Sedgwick Experts Outline Key Workers’ Comp Claims Trends
Insurance Journal
MAY 15, 2025
At last week's RIMS RISKWORLD conference in Chicago, experts from risk and claims administration partner Sedgwick outlined a few key workers' comp trends.
Claim Insurance Workers Comp 
The Grand Bargain: How Workers’ Comp Became a Win-Win for Employers and Employees
AMAXX
MAY 19, 2025
The workers compensation system may feel like a complex web of insurance premiums, claims adjusters, and legal disputesbut at its core, its rooted in one simple idea: a compromise. Small companies especially found themselves at risk of being put out of operation entirely after just one major injury claim.
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From Integrity Tests to Physical Exams: A 6-Step Hiring System to Reduce Workers’ Comp Claims
AMAXX
MAY 6, 2025
Hiring is more than finding the right resume or filling a seatits the first and most important line of defense in preventing workplace injuries and reducing workers comp costs. Employers struggling with first-year injuries, high turnover, or repeat claims often have something in common: a reactive hiring process.
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Part 2: Workers’ Comp Independent Premium Audits Explained
AMAXX
MARCH 24, 2025
This post is one in a 3-part series: Part 1: Workers Comp Independent Premium Audits Explained Part 2: Workers Comp Independent Premium Audits Explained Part 3: Workers Comp Independent Premium Audits Explained 5. You should consult with your insurance broker, attorney, or qualified professional.
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Reforming Your Workers’ Comp Program: Avoiding Common Pitfalls and Taking Action
AMAXX
JANUARY 27, 2025
Employers must recognize that effective workers comp management requires proactive employer involvement and robust internal processes to support external partners, emphasizing teamwork in workers’ compensation programs. Legacy claims that linger unresolved. What is the status of open or legacy claims?
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Long COVID Claims Still Impact California’s Workers Comp System, Report Shows
Insurance Journal
OCTOBER 6, 2024
The impact and surge of long-term COVID on the California workers’ compensation system since 2020 has been prevalent, including long-term impacts on disability and long-term patterns of medical cost and treatment on long COVID claims. That’s from a report by …
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The Case for Injury Duration Guidelines in Modern Workers’ Comp Programs
AMAXX
JANUARY 21, 2025
By setting clear expectations, these guidelines help manage claims efficiently, promote recovery, and ensure equitable treatment for injured workers. Setting Clear Expectations Injury Duration Guidelines establish realistic recovery timelines for injured workers, employers, and medical providers.
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How to Build a Rockstar Workers’ Comp Team
AMAXX
MAY 14, 2025
When a workers comp program isnt delivering results, many employers instinctively look outward. If you want a high-performing workers comp programone that reduces claims, controls costs, and supports injured employees you need a rockstar internal team. Step 2: Define Your Internal Team Workers comp is a team sport.
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2 Common Mistakes In Workers’ Comp Doctor Selection
AMAXX
MARCH 18, 2025
These errors can have significant consequences, including prolonged recovery times, increased claims costs, and a greater likelihood of litigation. While using an approved network is necessary for insurance and cost-control reasons, not all doctors within the network are equally effective at managing workplace injuries.
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Claim Frequency in California Workers’ Comp Higher in L.A. Area, Study Shows
Insurance Journal
DECEMBER 4, 2024
Claim frequency in California workers’ compensation remains significantly higher in the Los Angeles Basin than in the northern part of the state, a new study shows. The Workers’ Compensation Insurance Rating Bureau of California released its WCIRB Geo Study 2024, …
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Avoid Litigation and Improve Workers’ Comp Claim Outcomes
AMAXX
FEBRUARY 17, 2025
A lack of clear communication often leads to confusion, frustration, and even litigation , increasing costs for both the employer and the injured worker. However, implementing strong communication strategies can significantly improve claim outcomes and reduce unnecessary legal battles. How do I get paid?”
