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Welcome to our blog page! Here, you’ll find a collection of blogs written by our Synergy experts on a wide range of topics related to lien resolution, government benefit preservation, Workers Compensation, and more. While these blogs may not fit neatly into a specific category, they contain valuable information and InSights that we believe will be of interest to our clients and readers. Our team is committed to staying up-to-date on the latest developments and trends in the industry, and we’re excited to share our knowledge and expertise with you. Check back often for new blog posts and updates on a variety of topics!
The decision to outsource lien resolution is pivotal in a personal injury practice as it can significantly improve both the efficiency of the firm and financial outcome of a client’s case. With varying complexities and regulatory requirements, understanding which healthcare liens benefit from external expertise and which can be managed internally is crucial. Here’s a breakdown to guide your decision-making process:
Liens Suitable for Outsourcing
The following liens may benefit from hiring outside lien resolution experts to resolve them for a variety of reasons: Medicare conditional payments; Medicare Advantage liens; Medicaid liens, ERISA plan liens; Federal Employee Health Benefits Act (FEHBA) liens; military plan liens, private health and hospital/provider liens. All of these liens involve complex regulatory schemes or complicated legal issues that make them much more difficult to resolve without the requisite specialized knowledge. For example, Medicare has specific prescribed timelines and regulatory requirements as well as multiple methods for requesting a compromise or waiver. Medicaid varies greatly from state to state as it is governed by Medicaid third party liability statutes. ERISA plans have their own unique set of challenges for trial lawyers. These nuances for different lien types makes it challenging to resolve without specialized experts who understand all of the complicated issues that come with specific types of liens.
Liens Typically Not Appropriate for Outsourcing
However, some liens may be better resolved in-house due to their specific characteristics or the nature of the relationship with the lienholder. The following types of liens are typically better handled in-house: Small liens of $2,000 or less; local provider liens; worker’s compensation liens; Medicaid estate recovery liens; child support liens and pre-settlement funding liens. All of these involve either inefficiencies or specific characteristics that don’t make them good candidates for outsourcing. For example, a local provider a law firm has an ongoing relationship might not benefit from a third-party lien resolution company negotiating with them. Workers’ compensation liens, Medicaid estate recovery liens, child support liens and pre-settlement funding liens are all governed by state specific laws which are better addressed by those most familiar with that state’s applicable laws.
Conclusion
Deciding whether to outsource lien resolution involves evaluating the type of lien, its complexity, and your firm’s expertise. By understanding which liens benefit from specialized handling and which can be resolved in-house, you can optimize cost-efficiency and client satisfaction. This strategic approach ensures that lien resolution is handled effectively, whether by leveraging external expertise or utilizing internal resources.
If you would like to read more on this subject click HERE to download our white paper titled “A Guide To Resolution: Which Liens to Outsource and Those to Keep In-House. If you are ready to get started with outsourcing today and want to partner with Synergy, contact us TODAY.
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
Navigating ERISA liens can be a daunting task, given the complexity of the Employee Retirement Income Security Act (ERISA) and its impact on self-insured health plan reimbursement. Although a comprehensive exploration of ERISA is beyond this blog, understanding some key strategies can help in resolving ERISA liens effectively.
ERISA Overview
Enacted in 1974, ERISA aims to protect employee benefit plan participants by enforcing standards of conduct for plan managers and ensuring plan funds are secure. However, its application in lien resolutions often draws criticism, particularly concerning the practical protection it offers.
ERISA and Health Plans
ERISA governs most employer health plans, with notable exceptions including government and certain religious plans. ERISA health plans generally include subrogation clauses, requiring reimbursement for injury-related expenses paid by the plan. Section 502(a)(3) of ERISA allows these plans to seek equitable relief for enforcement, often through equitable liens or constructive trusts. The law’s intricacies, slightly clarified by the Supreme Court, reveal that the statute in its application is far from straightforward.
