California Workers' Compensation Training - ABD Insurance

35 Pages·2014·1.41 MB·English

ABD Webinar Series
California Workers’ Compensation
Training
WC-101
April 22, 2014
WORKERS' COMPENSATION TRAINING 101
Welcome
ABD Workers’ Compensation & Disability Team
Robin Hendrickson
SVP, Risk Control and Claims
Michael Okamura
AVP, WC Claims Consultant
Tyler Jones
Risk Control and Claims Specialist
WORKERS' COMPENSATION TRAINING 101
2
Agenda
• Workers’ Compensation Overview
• What is a work related injury/illness/What is not
• Red Flags and potential defenses
• Knowledge of injury/illness
• Classification of Claims
• WC Benefits
• Types of Claim Settlements
• Roles & Responsibilities
• Medical Providers
• Return to Work/Transitional work duty
• Accident Investigation
• WC required posters, notifications and claim forms
• Workers’ Compensation Workflow
• Resources
• Upcoming WC webinars
• Open for Questions
WORKERS' COMPENSATION TRAINING 101
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Workers’ Compensation
Overview
• Benefits include:
Employer paid benefit:
• Medical Care
• Insurance policy from a
• Temporary disability/lost wages
licensed insurance carrier
• Permanent disability payments
authorized to write WC
• Job displacement voucher
policies in California, or
• Death payments
• Self insured plan, upon
• Benefit levels determined
state approval
by the state
Claims Administration
• Limited to work related
injury, illness or death
• Insurance carrier’s claims
department • No fault system/Exclusive
Remedy
• Third Party Administrator
• Employee relinquishes the
right to sue the employer in
• Self Insured/Internal
exchange for a specified set
claims department of benefits
WORKERS' COMPENSATION TRAINING 101
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Workers’ Compensation
• Provides WC coverage • Receives benefits
• Reports injuries/illness • Participates in medical
treatment, claim
• Engaged through out
EMPLOYER EMPLOYEE process and return
life of claim
to work program
ADDITIONAL BROKER
• Medical Provider • ABD provides client
PARTIES
INSURANCE
services and
• Nurses
COMPANY advocacy
• Investigator
• Carrier or TPA
• Attorneys
administers the claims
WORKERS' COMPENSATION TRAINING 101
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Average cost of a WC claim: $87,000
Medical – 60%
Indemnity – 40%
Prescription Drugs
Physician dispensed RX average cost per
claim increased over 50%
Narcotics account for 25% of drug costs
“Sometimes the walk to the doctors’ office is a
better cure than the medicine you receive.”
–
Benny Bellamacina
WCIRB Report on 12/31/2013 Insurer Experience
NCCI Research Brief/Workers’ Compensation Drug Study:2013 Update WORKERS' COMPENSATION TRAINING 101
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What is a work related
injury/illness?
The injury or illness must arise out of employment (AOE) and
occur during the course of employment (COE)
Examples (on-the-job):
• Cumulative trauma injury caused by repetitive
keyboarding (RSI/musculoskeletal)
• A broken arm from falling off a ladder
• Lower back strain from lifting a box or
prolonged seating
• Hearing loss due to ongoing exposure to
excessive noise levels
WORKERS' COMPENSATION TRAINING 101
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Ouch...
Cumulative injury
claims have
increased 25%
since 2010
WCIRB Analysis of Changes in Indemnity Claim Frequency, 12/23/2013 Report WORKERS' COMPENSATION TRAINING 101
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Less recognized
work related injuries
• Special errand or assignment carried out at employer’s
direction
• Business trips
• Employer furnished or employer required
transportation
• Mandatory attendance at company sponsored events
• Lunch and break time accidents occurring on the
employer’s premises
WORKERS' COMPENSATION TRAINING 101
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Not related work injury?
Injuries & Illnesses usually not considered work
related include:
• Post termination or after notice of lay-off
• Ordinary commute to or from work (going and
coming rule)
• Off-duty recreational activity
• Injuries caused by intoxication or drugs
(medical evidence by physician)
WORKERS' COMPENSATION TRAINING 101
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