WORK COMP 101 Presentation

The Way it Was……. Here is the story…..

Started in 1870 with organized labor Employee had to sue to receive benefits Employee had to prove employer was at fault In 1915 case law was enacted to protect the injured worker: Resulting in the employee no longer having to sue for qualified benefits Benefits, when qualified, are paid according to the new law

Benefits under Act 57 Coverage begins on employees start date Medical coverage Loss of wages Death Benefits Restoration to pre-injury condition

Medical Benefits' Reasonable treatments from Panel approved provider-first 90 days Prescription coverage Out of pocket receipts for applicable expenses Second opinions on surgical cases may be required and covered

$ Loss of Wages $ 1.You are not eligible for benefits until after the 7 day grace period 2.Checks Calculate to 2/3 of employees average weekly wage 3.First check is issued within 21 days 4. Partial disability benefits

Death & Dismemberment  Death benefits are available to surviving dependents  Specific loss benefits are available for amputations and disfigurement

Misconceptions of Workers Comp Coverage Is not to be confused with: I.Welfare II.Health Insurance III.Unemployment IV.SSD V.Supplement income plan Does not pay time off to attend: I.Physical Therapy II.Chiropractic visits III.Picking up prescriptions IV.Physician visits

Employer Responsibilities

Timely reporting of a claim to PComp from the County or C.R.E. thru RISKMASTER Loss time status notification is important Providing guidance to injured employee’s with panel provider assistance If the injured employee changes status notify PComp of the change when information is discovered When requested for wage loss calculations, please respond in a timely fashion to ensure employee’s are paid within the guidelines of the Workers Compensation Act Notify PComp when an injured employee has returned to work; full or modified duty

Injured Workers Responsibility

1)Report your claim immediately to your supervisor or HR 2)If your not going to the ER, determine a panel approved physician(posted in your workplace) required 90 days min. treatment with panel provider 3)If referred by the ER Physician for follow up, seek an equivalent panel provider contact HR for updated list 4)Report your status and provide all medical documents to your supervisor or HR department on a frequent basis 5)Notify PComp of any changes

PComp’s Claims process Claim is received by PComp from the County or C.R.E. thru RISKMASTER The claim is investigated by an assigned adjuster Adjuster has 21 days to accept or deny the claim after the notice is received Confirm the employee is treating with a panel provider for the first 90 days For additional support a Nurse Case Manager may be assigned when needed

Investigation process The first 48 hours-adjuster makes three point contact Identify the injury and its relationship to the accident description Collect key written statements from all parties involved which can include recorded statements and witness interviews If the claim is not accepted the adjuster will notify in writing and/or advising employee of their rights

Claim Discretion Employees information shared between the supervisors and adjusters is private Family members of the employee are not substitutes for direct communication and information should not be shared with them concerning the claim-HIPPA Remember this is your claim!

Questions??

On-line claims reporting PComp PO Box Harrisburg, PA Phone: (800) Fax: (888) CCAP Insurance Programs

Meet the Staff Claims Manager: Dave Harman Claim Adjusters: Marian Mark Donna Lyter Jon Buehler Dianne Carman