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So far Alex Villalba has created 11 blog entries.

Determining Compensability in the Time of COVID: A Closer Look at Early Compensability Assessments

Low-cost, Expedient, Essential Since presumption laws related to COVID-19 vary by state, it's important for workers comp adjusters to know how to approach the clinical records and files to ensure accuracy in their claims. With legislation related to the virus and workers compensation changing every day, it can be difficult to appropriately determine compensability in workers comp claims with all the variables at play. This is why it's crucial that workers comp adjusters utilize a comprehensive Early Compensability Assessment (ECA) within the first 60 days of evaluating a workers comp claim to establish what the injury is and - more importantly - what it is not. ECA's can help adjusters determine early on in a claim what components of the reported injury are compensable and which items should be contested, saving time and money on treatments, surgical interventions and ongoing therapy. During an ECA, C³'s team of expert physicians - who specialize in various clinical fields - apply the standards of evidence-based medicine to determine what issues are a function of the event and those findings that have not been aggravated, exacerbated or otherwise compromised by the compensable event. C³'s early compensability assessments are proven to [...]

Determining Compensability in the Time of COVID: A Closer Look at Early Compensability Assessments2020-11-04T22:16:31+00:00

C³ Service Spotlight: Physician Pre-Authorization

Your Content Goes Here C³'s physician pre-authorization services rely on the expertise of medical specialists to answer specific questions related to utilization of care and claimant treatment plans in workers compensation claims. During the pre-authorization process, C³'s board-certified physician reviewers - who are specialized in various fields - provide medical, evidence-based determinations on clinical necessity and assess the appropriateness of the: Proposed treatment Level of care Length of stay Treatment setting C³ can complete preauthorization requests quickly and efficiently, giving adjusters the results they need in less time. With accurate, thorough reports and a fast turnaround, our low-cost pre-authorization services ensure that adjusters receive - in a timely manner - all the pertinent clinical information necessary to successfully adjudicate their workers comp claims. Watch below as C³ Director of Pre-Authorization Chelsie Merchen discusses the benefits and importance of utilizing this low-cost clinical service. Call us today to learn more about how C³'s physician pre-authorization services can save time and money on your next workers comp claim!

C³ Service Spotlight: Physician Pre-Authorization2020-10-26T19:11:00+00:00

Workers Compensation Continuing Education Topics: Seeking Contribution

When determining contribution for an injured worker, adjusters are faced with a slew of different questions and issues. What does the statute say? What does the appeals panel dictate? Seeking contribution can be a complex and often tedious undertaking, with countless requirements and hurdles that may complicate the adjudication process. In order to shed more light on this challenging concept, C³ CEO/Founder Donald A. Abrams, P.A. discusses the many facets of seeking contribution and how workers compensation adjusters can successfully navigate even their most difficult claims. Below is a C³ webinar recording on Seeking Contribution, hosted by Donald A. Abrams, P.A., which covers what the appeals panel says, what you need to do, what your doctor needs to do and, most importantly, what needs to be presented when determining contribution for an injured worker. ***For more information on C³'s continuing education program, or to schedule a complimentary CE course - which are available throughout the year for course credit - contact lderouen@comp-consultants.com.*** As a professional workers compensation cost containment and consulting firm with decades of combined experience in the work comp realm, C³ can offer insight and peace of mind on the topics that matter most [...]

Workers Compensation Continuing Education Topics: Seeking Contribution2020-10-02T18:07:01+00:00

C³ Continuing Education Courses Now Available Online

To help keep adjusters and TPA's educated and up-to-date on the workers compensation issues at hand, C³ founder and CEO Donald Abrams, P.A. hosts complimentary continuing education courses that cover a variety of workers compensation topics.  In light of the extended quarantine and unusual workplace circumstances, C³ now offers these CE courses online as live webinars. From ethics and file review to impairment ratings and seeking contribution, adjusters can earn course credits in multiple topics from an experienced workers compensation expert, all without ever leaving their desk! Here's a list of the current complimentary online CE course offerings from Clinical Compensation Consultants: For more information on C³'s complimentary CE courses, or to schedule an online course for you or your team, email lderouen@comp-consultants.com. Learn More

C³ Continuing Education Courses Now Available Online2020-09-22T22:00:08+00:00

Workers Comp in the Time of COVID: Industry news, important updates and the DWC’s Response to the Ongoing Pandemic

According to a recent release from Stone, Loughlin and Swanson LLP, there are many changes on the horizon for the workers comp industry due to the vicissitudes of the novel COVID-19 virus. From return to work procedures to designated doctor exams and presumption laws, this virus is affecting many areas of workers compensation claims and insurance professionals are working tirelessly to keep up with the constant changes. Here are a few noteworthy updates that are impacting the workers compensation industry today. Texas and COVID-19 Presumption in Workers Compensation Unlike several other states across the U.S., Texas has not enacted any workers compensation presumption rules. Besides the existing presumptions, the DWC has stated that workers compensation carriers should follow the typical rules regarding investigating and adjudicating claims. A number of groups in Texas have called for Governor Abbott and the city to adopt a workers compensation coverage presumption, including the Texas AFL-CIO, The Combined Law Enforcement Associations of Texas and local firefighters, who believe that COVID-19 claims should be covered under workers compensation based on Government Code Chapter 607, which provides that, for firefighters, peace officers, or EMTs who suffer from tuberculosis or other respiratory illnesses which have [...]

