Eric Sanchez – Your PI Firm Doesn’t Have an AI Problem. It Has a Process Problem.

Why Most Firms Get AI Adoption Wrong

I sat down recently with Eric Sanchez of Maestro Strategic Partners on the Trial Lawyer View by Synergy podcast to talk about AI adoption in personal injury firms. Eric is a legal technologist who works with plaintiff firms on operations, technology implementation, and leadership. He has been in the legal tech space for years, and he sees more law firms from the inside than most of us will in a career.

The conversation went places I did not expect. And the takeaway I kept coming back to after we wrapped was this: most firms that struggle with AI do not have a technology problem. They have a process problem. They have a people problem. And until they address those first, the AI tools will not save them.

AI Is No Longer Optional

Eric was blunt about where we are. AI adoption in law firms is not a preference anymore. It is a requirement to compete. The speed of change in AI makes it different from every other technological shift we have seen. Eric pointed out that AI is advancing every six to seven months in ways that took other technologies years. If you have not started adopting it, you are falling further behind with each passing quarter.

He referenced firms like Sweet James that have been building AI into their operations for two years. They are operating on a different level than firms still debating whether to buy their first tool. And the gap between the two grows wider every month.

The consumer side of this matters too. Your clients are already using AI for everyday tasks. They are using it to find recipes, troubleshoot appliances, and plan trips. That normalizes it. Your staff use it at home whether you know it or not. So, the stigma around AI is fading at the ground level, which means the appetite for it inside your firm is higher than you think.

People, Process, Technology. In That Order.

Eric laid out a framework I think every firm leader needs to hear. There are three legs to success with AI: people, process, and technology. And the order matters.

Most firms go straight to the technology. They buy a tool. They roll it out. They wonder why nobody uses it. The reason is simple. You skipped the first two steps.

Start with process. Eric told me the number one problem he sees is that firms have not codified their own workflows. If you have six paralegals and each one orders medical records differently, you do not have one problem to solve with AI. You have six. Before you bring in any tool, figure out what your people are doing now, identify what works, and lock it down as the standard. Then bring in technology to improve that standard.

Next, address your people. Eric described four personas that exist in every firm. There is the visionary, usually the firm principal, who wants to grow and innovate. There is the champion who is excited about new tools. There is the blocker, often the tenured paralegal who resists change. And there is the middle-of-the-road person who wants to get their work done with as little friction as possible.

Each persona requires a different approach. The visionary sometimes needs to be reeled in. The champion needs to be grounded in practical concerns. The blocker needs to be managed carefully. And Eric made an important point here: people do not hate change. They hate change that does not benefit them. If your team understands how a new tool makes their work easier or more effective, they will get on board.

Start with the Pain Points Your Team Already Feels

Eric recommends creating work groups within your firm to identify pain points from the ground up. Not top down. When product selection happens at the top without input from the people doing the work, you get low adoption every time.

He gave a good example. Ask your paralegals to rate opening insurance claims on a scale of one to ten. He said he has never met a paralegal who rates that above a three. That is where you start. Find the tasks your team dreads, the ones that eat up time without adding value, and look for AI solutions there first.

Lien verification is another one. Medical record retrieval. Treatment follow-up calls. These are high-volume, low-satisfaction tasks where the right tool gives you immediate leverage. And when your staff has identified the pain point themselves, the buy-in is already there.

Eric also made a point I agree with fully. If you find a solution that handles eighty percent of the problem, that is a win. Lawyers tend to focus on the outliers, the edge cases where the tool falls short. But if you are solving the bulk of the workload, you are ahead of most firms.

You Need an AI Policy Before You Need an AI Tool

This was one of the most practical pieces of advice from the conversation. Before you buy anything, write an AI policy for your firm. Eric pointed out that if you have twenty people in your office, some of them are already using public AI tools for work. They are pasting case details into ChatGPT. They are uploading documents to free tools without understanding the privacy implications.

An AI policy does not have to be complicated. At minimum, it should cover what tools are approved for use, what information is off-limits for public AI platforms, and what protections need to be in place around personally identifiable information. That is a quick, low-cost way to create a baseline of protection for your firm.

There Is No Single AI Tool That Solves Everything

One of the more interesting parts of our conversation was about tech stacks. Eric was clear that a single all-in-one AI platform is not the answer for most firms. The reality is that different tools do different things well. You might need one tool for medical chronologies, a different one for case valuation, another for marketing, and yet another for telephony and client communication.

Eric thinks the market will split into two camps. Some firms will go all-in on a single platform that handles intake, case management, and AI together. Others will keep their existing case management system and build a specialized tech stack around it with best-in-class tools for each function.

Neither approach is wrong. But the choice depends on your firm, your workflows, and your tolerance for managing multiple systems. A firm that litigates five percent of its cases has different needs than a firm that litigates forty percent. A high-volume TV advertising firm has different pricing sensitivities than a boutique trial firm handling high-value cases.

Eric also raised an important concern about the economics of legal AI. We are seeing staggering valuations and massive investment into these companies. Investors expect a ten-times return. At some point, the math will not work. That is worth thinking about when you are choosing which platforms to build your practice around.

AI Should Complement Your Team, Not Replace Them

I have been through a personal injury case myself. It is intensely personal. There is no place for AI to replace the human touch in client-facing interactions, especially during the most vulnerable moments of a case.

Eric shared a story that made this concrete. He tested a voice AI intake agent by pretending to be a prospective client. When he said he had lost his arm, the AI responded by asking if he had sought treatment. It completely missed the weight of what he had said. That kind of response puts your firm at the back of the line for any client paying attention.

The right approach is to use AI to support your people, not to stand in for them. Eric described a better application: using AI to create personalized video check-ins for clients, based on the lawyer’s own voice and likeness, with a clear option to connect with a real person. That adds value without removing the human connection.

He was direct about the workforce implications too. If AI is going to reduce your headcount, be honest with your team about that. The moment you start making cuts without being upfront, your best people, the ones with options, will leave. They will not wait to find out if they are next. Transparency builds trust. And the people who stay and learn to work alongside AI will become more valuable than ever.

