Denial on the Medical Basis

Today, let’s embark on an adventure through the world of denials, using real-life cases to shed light on how to navigate these tricky situations. Buckle up, because we’re about to dive deep into the stories of individuals who faced denials head-on and emerged victorious!
Sarah, hardworking nurse, who injured her back while lifting a patient at work. Despite her pain and medical reports confirming the work-related nature of her injury, Sarah’s employer denied her claim, citing a lack of substantial medical evidence. Frustrated and unsure of what to do, Sarah turned to legal experts for help.
With the guidance of her attorney, Sarah sought a second opinion from an AME, whose thorough evaluation provided the necessary evidence to support her claim. Upon review of her medical condition and how the injury occurred in the first place using the medical reports and all medical history documents to proper evaluation, it was proven that her injury was industrial. Armed with this newfound medical backing, Sarah’s employer had no choice but to accept her claim, and she was finally able to access the compensation and treatment she needed to recover.
With Sarah’s case resolved, We (MLM) focused on negotiating the remaining balance of medical bills with the insurance company. Representing the medical provider, we leveraged their expertise in communication and negotiation to reach a mutually beneficial agreement. Using the facts related to statute of limitation for the denial of the claim which is 90 days from the injury claimed.
At Medical Lien Management, we pride ourselves on our expertise in handling complex workers’ compensation cases. By presenting thorough documentation of the services provided and the necessity of treatment, we effectively advocated for fair reimbursement from the insurance company. Please contact us if you need to deal with such and we can help you out.

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