Zurich Refuses to Pay for Emergency Treatment
Oct 14, 2021
In a medical emergency, a doctor treats first and asks questions later. But in response to a medical emergency, Zurich refused to pay a doctor for suturing a lacerated finger...
CA Med-Legal Reporting Deadline Extension Official
Oct 6, 2021
California’s Division of Workers’ Compensation (DWC) has officially extended emergency regulations which add 15 days to the usual time frame for Medical-Legal reporting.
Pasadena Is (Still) Violating CA Workers' Comp Law
Sep 27, 2021
As costs skyrocket, physicians flee the system, and injured workers find it harder and harder to find a doctor willing to treat them, California workers’ comp has yet to reck...
Dollar Tree Stores/Sedgwick Refuse Payment for Authorized Treatment
Sep 21, 2021
Authorization is, by definition, a promise.It’s the promise that, once a doctor obtains authorization from an employer to treat an injured worker, the employer will pa...
CA Cheat Sheet: Required Reports & Supporting Documentation for Workers' Comp Bills
Aug 19, 2021
In California, when submitting a bill for treating an injured worker, it’s imperative to include the correct documentation to support the treatment. If the provider fails to ...
Audit Complaint: PacificComp Fails to Process e-Bills
Aug 4, 2021
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...
CA Workers' Comp Q&A Highlights
Jul 13, 2021
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"
Jul 12, 2021
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
Jul 5, 2021
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 ...
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MPNs: The Jekyll and Hyde of Workers' Comp
May 20, 2021
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 Discounts Result in Payments BELOW Medicare
May 19, 2021
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
May 12, 2021
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...