inside

• Editor's 2 Cents: The Era of  EAMS
• Legal Update: EAMS Has Arrived
• Joan Lloyd: If You Want to Keep Your Job, You Better Vote for Candidate X
• Fraud Watch: Don't Botch Your First Line of Defense: The Art of 3-Point Contact

• Newsflash: How to Practice Medicine Without a License
• Job Alert: New: LVN Positions in Monterey...
• Events Calendar: What's Happening in September
• Poll: Have You Ever Been Pressured by a Boss to Vote for a Candidate?
• Poll Results: Will EAMS Go Live Without a Hitch on August 25th?
• The Last Laugh

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The Era of EAMS

William Nathans
Editor

bill@adjustingworld.com  

 

Welcome to the 21st century WCAB! The era of  EAMS is now upon us. Things are going to be intersting for awhile. The WCAB has gone electronic.

As a claims examiner, I have many questions, but who has answers? Can someone explain how to get a settlement document approved that is on the old forms and not the new and improved EAMS forms?

Do you think ”see attached written on the new forms will work? And by the way, all of the old familiar WCAB numbers, you know the ones that started with the identfying Board i.e OAK for Oakland, have all been changed to something totally unfamiliar. The numbers now start adj and then tell you the venue.

Another question is how do you do a walk-through? One the attorney I know tried to walk a C &R through this week. He had to drop it off so it could be scanned and now it is lost. The Board up here in Northern California doesn't know where it is! Took only three days for the first screw-up.

In addition, while waiting for the implentation, the Boards stopped processing Declaratons of Readiness to Proceeds. The Oakland Board is the only one with over 1,800 unprocessed DOR's ( I suppose the applicant's bar will find some way to blame the defense community for this).

I do think that once the bugs get worked out of the adjudication, the system will be a vast improvment. 

 

  

Comments, questions, e-mail me at bill@adjustingworld.com

EAMS Has Arrived

Stephen L. Kline, Esq.
Armstrong Law Firm
stephenk@arm-law.com

 

On August 25, 2008, the Department of Workers Compensation (DWC) launched one of its most ambitious bureaucratic transformations ever.   This was the start date for the conversion of the DWC to a paperless system known as the Electronic Adjudication Management System (EAMS)

EAMS was designed by the DWC for the DWC’s management and reduction of their paper., NOT YOURS!  It’s too late to ask any Why questions about this system. Rather, how do we get our information, pleadings, exhibits, etc. into their system in the most efficient and effective manner for our clients.

Currently, we either hand deliver or mail certain documents to the various district offices. Those delivery systems will not change.  As early as September 4, they will add another delivery system which will be through Electronic filing.

The change is not the delivery system, but rather how the DWC handles the paper or information that they receive from us.

As I understand the new procedures and they are not set in stone until the new rules become effective in the middle of October, except at a Trial or a hearing, DO NOT file any original documents with the District Office.  This includes original proofs of service, etc.  All documents filed with the District Office will be destroyed after scanned. All documents filed with the Board should be on 8 1/2 by 11 paper, with no holes punched, no staples, no paper clips, no post it notes, single-sided, no extraneous marks, and not folded.  If mailed they should be in a large envelope and not a #10 envelope. One outside binder clip or paper clip to hold the entire packet together may be used.  If you want a conformed copy showing the date received stamp, you need to send a self addressed stamped envelope.

From August 25th to approximately October 15th (the anticipated effective date for the new Rules), there are five methods to get information into the EAMS Systems. They are listed in the priority order for speed in getting into the system.  They are also listed in the priority order that the DWC will be handling them.

• E-Forms Trial
• OCR Forms
• CD Filing
• Legacy Forms with Cover Sheets
• Legacy Forms without Cover Sheets

The E-forms trial will necessitate signing a contract with the DWC which would commit that every filing from your office within the Trial Period is done electronically.  It will also be burdensome technologically as the rules and procedures will be changed as they go along.  While that is truly the paperless way to go, the burdens and costs seem very steep at the moment.

The CD filing method was created at the last minute for the lien claimants and the high capacity insurance filers.  It is only an interim solution for the DWC and they have indicated that it will not be available after the effective date of the Rules.

The 5th method, just filing the documents, is always available, but because of the structure of the DWC’s management of their work load, it does not assure anyone that your information gets to the actual DWC file.  This method is really for unrepresented applicants.

The 2d and 4th methods involve the filing of documents with OCR Cover sheets and Document separators.  OCR means Optical Character Recognition.  In both methods, Cover Sheets and Document Separator Sheets must be used.  Let the paper flow!

Every filing is to have a Cover Sheet.  The cover sheet is the document that will tell EAMS where to put the papers that are following it. The DWC staff will do the scanning of these documents and within 48 hours you will be able to determine whether your document made it successfully to the case file. There is new terminology & codes for the form that is to be used.  A handbook for the form and these new codes is also available.

You must do an original form each time you file a document.  You cannot duplicate blanks and fill them in as you need to.  The form while fillable at the DWC site cannot be saved.  This form and the others will only be available at the DWC until either Lexis or West creates the software program for its use outside of the DWC.  The rumors are that they will have updates by September 15th.

Every individual document that is to be filed such as Application must also have a document seprator sheet in front of it.

