Imagine the following scenario when handling a workers’ compensation claim: John Doe is a construction worker who shows up for work on Monday morning appearing to being “a little off his game.” Shortly after starting work he falls from some scaffolding and suffers a severe work injury.  Following the accident, he was taken to a...
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The Worker’s Compensation Research Institute (WCRI) has issued a report that workers treating doctors will have an economic incentive to transfer treatment from the Affordable Care Act to workers’ compensation. Similar transfers have been going on for decades but they started when workers initiated the transfer to take advantage of the potential of a settlement...
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It is important for claims management teams to make effective use of Functional Capacity Evaluations (FCE) in workers’ compensation cases.  Failure to do so can result in losing control of your case. What is a Functional Capacity Evaluation? A Functional Capacity Evaluation (FCE) is a series of tests performed on an injured worker to determine...
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Complete job descriptions, with proper compliance can help reduce workers compensation loss values. They can be used both as preventative measure and as a tool to reduce a claim exposure.  Job descriptions that are stated clearly, as well as describe all duties and functions, will bring the most desired results. Preventative Uses: Job descriptions can be...
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Recently, the WCIRB submitted a regulatory filing to the California Department of Insurance proposing a number of changes to the Insurance Commissioner’s regulations. Among the proposed changes is a recommendation to amend the experience rating formula to replace the fixed primary and excess split point with a variable split point based on an employer’s size....
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To calculate your workers compensation insurance premium, the insurance company takes into consideration three things – the type of business you are in, the total amount of your company’s payroll and your experience modifier.  The only one of the three things the employer has control over (without reducing payroll) is the experience modifier (also referred...
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Medicare Advantage Plans (MA Plans) are growing in popularity and currently cover about 30% of all Medicare beneficiaries.  This is partly due to the fact MA Plans provide numerous coverage options for people with various medical needs. The increasing use of these Plans has created confusion for claim management teams as they handle workers’ compensation...
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Twenty percent of all workers’ compensation cost is incurred on less than one percent of the claims.  These high dollar claims are often referred to as catastrophic claims.  The term ‘catastrophic claim’ applies to the nature of the claim, not the dollar cost, even though the severe nature of the claim and the high dollar...
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The proper selection of defense attorneys is one of the most important things a self-insured employer can do to control cost of the larger workers’ compensation claims.  It is also one of the most over-looked ways to control claim cost.  Whether you are new to the world of self-insurance, or just not happy with the...
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The objective of the medical providers in every workers’ compensation claim is to assist the injured employee to recover completely or to the greatest degree of recovery that is possible.  Unfortunately, there are injuries where the employee does not recover fully from the effects of the injury.  When an employee reaches maximum medical improvement (the...
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