Lien on Me
William Nathans
Editor
It's that time again! Time for me to go on a rant that may or may not make sense. I think that liens need to be addressed. I am tired of lien claimants coming out of the woodwork two, three, or four years after the claim has been settled. I find it amazing that some doctors can stay in business operating their receivables the way they do.
I also think the time has come to regulate the lien collectors. I love the way they all operate off the same script. Once the adjuster starts to negotiate, the scenario goes something like this. First they reduce their demand by a percentage, then when you reject the counter offer they come back with lowering the demand by another percentage. You make a counter offer and the response is “I have to talk to my supervisor.”
Then after what is probably a heartfelt discussion with their supervisor regarding the nature of liens in general and how they can get more out of this particular negotiation. Face it, this is like negotiating with a use car dealer. It's right out of the same playbook.
The poor lien collector comes back with some sob story about how they need a little better offer so they can “look good.” At this point I'm suppose to feel for this person because we shared some quality time. So I should help them out, right?
I really don't care about making the lien claimant “look good,” these types of lien claimants I deal with take valuable time that could better be served by delivering benefits to injured workers. This is another example of medical providers placing their interests ahead of their patients.
Do we have any support for the lien collectors out there?
Comments, questions, e-mail me at bill@adjustingworld.com
Dangerous Predictions
Stephen L. Kline, Esq.
Armstrong Law Firm
stephenk@arm-law.comThis is probably the most dangerous thing that I have done since I attempted to climb a rope 14 feet off the ground in junior high school. As I am writing this, there are three workers compensation bills on the Governor’s desk that were passed by the State Legislature. At the end of the review of each bill that follows, I will predict, without any safety net, whether the Governor will sign it or not.
By the time you read this, he should have made his decision. You can either laugh at my folly or marvel at my insight or just say, “well, that was a no-brainer”.
AB 338 - An act to amend Labor Code §4656.
According to the Legislative Counsel’s Digest, “this bill would, for a single injury occurring on or after January 1, 2008, increase to 5 years from the date of the injury, the period of time during which an employee can receive aggregate (temporary) disability payments.”
Prior to SB 899 was that Total Temporary Disability for injuries before 4/19/2004 was uncontrolled. We all have a myriad of horror stories of those who were questionably disabled, stringing the temporary disability out for years and years. Some primary treating chiropractors never met an applicant who could ever be permanent & stationary.
If this bill is signed into law, Labor Code § 4656(c)(1) is retained for injuries between 4/19/04 and 12/31/07 and “temporary disability will be limited to 104 weeks within a period of two years from the date of the commencement of temporary disability payment”. The WCAB en banc has said that even if you pay retro-temporary disability with your first payment of temporary disability, the calculation of the 104 weeks does not start until the first payment. Thus, under this provision an applicant could receive more than the 104 aggregate weeks. Those battles may continue as there is no change in the wording.
Labor Code § 4656(c)(2) will be amended to read with the language, “Aggregate disability payments for a single injury occurring after 1/1/08, causing temporary disability shall not extend for more than 104 compensable weeks within a period of five years from the date of injury.”
Thus Temporary Disability is capped at 104 weeks within five years from the date of injury. The employee has more time to use the temporary disability benefit, but (s)he can’t get anymore than those 104 weeks. This would seem to suggest that if retro-temporary disability is paid that those weeks are not excluded from the calculation of the aggregate 104 weeks.
Labor Code §4656(c)(3) is the same as the current Labor Code §4656(c)(2) with exceptions of eight specific conditions for which temporary disability is extended to 240 weeks within the 5 years.
My prediction: The Governor will sign this bill.
SB 936 - An act to amend Labor Code §4658.
Haven’t we seen this bill before? This bill revises the formula for computing the permanent disability payments for injuries that occur after 1/1/08. Senate President Don Perata wrote and passed this same bill last year to absolve his vote for the confirmation of Andrea Hoch as Administrative Director. Over a three year period, he wants to double the permanent disability.
For example, instead of 3 weeks for each percent of permanent disability below 10%, the number of weeks increase yearly to 4 weeks for 2008 injuries, 5 weeks for 2009 injuries, 6 weeks for 2010 injuries.
For permanent disability percentages, in the range of 70 to 99.75, the current amount is 16 weeks. With this bill, that number would change to 21 weeks for 2008 injuries, 27 for 2009 injuries and 32 for 2010 injuries.
This destroys some of the economic reforms that SB 899 made.
My Prediction: The Governor will not sign this bill.
AB 1063 – An act to amend Labor Code §4604.5
For injuries, after 1/1/04, Labor Code §4604.5 (d) (1) limits an employee to no more than 24 chiropractic, 24 occupational therapy and 24 physical therapy visits per industrial injury, notwithstanding the ACOEM guidelines or evidence based medicine.
This bill would add section (d) (2) which states, “Paragraph (1) shall not apply when an employer authorizes in writing, additional visits to a health care practitioner for physical medicine services.” This means that if a 25th visit is authorized in writing, there are no more limits for that particular service or therapy, except that which can be done through utilization review and the Guidelines. A major part of the earlier reform will be lost.
Section (d) (3) would also be added. It provides, “Paragraph (1) shall not apply to visits for postsurgical physical medicine and postsurgical rehabilitation services provided in compliance with a postsurgical treatment utilization schedule established by the administrative director pursuant to Section 5307.27.” The potential for a Pandora’s box being opened is limited by the regulatory feature of guidelines. However, the implementation of those guidelines have been fertile ground for endless litigation and the threatened utilization review penalties for not meeting the tight timelines for review. The language seems docile enough, but the operation of this section has the potential of another costly nightmare. This one is hard to decipher. The Governor has a lot of chiropractic and physical therapy friends. Those muscles have often been massaged. The employer community is trying to impress upon him that the real cost of this bill will be a reform buster.
My prediction: He will not sign this bill. Well, you probably now know how I have done. Humbly, I wait for publication.
Thanks for your attention.
Don't miss Steve's Legal Update at the SBICA Luncheon on October 26th.
See the events calendar for more information......
Workers' Comp Still a Battlefield
Arnold Schwarzenegger's first major achievement as governor was to bulldoze the Legislature into overhauling the state workers' compensation system, much to the delight of employers, who have seen their costs drop by billions of dollars, and much to the dismay of labor unions and others on the other side of the perennial battle.
****************************************
Small employers, have you made changes to your workplace to bring an injured employee back to the job? If so, you may qualify for reimbursement from a special fund
According to the RAND Corporation, a non-profit think tank, both employers and injured workers benefit when employees return to work quickly following a workplace injury. That’s why the workers’ comp reforms implemented in 2004 placed the emphasis on providing injured workers with sound medical treatment and getting them back to work as soon as possible.
****************************************
Workers' Compensation Bill Makes System More Fair
The Mercury News editorial on workers' compensation reform (Aug. 27) suggests that the governor and Legislature use the 2004 workers' comp reform as a model for solving the state's health care crisis. Hold on there. Before we pop that champagne cork in celebration,
*********************************************************************************************
Have an insurance related event coming up?
Email us the relevant information and we can place it in our Events Calendar. Send us a note with the relevant facts and sponsoring organization to eventform@adjustingworld.com
POLL
Results of the September PollHave You Tried to Have a Bill Dismissed Based on the Medical Facilities' Fictitious Name Permit? Yes 30% No 70% |
|