ch 5 care

Card Set Information

ch 5 care
2011-09-20 16:21:03
workers comp

Managed Care in Worker's comp
Show Answers:

  1. Managed Care
    Includes any technique for containing injury costs, like HMO and PPO
  2. Retrospective Management
    Technique to evaluate necessity, frequency and costs of treatments. Investigates medical care that has already been given
  3. Prospective Management
    Investigation of what medical treatment will be received by the claimant using preadmisson testing/certification and fee arrangements
  4. Direct Intervention
    Medical treatments are monitored and recorded as they happen using IMEs, disability management, proactive case management, etc.
  5. Bodily injury claims
    Damage elements to consider: medical expense amount, type/extent of injury, wage loss, pain and suffering/loss of enjoyment, disability/disfigurement, preexisting conditions
  6. Individiual case method
    Adjusters evaluate the settlement value based on all of the circumstances of the claim and their experience in similar cases. Preferred technique for serious injuries.
  7. Roundtable technique
    Claim file is evaluated by 2 or more claim professionals, each suggesting a settlement range. Consensus should be reached or averaged. Not appropriate for minor claims because how time-consuming it is.
  8. Formula Method
    Mathematical formula is used to set reserves. Used widely with soft tissue injuries and other minor to moderate injury claims.