Medical Review

The benefits available to an eligible Category One Class Member depend on the outcome of the Medical Review process. The Medical Review process will involve the Fund Administrator along with the Participating Physicians who will review the Relevant Echocardiograms and other specified information submitted with each claim to determine if the required medical conditions exist.

The Fund Administrator's process will work like this: When the Participating Physician's report on the Relevant Echocardiogram comes back from Medical Review, the Fund Administrator will assign a "Relative Payment Value" to the claim. The Relative Payment Value will depend on how long the DDR used Diet Drugs, whether the DDR's medical condition falls into either a "High" or "Low" Threshold condition, how old the DDR was at the time of the diagnosis, and whether the DDR has an "Alternative Causation Factor." If the DDR's medical condition falls below the "Low" Threshold condition, no Relative Payment Value will be calculated, regardless of how long the DDR used the Diet Drugs and the age of the DDR at the time of the diagnosis.

Within 30 days after receiving a report from the Participating Physician, the Fund Administrator will provide a copy of the report to counsel for the DDR to whom the report relates or directly to the DDR, if unrepresented. As part of the report, the DDR will be given instructions and a filing deadline to request a Second Review of the Relevant Echocardiogram, if the DDR feels the results of the Initial Review were incorrect. The Second Review will be conducted by a different Participating Physician than the one that conducted the Initial Review and the DDR must pay the Fund Administrator a non-refundable fee of $1,000. When a Second Review of the Relevant Echocardiogram is requested and conducted, the final Relative Payment Value will be calculated based on the results of the Second Review only. There is no choice given to the DDR to use either the results of the Initial Review or the Second Review.

The Seventh Amendment's Treatment of Certain Medical Conditions.

1. High and Low Threshold Conditions under the Seventh Amendment. The Seventh Amendment takes the Matrix Level I and II medical criteria in the existing Settlement Agreement and divides them into "High Threshold" and "Low Threshold" conditions, recognizing that certain medical conditions on Levels I and II are more severe than others. DDRs who are found during the Medical Review process to have medical conditions on the High Threshold will receive more compensation from the Supplemental Fund than those on the Low Threshold. Click here for the table that describes generally what medical conditions qualify for High Threshold and Low Threshold conditions.
2. Alternative Causation Factors. Alternative Causation Factors are medical factors that cause some of the same medical conditions as those claimed to have been caused by the Diet Drugs. As in the existing Settlement Agreement, an Alternative Causation Factor found during Medical Review will reduce the value of a claim. Many of the same Alternative Causation Factors from the Settlement Agreement exist in the Seventh Amendment, although some have been changed, and others have been eliminated. Click here for the Comparison of Existing Reduction Factors with Seventh Amendment Alternative Causation Factors.

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Page was last updated on 3/24/2006 at 4:18:55 PM (EST).

PLEASE NOTE: If there is any conflict between the website, any related documents and the Settlement Agreement, the terms of the Settlement Agreement will govern.