Your Ultimate Guide to Mastering Workers Comp Costs: Reduce Costs 20% to 50%

The #1 training manual that covers how to assess your workers' compensation program, design the most cost-impacting strategy, roll out comprehensive changes to your organization, and monitor and manage the program going forward.

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2014 Edition
ISBN: 9780978897383
In Stock
Best value
2014 Edition
ISBN: 9780978897383
In Stock
Best value
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“When a workers' compensation maven of Rebecca Shafer's caliber shares her expertise about implementing cost containment best practices, industry professionals can't afford to do anything but listen. Likewise, now that Shafer has released the latest edition of Your Ultimate Guide to Mastering Workers' Comp Costs: Reduce Costs 20% to 50%, risk managers, adjusters, vendors, attorneys, agents and brokers, carriers, and employers can't afford to do anything but purchase the book and start reading. ”  
Karen C. Yotis, Esq., author of the website Straight Talk on Insurance at

The #1 training manual that covers how to assess your workers' compensation program, design the most cost-impacting strategy, roll out comprehensive changes to your organization, and monitor and manage the program going forward.

The book is based on hands-on experience with industry leaders who have developed programs that reduce workers comp costs 20% - 50% for employers in every industry. The author, Rebecca Shafer, has worked directly with large and small organizations developing practical, cost effective solutions to out of control workers' compensation costs.

This guidebook provides simple to advanced strategies — everything an employer "CAN DO" to reduce costs — an EMPOWERING experience. Learn now with 19 chapters - over 180 pages of cost reduction strategies and techniques.

Chapters include:
•   Workers' Compensation Basics
•   Fundamentals of Cost Containment
•   Training and Building Commitment
•   Injury Management Best Practice Roles and Responsibilities
•   Reporting the Claim
•   Post-Injury Response Procedure
•   Communication with Employees
•   Working with Insurance Companies or Claim Administrators
•   Safety and Loss Control
•   Wellness Programs
•   Return to Work and Transitional Duty
•   Other Indemnity Cost Containment Services
•   Directing Medical Care
•   Medical Cost Containment
•   Fighting Fraud and Abuse
•   Rehabilitating the Injured Employee
•   Managing Prescription Drug Use and Abuse Program
•   Claims Resolution and Settlements

