Coverage
If an employer has sent an employee to temporarily work in another state, the state should be listed where in the policy?
under 3C Other State Coverage
If you notice that a new body part is being introduced, what should you do?
1. Contact the IW, PR, and ER to investigate thoroughly
2. Update the I&TO screen appropriately
3. Consult with the NCM on medical causality
The Hartford's reserve philosophy is to promptly reserve the file for...
the most probable claim outcome based on information available at the time.
When settling a claim for a Medicare beneficiary, you need an MSA consult and CMS approval if the amount is greater than...
$75,000
One of the best tools to review after receiving a reassigned file is the...
Claim Avatar
What is the most common endorsement?
Broad Form Endorsement
A conversation with the employer reveals that she believes the injured worker is working off the books for a friend, based on a recent social media post. His doctor maintains him at a "No work ability" status and he has not returned to work with the employer. What action do you take?
Place a referral to SIU.
A Large Loss Notice should be filed when it is identified that the aggregate total on the file will likely be over...
$250,000
What two exposures must be considered with thinking about future exposure?
Indemnity and Medical benefits
When handling a newly reassigned file and you have reviewed the claim avatar; as well as the investigation and compensability determination and subro, as well as extent of injury- what should you do next?
Reconcile the indemnity benefits
If an injured worker is employed in a job class not listed in the policy, what should you do?
Contact underwriting to determine if the code should have been added and send a risk alert.
We would want to take a recorded statement when significant fraud indicators are noted; when there is evidence of a prior injury; when questions arise regarding the causal connection between the injury and alleged accident AND when:
Compensability is questioned.
When a material change impacts a file, how long do you have to update the reserves?
20 business days
When should the Present Cash Value be applied?
PCV should be applied if the settlement is in excess of 52 weeks of indemnity benefits and when you anticipate a recurring yearly medical charge.
When considering litigation, why should a CBA be completed prior to initiating any action?
A Cost Benefit Analysis (CBA) will help determine if something is going to cost more to litigate than to pay.
Your injured worker is a partner in a non-construction business in the state of Alaska. There are no special provisions in the policy. What tool would be used to determine if they would be covered?
The Include/Exclude chart.
When investigating compensability, what would be considered a major deviation?
A major deviation is when someone goes outside their job duties without being instructed to do so.
Your injured worker located and treating in the state of Virginia has been authorized for a total knee replacement. What tool do you have to help you reserve for the procedure which includes pre and post costs?
Procedure Pricing Guidelines
MSA Settlements can be paid in two ways. What are the two ways, and what is the difference?
Lump Sum: A single payment made at the time of settlement.
Annuity: Payments spread out over the life expectancy. This allows HIG to purchase the MSA amount from a life company at a lower cost. Annuity payments usually include an initial "seed" cash amount, then annual payments over the IW's life expectancy.
An employee sustained a severe hand laceration when the guard shields on a machine she was operating broke off, causing her hand to slip into the slicing mechanism. What course of action should be pursued?
Subrogation
What is the best endorsement for an employee who is expected to work out of the country temporarily?
Voluntary Compensation and Employers Liability Endorsement
When should "The One Question" be asked?
You have to reserve your file for a Georgia claimant who had a compensable injury of right carpal tunnel syndrome. What tool would you use to determine the estimated amount of permanency?
PPD Rating Reserve Estimator
What will trigger you to refer your file to the Permanent Partial Disability (PPD) unit?
You will refer your file to PPD if the medical provider has opined an impairment rating of 2% or more (1% for California files).
A settlement negotiator should focus on what three skills?
Preparation, taking notice of interests of both parties and understanding which barriers may arise.