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Thread: Home Care

  1. #1
    Join Date
    Dec 2007
    Location
    southern California
    Posts
    42

    Default Home Care

    If anyone is seeking information to justify home care billing or a home care lien for a MSC, or court, I am pulling up some entire cases at My FindLaw that I had initially pulled up short blurbs on at the Appeals Board Reporter.

    Specifically: SMYERS v. WORKERS' COMP. APPEALS BD. , 157 Cal.App.3d 36The short recaps at the ABR are great, but if one can get the entire case a thousand times better because all the information is there. SMYERS references KEIL v. STATE OF CALIFORNIA (1981) 46 Cal. Comp.Cases 696. These two appear to be standards for California home care provision cases, and what the WC judges use for references.

    I'm still missing one piece of information. What is a reasonable percentage the applicant attorney usually charges to represent a home care lien that is part of the applicant's case? However, I have been told tonight that many of them do represent the home care provision, as part of the case not charging an extra percentage. I still need to know a percentage for any that do charge though.

    My home care provider, a friend, has been providing home care for me since the date of my injury. A few months after my injury when I retained my attorney, he said she should begin billing the IC for her services which she began doing. He told her how much to charge, how to fill out the Lien Request, Proof of Service, billing, etc. and instructed her to send it to the IC once a month with a copy to him. Then, periodically, he would write demand letters to the IC, etc., etc. We learned the icing on the cake, i.e. how to fine tune the justification for home care, what covered services verses not-covered services are, etc., etc., etc.

    The AA has always maintained that her lien was part of the case and would be settled by the judge at trial. That is also what the IC has claimed in their letters. He has written us letters from time to time talking about evidence that he has filed on her home care provision, blah, blah, and all the usual talk one would relate if one was handling a claim. He also said he has filed her billings. Recently, we learned this is not true. None have been filed with WCAB.

    He has never once mentioned to her one word about charging a separate fee for representing her home care provision. Never mentioned anything about any percentage figure, or signing any agreement of any type. Of course we never gave it a thought thinking that if it was part of the case there would be no separate charge. This has continued for over seven years.

    A MSC is coming up and she received a letter from him saying I am not representing your lien in court. We were both in shock. When I contacted him he was up and down, back and forth, then said that if he represented her lien/claim he would charge from 20 to 45% to do it but he didn't know if there would be a conflict of interest. When I tried to learn what type of conflict of interest it had something to do with a poorly worded paragraph in a depo taken five years ago of an AME. When I looked at the depo there was only one poorly worded question in the entire depo however the question before it, and after it, made the poorly worded one perfectly clear so I didn't see any problem. It does no good to relate sensibly, so I just accepted the excuse and said....OK, how much is the percentage.

    He then began going back and forth on that. As of this date, still back and forth with an..."I'll let you know before the MSC." Well, since the MSC is in 14hours, and we still haven't been informed, I have a feeling that my home care provider is going to be informed five minutes before the MSC begins and the pressure will be on.

    I have been trying to learn what percentage applicant attornies charge to represent a home care provision that is part of their applicant's case for a couple of weeks now with no luck. I know everything about home care billing now except that.

    If anyone here has been involved in a claim, or knows someone who has, that has had a home care provision included in it I sure would appreciate knowing what percentage those attornies charged. 15% 20% Or what? I surely doubt that it would be 45%.

    Thanks.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,018

    Default Re: Home Care

    There are 'lien representative' companies and individuals who handle this issue.

    But, IF you/your friend are to prevail on the lien, you MUST have your PTP, and/or AME provide the basis for the need for the serivces you have received.

    The whole basis for WC benefits is 'medical necessity' and 'reasonableness'...without that, you stand little chance of being reimbursed for the home services provided to date...

    Specifically: SMYERS v. WORKERS' COMP. APPEALS BD. , 157 Cal.App.3d 36The short recaps at the ABR are great, but if one can get the entire case a thousand times better because all the information is there. SMYERS references KEIL v. STATE OF CALIFORNIA (1981) 46 Cal. Comp.Cases 696. These two appear to be standards for California home care provision cases, and what the WC judges use for references.
    If those cases are on 'recon', and not 'en banc' decisions, and 'citable', they are not relevant to your claim, and not a basis for granting your award.

    I'm not attempting to discourage you in your plight...just pointing out the pitfalls...'home services' are different than 'home health care'... and difficult to prove up the need, especially without the prior survey of your needs by a licensed provider, and the Rx of your PTP...

  3. #3
    Join Date
    Sep 2008
    Posts
    132

    Default Re: Home Care

    Quote Quoting Glenda Tucker View Post
    If anyone is seeking information to justify home care billing or a home care lien for a MSC, or court, I am pulling up some entire cases at My FindLaw that I had initially pulled up short blurbs on at the Appeals Board Reporter.

