WHY IS MY WORKERS’ COMPENSATION CLAIM DELAYED?  INJURED WORKERS, OUTSTANDING CLAIMS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Many Injured Workers have their workers’ compensation claims delayed.

This article will discuss why claims are delayed and what Insurance Company activities occur during the delay period.

Why Are Claims Delayed?

Insurance Companies delay claims in order to verify that there is a legitimate claim.  Per the Labor Code, they are afforded this opportunity to investigate.

As part of their investigation, Insurance Companies will investigate the following matters.

Coverage: Insurance Companies need to verify that they actually insure the Employer for the date of the injury.

Employment Verification: Insurance Companies need to verify the Injured Worker actually worked for the Insured Employer.

Date of Injury:  Insurance Companies need to verify the date of injury.

Employer Injury Knowledge:  Insurance Companies need to know if the Employer knows about the work injury.  They need to know the details how the injury happened, whether there were witnesses,  and whether it was reported to management.

Medical Verification: Insurance Companies will seek to obtain the medical reporting from the Industrial Clinic or the Medical Provider who treated the worker.

Statements: Insurance Companies may seek the use of an investigator to take statements of the injured worker, other employees of the company, or witnesses,  to verify the injury.  Investigations can be done by Attorney who may take depositions.

Records:  Insurance Companies may seek records from prior employers, insurance companies or medical providers

Qualified Medical Evaluation: An Insurance Company may seek a Panel Evaluator from the State of California to obtain a medical opinion on causation. .

What is the Authority for Delaying a Workers’ Compensation Claim?

Labor Code Section 5402(b) provides for a 90 day period upon which Insurance Companies have to deny a claim.  Thus, there is a 90 day period to delay the claim and investigate.  This 90 days is from the knowledge of the claim.

The date of knowledge is per LC 5402(a) which provides that “ [k]nowledge of an injury, obtained from any source, on the part of an employer, his or her managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400.” Thus, employer knowledge can trigger the start of the insurance company’s delay period

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

JANITORS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

A large part of the labor market is the occupation of Professional Cleaners.  They are also referred to as Commercial Janitors.  The Janitorial Occupation is susceptible for a variety of work injuries and occupational illnesses. Janitorial work presents unique risks for work injuries for those within the field.

This article will discuss Janitors, Janitorial Tasks, Industrial injuries and Occupational Illnesses that are prevalent within the Occupation, and the barriers that Janitors have with respect to filing claims.

What are Janitors?

Janitors perform a variety of maintenance tasks a variety of facilities. They use a multitude of tools and chemicals to perform their jobs.  They can engage in a large variety of repetitive physical tasks, ie. sweeping or mopping.

Janitors can work at institutions such as schools, hospitals, parks, and prisons.

Janitors can work in commercial buildings such as shopping malls, and they can work in residential properties.

What Are Janitor’s Risks of Industrial Injury?

Each type of facility can present unique risks of work injury for Janitors.

For example, hospitals and medical facilities can have significant amounts of potentially infectious biological material present.  Schools can have issues relating to mold exposure.

Further, the physical activities of being a Janitor may cause work injury.

What Types of Injuries Do Janitors Sustain?

There are a variety of work-related orthopedic injuries. These injuries relate, in part, due to the fact that “Janitorial work is repetitive and requires bending, twisting, and other motions that can lead to or exacerbate musculoskeletal disorders, such as arthritis” Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

Also, Janitors may sustain respiratory injuries relating to the cleaning chemicals that they use.  Further, they may sustain dermatological injuries due to wet work.

What Are the Injury Rates for Janitors?

In a Washington State Study, it was noted that “[t]he prevalence of self-reported work-related injuries in the past year was higher than that of all others …. Analyses of WC data indicate that work-related injury risk may be higher for the industry group containing Janitors than other industries2 overall and in several injury types, with women at particularly high risk.” Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH

Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

Thus, the workers’ compensation industry both has a concern over janitorial injuries as well as an understanding that work injuries are common.  Thus, Risk Management handling Janitorial claims will work hard to manage these claims.  This can be done with respect to reporting requirements.  It can also be done with respect to return to work issues which can include modified work.

Do Janitors Have Emotional Issues?

Yes. Janitors, in the study, reported “being diagnosed with a depressive disorder ..significantly higher and has been reported previously.    Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

While this finding did not address work-relatedness, it is possible that the depressive disorder may be in party work-related in nature and give rise to a workers’ compensation claim.

