Sedgwick: Careworks' Bulk Payments - Employers Take Note (Part 2)

Sedgwick: Careworks' Bulk Payments - Employers Take Note (Part 2)

Yesterday daisyNews reported on a California provider inexplicably receiving three large checks from Preferred Provider Organization (PPO) Careworks, purporting to bulk-pay 199 bills on behalf of multiple claims administrators. Today, we expand on that report by listing the employers whose funds Careworks used to issue these payments. We also take this opportunity to correct an error from the original post.

According to the paper Explanations of Review (EORs), Careworks applied payment reductions based on the provider’s alleged contract with Fast360. However, the provider has no contract with either Careworks or Fast360, meaning no contractual relationship exists that would justify those reductions.

Making matters worse, every single payment failed to comply with California workers’ comp laws and regulations:

  • All payments were untimely in violation of California Labor Code Section 4603.4
  • No electronic Explanations of Review (e-EORs) were issued
  • The paper EORs failed to contain the required data per CA regulations.

Below, we list the employers whose injured workers’ bills were paid (and discounted) in this confusing and non-compliant manner.

Correction:
In the previous blog article, daisyNews incorrectly cited California Insurance Code §2509.1(d) as prohibiting the commingling of client claims funds. That citation was inaccurate, and no current law expressly bans entities in the workers’ comp space from pooling funds across clients. While such practices may raise transparency concerns, there is no specific legal prohibition. We’ve updated the blog to reflect this and appreciate your understanding.

Employer Alert: Your workers’ compensation dollars are being inexplicably transferred to a third-party entity (owned by Sedgwick) to distribute to doctors treating injured workers.

Claims Administrator

Employer

Bill Count

Payment Amount

AmeriTrust Group, Inc.

Cal Enterprise Labor Solutions

1

$147

Kern Harvesting, Inc

1

$201

Trophy Automotive Dealer Group

1

$147

AmeriTrust Group, Inc. Total

3

$496

National Interstate Insurance

Storer Transportation

1

$127

Student Transportation Of America

1

$276

Thompson & Harvey Bay Area, LLC

2

$306

National Interstate Insurance Total

4

$709

QBE North American

Blue City Holdings, LLC

1

$610

Green 16, LLC

1

$147

Idg Holdco, LLC

1

$201

Msx International, LLC

1

$147

Tower Wav, LLC

1

$201

QBE North American Total

5

$1,307

Sedgwick Claims Management Services, Inc.

7-Eleven

1

$147

ABM Industries

4

$771

AHGL-Adventist Health Glendale

5

$898

AHSV-Adventures Health Simi Valley

1

$147

AHWM- Adventist Health White Memorial

1

$14

Albertson's

1

$147

Amazon.com, Inc.

13

$2,618

Anheuser-Busch, Incorporated

4

$771

Archdiocese Of Los Angeles

2

$476

ASCIP

1

$201

AT&T Services, Inc

6

$1,045

Avelo Airlines, Inc

1

$263

Avibank Mfg., Inc

1

$201

Bakersfield Arc, Inc

2

$551

Bank of America Corp

1

$147

Big Lots

1

$276

Blue Shield Of CA

1

$147

Cal-South Hampton

1

$14

Compass Group USA

4

$770

County of Ventura Fire Department

1

$147

D.D.R. Pizza, Inc

2

$423

Delta Air Lines, Inc

1

$147

Deskmakers, Inc

3

$752

DHL Global Mail

1

$147

Dollar General Corporation

2

$295

Entertainment Rent-A-Car Company Of Los Angeles

3

$496

Evergreen Pharmaceutical Of California

1

$18

Excel, Inc

1

$147

Express Services Inc

4

$658

General Motors

4

$590

Glendale Memorial Hospital And Health

1

$147

Glendale Unified School District

3

$910

Golden State Water Company

1

$147

Heritage Care, LLC

1

$338

Hilton Los Angeles/Universal City

1

$147

Hobby Lobby Stores

2

$295

Housing Authority City Of Los Angeles

2

$348

Humangood

1

$147

Jetsuite, Inc

1

$147

Jurupa Recreation District/Capri Workers Comp

1

$201

LA Arena Company, LLC

1

$147

LA Mission Hills

1

$147

Lakewood Regional Medical

1

$147

Langham Hotels Pacific Corporation

1

$147

Long Drug Stores California, LLC

3

$624

M S Aerospace Inc

1

$276

Macy's

3

$570

McKession Corporation

2

$348

Millcreek Electrical, Inc

1

$276

Momentum

1

$147

Mongomery Ward

1

$380

Northridge Hospital Medical Center

1

$276

Northrop Grumman

20

$3,389

Pacific Bell Telephone Company

2

$641

Panda Express

1

$201

Performance Team LLC

1

$380

Prime Communications L.P.

1

$147

Public Storage

1

$147

Restaurant Franchise Captive Program

1

$201

Ritchie Trucking Services Inc

1

$147

Ross Stores, Inc

2

$476

RTW Retailwinds, Inc

1

$201

Safelite Group, Inc

1

$147

Santa Clarita Valley School Food Services

1

$147

Saputo Cheese

1

$276

SAS Overhead Genops Alb So Cal

1

$147

Schneider National Carriers

1

$201

Skywest Airlines, Inc.

2

$402

Sony Corp of America

1

$421

Starr Companies

1

$276

Target Corporation

12

$2,111

The Boeing Company

4

$750

The Hertz Corporation

1

$147

Trader Joe's Company

6

$885

Tradesmen International, Inc

1

$147

Transdev Services

1

$147

Trinity Health

1

$276

Trustaff Management, Inc

1

$201

Valley Village

2

$348

Vanguard Car Rental USA

1

$147

Ventura County Sheriff

2

$685

Village Joann Fabric And Crafts

4

$953

Vons Companies, Inc

1

$201

Wells Fargo Bank

3

$496

Western Roadies Inc

1

$147

YRC Inc

1

$276

Sedgwick Claims Management Services, Inc. Total

187

$35,611

Grand Total

199

$38,123


daisyCollect fights the good fight on behalf of providers who treat injured workers with fully managed billing. Click below to learn more.

LEARN MORE: DAISYCOLLECT

RELATED TOPICS
MORE FROM THIS WEEK
0 Reader Comments
There are no comments for this article. Be the first to comment!

DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.