Another Outstanding Result for the Client
 
Congratulations to Nicole Graci on achieving an exceptional outcome through strategic analysis and negotiation in a complex healthcare reimbursement matter.

After a detailed review of the underlying workers’ compensation claim and the treatment sought through two Health Insurance Matching Program (HIMP) liens, she identified substantial issues regarding the causal relationship between the alleged treatment and the established workers’ compensation claim. Although the treatment involved the same body site as the established claim, a thorough comparison of the evidence in the workers’ compensation file against the treatment billed on the HIMPs revealed significant opportunities to challenge the claimed reimbursement amounts.

In addition, the defense conducted a detailed review of the charges using the New York State Workers’ Compensation Fee Schedule, identifying further reductions that significantly decreased the claimed exposure.

As a result, Nicole successfully negotiated favorable resolutions of two separate HIMPs on the same claim, generating more than $45,000 in savings for the client while minimizing litigation costs and avoiding prolonged disputes.

This outcome highlights the value of careful claim review, strategic analysis of medical causation issues, and a thorough understanding of New York workers’ compensation reimbursement and fee schedule requirements.

Congratulations to Nicole in securing this outstanding result and delivering meaningful savings for the client.

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