Although it may be difficult to believe, there is a definite home-field advantage in workers’ compensation when it comes to litigating claims at certain Appeals Board district offices. When a judge interacts with a particular attorney every day, there is a natural tendency to favor a familiar face over an attorney who is a stranger, …
WCAB Venue: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Oftentimes a primary treating physician (PTP) and a qualified medical examiner (QME) disagree over the extent of Permanent Disability. One physician may identify permanent impairment at 40%, while the other rates it at 60%. When PD falls within a range, parties will often split the difference to achieve settlement. In our 40%-60% example, a split …
We are cautiously optimistic that the title of today’s blog caught your attention in that most claims professionals have been trained that Labor Code §5401 requires an employer to present a DWC-1 claim form to an employee within one business day upon receipt of knowledge from any source of an industrial injury beyond first aid. …
A DWC Form 5020 is often the first document by which an employer learns about workers’ compensation claim procedures. Created by the state of California, it is also known as the “Employer’s Report of Occupational Injury or Illness,” and is informally known as the “Employer’s First Report” or the “5020.” The DWC-5020 sets forth 39 …
The DWC-5020: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
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 …
