Do you know what happens in a workers’ compensation case when an applicant and their employer simultaneously strike the same physician from a PQME list? Do you know what happens when a party fails make any strike? The answers to these questions are not contained in either the Labor Code or the Code of Regulations, …
QME Strike Procedures: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
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. …
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 …
A Near Miss: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
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 …
Defending Your MPN! A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
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 …
The Company Picnic: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
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 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 …
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 …
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 …
Defending EDD Liens: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
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 …
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 …
Where’s Your Evidence? A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
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 …
Unnecessary Insurance: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
