Risk Management & Insurance Industry - Knowledge & Resource Center
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GCat: Risk Mgt, Claims & Ins
MCat: Claims Management

Insurance claims handling administration for property and liability claims, WC claims, auto claims, bond claims. Claims reporting procedures. Injury management and return to work programs. Claims reserving practices. Structured settlements. Claim audits. Use of PEO's and TPA's

Auto Claims

Reference materials related to auto liability and fleet claims management. State PIP fee schedules

Claims Administration

Information on claims management, e.g., structured settlements, importance of prompt reporting, construction claim guidance, preservation of evidence, etc. Self-insurance & claims administrators/adjustors selection/evaluation checklist of TPAs. Variations in imaging technology and the issues confronting claims adjusters. Experts offer tips to adjusters about salvage.

Claims Filing

Property and casualty insurance claims kits, claims filing checklists and instructions, adjuster interview statement guides, insurance claims reporting/investigating guidance

EPL Claims

Advice on how to manage Employment Practices Liability claims.

Health Claims Code Sets

Index of diagnosis related groups. International classification of diseases ICD-9 code query system. Calculators, manuals related to DRG, APG & ICD-9-CM and ICD-10-CM coding.

Health Fraud

Department of Health and Human Services Office of Inspector General (OIG) provider compliance program guides. Database of Office of Audit Services (OAS) audit reports. Report on insurance fraud perpetrated by medical providers, primarily medical clinics. Fact sheets on health care fraud, physician fraud, patient lies, etc.

Insurance Fraud

Information on fraudulent claims. Red flags. Property insurance fraud. Attorney fraud. Tips on how to make best use of video surveillance. Insurance fraud recognition.

Medicare Secondary Payer

Workers' Compensation Medicare Set-Aside reporting requirements and related reference materials for Medicare Secondary Payer requirements

Property Claims

Property insurance claims handling and management resources

Return to Work

Steps to take to establish a return to work program. Forces that adversely affect RTW. Full text of RTW programs for the USA federal government, a university and the state of Georgia.

WC Claims

Guides to work-relatedness of occupational diseases. Activities to control disability costs. IME. How WC settlements are viewed in each state and the various forms of settlements. Cost and reserving guidelines for quadriplegia, massive injury, traumatic brain injury.

WC Decisions

State WC board decisions, administrative law judge opinions, WC Amicus Curiae briefs. Workers compensation case law. Workers comp court decisions.


State workers compensation Electronic Data Interchange (EDI) requirements for claim submission.

WC Fee Schedules

State mandated medical fee schedules for WC. Not all states provide online access to their fee schedules. For those states, information is provided as to where to order their fee schedules. Note the short description under the title with (fees) - indicating these must be purchased elsewhere. A few states (such as Tennessee) base their computation of WC fee schedules on Medicare rates which are available in our library in the Managed Care - Medical Costs section under Medicare Payment Systems. You must conduct the calculations yourself. They are not provided for you. The following states allow payment of Workers' Compensation claims at usual and customary rates: District of Columbia, Indiana, Iowa, Missouri, New Hampshire, New Jersey, Virginia, Wisconsin

WC Forms

Obtain access to workers compensation forms for those states who provide them on their websites. The majority can be downloaded.

WC Fraud

Full text of a training manual on fighting workers compensation fraud. Statistics, guidelines to spot WC fraud, case studies of fraud, etc.

WC Managed Care

Challenging hospital and doctor costs. Entire text of the results of California's survey of workers compensation managed care practices.

Related Categories & Information

- Cross References to LAD Directories (10)

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