Can Shift Work Impact Janitors?

Yes. Shiftwork has been connected to various medical conditions.

Shiftwork can cause issues of inadequate sleep.  Inadequate sleep can lead to other health issues.

Do Janitors Have Barriers in Filing Workers’ Compensation Claims?

Yes. There is some concern as to whether all janitor work injury claims are filed.  As noted in the study, “[l]ow-wage, immigrant, and/or Hispanic worker populations, including many Janitors, may also not be aware of the WC system (or how to navigate the system, if they lack internet access) or of their right to seek medical care for an occupational injury or illness. Janitors may also face barriers to reporting an injury to their employer, such as fear of consequences.    Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

If a Janitor is concerned about their employment situation if they claim a work injury, it is important for them to seek legal counsel to discuss their concerns to make a determination as to whether they should file the claim.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

INJURED WORKERS WAKE UP! CARRIERS AND EMPLOYERS HAVE OTHER GOALS THAN YOU: RISK MANAGEMENT AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Injured Workers need to know that the workers’ compensation system is a risk management system. Therefore, it is important to understand the nature of a risk management system.  Insurance Companies and Employers may take actions on your claim and your employment.  Therefore, understanding risk management may allow you take measures to protect yourself.

Risk Managers compile information and techniques which allow them to limit costs with respect to workers’ compensation claims.

Injured Workers and Workers should have a general understanding risk management within a work injury context. Risk Managers’ approaches in workers’ compensation claims may unfortunately impact an Injured Worker’s treatment or benefits.

This article will discuss the various factors that Risk Managers consider as important and what areas that they will address as cost-savings measures.

What Is Workers’ Compensation?  How Is It Related To Risk Management?

Workers’ Compensation was created to be insurance program that manages work injury losses or costs for employers.  The system is designed with the context that businesses and employers can be able to cover the employee injury risk and no go broke.  In other words, a work injury claim should be something that can be affordable and not bankrupt a business.

Work Injury losses and costs include indemnity payments, transactional costs such as adjusting and legal costs, and medical treatment costs.  Further, employers and insurers are also concerned with respect to reserves. Reserves are monies that are set aside to pay the expected costs on a claim.

What Is Risk Management?

Risk Management is a field which addresses aspects of insurance and loss.   Thus, with respect to industrial injuries, Risk Managers focus on both injury reduction and injury prevention.

Part of the injury reduction component includes limiting the nature and extent of injuries as well as the attending costs for the claim. This can include reducing indemnity payments as well as medical treatment.

Part of Risk Management is the ability to predict outcomes.   Therefore, knowledge of past claims and past results lays the foundation as to how to approach future claims.

What Are the Methods of Risk Management?

Risk Management methods include safety training, control banding, protective equipment safety guards, safety mechanisms on machinery, and safety barriers. Also, analyzing causes by using root cause analysis may help reduce future injury. Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Some aspect of risk management can include workplace inspection.

What Is Risk Management’s View of the Sources of Occupational Injuries?

Risk Managers need to know what can cause injuries in the workplace.  Occupational injuries can result from physical, biological, chemical, or psychosocial hazards. Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may have a goal of controlling these hazards.  In doing so, this can lead to loss prevention with respect to work injury claims.

Thus, Risk Managers may implement workplace training, rules, and regulations.

What Is Risk Management’s View as to the Types of Work Exposures That Can Cause Injury?  

Risk Managers see a variety of exposures that workers encounter in the workplace that are causative towards injuries.  Unlike sources of injury, exposures are ones that are in fact injurious in nature.  These include “noise, temperature, insect or animal bites, aerosols, blood-borne pathogens, hazardous chemicals, radiation, and occupational burnout.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may control the amount of worker’s exposure to these items or events to prevent work injury claims.

What is Risk Management’s View as to Common Sources of Injury?

“Many injuries still occur due to poor ergonomics, manual handling of heavy loads, misuse of equipment, general hazards, and inadequate safety training.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers, to prevent injury, may implement of ergonomic work stations, training and rules for properly lifting and safety training.

What is Risk Management’s View as to the Common Types of Injuries?

“Slipping or tripping, which causes a fall are common work-related injuries, accounting for 20% to 40% of disabling occupational injuries.”  Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Further, it should be noted that orthopedic injuries tend to be the most common medical specialty that is employed to treat industrial injuries.

What is Risk Management’s View as to the Parts of the Body Get Injured?