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9 Characteristics of Transitional Duty Assignments in Workers’ Comp
AMAXX
FEBRUARY 4, 2025
These assignments help businesses manage claims costs, reduce lost workdays, and maintain workforce productivity. He is co-author of the #1 selling comprehensive training guide Your Ultimate Guide to Mastering Workers Comp Costs: Reduce Costs 20% to 50%.
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10 Mistakes That Blow Up Workers’ Comp Costs (and How to Avoid Them)
AMAXX
MAY 27, 2025
In reality, workers comp costs are one of the most controllable expenses in your organization. If you’re serious about lowering premiums, reducing claim durations, and improving outcomes for injured workers, start by identifying and correcting these ten common pitfalls.
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Workers’ Comp Is a Team Sport: Understanding the Puzzle of Stakeholders
AMAXX
MAY 26, 2025
But beneath the surface lies an intricate, interconnected web of stakeholders, each playing a unique role in managing the outcome of the claim. Workers compensation isnt a solo actits a team sport. Thats a critical mindset shift: every stakeholder in workers comp is here to support the employee-employer dynamic.
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Workers’ Comp Mega Claims Total $1B-Plus Yearly, Multiagency Study Shows
Insurance Journal
DECEMBER 12, 2024
Mega claims in workers’ compensation represent far less than 1% of total workers’ comp claims yet account for more than 2% of total loss dollars, and total in excess of $1 billion each year, a new study from 10 state …
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Part 1: Layoff Planning to Control Workers’ Comp Claims
AMAXX
MARCH 10, 2025
Proper layoff planning isn’t just about handling employment transitions; it’s crucial for controlling claims costs and ensuring that resources are available to support genuinely injured workers. Timely processing prevents claims from becoming unnecessarily expensive and ensures each case receives the attention it deserves.
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Who Really Pays for Workers’ Comp? Debunking a Common Myth
AMAXX
MAY 21, 2025
Ask the average employee who pays for workers compensation, and you might hear answers like the insurance company, the government, or even nobodyits just a benefit. In reality, the employer foots the bill for every dollar spent in the workers compensation system. These misconceptions are widespreadand costly.
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Five Metrics Every Employer Should Track to Master Workers’ Comp
AMAXX
MAY 13, 2025
Thats as true for workers comp as it is for fitness, finance, or sales. Yet many employers still fly blindunsure where to focus, overwhelmed by options, and frustrated by rising claim costs and stagnant outcomes. Click Link to Access Free PDF Download “Step-By-Step Process To Master Workers Comp In 90 Days” 1.
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Part 2: Layoff Planning to Control Workers’ Comp Claims
AMAXX
MARCH 10, 2025
In the first part of our series, we emphasized the importance of thoughtful layoff planning to mitigate the risk of increased workers’ compensation claims following a workforce reduction or facility closure. Be meticulous in updating personnel files, health insurance documentation, and records of sick leave.
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Cyber Risk: West Virginia OIC Plans to Dispose of Older Workers’ Comp Files
Insurance Journal
AUGUST 22, 2024
The West Virginia insurance commissioner’s office has adopted a new policy: It will soon begin destroying workers’ compensation claim files that are 10 years old or older. “Given increasing cybersecurity concerns and the type of information contained in the closed …
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Florida Appeals Court Upsets Applecart on Workers’ Comp Statute of Limitations
Insurance Journal
JANUARY 15, 2025
A recent decision and concurring opinion by a Florida appeals court may have upset years of practice and could raise costs for workers’ compensation insurers. Some claims that carriers were once ready to close out of due to the statute …
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Minnesota Workers’ Comp System Stable Despite COVID-19 Impact
Insurance Journal
JULY 17, 2024
Workers’ compensation claim rates and benefits paid in Minnesota continue to be stable or follow their long-term downward trajectories, a new Department of Labor and Industry (DLI) report shows. The 2024 Minnesota Workers’ Compensation System Report presents trend data regarding …
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Employer’s Clinic May Not be Protected by Workers’ Comp Remedy, SC Court Says
Insurance Journal
AUGUST 12, 2024
The South Carolina Court of Appeals has signaled that employers who offer on-site health clinics may not be immune from tort claims from injured or sickened workers. It’s the latest twist to a question that has bounced around courts and …
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California Vocational School Owner Charged With Fraud in Workers’ Comp Scheme
Insurance Journal
OCTOBER 24, 2024
The owner of a Fresno, California-based for-profit vocational school was charged with engaging in fraudulent billing practices related to workers’ compensation. Paul Steve Ramirez, 59, was charged with 11 felony counts, including insurance fraud. The fraudulent insurance claims could reach …
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The Real Reason Workers’ Comp Claims Go Off the Rails — And How to Fix It
AMAXX
APRIL 30, 2025
When a workers compensation claim spirals into a costly, prolonged, or litigated nightmare, most people instinctively look for a technical failure: late paperwork, a coverage issue, or a misstep by the claims adjuster. The real reason many workers comp claims go off the rails? And guess what?
