Employers Should Demand That Zurich Pay Providers

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Employers Should Demand That Zurich Pay Providers

Yesterday we published the first in a series of urgent articles alerting California’s workers’ comp community that Zurich is refusing to pay providers who treat injured workers.

Employers and their injured employees are the true victims of Zurich’s deception or incompetence, as the case may be. The payment abuse that Zurich inflicts on providers is precisely the reason many thousands of providers refuse to treat injured workers -- the struggles to receive payment seem unmanageable.

This question from yesterday’s article bears repeating: How can claims administrators (aka ‘payers’ or ‘carriers or ‘insurers’) like Zurich ignore California payment laws, regulations, and rules? The answer is because there are ZERO repercussions for the claims administrators that refuse to reimburse providers who treat injured or sick workers.

It’s really very simple:

  1. Employers pay workers’ comp premiums to Zurich.
  2. Providers treat Zurich’s injured workers.
  3. Zurich refuses to pay providers.
  4. Zurich keeps employers’ premiums.

While providers treat injured workers for free, Zurich’s bank account increases from the unspent employers’ premiums.

Fortunately, providers can stop the payment abuse -- providers can cease treating Zurich patients. Data and a united community of providers make it simple to identify offending claims administrators that refuse to follow California laws, regulations, and rules. Once identified, rather than plead for reimbursement or settle for cents on the dollar, a provider has the power to avoid the offending claims administrator.

Zurich should be avoided by all providers, because Zurich is refusing to pay providers.

To reiterate: Sadly, employers and their injured employees are the true victims of Zurich’s deception or incompetence, or combination thereof. Thousands of providers refuse to treat injured workers because of the payment struggles inflicted, with impunity, by claims administrators.

Zurich Misleads Hundreds of Providers

In the recording below, a different one than yesterday’s recording, again a Zurich representative misleadingly and confusingly tries to convince a DaisyBill representative that California Labor Code allows Zurich to deny bills received over thirty days after the date of service.  

Yesterday, we explained that no California Labor Code exists which allows a claims administrator to deny bills submitted over thirty days from the date of service. In the recording, Zurich misinforms the provider by incorrectly lumping together two unrelated laws: Labor Code 4603.2(b) and Labor Code 4610(d).  

The Zurich representative clearly states Zurich’s policy of refusing payment if a bill is received more than thirty days after the date of service. Because California affords no protection to providers against claims administrators that choose to ignore California laws, Zurich can simply make up its own rules.

Zurich Misleads Hundreds of Employers

Since 9/1/2020, and as of this morning, Zurich has denied 722 bills submitted by DaisyBillers. Because DaisyBill technology includes the California Official Medical Fee Schedule (OMFS), we know that the OMFS would require Zurich to reimburse providers approximately $371,136.50 for these denied bills.

Below is a list of employers for those 722 bills as supplied by our client providers when submitting these bills to Zurich. We can all do the math: Employers pay Zurich. Providers treat these employers’ injured workers. Zurich refuses to pay providers.

Zurich’s improper bill denials hurt injured workers because this type of payment friction drives providers from caring for workers’ comp patients. Employers should protect their injured and sick employees and hold Zurich accountable for failing to reimburse providers who treat these employees. 

Tomorrow, we will give detailed instructions for providers on how to submit a Second Review appeal to obtain payment for these improperly denied Zurich bills. It is not easy but it is necessary -- not only for each individual provider’s financial health, but also to send a message that such payment abuse is noticed and will be opposed.

When providers fail to submit a timely Second Review appeal for the reimbursement owed, Zurich gets to keep the providers’ reimbursements: Failure to timely submit this Second Review appeal within 90 days of the Zurich denial means “the bill shall be deemed satisfied and neither the claims administrator nor the employee shall be liable for any further payment.” 

* The California Division of Workers’ Compensation Medical Billing and Payment Guide requires that providers furnish the name of the employer of the injured worker when submitting a bill for services. Below are the employer names furnished by DaisyBill clients for the denied Zurich bills. Clients may use different versions of any given employer name.

Employer*

Count of Zurich Denied Bills

OMFS Reimbursement Due for Denied Bills

ACON MARINE INC

1

$87.86

Aerospace Corporation

1

$177.04

AIG

1

$325.91

AIM SPECIALTY HEALTH

1

$2,241.68

Airtec

2

$8,750.00

Alexanders Mobility Services

3

$1,227.30

ALEXANDRIAN DENTISTRY INC

1

$562.49

All Counties Courier/92408

1

$169.89

Alpert & Alpert Iron

1

$190.00

Alquest Technologies, Inc.

