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Table Of Contents

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!

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