Explanation of Review

CA EOR Trap #1: ECHO Withholds EORs as Bait for MPX Sales Pitch

Payment processing vendor ECHO Health is withholding Explanations of Review from California workers' compensation providers. ECHO then uses the missing EORs as bait to compel...

CA: Sedgwick Hits 359,626 Violations (and Counting)

Sedgwick Claims Management Services, Inc. is routinely non-compliant with California workers' comp payment laws and regulations. Among its violations: repeatedly faili...

CA IBR Chicken 2.0: Gallagher Bassett and JPMorgan Turn IBR Into a Provider Trap

Gallagher Bassett, one of the largest Third-Party Administrators (TPAs) in the country, and its vendor, JPMorgan, may be derailing California providers' ...

ESIS e-EOR Compliance Nosedives; Vendors Step Up to Help

Third-Party Administrator (TPA) ESIS recently switched bill review vendors, which unfortunately delayed the delivery of thousands of electronic Explanations of Review (e-EORs...

Sedgwick Authorizes FedEx Care. Then Stiffs the Provider.

Third-Party Administrator (TPA) Sedgwick Claims Management Services authorized treatment for an injured FedEx employee — and then refused to pay for it. Worse, Sedgwick won't...

CCMSI e-EOR Violations Create Chaos for Providers

In California and other states, payers must respond to providers' electronic bills (e-bills) with electronic Explanations of Review (e-EORs), which automatically post payment...

NYSIF e-EOB Non-Compliance Rises in 2025

The New York State Insurance Fund (NYSIF) is making it harder for providers to treat the state’s injured workers by repeatedly failing to comply with payment requirements for...

Sedgwick Hits 298,034 Violations (and Counting)

Sedgwick Claims Management Services, Inc. continues to violate a critical California payment requirement with apparent impunity. The Third-Party Administrator (...

NY Data: Payers That Fail to Respond to Providers' e-Bills

Since August 2025, New York has required workers’ comp medical providers to send their workers' comp bills electronically (e-bills). Since October 2021, the New York W...

Taxpayers Beware: Anaheim Misreports Payment Data

Citizens of Anaheim, CA, may want to examine the city’s books closely, given the suspicious accounting of taxpayer dollars designated for the care...

Liberty Mutual's Ongoing e-EOR Violations Hurt Employers

Liberty Mutual’s ongoing failure to consistently adhere to California workers’ comp regulations should raise concerns for employers and healthcare providers. Despite c...

Liberty Mutual: 7,369 Audit Complaints Filed With the CA DWC

Liberty Mutualfails to uphold its obligations to workers’ compensation providers, making it even more challenging for providers to treatinjured workers. All...