Worker's Comp, No Fault, and Liability Claims

by: Lori Tubia, CPC
Medcare Administrators
It seems more and more patients now have a third party payer for their medical bills.  To tighten up information gathering on these patients to ensure payment for these claims as quickly as possible, getting it right from the beginning is key.  Here are tips for three types of claims:
 No fault claims: If a patient tells you he or she doesn’t know the NF information, have the patient contact their agent while he or she is at your office.  Make sure you get the name, address, and phone number of the carrier as well as the claim number, the date of the accident, and the name of the insured on the policy.  Contact the carrier. Verify the claim has been accepted and ask if the no fault benefits have been exhausted.  Confirm the billing address and file number. 
Worker’s Comp:  Make sure you get the name, address, and phone number of the carrier; the name, address, and phone number of the employer; the date of injury, the carrier case number, and, if possible, the worker’s comp board number.   If a patient doesn’t have all of the WC information, contact the patient’s employer while he or she is at the practice to gather the information.  The human resource manager (or if a small company, the accountant) should be able to help you.  It is a good idea to also contact the carrier and verify if the claim has been accepted or controverted.
Liability Claims:  When patients present with a claim against a third party such as a store, a restaurant, a neighbor, or a school, litigation is often involved.  It is important to find out from the insurance company if they will be paying you.  Often these cases can drag on, and you will not receive payment until the lawsuit is settled.  You have the option to have the patient sign a lien against their settlement entitling you to be paid out of the settlement before the patient gets the balance.  You also have the option to have the patient pay you for treatment during the entire process and seek reimbursement through the settlement.

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3 Responses to “Worker's Comp, No Fault, and Liability Claims”

  1. Bonnie P says:

    If the patient is involved in a law suit and the practice does not want to wait for the settlement why can’t you bill the commercial insurance carries with a denial from the liability insurance? In the past we have waited for the settlement and not received reimbursement. I found this out by following up with the patient. It is then hard to collect.
    If a letter of protection is received we still have to followup. If the patient does not receive sufficient funds or the patient neglects to inform us do we have any recourse against the attorney since a letter of protection is received? But then, to fight with an atty will be costly.
    In the past I’ve always gotten the commercial carrier to collect the visit costs from them. These cases are always risky since the patient believes someone else should pay their medical cost.
    Lastly, will anyone out there share a copy of their lien letter?

  2. T Ford says:

    Patient _________________________________________
    Date of Accident / Injury ___________________________
    Case Number ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬___________________________________
    County of _________________________, State of Kansas
    Consent and Authorization
    The undersigned patient _____________________________________ (If underage, include name of guarantor), (“Patient”) hereby consents to the examination, treatment, procedures and services to be performed by ___________________________________ (“Provider”), including emergency treatment.
    Patient authorizes Provider to release any information needed to process the claims with respect to the examination, treatment, procedures and services rendered by Provider. Patient further directs that a photocopy of this Claim Agreement and Lien be considered as valid as the original.
    Patient further authorizes ________________________________________ (“Attorney”) to keep Provider advised of the progress of Patient’s court case at reasonable intervals.
    Irrevocable Lien
    Patient hereby authorizes and directs Attorney to pay Provider directly any sums due for medical services rendered to Patient. Patient directs Attorney to withhold such funds from any settlement, verdict or judgment that is rendered in the said court case. Patient herby notifies Attorney that Patient is giving Provider a lien on these benefits or settlement proceeds. In consideration for Provider waiting for payment, this lien is irrevocable and can only be satisfied by full payment of all sums due for medical services rendered. Patient authorizes Provider to notify Attorney of this lien at Provider’s discretion. Patient understands that any settlement, verdict or judgment proceeds cannot be disbursed to Patient without first satisfying this lien.
    Should a dispute arise regarding payment of Provider’s charges, Patient authorizes and directs Attorney to hold in escrow all monies sufficient to satisfy this lien until the dispute can be resolved. Patient acknowledges that it would be a violation of Attorney’s ethical duties to disburse the disputed funds prior to resolution of the lien dispute.
    Patient understands and agrees that even though this lien has been given, Patient remains personally responsible for payment in full of Provider’s fees for all services rendered. Patient is solely responsible to make appropriate arrangements for payment of such fees, including but not limited to insurance benefits. Patient acknowledges that this obligation to pay Provider’s fees is not dependent on the outcome of Patient’s court case.
    Payment Deferred Until Resolution
    Provider hereby agrees to await Patient’s payment of Provider’s fees until the said court case is resolved by settlement, judgment or verdict, except to the extent that payment is available from Patient’s medical insurance or other applicable insurance coverage.
    Collection Costs
    Should the Patient’s account fall into arrears, Patient agrees to pay Provider’s reasonable costs of collections, including attorney’s fees, court costs and/or third party collections costs. Advanced PT, LLC does not charge interest on its accounts.
    Change of Legal Counsel
    If Patient should retain new legal counsel, Attorney and Patient agree to notify Provider immediately upon such change. Patient shall direct new legal counsel to execute another copy of this Agreement and deliver same to Provider.
    Amendments / Revocation
    This Agreement cannot be modified, amended or revoked by any party without the express written consent of all parties.
    Acknowledgement by Patient
    I acknowledge that this Agreement must be signed by myself and by my attorney before any medical services will be provided to me by Provider.
    ______________________________________ _____________________
    ______________________________________ _____________________
    To Patient’s Attorney:
    Please sign, date and return a copy of this Claim Agreement and Lien to:
    Advanced PT, LLC
    200 W Douglas Ste 1040
    Wichita, KS 67202
    Phone 316-263-0003
    Fax 316-263-1241
    Please keep a copy for your records.
    Accepted and approved:

  3. Megan says:

    We are having issues where multiple employers are sending their employees here and advising their employee to bill their personal insurance. We get involved and refuse to bill the personal insurance for a work comp visit and the poor employee ends up stuck in the middle between us and an employer who doesn’t get it / is trying to save a buck. Is there any quick documentation anyone is aware of we can hand off to employees to make it clear they should not be billing their personal insurance for a work comp visit? We’re in IL.