Best Practices
An auditor looks for this to ensure the policy coverage was verified early in the claim, specifically checking for the correct job classification code.
What is coverage verification?
File should reflect diligent attempts of this including, phone calls, emails, letters, or text messages.
What are contact attempts?
This acronym refers to the cash benefit that replaces a portion of lost wages while an employee is completely unable to work on a temporary basis.
What is TTD?
To ensure defense counsel rates and tasks remain aligned with the insurer's metrics, an adjuster must request, review, and formally approve this before costly discovery begins.
What is a Litigation Budget?
This should be updated within 3 business days of the last office visit.
What is treatment and disability status (RTW Screen?)
This serves as your initial roadmap, must be completed timely, and must address all required elements of the ongoing claim strategy.
What is the Plan of Action?
Claim file should reflect that third party involvement or product defect was considered and documented. Description should be specific to the file and not a generic statement.
What is a subrogation?
This medical milestone is reached when a doctor determines an injured worker's condition has stabilized and further significant healing or improvement is unlikely.
What is MMI?
According to CorVel's best practices, awards should be paid within this time period.
What is 2 business days?
Work restrictions are to be conveyed to the employer within this many business days of notification.
What is 2 days?
This critical decision must be documented with rationale factors and accepted body part(s) within best practice deadlines to avoid severe client, carrier and state penalties.
What is a timely compensability decision?
These should be set within 5 days of claim assignment, then every subsequent 90 days or within 5 business days of a substantial change in the claim file.
What are reserves?
This specific physical assessment is performed by a physician to establish a claimant's permanent functional restrictions and final impairment percentage.
What is an FCE?
During the settlement process, all discussions must be entered into the settlement screen within this timeframe.
What is 1 business day?
Timely approval of medical payments should be made within this timeframe.
What is 2 business days?
Required claimant contact attempts.
What is 2 attempts within 1 business day of claim assignment, issue contact letter if unable to reach, then ongoing daily attempts for 7 business days, then escalate to leadership/account manager?
Obtain and document a wage statement and calculate benefit rates on all indemnity claims (regardless of work status or compensability) within this timeframe and follow up every what number of days?
What is within 14 days and every 14 days until received.
In Pennsylvania jurisdiction, full and final lump-sum settlements that completely resolve wage loss and/or medical benefits are formally executed using this specific legal agreement, which must be approved by a Workers' Compensation Judge.
What is a Compromise and Release (C&R) Agreement?
This note category should we used to document all communication with defense counsel.
What is Litigation - Defense Strategy?
What must be updated with the most severe ICD-10 code allowed?
What is the diagnosis profile?
Involving matters of real weight or consequence.
What is the definition of substantive?
The initial indemnity benefit payment is to be issued within how many calendar days of receipt of the claim file by CorVel, provided proper documentation has been received and the jurisdictional waiting period has been satisfied or is known to be satisfied.
What is 8 days (CHUBB files) or 10 days (All other carriers.)
All scheduling requests for these items should be directed here.
{PT/OT, Diagnostic tests, Durable Medical Equipment/Home Health, Translation, Transportation, Work Conditioning, FCE.}
What is CareIQ?
This is required upon claim assignment if the claimant is represented.
What is make contact with claimant attorney until you receive an answer if they will allow you to obtain a statement from the claimant?
This can be what you need to identify if you have the following Audit Violation: "Fill in Nature of Injury and Part of Body on the Safety Screen. Also Occupations, Accident type, and Source of injury if applicable to this customer."
What is Primary Body Part?