It is safe to presume that every administrator of claims for workers’ compensation benefits is aware of the government’s right to seek reimbursement of Medicare Conditional Payments. These payments are known as Medicare Secondary Payer (MSP) claims and are asserted by Medicare Secondary Payer Recovery Contractors (MSPRC) who seek reimbursement in the federal government’s behalf. …
A Near Miss: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
As strange as it may seem, employers in workers’ compensation can learn a valuable lesson from the airline industry. At 11:56 p.m. on the evening of July 7, 2017, the largest aviation disaster in the history of the world was narrowly averted by less than 1 second. It occurred at San Francisco International Airport when …
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Defending Your MPN! A Sixty-Second Seminar in Workers’ Compensation Claims Handling
It’s no secret that injured workers and applicant attorneys dislike Medical Provider Networks (MPN). They exploit every loophole to escape an MPN to select a doctor of their choice to be the worker’s primary treating physician (PTP). For years, a popular method to escape an MPN was for the worker to request a physician in …
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The Company Picnic: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
During the warm summer months many businesses elect to close for an afternoon to hold a good old-fashioned company picnic. Everyone goes off to a local park for a delicious barbeque lunch where employee camaraderie abounds, fostered by games, contests, and other physical activities, competitive and goofy. Typically, everyone has a great time, but very …
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Frivolous Penalty Petitions: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
It is an alarming reality that penalty petitions now seem to arise from most disagreements between an adjuster and applicant attorney as to a claims issue, even when the adjuster’s position is supported by the facts and a good-faith interpretation of the law. In our experience it appears that the applicant’s bar has seized on …
“Take Nothings” – Are They Worth It? A Sixty-Second Seminar in Workers’ Compensation Claims Handling
“Take Nothing!” This is often a magical phrase to an employer, administrator, and defense attorney. The phrase means that an applicant has lost at trial at the appeals board and was awarded no workers’ compensation benefits. In practice, “Take Nothing” orders are very rare, to the tune that only 1 in 750 cases that go …
Specious Claims Adjuster Education: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
On February 22, 2006, mandatory continuing education for workers’ compensation claims adjusters became required in California when Title 10, § 2592.10 of the California Code of Regulations became operational. Coupled with the 2005 enactment of Insurance Code 11761, adjusters became obligated to accumulate no less than 32 hours of continuing education every two years to …
Defending EDD Liens: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Of the numerous stakeholders who are involved in the resolution of a claim for workers’ compensation benefits, the role of the Employment Development Department (EDD) is often overlooked. However, in practice, an early determination of whether the EDD has paid money to the injured worker, and meaningful contact with the EDD thereafter, are critical. The …
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Dirty Tricks in Workers’ Compensation: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Nobody likes being fooled, especially when done maliciously. Although the Board will act to protect itself from being deemed a willing participant to a fraud, it is less likely to act when the victim is an employer, insurance company or a TPA. Therefore, please consider today’s blog as a public service announcement to warn our …
Where’s Your Evidence? A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Today we are going to tell you an incredible story about three newly-hired workers with physical and psych injuries, who each testified at the Board as to the nature of their industrial accident. The first injury resulted from a car crash. The second occurred from a fall off a ladder, while the third happened when …
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Unnecessary Insurance: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Let’s begin today’s blog with an easy question. Does your company own or lease any motor vehicles, including cars, trucks, vans or busses? Many businesses require employees to use company vehicles when working. Of course, we all know California law requires motor vehicles on a public roadway to be insured for liability. However, additional coverages …
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Serious & Willful Misconduct: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Whenever a catastrophic injury occurs, it is quite common for an applicant’s attorney to seek a penalty against the employer by filing a Petition for Serious and Willful Misconduct (S&W). This is just their way of trying to squeeze a little extra money out of the employer. Unfortunately, many employers do not fully understand exactly …