MTL Paid Claim Analysis

Our mass tort litigation (MTL) algorithms are designed to identify and prioritize member encounters within a plan’s paid claim data set that indicate a high probability of potential eligibility within one or more of the 45+ clinically centric MTLs. These MTLs often maintain private lien holdbacks that are typically valued at 25% – 35% of the average settlement value of the given MTL. These private lien holdbacks are set aside specifically to respond to financial obligations generated by the plan’s payment of claims related to the encounters associated with the injuries plan members suffered as a result of exposure to a defective drug, device or product.

There is no vicarious managed care liability exposure to the plan through these MTLs. They are driven by product liability back to the manufacturer. The MTLs are vehicles through which facultative or global settlements generated by the litigation are distributed to eligible claimants that successfully enroll into them.

 

MTL Outreach & Recovery Program

Once our discovery analytics have identified  members that have a high probability of successfully enrolling into a given MTL, they are eligible for outreach which informs members of their right to recover (and for the Plan to exercise its rights related to the private lien holdback for a given MTL). Current data suggest that only approx. 3% of all eligible MTL claimants are aware their potential eligibility and successfully enroll. Our program focuses on the remaining 97%, affording them with the opportunity exercise rights that they would have otherwise forfeited due to a lack of awareness. If a member successfully enrolls, they would be eligible to receive a portion of the settlement value of the applicable MTL for which they are enrolling.

We have designed a unique and optional Outreach & Recovery Program. First, all campaigns and campaign materials are reviewed and approved by each Plan. The Plan determines which recoveries it wishes to pursue, and we will only outreach to members the Plan has authorized for outreach. Outreach is conducted in a fully HIPAA-compliant manner using multichannel communications. We can also manage all aspects of mass tort recovery if desired (for cases newly identified and not currently being managed by another vendor). If desired for these cases, Allēus can manage the entire administration of the outreach and recovery program including member outreach and education and related lien management and recovery to resolution.

 

Impact

Our analytics are averaging approximately 9% of a given statistically material claims data set as being potentially eligible for private lien perfection within the current 45+ clinically centric MTLs, though results differ from client-to-client and cannot be predicted with certainty. For projection purposes, all of the MTL settlement variables are factored through a conservative lien discount rate of 50%. The other factor that determines the overall success of the MTL Recovery Program is the rate of successful MTL enrollment. These assumptions provide a conservative estimation of the average retrospective recovery potential a self-insured health plan could expect to realize through this unique program. The timing of MTL lien resolutions and payments vary between specific MTLs based on each MTL’s particular stage of development and maturation.