- Session 1 - Presentation B: The Transformation of Managed Care to Quality Care - How It Impacts Workers' Compensation
Session 1 - Session 1 - Presentation A: The Poppy Fields of Pain Management
Julie Fortune, Self Employed
Lisa Kinney, Cousineau McGuire Chartered
Kenneth Yuska, Kenneth H. Yuska, M.D., S.C.
What is pain? Is it real or not? Why are some people prone to pain and others do not suffer from it? How is pain managed? What works and why? What is the latest information available to assist claims adjusters and attorneys in understanding how to manage claims involving pain?
Participants will understand the difficulties surrounding the management of pain, options to treat pain, the costs (economic and social) associated with pain, and available tools to utilize in the management of pain claims.Back to top
Session 1 - Session 1 - Presentation B: The Transformation of Managed Care to Quality Care - How It Impacts Workers' Compensation
Kimberly George, Sedgwick
Sean McDaniel, Alternative Risk Underwriting (ARU)
Ronald Thackery, Thackery Group
Despite two decades of expanded managed care applications within the workers' compensation arena, there is a growing perception that the quality of healthcare provided to patients with work-related injuries is somewhat inferior to that provided in a more general healthcare setting. Over time, the industry seems to have lost sight of its ultimate goal – taking care of injured workers while returning much needed labor to the workplace. Fortunately, a shift in thinking is beginning to occur. Employers are realizing that if more immediate and effective medical treatment becomes the priority, cost savings and increased productivity tend to follow. One way employers are beginning to accomplish this objective is through the use of provider selection and benchmarking. This session is designed to explore these issues from an employer's perspective. An in-depth look at provider selection and benchmarking will be shared. In addition, results of a year-long trial in California will be presented. With plans to expand the outreach of this approach to other states, employers will certainly want to learn more. They will see firsthand how they can capitalize upon this industry transformation for the betterment of their own programs.Back to top
Session 1 - Session 1 - Presentation C: Illinois Workers' Compensation Reform, Two Years Later: Has Anything Really Changed?
Rich Lenkov, Downey & Lenkov LLC
Ellen Marie Menas, Global Risk Consultants
David B. Menchetti, Cullen, Haskins, Nicholson & Menchetti, P.C.
Joan Vincenz, United Airlines, Inc.
In June 2011 one of the most sweeping workers’ compensation reform packages in the country was signed into law in Illinois. This legislation affected many key facets of Illinois workers’ compensation law, including AMA ratings, physician panels, utilization review and repetitive trauma. With the benefit of two years hindsight, this all-star panel will lead a discussion of whether the legislation has actually had its intended effect, and whether anything has really changed with one of the largest and most expensive workers’ compensation programs in the country.Back to top
Session 2 - Session 2 - Presentation A: Stuff That Bugs Us: Litigation Do's and Don'ts
Toni Herwaldt, Navistar, Inc.
Bill McParland, Self Employed
Heath Sherman, The Sherman Law Group
Cindy Slubowski, PMA Companies
Everyone has a list of pet peeves when it comes to claims and litigation. This panel of claims and risk leaders from some of the country’s largest companies will explore the “do’s and don’ts” of workers’ compensation litigation through six distinct stages: (1) initial claim investigation; (2) retention of outside counsel along with development of an initial litigation strategy and budget; (3) medical management; (4) return to work/vocational rehabilitation; (5) resolution of the case through settlement or trial; and (6) interplay between the workers’ compensation case and third-party actions, subrogation, and federal employment laws.
The panel and audience will jointly develop a useful checklist of how to avoid bugging your clients. You will walk away from this fun, high spirited panel discussion with an understanding of what your client wants as well as inspiration to litigate each and every workers’ compensation claim with passion and solid direction.
Session 2 - Session 2 - Presentation B: The Dollars and Sense of RTW
Scott Armour, R & L Carriers
Bruce Bollman, Cincinnati Insurance Company
James M. Poerio, Poerio & Walter, Inc.
