Whenever an injured worker’s third-party tort claim settles out of court, it is common for the injured worker and the civil defendant to join forces in a mutual attempt to defeat all workers’ compensation liens and credit rights. Some of the tactics used are ingenious. One such tactic is to classify the entire settlement as …
Replacing the QME: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
We are continuously bemused at the frequency with which a newly hired applicant attorney will attempt to replace a QME permissibly chosen when an applicant was unrepresented by counsel. The purpose of today’s blog is to warn our clients of the various tactics some applicant attorneys use to avoid a good defense QME report. There …
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Pre-Designation: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
It is common knowledge that most applicant attorneys view Medical Provider Networks (MPNs) as a program created for the benefit of employers. As a result, applicant attorneys do not consider MPN physicians as being unbiased but rather, they believe them to be in “cahoots” with the employer to the detriment of injured workers. After all, …
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Legal Presumptions: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
California’s workers’ compensation system provides several legal presumptions that greatly impact benefit entitlement; however, notwithstanding that, some claims professionals are uncertain as to what a “presumption” is. A legal presumption is defined by Black’s Law Dictionary as “a legal inference, or assumption that a fact exits. It is based on the known or proven existence …
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True Claim Stories: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Today we are offering something different. Instead of a blog focused on a singular workers’ compensation topic, we’re offering up four true claims stories, each of which we believe will either elicit a smile or a knowing nod of the head from you, our dear readers. Up in Smoke: On his very first day at …
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In Memory of Paul Lee, Esq.
It is with profound sadness that we announce the sudden and tragic death of our treasured friend and co-worker, Paul Lee, Esq., who passed away on Friday, March 10, 2023. Paul’s warm and caring personality, his joy of life, and his boundless professional and personal talents will be terribly missed and impossible to replicate. We …
First Aid: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
As strange as it may seem, the rules under California’s workers’ compensation act pertaining to “first aid injuries” are becoming more and more complex. Instinctively thought of as minor injuries which could be handled directly by the employer without the necessity of reporting an injury to their workers’ compensation insurer or requiring formal claims administration, …
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Commutations: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
At a recent WCAB hearing, a judge was asked to approve a petition for commutation to enable an applicant to pay off a large credit card debt that was accruing interest at an annual rate of 22%. The applicant testified he could never get financially ahead in life as the interest charges alone were greater than …
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Surveillance: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Today’s blog is all about surveillance. Many employers and claims administrators tend to rely on surveillance as a last resort to disprove the existence of an industrial injury/disability, or perhaps to determine if a claimant is employed elsewhere while collecting compensation benefits. Before assigning an investigation, it is important for the claims administrator to develop …
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Workers’ Compensation Nurses: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
In today’s world of workers’ compensation, it is a most welcome and common occurrence for nurses to be engaged to assist and participate in the adjustment of industrial claims; however, most claims professionals are unaware there are six (6) different types of nurses available in workers’ compensation, each of which has a different but vital …
LC 5710 Attorney Fees: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Pursuant to Labor Code Section 5710, an applicant attorney is allowed to charge an hourly fee when representing an applicant at their deposition in a workers’ compensation case. Unfortunately, we do not have a fee schedule which provides guidance as to how much to an applicant attorney is to be paid for deposition services. In …
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Petition for Contribution: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
When multiple employers or insurance companies share liability for an industrial injury, the injured worker is allowed to choose which of those defendants they want to administer the benefits they are entitled to receive. The elected entity then handles the entire claim subject to their right to seek contribution from the other defendants. Having written …
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