Category: Simple Concepts by Bill Zachry

Introduction Font-line treating physicians need a good physical job description to target the patient’s recovery and return to work.  Having a good physical job description also helps the doctor better understand the mechanics of injury to help improve the accuracy of diagnosis.  A good physical job description helps the patient and the doctor agree on the recovery return to work goals.  When the front-line clinics that treat injured workers do…

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The workers’ compensation system is often seen as a fossilized benefit delivery system, with medical care provided by the lowest bidder, administered by Luddites, and adjusted by overwhelmed claims adjusters, all driven by ’attorneys' misplaced incentives. On the other hand, I see extraordinary people doing what they can to make the system work, focusing on what they can do to ensure injured workers are properly taken care of. An excellent…

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Introduction Distractions in the workplace pose a significant challenge to risk managers focused on preventing accidents and ensuring safety. Distractions can be visual, manual, or cognitive, each type posing unique risks to individuals and organizations. This paper explores the nature of these distractions, provides real-world examples, and offers practical solutions to mitigate their impact. Types of Distractions Visual Distraction: Involves taking one's eyes off the task at hand.  Manual Distraction:…

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Defense attorneys have traditionally focused on individual claims management in workers' compensation, primarily centered around injury, compensability, permanent disability, and future medical care. However, with artificial intelligence and data analytics, there is an opportunity to refocus defense attorneys' role to address broader systemic issues and achieve improved claims outcomes, including injury prevention. Artificial Intelligence and Data Analytics Artificial intelligence and data analytics offer new opportunities to gather insights from deposition…

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The workers’ compensation claims settlement philosophy has a significant financial impact on injured workers and their employers. In addition to the economic issues, the nature of the workers' compensation settlement with an injured worker can also significantly impact the worker's success in moving beyond the injury and productively returning to work. For the past four decades, employers have been subject to a de facto settlement philosophy without fully understanding all…

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Uses of Claims Reserving The rating bureaus use case reserves to help determine the pricing of workers' compensation insurance. This calculation uses the case reserves on the claim files 18 months after the insurance policy's inception. Actuaries rely on claims reserves to help determine the projected ultimate cost of the claims. They calculate a reserve loss development factor applied to the cash reserves. Their calculations use industry trends, paid losses,…

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Lost time is one of the top cost drivers in workers' compensation. Effective transitional return to work (TRTW) programs are the best tool for reducing lost time.  A TRTW program significantly reduces workers’ compensation costs, strengthens employee engagement, and helps employees quickly recover from injuries. Return to work is one of the best tools for the injured worker to help facilitate the recovery from an injury. Early return to work…

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Workers’ Compensation is known in insurance parlance as a “long-tail” benefits system, in part because most states do not require the claim to be legally concluded within a reasonable span of time. One of the worst elements of workers’ compensation is the extreme interval between the injury date and the claim's conclusion. Keeping injured workers unnecessarily and artificially tethered to the workers’ compensation system makes them think of themselves as…

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Read Part 1 of this paper in our Outreach Center. The Ideal caseload is needed to produce the optimum throughput The “ideal” caseload is elusive. These are some of the diverse factors that should be considered when trying to determine the “Ideal Caseload”: Adjuster Skill and training. The most critical determinant of an adjuster’s caseload is the skill and experience of the individual adjuster. Senior adjusters who are efficient with…

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Executive Summary The workers' compensation industry focuses on caseloads as a primary way to manage expenses. Claims administration, in the insurance vernacular, is Unallocated Loss Adjustment Expense (ULAE). This paper's primary premise is that the Workers’ Compensation industry needs to focus on reducing loss rather than managing ULAE expenses as a primary goal. The second premise of this paper is that claims administrators are focused on static claim caseloads instead…

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