Claims News Archive


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Advocating for our Industry

03.09.2017

By: Kimberly Brown, SVP Government Relations, Sedgwick

Sedgwick is proud to support the Association of Claims Professionals (ACP) to advance our industry and sustain future growth and positive outcomes. The companies that make up the ACP are leaders in the claims management industry and include independent claims adjusting companies and third party administrators. ACP companies respond every day to individuals and businesses who suffer a loss such as a workplace injury, property or casualty damage, or...
03.09.2017

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FUN WITH TEMPORARY DISABILITY

02.20.2017

By: Cynthia K. Karlen

Despite much confusion, calculating temporary disability (TD) can be easy—and fun—if we keep a few simple rules in mind.

All employees receive the maximum Temporary Disability rate UNLESS there is documentation proving the employee is not a max earner. First, get a wage statement from the employer and determine if the applicant is a full time or part time employee. When was he/she hired? Are there...
02.20.2017

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Workers’ Compensation’s Costly Psychosocial Issues (2)

02.02.2017

BY: Tom Lynch

First, a review.

Yesterday, we described the challenges confronting claims adjusters and injured workers when psychosocial issues are present in a workers’ compensation claim. These issues impede recovery and exacerbate costs. We confidently picked up our saw and walked out on the proverbial limb to suggest this thesis:

Our nation’s current system for treating injured workers with mental health issues is uncoordinated, overly fragmented, highly wasteful...
02.02.2017

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CMS Recovery Practice Ruled Improper Under the MSP

01.23.2017

By: Mark Popolizio

In an important new case—CIGA v. Burwell, 2017 WL 58821 (C.D. California, January 5, 2017)—the court ruled that the CMS practice of seeking full reimbursement of a medical provider’s single charge—even where some unsegregated portion of that charge relates to services not covered by a workers compensation plan—was improper under the Medicare Secondary Payer Statute (MSP) and its supporting regulations.

This new decision...
01.23.2017

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OSHA Issues Final Beryllium Exposure Rules

01.10.2017

A new rule issued today by the U.S. Department of Labor's Occupational Safety and Health Administration dramatically lowers workplace exposure to beryllium, a strategically important material that can cause devastating lung diseases. The new beryllium standards for general industry, construction and shipyards will require employers to take additional, practical measures to protect an estimated 62,000 workers from these serious risks.

Beryllium is a strong, lightweight metal used in the aerospace, electronics, energy, telecommunication,...
01.10.2017

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Reading the tea leaves: The Trump Administration and OSHA

12.14.2016

By: Julie Ferguson

Employers are in a state of limbo between one presidential administration and another, trying to intuit the potential impact as potential names of candidates for the  cabinet and key administrative posts are floated, debated and named. Much is still in the realm of speculation.

One thing is becoming clear: Despite the ambiguity that Trump’s recent comments about possibly preserving some parts of Obamacare, it’s clearly on the chopping block....
12.14.2016

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Florida Judge Strikes Rate Hike

12.05.2016

A Florida judge recently shot down NCCI and the Florida Office of Insurance Regulation’s (OIR) 14.5 percent rate hike for workers’ comp in that state, saying that NCCI held “secret” meetings without public notice, and because it is statutorily recognized, acted improperly in doing so. The ruling stems from a lawsuit filed by Miami-based attorney James Fee, who sued the organization in August in order to “introduce some required clarity and transparency...
12.05.2016

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More Bad News About Opioids

11.22.2016

By: Teresa Bartlett, MD SVP, Medical Quality, Sedgwick

At Sedgwick, we are committed to steering people away from opioid addiction and finding solutions to returning them back to healthy, productive lives. However, the lure of such drugs can begin even before entering the workforce and experiencing an unfortunate injury leading to the prescription of an opioid. This was exhibited last week in the following critical update from the Drug Enforcement Agency (DEA). Please read this important...
11.22.2016

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New Report Reveals Medicare’s “Low-Dollar” Threshold Calculations

11.15.2016

By: Mark Popolizio

U.S. Secretary of Health and Human Services (HHS) Sylvia Mathews Burwell released a new report to Congress that provides insight into the data the Centers for Medicare and Medicaid Services (CMS) used to calculate and substantiate its threshold figures. The report explains how Medicare calculated its recently revised “low-dollar” recovery and reporting thresholds for liability, workers compensation and no-fault settlements. 

Background Section 202 of the SMART Act requires the Secretary of...
11.15.2016

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Highlights from NCCI’s Workers’ Compensation 2016 Issues Report

11.09.2016

By: Julie Ferguson

“NCCI just released its Workers Compensation 2016 Issues Report: Fall Edition. It’s a robust 68-page edition, an important barometer of industry results and trends that we think should be on everyone’s reading list. In addition to updated State of the Line results for the workers compensation for 2014 and 2015 and preliminary estimates for Calendar Year 2016, this edition includes articles and reports on a number of key issues. It’s...
11.09.2016

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US Supreme Court Denies Workers’ Comp Petition in Florida

