Authorization

Liberty Mutual Plays “IBR (and IMR) Chicken” on UPS Claim

Two unfortunate necessities exemplify the broken state of California’s dysfunctional workers’ comp system:Too often, payers deny an injured worker's care, and the work...

CA DWC: Providers Must Use RFA Form (While Payers Can Do What They Please)

In California, before treating an injured worker, a physician must obtain prior approval from the payer for all treatment. The California Division of Workers’ Compensation (C...

The Hartford Ignores Its Own Authorization (Again)

When an employer pays The Hartford its workers’ comp premiums, the expectation is simple: The Hartford will pay for injured employees’ treatment and benefits. But this week, ...

The Hartford’s Authorization Exposes “Pay to Treat” System

California employers pay insurers like The Hartford to ensure that when one of their employees sustains a work injury, the providers who treat them get paid. Instead, ...

The Hartford Denies Payment With Bogus MPN Claim

As daisyNews frequently explains, California's Medical Provider Network (MPN) system accomplishes nothing other than making treatment less accessible for injured worke...

Tesla Insurer Zurich Sends "Certification" Providers Can’t Trust

Treatment authorization should be a fairly straightforward process, even in the convoluted world of California workers' comp: the doctor submits a compliant request for treat...

CA: CNA "Authorization" Doesn't Authorize Anything

CNA sent a California provider a treatment authorization letter that may double as a setup for nonpayment. The letter purports to authorize care while simultane...

CA DWC to Enact Useless New UR Regulations

The California Division of Workers’ Compensation (CA DWC) will enact new regulations to (theoretically) streamline authorization for injured workers’ care, effective April 1,...

Gallagher Bassett Denies Payment for Non-Authorization (Despite Proof of Authorization)

California has a workers' compensation system in which payers can't lose.In practice, there are no penalties for refusing to pay a legitimate bill; no consequences for...

Zurich: Vague Authorization Creates More Treatment Friction

Insurer Zurich North America offered a classic example of the bureaucratic absurdity that plagues California’s treatment authorization process, issuing a baffling, time-bound...

CA RFA Hell: Affirmative Cites the Most Cynical Excuse Yet to Deny Care

What’s the most absurd, bureaucratic, procedurally abusive excuse a claims administrator ever used to deny care to an injured worker?We’ve seen our share of bad-faith ...

RAND Gets $300K for UR Study—What's the ROI?

The California Department of Industrial Relations (DIR) plans to address the state’s broken Utilization Review (UR) system—by paying frequent contract recipient RAND Corporat...