New Jersey Employer Fined for Safety and Health Hazards

Not keeping workers safe on the job has resulted in fines for one New Jersey-based business.

 

Custom-order cabinetry company Choice Cabinetry LLC exposed employees to safety and health hazards, many involving methylene chloride, according to the U.S. Department of Labor’s Occupational Safety and Health Administration. Initiated as part of its Site-Specific Targeting Program for industries with high injury and illness rates, OSHA’s March 2014 inspection cited the Somerville company for 15 violations, including three willful. Proposed penalties total $136,290.

 

“Methylene chloride is a carcinogen, so it’s vital that employers like Choice Cabinetry take all necessary steps to protect workers when there is exposure,” said Patricia Jones, director of OSHA’s Avenel Area Office. “All workers have the right to a safe and healthy work environment, and OSHA will hold each employer accountable when this legal obligation is not met.”

 

Lack of Hazard Communication Program Noted

 

Three willful violations were cited for the company’s lack of a hazard communication program, hazard communication training and methylene chloride training. Workers exposed to methylene chloride are at increased risk of developing cancer and skin and eye irritation and may suffer adverse effects on the heart, central nervous system and liver. These willful citations carry a penalty of $53,900. A willful violation is one committed with intentional, knowing or voluntary disregard for the law’s requirements, or with plain indifference to worker safety and health.

 

One failure-to-abate citation, with a $27,720 penalty, was issued for the company’s failure to install alarms on the walk-in spray booth. Alarms would warn employees of inadequate ventilation during spraying operations. A failure-to-abate violation exists when the employer has not corrected a violation for which OSHA has issued a citation and the abatement date has passed or is covered under a settlement agreement.

 

Carrying a penalty of $21,560, four repeat violations were cited for damaging noise levels and respiratory program deficiencies. The company was previously cited for these violations at the same location in 2011. A repeat violation exists when an employer previously has been cited for the same or a similar violation of a standard, regulation, rule or order at any other facility in federal enforcement states within the last five years.

 

The company was cited for seven serious violations, carrying a $32,340 penalty, due to employee exposure to methylene chloride, including a lack of personal protective equipment and eyewash facilities. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.

 

One additional violation with a $770 penalty was cited because the company failed to provide injury and illness records within four hours of OSHA’s request.

 

Choice Cabinetry was given 15 business days from receipt of its citations and proposed penalties to comply, meet informally with OSHA’s area director, or contest the findings.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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How Would An Ebola Pandemic Affect Work Comp?

What does 1918 have to do with Ebola and work comp in 2014? Unfortunately a great deal. In 1918, the final year of World War I, the world saw a pandemic of influenza with the most deaths of any single event in world history – estimated to be 50,000,000 world wide, with 800,000+ in the United States in one year.

 

The pandemic came in two waves six months apart. The first was mild but the second was the killer. The virus had quickly mutated.

 

Work comp in NY was four years old in 1918 but the influenza event doesn’t seem to have received a single mention in the NY work comp cases. Perhaps that is due to the fact that communicable diseases were not yet covered under a law that was intended for heavy, dangerous work and covered only accidents, not diseases.

 

 

How Would An Ebola Pandemic Affect Work Comp?

 

What would be the effects of a pandemic be on work comp in the US? Certainly they will not be the same as they were in 1918. If we use the response to 9/11 as a guide, as many Ebola incidents as possible will be covered under work comp laws. The deaths on 9/11 were about 3000. The final number of occupational disease claims for first responders will surely be many multiples of the first day deaths.

 

It is difficult to imagine that work comp could resist expansion to cover Ebola when the largest available insurance program, in terms of percentage of workers covered, is work comp.

 

The effects of a pandemic are difficult to imagine in a nation that has not experienced one in more than three generations. Just one statistic shows what a pandemic can do. In 1919 the average life expectancy in the US had been lowered by 12 YEARS, largely due to infants under 1 year of age being the hardest hit.

 

The effects of the pandemic hit the most remote populations on earth, even in the high arctic. The death rates were the lowest in nations that had imposed the strictest barriers to influx of possibly infected persons (Japan had imposed a virtual ban on incoming ships).

 

 

Liberal Interpretation of Causal Relationship to Work Comp Claims

 

This would be an event unlike any other ever faced by a comp system, even though it has little to do with health risks created by hazards of a workplace. The impact will be enhanced by the liberal interpretation of causal relationship given to comp claims, a tradition started in the early years when only workplace trauma was covered.