Key Supreme Court Rulings
- Sereboff v. Mid Atlantic Medical Services, Inc. (2006): The Supreme Court confirmed that ERISA plans could enforce reimbursement provisions under equitable principles, affirming the power of self-funded plans to claim recovery via equitable liens.
- U.S. Airways, Inc. v. McCutchen (2013): The Court reinforced that written ERISA plan terms take precedence over equitable doctrines like “make whole” and “common fund.”
Select Strategies for Lien Reduction
While there are many tactics you can use to possibly reduce an ERISA lien, here are a few key ones to consider:
- Determine Plan Funding Status: Identify whether the plan is self-funded or fully insured. Self-funded plans are governed by ERISA and are harder to reduce under Supreme Court precedent, while fully insured plans generally will be subject to state law or common law principles. Review the Summary Plan Description (SPD) and Master Plan to determine funding status.
- Utilize ERISA Section 1024(b)(4): Request plan documents directly from the plan administrator, not from third-party administrators or recovery contractors. This legal right via the document request helps assess the strength of the plan’s claim and identify potential leverage points, such as challenging the applicability of equitable principles.
- Examine Plan Language: Look for ambiguities or specific provisions in the plan’s reimbursement clauses. Ambiguities can be used as leverage to reduce the amount owed to the lien holder.
- Leverage Equitable Doctrines: If the plan language does not explicitly reject doctrines like “make whole” or “common fund,” use these principles to argue for lien reduction. Make arguments based on partial reimbursement or proportional sharing of legal costs.
- Address Equitable Defenses: Use defenses like unjust enrichment or undue hardship to argue against full reimbursement, where applicable.
Conclusion
Effectively addressing ERISA liens requires a deep understanding of the plan’s funding status, precise examination of plan documents, and strategic application of legal and equitable arguments. The US Supreme Court’s ruling in McCutchen emphasized the importance of plan language, making it crucial to use Section 1024(b)(4) requests to your advantage. By leveraging these strategies, you can begin to navigate ERISA liens more effectively and potentially achieve optimal reductions in a claimed ERISA lien.
Working with specialized lien resolution companies can provide essential expertise and prevent costly mistakes when it comes to ERISA liens. If you want to find out more, contact us today to Partner with Synergy for lien resolution.
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
In our previous blog, we tackled the Medicare conditional payment resolution process. However, if your client, during treatment for their injuries, switched to a Medicare Advantage Plan (MAO-Part C), the resolution process might not be over. Here’s why: While you may have resolved conditional payments with Medicare Parts A and B (traditional Medicare), MAO plans operate independently and may have covered some or all of your client’s medical expenses.
The issue arises because MAO plans are distinct from traditional Medicare, and beneficiaries can enroll in them during specific periods. Consequently, even if you resolved Medicare conditional payments, an MAO might have stepped in later, without your knowledge. CMS will not notify you about these MAO payments, and beneficiaries often lack clarity on their coverage types so it can easily be missed.
To verify MAO plan coverage, clients can check their status on MyMedicare.gov. Additionally, the 2020 PAID Act requires CMS to report MAO enrollments for the past three years, though access to this data is limited to Non-Group Health Plan Responsible Reporting Entities (RREs). You might need to request this information from the defense or painstakingly review medical bills to uncover potential MAO liens.
Attorneys must be vigilant, conducting thorough due diligence to uncover possible MAO liens. Failure to address these could result in double damages, as MAOs do enforce their reimbursement rights aggressively. The Medicare Secondary Payer Act grants MAOs the right to sue for double the lien amount if not repaid, a risk highlighted by cases like Humana v. Western Heritage Ins. Co. Here, Humana successfully claimed double damages after Western Heritage failed to reimburse a $191,000 lien.
To prevent such pitfalls, start your investigation early upon client intake, continue throughout representation, and finalize it before disbursing settlement funds. Identify any MAO liens and seek reduction or compromise as appropriate. Understanding and managing MAO liens is crucial to safeguarding your firm against significant financial exposure for this hidden lien.
