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Include Future Medical in the Settlement

While many claims settle with the payment of statutory benefits, there are other claims needing further consideration, for instance in those states where the medical portion of the claim cannot be closed. The adjuster then needs to evaluate possible future medical exposure, taking steps to conclude it when the disability claim is settled, even if it involves payment for estimated future medical expense.


In most states, if the medical portion of a claim is not settled, the employee has the right to unlimited future medical coverage. For example, if the employee has a disability rating to the lumbar spine, by leaving medical open, you may be paying chiropractor bills for the rest of the employee's life, or worse, for a surgery -- related or not to the workers comp claim. 


Most plaintiff attorneys want to resolve the future medical, especially if they are entitled to a portion of the medical settlement in their fee. 


A tactic commonly used by plaintiff attorneys is to overstate the value of future medical. Your medical director must review any estimate of future medicals over a predetermined limit set by your risk management department.


Often, it will be necessary for the medical director to consult with both the treating physician and IME doctor to determine what is necessary and what is not in the plaintiff attorney's future medical estimate.


Once the medical director establishes the need for future medical care, the adjuster and/or defense attorney holds fast to the amount, even if it means adjudicating that aspect of the claim with the Workers Compensation Board.



The more red flags the employer sees on a claim, the higher the probability the claim is fraudulent. Use this sample claim to find potential fraud.

One claim's loss is another claim's treasure. The financial data in a loss run is a treasure trove of information the employer can use to reduce future work comp premiums. 

Medicare's preferred method to protect their interests is to include a Medicare Set-Aside Allocation (MSA) as part of the settlement. Read it.

Allegations, including asking his customers to pay him in cash, get an Ohio worker in hot water. How did surveillance and a tip help catch workers comp fraud?

Should California pass a law requiring companies to demonstrate adherence to safety standards in order to be eligible to bid for state contract?

An inadequate safety program buries a mechanic beneath 70 tons of rock, and this is not the first fatality. The Canadian Press reports.

The 2013 edition has many exciting revisions including Standard Defenses, Claim Leakage, FECA (by Managed Care Advisors), Opioid Abuse control Measures, Wellness, Drug Testing Policies, Control Techniques, Structured Settlements, Physical Therapy Management, Social Media and Workplace Monitoring Fraud Controls and much more.  PRICE SAME AS in 2012.

 "Understanding the Urgency for Reducing Unnecessary Medical Care and Costs" February 27-28, 2013 Cambridge, This problem is addressed in the context of the larger fiscal and political challenges faced in workers compensation.  
RIMS '13 will introduce new products, establish your presence in the marketplace, reinforce relationships with existing clients,
and discover new clients from your target audience-all
for a great value-all at RIMS '13. 
SEAK is the sponsor of the largest and most highly regarded national workers' compensation and occupational medicine conference. SEAK's Workers' Compensation and Occupational Medicine Conference was first held in 1980 and takes place each July on Cape Cod. 
New summaries for "drug testing and workers compensation state laws" for every jurisdiction are NOW posted on our website. Click on the link above to check it out.
REDUCE WC COST 20% to 50%
Workers Compensation Management Program
Learn more about our book on
for employers.
Article Library

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Adjuster Should Not Do

Inside Scoop - Six Things that Annoy Claim Adjusters

Every Workers Comp Claim has a FIRST Week. . . Learn Why It Is So Important

Five Practical Ways to Reduce Medicare
Set Asides (MSA)

Lowering Workers Comp Costs for Employers

Rebecca Shafer, Attorney & Risk Consultant

Contact Us: Becki@ReduceYourWorkersComp.com

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