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When Is A Claim Compensable – Each State Has Its Own Inputs

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Compensable Claims Are State Specific

An injury that meets the statutory qualification standard in a Workers Comp policy. It is the term used when an injured employee is qualified to receive workers compensation benefits. The term compensable also applies to work related illnesses.

Picture Of Supreme Court Compensable In USA
Wikimedia – Jeff Kubina

Each state generates its own level of compensability.  What may be compensable in Texas may not be in Ohio.  Workers Compensation rules and laws have a commonality among all states.   However, deeming a claim as payable or not is very state-specific.

This may turn on a dime when a  State Court of Appeals or Supreme Court hands down a major decision.  Workers comp adjusters make the compensability decision within a certain state-prescribed timespan after a thorough and complete investigation.

Once the decision is made on whether a claim is compensable or not, each state has very specific forms to inform all parties involved on the compensability decision.  Many insureds require a review of each large claim as to its compensability.   The requirement exists especially with a self insured that has a TPA adjusting its claims.

The dictionaries generically define it as entitling one to compensation.  The origin of the word comes from the French.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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