One of many topics in workers’ compensation where an adjuster is presumed to automatically know what to do concerns death benefits. Today’s blog tells an incredible story of what happened in a death benefit claim where the adjuster was ignorant of the applicable law. Our story begins with a claims adjuster for a major company …
Burial Benefits: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
It should not come as a surprise to anyone in our industry that abuse is rampant in the workers’ compensation system. Abuse is encountered everywhere, even when dealing with durable medical equipment. In today’s blog we will expose an element of DME abuse that most claims professionals are unaware of. Let’s presume a worker injured …
DME Abuse: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Often fraught with difficulty even in one’s personal affairs, the refilling of a medical prescription in a workers’ compensation case is sometimes a gargantuan endeavor! This is true even though prescription medicines and medical devices are covered benefits under a workers’ compensation claim and are often vital components in the treatment of an industrial injury. …
Rx Refills: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
When comparing the job requirements of today’s workers’ compensation claims adjuster to those of yesteryear, the difference is like night and day. Thirty-years ago, a claims adjuster was a jack of all trades. Adjusters of that era would handle all types of comp claims. An adjuster’s inventory consisted of med-only, indemnity and death cases. In …
Today’s Claims Adjuster: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
It seems incomprehensible but for the past twenty years our workers’ compensation system has failed to acknowledge a paradox that exists regarding death benefits. The purpose of today’s blog is to explain the paradox to allow our readers to decide on the interpretation of their choice. We believe it is safe to state that most …
The Death Benefit Paradox: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
In the process of estimating the final cost of claims under a policy of workers’ compensation insurance, insurers and claim administrators typically add a charge for what is known as “IBNR,” which stands for “incurred but not reported.” For the most part this acronym is foreign to a claims department; however, it has exceptional meaning …
Allow us to begin today’s blog by asking three workers’ compensation trivia questions: Q. 1: “What is the number one cause of death for men who die on the job?” Q. 2: “What is the number one cause of death for women who die at work?” Q. 3: “Where at work is the most likely …
Coworker Liability: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Today’s blog addresses the confusion in the workers’ compensation community over the DWC Debit Card law. In 2018, Senator Richard Pam (D-Sacramento) introduced Senate Bill 880, creating LC § 4651(a)(3)(A), effective 01/01/2019. Specifically, LC § 4651(a)(3)(A) authorized workers’ compensation claims administrators to voluntarily issue indemnity payments by debit card on a trial basis. The trial …
Work Comp Debit Cards: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Pursuant to Title 8 CCR §15251 all self-insured employers, both public and private, are required to file an annual report with the California Office of Self-Insurance Plans (OSIP). Individual-Private and Private-Group employers are to file by March 1 using Form AR-1 (1-2016), while all public self-insured employers, whether a member of a joint-powers authority, have …
The Self-Insurance Report: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
A most bizarre event occurs in workers’ compensation whenever there is a need for a QME panel. The parties race each other to determine who will be first to request a panel. All too often applicant attorneys request chiropractic panels regardless of the injury, whether it involves a foot, an ear or even a heart …
The QME Race: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
The other day we were thinking how nice it would be if workers’ compensation adopted a new fee schedule to reduce the number of interpreter liens currently being filed. The sheer number of interpreter liens being filed at the appeals board is truly staggering. We are not talking about hundreds or thousands of liens. We …
The Interpreter Fee Schedule: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Most claims professionals have never heard of the “20/120 rule” in workers’ compensation. It can be found in the Regulations under 8 CCR 10636(b), governing the request, production, and service of benefit printouts. For the most part, claims administrators consider the production and service of a benefit printout as a clerical function. Unfortunately, clerical staffers …
The 20/120 Rule: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
