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Archive | December, 2011

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JUDITH DENNIS’ Injured Worker Horror Story

Posted on 29 December 2011 by admin

I tore cartilage in my knee at work. Surgery was denied, and then unsuccessful. Temporary disability support was taken away. I have lost my apartment, my savings and everything I worked so hard to build up. $3,500 is not adequate compensation for my disability and lost past and future earnings.

Read more at the attached link.


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D.A.’s Office and State License Board team up to fight insurance fraud

Posted on 29 December 2011 by admin

The San Bernardino County District Attorney’s Office Workers’ Compensation Fraud Prosecution Unit has partnered with the California Contractors State License Board’s (CSLB) Statewide Investigative Fraud Team (SWIFT) to assure contractors and those engaged in home improvement and construction activity have the proper workers’ compensation insurance coverage and appropriate licensure for the job.

As a result, during the past two months, investigators from the District Attorney’s office and SWIFT conducted the first of what will be many compliance checks at jobsites throughout San Bernardino County.

So far, about 70 people involved in construction type work have been visited on jobsites in Redlands and Rancho Cucamonga, with other cities and unincorporated areas to follow. Of those contacted, most were in compliance with California’s Labor, Insurance, and Business and Professions Code requirements for workers’ compensation insurance coverage as well as contractor licensure.

“Workers’ comp fraud is crime that victimizes every honest business and taxpayer in San Bernardino County because they are forced to take on the unnecessary burden of higher premiums,” said District Attorney Michael A. Ramos. “By implementing strong anti-fraud activities and prosecutions, what we are ultimately hoping for is that every contractor working in our county will be in full compliance with the law, and this partnership is just another step in that direction.”

To date, four stop orders were issued to contractors during the compliance checks who had not secured workers’ compensation insurance for jobsite employees. A state law that took effect in January of 2011 gives CSLB the authority to issue these orders, which stop all work on the contractor’s jobsite until workers’ compensation insurance is obtained.

In addition to the stop orders, three licensees without workers’ compensation insurance coverage were identified; however, the appropriate insurance was obtained within days of the compliance check, which is the goal of this partnership. Those contacted who did not obtain the proper coverage are issued citations for failing to carry workers’ compensation insurance, which carries stiff penalties that, if left uncorrected, could include ­license suspension and fines. Four individuals who were contracting without a license were also issued citations.

“CSLB hopes its partnership with the DA’s office puts unlicensed, uninsured operators on notice that this activity won’t be tolerated in San Bernardino County,” said CSLB Registrar Steve Sands. “This proactive enforcement will help assure consumers are protected from financial harm and that a level playing field exists for those legitimate licensees who follow state laws and insure their workers.”

CSLB and the San Bernardino County District Attorney’s Office’s Workers’ Compensation Insurance Fraud Prosecution Unit urge consumers to follow these tips before they hire a contractor to work on their home or property:

• Only hire state-licensed contractors and ask to see their license and a photo ID to verify their identity. Always check the license number on CSLB’s website at or to make sure the license is in good standing.

• Confirm that the licensee has workers’ compensation insurance coverage if he/she has employees. C-39 Roofing contractors are required to purchase workers’ compensation insurance even if they certify they have no employees.

• Only pay 10 percent or $1,000 (whichever is less) as a down payment. There is an exception for about two dozen licensees who carry special bonds to protect consumers. These exceptions are noted on CSLB’s website.

• Don’t pay in cash, and don’t let payments get ahead of the work.

• Get at least three bids, check references, and get a written contract.

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Jerry Brown Predicts Tough Budget Year, Says He ‘Passed’ First Year In Office

Posted on 28 December 2011 by admin

Gov. Jerry Brown said Tuesday that he expects the first half of the new year to be dominated again by California’s budget problems, as he proposes more spending cuts and tries to clear the November ballot of tax measures that might compete with his. DAVID SIDERS in the Sacramento Bee — 12/28/11

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New Comp Legislation Takes Effect With New Year

Posted on 28 December 2011 by admin

Bills that aim to crack down on the underground economy and rein in costs associated with compound medications are among measures that take effect in California with the start of the new year.

Gov. Jerry Brown’s actions on workers’ compensation legislation passed in 2011 surprised many stakeholders. Labor was incensed with the governor’s decision to veto measures they said would help restore benefits that were slashed by the administration of former Gov. Arnold Schwarzenegger, while business generally applauded Brown’s actions.