Agentic AI Is Not the Same as Automation

Eric drew an important distinction between basic automation and agentic AI. A lot of what firms call AI today is not AI at all. It is an if-then automation. Zapier zaps, workflow triggers, rules-based routing. Those are useful, but they are not intelligent.

Agentic AI is different. An AI agent recognizes an event, makes a determination on its own, and executes. Eric compared it to the difference between “lawyer” as a label and the specific kind of law you practice. Agentic AI is a broad category. Some agents research and compile information. Some make phone calls to schedule appointments. Some monitor metrics and reallocate marketing spend without being told.

The AI-enabled firm of the near future will have paralegals operating like piano players, with each key being a different agent. They will manage workflows by launching agents to handle discrete tasks. That requires a new level of skill and sophistication from your team, which is another reason the people side of this equation matters so much.

What the AI-Enabled Firm Looks Like

Eric sees consolidation ahead. Firms that did not adopt AI will not be able to compete for cases. They will be absorbed by firms that did. The firms at the top will not be using a single AI tool. They will have built specialized tech stacks with tools for every function, from intake to litigation to marketing to client communication.

Those firms will respond to new mass tort opportunities in hours, not days. They will have agents monitoring case metrics and adjusting strategies in real time. They will compete for talent differently because the people who know how to work with AI will be in high demand.

Eric put it plainly. It is almost malpractice not to be using technology at this point. Not because it is trendy. Because it is necessary to serve your clients at the level they deserve.

The Bottom Line

If you take one thing from this conversation, make it this. Do not start with the tool. Start with your process. Start with your people. Write an AI policy. Identify pain points from the ground up. Then, and only then, bring in technology that fits your firm, your culture, and your workflows.

The firms that get this right will have a meaningful advantage in the years ahead. The firms that skip the foundational work will spend money on tools that collect dust.

If you want to hear the full conversation with Eric Sanchez, check out the Trial Lawyer View podcast. And if you want to connect with Eric’s team at Maestro Strategic Partners, contact him at eric@mstratpartners.com.

🎧 Listen to the full podcast conversation on Trial Lawyer View here: https://triallawyerview.com/podcast/eric-sanchez/

🔗 Want more insights like this?

If you’re a personal injury lawyer ready to scale, streamline, and step into your role as CEO, let’s talk. Join the Peak Practice Community, and learn how synergy. can help you eliminate settlement bottlenecks, resolve complex liens, and maximize recoveries. Learn more here: https://partnerwithsynergy.com/peak-practice/

If you want to grow and scale your law firm more effectively, consider partnering with Synergy for lien resolution. Learn more at: https://partnerwithsynergy.com/liens/

How to Build Medicare Compliance in a PI Firm

Medicare compliance sits at the center of modern personal injury practice operations. Trial lawyers and paralegals face real exposure when Medicare interests go unaddressed or get handled incorrectly. The risk is not abstract. Medicare can assert direct recovery rights, including against plaintiff personal injury firms, with double damages on the table under the Medicare Secondary Payer Act. Building a repeatable Medicare compliance framework inside a personal injury firm protects client recoveries and shields the practice from avoidable liability. The guidance below follows the Total Medicare Compliance framework developed and used by Synergy in daily practice

Why Medicare compliance belongs in firm operations

Medicare compliance is not a closing checklist item. Medicare tracking starts early, often before settlement discussions begin. Mandatory Insurer Reporting and expanding data analytics that results means Medicare identifies settlements quickly. When firms rely on informal processes or wait until funds arrive, mistakes can accumulate. Interest accrues, final demands go unpaid, and files lack documentation to defend decisions later.

A structured compliance process gives a person injury firm control. It replaces reactive problem solving with deliberate planning tied to each stage of the case. Here is a usable framework for firms handling cases on behalf of Medicare beneficiaries.

Step one. Identify Medicare status early and consistently

Every Medicare compliance program starts with identification. Your intake and case review procedures should screen for current Medicare beneficiaries. It is also a good idea to screen for those with a reasonable expectation of Medicare eligibility within thirty months. This group includes clients on SSDI, clients nearing age sixty five, and individuals with qualifying conditions such as ALS or ESRD.

Relying on client memory alone is risky. Build intake questions, document requests, and follow up protocols into your workflow. Confirm coverage using Medicare cards, Social Security status, and insurer information. Early identification drives every downstream compliance decision.

Step two. Report and track conditional payments with discipline

Once Medicare involvement is confirmed, reporting and tracking must follow. Contact the Benefits Coordination Recovery Contractor early to open the file and request a Conditional Payment Letter. Treat this letter as a working document, not a final number. Audit line items for unrelated care and submit disputes as treatment continues.

After settlement, report the full settlement details promptly to trigger the Final Demand. Pay the final demand within sixty days to stop interest accrual, even if you plan to pursue a compromise or waiver. Firms that delay payment expose themselves to interest, Treasury referral, and enforcement actions.

Step three. Address Medicare Advantage and Part D liens

Total Medicare compliance extends beyond traditional Medicare Parts A and B. Medicare Advantage plans and Part D prescription plans assert independent recovery rights, often through aggressive recovery vendors.

Your process should include plan identification, verification of recovery rights, and parallel resolution efforts. Treat Part C and Part D liens as distinct obligations, with separate documentation and negotiation strategies.

Step four. Advise clients on future medical implications

Medicare compliance does not stop with past payments. When a client is a Medicare beneficiary or approaching eligibility, future injury related care matters. You should be advising clients on Medicare Secondary Payer implications tied to future treatment. Or hire experts to do so.

The CAD framework provides clarity. Consult with Medicare compliance experts, advise and educate the client about future medical exposure, and document each step. If a client declines a Medicare Set Aside analysis or elects to set aside nothing, your file should reflect informed decision making with signed acknowledgment.

Step five. Review release language from the other side carefully

Release language plays a critical compliance role. Overbroad language supplied by defendants often imports workers’ compensation concepts into liability cases, assigns specific set aside figures, or shifts improper responsibility to the client.

