As part of the WorkSAFE Webinar series, we recently hosted a seminar titled, “Advanced Work Comp: Understanding the Settlement Phase”* presented by Lynn Peoples, Missouri Employers Mutual claims field service manager, and Laura Sides Cooper, MEM senior litigation attorney.
Not able to tune in? You can also view the recording of the event here:
Here are a few takeaways and best practices we covered.
What is the role of the policyholder?
- Report the claim as soon as possible
- Maintain communication and contact with the injured employee
- It’s important to note: once an injured worker retains an attorney, the insurance company cannot have contact with the employee.
What are the steps necessary to help manage litigation?
- Continue ongoing communication with the injured employee
- Communicate changes and activity with the insurance carrier’s claim department
- Help gather information in the investigative process
- Provide timely and accurate 13-week wage statements (the law requires it, and that time frame allows the insurer to calculate an accurate weekly wage statement)
- Forward all legal correspondence to the carrier’s claims staff
- It’s important to note: in Missouri, the employer decides the physician the injured worker sees, not the insurance provider. Work comp is a unique area of medical practice and sometimes requires special expertise for optimal results.
Key terms involved in the settlement process
- MMI (Maximum Medical Improvement): a term used when the treating doctor releases an employee from treatment indicating they have offered all necessary treatment and reached the end of healing
- AWW: Average Weekly Wage
- TTD: Temporary Total Disability, based on employee’s 13-week wage rate
- PPD: Permanent Partial Disability, based on employee’s 13-week wage rate
- IME: Independent Medical Exam, an Alternate Medical Opinion
- Prevailing Factor: the law states an injury must be the prevailing factor. Defined as “the primary factor, in relation to any other factor, causing both the resulting medical condition and disability.”
- Reporting and Managing Claims FAQs
- Warning Signs of Work Comp Fraud
- Virtual Claims Kit
- Injury Management Kit
- Injury Reporting Forms
*Disclaimer: This information is not considered official legal advice. Each work comp case is different and must be considered on its own merits. You should seek professional legal counsel when legal issues arise.
Interested in further training? Contact us.