Managing Your Litigation
Sometimes despite the adjuster’s best effort to control the claim and to settle the claim fairly, the employee and/or the employee’s attorney is motivated by greed to pursue a settlement higher than is properly justifiable. If your insurance carrier or TPA is large enough, they should have a litigation specialist who takes over the file when it moves into litigation, If not, the adjuster will continue to handle the file. Either way, your Risk Management Department workers’ compensation coordinator or your in-house counsel needs to oversee the activity of the litigation specialist or adjuster. It’s YOUR money, so YOU should set standard protocol for how you want your litigation handled. Don’t be shy about putting your protocol in writing.
Selection of Defense Counsel
Proper selection of defense counsel is critical. The attorney selected must be an expert in workers’ compensation. The adjuster’s office probably has a list of preferred defense counsel. While all the attorney’s on the adjuster’s list are probably qualified attorneys, many of them are on the adjusters list due to the business relationship they have built with the adjuster’s office over the years. You need a defense attorney who obtains the best results, not the attorney who hosts best golf outings or the best Christmas party.
To find the best workers’ compensation defense counsel, look for attorney selected and listed by Super Lawyers.com. The lawyers listed are recommended by their peers as the best in their specialty. Only the top five percent of each specialty are selected for listing.
Other ways to find an excellent attorney is to find out who is on the state bar association’s committee on workers’ compensation and identify those attorney’s who are published authors on workers’ compensation. Also ask others in your field. The claims representative at your insurance broker or agent may be able to recommend defense counsel. Make sure you are in the position to select your own defense counsel. Make sure this is in your account handling instructions.
Going to Trial: Litigation Budget
Too often the adjuster becomes so focused on not settling the claim for the plaintiff attorney’s demand focus on the big picture is lost. If you save $10,000 on the settlement cost by aggressively defending the claim, but spend $25,000 in defense costs doing so, you may have won the battle but lost the war. To minimize the potential for this mistake, the adjuster should require the defense attorney to provide a litigation budget. (workersxzcompxzkit) HOWEVER, many companies have policies against settling litigation for defense costs unless the claims are legitimate because it sets them up for future frivolous claims. They become an easy target for claimants who know how to scam the system.
The initial referral letter requests the defense counsel to provide recommendations on any issues in dispute and requires defense counsel to provide a budget for handling of the case. With the litigation budget provided by defense counsel the adjuster is able to estimate and compare the cost of going forward with the defense of the claim to the cost of paying of an additional amount to settle the claim.
“FRAUD PREVENTION,”
TO DOWNLOAD OR LISTEN TO FREE AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
The average WCB assessment rate in Manitoba will remain stable at $1.60 effective January 1, 2010, remaining one of lowest average rates in Canada. Overall, about 34% of employers will experience lower WCB assessment rates in 2010.
Manitoba employers will pay an average of $1.60 per $100.00 of their assessable payroll to the WCB for injury insurance coverage, including wage loss payments, medical benefits and rehabilitation services. That rate may be higher or lower, depending on the employer’s injury experience and the safety and health risk of their industry.
“Our average assessment rate is the third lowest in the country,” says Doug Sexsmith, WCB President and CEO. “We remain fully funded, markets have improved and injuries have been decreasing, allowing us to provide a good rate and a competitive advantage for Manitoba employers, which is especially important in a difficult economy.”
The average assessment rate the WCB sets, however, is just one of many factors that determines what an employer pays in premiums. The best way for employers to reduce their premiums is prevent injuries and return injured workers to safe and productive work. (workersxzcompxzkit)
“The WCB works with employers and community partners to create safe workplaces and promote a culture of safety and health,” said Sexsmith. “It’s in the best interest of everyone. Workers are better protected from injury and employers can see reduced workers compensation and business costs.” The gradual increase in the maximum assessable earnings cap also continues, with the 2010 ceiling set at $89,000.