On Oct. 7, Brown signed Assembly Bill 378 — one of the most contentious workers’ compensation bills debated during the first year of California’s two-year legislative session — that is intended to eliminate the profit motive for prescribing compound drugs.

The bill, by Jose Solorio, D-Santa Ana, states compound medications must be billed at the ingredient level and be reimbursed at the Medi-Cal rate for each ingredient as identified by its national drug code (NDC). Ingredients without an NDC are not reimbursable under Solorio’s bill.

Ingredient level reimbursement must be equal to 100% of the reimbursement allowed by the Medi-Cal payment system and payment must be based on the sum of the allowable fee for each ingredient, plus a dispensing fee equal to the dispensing fee allowed by Medi-Cal. If a compounded drug is dispensed by a physician, the maximum reimbursement may not exceed 300% of documented paid costs capped at $20.

The bill also adds compound drugs, medical foods, co-packs, physician-dispensed over-the-counter medications and durable medical equipment to the list of goods for which physician self-referral is prohibited.

Pharmacists claimed victory, saying the bill could make it easier to get payer approval when using compound drugs. Khoa Tan Huynhn, president of Script Life Pharmacy, said he doesn’t do much compounding primarily because insurance companies reject requests for compound drugs. He said compound drugs play an important role in treating injured workers because they can alleviate pain without some of the side effects associated with opioids such as drowsiness and addiction.

Jason Schmelzer, lobbyist for the California Coalition on Workers’ Compensation, said the legislation will help control rising medical costs attributed to prescribing compound medications for profit.

Mark Sektnan, president of the Association of California Insurance Companies, said in a statement that AB 378 will “curb abuses in the workers’ compensation system.”

Brown also signed three bills intended to crack down on abuses by contractors who fail to carry workers’ compensation insurance.

On Oct. 7, he signed AB 397 by Bill Monning, D-Santa Cruz, requiring contractors to provide proof of coverage or certify that they have no employees and are exempt when applying for a contractor’s license or renewing a license. On Oct. 9, Brown signed AB 878 by Bill Berryhill, R-Stockton, requiring an insurance carrier to notify the Contractors State License Board when it revokes a license following an audit or investigation.

Brown on Oct. 9 also signed SB 459, by Ellen Corbett, D-San Leandro, authorizing the Labor and Workforce Development Agency, upon finding a person or employer willfully misclassified an employee as an independent contractor, to impose civil fines of $5,000 to $15,000 for each violation. If the development agency or a court finds a pattern of willful misclassification, the civil penalty created by the bill is between $10,000 and $25,000 for each violation.

The bill also requires an employer to display on its website or, if it doesn’t don’t have a website, in a prominent area at the physical location of the business, notification that the development agency or court found it committed a serious violation of the law by engaging in willful misclassification. The employer must also state it has changed its business practices and inform employees if they believe they have been illegally classified as a contractor.

Tom Holsman, chief executive officer of the Associated General Contractors of California, said the bills essentially guarantee a contractor must maintain a valid workers’ compensation policy and that they can’t work with a fictitious license or without insurance without facing “severe penalties.”

The governor signed a pair of bills intended to ease the burden on employers who purchase large-deductible policies or who have a few employees located outside of California.

Brown on Oct. 7 signed Senate Bill 684, by Corbett, requiring insurers to provide written disclosure to California employers if the carrier includes in the employer’s policy a provision that requires disputes to be arbitrated or resolved in courts outside of the state.

On Oct. 9, Brown signed AB 228 by Felipe Fuentes, D-Los Angeles, allowing State Compensation Insurance Fund to write policies covering the out-of-state employees of companies who have the majority of their workers located in California.

Gina Simons, communications director for State Fund, said the bill will save employers time and money because they can buy coverage for all their employees from State Fund in a “one-stop shop.”

The Association of California Insurance Companies opposed the bill saying that other carriers want to compete for the out-of-state business that State Fund will be authorized to write starting Jan. 1. Sektnan, the association’s president, said as the state-chartered carrier of last resort, State Fund is exempt from paying federal taxes on its premiums, giving it an unfair competitive advantage.

Solorio’s AB 335, signed on Oct. 7 by Brown, is another measure backed by employers.

