Rafael Gonzalez – Partner
Cattie & Gonzalez, PLLC
A Partner at Cattie & Gonzalez, Rafael has a rich experience of 35 years in workers’ compensation claims handling, litigation, and resolution. He is recognized for his expertise in Medicare, advantage/prescription plans, and secondary payer compliance, among others.
With over three decades of experience, Rafael has found innovative ways of nurturing his passion to help people. His legal expertise combined with his inherent quest at helping people through their most difficult times have made him one of the most recognized names in the industry. In this interview, Rafael walks me down his journey from an attorney to Partner and valuable formative moments along the way.
An Early Start in Workers’ Compensation
Rafael got his first taste of the workers’ compensation domain as early as high school. In 1981, he worked for a solo practitioner attorney involved in such claims in Miami and was instantly drawn to this field. He continued working there for the next 3-4 years through high school.
‘I fell in love with the workers’ compensation domain from the very beginning. The idea of helping people through the most difficult period in their lives is very rewarding. It is an area of the law where we help people, probably on their worse day from having had an accident in the course and scope of their employment.’
Rafael then attended college at the University of Florida in Gainesville and secured a job with an attorney who also practiced workers’ compensation. Following graduation, Rafael attended law school at Florida State University in Tallahassee and once again worked with a solo practitioner in the area of workers’ compensation.
While at law school, Rafael gained valuable experience working at the Florida Legislature as well as at the Supreme Court on several workers’ compensation cases from their perspective.
Recalling the initial days, Rafael began by representing injured individuals in a law firm. A young individual in his 20s, he was often representing people in their 50s and 60s with a lot more experience than him. One of his most significant memories that cemented his passion for this domain was the feeling of accomplishment in helping people out of difficult situations using the law.
Journey to Partner at Cattie & Gonzalez
Rafael has been an important leader in this field for over 2 decades. He has served as CEO or President of multiple organizations in the Medicare secondary payer space, compliance for workers’ compensation claims that end up with Medicare beneficiary or a Medicaid beneficiary.
His notable roles in his career include CEO of the Center for Medicare Set Aside Administration, the Center for Lien Resolution, and the Center for Special Needs Trust Administration, Vice President at Gould & Lamb, Vice President at Helios, and President of Flagship Services Group where he was responsible for liability and no-fault claims in addition to workers’ compensation claims.
Next, Rafael served as the President of Settlement Solutions at Optum which is associated with and part of United Health Group, the large group health insurance company. Therein he oversaw their entire Medicare secondary payer program within the workers’ comp world.
He was responsible for mandatory insurer reporting, reimbursement of conditional payments or the creation of Medicare set-asides, all of the Medicare compliance components for employers and carriers who were settling these claims with an individual who has been hurt in the course and scope of employment but who is also a Medicare beneficiary.
Rafael would play a pivotal role in assisting insurance companies and making sure that they were compliant with federal laws specifically regarding Medicare/Medicaid laws.
Current Business Scope
At his current law firm, Rafael looks at workers’ compensation from both sides. They work with the injured individuals and the law firms that represent them while also working with employers and carriers responsible for payment of the benefits.
In addition to workers’ compensation, the law firm also works for insurance companies around the country that handle automobile cases, medical malpractice claims, no-fault claims, and nursing home cases. Their main clientele includes insurance carriers, third-party administrators, and self-insured entities.
Currently, the law firm has hundreds of clients throughout the country. On the plaintiff side, they represent several law firms on compliance while they also have a large volume of employers, carriers, third-party administrators, and insurance carriers that also seek compliance help.
‘My law partner and I have been doing this type of work for a long time. We have been blessed with people that believe in us, trust in us, and recommend us to others.’
While the central office is in Charlotte, North Carolina, the firm has several employees all over the country. Their employees include administrative staff, paralegals, and nurses, among others. There are a range of disputes handled by the firm, some of which are short while some of them can take a long time. Request for re-determination, request for reconsideration, claims before federal administrative judges, – these are some examples of the types of cases the firm is engaged in.
Standout Moments Along the Way
Rafael had a realization early on in his career that often catastrophically injured individuals ended up with a lifelong disabling condition and most of them ended up applying for social security disability benefits. A lot of these people end up receiving Medicare or Medicaid benefits.
In an attempt to help people receive the best compensation and recognizing the challenges in the legislative systems, Rafael started becoming increasingly active in the Medicare/Medicaid space.
This has allowed him valuable opportunities to serve in different capacities from corporate counsel to CEO and Presidents of important organizations in furthering workers’ compensation rights.
Currently, the law firm in Cattie and Gonzalez boasts of clientele across 50 states which is a huge source of pride for Rafael. The firm serves in a compliance capacity where they provide legal advice to both sides of the fence. They take a holistic approach wherein they advise what employers should be doing to help make sure that once the case is settled people have been taken care of, that the employer and carrier have done what legally they must do under the law and that that injured individual has the ability to take care of those injuries for the rest for his/her life.
‘We’re really proud of the role that we play for both injured individuals and employers and carriers to make sure that they are compliant with the federal laws and the state laws that apply to those cases.’
Overcoming Challenges in Workers’ compensation
One of the biggest challenges for Rafael is the variation across State laws. The firm has clients across 50 states, while there is some commonality across them, every state tends to have its own law. This can be extremely challenging and mandates the awareness of each State law before discussing compensation.
Additionally, most people are on Medicaid or Medicare. At present, there are over 60 million people on Medicare and over 75 million on Medicaid. These numbers are constantly growing on a day-to-day basis. However, the dollars flowing in are reducing owing to the economy and a large number of people losing their jobs.
