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WORK COMP 101 Presentation. What is Workers’ Compensation?. Provide income and medical benefits to injured employees Provide a single, exclusive remedy Encourage employer interest in safety and promote accident investigations. The Way it Was……. Here is the story….

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Presentation Transcript
slide2

What is Workers’ Compensation?

  • Provide income and medical benefits to injured employees
  • Provide a single, exclusive remedy
  • Encourage employer interest in safety and promote accident investigations
slide4

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
Benefits under Act 57
  • Coverage begins on employees start date
  • Medical coverage
  • Loss of wages
  • Death Benefits
  • Restoration to pre-injury condition
medical benefits
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
$ Loss of Wages $
  • You are not eligible for benefits until after the 7 day grace period
  • Checks Calculate to 2/3 of employees average weekly wage
  • First check is issued within 21 days

4. Partial disability benefits

death dismemberment
Death & Dismemberment
  • Death benefits are available to surviving dependents
  • Specific loss benefits are available for amputations and disfigurement
misconceptions of workers comp coverage
Misconceptions of Workers CompCoverage
  • Is not to be confused with:
  • Welfare
  • Health Insurance
  • Unemployment
  • SSD
  • Supplement income plan
  • Does not pay time off to attend:
  • Physical Therapy
  • Chiropractic visits
  • Picking up prescriptions
  • Physician visits
slide11

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

slide13

Report your claim immediately to your supervisor or HR

If your not going to the ER, determine a panel approved physician(posted in your workplace) required 90 days min. treatment with panel provider

If referred by the ER Physician for follow up, seek an equivalent panel provider contact HR for updated list

Report your status and provide all medical documents to your supervisor or HR department on a frequent basis

Notify PComp of any changes

pcomp s claims process
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
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
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!

ccap insurance programs
CCAP Insurance Programs
  • On-line claims reporting
  • https://onlineclaims.pacounties.org PComp PO Box 60769

Harrisburg, PA 17106

Phone: (800) 895-9039

Fax: (888) 692-2368

meet the staff
Meet the Staff

ClaimsManager: Dave Harman

Claim Adjusters:

Marian Mark mmark@pacounties.org

Donna Lyter dlyter@pacounties.org

Jon Buehler jbuehler@pacounties.org

Dianne Carman dcarman@pacounties.org