For example if you were to file a DOR in a case, you would have the following documents, using the current (legacy) forms:

• Cover Sheet
• Document Separator Sheet
• DOR
• Document Separator Sheet
• A Copy of the Medical Report upon which DOR is based
• Document Separator Sheet
• Proof of Service

If you use the new DWC OCR DOR form, then the document submission would look like this:

• DWC DOR Form available on its website (A Cover Sheet is self contained in all the new DWC OCR Forms)
• Document Separator Sheet
• A copy of the Medical Report in support of DOR
• Document Separator Sheet
• Proof of Service

In sum, EAMS is here.  It’s their new system and our job for our clients is to make sure that our documents get to the case file for the appropriate judicial action.  As Betty Davis said, “Hold on it’s going to be a bumpy ride”

Thanks for your attention.

 

Don't miss Steve's Legal Update at the SBICA Luncheon on September 26th. 

See the events calendar for more information......

Have a question for Steve?

Don't hesitate to ask.  Email it to: steve@adjustingworld.com and get it answered right here.

 

Don't Botch Your First Line of Defense: The Art of 3-Point Contact

David Dindak

Coast to Coast Data Search

david@2mypi.com

Some of our best investigation results came about because a savvy adjuster made a thorough initial investigation.  That’s why I thought I would talk about what I’ve heard might be an examiner’s least favorite adjusting duty.

Reaching Out

Companies normally require an adjuster to perform a 3-point contact within 24 hours of receiving a new claim.  As you know, calls are made to the employer, injured worker and the medical facility to verify the information received as well as to provide some customer service to assure everyone that the claim has been received and is being handled.

The information gathered within the first 24 hours is critical data that can give the adjuster the information needed to determine if a claim is compensable, evidence to delay or deny a claim, or assign it for additional investigation or even legal representation.

How many times have you been given a stack of new claims about 4:00 in the afternoon on Friday just before a 3 day weekend?  I know the first thought is to rush through the calls and make some quick notes in the diary; but don’t be tempted.  Sometimes what looks like a run of the mill case can morph into something very different as you start to make those calls.

If you use a check list you can work through the process efficiently and reduce the risk of missing important information.

Review the information before you call

Compare the information on the Employer’s Report of Occupational Injury or Illness (5020), Doctor’s First Report of Occupational Injury or Illness (5021) and the DWC1 and any other information received.

Note any discrepancy from the misspelling of the injured worker’s name to the listing of which body parts are involved.  Note this in the diary that you will verify the information.  It will be easier if you jot down notes now to help form your plan of action later. 

Example: The Employer’s first report could list that the employee injured her left foot, but when you review the doctor’s first report the left foot is listed and a right elbow.

Get complete information for any blank spaces on the forms.

Make a copy of your standard checklist so you can add specific questions or notes about the contacts and the claim.  Refer to your checklist as you make your contacts and add more questions as you work your way through the list of contacts.

Make the Call

Start with the employer

There isn’t much room on the Employer’s report form, so going over the information again will give you a better picture of what occurred during the time of the injury.  If a claim is fraudulent the employer will be suspicious and will give you more information.

• It is better to begin with the employer, and then contact the medical facility.  You will have all the information assembled and verified before you speak with the Claimant.
• Ask the employer what type of employee he/she is, and of any problems
• Ask for witnesses.  Get names, and if there are no witnesses ask who saw the Claimant just after the injury and just before.
• Was there any person, place or thing that contributed to the injury.  If machinery is involved, get maintenance records. 
• Auto: get the name of the driver and insurance company info.
• Ask about surveillance tapes.  Remember, some facilities have cameras monitoring activities throughout the day.  Furthermore, you might find out later that the Claimant was not even working the DOI.
• Ask employer if they think it is a legitimate claim.  If not, why?

Medical Facility

Verify all medical information and clear up any discrepancy.  Many times you are verifying information with a clerk.  But if you are able to speak with the doctor who did the exam, ask about the Claimant’s demeanor.  Any mention of old injuries?

Injured Worker

• Make sure all information is accurate, i.e, addresses, SSAN, etc.
• If the Claimant can’t recall day, date, time, etc., provide some question like – mid week, end of week, before first break –
• Encourage the Claimant to explain in detail how the injury took place, not just something like “I was assisting a patient”.  Ask the right questions and listen carefully to the answers.  Continue to question until you receive the answers.  Sometimes rephrasing the questions or asking it again later, helps.
• Be pleasant, helpful and professional when you talk to everyone, especially the Claimant.  For many Claimants, this is the first time they have filed and are naturally leery of insurance companies…so go slowly making certain that they understand why you are asking questions.

Write Action Plan & make Referrals if Appropriate

• Assemble all the information gathered to recap the claim and formulate a

plan of action.

• Referrals to an investigator should be made ASAP.  If possible, no longer than the first week of opening a claim.  If you are requesting an AOE/COE investigation, the turnaround time to complete an investigation is about 30 days.  If you have delayed the claim and do not make the referral for 30 even 60 days you run the risk of not receiving your report before your decision date.  Also, it is quite possible that additional information could have been discovered that will require additional time to obtain and could be crucial in accepting or denying the claim.

Read your Investigation Reports Timely 

• Don’t run the risk of not acting upon any new information uncovered in the report.
• Here is a checklist that you can use for you interviews.

If you have any questions about Sub Rosa, AOE/COE, Fraud or Investigation, email me. at david@2mypi.com   

 David Dindak is the CEO of Coast to Coast Data Search, an investigation firm that has successfully serviced the insurance industry for the past 20 years.  He is a licensed PI and a continuing education trainer in Investigation and Fraud. The above article is from the 2008 Investigation & Fraud Training Series. 

This training series is a free and is provided to companies onsite.

For additional information on Coast to Coast Data Search and/or how to bring the 2008 Investigation and Fraud Training Classes to your company. Visit the website at: www.2mypi.com or call (800) 282-6278.

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