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Workers' Comp Training Seminar & Workshop

DAY ONE

About Workers' Comp

• What is it
  
• Why established
  
• Penalties for non-compliance

Who Is Covered By Workers' Compensation?

• Employees
  
• Temp workers / borrowed workers
  
• Necessary contractual terms for hiring temps through an agency
  
• Criteria for determining who is an independent contractor
  
• Handling improperly designated independent contractors
  
• Statutory coverages
  
• Statutory exclusions from coverage

What Is An Accident Under Workers' Compensation?

• "Arising out of and in the course of employment"
  
• Repetitive trauma claims
  
• "Exposure" claims
  
• Parking lot claims (coming and going)
  
• Coverage for traveling employees
  
• After-work activities/social activities that are considered work accidents
  
• Accidents at home for telecommuting employees
  
• Psychiatric and stress claims

Requirements For Compensability

• Employment relationship
  
• "Accident"
  
• Causal connection between the accident and alleged injury
  
• Reasonableness and necessity of medical treatment
  
• Statute of Limitations

Defenses To "Arising Out of And In The Course Of Employment"

• Intoxication
  
• Misconduct
  
• Horseplay
  
• Fighting
  
• Performing personal work at work location

Interactive Exercise: Determining Whether A Reported Injury Is A "Work Accident"

Benefits Available Under Workers' Compensation

• Medical Benefits
  
  
  • What benefits are covered and for how long
    
  • Choice of doctor
    
  • Chiropractic treatment
    
  • Alterations to house and/or vehicle for mobility
  
  
• Monetary benefits based on Average Weekly Wage (AWW)
  
  
  • Basic AWW calculation
    
  • What wages are used for calculation?
    
  • Is overtime included?
    
  • Are there special considerations for part-time and/or low wage workers?
  
  Interactive Exercise: Calculating The AWW And Benefit Rates
  
  
• Temporary Total Disability
  
  
• Temporary Partial Disability
  
  
• Permanent Partial Disability
  
  
• Total Permanent Disability
  
  
  • Medical disability
    
  • Statutory disability (some states)
    
  • "Odd-lot" total permanent
  
  
• Vocational Rehabilitation
  
  
  • Maintenance benefits
    
  • Costs of vocational program
    
  • State-specific additional benefits
  
  
• Right to reinstatement/rehiring in some states (state specific)
  
  
• Death and survivor benefits
  
  
  • Burial benefits
    
  • Who is entitled to benefits?
    
  • How are benefits calculated?
    
  • How long are benefits paid?

Apportionment Of Disability Due To Pre-Existing Condition Or Prior Injury

• Employer credits for prior WC claims
  
• Pre-existing condition and WC value

Recommended HR Policies & Documents

• Accident reporting policy
  
• Accident report forms
  
• Accident investigation procedure
  
• Modified duty policy
  
• Three-day no call/no show policy
  
• WC leave counted under FMLA entitlement
  
• Safety Program
  
• Written job descriptions
  
• Effective hiring screening

Designing & Communicating Prevention Programs

• The role of management
  
• Assess current safety performance
  
• Assess safety needs
  
• Workplace violence and safety
  
• Designate safety team
  
• Develop safety rules
  
• Train employees and supervisors
  
• Enforce safety rules
  
• On-going evaluation of safety program
  
• Recommended metrics
  
• Do safety incentives make sense for your organization?

DAY TWO

Investigating A Workers' Compensation Claim

• Necessary steps to investigation process
  
• Designated reporting personnel
  
• Choosing an investigator
  
• Securing the scene
  
• Accident report forms
  
• Gathering evidence
  
  
  • Documents
    
  • Photos/videos
    
  • Witness list
  
  
• Witness interviews
  
• Determining if any third parties may be liable
  
• Reporting work accidents to the insurer/administrator
  
• The difference between a WC accident investigation and a "root-cause" investigation

Managing Workers' Compensation Claims

• Working with claims adjusters/TPA's
  
• Company involvement & contact with claimant
  
  
  • Required communication
    
  • Best practices for ongoing communication
  
  
• Nurse case managers
  
• Independent Medical Exams (IMEs)
  
  
  • Choosing the right doctor
    
  • Providing the IME with the right information
    
  • Asking the right questions of the IME doctor
    
  • How to strategically use IME reports
  
  
• Utilization Review
  
• Surveillance
  
• Managing defense counsel
  
• Choosing which claims to litigate
  
• Pro se settlements as a claim handling strategy
  
• Defending claims for chronic pain syndromes
  
• Defending total permanent disability claims
  
• Defending loss of earning capacity/income claims

Interactive Exercise: Working With Claims Forms

Getting An Injured Worker Back To Work

• Modified Duty Program
  
  
  • Designing a good modified duty program
    
  • Begin planning as soon as possible after accident
    
  • Duty to accommodate under the ADA
  
  
• Charity organizations as source of modified duty

How Claims Are Adjudicated

• Enforcement
  
• How the "system" works
  
• Statute of limitations
  
• Required filings/reports
  
• Deadlines for accepting or denying claims
  
• Re-opening rights of the worker
  
• Types of settlements
  
• Appeal process
  
• Why employer participation is important at trial

Protecting Your Denials From Penalty Awards

• Workers' Compensation Penalties in your State
  
• Required proof to contest claims
  
• Payment deadlines

Medicare Set-Asides

• Employer obligations under Medicare Secondary Payer Laws
  
• Claims requiring CMS approval
  
• Settlement options involving Medicare

Discipline/Termination Of A Workers' Compensation Claimant

• Legal pitfalls
  
• Practical considerations
  
• Necessary steps
  
• Required documentation

Recordkeeping

• State-required reporting of work accidents
  
• OSHA overlap: Rules for location, retention, and maintenance of records
  
• Filing requirements
  
• Necessary internal documentation
  
• Document retention requirements

Overlap With Other Laws

• FMLA
  
• ADA
  
• OSHA
  
  
  • Necessary definitions for properly categorizing injuries
    
  • Using your Workers' Compensation program to decrease OSHA reportables

Workshop/Interactive Problems

Depending upon the class needs, your Instructor will cover some of the following Interactive Exercises:

• Whether a reported injury is an "accident" under WC
  
• The overlap of WC with FMLA and ADA
  
• Managing large value and/or complicated claims
  
• Return to work issues
  
• Filling out forms
  
• Sample investigation of a traumatic accident
  
• Sample investigation of alleged repetitive trauma claim
  
• Record retention/documentation/paperwork

You obviously get a lot of bang for your training dollars, and just one tip learned can more than pay for the cost of the seminar. So what are you waiting for? Order today!