 

With any great disaster, hindsight clearly locates the deficiences in responses to it. Unfortunately, for a system as litigation driven as work comp that can only mean a degradation of efficiency in the system overall.

 

 

 

Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Nova Scotia WBC Unveils 2015 Rates

Officials in Nova Scotia unveiled some good news recently regarding workers compensation rates in the Canadian province.

 
Demonstrating leadership in workplace safety and return to work programs can reduce the impact of workplace injury as well as the costs of workplace injury insurance, reported the Workers Compensation Board as part of its 2015 employer rate announcement.

 
The Workers Compensation Board notified 18,500 covered employers of their 2015 rates for workplace injury insurance. An industry’s rate is set based on claims cost experience – the ratio of injury costs to payroll. Just like other insurance models, employers with higher claims costs in their industry pay a higher rate.

 
That means the best way to reduce workers comp premiums comes through industry and employer leadership.

 
This starts with a focused and dedicated approach to safety leadership at all levels of business.

 
Individual employers can take steps to prevent injuries in the workplace, and, if an injury does occur, support injured workers to return to work. Similarly, when an industry works together to reduce its claims cost experience, and brings down the relative percentage of costs to the system, that industry will see a reduction.

 

Health Care Sector Benefits from Safety Commitment

 
Nova Scotia’s health care sector, for instance, which includes hospitals, specialty care homes and long term care facilities, is an example of an industry whose rate is benefiting from leadership commitments to safety and return to work programs.

 
According to the WCB, the average rate of assessment for the health care sector has declined by almost 15 per cent over the last five years. If the industry didn’t make improvements, it would be paying roughly $8.6 million more in premiums today.

 
New programs introduced by the WCB have also challenged more employers to step up their safety leadership, and have driven more improvements in workplace safety this year.

 
Rebates and refunds were issued for the first time in 2014 as a result of the practice incentive rebate program and the conditional surcharge refund program. To date, just over $2.43 million have been issued through these programs.

 

Each year, the WCB issues surcharges to employers whose claims costs are significantly and consistently higher than their industry peers. In 2015, 107 employers will receive a surcharge, down slightly from 113 in 2014.

 
To be surcharged, an employer’s claims cost experience must be at least three times their industry average, or at least 200 per cent higher, for at least four consecutive years.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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Consequences of Failing to Report & Respond to Work Injuries

Over the years, state and federal governments have enacted a number of safety regulations in workers’ compensation programs to provide for a safe working environment.  Even for the best employers following workplace safety guidelines, accidents do happen.  When they do, it is important to follow recognized procedures when responding to work injuries.  Failure to properly report and respond to the injury can have significant adverse consequences.

 

 

Penalties under State Workers’ Compensation Act

 

Being aware of requirements under a state workers’ compensation are important for an employer who is required to purchase and maintain workers’ compensation insurance.  It is important to be aware of the statutory guidelines associated with a number of responsibilities an employer has once someone is hurt at work.

 

Some common errors and omissions are as follows:

 

  1. Failure to file the First Report of Injury in a timely manner;
  2. Commencement of wage loss and other workers’ compensation benefits; and
  3. No clear guidance to injured workers as to their rights and responsibilities when it comes to medical and rehabilitation benefits.

 

While an employer is not required to give an injured person legal advice regarding their work injury, each state has basic responsibilities under the Act to their employees.  It is important for employers to understand their obligations and properly follow through after an incident.

 

A best practice to communicate with employees regarding workers compensation benefits is to provide an Employee Brochure. The employee brochure will provide information on the principles of workplace safety, the benefits to the employee workers compensation provide, an action plan for what to expect, and information on the role played by medical providers.

 

 

 

Compliance with State and Federal OSHA Regulations

 

The Occupational Safety and Health Administration (OSHA) is a federal agency within the Department of Labor that has congressional authority to implement workplace health and safety.  All states have similar departments that also advise employers of additional state regulations that govern these same issues.

 

In addition, the responsibilities imposed by a state workers’ compensation act, employers are also required to implement applicable state and federal policies.  In the context of work injuries, this often includes accurate reporting of certain injuries and provides parties with information about incidents.

 

Various OSHA requirements also require employers to have various safety postings and make them available to all workers.  One such posting includes Material Safety Data Sheet (MSDS) requirements that contain information about harmful substances.