    Specifically: SMYERS v. WORKERS' COMP. APPEALS BD. , 157 Cal.App.3d 36The short recaps at the ABR are great, but if one can get the entire case a thousand times better because all the information is there. SMYERS references KEIL v. STATE OF CALIFORNIA (1981) 46 Cal. Comp.Cases 696. These two appear to be standards for California home care provision cases, and what the WC judges use for references.

    I'm still missing one piece of information. What is a reasonable percentage the applicant attorney usually charges to represent a home care lien that is part of the applicant's case? However, I have been told tonight that many of them do represent the home care provision, as part of the case not charging an extra percentage. I still need to know a percentage for any that do charge though.

    My home care provider, a friend, has been providing home care for me since the date of my injury. A few months after my injury when I retained my attorney, he said she should begin billing the IC for her services which she began doing. He told her how much to charge, how to fill out the Lien Request, Proof of Service, billing, etc. and instructed her to send it to the IC once a month with a copy to him. Then, periodically, he would write demand letters to the IC, etc., etc. We learned the icing on the cake, i.e. how to fine tune the justification for home care, what covered services verses not-covered services are, etc., etc., etc.

    The AA has always maintained that her lien was part of the case and would be settled by the judge at trial. That is also what the IC has claimed in their letters. He has written us letters from time to time talking about evidence that he has filed on her home care provision, blah, blah, and all the usual talk one would relate if one was handling a claim. He also said he has filed her billings. Recently, we learned this is not true. None have been filed with WCAB.

    He has never once mentioned to her one word about charging a separate fee for representing her home care provision. Never mentioned anything about any percentage figure, or signing any agreement of any type. Of course we never gave it a thought thinking that if it was part of the case there would be no separate charge. This has continued for over seven years.

    A MSC is coming up and she received a letter from him saying I am not representing your lien in court. We were both in shock. When I contacted him he was up and down, back and forth, then said that if he represented her lien/claim he would charge from 20 to 45% to do it but he didn't know if there would be a conflict of interest. When I tried to learn what type of conflict of interest it had something to do with a poorly worded paragraph in a depo taken five years ago of an AME. When I looked at the depo there was only one poorly worded question in the entire depo however the question before it, and after it, made the poorly worded one perfectly clear so I didn't see any problem. It does no good to relate sensibly, so I just accepted the excuse and said....OK, how much is the percentage.

    He then began going back and forth on that. As of this date, still back and forth with an..."I'll let you know before the MSC." Well, since the MSC is in 14hours, and we still haven't been informed, I have a feeling that my home care provider is going to be informed five minutes before the MSC begins and the pressure will be on.

    I have been trying to learn what percentage applicant attornies charge to represent a home care provision that is part of their applicant's case for a couple of weeks now with no luck. I know everything about home care billing now except that.

    If anyone here has been involved in a claim, or knows someone who has, that has had a home care provision included in it I sure would appreciate knowing what percentage those attornies charged. 15% 20% Or what? I surely doubt that it would be 45%.

    Thanks.
    The two cases I know of the AA who represented the wife of the IW for home care is getting 50% of the every months payment. They can charge so much because home health care is not always awarded, depending on how the PTP writes the report indicating the necessity.

  4. #4
    Join Date
    Dec 2007
    Location
    southern California
    Posts
    42

    Default Re: Home Care

    Thanks BViA,

    My home care provider has talked with several lien reps who have all told her the same thing. They "could" handle it, but would not be an expert in this field as they have never handled a home care lien because the AA usually does that as part of the case. But, mainly there are problems within the case involving misrepresentations and whoever represents home care needs to be well versed with the tools for rebuttal against these misrepresentations plus any new ones that pop up during trial on the spur of the moment. I'm sure that will happen knowing this IC as I do. Someone, not being completely familiar with the case could not do that and would be shark bait. This particular IC is widly known for bad faith claims handling and misrepresentations and they have proven that ten fold in this case. We have an entire list of dirty deeds that can easily be knocked out IF one knows ALL the aspects of the case. I'm sure that the IC will be armed with new tricks at trial that my home care provider will have no forewarning of, BUT she knows the case like the back of her hand putting her at an advantage over anyone else.

