The Workers’ Compensation Insurance Rating Bureau of California (WCIRB)  issued a statistical report on August 26, 2010 that shows the average cost of an indemnity claim reached $60,253 in 2009 — of which $19,682 was spent on indemnity and $40,571 was spent on medical costs.

In comparison, the 2005 average cost of an indemnity claim was $38,105 — of which $13,079 was spent in indemnity and $25,028 was spent in medical cost.

The report shows that, since 2005, indemnity has risen 50.485% and medical costs have risen 62.1%.

Monies spent on indemnity and medical plus reserves are used to calculate your experience modification. AS an employer, you may not have control of what is happening to the whole Work Comp industry but you do have control of your experience modification. Your Work Comp broker or agent should be guiding you on how to obtain the lowest experience modification possible for your class of business.

The 2011 experience modifications issued by the WCIRB will now  include your ZERO claims EMR. Your company’s EMR goal every year should be to get as close a possible to your ZERO claims EMR. If your broker or agent is not willing or can’t give you a plan on how to lower your future EMR you should contact my team here at Van Beurden Insurance.

Rene Sanchez
Work Comp Claims Liaison
rsanchez@vanbeurden.com
Kingsburg • (559) 634-7120
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I received a call yesterday from a client that was upset because their company was sent to collections for unpaid workers compensation medical bills. The language in the letters from the collection agencies are very threatening to you and your company. With the current economic times and credit rating being a major lifeline for companies dealing with a threat to your credit score from a collection agency is a very serious matter that needs to be dealt with immediately. Your California workers compensation carrier will most likely not deal with the collection agency on your behalf. However, you do have a defense to get the collection agency off of your back. As I advised our client, write back to the collection agency and cite California Labor Code 3751 (b)

“If an employee has filed a claim form pursuant to Section 5401, a provider of medical services shall not, with actual knowledge that a claim is pending, collect money directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed, unless the medical provider has received written notice that liability for the injury has been rejected by the employer and the medical provider has provided a copy of this notice to the employee. Any medical provider who violates this subdivision shall be liable for three times the amount unlawfully collected, plus reasonable attorney’s fees and costs.”

In your correspondence back to the collection agency include a copy of the DWC1 (employee claim form). Tell them to immediately remove the employee and employers names from collections with written confirmation of it being done. If they don’t comply threaten to counter sue at their costs as indicated in the labor code. This should make them back off and relieve your stress. Labor Code 3751 (b) is not very well known or referenced by many in our industry. If you would like additional information on this topic please send me an email or if you have any other workers compensation claims related questions please let me know. I would be happy to help.

Rene Sanchez
Work Comp Claims Liaison
rsanchez@vanbeurden.com
Kingsburg • (559) 634-7120
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In my interactions with employers the question about one year statute of limitations defense for a workers compensation claim (for a single incident) is brought up on a regular basis. Most employers don’t know to establish the one year statute of limitations defense an employer must meet its burden of proof that an applicant had actual knowledge of their eligibility for workers compensation benefits. Some of us might scratch our heads on this one? Let’s review the case of:

C.I.G.A. v. W.C.A.B (2008) 73 Cal. Comp. Cases 771 Second District

In this case, David Carls reported to work, in 1997, two hours early and during that time he stepped in a hole and twisted his body. He then went to the company office and laid on the floor. An injury report was completed but he was told, by his supervisor, that since his injury occurred prior to his shift, it was not considered work related. His employer did not give him a workers compensation claim form (DWC1). He received medical treatment. A few years later(in 2004) he filed his claim for this injury.  (some additional history ) Carls had suffered a work injury in 1996 received benefits and litigated that one in 1999 (he was familiar with workers compensation rights and benefits for his 1996 injury)

The court held that the employer did not meet its burden of proof that Carls was aware of his rights (for the 1997 injury), they stated in part: …Whether it was compensable depended upon whether “at the time of injury, (Carls was) performing service growing out of and incidental to his… employment and acting within the course of his employment”… The record contains no evidence suggesting that Carls had any reason to doubt his employer’s implication that the injury was not compensable. On the contrary, Carls testified that he sought treatment from his own physician. Thus, Carls awareness of his right to compensation for the 1996 injury did not necessarily inform him of his potential right to compensation for the 1997 injury. We conclude that such evidence was insufficient to overcome the presumption that Carls was ignorant to his compensation rights…

My lesson from the Carls case is, if an employee reports an industrial injury that results in time off beyond the employee’s work shift, at the time of the injury, or results in a need for medical treatment beyond first aid, GIVE the employee a claim form (DWC1) and document that you did. An employer should never deny workers compensation benefits to an employee,  leave that up to the insurance carrier. In all, I tell employers there is NO statute of limitations when a claim form is NOT provided.

Rene Sanchez
Work Comp Claims Liaison
rsanchez@vanbeurden.com
Kingsburg • (559) 634-7120
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Hello world!

As a Work Comp Advisor, and a former claims liaison with the State Compensation Insurance Fund, helping businesses reduce their insurance costs is my goal. I truly enjoy using my experience to save money for Van Beurden clients.

Happy New Year 2010, and thanks for reading my first blog post. We plan to update these soon.

Rene Sanchez
Work Comp Claims Liaison
rsanchez@vanbeurden.com
Kingsburg • (559) 634-7120
Subscribe to Rene's RSS Feed

Contact Rene