 

 

 

Impact on Experience Modifier

 

In order to accurately price workers’ compensation premiums, companies offering insurance base a premium around an employer’s “experience modifier.”  This calculation is based on a period of three years of loss and is recalculated annually.

 

While the purchase of workers’ compensation insurance is a significant driver in costs for businesses, it is fraud to not report workplace incidents.  It is also not ethical to “pay off” an injured employee so he or she does not file a workers’ compensation claim.  If an employer is caught engaging in such practices, it can result in loss of insurance, as well as civil or criminal penalties.

 

 

Loss or Evidence Spoliation

 

Immediate accident investigation is key to driving down costs associated with workers’ compensation claims.  Failing to investigate a claim from the onset can have a number of adverse consequences.  The following is a partial list:

 

  1. Failure to identify and interview witnesses to the event;
  2. Loss of physical evidence that may diminish chances of recovery against a third party in a subrogation claim; and
  3. Court sanctions for the loss or spoliation of evidence.

 

 

Conclusions

 

Failure to report and respond to a work injury can cause problems in the end.  While there is the moral obligation to help a person suffering physically from an injury, there are also a number of legal obstacles that can be difficult to overcome.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

OSHA Dialogue on Hazardous Work Chemical Exposures

Workplace exposure to hazardous chemicals is something no employer can take for granted.

 
The U.S. Department of Labor’s Occupational Safety and Health Administration recently announced it is launching a national dialogue with stakeholders on ways to prevent work-related illness caused by exposure to hazardous substances. The first stage of this dialogue is a request for information on the management of hazardous chemical exposures in the workplace and strategies for updating permissible exposure limits.

 
OSHA’s PELs, which are regulatory limits on the amount or concentration of a substance in the air, are intended to protect workers against the adverse health effects of exposure to hazardous substances.

 
Ninety-five percent of OSHA’s current PELs, which cover fewer than 500 chemicals, have not been updated since their adoption in 1971. The agency’s current PELs cover only a small fraction of the tens of thousands of chemicals used in commerce, many of which are suspected of being harmful. Substantial resources are required to issue new exposure limits or update existing workplace exposure limits, as courts have required complex analyses for each proposed PEL.

 
“Many of our chemical exposure standards are dangerously out of date and do not adequately protect workers,” said Assistant Secretary of Labor for Occupational Safety and Health Dr. David Michaels. “While we will continue to work on updating our workplace exposure limits, we are asking public health experts, chemical manufacturers, employers, unions and others committed to preventing workplace illnesses to help us identify new approaches to address chemical hazards.”

 

Public Comment Sought on Practices, Methods

 
OSHA is seeking public comment regarding current practices and future methods for updating PELs, as well as new strategies for better protecting workers from hazardous chemical exposures. Specifically, the agency requests suggestions on:

 

  • Possible streamlined approaches for risk assessment and feasibility analyses and
  • Alternative approaches for managing chemical exposures, including control banding, task-based approaches and informed substitution.

 

The goal of this public dialogue is to give stakeholders a forum to develop innovative, effective approaches to improve the health of workers in the United States. In the coming months, OSHA will announce additional ways for members of the public to participate in the conversation.

 
The comment period for the RFI will continue for 180 days.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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WC Cost Reduction Webinar Garners Unprecedented Participation

Lowering Workers’ Comp Costs – Best Practices webinar attracted over 750 industry professionals, including employers, risk managers, safety directors, brokers, consultants, or producers involved in claims management, specific aspects of cost containment, and/or, the latest workers’ comp strategy issues. The webinar was jointly hosted by Advisen and Amaxx Risk Solutions presented on October 9, 2014.

 

A panel of experts speakers, California Pizza Kitchen’s David Williams, Blackstone Consulting’s Mark Newman, AJG’s Bob Walker, Amaxx Risk Solutions’ Rebecca Shafer and Michael Stack, and Advisen’s Dave Bradford, discussed how organizations, big and small, can hone their pre-injury and post-injury procedures in order to significantly reduce their workers’ comp expenses by applying proven workers’ comp best practices.

 

Using the #1 best-selling “Your Ultimate Guide to Mastering Workers’ Comp Costs – Reduce Cost 20% to 50%” as reference material, the panel answered these questions:

 

  1. What should the realistic goal be when reducing workers’ comp costs? Can you benchmark the expense impact that the best organizations achieve?
  2. How soon is too soon to get involved with a workers’ comp claim?
  3. What is the best way to develop and implement a Return-to-Work program?
  4. What are the essential aspects of employee communication around a workers’ comp claim, and how do the best practitioners exceed this criteria?
  5. What strategies do risk managers and safety directors employ to get commitment of senior management?
  6. How are the leading experts in the field establishing the most effective training programs related to these issues?
  7. What does an in-house SIU Director do vs an insurance company’s SIU Director?
  8. How does having an in-house SIU Director help the company’s bottom line?

