AMCOMP has established an education program to raise professional standards in the field of workers compensation. Each of us is able to detail the need to improve the industry in our own business histories, almost always concluding that a common body of knowledge and measurement would benefit all participants in the field: insurers, reinsurers, insureds, self-insureds, regulators, agents, brokers and most importantly, claimants. The formation of AMCOMP and the commitment by its board and membership to do something about this universally perceived need set the AMCOMP Education Committee on a course that has spanned several years and produced quality results.
In the summer of 1999, AMCOMPbegan to develop a comprehensive education program, involving individuals associated with well-established, educational institutions who could help AMCOMP achieve the educational goals the Association set forth.
After a period of refining and fine-tuning the program, the Association achieved its goal of completing a comprehensive, three-part certification program. The AMCOMP Certification program, leading to the certified Workers Compensation Professional (“WCP”) designation, consists of three parts, each consisting of ten chapters. The program utilized multiple reading sources and was designed in a fashion similar to a regular college course, building on material covered in the preceding chapters.
Efforts were continued to identify ways to improve the program. Most recently, the various reading sources were consolidated into a single text. This text, entitled Workers Compensation: The First One Hundred Years, provides a comprehensive base of information regarding the various aspects of workers compensation. Through this text, those who have taken the course of study will have a better understanding and appreciation for how the multiple pieces of the workers compensation program (e.g., claims, risk management, pricing, etc.) work together to make the greater whole.
The following serves to highlight the material covered in each of the twelve chapters:
Chapter One - The early development of workmen’s compensation (later to become workers compensation) in Europe is traced along with its subsequent development in the United States. With the passage of time, certain shortcomings of the program were recognized, and in 1972, a national commission was created to study the program and make recommendations for improvement. In response to these recommendations, states enacted substantial reforms in sub-sequent years. The chapter concludes with an examination of the subject of coverage including those employers who must be covered along with a review of those employees who are covered.
Chapter Two-The almost universal test for compensability of a workplace injury or death is that it must “arise out of and in the course of the employment.” While the two phrases “arising out of” and “in the course of” the employment appear fairly straight-forward in actual terminology, these phrases have been the subject of extensive litigation and expansion since their first enactment. A review of statutory provisions along with case law serves to depict how the subject has evolved over time and how it is being addressed legislatively in a number of jurisdictions.
Chapter Three- Many states modeled their original compensation laws after the English Workmen’s Compensation Act of 1897 which included reference to “personal injury by accident.” This language was designed to ensure that employers were only responsible for unintended injuries stemming from a workplace incident. With the passage of time, this limited definition evolved and today, the workers compensation program includes not only an expanded scope of covered injuries, but also a broad array of occupational diseases. These conditions continue to be the subject of controversy and litigation today.
Chapter Four - The fundamental concept behindworkers compensation is that the employer is responsible for certain benefits to an employee injured on the job without consideration for the issue of fault. These mandated benefits include the furnishing of medical care necessary for recovery and the payment of a portion of lost income in the instance of injury or death resulting from a work-related cause. This chapter examines the various types of benefits afforded through the workers compensation program along with the different forms of income replacement benefits that may be available to a worker who receives a work-related injury. Certain prescribed benefits are also payable to surviving dependents in the event of a work-related death.
Chapter Five – Benefit security, and the various forms of that security, is examined in Chapter Five. Benefit security takes the form of insurance or individual or group self-insurance. Within the insurance mechanism, one finds private insurance, competitive or monopolistic state funds, and the residual market or assigned risk pools. While benefit security is a critical component of the program, responsible employers focus on workplace safety as the primary approach for purposes of reducing work-place injuries. The chapter concludes with a look at various employer loss control techniques along with the role played at the federal and state level by the Occupational Safety and Health Administration (OSHA).
Chapter Six– Following an examination of the forms of benefit security available to employers in the preceding chapter, this chapter shifts to an examination of the standard Workers Compensation and Employers Liability policy. Each section of the policy is reviewed with a copy of the policy available for purposes of perusal. The chapter includes a review of some of the more frequently used policy endorsements, along with an explanation of the particular situations in which the endorsements should be included with the policy. The chapter concludes with an examination of some of the various federal compensation programs involving the payment of benefits.
