Who is this book for?

For employers

For injured workers (claimants)

For medical providers

For the insurance companies

For administrators, adjudicators, legislators and attorneys

How will this book help me as the employer?

I believe employers may be the group that benefits the most from this book.

• As an employer you will discover how to manage the rising costs and see cost containment strategies inworkers’ comp insurance, and perhaps more importantly what you can do to change factors involving those costs.
• You will learn “specifically” what those factors are that effect your company’s premium rates, both positively and negatively.   Learn how to control EMODS.
• You will be informed why preventing injuries is the best course of action and how to accomplish that goal. But, when injury claims do happen, you will see what you can do and/or be sure that your insurance carrier does to “minimize” the effects of those claims on your premiums.
• The employer will learn what to do when fraud occurs with any participant involved in your company’s claims.
• You will be informed about the importance of having a work-comp specialist in your company to handle work-comp issues, no matter how small or large your company is.
• Information is discussed about the importance of caring for and following up with your company’s injured workers.
• You will receive valuable tips on the good things that employers should be doing. As well you will learn what activities are considered bad and/or ugly and the importance of not doing them. order book online back to top

How will this book help me as the injured worker (claimant)?
Although employers may benefit the most from this book, any one who finds themselves as an injured worker (called a claimant) will be a close 2nd and find some great “insider” tips on how to get through this unique system of insurance.

• Learn about the hows and whys of submitting the claim and why this is perhaps one of the most vital steps you can undertake.
• You will discover some inside tips on how to deal with the insurance company’s representative, mainly the claims adjuster.
• You can read about the so-called “red flags” that adjusters look for which may cause them to initiate a thorough investigation of your claim.
• Perhaps most importantly, you will see a summary of most of the benefits that you may be entitled to. Also, you will understand how they are calculated so that you can verify if they were done correctly. As well, when these benefits are due you.
• You will learn about what your options are when claims are denied and/or the insurance company seems to be stalling your benefits. order book online back to top

How as a medical provider will your book help me and our clinic?

As a medical clinic administrator at one point in my life, I understand how medical practitioners and medical clinics need good business management skills.

• Accordingly, medical providers will learn important ways to get billings paid more promptly by insurance companies. What key things they (and the administrative body of the state) require in order to pay your billings.
• Similarly you will see how to seek reconsideration and what to provide to the insurance carrier to facilitate payment of higher fees in unusual situations.
• There will be explanation about recourses you have if your billings are not paid within specified time frames or if reduction explanations are inadequate.
• You will also learn some of the important and necessary distinctions between general health care insurance and workers’ compensation insurance.
• There will be ample discussion raising the questions whether medical providers hinder or help the work-comp process.
• There will be information about what work-comp people call compensability and why it is so important to this specialized insurance. Also, you will learn why insurance adjusters ask the questions they do about specific injury facts and prior histories. order book online back to top

How can state administrators, adjudication departments, legislators and attorneys on both sides benefit from this book?

• It just might be beneficial to see how most insurance people (especially claims department people) view your roles in this complex business.
• There will be examples that challenge the current state of affairs, regarding whether adjudicators really use “fairness” and “equal consideration” in rendering decisions.
• You will be learn that truly, most insurance people do NOT want the blind lady holding the scale of justice to be swayed towards the insurance position on litigated issues. But accordingly they do not want the scales tipped in favor of the applicant either.
• Finally there will be suggestions regarding benefits, medical providers and litigation matters that hopefully might make the system function better and fairer to all parties. order book online back to top

How about insurance companies and adjusters, can they benefit from this book?

I certainly believe so. For myself or any other insurance personnel to assume that individually or as a company, that they are doing their absolute best would be erroneous and perhaps grievous.

• There will be suggestions, reminders and ideas about how we in the insurance business, especially in claims departments, should treat all the participants. We need to assume all claims are legitimate until valid facts and information support otherwise.
• As well, there will information about the need for prompt and proper delivery of benefits.
• There will be insider information about the pros and cons of being in the claims adjusting profession. What are the qualifications, training, education requirements and continuing need for training?
• For insurance companies some valid insights and information about the actual functions involved in claims management. Also provided will be insights from a claims professional of 25 years about claim loads, the philosophy of claims processing versus claims managing, and the qualifications of senior management having charge of claims functions. order book online back to top