 

These materials are now posted on Webinar October 9, 2014

  1. Slide deck
  2. Audio file for re-play

 

 

 

Author Rebecca Safer, Attorney and Risk Consultant and President of Amaxx Risk Solutions, Inc., is an expert in workers’ compensation cost containment and litigation management systems. National, mid-market, and local companies use her consulting services to develop benchmarking comparisons, assess key cost drivers, structure strategies, and design training to reduce workers’ compensation and risk management costs. Contact: RShaferB@aol.com.

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

 

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

 

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

 

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

 

Take The Extra Step When Describing Workers Comp Injury

Adjusters are very particular on wording, especially when it describes an injury or event.  Below I am going to use some real-world examples of injury descriptions from real work comp claims.  Don’t laugh, you may be the one reporting injuries this way.  If you are, hopefully you will find some helpful tips to be more expressive going forward:

 

 

Example #1: “Injured Back Lifting Boxes”

 

For example, an adjuster reads the injury report on a new claim and the description reads “Injured back lifting boxes.”   That entire statement says nothing in the mind of an adjuster, other than the back is the area injured.

 

 

Supervisors often provide little information

 

The employer is often contacted first, and this is sometimes a mixed bag of results.  They confirm a back injury, but another supervisor was there and that person knows more about it, they just heard through the grapevine that so and so got hurt last night and are not back at work today.  That is the extent of what the supervisor knows, and the other contact person was not at that location and has no idea what is going on.

 

First of all, that phone call was a waste of time for both people.  Not only did the adjuster get zero information from the employer, but now the adjuster has to talk with the claimant without any prep information, and no information on the accident details.

 

Then when the adjuster calls the injured worker, the injured worker states that he/she was injured when they “Lifted a 65lb box and felt a pop in their back which radiated down the legs causing them to drop the box and EMS was called to take to hospital due to severe pain.”

 

The employee always does the best job of describing an injury.  Leave it to them to tell the adjuster every detail.  And they should, because they are hurt and they want everyone to know what hurts and how they were hurt, and they want treatment for everything that hurts.

 

This entire scenario is how a loss control protocol should not work.  Every claims person out there loves that an employer has a loss protocol set up, and they follow it to the T.  But, what information are they actually providing the adjuster?

 

 

Injury response procedure goal should be to provide adjuster with as much detail as possible

 

The claims person is the one that needs as much information as possible, before they talk to the claimant within a 24-hr period post-notification of the claim.  But if the employer can’t help the adjuster with any information, what good is having protocol to begin with?  Sure, you reported the claim timely, but it is void of any real information that is helpful.

 

I understand that there are technical limitations.  Most injury forms only give you a little area to type in what happened, but be creative and descriptive.  That is what will help the adjuster.

 

Better yet, if you are not using Injury Triage, you should be.  The triage nurse will get the details of the injury, assess its severity, and recommend the property treatment.

 

 

Example #2 on a hernia claim:  “Worker lifted boxes all day and has hernia.”

 

What kind of boxes and how much did they weigh?  Were they lifting one box and had a specific incident that was diagnosed a hernia, or did this person come in and say they have a hernia?  How long is “all day?”  This entire injury statement says nothing other than a hernia.  A great way to correct that statement is “lifted a 45lb box/felt pain/clinic diagnosis hernia.”  Now in that statement, you know the worker was lifting a box, it weighed 45lbs, and that they must have went to the clinic right away because a hernia was already diagnosed by the clinic doctor.  That is good information to know!  Now the adjuster knows more about the injury, the diagnosis from the clinic doctor, and that it appears to be a specific isolated incident.

 

 

 

Example #3 “While unpacking parts she felt a boom in her back.”

 

I am far from a physician, but that is the first time I have heard of a boom in relation to an injury.  So she felt a boom.  What is a boom?  Is that burning pain?  Shooting pain?  A strain? Where was the boom, in her low back or upper back?