Your firm should actively revise proposed language. Focus on language that reflects consideration of Medicare’s interests without creating unintended tax, coverage, or reporting consequences. Avoid making settlements contingent on CMS review of anything. CMS review is voluntary and inconsistent across regions, with no appeal process.

Step six. Start early and collaborate strategically

Medicare compliance improves when planning starts early. Confirm Social Security disability status, collect insurance documentation, and identify ICD codes likely to appear under Mandatory Insurer Reporting. Coordinate with defense counsel to align reporting and coding.

Early intervention also opens strategic options. Future medical exposure sometimes supports higher settlement values when framed correctly. Firms that understand this dynamic use Medicare planning as leverage rather than an obstacle.

Step seven. Document everything

Documentation is the backbone of compliance. Courts and regulators focus less on outcomes and more on process. Your file should show identification efforts, reporting timelines, client education, expert consultation, and decision rationale.

This level of documentation protects your firm if CMS questions something later. It also strengthens internal quality control and training.

Why firms turn to Medicare compliance partners

Most personal injury practices recognize the limits of internal resources. Medicare Secondary Payer law evolves constantly. Medicare procedures shift. Recovery vendors change tactics. Building deep internal expertise across conditional payments, Part C liens, future medical analysis, and release drafting strains even experienced teams.

Partnering with a specialized Medicare compliance provider supports ethical practice, protects client recoveries, and reduces risk exposure. Synergy’s Total Medicare Compliance approach integrates identification, resolution, documentation, and education into a single workflow designed for trial lawyers and paralegals who need reliable outcomes, not theoretical guidance.

Building Medicare compliance inside a PI firm is a deliberate operational decision. Firms that commit to structured processes, early action, and expert support position themselves as responsible advocates who protect both clients and practice.

Written by: By Jason D. Lazarus, J.D., LL.M., MSCC | Founder & Chairman of Synergy | Founder of Special Needs Law Firm | Author of Amazon Best Sellers – Art of Settlement & Litigation to Life | Host of Trial Lawyer View by Synergy Podcast | Peak Practice by Synergy Curator

AI Is Coming for Your Client’s Recovery. Here Is How to Fight Back!

Insurance carriers are spending billions on artificial intelligence. The stated goal is faster claims processing and fraud detection. The practical result is something different. AI is being used to systematically undervalue personal injury claims and pressure injured people into accepting less than they are owed. If you handle PI cases and you are not paying attention to this, you are already behind.

The Problem Is Not New. The Scale Is.

For decades, insurance companies have used software tools to assign values to bodily injury claims. The most well-known is Colossus, a program that converts medical data into severity points and spits out a settlement range. Over 70 percent of insurers in the United States use Colossus or similar software to assess bodily injury claims. The manufacturer’s own sales literature once promoted that the program would reduce bodily injury claims payouts by up to 20 percent. That was the old playbook. The new one is worse.

Today, carriers are deploying machine learning models that go far beyond Colossus. These systems analyze photos of vehicle damage through mobile apps, cross-reference police reports with medical records, and generate settlement offers before a human adjuster reviews the file. A 2025 McKinsey report found that insurers using AI-driven systems have reduced total claims processing time by 70 percent. Faster processing, though, does not mean fairer outcomes.

AI models are trained on historical settlement data. If an insurer paid lower settlements to certain demographics or geographic areas in the past, those patterns get baked into the algorithm. The system reproduces the old biases while appearing objective on the surface. And because no one outside the carrier knows how these algorithms work, claimants and their lawyers are left in the dark about why a particular number was generated.

How Carriers Use AI Against Your Clients

Here is what is happening on the ground. Insurance AI systems flag claims for denial or reduced payment based on narrow criteria that do not account for individual circumstances. The software assigns weights to specific words in medical records. Terms like “conservative care,” “delayed complaint,” or “pre-existing condition” trigger automatic deductions, even when those terms are medically appropriate and say nothing about the legitimacy of the claim.

The systems fail most in the area that matters most to your clients: noneconomic damages. Pain, suffering, emotional distress, loss of enjoyment of life. These do not translate easily into data points. The algorithm does not know your client. It does not understand how their injuries have changed their ability to work, care for their family, or live their daily life. It reduces a deeply personal experience to a statistical average.

The carriers know that most claimants will not fight an AI-generated lowball offer. They count on it. When the system is designed to produce low offers at scale, and almost nobody pushes back, the math is simple: the insurer profits.

What Trial Lawyers Need to Do Right Now

You do not need to become an AI engineer to fight back. You need to change how you build cases and how you present evidence, because the other side already has.

Get the documentation right from day one: AI systems rely on specific diagnostic codes and treatment descriptions. If your client’s pain, functional limitations, and daily impacts are not clearly documented in their medical records with proper terminology, the algorithm treats it as if the injury does not exist. Work with your client’s treating physicians to make sure the records reflect the full picture, not shorthand that a computer will discount.

Demand transparency in discovery: Attorneys across the country are beginning to request algorithmic transparency during the discovery process. Ask for the specific AI tools used to evaluate the claim. Request the data inputs, the weights assigned, and the output. Ask whether a human adjuster reviewed the file before the offer was generated, or whether the number came straight from software. The more lawyers who ask, the more precedent we build.

Hire forensic experts when warranted: In complex cases, consider consulting experts who specialize in evaluating AI-driven claim assessments. They review how the system arrived at a number and identify where the algorithm failed to account for your client’s specific circumstances. This is similar to hiring an accident reconstructionist or an economist. It is one more expert in your toolkit.

Prepare for trial: Colossus and similar systems factor in whether the plaintiff’s attorney has a track record of going to trial. If the algorithm determines the attorney on the file is unlikely to litigate, it generates a lower range. One of the most effective things you do for your client is to make clear, through your actions and your track record, that you are prepared to put the case in front of a jury. Juries do not care about software-generated valuations. They care about real human suffering.

Building Internal AI Policies for Your Firm

While you fight AI on the carrier side, you should also think about how your own firm uses AI. Technology has clear benefits for case management, document review, and research. But there are real risks if you adopt AI tools without a framework for responsible use.

