South Texas ASSE San Antonio, TX

Size: px
Start display at page:

Download "South Texas ASSE San Antonio, TX"

Transcription

1 Presentation To South Texas ASSE San Antonio, TX May 21, 2007

2 Presentation Summary Corporate Overview Essentials of Workers Compensation Law Red Flags of Questionable Comp Claims Influencing the Outcome of Your Claims Using Case Management to Save $$$$ Q & A

3 Corporate Overview

4 CasePro was founded August 1, 1996 Woman-owned Certified as WBE by the SCTRCA, and as SBE, DBE and WBE by NCTRCA Corporate Office San Antonio, Texas

5 Two Divisions Disability Management Division Federal Contracting Division Multi-State Operations Seven core states in Disability Management Division Capability for national coverage

6 Experienced Management Team Shirley Hill, RN, CRRN, CCM President 20 Years in Healthcare Management John Hill, CPA Executive Vice President 30 Years in Corporate Finance and Accounting Michael McCabe, BS Engineering, MBA Finance Senior Vice President, 15 Years Multi-National Corporate Experience

7 Your Presenter Nancy Lewis, BS, MS Psychology, CRC Vice President, Disability Management 27 Years Providing Rehabilitation Services (210)

8 Other Members of the CasePro Team Registered Nurses Vocational Rehabilitation Consultants Life Care Planners

9 Overview of Texas Workers Comp Law

10 General History of Workers Comp Grew out of the Industrial Revolution Protects employer from being sued Provides wage replacement (indemnity) and medical care to eligible IW, i.e., claim must be compensable

11 Texas Law Employer Driven 1/2006 TWCC replaced by Division of Workers Compensation DWC oversees administration of comp rules and regulations Employers can now elect for injured worker to treat within a Physician Network

12 Types of Comp Coverage Fully insured Large deductible Self-Insured Self-Funded Non-Subscriber

13 Types of Benefits Medical benefits Temporary Income Benefits (TIBs) Impairment Income Benefits (IIBs) Supplemental Income Benefits (SIBs) Lifetime Income Benefits (LIBs) Death benefits

14 Settling Disputes Benefit Review Conference (BRC) Contested Case Hearing (CCH) IW can request representation by DWC ombudsman or may be represented by plaintiff attorney Employer can be present at BRC and CCH and is represented by claims adjuster as well as defense attorney if they wish

15 Red Flags

16 1. File Open More than Six Weeks Most back injuries resolve within six weeks, with or without care 2. Catastrophic or Multiple Injuries* Probability of prolonged time off work with considerable medical expense Need for highly skilled, specialty medical care * Catastrophic claims should always be referred for case management.

17 3. Co-Morbid Conditions Smoking Diabetes Hypertension Overweight Drug abuse

18 4. Choice of Treating Physician Physician s specialty and strengths Physician s focus IW or employer? Physician s willingness to meet and work with case manager 5. Treatment Plan Appropriate? Conservative care vs premature diagnostic testing or more invasive treatment Treatment reasonable, necessary and related?

19 6. Lack of Objective Findings Objective testing should support subjective complaints Complaints without objective findings suggest symptom magnification and/or secondary gain 7. Positive Waddell s Signs Tests performed by MD revealing non-physiologic findings Suggest symptom magnification

20 8. Any Misrepresentation of Facts IW may represent condition as worse than it is IW may mislead physician regarding job demands* 9. Injured Shortly After Being Hired May indicate pre-existing condition for which IW is seeking treatment *A job analysis provides objective documentation of a job s physical demands.

21 10. History of Work Injuries Past injury may be cause of current complaints Or may be indicative of a professional claimant 11. Non-compliance With Medical Care Typically occurs with less serious injuries Suggests lack of commitment to recovery Secondary gain may be involved

22 12. Injury Occurring on Monday May indicate injury actually occurred over weekend 13. Injured Worker Has Personal Crisis Frequent correlation with more extensive disability 14. Excessive Use of Medications May be utilizing claim for drug seeking May correlate with history of substance abuse

23 15. History of Recent On-Job Discipline Claim may be retaliation 16. Injured Worker Adversarial Often has prior workers comp experience May be trying to drive up value of claim Usually a demanding and manipulative personality 17. Attorney Involvement Motivation to resolve claim and return to work questionable

24 18. Symptom Magnification Failure to respond to conservative care Complaints unsupported by objective findings Often prolonged chiropractic care or excessive physical therapy May be attempt to prolong time off work High percentage become permanently & totally disabled

25 19. Additional Diagnosis Secondary to Injury Such as back pain secondary to knee pain or Any kind of psychological (functional) overlay Multiple diagnoses typically complicate and prolong claim

26 20. Surgery Recommended Without Objective Findings Suggests physician may not be objective Suggests secondary gain or ignorance on part of IW 21. History of Psychological Problems Typically prolongs claim due to secondary gain issues Family dynamics Inability to withstand stress of being injured

27 22. Repetitive Trauma Treatment may be prolonged and include surgery Work station or job duties may require modification 23. Injured Worker Refuses Bonafide Job Offer Strongly suggests lack of motivation and secondary gain

28 Influencing the Outcome of Your Claims

29 Employer Must Take The Initiative Maintain contact with IW communication is key Hold claims handler and other team members accountable Create effective return-to-work program Recognize Red Flags Involve ancillary services (i.e., case management or private investigator) when appropriate

30 Communication is Key Positive contact with IW helps minimize time off Should be from supervisor or other manager Demonstrates genuine concern for and value of employee Helps offset negative influences Models expected work behaviors

31 Manage Your Team Members They work for you and: Should be responsive to you and IW Should be dedicated to your account whenever possible Should recognize and promote your values Should work and play well with other team members

