The Division of Workers’ Compensation quietly released its 2023 Audit of Claims Shops report over the holidays. The annual report to the Legislature is mandated by Labor Code section 129(e) and is required to be submitted by April 1st each year. The 2023 report was due April 1st, 2024. Releasing news on a Friday or …
The federal district court in San Francisco granted a third-party administrator’s motion to dismiss an injured worker’s lawsuit on the basis that the California Workers’ Compensation Act bars the claims. The court held that the claimant, Kenneth Montesano, must either take up his claims with the Workers’ Compensation Appeals Board or seek another avenue of …
The package sale of a managing general agency (MGA) and a third-party administrator (TPA) by Sunz Holdings to Acrisure LLC in 2021 is now spawning litigation between the parties. The deal, according to court documents, was valued at hundreds of millions of dollars. In the deal, Acrisure acquired Next Level Administrators, a third-party administrator, a …
Correction: The article has been updated to reflect the number of positions currently authorized for the Division of Workers’ Compensation’s Audit and Enforcement unit at 34 positions. The 1,081 positions initially referenced in the article are the authorized positions for the Division as a whole. Intercare, a third-party administrator (TPA), is suing the Department of …
The Division of Workers’ Compensation agreed to drop nearly $200,000 in administrative penalties against Keenan and Associates, a Third-Party Administrator that failed a DIR claims audit. For its part, Keenan agreed to fix the problems identified in the audit and drop its appeal. The settlement leaves the failing grade intact. The deal was revealed as …
The Division of Workers’ Compensation is reviewing comments and feedback it received from a recent outreach to workers’ comp industry stakeholders to gather thoughts about what needs to be fixed in California’s audit regulations for claims adjusters and third-party administrators (TPAs). Division officials did not provide a timeline for when or if formal changes to …
Five years into its ownership of York Risk Services, private equity firm Onex found its exit with a deal to sell the third-party administrator (TPA) to competitor Sedgwick for an undisclosed amount. Onex reportedly paid $1.3 billion to acquire York in 2014. The deal reinforces Sedgwick’s position as the nation’s largest TPA. Sedgwick itself is …
A third-party administrator that failed to timely respond to a settlement offer for $30,000 is now on the hook for the full $18.5 million an arbitration panel awarded the carrier on the case for the TPA’s malfeasance. The underlying case had settled for $15 million after a trial court returned an award for the plaintiff …