Certified Master of
Workers' Compensation
- WC Claims Management -

Curriculum

Claims Core (required for Fraud - Investigation - Litigation, Claims Management, 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!


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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

And more…


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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

And more…


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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

And more…

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    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
    And more...


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      Claims Management Specialty Courses 

      Specialty Course 1: Rapport

      How To Create Instant Rapport With Injured Workers To Drive Positive WC Claim Outcomes

      The definition of rapport is "a close or harmonious relationship in which the people or groups concerned understand each other's feelings or ideas and communicate well." While intentional development of this soft skill is often overlooked, it is a highly valuable asset in the complex puzzle of a workers' compensation claim management.

      Workers' compensation professionals who take the time to improve rapport with both injured workers and other claims management stakeholders will instantly find claims are easier to manage, resolve quicker, and close for significantly lower costs.

      You Will Learn To...

      - Respond Correctly to a Report of Injury
      - Create an Atmosphere with the Injured Worker of Teamwork Rather Than Combat
      - Evaluate Your Personal Rapport-Building Effectiveness
      - Build Active Participation in WC Claim Management from ALL Stakeholders

      And more..


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      Specialty Course 2: Litigation

      How to Avoid, Manage, and Win Workers’ Comp Litigation

      The BEST way to reduce litigation costs is — to avoid litigated claims altogether. However, when claims do become litigated, it is important to be prepared in advance. Learn the secrets to manage, avoid, and win workers’ comp litigation.

      This session will cover:

      - How to avoid the litigation model of resolution
      - Establishing trust between the company and injured workers from various ethnic backgrounds
      - How to avoid litigated claims that balloon into much larger and more expensive claims
      - Dealing with other attorneys that have no concept of the complexity of workers comp law.

      And more…


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      Specialty Course 3: Catastrophic Claims

      Highly Effective Strategies to Manage Catastrophic Workers’ Comp Claims

      5% of workers’ compensation claims account for 80% of total costs. For this small group of claims the stakes are highest in both financial dollars and impact on the injured worker’s life. Knowing how to approach these claims, what strategies to use, and when can make a dramatic difference in the claim outcome.

      This training session will cover:

      Critical injury response elements at the time of injury
      The best ways to approach, and resolve, old dog claims
      Specific claim examples of turning around a difficult scenario
      Effectively using nurse case management
      The little things that make a big impact
      Coordinating appropriate medical treatment

      And more…


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        Specialty Course 4: Prescription Drugs

        How to Control Prescription Drug Costs, Avoid Abuse, and Deliver Pain Relief

        Prescription drugs are the fastest growing component of medical care, carry huge lifetime costs in the treatment of injured workers, and have a high propensity for addiction. When left unmanaged, employers/payers are vulnerable to abuse from both prescribers and patients which drastically increases costs and can cause devastation in the lives of injured workers’.

        In this training session, you will learn:

        - Proper utilization of your pharmacy benefit management company
        - How to customize your drug formulary
        - How to ensure unauthorized prescriptions are not being filled
        - Proactive drug management techniques to avoid overuse, abuse, and addiction
        - How to deliver the right prescription, at the right time, for the right cost to help the injured worker recover.
        - How to seamlessly integrate pharmacy management best practices into your work comp management program

        And more...


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          Specialty Course 5: Trade Secrets

          Critical Trade Secrets to Settle the Most Difficult Workers’ Comp Claims

          Bringing old dog, expensive claims to settlement can have a positive effect both on an employers workers' compensation program, as well as the life of the injured worker. In this session, you will learn the trade secrets to settling the most difficult and challenging workers' compensation claims.


          This session will cover:

          - Identifying and breaking down the biggest barriers to settlement
          - The first step in approaching a "lost cause" case
          - Coordinating risk manager, adjuster, plaintiff/defense attorney, and vendors
          - The most powerful asset to bring a case to successful conclusion
          - 3 case study examples: the challenges, the negotiation, and the resolution

          And more…


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            Specialty Course 6: Settlement

            The Process to Successfully Settle More Workers’ Comp Claims

            Successfully settling workers compensation claims can have a positive effect both on an employers workers' compensation program, as well as the life of the injured worker. However, often claims remain open unnecessarily for months or years because the stakeholders involved have been unable to create a win-win outcome for the injured worker and payer.

            In this session you will learn the process and system to consistently achieve successful settlements in workers' comp claims.

            In this training, you will learn to...

            - Identify Claims EARLY to Consider and Plan for Settlement
            - Build Out and Leverage an Effective Claim Settlement Team
            - Create and Consistently Follow A Settlement Process
            - Create a Win-Win Outcome for Each Injured Worker with a Customized Settlement Package

            And more...


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              Specialty Course 7: Audit

              How to Plan, Prepare, & Execute a Meaningful Work Comp Claim Audit

              You are likely sitting on a gold mine of data that can hold the secrets to dramatically reducing your workers' compensation costs and improving injured worker outcomes.  In this session you will learn from 22 years experience in planning, preparing, and executing meaningful workers' comp claim audits.

              This session will cover:

              - The biggest benefits to conducting a claim audit (hint: it's more than just the data)
              - Why most companies time their audits incorrectly, and how to do it right
              - The art of selecting which claims to audit
              - The 6 most important elements to review in each claim
              - Critical steps to take after completing the audit

              And more…


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                Bulletproof Investigation

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                Evidence-Based Medicine

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                Nurse Case Management

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                Injury Causation

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                Early Indicators

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                Rapport

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                Litigation

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                Catastrophic Claims

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                Prescription Drugs

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                Trade Secrets

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                Settlement

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                Audit

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