Even though many examiners work remotely on a full-time basis, they are still under the threat that an irate and potentially violent injured worker might become aware of their day-to-day whereabouts. Not only does this make the examiner fearful for their personal safety but also for that of their family and co-workers. Memories of a …
The Numbers Don’t Add Up: A 60-Second Seminar in Workers’ Compensation Claims Handling
Many employers and claims professionals don’t realize that the rules of conventional mathematics don’t always apply to claims for workers’ compensation benefits. For example, in workers’ compensation 25 + 25 does not equal 50, at least not in the context of permanent disability calculations! Allow us to demonstrate. A 25% PD award is worth $29,217.50. …
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Putting the Cart Before the Horse: A 60-Second Seminar in Workers’ Compensation Claims Handling
In today’s blog we will explain a legal tactic used by applicants’ bar for over 30 years that has needlessly cost employers untold amounts of money. It is our sincere desire to put an end to this maneuver by bringing it to the attention of the workers’ compensation defense community. In September 1994 Governor Pete …
Physicians Who Quit Comp: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Have you ever wondered why so many physicians refuse to treat workers’ compensation patients? The answer is actually easy to explain. Physicians have a difficult time dealing with our present-day work comp system, which is exceptionally tedious and, for many physicians, simply not worth the time and expense. In fact, it’s surprising that more physicians …
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Common Bill Review Issues: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
It is truly mind-boggling to learn that over the past four years, over 600,000 DWC targeted audit complaints have been filed by medical providers against bill review companies. Such a volume of disputes makes it difficult for us to decide where to begin today’s blog. Therefore, to keep this blog as a one-minute read, we …
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The Claims Consultant: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
In California, every large insurance agency or brokerage firm has at least one workers’ compensation claims consultant on staff to analyze reserves, evaluate claims administrator performance and consult with their clients, the employers. There are also numerous private claims consultants available for hire to assist companies with their work comp needs. In addition, attorneys have …
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LC § 132a Discrimination: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
In workers’ compensation, it is common knowledge that discrimination in any manner against an injured employee in retaliation for filing an industrial claim is illegal. It is also illegal for an employer to discriminate against a co-worker who testifies or makes known their intent to testify on behalf of an injured worker. The penalties for …
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Removing Physicians from an MPN: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Substantial savings are often realized through use of a Medical Provider Network (MPN), especially if the MPN offers the highest quality of medical providers. Since the creation of MPNs, we have seen our share of “problematic” doctors. Some physicians have a reputation for recommending surgery for every work comp patient they see, while others are …
Garnishments: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Pursuant to California Labor Code § 138.5, the Division of Workers’ Compensation is required to cooperate with the Department of Child Support Services in the enforcement of family support orders. In addition, Code of Civil Procedure § 704.160 explains the procedure for garnishment of workers’ compensation temporary disability benefits to satisfy child support obligations. The maximum amount …
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PD Overpayments: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …
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Surveillance Films: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …
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Medical Confidentiality/HIPAA: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …