We are somewhat confident that most claims professionals are aware the law requires utilization review (UR) to issue a decision within five business days of receipt of a request for authorization (RFA). It’s called the five-day rule. However, the amount of litigation occurring over interpretation of this rule is absolutely mind boggling. We are not …
The Five-Day Rule: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Most workers’ compensation claims professionals are aware of the axiom, “what the employer knows, the claims administrator is presumed to know.” This phrase is interpreted to means that if an employer is aware of a fact pertaining to a workers’ compensation case, then its administrator is also presumed to be aware of it, under the …
Imputed Knowledge: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We recently faced an interesting situation arising from a carrier’s failure to timely issue a decision in a case where compensability was being investigated. The decision was issued well beyond the limit allowed under Labor Code 5401(b)(1), which provides that once 90-days from submission of a DWC-1 Claim Form has elapsed without a decision, the …
Claims Forfeiture: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We suspect that many claim professionals have wondered what workers’ compensation law has to say as to employees injured as a result of an act of terrorism. Sadly, injury by that scenario is not that far-fetched. Case in point, the terrorist attack which occurred on December 2, 2015, in San Bernardino resulting in the death …
Terrorism Claims: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We are substantially certain that our readers will not be surprised to learn that certain applicant attorneys are known for issuing a dozen or more document production subpoenas in every case they handle. The subpoenas almost always include one which seeks the applicant’s personnel file. These attorneys can’t wait to read what the employer has …
Employment Records: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Today we will discuss a topic that we believe has never been presented to claims professionals anywhere in this state. It’s called “Parental Rights in Workers’ Compensation.” Allow us to begin by asking two questions. As strange as it may seem both scenarios are possible. Let’s begin our analysis by examining the first question where …
Of all the affirmative defenses in workers’ compensation, by far the most difficult for an employer to successfully litigate is intoxication. This defense is comprised of three elements, all of which must be proven by the employer. The purpose of today’s blog is to review the requirements to successfully raise an intoxication defense as it …
Intoxication: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We will begin today’s blog with a question. “Is it possible for someone to be declared a dependent in a death claim based solely on a decedent’s promise to provide financial support?” In other words, “Is a financial promise sufficient to allow successful presentation of a dependency death claim under workers’ compensation?” First, let’s discuss …
A Promise to Pay: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
There are times when an unrepresented injured worker vehemently disagrees with the findings of a Qualified Medical Evaluator’s (QME), and as a result, the worker seeks legal representation in hope of somehow setting aside the examination report. The purpose of today’s blog is to explain what some applicant attorneys do to throw out a QME …
Throwing out a QME Report: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Surprisingly, workers’ compensation claims professionals continue to encounter problems administering the three-day temporary disability waiting period. One misunderstanding concern whether the waiting period is applied or waived when an injured worker returns to work on light duty at half-days immediately following an injury. In our blog today we will tackle some of the basic questions …
The Waiting Period: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
In general, California’s Workers’ Compensation Act excludes benefits to “volunteers” who are injured while rendering services to a business, on the grounds that they are not “employees.” Having written that, and even though the parties may have agreed beforehand that a worker is a volunteer, the situation often changes once an accident occurs and the …
Volunteers: 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
