Resolving workers’ compensation claims in California can be a legal battle, often resulting in workers comp delays that impact providers’ timely billing and collection.
A recent case involving a dedicated employee at a manufacturing plant exemplifies medical providers’ challenges in such situations. John’s severe back injury, caused by a mechanical malfunction at work, led to workers comp dragging out medical treatment because his employer’s administration took time to authorize the necessary medical care. This delay in authorization prolonged the time it took for the medical provider to bill and collect for the services rendered. Essentially, without prompt authorization, the provider couldn’t proceed with the treatment, causing delayed treatment and delaying the entire billing process.
As the representative of the involved medical provider, MLM submitted an RFA before the medical services were provided on behalf of our client for urgent bill clearance, as Californian law requires. The administrator further delayed response to the RFA, prolonging the settlement negotiations and accumulating unpaid medical bills.Â
| Category | Statistical Aspect | Percentage Value/Range |
| Claim Processing | Delayed Claims in California | 20% |
| Denied Claims in California | 10-15% | |
| Financial Impact | Unpaid Medical Bills | 25% |
| Average Cost of a Workers’ Comp Claim | $40,000 – $50,000 | |
| Provider Impact | Impact on Providers | 30% |
| Legal Outcomes | Settlements Achieved with Legal Aid | 70% |
| Legislative Benefits | Cases Benefitting from Labor Code 5402 | 15% |
Medical Lien Management (MLM) engaged with the adjuster, stressing the importance of promptly settling the bill owed to the medical provider. We leveraged § 5401, which mandates that within one working day after an employee submits a claim form, the employer must authorize all treatment for the alleged injury, consistent with § 5307.27. This treatment must continue until the claim is either accepted or rejected. Until the date the claim is accepted or rejected, liability for medical treatment shall be limited to ten thousand dollars ($10,000).
We ensured that the medical provider received payment for the necessary treatments and medication they provided John with. Effective legal representation and negotiation skills are vital in securing fair outcomes for medical providers. As settlement experts, MLM advocates for the highest collection for the medical provider. If you’re dealing with delayed treatment or wondering if you can sue workers comp for taking too long, contact us for further help today.
