The Tennessee CWCE Curriculum
State legislated Workers Compensation requirements have existed for some 100 years. The Workers Compensation insurance system is based on a theory that neither the employer nor the employee is at fault in the event of an injury or death to a worker — a true no-fault system. Prior to Workers Compensation laws, an injured worker had to sue his employer for an “unsafe workplace” under common law to receive post-accident compensation or medical benefits.
This system of insurance has served the employee, employer, courts and the insurance industry well for many years.
Once you register you may begin your training immediately. Each month you will be released a new chapter and once you have successfully completed the first ten chapters, you will earned your CWCE. If you are not ready to start your training you may opt-in and we will open the link to the CWCE Introduction Video. We will periodically email you the CWCE Newsletter, segments of the training and Workers Compensation Tips.
The CWCE course has eighteen chapters. We will cover:
When a workplace injury occurs, the Workers Compensation insurance company promises to “pay all compensation and other benefits required of the employer by the state’s Workers Compensation law.” Workers Compensation is the simplest insuring agreement in the field of insurance to understand, but involves more parties than any other insurance policy; the injured worker, the employer, physicians, carrier, agent, claim adjuster, pharmacy, and many more.
It’s all here in Chapter One! Each CWCE designee will dive deep into this promise and review the most important components of a standard State of Tennessee Workers Compensation policy. Upon completion of this chapter, the designee will have knowledge of the most important Workers Compensation Policy Coverage Parts of Statutory Benefits, Employers Liability and the Territory of Coverage.
-Check out the Introduction video for Chapter One-
State-mandated coverage requirements have safeguarded the income and welfare for thousands of employees for nearly a century in Tennessee. This has not been without many questions, misunderstandings, and problems for all stakeholders.
Chapter Two is complete and the experts don’t miss anything about the Tennessee Workers Compensation coverage requirements. Each CWCE designee will learn the best way to know the rules of a state in which an employer operates by applying the “Who, What and When.”
• Who is and is not covered under a State of Tennessee Workers Compensation policy?
• What businesses, industries or organizations are exempt and which ones that are not exempt from purchasing Workers Compensation in Tennessee?
• When should an employer consider Workers Compensation if the law exempts the business from the “mandate” to secure coverage? When is an accident not covered? When does a business need to be cautious about employment status?
-Check out the Introduction video for Chapter Two-
The Workers Compensation insures an employer’s most important assets – the employees. In many circumstances it fulfills a State of Tennessee mandate. Reading an insurance policy requires patience, motivation and time that could be devoted to a number of other tasks. However, the time spent reading and understanding this vitally important document is very much worth the effort.
Chapter Three is extensive. We will cover, what to spot in the policy, the two coverage parts – Statutory Coverage and Common Law Coverage, policyholder’s duties post-accident, information about how premiums are calculated. Additionally, we will go deep into the Tennessee Workers Compensation Policy that is made up of Eight Sections.
-Check out the Introduction video for Chapter Three-
Insurance companies rely on selecting enough policyholders and charging the policyholders an adequate premium for coverage to maintain a sustainable company to pay losses and earn a fair profit. When a Workers Compensation insurance policy is issued, the insurance company issues the policy with an “estimated premium” based upon many different factors.
In Chapter Four, we study the computation of premium and how to budget the cost of insurance affects the cost of operations. We review how to factor the premium into every job, sale, development, business plan, salary, or wage – just like rent, taxes or materials. We look at:
• how an insurance company arrives at a final premium;
• what an employer should do to get any “deserved” discounts; and
• the unique exceptions in calculating premiums in Tennessee.
-Check out the Introduction video for Chapter Four-
There is no substitute for good dialogue between a business owner and an insurance agent. Businesses need to avoid setbacks, keep employees safe, help employees avoid injuries, and evaluate proper insurance coverage with an insurance agent. The policyholder must have confidence in the insurance company’s financial stability and in the agent’s knowledge and integrity. The insurance company underwriters must trust that they have complete and factual information from the agent about the business’ operations, loss runs, and the policyholder’s ability to control claims.
Agents and insurers expect an insured to maintain complete and accurate payroll information for all employees, to use only subcontractors that maintain proper State of Tennessee Workers Compensation, and to be financially responsible to remit all premiums when due. To purchase or renew insurance coverage can be confusing, expensive, and challenging for new or existing business owners. Choosing the right carrier and agent can be as important as hiring the right employees.
Chapter Five is information-packed! We will cover the importance of working with a competent insurance agent, overcoming the concerns caused by workers in multiple jurisdictions and how to work with an insurance agent to get the best policy.
-Check out the Introduction video for Chapter Five-
Today more than ever, a company’s reputation and performance are virtually indistinguishable from its people. Improper hiring procedures will levy unnecessary costs to all stakeholders. Systematic, careful hiring procedures protect an organization’s integrity, reduce workplace turnover, misconduct and injuries. Ultimately, the pre-hiring process is an investment in a company’s service offerings, value proposition, and bottom-line profits — an investment with measurable returns.
