Today we will discuss a topic that we believe has never been presented to claims professionals anywhere in this state. It’s called “Parental Rights in Workers’ Compensation.” Allow us to begin by asking two questions. As strange as it may seem both scenarios are possible. Let’s begin our analysis by examining the first question where …
When to Pay PDAs: A 60-Second Seminar in Workers’ Compensation Claims Handling
Today’s blog focuses on when permanent disability advances (PDAs) are to be paid. The rules pertaining to PDAs have been somewhat murky ever since the governing law was amended eleven years ago. Prior to 2013, the only statute which addressed the payment of PDAs was Labor Code § 4650(b), which directed that PDAs begin within 14 …
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The EDD Experiment: A 60-Second Seminar in Workers’ Compensation Claims Handling
Today’s blog tells the story of a long-forgotten workers’ compensation experiment that occurred back in 2003. It was a time when there was a significant shortage of worker’s compensation adjusters. Coincidentally, in 2003 our state economy was in a recession with an unusual number of recently laid off and out of work college graduates receiving Unemployment …
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Medical Bill Review: A 60-Second Seminar in Workers’ Compensation Claims Handling
Allow us to give fair warning that some readers may find today’s blog to be disturbing. A great deal of needless trouble and frustration is currently occurring due to the inability of a few medical bill review companies to recognize a simple DWC form. Their actions are causing many problems in workers’ compensation, especially for …
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Nature and Extent: A 60-Second Seminar in Workers’ Compensation Claims Handling
There are times when a workers’ compensation claims administrator will admit industrial injury but deny disability benefits due to a nature and extent defense. In addition, some claims professionals are confused when to acknowledge an event as being an incident as opposed to an accident. The purpose of today’s blog is to explore the nature and extent …
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Applicant Attorney Fraud: A 60-Second Seminar in Workers’ Compensation Claims Handling
The other day a claims adjuster reported an applicant attorney to the company’s SIU department for suspected workers’ compensation fraud. The attorney had been handling a death claim where he named a widow and two grandchildren as dependents. The claims adjuster accepted liability for the widow but disputed dependency as to the grandchildren. At the time of …
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Intoxication: A 60-Second Seminar in Workers’ Compensation Claims Handling
Of all the affirmative defenses in workers’ compensation, by far the most difficult for an employer to successfully litigate is intoxication. This defense is comprised of three elements, all of which must be proven by the employer. The purpose of today’s blog is to review the requirements to successfully raise an intoxication defense as it …
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A New TD Entitlement: A 60-Second Seminar in Workers’ Compensation Claims Handling
Today we will discuss a recent development in workers’ compensation law involving a situation that arose when EDD was not immediately reimbursed following an award of compensability. Our story begins with a denied claim for worker’s compensation benefits where the claimant filed for and received 52-weeks of SDI benefits from the EDD. Two years later …
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Uncooperative Injured Workers: A 60-Second Seminar in Workers’ Compensation Claims Handling
Allow us to begin today’s blog by asking a question. “What happens when an injured worker is uncooperative in their claim for benefits?” Presumably, the answer depends on the issue at hand and the degree of non-cooperation. There are many forms of uncooperative behavior, ranging from failure to provide requested information during a compensability investigation …
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The Gambler: A 60-Second Seminar in Workers’ Compensation Claims Handling
It is truly puzzling how certain parties at the appeals board gamble by proceeding to trial when they have no realistic chance of successfully litigating a dispute. It’s as if they somehow convinced themselves they are holding a winning hand. They usually end up losing badly. The purpose of today’s blog is to identify four scenarios where employers …
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A Promise to Pay: A 60-Second Seminar in Workers’ Compensation Claims Handling
We will begin today’s blog with a question. “Is it possible for someone to be declared a dependent in a death claim based solely on a decedent’s promise to provide financial support?” In other words, “Is a financial promise sufficient to allow successful presentation of a dependency death claim under workers’ compensation?” First, let’s discuss …
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GAF Scores: A 60-Second Seminar in Workers’ Compensation Claims Handling
Although several states do not recognize the compensability of psychiatric injury claims, here in California mental injuries have long been an integral part of our workers’ compensation system. The medical authority used in California to diagnose psychiatric injury and disability is the Global Assessment of Functioning (GAF) Scale, found in Axis V (aka Chapter 5) …
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