This is an introduction to the California workers' compensation system. This is a good starting point for students who are not familiar with workers' compensation. Topics covered in this course include the following.


Introduction - History and Principles of Workers' Compensation, Landmark Political Reform Measures and the Historical “Stress Claim" Stigma. The “Perfect Storm", Unicover and Stock Market Losses. Organization and Stake Holders. Current political socioeconomic climate.

Threshold Issues of Compensability AOE-COE Basic Concepts of Injuries, Employment and AOE-COE

Benefit Scheme
a) Medical Care and Benefits - Treatment Issues. UR and ACOEM Guidelines
b) Temporary Disability Benefits
c) VR, Supplemental Job Displacement Benefits, Return to Work Incentives
d) Permanent Disability Benefits, AMA Guides and Apportionment
e) Death Benefits AOE-COE Suicide

Penalties, Extraordinary Remedies. Audits and Enforcement. Penalties for Delay. Serious and Willful Misconduct. 132a

Physician Duties and Responsibilities Specialist Reporting Requirements, Medical Legal Benefits. Substantial Evidence Rule

Introduction to Worker's Compensation Informal Dispute Resolution and Litigation. The AME/QME process. WCAB Litigation Process and Statutes of Limitations.
"From Soup to Nuts - The Life of a Claim File" explains the process of handling a claim file as a worker's compensation adjuster from beginning to end. From receiving and investigating, from contacting the employee and employer, to using statutory defenses to defeat a bad claim, this course does it all. Veteran workers compensation adjuster Dennis Knotts shares his years of experience filing claims to empower you to do the same! This 3.75 hour course covers the following topics.

  1. Getting Started Part I - Getting a New Loss and Investigation (37 Minutes)
  2. Getting Started Part II - Where to Begin Part I (34 Minutes)
  3. Getting Started Part III - Where to Begin Part II (26 Minutes)
  4. The Three Point Contact Part I (36 Minutes)
  5. The Three Point Contact Part II - The Decision-Making Process (35 Minutes)
  6. Statutory Defenses Part I (28 Minutes)
  7. Statutory Defenses Part II - The Post Termination Defense (27 Minutes)

"An Overview of Liens" explains what a lien is and how to handle them as a claims adjuster. Join Dennis Knotts, adjuster veteran, on a journey of the lien process, learning from his experience and techniques in handing lien claims. This 1.25 hour course covers the following topics:


Part 1 - What is a Lien, Types of Liens, and Conditions of Compensation (17 Minutes)
Part 2 - Medical Control and Medical Necessity (27 Minutes)
Part 3 - Case Law, Statute of Limitations, and the Lien Filing Fee (15 Minutes)
Part 4 - OMFS and IBR (19 Minutes)

This course goes over many of the changes to Liens and UR due to legislation taking effect in 2017 and 2018. Suzanne P. Honor-Vangerov, Managing Attorney of Floyd, Skeren & Kelly's Lien Unit leads the charge to 2017 with this informative presentation.

SB 1160 was signed by Governor Brown in September 2016, and takes effect January 1st, 2017. This course reviews the changes in California Workers' Compensation resulting from this bill. 


The course consists of:

1: Speech from California State Senator Tony Mendoza.
2: Utilization Review Update - John Riggs, Manager of Workers' Compensation in Disneyland, and Jay Garrard, CEO of GSG Associates, Inc.
3: Lien Provisions of SB 1160 - by Suzanne Honor-Vangerov, Managing Attorney Lien Unit, Floyd, Skeren & Kelly LLP.

The California workers compensation system is a no-fault system which means that the injured worker need not show fault such as negligence on the part of his employer in order to recover benefits. However, although fault is not required, the claimant must show that an "injury" occurred and that it "arose out of employment". The acronym for this is called AOE-COE or "Arising Out of Employment and Course of Employment." Thus, if an injury is found to be AOE-COE that means the threshold issues have been met and the claimant should recieve the scheme of benefits.
Once a claim has been made of an industrial injury by an employee, the employer or their carrier must conduct a thorough investigation to determine if the claim is authentic, and what benefits are payable. Investigation is therefore a required job skill for professional claims administrators and attorneys. The administrator may not restrict its investigation to preparing objections or defenses to a claim, but must fully and fairly gather the pertinent information, whether that information requires or excuses benefit payment. This course will discuss essential investigatory tools and methods used for basic AOE-COE investigations and more advanced topics including the SIU investigation of potentially fraudulent claims.
The California system of Workers' Compensation has its own adjudication system known as the WCAB. Although most litigation is accomplished by attorneys, the labor code allows non attorneys to litigate claims as well. Non attorneys are known as hearing representatives, and they are commonly used by some insurance companies. This is a basic course about litigation before the WCAB. It is appropriate for hearing representative and new attorneys who desire to litigate cases before an Administrative Law Judge of the WCAB. This course will cover the following topics.
  • Preparation Process and The IRAC Framework
  • Rules of Law and Legal Precedent
  • Timeline Preparation and Issue Spotting
  • Discovery & Investigation Methods and Tools
  • Negotiation and Negotiation Strategy
  • Rules of Evidence
  • Trial Planning and Procedure
  • Examination of Witnesses
  • Reconsideration and Appeals
One of the major benefits provided by the California workers compensation system is medical care to cure or relieve from the effects of an industrial injury. Safeguards have been implemented to contain costs. One safeguard is called utilization review (UR) which provides a method for the review of a request for treatment requests to determine if they are medically necessary. UR applies standards called "evidence based medicine" which are published in various treatment guidelines such as the ACOEM (American College of Occupational and Environmental Medicine) Guideline which is incorporated into the California Medical Treatment Utilization Schedule (MTUS). This course will cover the following topics.

