Raleigh, NC – The North Carolina Industrial Commission’s Compliance and Fraud Investigative Division continues to proactively identify businesses not complying with the Workers’ Compensation Act at an unprecedented rate. At the end of the Third Quarter of Fiscal Year 2017-2018, the Compliance Unit collected over $5.1 million in penalties, significantly more than the $1.15 million collected the first three quarters of Fiscal Year 2016-2017. The Commission attributes a significant portion…[Continue Reading]
Claims, Legal, & Compliance News
NCCI “On Opioids” Part 2 Examines Impact of Opioids on WC from Claims Pros’ Perspective
Boca Raton, FL – The National Council on Compensation Insurance (NCCI) is examining the growing issues related to opioid use in America through a three-part series, On Opioids. The series is aimed at exploring three viewpoints on issues surrounding opioid use and workers compensation: those of doctors, insurers, and regulators. NCCI conducted interviews with professionals from each of these areas and the articles in the series reflect their opinions on the topic. In the second of…[Continue Reading]
CA Security Company Busted for $3.2 Million Workers’ Comp Premium Fraud
San Jose, CA – Security Code 3, Inc. owner Troy Carson, 55, of San Jose was arrested by Department of Insurance detectives for allegedly underreporting payroll by more than $12 million in an attempt to secure a lower workers’ compensation rate under false pretenses and cheating his insurer out of more than $3.2 million. Victoria Cruz, 46, Lanette Wiegand, 46, both from San Jose and Jaime Lugo, of La Crescenta also face charges in connection with the fraud scheme. In total, the quartet is…[Continue Reading]
Genex Announces 2018 Heart of Case Management Award Winners
Wayne, PA – Three case managers were selected from more than a thousand highly skilled professionals to be named 2018 Heart of Case Management Award winners. This is the third year of the national awards program spotlighting case managers at Genex Services, one of the nation’s largest providers of managed care services to the workers’ compensation, disability, and automobile insurance markets. Genex’s case managers are highly regarded in the industry for transcending beyond their…[Continue Reading]
Kathleen Losada Joins Tower MSA Partners as Vice President, Strategic Services
Delray Beach, FL – Kathleen Losada has joined Tower MSA Partners as vice president of strategic services. In this role, she identifies and develops new markets and service offerings for the company, which provides Medicare Secondary Payer compliance services and Medicare Set-Asides. “Kathleen is a great addition to Tower,” said CEO Rita Wilson. “Her extensive background in MSP compliance and her ability to guide clients toward claims resolution align well with Tower’s consultative approach…[Continue Reading]
CWCI Study Shows Drop in CA Workers’ Comp Hospital Stays and Spinal Surgeries
Oakland, CA – A new California Workers’ Compensation Institute (CWCI) study finds that the number of California workers’ compensation inpatient hospital stays fell 31.2% between 2008 and 2016, compared to a 19.6% drop in hospital stays paid under private plans, a 2.4% increase in Medicare inpatient stays, and a 19.6% increase in inpatient stays paid by Medi-Cal, which saw a huge jump in enrollment with the rollout of Affordable Care Act (ACA) plans. To measure and compare the use of…[Continue Reading]
KS Insurance Department Closing Backlog of Workers’ Comp Cases
Topeka, KS – The Kansas Workers’ Compensation Fund, administered by the Kansas Insurance Department (KID), has closed more than 2,000 unresolved workers compensation cases during the past two-and-a-half years, according to Ken Selzer, CPA, Kansas Commissioner of Insurance. Our legal division has worked hard to reduce costs to the State of Kansas by finding a resolution to more than 2,000 of its workers compensation cases, some dating back to 1985,” Commissioner Selzer said…[Continue Reading]
Guest Post: Innovations in Workers’ Compensation Managed Care
I was recently invited to moderate a panel on innovation for the Southern California Chapter of the Case Management Society of America (CMSA). The case managers who attended the event were all versed in the challenges of managing complex work-related injuries, and they were eager to hear about the latest innovations that could help them better coordinate care and enhance outcomes for the injured workers they assist. The panel of experts discussed the latest high-tech capabilities, barriers to…[Continue Reading]
Sedgwick Completes Acquisition of Cunningham Lindsey
Memphis, TN – Sedgwick recently announced that it has finalized the purchase of global loss adjusting, claims management and risk solutions firm Cunningham Lindsey and its subsidiaries. The combined organization—including the subsidiaries of Sedgwick, Vericlaim and Cunningham Lindsey, with select exceptions—will move toward operating globally under the Sedgwick brand name. The strategic acquisition brings Sedgwick nearly 6,000 highly skilled Cunningham Lindsey colleagues in 65 countries who provide expert…[Continue Reading]
Travelers Introduces New Workers’ Comp Tools for Better Claim Experience
Hartford, CT – The Travelers Companies, Inc. (NYSE:TRV) recently announced its newest digital capabilities to improve the claim experience for injured employees. The additions provide an engaging customer experience with increased access to medical professionals after a workplace injury. MyTravelers® for Injured Employees, the company’s web-based and mobile-friendly self-service tool for workers compensation claims, offers two-way messaging between an injured employee and a Travelers Claim Nurse professional…[Continue Reading]