 

Other descriptive words do a better job.  Words like “sharp” or “shooting” or “burning” pain help adjusters with the type of pain this worker had at the time of injury.  A way to correct that statement is to label the pain differently, using the examples above.  Also always be sure to include the injured area as specific as possible.  Descriptions such as “While unpacking 2lb parts she felt a sharp pain in right low back.”  Now you have given the adjuster something to work with.  We know the part weight, the type of pain, and the location of the pain.

 

 

 

Challenge Yourself To Provide Specific Information

 

The reason why all of this is important is because of when the adjuster takes the statement from the employee.  Using example 3, the worker may say she had pain all over her back, or she may say she had pain in a different location, or she may say the parts were 25lbs each and not 2lbs in order to make her claim sounds more convincing.

 

So think about your injury statements.  Be as descriptive as possible while providing as much information as you can.  We all know there are only so many words you can put in that description, so challenge yourself to address weight, injury locations, pain types, and anything else you can fit in there.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Washington L&I Cites Olympia Roofing Business

The roofing business can be one of the most dangerous fields out there, especially if safety protocol is not being followed.

 

Recently, the Washington State Department of Labor & Industries (L&I) cited an Olympia roofing company for the seventh time in recent years for safety violations involving fall protection for roofers.

 

The Roof Doctor Inc. was cited for six willful violations and one serious violation, with total proposed penalties of $219,600. Each of the six willful violations carries a penalty of $36,000, and the serious violation has a penalty of $3,600.

 

A serious violation exists in a workplace if there is a substantial probability that worker death or serious physical harm could result from a hazardous condition. A willful violation can be issued when L&I has evidence of plain indifference, a substitution of judgment or an intentional disregard to a hazard or rule.

 

“Falls from elevation are the leading cause of Washington’s worker fatalities and immediate hospitalizations, and they are fully preventable,” said Anne Soiza, assistant director for L&I’s Division of Occupational Safety and Health. “The tragedy, pain and suffering from these incidents are completely unnecessary for the workers’ families and friends and our communities.”

 

Workers Not Using Proper Fall Protection Equipment

 

The Roof Doctor inspection began last spring when an L&I safety compliance officer observed employees working on a rooftop at an Olympia-area residence without proper fall protection equipment.

 

The investigation found that five workers were exposed to falls from as high as 17 feet while engaged in various roofing activities.

 

The employer has appealed the citation. The appeal will be heard by the Board of Industrial Insurance Appeals, an independent state agency separate from L&I.
Penalty money paid as a result of a citation is placed in the workers comp supplemental pension fund, helping injured workers and families of those who have died on the job.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

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Workers Comp Claim Adjuster’s Dream Job

For the most part an adjuster works from day to day.  They work in an office or cubicle, and go about their business.  Recent polls and studies have shown that the adjuster is mostly satisfied with their job.  They feel as if they make a difference, and that their job matters in the global sense.

 

However I think if I were to pull a series of claims professionals aside and ask them if they are really satisfied, I think the results would be different.  The key question to ask would be “How could you do a better job, and become more involved and more proactive in the claim versus the environment you currently have?”

 

No carrier is perfect.  When you are dealing with large sums of money and other monetary authority, there are a lot of people that are going to be involved.  These people may or may not have influence on the claim as a whole, but the fact remains that their voice is going to be heard by the adjuster.  That being said, given the claims environment most adjusters are in, how do we make it better?  How do carriers make an impact on the claim, instead of just hitting their audit marks for best practices?

 

I have dealt with claims professionals for a long time, and over the years I think I have a pretty good idea of what the adjuster would want if given a “perfect world” scenario.  This list is probably a dream, and chances are no carrier would ever allow this to be the standard of how they handle claims.  But, maybe if a few of these items were to happen, who knows what the impact would be on the profession as a whole?  I am only going to go in to a few points here, because this list could be pages and pages long.  Keep an open mind, and imagine the possibilities if……….

 

 

The handling adjuster has the freedom to assign whatever vendor they prefer.

 

This is an easy one.  For example, I know plenty of adjusters that avoid using surveillance because they dislike the vendor they are forced to use.  Adjusters feel the SIU vendor is not aggressive enough, they do not communicate enough, or the results just never seem to be there.  On top of that, most adjusters are only allowed to complete a day or two of surveillance and hope they hit a jackpot.  This is rarely the case, so it sours the entire experience.

 

But let’s say they have the freedom to use whatever local vendor they wish.  Every claims person knows the SIU team they wish they could use, because at a prior carrier they had great success with them.  But at Carrier ABC, they are forced to use SIU vendor X, who never seems to get the job done.

