A few HMOs and PPOs have such a large customer base that they wield a lot of influence in the industry. A service provider that is habitually not being paid on time for services rendered even with a clean claim may be reluctant to complain for fear of losing the contract as retaliation.
One of the biggest hindrances to the effectiveness of the Texas Prompt Pay Act is this reluctance by service providers to expose this practice, and so it becomes vicious cycle. According to the website of prompt pay law firm Williams Kherker, the medical community is unable to provide adequate health services to the public because they are not being paid according to their contract in a timely manner for their hard work.
The solution is at hand, and retaliation should not be a concern. The Texas Insurance Code (§1301.066 and §843.281) and the Texas Administrative Code (§11.901(a)(2) and (8)) address the legal protection of service providers that file prompt pay violations from retaliation from insurance companies.
HMOs are forbidden by Texas Ins Code §1301.066 and §843.281 from cancelling, terminating, or refusing to renew service contracts of medical providers and health service providers for filing formal complaints against or appealing decisions of the HMO.
The Texas Administrative Code, on the other hand, requires that service provider contracts include anti-retaliation and prompt pay provisions. This gives the service provider legal protection and encourages them to report any illegal or unfair practices of the carrier, including delayed payments for clean claims.
Of course, some insurance companies will attempt to exert their influence by retaliating anyway on service providers that complain, confident that they have the legal muscle to do so. The laws say otherwise, and with the help of an experienced and competent prompt pay lawyer, these insurance carriers will find out they made a bad mistake.Read More
Commercial roofing provides protection for the building from the elements, mostly from water and air damage. But another major function of roofing is to keep temperatures inside any building, commercial or residential, at comfortable levels, and that means providing insulation during both hot and cold weather. It is much more difficult to design a roof that keeps cool in the summer and warm in winter, but roofing contractors in Texas have figured out a way to have the best of both worlds.
The system is called cool roofing and makes use of three layers of structure: a reflective surface, above-sheathing ventilation (ASV), and above sheathing radiant barrier. The key to keeping the building cool is in the ASV, which is essentially space between the outer roof and the foil insulation leading to a vent at the top where heat can escape back out rather than radiate into the house like a convection oven. In a commercial building, this will work well with a low-slope roof as the ventilation shaft will more efficiently carry the heat away than a flat roof.
This type of roofing also works well in keeping the cold out during winter because while the design prevents heat from entering from outside, it also keeps in heat that’s already inside, such as that from a heater. This means significant reductions in both cooling and heating costs as temperature regulation is much more efficient.
When designing a new building or planning on replacing an existing roof in Texas, it is important to specify a cool roofing structure to the contractor such as Black Slate Roofing, LLC. It may cost more to have a cool roof installed, but the benefits over the long run can more than make up for any additional outlay on labor and materials at installation.Read More
Employers in the US, whether from the private or government sector, are obliged provide their employees with a safe and healthy work environment to significantly reduce, if not totally eliminate, occurrences of accidents in the workplace. This duty is base on the mandate of the Occupational Safety and Health Act, a federal law that was enacted by the US Congress in 1970. The Act requires the assurance for a safe and healthy working environment for all employees, the conduction of training in the area of occupational health and safety, and the provision of vital information, research and education on the same area.
In 1971the Occupational Safety and Health Act or OSH Act gave birth, in turn, to the Occupational Safety and Health Administration (OSHA), which is tasked to fully and strictly implement all the safety standards mandated by the Act, such as a workplace free from mechanical dangers, excessive level of noise, heat or cold stress, exposure to toxic chemicals, poisonous gases, radiation, unsanitary conditions, and other hazards.
The Hazard Communication Standard or HCS, is another mandate that OSHA enforces. This federal mandate, which was passed into law in 1980 and took effect in 1986, gives those exposed to hazardous chemicals in the work area the right to be informed about the type of danger they are exposed to and how they can protect themselves from such danger.
The HCS, also known as the Right-to-Know law or the Worker Right-to-Know Legislation, also requires manufacturers and importers to attach Material Safety Data Sheets (MSDS) and warning labels on all their hazardous products. And, besides indicating on the label that a product is poisonous or hazardous, there should also be information on the product’s safe storage suggestions, potential health effects, precautions for use, emergency first aid instructions, and contact numbers for further information.
On its website, Scudder & Hedrick, PLLC, explains that each type of work environment presents a unique set of safety risks; thus, employers should take full responsibility in implementing the necessary measures that will prevent accidents from occurring. Anticipation of potential problems through risk assessment, safety training, provision of the necessary protective equipment, installation of safety barriers and so forth, are just few of the precautions that ought to be observed inside work premises. While OSHA maintains that accidents can be avoided, this will only be possible if owners of firms and their managers observe government safety standards, and the employees follow company safety rules.Read More
The gender lines between male and female have become more and more blurry, and in the 21st century it has been socially accepted to have men be more health and beauty conscious and for women to enjoy sports and other outdoor activities. Call it “gender equality” if you must, but there are still some things that can be surprising. Although men (and even some women) find the idea of men’s cosmetics laughable, it has become the fastest-growing sector in the beauty and cosmetic industry.
