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  • Adjuster Law I: Contracts
    This course discusses the basics of contract law. In this module, you'll learn the elements of a contract that must be present for a contract to be binding; Hold Harmless Agreements and how they impact the parties involved and their exposure to liability in a claim; and Indemnity Agreements, their impact on claims, and the difference between Indemnity Agreements and Hold Harmless Agreements.
  • Adjuster Law II: Torts
    This course, Adjuster Law II, focuses on torts, proximate cause, negligence and negligence laws, tort defenses and damages.

    After completing this lesson, you will be able to identify a tort and its causes; determine the proximate cause of a tort; recognize negligence by one of the parties to an accident, which has resulted in an injury to another party; explain the different negligence laws applied in the various states; recognize possible tort defenses that can be raised to defend the insured; and explain the principle of damages and how it relates to the tort.
  • Adjuster Law III: Civil Law
    As an adjuster you will frequently have to work with civil law to understand the financial responsibilities in the claims process.
    This is the third course in a series of three.
    In this course, after completing this lesson, you will be able to analyze evidence; explain bailment and an agency relationship; identify a non-commercial joint venture; recognize an independent contractor and their relationship to the principal; apply land laws; and apply statutes of limitations, while recognzing that they vary by state.
  • Advanced Investigation I
    In this module, the adjuster will learn how to investigate complicated and serious injury claims. The objectives of this first module are to help the adjuster in the investigation and evaluation of coverage, compensability under the statutes, accident causation, and the correct preservation of evidence.
  • Advanced Investigation II
    In this module, you will learn how to confirm and evaluate the care that an injured worker is receiving in order to encourage the worker's recovery and return to work. This includes both the worker's medical care and the circumstances surrounding his or her disability. This module will also cover how to handle catastrophic injury or death claims, and discuss the various aspects of workers compensation fraud, malingering and psychogenic injury.

    After completing this lesson, you'll be able to confirm and evaluate an injured worker's medical care and progress; confirm and evaluate an injured worker's permanent partial or total disability; deal with a catastrophically or fatally injured worker; recognize and handle occupational disease claims; and determine whether a worker is being entirely honest about the injury.
  • Basics of Risk Management
    Risk management is the culmination of all the risk sciences: underwriting, medical and scientific studies, engineering, pre- and post-loss control, loss financing, contractual transfer and similar factors that assist in the management of pure risk.

    This course will explain the basics of risk that must be assessed and managed by anyone in the risk science arena, from data management and interpretation to law. Understanding the basics of risk management is a process separate and apart from related fields such as insurance policy management or claim adjusting, but they are a major part of the risk management process.
  • Contracts and Construction Contractor Claims
    The objective of this module is for you to gain a better understanding of contractual relationships that affect commercial liability and workers compensation claims. Before taking this module, you should have already taken the modules on basic liability claim handling. This advanced course module will begin by reviewing the basics of legal contracts, then exploring various types of contracts that shift liability from one party to another. One party naming another party as an additional insured on a liability policy often accompanies transfers.

    Many complex claims involve the relationships between general contractors and subcontractors relating to various types of construction.
    These claims often involve injuries to employees, damages to the public, or product and completed operation issues. Adjusters must understand these factors in terms of the policy and the contracts.
    In addition, the use of what are called wrap-up programs, in states where such programs are permitted, will be discussed.
  • Diagnostic Tests Used in Workers Compensation Claims
    As an adjuster, you will need to determine when certain diagnostic procedures are warranted and how to determine which test is appropriate. You will also need to read the physician's notes and review test results to understand the condition of the individual following an injury or illness.

    After completing this lesson you will be able to recognize the difference between x-rays, CT scans, and MRI's; explain the use of EMG and NCS to determine nerve and muscle damage; and identify the difference between objective and physical signs as documented in physician records.
  • Disabilities and Scheduled Injuries
    In this module on Disabilities and Scheduled Injuries, you will learn about various types of disabilities that arise from injuries and occupational diseases, the degree of seriousness of each type, and how indemnity benefits are calculated.

    Occupational injuries come in all sizes, from very minor to fatalities. The rules for handling these claims are somewhat different in each jurisdiction.
    You will learn what information is needed, what kind of assistance is available in handling these claims, and how claim disputes are handled.
  • Employers Liability & Employment Practices
    Employers can have claims made against them by current or former employees in a variety of ways. Both Employers Liability claims and Employment Practices Liability claims involve some sort of injury, but it is not always a "bodily"? injury. The objectives of this module include the differentiation between Workers Compensation claims and either Employers Liability or Employment Practices Liability claims; explaining the insurance coverage for Employers Liability and Employment Practices Liability claims; identifying the kinds of claims covered or excluded under these coverages; and identifying the state and federal laws that affect and control these claims; as well as recognizing class action lawsuits.

