BCM Law Medicare Department Secures Three Favorable Results

June 2023

Surbhi Saraswat Goyal

The Social Security Act established five levels to the Medicare appeals process: redetermination, reconsideration, Administrative Law Judge hearing, Medicare Appeals Council review, and judicial review in U.S. District Court. The BCM Medicare team has been successfully navigating the complex and time-sensitive appeal process to gain significant reductions in conditional payments owed to Medicare.

Medical Records and Witness Testimony Led to Denied Benefits and $50K Savings

Noah P. Hamann

Petitioner was a 49-year-old handyman for a property management company. He alleged a left knee injury on November 26, 2019. Specifically, he claimed that while descending a ladder, he missed a rung and fell approximately three feet to the ground. He was recommended for left knee arthroscopy with a possible meniscectomy. Accident was disputed. On September 16, 2021, the case was tried before Arbitrator Linda Cantrell.

Respondent was able to use the medical records to contradict the petitioner’s allegations. In detail, on the alleged date of accident, the petitioner was seen at a local emergency room with complaints of left leg pain for one week. The timeline did not correlate with an acute accident earlier that day. Likewise, there was no mention of a work-related fall in this initial record. The same was true for a second emergency room visit on November 29, 2019. The first mention of a work-related accident did not appear until the petitioner’s initial orthopedic evaluation on December 5, 2019. At trial, the petitioner testified that he did not describe the work accident in the first two medical records because he was focused on his pain and he did not think his injury was serious.

Pre-Trial Prep Pays Off

Noah P. Hamann, Jeffrey F. Clement

Asking not how the case could be closed but how it could be won, BCM’s Civil Department emerged victorious in a recent law division case in the Eighth Judicial Circuit. Our client was accused of improperly servicing a combine harvester resulting in damages to the plaintiff of $30,000.00.

Thorough preparation and teamwork between Firm attorneys Noah Hamann and Jeffrey Clement resulted in a crucial pre-trial win on a motion in limine. The motion precluded plaintiff from presenting a hearsay invoice, thereby preventing him from linking the repair work to the client’s supposed failures. Additionally, plaintiff was unable to use the invoice to correlate the monetary damages to the defendant’s work.

Recent Case Denied Based on Prior Medical Evidence

November 2021

Matthew P. Sheriff

We were victorious at the Arbitrator, Commission and Circuit Court level defending a case based on the opinion of the independent examining physician and the petitioner’s own medical records, in light of the testimony.

The case involved a 61-year-old custodian/mail carrier who alleged a low back injury as a result of “moving a shipment of batteries” on September 14, 2015. The petitioner had prior low back complaints that were downplayed by him during his regular treatment and before the IME physician, Dr. Babak Lami.

The case was denied based on these inconsistencies and prior medical evidence. The petitioner obtained medical treatment based on his post-accident condition, including two separate fusion surgeries to his lower back. The medical disputed and incurred by the petitioner was over $350,000.

Arbitrator denied all benefits to petitioner’s claims of a repetitive walking injury

Noah Hamann was victorious in his defense against petitioner’s claims of a repetitive walking injury. His efforts disproved causal connection and resulted in a denial of all benefits at arbitration and on review before the Illinois Workers’ Compensation Commission.

Petitioner was a 44 year old custodian for a temporary staffing agency. It was undisputed that her job required constant walking. However, the respondent was immediately suspicious of the petitioner’s claims because they were not raised until after the petitioner was terminated for failing to disclose a felony. Likewise, petitioner’s claims were not raised until petitioner had retained counsel and was treating with a petitioner-friendly physician.