1

$37.82

Ambridge Employee

1

$3,473.11

American Technologies, Inc

1

$865.60

Anabi Oil Corporation

3

$540.00

ANACAPA WATER BLASTING INC

1

$6,380.49

ANTHEM BLUE CROSS

1

$169.89

Anthem Inc.

2

$397.29

Apro LLC

2

$243.92

Apro LLC DBA United Pacific

1

$810.89

ARBORWELL INC

1

$250.00

AUTO PARTS SUPER STORES

1

$169.89

Automated Harvesting

1

$165.08

B & P PACKING COMPANY

1

$152.19

Baron HR

2

$326.74

BENIHANA CARLSBAD

1

$1,045.00

Bentley Mills Co

1

$3,053.81

BETTER 4 YOU MEALS

2

$1,194.91

BLOIS CONSTRUCTION

1

$76.10

BRAGG INVESTMENTS

1

$180.00

BRIANS TEXTILES

2

$1,092.97

C&F FOODS INC

1

$90.00

CA FARMS MEAT COMPANY

1

$269.58

CACIQUE INC

2

$395.41

CAL SUPPORT SERVICES

1

$193.42

CAL SUPPORT SERVICES LLC

1

$100.66

California Pizza Kitchen

1

$2,054.62

CALIFORNIA PIZZA KITCHEN INC

1

$772.15

CALIFORNIA PIZZA KITCHEN, INC

2

$957.46

CAREGIVER/ MED TECH

1

$863.64

CASE PACIFIC COMPANY

1

$150.87

Cast & Crew

2

$1,710.87

Cast & Crew Entertai

1

$190.00

CAST AND CREW

1

$569.47

Cast and Crew Entertainment

1

$2,500.00

CC MYERS, INC.

1

$254.17

Centene Corporation

1

$617.49

CF UNITED, LLC., DBA

1

$1,031.25

Clark, Gonsalbes & Santucci dba Conco

2

$2,062.50

Clark/Hall of Justics Contruction

1

$300.00

CMC Rebar/91739

1

$279.35

CMC STEEL CALIFORNIA

3

$967.68

COAST PLAZA HOSPITAL

1

$25.00

COASTER COMPANY OF AMERICA

2

$263.96

Coin Acceptors Inc

1

$187.50

COMMERCIAL METALS COMP-CALIF STEEL

2

$299.17

COMMERCIAL METALS COMP-CMC RANCHO CUCAMONGA

4

$730.73

Community Hospital of Huntington Park

3

$779.19

COMMUNITY THRIFT STORE

2

$25.78

CONRAD FOREST PRODUCTS

2

$274.93

CONRAD WOOD PROCESSING CO.

2

$229.20

Contemporary Service

2

$380.00

CONTEMPORARY SERVICES CORP.

1

$1,875.00

CORNER STONE STAFFING

1

$12.89

Cornerstone Staffind

1

$75.00

Cowelco

1

$180.00

CROWN BUILDING MAINTENANCE CO.

1

$231.35

Crown Poly, Inc

1

$2,523.04

Cruz Modukkarm

2

$1,372.24

CSI ELECTRIC

2

$501.23

CUPERTINO ELECTRIC

1

$161.62

Cupertino Electric Inc

1

$3,450.00

Custom Control Sensors LLC

1

$169.89

Dale Canfield Construction, Inc.

1

$4,037.52

DE MATTEI CONSTRUCTION INC

1

$12.89

Del Monte Foods

1

$118.14

Denny's Restuarant

1

$937.50

DESERT VALLEY CONSTRUCTION

1

$687.50

DIVERSIFIED ROOFING SERVICES

2

$448.20

DMS FACILITY SERVICES

1

$344.23

DON CHAPIN CO

4

$754.22

DPR Constructon

2

$330.16

DS WATERS

1

$298.58

EARTHBOUND FARMS

1

$220.18

ECOLOGY CONTROL INDUSTRIES

1

$121.44

EMBASSY SUITES GARDEN GROVE

1

$121.44

Eminent Inc.

