Tagged in: TPA

DWC Considers Updates To Claims Unit Audit Regulations

The Division of Workers’ Compensation is reviewing comments and feedback it received from a recent outreach to workers’ comp industry stakeholders to gather thoughts about what needs to be fixed in California’s audit regulations for claims adjusters and third-party administrators (TPAs). Division officials did not provide a timeline for when or if formal changes to … Read More »

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Sedgwick Grows With York Risk Acquisition

Five years into its ownership of York Risk Services, private equity firm Onex found its exit with a deal to sell the third-party administrator (TPA) to competitor Sedgwick for an undisclosed amount. Onex reportedly paid $1.3 billion to acquire York in 2014. The deal reinforces Sedgwick’s position as the nation’s largest TPA. Sedgwick itself is … Read More »

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TPA Owes Carrier $18.5M In Claims Handling Dispute

A third-party administrator that failed to timely respond to a settlement offer for $30,000 is now on the hook for the full $18.5 million an arbitration panel awarded the carrier on the case for the TPA’s malfeasance. The underlying case had settled for $15 million after a trial court returned an award for the plaintiff … Read More »

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It’s All About Control

Why is it a good thing to be a Member of a SIG? How does this work? Clay Jackson explains.

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California Supreme Court Considers Overtime Pay for Claims Adjusters

Workers’ comp carriers in California are taking heat from both employers and regulators over the dollars they spend to administer and defend workers’ comp claims. Loss adjustment expenses (LAE) ballooned following the reforms, but a case now pending before the California Supreme Court could have a moderating effect on one component in that cost driver … Read More »

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E-Billing Is on Its Way

Employers, claims adjusters and health care providers doing business with California’s workers’ comp system will have to use a new set of standardized paper forms beginning this fall while the system as a whole prepares for implementation of electronic billing standards a year later. The rules approved by the Office of Administrative Law promise quicker … Read More »

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Commissioner’s Report Urges CIGA Reforms

Echoing the concerns of an independent auditor and a termed out board member, Insurance Commissioner Steve Poizner released a report yesterday that calls on the California Insurance Guarantee Association to improve its internal controls and to better manage its costs. And while the report includes dozens of potential improvements, this same report also clears CIGA … Read More »

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School JPA Wins Major Claims Case

The Marin School Insurance Authority is rolling in a $4.66 million verdict after a Napa County Superior Court jury found that the Authority’s third-party administrator (TPA) was negligent in handling at least 230 workers’ comp claims. Attorneys for MSIA say the case underscores the importance of payors and TPAs paying attention to proper claims handling … Read More »

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