A Tennessee employer should devise a methodical approach to their hiring process and follow this consistently with every hiring event. Establishing a standard protocol ensures that the company is taking every reasonable effort to avoid costly mistakes, decrease risk and comply with Federal laws, as well as prevent cost directly associated with Workers Compensation claims.
Many insurance professionals believe that understanding an exact hiring process is an “automatic;” but it is not. Executing proper hiring processes are not an inherent skill; it is a learned skill. Often people do not consider the implications of the hiring process and the selection of employees in Workers Compensation success, but it is primary to the success. Instead, most in the industry focus on just a small segment of the administration of the Workers Compensation system such as reducing accidents through managing unsafe acts or conditions.
Chapter Six, covers the steps to create the correct hiring process – placing the right employees in the right positions – at the right time. This Step-by-Step – Thirteen Step System is custom for the State of Tennessee employer. We uncover little known practices that are a must for any Human Resource Department Manager.
-Check out the Introduction video for Chapter Six-
Post offer pre placement is the one chance the employer can make sure the job candidate is qualified for the job and make any changes to the employment agreement. There are only certain things that an employer may ask a prospective employee, but it is incumbent upon the employer to learn the additional responsibilities or face problems in many areas – particularly in Workers Compensation.
Chapter Seven is packed with details. We continue to cover the steps in the exact hiring process. The Post Offer includes the use of an ADA compliant Medical History Questionnaire, State of Tennessee Previous Injury Registry, Drug Testing, background checks and then the selection of the employee. Once the employee has “passed,” the proper set up files and a checklist will be covered.
-Check out the Introduction video for Chapter Seven-
Employers have to follow rules in the hiring process or face consequences from legal actions or the negative effect on the Workers Compensation program. An employer should understand the direct link between selecting qualified employees that may safely perform their duties and Workers Compensation.
A step often missed by employers is training the employee as to what is expected of him or her. The employer must emphasize the safety standards and the what, how and why the job is to be performed. The employer can never take for granted that the employee will understand what is expected unless it is written down and signed off on by each employee. If it is not written and signed, it is as though it never happened.
Chapter Eight is thorough. Designees will learn the specific steps to train the new employee how to safely perform their duties, the documentation needed to be immediately completed once the employee is hired, how to perform an employee orientation and training program, how to promote reporting unsafe acts or conditions, implementing a cross-training program, how to teach the employees how Workers Compensation benefits work and the expectation of the early return to work program.
-Check out the Introduction video for Chapter Eight-
Being prepared for a work injury is the most critical but yet overlooked process for both employers and their insurance carriers. There are fifteen crucial items that if put in practice will reduce the cost of injuries and possibly eliminate a work injury.
The Claims Executive is the employee charged with making sure that all steps are implemented. Having a process in place will provide both efficiency and safety for all stakeholders.
Chapter Nine is one of the most comprehensive chapters as we introduce many topics that should be implemented prior to an injury. All stakeholders will be able to prepare and take a proactive part of the process.
-Check out the Introduction video for Chapter Nine-
It has happened. A worker is injured. The CWCE designee will have implemented the items laid out in the preceding chapters and this will be implementation of the process. Regardless if you have or have not put the pre injury processes into effect, this chapter will walk the designee through the proper response to an injury.
The response to the injury will include not only what the Workers Compensation policy mandates after an injury (the policyholder’s obligations post accident), but what to do to control costs after an accident occurs. The chapter will define the proper reporting of an injury from the employee to the employer and then from the employer to the insurance carrier and beyond.
The concluding part of the chapter will explore what injuries are to be reported to the Tennessee Occupational Safety and Health Administration (TOSHA). This is just the beginning of the post injury and cost containment processes.
-Check out the Introduction video for Chapter Ten-
The insurance industry has its own language from actuaries to adjusters and acronyms to calculations. The designee will be able to understand what goes into the Loss Run calculation, including the calculation of the reserves. We go through a proven step-by-step system to calculate the claim costs.
We will show the claim cost of a broken ankle injury for a prepared employer and the same injury for an employer with no plan through the use of a Reserve Worksheet; the same formulated worksheet that a Tennessee Claims Adjuster uses. Utilization and understanding of the Reserve Worksheet as an effective tool to enable the Claims Executive to communicate with the stakeholders to develop a true and accurate cost of a claim. This tool will be utilized to progress old claims that have stalled in the claims process.
Chapter Ten content plugs the missing piece, especially for a Tennessee employer with reserves. The practical methods will show example after example how to communicate effectively with all stakeholders to bring claims to a final conclusion in the most effective manner.
-Check out the Introduction video for Chapter Eleven-
The CWCE designee will recognize that just turning the claim over to the Insurance Carrier or Third Party Administrator is not the end of the claim. Cost Containment measures can be taken by the employer or by the insurance carrier – but neither can effectively do so without working as a team. Yes, Workers Compensation is a TEAM effort.
