OVERVIEW KNOW YOUR BURDEN CONNECT THE DOTS FILE PREPARATION

KNOW YOUR BURDEN Lien claimants always have the burden of proof for all aspects of their lien. Treatment of an industrial injury as recommended by the treating physician. That the employer didn’t have medical control and applicant was able to treat with the physician. The treatment was reasonable/necessary. The reasonable value of the treatment.

Too often the chain of how applicant got to provider can’t be determined.  Diagnostic company A was referred by Doctor No.  The applicant was referred to Doctor No by PTP Dr. Zhivago.  Was Zhivago the elected PTP? Where is the evidence of that….election letter?  Where is the referral to Dr. No from Zhivago?  Recommendation or Rx from Dr. No to Diagnostic company?

You are sometimes at the mercy of the PTP and his reporting requirements.

FILE PREPARATION

When you file a lien or even bill for goods or services that is allowable as a lien and don’t get reimbursed for those services in a Workers Comp case, you are in litigation.

EVIDENCE….WHAT IS THAT? EVIDENCE Medical reports RFA Referral/election letters UR denial or certification Certified bill review NOT EVIDENCE Labor codes Case law OMFS ACOEM

Prepare your files like everything is going to end up in litigation.