Medical malpractice cases require meticulous attention to detail—especially when reporting critical details like the date of incident (DOI).
A simple reporting error can lead to inflated medical liens and unnecessary repayment of proceeds by the plaintiff. In this case study, we’ll explore how a misreported date resulted in a nearly $100,000 lien, and how the efforts of Precision Resolution Case Manager Emma Andrews saved the plaintiff approx. $96,000.
The Case: A Medical Malpractice Claim for Delayed Diagnosis of Colon Cancer
This case involved a medical malpractice lawsuit alleging a failure to diagnose colon cancer in a timely manner. The Precision Resolution team was brought in for lien resolution after plaintiff’s counsel reported the case to the Medicare Advantage Plan’s recovery contractor. The plan’s recovery contractor issued an initial lien amount of $97,087.84.
The Reporting Error: Incorrect Date of Incident (DOI)
The inflated lien amount in this matter stemmed from an incorrect DOI on file with the recovery contractor.
Misreporting the date of incident is not uncommon in medical malpractice cases.
Reporting the correct DOI is a critical step to ensuring an accurate lien amount. Health insurers, especially Medicare and Medicaid, use the DOI to identify and track injury-related medical expenses. If an incorrect DOI is reported—whether due to clerical error or miscommunication—the insurer may mistakenly include unrelated medical treatments in the lien calculation. This can significantly increase the lien amount and require an unnecessary fight to remove non-compensable charges.
Alternatively, a DOI that postdates the incident may lead to an artificially low lien amount.
Incorrect DOI reporting can be especially problematic in Medicare lien matters. In these instances, when it comes time for Section 111 reporting, if the carrier’s DOI does not match what is on record and has been reported by the plaintiff’s representative, Medicare might open a duplicate case or apply payments from the wrong coverage period. This can lead to inflated lien demands and settlement delays. Correcting these errors often requires an appeal, which can be time consuming, and further delay payment of proceeds.
The Problem?
- Prostate cancer was never part of the cause of action, yet its treatment costs were included in the lien.
- Additional unrelated medical charges were added simply because of the incorrect DOI.
- A simple reporting mistake led to an inflated lien, nearly $100,000 more than necessary.
The Dispute Process: Reducing the Lien by Over $95,000
After spotting the reporting error, our team immediately filed a dispute. However, the recovery contractor handling the case initially refused to remove the incorrect charges. This required persistent follow-ups and a strong argument.
Key points in our dispute:
- The plaintiff could not have received treatment for colon cancer before the actual date of diagnosis. Even after correcting the DOI with the recovery contractor, they still were asserting claims for the colon cancer, which was pre-existing. Our team argued that the colon cancer was pre-existing, and the prostate cancer was the only cancer that was a claimed injury.
- Prostate cancer treatments were unrelated to the claim and should not be included in the lien.
The Outcome?
After multiple dispute submissions highlighting the accurate date of incident, the lien was reduced from $97,087.84 down to just $1,221.54—a total savings of $95,866.30 for the plaintiff.
The Power of Accurate Reporting & Persistent Advocacy
Medical malpractice cases are complex, and even minor reporting errors can lead to major financial consequences.
This case was a perfect example of how knowledge, diligence, and an aggressive dispute strategy can protect plaintiffs from unjustified financial burdens. In the end, reducing a $97,000 lien to just over $1,200 wasn’t just a win—it was a lesson in the power of accurate reporting and persistence.
Precision Resolution offers premier outsourced lien resolution services for attorneys aiming to enhance client services, achieve optimal case outcomes, and maximize settlements for plaintiffs.
About the Author
Emma Andrews is one of Precision Resolution’s longest-tenured Case Managers and also serves as Director of Intake Operations. With years of experience in personal injury and lien resolution, Emma brings a wealth of knowledge, expertise, and compassion to her role, ensuring that every client’s journey through the process is smooth, efficient, and effective. To contact Emma, email her at andrews@precisionlienresolution.com.