    I had memorized the wrong date for the MSC - it isn't until next week. But, we did learn what we wanted to know. I finally began contacting some AAs who represented some of these cases we have pulled up and I also found a few others who knew how to represent home care. Some didn't want to comment on percentage, but a few said they didn't charge anything over the 15% on the case because it was part of the case (where were these when I was looking for an attorney); three said 20%, and one said 25%. They were all approached with the possibility of handling my home care provider's lien at trial and said they would have to know the case inside and out to be able to do that. No duh! We knew that. Two wanted to meet with my home care provider with the possibility of representing her lien. She took in the twelve page justification that took us a year to compile and after reading it they said she had more than enough compelling information on those pages to easily represent herself and that there was nothing they could even add to them. One of them asked if he could have a copy of her information. She said she'd sell it to him, LOL! I wish I had found those attornies when I was looking for one years ago, they were outstanding. Never thought I'd say that about an AA.

    The PTP and AME have provided the basis for the need for the services I have received. The PTP has been writing prescriptions, letters to the IC, and requesting home care in most every report for years, and the AME ratified the PTP's requests in writing years ago. All those ducks are in a row.

    The cases (opinions) I pulled up on Smyers, Keil, etc., etc., etc. (we've got around 30 now), have been used for the critera presented therein to either award the lien, or disallow it. The information pertaining to either is extremely useful for anyone wanting to know the merits of their claim. These cases and opinions were not used because they were "awardable" home care provisions. Any cases that the claimant has sought a writ for review on because their home care was originally denied, and then had their writ denied, are just as useful as the ones that were awarded. Realizing what caused a home care provision to be denied is just as important as knowing what qualifies it to be awardable. We also pulled up several pages on criteria used by defense attorneys in order to try and have the provision kicked out which was probably the icing on the cake. That, along with having rebutted all of the ICs numerous written objections over the years, has also been helpful. Judges use the Smyers and Keil cases as references in reviewing other cases because of the information presented in these cases. That is what I read.

    BViA, when you said that "home services" are different than "home health care" - perhaps instead of "home services," you meant "housekeeping services?" Yes, housekeeping services are different than home health care, but the number one question is...are housekeeping services unrelated to any nursing services and therefore not included within the term "medical treatment" found in section 4600? And then it goes on for a mile. It has taken a long to put all this information together because there is nowhere that one finds it all in one place or even close to being in one place including bits and pieces from perhaps a hundred different sources starting with the foundation for Home Care..."supportive services" as applied to In-Home Supportive Service Providers governed by the Welfare & Institutions Codes 12300 - 12317.2. I don't believe there is anything that we've missed, but it has taken over a year and a lot of hair tearing to find it all. A lot of work, but for the amount of money involved it is worth it.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,018

    Default Re: Home Care

    when you said that "home services" are different than "home health care" - perhaps instead of "home services," you meant "housekeeping services?" Yes, housekeeping services are different than home health care, but the number one question is...are housekeeping services unrelated to any nursing services and therefore not included within the term "medical treatment" found in section 4600? And then it goes on for a mile. It has taken a long to put all this information together because there is nowhere that one finds it all in one place or even close to being in one place including bits and pieces from perhaps a hundred different sources starting with the foundation for Home Care..."supportive services" as applied to In-Home Supportive Service Providers governed by the Welfare & Institutions Codes 12300 - 12317.2. I don't believe there is anything that we've missed, but it has taken over a year and a lot of hair tearing to find it all. A lot of work, but for the amount of money involved it is worth it.
    The difference between "in-home service" and '' and ''home health care'' is/can be huge.

    "home health care'' requires a provider with licensed health care personel...and helps the tacking times for meds, changing surgical dressings and the like...An in home survey done and co-ordination with the PTP..a benefit billed directly to the ER/IC as a 'medically necessary' item, and 'reasonable' to the orginial injury. You're asking the ER/IC to continue to hold liability on this, and the billing reflects the level of liability.

    "home services'' would include housekeepping, preparing meals, transportation if necessary...etc...functions a 'medical' person/aide would not normally be responsible for, and it would be a 'benefit' paid to the IW...who in turn would pay the 'provider' of the services...the ER/IC has no liability for your contracting a family member/friend or Merry Maids to help around the house.
    You won't see or receive the same hourly rate as a aide from a licensed provide would be able to charge...max would probably be around $10/hr. maybe a little more to cover the SSA/FICA and WC premiums you could be faced with.
    If the person providing the service to you is ongoing long term, you no doubt are required to provide a 1099, along with the other requirements of an 'ER'.

    Generally, neither service would be required as an on going, long term necessity. But, that again would be dependant on the injury and condition of the IW. IF both were mandated 'medically' speaking, the IW should probably be in an 'assisted living' facility where the services were provided on a daily basis as part of the package.

    I hope you prevail in this...as I said the biggest hurdle is going to be the ACOEM/MUTS/EBM that mandates the need, and length of time the 'benefit' was/is provided.

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