California workers’ comp claims administrators are denying providers’ bills with increasing frequency in 2024 compared to 2023.

The data below represent the 20 claims administrators to which daisyBill providers sent the highest number of bills in 2024. For each claims administrator, we record the number of daisyBills the claims administrator denied in its entirety (as opposed to denying individual line items) and compare denial rates from January to April 2024 with denial rates for January to April 2023.

Collectively, bill denial rates for all claims administrators increased by 4% compared to last year—demonstrating that every California provider must be even more vigilant in tracking responses to their bills in 2024.

Of note, bill denial rates for one claims administrator, The Hartford, jumped from 14% in 2023 to 37% in 2024, a 23% increase (Apparently, The Hartford was only just sharpening its denial horns in 2023).

Meanwhile, the Division of Workers’ Compensation (DWC) maintains an apparent policy of inaction against claims administrators, ensuring zero consequences for even the most well-established patterns of inappropriate payment denial.

The inevitable result is reflexive, careless—even perhaps knowingly false—denials by claims administrators who understand there’s a fair chance providers will fail to send a timely Second Review appeal, relieving the claims administrators of any legal obligation to pay.

daisyData: Denial Rates 2023 vs 2024

The table below compares bill denial rates from January through April of 2024 against denial rates from January through April of 2023.

The table is sorted by the percentage change in denial rates, from highest to lowest. Perhaps most revealingly, the final column shows the percentage difference in denial rates from 2023 to 2024. Overall, the 20 largest claims administrators (as measured by the volume of bills our daisyBill clients sent) increased their collective denial rate by 4%.

For all but five claims administrators, denial rates increased. Of particular note:

• The Hartford’s denial rate increased by 23%
• Travelers’ denial rate increased by 17%
• Next Level Administrators’ denial rate increased by 16%

Only two claims administrators' denial rates decreased in 2024:

• Los Angeles County Metropolitan Transit Authority 
• Tristar Risk Management

Meanwhile, Keenan & Associates, Sedgwick Claims Management Services, Inc., and Athens Administrators maintained the same statistical bill denial rates.

In California, claims administrators have little incentive to put much effort into avoiding improper payment denials, as the appeals process for disputing improper denials defaults to the claims administrator’s advantage.

Even the slightest error by providers (e.g., submitting an appeal a day beyond the deadline or failing to sign the SBR-1 form) allows the DWC to uphold the bill denial—no matter how nonsensical or false.

In effect, California law and enforcement policies incentivize claims administrators to deny first and ask questions later. Providers must track each bill submission and appeal every erroneous denial. The difference in recovered reimbursement can substantially impact overall practice revenue.

For California providers, there are only two choices: be prepared to appeal every bill sent, or wave the white flag and give up on treating injured workers.

With tools for quick, easy appeals, daisyBill empowers your practice to demand full reimbursement—with just a few clicks. Learn more below:

LEARN MORE