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Employment law in the US requires most employers to carry Workers Compensation insurance coverage for employees. This coverage is based on a cost formula that uses payroll dollars and a Classification of the associated trade. For example, the rate of insurance for steel erection is relatively high, vs. that for office workers.
If an employee is injured or becomes ill from a job-related condition, Workers Comp insurance covers the medical costs and lost wages for this case. The details of this process can be daunting. There are multiple avenues for a claim to run off the rails.
This webinar will examine Best Practices for investigating, filing, tracking and managing a typical Workers Comp claim to ‘closure’. Even a minimal claim can involve some eye-popping numbers if it is mis-handled.
Why should you attend?
The claims management process is relatively straight-forward when done correctly. Knowing the critical elements and specifications can help avoid the minefield of claim fraud, mistakes, duplication, extra cost, frustrated employee and family, risk of opioid abuse, doctor-shopping, higher insurance rates and other negative outcomes.
How to properly file a claim, communications with the multiple parties involved, having a safety program, investigating an incident, documentation and follow up are among the topics we will discuss.
Learning the ‘Red Flag’ indicators of claim abuse are included. Insurance agency and Insurance Carrier involvement are also topics. Medical service providers follow up specialty services, Nurse Case Managers are included. Each of these categories has multiple moving parts, which we will discuss in terms of the employer’s responsibility in assuring proper claim handling and outcome.
Description of the topic:
The cost of business insurance is significant. Employee safety & health programs are critical elements in controlling these costs. Most small to medium size companies do not have a full-time staff person for safety or insurance. Rather, these are ‘adjunctive’ responsibilities for a Human Resource or administration or production/operations person. To the uninformed person, filing a claim is simply an additional ‘chore’ in their busy schedule.
Filing, tracking and managing a claim is, in fact, a discreet science and subject to highly detailed performance criteria. Most persons do not fully understand the mechanisms or players at work in the process. This webinar will deconstruct the critical steps, affording a better understanding of this process, helping you achieve the best outcome and keep your insurance costs under control.
Because Workers Comp is a form of ‘no-fault’ insurance, a claim must be managed in a certain way, avoiding cost over-run. This webinar will offer insight into the insurance process and help you define the key players in the system.
Areas Covered in the Session:
· Your Company Experience Modification Factor (EMF or ‘Mod’)
· National Council on Compensation Insurance (NCCI) and what it means to you
· The ‘Claim Reserve’ process and how to manage it
· Role of the insurance carrier
· Role of a Claim Adjuster
· Role of your insurance agent
· Role of the medical providers
· Relationship with occupational medicine clinics
· Importance of a ‘Pre-employment Physical’
· Early Return to Work programs
· Drug & Alcohol testing programs
· Incident Investigation – who should do it and how it should be done
· Red Flag claim fraud indicators
· Claim communications –filing an ‘Employers 1st Report of injury or illness’, error avoidance measures. I.e.: avoid phone calls.
· Employee Wellness Programs – the new ‘normal’ in Human Resource programs
· Safety & Health Programs
· New hire safety orientation – recommended practices
· Accountability and responsibility of management and employees
· Do’s and Don’ts of the claim handling process
· Resources for more help and assistance
Who will benefit:
· HR managers and assistants, technicians, administrative staff
· Operations and Production managers, supervisors
· Company Owners, Officers, Directors, Financial and Risk Managers
· Safety Directors and Managers
· Working foremen, Lead Persons and supervisors
· QA/QC managers and technical staff
· Insurance Claim Handlers and Adjusters
· Insurance Loss Prevention and Control representatives
· Attorneys, para-legals, technicians
· Occupational Nurses and physicians, re-hab and therapy providers
· Nurse Case Managers, counselors, clinicians
John J. Meola, CSP, ARM is the Safety Director for Pillar, Inc. based in Richmond, VA.
He is also an Instructor at the VA Commonwealth University, School of Business, Risk Management and Insurance Department and an OSHA 500 Community Outreach Construction Safety Trainer. He has authored two safety handbooks and contributes numerous technical safety articles for trade industry publications.
Mr. Meola is also an Executive Officer with the Colonial VA Chapter of the American Society of Safety Engineers and a Past-President of this Chapter. He works closely with clients from private industry to develop and manage employee safety and health issues across a wide range of businesses.