Term Of The Day – Future Medicals
Workers comp future medicals demand accurate calculations from claims adjusters. The medical part of the total incurred and reserves requires many more calculations than the indemnity part of the reserves. Indemnity reserving possesses much more structure than any medical forecasting.
Each human body heals differently depending upon genetics, lifestyle, medication management, type of injury, and many more other factors. Adjusters should not just post a reserve that required very little thinking. Most insurance carriers and TPA’s provide the adjusters with very involved future medicals reserve sheets with a breakdown of medical costs. How adjusters use these sheets causes a large amount of debate in the insurance community.
Typically, employers are responsible for medical expense payment if associated with their employees’ on-the-job injuries. These medical benefits are often lifetime benefits (employers are generally on the hook for future meds for the injured employee’s lifetime as long as the medical expenses are related to the underlying job injury). In some states however,
the employee’s right to future meds can be terminated when the employee and employer agree to the terms and a judge or appropriate administrative authority approves the agreement