“Preventing Workers Comp Fraud,”
TO DOWNLOAD OR LISTEN TO FREE AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
Visit Our Websites:
Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/
Workers Comp Kit: www:workerscompkit.com/
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Construction Industry Workers’ Compensation Coverage Act Approved
Recent unanimous approval of a model act to protect construction workers by The National Conference of Insurance Legislators (NCOIL) sent a strong message against employee misclassification for constructions workers. The model reportedly provides needed protections for injured construction workers through transparency, accountability, and disclosure.
NCOIL Workers’ Compensation Insurance Committee Chair Rep. Susan Westrom (KY), whose committee unanimously approved the model last month-stressed the importance of strong enforcement, stating “by setting strict coverage requirements up front and increasing penalties and enforcement on the back end, the model will help states to weed out and deter abusive practices.”
Model co-sponsor Rep. Charles Curtiss (TN) noted, “We know that certain employers misclassify workers to avoid paying premiums, leaving injured employees without benefits. This practice shifts costs to an already overburdened health insurance system and ultimately raises workers’ comp costs for all businesses. In focusing the model on construction-an industry prone to accident and abuse-NCOIL believes it will take a large bite out of insurance fraud.”
Co-sponsor Sen. Ralph Hudgens (GA) added, “As a small business owner, I know firsthand the advantage employers gain when they misclassify their employees or don’t carry workers’ comp. Fraud is a serious matter for the states, especially during the economic downturn. The model is an important tool to level the playing field for honest business owners that play by the rules.”
Stemming from 2009 Tennessee and West Virginia laws, the model mandates workers’ comp in the construction industry with the exception of sole proprietors on residential projects and homeowners, and holds primary contractors liable for the uninsured employees of any subcontractor hired. The legislation establishes auditing procedures, provides penalties for insurance fraud, and enhances state enforcement authority, based on provisions of Florida workers’ comp statutes.
Originally proposed as a broad-based workers’ comp bill dealing with all employments, the model was narrowed to hone in on construction – an area of widespread abuse. An NCOIL Subcommittee held seven conference calls between the NCOIL Summer and Annual Meeting to develop the model.
On the conference calls, legislators rejected a nine-point test for independent contractor status and synchronized model definitions with already established language in state workers’ comp, disability, and unemployment statutes.
The subcommittee worked with a range of interested parties to develop the model legislation, including several individual state regulators through the International Association of Industrial Accident Boards & Commissions (IAIABC) and National Association of Insurance Commissioners (NAIC). (workersxzcompxzkit)
Approval of the model legislation fulfills a 2009 charge and responds to a joint NAIC and IAIABC review of workers’ comp independent contractor issues. As an offshoot of the model, the NCOIL Workers’ Compensation Committee has been charged in 2010 to examine the use of independent contractors in the trucking and transportation industries.
“PREVENTING FRAUD”
TO DOWNLOAD OR LISTEN TO FREE AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
Visit Our Websites:
Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/
Workers Comp Kit: www:workerscompkit.com/
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker and agents about workers’ comp insurance issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
In spite of economic conditions, the workers' compensation marketplace remains remarkably stable and not significantly changed from a year ago. There are, however, key factors on the horizon that could negatively impact the profitability and future prognosis for the line. Evidence of the line's steadiness can be found in the 2008 preliminary calendar year combined ratio. The National Council of Compensation Insurers (NCCI) advises it remained level with that of 2007 at 101 percent. And there are other relatively positive indicators for the line. Lost time claim frequency continues its downward spiral, dropping another 4 percent from 2007 to 2008. The depopulation of the residual market persists unabated. Between 2004 and 2008, premium in NCCI-serviced residual markets dropped 50 percent. But for all the positive factors, there are also negative indicators, as well as a few unknowns that could impact the future performance of the line. Medical claim costs continue to escalate, outpacing inflation. Low investment returns on insurer portfolios persevere as a consequence of the current economic conditions, offering insurers no relief in offsetting underwriting losses. Insurers won't be able to continue relying on streamlining and consolidating