3 Indicators Open Work Comp Claims Are Ready to Settle

Spring is in the air—time to do some spring clean.  This should not be limited to your home.  Use it as an opportunity to employ creative settlement strategies and close out those troublesome files and legacy claims that have been collecting dust in your claims department.

 

 

How to Get Started?

 

The first step in the process is to identify cases that are prime for settlement.  This should start with a review of all open files.  Indicators that a workers’ compensation file might be ready for settlement include:

 

  1. Cases where the employee is at, or should be at maximum medical improvement (MMI)/end of healing period. Identification of this factor includes evidence of a healing plateau or continued medical care without improvement of symptomology.

 

  1. Cases where the employee is nearing the end of entitlement for temporary total disability benefits or other wage loss benefits. Most jurisdictions cap the number of weeks an injured worker is entitled to various indemnity benefits.  It is important to review these cases for settlement as it could very well morph into a claim for permanent total disability benefits or costly retraining benefits.

 

  1. Cases where the employee has recently or will become eligible for Social Security Disability and/or Medicare benefits. Entitlement to these benefits drives claims toward the contention the employee is permanently and totally disabled.  These files require an analysis for exposure regarding future medical benefits, including the recommendation for a Medicare Set-aside (MSA).

 

Once you have identified claims ready for settlement, it is important to contact the employee or their attorney regarding settlement.  What do you have to lose?  Nothing!

 

 

Settling Troublesome Cases: Time to Think Outside the Box

 

Settling a workers’ compensation case is like making a sales pitch.  Preparation is key.  This includes thinking of the various alternatives and developing a strategy.  There are also several tools the proactive claims management team has available to kick-start settlement discussions.

 

  • Independent Medical Examinations (IME): Scheduling an IME is a great opportunity to move a case toward settlement.  This can be especially useful for legacy cases where the employee’s treatment has been inconsistent or sporadic.  The findings from an IME can also be used to initiate litigation with the intent of moving the claims file toward settlement.

 

  • Mediation: This is one of the most underutilized tools in workers’ compensation.  Mediation allows for all interested stakeholders to have a voice and role in settling a claim.  It can also be beneficial to understand the concerns of an injured employee and tailor a settlement to suit their needs.

 

  • Structured settlements: This tool can be used effectively in many instances—not just high value settlements.  The employee receives the full value of their settlement, which is paid out over a period of time via an annuity.  There is built-in “savings” when using this tool the insurance carrier receives based on the actual cost of purchasing an annuity contract.  All parties receive “free” advice and services as the broker who prepares the quote and necessary paperwork is paid via commission from the life insurance carrier who initiates the annuity.

 

  • Medicare Set-asides: Failure to settle cases involving Medicare beneficiaries (or those soon to be entitled) is driven mainly by an irrational fear of being reasonable.  This excessive caution can lead to delay and lost settlement opportunities.  Using a service provider to evaluate the risks is helpful.

 

 

Conclusions

 

It is time for spring cleaning in your claims department.  Now is the time to dust off your troublesome files and think about settlement.  This requires interested stakeholders to review their files, engage the other side and use creativity to drive settlements.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

RIMS 2017 Conference and Other News Tidbits

RIMS Conference 2017: Disrupt the Status Quo & Join the Risk Revolution

“RIMS Annual Conference is a must do for any level of risk professional. By attending you can increase your knowledge and walk away with better deals on your insurance renewals. The conference is well worth every moment.” – RIMS 2016 Attendee

 

 

RIMS 2017 Live Streaming | Monday, April 24 (RIMS Members Only)

RIMS will be streaming RIMS 2017 live on Monday, April 24 at 8:30 am EDT – just for RIMS members. Watch the General Session and Awards Luncheon. Register now and watch for free.

