We are somewhat confident that most claims professionals are aware the law requires utilization review (UR) to issue a decision within five business days of receipt of a request for authorization (RFA). It’s called the five-day rule. However, the amount of litigation occurring over interpretation of this rule is absolutely mind boggling. We are not …
The Five-Day Rule: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
There are times when an employer is uncertain if a claim should be filed when a worker claims injury, especially when compensability is in question. Employers are often advised by their administrator that when in doubt, err on the side of caution by submitting an Employer’s First Report of Industrial Injury form, knowing that the …
Creating Needless Claims: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Most workers’ compensation claims professionals are aware of the axiom, “what the employer knows, the claims administrator is presumed to know.” This phrase is interpreted to means that if an employer is aware of a fact pertaining to a workers’ compensation case, then its administrator is also presumed to be aware of it, under the …
Imputed Knowledge: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We recently faced an interesting situation arising from a carrier’s failure to timely issue a decision in a case where compensability was being investigated. The decision was issued well beyond the limit allowed under Labor Code 5401(b)(1), which provides that once 90-days from submission of a DWC-1 Claim Form has elapsed without a decision, the …
Claims Forfeiture: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
The California Office of Self-Insurance Plans (OSIP) is the state entity responsible for offering the Self-Insured Workers’ Compensation Claims Administrator examination. Candidates who successfully pass the exam receive a certificate demonstrating their competency to handle self-insured claims. By regulation, every self-insurance adjusting location is required to have at least one person on staff who successfully passed the …
The Self-Insurance Exam: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Many claim professionals are unaware that our California workers’ compensation system allows the public free limited access to records of the Workers’ Compensation Appeals Board through the EAMS computer database. EAMS is an acronym for “Electronic Adjudication Management System” which has been used by the WCAB since November 17, 2008. It replaced the Electronic Data Exchange …
EAMS Case Search: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Due to the nature of certain industrial injuries, there are times during the life of a workers’ compensation claim when an injured worker may require QME examinations by physicians specializing in different fields of medicine. For example, a worker with alleged foot, ear and heart injuries will probably require evaluations by a podiatrist, otologist, and …
Requesting an Additional QME: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We will begin today’s blog by asking our readers to answer four questions concerning the role an injured worker’s occupation plays when calculating a PD rating. Question #1: If a worker performs two occupations for an employer, which occupation is used when rating PD? Answer: The occupation producing the greater rating is used. Question #2: …
Occupational Adjustment: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We suspect that many claim professionals have wondered what workers’ compensation law has to say as to employees injured as a result of an act of terrorism. Sadly, injury by that scenario is not that far-fetched. Case in point, the terrorist attack which occurred on December 2, 2015, in San Bernardino resulting in the death …
Terrorism Claims: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Sadly, even though opioid prescriptions have significantly decreased over the past two years, the number of drug overdose deaths occurring in the United States each year are at epidemic levels. Overdose death attributed to prescription drugs in 2019 was recorded at a staggering 70,639. In 2020 the number of deaths increased to 91,799, then to …
Accidental Drug Overdoses: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We are substantially certain that our readers will not be surprised to learn that certain applicant attorneys are known for issuing a dozen or more document production subpoenas in every case they handle. The subpoenas almost always include one which seeks the applicant’s personnel file. These attorneys can’t wait to read what the employer has …
Employment Records: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Allow us to begin today’s blog with a quick history lesson. It was the year 2002. The California Department of Insurance was literally swamped with complaints from employers concerning the cost of workers’ compensation insurance. In addition, injured workers complained about poor claims adjuster performance, while physicians squawked about medical bill reviewers improperly applying the state’s …
Education Certificates: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
