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How to Make Handling a Medical Only Claim Interesting

 
 The handling of medical-only  workers’ compensation claims may seem routine or even mundane. Let’s look beyond the surface to see there’s more than meets the eye. Many of the questions considered in evaluating a claim for compensability apply whether the claim is a medical- only or involves indemnity payment. The first step in handling either type of claim involves determining whether there is coverage. So, take a look at the policy dates and be sure the injury date falls within the coverage period. 
 
Also confirm the claimant works for the named insured on the policy and he or she is covered. Owners or officers of a company may have opted out and employees “hired” from a temporary agency may be covered under the agency, not you’re named insured. 
 
Review the  first report of injury and be aware of “red flags” including  – Monday morning injuries (may really have occurred over the weekend), un-witnessed accidents, injuries reported late or after termination, injuries reported just as seasonal work is ending or injuries occurring in an area where the employee would not normally be expected to work. This is just a partial list of things to consider, even when reviewing medical-only claims. 
 
Scrutinize the medical bill(s) and read the explanations next to the boxes on the Health Care Financing Administration (HCFA) form. The bill tells you whether the charges stem from an auto accident, employment or another accident.
 
You can also verify the employee’s date of birth and social security number to be certain you have the correct bill. The bill also indicates if this is an initial visit for the current complaints. If it’s not the initial visit, it’s an indicator to pursue other medical records possibly providing an accident history inconsistent with the reported injury, thus warranting additional investigation.  
 

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/

Fraudulent_Workers_Compensation_Claims/index.php

We accept articles about WC cost containment. Contact us at: Info@WorkersCompKit.com.
 
Visit Our Websites: Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Medical Cost Containment & Managed Care, Medical Issues |

Victoria Australia Officials Use Wellness to Reduce Workers Compensation Occupational Injuries

Officials in Victoria, Australia  are promoting WorkHealth, a five year, $218 million program aimed at improving the health and wellbeing of Victorian workers. It represents a significant new investment in the health and safety of Victoria’s workers and a major contribution to the Victorian Government’s action on chronic disease prevention. 
Over the next five years,  every workplace in Victoria will have the opportunity to take an active part in health programs in the workplace. Programs for workers will include workplace-based health checks and information, as well as access to advice and education programs to help workers reduce their risk of chronic disease.
 
Over time,  the WorkHealth initiative aims to reduce absenteeism, improve productivity, reduce injuries and reduce the burden on the Victorian health system.
 
Employers  are eligible to apply for worker health checks if they are a Victorian business or have Victorian based operations and pay a WorkSafe Injury Insurance premium, or are an approved WorkSafe self-insurer. (workersxzcompxzkit)
 
Visit  www.workhealth.vic.gov.au and quote the promotional code 1011 in your worker health check/grant application.

 Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

Podcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/
Fraudulent_Workers_Compensation_Claims/index.php

We accept articles about WC cost containment. Contact us at: Info@WorkersCompKit.com.
 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Medical Issues, Safety and Loss Control, WC in Other Countries (International) |

Claims Resolution and Settlements: MSA and Annuities

Medicare Set Asides
Under federal law,  Medicare is precluded from paying the medical expense for a person's workers' compensation injury.  The Center for Medicare and Medicaid Services requires all Medicare (CMS) beneficiaries to protect Medicare's interest in all work comp claims and ensure Medicare is secondary to work comp.  Therefore, it is required of the adjuster to take Medicare's interest into account every time a work comp claim is settled.  On small claims this amounts to the adjuster paying the estimated future medical cost.  

Where things get  interesting is on the larger claims.  If the employee is a Medicare beneficiary at the time of the settlement and the total settlement is over $25,000, or if the employee has a reasonable expectation of Medicare enrollment within 30 months of the settlement and the total settlement is greater than $250,000, a Workers' compensation Medicare Set Aside (MSA) proposal must be submitted to the Center for Medicare and Medicaid Services for their pre-approval of the settlement. If

Medicare's  interest is not protected, and the CMS determines Medicare made improper payments, it can seek recovery not only from the employee but also from the employer.  If CMS determines the failure to take Medicare's interest into consideration was intentional, it can recover double the amount paid out. 

