California Professional Forums

HOME PAGE

GO to Injured Worker Forum

Navigation:

ALL FORUM'S TOPICS OR LIENS TOPICS

[ REFRESH ]

Thread Title: Dumb Question..
Created On Monday December 01, 2008 10:02 PM

accdoc@hotmail.com
Junior Member

Posts: 16
Joined: Jul 2004

Monday December 01, 2008 10:02 PM

Urgh..I feel stupid to ask this...I'm filing my first lien tomorrow lol...
Do you get paid to attend hearing? I mean I'm not sure if it'd be in my best interest to skip a day of clinic in order to go get collected for a few hundred dollars...
Thanx ahead for heads up...

-------------------------
An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out, and that the growing generation is familiarised with the ideas from the beginning.

Max Planck (the founder of Quantum Physics)

Posts: 187
Joined: Aug 2007

Monday December 01, 2008 10:41 PM

Usually no.
Most lien claimants hire reps for this reason.

Now if the Defense is particularly bad over two or more hearings, the judge may grant expenses if you ask for them.

The word Justice is never used at the WCAB.

Be sure to ask for late payment penalty and interest in your lien

Good Luck

Posts: 53
Joined: Aug 2005

Tuesday December 02, 2008 11:39 AM

For smaller liens i have found this approach quite succesfull. First you must be signed up with EDEX either through work comp central or some another provider. Through these providers you can file a case watch without filling a lien. The casewatch will notify you when a case settles. Dont file your lien until the lien conference already happens and all other lien claimants have been dealt with. The reason for this is it is cheaper for the insurance carrier to deal with all the lien claimants at once and therefore cheaper for them to string all of you along. The carrier is also more likely to go to trial when their are multiple lien claimants. After the lien conference has happened and no other hearing are scheduled file your lien and send it out to all parties with a settlement letter stating a reasonable offer. Polietly state that if no response to your settlement offer is receive within 30 days from the date of the letter that you will be filling a Declaration of Readiness (DOR). Most carrier will not respond to your settlement offer. File the DOR and get scheduled a lien conference (status conference). 80% of the time the carrier will call you the week of the lien conference to settle because they dont want to have to pay their attorney AGAIN to attend a lien conference when your billing is less than their appearance fee and preparation. Be proactive after filling the DOR, call the adjuster and try to settle. Be prepared to appear at the hearing if a settlement has not be reached by the time of the conference. Insurance carrier will pay the lesser of the two evils. Of course this approach requires a bit more time and a basic understanding of the process but it allows you for the most part to have someone in house handle handle the process without giving all of your hard earned money away to lien reps.

Quote

Top

Bottom

steve appell
Senior Member

Posts: 1017
Joined: Feb 2005

Tuesday December 02, 2008 12:03 PM

The lien filing stratagy explained by rider001 is 100% accurate and is also a classic example of why the SOL really does not exist.

-------------------------
Steve

A government which robs Peter to pay Paul can always depend on the support of Paul.
- George Bernard Shaw

Posts: 53
Joined: Aug 2005

Tuesday December 02, 2008 12:20 PM

In additional there are at least five panels decisions basically stating that once a carrier has responded to a bill the Statue of Limitation is tolled. But to be safe make sure that you file the lien and meet at least one of the conditions: within 5 years of the DOI, within 6 months of the case settling, or within a year of the last day of treatment.

Balcon v. SCIF, http://www.workcompcentral.com/pdf/2008/misc/Balcon.pdf
Loc Tran v. Viet Nguyen Trucking, http://www.workcompcentral.com/pdf/2008/misc/LocTran.pdf
Picos v. SCIF, http://www.workcompcentral.com/pdf/2008/misc/Picos.pdf
Barajas v. Don Steve Chevrolet, http://www.workcompcentral.com/pdf/2008/misc/Barajas.pdf
Chablet v. Staff Management, http://www.workcompcentral.com/pdf/2008/misc/Chablet.pdf

Quote

Top

Bottom

accdoc@hotmail.com
Junior Member

Posts: 16
Joined: Jul 2004

Wednesday December 03, 2008 2:21 PM

Thank you guys..you've shed a light on a lot of issue..and raised some issues also lol...

