Federal and State Programs
This federal program provides workers' compensation benefits to civilian employees of the federal government.
Federal Employees Compensation Act (FECA)
These are the easiest claims to process as they usually involve minor illnesses or injuries treated by a healthcare provider.
Medical treatment claims
Routinely submitting duplicate claims in an attempt to expedite reimbursement.
Provider waste
These types of claim forms are generally accepted by most workers' compensation payers
CMS-1500 and UB-04
This program helps ensure safe and healthful working conditions free from unlawful retaliation.
Occupational Safety and Health Administration (OSHA)
These cases involve employee retraining for both temporary and permanent disability.
Vocational rehabilitation
Making false statements about work-related conditions to obtain benefits
Employee fraud
The state workers' compensation laws/rules that are followed when an employee is injured in one state and treated in another.
The state where the injury took place.
This is a state agency responsible for administering workers' compensation laws and handling appeals for denied claims and insufficient compensation.
workers' compensation board/workers' compensation commission
This refers to an employee's diminished capacity to return to work.
Permanent disability
Insufficient occupational safety programs that increase compensation claims and cost.
Employer waste
When the first report of injury is generated, this is how many copies are required.
4 copies
This program provides benefits to current/former employees of the Department of Energy
Energy Employees Occupational Illness Program (EEOICP)
These claims provide benefits to eligible dependents in the event of employee death.
Survivor benefits
Intentionally misclassifying employees as independent contractors to avoid paying benefits
Employer fraud
This is a quasi-public agency that provides compensation coverage to private and public employers involving state employees
State insurance fund/state compensation fund
This classification is used when an employee's wage-earning capacity is totally lost on a temporary basis
Temporary total disability.
Failing to follow best practices in medicine, resulting in unnecessary services.
Provider abuse.