1

$213.03

Employers Resource M

1

$190.00

ENVIRONMENTAL CONSTRUCTION GROUP

2

$1,308.70

Environmental Service Concepts

1

$300.00

ESC FEDERAL - CORP

2

$326.89

ESSILOR OR AMERICA

1

$569.47

Evolution Hospitality

1

$467.06

Extended Stay America,

6

$1,832.12

Fairmont Hotel

1

$0.00

Fairmont Hotels and Resort

2

$408.20

Fairmont Miramar Hotel

1

$237.97

Federal Cleaning Contractor

1

$1,250.00

FEDERAL CLEANING CONTRACTORS INC

1

$325.91

Fig & Olive Newport Beach LLC

1

$1,023.96

FIREBRAND ARTISAN LLC

1

$190.01

FISK ELECTRIC CO

1

$116.27

FITNESS INTERNATIONAL

5

$2,275.72

Fitness International LLC

2

$521.17

FLAGSHIP FACILITY SERVICES

2

$1,906.25

FLYING FOOD GROUP

1

$175.72

Flying Food Group Inc

2

$5,500.00

FLYING FOOD GROUP LLC

3

$1,076.15

FLYING FOODS GROUP

2

$553.85

Foundation Constructors Inc

1

$587.73

Frank Crum Inc; Drapery Hardware by Jema

1

$8,472.16

FRANKCRUM INC

2

$374.54

Fresh & Ready Foods, LLC

1

$121.44

FRESH AND READY FOODS LLC

1

$536.06

Fresh and Ready Foods/91340

3

$294.89

FRESH BROTHERS

2

$282.79

fresh foods

1

$180.00

Frontier Communcations/92880

1

$300.00

Frontier Communications

2

$449.24

Frontier Communications/93030

1

$300.00

Frontier Communications/Verizon

5

$704.68

Garcia Asset Management Inc.

1

$198.32

Gate Gourmet

2

$783.52

GATE GOURMET, INC.

1

$304.77

GATEGOURMET 1023

7

$1,249.89

GELSON'S MARKET

1

$169.89

GHP MGMT

1

$569.47

Global Scaffold Cons

1

$190.00

GREAT SCOTT TREE SERVICE

2

$339.78

Greka Integrated, Inc

1

$6,562.50

GRIFFIN HOLDCO, LLC

3

$999.24

GRIFFITH COMPANY

2

$670.43

HANSON AGGRETATES

1

$216.85

HEALTH NET OF CALIFORNIA INC

1

$771.87

HENKEL AND MCCOY INC.

1

$625.00

Hidden Valley

1

$887.57

Home Goods/91740

1

$187.50

Horizon Personal Serv. (Sac)

1

$357.59

Household Finance Corp

2

$320.66

HYATT PALM SPRINGS

1

$161.62

Hyland Nursing Facility

3

$655.87

IEHP

1

$125.00

IL FORNAIO

1

$276.03

Inland Empire Health Plan

1

$764.42

Interior Removal Specialist, Inc.

1

$169.89

Interior Removal Specialties

1

$121.44

International Education Corporation

1

$1,062.19

INTERNATIONAL IRON PRODUCTS

1

$165.11

IRON MOUNTAIN

1

$121.44

IRONMAN

1

$180.00

JADE OPCO CA LLC DBA PARAMOUNT BUILDING SOLUTIONS

1

$75.00

JADE OPCO CA LLC DBA US METRO

1

$560.09

Janus Corporation

1

$247.47

JB Hunt Transport

1

$312.50

JD MILLER CONSTRUCTION

1

$172.43

JOHANSON DIELECTRICS, INC.

1

$1,333.83

Jomar Table Linens Inc/91761

1

$327.80

JONS MARKET #03

1

$108.55

JONS MARKET #11

3

$479.16

Jons Marketplace

4

$1,146.69

JUST WORKS EMPLOYMENT GROUP LLC

1

$75.00

KCP Investment Holding LP Package Advance Group

1

$300.00

KHS&S CONTRACTORS (MASTER ACCOUNT)

11

$1,696.13

KOVACH ENCLOSURE SYSTEMS LLC

4

$589.64

L KORAL, LLC

1

$121.44

LA FITNESS

1

$1,419.58

LA Fitness/91324

1

$1,023.96

LA Fitness/91763

1

$169.89

LAND S FRAMING

2

$431.72

Lisi Aerospace

1

$121.44

LOBOSTAR INC

1

$313.85

LONG BEACH JOB CORP

1

$121.44

MACOM TECHNOLOGY

2

$300.00

Makeup Art Cosmetics

1

$762.40

MALIBU BEACH INN HOTEL

1

$352.94

MAN STAFFING, LLC

1

$812.50

Marriott Hotel

1

$135.00

MARSHALLS

4

$651.04

Marshalls #1153

2

$308.02

MARSHALLS OF CA LLC

1

$1,419.58

Material Transport S

1

$190.00

Merit Framing Inc.