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Table of contents

Chapter 1: Workers’ Compensation Insurance Basics

Purpose of Workers’ Compensation

Who Pays for Workers’ Compensation

Parties Involved in Workers’ Compensation

Benefits for the Employer

Independent Contractors

Benefits for the Employee

Injuries Covered

Determining Compensability

Aggravation vs Exacerbation

Standard Defenses

Types of Workers’ Compensation Insurance

How Losses Are Categorized

How Losses Are Reported

Reducing Your Premium

Calculating Your Premium

How Mod Affects Your Premium

Good/Bad Mod Examples

Ways to Reduce Your Mod

Unit Statistical Date

Types of Insurance Structures

Voluntary Markets

Alternatives to Voluntary Markets

Collateral Requirements

Chapter 2: Fundamentals of Cost Containment

Reasons Workers’ Compensation Costs Are High

Who Is in Charge

Work Ability Form Properties

Who Is Responsible for Managing Workers’ Compensation Claims

Who Is Responsible for Managing Workers’ Compensation Process

Hidden (Indirect) Costs of Workers’ Compensation

Additional Costs

Calculating Workers’ Compensation Costs

External Obstacles to Cost Control

Internal Obstacles to Cost Control

Chapter 3: Training and Building Commitment

Implementing a Workers’ Compensation Program

Key Training Responsibilities

Management Awareness

Presenting to Supervisors

Conflicting Roles of Supervisors

Supervisors Must Be Involved

Develop Supervisor Guide

Building on Success

Consider Use of Tools

Bringing Employees on Board

Your Company Message

Workers’ Compensation Implementation Timetable

Facilitator’s Training Agenda

Chapter 4: Injury Management Best Practices Roles and Responsibilities

Injury Coordinator Best Practices

Supervisor Best Practices

Employee Best Practices

Middle Manager Best Practices

Risk Manager Best Practices

Medical Department and Medical Director Best Practices

Senior Management Best Practices

Special Investigation Unit Director Best Practices

Legal Department Best Practices

Chapter 5: Reporting the Claim

Immediately Report All Losses

Critical Issues

Reporting Procedure

Intake Procedures

Essential Intake Considerations

Injury Triage

Employer’s First Report of Injury

What Is Included on the FROI

Completing the FROI


Chapter 6: Post-Injury Response Procedure

Post-Injury Response Procedure Guidelines

Benefits of a Consistent Post-Injury Response

Post-Injury Response Worksheet

Implementing Post-Injury Response on the Road

Sample Post-Injury Response Procedure

Summary Steps and Format

Chapter 7: Communication with Employees

Proactive Communication

Reactive Communication

Keep Complete Record

Two Types of Communication

Employee Brochure

Meeting with Your Employee

First Day Phone Call

Weekly Contact

Weekly Meeting Guidelines

Scheduling Weekly Meetings

Reducing Attorney Involvement

Chapter 8: Working with Your Insurance Adjusters or TPA

Claims Adjusters

What Is a TPA

Adjuster File Assignments

Dedicated vs Designated Claims Units

Bundled and Unbundled Services

Deductible vs Control

How to Select a TPA

Learning About Your Claim Partners

Preparing for the TPA Visit

Meeting with Your Claims Handler

Chairside Visits

Doing a National Rollout

Vendor Day

Account Handling Instructions

Reviewing Open Claims with the TPA

Reserving Practices

Information Needed to Establish Reserves

Reserve Calculation Worksheets

Reasons Reserves Are Higher Than Expected

Verifying Reserves Accuracy

Plan of Action (POA)

How to Evaluate a TPA

Medical Management Quality Review

Quality Control File Audit

File Reviews and File Audits

Audit Timing

File Review Procedures

File Audit Procedures

File Audit Participants

MD Participation

How to Control Leakage

What Is Leakage

Types of Leakage

Causes of Leakage

Leakage Claim Audits

Leakage Identification Checklist

Chapter 9: Safety and Loss Control

How to Develop an Effective Safety Program

Initial Assessment

Assignment of Roles and Responsibilities

Record Keeping

What OSHA Requires

Select Safety Committee, Chairman, and Recording Secretary

Safety Committee Responsibilities

Safety Committee Meetings

Communication Methods

Conduct a Thorough Workplace Assessment

Hazard Correction/Safety Work Order Tracking System

Develop Written Policies, Procedures, and Programs

Accident Investigation Program

Education and Training: Employees, Supervisors, and Managers

Who Receives Training

Safety Equipment Required Signs

Communicate Safety Often

Safety Awareness Posters

Safe Days Posters

Safety Recognition and Incentive Programs

Employee Screening

Hiring Safe Employees

Job Analysis

Screening Tools

Chapter 10: Wellness Programs

Wellness in the Workplace

Benefits of Wellness Programs

Incentives for Wellness

Negative Effects of NOT Having a Wellness Program

Types of Wellness Programs

Weight Control

Smoking Cessation Programs

Depression/Anxiety Awareness Treatment

Migraine Headache Management

Substance Abuse Treatment

Drug, Alcohol, and Substance Abuse Policy

Drug, Alcohol, and Substance Abuse Testing

Putting Wellness Programs into Practice

Chapter 11: Return to Work and Transitional Duty

Cost Savings

Measuring Effective of Return-to-Work Programs

Transitional Duty Policy Overview


Program Goals

Drafting a Transitional Duty Policy

What to Include in a Transitional Duty Policy

Characteristics of Transitional Duty Assignments

Transitional Duty Program Pay Rate

Estimating the Duration of an Injury

Medical Treatment Guidelines

Medical Treatment and Comorbid Conditions

Using Medical Treatment Guidelines

Using Injury Treatment Guidelines to Estimate Cost Savings

Types of Transitional Duty

Modified Duty

Alternate Work

Alternative Off-Site Jobs

Non-Profit, Volunteer, or Charitable Positions

Transitional Duty Tips

Putting Return-to-Work into Action

How to Identify Transitional Duty Jobs

Employees Who Never Return to Work

Overlapping Benefits

Americans with Disabilities Act (ADA) Key Points

Coordinating Workers’ Compensation with Federal and State Leave Statutes

Workers’ Compensation, ADA, and FMLA Interactions

Case Study

Working with Unions

Chapter 12: Other Indemnity Cost Containment Methods

Work Hardening

Independent Medical Evaluations (IME)

Before the IME

Customize Medical Inquiries

Timeframes for Scheduling and Obtaining IME

Functional Capacity Evaluations (FCE)

Retraining Programs

Telephonic Disability Intervention

Translation Services

Transportation Services

Layoff Planning

Chapter 13: Directing Medical Care

Gain Cooperation from Medical Providers

Types of Doctors

Remote Health Services

Methods of Doctor Selection

If the Employer Can Direct Care

If the Employer Cannot Direct Care

Ten Considerations for Your Company Doctor

Eleven Reasons NOT to Select a Doctor

The PRIMARY Treating Physician (PTP)

Understand the PTP’s Perspective

Information You Need from the Doctor

Understanding KEY Medical Injury Terms

California Medical Provider Network (MPN)

