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Replying to Thread: Lien Negotiators, Can't live with 'em, can't shoot 'em
Created On Monday 10, January, 2005 4:49 PM by gaiassoul1@yahoo.com


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gaiassoul1@yahoo.com
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Posts: 1275
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Monday January 10, 2005 4:49 PM

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Ok, so just because this is a rainy day and most forum regular lien claimants are exempt from my anticipated rant below.

WHO are you all out there negotiating liens?

The phone call today goes like this.

Joe Schmoe from XYZ Diagnostics calls me.

I ask him what his lien balance is and he tells me he has a lot of accounts for this applicant but that he is calling on only one of them now, gives me a less than $200 balance on one date of service. (can you please kill me and waste more of my time)

Next, I ask what service was provided -- the answer is physical therapy on an emergency basis --- advise the lien claimant there is no such thing.

Next, ask him for that one date of service has my client(the insurance co.) paid anything???, Yes, they have paid $1000, advise him that $1000 for PT on one day is impossible and I think he owes my client a refund.

Suggest to the lien rep that he re-review his file and call me back when he figures out what he would say to a judge and since he has been paid is this an RVS dispute?

He, who calls me then asks me for my phone number, and I remind him he called me. So he says I want to make sure it is right, SO when I tell him, I guess it is right since you are talking to me?

HE HANGS UP ON ME! So guess what, I am just a little tiny bit chagrinned.

Cie la vie, give me a professional any day of my life who can at least speak to the facts of a case.

Ginger

Ginger

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ymcgavin@socal.rr.com
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Monday January 10, 2005 6:05 PM

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Oy Vey Ginger,

I feel your pain ----- I end up having to stand shoulder to shoulder with these types of bozos in the trenches of numerous WCABs. I agree with you 100% Ginger. Give me a professional who knows his/her stuff as an opponent, and I am a happy camper.

However, it is my usual misfortune to be stuck on the other side of the street, trying my best to educate uninformed DAs about the OMFS, and the fact that once they receive a 10608(a) demand, they have a duty to serve ALL the medicals.

Just last Friday, I had a DA opponent from a large firm that usually, I truly respect. The stage of proceedings was the second lien conference. At the first lien conference last October, the matter was continued due to the failure to serve my company any medical reports, despite six (6) previous demands, and the DA was ordered by the WCJ to serve us the medical reports.

In early November, I served a Petition for Sanctions/costs on the DA, his client, the AA, and the WCAB. The Petition for Sanctions/costs was based on me having wasted my day by having to drive to the WCAB for a hearing that was continued due to the previous failures to comply with my 10608(a) demands.

One would think that this DA, after having been ordered to serve the medicals by the WCJ, then after being reminded by having received my Petition for Sanctions/costs, this DA would have promptly served me with a copy of the entire medical file. Not a snowball's chance in Hades.

I show up at the WCAB empty handed, expecting to hear that the medicals were "in the mail." Naw, the DA ends up handing me a packet of selected medicals that he intends to enter into evidence.......not the entire medical file.

All of our services (supplies and materials) were provided in 2004. This bozo DA is attempting to get the WCJ to allow his Notice To Produce (NTP) ordered by the WCJ. This DA could not be derailed from his train of thought that he was entitled to learn how much my company pays for the supplies and materials furnished the IW.

Before we saw the WCJ, I informed this DA that the amount I paid for supplies was irrelevant, being as we were pegged to Medicare plus a 20% mark-up, effective 1/1/04 per SB 228. He kept on turning a deaf ear to me. Finally, when we did get before the WCJ, this DA continued to push for the WCJ to issue an order for me to comply with the DA's NTP.

The WCJ told the DA that the NTP was immaterial because the OMFS was controlling in regards to the amount that was considered reasonable. Then, when I inform the WCJ that I have only received the defense medicals, and I needed another continuance, and I needed the WCJ to issue an additional order to serve the entire medical file, and that I will be amending my Petition for Sanctions, the DA blows a 50 amp fuse in front of the WCJ.