Therefore,  it is recommended an expert in Medicare Set Aside Trust be retained on all claims meeting these thresholds.  The MSA expert evaluates the employee's medical condition, medical history, and potential future medical cost, along with an evaluation of the employee's current and future disability.  The MSA proposal should be submitted to CMS and the settlement delayed until the settlement has been approved by the CMS.

It is recommended  CMS approval be obtained whenever possible.   When CMS approval is not obtained, the settlement agreement/release must contain language verifying Medicare's interest was considered and protected in the settlement.  Source:  http://blog.reduceyourworkerscomp.com/?p=32  Medicare Set Asides Blog.

Structured Settlements/Annuities
In conjunction  with the MSA, it is often wise to conclude the large workers' compensation claims through the use of a structured settlement or an annuity.  With this type of settlement of a workers' compensation claim, the employee receives an immediate cash settlement plus a stated number of future payments at stated intervals.  The future payments are funded by the employer or the insurance carrier purchasing an annuity from a life insurance company, with the future payments made directly to the employee.

When the  employee has anticipated future medical needs, the structured settlement can prevent the employee from spending the entire settlement before the future medical cost is incurred.  As a part of the structured settlement process, a life care plan should be prepared showing the anticipated future medial cost and the approximate dates of the medical expenses.  A "spend thrift" MSA Trust can be established as part of the structured settlement protecting the employee from wasting their settlement and protecting the employer from a CMS claim for medical expenses spent by Medicare. (workersxzcompxzkit)

The structured  settlement benefits the employer or the insurance company by establishing a set amount for the future exposure of the claim.  The total future cost of the claim can be paid and the need to carry reserves for the claim is eliminated with the purchase of the structured settlement.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

"FRAUD PREVENTION" PODCAST click here: http://www.workerscompkit.com/gallagher/mp3

By: Private investigator with 25 years experience.

We accept articles about WC cost containment.
Contact us at: Info@WorkersCompKit.com.
 
 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues. ©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com

Posted in Medicare set-asides (MSAs), Settling WC Claims |

How One Doctor Really Can Make a Difference

 

Here is a true story  about how one doctor successfully helped his client-employers reduce workers’ compensation costs by 50%.  And further reductions are seen in lost time, light duty days, replacement workers costs, and cost of treatment of employees who claim work-related injury.
His name is Dr. Nathaniel Evans – let’s read his story.  Thank you for the contribution, Dr. Evans. It is very enlightening.

As I reflect
 on almost 25 years of solo practice in occupational medicine, I am grateful for the opportunities I have had to help my clients (employers) and their employees meet their objectives of health, prosperity and productivity. 

When I bought
 my occupational medicine practice, after serving for six years as Chief of the Emergency Department of a local hospital, I entered the practice with a commitment to serve the needs of my patients and their employers with attentive, compassionate, effective and cost-effective care. I know I’ve succeeded in my mission when I am greeted by smiles from patients returning for follow-up visits, annual examinations or new injury treatment. 

Equally important
 to me are the statements from clients telling me I have reduced their lost time, OSHA recordables, and workers’ compensation costs by 50% or more. The principles I’ve used are universal and they work when applied. 

Unfortunately
, the tendency of most occupational medicine organizations is to seek low-cost providers (often nurse practitioners or physicians’ assistants) to provide primary care in occupational medicine. Such providers often lack the experience and the depth of clinical understanding to allow them to optimally and cost-effectively manage the spectrum of clinical problems seen in an occupational medicine office.

My clients have much
 to say about savings resulting from my services. Just one year after switching from a local hospital’s occupational medicine service to become my client, the Mid-Atlantic Distribution Center for a very large chain of restaurants wrote to me and reported having seen a more than  50% reduction   in lost time and light duty days as a result of my services. He further reported   his employees were pleased with the “family doctor type attention” in my office. 

Two years
 after becoming my client, a food processing company employing 500 workers reported, “Our lost days have been reduced drastically: well over 50%.” 