The most common injury is to the Upper Extremities.  They represent 50 percent of workplace injuries.   Hearing Loss also accounts for a significant amount of occupational injury claims.  Further, needle sticks are also a source of injuries as well. Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may impose rest breaks, ergonomics, hearing testing, hearing protections, and proper disposal of needles to prevent work injuries.

What Is Risk Managements’ View of Age?

A Worker’s age can statistically have value to Risk Managers.

Statically, “[a]ge is perhaps the most common personal factor that predisposes a person to an increased risk of work-related injury. Workers aged 65 years and older are more likely to suffer from occupational injuries compared to their younger occupational counterparts.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Additionally, older workers can make them ”at higher risk for hearing loss, visual impairment, and the use of multiple prescription medications that are linked to higher rates of work-related injuries.”

In sum, Risk Management, although there are laws against age discrimination, may be focused on the tasks that older workers perform.

Does Risk Management Have a Concern with Respect to Occupations?

Yes.  Certain occupations for which there are higher rates of work injuries.  In particular, the occupations with high rates of include farming, fishing, forestry, construction and manufacturing.  Supra.

What is Risk Management’s View with Respect to Testing Proving or Disproving Claims?

Risk Managers rely on traditional work-ups by medical providers to assess work injury claims.

The work-ups include the taking of a comprehensive history and a physical examination. Also,  a diagnostic workup should be considered. This diagnostic work-up can include, but is not limited to, radiographs, ultrasound, and advanced imaging modalities.

Risk Managers, however, have concerns with respect to MRIs.  It is noted that “while the use of magnetic resonance imaging (MRI) is often helpful in delineating the actual clinical pathology, providers should remain cognizant of the potential for overdiagnosis and the potential for treating a potentially incidental finding that is not the primary source of a patient’s current debilitating condition.” [emphasis added]

Note: This passage shows notes that allowing for medical testing can open a Pandora’s Box of liability.  An incidental finding on a MRI can lead to a claim being amended for additional body parts.

Further, it is noted that “MRI has been demonstrated previously in the literature to its known limitations in the appropriate clinical setting. For example, a 2010 study reported on the inconsistent diagnostic accuracy of wrist MRIs being obtained to identify the potential source(s) of ulnar-sided wrist pain.” Supra.

Further, “a 2017 study analyzing work-related injuries consistent with unilateral knee or shoulder injury and subsequent bilateral MRI studies being performed during the diagnostic evaluation reported that less than half of patients had degenerative and/or pathologic findings that would be considered worse than the contralateral, asymptomatic, “normal” side.”

Note: This research is Risk Management propaganda concerning MRIs.  The issue is treating symptomatic disabling body parts.  The fact that an asymptomatic body part with pathology is present should not create excuse.

What Is Risk Management’s View on Treatment?

Risk Managers view treatment with a two-fold perspective.  In the treatment setting, there is the opportunity to treat the injury. Also, there is the opportunity to analyze the work-relatedness of the claim. This can include an assessment as to the value of the claim.

“Each work-related injury is different. Thus, providers should first establish whether the injury is preexisting, directly or indirectly related to the patient’s occupational requirements and if the claim is considered to fall under the workers’ compensation system.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Risk Managers note that “[t]reatment is specific to the specific condition and may include pain management modalities, physical therapy, NSAIDs, injections, and surgery.  It is important to recognize that each patient presenting with occupational-related injuries should be managed on an individual basis as not all conditions are created equal.”   This is position is true.   This position is not however adhered to during the course of workers’ compensation treatment.

Risk Managers limit claims exposure by asking providers to limit their evaluations and treatment.  This can be done by limiting authorization to treat certain body parts or what treatment will be authorized.

What Is Risk Management’s View on Surgery?

Surgeries are not necessarily viewed as beneficial from a Risk Management perspective.

“The literature supports many different types of clinical encounters the potential disparity with respect to postoperative outcomes comparing work-related injury patients compared to their non-work counterparts.”

“For example, total joint replacements are, in general, consistently reproducible procedures that yield excellent outcomes in the vast majority of patients. However, when comparing occupational-based (or workers’ compensation) patients to non-workers’ compensation control patients via matched cohort or comparative studies, the literature demonstrates the potential for a comparably inferior outcome in the former.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may have some fear and trepidation as to authorizing surgeries due to the fact that there is the anticipation that the results may not be optimum.  As a result, Risk Managers may scrutinize and resist requests for surgery.

