Whenever a catastrophic injury occurs, it is quite common for an applicant’s attorney to seek a penalty against the employer by filing a Petition for Serious and Willful Misconduct (S&W). This is just their way of trying to squeeze a little extra money out of the employer. Unfortunately, many employers do not fully understand exactly …
Credit Rights: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
When an industrial accident is caused by a third party, an injured worker has the right to seek workers’ compensation benefits against the employer, as well as pursue a tort action against all responsible individuals. If the injured worker thereafter receives a settlement in a third-party case, the employer is entitled to a credit against …
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New and Further Disability: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
It is a common practice for applicant attorneys to calendar cases years in advance to reopen for new and further disability. It’s just something applicant attorneys automatically do shortly before the five-years statute of limitations is scheduled to expire. The purpose of today’s sixty-second blog is to share some quick defense tips when handling reopened …
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Blaming the Claims Adjuster: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Have you ever noticed how everyone seems to blame the claims adjuster whenever anything goes wrong in a file? It’s amazing how often it occurs. Let’s start with an injured worker who blames the adjuster for their injury, as if the adjuster somehow caused the accident. We know in reality the adjuster had nothing to …
Exceptions to the $10,000 Rule: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Pursuant to LC 5402(c) an injured worker is entitled to up to $10,000 in medical benefits when compensability of a claim is on delay and/or under investigation. However, this entitlement is not automatic. There are conditions and exceptions to the $10,000 Rule. First of all, a DWC-1 Claim Form must be on file before even …
The Incarcerated Worker: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Isn’t it ridiculous when an injured worker receives temporary disability compensation benefits while in jail? It drives employers absolutely crazy. Paying someone disability while incarcerated at a federal prison, state penitentiary, county jail, local or city jail, or a juvenile correctional facility is just plain wrong. However, under California law an injured worker on TD …
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Destroying a Claims Department: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
How does an insurance company accidentally destroy its own claims department? It’s easy and we have seen it done three times. In all three instances, underwriters were to blame for destroying the claims department. Here is how they did it: First of all, an underwriter’s goal should never be to focus on writing as much …
Piggyback MSAs: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Today’s sixty-second blog can easily save a company a few hundred thousand dollars in just one workers’ compensation claim. You won’t believe how simple it is. We call it settling a claim with a Piggyback MSA. Before explaining the process, please allow us to first ask two simple questions: Have you ever seen a situation …
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UR and IMR Decisions: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Under California law, utilization review (UR) is designed to address requests for medical services as submitted by primary treating physicians on RFA forms. For the most part UR either certifies or non-certifies requested services, although at times a response may legally be delayed pending receipt of additional information. When an RFA is certified the requested …
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Benefit Notices: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Why do so many claims administrators pay such little attention to benefit notices? Most insurance companies and third-party administrators consider drafting and sending out benefit notices to be nothing more than a clerical function, unworthy of an adjuster’s time or review. Consequently, errors are often made with some mistakes being downright cruel. For example: In …
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The Two-Year Rule (LC 4661.5): A Sixty-Second Seminar in Workers’ Compensation Claims Handling
When TD benefits are paid more than two years from the date of injury, the claims administrator is required pursuant to LC 4661.5 to verify if the benefit rate should increase. However, this requirement only applies if the injured worker is a maximum or minimum earner. Exactly how does the two-year rule work? The best …
Reserve Redundancy Reports: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Do you know what a reserve redundancy report is? Almost every major insurance company, third party administrator, and self-insured employer generates this report. Its purpose is to grade a claims adjuster’s reserve accuracy performance. It can make or break and adjuster’s career with a company. Yet the report has a serious flaw that often goes unnoticed. When a claim …
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