 

 

Derreck Kayongo To Deliver RIMS 2017 Opening Keynote

Have you ever wondered what happens to that barely used bar of soap in your hotel room? This guy did, and he didn’t like the answer. So Derreck Kayongo talked hotels into donating their used bars of soap instead of throwing them away. His Global Soap Project takes donated, melted, purified and reprocessed hotel soap and redistributes it to vulnerable populations around the world. This successful entrepreneur is a renowned expert in environmental sustainability and global health and is using his knowledge to disrupt the way hotels dispose of their “trash.”

 

 

Broadspire Joins City of Murals w/ Jane Golden at RIMS 2017

Look for Jane Golden of @muralarts in Booth 701 on Monday 4/24.

 

 

Tips to Prevent Prescription Drug Abuse at Home

The National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs. Prescription drug abuse has reached epidemic proportions across the U.S. According to the National Survey on Drug Use and Health, more than 6 million Americans abuse prescription drugs, and much of the abuse begins at home. In fact, more than 70% of those who illegally use prescription pain relievers obtained them through friends or family, including surreptitiously raiding the home medicine cabinet.

 

 

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

6 Steps to Identify and Address Mental Health Challenges Early

The days of focusing solely on an injured worker’s physical injuries are over. Savvy employers and payers are finding that ignoring behavioral issues can end up costing a boatload of money in delayed recoveries. Early intervention, good communication and worker advocacy are among the best practices to use.

 

Injured workers who have, or develop undiagnosed and untreated behavioral health issues are more likely to fall into the ‘creeping catastrophic’ claim pool; a simple meniscus tear that degenerates into a months- or years-long claim with multiple treatments and medications — and exorbitant costs.

 

Identifying and treating these issues is tricky. The stigma attached to mental health issues prevents many people from seeking treatment; providers and claims handlers are often unfamiliar with signs and symptoms; and payers may be reluctant to pay for something they believe is unrelated to the actual injury. However, it behooves employers and other payers to at least consider ways to target behavioral health issues among their injured workers.

 

 

Behavioral Health Issues

 

Behavioral health issues — also called mental health or psychosocial — include a variety of diagnoses. Anxiety and depression are the ones more commonly seen among injured workers.

 

In addition to an extended duration of the claim, some signs that may indicate a psychosocial issue is present include:

 

  • Pain develops due to non-medical issues.
  • Function does not improve.
  • Multiple providers are involved.
  • Visits to the emergency room with drug seeking behavior.
  • Overutilization of treatments.
  • Catastrophic thinking.
  • Perceived injustice, toward the employer or others.

 

There are myriad reasons why some injured workers develop psychosocial issues, related to such things as adverse childhood experiences, environmental stimuli or genetics. The important thing is to identify them and intervene as early as possible.

 

Identification

 

Training and education are key to uncovering psychosocial issues. Most claims handlers as well as medical providers and others don’t have the backgrounds to detect psychosocial issues.

The injured worker, supervisors, and all others involved in the claim should also be trained to understand the realities of mental health issues. Soft skills, such as communication, conflict resolution, and identifying potential issues should be included.

 

Contact with all injured workers soon after the injury and on an ongoing basis is a best practice. During the conversations, certain screening questions can be asked that might trigger a red flag for potential issues:

 

  • When do you think you will be going back to work?
  • How are you doing?
  • Have you talked with your employer?
  • What does your treating physician say about your recovery and return to work?

 

Such questions can reveal the injured worker’s overall feelings toward his workplace. The answers might signal contention between the injured worker and his supervisor and/or colleagues.

 

The person’s sense of control, or lack thereof over his work can also be an indicator of stress and, potentially, psychosocial issues. People who feel they have little or no control tend to experience more stress. The lack of a sense of belonging at the company, and concerns about job security may also lead to psychosocial issues. The injured worker needs to know his job is safe and that you want him back on the job as soon as possible, even if that means doing light duty.

 

 

Interventions

 

There are formal programs to address injured workers with psychosocial issues. Companies looking to develop their own programs should consider the following:

 

 

Special Attention

 

Once an injured worker has been deemed a potential risk for psychosocial issues, the claim should be handled by those who have been trained and have an understanding of the challenges. Specialized claims adjusters, for example should be assigned the claim. The injured worker should be given a detailed outline of the workers’ compensation process and understand what to expect and what is expected of him. He should be made to realize he does have control over his own recovery.

