Today’s blog centers on a farm hand who was injured at work while using a tractor to plow a field. The accident occurred when the tractor tipped over onto its side as the employee drove over a dirt mound. The worker ended up pinned beneath it. A tow truck was called to lift the tractor …
To the Rescue! A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Although rarely seen, there are times when an injured worker’s permanent-total disability (PTD) rate may “decrease” just like it did this year. In today’s blog we will discuss how this rare phenomenon occurs, as we suspect that most claims offices are unaware of the decrease, and as a result are overpaying PTD benefits. When an …
Overpaying PTD: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
One of many topics in workers’ compensation where an adjuster is presumed to automatically know what to do concerns death benefits. Today’s blog tells an incredible story of what happened in a death benefit claim where the adjuster was ignorant of the applicable law. Our story begins with a claims adjuster for a major company …
Burial Benefits: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
When comparing the job requirements of today’s workers’ compensation claims adjuster to those of yesteryear, the difference is like night and day. Thirty-years ago, a claims adjuster was a jack of all trades. Adjusters of that era would handle all types of comp claims. An adjuster’s inventory consisted of med-only, indemnity and death cases. In …
Today’s Claims Adjuster: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
It seems incomprehensible but for the past twenty years our workers’ compensation system has failed to acknowledge a paradox that exists regarding death benefits. The purpose of today’s blog is to explain the paradox to allow our readers to decide on the interpretation of their choice. We believe it is safe to state that most …
The Death Benefit Paradox: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
In the process of estimating the final cost of claims under a policy of workers’ compensation insurance, insurers and claim administrators typically add a charge for what is known as “IBNR,” which stands for “incurred but not reported.” For the most part this acronym is foreign to a claims department; however, it has exceptional meaning …
Allow us to begin today’s blog by asking three workers’ compensation trivia questions: Q. 1: “What is the number one cause of death for men who die on the job?” Q. 2: “What is the number one cause of death for women who die at work?” Q. 3: “Where at work is the most likely …
Coworker Liability: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Pursuant to Title 8 CCR §15251 all self-insured employers, both public and private, are required to file an annual report with the California Office of Self-Insurance Plans (OSIP). Individual-Private and Private-Group employers are to file by March 1 using Form AR-1 (1-2016), while all public self-insured employers, whether a member of a joint-powers authority, have …
The Self-Insurance Report: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
The other day we were thinking how nice it would be if workers’ compensation adopted a new fee schedule to reduce the number of interpreter liens currently being filed. The sheer number of interpreter liens being filed at the appeals board is truly staggering. We are not talking about hundreds or thousands of liens. We …
The Interpreter Fee Schedule: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
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
Have you ever encountered an applicant attorney demanding two supplemental job displacement benefit (SJDB) vouchers when settling multiple claims filed on behalf of an injured worker? Perhaps the case involves two injuries (a specific and a CT) where both claims are eligible for a voucher. Is that even possible? Also, what happens if an injured …
Double Vouchers: 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
