Second Review

When Zurich Speaks, Garbled Noncompliance Comes Out

We are writing about Zurich again, as the claims administrator’s conduct continues to be a symptom of the deep unfairness that permeates California’s workers’ comp system. Th...

Zurich: Triples Down on Foul Play

Clearly Zurich fears no recourse as it continues to systematically ignore rules while stripping California providers of proper reimbursement. In this latest development, Zuri...

Gallagher Bassett: Audit Complaint Filed With DWC

In a previous article, we demonstrated how Gallagher Bassett ignores the California-mandated workers’ comp Official Medical Fee Schedule (OMFS). Gallagher Bassett also ignore...

Broadspire Defies CA Law and Denies Appeals Sent by Providers

Broadspire, A Crawford Company, is another example of a claims administrator that disregards California regulations with impunity. After accepting a compliant and time...

Zurich: CORRECT Appeal Instructions for Zurich Denials

Today, we explain the COMPLIANT protocol for California providers to dispute the noncompliant denials that Zurich recently issued, and that were based on its completely nonco...

Zurich Further Jeopardizes Providers' Payment With Incorrect Appeal Instructions

Even when there is potential payer fraud, California requires the provider -- not the payer -- to shoulder the burden of correcting claims administrator “mistakes.” For the t...

Gallagher Bassett Sinks Second Review Appeals

For California workers’ comp providers, we encourage submitting Second Review appeals when the claims administrator incorrectly adjusts or denies payment. Below we sho...

$47 Million and Counting: Second Review Saves Provider Revenue

California workers’ comp providers face an inexcusable amount of hassle, red tape, and outright abuse in the struggle to collect correct reimbursement. Take it from us...

CA Interpreters: No Second Review = No Payment

Providers — interpreters in particular — be advised: a California appeals court ruled that claims administrator Meadowbrook Insurance is not required to pay a disputed fee fo...

Liberty Mutual and a Cautionary Tale of Payment Woes

Today we’re sharing a maddening and all-too-common story of payment woes, this time featuring Liberty Mutual as the miscreant that just won’t pay a bill correctly -- despite ...

Berkshire Hathaway Fails to Process Second Review Appeals

Berkshire Hathaway Homestate Companies (BHHC) is failing to process electronic second review appeals, leaving providers in an unacceptable payment limbo. The insurer incorrec...

Claims Admins Deny Second Review Appeals as Duplicate Bills

Two claims administrators, York and Sedgwick, denied hundreds of compliant second review appeals on the grounds that the appeals were “duplicates” of the Original Bills in qu...