The measure requires the administrative director of the Division of Workers’ Compensation to work with the Commission on Health and Safety and Workers’ Compensation (CHSWC) to develop regulations regarding notices to injured workers that explain the claims process in plain language. It also requires workers’ compensation notices posted by employers include the website address and contact information for the nearest DWC information and assistance officer so workers can get additional information.

Employers didn’t enjoy a complete sweep, however, with Brown signing a bill allowing the Department of Industrial Relations to borrow up to $4.3 million from an account funded by premium assessments that pays benefits for employees of illegally uninsured businesses.

Brown signed AB 436 by Solorio on Sept. 30, establishing the State Public Works Enforcement Fund to pay for efforts to monitor prevailing wage issues on public works projects.

Jerry Azevedo, spokesman for the Workers’ Compensation Action Network, said employers agreed to pay assessments so the Division of Workers’ Compensation could operate unfettered by state budget problems, and not to create a “government slush fund.”

Other bills that take effect on Jan. 1 include:

— AB 1416, signed on Oct. 2, amending California Insurance Code Section 11691 to allow workers’ compensation insurance and reinsurance companies to file mandatory deposits with banks domiciled in California, as well as national banks with a trust office located in the state.
— AB 1426, signed on Oct. 7, eliminating the court administrator position at the Division of Workers’ Compensation. Solorio, who authored the bill, said the position “creates divided lines of authority and accountability.”

Employers had much to celebrate, but labor was furious when Brown vetoed bills prohibiting discrimination in apportionment, making supplemental job displacement benefits available to workers earlier in the claims process and extending the period of temporary disability benefits for up to five years. Brown said in his veto messages that he wanted stakeholders to come together to develop reform proposals “on a broad and balanced scale.”

Similar versions of each bill were vetoed by Schwarzenegger. Jesse Ceniceros, president of Voters Injured at Work, said he was disgusted that Brown didn’t do anything to help injured workers and asked why labor supported Brown in his gubernatorial campaign.

Brad Chalk, president of the California Applicants’ Attorneys Association, said he was disappointed, but is happy to help work on a major reform package.

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Ten Things Workers Say About Workplace Bullying

Posted on 27 December 2011 by admin

Republished with permission from

If your fear of work involves more than just that towering pile of assignments on your desk, you may not be alone.

According to a survey from, 27% of employees have indicated they felt bullied while at the workplace. The survey notes that the problem is more commonly reported for women (34%) than for men (22%). (WCxKit)

For those employees who reported they had been bullied, the following points were noted as the most typical forms of such actions:

1. My comments were dismissed or not acknowledged – 43%

2. I was falsely accused of mistakes I did not make – 40%

3. I was harshly criticized – 38%

4. I was forced into doing work that really was not my job – 38%

5. Different standards & policies were used for me than for other workers – 37%

6. I was given mean looks – 31%

7. Others gossiped about me – 27%

8. My boss yelled at me in front of other co-workers – 24%

9. Belittling comments were made about my work during meetings – 23%

10. Someone else stole credit for my work – 21%.

While standing up to bullying can get a worker in trouble, it appears many do seem to see it as a deterrent to confronting the situation. A majority of employees claim they will stick up for themselves. Close to half of workers who indicated they’d been bullied also noted they would confront the individual head on, and 28% said they informed human resources. (WCxKit)

“Bullying is a serious offense that can disrupt the work environment, impact morale, and lower productivity,” said Rosemary Haefner, vice president of Human Resources at CareerBuilder. “If you are feeling bullied, keep track of what was said or done and who was present. The more specifics you can provide, the stronger the case you can make for yourself when confronting the bully head on or reporting the bully to a company authority.”

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contributor to the best selling book, Workers Compensation Management Program: Save 20% t0 50%. See for more information.





SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

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Business interests were top bill-killers in California’s Capitol this year

Posted on 27 December 2011 by admin

By Laurel Rosenhall and Chase Davis, California Watch

The Sacramento Bee By Laurel Rosenhall and Chase Davis, California Watch The Sacramento Bee

Business interests were the top bill killers inside California’s Capitol during Gov. Jerry Brown’s first year back in office, as concerns about the state’s weak economy cut into labor’s newfound clout. Legislative data show business interests wielded strong influence despite a Capitol dominated by Democrats in the Legislature and the Governor’s Office. Business lobbyists defeated bills that would have cut back various tax breaks, required employers to give workers unpaid bereavement leave and prolonged the foreclosure process. In the current economy, “all legislators are more sensitive to the argument that something would be a job killer or harmful for investment or expansion,” said Dorothy Rothrock, a lobbyist for the California Manufacturers and Technology Association, which represents major businesses around the state. “That’s made it easier for us to stop or amend bills to make them less hostile or burdensome. “Brown’s first year back was good for labor unions, too. They successfully pushed bills that limit the state’s ability to use private contractors, allow local governments to require union construction crews on public works projects, and reduce the use of electronic self-checkout lanes in grocery stores. But in the tug-of-war between the Capitol’s two power players, industry more than held its own. Business-related groups dominated the list of organizations with the most influence, according to a review of hundreds of bills.

The Bee and California Watch examined the final analyses written by legislative staff for all 906 bills introduced this year that listed supporters and opponents. For each group whose stand was registered on at least 10 bills, the news organizations tallied the number of cases in which supporters’ bills were signed by the governor and opponents’ bills stalled or were vetoed. Either scenario counted as a “win” for that group.While such a tally is imperfect – it does not assess all influence exerted under the dome – it captures the outcome of the legislative year for many who carry clout at the Capitol. Economy key influenceInterviews with dozens of key players confirmed a trend suggested by the numbers: The weak economy was a major factor as groups decided which bills to push and lawmakers made up their minds.Angie Wei, lobbyist for the California Labor Federation, said 2011 was better for workers “than under any year under Arnold Schwarzenegger.” Even so, Wei said, the state’s financial reality made her union less aggressive. The Labor Federation sponsored Assembly Bill 400, which would have required employers to provide paid sick days for their workers. But Wei said the union asked lawmakers to hold the bill in committee because “we didn’t think it was the right time to do it.”

Among other findings:

• Labor and business wielded their power differently. Labor groups generally won by passing new laws, while business groups mostly fought battles to maintain the status quo.

• The two groups that prevailed on the largest number of bills this year were the California Chamber of Commerce, which won on 62 of 87 bills, and the American Federation of State, County and Municipal Employees, which triumphed on 61 of 106 bills.

• Associations representing Realtors, bankers and insurance companies took positions on far fewer bills, but won at least 85 percent of the time.

Interest groups exerted their influence with money – combined they spent a total of $216.1 million on lobbying in the first nine months of the year, a 6 percent increase from the year before. Cash not always keyBut the spending didn’t always guarantee victory in 2011. The California Manufacturers and Technology Association spent $1.9 million while winning half its legislative battles.

The American Civil Liberties Union and the Sierra Club, meanwhile, each spent less than $350,000 on lobbyists during the first nine months of the year, yet did well in a Legislature where majority Democrats are sympathetic to their causes.Campaign spending on legislative races likewise didn’t necessarily result in a high success rate in the Legislature. The 15 groups that spent the most on winning legislative candidates and took positions on at least 10 bills had an average win rate in the Capitol of 63 percent.Still, special interests and other donors spent $229 million in political contributions on state candidates in 2010, $105.8 million of it on candidates for the Legislature, according to the National Institute on Money in State Politics. They contributed $36.3 million more to state candidates through independent expenditure committees, which cannot legally coordinate with candidates’ campaigns but can spend an unlimited amount to support or oppose a candidate.The business lobby wielded much of its influence through JobsPAC, a political action committee that collects millions from insurance, oil, tobacco, pharmaceutical and other companies to make independent expenditures in key races.

Last year, the committee spent $9.2 million statewide, a portion of it supporting candidates thought to be business friendly in four key Senate districts: Republicans Sam Blakeslee of Santa Maria and Anthony Canella of Ceres, and Democrats Juan Vargas of San Diego and Lou Correa of Anaheim.By session’s end, Blakeslee and Canella voted the California Chamber of Commerce’s way on each of the 13 important business bills listed in the chamber’s scorecard. Correa went the chamber’s way 69 percent of the time, tops among Democrats.Interest groups typically wind up named as supporters or opponents on a bill analysis because they sent lawmakers letters stating their position. But nothing compels a group to write such letters. Some entities prefer to lobby by meeting privately with legislators, and legislative committees have different approaches in determining whom to list in their bill analyses.Still, the findings broadly illustrate that business did better than might have been expected at the Capitol, where Democrats control both houses of the Legislature and, after several years under Schwarzenegger, now occupy the Governor’s Office as well.

