Medical Treatment Lien (California)

The filing and enforcement of liens (different states refer to these with different terms) to secure payment for services or goods against a workers' compensation award is complex and filled with special rules - this category is for questions and discussion of this special area of work comp law.

Re: Medical Treatment Lien (California)

Postby rider001 on Fri Apr 10, 2009 12:11 pm

Inmagine a perfect comp world. How many jobs would be lost? This is disfunction perfected. As long as overzealous UR reviewers and applicant treators exists we remain empoyed. Until physician are paid appropriately for dealing with all of the BS that comes with comp there will always be the push and pull eb and flow. Until the states wises up and comes to the realization that medicare rates grossly underpaid treators, they will continue to try and make up the loss, time, effort, and reporting that comes with comp.

This is what happens when you take Marxist idealogoy and put a liberal twist on it. We are moving towards a government ran Kaiser.
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Re: Medical Treatment Lien (California)

Postby stewshe@comcast.net on Fri Apr 10, 2009 12:46 pm

Costs of UR review:

Like any other aspect of comp, there are good and bad UR companies. I have seen printouts where the UR charges varied from $1.75 to $2.75 or so for what was apparently simple bill review one firm to $40 - $50 or so +/- per review from another!

I do recall a UR review for a crutch, post total knee or hip replacement costing more than the crutch! (The denial said ACOEM only allowed crutches for ankle injuries!)

Most UR charges I see on benefit printouts are on the low end of the scale and seem reasonably priced.

As far as the "band-aid" is concerned, I recall one poor guy, post L4-5 fusion, who was prescribed a 12" x 12" bandage to cover the wound, plus a solution to disinfect the wound and a nurse to stop by twice a day for I think 4 or 5 days.

The adjuster denied the bandage, saying he should buy a box of band-aids and a bottle of alcohol (which she would not pay for) and his "girlfriend" could apply/change the dressings! (He lived alone.)

She wouldn't budge, so I called the surgeon who was properly horrified! Possible infection, etc.! He said as soon as he hung up the phone he was calling an ambulance company to pick up the EE and transport him back to the hospital where he would be properly cared for!

I called the claims manager, whom I knew personally, told him my tale of woe....and would you believe he was able to get the ambulance turned around before it got to the EE's home (it was "rolling"). A visiting nurse was also on her way to the home that same afternoon.

That adjuster's penny-wise, pound foolish mentality is the same type of "UR" I see at least once a week. Most of the reports seem reasonable enough, but there are enough really miserable ones which give the rest a bad rep!

One company insists on issuing denials after saying treatment proposed is medically reasonable! They deny because they dispute the "work-relatedness" of the condition which is simply not the function of UR!

Last of all, the UR companies which frequently "just say no" and in turn are frequently reversed by AMEs, are the same ones who, it seems to me, charge the most! Perhaps they think if they "just say no" often enough they can charge more than others because their "no" is saving money for their customers? (In the long run, I suspect they cost a bunch more!)
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Re: Medical Treatment Lien (California)

Postby jpod on Fri Apr 10, 2009 2:37 pm

Rider001 I have to take issue with your post. If insurance companies came anywhere close to preforming as well as Kaiser does we would not have a national crisis, and insureds would have more discrectionary income.

I used to think Kaiser was "low-end" medicine. But I have several friends who have had lifelong satisfaction with Kaiser so I decided to give it a try a few years ago and have been pleasantly surprised.

First, no insurance company spends a larger percetnage of premium dollars on patient care than kaiser.

Second, doctors get to practice medicine and do not have to spend time fighting with insurers over billing and insurance forms, or payroll, or running a business fro that matter.

Third the offices I go to at keast are new, clean and functional. My PTP's office is about a mile from my home in a small office park. The hospital is about 5 miles away. When I go to a PTP visit, if I need drugs I can pick up the drugs in the same office as my PTP.

Fourth, I have $10 co-pay for an office visit; $25 for urgent care or ER. I thionk drugs have a $10 co-pay.

Fifth, last year I had to have a minor out pateint surgery. When called to make an appointment I got one for the very same week. The surgeon graduated from Havard Medical School. Kaiser has gone after graduates from top tier medical schools by offering very hiogh salaries ($350,000 a year is not uncommon) and they pay for malpractice coverage too.

It is true that 30 years ago Kaiser had a lot of malpractice issues but that has really changed quite a bit over.

Lastly I am not sure what you mean by taking a Marxist idea with aliberal twist but if you refer to worker's comp you are way off base. Worker's comp dates back to commopn law and the master-servqant relationship. The master was responsible for the welfare of the servant as well as training. germany was the first country to provide for worker's compensation.

Insurance by its very nature is socialistic. The masses pay premiums so they can trade an unknown risk for a known risk (the premium) and in exchange we get coverage if, and when, we need it. But it is a numbers game that counts on the contribution of the massess to help pay for the cost of the few. Car insurance works the same way.
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Re: Medical Treatment Lien (California)

Postby kpusavat@bagbylaw.net on Fri Apr 10, 2009 3:46 pm

Stewshe -

Was it a $2,000 bandage or a $2.00 one?