What Is the Risk Management’s View of Case Settlement?

Risk Managers have a concern with respect to the future medical costs. This is especially the cases with respect to older workers. It is noted that “the synergistic combination of the older population falling at work, in addition to the older population’s predisposition to these low-energy injuries, sets up the potential for an overall devastatingly morbid effect on the entire healthcare system.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238. The Risk Management perspective to include nurse practitioners as part of the diagnosis progress.

This perspective indicates that there may be an increased sense of urgency to settle older workers’ case.   This is due to the fact of the possible high medical exposure costs.   Further, Risk Managers may desire to avoid placing older workers in work setting in which they may be subject to trip and fall injuries.

What Is Risk Management’s View on Obtaining a Medical Diagnosis?

“All healthcare providers are encouraged to manage these patients individually in order to ensure the best possible outcomes.”  Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238. Nurse practitioners were included as part of the providers who could make the medical diagnosis. Supra.

As a representative of Injured Workers, it is my contention that diagnosis and treatment of Injured Worker should be the purview of medical doctors.  They should be the one making the diagnosis and not nurse practitioners.   The reliance on nurse practitioners is solely a cost savings measure, Improper or inadequate diagnosis by a nurse practitioner can lead to delay in a achieving a proper medical diagnosis.  This improper or inadequate diagnosis can lead to delays in both proper treatment and return to work. Therefore, while reliance on lower level practitioners for diagnosis of a condition may be perceived as cost-cutting, it may not actually be more costly in the long run.

What Is Risk Management’s View Concerning “Return-to-Work?”

Yes. Risk Managers recognize that there are “return to work” issues for Injured Workers. I attended a lecture on this issue.  The speaker noted that every day that an Injured Worker missed as a result of their injury impacted on the probability that the worker would return to their usual and customary job.

Thus, Risk Managers acknowledge that an Injured Worker returning to work can have a profound impact on both their workers’ compensation case and the Injured Worker’s employment.

Thus, there may be some instances where Insurance Companies and Employers may encourage early return to the workplace.  This can be done via offers of alternative or modified work.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

UTILIZATION REVIEW IN CALIFORNIA WORKERS’ COMPENSATION:  A PERSPECTIVE FOR INJURED WORKERS

For Injured Workers seeking medical treatment for their workers’ compensation claims, Utilization Review (UR) of their Physician’s Requests for Authorization for medical treatment is all too common.   Injured Workers often receive letters denying treatment, modifying treatment, deferring treatment authorization, requesting further information and certifying treatment.  These letters are generated by the Insurance Companies via their Utilization Review process.

This article will briefly discuss the history of Utilization Review, what is Utilization Review, why the workers’ compensation system employs UR, and how an Injured Workers should address UR.

What Is the History of Utilization Review?

“Background Utilization management has been defined by the Institute of Medicine as “a set of techniques used by or on behalf of purchasers of health benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision.”[1] Utilization management is used in an effort to discourage the use of unnecessary or inappropriate medical services, without jeopardizing necessary high-quality care.

The terms “utilization management” and “utilization review” (UR) are used interchangeably in this report. By the late 1980’s, UR had become ubiquitous in health care, effecting virtually everyone with any form of health insurance coverage in the U.S., and many workers’ compensation claims administrators had also begun to use UR as a cost-containment tool.” Utilization Review in California’s Workers’ Compensation System: A Preliminary Assessment July, 2001 Division of Workers’ Compensation Public Health Institute Department of Industrial Relations Berkeley, California State of California [emphasis added]

What is Utilization Review?

“Utilization management is a set of techniques used to manage health care costs through the assessment of the appropriateness of care in individual cases. The primary focus of utilization management is reduction of the use of unnecessary or inappropriate medical services.” Utilization Review in California’s Workers’ Compensation System: A Preliminary Assessment July, 2001 Division of Workers’ Compensation Public Health Institute Department of Industrial Relations Berkeley, California State of California

In layman’s term, managing health care costs saves Insurance Companies money by denying treatment.  Denying treatment leads to less bills. Less bills leads to less costs.

What are the Reasons for Utilization Review?

Medical costs within the workers’ compensation system are driven my multiple factors.  These can include fraud, overuse, and greed.

First, fraud in workers’ compensation could include prescriptions for expensive and unnecessary treatment.

Second, overuse in workers’ compensation involved Injured Workers who were enthusiastic about their treatment and had providers who would enable it. For example, before UR, there were individuals with minor back injuries with open medical awards that would seek chiropractic adjustments 3 days a week in perpetuity.