    As a prerequisite to this module, it is recommended that you complete the NCCI Workers Compensation policy module before beginning this one since that policy will be referenced here.
  • Federal Workers Compensation Coverage
    In this module, we will focus on federal workers compensation programs that you may encounter in your claim handling. Many of these coverages supersede state workers compensation laws, and can be endorsed onto the standard NCCI Workers Compensation Policy form. Therefore, it is recommended that you complete the modules on the NCCI Workers Compensation Policy, and Advanced Workers Compensation before taking this module.

    Objectives of this module include understanding the differences between state and federal programs that involve employees of the U.S. Government, military base contractors, men and women subject to maritime and navigable waters legislation, railroad employees and other federal compensation programs.
  • Insurance Fraud Awareness
    This course is intended to introduce adjusters to insurance fraud factors so that there will be greater awareness of fraud and what to do when it occurs. The course includes discussion of various types of insurance fraud, state fraud laws, and other agencies that deal with fraud. The course describes the numerous indicators of possible fraud as well as advising what actions are required by adjusters when potential fraud is suspected and how to conduct or utilize field investigation of a potentially fraudulent situation.

    The approximate times to complete the module is one hour. Please keep in mind that times may vary as people learn at their own pace.
  • Introduction to Evidence Based Medicine
    Evidence-Based Medicine remains a relatively young discipline whose positive impacts are just beginning to be validated as it continues to evolve.
    In compliance with the Utilization Review Accreditation Commission (URAC) Standards, case managers, utilization management reviewers, and peer advisors access EBM for three reasons: first, to determine diagnosis-specific Return to Work (RTW) durations; second, to review treatment guideline; third, to compare, discuss, and document consistency or discrepancies between Evidence-Based Medicine and the treating providers information. In this lesson, you will learn what Evidence-Based Medicine (EBM) is, and what it is not; describe the benefits of EBM in case management practices; list the benefits of EBM for case managers and providers; and document the review of EBM in case documentation.
  • Introduction to Litigation Management
    It is your job to manage legal expenses. After completing this lesson you will be able to recognize your role in the litigation process.
    You will be able to strategize with defense counsel, request written legal reports and budgets, and effectively manage the discovery process by obtaining reports, advising defense counsel of reporting guidelines and receiving and discussing interrogatories and depositions.
    Finally, you will be able to determine the requirements for outside legal research requested by defense counsel.
  • Introduction to Workers Compensation
    This course outlines some of the basic rules and components of worker's compensation.

    Intro to Worker's Compensation describes the various types of worker's compensation coverage and defines what constitutes a worker's compensation injury. It lists the disability benefits provided under worker's compensation law and describes the difference between disability and impairment.
  • Legal Liability
    This lesson on Legal Liability will outline the basic principles of liability insurance.
    After completing this lesson, you will be able to define the various principles surrounding legal liability; recognize the difference between criminal and civil law; understand the meaning of tort and list the elements of negligent liability. You will also be able to identify defense concepts and understand liability coverage.
  • Legal Nurse Consultant
    The legal nurse consultant has a significant role in each case assigned. The analysis and recommendations may form a pivotal part of the case plan and the case defense. In this module we will describe the role and responsibilities of the legal nurse consultant and outline the three basic reasons files are referred for medical consulting. An overview of the referral process will also be described.
  • Medical Aspects of Claims I
    This is one of two courses on medical aspects of casualty claim adjusting. Either module may be studied first. In this module you will learn about the various types of insurance claims where injuries occur.
    The objective of this module is to give you an overview of state and federal medical record privacy law requirements, explain how to procure a patient's medical records and other information, and how best to review and understand those records and the information they contain. The final objective of this module is to learn why, when and how to arrange and conduct an effective Independent Medical Examination, commonly known as an "IME."
  • Medical Aspects of Claims II
    If you receive a medical report stating that the subject has "a depressed fracture of the left tibia," you must understand what this means in terms of prognosis for recovery and the necessary treatment. The objectives of this module are to learn about the parts of the body and injuries to them that are frequently encountered in claims, their diagnosis and treatment.

    After completing this second module on the medical aspects of claims, you will be able to relate the human anatomy that may be involved in injuries or related illnesses, describe the common types of injuries to the body, and interpret the physician's diagnosis, prognosis and treatment of the injuries or illnesses.
  • Medical Conditions in Workers Compensation Claims
    As an adjuster you will be reviewing medical treatment and evaluating proposed medical treatment for various types of medical conditions associated with workers compensation claims.