Start with a simple question: does the AI tool serve the client’s interest, or does it create shortcuts that compromise quality? If you are using AI to draft demand letters, review medical records, or identify case patterns, make sure there is a human in the loop who reviews every output. AI tools make errors. They produce confident-sounding answers that are factually wrong. In a profession where mistakes lead to malpractice exposure, that is a serious concern.

Create a written internal policy for AI use in your firm. Spell out which tools are approved, who reviews the output, and how client data is protected. Make sure your team understands that AI is an assistant, not a decision-maker. The ethical obligation to provide competent representation still rests with you.

The Bottom Line

AI in personal injury is not going away. The global market for AI in insurance is projected to grow from roughly $15 billion in 2025 to over $246 billion by 2035. Claims processing is one of the largest use cases fueling that growth.

The carriers will keep investing in tools designed to reduce what they pay. Your job is to make sure those tools do not succeed at the expense of your clients.

That means better documentation. Smarter discovery. Expert challenges to algorithmic valuations. A willingness to try cases. And a clear-eyed understanding of how the other side is using technology against the people you represent.

The trial lawyers who adapt to this reality will get better results for their clients. The ones who ignore it will find themselves accepting settlement offers generated by a machine that was programmed to pay as little as possible.

Why Synergy is the Answer to Help You Scale

Synergy exists to help firms confront the operational realities being driven by technology and scaling pressure. By removing administrative burdens related to lien identification, verification and resolution, from your staff, we help you strengthen your practice’s capacity for high-value legal work and sustainable growth.

🔗 Want more insights like this?

If you’re a personal injury lawyer ready to scale, streamline, and step into your role as CEO, let’s talk. Join the Peak Practice Community, and learn how Synergy can help you eliminate settlement bottlenecks, resolve complex liens, and maximize recoveries. Learn more here: https://partnerwithsynergy.com/peak-practice/

If you want to grow and scale your law firm more effectively, consider partnering with Synergy for lien resolution. Learn more at: https://partnerwithsynergy.com/liens/

David Craig – The Jury Is the Equalizer: What Trucking Litigation Teaches About Building a Stronger Trial Practice

Trial lawyers know that some cases are simply different. Truck crash cases are a great example.

When a catastrophic trucking case lands on your desk, you are no longer just dealing with negligence. You are stepping into a fight with well-funded corporations, experienced defense teams, and insurers who have spent decades refining their playbook.

In a recent episode of the Trial Lawyer View by Synergy podcast, Jason D. Lazarus, J.D., LL.M., MSCC sat down with nationally recognized trucking attorney David W. Craig of Craig, Kelley, and Faultless LLC to talk about what it really takes to hold dangerous trucking companies accountable and what trial lawyers can learn from these cases when it comes to building stronger, more resilient practices.

The conversation goes far beyond trucking cases. It touches on strategy, technology, firm management, and the mindset required to compete at the highest level.

Here are a few lessons every growth-minded trial lawyer should be thinking about.

When the Playing Field Is Not Level

Truck accident litigation often pits injured individuals against companies with enormous resources. As Craig explains, trucking companies and their insurers can deploy top tier defense lawyers, experts, and investigators almost immediately after a crash. Without the right legal team on the other side, injured victims may never have a fair shot.

That is why jury trials matter so much in these cases. “The jury trial is the great equalizer,” Craig explains. It allows ordinary people to hold powerful corporations accountable and ensures that the story of what really happened is heard.

For trial lawyers, the takeaway is clear. Serious cases demand serious preparation. Expertise, resources, and strategic discipline are not optional. It is the price of admission.

The Strategic Mistakes That Cost Cases

One of the most valuable parts of the conversation was Craig’s perspective on the mistakes he sees when lawyers who do not regularly handle trucking cases step into the arena.

Two issues come up again and again.

1. Failing to identify every responsible party

A trucking collision is rarely just about the driver. There may be brokers, shippers, maintenance companies, contractors, or others involved in the chain of responsibility. Lawyers who treat these cases like standard car accidents may leave significant accountability and compensation on the table. Craig stresses that experienced trucking lawyers approach these cases differently. They investigate the entire ecosystem behind the truck.

2. Waiting too long to preserve evidence

Evidence disappears quickly after a crash. Electronic logs are overwritten. Vehicles are repaired. Data downloads are lost. Craig’s firm deploys a rapid response team immediately after being hired to secure critical evidence. Even if the case ultimately does not proceed, preserving the opportunity for justice is worth the investment. The lesson for trial lawyers is simple but powerful. Early action shapes outcomes.

Technology Is Changing the Battlefield

Technology is also reshaping how trial lawyers compete with large corporate defendants. Artificial intelligence and advanced tools are helping law firms become more efficient, whether through document review, medical record summaries, or discovery management.

But Craig also raised an important caution. AI is changing how potential clients search for lawyers. In some cases, it may direct injured people toward attorneys who have never tried a trucking case.

That raises an important issue for the profession. Expertise matters, but the signals people rely on to identify that expertise are evolving. For trial lawyers building their practices, visibility and authority in your niche are becoming just as important as courtroom skill.

Running a Law Firm Like a Business

Beyond the courtroom, Craig shared a candid lesson from his own experience building a successful firm. Early in his career he believed that hiring talented people and working hard would naturally lead to success. It did not. At one point, despite having strong cases and a great team, the firm experienced its least profitable year. The issue was not effort. It was focus.

The solution was introducing operational discipline through metrics, leadership structure, and clear accountability. By implementing key performance indicators and better workflow management, the firm ensured that cases were moving forward at the right pace and that teams were focused on the work that actually drives results.

In other words, the practice of law still requires business leadership. For firms looking to grow, this is a familiar theme within the Peak Practice community. Strong legal work and strong operations go hand in hand.

Making an Impact Beyond the Case

Another powerful part of the conversation had nothing to do with litigation strategy. Craig shared how his firm gives back through safety initiatives like distributing bicycle helmets to children and running distracted driving simulations for local communities. The motivation is simple. Every case represents someone’s life being turned upside down. For Craig, the goal is not just winning cases. It is helping prevent tragedies in the first place. That mindset resonates deeply with the mission many trial lawyers share: making a real difference in people’s lives.