“The arguments business has made, that companies and job creators have made for years, are resonating more with Democratic legislators given the (state’s financial) situation,” said Robert Callahan, a lobbyist for TechAmerica, a trade group that represents roughly 1,000 technology companies.

TechAmerica succeeded on 11 of the 12 bills on which its position was listed in an analysis.Two key victories, Callahan said, were defeating legislation that would have rolled back some tax credits. One, Senate Bill 508, proposed including “sunset” dates in all new tax break programs so they would be phased out after a period of time.

Another, Senate Bill 364, sought to allow the state to charge a fine and take back the money from a tax incentive if a company laid off at least 10 percent of its employees in a year.Labor unions supported both bills, arguing the state should be more careful about handing out tax breaks given the budget crisis. Tech America and other business groups opposed them, saying the first bill painted all tax breaks with the same brush, and the second one created too much uncertainty for employers. Brown vetoed both bills with short messages saying they were too broad. The vetoes also stack up as wins for the California Taxpayers Association and the California Chamber of Commerce, which joined TechAmerica in opposing both bills.

The chamber had a good year despite supporting Brown’s Republican opponent, Meg Whitman, in last year’s gubernatorial race. In the Legislature this year, chamber lobbyists fended off 25 of the 30 bills the group labeled “job killers.” They successfully persuaded Brown to veto four of the five that made it to his desk. “From a political standpoint, when the economy goes down and business is what can bring you back, then people listen to business,” said Marc Burgat, vice president of government relations for the California Chamber of Commerce. Business, labor claim winsOne of the so-called “job killer” bills Brown vetoed was Assembly Bill 325, which would have required employers to offer up to three days of unpaid bereavement leave to workers who lose a loved one. The chamber made the case that California already requires several types of leave, and adding another one would be a burden on employers who may be juggling requests from several workers.It also argued that the bill would have established broad rights for workers to sue, a view that was repeated in Brown’s veto message.

After Brown finished considering the bills on his desk in mid-October, the chamber produced a 2 1/2-minute video praising the governor and touting the success of its “job killer” lobbying campaign. “As business grows, we employ more people, we pay more taxes and the general fund grows,” Burgat said. “I think that message has resonated.” AFSCME – the labor union that represents 1.6 million public sector workers – produced a full-color 44-page report to wrap up its year of legislative influence.”Much of AFSCME’s hard work during last year’s election season has come to fruition for us this year,” the report says. “With the election of Jerry Brown, AFSCME has been able to enjoy a greatly improved relationship with the Governor’s Office.” The union sponsored 20 bills in 2011. Twelve of them made it to Brown, who signed nine. Among them: Assembly Bill 366 benefits mental hospital employees by streamlining court procedures for giving anti-psychotic medication to certain patients; Senate Bill 857 strengthens public employees’ right to strike; and Senate Bill 930 removes the fingerprinting requirement for recipients of In-Home Supportive Services. But AFSCME took positions on dozens more bills, sending a letter to lawmakers on almost every one.

That broad approach is typical of the union’s lobbying strategy, said AFSCME lobbyist Willie Pelote. “We take positions on a large number of bills because we care about the communities in which our members live,” he said. “We care about how our streets look, how our schools are.”The union also makes its case by getting lawmakers to see first-hand the work its members perform. AFSCME takes legislators on field trips to accompany laundry workers in hospitals, custodians in mental health centers and caretakers who go house to house feeding and bathing the infirm. “That is a very good tool for them to see it and smell it and taste it, instead of them going to Hawaii to do it,” Pelote said, making a reference to the annual trip some interest groups sponsor for lawmakers to attend. Yet even with the all of the positions AFSCME took this year, the state deficit caused the union to hold back on pushing for many new laws it would have liked to introduce, Pelote said. Other unions echoed that sentiment. “During this fiscal crisis, we’ve pulled back half our bills we want to run because they’re just not a reality. Either they have a dollar amount or we don’t want to put members in that position of having to go after something that’s tough right now,” said Randy Perry, a lobbyist for several law enforcement unions.”The times have changed the last couple years even on what we’re introducing. It’s a stalemate right now because of the economy.”


