Workers Compensation 101: The ABCs of Claims Management PowerPoint

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Workers Compensation 101The ABCs of Claims
Management
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Goals At the end of this workshop you will be
able to
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Describe what you need to know about workers
compensation law, filling out a First Report of
Injury, and investigating a claim Describe the
benefits paid to the employee injured on the
job Describe your responsibility/role in the
return to work process, maintaining contact with
the employee, using the Work Ability Report and
monitoring the injured employees
progress Explain the options for returning an
injured employee, developing modified jobs,
generating coworkers support, overcoming
obstacles, and resources for assistance
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What do you do first? As a supervisor you are a
key in the management of work related injury and
early return to work. When an employee calls or
says he or she cannot work you should
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Ask What is wrong? If it is an emergency call
911. Ask How did this happen? and When did
this happen? (e.g., if the employee states he or
she has a sore muscle in the back, neck, or
shoulder) Complete the Accident Report and the
First Report of Injury (e.g., if the employee
states that he or she may have been hurt at work)
Refer injuries to designated clinic in a
non-emergency situation
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FirstReport ofInjury
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Information and Privacy Statement
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AgencyClaimsInvestigation
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CrashRecords Request
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Notice ofInsurers LiabilityDetermination
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REPORT OF WORK ABILITY CorVel Corporation, 3001
NE Broadway St 600, Minneapolis MN
55413 Telephone [phone] or [phone]
Fax [phone]
Report of Work Ability
1. PATIENT INFORMATION
Last Name First Middle Initial Social
Security Number Date of Injury/Illness Job
Title/Description Home Phone Employer
Supervisor or Contact Employer Phone Work Comp
Insurer Claim Number
2. AUTHORIZATION TO RELEASE FORM
I hereby authorize my medical provider to release
or exchange information acquired in the course of
my examination or treatment for the following
medical condition to my employer or employer
representative Patient Signature Date
CONFIDENTIAL
3. TREATING PROVIDERS EVALUATION
Treatment Date For ? Initial Treatment ?
Follow-up Appointment Describe Circumstances of
the Injury/Illness Diagnosis (include ICD-9
code) Treatment Medication (when ordering a
medication, MN Rules require the words Work
Comp or W.C. be included on the
prescription) Maximum Medical Improvement Reached
(see instructions on reverse side)
? Yes ? No Date of
MMI Disability Permanency Rating (PPD) if
applicable Referral/Consult Next Appointment
Date Time Doctor
4. RETURN TO WORK

• ? May return to work with no restrictions
  Immediately, or Beginning ________________________
  _______________
• ? Injury will result in loss of time from work
  from _____________ through _____________
• May return to work with the following
  restrictions from _____________ through
  ____________ (note schedule appointment)
• Patients capabilities Patient
  is able to lift up to ________________ lbs.

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Report of Work Ability is used to
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Identify essential tasks the employee can
perform Determine which tasks can be modified to
fit restriction
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Report of Work Ability is the basis for the
determination of light duty job
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The employee is obligated to comply Establishes
light duty performance standards It is updated
after each doctor visit
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Why have an early return to work program? An
employees chance for successfully resuming his
or her regular job is maximized if the employee
returns to work soon after the injury.
Implementing an early return to work program
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Communicates to the injured employee that he or
she is wanted back at work and is valued as part
of the work unit Keeps the injured employees
productive and connected to the workforce Reduces
overall work comp program costs
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Notice of Intention to Discontinue Workers Comp
Benefits
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Health Care Provider Report
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Notice of Benefit Payment
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Responsibilities
Supervisor, Manager and Compensation Coordinator
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FRI completionInvestigationInitiates medical
care
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DOER Claims Specialist
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Investigates claimDetermines liabilityMakes
payments
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Disability Management/QRC
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330 p.m. presentation Returning Injured
Employees toWork How it Really Works
Managed Care
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24 hour nurse lineMedical managementProvider
network
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