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 …
Benefit Notices: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
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 …
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 …
Reserve Redundancy Reports: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Written by Haik K. Bartoumian, Esq. Introduction: California workers’ compensation law allows injured workers to perform light-duty work at the employer’s facility and elsewhere, including working remotely from home. There are both advantages and disadvantages of working remote which must be considered as more fully discussed below. Also below is a section on applicable case …
California Workers’ Compensation Law: Working Light Duty from HomeRead More
Today’s sixty-second blog is designed to save employers over a hundred thousand dollars in death benefits due to a misunderstanding of law that very few claims professionals are aware of. Unfortunately, due to COVID-19, there has been a spike in death claims filed over the past two-years. As expected, the most frequent recipient of death …
The Misapplied Law: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
It is reasonably understood in the workers’ compensation industry that an employer is required to provide a DWC-1 Claim Form to an injured worker within one working day of receiving notice or knowledge from any source of an industrial injury resulting in lost time beyond the employee’s work shift at the time of injury, or …
The DWC-1 Claim Form: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Most claims professionals operate from the premise that temporary disability compensation benefits are limited to a maximum payout of 104-weeks within five-years of the date of injury; however, under Labor Code 4656(a)(3) there are 9 injuries which provide a disabled worker with temporary disability compensation for up to 240-weeks: Acute and chronic hepatitis B; acute and chronic …
The 240-Week TD Rule: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
For the most part workers’ compensation claims adjusters are aware of the need to complete state-mandated educational requirements every two years in order to continue to perform their job duties. However, we ask, “Who is overseeing and enforcing the educational rules?” Insurance Code 11761 directs the commissioner of the California Department of Insurance (CDOI) to …
Excluding burial expenses, what is the maximum value of benefits payable in a death claim to “one total and one partial-dependent?” If you need a minute to go look it up, go ahead and research it. We’ll wait. Did you look it up? Is your answer $290,000? That’s the answer that almost everyone, including judges, …
We are grateful to all our loyal clients, valued employees and dear colleagues. Thank you. A lot has happened since we first opened our doors. Please enjoy this flash to the past showing how far workers’ compensation has come in just 32 years. For some this could be history, but for Friedman and Bartoumian, it’s …
#5 DRUG TESTING POLICY Drug testing must be for cause with reasonable suspicion. Simply drug testing due to being involved in an industrial accident is not recommended unless required by federal or state regulations. Over the years many companies have implemented drug testing policies for various safety reasons. Certain drug testing policies are required by …
#11 FORMING COMPANY TEAMS Sponsoring Company Teams Can Lead to Workers’ Comp Liability If an Employee Becomes Injured Even Though Participation is Voluntary. Most employers are often aware that injuries occurring during an off-duty social, recreational or athletic activity are usually non-compensable. However, liability may apply when an employer generously offers to sponsor an employee …
