Washington Self-Insurers Association’s

Claims Training Series
September/October 2008

The Radisson Gateway Hotel
SeaTac, WA

Claims 1 - September 22, 2008
Claims 2 - September 23, 2008
Claims 3 - November 6, 2008
Claims 4 - November 7, 2008

 

About WSIA’s Claims 1 - 4 Training Series

Click Here To REGISTER for Claims Training

This training series is an essential resource for anyone working in Self-Insurance for Workers’ Compensation in Washington State. It addresses all aspects of Workers’ Compensation activity. The four sessions are designed to take individuals from claims basics to complicated claims resolution issues.  Each of the four levels serves to help attendees increase their on-the-job effectiveness.

Claims 1 reviews the history of industrial insurance, discusses the options available in Washington State, outlines current self-insurance requirements and issues, discusses the importance of efficient communication, details initial claims investigation steps,discusses the importance of “reserving” practices, and works through time loss calculations exercises and the issues that affect time loss..  

  

Claims 2 details steps for managing medical claims, reviews key elements of return-to-work programs, demonstrates loss of earning power calculations and procedures, outlines steps necessary for claims closure, and discusses PPD ratings and awards.

Claims 3 outlines effective ways of communicating with physicians, reviews segregation of pre-existing conditions, reviews key medical aid rules and the vocational rehabilitation pilot project and the use of nurse case managers and vocational counselors, addresses the issue of re-openings and highlights the latest on hearing loss and toxic exposure claims.

Claims 4 analyzes the complex area of confidentiality, reviews the elements of fraud/investigations/ surveillance, discusses pain management treatments, outlines steps to take to avoid protest/appeal problems, reviews third-party recovery procedures, and looks at how to fairly assess pension eligibility.

 

CLAIMS 1-2 COURSE INSTRUCTORS

Craig Bock - Bock Consulting

Chris Fowler - Eberle Vivian

Kathryn Kunkler - Keehn Kunkler

Deanna Moran - Life Care Centers of America

 

CLAIMS 3-4 COURSE INSTRUCTORS

Craig Bock - Bock Consulting

Chris Fowler - Eberle Vivian

Kathryn Kunkler - Keehn Kunkler

Deanna Moran - Life Care Centers of America

 

Who Should Attend Claims 1?

• Anyone who has an interest in self-insured workers’ compensation issues in Washington State
• Claims assistants, new claims examiners, and seasoned examiners new to Washington laws
• Those who want the latest updates on wage and time loss calculations, and the issues that impact those calculations
• Those wanting to learn or review time loss calculations
• Those preparing for Certification Testing or for the Washington Worker’s Compensation Professional designation

Who Should Attend Claims 2?

• Claims assistants, new claims examiners and seasoned examiners new to Washington laws
• Those who want the latest updates on medical management and return-to-work issues
• Those wanting to learn or review PPD and LEP payment procedures
• Those preparing for Certification Testing or for the Washington Worker’s Compensation Professional designation

Who Should Attend Claims 3?

• Claims examiners and supervisors
• Claims examiners that are new to Washington Workers’ Compensation
• Those wanting the latest on hearing loss, voc rehab and reopening issues
• Those wanting to learn about pre-existing condition segregation, hearing loss claims, and exposure claims
• Those preparing for Certification Testing or for the Washington Worker’s Compensation Professional designation

 

Who Should Attend Claims 4?

• Claims examiners and supervisors
• Experienced claims examiners that are new to Washington Workers’ Compensation
• Those wanting the latest on pain management, protest/appeal and confidentiality issues
• Those wanting to learn about fraud and surveillance, third party recovery and pensions
• Those preparing for Certification Testing or for the Washington Worker’s Compensation Professional designation

 

Claims Training Series Agenda

Click Here To REGISTER for Claims Training

Claims 1 Agenda

8:00-8:30am   Registration and Continental Breakfast

Section #1  Industrial Insurance in Washington State reviews the history of industrial insurance in the state, highlighting the introduction of self-insurance and describing current self-insurance requirements. It provides an understanding of the legislative rules that govern the process.

Section #2  Communication examines the ways we communicate and provides insight and examples of effective face-to-face verbal communication, phone conversations and written communications.  We will also discuss specific communication with the points of contact on your claims.

