Workers. Employers should be allowed to hire guest workers only for jobs that Americans have not taken.
• The Program Must Be Truly Temporary. Participation should be for a limited period of time, and the guest workers must return home after their authorized period of stay.
• Those who fail to return home in accordance with the law should become permanently ineligible for a green card and for citizenship.
• Participation Should Fluctuate With Market Conditions. When the economy is booming, and there are not enough American workers available to help businesses grow, the program should be open to more participants. But when times are tough and Americans struggle to find jobs, the economy cannot and should not support as many guest workers.

We Must Bring Undocumented Workers Already In The Country Out Of The Shadows

Comprehensive Immigration Reform Must Account For The Millions Of Immigrants Already In The Country Illegally. Illegal immigration causes serious problems, putting pressure on public schools and hospitals and straining State and local budgets. People who have worked hard, supported their families, avoided crime, led responsible lives, and become a part of American life should be called in out of the shadows and under the rule of American law.

The President Opposes An Automatic Path To Citizenship Or Any Other Form Of Amnesty. Amnesty, as a reward for lawbreaking, would only invite further lawbreaking. Amnesty would also be unfair to those lawful immigrants who have patiently waited their turn for citizenship and to those who are still waiting to enter the country legally.

The President Supports A Rational Middle Ground Between A Program Of Mass Deportation And A Program Of Automatic Amnesty. It is neither wise nor realistic to round up and deport millions of illegal immigrants in the United States. But there should be no automatic path to citizenship. The President supports a rational middle ground founded on the following basic tenets:

No Amnesty. Workers who have entered the country illegally and workers who have overstayed their visas must pay a substantial penalty for their illegal conduct.

In Addition To Paying A Meaningful Penalty, Undocumented Workers Must Learn English, Pay Their Taxes, Pass A Background Check, And Hold A Job For A Number Of Years Before They Will Be Eligible To Be Considered For Legalized Status.

Any Undocumented Worker Seeking Citizenship Must Go To The "Back Of The Line." The program should not reward illegal conduct by making participants eligible for citizenship ahead of those who have played by the rules and followed the law. Instead, program participants must wait their turn at the back of the line.

We Must Promote Assimilation Into Our Society By Teaching New Immigrants English And American Values

Those Who Swear The Oath Of Citizenship Are Doing More Than Completing A Legal Process – They Are Making A Lifelong Pledge To Support The Values And The Laws Of America. Americans are bound together by our shared ideals, our history, and the ability to speak and write the English language. Every new citizen has an obligation to learn the English language and the customs and values that define our Nation, including liberty and civic responsibility, appreciation for our history, tolerance for others, and equality. When immigrants assimilate, they advance in our society, realize their dreams, and add to the unity of America.

New Citizens Need Guidance To Succeed. The Office of Citizenship is creating new guides for immigrants and introducing a new pilot civics examination designed to foster a deeper understanding of civic virtues and the founding ideals. The President's Task Force on New Americans is fostering volunteerism through volunteer.gov and exploring partnerships with local organizations. Public libraries and faith-based and community groups will be encouraged to offer English language and civics instruction to immigrants who are seeking to make America their home.

Insurance Company Claims Adjusting Duties

South Carolina has statutes which require automobile insurance companies to treat people with claims in a fair and reasonable manner. The statute that relates to how adjusters must handle claims is S.C. Code Ann. § 38-59-20. Under Section 38-59-20, the following acts are some of those defined by statute as improper claims practices:

• Knowingly misrepresenting to insureds or third-party claimants pertinent facts or policy provisions relating to coverages at issue or providing deceptive or misleading information with respect to coverages.
• Not attempting in good faith to effect prompt, fair, and equitable settlement of claims, including third-party liability claims, submitted to it in which liability has become reasonably clear.
• Offering to settle claims, including third-party liability claims, for an amount less than the amount otherwise reasonably due or payable based upon the possibility or probability that the policyholder or claimant would be required to incur attorneys' fees to recover the amount reasonably due or payable.
• Invoking or threatening to invoke policy defenses or to rescind the policy as of its inception, not in good faith and with a reasonable expectation of prevailing with respect to the policy defense or attempted rescission, but for the primary purpose of discouraging or reducing a claim, including a third-party liability claim.
• Failing to acknowledge with reasonable promptness pertinent communications with respect to claims arising under its policies, including third-party claims arising under liability insurance policies.
• Any other practice which constitutes an unreasonable delay in paying or an unreasonable failure to pay or settle in full claims, including third-party liability claims, arising under coverages provided by its policies.

