By Lucia Giglia, Case Manager | giglia@precisionlienresolution.com
There are no two ways around it: health insurers, both private and government agencies, routinely include unrelated claims as part of lien itemizations in personal injury cases. The inclusion of these claims can stem from a number of variables that Precision Resolution can help plaintiff attorneys avoid or remove such claims.
In a recent case involving toxic exposure which led to hairy cell leukemia, our experience in these complex cases allowed us to deliver remarkable results for the plaintiff – reducing the lien by more than $340,000.00. The case presented a unique scenario as Medicare had no claims, leaving a private Medicare Advantage Plan as the primary lienholder, preventing the settlement of the case.
Background
The client’s situation was particularly nuanced, due to the nature of the disease and facts of the case. Hairy cell leukemia, a rare form of cancer, can require extensive and ongoing treatment, complicating the lien resolution process. As the Advantage Plan added unrelated claims at each interim request, the stakes for the plaintiff rose exponentially.
Once the interim lien amount exceeded the amount of any potential gross settlement amount, plaintiff’s counsel reached out to Precision Resolution.
Through a series of three appeals, supported by the inclusion of the client’s medical records, peer-reviewed medical studies, and journal articles, our team successfully removed the carrier’s claims. Why three attempts to appeal? First, our commitment to advocating for the plaintiff never wavers. With each appeal, the recovery contractor only conceded a small amount. However, we knew that our arguments were accurate and backed by medical findings, so we kept chipping away, finally convincing the contractor that the claims were unrelated on our third attempt.
The outcome was a testament to our team’s rigorous approach and the resiliency of the plaintiff. We achieved a total reduction amount of $341,608.80, a significant financial relief for the plaintiff. This reduction not only highlights our capability to handle complex medical-based lien disputes but also our commitment to protecting the plaintiff and maximizing settlement dollars for plaintiffs.
In other instances, when Precision Resolution is engaged with a case early on, our team of attorneys and paralegals may be able to prevent unrelated claims from appearing at all, by actively engaging recovery contractors to ensure that only claims related to the cause of action appear on any lien ledger.
As with all our cases, our unwavering commitment to client advocacy and excellence in lien resolution.