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7 Things Workers Compensation Adjusters Do All Day

Posted on 27 December 2011 by admin

Republished with permission from

Do you ever wonder what your workers compensation adjuster does all day? If you see the adjuster living easy, you may be surprised. The adjuster’s day is full of activities, requiring the adjuster to prioritize which actions are needed the most. Some of the daily routine you would see from the adjusters would include the following activities.


So, what will you see during your visit to the claims office?

1-The phone rings constantly

The typical workers comp adjuster has 100 to 125 indemnity files, depending on the jurisdiction and the experience level of the adjuster. Each of those 100 to 125 files has a claimant, one or more medical providers, and an employer. That alone makes for 300 to 375 plus potential parties that will want to speak with the adjuster. On top of that you have plaintiff attorneys, defense attorneys, triage nurses, nurse case managers, surveillance companies and state work comp boards that may call the adjuster. On a slow day the adjuster may only spend half of her time on the telephone. (WCxKit)

2-The e-mails come in fast

In this day where everyone expects instant service, the use of e-mail to convey messages and documents has surpassed paper mail. With attorneys, employers, employees and nurse case managers sending information by e-mail, it is normal for the adjuster to get 50 to 100 e-mails per day. While many of them can be copied right into the claim file, a significant portion of them require a response or other action by the adjuster.

3-The paper mail is voluminous

While the amount of paper mail has declined over the years, a two inch or five inch stack of new mail to be reviewed each day by the adjuster is still the norm. The mail has to be evaluated and the appropriate response taken on each piece of mail. Sometimes the response is only to send it to be scanned into the electronic file, but often a written reply or a phone call is needed.

Included in the paper mail are the faxes that come in each day. While most attorneys and employers are transmitting documents via e-mail, most medical providers are still using paper forms, paper bills and paper reports. These items are often easier for the medical offices to transmit by fax than by e-mail, so receiving numerous faxes each day add to the paper mail stack.

4-The consultations are frequent

A major portion of those telephone calls mentioned above are for the purpose of making decisions on what to do. The adjuster will often gather information by consulting with others. The adjuster will discuss the claim with the nurse case manager, the defense attorney, the employer, and other sources to make a judgment on the best course of action on a particular claim.

When the adjuster is not on the phone discussing a claim or reading the e-mails or reading the paper mail including faxes, the adjuster will often enter into consultations within the claims office. The adjuster will confer either with her supervisor or fellow adjusters on various aspects of a particular claim to gain insight or opinions of other claim professionals that have dealt with a particular situation or set of facts.

5-The decisions are major

The primary reason the adjuster enters into the consultations noted above is because the decisions the adjuster makes can have an impact on the life of the injured employee and all of the decisions have a financial impact on the employer. If the adjuster makes the wrong decision, either the employee or the employer or both will be hurt financially.

6-The appreciation is missing

While you are sitting there observing what the adjuster does all day, you will notice that the adjuster’s job often benefits both the employee and the employer. But it is the rare employer or even the rarer injured employee who expresses any appreciation for the work the adjuster does on the work comp claims. The most the adjuster hopes for is the claims supervisor will say “good job” when the claim is concluded. (WCxKit)

7-The adjusters best practices

While the adjuster is in constant modes of communication as noted above, the adjuster has a set of job requirements that have to be met.

1. Making contact with the employee, the employer and the medical provider on every new claim

2. Responding to all the communications noted above in a timely manner

3. Setting and maintaining accurate reserves on all of the assigned files

4. Making sure all indemnity payments are made timely

5. Making sure all medical bills are paid

6. Keeping in touch with the employees, the employers and the medical providers on a regular basis

7. Submitting the appropriate forms to the state work comp boards/industrial commissions

8. Identifying fraudulent claims

9. Pursuing subrogation when a third party is the cause of the employee’s injury

10. Attending mediations, either in person or by phone

11. Evaluating settlement opportunities and decisions

If you sit chair side by the adjuster, do not count on the adjuster having any time for chit chat, so just observe. They will have planned for your visit, and will have time to show you through your files. As you can see from the above the adjuster’s job fills the entire day, and then some. If you do sit and observe what the adjuster does all day, you will probably leave amazed at the dedication and hard work of the work comp adjusters.