Where do I find lien reps and what are the usual charges???

-------------------------
An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out, and that the growing generation is familiarised with the ideas from the beginning.

Max Planck (the founder of Quantum Physics)

Posts: 53
Joined: Aug 2005

Wednesday December 03, 2008 4:45 PM

Depending on your location i might be able to recommend some. Most lien reps. charge in the area of 30-50% of the settled amount depending on the complexity of the case. In addition some charge an appearance fee ranging up to $200 again depending on complexity. You should be able to find a good one that will only charge 30% with no appearance fee. For most cases lien reps are not need. A car sales man or monkey could work just fine. You go high they go low and then you split the difference. You could alway request an appearance by phone.

Quote

Top

Bottom

steve appell
Senior Member

Posts: 1017
Joined: Feb 2005

Thursday December 04, 2008 10:08 AM

MBC Systems which advertises every day on the front page of this site is a huge coporate lien rep, or you may also contact Ginger @ "gaiassoul1@yahoo.com" for very qualified independent lien rep.

Good Luck !

-------------------------
Steve

A government which robs Peter to pay Paul can always depend on the support of Paul.
- George Bernard Shaw

Quote

Top

Bottom

ymcgavin@socal.rr.com
Senior Member

Posts: 1351
Joined: Jun 2002

Friday December 05, 2008 7:16 AM

Hi Steve,

Actually, the SOL is viable, alive, and well --- but as long as the defense community only serves lien claimants listed on the OAR with a copy of the C&R or Stip, instead of serving a copy on all providers who have submitted billing, the SOL is tolled for those providers who have not been served.

As I'm sure you know, under the prior WCAB Rules of Practice and Procedure, or the present one, which became effective 11/17/08, a lien claimant is defined as follows:

"BR 10301(t): "Lien claimant" means any person or entity claiming payment under the provisions of Labor Code section 4903 or 4903.1."

If the defendant wants to effectively 'close the file' forever --- 6 months after the case-in-chief has resolved, serve a copy of the C&R or Stip on all lien claimants.

York McGavin
ymcgavin@socal.rr.com

Quote

Top

Bottom

steve appell
Senior Member

Posts: 1017
Joined: Feb 2005

Friday December 05, 2008 10:50 AM

Hi York!
I stand corrected.

-------------------------
Steve

A government which robs Peter to pay Paul can always depend on the support of Paul.
- George Bernard Shaw

Quote

Top

Bottom

Jpod
Junior Member

Posts:
Joined: Oct 2006

Friday December 05, 2008 11:27 AM

Rider1, I am not sure how wise it is for you to reveal what lien collectors demand for handling collections, but I guess the information gets out anyway.

But your post was an eye opener for me. It sheds light on the econmics behind liens and why we hear complaints on this forum from medical legal providers who apparently are routinely offerred less than 100% of their liens. Now I see why this might be so.

I have never given this much thought but i would think if a decent negotiator knew a doctor would have to pay a lien collector somewhere between 30-50% of what is collected why would they ever offer to pay the doctor (before the claim went to collection) 100% of the lien amount?

And why wouldn't a rational medical provider be willing to settle today for somewhere between 50% and 100% of their lien if they know that sending it to a collector will only get them 50-70% of their charges at some date in the future? They earn some interest, yes, but they still do not have access to the funds.

It seems to me the lien collection business has created a rational economic incentitve to both the payers and the payees to settle for less than 100% of the billed charges prior to sending the it to collections.

I am not condoning this b/c why not pay 100% up front (assuming it is appropriate to fee schedule) and be done with it?. But it does explain why we hear from some medical providers they are routinely offerred significantly less than their 100% of their lien.

Posts: 187
Joined: Aug 2007

Friday December 05, 2008 11:39 AM

The judges have the power to change this but can't be bothered.
I frequently have to appear, sometimes all the way to trial, to collect a Panel QME fee.
I always win. So the only logic I see in the carriers in doing this to is to discourage honest QME Doctors to stay in the system.

