Allow us to begin today’s blog by asking a question. “What happens when an injured worker is uncooperative in their claim for benefits?” Presumably, the answer depends on the issue at hand and the degree of non-cooperation. There are many forms of uncooperative behavior, ranging from failure to provide requested information during a compensability investigation …
Uncooperative Injured Workers: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
It is truly puzzling how certain parties at the appeals board gamble by proceeding to trial when they have no realistic chance of successfully litigating a dispute. It’s as if they somehow convinced themselves they are holding a winning hand. They usually end up losing badly. The purpose of today’s blog is to identify four scenarios where employers …
The Gambler: 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
Although several states do not recognize the compensability of psychiatric injury claims, here in California mental injuries have long been an integral part of our workers’ compensation system. The medical authority used in California to diagnose psychiatric injury and disability is the Global Assessment of Functioning (GAF) Scale, found in Axis V (aka Chapter 5) …
GAF Scores: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Every workers’ compensation adjuster can tell horror stories of newly hired employees who claim to be injured the very first day on the job. It’s even more troublesome when first notice of accident is reported by an attorney. Equally suspicious is when the injury is described as being both physical and mental, which leads us …
The Light Duty Trap: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
The other day a client mentioned to us that they received an RFA from a physician requesting that an emotional support animal be provided to an injured worker. We promptly undertook a search for controlling appellate caselaw and/or other relevant legal authority which would shed light on the employer’s obligation when faced with such a …
Emotional Support Animals: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Strangely, workers’ compensation has a way of punishing a good claim adjuster. No, we are not being facetious. When a fabulous adjuster is discovered, before you know it every major client wants that adjuster to handle their files. Also, whenever a new client is retained, management often wishes to impress that client by assigning their …
The Good Adjuster: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
When an injured employee returns to work limited to light duty, they might be eligible to receive temporary-partial disability (TPD) benefits, also known as wage loss. Surprisingly, many claim professionals find TPD difficult to properly calculate. Our blog today provides an explanation of the formula to be used. For the most part claims adjusters are …
Calculating TPD: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
There are times in the middle of a work comp case where the claimant unexpectedly passes away. Upon receipt of such news the claims administrator must complete several important tasks. The purpose of today’s blog is to explain the actions that must occur following news of a claimant’s death, regardless of the cause. The following …
When a Claimant Dies: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
There is no more awkward situation for a claims adjuster than to need to seek the reimbursement of overpaid temporary disability benefits from a “pro per” injured worker. Many insurance companies and TPA’s require claims handlers to request refunds even though that actions often prompt the worker to retain legal representation. By requesting a $25 …
TD Overpayments: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
For those who supervise or manage a claims department we ask that you take an informal survey of your staff to determine how many of them have ever attended a WCAB hearing. We believe you will be surprised to learn that very few have ever ventured to the appeals board, and that consequently, most claims …
The Best Laid Plans: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Everyone familiar with the handling of insurance claims is likely aware of the common practice that claims within an office are sometimes transferred from one adjuster to another. Sometimes claims are even transferred from one claim administrator to another. When a transfer occurs, it is said that the adjuster who receives a file is “inheriting …
Inheriting a Claim: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