The Safety Manager
  of a plastics manufacturing plant employing 104 people reported that after just two years, my services saved his company $309,000 or $1,485 per employee per year. 
 
Two of  my clients (manufacturing companies) each achieved 1,000,000 work hours without a single lost-time injury. 

How Did These Substantial Savings Occur?
The underlying   essential ingredient making such savings possible is goal-oriented, attentive communication between doctor and patient, coupled with (when necessary) communication with employer, or employer representatives. When such communication is exercised by a knowledgeable occupational medicine provider whose goal is to expedite the safe return of injured patients to productivity and to avoid ineffective or unnecessary medical procedures, tests or therapies, patients do well and employers experience dramatic savings.
 
Author Nathaniel R. Evans, II, M.D., FACEP,  is Medical Director of the Burlington Medical Center in Willingboro, New Jersey. A graduate of the Johns Hopkins School of Medicine, he is board certified in Internal Medicine, Emergency Medicine, Addiction Medicine, and Occupational Medicine. Dr. Evans has been successful in helping employers greatly reduce costs associated with workers’ compensation. Dr. Evans has served as an expert witness in cases involving occupational medicine, emergency medicine and internal medicine. Attorneys praise him for his clear and effective expert reports and expert testimony. He can be reached at nrevans@comcast.net.

Podcast/Webcast: Claim Handling Strategies
Click Here
:
http://www.workerscompkit.com/gallagher/podcast/  Claim_Handling_Strategies/index.php  

We accept articles about WC cost containment. Contact us at: Info@WorkersCompKit.com.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Coordinating Medical Care, Medical Cost Containment & Managed Care, Medical Issues, Risk Management |

New York Based Law Firm Cited for Alleged Workplace Discrimination

An international law firm  with its primary office in New York City, allegedly violated federal age discrimination law through its compensation system, the U.S. Equal Employment Opportunity Commission (EEOC) charged in a recent lawsuit. 

According to the EEOC’s suit
, in the firms system, attorneys who practiced law after turning 70 years of age received dramatically reduced compensation compared to similarly productive younger attorneys solely because of their age. The EEOC further charged the law firm unlawfully retaliated against one of its attorney’s who practiced law at the firm for over 40 years, by further reducing his compensation after he complained about this discriminatory policy and filed a charge with the EEOC.

“Law firms
 that single out older attorneys for adverse treatment simply because of their age run great risk of violating the federal prohibition on age discrimination,” said EEOC Acting Chairman Stuart Ishimaru.  “This lawsuit should serve as a wake-up call for law firms to examine their own practices to ensure they comport with federal law.”

The EEOC’s lawsuit
, Civil Action No. 10- CV-0655, filed in U.S. District Court for the Southern District of New York, said the firm requires all partners to give up their ownership interest in the firm at the age of 70. If an attorney continues to work, his or her compensation consists of an annual "bonus" payment in an amount totally within the discretion of the firm's executive committee. 

Since the claimant turned 70 in 2001, even though he previously earned a $1 million plus in fees annually routinely from his clients, his compensation was substantially less than the firm’s younger firm lawyers with similar productivity. Moreover, in 2008 and 2009, after the attorney complained internally about the age-based compensation system, ultimately resulting in his filing of an age discrimination charge with the EEOC, the firm reduced his bonus payment by two-thirds even though his productivity remained the same.

This alleged conduct
 violates the Age Discrimination in Employment Act (ADEA), prohibiting age-based employment discrimination against workers 40 and older. ADEA also bars employers from retaliating against those who complain about these unlawful practices.  The EEOC filed suit only after attempting to reach a voluntary pre-litigation settlement.   

“A law firm's
 compensation for its attorneys should be based on ability and productivity, not on age-based stereotypes about declining effectiveness,” said Elizabeth Grossman, regional attorney in the EEOC's New York office.