Preparing Every Case for Trial

Perhaps the most important insight from the episode is also the simplest. Craig’s firm prepares every case as if it will go to trial. Not because every case will. But because preparing that way gives clients the strongest possible position whether the case ultimately settles or proceeds to a courtroom. That level of preparation changes the conversation with the defense. It signals readiness, credibility, and resolve. And in complex litigation against powerful defendants, those signals matter.

The Bigger Picture for Trial Lawyers

The themes from this conversation align closely with what we talk about inside the Peak Practice community. The legal landscape is evolving quickly. Technology is changing the way firms operate. Client expectations are shifting. Competition is increasing.

The lawyers who thrive will be those who combine exceptional trial advocacy with strong operational systems, strategic thinking, and a commitment to continuous learning. In other words, the lawyers who treat their practice like both a profession and a business. That is what Peak Practice is all about.

If you want to hear the full conversation with David W. Craig, you can listen to the episode on Trial Lawyer View. It is a thoughtful discussion about accountability, preparation, and what it really takes to compete at the highest level in today’s litigation environment.

And if you are building a firm designed for the long run, it is a conversation well worth your time.

🎧 Listen to the full podcast conversation on Trial Lawyer View here: https://triallawyerview.com/podcast/david-w-craig/

🔗 Want more insights like this?

If you want to grow and scale your law firm more effectively, consider partnering with Synergy for lien resolution. Learn more at: https://partnerwithsynergy.com/liens/

Medicare Compliance: Best Practices for Personal Injury Firms

Medicare compliance is not optional. It is an obligation that directly impacts your clients and your firm. The Medicare Secondary Payer Act (MSPA) makes Medicare the payer of last resort. That means Medicare must be reimbursed for any payments it made related to a personal injury settlement and must be protected from future costs that should be covered by that settlement.

Medicare compliance failures have led to law firms facing civil penalties, government audits, and malpractice claims. The good news is that compliance is manageable with a clear process and expert support.

Why Medicare Compliance Matters

Legal exposure: Firms have been forced to repay Medicare and face regulatory compliance requirements for ignoring conditional payments.
Client protection: Improper handling could lead to a client’s loss of future Medicare coverage or denial of injury-related care.
Professional responsibility: The Department of Justice has held attorneys personally liable for failing to reimburse Medicare.
Reputation: Compliance missteps damage client trust and referral relationships.

Every lawyer handling injury cases involving current or soon-to-be Medicare beneficiaries must understand the MSPA’s implications.

Core Compliance Steps

Identify and Screen Early
Establish a process to flag any client who:

Is currently on Medicare
Is receiving Social Security Disability Insurance (SSDI)
Has applied for SSDI or is likely to become eligible within 30 months

Confirm Medicare status and document eligibility. Early identification drives every other compliance step.

Resolve Conditional Payments
Request a conditional payment letter from the Benefits Coordination & Recovery Contractor (BCRC). Audit it carefully. Resolve it before disbursement. Never release funds based on a conditional payment letter alone. Wait for the final demand. Use compromise and waiver requests when appropriate to attempt to reduce the amount owed.
Address Future Medicals (Medicare Set-Asides)
If a settlement funds future medical care, Medicare’s “future interests” should be considered. This involves analyzing whether a Medicare Set-Aside (MSA) is appropriate.

Not every case requires one.
If future medicals are not funded, document why.
If an MSA is considered, calculate and document the reasoning.
Always educate the client about the risks of not setting funds aside.

The key is documentation. If the client declines to set funds aside, have them sign an acknowledgment confirming they were advised and informed.

Release Language
Defense counsel often adds Medicare-related language that is inaccurate or overly broad.

Avoid agreeing to any requirement that the client “shall not apply for Medicare” or “must establish an MSA.”
Use concise, neutral language acknowledging compliance with the MSPA without creating unnecessary obligations.
Never make settlement contingent on CMS approval of a liability MSA.

Collaborate and Verify Reporting
Mandatory Insurer Reporting (MIR) requires insurers to report settlements involving Medicare beneficiaries. Errors in reported ICD codes or accident dates can lead to care denials or duplicate conditional payment demands.

Coordinate with defense counsel on what will be reported.
Confirm ICD codes reflect only injury-related conditions compensated for in the settlement.

Avoid Federal Court
Most Medicare disputes can be avoided with proactive planning. A well-documented, collaborative process prevents disagreements that hold up resolution of the case.
Educate and Document
Follow the “CAD” principle:

Consult with a qualified Medicare compliance expert.
Advise the client on how Medicare may be impacted by the settlement.
Document all communications, recommendations, and client decisions.

Proper documentation protects the client and your firm.

Common Compliance Mistakes

Disbursing before receiving a final demand.
Missing Part C (Medicare Advantage) or Part D (Prescription Drug) liens.
Accepting defense-drafted release language without review.
Failing to identify Medicare status early.
Lacking documentation when a client declines a set-aside.
Not coordinating ICD codes with the defense during reporting.

Each of these can create issues for your client and for your firm.

MSP Consequences

Government oversight and enforcement has increased relating to the MSP. Law firms have been fined for failing to repay conditional payments, even when settlement proceeds had already been distributed. There is precedent that attorneys remain responsible for ensuring Medicare is reimbursed.

With futures it is very much a gray area. In Aranki v. Burwell, the court confirmed there’s no legal requirement to create an MSA—but Medicare can still deny care if its interests aren’t protected. These cases illustrate the nuance of MSP compliance and the importance of documenting the reasoning behind each decision.

Building a Compliance System in Your Firm

To achieve total Medicare compliance, create a repeatable internal process:

Train your staff on identifying Medicare beneficiaries.
Appoint a compliance lead responsible for MSP obligations.
Maintain templates for client advisement and documentation.
Partner with an MSP expert for conditional payment and MSA analyses.
Audit every file involving Medicare before final disbursement.

Conclusion

Medicare compliance protects your clients and your practice. It demonstrates diligence, reduces malpractice exposure, and strengthens settlement integrity. It also positions your firm as a trusted partner for co-counsel and referral sources.

