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
An advocacy group has published a first-of-its-kind comprehensive list of coaches banned from Olympic sports, creating a database of nearly 1,000 people no longer allowed to work in the U.S. Olympic system because of sex-abuse allegations, doping positives and other …
Source: Claims Journal USA Website Lists Coaches Banned from U.S. Olympics
Baltimore has filed a lawsuit against the agrochemical giant Monsanto and two other companies, accusing them of polluting city waterways and stormwater. The legal effort focuses on PCBs, the industrial chemicals that have long accumulated in animals, plants and people …
Source: Claims Journal USA Baltimore Sues Monsanto Over PCB Pollution
British Columbia’s public auto insurer says about 450 vehicles have been written off since sulphuric acid spilled along a busy commuter route near Trail¸ B.C.¸ in two incidents last spring. The Insurance Corp. of B.C. says there have been more than 4¸450 claims received in the wake of the spills but the vast majority of those vehicles were not damaged. It says it is still in the early stages of a lawsuit but no trial date has been set. The spills happened on April 10 and May 23¸ 2018¸ when tanker trucks owned and operated by Westcan spilled sulphuric acid from Teck’s plant in Trail along a stretch of highway near the city. ICBC filed a notice of civil claim against Teck Metals¸ Teck Resources¸ International Raw Materials¸ Westcan¸ the Regional District of Kootenay Boundary¸ the City of Trail¸ two drivers and the provincial government in October. Most defendents have filed responses denying responsibility.
Source: The Claims Page – USA About 450 Vehicles Declared Total Losses After Acid Spill On Canadian Highway
The frequency of medical malpractice claims has dropped substantially¸ but average case management expenses and indemnity payments continue to rise¸ according to a report. The rate of medical professional liability claims declined 27% from 5.1 cases per 100 physicians to 3.7 cases from 2007 to 2016¸ according to a report issued on Tuesday by CRICO Strategies called Medical Malpractice in America: A 10-year Assessment with Insights that examines national trends in claims frequency¸ payment and root causes of preventable harm. The report analyzed events affecting 124¸000 patients. “For the roughly one million physicians across the country¸ this trend signals a dramatic change in their risk of being named in an MPL case¸” the report stated.
Source: The Claims Page – USA Medical Malpractice Claims Down¸ Payouts Up: Study
Erie Insurance has reviewed police data on car crashes¸ and found that Saturdays in September are the most frequent days for fatal car crashes involving daydreaming while driving. The insurer recently published an analysis on its findings¸ which also discovered that Tuesdays in February are the lowest days for crashes involving daydreaming. Erie’s previous analysis last year found that being “generally distracted” or “lost in thought” is the number one distraction identified in fatal crashes. Erie cited its crash data from the Fatality Analysis Reporting System (FARS) – a repository that includes information from police reports on the causes of fatal car crashes. The insurer also consulted with the Insurance Institute for Highway Safety to analyze the data.
Source: The Claims Page – USA Insurer Reveals The Most Frequent Days For Crashes Due To Daydreaming
The out-of-state driver of a charter bus full of high school students that crashed into a low-hanging overpass on a Long Island parkway was using a non-commercial GPS device that didn’t warn him about the hazard in time to prevent …
Source: Claims Journal USA GPS Failed to Warn Bus Driver Before Overpass Crash
Few older adults use medical marijuana, a new national poll finds, but the majority support its use if a doctor recommends it, and might talk to their own doctor about it if they developed a serious health condition. Four out …
Source: Claims Journal USA Poll: Older Adults Wary of Medical Marijuana
Strong winds took down a large hangar at Hobby Airport overnight when severe storms rolled through southeast Houston. No one was inside the hangar when it happened. No one was hurt. The Houston Airport System says the runway that was once covered by debris from the collapsed hangar reopened sometime after 3 p.m. Wednesday¸ but that part of a neighboring taxiway is still closed. According to HPD Lieutenant Larry Crowson¸ police received a call a little after midnight to assist the fire department at the hanger owned by Jet Aviation.
