A performance report on the first five years of California’s independent bill review program reveals that claims adjusters’ billing decisions rarely align with how the state workers’ comp system sees things. According to the latest report from the California Dept. of Industrial Relations’ Division of Workers’ Compensation (DWC)¸ more than 70 percent of workers’ comp bills submitted to the state for bill review adjudication are decided in favor of the medical provider disputing the amount remitted by payers. That means that in seven out of 10 cases¸ not only are payers on the hook for additional medical costs¸ they also have to pick up the tab for the review fee.
Source: The Claims Page – USA 70% Of Workers’ Comp Billing Disputes End Badly For California Payers
If your client has filed a claim after experiencing a major event like a flood or fire¸ it’s likely that contractors have removed salvageable materials that are still usable. For example¸ in the event of a kitchen flood¸ contractors may place a large bin outside and start taking apart the flooring and cabinets that had been damaged. But in this case¸ the flood would have likely damaged flooring and lower cabinets¸ so why throw the upper cabinets in a bin destined for the landfill when they can be repurposed? One large Canadian insurer has taken a unique approach to divert such salvageable materials from landfills. Since 2014¸ The Co-operators has partnered with Habitat for Humanity Canada for the insurer’s ReClaim program¸ which provides Habitat for Humanity ReStores with good quality materials salvage from a home claim.
Source: The Claims Page – USA How Insurers Can Turn Their Salvage Into Social Purpose
Security cameras in a company cafeteria recently captured a brazen attempt to fake a workers’ compensation injury. The video shows that the man dumped a cup of ice onto the floor¸ disposed of the cup and then lay down on the floor as though he slipped on the ice. Prosecutors have charged the man with insurance fraud and theft by deception. In this case¸ the fraud was well-documented. But most employers do not have cameras in their lunch rooms or other areas of their work places. It can be very difficult to prove someone has faked an injury in the workplace without cameras catching the person in the act. But the consequences of undetected workers’ compensation fraud are enormous.
Source: The Claims Page – USA Real Or Fake? Finding Workers’ Comp Fraud
Specialist firm says staff must know their stuff
Source: Insurance Business Online Expertise “essential” to smooth claims process
Many companies still lack equal representation in the C-suite, and male leaders need to be part of the inclusion conversation
Source: Insurance Business Online Innovation and diversity in the insurance industry are not mutually exclusive
Panel announced for prestigious industry awards
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The incident was caught by a dashcam and then posted online
Source: Insurance Business Online “Arrogant” driver lies to insurer after crash
The partnership seeks to deliver a better insurance experience to brokers and insurers
Source: Insurance Business Online POP Insurance Holdings in worldwide tech tie-up