Compliance is not about red tape. It is about safeguarding your client’s future medical care and your professional credibility. With the right process and expertise, you can close every case knowing you did it right. If you don’t want to create your own process, Synergy’s Medicare Compliance experts help trial lawyers nationwide protect their clients’ recoveries, ensure full MSPA compliance, and eliminate post-settlement exposure.

Could a Law Firm Owe Double a Part C Plan Lien?

Law firms handling personal injury cases know they must protect Medicare’s interest when it comes to conditional payments. But fewer realize the steep risk involved when that Medicare claim comes from a Part C Medicare Advantage plan. Under federal law, just like with Medicare, failing to properly reimburse a Medicare Advantage Organization (MAO) could trigger a private cause of action. That action comes with a painful penalty: double damages.

The Law Says “Double”

The Medicare Secondary Payer (MSP) Act allows Medicare to recover conditional payments it makes when another insurer is responsible. This right also applies to MAOs, which operate under Medicare Part C. Regulations clarify that MAOs have the same recovery rights as traditional Medicare. That includes the right to sue and demand double what they are owed if reimbursement is ignored.

This isn’t theoretical. In Humana v. Western Heritage Insurance Co., the court awarded double damages when a MAO lien wasn’t paid. The defendant set the funds aside in a trust, but the Eleventh Circuit found that insufficient. The insurer owed $38,310.82, twice the original $19,155.41 lien.

Law Firms in the Crosshairs

It’s not only insurers who face this risk. Law firms have been sued too. One personal injury firm was hit with a $382,000 demand for failing to resolve a $191,000 Part C lien. The case settled out of court, but the lesson is clear: lawyers who disburse funds without addressing MAO liens risk personal liability.

The statute doesn’t require bad faith. Intent doesn’t matter. Good faith isn’t a defense. Nor is ignorance. If your firm had control of the funds, you could be liable.

Why Part C Plans Are Different

Part C plans are run by private insurers, not CMS. That changes the recovery process. You won’t find Part C lien info in the Medicare portal. You must identify and negotiate directly with the MAO plan or their recovery vendor.

Failing to recognize a Part C lien can result in unpaid debts and potential exposure to double damages.

What You Should Do

You need a process. Start by identifying Medicare beneficiaries early. Ask the right questions. Request all insurance cards. Confirm if a Part C plan is involved.

Once you know a Part C plan is in play, get a itemization of charges. Don’t assume you’re in the clear because you’ve resolved the conditional payments with CMS.

Before distributing any funds, ensure all MAO liens are paid. Document your file. Consult a Medicare compliance expert if needed.

Double the Risk, Double the Reason to Care

The takeaway is simple. If you miss a Medicare Advantage lien, you risk more than a claim. You risk paying double.

Don’t let your firm be the next cautionary tale. MAO liens are enforceable, aggressive, and financially serious. Treat them that way.

The Tech Shift Every PI Team Must Make to Move Cases Faster

Robert Simon of The Simon Law Group recently said the following:

“AI & Private Equity about to transform the entire legal industry and I’ll be completely honest: Being a law firm owner, trial lawyer, owner of legal technology companies, legal communities, and being in the room with the leaders of all industries, many will not survive. It’s a reality. We need to all get in the know and recalibrate quickly.”

Dead on point! For personal injury firms, as caseloads grow, costs rise, and client expectations have shifted in ways that most firms have not adapted to yet. What has not changed is the number of hours in a day your team has to get the work done. If you aren’t adapting at what is happening right now, you are already behind.

I have spent over twenty years working with personal injury firms, and I can tell you that the operational side of running a PI practice has never been more demanding. The firms we work with that are growing and thriving have one thing in common: they have made deliberate decisions about where to invest in technology and where to rely on outside expertise. The firms that are struggling tend to be the ones still doing everything the way they did ten years ago.

This article is a practical look at the technology trends that matter for PI firms and how to think about integrating them without disrupting what already works.

Why This Should Be on Your Radar

Your firm is no longer judged only by trial results. Clients today expect clear communication, faster case movement, and predictability about timelines. That may frustrate you, but it is reality. Technology is no longer something you can treat as optional. It is the infrastructure that supports productivity, growth, and profitability.

The data supports this. Firms that have adopted automation for administrative tasks are reporting significantly faster case cycle times. AI-supported research and document review tools are cutting hours off work that used to consume entire days. And firms that connect their internal workflows with outsourced resolution partners are lowering overhead in meaningful ways, which creates room for actual revenue growth.

This tracks with what we see every week at Synergy. When firms offload lien resolution to a team that handles it at scale, they see more efficient disbursements and higher total case throughput. The math is straightforward: less time stuck on back-end resolution work means more time spent on the work that generates fees.

AI for Case Movement

AI tools are now capable of handling parts of a PI case that used to consume significant staff time. I want to be clear about what I mean here. I am not talking about replacing lawyers or even paralegals. I am talking about using technology to handle repetitive, time-consuming tasks so your team can focus on the legal work that actually requires their training and judgment.

The best current use cases are practical ones: drafting demand summaries, organizing medical records, verifying liens, reviewing insurance documents, flagging treatment gaps, and creating follow-up tasks. These are the tasks that eat hours without adding value to the legal analysis. Firms using AI for this category of work are reporting a measurable drop in manual hours per case, and fewer errors in the process.

When you pair AI-driven case management and verification with outsourced lien resolution, you create a clear path from treatment through final disbursement. Each step is handled by the resource best suited to handle it, whether that is technology, your internal team, or an outside expert.

Legal Ops Dashboards

One of the more valuable tools I have seen firms adopt is a real-time operational dashboard. This is not about generating reports for the sake of having data. It is about seeing what is actually happening in your practice so you can make better decisions.

Dashboards can show you average case age, time spent on administrative work, client communication frequency, and how workload is distributed across your staff. This kind of visibility changes the way you manage. You stop relying on gut feeling and start measuring what actually drives revenue: operational efficiency, throughput, and client satisfaction.

The firms that are measuring these things are catching bottlenecks before they become serious problems. That is a competitive advantage, and it is available to any firm willing to invest in the tools.

