RFA

CA Employers Need to Know: Is It the Injury or the UR System?

Last year, California raised employers’ workers' comp premiums by 8.7% while other states continued to cut rates, some for over a decade straight. Across the nation, premiums...

Does CA Workers’ Comp Cause Secondary Psych Injuries?

New research illuminates a serious problem for injured workers: secondary psychological injuries resulting from the sheer hardship of navigating workers’ comp systems....

CA's "Cost Control" Mechanisms May Be the Most Expensive Parts of the Claim

Employers in California pay more for workers' comp coverage than in almost every other state, and the gap is widening. In our view, thereason isn't provider or ...

CA DWC's UR Audits: A Keyhole View of a Statewide Crisis

As early as 2016, California legislators recognized the potential for payers to abuse Utilization Review (UR), the process by which payers decide whether to deny or approve t...

Zurich: Vague Authorization Creates More Treatment Friction

Insurer Zurich North America offered a classic example of the bureaucratic absurdity that plagues California’s treatment authorization process, issuing a baffling, time-bound...

CA RFA Hell: Affirmative Cites the Most Cynical Excuse Yet to Deny Care

What’s the most absurd, bureaucratic, procedurally abusive excuse a claims administrator ever used to deny care to an injured worker?We’ve seen our share of bad-faith ...

An Open Letter to CHSWC re: UR Abuse (cc: Governor Newsom)

To the Members of the Commission on Health and Safety and Workers’ Compensation (CHSWC)CC: Governor Gavin NewsomRE: California’s Broken Utilization Review Syste...

Sedgwick Removes 54% UR Denial Stat From Website

We knew it was only a matter of time. The question was how much time?Third-party administrator (TPA) Sedgwick Claims Management Services screamed the quiet part out lo...

Liberty Mutual: 23-Month Wait for Surgery in CA

If you need proof of how dysfunctional California workers’ comp is—and that absurdly long claim durations have become the appalling standard—see the 23-month ordeal an injure...

daisyData: CA RFA & Utilization Review 2024 Data

In California, Utilization Review (UR) is the mandatory process by which claims administrators decide whether or not to approve treatment requests submitted by doctors treati...

CA DWC to Impose Costly New Reporting Burdens on Providers

California’s Division of Workers’ Compensation (DWC) is proposing major changes to the forms providers use for injured workers’ Progress Reports, the Doctors’ First Report of...

Albertsons Employee's Post-Amputation UR Nightmare

Two days before Christmas in 2022, an Albertsons Companies employee suffered “traumatic amputations” of three toes in a work accident. This worker lived alone on the t...