Spencer Lewis, Jr.,
 director of the EEOC’s New York District Office, added, “More and more attorneys are effectively practicing law into their 70s and beyond.  This is also seen by the fact that most current Justices on the U.S. Supreme Court are over 70 years old.”
(workersxzcompxzkit)

In FY 2009
,  the EEOC received 22,778 age discrimination charge filings, the second highest level ever, accounting for 24% of its private sector caseload.

Author Robert Elliott

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/

Fraudulent_Workers_Compensation_Claims/index.php

We accept articles about WC cost containment. Contact us at: Info@WorkersCompKit.com.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in ADA (Americans with Disabilities Act), EEOC, Fraud and Abuse, Litigation Management, NY Workers Comp Issues |

2009 Record Year for Workplace Discrimination Claims

The goal  of a discrimination-free workplace remains elusive as in fiscal year 2009 a record number (93,277) workplace discrimination charges were filed nationwide, the second highest ever, according to the Equal Employment Opportunity Commission (EEOC). Monetary relief for victims topped $376 million. 

“The latest data   tell us that, as the first decade of the 21st century comes to a close, the Commission’s work is far from finished,” said EEOC Acting Chairman Stuart Ishimaru. “Equal employment opportunity remains elusive for far too many workers and the Commission will continue to fight for their rights. Employers must step up their efforts to foster discrimination-free and inclusive workplaces, or risk enforcement and litigation by the EEOC.”

Private sector  job bias charges (including filings against state and local governments) alleging discrimination based on disability, religion and/or national origin hit record highs. Multiple types of discrimination may be alleged in a single charge filing.

1.  Age-based discrimination numbers reached the second-highest level ever.

2.  Race-based – 36%

3.  Retaliation – 36%

4.  Sex based – 30%

The near-historic   level of total discrimination charge filings may be due to multiple factors, including greater accessibility of the EEOC by the public, economic conditions, increased diversity and demographic shifts in the labor force, employees’ greater awareness of their rights under the law, and changes to the agency’s intake practices reducing the number the steps needed for an individual to file a charge.

Fiscal Year 2009   data showed the EEOC resolved 85,980 private sector charges. In FY 2009, the Commission resolved more charges alleging unlawful harassment than ever before, as well as allegations under Title VII of the Civil Rights Act. In FY 2009, the EEOC recovered a record high of $294 million through administrative enforcement and mediation. Further, the productivity of EEOC investigators increased in FY 2009. The EEOC resolved the second highest number of charges per available investigator in the past 20 years. (workersxzcompxzkit) T

The Commission   also filed 281 new “merits” lawsuits and resolved 321 merits lawsuits in FY 2009.  Merits suits include direct suits and interventions alleging violations of the substantive provisions of the statutes enforced by the Commission and suits to enforce administrative settlements. Learn more at http://www.eeoc.gov/eeoc/statistics/enforcement/index.cfm

Author Robert Elliott

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims  Click Here:  http://www.workerscompkit.com/gallagher/podcast/Fraudulent_Workers_Compensation_Claims/index.php

 
Workers Comp Kit: www:workerscompkit.com/ 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in EEOC, Litigation Management |

CANADA Ontario Schedules Review on How to Protect Workers After Several Fatalities

After a string of deaths at industrial sites across the province, the government  announced  a review into how to better protect workers in Ontario, stopping short  of agreeing to a public inquiry into the accidents, according to The Canadian Press

 "Our workplace safety
 system is one of the best in the world, but we're always striving to improve our system,'' said Labour Minister Peter Fonseca. "We've made some significant strides in the province over the last six years . . . but we've all read and heard about fatalities in the workplace, and one fatality is one too many.''

The province
 is setting up an advisory panel to improve its occupational health and safety system. A report to the government is expected by the fall of 2010. The panel will be headed by Tony Dean, a University of Toronto professor and veteran civil servant, and include safety experts from labor groups, employers and academic institutions.

The move comes
 following several deaths, including that of a 69-year-old man in the Ottawa area and a 52-year-old near Schreiber, Ont. In the Ottawa case, the man fell almost five meters from a scaffold as he was repairing a garage heater. The 52-year-old man died when an excavator machine fell off a rail car and plunged 25 meters down a steep cliff onto the Lake Superior shore. A coroner's inquest is expected into the death of four immigrant, non-union workers who plunged to their deaths on Christmas Eve in Toronto when their scaffold collapsed 13 floors above ground.

