Certified Master of
- Fraud, Investigation, & Litigation -
Claims Core (required for Fraud - Investigation - Litigation, Claims Management, and Best In Class Specialties)
Core Course 1: Bulletproof Investigation
How to Execute A Bulletproof Workers’ Comp Claim Investigation
Good decisions in workers' compensation are made with good information. There is no time more important to lock-down good information than immediately following a work-related injury.
In this training, you will learn:
- Steps to properly preserve the scene
- The exact questions to ask following an injury
- The one crucial piece that is likely missing from your injury form
- How to identify pre-existing conditions
- Why eye-witness testimony is not the best
- How to leverage your investigation to win litigation
... and much more!
Core Course 2: Evidence-Based Medicine
How to Use Evidence-Based Medicine to Create Better Workers’ Comp Claim Outcomes
A common fact often forgotten is workers’ compensation claims are medical injuries and medical expertise is needed to get the best claim results. The workload of the everyday adjuster is unrealistic to expect accurate and appropriate medical determinations. This session will go in-depth on how to leverage evidenced-based medicine guidelines to empower claims handlers and drive positive claim outcomes.
This session will cover:
- Integrating evidence-based medicine tools into your claims process
- Avoiding excessive medical treatment and unregulated compound prescriptions
- Getting appropriate treatment approved
- Proper utilization of doctor questions to push for needed interventionshttps://workerscomptraining.com/courses/how-to-use-evidence-based-medicine-to-create-better-workers-comp-claim-outcomes/
- Proper utilization of IME questions to move the claim toward resolution
- Inappropriate use of Utilization Review
Core Course 3: Nurse Case Management
How to Use Nurse Case Management to Improve Outcomes and Lower Workers’ Comp Costs
Nurse case management in workers' compensation can be a highly effective service to improve outcomes and lower costs....when used correctly. When used incorrectly the nurse case manager can add additional expense with little to no added value.
In this training session you will learn:
- Clearly defined criteria for when, and when not, to use nurse case management
- How to coordinate your nurse case manager as part of your team
- Best practices you should expect from your service provider
- Red flags for when hours billed are too high
- Concrete data showing nurse case manager results
- Typical fee ranges and common billing options
Core Course 4: Injury Causation
How to Determine Workers’ Comp Injury Causation
The existence of a workers' compensation claim relies on the determination of an injury being legitimately work related or not. While many details of causation can be both medically and legally complex, employers and claims handlers need to understand key concepts in order to make informed and fair decisions.
This training session will cover:
- Action steps when an employee has a condition that may or may not be work related
- If / Then case examples of what to do in specific scenarios
- Red flags to look for as evidence of workers' comp fraud
- When to leverage medical expertise to make a defensible determination
- Using evidence-based medicine to complete a causation analysis
Core Course 5: Early Indicators
How to Identify EARLY Indicators of Expensive and Problematic Workers’ Comp Claims
5% of claims account for 80% of workers' comp costs, and according to the Journal of Occupational and Environmental Medicine, 60-80% of lost workdays are unnecessary. These statistics illustrate the fact that a small number of claims are costing a large amount of money, and much of this money, time, and frustration is wasted and unnecessary.
This session will cover the tools, techniques, and tactics to identify potentially problematic and expensive claims EARLY in the claim cycle.
This session will cover:
-Quantifying wasted claim dollars on your loss run
-Simple characteristics of typical problematic claimants
-Formal screening tests which deliver results
-Bringing the claims handling team on board with screening tactics
-What to do when an early indicator claim is identified
Fraud-Investigation-Litigation Specialty Courses
Specialty Course 1: Litigation
How to Avoid, Manage, and Win Workers’ Comp Litigation
The majority of workers’ compensation claims resolve without going to litigation, but those that do can be extremely frustrating and expensive. A best-in-class, high-integrity injury management program starts with strategies to avoid litigation which also serve as fundamental elements to ultimately winning cases should they go to trial.
You will learn to…
- Recognize employees with a high likelihood of hiring an attorney
- Implement a simple communication system to avoid litigation
- Ask the right questions to hire the right defense attorney
- Properly prepare every case to avoid the fear of trial
- Present evidence at trial in the most persuasive manner possible
Specialty Course 2: Communication Strategies
Highly Effective Workers’ Comp Communication Strategies: What To Say & How to Say It
Communication in workers' compensation is the single most important tactic to learn and master. Every single aspect of work comp management will be better or worse depending on the effectiveness of your communication.
This training session will learn to ...
- Follow a Proven Script with Injured Workers Before and After an Injury
- Leverage Your Claims Management Team to Create Multiple Touch Points
- Prove the Value of Communication to Senior Management and Clients
- Demonstrate Care Quickly and Inexpensively
Specialty Course 3: Injury Triage
How to Leverage Medical Expertise To Immediately Return 95% of Injured Employees to Work
The best in class standard for returning injured employees to work is 95% within 0-4 days. There are many factors that go into achieving this goal, however, leveraging medical expertise ranks high on the list of critical factors, and can be the difference between employees returning to work rapidly or potentially being out of work for an extended and often unnecessary period of time.
This session will cover:
- What is the first thing you do when an employee is injured?
- How to get your injured worker to the right level of medical treatment for every injury.
- How Injury Triage really works.
- How to set up the treating physician relationship and what medical information you need to obtain.
- When / if you talk to the injured worker, and what are you supposed to tell him?
Specialty Course 4: Hire Employees
How to Hire the Right Employees to Avoid Immediate Workers’ Comp Problems
Proper management of workers' compensation costs begins before an employer hires their first employee. Having the proper systems in place to hire the right employees will ensure they can safely perform the job, as well as avoid such negative actions as fraud, malingering, drug abuse, and theft.
In this training you will learn...
- how to address the challenges of finding the right candidates
- best practices of employee selection
- pre-employment screening options
- physical testing options to ensure employees can safely perform work tasks
- legal considerations and the Americans with Disabilities Act
- ROI examples of implementing hiring best practices
Specialty Course 5: ADA Compliance
How to Coordinate Return to Work with ADA Compliance
The interpretation and application of the Americans With Disabilities Act (ADA) is often confusing and overwhelming. In this session you will learn from Senior Attorney Advisor of the EEOC, Aaron Konopasky, on interpretations of this law in workers’ compensation, and how to coordinate return to work best practices with ADA compliance.
Learn answers to the following and more...
- Is a reasonable accommodation having someone do part of their job? Example all lifting?
- How does the identification of light duty jobs factor into ADA's interpretation of reasonable accommodations?
- What if the employee doesn't want to return-to-work, but wants to be out of work?
- What if an employee, during the interactive process, says no, he or she is not aware of a reasonable accommodation?
- If we have a transitional duty program, are we in jeopardy of being sued by employees if we terminate them because we cannot provide a reasonable accommodation?