Insurance Companies owe a fiduciary and statutory duty to their insureds to fairly adjust their claims. The process of making a claim to an insurance company should not be an adversarial process. However, because insurance companies are profit-driven organizations, it often seems to be difficult for an insured to make a fair and full recovery .

Monetary Damages: Who Gets the Money?

The purpose of any personal injury lawsuit against a careless party is to recover monetary damages for an injured person. The monetary amount is intended only to compensate the person, or restore them to the position in which they would have been had the injury not happened.

Monetary damages may be awarded to a person for a number of different types of harms. In most cases, the most concrete of these categories of damages is compensation for medical bills related to treatment caused by the carelessness.

The medical bills of many people are initially paid by the health insurance company. During the course of a trial, jurys often become aware of the fact an injured person is covered by health insurance. Usually, testimony about lost work, or from coworkers is offered, and the fact an injured person is employed is elicted during the testimony. It is not hard for people to figure out the person is covered by insurance even if evidence about it is excluded by a judge. Moreover, many defense lawyers suggest the presence of health insurance or otherwise elicit evidence to increase a jury's awareness of the presence of it. Defense lawyers know that a jury's awareness about a person's health insurance coverage tends to result in reduced damages awards.

Why are verdicts lower when juries assume that the person's medical bills were paid for by the health insurance company? Juries are simply resistant to awarding compensation when they believe doing so creates what they percieve to be a double recovery, an injustice. They figure why should we award this person the full amount of her medical expenses when her bills were already paid by her insurance company? They figure, even if we do make such an award, the the full award of medical expenses is overcompensating and the verdict must be reduced in other areas, such the amount of her compensation for pain and suffering.

However, when juries speculate about the impact of insurance paying medical bills they make a wrong assumption. They assume the compensation in the verdict will be given to the injured peson and that the health insurance company will not get any of money awarded. This assumption is very, very wrong.

It is wrong because almost all health insurance plans now have the right of reimbursement from any verdict. Check out your own policy and look for a paragraph often called "subrogation." Subrogation provisions give the health insurance company a form of super lien. Subrogation means the health insurance company is paid first from any verdict, sometimes even before the person can pay her attorney or the costs of prosecuting the lawsuit.

Therefore, when a jury resists awarding full medical expenses to an individual because of a reluctance to give the person a double recovery, it actually creates a windfall for the careless defendant and undercompensates the injured person.

More will be written about the right of subrogation in this blog. However, as an inital matter, we will just introduce this idea of subrogation and address the specifics of this phenomenon at a later date.

Settlements for Minors

Often, a child is injured in a motor vehicle collision. When this happens, a mother or father may seek recovery of damages on behalf of the child, or minor. When and if a settlement on behalf of a minor is reached, the money that is delivered on the child's behalf, often to the mom or dad, is considered to be the property of the injured child.

The way that child's money is spent is limited by South Carolina statute. Failure to comply with the South Carolina statute could expose the parent to a claim by the child for misappropriation of the funds. If the settlement is large enough to be under the management of a Probate Court, improper spending of the child's settlement fund could result in sanctions by the court.

Section 62-5-103 of the South Carolina Probate Law explains in detail the obligation of the parent to preserve their child's money, and has some details about what the money cannot be spent upon. (These same rules apply to incapacitated persons.) It states, in part, as follows:

Money or other property received on behalf of a minor or incapacitated person may not be used by a person to discharge a legal or customary obligation of support that may exist between that person and the minor or incapacitated person. Excess sums must be preserved for future benefit of the minor or incapacitated person, and a balance not used and property received for the minor or incapacitated person must be turned over to the minor when he attains majority or to the incapacitated person when he is no longer incapacitated. Persons who pay or deliver in accordance with provisions of this section are not responsible for the proper application of it.

