Ch' 14 Workers Compensation

1
Ch. 14 Workers Compensation

• Workers compensation insurance coverage which
  provides benefits to employees and their
  dependents if employees suffer work-related
  injury, illness, or death

2

• Federal compensation programs employees of the
  federal government, coal miners, longshoremen,
  and harbor workers

3

• State-sponsored coverage
• State compensation fund a state government
  agency functions as the insuring body to cover
  workers comp. claims. Employers pay premiums to
  this fund to cover all employees of the company.

4

• Employer self-insured program some employers
  with sufficient capital to qualify can
  self-insure.
• Private, commercial workers comp. programs
  employers can purchase policies from commercial
  insurance companies

5

• Combination programs employers can choose a
  combination of any of the previously mentioned
  programs

6

• To qualify for benefits, the employee must be
  injured
• While performing a service required by the
  employer
• While working within the scope of the job
  description

7

• Or succumbs to a disorder that can be directly
  linked to employment

8

• Classification of on-the-job injuries
• Non-disability claim filed for minor injuries
  when the worker is treated by a doctor but is
  able to continue working

9

• Temporary disability the worker is unable to
  perform his or her usual duties for a limited
  period of time it is expected that the worker
  will fully recover and return to the workplace.

10

• Permanent disability an injured employees
  diminished capacity to return to the work force.
  Employee is not expected to be able to return to
  the job held before the illness or injury or to
  have any other form of employment

11

• Vocational rehabilitation covers the expense of
  retraining for both temporary and permanent
  disability cases.

12

• Occupational Safety and Health Administration a
  federal agency that regulates and investigates
  safety and health standards of jobs.

13

• Billing claims
• Health care provider is required to accept the
  workers compensation-allowable fee as payment in
  full for covered services involving on-the-job
  injuries.

14

• If , during the course of treatment for the
  work-related injury, a physician finds another
  health problem, keep the codes for the treatment
  of the work-related injury separate.

15

• Medical reports
• Never mix a private medical record with a
  workers compensation case
• Set up a separate medical record and financial
  record for the work-related injury

16

• First Report of Injury (p. 455) a form filed by
  the health care provider when a patient initially
  seeks treatment for a work-related injury or
  disorder

17

• Review fraud and abuse, p. 438-443