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Workers Compensation

Transcript: Current Procedural Terminology (CPT) codes Healthcare Common Procedure Coding System (HCPC) International Statistical Classification of Diseases and related Health problems ICD 9/ICD 10 Utilization review (UR) Countries with Workers' Compensation Permanent Total disability Temporary total disability Worker's Compensation: Test Your Understanding Know what is Workers' Compensation 1911 - First Comprehensive Workers' compensation law was passed in Wisconsin. Nine other states passed regulation that year. Followed by 36 other states before decades was out. 1948 - Final state to passed Workers Compensation was Mississippi. Common Workers' compensation Terminologies Common Workers' compensation Terminologies: Workers' Compensation Turn Around Time Rehabilitation of the Persons with Work-Related Disability (PWRDs) Program Disability Benefit Knowledge Check!!! A construction worker renders overtime in order to finish a construction project before the holidays. He sustains a torn knee ligament while erecting a scaffold. He will be requiring immediate surgery to repair the torn ligament. Question: 1. Based from the situation above, will this be considered compensable considering the criteria for accepting the compensability of the claim? If yes or no, why? Worker's Compensation: Automatic entitlement Workers Compensation 6. E_ P_R_E C_MM_N_C_T_ON 7. P_ _R TO _EE_ R_V_EW 8. _ AX_M_M M_D_ _AL I_P_OV_M_NT 9. A_P_AL 10. P_RMA_EN_ & STA_IO_ARY Common Workers' Compensation Terminologies Test Your Understanding Disability Insurance Is the number of hours or days that is required for a Workers Compensation Insurance to complete a decision regarding medical treatments or claim approvals. A quality control inspector who works for smartphone manufacturer forgot to wear safety goggles before entering the production floor. While performing the final QC on an item, the item short-circuited, and a shard of glass went into the inspector’s right eye. The inspector sustained a corneal abrasion. Question: 1. Based from the situation above, will this be considered compensable considering the criteria for accepting the compensability of the claim? If yes or no, why? 1. C_A_IM_ A_J_ST_R 2. C_MP_N_ _BL_ B_D_ P_ _ T 3. I_N_JU_ED W_R_ER 4. _AT_ OF _N_U_RY 5. U_IL_Z_TI_N R_VI_W illness, injury or death is deemed compensable One morning, a homeless person assaults a security guard who was doing routine patrols around the building premises. The security guard sustains a fractured hip and a strained shoulder following the injury. Question: 1. Based from the situation above, will this be considered compensable considering the criteria for accepting the compensability of the claim? If yes or no, why? Know the Worker's comp Process At the end of the session, the trainees will be able to: Also known as Income Protection Protects the employees lost wages in the events of illnesses Reporting Injury A matter of right Worker's Compensation: 1. ECC-Quick Response to PWRDs This project aims to provide immediate assistance to workers or their families in the event of major work accidents or outbreak of occupational diseases at the workplace. The ECC intervention includes psycho-social counseling services, medical help and assistance in the filing of the necessary claims with the System. 2. KAGABAY Project “Katulong at Gabay sa Manggagawang May Kapansanan” or KaGaBay is an assistance project to PWRDs which provides vocational skills and entrepreneurial training and other assistance that will allow PWRDs to find employment or self-employment. Temporary partial disability Objectives: Claim Claims administrator/Claim Handler/Claim Adjuster/Claim Adjudicator (CE) Compensable body part Injured Worker (EE) Date of injury (DOI) 1. Employees only 2. Accidental Personal Injury & Occupation Disease 3. Arising out of Employment (AOE) 4. Arising in the Course of Employment (ACE) Permanent Partial Disability Common Workers' compensation Terminologies * Primary Treating physician (PTP) * Agreed Medical Evaluator (AME) * Independent Medical Examiner (IME) * Panel Qualified Medical Evaluator (PQME) * Qualified Medical Evaluator (QME) * Maximal Medical Improvement (MMI) * Permanent and Stationary (P and S) Test Your Understanding Unholy Trinity of Defenses Worker's Compensation Identify common Worker's comp terms Disability Benefit A financial support system provide benefits to employees conditions/injury as result of employment Are you able to: Know what is Workers Compensation Identify common W.C. terms Know the W.C. Process Difference of Workers' Comp Vs Disability Insurance 1. Contributory Negligence ==> responsible for his injury 2. Fellow Servant Rule ==> action or negligence of a fellow employee. 3. Assumption of Risk ==> knows the hazards of a particular job when they sign their contracts Requirements for a Compensable Claim: * Ex Parte Communication * Appeal * Independent review Organization (IRO) * Peer Review/Physician Advisor (PA) * Peer to Peer Review *