 

 

 

The adjuster keeps the file from day 1 until the file is over.

 

Another pet peeve of the adjuster is that once they complete all of the dirty work and investigative tasks, it is then transferred to another adjuster to take it over from there.  I cannot tell you the complaints I hear of an adjuster who set a file up to settle after spending countless hours on it, only to have the file transferred to another adjuster.  The new adjuster then gets to bask in the accolades for a job well done come file settlement.  Sadly the reality is that the new adjuster really just made a few phone calls.

 

Plus when the file is transferred after a period of time, the claimant gets confused.  This confusion can derail many things, and it probably hurts the claim rather than help it.  Carriers have their reasons for transfer, but I could never see the benefit in moving the file from a qualified experienced lost time adjuster to yet another qualified lost time adjuster.  Why not just keep it where it is?  Adjuster 1 has already established a relationship with all involved parties.  Why start over?

 

 

If the adjuster wants to go in the field to perform accident investigations or to complete a recorded statement in person, then let them go do it.

 

Permitted if geographically possible, if the adjuster wants to go size a claimant up by doing a statement in person, why are they not able to do so?  Details obtained over the phone only go so far.  You really cannot truly investigate all aspects of the claim via the phone.  Do you know what the machine looks like that injured the claimant?  Where were they standing?  How were they operating the machine at the time of the injury?  Without being able to actually see these details, I do not think an investigation is truly completed.

 

 

 

Provide claim assistants to help the adjuster manage their time.

 

Maybe the most important, I hear from adjusters that they have to spend too much of their time doing clerical work, instead of actually working on their claims.  This can range from coding bills, to processing mileage checks, to completing forms, calculating wages, and so on.  These are all tasks that could be completed by a claims assistant.  This frees up the adjuster to work on the actual claim compiling investigative data, discussing cases with Counsel, and so on.  Even though the positives of providing such a service to the adjuster chart off the paper, carriers are reluctant to provide little if any assistance to the adjusters.  If you ask me, the adjuster has more important things to do instead of sitting on hold with a doctor’s office waiting to talk to a person to request medical records.

 

I have only scratched the surface here.  In a perfect world, think about how efficient the claims adjuster could be.  How proactive they could be.  How their insight and approach towards claims could differ when given the time and resources to focus on the claim itself.  The possibilities are endless.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Ohio BWC Reports Grants, Comp Fraud Suspect Nailed

It turned out to be some busy days recently for The Ohio Bureau of Workers Compensation (BWC).

 
First, the BWC approved 127 safety grants for Ohio employers totaling more than $3.5 million. BWC designed the Safety Intervention Grant Program to assist Ohio employers in reducing illnesses and injuries and to create a partnership with them to establish best practices for accident and injury prevention.

 
“The safety grant program has proven extremely effective in preventing workplace accidents and injuries. Employers that receive safety grants find their claims in the area of intervention go down an average of 66 percent,” said BWC Administrator/CEO Steve Buehrer. “Many employers are surprised to find a simple adjustment to a work process can make a tremendous difference in reducing the number of injuries and corresponding costs.”

 
Both public and private employers from 10 different industries in 47 counties were approved for the grants.

 
Ohio private and public employers are eligible for safety grants, which include a 3-to-1 matching amount up to a maximum of $40,000. Quarterly data reports and follow-up case studies help BWC determine the effectiveness of employers’ safety interventions and establish best practices.

 
BWC’s microsite allows employers to compare the average rates and average cost per claim in their industry. It also links employers directly to BWC safety consultants who can survey their worksites and advise them on how to prevent occupational injuries and illnesses in their workplaces.

 
Ohio Man Must Repay More than $31K

 
Meantime, a Bethel (Brown County) man was ordered to pay more than $31,000 in restitution to the BWC.

 
Shannon Watson was sentenced in September in Franklin County Court of Common Pleas on one count of workers comp fraud, a fifth-degree felony. He pleaded guilty to the charge in July.

 
Investigators found that Watson was working for a heating and cooling company in Brown County while collecting temporary total disability, and collected $31,100.28 in benefits between November 2007 and July 2009.

 
Watson was placed on community control for five years with basic supervision, must obtain and maintain employment, undergo urine screenings and pay court costs as well as $31,100.28 in restitution.

 
If he violates conditions of his community control, Watson will serve 11 months at the Ohio Department of Rehabilitation and Correction.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

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