Third, greed and distrust of medical providers. There is a distrust by insurance Companies of medical providers.   Medical providers may be incentivized to provide treatment to make money versus providing the care that was needed.   For example, epidural injections, at one point in time, became increasingly used.  Arguably, they were done because they were profitable for the providers rather than helpful to the Injured Workers.

How Should Injured Workers Address Utilization Review?

Injured Workers need to address utilization review by choosing treating doctors who are responsive to the UR process.  Further, Injured Workers should be aware of UR denials and the need to file for Independent Medical Review.

An Injured Worker should choose the right treating doctor for UR processes. An Injured Worker should look for treating doctors who understand the utilization review process.   This means that the doctors should understand the forms that need to be filled out to get treatment approval.  This means that the doctors should understand the treatment utilization schedules as to what treatment can be approved and how to request it. Finally, the doctor should be responsive to inquiries from utilization review when they request peer to peer discussions as well as requests for supplemental reports.

Also, Injured Workers need to have treating doctors who will be responsive to the utilization review company’s requests for further information.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

THE JOINT POWERS INSURANCE AUTHORITY: WORKERS’ COMPENSATION INSURANCE COVERAGE FOR GOVERNMENT AGENCIES: WHAT YOU NEED TO KNOW

The State of California provides for Private industry and Government Entities a variety of ways in which they can fulfill their commitment to maintain workers’ compensation coverage for their workers.  One of the entities that assists Government Entities provide workers’ compensation coverage is the Joint Powers insurance Authority (JPIA.)

While Injured Workers are entitled to benefits in accordance with workers’ compensation law, it is important to know who is providing the coverage.  This knowledge provides insight as to how the claim will be managed and how a settlement may occur.

This article with discuss what is the Joint Powers insurance Authority and how the JPIA is involved with workers’ compensation coverage.

What is the Joint Powers Insurance Authority?

The Joint Powers Insurance Authority is a Risk Management Entity.  The JPIA was formed to fill the needs for public agencies to handle their risk obligations.  For public agencies with employees, one of their risk obligations is workers’ compensation.

In addition to the Authority, the Joint Powers members have associations which may lobby on their behalf to impact workers’ compensation legislation.

How Does the Joint Powers insurance Authority Provide Workers’ Compensation Coverage?

Per the JPIA, “[t]he California JPIA provides workers’ compensation coverage that offers members two options: the primary workers’ compensation program and the excess workers’ compensation program.”

What Is a Primary Workers’ Compensation Program?

A primary workers’ compensation program would provide coverage and administration in the adjustment of workers’ compensation claims. JPIA members will generally use a third-party administrator to adjuster their claims.

What is An Excess Workers’ Compensation Program?

Excess Workers’ Compensation Insurance is coverage that covers costs that exceed a set point.   This set point of excess is to be determined by the insurance.  It can be for payments exceeding $500,000.00 or $1,000,000.00.   The coverage can be capped. The coverage can even be unlimited.  Excess coverage protects the employer in the event of a catastrophic case.  Additionally, an employer can purchase multiple policies to cover various levels of excess amounts.

Note: My personal experience is that excess carriers can be difficult and resist in contributing to settlements of cases.   There have been many times in which the employer is at odds with their excess carrier on the issues of settlement.

How Extensive is the JPIA?

JPIA is quite extensive. There are a number of agencies which employ their services.   JPIA indicates that they have more than 100 public agencies have partnered with them.  Also, the agencies employing JPIA include small, single-purpose entities to cities to special districts.

What Are The Core Values of JPIA?

Per their website, there core values are “Integrity: We hold ourselves to the highest ethical and professional standards. We pledge to fulfill our duties and deliver on our commitments; Excellence: We pursue distinction with a passion. We proactively assess our performance and strive to continuously improve programs, services, and work product;  Innovation: We foster creativity as we explore opportunities and meet challenges; Teamwork: We pursue productive relationships through communication, collaboration, understanding, and respect.”

Note:  The Core Values are all about risk management.  There is no mention of any values directly related to workers’ compensation and the treatment of injured workers.

How Do I Know My Claim Is Being Handled via JPIA?

If you work for a government agency, there is the possibility that JPIA may be involved in your case.   Further, JPIA may not be administering the claim.   It will most likely be a third-party administrator.   On your claim correspondence, however, there may be a reference to JPIA.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

 

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