According to NDP
 Leader Andrea Horwath, it has taken the province an "extremely long time'' to review its practices, adding what she'd really like to see is a public inquiry into the deaths.

 "I will support
 whatever comes out of the investigations that take place,'' Horwath said. "But let's realize that we have a Public Inquiries Act in this province and I believe that these several tragedies over the last couple of weeks since the new year really speak to the need for extremely broad, effective third party view.'' (workersxzcompxzkit)

In 2008
,  in Ontario alone, there were 488 fatality claims and 317,031 claims for work-related injuries and diseases reported to the Workplace Safety and Insurance Board.
 

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/

Fraudulent_Workers_Compensation_Claims/index.php

We accept articles about WC cost containment. Contact us at: Info@WorkersCompKit.com.
 
Visit Our Websites: Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Canada Workers Comp, Safety and Loss Control |

Texas Work Comp Medical Costs Stop Decline

Following several  years of dramatic decreases, medical costs per workers’ compensation claim in Texas were reported as stable in 2007 according to the Workers’ Compensation Research Institute (WCRI). The drop in costs resulted from the enactment of a pair of major pieces of reform legislation as well as an increased effort to manage medical care by system payers.
Monitoring the Impact of Reforms in Texas: CompScope™ Benchmarks, 10th Edition reports medical costs per claim in Texas were the highest of the states studied before the passage of House Bill 2600 (2001) and House Bill 7 (2005) .

By 2007
,  Texas medical costs per claim were 19% less than the typical study state for claims with more than seven days of lost time. Fee schedule decreases under HB 2600 combined with increased management of medical care by payers through utilization review and other means were behind the decline. However, the increase in the 2008 medical fee schedule conversion factors to reflect increases in practice expenses since 2002 and the separate conversion factor established for surgery may result in a one-time increase of 16% to 41% in prices paid for services by nonhospital providers.

At the same time
,  WCRI reported medical cost containment expenses per claim continued to grow rapidly in Texas, even after medical costs began to decline. At an average of $2,818, Texas had the highest medical cost containment expenses per claim among the study states in 2007/2008, 37% higher than typical. The study noted indemnity benefits per claim rose 10% in 2007, largely due to a nearly 25% increase in the maximum benefit for statutory weekly temporary total disability. Despite this significant increase in the maximum benefit, the percentage of workers whose benefits were limited by the maximum was 17%, more than double the percentage in the typical study state.

The study also
  discovered from 2002 to 2006 indemnity benefits per claim decreased 9% overall, largely the result of a decrease in the duration of temporary disability. Since 2002, WCRI reports the average duration of temporary disability for injured workers in Texas dropped by more than three weeks for claims at an average of 36 months of experience, likely related to the decrease in medical utilization under HB 2600 and payer focus on managing medical care. (workersxzcompxzkit)

In addition
,  the study indicates Texas had faster time to first indemnity payment, lower defense attorney involvement, and lower permanent partial disability/lump-sum payments compared to the typical study state.
Defense attorney involvement was lowest in Texas, 8% compared to 24% in the typical study state for 2005 claims with more than seven days of lost time and 36 months of experience. This likely reflects some combination of the dispute resolution process, limits on attorney fees, limits on settlements, and relatively lower PPD/lump-sum payments per claim – which may impact the necessity or the willingness of defense attorneys to become involved in certain types of workers’ comp cases in Texas.

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/

Fraudulent_Workers_Compensation_Claims/index.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Litigation Management, Medical Cost Containment & Managed Care, Medical Issues |

Five Top Ways to Know You Need a Workers Comp Management Plan

1-Your Experience Mod Creeps Over 1.0

You may not  always understand what the experience mod is but you know when it creeps up, so does your blood pressure. Less is better. The higher your experience mod, the more you pay in premiums. The good news —  there is something you can do to decrease experience mod. I spoke with a broker whos client was 1.65 recently. There's no reason for such a high mod — so get started NOW and bring it down! Inaction is not an option, start your workers' comp management program with an assessment from Workers' Comp Kit which is fast and easy, and provides recommendations immediately after the assessment is complete.