32 Facilitate Modified Duty RTW Studies show IWs off work for more than 6 months are unlikely to return to any job ever DWC Reimbursement Account for small employers helps cover costs of job modification (see handout) Modified duty saves employer money Modified duty limits opportunity for secondary gain

33 Recognize Red Flags Red flags heads up for problem claims with potential for prolonged time off work and higher costs May require greater vigilance on your part May indicate need to mobilize ancillary services such as case management

34 Case Management

35 What is Case Management? Service provided by medical and vocational rehabilitation professionals who are: Representing your interests Assisting IW navigate medical and comp systems Facilitating rapid return to work Achieving cost savings for you

36 Two Types of Case Management Medical Case Management (MCM) Vocational Case Management (VCM) Either can be telephonic or field

37 MCM Should be Medical Pro Typically RN or with related degree Possesses years of medical and/or case management experience Expertise supported by national certifications such as CCM, CRRN, CRC or CDMS Participates in continuing education

38 Keys to Good Medical Case Management Sound medical knowledge Understanding of the law and its implications Excellent negotiating skills Ability to think like the account Knows when to close the file

39 Medical Case Management Should be involved early in life of claim With focus on resolving medical issues and limiting impairment And facilitating timely return to work

40 MCM Helps Resolve Claim By Assessing medical status Facilitating and coordinating appropriate medical care Holding medical providers and IW accountable Promoting communication between all parties Expediting return to work Resulting in cost savings for you

41 VCM Should be a Vocational Rehab Pro Typically has MS in rehab studies or related field Or may be a RN with appropriate on-the-job experience Expertise supported by national certification such as CRC, CCM, CRRN, CVE or CDMS Participates in continuing education

42 Vocational Case Management Assigned to IWs receiving 15% or greater impairment With focus on demonstrating access to the labor market and facilitating return to work To limit eligibility for SIBs Resulting in cost savings for you

43 VCM Helps Resolve Claim By Identifying IW s vocational interests and abilities, then Creating a Rehabilitation Plan and initiating job search While coaching IW in job seeking skills With goal of achieving return to work And limiting or preventing eligibility for SIBs Resulting in cost savings for you

44 Case Managers Represent Your Interests By Knowing your corporate values and goals Promoting those values and goals whenever possible Acting as your eyes and ears in the field All the while moving your files toward closure For the bottom line purpose of saving you $$$$

45 Good Case Management = Cost Saving

46 Glossary of Terms (see handout) Q & A

47 Thank you for your time! Please let us know how we can assist you with your claims.

Overview of the Income Benefit Structure in the Texas Workers Compensation System. Texas Department of Insurance, Division of Workers Compensation

Overview of the Income Benefit Structure in the Texas Workers Compensation System. Texas Department of Insurance, Division of Workers Compensation Overview of the Income Benefit Structure in the Texas Workers Compensation System Texas Department of Insurance, Division of Workers Compensation 1 Workers' compensation will provide benefits if: The injury

More information

WORKERS COMPENSATION FUNDAMENTALS. Know How to Navigate Your Claim

WORKERS COMPENSATION FUNDAMENTALS. Know How to Navigate Your Claim WORKERS COMPENSATION FUNDAMENTALS Know How to Navigate Your Claim Overview Workers Compensation System Rights and Responsibilities Return to Work Benefits Dispute Resolution Complaints vs Disputes 1 Workers

More information

Zurich Handbook. Managed Care Arrangement program summary

Zurich Handbook. Managed Care Arrangement program summary Zurich Handbook Managed Care Arrangement program summary A Managed Care Arrangement (MCA) is being used to ensure that employees receive timely and proper medical treatment with respect to work-related

More information

EXAM SPECIFICATIONS FOR WORKERS COMPENSATION LAW

EXAM SPECIFICATIONS FOR WORKERS COMPENSATION LAW EXAM SPECIFICATIONS FOR WORKERS COMPENSATION LAW PURPOSE OF THE EXAM. The purpose of the certification exam is to require an applicant to demonstrate substantial knowledge of significant legal concepts

More information

An Injured Workers Guide to the Workers Compensation Process Table of Contents

An Injured Workers Guide to the Workers Compensation Process Table of Contents An Injured Workers Guide to the Workers Compensation Process Table of Contents I. Claim Information A. General Information 1. What is workers compensation? 2. How do I know if I qualify for Workers Compensation?

More information

Vocational Rehab Within Ohio Workers Comp System. Karen Fitzsimmons, Manager BWC Rehab Policy Unit

Vocational Rehab Within Ohio Workers Comp System. Karen Fitzsimmons, Manager BWC Rehab Policy Unit Vocational Rehab Within Ohio Workers Comp System Karen Fitzsimmons, Manager BWC Rehab Policy Unit What Is Vocational Rehabilitation? o Programs and services to assist an eligible injured worker return

More information

RULE V. VOCATIONAL REHABILITATION RULES APPLICABLE TO CLAIMS BASED UPON AN INJURY OR ILLNESS OCCURRING PRIOR TO JULY 2, l987 at 4:16 p.m.

