In Part 1 of our exposé on Adminsure, we detailed the painful odyssey providers must endure just to confirm payment for the treatment of injured workers.

Below, we spotlight an equally troubling issue: Adminsure’s failure to consistently send electronic Explanations of Review (e-EORs) in response to providers’ electronic bills (e-bills). When payers refuse to send e-EORs, providers must expend significant time and resources manually posting payment information from paper EORs.

Adminsure is a Third-Party Administrator (TPA) handling claims for dozens of California public employers, including municipalities, school districts, and fire departments. By imposing unnecessary billing friction, this TPA makes it difficult for providers to treat city workers, teachers, firefighters, and other essential personnel.

When injured workers can’t find doctors willing to treat them, injuries worsen and legal battles become more likely. The attendant costs to employers, including attorney fees, Medical-Legal evaluations, and more, ultimately hit taxpayers.

Below is a list of employers currently using Adminsure. Every one of these employers (and the taxpayers who fund their operations) should demand better for their injured workers.

Adminsure’s e-EOR Failures Impact Care

California law requires claims administrators to send an e-EOR in response to a provider’s e-bill within 15 working days. Yet, daisyData show that over the last year, Adminsure failed to respond with a valid e-EOR 13% of the time. Of the e-EORs Adminsure sent, 16% were late.

For 2,643 Adminsure e-bills, the e-EOR was either missing or so technically deficient that it was unpostable. Every one of those missing or invalid e-EORs means one of two things:

• Adminsure did not pay the provider, or
• The provider had to waste administrative time tracking down and manually posting payments from a paper EOR.

As we detailed in Part 1, even when Adminsure sends an e-EOR, it doesn’t necessarily guarantee that the TPA sent payment. As daisyCollect agents learned, tracking down missing checks from Adminsure involves a maddening loop of online portals, representatives without information, and circular errors.

The result is revenue management chaos for practices.

Throughout California, physicians hesitate to treat injured workers because they (correctly) conclude that there’s less hassle (and more financial sustainability) in treating patients covered by group health insurance or Medicare.

The Downstream Effect: Legal Battles, Delayed Care

When providers can’t receive or confirm payment, they’re more likely to stop treating injured workers. In the absence of adequate care, how much more likely are injured workers to seek legal assistance from attorneys to resolve claims related to their injuries?

With inadequate care, the results are predictable:

• Claim durations lengthen as injuries take longer to resolve
• Administrative and legal costs for each claim climb
• Injured workers face potentially harmful delays in care

A costly and time-consuming battle should not be the default path for injured public employees seeking treatment. But when payers’ billing practices make quality care scarce, the system suffers.

Taxpayers Pay the Price for Dysfunction

Many of Adminsure’s clients are taxpayer-funded entities, which means that the public is footing the bill for a system that effectively sabotages the efficient delivery of care and payment for that care.

When Adminsure fails to meet its e-billing obligations, it doesn’t just hurt providers. It undermines the entire purpose of the workers’ comp system: to provide timely, effective treatment and return injured employees to work.

Below, we list the Adminsure clients in our system, based on bills daisyBill providers sent in the first three quarters of 2025. These entities should consider whether the impact of their TPA is inhibiting their injured employees’ access to care.

daisyBill lets you know when payers ignore or underpay your bills. Click below for a closer look:

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