IBR
Jun 28, 2022
Sedgwick Asserts CA "Loosened" Appeal Process
California workers' comp is — supposedly — governed by laws, enacted by the state legislature, and carried out by the Division of Workers’ Compensation (DWC). For disputes ov...
Jun 23, 2022
CA: Employer Authorization Is Ultimately Worthless
California law mandates that once an employer authorizes treatment for an injured worker, that authorization may not be rescinded “for any reason,” theoretically guaranteeing...
Jun 15, 2022
Sedgwick: Gruesome and Abusive IBR Games
In California workers’ comp, providers cannot rely on authorization to guarantee payment — despite what the law says. Today’s article shows exactly how a claims administrator...
Jun 8, 2022
Hurray! Proposed IBR Changes Benefit Doctors
Proposed legislation in California would allow the state’s Independent Bill Review (IBR) organization (Maximus) to invoice the payer (aka claims administrator) for the review...
Apr 19, 2022
Med-Legal IBR: Maximus Denies Documented Interpreter Reimbursement
In a perfect example of California’s failing Independent Bill Review (IBR) process, Maximus (California’s designated IBR organization) abandoned all semblance of lawfulness a...
Mar 31, 2022
Farmers Insurance: Winning "IBR Chicken”
California workers’ comp technically offers an appeals process for providers to dispute incorrect reimbursements. However, this appeals process actually encourages claims adm...
Mar 22, 2022
PPO: No Provider Recourse for Unnamed Discounts
In California workers’ comp, the appeals process for disputing improper Preferred Provider Organization (PPO) reductions has a serious flaw.Routinely, Explanations of ...
Mar 21, 2022
CA Workers' Comp: Appeals Rigged to Profit Payers
When a claims administrator incorrectly reimburses a California workers’ comp provider, the mandated process for the provider to dispute the error (or purposeful theft) is co...
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Feb 8, 2022
CA DWC Rigs IBR and Helps SCIF
A doctor treated a California injured worker. Subsequently, in an apparent attempt to avoid paying for the treatment, the State Compensation Insurance Fund deni...
Feb 4, 2022
MLPRR: Costco/Helmsman Play Med-Legal IBR Chicken
Call it “IBR Chicken: MLPRR Edition.” Third-party claims administrator (TPA) Helmsman, acting on behalf of self-insured employer Costco, refused to reimburse a physici...
Jan 13, 2022
Berkshire Hathaway: DWC Targeted Audit Needed ASAP
As Berkshire Hathaway HomeState Companies (BHHC) persists in its failure to compliantly process thousands of valid Second Review appeals, the California Divisio...
Jan 12, 2022
Berkshire Hathaway Ignores THOUSANDS of Second Review Appeals (& CA Law)
Berkshire Hathaway Homestate Companies (BHHC) continues to fail to compliantly process valid Second Review appeals submitted by California doctors to dispute erroneously deni...