The 2024 data are in, and they paint a grim picture for every California provider treating injured workers.

The numbers prove beyond a doubt that California’s workers’ comp system is rigged—forcing providers to engage in hand-to-hand combat just to collect rightful payment.

Last year alone, California providers using daisyBill submitted 241,527 Second Review appeals, recouping over $18 million in additional revenue.

That’s $18 million providers would have forfeited if they had not proactively challenged claims administrator errors and non-compliance.

Since 2013, daisyBill providers have submitted over 1.3 million Second Review appeals, recovering over $120 million in revenue. This staggering amount represents money (read: profit) payers would have kept if these providers had not fought back with timely and compliant appeals.

These data result from a deeply flawed system that incentivizes payers (aka claims administrators) to underpay or deny workers’ compensation bills. California Division of Workers’ Compensation (CA DWC) regulations skew the playing field with rules that force the provider to commit more resources to receive correct payment.

At the same time, payers face zero regulatory or legal consequences, even for deliberate non-compliance.

When a provider fails to dispute an incorrect payment within 90 days of receiving the Explanation of Review (EOR), the claims administrator is no longer obligated to pay the provider the reimbursement owed. By failing to implement consequences for incorrect reimbursements, the CA DWC monetarily incentivizes claims administrators to underpay since many providers cannot catch or dispute every underpayment in time.

It’s a lose-lose scenario for California workers’ comp providers.

The data below clearly show that Second Review appeals are more than a best practice. These appeals are a non-negotiable line of financial defense for practices.

2024 CA Second Review Appeal Data

In 2024, daisyBill providers sent Second Review appeals for 12% of their California workers’ comp bills, collecting an average of $293 per bill in additional revenue.

These data prove beyond doubt that consistent Second Review appeals are a necessary financial lifeline, and should be standard billing protocol for every practice.

For claims administrators in California, workers’ comp is a “heads we win, tails providers lose” scenario. 

For providers, billing and payment is a rigged game where the odds are stacked against them—unless they commit the resources to push back. That means proactively appealing incorrect payments every single time.

Protect Your Practice: Always Appeal

Providers should make it standard operating procedure to check workers’ comp payment amounts against the applicable fee schedules—and always appeal when appropriate.

California providers must comply with state requirements to dispute an incorrect payment or risk forfeiting any additional reimbursement. Unlike state requirements for payers, requirements for providers are truly mandatory—because the consequences are real.

• Submit the Second Review appeal within 90 days of receiving the Explanation of Review (EOR) from the claims administrator.
• Submit the Second Review appeal using the DWC Form SBR-1 (technically, providers may submit a modified version of the original bill, but many payers refuse to process a compliant modified version of the bill).
• Submit the Second Review appeal using the same delivery method (i.e., paper or electronic) as the original bill.
• Include all relevant supporting documents.

daisyBill providers have a unique advantage: our software’s automated ‘Task’ prompts help manage billing workflow and ensure staff catch untimely or incorrect payments. When daisyBill flags an incorrect payment, practice staff can electronically submit the SBR-1 and necessary documents in seconds.

Providers without advanced technology or the administrative resources to constantly appeal are at a disadvantage, and claims administrators know it.

See the short video below to learn how Second Review appeals are one of the easiest ways to optimize billing and maximize revenue for treating injured workers.

If you have any questions about the Second Review process, contact our experts using the chat icon at the bottom right of this screen or email us at info@daisybill.com.

daisyBill makes treating injured workers easier, faster, and less costly. Schedule a free demonstration below.

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