It is truly mind-boggling to learn that over the past four years, over 600,000 DWC targeted audit complaints have been filed by medical providers against bill review companies. Such a volume of disputes makes it difficult for us to decide where to begin today’s blog. Therefore, to keep this blog as a one-minute read, we …
Common Bill Review Issues: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
In California, every large insurance agency or brokerage firm has at least one workers’ compensation claims consultant on staff to analyze reserves, evaluate claims administrator performance and consult with their clients, the employers. There are also numerous private claims consultants available for hire to assist companies with their work comp needs. In addition, attorneys have …
The Claims Consultant: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
In workers’ compensation, it is common knowledge that discrimination in any manner against an injured employee in retaliation for filing an industrial claim is illegal. It is also illegal for an employer to discriminate against a co-worker who testifies or makes known their intent to testify on behalf of an injured worker. The penalties for …
LC § 132a Discrimination: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Substantial savings are often realized through use of a Medical Provider Network (MPN), especially if the MPN offers the highest quality of medical providers. Since the creation of MPNs, we have seen our share of “problematic” doctors. Some physicians have a reputation for recommending surgery for every work comp patient they see, while others are …
Pursuant to California Labor Code § 138.5, the Division of Workers’ Compensation is required to cooperate with the Department of Child Support Services in the enforcement of family support orders. In addition, Code of Civil Procedure § 704.160 explains the procedure for garnishment of workers’ compensation temporary disability benefits to satisfy child support obligations. The maximum amount …
Garnishments: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
California workers’ compensation law requires that permanent disability (PD) advances be issued upon termination of temporary disability (TD) entitlement and/or when the injured worker reaches maximum medical improvement (MMI) status, provided that there is a reasonable expectation PD will be found. Pursuant to Labor Code § 4650(b)(2), there are two exceptions allowing for non-payment of …
PD Overpayments: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
It is quite common in a litigated claim for an applicant’s attorney to demand disclosure and service of surveillance videos. Such a demand is usually found in the attorney’s Notice of Representation, which advises the employer that the applicant is now represented by legal counsel. In today’s blog our readers will learn that even when …
Surveillance Films: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
We believe with a high degree of certainty that almost every workers’ compensation claims administrator has encountered a situation where a medical provider refused to release information unless the adjuster first produced a HIPAA release signed by the applicant. HIPAA is an acronym for Health Insurance Portability and Accountability Act of 1996, and is codified …
Every so often, a case dramatically alters what we thought we knew about “the rules of the game.” This is the story of Marisol Resendiz v. La Corneta, Inc. (2021 Cal. Wrk. Comp. P.D. LEXIS 207), the WCAB case that forever changed our understanding of the horseplay defense. On May 19, 2019, Marisol Resendiz, a …
When Horseplay Pays: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
When dealing with a cumulative trauma claim involving multiple employers, an injured worker has the right to elect the employer they wish to proceed against. Alternatively, when multiple insurance companies provide coverage to a single employer over the time frame of a CT injury, the injured worker may elect one carrier as the primary defendant. …
On July 16, 2003, Labor Code § 3201.5 was enacted, establishing an alternative dispute resolution (ADR) process in California’s workers’ compensation system. ADR is also often referred to as a “carve-out” program. The intent of ADR is to bypass WCAB conferences, hearings, and trials to quickly resolve workers’ compensation disputes without the delays and expense …
Allow us to begin today’s blog with a question. Have you ever experienced the thrill of scratching off a winning California lottery ticket? A $5 winner alone would probably make a smile come to your face. Winning $50 would likely inspire multiple fist pumps. But how about winning $500? How exciting would that be? Our …
Lucky Bucks: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
