At NBKL, we pride ourselves in our ability to take teamwork to the next level, and in a recent MSA case, we put this teamwork to the test. The case involved a complex injury with multiple reconstructive surgeries and significant ongoing care, but our client was only able to provide limited medical records. With some sleuthing, we were able to gather extensive records from the claimant’s treating physicians. Our nursing specialist then drafted two comprehensive life care plans for our client, each including Medicare and non-Medicare covered treatments. One life care plan provided a low-end estimate of the MSA, and the second provided what we determined to be a worst-case, high-end scenario for the MSA.
We submitted the low-end MSA proposal to the Centers for Medicare and Medicaid Services (“CMS”) for review. Unfortunately, CMS approved an MSA at just below our high-end estimate. Our team immediately went to work analyzing the approval to determine if there were any grounds to request re-review and pinpointed several potential grounds for dispute. We worked with the client, defense counsel, and even the claimant’s counsel to obtain evidence to support the exclusion of certain line items, and ultimately, it was the claimant himself who provided the medical records needed for the dispute. On re-review, CMS reduced the MSA by more than $300,000.00. The NBKL teamwork in this case quite literally paid off for our client.