<<the UR companies which frequently "just say no" and in turn are frequently reversed by AMEs, are the same ones who, it seems to me, charge the most!>>

Basically proving my original point, which was that AME's are the closest thing to impartial in the system, and their opinions should control the issue of medical necessity. Who's best able to make an unbiased determination, besides AMEs? Not the PTP, party-selected QMEs, or UR docs, apparently, because of bias issues. Is there any advantage to using panel QMEs, or IMEs instead of AME's? I don't think so.
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Re: Medical Treatment Lien (California) (California) (California

Postby rider001 on Fri Apr 10, 2009 4:17 pm

Jpod
I was in no way applying that Kaiser is not a adequate. I like Kaiser myself. I have always been treat well and given prompt service. What i was trying to point out is that is where the industry is going to go, republicans and democrats beware. I think Kaiser would do a much better job as you said. Worker comp is a Marxist idea. Germany may have been the first to prvde them but Marx was the first person to suggest worker comp benefits, unless i was mislead by my history teacher which is possible. Eitherway i beleive when Germany enacted them they were a communist state. Still close government control. Maybe not in the near future but someday Kaiser or an organization like Kaiser will handle all comp claims which will be administer by the government. Marxist idealogy includes close government control. Not private interest only concerned for making a buck for themselves. Not greedy insurance companies or greedy physisican but providers of services paid hourly whos only benefit is the enjoyment of helping an injured party.
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Re: Medical Treatment Lien (California) (California)

Postby jonbrissman on Sat Apr 11, 2009 11:10 am

For the record, here is the article that ran on the editorial page of the L.A. Times on April 8, 2009 (downloaded from the L.A. Times website):

Already struggling to cope with the recession, California businesses recently learned that their workers' compensation insurance premiums could swell this summer. Last month, a state board that tracks workers' comp costs recommended a rate increase of more than 24%. The reason: higher medical expenses and the threat of increased payments to permanently disabled workers. Gov. Arnold Schwarzenegger called on Insurance Commissioner Steve Poizner to reject the board's findings and issue an advisory rate more in line with the current charges.

The dispute exposes a troubling problem in the workers' comp overhaul that Schwarzenegger pushed through the Legislature in 2004. The measure, which gave employers and insurance companies significant control over workers' treatment, drove rates down steadily. Today, workers' comp insurance adds a little bit more than 2% to a company's payroll expenses, less than half of what it was in 2003. The number of claims has dropped steadily too. But in the last couple of years, the system's costs have started rising again, especially the medical costs. In fact, the board projected that medical costs for injuries last year will be higher than they were before the reforms were enacted.

Among the factors driving up those costs, according to the board, are sharp increases in expenses related to "medical cost containment" and "medical legal costs." In other words, the mechanisms that insurers use to keep a lid on healthcare expenses are becoming increasingly expensive. And no wonder -- in the overhauled workers' comp system, more people are likely to review an injured worker's paperwork than his X-rays. Insurers can require doctors to submit treatment plans to one set of reviewers to make sure it complies with national standards for care, then have a second set scrutinize the bills once the treatment is performed -- even when the doctors were handpicked by the insurance company. Critics say the review process not only can delay treatments but can pad costs. For instance, an insurer might charge the system more for reviewing a treatment plan than it pays a contractor to do the work.

The increased "cost containment" expenses account for only part of the swift rise in medical charges. Analysts say treatment bills per injured worker are rising unusually fast, as are pharmaceutical costs. Clearly, the system is still adjusting to the changes made in 2004. Nevertheless, policymakers should scrutinize why healthcare costs in the workers' comp system are outpacing the rate of healthcare inflation, and why the mechanisms that were intended to hold down costs are contributing to their rapid growth.

++++++++++++++++++++++++++++++++++++++++++++++++++

The "state board that tracks workers' comp costs" is likely the WCIRB, and it is the source of the data on the expense of cost containment. Argue with them about their data being inaccurate.

JCB
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Re: Medical Treatment Lien (California)

Postby rbaird on Sat Apr 11, 2009 2:40 pm

Just a historical footnote to the comment about "Germany being communist at the time" Don't know where you learned history, but the concept of a fixed indemnity schedule for partial recovery to injured workers was a reform in the Austrio-Hungarian empire or perhaps the Kaiser (Wilhelm). In any event, hardly Marxist or communist. Again, in this country, the common law doctrines of contributory negligence, absence of product liability and a few others which don't come to mind effectively closed the door to injured workers in civil court. Thus, the enactment of the administrative remedy, ca. WW I.
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Re: Medical Treatment Lien (California)

Postby tristar on Sun Apr 12, 2009 2:18 pm

There's argument that if the case settles by C&R the AME becomes a Defendant QME. We successfully argued this point and simply dueled the QME with our own. Our QME reviewed all medical reports from the PTP, and the AME/ AME supplemental (now DQME)

Filed a cost lien for our QME.

It was successful for us since before our QME reported the Defendant was offering $500.00 on a $10,000.00 lien.

After our QME we settled at $5,000.00 on our PTP's lien plus $600.00 for the QME lien.

Michael
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Re: Medical Treatment Lien (California)

Postby compexpert on Sun Apr 12, 2009 8:43 pm

Brissman NEVER goes to trial on liens since (1) he doesn't really know much about the OMFS and (2) he tries to make most of his dough on P&I.
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Re: Medical Treatment Lien (California)

Postby steve appell on Mon Apr 13, 2009 8:37 am

Hi compexpert:
I don't know if your above post is serious or a joke. However, personel attacks are not appropriate in this forum, and I recommend it be deleted.

PS:
I find Jon to be one the most knowlegable lien attorney/reps in the entire state.
Steve

appellandassociates.com
6311 Van Nuys Bl #480
Van Nuys, Ca 91401
wcexaminer@aol.com


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