Newsletter is the Source of Official 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). The 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:
• Notice of Change In Manville Trust Medical Audit/X-Ray Submission Policy,
Effective August 20, 1998
• Lawsuit Filed
• 30,000 Additional Claims To Be Made Eligible For Payment in 1998
• EH Claims Requesting Reactivation
• Claim Filing and Settlement Statistics
• Unacceptable PFT Lab Reports
• Providing Pathological Evidence
• How To Respond To Deficiency Letters
NOTICE OF CHANGE IN MANVILLE TRUST MEDICAL AUDIT/X-RAY SUBMISSION POLICY, EFFECTIVE AUGUST 20, 1998
The following is the text of an announcement previously mailed to all Plaintiff Firms:
Based on the information gathered during three years of random medical audits of Trust claims, in order to ensure that claims are appropriately valued, but mindful of the Trust's duty to do so efficiently and effectively, the present medical audit program is being replaced. The new x-ray submission policy is outlined in general terms below. It is effective as of the date of this notice, and is applicable to claims with FIFO numbers higher than 306,000, as well as requests for recategorization, regardless of FIFO number. (Regardless of the general policies stated, the Trust reserves the right, in any case, to request additional medical evidence on any individual claim. In addition, any claimant whose diagnosis of asbestos-related disease was provided by Drs. Mitchell or Kuebler (see Memorandum to Plaintiff's Counsel dated June 19, 1997 from Patricia G. Houser, Executive Director) will continue to require submission of an x-ray):
1.
Claims categorized as an asbestos-related cancer (Categories IV, V, VI and
VII) will not
routinely be subject to audit.
2.
Claims categorized as bilateral pleural disease (Category I) will not
routinely be subject to
audit. However, some of these claims may be targeted for closer scrutiny when the Trust
believes it is appropriate to do so. Should that occur, a notice will be provided that
submission of an x-ray will be required.
3. For all claims for bilateral interstitial lung disease (Categories II and III), submission
of an x-ray for review by up to two independent Trust B-readers will be required.
If either one of two independent B-readers confirms the presence of bilateral
interstitial lung disease, an offer of the appropriate category will be made.
Once a notice has been given that submission of an x-ray is required, the claimant has 180 days in which to respond. Failure to respond will result in the claim being deemed to have been withdrawn, and the claim will lose its FIFO queue number. Submission of co-defendant settlement information and/or corroborating medical information, which was provided as a possible optional response under the current medical audit program, will no longer be an acceptable substitute for submission of an x-ray.
This simplified policy will reduce the overall number of claims requiring a medical audit response, will enable the Trust to increase the number of offers it makes, and will ultimately decrease the time between receipt of a new claim and its eligibility to receive an offer. Security, tracking and timely return of x-rays is of paramount importance and we will work with firms to assure that x-rays are reviewed in a minimum amount of time, and that if needed for other litigation, x-rays are quickly retrieved and returned. Please do not send x-rays until requested to do so.
Policy For Claims With FIFO Less Than 306,001Other special problems regarding the availability of x-rays and their use will inevitably arise. The Trust staff is committed to working with firms to resolve those questions, and make the process as efficient and effective as possible for firms and for the Trust.
In general, for claims with FIFO numbers less than 306,001, results of the random audits of a firm’s claim population will determine whether or not a claim is subject to x-ray review. Audit records on Category I claims in this population are being reviewed and some may be released without further audit. Each firm will receive specific instructions on its claims. However, it is important to note that, effective immediately, the Trust will no longer allow the option of providing co-defendant settlement information or corroborating medical reports as a substitute for submitting an x-ray.
The notices that have already been sent to each firm with unsettled claims filed with the Trust should answer most questions regarding this new policy as it specifically affects that firm's claims, and will provide a contact at the Trust to respond to its concerns.
Please direct inquiries via e-mail to: inquiry@claimsres.com.
The Trust was served on September 15, 1998 with a lawsuit filed on behalf of a number of Trust claimants alleging that the Trust lacks the authority to downgrade or deny claims based on a review of a claimant’s x-ray evidence.
All claims through FIFO number 306,000 are currently eligible to receive an offer. As a general rule, this includes claims filed through December 1996. However, because FIFO number assignment is not solely a function of the date on which a claim was filed with the Trust, the dates are approximate. Firms with unsettled claims recently received a list of the status of each of their claims. The Trust plans to make an additional 30,000 claims eligible for offer this year, which it expects will cover claims filed through approximately November 1997. Initially, a notice will be sent which will indicate those claims for which an x-ray must be submitted or a deficiency must be cured in order to receive an offer. Approximately 60 days after the initial notice, offers will be sent on the newly eligible claims.
The Trust expedites the handling of claims where the claimant is currently living and suffering from an asbestos-related lung cancer or mesothelioma and therefore qualifies for Exigent Health (EH) status. The presumption is that a claimant’s life expectancy is limited due to the severity of the disease. If an offer lapses and the claim is deactivated, in order to reapply for Exigent Health status the claimant must be living at the time of the request for reactivation and an affidavit must be submitted along with that request. This affidavit must be current and signed by the claimant’s physician and attest to the fact that the claimant’s life expectancy is less than six (6) months due to his/her asbestos-related disease. If an affidavit is not received, the claim will receive a new offer when it is reached in the FIFO queue.
