This course provides an explanation of the history of workers’ compensation and why workers’ compensation exists. Attendees will conclude the course with basic knowledge of state workers’ compensation and Federal schemes, what statutes and regulatory agencies are involved in the workers’ compensation system, and types of insurance and insurance alternatives available. Course objectives:
Explain the history of worker’s compensation and why it exists.
Understand basic types of state WC plans and Federal plans.
Understand types of workers’ compensation insurance or insurance alternatives.
Have a basic knowledge of what regulatory agencies/law/statutes affect workers compensation.
Claims professionals should have the training and knowledge to determine on each claim the scope of investigation required/proper analysis of the information obtained and then how to execute the decision on compensability. This course teaches the skills/steps necessary to put each claim in the best possible position to defend a compensability decision.
After completion, participants will be able to:
Identify the steps required to investigate a claim both at first notice and as new information is received regarding compensability.
Be confident in their skills to obtain information in an investigation.
Be confident in their ability to deal with plaintiff/applicant attorneys.
Understand how to deny body parts/medical treatment/disability.
Understand the basic steps needed to deny a claim and jurisdictional considerations.
Be able to identify the information necessary to determine if any third party liability.
Be knowledgeable regarding unfair claims practices and what steps to take to avoid this potential issue.
Managing the claim to bring forth the best possible outcome is crucial in the early stages, and ongoing, during the life of the claim. This course engages the learner by challenging them to think differently to achieve a superior claim outcome.
Medical cost in a workers’ compensation claim can get out of control quickly. It is essential to manage all aspects of the medical care in a claim from the onset and to never take your eye off the ball. This course will provide you with tools necessary to improve the medical and cost outcomes of each case.
Claims professionals must continually evaluate the financial exposures of the claim to ensure sufficient funds are set aside in reserve to pay for expected costs. Proper forecasting of the financial impact of a claim is essential to having funds available for timely benefit payment and the balance sheet of the company being represented. It isn’t simply a matter of stating how much money is needed, but rather ensuring the organization has adequate funds in reserve to cover the financial obligation tied to the claim. It is also important to understand the impact of the development factor applied by actuaries, collateral demands, and financial planning. This course teaches claims professionals the importance of forecasting the primary components to consider in establishing the reserve fund.
Resolving a claim with the best possible outcome for all involved is the delicate balance that exists in claims handling. Depending upon the claim, the stake holders involved in the claims resolution will vary. This course will outline and review the steps that should be taken by a claims professional to successfully bring a workers’ compensation claim to resolution. Additionally, the idea that an injured worker who is entitled to workers’ compensation benefits in the state where they are injured is subject to the provision of exclusive remedy for that injured worker, and is a very important concept for the claims professional.