Today’s Topic: Destroying a Claims Department 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 focus on …
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Today’s Topic: Piggyback MSAs 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 …
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Today’s Topic: UR and IMR Decisions 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 …
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Today’s Topic: Benefit Notices 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. …
A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Today’s Topic: The Two-Year Rule (LC 4661.5) 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 …
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Today’s Topic: Reserve Redundancy Reports 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 …
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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 Topic: The Misapplied Law 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 …
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