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Part 1: Workers’ Comp Independent Premium Audits Explained
AMAXX
MARCH 24, 2025
Click Link to Access Free PDF Download “Workers’ Comp Claims Review Checklist: 9 Must-Have, Serious-Impact Elements” A common and costly mistake employers make is overlooking allowable payroll deductions. You should consult with your insurance broker, attorney, or qualified professional.
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Washington Metal Fabricator Faces Felony in $340K Workers’ Comp Scam
Insurance Journal
SEPTEMBER 19, 2024
A Washington man who claimed he was too injured to work while operating a metal fabrication shop faces a felony charge in an alleged $340,000 workers’ compensation scam. Travis Lee Johnson, 52, of Spokane Valley, pleaded not guilty recently to …
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Vocational School Owner Arraigned in $1M Workers’ Comp Fraud Case
Insurance Journal
AUGUST 29, 2024
Los Angeles area vocational school owner, Guillermo Frias, 65, of Paramount, and the school’s accounting manager, Yesid Colon, 54, of Baldwin Park, were arraigned following a California Department of Insurance investigation into allegations they submitted fraudulent claims to receive money …
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Avoiding the Bugs Bunny Trap: Why Most Employers Struggle with Workers’ Comp
AMAXX
MAY 12, 2025
Its a funny sceneuntil you realize its exactly how most employers manage their workers compensation programs. The Bugs Bunny Trap is a perfect metaphor for how workers comp can spiral out of control without a strategic framework. So how do you escape the chaos and build a streamlined, high-performance comp program?
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Impacts of Economic Changes on California Workers’ Comp
Insurance Journal
JULY 14, 2024
Projected changes to California workers’ comp claims frequency and severity due to industry mix of employment are negligible through 2026, while employment in most industries fully recovered from the initial pandemic related changes by the end of 2022, a new …
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Evidence-Based Medicine (EBM) in Workers’ Comp: A Case Study on Partial Rotator Cuff Tear
AMAXX
FEBRUARY 25, 2025
Once employers and adjusters understand the value of evidence-based medicine (EBM) in workers’ compensation claims, the next challenge is applying it effectively. EBM helps ensure that medical treatments align with standardized recovery timelines, reducing unnecessary disability durations and claim costs.
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How Lag Time Sabotages Claims—And What You Can Do About It
AMAXX
MAY 27, 2025
In the world of workers compensation, few factors have a more immediate and measurable impact on claim outcomes than lag time the delay between when an injury occurs and when it is reported to the carrier or third-party administrator (TPA). Beyond four weeks , claim costs jumped 31%. Here’s what you need to know.
