California DWC

Audit Complaint: PacificComp Fails to Process e-Bills

In California workers’ comp, a provider’s failure to adhere to the billing regulations allows the payer to refuse payment for treatment of the injured worker. But all too oft...

Sedgwick Violates LACoFD Employer Contract, IBR Drops Ball

A physician agreed to serve as Independent Medical Examiner (IME) for the Labor Management Committee (LMC) representing the Los Angeles County Fire Department (LACoFD) and Lo...

CA Workers' Comp Q&A Highlights

We asked our readers to submit their most vital California workers’ comp questions for a live Q&A webinar. They did not disappoint!If you missed it, below is a brief r...

Sedgwick Denies Second Review Appeals as "Duplicates"

Sedgwick has a Second Review problem.On too many occasions, Sedgwick incorrectly denies providers’ Second Review appeals as “duplicate submissions” of the original bil...

OMFS Update: 59 Codes Newly Billable

California’s Division of Workers’ Compensation (DWC) issued an update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for ...

Med-Legal Bill Denied for Liability? Request IBR

Certain California workers’ comp payers deny reimbursement for Medical-Legal evaluations by claiming lack of liability for the initial injury. With this twisted, circular log...

CA DWC Lets SCIF Skirt IBR for Incorrect GPCI

In a baffling decision, the California Division of Workers’ Compensation (DWC) declared a straightforward billing dispute ineligible for Independent Bill Review (IBR) — despi...

Zurich - An Example of California's MPN Shell Game

Where opacity and obfuscation reign, injustice thrives. There may be no better example of this than California’s Medical Provider Network (MPN) system. T...

Sedgwick Defies DWC COVID Rules; DWC Washes Hands

Sedgwick defied California workers’ comp regulations, costing a provider thousands in due reimbursement. Unfortunately, the Division of Workers’ Compensation (DWC) has declin...

MPNs: The Jekyll and Hyde of Workers' Comp

We’ve argued that MPNs are mostly a drag on the workers’ compensation system. But as some employers demonstrate, they don’t have to be.When employers use MPNs to maint...

Anthem: PPO Discount Payments BELOW Medicare

Q: How much can a workers’ comp provider lose by signing a Preferred Provider Organization (PPO) agreement?A: Much, much more than the provider probably realizes.

CNA Repeatedly Ignores California Law

By law, claims administrators must remit payment for Medical-Legal services within 60 days of receiving the physician’s bill. As of this writing, payment to one physician fro...