Source: The Claims Page – USA Strong Winds Collapse Hangar At Houston Airport¸ Millions In Damage
Cigna’s purchase of healthcare pharmacy benefit manager Express Scripts last month was just the latest insurer/PBM acquisition in an effort to control rising medical treatment and drug costs. There’s been quite a few pharmacy benefit manager (PBM) acquisitions in healthcare …
Source: Claims Journal USA Cigna’s Purchase of Express Scripts Unlikely to Affect Workers’ Comp
Firefighters have extinguished a two-alarm fire that caused heavy damage to two homes in the Pecan Gardens area of Virginia Beach. The fire also killed a cat at one of the homes. As of 4:30 p.m. another cat from the home where the one cat died was unaccounted for. Fire officials say two more cats were in the other home¸ but haven’t shared whether they’ve been accounted for at this time. The blaze started at a shed between the two homes in the 500 block of Grant Avenue just after 3 p.m. Firefighters received a call at 3:15 p.m. and got the fire under control approximately 30 minutes later. Investigators determined the fire was started by a juvenile playing with fire.
Source: The Claims Page – USA Two Virginia Beach Homes Burned By Kid Playing With Fire
A charter bus headed to the Masters golf tournament overturned on a Georgia interstate Thursday¸ injuring 15 people and snarling traffic as scores of fans made the pilgrimage to one of the sport’s premier events. The bus driver was charged with driving under the influence. The bus carrying 18 passengers crashed about 8:45 a.m. Thursday¸ just as fans were driving in for the tournament’s first round. Sgt. Chris Wright of the Georgia State Patrol said the driver ran off the right side¸ then overcorrected and caused the bus to overturn in the median. Some passengers suffered broken bones and head injuries¸ Wright said¸ but none were life-threatening.
Source: The Claims Page – USA DUI Driver Repeatedly Swerved Before Crashing Charter Bus
Kenny Lawson loved being a garbage collector. The Germantown, Ohio, resident enjoyed working outdoors alongside his family, throwing his “solid as a horse” frame into physical labor that made people’s lives better. One customer left a cooler near the curb …
Source: Claims Journal USA Sanitation Worker Safety Group Pushes Penalty Bills
A team including an Iowa State University researcher studied Galveston, Texas, homes following Hurricane Ike, finding that the types of housing and homeowners – and how U.S. recovery policy handles each – played a major role in recovery outcomes. Sara …
Source: Claims Journal USA Research Reveals Coastal Housing Recovery Gaps After Disasters
Roads slickened by a spring snowstorm caused a messy and dangerous commute for drivers throughout the state Tuesday night. The State Patrol and local authorities responded to stalled vehicles¸ spinouts and cars in ditches as snow totaled 8.2 inches in Minneapolis and St. Paul and 6.5 inches in St. Cloud.With a low of 9 degrees overnight¸ roads were expected to be treacherous again into Wednesday. Temperatures below freezing and drifting snow were expected to combine to create continued hazardous conditions. Statewide¸ the patrol reported 421 crashes¸ 32 with injuries¸ in 24 hours from Monday to Tuesday evening.
Source: The Claims Page – USA Hundreds Of Accidents Reported On Slick Minnesota Roads
As controversy swirls around the death of a Model X driver last month¸ the head of Alphabet Inc.’s self-driving car unit is drawing distinctions between his company’s technology and Tesla Inc.’s Autopilot. Wei Huang¸ 38¸ died March 23 when his crossover using the driver-assistance system Autopilot collided with a highway barrier in Mountain View¸ Calif.¸ and caught fire. Computer logs recovered from the vehicle showed he didn’t have his hands on the steering wheel for six seconds before the crash¸ according to a Tesla blog post.
Source: The Claims Page – USA Waymo CEO Says Self-Driving Tech Not To Blame In Deadly Tesla Crash