There is no more awkward situation for a claims adjuster than to need to seek the reimbursement of overpaid temporary disability benefits from a “pro per” injured worker. Many insurance companies and TPA’s require claims handlers to request refunds even though that actions often prompt the worker to retain legal representation. By requesting a $25 …
TD Overpayments: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
For those who supervise or manage a claims department we ask that you take an informal survey of your staff to determine how many of them have ever attended a WCAB hearing. We believe you will be surprised to learn that very few have ever ventured to the appeals board, and that consequently, most claims …
The Best Laid Plans: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Everyone familiar with the handling of insurance claims is likely aware of the common practice that claims within an office are sometimes transferred from one adjuster to another. Sometimes claims are even transferred from one claim administrator to another. When a transfer occurs, it is said that the adjuster who receives a file is “inheriting …
Inheriting a Claim: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Today’s blog centers on a farm hand who was injured at work while using a tractor to plow a field. The accident occurred when the tractor tipped over onto its side as the employee drove over a dirt mound. The worker ended up pinned beneath it. A tow truck was called to lift the tractor …
To the Rescue! A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Although rarely seen, there are times when an injured worker’s permanent-total disability (PTD) rate may “decrease” just like it did this year. In today’s blog we will discuss how this rare phenomenon occurs, as we suspect that most claims offices are unaware of the decrease, and as a result are overpaying PTD benefits. When an …
Overpaying PTD: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
One of many topics in workers’ compensation where an adjuster is presumed to automatically know what to do concerns death benefits. Today’s blog tells an incredible story of what happened in a death benefit claim where the adjuster was ignorant of the applicable law. Our story begins with a claims adjuster for a major company …
Burial Benefits: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
It should not come as a surprise to anyone in our industry that abuse is rampant in the workers’ compensation system. Abuse is encountered everywhere, even when dealing with durable medical equipment. In today’s blog we will expose an element of DME abuse that most claims professionals are unaware of. Let’s presume a worker injured …
DME Abuse: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
Often fraught with difficulty even in one’s personal affairs, the refilling of a medical prescription in a workers’ compensation case is sometimes a gargantuan endeavor! This is true even though prescription medicines and medical devices are covered benefits under a workers’ compensation claim and are often vital components in the treatment of an industrial injury. …
Rx Refills: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
When comparing the job requirements of today’s workers’ compensation claims adjuster to those of yesteryear, the difference is like night and day. Thirty-years ago, a claims adjuster was a jack of all trades. Adjusters of that era would handle all types of comp claims. An adjuster’s inventory consisted of med-only, indemnity and death cases. In …
Today’s Claims Adjuster: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
It seems incomprehensible but for the past twenty years our workers’ compensation system has failed to acknowledge a paradox that exists regarding death benefits. The purpose of today’s blog is to explain the paradox to allow our readers to decide on the interpretation of their choice. We believe it is safe to state that most …
The Death Benefit Paradox: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
In the process of estimating the final cost of claims under a policy of workers’ compensation insurance, insurers and claim administrators typically add a charge for what is known as “IBNR,” which stands for “incurred but not reported.” For the most part this acronym is foreign to a claims department; however, it has exceptional meaning …
Allow us to begin today’s blog by asking three workers’ compensation trivia questions: Q. 1: “What is the number one cause of death for men who die on the job?” Q. 2: “What is the number one cause of death for women who die at work?” Q. 3: “Where at work is the most likely …
Coworker Liability: A 60-Second Seminar in Workers’ Compensation Claims HandlingRead More
