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Navigating the intricacies of workers' compensation claim investigations is a crucial aspect of maintaining a balanced and fair workplace. Dive into this article below for suggestions on how to create a strong claim investigation. https://lnkd.in/g3kAex4k #WorkplaceInsights #ClaimInvestigations #BalancedApproach #PSIA #workerscompensation #workerscomp #pennsylvaniabusiness #PAworkerscomp  #PennsylvaniaSelfInsurersAssociation #Teamwork #Collaboration #Innovation #TogetherWeAchieve #pennsylvaniabusiness 

#hiring Workers Compensation Coordinator Bilingual Preferred, Chicago, United States, fulltime #jobs #jobseekers #careers #Chicagojobs #Illinoisjobs #Administration Apply: https://lnkd.in/d6A5c4Pa Workers Compensation Coordinator Bilingual PreferredPosition Summary The Workers Comp Coordinator meets these objectives by making telephonic contact with the injured worker, the worker's supervisor, the treating physician, and the claims adjuster. The contact provides reassurances to the worker, answers questions, identifies concerns, sells the benefits of transitional duty and occupational doctors, and is the workers primary source of assistance. Essential Functions: Initiate contact with injured employee immediately upon notification of injury. Continue contact as needed-at least weekly. Explain workers' compensation, the insurance carrier's role, and the injury counselor's role. Facilitate communication on benefits questions. Assess the injured worker's understanding of their injury, treatment, and satisfaction with care. Listen to concerns-encourage employees to call with concerns/problems. Establish open communication/maintain trust. Contact physician after every visit. Obtain work restrictions. Reiterate to the physician and employee about the desire to return to work as soon as appropriate and possible. Determine employee's condition and treatment plan. Determine cases requiring medical case management involvement. Act as liaison between management, claims adjuster, and employee to support return-to-work

CAN YOU FIRE AN EMPLOYEE FOR MAKING A FALSE WORKERS’ COMPENSATION CLAIM IN CALIFORNIA? - https://lnkd.in/gdbrBT5k Employers in California are legally required to provide no-fault workers’ compensation insurance coverage for their staff. When someone is hurt on the job, they have the right to file for workers’ compensation benefits without fear of facing retribution. This raises an important question: What rights do employers have when an employee files a fraudulent workers’ compensation claim?   The short answer is that the employer can and should raise their concerns directly to their insurer and/or claims administrator. An employee should not be fired based only on suspicions of a false claim. Here, our Fresno workers’ compensation defense law firm provides an overview of the key things that employers need to know about handling a false work injury claim under California law. Understanding the Law: California Labor Code §132a Under California law (California Labor Code §132a), it is official state policy that there “should not be discrimination against workers who are injured in the course and scope of their employment.” An employer that retaliates against an employee because that employee filed workers’ compensation benefits can face serious sanctions. The fact that an employer is convinced that a worker is making a false or even outright fraudulent claim is not sufficient to justify an immediate termination of that employee. An employer risks facing sanctions under Labor Code §132a. A False Workers’ Compensation Claim Can Be Denied; That is the Appropriate Initial Remedy That is not to say that employers have no options to handle a false workers’ compensation claim. Quite the contrary, there are a number of potential remedies available. If an employer in Fresno suspects a workers’ compensation claim to be false or exaggerated, the first and most appropriate step is to report their concerns to the claims administrator and/or the insurance claim. A false claim can be denied. The denial will push the claim into a dispute resolution process. During this process, both parties will present evidence to support their stance. If the employee's claim is genuinely false, the evidence will likely prove that, and the claim can be officially denied. If a Claim is Proven Fraudulent, an Employee May Be Able to Lawfully Terminate a Worker While an initial suspicion or denial of a workers' compensation claim is not grounds for termination, proving a claim is fraudulent is a different matter. Fraudulent claims—assuming that they have already been officially adjudicated as such—can be grounds for lawful termination in many cases. In fact, an employee who commits workers’ compensation fraud against his or her employer could even face serious criminal charges in California. Contact Our Fresno, CA Workers’ Compensatio

An alternative dispute resolution (ADR) program might be a good fit for your #construction company to help lower workers' compensation costs and improve employee care. Click the link to learn if this sort of program is right for your company. #WorkersComp #RiskManagement