Although it is significantly smaller than the female beauty industry, there has been a recent increase in sales for men’s cosmetics. Today, more and more men are spending money for more than just grooming products. It may be a wonder how cosmetic companies and marketers made these men buy “makeup,” but the answer is actually really simple. Marketers and advertisers tend to avoid using the word “makeup” and instead prefers to use the terms “urban camouflage” or “facial fuel” to appeal more manly. Even their packaging is meant to look more masculine, shunning away any colors or descriptions that allude to women’s cosmetics.
Having the same purpose as those of women’s cosmetics – cover up wrinkles and blemishes, moisturize, prevent aging, and many others – men’s make-up generally aim to hide imperfections. Men have become more and more comfortable being metrosexual, understanding the importance of appearance and youthfulness in today’s society. Gender lines are blurring. The stereotypical appeal of the classical man – the strong and silent type, with rugged features – is being threatened by the rising number of men embracing the metrosexual lifestyle. Being metrosexual and using men’s cosmetics does not necessarily mean a man has to become feminine, they can still hang on to a number of traditional paradigms of manhood. Although it does help to take care of one’s self and be self-conscious, a man who takes his imperfections with grace and carries on with his life is still viewed as the norm.Read More
There is nothing more difficult to fight than an unseen enemy. For women and minorities in employment, this is referred to as the “glass ceiling.”
It is actually a political term that was first used in an article by former Working Woman magazine editor Gay Bryant in March 1984 to refer to the inability of women in middle management to break through to upper management despite their experience and qualifications. The term has also been used to refer to the same plight of minority men.
It may be tempting to state that in 2014 there is no longer any glass ceiling, that discrimination based on sex or gender no longer exists. But in fact, 73% of female executives today believe that it still does.
The statistics seem to bear this out. While women comprise 51% of those in middle and senior management, there are only 8% who make it to the top position. The statement of Gay Bryant in her 1984 article that women in the corporate world are being blocked from advancing past a certain point continues to hold true.
It is not always easy to prove that there is discrimination in the workplace as there are many factors that come into play when it comes to climbing the corporate ladder. But those who are in position can tell when they’ve hit that invisible barrier. While some shrug it off as part of the status quo, this is actually illegal because it is a violation of a person’s civil rights. Ironically, women lawyers are not exempt. In 2011, 45.4% of all lawyers were women, but only 19.5% made partner in law firms.
If you believe that you have hit the glass ceiling, you may be able to prove workplace discrimination. Consult with an employment discrimination lawyer to find out more about your options.Read More
Personal injury lawsuits have been on the rise in the US ever since the concept of liability was raised to protect the rights of the innocent bystander from the consequences of a third party’s actions. While tort (wrongdoing) law has a long history, it has really only entered into the general public’s consciousness since the 1970s, but when it did it gained rapid ground. Yet there are some common misconceptions about personal injury litigation.
Two of the major concepts in a personal injury lawsuit are negligence and proximate cause. Negligence is defined as the act or the failure to act of a reasonable person resulting in foreseeable harm to another person. It is not enough that a person is negligent, however. The rule is that the plaintiff in a personal injury lawsuit must prove that there was negligence by a third party and that this negligence was a proximate cause of serious injury. It does not have to be the sole or even ultimate cause of the injury as long as the negligence can be connected to the injury in some way.
For example, in dram shop laws in any of the 38 states that enforce it in the US, the business establishment that fails to cut off a customer who is obviously inebriated or nearly so can be held liable for injuries resulting from a drunk driving accident. The bar owner is said to owe a duty to the public to refuse service to an individual who may have had “one too many.”
Is it possible that even if the bar owner had refused service to the customer that the accident may have still happened? Yes, but that does not relieve the bar owner of liability for not cutting off the customer. In such cases, the “but-for” cause of action is not applicable, because the action of the bar owner increased the risk of a foreseeable event such as a car accident.
Proving negligence and proximate can be complicated, and according to the website of Pohl & Berk, LLP in Tennessee, can add to the struggle that a victim will have to contend with on top of all the other problems associated with serious injury. It is advisable to have an experienced and knowledgeable legal team on board to help in proving the case and bring the case to a just and satisfactory conclusion.Read More
People typically associate exposure to toxic substances with things that carry disease such as the flu, a flesh-eating virus, or one that will turn you into a zombie. But a substance does not have to be infectious to be harmful to the health.
