Workers Compensation Learning Institute

Welcome to ASBO's Workers Compensation Learning Institute  sponsored by CM Regent.  The WC Learning Institute is a work in progress that will feature examples of best practices, links to relevant articles and government agencies involved in workers compensation matters.  If you are interested in being involved in the WC Learning Institute and sharing your knowledge and expertise, please email Michael Borges at mborges@asbonewyork.org.

 

This tab contains links to relevant articles about workers compensation.

Education

How does employee empowerment improve workplace safety performance? Read more.

The WCB launches state-of-the-art virtual hearings. Injured workers and others can attend hearings remotely, avoiding travel burden. Read more.

People

The WCB provides vital oversight. Read the profiles of the eleven members. Read more.

 

This tab contains discussions and examples of best practices on a variety of workers comp topics ranging from work safety to health care and claims solutions.

Work Safety

Safety Reality Starting Points

Safety Has No Finish Line

Fundamentals And Safety Culture Framework

  1. Board Policy
  2. District Administration Accountability
  3. Senior Administration Commitment
  4. Safety Champion 
  5. Supervisors Commitment
  6. Employee Involvement
  7. Safety Steering Team 
  8. Standards, Activators And Consequences
  9. Communication
  10. Continuous Improvement Evaluation

Behavior-based Safety Elements

  1. Defining Critical Behaviors
  2. Metrics
  3. Recording Observations
  4. Data Mining
  5. Variations And Uses

Administrative And Engineering Controls

  1. Personnel Selection
  2. Hazard Identification
  3. Hazard Control
  4. Incident Analysis

Safety And Health Education And Training

Empowerment And Ongoing Engagement Practices

PESH Information And Compliance

NYS Safety, Loss Consultation And Incentive Programs

Topical References

Helpful Sources

Abbreviations And Glossary Of Terms

 

 

Return to Work

Return To Work Program Logic

The NYS WCB Return to Work Program Handbook

New Program Implementation Team

Seven Best Practices

Roles and Responsibilities

Return to Work Policy 

Steps of a Return to Work Program

Develop Individualized RTW Plans

Important Communication Guidelines

Properly Managing the Interplay Between RTW, ADA and FMLA

Evaluating the District’s Return to Work Program

 

Health Care

The healthcare industry is evolving rapidly, and the evolution encompasses everything from: pharma, drug pricing, technology disruptors, scope-of-practice advancements for physician assistants and nurse practitioners. Competition is increasing for convenient, faster, more-accessible options, with emphasis on community care, home care, retail clinic care and telemedicine, value-based care models and value-based reimbursements.

These are some of the important topics for school business officials to understand:

Behavioral health. Moving efforts to the front end of the claim is one of the significant changes that industry thought leaders believe would help chronic pain patients. Reductions in future costs will offset up front cost, the experts believe.

Case Management and U.R.

Chronic pain treatment. Experts expect a shift from fee-for-service to outcomes-based care. This would create a more holistic approach and integration of behavioral health.

Deep phenotyping, plus and array of psychosocial assessments, can determine the specific needs of each patient for targeted intervention and provide care beyond the one-size-fits-all approach.

Digital Health. Digital health is a broad term related to the use of technology and health that includes mobile health apps, telemedicine products, tools to track patient data, education and patient reminder programs.

Medical Provider Relations

Nurse Triage

Pharmacy Benefit Management

Precision medicine is an emerging field with great promise for treating injured workers with chronic pain.

Preferred Provider Organization

Spinal Surgery

Substance Impaired Workforce. Recreational marijuana is now legal in more states, with California becoming the largest; Congress may be prompted to take action on marijuana.

Technological advancements can deliver more and better treatment, New apps and videos can reinforce behavioral health techniques.

Telemedicine can keep patients better engaged.

Treatment Guidelines and Drug Formularies. New York is implementing new treatment guidelines or drug formularies; there has been positive trend in states adopting treatment guidelines and drug formularies.

