California Medical Bill Reviewer
Certification
Unit 1: Workers’
Compensation Benefit
Program
Module 4: Liens
Overview
Hi! In this module, you
will learn what liens are
Let’s start by discussing
and who files them. Then,
what liens are, and who
you will learn how liens
can file them...
are resolved and who is
involved in the process.
Part I:


What Liens Are, and Why They Are Filed
Who Files Liens in Workers’ Compensation
 Injured Workers
 Providers
 The State
CA Regulations Training - Liens
June 2013
Why Are Liens Filed?

1.
2.
In most workers’ compensation
claims, the employee and the
employer know the injury
occurred on the job, and benefits
payment occurs without a hitch.
The insurance carrier pays
for treatment as it occurs.
The injured worker receives
workers’ compensation
benefits while he/she is
unable to work.
CA Regulations Training - Liens
However, in some instances
payments are not received as
easily. In these situations, a lien
may be filed.
June 2013
What is a Lien?

Lien: the legal right to
take and hold, or sell the
property of another to
satisfy an obligation or
debt.

Many different entities may
file a lien against a
workers’ compensation
claim.
CA Regulations Training - Liens
Injured
Workers
Insurers
Service
Providers
Employers
The
State
June 2013
Who Files Liens?
An injured worker may file a lien for
rehabilitation or compensation for
permanent
injuries
that have not
Injured
Workers
been covered by her assessed
benefits.
A provider may file a lien if his
patient’s injury was clearly workProviders
related and
the reimbursement for
his services was incorrect.
CA Regulations Training - Liens
June 2013
Who Files Liens?
The insurance carrier may file a lien
to be reimbursed for payments
Insurance
made
for an injury Carriers
that was found
not to be work related.
A self-insured employer may file a
lien to be reimbursed if the workers’
Employers
compensation
claim was found to be
fraudulent.
CA Regulations Training - Liens
June 2013
Who Files Liens?
If a case is determined to be a legitimate
workers’ compensation case, the State may file
a lien to be reimbursed
for a worker’s disability
The State
payments received while arguing for workers’
compensation status.
CA Regulations Training - Liens
June 2013
What is Reimbursed?

Depending on the circumstances, liens may be filed
against a claim for reimbursement for any of the
following:
Treatment
Living Expenses
Supplies
CA Regulations Training - Liens
Permanent Disability
June 2013
Lien Filing
Process
Now that you understand
Let’s
whatstart
liensby
are,
discussing
you are
ready
howtoa learn
lien ishow
filed...
liens
are filed and resolved.
Part II:



The Process: How a Lien is Filed
The Bill Reviewer’s Role
How Liens Are Resolved


Negotiation
Workers’ Compensation Appeals Board
(WCAB)
CA Regulations Training - Liens
June 2013
Filing Liens

Each entity requesting
payment may file a
separate lien against
the insurance company
covering the injured
worker.
CA Regulations Training - Liens
June 2013
How is a Lien Filed?

To begin this process, a
Notice and Request for
Allowance of Lien is filed.
This asserts a claim or right
against a workers’
compensation case.

CA Regulations Training - Liens
The Notice and Request form
is filled out and attached to a
full statement or itemized bill
that supports the lien and
justifies the right to
reimbursement.
June 2013
Who Receives the Forms?

When a lien is served on a
party, it gives notice to the
parties involved that a lien
has been filed.
These parties may include:




CA Regulations Training - Liens
Applicant
Employer
Insurance carrier
Respective attorneys or
other representatives of
record.
June 2013
What About All the Bills?

Bills from a lien may
need to be processed to
determine payment
recommendation.
Bills may:


CA Regulations Training - Liens
Be adjudicated the same
as any other bill.
Have very specific
payment instructions from
the claims adjustor.
June 2013
So, What’s Your Role?

For bill review personnel,
contact with lien situations
is chiefly for verification of
the reimbursement.
Remember,
liens are
legal
documents
that are
handled by
legal experts!

CA Regulations Training - Liens
Several steps occur when a lien
bill is sent in for pricing review
or the previous pricing needs to
be verified.
June 2013
Step 1: Account Management
Account management notifies the
legal department
that the bill(s) are
Account Management
being reviewed.
CA Regulations Training - Liens
June 2013
Step 2: Pricing Examination
The pricing is examined and, if the
provider
is inExamination
the network, the
Pricing
contract discounts are verified.
CA Regulations Training - Liens
June 2013
Step 3: Verification
A representative signs off on the
accuracy of review or suggests
Verification
changes, and sends the review to the
legal counsel for final determinations.
CA Regulations Training - Liens
June 2013
How are Liens Settled?
Negotiation
CA Regulations Training - Liens
Workers’ Compensation
Review Board (WCAB)
June 2013
Negotiation
Negotiation

CA Regulations Training - Liens
Negotiation: the insurance
carrier may negotiate a
settlement, based on a
compromise agreement
stipulated by all of the parties
involved.
June 2013
Workers’ Compensation
Appeals Board

Workers’ Compensation
Appeals Board: the WCAB
reviews the lien in a hearing
to determine the
compensability and amount of
payment.

The judge can issue a
Compromise and Release
that resolves the case and
dictates payment or denial of
the lien.
CA Regulations Training - Liens
Workers’ Compensation
Review Board (WCAB)
June 2013
Summary
What liens are,
and why they are
filed.
Who files
liens.
The lien filing
process.
CA Regulations Training - Liens
The bill processor's role.
Liens resolved by
negotiations.
Lien Hearings: Workers’
Compensation Appeals
Board.
June 2013
Module Quiz
It’s time to check your knowledge of the concepts presented in this
module.

This quiz is scored.

You must achieve a score of 80% to pass. You may attempt this
quiz as many times as needed to achieve a passing score.

When finished, you may move on to the next module.
CA Regulations Training - Liens
June 2013
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