 

 

Team approach

 

The Claims adjuster, nurse case manager, treating physician, injured worker and anyone else should work together on the claim. The treating physician, for example, needs to be a part of the effort to avoid him undercutting the team’s efforts.

 

 

Clinical interventions with a work focus

 

The injured worker should have access to a mental health provider as soon as possible. If your company or insurer does not already have a psychologist in the network, working with a local provider should be considered. Community resources can be checked to see what is available.

 

 

Goal setting  

 

Working together the team should establish timeframes for various aspects of the recovery, with the injured worker’s buy-in. The focus should be on the injured worker’s abilities, rather than his disability. The employer must be open to allowing the injured worker to return in a light- or modified-duty capacity.

 

 

Conclusion

 

Some state workers’ compensation laws allow coverage for mental injuries while others do not. Regardless of the regulations in a particular jurisdiction, taking a proactive stance and, perhaps spending some money at the beginning of a claim will generally be much more cost effective than ignoring psychosocial issues.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

Two Key Aspects To Controlling Workers’ Comp Medical Costs

Medical costs continue to be a significant driver in workers’ compensation claims across the United States.  This is due to a number of different factors, which include fraud, waste and abuse within the system.  In other instances, the increase in medical specialization is a driver of costs, which can lead to duplicative and unnecessary care.  When this takes place in the context of a workers’ compensation claim, the result is an unnecessary financial burden to the program.

 

Now is the time for members of the claims management team and other interested stakeholders to take control of their programs.  One important way to do this is by being proactive on the medical factors of claims and to direct effective medical care and treatment.

 

 

Responding to Injuries

 

All employers, regardless of size need to take a proactive and immediate approach to every workplace injury.  This includes personnel within the work environment who know how to provide medical care and being responsive to employees who suffer an injury.  Other key elements of an immediate and effective injury response include:

 

  • Rapid response to injury and with 24/7 nurse triage hotline. Time is of the essence to triage the injury and direct the employee to the right level of medical care, whether home treatment or the appropriate medical provider. The ability to use a 24/7 nurse triage hotline is not affected by differences in state laws regarding directing medical care.

 

  • Transportation to a medical facility is also an important component of responding to a work injury. This includes providing a means of transportation for a person who does not need an ambulance.  Instead of making that person drive himself or herself to the appropriate facility, an employer representative should make every effort to provide transportation.  This best practice demonstrates “good will”, and ensures the employee arrives at the medical provider to receive treatment.

 

 

Working with Treating Physicians

 

Having a designated medical facility for initial post-injury care does not preclude an injured worker from seeking future treatment at another location.  It is a general rule that employees suffering from the effects of a work injury have the right to choose their initial medical provider and seek care from a facility of their choosing.  It is important for members of the claim management team to communicate effectively with these treating physicians.

 

When working with the employee’s treating physician, claims handlers and other interested stakeholders should also keep the following factors in mind:

 

  • Professionalism: As a claim hander, you are the “face” of the employer and insurer.  Claim handlers need to understand and respect the doctor-patient relationship.   It is important to be patient and professional at all times. While state and federal privacy laws are relaxed in the context of a workers’ compensation claim, disclosure of information may be delayed.

 

  • Cooperation: This is an essential key when dealing with contentious matters such as workers’ compensation claims.  Building and maintaining cooperation is a two-way street.  Always seek to be a problem solver, not cause them.

 

  • Relationships: People like to do with business with people they like.  This includes working with medical professionals and the injured party.  The expression, “You catch more flies with honey than you do with vinegar,” is something to consider.  An employee suffering from a work injury has a number of worries beyond recovering from the incident.  This includes financial, emotional and family pressures.  Always seek understanding and approach every employee as a person, not just another claimant.

