WORK COMP 101
Presentation
What is Workers’ Compensation?
Provide income and medical benefits to injured employeesProvide a single, exclusive
remedyEncourage employer interest
in safety and promote accident investigations
The Way it Was…….Here is the story…..
Started in 1870 with organized laborEmployee had to sue to receive benefitsEmployee had to prove employer was at
faultIn 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 57Coverage begins on employees start
dateMedical coverage
Loss of wagesDeath Benefits
Restoration to pre-injury condition
Medical Benefits'Reasonable treatments from Panel approved
provider-first 90 daysPrescription coverageOut of pocket receipts for applicable
expensesSecond opinions on surgical cases may be
required and covered
$ Loss of Wages $1. You are not eligible for benefits until
after the 7 day grace period 2. Checks Calculate to 2/3 of
employees average weekly wage3. First check is issued within 21 days4. Partial disability benefits
Death & Dismemberment Death benefits are available to surviving
dependents Specific loss benefits are available for
amputations and disfigurement
Misconceptions of Workers Comp Coverage
Is not to be confused with:
I. WelfareII. Health InsuranceIII. UnemploymentIV. SSDV. Supplement income
plan
Does not pay time off to attend:
I. Physical TherapyII. Chiropractic visitsIII. Picking up
prescriptionsIV. Physician visits
Employer Responsibilities
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
Injured Workers Responsibility
1) Report your claim immediately to your supervisor or HR
2) If your not going to the ER, determine a panel approved physician(posted in your workplace) required 90 days min. treatment with panel provider
3) If referred by the ER Physician for follow up, seek an equivalent panel provider contact HR for updated list
4) Report your status and provide all medical documents to your supervisor or HR department on a frequent basis
5) Notify PComp of any changes
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 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 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!
Questions??
On-line claims reporting https://onlineclaims.pacounties.org PComp PO Box 60769
Harrisburg, PA 17106 Phone: (800) 895-9039
Fax: (888) 692-2368
CCAP Insurance Programs
Meet the Staff Claims Manager: Dave Harman Claim Adjusters: Marian Mark [email protected] Donna Lyter [email protected] Jon Buehler [email protected] Dianne Carman
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