Workers' Compensation Information and Tips


What Is A Claims Administrator?

A Claims Administrator for Workers' Compensation is a company working under the guidelines of the California Division of Workers' Compensation (DWC) and is charged with expediting the delivery of workers' compensation benefits and services to injured workers' without unnecessary litigation or delays. Typical examples of claims administrators are: Insurance Carrier - internal claims department Third-Party Administrator [...]

Types Of Workers’ Compensation Claims

If a work-related injury or illness occurs at your company, there are several scenarios that the particular incident may fall into, including: Incident or Report Only No medical care was necessary – your option of reporting to TPA First Aid Requires one-time medical visit and one follow up visit No lost time beyond the date [...]

Examples of Work-Related Injuries or Illnesses

The injury or illness must arise out of employment (AOE) and occur during the course of employment (COE). Examples of on-the-job injuries or illnesses are: Cumulative trauma injury caused by repetitive keyboarding (RSI/musculoskeletal) A broken arm from falling off a ladder Lower back strain from lifting a box or prolonged seating Hearing loss due to [...]

What Are Workers’ Compensation Benefits?

Workers’ Compensation claims are limited to work related instances resulting in injury, illness, or death. The benefits available to the injured employee are determined by the state of California and work through a process known as “No Fault System / Exclusive Remedy”. This means that an employee relinquishes the right to sue the employer in [...]

What is Permanent Disability?

Permanent Disability (PD) is defined by the State of California as any lasting disability from your work injury or illness that affects your ability to earn a living. If your injury or illness results in PD you are entitled to PD benefits, even if you are able to go back to work. Most employees injured on-the-job [...]

Types Of Settlements For Permanent Disability Claims

If you have a Permanent Disability (PD) caused by a work-related injury or illness, the State of California has two types of settlements that you may receive, known as "Stipulations with Request for Award" and "Compromise and Release". Stipulations with Request for Award If a workers' compensation case goes to a hearing, the judge may [...]

What Is Supplemental Job Displacement?

Supplemental Job Displacement Benefits (SJDB) is a non-transferable voucher that can be used to pay for educational retraining or skill enhancement (or both), at a state-approved or state-accredited school. The employee must have had a permanent partial disability caused by an injury on or after January 1, 2004 to qualify for SJDB. Here are a [...]

Understanding Life Pension Benefits and Death Benefits

Life Pension There are two types of Life Pension that you may be entitled to: Permanent Total Disability and Permanent Partial Disability. You must have a Permanent Disability (PD) rating of 70% or more to be entitled to a life pension. The amount is based upon a formula using variable determined by your PD rating [...]

If My Claim Is Accepted, What Can I Expect?

If your workers' compensation claim is accepted, you are entitled to receive payments because you can't perform your usual and customary work. We have listed some important information regarding your Lost Time Benefits: Lost Time Benefit, or Temporary Disability (TD) is not paid for the first 3-days (waiting period) until the employee has lost 14-days [...]

How Does Utilization Review Affect A Claim?

When you suffer an injury or illness at work, it is important to receive the necessary medical treatment to help get you healthy and back to work. A doctor or a physician will be responsible for requesting your treatment. For a physician to obtain medical treatment authorization, the requesting physician must submit a compliant Request [...]

Resolve Disputes With Independent Medical Review (IMR)

What if you disagree with the utilization review (UR) determination for your workers' compensation claim? As of July 1, 2013, medical treatment disputes for all dates of injury are resolved by physicians through an efficient process known as Independent Medical Review (IMR).  If utilization review denies, delays or modifies a treating physician's request for [...]

Employer’s Responsibility To Report A Work-Related Injury

Employer's in the State of California must abide by certain regulations administered by the Division of Workers' Compensation (DWC) when an employee suffers a work-related injury or illness. Elite Claims Management is ready to assist your company and work with your supervisors to make sure you are prepared if an incident happens. Here are a [...]

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