Medical Lien Resolution & Recovery
With more than 16 years of workers’ compensation defense and hearing representation experience, MLRS brings an expert perspective on how claims are evaluated from the payer side. We combine this with direct provider-side lien experience to identify realistic recovery opportunities through meticulous lien analysis and organization.
WCAB Procedure, Filing & Negotiation Strategy
MLRS handles the procedural and strategic positioning of provider claims, including timely lien filings, DORs, and verification of proof of service. We manage letters of representation, case briefs, and petitions for penalties and interest when applicable. Our expertise extends to PTC Statements, trial preparation where necessary, and thorough QME/AME review. We analyze settlement documents and prior awards to drive a precise negotiation strategy. The purpose is to position legitimate provider claims for informed recovery through strategic analysis and procedural compliance.
Claim & Medical Documentation Review
MLRS leverages more than 16 years of workers' compensation defense expertise to provide meticulous medical-record organization and claim-file assessment. We explicitly include review of PTP initial evaluations, PR-2 reports, P&S reports, medical-legal reports, medical records, RFAs, SBRs, UR determinations, and applicable UR timelines. Our analysis covers proofs of service, timeliness, denied-claim documentation, procedural history, Labor Code §4600 issues, and MTUS guidelines. We conduct CPT code reviews and detailed analysis of the California workers' compensation Official Medical Fee Schedule (OMFS) billing structure, including EORs and supporting documentation. MLRS also reviews settlement documents, prior awards, and relevant claim history where appropriate to understand value and negotiation position. Emphasizing individualized file development, each file is reviewed according to its specific requirements; when records are missing, we provide a case-specific documentation checklist to properly develop and position the claim for recovery.
California Workers' Compensation Strategy
MLRS applies a detailed working knowledge of California workers’ compensation requirements to each provider claim. As part of our file analysis and strategy, we consider key Labor Code provisions, including:
• §4600 – medical treatment and authorization requirements for reasonably required care
• §4610 – utilization review (UR) procedures and timelines
• §4610.5 – independent medical review (IMR) of disputed treatment decisions
• §4903 – lien rights and categories of allowable liens
• §§4603.2, 4603.3, 4603.6 – billing, explanations of review (EORs), payment timelines, and second bill review (SBR) procedures
We use these requirements to guide billing, UR/IMR, lien, EOR/SBR, and filing analysis while evaluating the underlying merits of each claim, including AOE/COE issues. We review claim history, medical documentation, reports, and treatment records to identify factors that may affect recovery and strengthen the provider’s position.
Our 16 years of defense-side experience working with claims professionals, adjusters, TPAs, and bill reviewers provides valuable insight into how claims are evaluated from the payer’s perspective. We apply that knowledge from the provider side to develop focused negotiation and recovery strategies tailored to each claim, while supporting providers with structured analysis and preparation rather than making legal determinations or guaranteeing outcomes.