Good things can happen when providers stand up for themselves.

Recently, Liberty Mutual and its Third-Party Administrator (TPA), Helmsman, demanded a refund from a California doctor—going so far as to threaten collections.

But this provider didn’t back down.

After daisyNews published an article explaining why providers are under no legal obligation to comply with these refund demands, the doctor forwarded the article to Liberty Mutual.

The result: Liberty Mutual canceled the refund request.

Below, see Liberty Mutual’s message to the doctor. California providers: if you get hit with a demand for reimbursement, take a page from this doctor’s playbook. Share our article with the claims administrator—or share your story with us.

Physician Prevails With daisyBill

Helmsman, acting as TPA on behalf of Liberty Mutual, initially paid the doctor correctly. But later, Helmsman reversed course—claiming it should have denied one of the procedure codes and demanding a $459.20 refund.

Helmsman/Liberty Mutual bombarded the doctor with 10 separate refund demands. Despite the pressure, the doctor stood firm.

Eventually, Liberty Mutual escalated the threat, sending an email warning that if the doctor didn’t comply, the matter would be handed over to their “collection vendor.”

But here’s a legal fact: California providers must only issue refunds if a judge, the Workers’ Compensation Appeals Board, or a separate reimbursement contract requires it. None of those conditions applied in this case.

Like many others, the doctor could have quietly complied. Instead, the practice forwarded our article to Liberty Mutual—and received the response below confirming the refund request had been “closed out and cancelled.”

What Providers Need to Accept

This incident illustrates the reality of California workers’ comp, and why providers have to be willing to take action in defense of their practices.

Claims administrators routinely issue improper denials, reductions, and yes, refund requests—not necessarily out of a purposeful design to swindle or abuse, but because there’s no real downside to doing otherwise.

In California, enforcement of workers' comp payment laws and regulations is virtually nonexistent, and providers are often too under-resourced to fight back effectively.

From the point of view of a rationally self-interested claims administrator (especially a large insurer or TPA), there's simply no incentive to know the law or follow it. For claims administrators, “Punch first and ask questions later" is a policy that generally pays dividends.

Providers, this is the system. Accept it, and protect yourself accordingly.

• Check reimbursements for accuracy and timeliness.
• Appeal incorrect denials and reductions.
• Brush off refund demands.
• …and when you're pushed, push back.

You may be pleasantly surprised at the results: all it took to turn Liberty Mutual around was a 500-word daisyNews article.

If you receive persistent harassment for a refund, remember that the law is on your side. If necessary, share your story with us and we’ll publicly remind the claims administrator of the facts. Sometimes, the only thing you have to do in the face of a bully is keep your lunch money in your pocket—and call on your friends.  

daisyBill makes it easy to protect practice revenue, tracking every bill and payment and alerting your staff when it’s time to take action. Click below to get in touch.

CONTACT US: DAISYBILL