My lien was only $1,317.00. My Petition for Sanctions was at $1,600.00. Now, I will be adding on additional costs for my second wasted day at the WCAB. I'm actually looking forward to setting this particular matter for trial. This matter was an accepted CTS claim, with additional body parts added that were disputed. The defense QME fully acknowledged the IW did have CTS, but found no industrial causation for the remainder. This matter settled with a Thomas for $35,000.00 ----- and the only body part for which we provided services was the CTS.

This was a 'nature and extent' case that should never have settled with a Thomas. If the DA had just offered to pay me at OMFS at the time of settlement, I would have accepted it. However, I have now had to make two additional totally unnecessary appearances, and I will be pressing for the full amount due, plus the statutory increase and interest, as well as sanctions/costs.

Ginger, give me a professional who knows his job, and does it. There are way too many bozos in the sandbox ----- on both sides of the street.

I hope getting this rant off my chest will make my evening easier tonight, but even if it does, I still have to appear before a different WCJ, at a different WCAB tomorrow, and I am appearing at a lien conference once again without having been served the medicals.

At least tomorrow I will be consoled that we only made two (2) demands for medicals that have gone unanswered. Maybe, just maybe, tomorrow's DA will offer to pay our billing at OMFS and I will not have to stroll tomorrow's DA down the same sanctions/costs street.

York McGavin
ymcgavin@socal.rr.com

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rosellavera
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Saturday September 24, 2005 7:21 PM

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If the medical reports are provided to you, wouldn't it be a violation of the privacy laws enacted after the reg you quote. Some of these medical reports should be confidential. I know of a party in a divorce proceeding whose ex tried to convince the mediators in a custody battle that his wife was mentally unstable using copies of psyche reports related to his wife's comp case. The AA's secretary gave him copies unaware that the parties were getting a divorce.

I personally would request an authorization signed by the applicant indicating permission to disclose this information and the scope of what is to be obtain through this authorization. If this information falls into the wrong hands it seems that there could be some liability on the part of the party that disclosed it without an authorization.


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ymcgavin@socal.rr.com
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Sunday September 25, 2005 9:13 AM

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Hi Rose,

The short answer in regards to workers' compensation proceedings, generally, is no. One has to be familiar with HIPAA, as well as the CMIA, and additionally be cognizent of who is subject to compliance with HIPAA and the CMIA.

As a suggestion, I would urge you, as well as other WCC Forum members, to review the applicability of HIPPA to workers' compensation proceedings. One can review the applicable portions of HIPAA at the HHS website specifically addressing individual State workers' compensation proceedings here, at the HHS website. HHS has provided the regulated community with a 25 page downloadable summary of the entire HIPAA act, which can be found here.

California has its own unique privacy regulations, the CMIA, which also address workers' compensation proceedings. One can review the entire language of the CMIA at the State of California's website located here, but you will end up spending hours wading through all the material in Division 1, Part 2.6, Chapters 1 - 7. A more succient summary can be found here.

Rose, prior to entering into a full-blown discussion of PHI, covered entities, who can disclose, when PHI can be disclosed and when it cannot, it is imperative that you become as intimately familiar with the ground rules regarding HIPAA and the CMIA as you are with the Labor Codes.

Interestingly enough, I know a pro per who is pursuing a HIPAA violation claim against her former employer, who happens to be a "covered entity" but whose counsel (WCAB DA) has not only distributed her psyche records to non-parties to the WCAB proceeding, but in addition, to add insult to injury, the WCAB DA has inadvertently provided the pro per IW with prohibited individually identifiable EORs for at least three (3) other IWs. (Ouch. The EORs added fuel to the fire of inappropriate maintenance of confidential PHI by the "covered entity," which was the former employer.) Although this particular pro per initiated a RICO action, partially based on the HIPAA and CMIA violations, those violations have been excised from the RICO complaint, and are now the subject of seperate and distinct legal actions. If you are a "Premium Subscriber" to WCC, you will be reading about these cases in the upcoming weeks.

As I suggestion, upon going to the above websites, I would bookmark these sites as "favorites" in your browser.

York McGavin
ymcgavin@socal.rr.com

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