Insurance Journal

DECEMBER 4, 2024

Claim frequency in California workers’ compensation remains significantly higher in the Los Angeles Basin than in the northern part of the state, a new study shows. The Workers’ Compensation Insurance Rating Bureau of California released its WCIRB Geo Study 2024, …

Workers Comp 245

Workers Comp Claim Compensation Workers Compensation Insurance 245

Insurance Journal

DECEMBER 12, 2024

Mega claims in workers’ compensation represent far less than 1% of total workers’ comp claims yet account for more than 2% of total loss dollars, and total in excess of $1 billion each year, a new study from 10 state …

Workers Comp 237

Workers Comp Claim Compensation Workers Compensation 237

AMAXX

MARCH 10, 2025

Proper layoff planning isn’t just about handling employment transitions; it’s crucial for controlling claims costs and ensuring that resources are available to support genuinely injured workers. Timely processing prevents claims from becoming unnecessarily expensive and ensures each case receives the attention it deserves.

Workers Comp 59

Workers Comp Claim Workers Compensation Injury 59

AMAXX

MARCH 10, 2025

In the first part of our series, we emphasized the importance of thoughtful layoff planning to mitigate the risk of increased workers’ compensation claims following a workforce reduction or facility closure. This reduces the potential for prolonged indemnity claims continuing after layoffs.

Workers Comp 59

Workers Comp Claim Workers Compensation Injury 59

Insurance Journal

JULY 17, 2024

Workers’ compensation claim rates and benefits paid in Minnesota continue to be stable or follow their long-term downward trajectories, a new Department of Labor and Industry (DLI) report shows. The 2024 Minnesota Workers’ Compensation System Report presents trend data regarding …

Workers Comp 263

Workers Comp Compensation Claim Workers Compensation 263

Insurance Journal

JANUARY 15, 2025

A recent decision and concurring opinion by a Florida appeals court may have upset years of practice and could raise costs for workers’ compensation insurers. Some claims that carriers were once ready to close out of due to the statute …

Workers Comp 264

Workers Comp Compensation Claim Workers Compensation 264

Insurance Journal

AUGUST 22, 2024

The West Virginia insurance commissioner’s office has adopted a new policy: It will soon begin destroying workers’ compensation claim files that are 10 years old or older. “Given increasing cybersecurity concerns and the type of information contained in the closed …

Workers Comp 279

Workers Comp Cyber Compensation Risk 279

Insurance Journal

AUGUST 12, 2024

The South Carolina Court of Appeals has signaled that employers who offer on-site health clinics may not be immune from tort claims from injured or sickened workers. It’s the latest twist to a question that has bounced around courts and …

Workers Comp 264

Workers Comp Protection Claim Workers Compensation 264

AMAXX

MARCH 24, 2025

Click Link to Access Free PDF Download “Workers’ Comp Claims Review Checklist: 9 Must-Have, Serious-Impact Elements” A common and costly mistake employers make is overlooking allowable payroll deductions. It is crucial to segregate payroll accurately by the correct classification codes.

Workers Comp 71

Workers Comp Premium Injury Workers Compensation 71

Insurance Journal

SEPTEMBER 19, 2024

A Washington man who claimed he was too injured to work while operating a metal fabrication shop faces a felony charge in an alleged $340,000 workers’ compensation scam. Travis Lee Johnson, 52, of Spokane Valley, pleaded not guilty recently to …

Workers Comp 264

Workers Comp Compensation Claim Workers Compensation 264

AMAXX

APRIL 10, 2025

In the complex world of workers compensation, risk managers play a vital role in aligning strategic oversight with day-to-day claims operations. Far from being a behind-the-scenes figure, a successful risk manager serves as the linchpin between claims administration, adjusters, and injury management teams.

Workers Comp 59

Workers Comp Risk Workers Compensation Injury 59

Insurance Journal

JULY 14, 2024

Projected changes to California workers’ comp claims frequency and severity due to industry mix of employment are negligible through 2026, while employment in most industries fully recovered from the initial pandemic related changes by the end of 2022, a new …

Workers Comp 243

Workers Comp Claim 243

Insurance Journal

OCTOBER 24, 2024

The owner of a Fresno, California-based for-profit vocational school was charged with engaging in fraudulent billing practices related to workers’ compensation. The fraudulent insurance claims could reach … Paul Steve Ramirez, 59, was charged with 11 felony counts, including insurance fraud.

