Arguably, the two most powerful words in workers’ compensation are “show me.” All too often opposing counsel will offer their interpretation of the law in an attempt to further an argument at the Board. When this occurs, it is vital for the defense to simply say, ‘show me.’ In other words, “prove it.” It is …
The Show Me Defense: 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
Have you ever carefully read California Labor Code §4610.3(a), on the issue of rescinding a physician’s authority to treat an injured worker? As you might expect, like most procedures in the workers’ compensation context, recission ain’t that easy! LC §4610.3(a) provides: “. . . an employer that authorizes medical treatment shall not rescind or modify …
Rescinding Medical Authority: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
For several years, the California Applicant Attorney Association (CAAA) has complained about the low weekly permanent disability rate being paid to injured workers. The applicants’ bar asserts that a disabled employee cannot survive on a compensation rate of only $290.00 per week. It is especially devastating when injured workers exhaust their entitlement to temporary disability …
The PD Rate: 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 …
Every workers’ compensation claims examiner has likely been told that an injured worker may not collect temporary disability and state disability insurance (SDI) benefits at the same time. We can confidently state that every examiner who received such training was given inaccurate information, as it is perfectly legal under certain circumstances for an injured worker …
Collecting TD and SDI: 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