 

 

Conclusions

 

There are no simple solutions to reducing the medical aspects of a workers’ compensation.  Interested stakeholders can take a significant step to addressing this issue through a proactive approach to directing medical care in all injury-related claims.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

4 Communication Strategies to Lower Workers Comp Costs

Here’s a sobering reality: most of the world does not understand the workers’ compensation system. Unless they themselves or a family member has sustained an occupational injury, most people haven’t the foggiest idea how the whole process is supposed to work.

 

That means it’s up to us to make sure an injured worker gets a clear understanding. Why? Because confusion and misunderstandings about the system drive up claims costs. People are afraid and don’t know how or when they will receive medical care or another paycheck. The way the system has historically worked clearly does not help the situation.

 

Think about it. There may be notifications from the claims adjuster, claims administrator, third-party administrator, insurer, pharmacy benefit manager, employer, medical provider or the case manager; with questions or information about the DOI, future medicals, impairment ratings, TTD/TPD/PPD, MMI, or FCE. Add to that a few comorbidities and biopsychosocial risk factors and it’s no wonder some cases go south.

 

 

Effective Communication

 

Ideally, you want the injured worker engaged in the recovery process so he’s motivated to get back to function and work as quickly as possible. Building trust is key. Training supervisors and managers on communication skills can go a long way to preventing animosity; i.e., delayed recoveries, litigation, etc.

 

 

Words

 

What you say has a big impact on how an injured worker responds to the workers’ comp process. You want to avoid creating animosity. Some tips on what to say (or not) include:

 

  • Don’t start sentences with ‘you.’ You don’t want to make accusations against the injured worker. Even if that is not the intention, sentences that start with ‘you’ may be perceived that way.
  • Avoid ‘never’ and ‘always.’ You want to be honest with the injured worker and show you are willing to work with him. Such definitive words may prematurely end a discussion, or provide false hope — neither of which will help.
  • Be positive. Use words that exude optimism. Let the worker know her job is not in danger and you are expecting and looking forward to her returning to work as soon as possible.
  • Use clear and concise language. The person speaking with the injured worker should have his message set and know what and how he plans to say before the conversation starts.

 

 

Tone/Attitude

 

It’s not only important what you say, but how you say it that matters. As the old adage goes, you catch more flies with honey than vinegar.

 

  • Be supportive. Ask the injured worker how he is doing, not only with his injury but overall. Find out if he’s experiencing any particular hardships with which you might be able to help, such as speaking with family members about the workers’ compensation process. Indicate you are interested in him as a person. Also, talk about what the person can do, rather than what he can’t due because of the injury.

 

  • Be friendly. Be polite and nice. Smiling when you speak is a trick used by radio announcers, as it affects how you come across to others.

 

 

Listen

 

Injured workers are often confused about their injuries and how the workers’ compensation process works. Give them a chance to say and ask what they want. Be open to hearing the injured worker’s point of view. Be an active listener by asking clarifying questions and paraphrasing what the person has said to make sure you understand.

 

 

Frequency

 

It’s imperative to keep the injured worker engaged throughout the claims process. That means maintaining regular communication in whatever forms best meet the injured worker’s needs, whether it be via phone, text, email, letter, etc.

 

The first contact should be made immediately following an injury, to show the person you care and are there for them. A phone call is typically best at this stage, as it provides for interpersonal communication. It’s also important to let the injured worker know what to expect throughout the claims process. Some organizations have developed brochures that clearly and concisely explain the workers’ compensation process. At the least, you can verbally tell the worker what he can expect.

 

Ongoing communications should focus on informing the injured worker about the status of his claim, in addition to continuing to show your support and concern. Also, convey the message that the person is still a valued employee. Update him on work-related goings on and send him any newsletters or other communications so he feels he is still part of the workplace. A get-well card signed by coworkers also helps them feel a part of the company.

 

It’s important that all communication with the injured worker is consistent. You should work with the claims handling team, providers, and others to ensure you are all on the same page.

