The Hartford Ignores TWO California Laws
Nov 11, 2021
By insisting The Hartford owed no payment for authorized treatment provided outside the Medical Provider Network (MPN), The Hartford pooh-poohed a clear-cut Cal...
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...
IBR Hall of Shame: Sedgwick Sets New Standard of Noncompliance
Jul 6, 2021
Sedgwick failed to comply with an Independent Bill Review (IBR) ruling for almost four months. Worse, the payor’s brazenness is likely to go unpenalized by the state.T...
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...
Broadspire Knows No Law But Its Own
Apr 2, 2021
Broadspire continues to break the rules, seemingly confident that California regulators will not hold the claims administrator to account. For months, we reported on B...
Zurich Denies Liability After Accepting Liability
Mar 30, 2021
Zurich recently denied liability for an injured workers’ treatment, claiming the 2003 injury was not work-related — despite the fact that Zurich already authorized the treatm...
IBR Hall of Shame: Employers
Mar 24, 2021
Employers Holdings set a shameful new standard of indifference with regard to promptly and correctly reimbursing providers. The insurer incorrectly denied payment, disregarde...
Gallagher Bassett, Foster Farms Lay A Rotten Egg in CA
Mar 12, 2021
Update: As of April 1, 2021 Gallagher Bassett can locate and process claims for Foster Farms employees. Workers’ compensation claims for injured employees of Foster Fa...
ESIS + Conduent + StrataCare = Provider Torment
Mar 2, 2021
Preferred Provider Organizations (PPOs) profit from reducing the reimbursements providers receive for treating injured workers. Yet, we would argue that providers (and injure...
ESIS & ABM Industries - IBR Hall of Shame
Jan 28, 2021
We continue to look at the misbehavior of ESIS, which yesterday entered the IBR Hall of Shame for its deplorable treatment of a provider who prevailed in two Independent Bill...
Is ESIS Gaming California's Work Comp System?
Jan 27, 2021
In this latest installment of the IBR Hall of Shame, we chronicle the never-ending payment torture inflicted on a provider who “wins” an Independent Bill Review (IBR). This i...
Data PROVES Electronic Billing for Workers' Comp Works
Nov 10, 2020
COVID-19 and our recent elections highlight the flaws, delays, and increasing creakiness of the US postal system. In 2020, as mail fails, electronic bill transmission offers ...