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News

The latest news articles from WHO, and around Australia.

Latest News

Auto Casualty’s Next Move: Optimizing Billing Review for Auto Injury Claims

The auto insurance industry’s fierce price competition is forcing rapid change. Auto insurance carriers who aren’t leveraging new technology and ideas to gain efficiency are losing the price war, and in turn, market share. For decades, these carriers have faced – and attempted to combat – rising medical costs. The traditional method of negotiating and […] Read More

Observations in Workers’ Comp

As the workers’ compensation industry emerges from (learns to live with?) COVID-19, stakeholders are finding many of the same pharmaceutical issues we thought we left behind in 2019. In many states, opioids, compounds, topicals, and poorly controlled drug costs are back on the radar. Among the questions accompanying them is “to formulary or not to […] Read More

The Utilization Review Process and the Origins of Medical Necessity in Workers’ Compensation

The Scenario: George, a 47-year-old male, injured his back at work two days ago putting a box on a shelf. He is seeing his primary care physician for the first time. George’s physical assessment revealed low back pain with tenderness upon palpation. No leg pain or numbness. He has no confounding factors. The primary physician […] Read More

Exploring the Impact of COVID-19 on Tort Liability in Workers’ Compensation

How long can the grand bargain of workers’ compensation survive if my quid starts to outweigh your quo? That’s the question some California stakeholders are posing in the face of a wrongful death lawsuit currently winding through the state’s courts. The case presents a novel question of tort immunity for a workers’ comp community still […] Read More

ODG Helpdesk Tip: Three Steps to Help Optimize Return to Work (RTW)

Quite often, stakeholders managing various aspects of workers’ compensation claims spend countless hours each day trying to do what is best for injured workers. However, knowing what is best can be elusive. Typically, claim managers focus on: Ensuring state government forms are filed in a timely manner Making three-point contacts and related calls as scheduled […] Read More

ODG Helpdesk Tip: The Difference Between Duration Values at the Diagnosis Vs. Claim Level

One of the most frequently asked questions at the ODG Helpdesk is: “How do I find duration values for a diagnosis, and how does it differ between diagnosis vs. claim level when managing return-to-work (RTW)?” An example of determining the difference can be found below. Let’s use ICD-10 Code S33.5 for this example. As the […] Read More

Optimizing Care and Reducing the Costs of City Government Workers’ Compensation Programs

In 2015, the City of Fort Worth, Texas, had 6,250 employees and calculated total workers’ compensation costs, claims plus indemnity payments, at $9.7 million. The city leadership sought more effective ways to reduce workers’ compensation costs and still help employees received the appropriate care to support quality outcomes and return to work. However, before the city […] Read More

Evidence-Based Medicine for Improved Outcomes

The ever-growing list of new federal, state, and local leave mandates has made administrative functions more crucial than ever to the effective operation of integrated absence management (IAM) programs. However, we sometimes let Health Insurance Portability and Accountability Act (HIPAA) constraints intimidate us into relinquishing medical case management. When we do this, we are forfeiting […] Read More

Employers Can Leverage Clinicians to Support Their ADA Compliance Efforts

While compliance with the Americans with Disabilities Act (ADA) is generally assigned to human resources (HR), employers can use the help of clinicians to build programs that facilitate ADA compliance. The ADA went into effect in 1990, with major amendments effective January 2009 to expand the definition of disability. Title I of the ADA obligates […] Read More

Targeting Clinical Support to Improve Outcomes

At the beginning of a claim, it can be difficult to know if or when referring to a case manager would be helpful. Having a case manager at the beginning of every claim would seem valuable, but it would dramatically increase overall costs, stretch limited resources too thin, and might fail to focus on critical […] Read More

A Case for Evidence-Based Medicine in Workers’ Compensation

Long before Tiger King clawed out his fifteen minutes of fame, there was Clark Stanley, a.k.a. the “Rattlesnake King.” Stanley, a silver-tongued Texan born in 1854, found fame and fortune in the late 1800s with “Clark Stanley’s Snake Oil Liniment.” He sold his salve across the country as a cure for “pain, lameness, rheumatism, neuralgia, […] Read More

Supervisor Follow-up and Positive Work Environment Help Avoid a Disability Mindset

We have all seen cases involving a “simple” back sprain claim that we don’t pay much attention to, only to find ourselves with the claim remaining open a few years later with no sign of the claimant ever returning to preinjury functional level. What is the difference between this claim and a similar one that […] Read More