 

 

Summary

 

Fear, misunderstandings and hurt feelings are prime drivers of adversarial relations between injured workers and employers. By working on communication skills and training all who play a part in the claims process, organizations can ensure their injured workers are on board with their recoveries and return-to-work processes.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

Three Common Mistakes In Enterprise Risk Management

Enterprise Risk Management (ERM) gives a holistic view of all risk across the enterprise and allows for timely decisions based on apples to apples comparisons. It requires process owners to think like owners and to provide timely and accurate reporting. It transitions what is most important into actionable plans that are supported by a consistent process for controls and monitoring. A company seeking to improve workers’ compensation management may be considering ERM improvements, and vice-versa.

 

Companies who engage in ERM have a strong competitive advantage. It gives all stakeholders the confidence that the management team is applying a structured approach to identifying, assessing and managing the company’s most important risk. It makes a clear statement to the value of appropriate allocation of resources  and efficiency in governance.

 

With the clear value ERM brings, why are so many companies missing the opportunity? Why do they recognize the value but struggle to get their programs up and running? Our research and experience shows:

 

1              They make it more complex than it needs to be

2              They spend too much time prepping and not enough time doing

3              They miss opportunities when it comes to technology

 

We recommend simplifying foundational concepts, streamlining the process into immediate action and using technology to get your program off the ground.

 

 

Make it Simple

 

Most have heard the terms and concepts of ERM, but do not have the time to get their arms around them. To successfully get off the ground and make progress, the first step needs to be — MAKE IT SIMPLE. Not just initially but for the long haul. Peers at an executive level need to be able to be on the same page and the message to process owners needs to be clear. If it is not simple and clear you will waste count- less hours with no real value.

 

A best practice ERM framework simply means your company has an efficient and effective way to collect risk across the enterprise, a way to quantify risk across business silos and a way to put what is most important into action.

 

If your employees are not aware you have an ERM initiative, you don’t have one. Foundational to the process is identifying what the team looks like that makes up your 3 lines of defense; defining roles, clearly/concisely communicating the core concepts and engaging stakeholders to be part of the process.

 

Moving forward, we recommend finding simple and efficient ways to capture the team’s perspective on risk. Keep the questions straightforward and use technology to gather data in a way that is easy for them. Use simple questions like, what could hinder their success in reaching objectives, what risk they have encountered over the last year, what they heard or observed from others and what is happening externally—in industry, among competitors, regulators, etc.?

 

The next step of the equation is putting time into dealing with governance obstacles. Things start to slow down when “simple” is not applied to the long haul. Look for opportunities to identify obstacles and apply efficiency.

 

 

Just Get Started

 

As companies are attempting to get their ERM programs up and running, they mistakenly think it must be perfectly mapped out before steps can be taken. This, unfortunately, pro- motes the idea of long drawn out committees with no value being realized for upwards of 2 years down the road.

 

Take steps that build long term success, while in tandem, build in steps to capture immediate value. Many companies take too long to capture their top risk and even longer to translate it into action. While the framework is taking shape and you’re capturing and organizing your top risk, jump ahead of the process, and put key risk you know will likely end up as a top 10 cate- gory into an ERM Plan. This will be time well spent to pilot a repeatable process to consistently assess, mitigate and monitor risk that will be transferable to other risk plans.

 

 

Begin with Technology

 

Unfortunately, some companies get started on an ERM initiative and end up putting their efforts on the shelf. This is a natural outcome of not simplifying and getting started (streamlining the process). Avoid wasted time and efforts by using technology early.

 

Many companies mistakenly think ERM technology comes into play after a mature program is in place. They do not take advantage of tools that can streamline the educational process, allow for efficient platforms to collect data, transition risk into structured plans and transition obstacles into governance efficiency.