Workers compensation

Transcript: Overall Perception By American Citizens How Does It Work? What law or program? It provides to federal workers (or their dependents) who are injured at work or acquire an occupational disease, wage replacement benefits, medical treatment, vocational rehabilitation, and other benefits. If you are a dependent family member of someone who was killed on the job, you might be entitled to death benefits through workers' compensation. There are some insights about the upcoming changes that may impact workers’ compensation costs and availability over time. First, the U.S. Department of Health and Human Services estimates that the physician supply will increase by only seven percent by 2020. Over the same time period, the U.S. Census Bureau projects a 36 percent growth in the number of Americans over age 65, the very segment of the population with the greatest healthcare needs. The Department of Labor's OWCP administers four major disability compensation programs which provides to federal workers, or their dependents, who are injured at work or acquire an occupational disease: Wage replacement benefits. Medical treatment. FONTS Workers compensation By: Taylor Snow and Payton O'Rourke Who Benefit's from this? Workers' Compensation insurance is a state mandated program consisting of payments required by law to be made to an employee who is injured or disabled in connection with work. In most situations, injured employees receive workers' compensation insurance, no matter who was at fault for the injury. Because these workers comp benefits act as a type of insurance, they preclude the employee from suing his or her employer for the injuries covered. It is a form of insurance providing wage replacement and medical benefits to employees injured in the time of employment in exchange for mandatory right's of the employee's right to sue his or her employer. What is workers compensation?

Workers Compensation

Transcript: In theory, Workers Compensation is good for those that work hard and unfortunately end up with injuries because they are covered. However, for those who take advantage of the system, billions of dollars are lost for companies paying for faulty injuries and claims. Still, workers compensation moreover is beneficial for the United States. Benefits Payments of Workers Compensation: Money Spent on Workers' Comp: Total: $58.3 BILLION (As stated in 2009) Arguments Against Workers' Comp: - FRAUD * Tens of billions of dollars in false claims/unpaid premiums per year * Under-reporting payroll * Inflating experience * Evasion Theodore Roosevelt signed legislation to provide workers compensation for certain Federal employees in usually hazardous jobs. History of Workers Compensation All employees who work for a company today are covered by workers compensation. * Workers receive all reasonable and necessary medical care for the injury or illness with no deductibles. (i.e. Lab tests, treatment by a Doctor, hospital services, x-rays, etc.) What is it? The first workers compensation act was passed in 1902 by Maryland working conditions in early factories were often hazardous and injury rates were high. Application Process: The workers compensation act is dicated by state law. * Tax-free payments which help workers replace lost wages while temporarily disabled. applying for workers compesation is not hard to do. Medical Benefits: $28.9 Billion Wage Loss Compensation: $29.4 Billion Benefits: Workers Compensation Connor Bogardus Christian Nizamis Erin States Samantha Hess Workers Compensation is a job-injury insurance that is paid for by one's employer and supervised by the state. Some people take advantage of workers compensation for their own selfish benefit, as seen in this comic. Medical Care Temporary Disability Permanent Disability Death Benefits Supplemental Job Displacement Benefit

Workers' Compensation

Transcript: I'm going to lose my job I'm weak I'm a burden to my department If I can't work, I can't pay my bills What the goal? To get employee working! Reduces lost wages paid and eliminates possibilities for fraud and malingering Employee does not suffer dire financial and family consequences of unnecessary lost time Reduces employee's fear of losing their job Ideally within their department (Ex: Employee using chair behind register to accommodate injury) If not possible, look for other light duty assignments within same building (Ex: Operations employee working at front desk) Hours could vary from employee's normal schedule Pay stays the same regardless of light duty assignment Prevention OR What is a Workers' Compensation Claim? Employee Overview Texas HCN What happens after an injury? Employees' Perceptions Must be preforming the scope of your job Supervisor completes Employee Incident Report Employee cannot come to work Employee Receives Drug Test Medical Evaluation ER Receives at Employee Discharge Medical facility Emergency Department Protocol Form No Duty Supervisor Human Resources Mercedes Riley, HR Director (817) 436-5908 mriley@texasrangers.com Bunch & Associates HCN Liason (800) 853-4735 ext. 1224 TXHCN@bunchcare.com Cannot be a willful attempt to injure themselves or unlawfully injure another person Cannot be injured for a personal reason by a non-employee Supervisor communicates with HR on employee's work/medical status Employee gets injured Workers' Compensation Employee goes to ER with Emergency Department Protocol Form No Duty: Not able to work Who should I contact if I have questions? Light Duty: Employee calls supervisor to discuss medical status What to do in case of an injury? What to do after an injury? How am I going to staff this position? How do I manage this situation? What are the procedures? Is this employee really injured or are they "milking" it? Supervisor completes Authorization to Treat Form & Employee Incident Report No horseplay Supervisors' Questions Not intoxicated Light Duty Practice Safe Lifting Avoid Slips, Trips and Falls Look for safer work practices Costs paid out in claims vs. cost of preventing HCN is a program that has been certified by the state. Only receive medical treatment from providers within the network. Only exception: HMO Primary Care Physician (PCP) Must notify employer in writing if you wish to designate your HMO PCP. Form can be provided by HR. Bunch & Associates process the claims, but if you need to find a provider in the network, please contact HR first. Except for emergency services, you should NOT obtain care outside of the HCN without approval. & Employee Incident Report is sent to HR Employee Receives Drug Test Medical Evaluation Full Duty: Immediate return to work or next scheduled shift Cannot be an act of God Employee goes to medical provider for follow up appointment(s) HR opens claim with Workers' Comp Insurance Carrier Supervisor's Role: Manage situation effectively & efficiently Respect employee's medical status Find a way to get their job covered while they are recuperating Can someone fill in from another area? Can someone on staff work more hours? Think of organizational resources Maybe HR can help find someone to temporarily work Employee goes to treatment facilty with Authorization to Treat Form Cannot be participating in a voluntary off-duty recreation, social, or athletic activity Example: Softball game