 

Claims Solutions

Allocated Loss Adjustment Expenses

Attorney Fees

Bill Review

Case Management and Utilization Review

Claims Review

Communication with Injured Worker
Fact Sheet – Employee Rights

Diagnostic Testing Networks
When claim administrators (insurance carriers, self-insured employers and third party administrators) contract with legally and properly organized diagnostic testing networks, injured workers are required to obtain diagnostic examinations and tests from providers affiliated with the diagnostic testing network. More

Employee Claims Reporting

External Vendor Claims Management

Extra Territorial Issues

Fitness for Duty Exams

Independent Medical Exam Services

Injury Reporting Timeliness

Internal Claims Handling

Litigation Management

Loss Portfolio Transfer

Medical Provider Relations

Medicare Set-Aside Allocation

Nurse Triage

Pharmacy Benefit Management (PBM) Programs

Post Hire Medical Questionnaire

Preferred Provider Organization

Preferred Provider Organizations (PPO)

Second Injury Fund

Service Professional Selection

State Specific Networks

Supervisor Claims Reporting

Surveillance

Vocational Rehab

 

This tab contains links to a variety of state and federal agencies involved in WC matters.

Workers’ Compensation System Agencies

To understand the workers’ compensation system, district officials and employees must first understand the role and responsibilities of these six State agencies and two Federal agencies.

New York State Workers' Compensation Board
The Workers' Compensation Board (WCB), was established to administer the New York State Workers' Compensation Law (WCL). To learn more go to:
New York State Workers' Compensation Board

New York State Insurance Department
The NYS Insurance Department, is directly responsible for authorizing insurance companies to issue workers' compensation insurance policies and the premium methods and rates that can be used. To learn more go to:
New York State Insurance Department

Compensation Insurance Rating Board
The New York Compensation Insurance Rating Board (CIRB) is a nonprofit, unincorporated association of insurance carriers, including the State Insurance Fund. In conjunction with the WCL, the Insurance Law provides for the Superintendent of Insurance to designate a statistical organization to collect the loss, premium and payroll data from each carrier, summarize this information and develop an adequate rate structure. To learn more go to:
Compensation Insurance Rating Board (CIRB)

New York State Department of Labor
The Department of Labor develops the State's average weekly wage for purposes of computing maximum weekly workers' compensation benefits for accidents that occur. The Commissioner of Labor will also determine hardship safety net benefits for claimants that are over 80% disabled but have exhausted their benefit timeframe under the Reform Legislation for receiving Permanent Partial Disability payments. To learn more go to:
New York State Department of Labor

Public Employee Safety and Health Bureau
The Public Employee Safety and Health Bureau (PESH) was created in 1980 to give occupational safety and health protection to all public sector employees. As a unit within the NYS Dept. of Labor, Division of Occupational Safety and Health (DIOSH), it enforces safety and health standards promulgated under the United States Occupational Safety and Health Act and several state standards. To learn more go to:
Public Employee Safety and Health Bureau

PESH Explained

PESH "Essentials"

Fact Sheet - Employee Rights

State Insurance Fund
The State Insurance Fund (SIF) is a not-for-profit agency established in 1914 to provide a guaranteed source of workers' compensation insurance coverage at the lowest possible cost to employers within New York State. Despite its State agency status, SIF is a self-supporting insurance carrier that competes with private insurers. SIF must provide insurance to any employer seeking coverage, regardless of the employer's type of business, safety record or size. To learn more go to:
New York State Insurance Fund



Coming soon:

National Institute of Occupational Health and Safety

Center for Medicaid and Medicare Services


©2018 Church Mutual Insurance Company. All rights reserved. CM Regent Insurance Company is a registered trademark of Church Mutual Insurance Company. NAIC #12356.

This material may include only a general description of insurance coverages and does not include all terms, conditions, and limitations found in CM Regent Insurance Company (“CM Regent”) policies. The insurance policy, not any general descriptions of coverage that many be found in this material, will form the contract between the insured and CM Regent. Neither CM Regent nor its employees, representatives, or agents shall be liable to any party for the use of any information of statements made or contained herein.