Chapter 14: Medical Cost Containment

Medical Cost Containment Services

Utilization Review Accreditation Commission Certification

Preferred Provider Organizations

Injury Triage

Telephonic Nurse Case Management (NCM)

Field Case Management (FCM)

Mental Health Registered Nurses

Chronic Pain Programs

An Aging Workforce

Medical Review

Medical Advisors and Medical Directors

Independent Medical Evaluation (IME)

Durable Medical Equipment (DME)

At-Home Recovery Services

Medical Bill Review

Medical Fee Schedules

Usual and Customary

Hospital Bill Reviews

Using a Diagnosis Related Groups (DRG) Review Company

Cost Savings Using DRG

Medical and Hospital Bill Review Considerations

Chiropractic Care

Chapter 15: Fighting Fraud and Abuse

When to Investigate a Claim

Types of Investigation

Red Flags of Fraud

Medical Terminology Used to Identify Malingering

Important Times to Use Surveillance

How to Use the Results

When Not to Use Investigation

Reviewing Investigation Reports and Videos

Avoid "Good Day/Bad Day" Syndrome

Additional Fraud Controls

Chapter 16: Rehabilitating the Injured Employee

What Is Physical Therapy

What Is Physical Rehabilitation

What is Occupational Therapy

What is Vocational Rehabilitation

Provider Differences

Physical Therapy

Physical Therapy Management

Determining Rehabilitation Needs

Reasons for Physical Therapy

Measuring Outcomes

Doctor’s Reevaluation

Determining Therapy Outcomes

Physical Therapy Settings

Physical Therapy Office Characteristics

Physical Therapy Cost

Physical Rehabilitation

Physical Rehabilitation Networks and Specialties

Medical Assessments

Cost of Physical Rehabilitation

Physical Rehabilitation Facilities

Measuring Physical Rehabilitation Outcomes

Occupational Therapy

Occupational Therapy Management

Role of the Occupational Therapist

Use Occupational Therapy When

Vocational Rehabilitation

Use Vocational Rehabilitation When

Managing the Vocational Rehabilitation Process

Chapter 17: Managing Prescription Drug Use and Abuse

Pharmacy Benefits Managers

Reasons to Use Pharmacy Benefits Management

Prospective and Retrospective Components

Proactive Drug Management Techniques

Authorized Drug Formulary

Narcotics for Pain Control

Cognitive Behavior Therapy

Pharmacogenetics Testing

Addiction Networks

Reviewing Your Program

Key Selection Criteria for a PBM

Prescription Drug Monitoring Programs

Toxicology Screening

Implementing the Program

Chapter 18: Claims Resolution and Settlements

When and How to Settle a Workers’ Compensation Claim

Action Plan

Disability Rated Losses

Disability Scheduled Losses

Jurisdictional Issues

Local Influences

Include Future Medical in the Settlement

Selecting Physicians to Obtain a Fair Disability/Permanency Rating

Challenging Impairment Ratings

Medical Issues

Disputed Issues

Offsets Against Other Payments

Social Security Disability Benefit Offsets

Social Security Reverse Offsets

States With Reverse Offset

Prior Injury Offsets


Pre-existing Conditions and Second Injury Funds

Availability of Future Employment in the Marketplace

Voluntary Resignations

Strengths and Weaknesses of Both Sides


Waivers and Releases

Include Medicare in Release

Medicare Set-Asides

Conditional Payment and Final Demand

Pharmacy Component of Medicare Set-Asides

Structured Settlements and Annuities

Structured Settlement Benefits

Structured Settlement Vendor Selection Criteria

California Settlement Process

Chapter 19: Federal Employees Compensation Act

Federal Employees and Workers’ Compensation

Paying for FECA Costs

Administering FECA Claims

Selection of Medical Providers

Medical Benefits

Lost Wages Federal Employees Receive

Permanent Disability or Death

Registering as a Federal Medical Provider

Challenges in Controlling Costs

Traditional Cost Control Techniques

Independent Medical Examinations

Cost Containment Vendors and Services

Gaining Management Commitment

Return-to-Work Programs

Federal Employees Return-to-Work: Transitional Work (before Maximum Medical Improvement)

Defining and Determining Maximum Medical Improvement

Transitional Duty Work and Assignment

Transitional Duty Barriers Checklist

Role of the DOL in Transitional Work

Federal Employees Return-to-Work: Alternative Work (after Maximum Medical Improvement)

Alternative Employment

Vocational Rehabilitation and Retraining

Difference Between an Impairment and a Disability

Appendix A: Glossary of Abbreviations

Appendix B: Documents Referenced in Book