SCIF Hacks IBR by Switching (Incorrect) Denial Reason
Sep 15, 2021
There’s a serious inequity in the appeals process by which California workers’ comp providers can dispute incorrect reimbursement for authorized treatment. State Compensation...
Sedgwick Denies Second Review Appeals as "Duplicates"
Jul 12, 2021
Sedgwick has a Second Review problem.On too many occasions, Sedgwick incorrectly denies providers’ Second Review appeals as “duplicate submissions” of the original bil...
City and County of San Francisco's Misleading Response in PPO Discount Dispute
Apr 5, 2021
Recently, a DaisyBill provider disputed a reduction in reimbursement from the City and County of San Francisco (CCSF) for treating an injured employee. In the Explanation of ...
Broadspire Knows No Law But Its Own
Apr 2, 2021
Broadspire continues to break the rules, seemingly confident that California regulators will not hold the claims administrator to account. For months, we reported on B...
Broadspire Employers: Audit Complaint Filed With DWC
Oct 21, 2020
In a recent article, Broadspire Defies CA Law and Denies Appeals Sent by Providers, we described Broadspires’ success in defying California workers’ comp laws without consequ...
DaisyBill Automates Zurich Second Review Appeals
Oct 21, 2020
DaisyBill recently broke the story (after receiving multiple reports from the DaisyBill community and beyond) that Zurich has improperly denied California providers’ bills fo...
When Zurich Speaks, Garbled Noncompliance Comes Out
Oct 20, 2020
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
Oct 15, 2020
Clearly Zurich fears no recourse as it continues to systematically ignore rules while stripping California providers of proper reimbursement. In this latest development, Zuri...
Broadspire Defies CA Law and Denies Appeals Sent by Providers
Oct 6, 2020
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
Oct 5, 2020
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
Oct 2, 2020
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
Sep 21, 2020
For California workers’ comp providers, we encourage submitting Second Review appeals when the claims administrator incorrectly adjusts or denies payment. Below we sho...