Date: 06/08/16
No: 2016-6

ADJ 1038684

Significance

CostFirst utilizes the special expertise of our expert witness to separate unrelated services and charges from those for a lung transplant caused by asbestos exposure.

Hearing: Second Lien Conference before Honorable Mary Ann Thompson in Long Beach

Lien-claimant(s) Lien Balance Resolution
4600 Group (Kaiser Permanente) $253,546.00 $70,000.00
Rawlings Group (Kaiser/Stanford Heart-Lung Hosp) $2,522,150.85 $220,000.00
UCSB LA (Stanford hospital and clinics) $355,510.00 $36,551.13

Case Facts

Client entered into a Joint Compromise and Release as terminal carrier for asbestos exposure CT over several years; as the elected defendant client agreed to negotiate the liens. Medical evidence was uncontroverted that the injured worker developed progressive work related occupational disease; ultimately a right lung transplant was required.

The surgery and post-operative care took place at Stanford Heart/Lung Hospital. There were several recurrent hospitalizations, some consequential and some entirely unrelated. Kaiser Health Plan paid the bills and sought reimbursement.

CostFirst Resolution

As a physician and certified coder, the CostFirst expert was able to present compelling reasonable non-industrial explanations for many of the subsequent inpatient events. Using coding principles and gleaming pertinent facts from medical records, the CostFirst expert determined proper reimbursement for treatment reasonable required to cure or relieve the effects of the occupational disease.

Conclusion

The parties were able to reach a satisfactory compromise without the further delays and hazards of litigation for sizeable group health liens with an essentially admitted injury. One co-defendant who was present at the proceedings gladly agreed to a pro-rata share. Note: each Stipulation & Order attached reflects only the opening lien filed with the WCAB. Gross savings of almost $3 million or 89.50% are detailed above.