#hiring Workers Compensation Coordinator Bilingual Preferred, Chicago, United States, fulltime #jobs #jobseekers #careers #Chicagojobs #Illinoisjobs #Administration Apply: https://lnkd.in/dTff8fxD Workers Compensation Coordinator Bilingual PreferredPosition Summary The Workers Comp Coordinator meets these objectives by making telephonic contact with the injured worker, the worker's supervisor, the treating physician, and the claims adjuster. The contact provides reassurances to the worker, answers questions, identifies concerns, sells the benefits of transitional duty and occupational doctors, and is the workers primary source of assistance. Essential Functions: Initiate contact with injured employee immediately upon notification of injury. Continue contact as needed-at least weekly. Explain workers' compensation, the insurance carrier's role, and the injury counselor's role. Facilitate communication on benefits questions. Assess the injured worker's understanding of their injury, treatment, and satisfaction with care. Listen to concerns-encourage employees to call with concerns/problems. Establish open communication/maintain trust. Contact physician after every visit. Obtain work restrictions. Reiterate to the physician and employee about the desire to return to work as soon as appropriate and possible. Determine employee's condition and treatment plan. Determine cases requiring medical case management involvement. Act as liaison between management, claims adjuster, and employee to support return-to-work

CAN YOU FIRE AN EMPLOYEE FOR MAKING A FALSE WORKERS’ COMPENSATION CLAIM IN CALIFORNIA? - https://lnkd.in/gf3fuSFU Employers in California are legally required to provide no-fault workers’ compensation insurance coverage for their staff. When someone is hurt on the job, they have the right to file for workers’ compensation benefits without fear of facing retribution. This raises an important question: What rights do employers have when an employee files a fraudulent workers’ compensation claim?   The short answer is that the employer can and should raise their concerns directly to their insurer and/or claims administrator. An employee should not be fired based only on suspicions of a false claim. Here, our Fresno workers’ compensation defense law firm provides an overview of the key things that employers need to know about handling a false work injury claim under California law. Understanding the Law: California Labor Code §132a Under California law (California Labor Code §132a), it is official state policy that there “should not be discrimination against workers who are injured in the course and scope of their employment.” An employer that retaliates against an employee because that employee filed workers’ compensation benefits can face serious sanctions. The fact that an employer is convinced that a worker is making a false or even outright fraudulent claim is not sufficient to justify an immediate termination of that employee. An employer risks facing sanctions under Labor Code §132a. A False Workers’ Compensation Claim Can Be Denied; That is the Appropriate Initial Remedy That is not to say that employers have no options to handle a false workers’ compensation claim. Quite the contrary, there are a number of potential remedies available. If an employer in Fresno suspects a workers’ compensation claim to be false or exaggerated, the first and most appropriate step is to report their concerns to the claims administrator and/or the insurance claim. A false claim can be denied. The denial will push the claim into a dispute resolution process. During this process, both parties will present evidence to support their stance. If the employee's claim is genuinely false, the evidence will likely prove that, and the claim can be officially denied. If a Claim is Proven Fraudulent, an Employee May Be Able to Lawfully Terminate a Worker While an initial suspicion or denial of a workers' compensation claim is not grounds for termination, proving a claim is fraudulent is a different matter. Fraudulent claims—assuming that they have already been officially adjudicated as such—can be grounds for lawful termination in many cases. In fact, an employee who commits workers’ compensation fraud against his or her employer could even face serious criminal charges in California. Contact Our Fresno, CA Workers’ Compensatio