11.01.2016

The United States Supreme Court DENIED the petition in the matter of Stahl v Hialeah raising constitutional issues in the present workers' compensation system in Florida. The Florida program mirrors trending aspects of other state programs that have also been questioned on constitutional grounds. No. 16-98  Title:  Daniel Stahl, Petitioner v. Hialeah Hospital, et al. Docketed: July 21, 2016 Lower Ct: District Court of Appeal of Florida, First District Case Nos.: (1D14-3077) Decision Date: March 25, 2015 Rehearing...
11.01.2016

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October is National Disability Employment Awareness Month

10.28.2016

By: Sedgwick Connection

October is National Disability Employment Awareness Month (NDEAM), a time devoted to exploring disability employment issues and celebrating the many and varied contributions of America’s workers with disabilities. Reflecting the important role disability plays in workforce diversity, the national theme of this year’s NDEAM observance is #InclusionWorks. In line with Sedgwick’s commitment to fostering a diverse and inclusive workplace and supporting the full potential of people with disabilities in our...
10.28.2016

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IL Supreme Court Blocks Amputation Claim Against Union Pacific

10.27.2016

Editor's comment: The Illinois Supreme Court restored a ruling in favor of Union Pacific Railroad in a court fight with a worker, employed by a third-party contractor, whose legs were amputated removing and scrapping an abandoned railroad bridge in Chicago, as the court’s majority ruled the IL Appellate Court erroneously overturned the ruling of a Cook County judge who found the railroad owed no duty in this case to the scrap contract worker. 

10.27.2016

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Illinois Workers’ Compensation Fraud Investigations

10.17.2016

At the 2016 Illinois Self Insurers’ Association 38th Annual Educational Seminar and Membership Meeting, William Blumthal Jr, Deputy Director Investigations from the Illinois Department of Insurance, provided an update on their efforts to combat workers’ compensation insurance fraud.

            First, the definition of fraud is important to understand. It is an intentional act that results in financial gain. This contrasts with abuse, which is the improper...
10.17.2016

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The Flip Side of Regulations

10.10.2016

By: John Wroten, Senior Vice President, Regulatory Compliance & Quality, Sedgwick

What does the Joni Mitchell song ‘Both Sides Now’ have to do with workers’ compensation regulations? I’ve looked at life from both sides now From up and down and still somehow It’s life’s illusions I recall I really don’t know life at all -Joni Mitchell, Both Sides Now (1969)

These days, when I...
10.10.2016

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Report: Immigrant Worker Exploitation in the Building Trades

10.05.2016

by Julie Ferguson

The issue of immigrant deportation is front and center in this year’s impending election. There’s a lot of anger and invective aimed at immigrant workers, today, both those who are legal and illegal. One side of the story that is not told frequently enough is that of the unscrupulous employers who exploit these workers. For more than a dozen years, we’ve been talking about the abuse of workers...
10.05.2016

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How Age Can Impact a Workers’ Compensation Claim in North Carolina

08.31.2016

Ah, the golden years. But for many, the "ah" is an "ouch," with aches, pains, stiffness—and work. Today, retirement is increasingly not an option. The U.S. Census Bureau reports that over 20 percent of American’s over the age of 65 are still working, and that percentage is likely to grow.

And when these seniors get hurt on the job, they face issues that their younger colleagues do not.

Older people often have pre-existing conditions that may affect their recovery from new injuries. They also may be more prone to back problems, joint issues, and repetitive strain injuries.

The North Carolina law firm of Riddle & Brantley offers insight into the injured older worker situation in a new blog.

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PTSD Help Sought for S.C.’s Emergency Responders

08.29.2016

The battle to award PTSD workers’ compensation benefits to first responders continues its slow state-by-state slog across the nation.

In South Carolina, State Sen. Paul Thurmond, R-Charleston, has been a stalwart advocate for such legislation, having introduced bills in 2015 and 2016.

In 2017, it will be different—but not in a good way for those who support his efforts. Sen. Thurmond is not running for re-election.

Thurmond hopes others will take up the cause, especially in light of the current spate in killings of law enforcement officers across the nation. “PTSD is real and people have to understand that,” said Richland County Sheriff Leon Lott. “We’re exposed to death. We’re exposed to people shooting at us. We see all the same things that people see in war.”

The State has the story.

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The Case Against a Cancer Presumption for Firefighters

08.26.2016

By REINALDO (REY) ALVAREZ

Firefighters put their lives on the line every single day. Their status as heroes was solidified during the 9/11 terror attacks, but we have always known that firefighters are heroes. After all, a hero is a person who risks his life to save the lives of others. Firefighters and police officers deserve our respect and support, especially when they are injured while protecting the lives of others. If a firefighter gets cancer from battling blazes and...
08.26.2016

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Scorecard Quantifies Workers’ Compensation Claim and Payment Differences in L.A. County

08.25.2016

The California Workers’ Compensation Institute (CWCI) has debuted a new series of research publications, “California Workers’ Compensation Regional Score Cards,” which use subsets of data from CWCI’s Industry Research Information System (IRIS) database to measure and analyze various aspects of claims experience within eight regions of the state.

Score Cards for each region will profile claimant characteristics and highlight data compiled from claims filed by residents of the region. Exhibits include...
08.25.2016

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