One of the best examples of a seemingly benign substance having harmful health effects are fiber-related diseases. These types of diseases include byssinosis, (brown lung disease related to industries dealing with cotton) and coal workers’ pneumoconiosis (black lung disease). These are occupational lung diseases that result from chronic inhalation of very small particles of otherwise harmless substances, which then collect in the lung and eventually lead to respiratory failure and death.
Exposure to asbestos can cause people to suffer from serious illness in the same way, but the difference is that asbestos exposure is not confined to workers in industries that handle the substance. Chronic asbestos exposure can occur in the home, the workplace, and in public areas. Because it had so many useful applications in the past before it was discovered to be toxic, you could be exposed to it without knowing it, such as from old electrical wiring or insulation.
Asbestos is a silicate material that occurs in nature and the fibers are very fine. Mining and manufacturing of asbestos is no longer carried out, but it is nevertheless in the air and water in the area where deposits are located. The health effects of naturally occurring asbestos are not proven but studies indicate that there could be a correlation between NOA exposure and mesothelioma. As pointed out on the website of law firm Williams Kherkher, mesothelioma is known to be caused by exposure to asbestos.
Liability for exposure to asbestos will become an issue when it is preventable i.e. failure to follow regulations for the proper disposal of asbestos-containing material. If you are injured from exposure to asbestos due to the carelessness or negligence of a third party, you should contact a personal injury lawyer to find out your legal options.Read More
Pinpointing liability for truck accidents caused by a defective or malfunctioning part such as brakes and tires can be a complicated issue. Because vehicles are in constant motion, the parts tend to wear out, and this is even truer in the freight and trucking industry. When the trucking company or truck owner fails to maintain their vehicles properly, accidents that result in serious injury to innocent third parties can happen even if all other safety regulations are followed. But it is also true that in some instances, new parts turn out to be defective, or were improperly installed. According to the website of these truck accident lawyers, innocent victims of such accidents should hold the responsible parties liable at least for their financial losses.
The liability for truck defects may be said to possibly lie with the:
- Truck Driver – for failing to report any observed problems with the vehicle
- Truck Company – for failing to do regular maintenance on vehicles
- Truck Parts Manufacturer – for design or manufacturer defects on parts
- Auto Parts Distributor – for sale of a defective or malfunctioning part
- Third-party Mechanic – for incorrect installation of a vehicle part or installation of an inappropriate model or size of a part
One or more of the parties above may be named in a personal injury suit in a semi truck accident, for example, in which one or more people were seriously injured. If they are found responsible, the next issue would be determining the percentage of fault. Insurance companies, which more likely than not will be making the pay out, will exert all necessary effort to minimize their exposure, which can mean an extended legal battle.
This can have serious consequences for the victims of the accident as a prolonged dispute can mean delays in getting compensation for medical and other financial costs. To keep the delays as short as possible, it is advisable to get experience truck accident lawyers practicing in the area to get the documentation together and handle the case.Read More
The internet and the plethora of information out there has convinced many people that they can do anything on their own with a little elbow grease and a lot of research. This can range from self-medication to drawing up legal documents. While it is a laudable objective to try to save on professional fees with the economy the way it is, it is really not a good idea to gamble on one’s health or legal issues. As pointed out in an article on the website of Arenson Law Group, PC in Cedar Rapids, it can lead to more expenses down the road, not to mention other undesirable circumstances. The assistance of a professional can help avoid these situations.
Because not all the information you find on the internet is updated, or applicable, or even true. After all, any Tom, Dick or Harriet can post information online and sound incredibly, well, credible. When drafting something as important as a prenuptial agreement, for example, it is recommended that you have it done by a competent legal professional in your state just to make sure that what you get is something that is actually valid and enforceable. It will cost more than the ink in your printer, that’s for sure, but you will have the assurance that you and your future spouse are not making any bad mistakes in such an important issue.
Prenuptial agreements, or sometimes referred to as premarital agreements, or a prenup, are a contract between two people who are about to tie the legal knot that dictates financial and other issues that may come up if and when they divorce, or if one of them dies. This may include guardianship or custody of children, alimony, property division, and so on. Most countries recognize prenups but the applicable laws in any jurisdiction are typically complicated. In the US, a prenup is recognized as legally binding provided it is properly drawn up in accordance with family laws in the relevant state. To be duly recognized in a court of law, a prenup must be:
- Voluntary on the part of both parties
- Based on full financial disclosure
- Completed prior to marriage
- Fair to all concerned
- Legal and in accordance with public policy
If a judge decides that the agreement violates one or more of these conditions, the prenup can be ruled invalid.Read More