RULE V. VOCATIONAL REHABILITATION RULES APPLICABLE TO CLAIMS BASED UPON AN INJURY OR ILLNESS OCCURRING PRIOR TO JULY 2, l987 at 4:16 p.m. RULE V VOCATIONAL REHABILITATION RULES APPLICABLE TO CLAIMS BASED UPON AN INJURY OR ILLNESS OCCURRING PRIOR TO JULY 2, l987 at 4:16 p.m. A. STATEMENT OF BASIS AND PURPOSE The rules of procedure governing

More information

Workers Compensation Claim State Environmental Guide - Tennessee

Workers Compensation Claim State Environmental Guide - Tennessee Workers Compensation Claim State Environmental Guide - Tennessee TENNESSEE http://www.state.tn.us/labor-wfd/wcomp.html Indemnity issues Temporary Total Benefits Temporary Partial Benefits Permanent Partial

More information

EMPLOYEE HANDBOOK FOR WORKERS COMPENSATION FLORIDA

EMPLOYEE HANDBOOK FOR WORKERS COMPENSATION FLORIDA EMPLOYEE HANDBOOK FOR WORKERS COMPENSATION FLORIDA District School Board of Pasco County Kurt S. Browning, Superintendent Dear Employee: The District School Board of Pasco County s (District) goal is to

More information

California Provider Reference Manual Introduction and Overview of Medical Provider Networks (CA MPNs)

California Provider Reference Manual Introduction and Overview of Medical Provider Networks (CA MPNs) California Provider Reference Manual Introduction and Overview of Medical Provider Networks (CA MPNs) Coventry/First Health has designed this manual for The Coventry/First Health Network providers participating

More information

THE INJURED WORKER. The first step is to report the injury or illness to your employer.

THE INJURED WORKER. The first step is to report the injury or illness to your employer. THE INJURED WORKER Who is entitled to workers compensation benefits? If you have an injury or illness caused by your job you may be entitle to workers compensation benefits, which are provided for you

More information

APPLICATION FOR SUPPLEMENTAL INCOME BENEFITS (DWC Form-052)

APPLICATION FOR SUPPLEMENTAL INCOME BENEFITS (DWC Form-052) Texas Department Of Insurance Division of Workers Compensation 7551 Metro Center Dr. Ste.100 MS-603 Austin, TX 78744-1609 (800) 252-7031 (512) 804-4378 fax www.tdi.texas.gov Please complete, if known:

More information

Georgia Workers Comp Basics: Non-Profits are Employers, Too. Michael E. Memberg, Esq. September 19, 2012

Georgia Workers Comp Basics: Non-Profits are Employers, Too. Michael E. Memberg, Esq. September 19, 2012 Georgia Workers Comp Basics: Non-Profits are Employers, Too Michael E. Memberg, Esq. September 19, 2012 Mission of Pro Bono Partnership of Atlanta: To provide free legal assistance to community-based nonprofits

More information

Workers Compensation and Seniors

Workers Compensation and Seniors Chapter 10 Workers Compensation and Seniors Gregory B. Cairns, Esq. Cairns & Associates, P.C. SYNOPSIS 10-1. Workers Compensation 10-2. Benefits Available 10-3. Filing a Workers Compensation Claim 10-4.

More information

Texas Mutual Insurance Company. The Employer s Guide to Workers Comp

Texas Mutual Insurance Company. The Employer s Guide to Workers Comp Texas Mutual Insurance Company The Employer s Guide to Workers Comp 2013-2014 Table of Contents n Workers Comp: What Is It, and Why Do You Need it? 1 n Legal protection for you 1 n Medical and income benefits

More information

CHAPTER 4 THE ROLE OF VOCATIONAL REHABILITATION IN OHIO WORKERS COMPENSATION

CHAPTER 4 THE ROLE OF VOCATIONAL REHABILITATION IN OHIO WORKERS COMPENSATION TABLE OF CONTENTS CHAPTER 4 THE ROLE OF VOCATIONAL REHABILITATION IN OHIO WORKERS COMPENSATION Introduction... 4-1 Remain at Work Programs... 4-1 Vocational Rehabilitation Program Coordinator... 4-1 Vocational

More information

Core Competencies. Investigation

Core Competencies. Investigation Core Competencies Investigation Claim Investigation Verify coverage for claimant / employer Three point contact (employer, claimant and medical provider) Recorded / written statements (claimant, witnesses,

More information

Customer Workers Compensation Benefit Overview

Customer Workers Compensation Benefit Overview Customer Workers Compensation Benefit Overview OREGON INDEMNITY ISSUES Temporary Total Benefits Temporary Partial Benefits Permanent Partial Benefits Permanent Total Benefits Workers injured on or after

More information

Workers Compensation Frequently Asked Questions

Workers Compensation Frequently Asked Questions Workers Compensation Frequently Asked Questions Injured Workers Employers Adjusters/Attorneys/Insurers Vocational Rehabilitation Injured Workers What do I do if my employer has failed to file a claim?

More information

Workers Compensation Program Review and Approval Authority

Workers Compensation Program Review and Approval Authority July 2003 Workers Compensation Program Review and Approval Authority Prepared and Edited by: Assistant Director Date UM Workers Compensation Manager Date Reviewed and Approved by: Chair - UM E, H & S Operations

More information

What is & what is not covered under workers compensation? Basically, what are the benefits... in plain language?

What is & what is not covered under workers compensation? Basically, what are the benefits... in plain language? SEQUATCHIE VALLEY PLANNING & DEVELOPMENT AGENCY Employee Workers Compensation Handbook wchandbk.wpd Preface. Workers Compensation is a state-defined optional benefit that may be provided by Tennessee s

More information

MODIFICATION, TERMINATION OR SUSPENSION OF TEMPORARY DISABILITY BENEFITS

MODIFICATION, TERMINATION OR SUSPENSION OF TEMPORARY DISABILITY BENEFITS RULE IX MODIFICATION, TERMINATION OR SUSPENSION OF TEMPORARY DISABILITY BENEFITS A. TERMINATION OF TEMPORARY DISABILITY BENEFITS BY AN ADMISSION OF LIABILITY IN CLAIMS ARISING PRIOR TO JULY 2, 1987, AT

More information

Revised May 2015. What Is Workers Compensation?