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WCIRB: California Workers’ Comp Written Premium in 2023 Was up Slightly
Insurance Journal
OCTOBER 8, 2024
California workers’ compensation written premium in 2023 was slightly above 2022, while written premium for the first six months of 2024 is 2% lower than the first six months of 2023, a new report shows. The Workers’ Compensation Insurance Rating …
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California Workers’ Comp Report Shows ‘Relatively Stable’ System Post-Pandemic
Insurance Journal
JULY 29, 2024
The California workers’ compensation system has been relatively stable in the post-pandemic era, as premium levels rose by 1% in 2023 and are forecast to increase modestly in 2024—while decreases in average insurer charged rates are moderating, a new report …
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Risk Manager Best Practices That Drive Workers’ Comp Results
AMAXX
APRIL 10, 2025
In the complex world of workers compensation, risk managers play a vital role in aligning strategic oversight with day-to-day claims operations. Far from being a behind-the-scenes figure, a successful risk manager serves as the linchpin between claims administration, adjusters, and injury management teams.
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Employer, Workers’ Comp Insurer, Survivor Join Baltimore Bridge Collapse Litigation
Insurance Journal
OCTOBER 2, 2024
The road construction firm that employed six workers who were killed and another who was seriously injured in the collapse of Baltimore’s Key Bridge, along with its workers’ compensation carrier, have filed claims against the owner and operator of the …
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NCCI AIS 2025: Key Insights on Workers Comp
Triple-I: Workers Compensation
MAY 20, 2025
Workers compensation is a product where compassion and analytics work hand-in-hand protecting and caring for employees, while also leveraging data to make the entire system more effective and sustainable, Ryan said. Continued strong results Workers comp remains financially fit, according to NCCI Chief Actuary Donna Glenn, FCAS, MAAA.
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Part 3: Workers’ Comp Independent Premium Audits Explained
AMAXX
MARCH 24, 2025
This post is one in a 3-part series: Part 1: Workers Comp Independent Premium Audits Explained Part 2: Workers Comp Independent Premium Audits Explained Part 3: Workers Comp Independent Premium Audits Explained To qualify for this treatment, construction employers must keep meticulous records specifying exact hours worked per classification code.
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Workers’ Comp Claims Audit: Initial Action Plan Checklist
AMAXX
OCTOBER 7, 2024
Claims audits and reviews are one of the most commonly used tactics by companies to control workers’ compensation costs. In fact, according to the RIMS 2009 Annual Benchmark Survey, 90% of companies had conducted a claim audit or review of at least some of their claims within the previous six months.
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Mistake: Accepting Every Workers’ Compensation Claim
AMAXX
MARCH 18, 2025
Many companies operate under an unwritten rule: accept every workers compensation claim, no questions asked. A well-managed workers compensation program should pay 100% of legitimate claimsand 0% of the claims that arent. Employees come to believe that every claim will be accepted, regardless of the circumstances.
Important Times to Use Surveillance in Workers’ Comp Claims
AMAXX
MARCH 11, 2025
Effectively managing workers compensation requires careful oversight and proactive measures to identify and prevent fraudulent or exaggerated claims. Surveillance serves as a powerful tool in validating claims, protecting your organizations financial health, and ensuring resources are dedicated to genuinely injured employees.
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Washington Adult Family Home Operator Facing Felony Charge in Alleged Workers’ Comp Scam
Insurance Journal
JULY 16, 2024
A Spokane, Washington woman who ran an adult family home while claiming she was too injured to work faces a felony charge in a $60,000 workers’ compensation fraud case. Serah Kamau, 52, reportedly operated her business, Brookhouse Adult Family Home, …
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How to Build a Workers’ Comp Program That Runs Itself: The Power of Systematized Communication
AMAXX
APRIL 30, 2025
Managing workers compensation can feel like playing whack-a-mole. One day its a delayed report, the next its an escalating claim or a frustrated injured worker. Thats not a dream its a reality for organizations that implement clear, consistent communication systems within their workers comp process.
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How Fear Impacts Workers’ Compensation Claims (and What to Do About It)
AMAXX
MARCH 4, 2025
However, for many workers, an overwhelming fear of losing their jobs adds unnecessary stress to an already difficult situation. Research has shown that fear of being fired is one of the top predictors of negative claim outcomes, including increased litigation rates and extended time off work. Heres how: 1.
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