Therefore, the child's settlement money cannot be used to help pay for such things as rent, groceries, clothing, medical expenses, or similar routine expenses even if the child would indirectly or directly benefit from these expendures. This Rule exists because those type of expenses are already the usual and customary obligations that go along with a person's parental duties.

As stated in the statute, absent unusual circumstances, any excess money that is not spent on legitmate expenditures should be given to the child when he or she becomes 18 years old.

Immigration Reform

There is a consensus in the United States today that our immigration system is broken. The question is "What is required to fix it?"

It is clear that more of the same will not work.

There are an estimated 11 million undocumented persons living and working in the United States today. Smugglers, traffickers and criminals preying on undocumented migrants have a growing negative impact on border communities.

Nearly 2,000 migrants have died trying to cross our border from the south from 1998 through 2003, and nearly 400 migrants continue to die at our borders every year.

America needs comprehensive immigration reform that will make immigration safe, orderly and legal. Such reform must provide three things:

• an opportunity for people already living and working here to earn permanent legal status;
• a new temporary worker program with adequate labor protections, so that essential workers can enter the U.S. safely, legally and expeditiously;
• backlog reductions in family-based immigration so that families can unite in a timely way.

Proposals that fail to embrace these components and seek only to increase enforcement of the current system will only exacerbate current problems.

Congress may enact harsh enforcement measures, such as the Sensenbrenner bill passed in the House of Representatives, which do nothing to increase our nation's security. Such measures only increase the pressures on hardworking but undocumented immigrants and force them to seek dangerous paths of entry to the U.S., where increasing numbers will die attempting to cross. Or Congress can engage the debate and enact realistic and comprehensive reform, which will ensure the U.S. remains a nation of immigrants in the decades to come.

AILA InfoNet Doc. No. 06092773 (posted Sep. 27, 2006)

Proving Damages to a Greenville Jury

Greenville, South Carolina, is one of the most conservative jurisdictions in the United States. The people who serve on juries here are not going to award millions for spilling hot coffee on yourself in a fast food drive through. Greenville juries are skeptical, and they demand that if you are bringing a personal injury case before them, that you have sufficient proof to meet your burden.

This is the great challenge (or burden) for the Greenville County trial attorney.

Yes, I said, "burden." The plaintiff has the burden of proof. A lawyer who relies on sympathy in Greenville, while just showing fault, introducing medical bills, and a video of the treating doctor, does a disservice to his client. That kind of proof will probably not be enough to generate an award of a fair and just amount of damages. If you are lucky, you might get a verdict equal to the medical bills.

A plaintiff who wishes to win her case and achieve a fair award of damages in Greenville must present her case with sufficient evidentiary weight to convince a group of twelve conservative upstate citizens that she has a legitimate case for such an award.

How does a trial attorney learn how to do this for his clients? For me, I like to rely upon authoritative literature for guidance. In this case, Deuteronomy 19:15 provides the answer.

One witness cannot establish any wrongdoing ... against a person, whatever that person has done. A fact must be established by the testimony of two or three witnesses.

Thus, a lawyer for the injured person should find at least two or three damages witnesses. These are the people who know the injured person and can provide their testimony about what has happened to their husband, child, friend, or coworker. These witnesses should be prepared to provide detailed testimony about specific events or observations that illustrate the harm caused to the person. Perhaps she is in pain. The witness should testify about his truthful observations of the person ... grimacing, complaining, limping, groaning, inability to do tasks or activities that they could do before. Even more persuasive is when witnesses describe the injured person's strivings to overcome her injuries; the grueling trial of physical therapy, the struggle to get back to work, or perhaps the decision to forgo medication and endure pain to avoid side effects of prescribed medicines.

These damages witnesses will usually be cross-examined by the defense lawyers about their bias toward the injured party. However, if two (or better yet, three or four witnesses) provide testimony about the facts of damage, well then you have a chance to meet your burden of proof in a Greenville County jury trial.