Intended Consequences

Earlier this year, April 1st to be exact, the Division of Workers’ Compensation (DWC) adopted changes to the Medical-Legal Fee Schedule (MLFS). This is the schedule governing the payment of … Read More »

Indicted Providers: 10 Times More Claims Than Honest Docs

California’s extensive anti-fraud efforts have had an impact on the state’s workers’ comp costs, but the true impact is just now coming into focus. New industry claim data linking indicted providers to the medical bills they generated show that they were generating ten times the claims and rendering nearly twice the amount of services per … Read More »

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QME Recertification Dispute Ends With Settlement

Eight qualified medical evaluators (QMEs) are again seeing injured workers after the Division of Workers’ Compensation agreed to reinstate them in good standing. The Division also agreed only to apply the state’s medical-legal billing rules “as written” not as it had been “reinterpreting” them. “Those four underground regulations, they’ve agreed to stop using them, and … Read More »

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SB 863 Impacts On California Workers’ Comp Claims

New research indicates that medical costs in California’s workers’ comp system declined by 5% in 2013 and estimates are the SB 863 reforms played a vital part in bringing these costs down. In spite of the reduction, however, the average incurred medical cost for a California workers’ comp claim is still significantly higher than comparable … Read More »

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WCAB Updates Rules For Lien Claimants, Unrepresented Workers

Lien holders, physicians with a medical-legal billing disputes and interpreters with petitions for costs soon will either have to show up at all non-expedited hearings and mandatory settlement conferences for the case or be otherwise available to settle their claims. These are the new rules adopted by the Workers’ Compensation Appeals Board. Claims of $25,000 … Read More »

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DEU Slow to Rate Unrepresented Cases, CHSWC Says

The Commission on Health and Safety and Workers’ Compensation (CHSWC) last week confirmed industry complaints that the Division of Workers’ Compensation (DWC) Disability Evaluation Unit has become a bottleneck preventing cases from being settled in a timely manner, but at this point it says clear solutions are lacking. But it is clear that unrepresented workers … Read More »

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Workers’ Comp Loss Ratios Increase—Costs Hold

Loss ratios for California workers’ comp carriers continued their upward trend last year, according to the latest report on carriers’ experience by the Workers’ Compensation Insurance Rating Bureau. The 2008 annual report on California’s workers’ comp losses and expenses shows that costs held steady last year at $11 billion, including $4.1 million in payments for … Read More »

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