Also most lien reps NEVER pursue penalties and interest.
I have talked with more than one lien rep that did not know that penalties or interest were available.

Quote

Top

Bottom

accdoc@hotmail.com
Junior Member

Posts: 16
Joined: Jul 2004

Friday December 05, 2008 2:07 PM

I think it must be an error...
I just talked with a lien rep and looks like his charge is 5%...
That was the first one I've talked with...so I'm sure there are others charging lower fee...
he must've meant 3-5%.....30-50% would be out of mind...
Considering average clinic's overhead is 50% of collection, clinics working with lien reps must be losing money with every lien patients treated...
With OMFS being fraction of what usual and customary charge is, plus that graduated discount for every successive treatment, I can't imagine paying half of the money to someone who had nothing to do with the treatment or management of the case...
Yikes...

-------------------------
An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out, and that the growing generation is familiarised with the ideas from the beginning.

Max Planck (the founder of Quantum Physics)

Edited: Friday December 05, 2008 at 2:09 PM by accdoc@hotmail.com

Posts: 53
Joined: Aug 2005

Friday December 05, 2008 3:22 PM

JPOD. You hit the nail on the head. If adjusters and physicians staff were able to negoitate before a lien conference it would reduce cost for both sides and everybody wins. I see no point in attending a lien coference unless it is a very complicated case. I also see no point to hiring a lien rep for most cases. I see no point in sending a defense attorney charging $200-$400/ hr who is attending four different conferences at the same time and charges each of his/hers clients the full amount for each case. Most defense attorney's are great at arguing law but have them argue medicine, not so much. In my experience the adjuster pulls the strings and hold the money anways. Why is it necessary to pay a defense attorney to essentially to relay a settlement offer? I dont bite and besides you cant contract my rabies over the phone. I have a great example of an adjuster going above and beyond. Case settles C&R w/ thomas finding. I have not even filed a lien at this point. Adjuster calls me up and offers to settle. By doing this she effectivly starts the SOL, settles my lien, and defense attorney does not have to appear. I settle on the principle that she had the same interest as i, getting the case closed, recouping cost, and moving on to the next. I have never been an independent lien rep. I have always worked in house. I can either sit at my desk and make my employer thousands of dollars or attend a lien confernce and make a few hundred. Smart providers will hire a double duty guy like myself who bill claims and have spent a lot of time at the board. This was what i was trying to get across to accodc@hotmail.com in my post. Cost effectiveness. I feel for physician's who get bullied out of their money.

Im sorry i dont have the time or feel like looking up it up but labor code allows a provider to bill 120% of OMFS which most providers due. Some provider bill more. So right off the bat if you are getting 80% of a lien for TREATMENT, you are probably getting right around the area of OMFS. Every provider i have worked for or know for that matter, would take a reduction to settle today that rather sending it to collections. Try it and see what happens.

Medlegals and treatment are two different animals completely. I have never and no one should ever take a reductions on medlegals. Any PQME that isn't paid and requires an attendance should be accompanied with sanctions, P&I, court cost, parking, gas, lunch, you name it. This is a bad faith action. If there is a chance the WCJ will award it, it will most definently be included. And yes i have gotten reimbursed for parking but Im still working on the lunch and gas part.

Posts: 187
Joined: Aug 2007

Friday December 05, 2008 3:50 PM

rider001

Wild guess you don't do much at the San Diego WCAB.

Common sense not allowed there.

Posts: 157
Joined: Apr 2005

Friday December 05, 2008 6:02 PM

Who, or what, sets the tone for the lack of common sense there. Is it the PJ, the water, or what?

Edited: Friday December 05, 2008 at 6:03 PM by Zorro

Quote

Top

Bottom

Jpod
Junior Member

Posts:
Joined: Oct 2006

Friday December 05, 2008 6:48 PM

Rider while I agree with your post there is one misconception: defense attorneys in workers comp do not get paid 200 an hour. I have never paid more than $115 an hour. Maybe there has been significant escaltion in the last 8 years b/c I have not paid an attroney bill in all that time due to working with in house attorneys.

