Work Comp for Employers - Speak the Speak, Walk the Walk

Sunday, August 29, 2004 | 0

I received a call from the claims adjuster on a workers' comp claim at a company where I was the HR Director. The conversation went something like this:

Mary:
Hello, this is Mary Appleton from ABC Workers' Comp Insurance. I want to discuss claim # 666-666, John Fakem.

Vie:
Yes, Mary, go ahead I have his file at hand.

Mary:
I received a disclosure statement for the claimant's AA and with it a 132(a). I suppose you're still taking an AOE/COE position because your DOK was well beyond the DOL.
I will send the IW to an AME ASAP, since we can't go the IME route. What a joke, the AME and the IME are both QME so why the hassle from the AA?
I'm still waiting for your payroll dept to send the AWE. I expect the State will find him QIW. When that happens the QRR will need an RU91.
I'll be recommending increasing the RESERVES at the QUARTERLY CLAIMS REVIEW. Even though I don't know when he'll be P&S'd and get a RTW order?
We're pushing Voc Rehab in hopes of getting a C&R.
We have his claims history so we may be going for APPORTIONMENT. Although they're tough when it's a CTD. I expect you'll be at the MSC, so I let our lawyer know.
Per your request I'll refer it to our Sill for SUBROSA.
Don't look for a C&R too soon. Your employee is going drag it out. He'll be collecting TD for couple of years and then go on to VRMA. I understand that you'll be paying the premiums on the group health insurance, as well.

Huh? Not only is the language of workers' compensation foreign to most, but the principles and procedures that govern the work comp laws, and the obligations of the employer are equally as confusing. This series will help clear the air. We'll review some of the more rules and obligations created by the system.

Obligation to Inform Employees

Employers must post, in a conspicuous place, a notice about the workers' compensation carrier and who within the company is responsible for handling workers' compensation claims.

Failure to post this notice may be considered evidence of non-insurance. The notice must also include advice about the injured employee's right to receive medical care, to select or change the treating physician, and to receive temporary disability indemnity, permanent disability indemnity, vocational rehabilitation services and death benefits as appropriate. LC section 3550

Failure to post this notice will automatically permit the employee to be treated by his/her own physician for an injury occurring during the period in which the notice was not posted. LC section 3550 (g)

Every employer subject to workers' compensation must give each new employee a written notice of the above information either at the time the employee is hired or by the end of the first pay period. LC section 3551

(a) Every employer subject to the compensations provisions of this code, except employers of employees defined in subdivision (d) of Section 3551 shall give every new employee either at the time the employee is hired or by the end of the first pay period, written notice of the information contained in Section 3550.

That notice includes: "A form that the employee may use as an optional method for notifying the employer of the name of the employee's "personal physician..."

SB 899 added some new requirements to the issue of pre-designation and removed the ability to pre-designate a chiropractor or acupuncturist.

1. The employer must either offer an HCO or provide non-occupational group health coverage in a group health plan. (New requirement)
2. The physician must be the employee's regular physician and surgeon, licensed pursuant to Chapter 5 of Division 2 of the Business and Professions Code.
3. The physician must also be the employee's primary care physician and have previously directed the medical treatment of the employee and retain the employee's medical records and medical history. (New requirement)
4. The physician must also agree to serve as the primary treating physician for occupational injuries. (New requirement)

Next - Effective Claims Handling for the Employer

by Brent Heurter, Founder and Chief Solutions Officer of ClearComp, a workers' compensation alternative for companies that desire to control and reduce their workers' compensation costs. Brent can be reached at 888-CLEAR-89 or email brent@clearcomp.com.

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The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.