4 Items Claims Handlers Want From Their Defense Attorney    Workers’ compensation defense attorneys may lay awake at night wondering what their claims handler really wants.  Besides getting their files closed in a timely manner, they want to work with defense attorneys committed to a zealous defense of the file in an ethical and cost-effective manner.  Here are some tips that can help defense attorneys sleep better at night, knowing they are giving their claims handler what they want.    Calculate the Average Weekly Wage (AWW)    The AWW is the basis for most indemnity benefits in a workers’ compensation claim.  Failing to calculate it correctly can increase the cost and exposure of the claim.  A seasoned defense attorney needs to communicate with the employer and receive additional explanations from the employee on a number of issues.  The list can be endless, but some special considerations include:    - Whether the employee was a full or part-time worker; - Whether the employee was working any additional jobs outside the employer involved in the claim; - Investigation into the nature of any fringe benefits the employee was receiving. This includes tips, bonuses, insurance benefits and other forms on potential income; and    Calculate and Evaluate the Indemnity Exposure    Once the AWW is correctly calculated, the defense attorney can provide an accurate analysis of wage loss exposure to the claims management team.  This includes information on the following benefits:    - Temporary Total Disability (TTD)Temporary Partial Disability (TPD)— - Permanent Partial Disability (PPD) - Permanent Total Disability (PTD)     Aggressive Defense Strategy That is Cost-Effective    Members of the claims management team also appreciate an aggressive defense strategy that moves a case toward settlement efficiently and cost-effectively.  Considerations for such planning include:    - An immediate status report upon receiving the claims file, with periodic reports that are robust and evaluate the strengths and weakness of various defenses, a reasonable strategy, and probable outcome; - Identifying missing information that needs to be discovered to provide an accurate analysis and defense. This includes a plan on how to uncover this information and who might be a witness at the hearing; and    Medicare Secondary Payer Compliance    Medicare Secondary Payer compliance is an important part of any workers’ compensation claim analysis.  This includes recommendations on the following topics:    - Whether a service provider should be utilized to prepare a Medicare Set-aside allocation; - If the Medicare Set-aside should be included for review and approval under the voluntary CMS process and - Matters concerning conditional payment identification and repayment.      https://lnkd.in/g3FjxMbR  P.S. Get our #1 Rated WC Training Manual "Your Ultimate Guide to Mastering Workers' Comp Cost"     https://lnkd.in/eWafrSba 

An alternative dispute resolution (ADR) program might be a good fit for your #construction company to help lower workers compensation costs and improve employee care. Click the link to learn if this sort of program is right for your company. #WorkersComp #RiskManagement

#hiring Senior Claims Adjuster, Workers' Compensation, Acton, United States, fulltime #jobs #jobseekers #careers #Actonjobs #Californiajobs #InsuranceSuperannuation Apply: https://lnkd.in/dFj855MQ Who We Are Method Workers' Compensation is a portfolio of workers' comp companies with the same mission: minimizing the human and financial cost of workplace injuries. We mitigate workplace injuries and deliver exceptional healthcare outcomes for injured workers, expediting a return to work, preserving families' livelihoods, and enhancing employers' productivity. We maintain in-house expertise in claims management, medical bill review, underwriting, and loss prevention for high-hazard, high-mod, and mid-market risks. From submission to claim, we're there every step of the way, improving outcomes for everyone involved. Method currently operates in all states. What To Expect The Senior Claims Adjuster is primarily responsible for analyzing workers' compensation claims to determine the benefits due. This position may have some supervisory roles. This role is also responsible for ensuring the ongoing adjudication of claims within service expectations and company best practices pursuant to all state, legal, statutory, and regulatory bodies. This is a full-time, salaried exempt position with standard business hours of Monday through Friday from 8:00am to 5:00pm, with some flexibility at manager's discretion. What You'll Do With minimal supervision, investigate claims, including but not limited to reviewing the first report of injuries, medical records; contracts; contacting insureds, injured workers, medical providers, and other parties to determine compensability in a timely manner.Understands, analyzes, and applies policy components to evaluate coverage.Ensure compliance of claims handling requirements pursuant to all state, legal, statutory and regulatory bodies.Exercise discretion and independent judgment with respect to evaluating and managing claims, including determining reserve amounts and document rationale.Evaluate exposure of claims by reviewing medical records and claim facts to determine causal relatedness of medical conditions.Manage the medical treatment and return to work process throughout the life of the claim.Adhere to Method Best Practices, Method Claims Protocol, and Claims Handling Guidelines.Maintain appropriate claim file documentation and accurate claim coding.Communicate claim activity regularly to any relevant internal and external stakeholders, including injured workers, policyholders, medical providers, and carriers, when appropriate.Timely prepare state filings within the state statutory regulations.Calculate the average weekly wage and indemnity benefits owed.Ensure all benefits are paid timely and in accordance with jurisdictional requirements.Exercise accurate discernment and decision-making to analyze claims exposure and to plan and d