There are times when an unrepresented injured worker vehemently disagrees with the findings of a Qualified Medical Evaluator’s (QME), and as a result, the worker seeks legal representation in hope of somehow setting aside the examination report. The purpose of today’s blog is to explain what some applicant attorneys do to throw out a QME …
Throwing out a QME Report: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Every workers’ compensation adjuster can tell horror stories of newly hired employees who claim to be injured the very first day on the job. It’s even more troublesome when first notice of accident is reported by an attorney. Equally suspicious is when the injury is described as being both physical and mental, which leads us …
The Light Duty Trap: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
The other day a client mentioned to us that they received an RFA from a physician requesting that an emotional support animal be provided to an injured worker. We promptly undertook a search for controlling appellate caselaw and/or other relevant legal authority which would shed light on the employer’s obligation when faced with such a …
Emotional Support Animals: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Strangely, workers’ compensation has a way of punishing a good claim adjuster. No, we are not being facetious. When a fabulous adjuster is discovered, before you know it every major client wants that adjuster to handle their files. Also, whenever a new client is retained, management often wishes to impress that client by assigning their …
The Good Adjuster: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
When an injured employee returns to work limited to light duty, they might be eligible to receive temporary-partial disability (TPD) benefits, also known as wage loss. Surprisingly, many claim professionals find TPD difficult to properly calculate. Our blog today provides an explanation of the formula to be used. For the most part claims adjusters are …
Calculating TPD: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Today’s blog focuses on an advanced topic in the realm of workers’ compensation insurance. Let’s presume a general contractor is hired by a developer to build a 50-story downtown skyscraper. As the project will be a major undertaking, the project will require the use of many different sub-contractors, such as carpenters, electricians, roofers, carpet layers, …
OCIP and CCIP Policies: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
There can be little doubt that the future of Artificial Intelligence (AI) will impact many industries for years to come, including the realm of workers’ compensation. In fact, AI is already being used today in work comp but to a limited extent. Some work comp law offices are using AI in place of paralegals, while …
AI in Work Comp: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
There are times in the middle of a work comp case where the claimant unexpectedly passes away. Upon receipt of such news the claims administrator must complete several important tasks. The purpose of today’s blog is to explain the actions that must occur following news of a claimant’s death, regardless of the cause. The following …
When a Claimant Dies: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
There is no more awkward situation for a claims adjuster than to need to seek the reimbursement of overpaid temporary disability benefits from a “pro per” injured worker. Many insurance companies and TPA’s require claims handlers to request refunds even though that actions often prompt the worker to retain legal representation. By requesting a $25 …
TD Overpayments: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
For those who supervise or manage a claims department we ask that you take an informal survey of your staff to determine how many of them have ever attended a WCAB hearing. We believe you will be surprised to learn that very few have ever ventured to the appeals board, and that consequently, most claims …
The Best Laid Plans: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Everyone familiar with the handling of insurance claims is likely aware of the common practice that claims within an office are sometimes transferred from one adjuster to another. Sometimes claims are even transferred from one claim administrator to another. When a transfer occurs, it is said that the adjuster who receives a file is “inheriting …
Inheriting a Claim: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Today’s blog centers on a farm hand who was injured at work while using a tractor to plow a field. The accident occurred when the tractor tipped over onto its side as the employee drove over a dirt mound. The worker ended up pinned beneath it. A tow truck was called to lift the tractor …
To the Rescue! A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