Working with specialized lien resolution companies can provide essential expertise and prevent costly mistakes when it comes to Medicare Advantage plan liens. If you want to find out more, contact us today to Partner with Synergy for lien resolution.
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
In personal injury law, attorneys focus on proving causation, liability, and damages. Given the complexities that arise during settlement, outsourcing certain tasks has become a common practice to enhance efficiency and client outcomes. Just as attorneys engage experts in probate, guardianship, tax matters or even medical record retrieval, lien resolution can similarly benefit from specialized assistance. This approach not only addresses the complications of lien resolution but also when done correctly complies with ethical requirements and improves client outcomes.
Why Outsource Lien Resolution?
Personal injury attorneys often face multifaceted lien issues that are governed by intricate laws and regulations, such as ERISA, the Medicare Secondary Payer Act, and various state-specific laws. For instance, a client may have multiple Medicare components—Traditional Medicare (Parts A/B) and Medicare Advantage (Part C)—each with distinct obligations and requirements. Navigating these can be overwhelming, especially when dealing with several different lien types in one case.
Ethical Considerations
Outsourcing lien resolution is both practical and ethical, provided it is managed correctly. ABA Formal Ethics Opinion 08-451 outlines that while lawyers can outsource legal and non-legal support services, they must retain ultimate responsibility for the work and maintain direct supervisory authority. This means that while lien resolution experts can handle the details, the attorney oversees their work and ensures compliance with all professional obligations.
State-Specific Guidelines
Different states have addressed the outsourcing of lien resolution. For example, New York permits lawyers to hire external lien resolution firms as long as the costs are reasonable, disclosed to the client, and result in a net benefit. Similarly, Ohio and Utah have established that outsourcing is permissible under certain conditions, including obtaining client consent and ensuring the fees are reasonable and transparent.
Key Takeaways
- Efficiency and Expertise: Outsourcing lien resolution can streamline the process, reduce operational costs, and leverage the expertise of specialists to enhance client outcomes.
- Ethical Compliance: Ensure that the outsourcing process adheres to ABA Model Rules and state-specific guidelines, including maintaining client confidentiality, securing informed consent, and ensuring costs are reasonable.
- Client Benefit: The primary goal of outsourcing should be to protect and maximize the client’s recovery. This approach helps ensure that lien resolution is handled expertly, safeguarding against potential legal and financial risks.
In conclusion, outsourcing lien resolution is a strategic decision that, when done ethically, helps a law firm run more efficiently and benefits clients by securing better outcomes. If you want to do a deep dive into ethical outsourcing of lien resolution, click HERE to download our white paper called “How to Outsource Lien Resolution Ethically”. If you are ready to outsource today and partner with Synergy, contact us TODAY.
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
As a trial lawyer, you might wonder why you should consider outsourcing lien resolution when it seems manageable to handle in-house. Additionally, you may question whether it’s ethically permissible to engage a lien resolution company like Synergy. The answers to these questions highlight both practical and ethical considerations essential for personal injury law firms to operate at peak efficiency.
Why Outsource Lien Resolution?
Efficiency and Expertise: Handling liens is a complex, time-consuming task that often diverts focus from core legal work for personal injury law firms. When law firms resolve liens in-house, they must investigate, identify, audit, verify and resolve various liens, including subrogation claims and debts against settlements. This involves assessing the legal validity of claims and engaging in protracted negotiations. Given these responsibilities, it is easy to see why outsourcing can enhance efficiency. Specialized lien resolution firms bring deep expertise and dedicated resources, offering a streamlined process that can significantly reduce the burden on a personal injury firm.
Navigating Complexities: The landscape of lien resolution involves dealing with various types of liens, including Medicare, Medicaid, ERISA, and more. Each has its own set of rules, regulations and resolution processes. Government benefit plans and recovery vendors are often large, well-funded entities with the sole focus of recovering money from personal injury settlements. These organizations have extensive resources and sophisticated strategies to assert their claims. Partnering with a lien resolution expert allows you to leverage their specialized knowledge and negotiation skills, leveling the playing field when confronting recovery contractors.
