RFA

Zurich: Blind to Its Own Treatment Authorization

In California workers’ comp, providers cannot render treatment without obtaining authorization from the payer. Accordingly, authorization is legally defined as a non-rescinda...

CA: Don’t Waste Your Time on RAND’s UR Study

If California’s Department of Industrial Relations (DIR) had taken $300,000 of taxpayer money, thrown it into a gravel pit, and set it on fire, it would have been only slight...

CA DWC: Providers Must Use RFA Form (While Payers Can Do What They Please)

In California, before treating an injured worker, a physician must obtain prior approval from the payer for all treatment. The California Division of Workers’ Compensation (C...

Tesla Insurer Zurich Sends "Certification" Providers Can’t Trust

Treatment authorization should be a fairly straightforward process, even in the convoluted world of California workers' comp: the doctor submits a compliant request for treat...

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...