Your experience mod
 number is calculated on the kinds of jobs your employees perform, how many times injuries occur at your work place, multiplied by each one hundred dollars ($100) of your payroll.

The state rate
 is a key factor in driving your experience mod. So, if employees at your company perform more hazardous jobs, your state rate is higher. If your employees are injured more than employees doing similar jobs at other companies, your state rate is higher.  If your state class rate is higher, so is your experience mod.

The higher
 your experience mod is, the higher your premiums. And,  we’re not even talking about indemnity payments.  If you have a bad year with several work related injuries, you experience mod is effected for the next three years.

For the short-turn,
 recalculate your loss runs to ensure they are correct. Separate medical claims from indemnities. Document early claim closures and ensure this is reflected in your loss runs. These steps  have a direct impact on your experience mod number!

For the long term,
 re-emphasize your safety program, but also establish a separate workers’ compensation management program to get injured employees back to work in a modified duty capacity as quickly as possible. Establish a workers’ comp management communication triangle between you, the injured employee, the treating physician and the insurance company. 

2-The Safety Person is in Charge of Workers’ Comp Management

Workers’ compensation is the flip side of safety. Safety kicks in BEFORE an accident occurs. But if a work related accident occurs, then a workers’ compensation management plan containing a post-injury response system and a return-to-work program must also kick in to contain costs.

If your safety person
 is also responsible for implementing workers' compensation management, you should make sure a formal workers' compensation management program is established and implemented. This begins with a thorough breakdown in assessment and benchmarking to determine where your company stands relative to similar companies. There are ten cost drivers in workers’ comp, you should know them and identify your strengths and weaknesses in terms of those cost drivers.

Once you have
 your data together, you should publish your intentions via a workers' comp policy statement, and a program including return-to-work policies and transitional duty. Include a formal communications component to bring employees on board from every work site. 

Update your benchmarking
 via a transitional duty or return to work ratio every month, to see how you’re progressing. Workers’ comp management is an art form unto itself, and merits attention in its own right. You will soon see rewards enough in terms of lower premiums and indemnity payments and higher profit margins. 

3-You Hear Management Say, “Data Processing” Will Handle Your Communications Program

Communications  is more than typing up brochures and wallet cards. Communications is a well-thought out strategy for bringing your employee audience into the workers’ comp management loop. You must know the state laws for every state you do business in and your communications varies accordingly. You must know the primary languages and reading levels of your target audiences and vary your communications accordingly. You must take very complicated concepts and make them simple so everyone gets the message.  Also, you must vary your communication program so your audience can see, hear and read the messages. You must know how to write a policy, dovetail it to program procedures and the take-aways audience members can carry with them after the meetings. All the while making it very, very interesting.

If data processing
 can do all this, so much the better. But while management is lamenting over their increasing experience mods, premiums, and indemnity payments, they would do well to rethink their attack strategy for implementing a workers’ comp management program able to effectively lower those costs in as little as 90 days.

4-You Have Claims Reports Going to Defunct Work Sites

How well you  know your insurer? Do you keep your insurer abreast of developments in your company? How responsive is your insurer? Communication is a two way street. If you are opening and closing work sites and these are not reflected on your insurance statements after you have informed your insurer, you must establish a formal communication path.

Get a contact person
, and while you’re at it, get the supervisor’s name. Visit the insurer’s office to see the lay of the land. If you see the office is disorganized, then this is a red flag. If you see files lying on the floor, or the adjusters are on different floors or geographically separated by cube walls this sends a message of disorganization.

Review your statements (loss runs)
  carefully every month to make sure defunct sites are not listed. 