operations to help compensate for underwriting losses and lack of investment income. Without a few excellent years with low losses, insurers will likely be forced to increase rates. Certain to impact the profitability of the line are recent developments in California. A pair of judicial decisions issued this year has breached the enforceability of the permanent disability provisions of the 2004 California reform legislation. These actions, coupled with the ruling by the California insurance commissioner to deny a pure premium rate increase effective July 1, 2009, will undoubtedly increase costs and affect insurer viability. A new issue on the workers' compensation landscape that can be expected to drive up costs is compliance with the Medicare set-asides reporting requirements contained in Section 111 of the Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP) Extension Act of 2007. Additional expenses will be incurred by insurers and TPAs in implementing systems to identify and report workers' compensation claims eligible for Medicare set-asides. At this juncture, the current market appears to be fairly balanced. A firming market exists in the minds of incumbent insurers, but the reality is that there are still reductions available on accounts where loss experience warrants it or competition exists. Due to the economic downturn, an organization's financials rank alongside its loss history as the key elements to a successful renewal. However, underwriters remain concerned about the aggregation of employees fueled by the ongoing terrorist threat and the potential posed by an outbreak of pandemic disease. As to pricing, generally accounts with good loss experience and financials are seeing premium reductions in the range of 10-15 percent on a stable exposure base. The market remains fairly competitive, even for accounts with average losses and/or financials. Those accounts with significant losses and/or a poor financial condition should not expect pricing concessions, and may actually see premium increases in the current market. (workersxzcompxzkit) With the market on a seemingly steady course, what can an employer do to prepare for renewal and maximize savings? Take ownership of the renewal process, and partner with the broker to prepare a comprehensive marketing submission. Provide underwriters with details of your efforts to reduce the frequency and cost of claims. If there are significant claims, request a file audit on open claims well in advance of renewal. For organizations with programs involving collateral, be ready for increased financial demands from insurers driven by current economic conditions. Finally, since incumbent insurers in this market are working very hard to retain accounts, ask for firm renewal terms early. This will allow the time needed to determine if quotes for coverage should be sought from alternate insurers. Reprinted with permission from the October 2009 Executive Briefing issued to subscribers to IRMI Workers' Comp. Copyright 2009, International Risk Management Institute, Inc. Enjoy a 10% discount off the price of IRMI Workers' Comp by using Discount Code WC8 when your order online from IRMI. FREE "FRAUD PREVENTION" AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3 By: Anthony Van Gorp, private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' compensation insurance issues. ©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Below are some statistics about workers’ comp costs and some things to consider when looking to cut costs.
Also, we invite you to participate in a new survey designed to gather additional statistical information about what is going on in the insurance industry. Here is a link to the survey:
http://www.nationaljobfinders.com/poll-question/
All participantants (who provide an email) will receive a copy of the results.
Did you know?
The median incurred benefits cost for workers’ compensation cases exceeding 7 days is $31,161.00, not including reserve requirements.
Did you know?
The Difference in Average costs from 12 month marker to 36 months could result in an Average savings of $72,908 dollars per case. (Michigan Sample)
Did you know?
The benefit delivery expenses increased on average 7.8% from 2006-2007 and are continuing to go up.
Did you know?
Permanent partial disability cases account for an average of 18.6% of workers’ compensation cases and 46% of cases over 7 days.
Did you know?
The average total cost per claim on cases greater than 7 days increased 4.8% from 2006-2007.
Cutting Workers’ compensation costs are a great way to increase your bottom line. To determine how much, you may want to research the following questions to determine where money can be saved or freed up.
1. Do you know how many of your employees are currently out on workers’ comp?
2. How many cases do you have over 3 years old?
3. How many cases were released with restrictions (or no restrictions) over a year ago?
4. What is your average wage loss benefit cost per case? (workersxzcompxzkit)
5. How much do you have sitting in reserve that could be released if you could close all of your permanent partial disability cases in the next 3 months?