    After completing this lesson, you will be able to describe various conditions associated with a workers compensation claim; to recognize the appropriate course of treatment; and to determine the estimated length of disability resulting from various medical conditions.
  • Medical Injuries in Workers Compensation Claims
    As an adjuster you will be reviewing medical treatment and evaluating proposed medical treatment for various types of injuries.
    The goal of this module is for you to be able to describe various conditions resulting from an injury; recognize the appropriate course of treatment; and determine the estimated length of disability resulting from an injury.
  • Medical Records Analysis
    This lesson, Medical Record Analysis, will discuss the techniques for completing a medical record analysis and will outline the steps involved in the process. It will also covery identifying fraud indicators including missing, altered, or fabricated records.
  • Medical Records
    In this lesson on Medical Records, you will learn how to request medical records, what is necessary to request them, and how to determine which information in each report will assist you in the handling of the claim.
    We'll review the most common reports and how they are typically formatted.
  • Negotiating for Workers Compensation
    Nearly everyone understands that adjusters negotiate settlements. But not everyone understands the negotiation process.

    After completing this course, you will be able to understand negotiation, what it is and what it is not. You will be able to identify why we negotiate, and reasons why we fear to engage in negotiation. You will understand that the negotiation process starts well before the final bargaining stage of claim handling. That knowledge should allow you to set and maintain the proper climate for successful negotiation. You will be able to successfully identify your own negotiating style and the styles of those with whom you negotiate and understand how that can benefit you in the final bargaining phase. You will build a negotiation plan which, if followed will help you succeed in negotiations. Finally you will be able to identify and employ negotiation tactics and strategies to help you reach win-win negotiation settlements.
  • Physician Consultants
    In this lesson you will learn the process for referring a case to a physician consultant. You will be able to describe the function of the physician consultant as it relates to the liability case. In addition, you will be able to prepare pertinent questions to forward to the medical expert.
  • Professional Liability for Healthcare I
    This module on Professional Liability for Healthcare Professionals will define the components of risk management; will provide an explanation of how the company handles risk, will identify hazards leading to a loss, and will define your role in the risk management process.
  • Professional Liability for Healthcare II
    In this second module on Professional Liability for Healthcare Professionals, you will learn to identify causes of professional liability, define specific areas of exposure, define the term "professional liability," explain how to prevent lawsuits, describe the responsibilities of each employee and describe the financial impact of a loss to the company.
  • Reports, Research, Closure
    In performing medical consulting work, the Legal Nurse Consultant will frequently be asked to review cases containing medical conditions that will require additional research due to the complexity of the case.

    The Legal Nurse Consultant may need additional information on medical conditions to assist in confirming relationships to an accident; may need to obtain information on the etiology of medical conditions, treatment process and duration of disability; may need information regarding appropriateness of care to confirm medication used as related to an injury; or may need to do research in order to provide information to the adjuster and/or attorney to serve as background review material or to define medical terminology used for reader and reviewer.

    This course will discuss research options, how to submit a comprehensive well-written report, how to develop appropriate questions, and how to follow guidelines to close cases.
  • Reserves & Evaluation
    In this module the adjuster will learn about the various types of reserves and how they are used by insurers and insureds. For any claim to be successfully concluded, it must be properly evaluated and negotiated, based on the information produced during the investigation. But both of these processes rely heavily on the adjuster's having set proper reserves. There are various types of Workers Compensation reserves, and in this module the adjuster will learn about each, and will understand why accurate reserves are paramount in importance in claim handling.
  • Second Injury Fund
    In this course, you will learn what a Second Injury Fund is, why such funds were created, and how to make use of the funds in the handling of Workers Compensation claims.
    When properly utilized, these state legislated funds can save employers and their insurers millions of dollars while providing jobs for already disabled employees who might otherwise be unable to find work.
  • Self Funded/Self Insured Claims
    The difference between methods of financing risk must be clearly understood by adjusters. All entities, including individuals, businesses, governmental agencies or institutions, must both control and finance their risks. Managing the perils that cause loss and damage requires a balance between risk control and risk financing. This module will explore various methods of both, along with the basic requirements of insurability, factors involved in a "pure self-insurance" program and the differences between handling of self-insured or self-funded claims under a policy of insurance.