 

 

ERM Checklist

 

  • Do staff/process owners know you are focusing on ERM and are they engaged? 
  • Is there consistent and effective reporting on risks and controls?
  • Are you putting efforts into keeping it simple
  • Can cross-silo’d decisions be made from your assessment scale?
  • Do you have an easy way to capture risk?
  • Is there structured focus on governance efficiency?
  • Are your most important risks getting transitioned into action?

 

 

Author Mark Bennett, Founder of Risk Innovation Group (RIG), is dedicated to helping large employers face the complexities of risk through innovative Enterprise Risk Management (ERM) practices. ERM programs don’t just help large employers manage business risks more effectively; a well-developed ERM program can protect and create value as well as improve business performance and generate a strong competitive advantage.  Contact: m.bennett@riskinnovationgroup.com

Claims Investigations 101: What Every Claim Handler Needs to Know

Investigating a workers’ compensation claim is an important step in claims management, however it can easily be overlooked or poorly done.  Now is the time to review how you investigate claims regardless of experience.  Doing so can save you time and ensure your program is effective and efficient.

 

 

First Things First: Determine Coverage

 

A workers’ compensation insurance carrier is responsible for a claim if they are contracted to provide coverage for an employer/insured.  This is something that should be verified from the onset of claim in order to avoid confusion later on in the process.

 

Verifying coverage is especially important in workers’ compensation cases that involve industrial exposure issues such as asbestos or repetitive trauma occurring over a period of time.  In other instances, insured falling into high-risk categories have multiple insurance carriers.  Conducting a diligent investigation on this matter may result in allowing a carrier to deny liability or identify other parties who may be responsible.

 

Important data points to consider as part of this review include:

 

  • Listed dates of injury on a claim petition;
  • Policy exclusions based on an employee’s different locations of employment; and
  • Dates when a policy was in force along with the requisite policy number(s).

 

 

Witness Identification 

 

All successful claim handlers need to be great sleuths.  They are given a limited set of facts found on the initial claim forms.  It is then their duty to ask questions and locate answers.  Part of this includes locating people who have information concerning the employee and the work injury.  Important people to consider include:

 

  • Employer: This includes not only the employee’s supervisor, but also other people who have contact with the injured party and understand their work activities.  It is especially important in claims subject to dispute such as unexplained injuries or those that take place over the course of time.

 

  • Other Fact Witnesses: These include a broad category of people.  It can include people who witnessed the accident in question, work directly with or have regular contact with the employee.  It is important to determine what information these persons have and also evaluate their credibility.

 

  • Employee: Contact with the employee is also important.  Not only will you be in contact with the employee as part of the injury report, but also following the injury as the claim handler manages the case.  Part of this contact may include a recorded statement.  When engaging in this activity, be sure to understand applicable rules and how to preserve it for use in litigation.

 

  • Expert Witnesses: The increasing sophistication and due process safeguards in workers’ compensation cases is leading to the growing us of experts.  This obviously includes medical doctors to address issues such as causation, the mechanism of injury and reasonableness/necessity of care.  Other experts include vocational rehabilitation counselors and others who can comment on design and safety matters.

 

 

Other Important Components of the Investigation

 

Members of the claims management team are responsible for investigating the claim at its onset.  This includes a number of other important considerations:

 

  • Determining issues of compensability. This goes beyond a determination of coverage and includes the threshold issue of all workers’ compensation claims—whether the injury “arose out of” and was “in the course of” employment;

 

  • Handling the injury triage and making sure the employee receives the medical care and treatment they are entitled to receive;

 

  • Obtain appropriate authorizations. This includes a number of different documents such as medical, insurance, workers’ compensation records and Social Security verification to name a few.

 

 

Organization is Key

 

A well-organized claim file can provide efficiency to internal processes, demonstrate competence to claim managers and assist legal counsel should the matter be referred for defense.