Katrina Paglierani, National Job Finders finds jobs for injured employees, performing job searches for injured workers’ with permanent restrictions to locate REAL jobs. National Job Finders sets up the interviews, notifies all parties, and follows up with their human resource contacts at the prospective employers. Contact at: Katrina@NationalJobFinders.com or 1-800-225-4070.
TO DOWNLOAD OR LISTEN TO FREE AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Anthony Van Gorp, private investigator with 25 years experience.
Visit Our Websites:
Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/
Workers Comp Kit: www:workerscompkit.com/
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Wales: More than a Quarter of Public and Commercial Service (PCS) Members Experience Bullying in the Workplace
One in four (26.4%) members of a civil service union in Wales have been bullied at work and 44% experience negative behavior on at least a weekly basis according to an independent survey by Glamorgan Business School’s Centre for Research in Workplace Behaviors (CRWB) for the Public and Commercial Services Union (PCS).
The initial estimates show over 1 in 3 (39%) members with a long-term health condition have been bullied and that 41% of respondents have witnessed bullying in the workplace. The CRWB study surveyed 728 members of PCS in Wales. According to the early analysis 47% of staff experienced negative behavior monthly or now and then.
Negative behavior in the survey can be characterized by being “treated unfairly compared to others in your workplace”, “having your opinions and views ignored” or “someone continually checking up on you or your work when it is not necessary.” The survey also found that less than 10% of those bullied are satisfied with the way the matter was dealt with by their employer.
Mark Serwotka, PCS general secretary, noted, “The findings of this survey reveal a disturbing picture which needs to be addressed. Bullying in the workplace in all its forms should not be tolerated. Not only does it damage morale and create a climate of fear, but leads to a more unproductive workforce with higher instances of sickness. Departments and agencies need to address bullying quickly by working with unions to ensure dignity at work and anti-bullying policies are in place, as well as ensuring adequate training is in place for managers and supervisors.” (workersxzcompxzkit)
Hazel Mawdsley, Centre for Research on Workplace Behaviors at the University of Glamorgan Business School, added, “These are early indications from an ongoing study into workplace bullying and further analysis is needed. Nonetheless, the figures are a cause for concern. While some negative behavior may be expected in workplaces striving for efficiency, if it is targeted against subordinates or colleagues in a systematic way it may be considered bullying. It is particularly worrying that those with some long-standing physical or psychological conditions reported more bullying. Further analysis will help us understand these trends and facilitate the development of effective anti-bullying prevention and intervention strategies.”
TO DOWNLOAD OR LISTEN TO FREE FRAUD PREVENTION AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Anthony Van Gorp, private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Introduction
We’ve talked about the benefits and concepts of training or mastery exercises. Now let’s talk about the nuts and bolts of designing a training exercise to empower your trainees to return home to apply and synthesize what you’ve taught them.
When you offer training exercises you must determine how much your trainees have absorbed. You must ensure trainees are competent in the stated training objectives once they leave the classroom.
More importantly you want trainees already armed with tools to begin implementing workers’ comp management concepts back home. Therefore your training exercises must replicate real-life because trainees must apply the knowledge have received and synthesize that knowledge to reflect their unique business situation.
Here, we will have trainees create a 3-4 slide presentation demonstrating costs of workers’ comp and benefits of workers’ comp management. Trainees must use injury management tools to convince senior management that establishing a workers’ comp management program will quickly save money.
Your core concept are costs and cost savings. First show senior management what current workers’ comp costs are, then show them how much they will save by doing one thing, such as instituting transitional duty. You want management’s collective eyes to light up.
1. Decide what level of skill mastery you want trainees to demonstrate.
Bloom’s taxonomy lists five measurable levels of mastery and these include: knowledge, comprehension, application, analysis, and synthesis.
By creating a small presentation, students will likely demonstrate all of the above. Ultimately they are applying tools it to their business, and analyzing which tools work best, and synthesizing all this into performance goals.