Section #3  Initial Claims Review covers the all-important initial investigation, including a review of timely filing, course of employment, and red flags.  You'll learn tools and tips to assist you in making claim validity determinations..

Section #4  Reserving looks at the proper procedures and practices for setting reserves and helps you understand the financial impact reserves have on employers.

Section #5  Time Loss Calculations helps you understand various payment issues including when to pay, basic time loss calculations, and provisional payments. We'll discuss wage and time loss calculations and the various issues that affect those calculations, such as work patterns, COLAs, and health care benefits.  We will also cover the Kept on Salary statute, and the new minimum time loss benefits statute.

3:45-4:00pm   Wrap Up

Claims 2 Agenda

8:00-8:30am   Registration and Continental Breakfast

Section #1   Medical Management discusses the purpose of medical management and the steps you can take to better medically manage your claims, thereby reducing your claims costs.  We'll cover some key Medical Aid Rules, what to look for in medical reports, and clarify objective medical findings.

Section #2   Return to Work reviews the key elements of Return-to-Work programs. It identifies job offers that meet the legal requirements and discusses issues surrounding ADA and FMLA legislation.

Section #3   Loss of Earning Power looks at what constitutes a loss of earnings, actions to take if the workers refuses a written light duty job offer, when to pay, and the Loss of Earning Power calculations process

Section #4  Closures looks at the ins and outs of claim closures. It will help you understand the criteria and process for Department and employer closures.

Section #5   Permanent Partial Disability (PPD) looks at the types of PPD ratings and analyzes the differences. We'll review ratings, the factors that impact PPD awards, how to calculate the down-payment, and how to devleop a schedule of future payments in paying the award..

3:45-4:00pm   Wrap Up

Claims 3 Agenda

8:00-8:30am   Registration and Continental Breakfast

Section #1  Communicating with Physicians addresses a critical element of good claims management. We'll discuss how to communicate effectively and minimize issues, along with the duties of the attending physician with regard to providing medical information.

Section #2  Pre-existing Conditions/Segregation discusses ways to identify and document pre-existing conditions. We’ll also review methods of segregating unrelated conditions.

Section #3  Medical Management, Vocational Rehabilitation, and Effective Referrals reviews ideas for effective medical and vocational rehabilitation management, including indicators for referrals to nurse case managers and vocational counselors.  Emphasis will be placed on the new vocational rehabilitation pilot project.

Section #4  Re-Openings reviews and discusses the steps you should take when you receive an application for reopening.

Section #5  Hearing Loss reviews the latest developments and court cases. Examine procedures to use in managing these claims and learn what steps you can take to protect yourself and your employees.

Section #6  Exposure Claims discusses the guidelines for the thorough investigation and effective management of an exposure claim, highlighting the “Invisible Disability.”

3:45-4:00pm   Wrap Up

Claims 4 Agenda

8:00-8:30am   Registration and Continental Breakfast

Section #1  Confidentiality looks at issues and practices for gathering, sharing and protecting employee information when managing workers' compensation claims.   We will also share some real world steps that you can put to work immediately.

Section #2  Fraud/Investigations/Surveillance provides a legal interpretation of fraud, how to spot it, and the techniques you can use to thoroughly investigate your claims.

Section #3  Pain Management reviews what it means to be a chronic pain patient, detecting early warming signs of chronic pain, and whatyou can do to minimize the impact on your claims.  We will also attempt to demystify pain clinics.

Section #4  Protests/Appeals provides a legal interpretation of protests, appeals, the mediation process, and how to identify and prepare difficult cases.  We will also review the timelines involved.

Section #5  Third-Party Recovery looks at how to identify, investigate, and manage thrid party claims.  We will also cover the steps in obtaining a recovery, and discuss real-life examples of motor vehicle accidents, product liability, and on-the-job injury claims.

Section #6  Pensions reviews ways to fairly assess and determine pension eligibility, and how to request pensions from the Department.  We’ll also discuss how and when to use the Second Injury Fund, as well as review some leading court cases.

3:45-4:00pm   Wrap Up

Click Here To REGISTER for Claims Training