Many of us have been presented with questions from our Work Comp clients and insureds regarding the seemingly out-of-control Experience Mod Factor (EMF) and premiums. These are related but not the same. A focus on Return-to-Work (RTW) is critical to controlling costs but does much more. When everyone is focused on a RTW “mentality” everyone wins.
The E-mod is an algebraic function. Once you take apart the pieces of the formula; you will see what can be done to “control” the E-mod and what factors go into figuring your minimum mod and more importantly, your “controllable” mod. The coming Split-point increases, DART (Days away OSHA) issues, etc. will also be included in the topic
Our presentation will review the current state of the market and the law. We will provide effective strategies that not only will reduce premiums and E-mods but keep derivative lawsuits (Employment Practices, Wrongful Termination) and other issues at bay. How can you have an impact on indirect costs (there are many) and, more importantly, the morale and well-being in the workplace? Fulfilling the employment contract makes common as well as financial sense. How accommodating can you or should you be in returning that injured worker to your workplace and why? This presentation will provide answers you can give when presented with a claim. This will not be an exhaustive study but will give you helpful hints and strategies to employ.Back to top
Session 2 - Session 2 - Presentation C: Employment Landmines in Workers' Compensation
Learn how small employment decisions can have big impacts on successful resolution of workers’ compensation claims. Top tips for the interaction of counsel, adjusters, and the employers, including avoiding subsequent disability discrimination and retaliation claims, and strategies for separating “high risk” claimants.Back to top
Session 3 - Session 3 - Presentation A: SMART Act Update and Impact on Claims Handling
Angela Henderson, ESIS
L. Tyler Laflin, Engles, Ketcham, Olson & Keith, P.C.
Jessica Smythe, ISO Claims Partners
The SMART Act, which was signed into law by President Obama in January, is sweeping new legislation which changes the landscape of Medicare compliance. This presentation gives a history and overview of the legislation, explains the next steps for the regulatory phase of the Act and details when certain provisions take effect. A top Claims Manager from a national workers’ compensation carrier, a workers’ compensation defense attorney and a national Medicare compliance consultant will discuss these important changes to Medicare conditional payment recovery and Section 111 reporting and how these changes will impact claims handling.Back to top
Session 3 - Session 3 - Presentation B: Management and Cost Containment of Vocational Rehabilitation Efforts
Mike Benedeck, Centegra Health System
Michael J. Brennan, Self Employed
Chris Marston, Gallagher Bassett Services, Inc.
Vocational rehabilitation is a costly option intended to return an injured worker to a similar level of employment. Its injection into a claim can have intended and unintended consequences. Its cost may far exceed its value. Costs include vocational counselors, ongoing maintenance, medical, legal and claim handling fees.
An unintended consequence may be the enhancement of the worker’s claim from a wage loss to an odd-lot permanent total disability award. Discussion will center upon claims that require vocational rehabilitation, handling, medical issues, reluctant participants (claimants), and meddlesome bystanders. Focus will center upon return to work, setting value, the tone for litigation, and settlement.
Participants will understand the costliness of the process and need for close monitoring. Dialogue will focus upon the cost and diminishing return of the process.
Session 3 - Session 3 - Presentation C: Predictive Modeling: Effective Implementation and Practical Application
Richard Goff, The Taft Companies, LLC
Keith Higdon, ESIS
William Pipkin, Austill, Lewis, Pipkin & Maddox, P.C.
Predictive modeling is the latest innovation taking shape in claims and litigation management. The concept of predictive modeling is not new, but its application in this arena continues to evolve and grow in acceptance. At its core, predictive modeling utilizes a variety of techniques, determined by the modeling question and data set, to identify patterns in data that are not discernible through traditional methods of reporting and trending. These patterns are based on historical data and identify opportunities for intervention. The implementation of predictive models requires specific expertise, a cultural shift in approach to management, and an understanding of how a model fits into a larger solution. Those who embrace these components can reap enormous benefits in program differentiation with returns based on both improvements in efficiency and effectiveness.
What does it really mean to utilize predictive modeling? How is it being used in the marketplace today? What is the future of predictive modeling? These are key questions that will be discussed by our panel of experts.
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