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% Contact:





SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact


Posted on 27 December 2011 by admin



Voters Injured at Work (, an advocacy group representing California’s injured workers reacted to the decision by State Compensation Insurance Fund’s Communications Director, Gina Simons, for a request for proposals from private insurance firms to conduct investigations. Thursday’s announcement also gave a timeline of the first quarter of 2012 to concretize an arrangement and sign a contract. According to VIAW’s President, Jesse Ceniceros, the move demonstrates that a reduction in the number of investigations could result in substantial savings for the California Workers’ Compensation system.

Jesse Ceniceros, president of Voter’s Injured at Work, recently spoke with WorkCompCentral, and indicated that if insurance companies are trying to cut costs associated with investigations, then it probably is a significant cost. In line with the mission of Governor Brown to reduce costs in the workers’ comp system, VIAW has been monitoring the cost of investigations particularly carefully since October.

Since the end of the legislative session Ceniceros has been collecting data on the cost to the system of private investigations as well as speaking directly with private investigation companies at conferences. What has come to light is that the money spent on these investigations could be as high as in the hundreds of millions but the exact number has yet to be pinpointed and merits more research. And in line with Governor Brown, “The governor said he wants to be cutting costs and this an area we think is flying under the radar, ” stated Ceniceros.

The difficulty in acquiring accurate figures on the money spent on investigations has to do with the manner in which they are reported. According to Jack Hanna, spokesman of the Workers’ Compensation Insurance Rating Bureau, they are reported as an insurance carriers’ allocated loss adjustment expenses with no further details. Likewise, the California Workers’ Compensation Institute does not track the cost of investigations as per their Research Chief, Alex Swedlow.

On the opposite end of the spectrum is the analysis by Jerry Azevedo, spokesman for the Workers’ Compensation Action Network, who claims that without concrete data on expenditures for investigations one cannot determine if insurance carriers overspend on investigations according to comments made to WorkCompCentral. He added that there is not data in existence to support the over spending scenario, and since fraud does occur and escalates costs, channels must be put in place to dissuade others from committing fraud.

One needs simply to review statistics by the California Department of Insurance’s Annual Report 201 of August 2011 to understand that fraud cases are not rampant. There were 1,497 fraud cases that were prosecuted during fiscal year 2009-2010. Of these cases 638 were for claimant fraud, 408 cases for employers without insurance, 205 cases underreporting of wages and 67 cases of medical provider fraud. The total amount for restitution determined was $121 million and of that $73.5 has been collected.

The California Insurance Code and the California Code of Regulations require insurance carriers to have special investigation units for fraud investigation and reporting of cases wherein there is reasonable belief of fraud to the insurance department. President Dale Banda of the Northern California Fraud Investigators Association made statements to WorkCompCentral about investigations and the reasons for them. Investigations are conducted to determine that an employer carries workers’ compensation insurance and also if an employee’s injury occurred during the course of employment and not specifically to find cases of fraud.

Additionally, Banda claimed that investigations are for the benefit of all stakeholders in the workers’ compensation process. Claims must be seen from the viewpoint of all those concerned, the injured worker, the employer, the medical provider and the insurance carrier. Injured workers with legitimate claims will eventually receiver their benefits and those who commit fraud will also eventually be discovered and be penalized with payment restitution. Banda concluded that via investigations all parties will benefit because costs will be kept lower and that insurance companies do not conduct enough investigations.

Jesse Ceniceros of Voter’s Injured at work believes that too much money is being spent on investigations. As such, he sent a letter to the Division of Workers’ Compensation to express his concerns. Ceniceros is committed to exposing this overspending and stated that VIAW will continue to monitor these expenditures in order to adequately identify savings for the system. The savings mean more than increases in permanent disability or medical care for injured workers. Cost savings should come from both sides in order to aid an ailing workers’ compensation system.


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3 Million Could Lose Jobless Pay in Impasse

Posted on 22 December 2011 by admin

More than three million people stand to lose unemployment insurance benefits in the near future because of an impasse in Congress over how to extend the aid and how to offset the cost. ROBERT PEAR in the New York Times — 12/21/11

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California leads in 2010-11 job growth

Posted on 22 December 2011 by admin


California’s 11.3% unemployment rate may be second highest in the country, but the state also created the most new jobs in the country over the last year, reports the U.S. Bureau of Labor Statistics.

In California, 233,000 more workers were on payrolls in November than in November 2010, edging out Texas, which was in second place with 226,000 new jobs. It was the third month in a row California had led the nation in year-over year job growth.

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