Revised May 2015. What Is Workers Compensation? This pamphlet provides an overview of the workers compensation system in the State of New Hampshire, including what is covered by workers compensation, what benefits are available, and what you should

More information

The Employers Guide to. Pennsylvania s Workers Compensation Law

The Employers Guide to. Pennsylvania s Workers Compensation Law The Employers Guide to Pennsylvania s Workers Compensation Law Table of Contents About this Guide. 3 The Pennsylvania Workers Compensation Act: An Overview for the Pennsylvania Employer....4 Your Duties

More information

WORKERS COMPENSATION In California. Workers Compensation Online Test

WORKERS COMPENSATION In California. Workers Compensation Online Test WORKERS COMPENSATION In California Workers Compensation Online Test DIRECTIONS: Simply list your answer in an email. Write down your letter choice only (a, b, c, d) in a NUMBERED VERTICAL COLUMN. Please

More information

Workers Compensation 101

Workers Compensation 101 Workers Compensation 101 Terminology, Concepts and Principles Melissa LeRoy VP Sales Specialty Risk Services Definition Workers Compensation State-mandated, employer-provided provided coverage in all 50

More information

The University of Texas at San Antonio Office of Environmental Health, Safety and Risk Management

The University of Texas at San Antonio Office of Environmental Health, Safety and Risk Management The University of Texas at San Antonio Office of Environmental Health, Safety and Risk Management Workers Compensation and Return to Work Plan Fully Revised i. REVIEW & SIGNATURE PAGE This Workers Compensation

More information

WORKERS COMPENSATION OVERVIEW

WORKERS COMPENSATION OVERVIEW WORKERS COMPENSATION OVERVIEW Personnel Coordinator & Workers Compensation Specialist Stark County Commissioners Human Resources Department Canton, Ohio Pg. 18 Claim reporting Red Flags Table of Contents:

More information

What is the overall deductible?

What is the overall deductible? University of Utah Comp Plan Coverage Period: 07/01/2016 06/30/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible Family Plan Type: PPO This

More information

Provided By Heath Benefit Partners Workers Compensation Employee Benefits

Provided By Heath Benefit Partners Workers Compensation Employee Benefits Provided By Heath Benefit Partners Workers Compensation Employee Workers compensation laws in California regulate the determination and payment of benefits for employees injured in the course of employment.

More information

Workers Compensation. Inside this Brief. Background Brief on. History in Oregon 1990 Reforms. 1995 Reforms. Management-Labor Advisory Committee

Workers Compensation. Inside this Brief. Background Brief on. History in Oregon 1990 Reforms. 1995 Reforms. Management-Labor Advisory Committee Background Brief on September 2012 Inside this Brief History in Oregon 1990 Reforms 1995 Reforms Management-Labor Advisory Committee Claims Process Medical Service Providers Fatality Benefits Staff and

More information

WORKERS COMPENSATION CLAIMS ADMINISTRATION STANDARDS

WORKERS COMPENSATION CLAIMS ADMINISTRATION STANDARDS Proposal No. 961-4891 Page 1 WORKERS COMPENSATION CLAIMS ADMINISTRATION STANDARDS WORKERS' COMPENSATION CLAIMS ADMINISTRATION GUIDELINES The following Guidelines have been adopted by the CSAC Excess Insurance

More information

Provider Reference Manual Introduction and Overview of Medical Provider Networks (MPNs)

Provider Reference Manual Introduction and Overview of Medical Provider Networks (MPNs) Provider Reference Manual Introduction and Overview of Medical Provider Networks (MPNs) To meet the requirements of SB899, First Health has designed this manual for The First Health Network providers participating

More information

Income Replacement Adequacy in the Texas Workers Compensation System

Income Replacement Adequacy in the Texas Workers Compensation System Income Replacement Adequacy in the Texas Workers Compensation System Texas Department of Insurance Workers Compensation Research and Evaluation Group August 2010 1 Five Types of Income Benefits Under the

More information

Presenting Economic Damage Experts in Litigated Matters: The Role of the Life Care Planner

Presenting Economic Damage Experts in Litigated Matters: The Role of the Life Care Planner Presenting Economic Damage Experts in Litigated Matters: The Role of the Life Care Planner DAN M BAGWELL, RN, CLCP, CCM DAVID J ALTMAN, MD, CLCP 1 What is a Life Care Plan? 2 Dynamic document Based upon

More information

Who Administers the Workers Compensation Program and Related Responsibilities?

Who Administers the Workers Compensation Program and Related Responsibilities? What is Workers Compensation? Who Administers the Workers Compensation Program and Related Responsibilities? Who is Eligible for Workers Compensation? What Coverage is Provided? What is a Compensable Injury?

More information

Dickinson ISD 084901 INSURANCE AND ANNUITIES MANAGEMENT: WORKERS' COMPENSATION CRE (LEGAL)

Dickinson ISD 084901 INSURANCE AND ANNUITIES MANAGEMENT: WORKERS' COMPENSATION CRE (LEGAL) OPTIONS DEFINITION NOTICE REPORT TO CARRIER FIRST REPORT OF INJURY The District shall extend workers' compensation benefits to its employees by choosing one of the following options: 1. Becoming a self-insurer.

More information

Workers Compensation Overview

Workers Compensation Overview Workers Compensation Overview YOUR LEGAL RIGHTS Workers compensation provides benefits to workers who are injured on the job or who have an illness, disease, or disability caused or made worse by workplace

More information

Settlement Philosophy. BWC Settlement Update. Right Time. Right Claims. Right Value

Settlement Philosophy. BWC Settlement Update. Right Time. Right Claims. Right Value Settlement Philosophy BWC Settlement Update Sessions 603 & 633 Ken Brown Project Lead, LSS Enhancement Team Settle the right claim, for the right value, at the right time, under the right circumstances.