2. Make sure the mastery exercise reflects a measurable learning objective.
It’s not enough to say, “trainees will understand how to create a presentation,” because you cannot observe trainees “understanding.” Write the objective like this:
Trainees will develop a 3-4 slide presentation to show senior management the cost of work-related injuries and the cost benefits of instituting a return-to-work program using the tools they have acquired in class and these include: Sales Required to Pay for Accidents and Transitional Duty Calculator.
Students are then to write 1-3 goal statements summarizing how to use the tools to form the basis of a workers’ comp management going forward.
You can actually see the trainees performing the stated objectives. Their slide presentations will show the level of application, and the goal statements determine how well they’ve synthesized training into their own work situations.
3. Determine the method.
Educators love to call this methodology, but it is really just the method you use to train. Will you group trainees or have them work alone? Will you have class discussion, or have each trainee provide something written?
4. Estimate how many trainees you will have in class.
This determines how you will configure trainees. How many trainees do you anticipate? Based on this number you have them work individually, in pairs, or in groups.
It is good to have trainees work together in mastery exercises because team building is essential since workers’ compensation management is a multi-disciplinary effort. An implicit part of the mastery exercise is determining how well individuals come together and work as a team.
5. Determine the materials you will need.
In this example, we will need empty overhead slides and markers. We don’t want to get hung up on the materials, we want the team to focus on developing a slide presentation based on the concepts they have acquired over the course of training.
Workers’ Compensation Tools:
Sales Required to Pay for Accidents hardcopy grid,(or calculator) to demonstrate costs of workers’ compensation.
Transitional Duty Cost Calculator to show workers’ comp costs and immediate cost savings.
If trainees are not using the website, provide hard copy grids and have trainees perform simplified calculations and plot results on slides.
6. Determine preparation and presentation time.
You want everyone to have the opportunity to develop, present and be constructively critiqued.
7. Write a description of the training exercise and the expected outcome so you can structure the exercise and move trainees forward:
a. Trainees will group in numbers of ___. 3-4 slides and a pack of markers are given to each group.
b. Trainees are instructed to construct a presentation to senior management, remembering, senior management likes their presentations to be brief.
c. Trainees are given 30 minutes to prepare and 1 hour for each presentation. Critique are 5 minutes after each presentation.
d. Trainees are graded on how they use the workers’ comp management tools to show
8. Decide the measurement against which you are going to grade.
Let’s look at the old dependent/independent variable paradigm. The dependent variable stays the same no matter what. These are the tools, slides and markers. Everybody has the same tools.
The independent variable is how well the students use those tools, and the level of mastery and imagination they use to convey, apply, and synthesize the information they’ve been given into a succinct presentation. (workersxzcompxzkit)
You will be amazed and heartened to see the imaginative ways your students will take the tools you’ve given them and create great presentations. Sometimes they are truly creative, often they are funny and everyone has a good laugh. But all the trainees enjoy the exercises and they are truly armed with valuable tools they can use the minute they return to work!
