Newsletter is the source of official Trust policy statements
It is important for all Trust constituencies to note that the Manville Trust Newsletter is the primary means by which official Trust policy is communicated to our constituencies. Please review the Newsletter carefully, and note any policy statements that impact the manner in which you process your claim(s). Trust Newsletters, indexed by topic, are available on the Internet at mantrust.org, beginning with the April 1, 1996 issue.
The Trust's subsidiary and claims resolution facility services provider, the Claims Resolution Management Corporation (the "CRMC"), will respond to your questions about the Trust, its operations and policies at inquiry@claimsres.com.
CONTENTS:
TDP REQUIREMENTS TO DOCUMENT BILATERAL LUNG DISEASE
In our April 10, 1996 Newsletter the Trust clarified its requirements regarding documentation to demonstrate that a claimant has bilateral lung disease as required to meet the categorization criteria specified in the Trust Distribution Process (TDP). Since that time we have received questions about this issue. What follows clarifies the policy we publicized in April.
The categorization criteria for five of the seven asbestos-related injury categories in the TDP REQUIRE that the claimant's lung disease be DOCUMENTED AS BILATERAL. The presence of bilateral lung disease is so fundamental and important to the accuracy of the diagnosis for categorization purposes that the report of the confirming medical procedure, such as the x-ray or CAT scan, must either use the term "bilateral" or must affirmatively specify/clearly imply that the disease process is present in both lungs.
The Trust adopted this requirement not only to comply with the terms of the TDP but because the Trust believes that except in rare cases (such as claimants who have undergone full lung resection), unilateral disease process indicates that the disease is unrelated to asbestos exposure. Bilateral findings significantly increase the likelihood that a diagnosis of an asbestos-related disease is well-founded. This information is, therefore, critical to ensuring that the Trust compensates for bona fide asbestos-related injuries only.
The five TDP categories that require proof of bilateral disease process are:
Category 1- Bilateral pleural disease;
Category 2 - Nondisabling bilateral interstitial lung disease;
Category 3 - Disabling bilateral interstitial lung disease;
Category 4 - Other cancers; and
Category 6 - Lung cancer (smoker).
More specifically, as described in the TDP, for a claim to qualify for Category 1, a claimant's medical reports must indicate "bilateral pleural disease (plaques or thickening) diagnosed on the basis of x-ray, CAT scan, or high resolution CAT scan." To qualify for Category 2, a claimant's medical records must document "bilateral interstitial lung disease diagnosed on the basis of x-ray, CAT scan or high resolution CAT scan, and [the claimant must] submit either: (a) a medical report stating that a causal relationship exists between asbestos exposure and the bilateral interstitial lung disease, or (b) documentation of the presence of either unilateral or bilateral pleural disease accompanying the bilateral interstitial lung disease." Claimants seeking Category 3 classification must document bilateral interstitial lung disease in addition to demonstrating impairment and must provide a medical report stating the causal relationship of the claimant's bilateral interstitial lung disease to asbestos exposure. Proof of bilateral interstitial lung disease or bilateral pleural disease as well as pathological evidence of asbestosis may fulfill an underlying disease requirement for Categories 4 and 6.
Requests for Recategorizaton Will Have to Meet the
Tighter Documentation Standard for Bilateral Lung Disease
Prior to December 1995, claims examiners attempted to draw broad inferences about the possible existence of bilateral disease process from non-specific language. However, the increasing lack of specificity seen in the language of medical reports as the Trust worked through the claims in FIFO order, convinced Trust managers that this approach was unreliable and could not be consistently and fairly implemented. Therefore, starting in December, 1995, only those medical reports that unequivocally diagnosed bilateral lung disease were determined to have met the TDP criteria. Thus, claims recategorized in 1996 may have been recategorized to lower categories if the medical reports were first reviewed during 1995. If the affected claimants should so choose, the Trust will have its B-readers review the x-rays of any unsettled claims for which recategorization was requested between December 1995 and August 1, 1996 which were downgraded for the lack of specific bilateral terminology. The Trust will review the submitted x-rays or CAT scans for bilateral disease process and will recategorize the claim and issue a new offer.
Alternatively, a claimant may provide notice of their intention to withdraw their request for recategorization, in which case their claim will be treated as if recategorization had not been requested. This notice must be provided in writing to the Trust's Response Logging Unit.
Effective August 1, 1996 all recategorized claims will be held to this standard for documenting bilateral lung disease. In the meantime, firms will receive lists of unsettled claims for which recategorization has resulted in reduced claim category. For more information about the documentation of a bilateral disease process, please contact Melissa Metzfield or Brian Schoppert at the Trust at (703) 204-9300.
Trust's Offer Expiration Procedures
The basics of offers and denials, and claim expiration are simple, though there are enough minor variations to make it appear complex. In a nutshell, offers and denials are valid for an 180-calendar-day period (as required by the TDP) that may, upon request during the first 180 days, be extended for a second 180 days for a total of 360 calendar days. When an offer or denial expires, no further action will be taken by the Trust on that claim, and that claim is considered expired until a request for "reactivation" is made by the attorney/claimant.