Chapter Twelve is a complete package and includes:
• Nurse Case Management utilization;
• Return to Work programs and methods;
• Permanent Partial Impairment Ratings verification methods;
• Medical Tourism;
• Independent Medical Review programs;
• Pharmacy Benefit Management programs;
• State Fee Schedule reductions; and
• PPO networks versus negotiated discounts.
-Check out the Introduction video for Chapter Twelve-
There is more misunderstanding on the calculation of benefits by all stakeholders than any other specific subject in Workers Compensation. From the Authorized Treating Physician not knowing the effects of not attributing factors directly related to the injury in setting the PPI rating to the employee/employer not understanding the calculation and why similar type injuries can vary in costs with just a few differences.
Chapter Thirteen breaks the settlement process down into a simple step-by-step process. Once the designee completes this chapter, he or she will be able to complete a Reserve Worksheet and be able to communicate easily with a Claims Adjuster. But we don’t stop there…
We review multiple claim examples; some with prepared employers and employees and compare the results of the same type injury when no one is prepared. The comparative results are astounding – commanding a vast 1,000% spread in claim cost! This chapter will not only prove our entire program but also, motivate all stakeholders to execute a plan.
-Check out the Introduction video for Chapter Thirteen-
Despite the glamour of court as played out in the media, in reality there are very few true winners in litigation. From the time it consumes to the relationships that are forever severed, it is not the recommended first place to try to resolve differences. However, there are always situations that can only be resolved through litigation. For Workers Compensation Cases in the State of Tennessee, for injuries occurring on or after July 1, 2014, the venue will be The Tennessee Court of Workers Compensation.
Chapter Fourteen explores this new and exciting court system for the State of Tennessee. This system is laid out to be very responsive and quick to resolve issues while keeping focused on treating the injured employee. We will present defenses that are available along with current case law of recent litigation. By understanding what defenses are available is the first step in prevailing or avoiding litigation.
In addition we will analyze the settlement of a Permanent Partial Disability claim, review what factors will lead a Court of Workers Compensation Judge to award a Permanent Total Disability Claim and the potential costs associated with this type of award. In this same realm we will break down the Death and Dependent Survivors Benefits.
A designee will view the settlement of Future Medical cost as well as the impact of Medicare Set Asides and eliminate the mysteries even the most seasoned professionals have. By reviewing the history of the Medicare Secondary Payers Act and the Center for Medicare Services Memos will shed light on the purpose and consequences of this very important topic.
-Check out the Introduction video for Chapter Fourteen-
Hiring subcontractors is not quite as detailed as hiring employees, it is not an easy task though if done right. From an insurance perspective, dealing with subcontractors is one of the most misunderstood subjects particularly when the subcontractors do not maintain Workers Compensation or when they have a propensity to periodically cancel their insurance coverage.
There are many concerns to consider, but in Tennessee, our government leaders have thought through these challenges and have created an up-to-date system to address many of the concerns. There is very little room for misunderstandings; except for those who may be uninformed.
The volatility of the exposure and hazards of using subcontractors creates uncertainty for the insurance companies and thus drives the cost of insurance and/or the availability of the best insurance programs, Loss Cost Multipliers and net rates. If a program is properly structured, insurance coverage monitoring and subcontracts in place, using subcontractors does not have to become a problem.
Chapter Fifteen will lay to rest any misunderstandings, reduce the exposure as well as the cost when using subcontractors. Details of the most effective risk transfer programs and contractual issues to consider are revealed. We will reveal methods to confirm that coverage is in effect for subcontractors as well as new methods to promptly become aware when a subcontractor drops insurance. There are some unique Workers Compensation laws for a Tennessee contractor – all will be simplified and each designee will be ready to sub out work.
-Check out the Introduction video for Chapter Fifteen-
Many towns across Tennessee are near navigable waterways and tributaries. These waterways can negatively affect an employer’s proper coverage even if the employee is near the waterway. This chapter is chocked full of examples of how and when the employer needs to extend this important coverage to a State of Tennessee Workers Compensation policy. These coverages include the United States and Longshore and Harbor Workers (USL&H) coverage form and companion coverage forms.
-Check out the Introduction video for Chapter Sixteen-
Each week, we all hear stories of tragic workplace injuries. Many of these injuries or deaths could have been avoided by the employer properly training or the employee following rules or policies and procedures.
Each designee will be taught how to structure a Job Hazard Analysis and a Job Safety Analysis. This is of particular interest in Tennessee because many injuries sustained while failing to use a safety device are not compensable. In this chapter we underscore the necessity to train employees properly and hold them accountable.
-Check out the Introduction video for Chapter Seventeen-
Predicting the exact amount of payroll is difficult in most cases; therefore Workers Compensation insurance companies will need to reconcile with their policyholder as to the exact amount of payroll by classification code.
This reconciliation process is called an “audit.” In most cases, until the audit is complete, premiums paid during the policy term will not be exact. In this chapter we show how to be prepared and keep up-to-date records for an audit. Each designee will learn how to properly budget around the variable cost of payroll by using our Complete Audit Package developed especially for the CWCE designee.
-Check out the Introduction video for Chapter Eighteen-