California workers’ compensation law requires that permanent disability (PD) advances be issued upon termination of temporary disability (TD) entitlement and/or when the injured worker reaches maximum medical improvement (MMI) status, provided that there is a reasonable expectation PD will be found. Pursuant to Labor Code § 4650(b)(2), there are two exceptions allowing for non-payment of …
PD Overpayments: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
It is quite common in a litigated claim for an applicant’s attorney to demand disclosure and service of surveillance videos. Such a demand is usually found in the attorney’s Notice of Representation, which advises the employer that the applicant is now represented by legal counsel. In today’s blog our readers will learn that even when …
Surveillance Films: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
We believe with a high degree of certainty that almost every workers’ compensation claims administrator has encountered a situation where a medical provider refused to release information unless the adjuster first produced a HIPAA release signed by the applicant. HIPAA is an acronym for Health Insurance Portability and Accountability Act of 1996, and is codified …
There are times when an applicant’s attorney will offer a claims administrator the opportunity to quickly settle future medical benefits in a very old workers’ compensation claim. Such an offer should be viewed as a red flag warning to the administrator that something may not be right. We usually see a request for a quick …
Red Flag Settlement Offers: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Every so often, a case dramatically alters what we thought we knew about “the rules of the game.” This is the story of Marisol Resendiz v. La Corneta, Inc. (2021 Cal. Wrk. Comp. P.D. LEXIS 207), the WCAB case that forever changed our understanding of the horseplay defense. On May 19, 2019, Marisol Resendiz, a …
When Horseplay Pays: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
When dealing with a cumulative trauma claim involving multiple employers, an injured worker has the right to elect the employer they wish to proceed against. Alternatively, when multiple insurance companies provide coverage to a single employer over the time frame of a CT injury, the injured worker may elect one carrier as the primary defendant. …
On July 16, 2003, Labor Code § 3201.5 was enacted, establishing an alternative dispute resolution (ADR) process in California’s workers’ compensation system. ADR is also often referred to as a “carve-out” program. The intent of ADR is to bypass WCAB conferences, hearings, and trials to quickly resolve workers’ compensation disputes without the delays and expense …
Allow us to begin today’s blog with a question. Have you ever experienced the thrill of scratching off a winning California lottery ticket? A $5 winner alone would probably make a smile come to your face. Winning $50 would likely inspire multiple fist pumps. But how about winning $500? How exciting would that be? Our …
Lucky Bucks: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
As we well know, when a worker suffers an industrial accident, the worker may obtain workers’ compensation benefits from their employer, even if the employer was not at fault. And when the workers’ injuries are caused by a third party, the worker may also seek civil damages via a claim/lawsuit against the negligent tortfeasor. Also, …
Clandestine Litigation: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Without a doubt the best way for an employer to control its workers’ compensation costs is to prevent accidents from occurring in the first place. An effective safety program is a proven means of protecting employees from injury while saving the employer thousands of dollars in insurance premiums. Various safety programs exist, mostly comprised of …
Preventing Claims: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Do you know what a VCB lien is? Many claims professionals have never heard of it, yet under Labor Code 4309(i) it is one of several types of liens which arise in a claim for workers’ compensation benefits. Our blog today will explain VCB liens and provide claims handling instructions, as VCB liens are not …
VCB Liens: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
It is a sad but unfortunate fact that catastrophic injuries resulting in serious injury or loss of life do occur in the workplace. Such tragedies are often investigated by Cal-OSHA and may even draw the attention of the local criminal prosecutor/district attorney should the incident be attributed to gross negligence. It is at this time …
Protecting the Employer: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
