March 18, 2018

Greg Moore: Should Workers’ Comp Be a Litigious Industry?

Greg Moore

Workers’ compensation was designed to reduce litigation by trading out the employee’s right to sue his or her employer for negligence in exchange for limited guarantee of care and compensation. This exclusive remedy “bargain” was the justification for why the system was first created a little more than 100 years ago. If we look at intent and where we are today…[Continue Reading]

Johnny Meyer: Life Post-Settlement: What Happens to Injured Workers After They Settle

Johnny Meyer

The workers’ compensation system has, for the most part, functioned successfully for more than 100 years. There are certainly controversies but the vast majority of injured workers get the medical treatment and the dollars they need to heal and return to productivity. But there is another segment of injured workers with quite different stories to tell. These are the injured workers who…[Continue Reading]

Johnny Meyer: Administration Experts Can Help Move Claims to Settlement

Johnny Meyer

Legacy cases may be the bane of your existence. You might have a case in particular where you know the injured worker is frustrated with the workers’ compensation system — the scrutiny, the providers, the delays, the denials — and yet he shows no interest in settling. You know because the adjuster asks him every few months. And yet, his claim continues for years…[Continue Reading]

Deborah Watkins: Using BIG Data to forecast Medicare Set Asides

Deborah Watkins

Is it possible to forecast Medicare Set Asides using data analytics? How does an analytics approach compare to conventional methods? And what is the value proposition for making the switch? These are great questions that we will attempt to address in this article, as well as our case for the use of data analytics to forecast Medicare Set Asides. The foundation for this report begins…[Continue Reading]

Deborah Watkins: Algorithms and Analytics: A Comparision of Data Driven MSAs to CMS Reviewed and Approved MSAs

Deborah Watkins

Last year we addressed the results of our non-group health payer survey findings regarding Medicare Secondary Payer (MSP) compliance programs. MSP compliance is excessively costly not only due to the added costs of compliance to a claim settlement, but additional costs are incurred due to delays in claim settlements and litigation. We proposed that…[Continue Reading]

Jim Harris: Unleashing Powerful Insights Hidden in Your Bill Review Data

Jim Harris LS 2018

Today, insurance and claims organizations are considering switching bill review vendors for a variety of reasons and, increasingly, the ability to leverage data analytics is one of them. There’s a treasure trove of information embedded in the bill review process, and if you’re not able to mine that data for program insights, you may be missing out on valuable opportunities to impact…[Continue Reading]

Michael Valasek: Ensuring a Quality IME Result: Three Players in the Process

Michael Valasek

A certain amount of contention has come to surround the independent medical examination (IME) process. Oftentimes, both the insurer and claimant will obtain an IME to substantiate their respective opinions on a case. Rather than bringing about clarification, claims decisions can get bogged down and stalled. Due to these issues, the workers’ compensation (WC) market has begun to…[Continue Reading]

Teresa Williams: Family Matters

Teresa Williams

Of all the psychosocial factors affecting workers’ compensation claims, family dynamics play a significant role in catastrophic claims requiring home health care. The more severe the injury, the bigger the impact on the family. A life-altering injury will stress any family. A person who could work, drive and take care of themselves one day can be incapacitated the next…[Continue Reading]

Jan Saunders: Getting Prosthetics Right from the Start

Jan Saunders

Amputations in the work comp space are traumatic, costly and rare enough to require specialized managed care. Often, prosthetic providers and manufacturers market directly to the patient and offer devices that do more than the person needs or is currently able to use. A treating prosthetist may discuss a sophisticated artificial limb with the injured worker before determining…[Continue Reading]

Dr. Michael Choo: The Future of Value-Based Care in Workers’ Compensation – Part 2

Dr Michael Choo

Catastrophic injuries, medically complex cases and chronic pain remain difficult challenges for all stakeholders in the workers’ compensation industry. To achieve greater results, the injured workers in these situations require care from those proficient in specialized skillsets and capabilities that extend beyond what is acceptable for more common, straightforward…[Continue Reading]

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