More information

MARITIME WORKER JOB RELATED INJURY

MARITIME WORKER JOB RELATED INJURY JEFFREY S. MUTNICK, P.C. jmutnick@mutnicklaw.com Admitted in Oregon MARITIME WORKER JOB RELATED INJURY As a maritime worker, your employer must provide compensation for job-related injuries. This entitlement

More information

PROVIDER REFERENCE MANUAL KENTUCKY MANAGED HEALTH CARE PROGRAM (MHCP)

PROVIDER REFERENCE MANUAL KENTUCKY MANAGED HEALTH CARE PROGRAM (MHCP) PROVIDER REFERENCE MANUAL KENTUCKY MANAGED HEALTH CARE PROGRAM (MHCP) (800) 937-6824 Coventry has developed this manual for Network Providers participating in the Coventry MHCP to assist in understanding

More information

WORKERS COMP 101. Presented by: PGCS/PRU & PGIT

WORKERS COMP 101. Presented by: PGCS/PRU & PGIT WORKERS COMP 101 Presented by: PGCS/PRU & PGIT Discussion Employee Assistance and Ombudsman The Injured Worker The Employer The Insurance Carrier Treating Physician(s) Benefits Calming Claims Light Duty

More information

28 Texas Administrative Code

28 Texas Administrative Code 28 Texas Administrative Code Chapter 127 - Designated Doctor Procedures and Requirements Link to the Secretary of State for 28 TAC Chapter 127 (HTML): http://info.sos.state.tx.us/pls/pub/readtac$ext.viewtac?tac_view=4&ti=28&pt=2&ch=127.

More information

A BRIEF OVERVIEW OF THE BENEFITS AND PERILS OF THE VIRGINIA WORKERS COMPENSATION ACT

A BRIEF OVERVIEW OF THE BENEFITS AND PERILS OF THE VIRGINIA WORKERS COMPENSATION ACT A BRIEF OVERVIEW OF THE BENEFITS AND PERILS OF THE VIRGINIA WORKERS COMPENSATION ACT If you were injured at work or know a family member or friend who was injured at work, I hope that the following information

More information

HOW TO DISPUTE THE INSURANCE CARRIER S DECISION IN A TEXAS WORKERS COMP CASE?

HOW TO DISPUTE THE INSURANCE CARRIER S DECISION IN A TEXAS WORKERS COMP CASE? HOW TO DISPUTE THE INSURANCE CARRIER S DECISION IN A TEXAS WORKERS COMP CASE? An injured worker is entitled to apply for workers compensation benefits in the state of Texas if the workers employer is a

More information

Chapter 3. Medical Care

Chapter 3. Medical Care Who pays for my medical care? Your employer pays for medical care for your work-related injury or illness, either through a workers compensation insurance policy or by being self-insured. The claims administrator

More information

Why Disability Insurance

Why Disability Insurance Why Disability Insurance Most people insure their material possessions their homes and cars, for example. But many people don t insure what is probably their most valuable asset their ability to work and

More information

Workers Compensation Information & Guidelines. Table of Contents

Workers Compensation Information & Guidelines. Table of Contents Workers Compensation Information & Guidelines Table of Contents Purpose Page 2 Summary Page 2 Coverage Page 2 Eligibility Page 2 Injury Defined Page 3 Benefits Available Page 3 Temporary Disability Page

More information

A GUIDE TO THE BENEFITS PROVIDED BY THE ILLINOIS WORKERS COMPENSATION ACT

A GUIDE TO THE BENEFITS PROVIDED BY THE ILLINOIS WORKERS COMPENSATION ACT A GUIDE TO THE BENEFITS PROVIDED BY THE ILLINOIS WORKERS COMPENSATION ACT INTRODUCTION The information contained in this booklet is an overview of benefits provided by the Illinois Workers Compensation

More information

Important Information

Important Information 16 An Employee s Guide to the South Dakota Workers Compensation System Division of Labor and Management Phone: (605) 773-3681 www.sdjobs.org Department of Labor and Regulation 700 Governors Drive Pierre,

More information

Personal Physician Predesignation and March 2006 Change of Physician Rules Approved

Personal Physician Predesignation and March 2006 Change of Physician Rules Approved Briefing Personal Physician Predesignation and March 2006 Change of Physician Rules Approved On March 14, 2006, The California Office of Administrative Law Department approved new rules and regulations

More information

C L A I M S M A N A G E M E N T & M I T I G A T I O N - W O R K I N J U R I E S I N T H E T R U C K I N G I N D U S T R Y M a y 6, 2 0 1 5

C L A I M S M A N A G E M E N T & M I T I G A T I O N - W O R K I N J U R I E S I N T H E T R U C K I N G I N D U S T R Y M a y 6, 2 0 1 5 C L A I M S M A N A G E M E N T & M I T I G A T I O N - W O R K I N J U R I E S I N T H E T R U C K I N G I N D U S T R Y M a y 6, 2 0 1 5 T H E D E A D L I E S T J O B S S T AG G E R I N G N U M B E

More information

Workers Compensation in California. A Guidebook for Injured Workers

Workers Compensation in California. A Guidebook for Injured Workers Workers Compensation in California A Guidebook for Injured Workers Fifth Edition July 2014 Publishing Information This guidebook was designed and produced by the Office of the Director, Department of Industrial

More information

WORKERS COMPENSATION POLICY

WORKERS COMPENSATION POLICY Revised: 08/03/06 THE CITY OF POMONA SAFETY POLICIES AND PROCEDURES WORKERS COMPENSATION POLICY City Manager: I. PURPOSE This Policy describes the procedures for the City of Pomona s self-insured workers

More information

Q: Has Dollar General had any claim issues around loosing the common law defenses and exclusive remedy? A: No.