Workers Comp 264

Workers Comp Compensation Insurance Claim Claim 264

Insurance Journal

AUGUST 29, 2024

Los Angeles area vocational school owner, Guillermo Frias, 65, of Paramount, and the school’s accounting manager, Yesid Colon, 54, of Baldwin Park, were arraigned following a California Department of Insurance investigation into allegations they submitted fraudulent claims to receive money …

Workers Comp 246

Workers Comp Claim Workers Compensation Insurer 246

AMAXX

FEBRUARY 25, 2025

Once employers and adjusters understand the value of evidence-based medicine (EBM) in workers’ compensation claims, the next challenge is applying it effectively. EBM helps ensure that medical treatments align with standardized recovery timelines, reducing unnecessary disability durations and claim costs.

Workers Comp 80

Workers Comp Injury Workers Compensation Claim 80

Insurance Journal

JULY 16, 2024

A Spokane, Washington woman who ran an adult family home while claiming she was too injured to work faces a felony charge in a $60,000 workers’ compensation fraud case. Serah Kamau, 52, reportedly operated her business, Brookhouse Adult Family Home, …

Workers Comp 245

Workers Comp Compensation Claim Workers Compensation 245

Insurance Journal

OCTOBER 8, 2024

California workers’ compensation written premium in 2023 was slightly above 2022, while written premium for the first six months of 2024 is 2% lower than the first six months of 2023, a new report shows. The Workers’ Compensation Insurance Rating …

Premium 277

Premium Workers Comp Compensation Workers Compensation Insurance 277

AMAXX

MARCH 11, 2025

Effectively managing workers compensation requires careful oversight and proactive measures to identify and prevent fraudulent or exaggerated claims. Surveillance serves as a powerful tool in validating claims, protecting your organizations financial health, and ensuring resources are dedicated to genuinely injured employees.

Workers Comp 52

Workers Comp Claim Workers Compensation Injury 52

AMAXX

OCTOBER 7, 2024

Claims audits and reviews are one of the most commonly used tactics by companies to control workers’ compensation costs. In fact, according to the RIMS 2009 Annual Benchmark Survey, 90% of companies had conducted a claim audit or review of at least some of their claims within the previous six months.

Workers Comp 105

Workers Comp Claim Workers Compensation Compensation 105

AMAXX

MARCH 24, 2025

This post is one in a 3-part series: Part 1: Workers Comp Independent Premium Audits Explained Part 2: Workers Comp Independent Premium Audits Explained Part 3: Workers Comp Independent Premium Audits Explained To qualify for this treatment, construction employers must keep meticulous records specifying exact hours worked per classification code.

Workers Comp 59

Workers Comp Premium Workers Compensation Compensation 59

Insurance Journal

JULY 29, 2024

The California workers’ compensation system has been relatively stable in the post-pandemic era, as premium levels rose by 1% in 2023 and are forecast to increase modestly in 2024—while decreases in average insurer charged rates are moderating, a new report …

Workers Comp 263

Workers Comp Compensation Premium Workers Compensation 263

AMAXX

MARCH 18, 2025

Many companies operate under an unwritten rule: accept every workers compensation claim, no questions asked. A well-managed workers compensation program should pay 100% of legitimate claimsand 0% of the claims that arent. Employees come to believe that every claim will be accepted, regardless of the circumstances.

Workers Compensation 71

Workers Compensation Compensation Claim Workers Comp 71

AMAXX

MARCH 4, 2025

However, for many workers, an overwhelming fear of losing their jobs adds unnecessary stress to an already difficult situation. Research has shown that fear of being fired is one of the top predictors of negative claim outcomes, including increased litigation rates and extended time off work. Heres how: 1.

Workers Compensation 82

Workers Compensation Compensation Claim Workers Comp 82

Insurance Journal

APRIL 20, 2025

Simpson An employee who claimed he injured his knee while swinging a club during an employer-sponsored TopGolf event has failed to qualify for workers’ compensation benefits. The Virginia Workers’ Compensation Commission (VWCC) recently upheld a deputy commissioner … By Andrew G.

