Blog: DaisyBill News

California workers’ comp billing and payment regulations are a minefield of complications. That said, some rules are fairly simple, and should be immutable.

For example, authorization guarantees payment.

Somehow, the state’s Division of Workers’ Compensation (DWC), and its proxy, Maximus, flubbed this very straightforward principle, ruling a dispute ineligible for Independent Bill Review (IBR) despite the services in question being authorized and despite having previously ruled in favor of the provider in other similar cases.

Which brings to mind this description of kafkaesque: "You don't give up, you don't lie down and die. What you do is struggle against this with all of your equipment, with whatever you have. But of course you don't stand a chance. That's Kafkaesque."

While this tale centers around reimbursement for treatment given to an injured employee of CVS Pharmacy, all employers that use Sedgwick as a Third Party Administrator need to consider whether refusing to properly reimburse physicians who treat their injured employees properly reflects the employer’s mission.