Matthew Necci is the chair of the Workers' Compensation Practice Group at Halloran & Sage LLP, providing workers' compensation representation for employers, insurance companies and third party administrators.
Matthew represents clients in workers' compensation, longshore, subrogation and general liability claims. He has considerable appellate experience, successfully defending clients before the Supreme Court of Connecticut and the Compensation Review Board of the Workers' Compensation Commission. Matthew was listed as a Rising Star in the 2013 edition of Super Lawyers in the areas of Workers Compensation, State, Local and Municipal Law and General Litigation.
In addition to his legal work, Matthew is an active member of the Connecticut Bar Association, currently serving as Chair-Elect of the Young Lawyers' Section, and as a member of the Board of Editors for Compensation Quarterly, a publication of the Workers' Compensation Section. For the 2013-2014 bar year, he was appointed a committee member of the CBA's Pro Bono Committee and for the Task Force on the Future of Legal Education and Standards of Admission. Matthew is also an active member of the workers' compensation section for ALFA International.
Matthew currently serves on the Board of Directors for the Special Olympics of Connecticut.
Compliance with the Fee Schedule in the Connecticut Workers' Compensation Commission - A Common Sense Approach
Compensation Quarterly, 07/01/2011
Imagine this hard to believe scenario: After weeks of endless snowfall, your Connecticut home is hit with yet another storm that leaves a fourteen-inch coating of snow and ice. Instead of battling the masses who buy up all of the snow rakes at your local hardware store, you decide to take the natural route and let the snow melt on its own. Unfortunately, before the melting can occur your gutters pull off the house under the weight of the snow. You believe your insurance company should pay to replace the gutters, while your insurance company argues that you were responsible for removing the snow from your rooftop.
While you fight with your insurance company over whether the repair work will be covered, you call up a gutter repair service. When the repair service arrives you are told that the cost of replacing your gutters will be higher if the insurance company declines coverage of the claim.
Seem unreasonable? Sure does. Replacing the gutters will require the same parts and labor regardless of whether the insurance company is covering the bill. Similarly, why would it be reasonable for a physician to charge more for services provided during a contested workers' compensation case than he would for providing the same services to a patient involved in an accepted case?
As noted in Chairman John A. Mastropietro's June 4, 2010 letter to the workers' compensation bar, the fee schedule established by the Workers' Compensation Commission pursuant to C.G.S. 31-280 is based on Medicare's resource-based relative value scale, and is intended to follow the methods used in the current medical marketplace to determine the appropriate level of compensation to physicians. Additionally, the chairman stated that the fee schedule is in place to allow health care providers to define their services in the most accurate manner, allowing for timely and efficient reimbursement. In short, the fee schedule has been established in an effort to regulate the market. It serves both as an authority for physicians to use in charging for services, and as a guideline for insurance carriers and employers to negotiate costs and premiums.
Two key questions come to mind when questioning whether a physician should be allowed to charge above fee schedule prices for services provided during a contested case:
1) What is the physician's rationale behind the increased cost?
2) Where do you draw the line for costs when a case that was initially contested is now accepted?
In a world that has become unbelievably (and at times unreasonably) complicated, one of the best tools for an attorney is one that is not used enough: common sense. If a physician is charging more than he is permitted, the first question should be why? Is a report prepared differently if a case is accepted than it would be in a contested case? Is the time that a physician spends preparing for a deposition different for a denied claim? And finally, are the procedures that a physician follows during a surgery different when his patient's case is accepted in the workers' compensation forum than those he would follow if the case had been denied?
The simple answer to all of these questions is no. The actions a physician takes, or the time he spends in preparation thereof, are the same whether the case is accepted or denied. The actual practice of medicine remains the same, as does the analytical review of the objective medical evidence. Consequently, there is no merit in charging differently for identical services.
If a physician is allowed to charge differently for denied cases, the question then becomes where do we draw the line? Based on the Supreme Court's opinions in Harpaz v. Laidlaw Transit, Inc., 286 Conn. 102, and Donahue v. Veridiem, Inc., 291 Conn. 537, respondents are being forced to issue immediate denials of cases so that they can preserve the right to contest the extent of liability. In such cases, compensability might not even be in question, but respondents would still be penalized in paying costs above the fee schedule simply due to efforts to comply with controlling case law by thoroughly investigating a claim. What if a case becomes compensable after initially being contested? Will a physician reimburse the respondent that initially paid the increased costs because the case was contested at the outset of the claim? It is highly doubtful.