Chapter Seven –The method for determining workers’ compensation rates – the manual rating system – and an examination of the subjects of experience rating and retrospective rating are covered in this chapter. The method of classification of risks is studied in some detail inasmuch as the classification system is the cornerstone of the rating process. Both experience rating and retrospective rating are programs available to employers of a certain size and are designed to make the cost for insurance more reflective of the employers actual experience.
Chapter Eight -Thischapter reviews the claims administration process performed at the state level through a board, bureau, commission or some other similar agency. Functions performed by these agencies include the promulgation of forms and regulations, the development of a dispute resolution process, along with other functions designed to expedite and ensure the accuracy of benefit payments by insurers. This chapter also examines the role of state second injury funds and special funds in terms of their original purposes(s) and the impact these funds have on overall program costs.
Chapter Nine – The discussion of mandated benefits under the workers compensation program is continued in this chapter with a focus on the factors influencing current medical cost increases. To address those increases, a number of cost containment strategies have been developed which include legislation regarding the choice of medical provider; the application of physician and hospital fee schedules; the development of treatment protocols; and the introduction of utilization review. This chapter delves into the subject of managed care at the state level and concludes with an examination of the issue of medical records privacy and ex parte communications
Chapter Ten - A central feature of the workers compensation program is the exclusive remedy doctrine. The quid pro quo of workers compensation calls for the employer to be responsible for wage replacement and the offering of necessary medical care in exchange for the injured employee foregoing any right to bring a direct action for damages against his/her employer. The limits of the exclusive remedy bargain are constantly being challenged and tested in the courts. Some of the more prevalent theories and situations under which these challenges are being brought today are identified.
Chapter Eleven - The workers compensation program is not the sole form of economic security available to workers today, and as such, does not operate within a vacuum. Other programs including Social Security, employer pension and disability programs, Medicare, Medicaid, unemployment compensation and state disability insurance programs may interact in some way with the more serious long-term worker’s compensation claims. A brief overview of some of the important features of each of these programs serves to reveal the purpose of each of the programs, where the various programs may overlap, and how benefits are coordinated with those payable from the workers compensation program.
Chapter Twelve - The concluding chapter addresses the events of September 11, 2001 and the resulting impact on workers compensation claims in New York. The discussion includes an examination of action taken at the federal level to enact legislation that ensures the availability of insurance including workers compensation insurance. The final portion of this chapter looks at five (5) foreign work injury programs (Germany, Italy, Sweden, Australia and China) along with a brief summary of their coverage and benefit structure.
In addition to the above noted text, an AMCOMP Code Ethics has been developed that setsforth the minimum standards of individual conduct expected of those certified as Workers Compensation Professionals (WCP’s). A copy of the AMCOMP Code of Ethics is included when ordering the course text.
Workers compensation is not a static form of economic security protection, but rather the product of many issues such as personal records privacy, ergonomics and the ever-evolving new world of e-commerce. The intent of the course of study is not to furnish a definitive answer on any of these topics, but rather to continue to put forth the best and freshest ideas that come to AMCOMP’s attention so that those who have taken the course of study will understand the many sides associated with each of these developing issues.
Upon completion of the first six chapters of the program Course Guide, applicants seeking the Workers Compensation Professional (WCP) designation are required to take a home study exam (based on the honor system). The exam should be requested when the applicant has completed study of the first six chapters of the Course Guide. Following completion of the exam, the exam should be submitted for grading.
Upon completion, applicants seeking the WCP designation are required to sit for a written, proctored exam. This exam is inclusive of all material covered in the text along with the AMCOMP Code of Ethics. The exam will be administered in conjunction with AMCOMP educational forums, seminars, and conferences, and other times arranged by AMCOMP.
Successful completion of the exam will enable AMCOMP to recognize an individual as a certified Workers Compensation Professional. Individuals will be issued a certification certificate and a WCP lapel pin. Ongoing educational opportunities will be available for WCP’s at regular forums and educational seminars to enable individuals to maintain the AMCOMP Certification status.
No single program can ever contain all of the potential topics and issues that might arise so as to make one an “expert” in every field of workers compensation. The AMCOMP program is no exception. However, this program is intended to create a foundation of knowledge -- both from the historical and the futuristic perspective -- that will ensure a comprehensive level of understanding for the individual who has taken the course of study.
AMCOMP is committed to maintaining a current understanding of emerging industry trends and issues that relate to injuries in the workplace. Such an understanding will be shared with professionals in the field of workers compensation through newsletters, annual meetings, seminars and workshops.
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