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CLAIMS MANAGEMENT 101

CLAIMS MANAGEMENT 101. A Team Effort AGENT – POLICYHOLDER- PINNACOL. Claims. KEY TERMS - BENEFITS. AWW TTD TPD PPD PTD. KEY TERMS - PROCESS. GA Rule 6 MMI FA DIME. PRE-ACCIDENT MANAGEMENT. Hiring practices Drug Screen Program Designated provider

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CLAIMS MANAGEMENT 101

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  1. CLAIMS MANAGEMENT 101 A Team Effort AGENT – POLICYHOLDER- PINNACOL

  2. Claims KEY TERMS - BENEFITS • AWW • TTD • TPD • PPD • PTD

  3. KEY TERMS - PROCESS • GA • Rule 6 • MMI • FA • DIME

  4. PRE-ACCIDENT MANAGEMENT • Hiring practices • Drug Screen Program • Designated provider • Supervisor education • Modified duty policy

  5. POST-ACCIDENT MANAGEMENT • Communicate with Pinnacol • Follow-up on medical appointments • Maintain relationship with employee • Document all information • Plan return-to-work options

  6. RED FLAGS • Recently hired • Poor relationship with employer • Attorney • Delayed medical progress • Prior claims

  7. MODIFIED DUTY • Temporary • Full or reduced hours • Full or reduced wages • Transitional

  8. RULE 6 PROCESS • Formal job offer • Job task letter • Certificate of service • Termination or modification of benefits

  9. AGENT - POLICYHOLDER- PINNACOL Together we can manage losses

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