Despite this, there are instances that warrant a request for an increased fee. One example would be a respondents' medical examiner who is asked to perform examinations on multiple body parts. There, the physician could either negotiate his or her rate directly with the insurance company or petition the commission and request that an increased fee be permitted in certain cases. If the physician will not reduce his or her fee, the respondents could decide to use a different doctor.
What should be avoided is the problem that is becoming increasingly more relevant in Medicare cases, physicians that will simply not treat patients because of a refusal to work within the system due to reimbursement rates. Because the best medical providers should be available to both claimants and respondents in workers' compensation cases, efforts should be made to resolve matters in accordance with the fee schedule, or to work with physicians to negotiate fair and reasonable costs in lieu thereof.
The commission has worked extensively to create a fee schedule that is fair to medical providers and benefit payors alike. Unless exigent circumstances arise that would justify the need to charge for services in excess of the fee schedule, physicians should be required to comply with the costs that have been established by the commission. Failure to do so should result in the provider in question being prohibited from serving as a treater or respondents' medical examiner in any workers' compensation cases. However, respondents share an equal responsibility in this endeavor, and in an effort to promote compliance on behalf of medical providers, respondents should reimburse for fair charges under the fee schedule in a timely manner.
News & Events
Halloran & Sage LLP Announces New Partners
The law firm of Halloran & Sage LLP is pleased to announce that Joseph Jay Arcata, III, Eric D. Bernheim, Matthew S. Necci, Jaimee Z. Newman and Allen Gary Palmer have been admitted as partners.
Joseph Jay Arcata, III is a member of the Firm's Litigation & Dispute Resolution and Insurance Practice Groups. He received his J.D. from Quinnipiac University School of Law and his B.A. from Providence College. Jay also serves on the Board of Directors of Hartford's Camp Courant.
Eric Bernheim is a member of the Firm's Corporate Business & Transactions, Land Use, Litigation and Real Estate Practice Groups. He is also certified as a LEED Green Associate. He received his J.D. from Roger Williams University School of Law and his B.S. from Ithaca College.
Matthew Necci is a member of the Firm's Litigation and Workers' Compensation Practice Groups. He received his J.D. from New York Law School and his B.A. from the University of Connecticut. Matthew also serves on the Special Olympics of Connecticut Board of Directors.
Jaimee Zuboff Newman is a member of the Firm's Corporate Business & Transactions and Real Estate Practice Groups. She received her J.D. from Suffolk University Law School and her B.A. from the University of Michigan. She is a frequent contributor of articles to the New England Real Estate Journal.
Allen Gary Palmer is a member of the Firm's Divorce and Family Law Practice Group. He received his J.D. from Benjamin N. Cardozo School of Law and his B.A. from the University of Connecticut. He is the Region 1 Representative for the ABA Family Law Section Council and the current Vice-Chair of the CBA Family Law Section.
Halloran & Sage LLP is a full service law firm with offices in Hartford, Danbury, Middletown, New Haven, New London and Westport, Connecticut, and a branch in Washington, DC. Founded in 1935, the Firm's client base ranges from Fortune 500 companies to closely held businesses, institutional and private investors, governmental units, public and private universities, and other non-profit organizations.Matthew Necci Appointed to Board of Editors for CBA Compensation Quarterly
Matthew Necci was recently appointed to the Board of Editors for the Connecticut Bar Association publication, Compensation Quarterly. CQ is a quarterly journal that is provided to CBA Workers' Compensation Section Members. The publication consists of interviews, content and topics that pertain to workers' compensation law, written by qualified members of the section and edited by appointed members of the elected board of editors.CBA Young Lawyer's Section Elects Matthew Necci
Halloran & Sage chair of the Workers' Compensation Practice Group, Matthew Necci, was elected Vice Chair of the Connecticut Bar Association Young Lawyer's Section. The Young Lawyers Sections' (YLS) primary focus is to encourage altruism, the promotion of justice, diversity and education of those within the YLS. The section includes all CBA members who are 37-years-old or younger or who have been admitted to the Bar for less than six full bar years.