Q: Has Dollar General had any claim issues around loosing the common law defenses and exclusive remedy? A: No. RIMS Webinar January 20, 2011 An Overview of Nonsubscription from Texas Workers Compensation Answers to Participants Questions Prepared by PartnerSource Q: What are the litigation rates associated with

More information

Reserves. Medical. Indemnity. Seminar Overview. Premium Impact 10/19/2014. Workers Compensation Return to Work. Benefits of RTW Program LIBC-757

Reserves. Medical. Indemnity. Seminar Overview. Premium Impact 10/19/2014. Workers Compensation Return to Work. Benefits of RTW Program LIBC-757 Workers Compensation Return to Work Seminar Overview Discussion Topics Forms Included Benefits of RTW Program LIBC-757 Personal Benefits of Sample Return to Work Letter Employee FMLA Settlements Litigation

More information

Managed Care 101. What is Managed Care?

Managed Care 101. What is Managed Care? Managed Care 101 What is Managed Care? Managed care is a system to provide health care that controls how health care services are delivered and paid. Managed care has grown quickly because it offers a

More information

Comparison of State Workers Compensation Programs

Comparison of State Workers Compensation Programs Comparison of State Workers Compensation Programs Preliminary Results Texas Department of Insurance Workers Compensation Research Group 1 Purpose of This Analysis To compare the medical and indemnity costs

More information

Survey of Rehabilitation and Return-to-Work Practices Among U.S. Disability Carriers

Survey of Rehabilitation and Return-to-Work Practices Among U.S. Disability Carriers Cornell University ILR School DigitalCommons@ILR GLADNET Collection Gladnet May 2007 Survey of Rehabilitation and Return-to-Work Practices Among U.S. Disability Carriers Robert W. Beal Milliman, Inc. Follow

More information

National Business Group on Health DATA DICTIONARY. Workers Compensation

National Business Group on Health DATA DICTIONARY. Workers Compensation National Business Group on Health DATA DICTIONARY Workers Compensation EMPAQ Workers Compensation (WC) Metrics Metric Calculation Annual Claim Incidence per 100 FTEs Total Number of New WC Indemnity Claims

More information

4123-6-02.2 Provider access to the HPP - provider credentialing criteria.

4123-6-02.2 Provider access to the HPP - provider credentialing criteria. 4123-6-02.2 Provider access to the HPP - provider credentialing criteria. (A) The bureau shall establish minimum credentialing criteria for provider certification. Providers must meet all licensing, certification,

More information

Federal Employees Compensation Act (FECA) AFGE Firefighter Council Seminar

Federal Employees Compensation Act (FECA) AFGE Firefighter Council Seminar Federal Employees Compensation Act (FECA) AFGE Firefighter Council Seminar 1 FECA Sole remedy for Fed workers injured on the job Benefits Medical treatment of injury Wage loss compensation Schedule award

More information

North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS

North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS Often times in the early care and education field we

More information

Information for the New Claimant WORKER S COMPENSATION

Information for the New Claimant WORKER S COMPENSATION Information for the New Claimant WORKER S COMPENSATION Published by: Employee Compensation and Benefits Services University of Wisconsin Madison 21 N Park Street, Suite 5101 Madison, WI 53715 Daim ntawv

More information

SOUTH CAROLINA BAR. Workers Compensation and the Law

SOUTH CAROLINA BAR. Workers Compensation and the Law SOUTH CAROLINA BAR Workers Compensation and the Law WORKERS COMPENSATION The South Carolina Workers Compensation Act provides a system for workers injured on the on the job to receive medical care and

More information

New Jersey State Disability Claim. Your New Jersey State Disability Benefit Claim. How To Apply For Benefits

New Jersey State Disability Claim. Your New Jersey State Disability Benefit Claim. How To Apply For Benefits Your New Jersey State Disability Benefit Claim This packet contains the forms that will help us to process your claim for New Jersey State Disability Benefits. Please save a copy of this material for your

More information

Guide to. For Connecticut Private Sector Employees

Guide to. For Connecticut Private Sector Employees Guide to Workers Compensation For Connecticut Private Sector Employees NEW ENGLAND HEALTH CARE EMPLOYEES UNION DISTRICT 1199, SEIU 77 Huyshope Avenue, Hartford, CT 06106 860-549-1199 September 2009 Workers

More information

Avoiding 10 Common Workers Compensation Pitfalls. Presented by Peter P. Greaney, M.D. Medical Director and CEO, WorkCare, Inc.

Avoiding 10 Common Workers Compensation Pitfalls. Presented by Peter P. Greaney, M.D. Medical Director and CEO, WorkCare, Inc. Avoiding 10 Common Workers Compensation Pitfalls Presented by Peter P. Greaney, M.D. Medical Director and CEO, WorkCare, Inc. Session Overview Improve understanding of workers comp Identify/correct weaknesses

More information

Workers Compensation Insurance A Primer

Workers Compensation Insurance A Primer Topics Affecting Buyers of Commercial Insurance MSP C 12/2001 Workers Compensation Benefits A Primer December, 2001 Workers Compensation Insurance A Primer Workers compensation insurance is mandatory in

More information

Employer Participation in the Texas Workers Compensation System: 2012 Estimates

Employer Participation in the Texas Workers Compensation System: 2012 Estimates Employer Participation in the Texas Workers Compensation System: 2012 Estimates Texas Department of Insurance Workers Compensation Research and Evaluation Group October 2012 Brief History of Non-subscription