Workers Comp in the Time of COVID: Industry news, important updates and the DWC’s Response to the Ongoing Pandemic2020-08-26T22:24:56+00:00

COVID-19 Debate: Examining Common Myths about Wearing a Mask

From respiratory problems to just plain inconvenience, the never-ending debate about wearing a mask during the ongoing COVID-19 virus has many arguments on both sides. While some arguments can - and should - be considered, others seem to be somewhat lacking in accuracy. According to the healthcare experts at Medical News Today, here is a look at the most common myths about wearing a mask - and what to consider about each: Argument 1: Masks Do Not Protect the Wearer, Only Those Around Them This argument seems to cause the most dissent among the general public, since it would seem the only mask that is effective at protecting the wearer from the new Coronavirus. Even most mass-produced masks come with the disclaimer that they cannot prevent the wearer from contracting the new virus. While this may presumably make a case that masks are futile in this pandemic, public health organizations urge everyone to wear masks to protect those around them against airborne particles from asymptomatic patients or carriers of COVID-19. This is called source control and is proven to be an effective way to slow down the spread of a virus as well as reduce its numbers significantly [...]

COVID-19 Debate: Examining Common Myths about Wearing a Mask2020-07-29T19:46:45+00:00

Psych Claims in Workers Compensation: What to Know

The effects of COVID-19 have had a major impact on the way insurance claims and workers compensation cases are handled, but it's not just physical health that is a concern for the workforce. While the physical symptoms of this novel virus may fade, there may be lasting psychological damage that needs to be accounted for and treated. In a recent webinar hosted by the National Workers Compensation Defense Network, these psych claims are explored and analyzed more closely, revealing that not only is this virus a complex issue to navigate in workers compensation, but also the surrounding psychological components that arise as a result of it. Here are some major topics discussed that show these devastating effects. Psychiatric components to COVID-19 claims may be the longest lasting and can also create the most exposure in workers compensation claims. Whether it is fear of claims or a positive COVID-19 diagnosis, it can morph into psych issues very quickly. The lasting impact of psychiatric exposure can result in activation or worsening of pre-existing psychological issues. Even the stay at home orders have been mentally challenging  for most and increase exposure and risk of developing lasting psychological issues. Isolation has taken [...]

Psych Claims in Workers Compensation: What to Know2020-07-10T13:24:51+00:00

7 Work from Home Tips to Stay Healthy and Productive

After a recent spike in COVID-19 cases across the country, many states are going back under quarantine to prevent further outbreaks. For all those who have been working remotely during the quarantine, here are a few helpful tips inspired by The Muse to stay healthy and productive while you work from home during quarantine: Get Dressed With most people working from home, it seems like an exercise in futility to get dressed before hopping on the computer for the day. But getting dressed is a great way to signify to your body and mind that it's time to get to work! You don't have to don your full business-casual attire, but avoiding wearing pajamas all day during the work week can have a significant positive outcome on your morale and work ethic. Getting dressed signifies that you're out of bed and ready to start the day as productively and constructively as possible. Define a Clear Workspace or Home Office Most people are used to leaving their homes to go to work, which is a clear sign that you are separating work life from home life. But for those working remotely, it's important to delineate a physical work [...]

7 Work from Home Tips to Stay Healthy and Productive2020-06-18T19:51:06+00:00

Elective Procedures and the Post COVID-19 Surge: What Happens Next?

Now that the COVID-19 quarantine is gradually being lifted, many hospitals and insurance providers are resuming elective procedures that were postponed due to the virus. According to the experts at Healthcare Bluebook, a leading provider of transparency data, 37 states canceled elective procedures during the peak of COVID-19 to conserve beds and resources for infected patients, postponing approximately 30% of all elective procedures across the country. 80% of these procedures are expected to be completed this year. But at what cost?? "When the first wave of this pandemic is behind us, the pent-up patient demand for surgical and procedural care may be immense..." -American Society of Anesthesiologists and the Association of PeriOperative Registered Nurses In the wake of the COVID-19 pandemic, many insurers and hospitals will most likely try to recoup their financial losses without regard to appropriate treatment or costs to the employee. After resuming elective procedures, the main patient concern will be "How soon can I get in?" and providers seeking volume will reschedule as quickly as possible, regardless of price. This surge in elective procedures could lead not only to increased volume but also higher prices and premiums as insurers and providers attempt to recover from the COVID-19 [...]

Elective Procedures and the Post COVID-19 Surge: What Happens Next?2020-06-02T22:45:54+00:00

Reopen Texas Phase I

It's been a week since Governor Abbott announced the reopening of businesses in Texas, and the COVID-19 quarantine is gradually being lifted. State by state, industries are reopening and slowly recovering from the devastating effects of COVID-19. But what can we expect now that workers are returning to work amidst a pandemic? The U.S. unemployment rate has jumped from 3.5% in February to 4.4% in March.  In the four weeks preceding April 11, 22 million new unemployment claims were filed "In the case of active claims, many injured workers are experiencing delayed recovery due to the pandemic. Hospitals and clinics have halted non-essential surgeries and procedures to free up resources, conserve supplies for doctors treating COVID-19 patients and to prevent the spread of the virus. " As always, Clinical Compensation Consultants is ready to handle any workers compensation claims that you may have, even those related to COVID-19. Read more from NCCI on how COVID-19 has affected the workers compensation industry below: Read More

Reopen Texas Phase I2020-05-11T18:48:24+00:00
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