Legal Process
The event that triggers the 90-day period to accept or deny the claim.
What is the filing of the DWC-1 claim form?
This is one common type of cumulative trauma injury.
What is Carpal Tunnel Syndrome?
This individual provides free advise to injured workers.
Who is an I&A Officer?
A reserving philosophy that is neither worst case scenario nor best case scenario.
What is most probable outcome?
A lie or exaggeration, prior claims, and an injury reported after a weekend are examples of this insurance fraud term.
What are Reg Flags?
Discovery is closed with this type of hearing.
What is an MSC? (Mandatory Settlement Conference)
This Labor Code section provides a Defendant's right to contribution against other carriers.
What is Labor Code 5500.5?
Provides court accepted ratings free of charge.
Who is the DEU?
This body part James says is most difficult to defend.
What is the head?
In a California transaction the company has 60 days to report the potential of this type of fraud.
What is Insurance Fraud?
A Defendant has 30 days from receipt of an Application for Adjudication to file this type of petition to change the court location.
What is a Petition for Change of Venue?
This case mandates that a later second cumulative trauma claim be merged into one actual pre-existing claim.
What is Western Growers?
The document that states an employee is litigating their claim.
What is an Application for Adjudication?
These two mechanisms of trauma James said often lead to more costly claims.
What are falls and MVA?
A Reservation of Rights Letter is recommended to be sent to avoid this act.
What is acting in Bad Faith?
A Defendant has 10 business days once served with a panel to issue this response.
What is a panel QME strike?
These entities may not be found liable for contribution if other insurers exist in the case.
Who is the UEBTF, CIGA?
The process involving the transfer of risk for expenses to be paid by the responsible party.
What is Subrogation?
The financial burden on an employer from over reserving.
What are higher premiums?
The key element in determining fraud.
What is material misrepresentation?
This pleading is used to challenge a final Order, decision or Award deciding threshold issues or substantive rights.
What is a Petition for Reconsideration?
One seminal WCAB case defining when an applicant may need care for an injury but the injury does not yet rise to a defined cumulative trauma.
Who is SCIF/ Rodarte?
An Adjusters Objection to a medical opinion and notice of request for a Qualified Medical Evaluator.
What is a 4062 objection to the PTP?
Mechanism of Trauma, Pre-Existing Medical Conditions, and Applicant Attorney are a few indicators of this.
What are early identifiers of high exposure claims?
The type of fraud an employer can be guilty of.
What is premium fraud?