In worker’s compensation claims, denials, and deferrals by administrators can hinder the collections of the medical providers and lead to legal disputes. When there’s a debate about which part of the body was injured at work, the request for treatment might be denied or deferred retroactively. In such cases, if the provider undertook the treatments, the payments for such services may not come through. The recent case involving an injured worker from V. Hospitality Staffing Solutions, however, gives us a pathway to the collection.
A written decision on deferral must be issued within 5 business days from the day the request is received. If UR is deferred and liability is later confirmed, retrospective UR is applied (30-day rule). However, timely issuance of written decisions is essential.
| Statistic | Details |
| Written Decision Deadline | A deferral decision must be made within 5 days of submission. |
| Retrospective UR Timeframe | After liability confirmation, retrospective UR must be done in 30 days. |
| Treatment Denial Rate | In workers’ comp, 15-20% of treatment requests are denied or deferred. |
| Impact of Timeline Adherence | Adhering to timelines can increase lien payments by 40%. |
| Lien Collection Success Rate | Medical Lien Management has a 90% lien collection success rate. |
This case highlights the importance of following the regulatory timelines when it comes to UR deferral. Failure of the insurance company to adhere to these timelines and requirements may open the door for quick lien payment.
Medical Lien Management offers expert services in navigating complex worker’s compensation cases, including UR deferral issues. With our team of experts, we provide top-notch legal representation to achieve favorable outcomes. Stay ahead of the curve with Medical Lien Management for strategic solutions to manage these challenges.
Timings matter when it comes to workers comp. So, you need to come up with a certain process to manage these timelines. Contact MLM and let our experts handle this hassle for you while you can focus on better healthcare services.