This disparity in numbers is a huge challenge and the law firm is engaged daily in this space. The prime focus is to make sure that Medicare/Medicaid trust fund is available for the next generations of Americans, especially those who are engaged in workers’ compensation accidents.
Additionally, this domain is constantly changing and evolving. The Center for Medicare and Medicaid Services which is within the Department of Health and Human Services at the federal level, is constantly putting out laws, regulations, and policies on a daily basis that impact the work. Keeping up with all these changes can be challenging which is further complicated when they have to be explained to the clients in a simplified way.
Plans for the Future
The firm has several opportunities that they are working on. Rafael hopes that these avenues can help significantly grow the relationship of the different bar associations, the different lawyer groups, and the different insurers in each of the states they are already involved in.
Additionally, with regards to scaling the firm, they have been interviewing people in the industry that can help spearhead growth based on which plans come to fruition.
‘In this domain, you have to know the client, know their needs and know what is that they want to do, know what they cannot do, and know their appetite and risk. At the end of the day we make sure that we get to know our client and their needs so that we can do exactly what they want us to do.’
Regarding the marketing methods that the form adopts, Rafael credits their social media presence, informative blogs and conferences as prime ways of staying active in the industry. Both his partner in the firm, John, and he are extremely active on LinkedIn and Twitter. They update informative content in the form of blogs on a daily basis on important topics covering workers’ compensation, social security, Medicare and Medicaid, among others. Additionally, they are both highly qualified speakers and were speaking at conferences almost on a weekly basis before the COVID-19 pandemic. In 2019, Rafael was invited to speak at a whopping 58 conferences.
Top Philosophies and Core Values
For Rafael, the most important philosophy is to keep the injured worker at the center of everything they do. Having gained deep insight and experience in this industry, he believes that often when fighting a claim, the focus shifts on the technical aspects of what needs to be done entirely. While that is crucial, it is important to remember that in the center of it all is an individual who woke up one day, went to work and had a horrific accident and now his/her life has been changed forever.
An injury like this affects not just the individual but their family members, spouse, kids, and it affects their ability to engage in substantial gainful activity, earnings, and their health. The ramifications of an injury go a long way and it is important for people working in this domain to remember that as well.
‘Sometimes, in the midst of a claim, we tend to forget that there is an individual who is confused, who does not quite understand the process, who does not know the law, who is afraid of what’s going to happen to him/her next: how am I going to be able to feed my family, how am I going to be able to keep the roof over my head, those kinds of issues.’
Ultimately, it is always making sure that the injured individual is at the core of every act to assist them to get through the process.
Advice for People Looking to Start a Career in Workers’ Compensation
Talking about working in this domain, Rafael believes it is a wonderful area as it allows one to help people. Either help injured individuals with the process or help an employer or carrier go through the process. Here, one can actually make a difference, help the community and society by helping people who are going through a difficult situation.
Additionally, it is beneficial to learn as much as possible about this particular law. Try to understand as much about medical care and treatment.
Learn what a herniated disc is, what a discectomy and laminectomy is, how a neck injury is different from a lower back injury, all about the psychiatric component to an individual’s loss of earning capacity, or the fact that there’s someone who may not be able to engage in the same type of activities. Learning as much as one can about the medical aspect is important to help the individual best deal with their newfound situation.
Key Benefits of the Services at Cattie & Gonzalez
One of the main reasons that clients rely on their expertise and depend on them is to ensure compliance with the federal laws that mandate Medicare assistance. If one is a Medicare beneficiary, it is important that Medicare remains a secondary payer after all payments have been reimbursed, Additionally, a suitable plan needs to be developed to ensure that the injured worker receives adequate compensation to be able to pay for his/her future needs so that the responsibility of care does not fall on the American taxpayers.
Vision for the Workers’ Compensation Domain
Following the aftereffects of the COVID-19 pandemic, Rafael states that each challenge can impact the workers’ compensation domain in a variety of ways. For instance, no one could have predicted a year ago that 15 million jobs would be lost within a year. The domino effect of this continues on the economy and the workers’ compensation segment.
There are millions of people who aren’t working and therefore potentially hundreds of millions of dollars of loss to insurers in premiums. This also means thousands of jobs are gone because if there are no claims there are no people required to work on those claims.
All these factors, along with the news of increasing pandemics, make it difficult to have a clear vision. Each challenge affects the economy differently and thus the consequence on this domain.
However, Rafael considers himself to be someone who looks at the glass as half full. He believes that the economy is going to be rebound and people will get back to work. As this happens, the workers’ compensation will stabilize.
‘The pandemic has certainly affected the workers’ compensation industry significantly and I think it will be a while before we get back to normal in this domain.’
For individuals in the field looking to stay successful, Rafael claims that this is the right time to re-evaluate what one is doing and their role in the industry. People should use this time to reflect on their services and how they can be improved. Or how can they adapt their processes to make it easier for the clients to engage and trust them.
It is important to make sure that all organizations are serving clients timely, providing excellent and quality services, and engaging with clients. Remember to listen to their needs to better earn their confidence and trust.
‘I think at the heart of what this entire experience has taught us is that if something like this happens, a lot of people lose jobs and a way to feed their family, which affects the employer and the comp insurance company and everything that surrounds it. I think the challenge then is if that is a norm for a while then how can you do what you do better?’
Leadership Lessons Taught by Experience
Patience and active listening – while simple, they are the key. It is extremely important to understand what it is that people are suffering through or need help with. Then be solution-driven and find an easier way to be able to give the client what they would like. It sounds so basic but it is at the very core of it.
‘What we’re doing every day is making sure that we truly understand and educate people so that they understand what’s at stake if they don’t comply with the laws. Then ultimately it is finding a compatible way for them to be able to engage and say okay, here’s how we can solve that problem.’