More than half of all injured workers have a pre-existing condition, according to one expert. When you have an employee with a permanent impairment who suffers a second injury, you are responsible for compensating only the most recent injury. Many employers fail to realize this, leaving thousands of dollars on the table. More than 20...
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Two Techniques for Managing Claim Costs
Utilization reviews have saved companies around the country billions of dollars in workers’ compensation costs since California mandated utilization review in 2004. Other techniques, such as using a specialized workers’ compensation medical care network, can also work. Here’s a brief overview. Utilization Review Utilization review is designed to bring greater efficiency to the recovery process...
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What Does a Claims Professional Do?
After a loss, your insurer will probably call in one of several claims experts before it pays your claim. Here’s a brief overview of some of the claims professionals you might encounter after filing a claim. Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim,...
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PTSD and Workers’ Compensation
According to the National Center for Post Traumatic Stress Disorder (NCPTSD), some 7.8 percent of Americans will experience post traumatic stress disorder (PTSD) at some point in their lives. How does PTSD impact an employer’s workers’ compensation program? PTSD is a psychological syndrome that can affect a person of any age. A person can develop...
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The Prohibited Acts Doctrine
Under the workers’ compensation bargain, the employer agrees to compensate an employee for any work-related injury or illness…unless the employee was engaged in a “prohibited act” at the time of injury. A prohibited act is an act that the employer expressly prohibits—such as consuming alcohol or using other intoxicants while on the job or on...
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Workers’ Comp Fraud Investigations: Proceed With Caution
The National Insurance Crime Bureau reported that the number of “questionable” workers’ compensation claims increased, although the total number of claims decreased between January 1, 2011 and June 30, 2013. “Questionable claims” included claims involving claimant fraud, prior injuries unrelated to work and malingering. If you suspect a workers’ compensation claimant might be committing fraud...
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Preventing Workers’ Comp Fraud
In early 2012, the National Insurance Crime Bureau (NICB) reported that all types of “questionable” insurance claims increased 19 percent between 2009 and 2011. Studies from 2000 estimated that one to two percent of workers’ compensation claims nationwide were fraudulent. If the NICB’s results apply to workers’ compensation claims, the percentage of fraudulent workers’ compensation...
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How to Keep Attorneys Out of Your Workers’ Comp Claims
The Yellow Pages for New York City lists 45 law firms in its section on workers’ compensation attorneys. Even tiny Medford, Oregon (population 75,000) boasts five workers’ compensation law firms. It takes a lot of employers to keep all those lawyers busy—here’s how to ensure that your business isn’t one of them. When the workers’...
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