I tend to think the issues we hear about on this forum represent the extreme exceptions that fall many standard deviations from the mean. The actual shape of the curve appears to be latitude dependent.

Posts: 53
Joined: Aug 2005

Friday December 05, 2008 9:45 PM

No idea about San Diego I'm from Northern California with most of my WCAB appearances in San Jose, San Francisco, Oakland, and Salinas. I have heard about the differences the between the two states. I guess I'm in the better part.

JPOD i have heard and read on this forum that adjuster for the same company make more money in northern California than in southern California. So this may also be the case for def. attorney's. What the defense charges is right from the horses mouth to my ears. Now i am sure there are bulk discounts and such. But do you think a senior partner or someone with their name on the door is going to work for what you are suggesting? I think perhaps your info is a little dated. I'm not sure you could get a paralegal to attend.

My posts were not meant to put everyone's business out there. They are meant to suggest that things could be handled much more efficiently monetarily for all parties. It is my duty to help those entities who want to waste money, well waste money. And those who want to save money, I will help them too but with my employers best interests at heart.

Quote

Top

Bottom

RBaird
Senior Member

Posts: 211
Joined: Mar 2004

Saturday December 06, 2008 6:07 PM

There is a clear distinction drawn here between treatment liens by medical providers and medical legal by evaluators, and an attempt to characterize a divide roughly at the Tehachapis between North and South. As to the vast majority of medical legal, they should be paid per reg and promptly absent something extraordinary. Most evaluation mills have been by and large taken out of the game. Treatment and the definition of "Reasonable" and the ever increasing attempts to schedule and list and price fix ad nauseum are really part of a much larger struggle over the structure of health care generally. Hospitals and most treaters bill for more than they are willing to accept because almost all paying entities reduce the charges. The dynamics and economic structure of the various amounts quoted by lien representatives suggest to me that it would be cost effective to deal directly and informally, with a minimum of third party involvement, whether hearing representative, AA, defense counsel or lien rep. No one wants that, apparently. The WCAB has quite enough on its plate in general, and most judges abhor having to do a line item review of codes, or an itemized billing because the statutory duty of the WCAB is to resolve disputes between employers (and carriers because of direct action) and employees. I was not highly impressed with the methodology of most bill review services or proffered expert testimony on the subject. I do believe that the long term interests of all are adversely impacted by a rigid, over-regulated and penny pinching approach to treatment, and the more the regulations proliferate and the legislature (shudder) gets involved, the worse off we are. As to North v. South, peddlers of snake oil freely move from one geographic area to another...

Quote

Top

Bottom

jonbrissman@verizon.net
Senior Member

Posts: 377
Joined: Oct 2003

Saturday December 06, 2008 8:32 PM

Judge Baird, I agree with most of what you said, but I disagree with your statement, "Hospitals and most treaters bill for more than they are willing to accept because almost all paying entities reduce the charges." The reason for billing more that a provider is willing to accept has its roots in Medicare, federal regulations, and fee-schedule provisions. Providers can charge a flat fee to a non-insured patient who is paying in cash, and that charge becomes the provider's usual and customary charge. A provider is allowed to accept less than its U&C fee but it cannot charge more without being accused of billing fraud. So if a provider bills Medicare at the Medicare rates, for example, Medicare then defines those charges as the provider's U&C fees, and if the provider later charges another payer on a different patient for the same service at a higher rate, it can be charged with fraud. Nearly all fee schedules, including HMOs and the OMFS, include language that the payor is liable for the fee schedule or the provider's U&C charge, whichever is less. It thus becomes important for a provider to establish a U&C rate that is higher than any of the various fee schedules to which it might be subjected. As a result of providers establishing an inflated U&C to avoid fraud charges, bill-review services sprang up as an industry and claims adjusters' and defense attorneys' jobs became more complicated. Maybe this is an object lesson in the Law of Unintended Consequences.

JCB

Posts: 187
Joined: Aug 2007

Saturday December 06, 2008 8:47 PM

What chance does an honest provider have when the trier of fact believes that most providers commit fraud in the face of penalty of perjury statements?