More information

Does Texas Need a Workers Compensation System? Bill Peacock Texas Public Policy Foundation

Does Texas Need a Workers Compensation System? Bill Peacock Texas Public Policy Foundation Does Texas Need a Workers Compensation System? Bill Peacock Texas Public Policy Foundation Beginnings of Workers Compensation Liability and Litigation in the 19 th Century The problem of industrial accidents

More information

Managing the Care and Return to Work of Injured Workers (and controlling your Workers Compensation Costs)

Managing the Care and Return to Work of Injured Workers (and controlling your Workers Compensation Costs) Managing the Care and Return to Work of Injured Workers (and controlling your Workers Compensation Costs) This Guide was developed to provide you with valuable information regarding our managed care program,

More information

2014-15 EMPLOYEE BENEFITS GUIDE

2014-15 EMPLOYEE BENEFITS GUIDE 2014-15 EMPLOYEE BENEFITS GUIDE ELIGIBILITY All People 2.0 employees are eligible to enroll in The American Worker program within 30 days of your first pay check. People 2.0 offers a variety of affordable

More information

C-20077EE-CVR New 1-00 Printed in U.S.A.

C-20077EE-CVR New 1-00 Printed in U.S.A. Employee: Employer: Date File Social Number: of Security Injury: We are your employer's No.: informational regulations. If have attached your copy workers' of the compensation Notice of Injury, insurance

More information

Comparative Review of Workers Compensation Systems in Select Jurisdictions

Comparative Review of Workers Compensation Systems in Select Jurisdictions of Workers Compensation Systems in Select Jurisdictions JURISDICTION: TEXAS ENVIRONMENT Population Size 19.3 million in 1997. Labour Force 8 million (1997) Demographic and Economic Indicators has enjoyed

More information

Frequently Asked Network Questions

Frequently Asked Network Questions Frequently Asked Network Questions Press CTRL and click on the question to jump to a specific question New and revised questions from the previous version are noted in italics General Questions...3 1.

More information

The only Workers Compensation Services Provider with a Mission to Protect & Grow Ohio Manufacturing

The only Workers Compensation Services Provider with a Mission to Protect & Grow Ohio Manufacturing The only Workers Compensation Services Provider with a Mission to Protect & Grow Ohio Manufacturing Table of Contents: A Comprehensive System for Managing Workers Compensation Claims.... 1 Not All Workers

More information

FLORIDA ATLANTIC UNIVERSITY WORKERS COMPENSATION RETURN TO WORK PROGRAM

FLORIDA ATLANTIC UNIVERSITY WORKERS COMPENSATION RETURN TO WORK PROGRAM FLORIDA ATLANTIC UNIVERSITY WORKERS COMPENSATION RETURN TO WORK PROGRAM APPLICABILITY/ACCOUNTABILITY: In compliance with statutory requirement, this program provides general guidelines for employees who

More information

Employer Profile Summary SCHOOL DISTRICT #71 (COMOX VALLEY) (37606)

Employer Profile Summary SCHOOL DISTRICT #71 (COMOX VALLEY) (37606) Employer Profile Summary SCHOOL DISTRICT #71 (COMOX VALLEY) (37606) 765008 - Public School District Performance Scorecard Measure Period Actual Rank Better Comparison vs. Peers Worse Experience Rating

More information

Frequently Asked Questions About Georgia Workers Compensation Ty Wilson Attorney At Law 1-866-937-5454 www.tywilsonlaw.

Frequently Asked Questions About Georgia Workers Compensation Ty Wilson Attorney At Law 1-866-937-5454 www.tywilsonlaw. Frequently Asked Questions About Georgia Workers Compensation Ty Wilson Attorney At Law 1-866-937-5454 www.tywilsonlaw.com Special Report Frequently Asked Questions About Claims Special Report Ty Wilson

More information

Rights and Responsibilities

Rights and Responsibilities Rights and Responsibilities Employee New Partnerships Provider Employer/Insurer For partnerships to be effective, all involved parties need to understand their rights and responsibilities and how they

More information

GEORGIA WORKERS' COMPENSATION Explanation of Basic Procedures

GEORGIA WORKERS' COMPENSATION Explanation of Basic Procedures GEORGIA WORKERS' COMPENSATION Explanation of Basic Procedures A. Initiating Claim 1. Accident must arise out of, and in the course of, employment (O.C.G.A. 34-9-1). a. "Arising out of" means what the employee

More information

Thank you for choosing CNA

Thank you for choosing CNA Thank you for choosing CNA As every employer knows, workers compensation is a significant cost of doing business, not only in actual dollars, but in lost work days and reduced productivity. In order to

More information

Approach To Worker s Compensation Patients ERIC S. SMITH, M.D. APRIL 2013

Approach To Worker s Compensation Patients ERIC S. SMITH, M.D. APRIL 2013 Approach To Worker s Compensation Patients ERIC S. SMITH, M.D. APRIL 2013 WHATCOM OCCUPATIONAL HEALTH What is it? Insurance to cover on-the-job injuries or illnesses State of Washington only one of three

More information

Worker' Compensation and Reemployment Rights

Worker' Compensation and Reemployment Rights Worker' Compensation and Reemployment Rights The Federal Employee's Compensation Act provides workers' compensation for employmentrelated injuries and occupational diseases. Benefits include wage replacement,

More information

PREDESIGNATION OF PERSONAL PHYSICIANS AND REPORTING DUTIES OF THE PRIMARY TREATING PHYSICIAN REGULATIONS

PREDESIGNATION OF PERSONAL PHYSICIANS AND REPORTING DUTIES OF THE PRIMARY TREATING PHYSICIAN REGULATIONS PREDESIGNATION OF PERSONAL PHYSICIANS AND REPORTING DUTIES OF THE PRIMARY TREATING PHYSICIAN REGULATIONS Title 8, California Code of Regulations Chapter 4.5. Division of Workers Compensation Subchapter

More information

Workers' Compensation in California: Questions & Answers

Workers' Compensation in California: Questions & Answers Workers' Compensation in California: Questions & Answers prepared for the California Commission on Health and Safety and Workers' Compensation October 2006 Page 2 Introduction. How To Use This Booklet.....................................

