Lien Negotiation Tips
Here are some tips for navigating through a lien negotiation.
Lien claimants are in the “percentage business” not the “fact business.” They generally work off a percentage recovery model, so they are not generally conversant with the facts of your case. You start with a substantial advantage if you appear knowledgeable, certain and assured of the facts.
The more confidence you demonstrate, the less likely the lien claimant will want to bring this particular case to the WCAB.
This should be at the very top of the list. For services prior to 7/1/2013, it is a 3 year statute from the date services were provided. [Lab C 4903.5(a)]
For services on or after 7/1/2013, the limitation is only 18 months. Check with EAMS
If the statute has run, then game over.
The stronger the basis for your denial of injury, the stronger defense you have to liens. Remember, the lien claimant has the burden of proof on all issues and they become a party after the C and R or the applicant decides not to pursue his or her claim.
Under Torres v. Unitech (En Banc), lien claimant has affirmative burden of proving all elements by a preponderance of the evidence and that simply introducing a lien is not enough.
If the lien claimant is not reasonable, then let them know they can set the matter for Lien Trial and they will have the full burden of proving injury and need for treatment. And if the clam is denied and the applicant is not present, well?
Make sure you know the amount of the payment which would be allowable “if the injury” or the body part were admitted.
A “solid defense” might include, among other things:
• PQME said no further care or subject care not necessary
• AME said no further care or subject care not necessary
• UR denied RFA with no IMR triggered
• IMR determined no medical necessity on the RFA
• MPN: Out-of-network treatment and the facility was placed on notice (Valdez)
• Impermissible lien assignment. Assignment not filed with WCAB or multiple assignments, which are prohibited by statute
• Lien is not properly supported by required declaration (Lab C 4903.8(d). Lien considered invalid without declaration that the services or products were actually provided and that the billing statement is accurate
• IBR has taken place with no appeal to the WCAB so the issue is resolved and any further effort to collect will be met with sanctions
• Improper compounding of medications
• You have a stipulated award or even open C and R for medical care, which limits treatment and therefore justifies denial of this bill
BILL REVIEW: Use your bill review as a guide/script
Under Torres, if the lien claimant appears for Lien Trial and is unable to prove their case, then you may be entitled to sanctions.
Tell the lien clamant that we will fully expect them to be ready to try the case and that if they do not sustain their burden as to the “underlying case,” that you will be filing a DOR for sanctions, costs and attorney fees.
Lien claimants are the first to demand service of your medical evidence, but probably the last to actually review, much less digest and analyze what is served. You should cheerfully advise them that the proof of your assertions are contained in the stack of documents which you will enthusiastically send over for their review.
Ask to speak to the next higher supervisor in the chain.
If you are at the WCAB, you will likely encounter more aggressive lien representatives, who are often schooled for the “game.” Their tactics often include intimidation. Forget their bluster and stick to your game plan. A calm response is actually what they are not looking for. They want an emotional response, so that a fear-based negotiation will provide them with more money. A calm confidence in your facts and evidence will trump intimidation.
I don’t spend a lot of time with these people, since they are “programmed.” They are also much less likely to be as aggressive at a Lien Trial, so you are going to generally do much better at a Lien Trial than a Lien Conference. Sometimes, the additional appearance is worth the cost.
These seem to have a better tone. I like to take my time and go through elaborate facts. If I am dealing with a “robot,” then of course I switch gears. But again, you have to gauge the opposition. You also need to stay away from percentages and stick by the facts of your case, and why your case is unique.
Sometimes, it is better to recommend a sum certain, rather than responding to their “demand,” which is always percentage centric.
You can also politely correct the other side when they misstate the case facts, since it is highly unlikely that they have studied the matter or they are familiar with the facts and evidence.