Automation for Intake and Client Updates

Intake is the first operational touchpoint with a potential client, and it is often where inefficiency begins. Modern intake tools use rule-based logic and AI to qualify leads and build the initial case file before your team ever touches it. This is not about cutting corners. It is about eliminating unnecessary manual steps in a process that should be consistent every time.

Automated client update systems are equally important. These tools send personalized texts or secure portal messages to clients so your staff does not spend hours each day answering the same basic questions about case status. Clients stay informed. Your team stays focused. Inbound call volume drops.

What the Results Look Like in Practice

The firms adopting AI, automation, and outsourced support functions are seeing three consistent outcomes.

First, faster cycle times. AI and automation reduce the administrative drag that slows cases down. Outsourcing lien work removes the biggest bottleneck at the end of the case, which is often where disbursement stalls for weeks or months.

Second, lower overhead. Offloading record retrieval, lien verification and resolution, and repetitive administrative tasks lowers internal labor costs. In some cases, firms are using offshore support in the right roles to drive additional savings.

Third, more revenue opportunities. When your team is not buried in paperwork, they have the capacity to take on higher-value work. Reducing cycle time alone increases your annual case capacity without hiring additional staff. That is how you grow a practice.

What This Means for Trial Lawyers

You do not need to be a technologist. That is not the point. You need a clear plan for integrating tools that strengthen your practice, and you need the discipline to implement them one step at a time.

Start by auditing how many hours your team spends on non-legal work. Track your case cycle times from intake to disbursement. Identify the three tasks that slow cases down the most. Then evaluate whether those tasks should be handled in-house, by technology, or by an outsourced partner. Adopt one new tool at a time and measure its impact within sixty days.

This approach keeps you moving forward without the disruption that comes from trying to overhaul everything at once. Most firms that attempt a full-scale technology transformation fail. The ones that succeed are methodical about it.

Where Synergy Fits

Synergy has always had a simple mission: help trial lawyers remove the settlement bottlenecks that drain time and money. We combine expert lien resolution with modern technology and national resources. Our teams handle the complex, time-intensive work so your lawyers can stay focused on what they do best, which is securing justice for their clients.

This is the operational foundation of a peak personal injury practice. It is not about doing more. It is about doing the right things with the right resources.

Final Thought

The future of PI law will belong to firms that use technology wisely. You do not need every new tool that comes to market. You need the right tools, the right partners, and the right metrics to know whether what you are doing is working.

If you want help identifying which technologies will make the biggest impact on your timelines, Peak Practice is here to help.

Scale Your Practice with Synergy

Synergy exists to help firms confront the operational realities being driven by technology and scaling pressure. By removing administrative burdens related to lien identification, verification and resolution, from legal teams, we help personal injury firms strengthen their practice’s capacity for high-value legal work and sustainable growth.

🔗 Want more insights like this?

If you want to grow and scale your law firm more effectively, consider partnering with Synergy for lien resolution. Learn more at: https://partnerwithsynergy.com/liens/

Part C: The Hidden Lien That Comes Back Later

You settled the case. Medicare was paid back. The file is closed. Or so you thought.

If your client had a Medicare Advantage Plan, also known as Part C, that “closed” file could come back to haunt you. Part C liens are the sleeper issue in Medicare Secondary Payer Act (MSP) compliance. Miss one, and your firm could be liable for double damages under a private cause of action brought under the MAO.

Here’s what you need to know to protect your clients and your practice.

What Makes Part C So Dangerous?

Medicare Advantage Plans are not the same as traditional Medicare. They are private insurance plans approved by Medicare that bundle Part A, B, and D benefits. But unlike traditional Medicare, there’s no central clearinghouse like BCRC or CMS that alerts you to Part C lien exposure. This creates a blind spot.

Clients often don’t understand which type of Medicare coverage they have. Even if you asked about Medicare and paid the conditional payment final demand, that doesn’t mean you’ve satisfied every lien. A client could have switched to a Medicare Advantage Plan without your knowledge. If that plan paid for accident-related care, they’re entitled to reimbursement and they can come after you for it.

No Notice, Big Consequences

You won’t be notified about a Part C lien through the standard Medicare conditional payment resolution process. Neither CMS nor BCRC will alert you. And you don’t have direct access to the data that shows which MAO your client might have been enrolled in.

That changed slightly with the PAID Act, which now requires CMS to share a client’s Medicare Advantage enrollment history, but only with Responsible Reporting Entities (RREs). Plaintiff lawyers don’t have access unless the defense is willing to cooperate.

Without this information, a Part C lien might surface months or years after the settlement is disbursed. At that point, it’s too late to pass the cost to anyone else. The MAO can file a private cause of action for double damages under the MSP.

How to Detect a Part C Lien Early

You can’t rely on clients to know or remember their coverage. You need process. By doing a bit of detective work, here is how you can protect against these hidden liens:

Collect insurance cards at intake. Ask for every government and private insurance card, not just the red, white, and blue Medicare card.
Verify coverage. Have the client log into their MyMedicare.gov account to check current and past coverage.
Review the medical bills. Look for plan names or EOBs that indicate private Medicare Advantage billing.
Partner with experts. Specialized lien resolution services can help identify and negotiate these liens.

Why Part C Liens Are Enforceable

MAOs have the same recovery rights as Medicare when it comes to conditional payments. They operate under the same MSP statute. But they also have a big stick: the ability to file a lawsuit for double the lien amount if they’re not paid. That’s not theoretical. MAOs and their subrogation vendors have already filed these types of suits. Certain jurisdictions have upheld their rights.

What To Do When You Find One

Once you identify a Part C lien, treat it like any other statutory lien.

Demand documentation. Request itemized statements that tie the charges to accident-related care.
Push for reductions. MAOs must apply procurement cost reductions and are generally open to negotiation.
Evaluate compromise or waiver. If the lien would take an unfair portion of the settlement, explore options under the MSP compromise/waiver provisions.

Don’t Wait Until Disbursement

MAO lien exposure needs to be tracked throughout the life of a case. Intake is the first opportunity, but you should re-check coverage again before settlement and once more before disbursement. Treat it like a compliance checklist.

