DWC Organization & Claim Audits
Division of Workers’ Compensation Organization & Claim Audits Understanding the oversight and auditing role of the Division of Workers’ Compensation (DWC) is essential for staying compliant. This module covers the structure and authority of the DWC, how claim audits are conducted, and how penalties may be assessed. You’ll learn how to prepare for audits, respond […]
Ethical Issues
Ethics and Claims Administration Issues Ethical decision-making and regulatory compliance are essential to maintaining integrity in the workers’ compensation system. This module explores the ethical responsibilities of claims professionals, common administrative pitfalls, and how to navigate conflicts while adhering to state guidelines and professional standards. 50 Students enrolled last month Key Learning Outcomes Understand ethical […]
Defense & Resolution of Liens
Defense & Resolution of Liens Liens are a frequent source of delay and litigation in workers’ compensation claims. This module explains the lien process, including how and when liens are filed, contested, or resolved. You’ll gain a clear understanding of your role in defending against improper liens, supporting lien negotiations, and minimizing claim exposure. 50 […]
Medical Bills, Fee Schedules & IBR
Fee Schedules & Billing Codes Understanding how medical providers are reimbursed is essential for managing claim costs and ensuring proper billing practices. This module explores California’s workers’ compensation fee schedules, billing codes, and audit rules. You’ll gain the knowledge needed to interpret medical bills, spot inaccuracies, and work effectively with bill review services. 50 Students […]
Medical Disputes & Process
Medical Legal Dispute Resolution When medical opinions differ, resolving disputes is critical to fair and timely claims management. This module explains the medical-legal process in California workers’ compensation, including how Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs) are selected and used. You’ll also explore how to prepare for evaluations, interpret reports, and manage […]
Medical Treatment Issues & UR
Medical Treatment Issues and Utilization Review Medical treatment is one of the most regulated and scrutinized areas of workers’ compensation. This module explores how treatment decisions are made, approved, and challenged within California’s system. You’ll learn about the Medical Treatment Utilization Schedule (MTUS), utilization review (UR), and independent medical review (IMR), as well as how […]
Medical Terminology & Examinations
Medical Terminology and Examinations Understanding medical language and the examination process is essential for effective claims handling. This module introduces key medical terms, common diagnoses, and the structure of medical reports. You’ll also learn how medical exams are used in the workers’ compensation system, including the roles of treating physicians, panel QME, and AME evaluations. […]
Overview of WC Benefits
Overview of Workers’ Compensation Benefits This module provides a clear and comprehensive overview of the benefits available to injured workers under California’s workers’ compensation system. You’ll learn how these benefits are categorized, what triggers eligibility, and how they’re administered. It sets the stage for deeper exploration in later modules focused on temporary disability, permanent disability, […]
Claim Compensability Part 2
Claim Compensability Part 2 Building on the foundations from Part 1, this module dives deeper into advanced compensability issues that arise in complex or disputed claims. You’ll explore exceptions, special circumstances, and case law that influence whether a claim is accepted or denied. This includes injuries during breaks, off-duty conduct, and unique employment scenarios. 50 […]
Claim Compensability Part 1
Claim Compensability Part 1 Compensability is the cornerstone of every workers’ compensation claim. In this module, you’ll begin exploring the legal and factual criteria that determine whether an injury is covered under the California workers’ compensation system. This first part focuses on the foundational concepts of arising out of and in the course of employment […]