Medical Care - General Concepts Provision of Care. Escalation of Costs. Cost Drivers and Solutions. Access to Care Issues.

Price Controls - Fee Schedules OMFS. Payment Calculations. Abuses

Quantity Controls - Evidence Based Medicine EBM General Concepts. Next Step - Pay for Performance. Functional Restoration. Measurement Concepts.

Quantity Controls ACOEM/MTUS Implementation Transition to MTUS. Rebuttal of MTUS. Chapter 12-Low Back. Acupuncture. Pain Guideline.

Implementation of ACOEM/MTUS with Utilization Review Mandatory Plan. UR Reviewers. Time Limits. Types of Review. Penalty Regulations. Hard Caps. Recent Cases.

Quantity Controls- Spinal Surgery Second Opinion Process (SSSOP) Cost Drivers. CPT Codes. Voicing Objections. SSSOP Evaluations. Agreement and Disagreements.

Price and Quantity Controls – The MPN. Voluntary Implementation. 2nd and 3rd Opinion Process and IMR.

AME QME Dispute Resolution Historical Provisions. QME Process for Represented and Unrepresented Workers. Proposed New Regulations.
Essentially workers compensation benefits have statutory restrictions on assignment of benefits to any third parties. In instances where a third party claims some right to claim an injured workers' benefits, the person making such claim is called a lien claimant, and they document their position by filing a "lien" claim in the litigation case. The most common lien claimant is a medical treatment provider who has not been paid the fees to which they feel they are entitled. In this 4.5 hour course the following topics are discussed.

Introduction, Lien Definition and Types
Limits on Benefit Assignment

Liens Against Compensation Attorney Fees. Inadequate Withholding. Fees during Subrogation. Reasonable Living Expenses. Neglected Family. ADFC and County Welfare. Child Support. Group and EDD Disability. Baird Formula
Victims of Violent Crimes.

Other (Conditional) Liens Medical Legal Liens. Non Medical Litigation Costs. Interpreter Fees. LC 5811 Costs.

Medical Treatment Liens. Non Medical Provider Liens (3d Party Payers). Gregory Formula. Direct Provider Liens. Threshold Issues. Failure to Object, Thomas Findings. Strategic Disadvantage of Liens. Medical Control. Qualifications of Provider. Corporate Status and FBN Statements. Kickbacks and Referral Fees. Medical Necessity. MTUS. Employer Dilemma. Reasonable Value. OMFS. Medical Transportation. Repackaged Pharmaceuticals. Interpreters. Housekeeping and Attendant Care.

Penalties and Sanctions Applicant. Treatment, Med-Legal, and Non Providers.

Lien Litigation Procedure. Time Limits. Filing and Service. Post Settlement Process.

Medical disputes in California workers' compensation claims are resolved by use of either an Agreed Medical Examiner (AME) or a Qualified Medical Examiner (QME). A QME is picked from a list of state-certified doctors issued by the DWC Medical Unit. QME lists are generated randomly. This list of three QME physicians is known as a QME panel. The panel is requested by one of the parties by completing and submitting a Panel Request Form within the time constraints imposed by law.

Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers' Compensation - Medical Unit to examine injured workers to evaluate disability and write medical-legal reports. The reports are used to determine an injured worker's eligibility for workers' compensation benefits. QMEs include medical doctors, doctors of osteopathy, doctors of chiropractic, dentists, optometrists, podiatrists, psychologists and acupuncturists.

This 2 hour course is designed to help practitioners meet the regulatory requirements so that a QME panel can be obtained on the first try. The Labor Code and QME regulations have been amended in 2013 to comply with newly enacted S.B. 863. This course discusses these changes.

