Workers' compensation-related costs are expensive for employers at every step of the process: lost productivity, wages, medical costs, fraudulent claims and administrative costs.
How does an employer reduce costs? How does an employer stay in compliance? This seminar cannot make your problems and costs go away, but it should help you minimize the expense and headache of workers' compensation claims and improve compliance.
- Negotiating settlements that require a Medicare set-aside
- Fraud prevention and investigation strategies
- Up-to-the-minute legislative and caselaw updates for 2005
- The attendee will be able to understand a claimant's entitlement to workers' compensation benefits in the state of Maryland.
- The attendee will be able to recognize when a Medicare set-aside is required for a full and final settlement.
- The attendee will be able to identify useful tools for investigation and learn cost saving strategies for managing a workers' compensation claim.
9:00 a.m. - 10:00 a.m.
I. Covered Employees And Compensable
A. Covered Employment
1. Employer/Employee Relationship
2. Statutory Employment
1. Accidental Injury
a. 'Arising Out Of'
b. 'In The Course Of'
2. Occupational Disease
a. Injurious Exposure
3. Psychiatric Claims
a. Physical/Mental Injuries
b. Mental/Mental Injuries
C. Defenses To Compensability
1. Going And Coming Rule
2. Wilful Misconduct
4. Statute Of Limitations
10:00 a.m. - 10:45 a.m.
II. The Benefits...Part I
A. Average Weekly Wage
1. Why Is It Important?
B. Temporary Total Disability
C. Temporary Partial Disability
D. Light Duty Programs
1. Why Have One?
2. What Should It Be?
3. How Long Should It Be For?
E. Medical Treatment
1. 'Reasonable, Necessary And Causally Related'
2. Medical Evaluations
a. Choice Of Physicians
b. Directed Medical Care
10:45 a.m. - 11:00 a.m.
11:00 a.m. - 12:00 p.m.
III. The Benefits....Part 2
A. Permanent Partial Disability
1. Impairment Ratings
2. 'Whole Person' vs. 'Scheduled Member'
3. Industrial 'Loss Of Use'
4. Worsening Of Condition
B. Permanent Total Disability
1. What Standard Will The Commission Apply?
2. How Do I Defend A Perm Total Claim?
C. Death And Dependency Claims
1. Whole vs. Partial Dependency
2. Litigating The Dependency Claim
D. The Subsequent Injury Fund
1. What Is The 'SIF'?
2. When Does The SIF Come Into Play?
3. What Does The SIF Pay?
12:00 p.m. - 1:00 p.m.
Lunch (On Your Own)
1:00 p.m. - 2:30 p.m.
IV. Settlements And Other Interested Parties:
Third-Party Liens And Medicare Set-
A. Considerations In Fully And Finally Settling A Workers' Compensation Claim
1. Closing Out The Medical Benefits
2. Will The WCC Approve This Settlement?
B. Medicare Set-Asides
1. When Do I Need To Consider Medicare Approval Of A Settlement?
2. How Does The Process Of Approval Work?
3. How Long Will It Take To Get Approval?
C. Subrogation And Third-Party Lien Recovery
1. Is There A Viable Third-Party Claim?
2. How Much Money Can The Employer/Insurer Recover?
2:30 p.m. - 3:30 p.m.
V. 2005 Case Law And Legislative Update
A. Recent Case Law And Its Impact On The Practice Of Workers' Compensation
B. New And Proposed Legislation From The 2005 Session Of The Maryland General Assembly
3:30 p.m. - 3:45 p.m.
3:45 p.m. - 4:30 p.m.
VI. Claims Investigation And Fraud
A. Spotting The Fraudulent Claim
1. Tip-Offs And Red Flags
2. Sources Of Information
B. Useful Tools For Investigation
1. 'The Grapevine'
4. Independent Medical Evaluations
5. Witness Interviews
C. The Employer's Role In Spotting And Preventing Fraud
1. The Employer's First Report
2. The Personnel File
3. Accident Reporting Protocol
D. Fraud Legislation And The Enforcement Of Same