California Workers' Comp
Dec 1, 2022
MPN Chaos: Trader Joe's Employee Denied QME Treatment
Third-Party Administrator (TPA) Sedgwick Claims Management Services, acting on behalf of ACE American Insurance Company, refused to consider authorizing care recommend...
Dec 1, 2022
Sedgwick Uses Terminated ACE American MPN to Deny Payment
The Medical Provider Network (MPN) system in California is so chaotic, even the adjusters can’t keep up.For example: Third-Party Administrator (TPA) Sedgwick Claims Ma...
Dec 1, 2022
MPN Chaos: Sedgwick Denies QME Payment - Lowe's Home Center
The Medical Provider Network (MPN) system in California is out of whack — to the point that it breeds the kind of improper payment denials that make it impossible not to ask ...
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Nov 29, 2022
CA: Sedgwick Stiffs Doctor Who Treated Injured Honda Worker
The Medical Provider Network (MPN) system in California is chaos — and chaos breeds the kind of abuse that is currently crippling workers’ comp.Case in p...
Nov 8, 2022
CA Med-Legal: Q&A for Confused Physicians
Recently, a physician evaluator reached out to us with questions regarding Medical-Legal services for California workers’ comp. Rather than share the answers with this physic...
Nov 8, 2022
Midwest Insurance Fails to Pay QME
If there’s any doubt regarding why California workers’ comp is facing a shortage of Qualified Medical Evaluators (QMEs), look no further than Midwest Insurance. Midwest has b...
Nov 8, 2022
ALERT: Municipal Pooling Authority Bounces QME Check (Twice)
The Municipal Pooling Authority (MPA) recently bounced a check to a California Qualified Medical Evaluator (QME) — not once, but twice. According to MPA representative...
Nov 2, 2022
MPNs: How to Detect Dubious Payment Denials
In California workers’ comp, one of the biggest — but least talked about — challenges for providers is navigating the Medical Provider Network (MPN) system. MPNs were ...
Nov 2, 2022
Sedgwick Stiffs QME With False MPN Denial (Again)
It’s been said that insanity is best defined by doing the same thing repeatedly, but expecting different results. If that’s the case, Sedgwick Claims Management Services has ...
Nov 2, 2022
Employers Insurance: False MPN Payment Denial
California allows insurers and self-insured employers to establish Medical Provider Networks (MPNs) to direct injured workers’ care. While Employers Preferred Insurance Compa...
Nov 2, 2022
Gallagher Bassett: False MPN Denial
In yet another instance of a claims administrator improperly denying payment because the provider was (allegedly) not a member of the applicable Medical Provider Network (MPN...
Nov 2, 2022
AmTrust: False MPN Payment Denial
AmTrust North America, a Third-Party Administrator (TPA), offered a perfect example of what makes the Medical Provider Network (MPN) system so challenging for California work...