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 be to focus on writing as much …
Piggyback MSAs: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 seen a situation …
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UR and IMR Decisions: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 RFA is certified the requested …
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Benefit Notices: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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. For example: In …
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The Two-Year Rule (LC 4661.5): A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 the two-year rule work? The best …
Reserve Redundancy Reports: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 goes unnoticed. When a claim …
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The Misapplied Law: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 most frequent recipient of death …
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The DWC-1 Claim Form: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
It is reasonably understood in the workers’ compensation industry that an employer is required to provide a DWC-1 Claim Form to an injured worker within one working day of receiving notice or knowledge from any source of an industrial injury resulting in lost time beyond the employee’s work shift at the time of injury, or …
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The 240-Week TD Rule: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Most claims professionals operate from the premise that temporary disability compensation benefits are limited to a maximum payout of 104-weeks within five-years of the date of injury; however, under Labor Code 4656(a)(3) there are 9 injuries which provide a disabled worker with temporary disability compensation for up to 240-weeks: Acute and chronic hepatitis B; acute and chronic …
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State Mandated Education for Claims Adjusters: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
For the most part workers’ compensation claims adjusters are aware of the need to complete state-mandated educational requirements every two years in order to continue to perform their job duties. However, we ask, “Who is overseeing and enforcing the educational rules?” Insurance Code 11761 directs the commissioner of the California Department of Insurance (CDOI) to …
The DWC Death Benefits Chart: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Excluding burial expenses, what is the maximum value of benefits payable in a death claim to “one total and one partial-dependent?” If you need a minute to go look it up, go ahead and research it. We’ll wait. Did you look it up? Is your answer $290,000? That’s the answer that almost everyone, including judges, …