 

 

Conclusions

 

Members of the claims management team play an important role in investigating workers’ compensation claims.  It is important to be organized and work newly received file materials in an effective and efficient manner.  It can also result in a cost savings to your program, which pays dividends to all involved.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

Examine 3 Common Disincentives to Return to Work

Understanding the psychology of human nature is an important component to reducing workers’ compensation program costs.  While most employees are genuinely interested in gainful employment, various collateral sources of benefits in the form of workplace perks can promote higher workers’ compensation costs.  In order to run an effective program, it is important for interested stakeholder and employers to evaluate the financial incentives they provide employees to determine possible detriments to return-to-work and reducing costs associated with workers’ compensation matters.

 

 

Common Examples of Collateral Disincentives

 

Employers offer a variety of different benefits to employees to boost morale and encourage employment.  Some common incentives that can drive higher workers’ compensation costs include:

 

  • Salary Continuation Programs: Under these programs, an employer may offer employees suffering any disability, including one resulting from a work-injury, 100% salary or partial wage replacement greater than what they would receive under a workers’ compensation wage loss rate.  In a majority of these instances, benefits are capped at after period.  Studies demonstrate these replacement programs result in longer disability periods for employees suffering work-related disabilities and injuries.

 

  • Disability Benefits: Many employers offer employees short- and long-term disability benefits.  These benefits are paid instead of salary for disability.  While some employers require employees to subsidize the cost of these benefits, others are willing to pay the price.  Depending on the policy language, an employee suffering a workers’ compensation claim can receive a “windfall” recovery by receiving disability benefits under a private program, plus wage loss benefits under workers’ compensation.

 

  • Supplemental Wage Replacement: Some employers offer supplemental pay for employees when they are off of work.  While this is often used in the correct manner, it can be common for employees off work due to a workplace disability to game the system and prolong their recovery.

 

In many instances, these well-intended incentives can have perverse outcomes.  This is why all parties interested in reducing costs in their workers’ compensation program should evaluate the effectiveness of rewards and fringe benefits on a regular basis.

 

 

Reducing Work Comp Costs and Promoting Efficiency

 

Employers offering generous rewards and other forms of financial compensation to employees should be prepared to expect the worse.  Human nature dictates a certain percentage of the employee population will “game the system,” other otherwise delay recovery.  Concerns regarding a slow recovery should be monitored closely.

 

Employer representatives and other interested stakeholders should pay close attention to employee benefit programs and workers’ compensation costs.  Action should be quick and decisive if it is suspected an injured worker is delaying their return to work.  If this is the case, the following tools can be used to correctly ascertain the true medical status and workability of an employee:

 

  • Independent Medical Examination (IME): There are limitations on when and how an IME can be used.  In many jurisdictions, this type of examination can only be used once.  Other jurisdictions allow for additional visits by a defense medical expert if there is a documented change in condition, or need to properly assess restrictions or maximum medical improvement (MMI) following surgery.

 

  • Independent Vocational Evaluations (IVE): IVE’s are conducted by a trained vocational or rehabilitation expert.  It involves a number of different tests, which can require the employee to undergo physical activities to determine mobility and function.  Other testing can be educational in nature to measure cognitive function and mental abilities.  The timing of the IVE typically coincides with the placement of the employee at MMI.

 

  • Surveillance: This tool can also be used to determine the true physical ability of an injured worker.  It should be performed in a manner consistent with state law and rules governing workers’ compensation proceedings.  Failure to do so can result in adverse consequences to the defense of a workers’ compensation claim, admissions against interest and/or sanctions.

 

 

Conclusions

 

All employees deserve dignity and respect.  However, sometimes attempts to extend courtesy can lead to perverse consequences.  Interested stakeholders in workers’ compensation programs should be mindful of unintended consequences and monitor matters to ensure the true intent of generosity is extended in return.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

9 Steps to Integrate Your Absence Management Policies

Navigating the minefield of workers’ compensation and other absences can be a nightmare for employers. The patchwork of policies and procedures overseen by multiple departments or vendors can result in compliance problems as well as decreased morale for workers, plus a waste of money and resources.

 

By integrating leave programs, employers can see significant cost savings, fewer days away from work and improved productivity. But going from a mixture of rules and regulations to a single, streamlined system can be daunting, especially for smaller organizations.