3

$495.45

MERRIT FRAMING

1

$118.04

MHX

1

$161.62

Michael L. Green DBA Precision Roofing Company

1

$1,031.25

Milestone Technologies

4

$6,096.15

Moda Construction corp

2

$320.66

Modern HR

1

$625.00

Modern HR Inc

4

$1,351.26

Modern HR, Inc.

1

$312.50

MONTEBELLO CARE CENTER

1

$169.89

MUIR CHASE PLUMBING CO INC

1

$536.06

MXH LLC

1

$325.36

NEVELL GROUP INC

1

$236.42

NEW HORIZON

1

$1,226.10

NFI Industries Inc.

2

$150.00

NMS Properties Inc.

2

$941.29

NORTH COUNTIES DRYWALL,IN

1

$12.26

NORTHRIDGE MILLS HOLDINGS

1

$665.20

NOT AVAILABLE

1

$178.41

NOT LISTED

1

$173.73

NPL CONSTRUCTION CO

1

$2,039.62

NRC ENVIROMENTAL SERVICES INC

1

$3,616.80

NU WOOD DESIGN

1

$473.61

NX Utilities, LLC

22

$3,371.89

O'BRYANT ELECTRIC

2

$746.66

OBAYASHI CORPORATION

1

$184.26

ONE MAIN FINANCIAL

1

$191.60

Oportun, Inc

2

$924.41

Optimus Group Inc.

1

$190.00

OPURTUN

2

$700.94

Pacific Life Insurance

1

$3,450.00

PACIFIC STEEL GROUP

1

$169.89

Pacific West Management

1

$135.00

PDA Group Valencia

1

$985.86

Peck and Hiller

2

$361.40

People Now

3

$1,896.57

People Now Inc. Center

1

$169.89

PERFORMANCE CONTRACTING INC

1

$522.06

PERSONAL STAFFING GROUP

1

$344.52

Personnel Staffing G

2

$380.00

PERSONNEL STAFFING GROUP

1

$2,031.25

PERSONNEL STAFFING GROUP LLC DBA HORIZON

1

$203.55

Pet Distribution

2

$380.00

PIERRE LANDSCAPING

2

$1,239.27

Pirate Staffing

1

$190.00

PREMIER COMMERCIAL PAINTING

1

$325.36

Priority Workforce

3

$570.00

Priority Workforce Inc

2

$941.29

production framing inc

6

$1,197.96

PROSPECT MEDICAL HOLDINGS INC.

1

$121.44

PTI Technologies Inc.

1

$484.65

PVH Corporation

1

$212.43

RAINY DAY ROOFING INC

1

$1,419.58

Ramat Medical

3

$503.43

Ramco Enterprises Lp

1

$264.00

RED LOBSTER

1

$1,204.98

REGIONAL CONNECTOR CONSTRUCTORS JV

1

$396.85

RFJ Meiswinkel Company

4

$369.74

RICK HAMM CONSTRUCTION

1

$12.89

RIO HONDO SUBACUTE AND NURSING CENTER

2

$501.28

Robinson Helicopter Company

3

$391.20

ROBINSON PHARMA INC

2

$180.00

ROYAL ROOFING CONSTRUCTION COMPANY

2

$150.00

Sanmina Corporation

1

$75.00

SCS ENGINEERS/WORKCARE

2

$690.78

Shanska Taylor Shea

1

$130.40

SHG OPERATIONS

1

$536.06

SHIPITTO

1

$781.25

Sialic Contractors

2

$380.00

SIERRA FRAMING INC

1

$897.63

SIGNAL HEATING, AIR CONDITIONI

1

$374.81

SMG

7

$1,528.11

Smith Emory Iternational

1

$625.00

SMM Facilities

6

$1,715.05

social vocational services

2

$255.00

SOLTEK PACIFIC CONSTRUCTION

1

$165.11

SOUTHWEST EXPRESS, LLC

3

$695.08

SP MANAGEMENT SERVICES INC

1

$556.30

Spears Manufacturing Co.