Each time a new offer (including denials) is made by the Trust, the 360-day time limit (180 days plus one extension) restarts. A new offer is defined as an offer check or denial letter that results from an initial categorization, a recategorization, or an individual evaluation. One extension is allowed for each new offer. Each offer response form now displays the offer expiration date.
Checks are valid for 90 days. If a check expires at the end of 90 days, it may be reissued. A check reissue is not a new offer. When a reissue occurs near the end of an offer period, the claim will expire either on the 180th/360th day of the offer period or the check expiration date, whichever is later. If there is a change in legal counsel after the offer process has begun on a claim, any offer/denial made to the new counsel or pro se claimant will be considered a new offer.
Expired claims may be reactivated in one of two ways.
Most commonly, a written request for reactivation is received by the Trust and the claim is assigned a new FIFO date based upon the date of reactivation. (Note that the proof of claim number assigned to the claim remains the same.)
Infrequently, a claim's expiration is canceled and the claim is allowed to return to its original FIFO spot. This is done only when there are extenuating circumstances. These requests must be approved by the Director of Operations, Karin Croft.
However, if a client has decided to accept an offer as it existed when the claim expired, and the law firm has a signed release on file, the Trust will reissue the offer check. Under this circumstance, additional options, such as ADR, recategorization or individual evaluation are not available.
Individual Evaluations Going Slowly
Operations Changed to Speed the Process
Since the Trust began individual evaluations in March of this year of non-Exigent Health or Hardship claims (the regular opt-out queue), settlement progress has been extremely slow. Because the claims have been dormant for a considerable period, law firms generally have to update a significant amount of information in the file.
Hundreds of claims have now received an initial review, and telephone calls have been made (usually followed with confirming faxes) to firms outlining the additional information required to complete the evaluation. Unfortunately, in most cases, months have passed without responses to these information requests. This lack of response has been pervasive despite multiple telephone calls and written requests.
In order to maximize the number of individual evaluation settlement discussions and to allocate resources more effectively, the Trust has implemented a new approach to processing claims in individual evaluation. Claims will be reviewed in the order the request for individual evaluation was received, and telephone contact will be attempted to let the firm or pro se claimant know what (if any) additional or updated information is needed in order to fully value the claim. Whether or not the Trust is able to reach an appropriate person in the firm or the pro se claimant (using reasonable effort), the Trust will send a letter via certified mail, confirming the information requirements. After the letter has been sent, no further contact with the firm will be attempted until the additional information requested from the firm is received. Settlement negotiations will proceed only on claims for which complete information has been provided.
By considerably reducing the number of attempts to extract claim information by telephone or correspondence, it is hoped that more claims will be evaluated more efficiently, thereby increasing the number of actual settlement discussions. Firms will be able to respond on their own timetable, and settlement discussions will proceed on claims for which the information is provided. It is important to note, however, that if more than 90 days passes from the time the letter is sent and the information is received, it is likely that the file will have been returned to storage, further delaying additional claim evaluation.
Claim Filing and Settlement Activity as of June 30, 1996
During the first six months of 1996, the Trust received 20,600 new claims. Over 6,500 of these were received in June in anticipation, we surmise, of the July implementation of the new proof of claim form. Our inventory of claims received was greater than 300,200 on June 30, 1996. Of these, 110,300 are settled, and 18,000 are expired or otherwise disqualified from further processing. As of June 30th, there were nearly 40,000 offers and denials outstanding.
Medical Audit Responses Due August 1, 1996
The next medical audit responses are due by August 1, 1996 for the second and third quarters, 1996. Firms must adequately respond to the Trust's medical audit requirements by providing information and/or chest x-rays on 90% or more and by passing the audit on 80% or more of the claims selected for your firm's audit. Soon after the August 1, 1996 deadline, we will be reviewing the results of the audit prior to the issuance of third quarter offers.
Those firms not achieving the minimum response and pass rates (90% and 80% respectively) will be placed or remain on 100% audit. This means that all of a firm's claims will be medically audited before receiving an offer except for certain categories of claims not presently required to complete medical audit. These are eligible Category V, VII, and nonsmoking Category VI claims submitted by your firm, claims that qualify for Exigent Health or Hardship status, and currently outstanding (unexpired) offers. If, however, an outstanding offer is recategorized to a more serious disease (excluding the exempt categories listed above), enters individual evaluation or arbitration, or expires, the claim may have to complete medical audit before becoming eligible for payment.
If you have any questions about medical audit requirements or your firm's responses, please call Richard Flynn or John Galik in the Trust's Claims Department, or contact the Trust via e-mail at "medaudit@claimsres.com". The Trust's Internet Homepage address is: "www.claimsres.com".
Manville Trust Staff Announcements
The Trust is pleased to announce the appointment of two new senior managers. Susan Prytherch has been appointed Chief Claims Officer. She will manage all programs involved in the evaluation and settlement of claims including the matrix and individual evaluation programs and medical audit.
Patricia Bak has been appointed Managing Attorney. Working for the General Counsel, David Austern, Pat will manage the internal operation of the Trust's Legal Department.
We have also hired Paul Travis as Claims Payable Administrator. He replaces Barbara Emmons who has moved to the Trust's Information Services Department.