Most Recent Articles
Mar 31, 2022
Farmers Insurance: Winning "IBR Chicken”
California workers’ comp technically offers an appeals process for providers to dispute incorrect reimbursements. However, this appeals process actually encourages claims adm...
Apr 19, 2022
Med-Legal IBR: Maximus Denies Documented Interpreter Reimbursement
In a perfect example of California’s failing Independent Bill Review (IBR) process, Maximus (California’s designated IBR organization) abandoned all semblance of lawfulness a...
Jun 8, 2022
Hurray! Proposed IBR Changes Benefit Doctors
Proposed legislation in California would allow the state’s Independent Bill Review (IBR) organization (Maximus) to invoice the payer (aka claims administrator) for the review...
Jun 15, 2022
Sedgwick: Gruesome and Abusive IBR Games
In California workers’ comp, providers cannot rely on authorization to guarantee payment — despite what the law says. Today’s article shows exactly how a claims administrator...
Jun 23, 2022
CA: Employer Authorization Is Ultimately Worthless
California law mandates that once an employer authorizes treatment for an injured worker, that authorization may not be rescinded “for any reason,” theoretically guaranteeing...
Jun 28, 2022
Sedgwick Asserts CA "Loosened" Appeal Process
California workers' comp is — supposedly — governed by laws, enacted by the state legislature, and carried out by the Division of Workers’ Compensation (DWC). For disputes ov...
Jun 28, 2022
Data: Sedgwick Fails to Process 16,261 Second Review Appeals
Third-Party Administrator (TPA) Sedgwick Claims Management Services consistently ignores California workers’ comp requirements for properly responding to Second Review appeal...
Jun 28, 2022
Audit Complaint: Sedgwick 16,261 Noncompliant Second Review Responses
Using data generated by tens of thousands of electronic bills sent by our provider clients, daisyBill has demonstrated consistent non-compliance with California e-billing reg...
Jul 27, 2022
SCIF: Med-Legal IBR Chicken Champion
Welcome to another round of IBR Chicken, where California claims administrators (falsely) deny payment for the treatment of injured workers for implausible reasons — and keep...
Sep 7, 2022
CA SCIF Baits & Switches MD Out of Payment
Once again, California’s State Compensation Insurance Fund (SCIF) may profit by exploiting a flaw in California’s Independent Bill Review (IBR) system.SCIF initially d...
Sep 7, 2022
IBR: Sedgwick Ordered to Pay QME $20k+ for False Med-Legal Denial
Sedgwick Claims Management Services just set a dubious new record. Maximus, the entity which conducts Independent Bill Review (IBR) on behalf of California’s Division of Work...
Oct 6, 2022
Practice Recovers $1 Million Annually via Second Review Appeals
It’s official: daisyBill providers have recovered over $100 million in revenue by electronically submitting Second Review appeals to dispute incorrect reimbursements f...