If you’ve read my previous posts, you know that I believe in strictly following the law and using evidence-based medicine throughout the workers’ compensation process. I recently attended the TDI/DWC conference and went to a lecture on a new idea for managing claim files called Whole Person Recovery Management. This approach prioritizes the well-being of the injured employee, which is a refreshing concept. As members of the work comp community,…
As any experienced individual in the worker’s compensation system will know, there is a basic concept in certain sections of the statute known as presumption. To be clear, there is a basic presumption which is simply an assumption of the law about a fact. This fact is considered true unless proven otherwise. The burden of proof is assigned to those trying to overcome this presumption. A separate aspect is what…
Whenever you are handling a claim, something issues, problems are simply not avoidable. However, there are a few steps to take that can minimize your more problematic files. With elimination of these issues, you should be able to reach file conclusion more swiftly. Several points to keep in mind from the outset of the claim. Communicate frequently, effectively and in as much a comprehensive manner ss possible. If you cannot…
The cost of health insurance in the United States has been rising steadily for decades. In 2021, the average annual premium for employer-sponsored health insurance was $7,739 for single coverage and $22,827 for family coverage. These costs are surpassing wage growth, meaning that workers are devoting a greater portion of their income to health insurance. As noted in the September 8 Wall Street Journal, the growth of health insurance costs…
The good news is the pandemic is over. The better news is that a large number of the working population, particularly those in the non-retail, non-manufacturing areas, have enjoyed an expanding role in terms of working from home (WFH). Working from home has been established as a significant equalizer in the work/life balance parameters among today’s service sector employees. It is a frequent news story noting that many larger employers…
Every licensed work comp adjuster in Texas should be aware that their license is only valid for two years. To renew it, they need to submit a new application along with proof of completing appropriate continuing education. As an adjuster, making continuing education a top priority is crucial not only for legal compliance but also for several other significant reasons that should not be overlooked. These reasons include: In the…
As part of the Grand Bargain, we have in the workers’ compensation system a process known as the exclusive remedy. What has been traded for is a quick and easy way to address injuries received in the occupational space. Consequently, we have a system that takes us out of the court system to receive proper benefits for those injuries. Exclusive remedy is doctrine and in return, employees cannot sue their…
A significant issue facing workers’ compensation professionals is rising medical costs. We all deal with escalating expenses, and there are a number of vendors who have offered various solutions to limit this escalation. The question becomes what can that workers’ compensation professional do to mitigate the expenses? Understanding that there are multiple methodologies to mitigate rising healthcare costs, one of the first steps noted is prevention. Candidly, that is well…
By definition, fraud is the intentional intent to use deceit, trickery, or other nefarious means to deprive another individual of their inherent money, property, or legal rights. The majority of injured individuals were legitimately injured while furthering their employer’s interests. However, we all know that there are those individuals who feel they are entitled to something to which they are not, and as such will employ various tactics to pad…
All too often, we see a diagnosis of a “sprain/strain” relative to the lumbar or cervical spine. There is a huge difference between the two, and the treatment may overlay initially, however, in the long run, the interventions can become quite different as will the length of duration. Thus, it is imperative that the exact diagnosis be objectified and the injury be limited to what actually occurred. The major difference…
