Explanation of Review

Audit Complaint: CA DWC Must Address Gallagher Bassett Violations

Gallagher Bassett is violating California law and regulations through its vendor, InstaMed. The Third-Party Administrator (TPA)’s non-compliance i...

CA: JPMorgan’s InstaMed Leaves Gallagher Bassett Out of Compliance

Third-Party Administrator (TPA) Gallagher Bassett has failed to send electronic Explanations of Review (e-EORs) in response to thousands of providers’ electronic bills (e-bil...

Paradigm’s 96-Page “Frankenstein” EOR Covers ~400 Bills

Paradigm Specialty Networks created a 96-page Frankenstein’s monster of an Explanation of Review (EOR), stitched together from hundreds of bills for mult...

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...