For the Best Defense
When comparing the job requirements of today’s workers’ compensation claims adjuster to those of yesteryear, the difference is like night and day. Thirty-years ago, a claims adjuster was a jack of all trades. Adjusters of that era would handle all types of comp claims. An adjuster’s inventory consisted of med-only, indemnity and death cases. In …
Today’s Claims Adjuster: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
It seems incomprehensible but for the past twenty years our workers’ compensation system has failed to acknowledge a paradox that exists regarding death benefits. The purpose of today’s blog is to explain the paradox to allow our readers to decide on the interpretation of their choice. We believe it is safe to state that most …
The Death Benefit Paradox: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
In the process of estimating the final cost of claims under a policy of workers’ compensation insurance, insurers and claim administrators typically add a charge for what is known as “IBNR,” which stands for “incurred but not reported.” For the most part this acronym is foreign to a claims department; however, it has exceptional meaning …
Allow us to begin today’s blog by asking three workers’ compensation trivia questions: Q. 1: “What is the number one cause of death for men who die on the job?” Q. 2: “What is the number one cause of death for women who die at work?” Q. 3: “Where at work is the most likely …
Coworker Liability: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Today’s blog addresses the confusion in the workers’ compensation community over the DWC Debit Card law. In 2018, Senator Richard Pam (D-Sacramento) introduced Senate Bill 880, creating LC § 4651(a)(3)(A), effective 01/01/2019. Specifically, LC § 4651(a)(3)(A) authorized workers’ compensation claims administrators to voluntarily issue indemnity payments by debit card on a trial basis. The trial …
Work Comp Debit Cards: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Pursuant to Title 8 CCR §15251 all self-insured employers, both public and private, are required to file an annual report with the California Office of Self-Insurance Plans (OSIP). Individual-Private and Private-Group employers are to file by March 1 using Form AR-1 (1-2016), while all public self-insured employers, whether a member of a joint-powers authority, have …
The Self-Insurance Report: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
A most bizarre event occurs in workers’ compensation whenever there is a need for a QME panel. The parties race each other to determine who will be first to request a panel. All too often applicant attorneys request chiropractic panels regardless of the injury, whether it involves a foot, an ear or even a heart …
The QME Race: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
The other day we were thinking how nice it would be if workers’ compensation adopted a new fee schedule to reduce the number of interpreter liens currently being filed. The sheer number of interpreter liens being filed at the appeals board is truly staggering. We are not talking about hundreds or thousands of liens. We …
The Interpreter Fee Schedule: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Most claims professionals have never heard of the “20/120 rule” in workers’ compensation. It can be found in the Regulations under 8 CCR 10636(b), governing the request, production, and service of benefit printouts. For the most part, claims administrators consider the production and service of a benefit printout as a clerical function. Unfortunately, clerical staffers …
The 20/120 Rule: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Have you ever encountered an applicant attorney demanding two supplemental job displacement benefit (SJDB) vouchers when settling multiple claims filed on behalf of an injured worker? Perhaps the case involves two injuries (a specific and a CT) where both claims are eligible for a voucher. Is that even possible? Also, what happens if an injured …
Double Vouchers: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Arguably, the two most powerful words in workers’ compensation are “show me.” All too often opposing counsel will offer their interpretation of the law in an attempt to further an argument at the Board. When this occurs, it is vital for the defense to simply say, ‘show me.’ In other words, “prove it.” It is …
The Show Me Defense: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
When industrial compensability is in dispute, either for an entire injury or for just a body part, claims administrators should act cautiously should a Request for Authority (RFA) be received. The RFA is not to be addressed by utilization review (UR). Instead, pursuant to Labor Code §4610(l)&(m) and C.C.R. 9792.9.1(b)(1), the administrator should respond within …
Red Flag UR Decisions: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
