Schedule/Sessions

Breakfast

Welcome

Caught Red Handed

This class will address the fraudulent side of the WC claim.  Taught by experts in the investigation of workers compensation claims, this class will bring in real life video and case studies of claims as examples and will start with an overview of what claims may need additional investigation.  Red Flags and other criteria will be addressed.  Surveillance is a big part of workman’s compensation claims, but there are serious consequences if this tool is misused.  An overview of what is good surveillance and what to avoid will assist the student in using this tool efficiently as well as legally. 
 

Break

Loss Control and Claims Management Programs - Measuring Program Success

• Understand how to review claim loss runs and loss development triangles to measure success of a program.
• Understand how human resource policies interact with workers compensation processes.
• Evaluate your safety program to include the formation of a safety committee, new employee orientation and ongoing employee safety training.
• Identify, evaluate and monitor the ancillary services needed to assist in adjudication of your workers compensation program.
• Create and review best practices of the client’s program, third party administrator and carrier along with any third party vendor that is assisting in the adjudication of workers compensation claims.

Lunch

Controlling Drugs and Pharmacy Management Impact

At the end of this course, you will be able to:

• Understand today’s medication/pharmacy cost factors
• Understand how to control costs through use of vendors
• Understand how to control costs through use of a formulary
• Develop and understand reporting packages through your vendor(s) to manage high risk/inappropriate medications
• Determine steps to manage chronic opioid use
• Create an effective pharmacy benefit management (PBM) program
• Calculate medication reserves for long term claims and Medicare Set-Asides
• Understand the impact of Medical Marijuana laws on WC

Break

We're Going to Trial and Trial and Jury Deliberation

Instruct Workers Compensation claim adjusters on all aspects of pre-trial and trial phases of a claim, including how a thorough investigation, specific documentation, and collection and preservation of evidence aids in trial preparation and presentation.    
Course Learning Objectives:

• Define litigation
• Understand how initial investigation and evidence collection phases relate to the trial phase
• Recognize when a case is ready for resolution via trial
• Describe what a trier of act will consider in rendering a decision

Break

Review and Prepare for FINAL Group Presentations