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 …
Garnishments: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …
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PD Overpayments: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …
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Surveillance Films: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …
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Medical Confidentiality/HIPAA: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …
When Horseplay Pays: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …
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Electing Against an Employer: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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. …
Alternative Dispute Resolution (ADR): A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …
Lucky Bucks: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
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 …
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Clandestine Litigation: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
As we well know, when a worker suffers an industrial accident, the worker may obtain workers’ compensation benefits from their employer, even if the employer was not at fault. And when the workers’ injuries are caused by a third party, the worker may also seek civil damages via a claim/lawsuit against the negligent tortfeasor. Also, …
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Preventing Claims: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Without a doubt the best way for an employer to control its workers’ compensation costs is to prevent accidents from occurring in the first place. An effective safety program is a proven means of protecting employees from injury while saving the employer thousands of dollars in insurance premiums. Various safety programs exist, mostly comprised of …
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VCB Liens: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Do you know what a VCB lien is? Many claims professionals have never heard of it, yet under Labor Code 4309(i) it is one of several types of liens which arise in a claim for workers’ compensation benefits. Our blog today will explain VCB liens and provide claims handling instructions, as VCB liens are not …
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