1

$1,800.00

SPRINGS WINDOW FASHIONS

1

$175.72

St George Employee Leasing Inc.

2

$255.00

STAFFING SERVICES INC

1

$75.00

STAHLS WILD SIDE WEST LLC

2

$5,600.00

STANFORD

1

$173.73

Stanford Hospital

8

$1,416.02

Stanford University

11

$2,203.49

State Bank of India CA

1

$121.44

STAYBRIDGE SUITES SAN DIEGO

1

$142.28

Stellar Staffing Solutions

2

$454.18

STS Corporation

2

$360.00

SUNRISE SOLAR

1

$2,375.00

Sunrun Solar

2

$1,310.97

Superior Electrical and Plumbing

1

$284.80

Swat Fame Inc.

1

$375.00

SWINERTON BUILDERS

2

$2,235.64

SWINERTON BUILDERS INC

1

$169.89

SWINERTON INCORPORATED/BUILDERS

2

$436.53

SWINERTON PSI PHASE VI

1

$3,078.96

TAYLOR FARM RETAIL

3

$594.69

TAYLOR FARMS

2

$431.85

TAYLOR FARMS FOOD SERVICES

1

$165.08

Taylor Farms Retail

6

$1,334.70

TAYLOR FRESH FOODS

13

$2,667.92

TELEDYNE CONTROLS

2

$316.89

TEPPANYAKI GRILL & SUPREME BUFFET

1

$562.49

TERMINIX

1

$177.21

Tesla

55

$24,586.31

TESLA MOTOR, INC.

1

$9,687.50

Tesla Motors

8

$4,150.53

TESLA MOTORS INC

35

$9,124.29

Tesla Motors Inc.

2

$830.46

THE AEROSPACE CORP

1

$276.03

The Aerospace Corporation

1

$190.00

The Kingdom Group

2

$407.18

THE TJX COMPANIES

1

$167.85

Thomas Builders

2

$361.40

TJ Maxx

3

$542.23

TJ Maxx/91403

1

$196.50

Transystems Corp./64108

1

$62.50

TRIBUS SERVICE/CORIX UTILITIES

2

$339.78

TRIDANT SEAFOODS

1

$687.50

Tutor Perini Building Corp

1

$750.00

UNIFIED PROTECTIVE SERVICES

1

$561.32

UNIFIRST CORPORATION

1

$773.32

Unimin Corp

1

$1,419.58

UNITED PACIFIC

1

$90.75

University Healthcare Alliance

2

$1,495.38

UNIVERSITY MECHANICAL & ENGINEERING

1

$169.89

Unknown

1

$104.28

Unspecified

5

$57,360.07

Valley Agricultural Software

1

$160.33

VERIZON CALIFORNIA, INC.

1

$121.44

VERSA PRODUCTS

2

$1,262.49

VIVINT SOLAR

1

$180.00

VIVINT SOLAR INC

2

$265.77

VULCAN STEEL COMPANY

1

$687.50

Wash Multi Family Laundry System

2

$1,558.73

WASH MULTIFAMILY LAUNDRY SYSTEMS

2

$1,306.30

Watersafe Swim School

2

$1,946.35

Waxie Sanitary Supply

4

$2,468.11

Wayfare

2

$2,125.00

Webcor Builders

1

$300.00

WELLPOINT

34

$4,157.09

Western Pacific Roofing

1

$1,250.00

WESTERN REFINNING RETAIL LLC DB ARCO

1

$325.10

WHOLE FOODS MARKET

1

$90.00

WINCO FOODS

1

$97.05

Winco Foods/91766

1

$116.76

WINCO HOLDINGS, INC

6

$1,096.68

WOODWARD DUARTE

1

$1,113.89

WOODWARD HRT

1

$146.34

Woodward Inc./80525

1

$600.41

Woodward, Inc

2

$125.00

Woodward/91010

1

$166.56

WORKFORCE BUSINESS

1

$12.89

WORKFORCE BUSINESS SERVICES

8

$2,200.54

WORKFORCE BUSINESS SERVICES INC

1

$345.75

Worldwide Tech Services

3

$2,788.74

YORK RISK SERVICES GROUP

2

$101.78

ZURICH NORTH AMERICA

1

$185.30

Grand Total

722

$371,136.50


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