daisyBill submits millions of bills for injured workers' treatment every year. We've heard every excuse payers can produce for failing to reimburse, but Liberty Mutual just set a new standard.

The insurer told our agents it isn't paying any bills on a particular claim because the claim is on a “payment holiday.”

Liberty Mutual acted as though the deadlines in California's Labor Code don't apply to this claim, at least for now. Instead of offering an Explanation of Review (EOR) with a reason for non-payment, as the law requires, Liberty Mutual simply claimed a “holiday” of its own invention.

Worst of all, Liberty Mutual is unlikely to face any consequences.

Payment deadlines and EOR requirements, like most of the state’s payment requirements, are effectively theoretical. On paper, penalty and interest payments are due for untimely reimbursement; however, the California Division of Workers’ Compensation (CA DWC) dubbed those payments “self-executing” by payers, and rarely (if ever) takes meaningful enforcement action to address even the most blatant violations.

As a result, providers must chase down reimbursement, placing call after call to payers and vendors that (in this case) openly declare they’re “taking a break” from issuing payments, as a Liberty Mutual representative stated.

As of this writing, 45 bills remain unpaid on this claim. The CA DWC remains out to lunch, leaving providers at the mercy of insurers who treat compliance as optional…because in practice, it often is.

“The Insurance Takes a Break”

When the deadline for payment of a provider’s bill passed, and Liberty Mutual ignored a duplicate bill submission, a daisyCollect agent called for an explanation.

The Liberty Mutual representative first claimed that the bill wasn't on file. When our agent pushed further, the rep admitted that the bill was on file, but made the stunning assertion that the entire claim had been placed on a “payment holiday” by the adjuster.

Asked to explain what in the actual heck a “payment holiday” is in this context, the Liberty Mutual rep explained that the insurer “takes a break from making a benefits payment for either some or all benefits for a certain period of time.”

We’ve searched the Labor Code, Code of Regulations, and the CA DWC Medical Billing and Payment Guide, and can find no mention of a “payment holiday” or any other legal excuse for an insurer to “take a break” from its statutory duty.

An Adjuster Who May or May Not Exist

The Liberty Mutual rep claimed that only one person could fully explain the “holiday”: the adjuster assigned to the claim. Unfortunately, the rep told us, the adjuster is no longer with the company.

…or are they?

The rep instructed our agent to call the main branch office to determine who the current adjuster is. When we did so, a different representative asserted that the original adjuster was still at Liberty Mutual and still assigned to the claim. The rep provided a direct phone number and email for the adjuster. We called, left a voicemail, and sent an email on June 29.

As of this writing, there has been no response.

Liberty Mutual invented a holiday, can't resolve whether or not its own adjuster exists, and ignored our outreach for a week and counting. This is the consequence of statewide non-enforcement, and it falls squarely on providers and the injured workers they treat.

How Does Liberty Mutual Treat Injured Workers?

Our clients, at least, have the advantage of daisyBill in their corner. We can badger Liberty Mutual on their behalf, and document and publicize the insurer’s violations.

The injured worker has no such support.

If Liberty Mutual is willing to stonewall us, we can only wonder how its “payment holidays” affect our clients’ patients. We wonder if Schrödinger's adjuster, if he still works at Liberty Mutual, is showing the injured worker the same consideration he's shown our agents. How is this worker faring while Liberty Mutual “takes a break?”

Liberty Mutual did more than fail to reimburse. It reported treating medical bills as if its legal obligations are optional at random intervals of its own choosing. Worse, this behavior is unlikely to produce repercussions, if the CA DWC’s enforcement history is any indication.

California’s state legislature established payment deadlines; the CA DWC exists to enforce them. Until it actually does so, “payment holidays” won’t be the only oddball excuses insurers produce, even if it’s among the most creative.

Every payer in the state is watching, and taking notes.

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