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All employers need workers’ compensation coverage, and our customers rave on our excellent and detailed service we have been providing for many years.

Our goal has been to assist the employer in gaining control of their workplace safety program, to reduce the potential occurrence of expensive and/or frequent injury claims, and to make the work environment more productive, that can affect workers’ compensation insurance premium.

Here are Highlights of our services:

  • Audit of Rating Classification
  • Audit Dispute assistance
  • Analysis of the Loss History and Causes of Employee Accidents and Loss
  • Assist Employer in the Enrollment of CA Medical Provider Network (MPN)
  • Review of outstanding claims and negotiate open reserves by working closely with the claims adjusters/liaisons
  • Loss Control and Safety Program Consultation including Injury and Illness Prevention program (IIPP)
  • CA Employment Poster

Common Red Flags of Suspicious Activities in Claims

Common Red Flags of Suspicious Activities in Claims

  • Unexplained or unreasonable delay by employee in reporting the injury
  • "First thing Monday morning" injury
  • Post termination claim
  • Inconsistent description of how the injury occurred
  • Trouble reaching the injured employee at home while they are supposed to be off work due to injury

**Final Audit

The insurance company conducts audit to verify the operations of the insured and to update policy information, such as changes in operations, business locations and ownership.
  • Reporting Total Gross Payroll:

  • Salaries
  • Commissions
  • Vacation Pay
  • Sick Pay
  • Bonuses
  • Holiday Pay
  • Overtime Base Wages
  • Auto Allowances
  • The market value of gifts
  • All substitutes for money earned or paid during the policy period including meals and lodging in lieu of wages
  • Some pension plan payments
  • What You May Exclude:

  • Payroll for officers specifically excluded from coverage under the policy
  • Excess portion of overtime
  • Severance Pay
  • Charges for the Personal Use of Company Vehicles
  • Tips or Gratuities
  • Reimbursements for actual expenditures, to the extent they are substantiated in the payroll records
  • Salary reductions to fund the welfare or fringe benefit portion of a Section 125 cafeteria plan

ABOUT SB899 (CA ONLY)

SB 899 was signed into law on 04/19/2004. What Employers need to know about SB899
  1. Give employees reporting an injury the Employee's Claim form Workers' Compensation Benefits (Form DWC-1) - updated 2010
  2. Refer all injured employees to a physician, clinic, or hospital in Medical Provide Network (MPN) - law updated 2010
  3. Requires authorization for immediate medical care: During the investigation of a claim, the provision of medical treatment is required during the course of the investigation up to a limit of $10,000 or denial of the claim, whichever occurs first

Medical Provider Network (MPN)

Effective 10/08/2010 the CA regulation streamlined the MPN implementation process.

The Employer’s Role

The employer implements the MPN, which involves providing information to employees and handling limited administrative duties. Every employee must be given a copy of the “Initial Notice of MPN”, as well as the “Predestination of Personal Physician (form 9873).” Every employee must sign and return to you a Network Acknowledgement form. It is important that the employer maintain a copy of every signed form, as without the form, the network may lose its right to direct care for an injured employee. Finally, as part of each injured worker’s recovery process, the employer helps develop a program to bring the employee back to work as quickly and safely as possible. The steps that follow will guide you through the process of setting up and managing the network in your workplace.

Claim Contact / Provider Search

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