Failure to detect and resolve a Part C lien doesn’t just create client dissatisfaction, it creates real financial exposure for your firm.

Bottom Line

Part C liens are hidden, hard to find, and aggressively enforced. Your best protection is a process-driven approach to identifying MAO coverage as early as possible. Synergy has deep experience resolving these liens and minimizing client and firm exposure.

Don’t let a hidden lien cause you future heartache.

FEHBA Plans and the Limits of Lien Reduction: History, Preemption, and Practical Strategy for Trial Lawyers

A core challenge for plaintiff attorneys handling third-party liability cases involving federal employees or retirees is navigating FEHBA (Federal Employees Health Benefits Act) reimbursement and subrogation rights. Unlike state statutory or common-law liens, FEHBA liens are grounded in a federal statutory framework and contract obligations imposed by the Office of Personnel Management (OPM). Understanding where these rights come from and how they operate is essential to protecting client recoveries.

When FEHBA was enacted in 1959, it established a nationwide health benefits program for federal employees and tasked OPM with negotiating contracts with private carriers. Although FEHBA itself does not explicitly articulate subrogation or reimbursement rights, OPM has long required those rights as a condition of coverage in carrier contracts. Over years of litigation, the courts have wrestled with how those contractual rights interact with state law and where such claims must be litigated.

The first major Supreme Court decision on this issue came in Empire HealthChoice Assurance, Inc. v. McVeigh (2006). In McVeigh, a FEHBA plan administrator sued in federal court to recover amounts it had paid for medical care after a beneficiary’s state-court tort recovery. The Supreme Court held that FEHBA’s preemption clause does not by itself create federal question jurisdiction, because FEHBA contains no express federal cause of action for reimbursement and does not automatically displace state contract law. As a result, plan reimbursement claims are generally governed by state contract principles and are typically litigated in state court unless another basis for federal jurisdiction exists.

In the years following McVeigh, lower courts developed competing views on whether state laws that restrict subrogation or reimbursement like anti-subrogation or made-whole doctrines applied to FEHBA plans. One notable example was Calingo v. Meridian Resource Co., where a federal district court initially held that FEHBA did not preempt a state anti-subrogation statute because the contract provisions did not “relate to coverage or benefits.” However, after OPM issued guidance clarifying that subrogation and reimbursement rights are integral to the nature, provision, and extent of federal benefits and do fall within FEHBA’s preemption clause, the court reversed course and upheld preemption.

The legal landscape solidified in Coventry Health Care of Missouri, Inc. v. Nevils (2017). In Nevils, a FEHBA carrier asserted a reimbursement lien after paying medical benefits; the insured satisfied the lien and then sued under state law that prohibited subrogation. The U.S. Supreme Court held unanimously that FEHBA’s express-preemption provision preempts state laws barring or limiting reimbursement when the plan’s contractual terms “relate to the nature, provision, or extent of coverage or benefits, including payments with respect to benefits.” This decision confirmed that FEHBA plans’ contractual reimbursement rights are enforceable nationwide and are not subject to state anti-subrogation or lien-reduction doctrines.

Today, FEHBA lien enforcement is relatively uniform: carriers have robust contractual reimbursement rights that federal law preempts state limitations, but those rights are still typically enforced through state-law contract or equitable claims unless an independent federal jurisdictional basis (such as diversity) exists.

What Nevils Means for Plaintiff Attorneys

This doctrinal history matters because it dictates how you approach reductions. Under FEHBA, you cannot rely on state made-whole rules, anti-subrogation statutes, or generalized fairness doctrines to nullify or reduce a carrier’s lien. Once coverage is established and there is a clear connection between the benefits paid and the injury at issue, federal preemption controls, and your traditional state-law offsets will often fail.

Many plaintiff lawyers approach FEHBA liens the same way they approach Medicaid liens or hospital liens, relying on state law doctrines, but FEHBA recovery provisions are fundamentally different.

Practical Ways Liens Can Be Reduced or Compromised

Focus on the Contract Language.
Unlike Medicare, FEHBA does not provide a statutory fixed repayment formula. Each FEHBA carrier operates under an OPM-approved contract. It is imperative that you obtain the proper contract. Some contracts include provisions for attorney fee offsets or limits tied to amounts actually paid. Others assert broad priority rights against settlement proceeds. Your leverage depends entirely on what the contract says, not on what state law would prefer.
Audit the Lien Charges.
Many FEHBA carriers and their subrogation vendors still overreach. Charges unrelated to the injury, duplicate billings, or amounts covered by secondary plans do not belong in the demand. Obtaining and auditing the itemized paid-claims ledger remains one of the few realistic reduction tools and often uncovers legitimate disputes that support negotiation leverage.
Request a Formal Waiver or Hardship Reduction.
Some carriers, through internal subrogation or recovery manuals, allow discretionary reduction or compromise based on financial hardship or equity factors. These are not legal entitlements, they are negotiated concessions. A strong written compromise request, with documentation of limited settlement funds, attorney fees, future medical needs, and hardship, is often required, and carriers vary widely in flexibility.
Highlight Attorney Fees and Settlement Constraints.
Some carriers will in writing consider equitable factors such as attorney fees and case severity in a compromise, again, not because FEHBA requires it, but because the specific contract language allows it. Always secure any reduction or compromise in a written payoff agreement before settlement funds are disbursed.

Why FEHBA Experience Matters

FEHBA liens occupy a narrow but unforgiving corner of lien resolution. Congress chose uniform federal enforcement over state flexibility, and the Supreme Court enforced that choice. For plaintiff counsel, the takeaway is simple: FEHBA lien reduction is not easy, and state law arguments often fail. Success depends on early identification, contract-based analysis, and disciplined negotiation grounded in the federal scheme, not assumptions rooted in state law.

Handled correctly, FEHBA liens become manageable and predictable. Handled casually, they erode client recoveries and delay settlements. In this area of practice, experience and process translate directly into better outcomes for your clients.

Written by: Teresa Kenyon | Vice President of Lien Resolution at Synergy