Advanced Reserving
Reserve statements appear as this on an insured's balance sheet.
What is a liability?
The medical treatment guideline principle that requires care to be reasonable, necessary, and related to the work injury.
What is medical necessity?
Workers' compensation benefit fraud may involve employees doing this while collecting benefits.
What is working another job off the books?
CMS approval may be required when settling certain Medicare-related claims.
What is a Medicare Set-Aside situation?
This legal concept determines which state's workers' compensation law applies to a claim involving multiple states.
What is jurisdiction?
Negative reserving trend where reserves increase only one year at a time.
What is stair-step reserving?
Cost containment is primarily accomplished through this activity.
What is bill review?
Adjusters frequently review this online source to identify activities that may be inconsistent with reported work restrictions.
What is social media?
Primary purpose of a PPD award.
What is compensation for loss of use or function?
The right of a carrier or employer to recover benefits paid when another party caused the injury.
What is Subrogation?
Claim professionals are primarily responsible for this type of reserve.
What is case reserving?
Medical stability occurs when neither treatment nor time will do this.
What is materially improve the condition?
Surveillance generally must occur before this.
What is disclosure of evidence?
Workers' compensation is considered this type of system.
What is an exclusive remedy system?
The legal deadline by which a claim or lawsuit must be filed.
What is the Statute of Limitations?
Reserve period considered when estimating exposure.
What is the life of the claim?
Medical recovery generally requires reaching this milestone.
What is maximum recovery?
An activity check commonly involves this.
What is canvassing the neighborhood?
Binding agreement resolving current and future liabilities.
What is a Compromise and Release?
This proceeding allows parties to resolve disputed claim issues before a workers' compensation judge.
What is mediation?
Initial data-driven reserving process often called this.
What is factor reserving?
This evaluation is often used to obtain an independent medical opinion regarding diagnosis, treatment, or work restrictions.
What is an Independent Medical Examination (IME)?
E&O exposure in subrogation results from failing to do this timely.
What is pursue reimbursement or file suit within deadlines?
Example of a third-party action.
What is a liability claim against the responsible party?
A formal proceeding where disputed workers' compensation issues may be decided by a judge.
What is a Workers' Compensation Hearing?