In California workers’ comp, providers cannot render treatment without obtaining authorization from the payer. Accordingly, authorization is legally defined as a non-rescindable “assurance” of reimbursement.

Yet somehow, payers repeatedly refuse to reimburse providers for inarguably authorized treatment.

In a recent example, Zurich Insurance North America signed a provider’s Request for Authorization (RFA) approving treatment for a Cornerstone Staffing employee. The provider rendered said treatment and sent Zurich multiple bills that included the RFA Zurich signed.

Zurich denied payment for the treatment, citing…no authorization.

The provider submitted Second Review appeals to dispute the payment denials, again including the signed RFA. Zurich denied payment, again citing no authorization.

In an even more frustrating twist, demonstrating both Zurich’s ineptitude and the needless administrative burdens California comp puts on providers, Zurich/Cornerstone’s defense attorney contacted daisyCollect requesting a copy of the RFAs to “review” and decide if payment is “appropriate.”

California law requires payment of an electronic bill (e-bill) within 15 working days. It has now been over four months since Zurich received the first of these bills, and no payment has been sent as of this writing.

No provider should have to prove the obvious, over and over, and to multiple parties, and still not receive reimbursement for authorized care.

It’s the latest example of the absurd administrative slog that, multiplied by multiple visits from multiple injured workers, helps explain why California doctors are refusing to treat injured workers.

Zurich Authorizes Care

California requires providers to request authorization for all treatment using the standardized RFA form. If the provider fails to adhere to the mandated process in any way, the payer has no obligation to authorize the care.

By contrast, payers may respond to RFAs in any form or format they choose, often resulting in unclear, bloated, or illegible decisions that cause payment disputes down the road. However, in this case, Zurich actually authorized care in the most straightforward (though optional) way: simply checking the “Approved” box on the RFA form (below) and affixing a signature.

Zurich Inexplicably Denies Payment

With unmistakable approval to render the appropriate care in hand, the provider treated the injured worker and sent Zurich e-bills for reimbursement.

The provider included copies of the approved RFA with each e-bill.

Yet, in what would seem like a cruel joke (if we hadn’t seen it so many times before), Zurich denied payment by claiming the treatment wasn’t authorized. In accordance with the mandatory bill dispute procedure, the provider submitted Second Review appeals, also with copies of the approved RFAs.

Zurich doubled down on its bogus denials, refusing to pay again.

Subsequently, daisyCollect received a separate communication from an attorney representing Cornerstone Staffing. In the email, the attorney makes the patently untrue statement that the provider sent “no supporting evidence” of authorization.

The attorney’s email requested a copy of the RFA forms that the provider had already sent to Zurich twice (emphases ours):

“We represent Cornerstone Staffing and have received 2 Provider’s Request for Second Bill Review for [redacted] for the dates of service: 3/19/26 and 4/2/26.

The requests indicate that prior authorization was obtained for the service and documentation included.  There was no supporting evidence attached. A copy of each is attached for your convenience.

Please forward the RFA forms approving the service so we can have an opportunity to review and provide to the administrator for payment if appropriate.

Please do not hesitate to contact us if you have any questions.”

We responded by sending out the approved RFAs for a third time, along with an email to the law firm outlining Zurich’s repeated failure to reimburse for authorized care and noting additional bills on the claim that Zurich also failed to pay.

“Thank you for reaching out regarding Zurich failing to pay for care it authorized for a Cornerstone Staffing injured employee.

To date, for Dates of Service 3/19/2026 and 4/2/2026, Zurich:

1. Denied payment for the original bill, incorrectly citing that there was no authorization. With the bill, the provider included the RFA form where Zurich checked and signed that it authorized the treatment. Further, Zurich indicated on the RFA form, “Per IMR determination, 6 visits of CBT are authorized.”

2. Denied payment for the Second Review appeal the provider submitted to dispute the original bill non-payment. The Second Review also included the RFA with Zurich authorizing treatment.

Additionally, Zurich has denied payment for the following two dates of service that Zurich authorized: 3/5/2026 and 4/9/2026.

Of the six treatments Zurich authorized, it paid for only two. All four treatments were incorrectly denied as not authorized. All four treatments included proof of authorization.

Attached is the RFA form you requested.

Please advise when the provider can expect to receive payment for these authorized services.”

For those keeping score, to have any hope of getting paid for authorized services, this provider had to:

1. Complete an RFA and obtain authorization
2. Submit proof of that authorization with the original bills
3. Submit proof of that authorization with subsequent appeals
4. Submit proof of that authorization to defense attorney

The time and administrative hassle necessary to pursue payment here is a classic example of what makes treating injured workers such an unappealing prospect for providers. Even assuming payment arrives eventually, it will likely not include the mandatory (but “self-executing”) penalties and interest for untimely reimbursement.

In other words, Zurich will almost certainly face no consequences for making it so difficult to get paid for treatment it authorized. Extrapolate this experience across multiple bills and injured workers, and the current exodus of doctors from this broken system begins to make sense.

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