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
When industrial compensability is in dispute, either for an entire injury or for just a body part, claims administrators should act cautiously should a Request for Authority (RFA) be received. The RFA is not to be addressed by utilization review (UR). Instead, pursuant to Labor Code §4610(l)&(m) and C.C.R. 9792.9.1(b)(1), the administrator should respond within …
Red Flag UR Decisions: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We begin today’s blog by asking a simple question: if an injured worker lies to a workers’ compensation administrator, can that employee be charged with criminal fraud? The answer depends on the nature and extent of the lie. Some deceptions are of negligible import, while others are material and should lead to a criminal prosecution, …
Claims Adjuster Fraud: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
In today’s world of workers’ compensation, it is common for claims administrators, insurance companies and law firms to use an out-of-state mailing address, which may result in a misunderstanding of our state’s mailbox rule and how it applies to extend response time. With that said, we will dedicate today’s blog to provide a timely discussion …
The Mailbox Rule: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Three days before Christmas, a funny thing happened in the workers’ compensation world. A long-standing provision of the Labor Code was declared unconstitutional. Specifically, on 12/22/23, the California Court of Appeals declared LC §139.32(b) unconstitutional on the grounds of vagueness. What’s funny about that? Nobody in the workers’ compensation community seems to have noticed! LC …
Nobody Noticed: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Have you ever heard of the “Wimpy Syndrome”? It occurs every few years when our state legislature considers workers’ compensation reform. The Wimpy Syndrome is named after a fictional cartoon character prominently featured in the original Popeye the Sailor comic strips of the 1930’s. J. Wellington “Wimpy” is a gourmet of the finest hamburgers money can buy, …
The Wimpy Syndrome: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
When attempting to settle an expensive/high exposure claim for workers’ compensation benefits have you considered a structured settlement funded by an annuity? If not, our blog today will be of interest as we will put to rest three prevailing myths about settling via an annuity. Note, to abide by our one-minute blog time limit we …
Hello and Happy New Year’s wishes to our friends, clients, and colleagues in the workers’ compensation claims community! F&B is proud to publish the 100th edition of our “60 Second Seminar” series of workers’ compensation educational blogs, providing practical, succinct, and timely information for use by insurers, claims administrators, employers, and brokers! It is also …
New Laws of 2024: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
For years, it was a common practice for employers to require a resignation before settling a workers’ compensation claim by Compromise and Release (C&R). However, all that changed on 1/1/2020 when Assembly Bill 749 was enacted, amending Code of Civil Procedure § 1002.5(a), prohibiting mandatory resignation as a condition to the settlement of an employment dispute, …
Requesting a Resignation: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
When it comes to invoices from medical providers and other vendors, the standard rule in workers’ compensation claims administration is to pay what the administrator believes is owed and object to the balance. Unfortunately, the balance often becomes a point of contention resulting in a lien being filed with the Workers’ Compensation Appeals Board, and …
Lien Tactics: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
We believe most claims professionals are aware that there two methods which allow for termination of workers’ compensation death benefits. They are: Inexplicably, a third method for termination of death benefits has also been put into use, a method which is not only illegal but subject to penalty. Various claims administrators are terminating death benefits once …
Termination of Death Benefits: 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
