I want to present an actual case to you, where you can watch how, what on the surface should be a straightforward claim, can quickly morph into an expensive, compliance quagmire. This case was first presented to me by a client who has my HR Helpline service. I will outline the case to you and will the give you an opportunity to decide how you would handle it before I show how the case was resolved.
Work Comp expert witness reserve reviews premium audits for employers Call us today! The concept of case shifting instead of cost shifting was a very unique viewpoint. WCRI has surprised the Workers Comp community in the past with some of its concepts and follow up studies.
One of the more groundbreaking studies consisted of the WCRI actually contacting former injured employees to understand and analyze their viewpoints of the WC claims process.
In my humble opinion, this is not a concept to be taken lightly. The effects of the Affordable Care Act may not be known for 40 — 50 years as perfect hindsight will be available by that time. Under these plans, providers are paid a fixed insurance premium per insured regardless of the amount of care provided to a given patient during the year.
Under traditional fee-for-service insurance plans, providers are paid for each individual service rendered.
Case-shifting was more likely in states where a higher percentage of workers were covered by capitated group health plans. In a state where at least 22 percent of workers had capitated group health plans, the odds of a soft tissue case being called work-related were 31 percent higher if the patient was covered by such a plan compared with similar workers covered by fee-for-service group health plans.
By contrast, in states where capitation was less common, there was no case-shifting seen. This is more than just the result of having fewer capitated patients seeking care.
It also appears that when capitation was infrequent, the providers were less aware of the financial incentives. The database used is based on a large sample of health insurers and self-insured employers.
It includes individuals employed by mostly large employers and insured or administered by a variety of health plans.Read chapter 5 Case Studies Summary Chapter: The United States has long recognized and honored the service and sacrifices of its military and veterans.
This body of information is summarized in Annex at the end of this chapter, and the full case study series is in Appendix I. Radiation Exposure Compensation Act of ( ABUEG timberdesignmag.com DIEGO Such compensation has nothing to do. WORKMEN COMPENSATION ACT CASE STUDY METTUR THERMAL POWER STATION CASE-1 “Is Proceeding to work covered under the term ‘In The Course of5/5(2).
The most important factor in a successful resolution to any workers compensation claim is a timely return to work. With proper claims handling, your insurance company can make a big difference by identifying treatment options that. Integrating Compensation Strategies: A Holistic Approach to Compensation Design.
In this case study a company in a high-growth industry successfully used a new integrated incentive compensation program to satisfy strategic concerns and differentiate itself in the marketplace.
With the encouragement of Assurance, a manufacturing company located in Lake Geneva, Wisconsin decided to roll out a High Deductible Health Plan with a Health Savings Account (HSA), in addition to their Preferred Provider Organization Plan, for their employees.