Claims Management
To bring forth a positive outcome, every claim should have this.
What is a proactive road map?
Insurance industry definition of a claim reserve.
What is anticipated future claims cost?
Fire credited as catalyst for workers' compensation in the U.S.
What was the Triangle Shirtwaist Fire?
For an injury to be work-related, it must meet this standard.
What is arising out of and in the course of employment?
A program designed to help injured employees safely resume productive employment.
What is Return-to-Work (RTW)?
Essential three-point contact participants.
Who are the employer, employee and physician.
The goal of reserving is to identify this at the earliest possible time.
What money must be set aside for future payments?
First workers' compensation law passed in the United States.
What was FELA?
Exception to the coming-and-going rule involving travel to a required company event.
What is travel to a mandatory company picnic?
This benefit replaces a portion of lost wages while an employee is unable to work temporarily.
What is Temporary Total Disability (TTD)?
This document outlines the adjuster's strategy, action items, and anticipated next steps on a claim.
What is a claim action plan?
The best definition of reserving.
What is reserving for ultimate exposure of the claim?
Before workers' compensation laws existed, injured employees generally had to prove this in court to recover damages.
What is employer negligence?
Employee role in horseplay most likely to make an injury compensable.
Who is the innocent victim?
An injured employee returns to work but earns less than before the injury and may qualify for this benefit.
What is Temporary Partial Disability (TPD)?
A "red flag" indicates this.
What is a possible questionable claim requiring further review?
Three categories reviewed when setting reserves.
What are Future Medical, Allocated Expenses, and Indemnity Benefits?
Claims are typically adjudicated by these judges.
Who are Administrative Judges?
Type of claim involving only medical benefits and no indemnity.
What is a Medical Only claim?
One of the most effective tools for reducing workers' compensation costs and improving outcomes.
What is an early return-to-work program?
This communication skill is considered one of the most important factors in building trust with injured workers and reducing claim disputes.
What is active listening?
This type of loss is abbreviated IBNR.
What is Incurred But Not Reported?
State workers' compensation systems are usually administered by this branch.
What is the Executive Branch?
Type of psychological condition that does not arise from physical injury.
What is a Mental-Mental injury?
This party should be kept informed throughout the claim process to support a successful return to work.
Who is the employer/supervisor?