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Erasing Uncertainty: How To Determine When To Deny And Fight A Workers Compensation Claim

Chasing perfect claims results can seem like chasing the wind, especially when it comes to making denial decisions. As Isaac Newton presented in his third law of motion, every action has an equal and opposite reaction, and deciding when to deny a claim is no exception.<br /><br />When initially evaluating claims, there are three general claims types encountered: the likely valid, the possibly valid, and the likely invalid. There is an art to analyzing and balancing these three types of claims and deciding which should be denied and fought. An initial analysis requires a grasp of the applicable legal standards and associated potential risks and exposure. Knowing up front how to navigate between types of claims, the applicable law, how much time to devote to a claim, when to hit a decision point, and when to deny and fight is essential to any claims-handling st




Measuring Success In Workers’ Comp

The adage says, “What gets measured gets managed.” What does that mean for workers’ compensation? What can we measure to truly improve outcomes for everyone in the workers’ compensation system, from injured workers, to employers, to insurers and others?
October 22, 2019 Workers' Compensation


Father-Daughter Workers’ Comp Fraud Scheme

Workers’ compensation fraud hurts everyone. It can cause premiums to go up, increase litigation, and burden the court system as well as the prosecutor’s office. However, that did not stop a Father-Daughter couple from engaging in a scheme to defraud an employer/carrier.
October 16, 2019 Workers' Compensation