Cost-Effectiveness: Outsourcing lien resolution can also be financially advantageous. The costs associated with managing liens internally—such as time, resources, and potential delays—can add up quickly. By outsourcing, a personal injury law firm can reduce operating expenses and avoid the inefficiencies associated with handling these tasks in-house. This approach allows you to focus on moving cases toward settlement or trial, ultimately improving your firm’s bottom line.
Ethical Considerations When Outsourcing
Compliance and Integrity: It is important to ensure that outsourcing lien resolution complies with ethical and legal obligations. Law firms must adhere to specific rules governing the management of client funds and lien resolution. This includes maintaining transparency and ensuring that the outsourced firm operates within the legal and ethical frameworks set by the applicable Bar regulatory bodies. A future blog post will address how to comply with ethical rules when outsourcing lien resolution, ensuring that client interests are protected and professional integrity is maintained.
Conclusion
Outsourcing lien resolution is more than a logistical decision; it is a strategic move that can greatly benefit personal injury law firms. It provides access to specialized expertise, enhances efficiency, and reduces operational costs. While navigating lien laws can be challenging, partnering with a dedicated lien resolution team ensures that you can achieve optimal results for your clients and maintain a competitive edge in your practice.
If you want to learn more about outsourcing, click HERE to download our “Strategic Benefits of Outsourcing Lien Resolution for Personal Injury Law Firms” white paper. If you would like to get started with outsourcing lien resolution and partner with Synergy, contact us today!
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
In the complicated world of personal injury practice, lien resolution is a pivotal yet often daunting aspect of the resolution process for cases. For trial lawyers, the task of the resolution of various liens can be both challenging and crucial to maximizing the client’s net recovery. The evolving complexity of healthcare reimbursement systems and the rigorous regulatory requirements of government plans necessitate a meticulous approach to lien resolution.
Understanding Lien Resolution
Lien resolution requires a detailed process for addressing and negotiating claims made by healthcare providers, government agencies, and other entities against a portion of a settlement in a personal injury case. These claims, or liens, must be resolved to ensure that settlement funds are distributed to the injured party free of any future claims by healthcare providers or insurance plans. Failure to resolve liens correctly can lead to significant financial and legal consequences for everyone involved.
The Importance of Lien Resolution
- Client Recovery: The accurate and efficient resolution of liens is essential for maximizing the amount of settlement funds available to the client. A less-than-optimal lien resolution process can drastically reduce the client’s net recovery, creating more financial strain post-settlement and less satisfaction with the outcome.
- Compliance: Adhering to legal and ethical requirements is crucial. Different types of liens—such as those from Medicare, Medicaid, ERISA, FEHBA, Military, hospital, and private health insurance—come with specific resolution processes and legal issues. Understanding and complying with these processes/laws is vital to avoid complications.
- Financial Responsibility: Appropriate resolution helps prevent financial liabilities for all involved parties. Incorrect handling can result in claims against settlement funds even after they’ve been disbursed, potentially leading to additional financial burdens.
- Professional Reputation: Efficiently resolving liens not only satisfies clients but also enhances an attorney’s reputation. Positive outcomes and satisfied clients often translate into more referrals and better professional reviews online.
Lien resolution is more than just a procedural necessity; it is a critical element in ensuring that clients receive the maximum net recovery from their settlements. For trial lawyers, mastering this aspect of resolution is essential for achieving optimal outcomes and maintaining a high standard of professional excellence. In many situations, it may be best to outsource this function to reduce liability, eliminate internal costs of resolution, and get the best net recovery for the client.
If you want to learn much, much more about lien resolution and outsourcing, click here to download our Outsourcing & Lien Resolution Guide for Trial Lawyers. To learn more about partnering with Synergy for lien resolution click HERE.
Written by: Jason D. Lazarus, J.D., LL.M., CSSC, MSCC | CEO
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