I would be very interested to know why when "extraordinary" events are not present, Judges rarely issue sanctions for delayed or no payment of QME/AMEs?

Punish the abusers if you want to relieve the WCAB from the collection business.

Quote

Top

Bottom

Jpod
Junior Member

Posts:
Joined: Oct 2006

Monday December 08, 2008 9:41 AM

I can confirm what Jon has said.

Long ago when I used to attend the IMC meetings I ran into Dr. Roback. I pulled him aside one day and I said: "Dr. why is it you bill us for your treatment and med-legal charges; we use the RVS code and fee schedules to cut your bill, we pay you in 2 weeks and you never complain and every one is happy. Why is it you can't just bill the fee schedule and we could pay you in a weeks time?"

Dr. Roback answered: "becasue I have to maintain my usual and customary fee; I do not want another payor, like a health insurer, claiming that my usual fee is what workers' comp pays, they weill try and argue that they should only have to pay what WC pays..."

It was enlightening and made me realize one again how usually, if we can see the other's point of view, it makes some sense to us.

Posts: 187
Joined: Aug 2007

Monday December 08, 2008 10:04 AM

I have always billed my Usual and customary for treatment and ML for Medlegals
Adding to the reason Dr. Roback mentioned there is also payment of U &C if the carrier denies the case without proper cause.
My U & C is not far from the WC rates ( sometimes within $1) but if the WC rates are used and precascaded, an enterprising review company finds a reason to cut further.
They seem satisfied reducing to fee schedule if I use U & C.

Posts: 53
Joined: Aug 2005

Monday December 08, 2008 12:04 PM

As it pertains to worker comp. I have always encouraged provides to bill 120% of medicare as allowable by labor code. It makes monitary sense on denied cases that later become accepted and when negotiating liens. When a denied cases becomes accepted a WCJ will allow the full amount of the lien with P&I it the defense does not object to the treatment. When negotiating liens settlement offers are costomarily a percentage of the billed charges instead of being reviewed for OMFS.

I find a problem with the thought process behind the usual and customary. Since labor code only allows a provider to bill 120% of medicare i can't see this limiting the usually and customary of private insurance's. It is usuall practice for physician's to have two fee schedules one for workers comp. and the other for PPO/Medicare.

Quote

Top

Bottom

accdoc@hotmail.com
Junior Member

Posts: 16
Joined: Jul 2004

Wednesday December 10, 2008 6:18 PM

Rider001 are you an attorney or billings rep?

-------------------------
An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out, and that the growing generation is familiarised with the ideas from the beginning.

Max Planck (the founder of Quantum Physics)

Posts: 53
Joined: Aug 2005

Thursday December 11, 2008 9:06 AM

I am a biller and in house lien representative.

Posts: 91
Joined: Mar 2006

Tuesday December 30, 2008 9:43 PM

Does it really cost carriers $$$ to defend in an MSC or trial if the carriers already have inhouse counsel? In any case, an adjustor from Gallagher Basset told me (sounded like a punk kid right out of college) that he will try a case for a $1000 lien, since they have hearing Reps doing the defense work now -- and this adjustor has the assumption that judges will always find in favor of the carrrier if the lien claimant did not get UR approval. I am not sure what planet he is on, or if there is any truth to the "carrier party line."

Quote

Top

Bottom

Lienexaminer
Junior Member

Posts: 9
Joined: Sep 2007

Wednesday December 31, 2008 9:22 AM

I am with a carrier too and we will absoulutely defend a $1000 lien or even less. We use primarily in house people.
But I will attempt to resolve any lien prior to a WCAB appearance if I believe our chances of prevailing are not good, such as a untimely UR non-cert.
But if we do have a UR non-cert; treatment is over the cap, treatment outside our MPN; or treatment is on a denied case and after the delay period then I will send my in house representative to resolve a lien of any amount.