Author Robert Elliott can be reached at Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
TO DOWNLOAD OR LISTEN TO FREE AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Anthony Van Gorp, private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues and purchasing workers’ compensation insurance.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Include Future Medical Exposure in the Settlement While many claims settle with the payment of statutory benefits, there are claims needing further consideration. In the states where the medical portion of the workers' compensation claim cannot be closed, the adjuster needs to evaluate possible future medical exposure and take the appropriate steps to conclude the medical where appropriate at the same time the disability claim is concluded, even if it involves payment for estimated future medical expense. If the medical portion of the claim is not settled, in most states the employee will have the right to unlimited future medical coverage (with actively treating time restrictions in some states). For example, if the employee has a disability rating to their lumbar spine and you leave the medical open, your company may be paying for the chiropractor bills for rest of the employee's life, or even worse, paying for surgery possibly unrelated to your work comp claim. (Note: Most plaintiff attorneys will want to resolve the future medical, especially if they are entitled to a portion of the medical settlement in their fee). To establish the value of the open medical, the adjuster will need to rely on the insurance company's/TPA's medical director for the amount of future medical care needed. In most cases, the adjuster can multiply the number of future doctor visits by the cost per visit to get an estimate of the value of the future medical expense. When the employee's future medical cost cannot be determined or future medical care is expected to be minimal, the adjuster should still make a nominal payment (large enough to satisfy the workers' compensation board/industrial commission) to settle the future medical. The adjuster will need to obtain the employee's signature on the appropriate release or settlement form(s) used in their state to document the resolution of the future medical claim. Determine the Disability Rating/Permanency Rating In about half of the states, the employer can select the treating physician for the employee. As part of your risk management plan, a list of approved conservative physicians selected by their area of expertise should be established before an injury ever occurs. The employee can then be directed to the approved physician who provides the necessary medical care without keeping the employee out of work any longer than necessary. Employer-selected and approved physicians less likely to overstate the disability rating as a plaintiff's attorney-selected physician might be inclined to do. In these states as soon as the employee reaches MMI, the adjuster needs to take the doctor's permanency rating and apply it to the disability schedule utilized in that state. In the states where employees can select their own doctor to treat them for their injury, the adjuster needs to be ready to immediately refer the employee for an Independent Medical Exam (IME) or Peer Review when the treating physicians states the estimated disability. If the disability rating given by the employee's physician is low or acceptable to the adjuster, a referral for an IME may not be needed. If the adjuster, medical director or nurse case manager questions about the validity of the permanency rating given by the employee's physician, then proceeding with a prompt IME is essential to controlling the settlement value of the claim. In those states where the workers' compensation board/industrial commission often splits the difference between the permanency rating given by the employee's physician and the permanency rating given by the employer's physician, the IME is absolutely necessary for a fair settlement of the claim. The area of the claim where the plaintiff attorneys or the employee most often try to capitalize is in establishing the permanency rating. Plaintiff attorneys will try to send the injured employee to a doctor with a reputation for being generous with (overstating) the disability ratings, not to the doctor who will provide the best medical care to the employee. The reason the plaintiff attorneys do this is to maximize their earnings, because they are paid a percentage of what the employee receives. Resource: http://reduceyourworkerscomp.com//documents/Doc-List-by-Module.pdf Superior Employee Communication The best way to prevent the involvement of an employee's attorney is proper on-going contact with the employee. While there will always be some employees who are very claims conscious and will obtain an attorney despite the best efforts of the adjuster, most employees get an attorney when they don't know what to expect or they do not feel the adjuster is helpful. When both the employer and the adjuster maintain good rapport with the employee throughout the medical recovery, the involvement of the plaintiff attorney is often eliminated. The adjuster should always direct the employee to a physician, where doing so is not barred by statute, who will provide prompt, complete medical care and provide an accurate permanency rating. In states where the employee has the right to select the physician and the employee's attorney sends them to a medical provider who provides the highest medical rating, the adjuster should continuously press the treating physician for current medical reports. In addition, all allowable examinations by an Independent Medical Examiner should be completed at the appropriate time(s) to provide an accurate permanency rating. (workersxzcompxzkit) If the employee's physician gives a high rating and the employee's attorney is unwilling to settle for the IME rating, then the timely use of defense counsel becomes necessary to adjudicate the differences in the permanency rating. Impairment Rating Firms are often used to evaluate the correct rating according to the edition of the AMA guidelines, or ODG, used in your state. One such firm is Impairment Resources at www.Impairment.com. These are MD's who research then write an report based on objective evidence, not a physical exam of the claimant, specifying the correct impairment rating. If you use such a firm, remember to include it in your account handling instructions. According to www.Impairment.com, the average error rare of impairment ratings is over 70%, and the vast majority of those errors are over (not under) rated. TO DOWNLOAD OR LISTEN TO FREE AUDIO PODCAST click here: http://www.workerscompkit.com/gallagher/mp3 By: Anthony Van Gorp, private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues. ©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
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