5-You Have Employees Out on Comp for Years and You Truly Don’t Know Where They are or What They’re Doing

Unbelievable, right?  Unfortunately it’s actually the case in many long-term indemnity claims. Companies hire private investigators who videotape injured employees at the car races, water skiing, para-sailing and what not. Injured employees must never be allowed to languish incommunicado while on the company payroll. It’s simply not acceptable. Spend enough on investigations — this is not an area to cut back for the long long employee. Spend enough so you can view activities over a sufficent time so they can't say they had a "good day." This is called "good day, bad day syndrome." I investigated one employee for over a year. Of course, you'll have to observe the laws and if your state limits doing an investigation on employees on workers' comp then you'll need to reconsider this option in favor of other things. (workersxzcompxzkit)

Communicate
 with your injured employee from day one. Insist a copy of the work ability form, completed by the treating physician, be faxed to you. Send flowers and a get-well card to the employee. Call every week for an informal telephone meeting, until the employee can come on site for meetings. Create a company-wide expectation stating work related injuries are a temporary setback and employees return to work in a modified duty capacity, while they work toward full duty employment.   

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims
Click Here
http://www.workerscompkit.com/gallagher/podcast/
Fraudulent_Workers_Compensation_Claims/index.php


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Posted in Buying Workmans Comp, Implementation and Rolling Out Your Program, Insurance Issues, Rates, Premiums, Lowering Premiums & Experience Mod, Management Commitment |

How Adjusters Can Speed Return to Work

Statistics prove   time and time again, the longer an employee is out of work following a work injury, the more unlikely it is he or she will ever return to work and the more expensive the claim costs. Prompt return to work therefore is very important.

Employers must
 have a well-administered, strong early return-to-work program in place. “Light” jobs and tasks are identified in advance for those employees unable to return to full duty jobs following a work injury. In jurisdictions where possible, occupational physicians utilized by your company should be aware of these jobs and tasks so the physician is able to release the employee to specific work after the initial visit. This will alleviate a potentially lengthy exchange between the physician, adjuster and insured to clarify what the physician meant by “light duty.” The employee may be able to do 80% of his or her regular work and require only 20% in modified tasks. 

If an employee
 is taken out of work entirely or has restrictions and there is no modified duty, the adjuster confirms a follow-up medical appointment is scheduled and notes the date. If the physician schedules a one- week follow up, make sure the appointment IS in one week and not a week and a half or two weeks later. OR, better yet — make SURE the employee has a form to collect restrictions during the first medical visit, not a week or two later, but DURING the first medical visit. Employers or insurance companies that do not have work ability forms are almost certainly turning the claim into a lost time claim instead of a medical only claim.

The adjuster
 also makes sure the treating physician has a copy of the employee’s full duty, quantified job description for a clear understanding of what the employee does. Leaving up to the employee to communicate to the physician may not be a good idea and providing a quantified job description removes subjectivity from the decision-making process.

Provide modified duty job
 descriptions to the doctor and suggest the possibility of a modified schedule. A release to work 50% of the time is better than being out of work completely.   The adjuster speaks with the employee and/or physician immediately after each medical appointment to stay on top of any changes in restrictions or abilities and act accordingly and also to be certain a follow up was scheduled. If the length of disability is disproportionate to normal expectations,  consider an exam (IME) with an independent doctor. (workersxzcompxzkit)

Adjusters closely
 manage claims with current lost time and mitigate the length of disability to the extent possible by making sure injured employees are is examined in a timely way for follow up visits and provide the physician with full and modified job descriptions for consideration. 
 
Site-less workplaces  might need specialist to find jobs for employees that are unable to return to work. Companies such as trucking or contractors, might not have a site on which to place a modified duty position, and some employers may just not want such a program not matter how much the potential savings, so adjusters should be sensitive to that need also and use companies that locate jobs at other locations.  

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.

Podcast/Webcast: How To Prevent Fraudulent Workers' Compensation Claims Click Here http://www.workerscompkit.com/gallagher/podcast/

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
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Posted in Insurance Issues, Rates, Premiums, Medical Cost Containment & Managed Care, Medical Issues, Return to Work and Transitional Duty |