    In this module you will learn about the basics of risk management including risk financing and the principles involved in self-insurance and self-funding. The objectives include recognizing and identifying:

      • The differences between risk control and risk financing

      • The various methods of risk financing

      • The basic requirements of insurability

      • The key elements in "pure self-insurance"

      • The factors involved in the handling of self-insured or self-funded claims.
  • Serious Injuries/Wrongful Death Claims
    In this module on serious injuries, wrongful death actions and fatalities, the objectives of this module are to understand the ramifications of coverage in such claims and avoid the pitfalls of bad faith claim handling. The sections will include dealing with serious injuries, understanding state wrongful death statutes, how to investigate and evaluate a death claim, and how to deal with multiple death and injury claims. Occupational fatalities and death claims under other insurance coverages will also be discussed.
  • Settlements
    In this course the various aspects of preparing to negotiate a claim will be explored, along with the "art" as well as the "science" of negotiating with an attorney or unrepresented claimant. Various ways of concluding claims will also be discussed to include the use of structured settlements in death or catastrophic injury cases.
    This lesson will also explore the documents needed to conclude the claim, and how to deal with claims that require a hearing, including "stipulations" or admissions filed with the board.
  • Short Term and Long Term Disability Benefits
    This lesson is designed to define short and long term disability benefits and to explain the differences between own occupation and any occupation. It will describe the importance of clarifying the goal of case management and match short and long term needs for appropriate actions or recommendations for the case management plan.
  • State Fraud Laws
    This module is intended to introduce consultants to insurance fraud factors so that there will be greater awareness of fraud and what the adjuster needs to do when it occurs.
    The course includes discussion of various types of insurance fraud, state fraud laws, other agencies that deal with fraud, and the numerous indicators of possible fraud. This course will also advise what actions are required by adjusters when potential fraud is suspected and how to conduct or utilize field investigation of a potentially fraudulent situation.
  • Subrogation
    In this module, you will learn about the laws that permit assignment of interests from insured to the insurer, and how subrogation is managed.
    This module will also explore how a right of subrogation granted in the policy may be modified by contractual agreements, and about contribution between insurance companies.
    You will also learn about subrogation letters, use of Inter-company Arbitration, and the distribution of recoveries.
  • Understanding NCCI Policy
    The National Council on Compensation Insurance, or NCCI, provides services to the workers compensation insurance industry including loss data evaluation by types of work, from safe to dangerous occupations; tracking of loss costs in each classification in order to establish standard manual rates; and the creation of a standard Workers Compensation policy form accepted in most states where workers compensation is not provided directly by the state. It may also perform other risk management services as needed to employers and insurers.

    The objective of this module is to provide an understanding of the NCCI policy.
  • WC - Employees Injured Away from Employers' Premises
    More often than ever before, employees work away from an actual employer premises. They may work from home, travel for their job, or work off premises regularly such as construction jobs or inspectors.

    Injuries to employees occuring away from an employer premises requires a detailed investigation. This course will discuss investigation of the loss, what qualifies as a compensable situation,and the application of various state and federal laws regarding employees who are injured while away from the insured's employment premises.

    This one module course covers the status of employee; statutes and jurisdiction; exempt and non-exempt employment; deviation from the employment; accidents to and from work; business travel; employee outings; investigation of compensability of a home-based employee injury; subrogation and investigating potential fraud. This one module course should take approximately one and 1/2 hours.
  • Workers Compensation - Employment
    When a claim for workers compensation benefits is made, the adjuster is asked to investigate the claim and pay benefits, if owed. To be able to investigate and determine whether compensation is owed the adjuster must understand to which employers and workers the law applies and understand the elements of the employment relationship.

    After completing this lesson, you will be able to:

      • Recognize exempted employments

      • Discuss the employment relationship

      • Distinguish employees from independent contractors

      • Discuss compensability for other employment relationships
  • Workers Compensation - Compensability
    Making a compensability determination is making a coverage decision. When determining compensability the adjuster is deciding whether the costs of an injury should be born by the worker or the employer. Each state writes its own workers compensation acts, statutes or laws. The court interprets the laws enacted by the state. To make compensability decisions the adjuster must understand the state's requirements for compensability.

    After completing this lesson, you will be able to:

      • Discuss the three requirements necessary for compensability

      • Describe accidental as applied to incidents and injuries

      • Distinguish between "arising out of" and "in the course of"

      • Examine activity's and injury's relationships to employment
  • Workers Compensation Fraud Awareness
    This course will help raise your awareness in understanding what fraud is, the government's role and the adjuster's role in preventing fraudulent claims. Upon completion of this module you will also be able to conduct a more thorough claim investigation to confirm or rule out fraud.
    You will have a guide to selecting a qualified surveillance expert and how to give appropriate direction to this independent contractor.
  • Workers Compensation History & Benefits
    In this module on the History and Benefits of Workers Compensation, the adjuster will learn about how and why the concept of Workers Compensation developed over the last two centuries, and why the rules may differ from state to state.

    This module will also review the function of the National Council of Compensation Insurers (NCCI) and examine the government safety program under the Occupational Safety and Health Act.

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