Workers Comp 130

Workers Comp Injury Claim Compensation 130

Insurance Journal

OCTOBER 2, 2024

The road construction firm that employed six workers who were killed and another who was seriously injured in the collapse of Baltimore’s Key Bridge, along with its workers’ compensation carrier, have filed claims against the owner and operator of the …

Workers Comp 203

Workers Comp Compensation Claim Insurer 203

Insurance Journal

AUGUST 21, 2024

A 56-year-old former Washington State meter reader who claimed she was so traumatized from a workplace dog attack that she fainted at the sight of dogs has pleaded guilty in a workers’ compensation fraud case. According to a Washington State …

Workers Comp 200

Workers Comp Compensation Claim Workers Compensation 200

AMAXX

FEBRUARY 24, 2025

However, there are times when the NCM doesn’t serve a specific purpose and is assigned to the claim to get it moving. Ask your third-party administrator or adjuster to work with you to determine when nurses are needed to resolve claims quickly and ensure good-quality medical care for employees.

Workers Compensation 66

Workers Compensation Workers Comp Compensation Claim 66

AMAXX

OCTOBER 1, 2024

When managing workers’ compensation, a claim audit or review is a crucial opportunity for employers, carriers, TPAs (Third-Party Administrators), and brokers to come together and optimize claim-handling practices. Here’s how to effectively plan and prepare for a successful claim audit or review.

Workers Comp 102

Workers Comp Claim Workers Compensation Compensation 102

Triple-I: Workers Compensation

FEBRUARY 14, 2025

Combined ratio the most common measure of insurer underwriting profitability is calculated by dividing the sum of claim-related losses and expenses by premium. Net combined ratio and net written premium growth rates for Workers Comp are analyzed, forecasted, and reported in Triple-I quarterly members-only webinars.

Workers Comp 40

Workers Comp Premium Workers Compensation Workers Compensation Insurance 40

Insurance Journal

APRIL 15, 2025

An insurer erred in denying workers’ compensation benefits to a utility worker who contracted COVID-19 while on the job, a job the state had deemed as “essential” during the pandemic. The insurer had denied the claim on the basis that …

Workers Comp 147

Workers Comp Compensation Claim Workers Compensation 147

AMAXX

JANUARY 6, 2025

When embarking on the journey to master workers compensation, the road is well-traveled and marked by proven strategies. Our three components to achieve workers comp mastery are: Framework , Employer Controls , and External Controls. ” “I asked for surveillance on that claim, and they refused.”

Workers Comp 105

Workers Comp Building Workers Compensation Compensation 105

Insurance Journal

OCTOBER 20, 2024

The impact and surge of long-term COVID on the California workers’ compensation system since 2020 has been prevalent, including long-term impacts on disability and long-term patterns of medical cost and treatment on long COVID claims. That’s from a report by …

Workers Comp 130

Workers Comp Claim Compensation 130

Insurance Journal

JANUARY 16, 2025

Increases in average medical payments and average indemnity payments drove public self-insureds’ total paid losses up last year even though the number of claims fell, a new report shows. The California Workers’ Compensation Institute reviewed the initial report on fiscal …

Workers Comp 130

Workers Comp Claim Compensation Insurer 130

AMAXX

JANUARY 27, 2025

Click Link to Access Free PDF Download “Step-By-Step Process To Master Workers Comp In 90 Days” Start With Goal of Where You Want to Go We start with a goal of where we want to go. It might be too many claims. It might be too many open claims. This is where we start. We start with a vision.

Workers Comp 92

Workers Comp Workers Compensation Injury Compensation 92

AMAXX

SEPTEMBER 10, 2024

Efficient Communication of Medical Records Communication is critical, especially when it comes to sharing medical records with insurance claims adjusters or your company. By streamlining this process, the provider helps ensure smooth claims management, reducing delays in treatment authorization or return-to-work decisions.

Workers Comp 105

Workers Comp Workers Compensation Compensation Injury 105

Insurance Journal

OCTOBER 15, 2024

in the year ending March 31, resulting in an increase in California workers’ compensation temporary total disability and permanent total disability rates for 2025 work injury claims and other workers’ comp benefits … California’s State Average Weekly Wage rose nearly 3.8%

Workers Comp 147

Workers Comp Injury Compensation Claim 147

AMAXX

SEPTEMBER 9, 2024

Medical cost containment is an essential aspect of managing workers’ compensation claims effectively. Various medical cost containment strategies play a pivotal role in managing these claims efficiently. These discrepancies can lead to unnecessary claims if not identified and addressed by a qualified medical professional.

Workers Comp 102

Workers Comp Injury Compensation Claim 102