Quote

Top

Bottom

RBaird
Senior Member

Posts: 211
Joined: Mar 2004

Wednesday December 31, 2008 12:39 PM

The point of my prior post was to encourage direct and informal adjustment of liens. You may be willing to go to war over a disputed charge of $1,000 and the carrier/tpa may incur little direct costs in doing so by using in-house hearing reps. But, there is an opportunity cost to this. The more you involve the WCAB in relatively small stake disputes, the less adjudication service is available to deal with more serious issues and the longer the calendar delay. This does not serve either the defendant or the applicant. I know the administration disbanded the lien strike force and declared victory, but it looks like the victory was helicopters leaving Saigon...

Posts: 53
Joined: Aug 2005

Wednesday December 31, 2008 1:39 PM

Is the inhouse lien reps a relatively new thing for insurance companies? I have been doing lien work for 6 years and have only came across two in house lien reps.

Quote

Top

Bottom

Lienexaminer
Junior Member

Posts: 9
Joined: Sep 2007

Wednesday December 31, 2008 2:36 PM

If my defenses are strong. If the IC does NOT owe, because a provider billed for something non-certified by UR or for over the cap PT -- then why should the IC pay anything?If the IC put the treatment request thru UR, UR non-certified, everyone was notified of this -- but yet the provider went ahead and provided the services anyway -- why should the IC pay? If the IC followed the rules but now here's this lien claimant that expects payment --- and I DO try to resolve informally over the phone -- but I am clear with the collector that I can only resolve for nuisance value since we have a non-cert but most of the collectors do not understand that only a nuisance value offer can be made because they must collect for their client -- so they are unwilling to accept so we go to the board. I advice them to let their client know that their lien has no merit but either they do not do this, or can not because perhaps it is not within their authority -- I do not know. But I do know that if I have everything in order and I know that my IC did everything right then I will go to trial. I deal with the same lien claimants again and again and if I pay on this one -- then they expect me to pay on another one. The problem usually is the nuisance value because the provider has billed $10,000 -- fee schedule is $4,500 and my nusiance value offer will be in the range of $450. So a collector does not want to tell their client I could only get you $450 on a $10,000 lien -- so off to the board we go.

I remember on one file for a denied case, I offered fee schedule for the delay period only per LC 5402 (c) and the collector said "How can I justify that to my client?" and I said "Tell them LC 5402 (c) -- you should not have to say anything else." But my offer was rejected so now I am filing the DOR.

And my people are in house and they know the labor code and love their job, as I do.

Posts: 91
Joined: Mar 2006

Wednesday December 31, 2008 3:15 PM

Lienexaminer, I understand your arguments re: not-certified. And I posted a follow-up to this on a different thread titled "substantial evidence." Your argument is that if it was not certified, within a timely fashion, you/carrier is not liable.... However, I ask memebers here to address the issue: there is a difference in opinion of a treating Dr. vis a vis the negative UR determination, then what, after the case in chief has settled, and liens need be resolved. Lienexaminer, in a trial would your reps argue that the treatment was not reimburseable b/c your UR dr. (paid by you/carrier) deemed it not certified? What about substantial evidence? It was your UR's opinion, based in interests of carrier, that treatment was not to be certified. But the Dr., whom examined the patient, found the treatment necessary? So in a lien trial, aren't all parties equal, Or is a UR determination essentialy on from GOD, and they cannot be incorrect in their determination?
Can someone address these questions? thanks!

Quote

Top

Bottom

lealworkcomp.com
Junior Member

Posts: 1
Joined: Jan 2009

Monday January 12, 2009 8:46 PM

Quote

Top

Bottom

loki2@dslextreme.com
Junior Member

Posts: 6
Joined: Dec 2004

Monday February 02, 2009 1:30 PM

To Lienexaminer: and this is why more and more health care providers do not treat work injuries. Too much interference between the doctor-patient relationship, too many hands-in-the pie (silent ppos) of the measly fee schedule rates, and too much costly hassle on top of that to collect your measly fees should you treat on a lien basis or even in some cases even when treatment was authorized.

Having been married to a physician for 14 years I have some first hand experience in the matter.
In the past my husband would treat on a lien basis instead of booting someone out the door that needed the care, because in the end showing medical necessity is all you needed to get your bill paid - with penalties and interest.

Quote

Top

Bottom

FORUMS > LIENS

[ REFRESH ]