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Workers' Compensation Reserve Management Symposium
This one-day symposium will assist the Claims Professional in appropriately reserving cases through reliable and proven techniques. In addition, the speakers associated with this symposium will be from the Members' region and will address state-specific statutory requirements that govern workers' compensation benefits in all fifty-state jurisdictions, as well as the federal jurisdiction, which ultimately affect the proper reserve needed for a specific case. The presentation will include case studies of burn injuries and six other common workplace injuries: low back pain, failed back syndrome, loss of hearing, burns, inguinal hernia and closed fracture of the foot vs. a fracture requiring open reduction of the foot. Experienced workers' compensation practitioners, attorneys, physicians, and other experts will provide practical advice and effective techniques to evaluate the financial exposure of workers' compensation reserves.

This one-day symposium will address:

  • Identifying the need for a reserve in any given case
  • Realistically establishing a reserve that will cover the legal financial obligation of the company
  • Application of medical and claims guidelines to effectively reserve a case
  • Medical healing periods as they relate to properly setting reserves
  • Medical terminology
  • Practical "how-to" strategies for setting reserves
  • Jurisdictional obligations to set reserves

 

TIME TOPIC
 
8:45 AM to 9:00 AM Welcome/Opening Remarks
 
9:00 AM to 9:45 AM Purpose and Approaches to Reserving and Self-Insured Reserving
The Claims Professional will be presented with the philosophical and business/financial reasons for case reserving. Three different approaches to establishing reserve funds will be presented (Probable Ultimate Exposure, Stair-Stepping and Worst Case Scenario).
 
9:45 AM to 10:45 AM Statutory & Non-Statutory Requirements Effecting Indemnity & Medical Reserving
Statutory requirements for reserving in specific states with varying state requirements will be discussed. Statutory benefits requirements will be discussed in detail. Benefits such as Temporary Total Disability, Permanent Total Disability, schedule awards, death benefits, cost of living adjustments and the average weekly wage will be discussed in detail. The necessity of a medical inflation factor in the reserve process will also be discussed.
 
10: 45 AM to 11:00 AM Morning Break
 
11:00 AM to 12:15 PM Medical Terminology and Anatomy
Common medical terminology, anatomy and selected diagnosis to facilitate the determination of the financial severity of a particular injury will be presented. Selected injury types will be discussed in detail with attention given to parts of the body that are most commonly affected by a work-place injury.
 
12:15 PM to 1:15 PM Lunch
 
1:15 PM to 2:00 PM Continuation of Medical Terminology and Anatomy
Medical suffixes and prefixes that will assist the workers' compensation professional in understanding diagnosis and prognosis will be discussed. In addition, it will provide an introduction to the American Medical Association Guide to the Evaluation of Permanent Impairment, fourth edition or latest version. The AMA Guide covers the methodology of assessing permanent impairments.
 
2:00 PM to 2:30 PM Guidelines for Medical and Indemnity Reserving for Various Diagnosis and Occupational Diseases
The current medical literature concerning the healing periods and treatment protocols for various types of injuries and occupational diseases will be presented. Assessment of factors, which enhance or prolong the healing process of an injured worker, will be presented.
 
2:30 PM to 3:15 PM Reserve Case Studies
Participants will review reserve case studies involving selected medical conditions. Each group will evaluate individual case studies to determine what reserve to set. After the participants have finished with their reserve analysis, each group will discuss how and why they arrived at the reserves they posted for each of the given scenarios.
 
3:15 PM to 3:30 PM Afternoon Break
 
3:30 PM to 4:15 PM Recapitulation Workshop: Non-Life vs. Lifetime Benefits
Participants review critical factors that could determine whether a specific case is a lifetime case vs. a non-lifetime case. An overall summary of the reserve analysis will be presented. The factors that drive the medical cost and the inflationary component of the medical benefits under workers' compensation will be addressed. Summarization of death case attributes that are needed to determine eligibility and the critical documentation necessary to document the file will be discussed. This presentation will conclude with the importance of early excess reporting.
 
4:15 PM to 4:45 PM Questions and Closing Remarks