When a fatality claim is filed, the claims administrator’s best practice is to immediately investigate the circumstances of both death and dependency. Often, the only dependent of the decedent is the spouse. For the sake of this blog let us presume that a deceased worker is survived only by a fully dependent wife. The decedent …
Investigating Dependency: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Most claims professionals are aware that LC §4658.7(g) forbids settlement of a Supplemental Job Displacement Benefit (SJDB) voucher for an admitted industrial injury occurring on or after 1/1/2013. There is however, one exception. Namely, when an affirmative defense is raised, where if litigated the employee may “take nothing,” including the voucher. The purpose of today’s …
Voucher Eligibility: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Although it may be difficult to believe, there is a definite home-field advantage in workers’ compensation when it comes to litigating claims at certain Appeals Board district offices. When a judge interacts with a particular attorney every day, there is a natural tendency to favor a familiar face over an attorney who is a stranger, …
WCAB Venue: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Oftentimes a primary treating physician (PTP) and a qualified medical examiner (QME) disagree over the extent of Permanent Disability. One physician may identify permanent impairment at 40%, while the other rates it at 60%. When PD falls within a range, parties will often split the difference to achieve settlement. In our 40%-60% example, a split …
We are cautiously optimistic that the title of today’s blog caught your attention in that most claims professionals have been trained that Labor Code §5401 requires an employer to present a DWC-1 claim form to an employee within one business day upon receipt of knowledge from any source of an industrial injury beyond first aid. …
A DWC Form 5020 is often the first document by which an employer learns about workers’ compensation claim procedures. Created by the state of California, it is also known as the “Employer’s Report of Occupational Injury or Illness,” and is informally known as the “Employer’s First Report” or the “5020.” The DWC-5020 sets forth 39 …
The DWC-5020: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Do you know what happens in a workers’ compensation case when an applicant and their employer simultaneously strike the same physician from a PQME list? Do you know what happens when a party fails make any strike? The answers to these questions are not contained in either the Labor Code or the Code of Regulations, …
QME Strike Procedures: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
It is safe to presume that every administrator of claims for workers’ compensation benefits is aware of the government’s right to seek reimbursement of Medicare Conditional Payments. These payments are known as Medicare Secondary Payer (MSP) claims and are asserted by Medicare Secondary Payer Recovery Contractors (MSPRC) who seek reimbursement in the federal government’s behalf. …