Workers Compensation

Transcript: Workers Compensation Unit 8 Key Terms NO FAULT INSURANCE- a worker injured while at work and employed in an industry protected by the act can get benefits. It doesn't matter who caused the accident. The injured worker and employer cannot sue each other. Let's Role play! -Alex is a worker working for Caylee's Tube Sock industry inc. and while working on the job, she stabs her finger with a sewing needle. Her finger is bleeding and she may have to get stitches... -Let's see how it turns out... Collective Liability: All employers who operate in industries covered by the act pay for the cost of insurance. The provincial government does not fund the WCB. Employers pay all premiums. -ROLE PLAY #2: -Alex is playing the role of a Government Person. Caylee, being the employer of her weird Tube Sock Company, is asking Alex to pay for her WCB bill, because she does not know that the government does NOT pay for it for her. What Benefits Did Injured Workers get during the Industrial Revolution? During the Industrial Revolution, there was a multitude of new job opprotunties. Workers were faced with exceedingly poor working conditions. For the first time, workers used power-driven machinery. Accidents were common. If a worker was injured, they recieved little to no help. Many employers thought workplace injuries and deaths were not their concern. To get any help from employers, injured workers and their famlies had to go to court to prove the employer was at fault. What is the WBC ? The WCB stands for the Workers Compensation Board Each Canadian Province has a similar WCA; Each act permits the setting up of a WCB; an organization that manages the WCA insurance business to protect employers and workers when workplace injuries happen. Why was the first Workers Compensation Act created in 1915? In the early 20th century, Canadian Law creators realized that workers needed to be protected. They knew some form of pay had to be available for injured workers and for the familes of workers killed on the job. The WBC assists injured workers by providing benefits such as; Wage Replacement: Injured Workers get money to replace lost pay due to injury For example, disabled workers can receive up to 90 percent of their net, which is the maximum amount This benefit is based on the amount of money workers earned at the time they were injured Medical expenses: All medical costs related to the workplace accident are paid by the WBC Return to Work Planning: WCB case managers talk to injured workers, their employers and health care providers The managers then make decisions about the type of work injured workers can do, whether or not workers can return to the job they were attending before being injured. If a workers can perform the same job, the case manager arranges treatment to help the injured worker recover. A case manager can also ask an employer if an injured worker can: .work less hours .perform fewer or different tasks . return to work earlier Vocational Services: If injured workers cannot return to their jobs because of their injuries, the WBC helps these workers learn other types of work Fatality Benifits: If a worker dies from workplace injuies, the WBC will help pay funeral costs The dead worker's family will also get the money that the worker would have recived if still living The Different Types of Coverage All new employers in compulsory industries must open a WBC or similar account within 15 days of employing their first worker(s), or other wise known as Compulsory Coverage. Employers in industries not covered by the WCB Act can apply to have workers' compensation insurance to protect their workers. This is also known as Voluntary Coverage. Bussiness owners (indivuals, partners, and directors) can buy workers compensation insurance for themselves as well, this type of Coverage is called Personal Coverage. This type of coverage offers the same insurance benefits to owners that workers get when injured on the job. They will need to purchase this because they are not covered automatically by the WBC for work related injuries. If a worker is injured on the job, a employer should write down all possible information about the accident, and complete an Employers Report of injury form. This form must be sent to the WBC within 72 hours of becoming aware of the injury. Question # 6: 1. Inform your employer and ask for a few days off. 2. Get your employer to complete and send an Employers Report of injury form to the WBC within 72 hours of the injury. 3. You yourself must also complete a Worker's Report of Injury form and send it to the WBC within 72 hours fo your injury. 4. Tell your doctor of your injury and get them to file a report with the WBC within 48 hours of your injury. 5. Vist a Chiropractor or possibly get a back massage. 6. Do not attempt any strenuious work until you feel better. Info Time! We need 4 VOLUNTEERS! Anybody? Anybody? Alright, here’s how it’s going to work. Student 1: You had a sheet of metal drop onto your

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