Prior to becoming an attorney, the instructor, Suzanne Honor-Vangerov, was the Manager of the DWC Medical Unit. As the Medical Unit Manager she oversaw the Qualified Medical Evaluator, Spinal Surgery Second Opinion, Medical Provider Network, and Utilization Review programs.
The California legislature has created various penalties and sanctions to help ensure that parties will comply with the provisions of the labor code. When violations are alleged, then if proven, penalties and sanctions may apply. This course covers the more common claims for penalties, sanctions and other extraordinary remedies as follows:
  • Serious and Willful Misconduct
  • Penalties for Delay
  • Bad Faith Claims
  • Costs and Attorney Fees
  • 132a Discrimination
  • SIF Benefits
  • Concluding Remarks
This 3 hour course will discuss the basics of each of these topics. This course is suitable for claims adjusters, hearing representatives or new attorneys who are building their knowledge base of information about workers' compensation.
One of the several benefits paid by California workers' compensation is a permanent disability benefit. The calculation of the value of the benefits requires the use of the AMA Guides 5th Edition and the Schedule for Rating Permanent Disability. An estimate of this calculation is also required for reserving and negotiation prices. Topics in this class include the following.

Rating Permanent Disability Versions of PDRS. Which version to use. Rating Formula. FEC, Occupation and Age Adjustments. Combining and Adding. 15% Step Up/Down Examples and Exercises. Presumptions.

Introduction to the AMA Guides Historical Issues. Basic Concepts. General Overview. Introduction to the Quick Reference Guide. Spine Injury Examples.

Apportionment of PD Apportionment Rules Before and After S.B. 899. Pathology and Speculation. Calculation Using Formula A. Benson Case

Life Pensions Formula and Calculators

Commutation of Permanent Disability Authority, Grounds and Examples.

Reserving Rules for Insurance Companies and Self Insured. Use of Quick Reference Chart. Review and Adjustments.

Claim Evaluation and Negotiations Claim Evaluation Tangible and Intangible Factors. Types of Settlement. Intended Resolution Point. Negotiation Psychology. Transcending Impasse.
This is a course in basic workers' compensation subrogation. In the event an industrial injury is caused a third person who is not the employer or co-employee, the possibility exists for the employer and their industrial insurance carrier to pursue an action in civil court to recover their claim costs. These cases are based upon tort law. In order to recover in such a subrogation claim, the employer or carrier must show fault. This is a basic two hour course on subrogation fundamentals. The course will discuss some of the following topics.
  • Introduction to tort law.
  • Spotting the case
  • Investigation techniques
  • Civil discovery rules
  • Civil litigation basics
  • Rules for obtaining credit at the WCAB
  • Formulas for computing comparative negligence
Attorneys may receive 1.5 hours of MCLE or Legal Specialization credit, and claims administrators may obtain 1.5 hours of continuing education credit for completing this course.

In mid 2013 S.B. 863 passed the state legislature, and was soon signed by Governor brown. The new law brings wide-ranging changes to California's system for treating and compensating injured and ill workers.

Key elements of SB 863 would increase permanent disability benefits by $740 million - an average hike of about 30 percent - and would create a $120 million program for workers injured severely enough that they cannot go back to a job at their previous wage level. It would pay for the increased benefits by squeezing medical costs and administrative procedures.

This two hour seminar will guide you through this new law, and will focus on "what changed?" The 85 new or amended statutes are organized by topic. Topics include what changed in Jurisdiction, Insurance Coverage, Permanent Disability Benefits, Medical Care, Lien Claims, The AME/QME UR, IBR, IMR, and SSSOP Process, and to the Practice and Procedure before the WCAB.

Two hours of MCLE or Continuing Education credit for adjusters will be given for taking this class. To enroll please call 805 341-2296.


Read more here: http://blogs.sacbee.com/capitolalertlatest/2012/08/workers-compensation-overhaul-easily-clears-assembly.html#storylink=cpy
This is a comprehensive 4.5 hour course in Workers' Compensation Ethics. The theme is based upon a presentation made by Casey Young, former Administrator of the Division of Workers Compensation. Several decades ago, Mr. Young conducted a survey of all stakeholders in the Workers' Compensation Community, and discovered that each stakeholder had little or no trust in the ethics of the other stakeholders. In essence, each profession had failed to hold the public trust. His conclusion is that it is of utmost importance for each group of stakeholders to restore the public trust. The focus on this ethics course will be to enhance the public trust in your role in the California Workers Compensation System.

Topics include:
  1. Introduction to Workers' Compensation Ethics
  2. Aftermath of Harvey Levin Fraud Expose
  3. Social Benefits of Ethic Standards
  4. Ethical Standards for Workers' Comp Attorneys
  5. Ethical Standards for the Insurance Industry
  6. Ethical Standards for Claim Administrators
  7. Sanctions and Attorney Fees
  8. Ethical Standards for Employers - Part I
  9. Ethical Standards for Employers - Part II
  10. Safety in the Workplace
This course qualifies for 4.5 hours of MCLE or Legal Specialization credit, or credit toward Claims Administrator Certification. Ethics is a mandatory subject.

The Official Medical Fee Schedule (OMFS) is promulgated by the DWC administrative director under Labor Code section 5307.1 and can be found in sections 9789.10 et seq. of Title 8, California Code of Regulations. It is used for payment of medical services required to treat work related injuries and illnesses.

Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radiologic results, etc.

This course is an introduction to coding medical treatment bills and using the OMFS.