Since the Trust's inception in late 1987, it has received over 388,000 claims. As of August 31, 1998, the status of those claims was as follows (numbers have been rounded to the nearest 100):
Settled
185,000
Dead, Disqualified or Expired
66,600
Offers/Denials
Outstanding
22,600
Awaiting
CXR Response*
48,500
Awaiting Deficiency Response*
5,900
Categorized - Not Yet Eligible
27,300
Not Yet Categorized
22,400
Response in Process*
6,200
Individual Evaluation Queue*
3,300
ADR*
300
Total
388,100
* Comprises or includes claims for which the Trust is waiting for a claimant response.
The Trust has paid a total of $1.8 billion to claimants. Since the inception of the TDP, the Trust has settled over 157,000 claims, paying a total of almost $770 million. During 1998, the Trust has averaged a little over 2,000 settlements per month, and had settled over 16,000 claims as of the end of August. The Trust has averaged over 2,800 payment offers per month from categorizations, re-categorizations, individual evaluations and alternative dispute resolution.
As of August 31, 1998, Total Net Claimants’ Equity was $2.68 billion, $1.7 billion of which was held in the stock of Johns Manville Corporation, the remainder of which is held in a diversified portfolio of equities and long and short-term fixed income instruments, and cash.
In the Trust newsletter dated October 28, 1996, the Trust announced it would no longer accept Pulmonary Function Test (PFT) results from certain labs. A number of additional PFT operations (in bold below) have now been added to that list. These facilities include:
• Pulmonary Advisory Services, Inc. - Jackson, MS
• Pulmonary Advisory Services of Louisiana - New Orleans, LA
• Pulmonary Testing Services, Inc. - Grand Bay, AL & Pascagoula, MS
• Gulf Coast Pulmonary Lab – Pascagoula, MS
• Pulmonary Function Lab operating out of: Madison, MS, Brandon, MS,
Jackson, MS, Gautier, MS, Bessemer, AL, and in the Cleveland, Ohio area.
PFTs submitted by these facilities will not be used in assigning a Scheduled Value disease category to the claim. All other medical information will be reviewed and a disease category assigned accordingly.
The question has arisen as to what needs to be submitted when the term "pathological evidence" is used in the Matrix Criteria or in response to a Request for CXR. You do not need to submit the specimen slides and we request that you do not. The written pathologist’s report is sufficient.
While the Trust does not presently routinely audit pathological findings, it reserves the right to do so.
After a claim is filed with and reviewed by the Trust, you will receive one of the following:
- Scheduled Value Offer corresponding to one of the 7 matrix categories
- Denial Letter
- Notice of Request for CXR
- Deficiency Letter
The receipt of a Scheduled Value Offer or a Denial Letter indicates that the Trust has made its determination as to the value of the claim based on the information submitted. Both are considered "offers" and are only extended for claims with eligible FIFO numbers. Offers are good for 180 days and you may request an extension for another 180 days. Once you receive an offer, your options are to accept the offer, send in additional information and request recategorization, dispute the categorization through arbitration or request individual evaluation of the claim. Requests for recategorization, extension, arbitration or individual evaluation must be written and sent to Claims Processing. To ensure that your request is properly recorded please use the Trust’s response form sent to you when the offer was extended. If the offer lapses, you can reactivate the claim. Requests for Reactivation must be in writing and sent to Claims Processing. Once a claim is reactivated, it is assigned a new FIFO number based on the date the request for reactivation is received.
Notices for Request for CXR and Deficiency Letters are not "offers." They are used to notify the claimant that additional information is needed to complete the processing of the claim. (See the Newsletter article entitled "Notice of Change in Trust Medical Audit/X-Ray Submission Policy" on page 1 for information regarding the CXR Submission Policy.)
Deficiency Letters are sent when the Trust determines the information submitted by the claimant is insufficient to satisfy the criteria of any of the seven matrix categories and, based on the medical evidence submitted, the Trust will in all likelihood request a CXR once additional information is submitted to cure the deficiency. Deficiency Letters identify the specific matrix criteria that have not been met and which need to be satisfied in order to receive a Scheduled Value Offer.
If you receive a Deficiency Letter, you may send additional information to cure the deficiency and request recategorization. To do this, return the Deficiency Response Form you received along with the new information to the attention of Claims Processing.
If the claimant does not have additional information to submit and/or disputes the Trust’s interpretation of information already submitted and wants to proceed with the claim as filed, please do the following:
- Write on the Deficiency Letter Response Form you received that no additional information will be submitted for the purpose of placing the claim in a matrix category. (Please note that the Deficiency Letter is being revised so you will be able to simply check this option in future versions.);
- Attach a completed Request for CXR Response Form. Forms are available through the Manville Trust web page at www.mantrust.org; and
- Enclose the documentation necessary to meet the requirements of the CXR Response you have chosen.
A Scheduled Value Offer or Denial Letter will be issued based on the information provided (including a review of the CXR). At that point, the claimant will have the option to accept the offer, submit new information for recategorization, request AD1 (categorization arbitration) or Individual Evaluation.