More information

National Trends in Workers Compensation

National Trends in Workers Compensation National Trends in Workers Compensation by Niki Ingram November 1, 2013 at 6:00 am As workers compensation costs continue to rise, it is crucial to understand the national issues currently impacting the

More information

Covered Employee Notification of Rights Materials

Covered Employee Notification of Rights Materials Covered Employee Notification of Rights Materials Regarding Antelope Valley Community College District PRIME Advantage Medical Network Medical Provider Network ( MPN ) This pamphlet contains important

More information

An Employee s Guide to the Missouri Workers Compensation System

An Employee s Guide to the Missouri Workers Compensation System An Employee s Guide to the Missouri Workers Compensation System Missouri Department of Labor and Industrial Relations Division of Workers Compensation Important Information You may want to put names and

More information

CHAPTER 1. Wyoming Workers Compensation. Workers Compensation Programs Benefit Injured Workers and Employers

CHAPTER 1. Wyoming Workers Compensation. Workers Compensation Programs Benefit Injured Workers and Employers CHAPTER 1 Wyoming Workers Compensation Workers Compensation Programs Benefit Injured Workers and Employers Injured workers receive medical and lost wage benefits, regardless of fault. Employers receive

More information

Division of Workers' Compensation

Division of Workers' Compensation 1 of 5 10/14/2010 11:32 AM Division of Workers' Compensation Frequently Asked Questions Employer FAQs Who needs Workers' Compensation coverage? How does an employer obtain workers' compensation insurance?

More information

NCAA CATASTROPHIC INJURY INSURANCE PROGRAM FREQUENTLY ASKED QUESTIONS

NCAA CATASTROPHIC INJURY INSURANCE PROGRAM FREQUENTLY ASKED QUESTIONS NCAA CATASTROPHIC INJURY INSURANCE PROGRAM FREQUENTLY ASKED QUESTIONS APPLICABLE TO 8/1/12 TO 7/31/13 POLICY PERIOD This document is a summary of the NCAA Catastrophic Injury Insurance Program. The insurance

More information

THOMAS WEIFORD, CRC, CCM, CLCP, D/ABVE 7033 SW Macadam, Suite 107 Portland, OR 97219 (503) 245-5494 Tom@Weifordcasemanagement.com

THOMAS WEIFORD, CRC, CCM, CLCP, D/ABVE 7033 SW Macadam, Suite 107 Portland, OR 97219 (503) 245-5494 Tom@Weifordcasemanagement.com THOMAS WEIFORD, CRC, CCM, CLCP, D/ABVE 7033 SW Macadam, Suite 107 Portland, OR 97219 (503) 245-5494 Tom@Weifordcasemanagement.com NATIONAL PROFESSIONAL CERTIFICATIONS: * Certified Rehabilitation Counselor

More information

California Orthopaedic Association SUMMARY 2012 WORKERS COMPENSATION REFORMS. 1 California Orthopaedic Association

California Orthopaedic Association SUMMARY 2012 WORKERS COMPENSATION REFORMS. 1 California Orthopaedic Association 2012 California Orthopaedic Association SUMMARY 2012 WORKERS COMPENSATION REFORMS 1 California Orthopaedic Association A deal crafted by labor and business came together in the last hours of the 2011-2012

More information

CITY OF NEWPORT NEWS PERSONNEL ADMINISTRATIVE MANUAL Effective: 4/01/08

CITY OF NEWPORT NEWS PERSONNEL ADMINISTRATIVE MANUAL Effective: 4/01/08 This section establishes policies and procedures pertaining to work-related injuries and diseases. I. PROCEDURES A. Any employee who sustains or witnesses a work-related injury or any employee who is diagnosed

More information

Testimony before Texas Senate Select Interim Committee on Workers' Compensation. About WCRI

Testimony before Texas Senate Select Interim Committee on Workers' Compensation. About WCRI 1 Testimony before Texas Senate Select Interim Committee on Workers' Compensation April 29, 2004 About WCRI Independent, not-for-profit research organization, established 1983 Has diverse membership support

More information

Workers Compensation & Loss Prevention. City of Dallas Council Briefing April 6, 2005

Workers Compensation & Loss Prevention. City of Dallas Council Briefing April 6, 2005 Workers Compensation & Loss Prevention City of Dallas Council Briefing April 6, 2005 1 Purpose Three organizations have completed assessments of the City of Dallas Workers Compensation Program (WC): Aon

More information

Common Myths Associated With Georgia Workers Compensation Claims Ty Wilson 1-866-937-5454 www.tywilsonlaw.com Special Report

Common Myths Associated With Georgia Workers Compensation Claims Ty Wilson 1-866-937-5454 www.tywilsonlaw.com Special Report Common Myths Associated With Georgia Workers Compensation Claims Ty Wilson 1-866-937-5454 www.tywilsonlaw.com Special Report COMMON MYTHS ASSOCIATED WITH GEORGIA WORKERS COMPENSATION CLAIMS Special Report

More information