 

 

The Challenges

 

There are a variety of federal, state and municipal programs. The Family Medical Leave Act, Americans with Disabilities Act, short- and long-term disability, and workers’ compensation are just some of them, along with state, county and municipal leave laws and employer-specific leaves. Some may overlap. Some involve payments, while others do not. And they change frequently — through amendments or the implementation of new leave laws. Keeping up to date with them all and ensuring you administer them properly is a challenge for even the largest employers.

 

There are likely multiple contact points, depending on the type of leave involved. Each leave involves forms that must be filled out and, sometimes, require payments. If outside vendors are used, inaccurate information sharing may result in payments being too little or too much. Employees may receive information from multiple vendors, causing confusion and frustration. Finally, it’s nearly impossible for an organization to analyze the data and understand the impact of absences — unless the systems are integrated.

 

Getting a streamlined, integrated system involves collaboration, more than anything. Where there are silos within a company, those within them must be willing to work with one another and share information. At the least, HR, legal, benefits and risk departments must cooperate.

 

 

 

Leave Integration Programs

 

Integrating occupational and non-occupational leave programs can take a variety of forms, from the simple to the highly sophisticated. The more advanced models include wellness, disease management and even employee assistance programs.

 

Whatever type of program is implemented, integrating leaves generally results in overall lower costs and possibly better outcomes. You can start the process by taking stock of what’s already in place at your company.

 

  • Look at your data. Starting an integrated leave program should begin with an assessment of the amount and cost of absences taken annually by employees. Employers who do so typically find their employees are taking off more time than they realized, pointing to the need to take action.
  • Talk to your partners. Third party administrators and insurers, along with any vendors you use should be willing to provide data and other information that sheds light on the management of your leave programs; as well as what they do for other employers..
  • Read the handbook. Take a close look at the policies and procedures already in place for various leaves. You may find some that duplicate or contradict one another.
  • Bring in the troops. Departments that have any responsibility for absence programs should be included in discussions right from the start of the integration process. You might find ways to automate some of the existing processes.

 

 

Building the Program

 

Once you’ve seen a picture of your company’s leave programs and looked at the data, there are several key factors that can help make for an effective IDM program.

 

 

1) Single Claim Intake Source.

 

This will reduce administrative costs and make it an easier, more pleasant experience for employees. Having one phone number is a great way to ensure all leave requests are captured in a single source. This could also allow for a single provider to contact the worker if their leaves constitute more than one, such as short-term disability and FMLA.

 

 

2) Communication 

 

Any and all changes to leave policies should be shared with managers, supervisors and employees. It’s imperative that everyone has the most up to date information.

 

 

3) Collaboration

 

As explained above, integrating your absence management programs should involve personnel from several different departments who must work together. Workers’ compensation, group heath, disability insurers, legal counsel, and any other organizations that manage employee health should discuss how they can combine their data and resources. During such meetings, goals should be set and roles and responsibilities should be discussed and agreed upon.

 

 

4) Data Sharing / Tracking.

 

Employers can look at trends for such things as frequency, duration, cause, occupation and business unit to determine if and where changes could be made to reduce costs and improve productivity.

 

 

 5) Updates

 

Changes in laws that affect any of your leave programs should be brought to the attention of all involved. The team can assess the changes and determine how to proceed. There should be a process established to update leave programs depending on changing needs of your company. In addition to tracking legal and internal changes are technological advancements that should be considered. For example, having an app for employees to report absences might be useful.

 

 

6) Uniformity.

 

It is crucial that leave policies be administrated consistently and clearly.

 

 

7) Evaluating The Program.

 

Depending on how the program is handled, you want to be able to see the effectiveness. It may involve a software system or outsourced organization. Ideally, you should be able to identify lost time, costs and return-to-work rates, and see what if any changes should be made.

 

 

8) Keep Good Records.

 

Proper documentation will ensure your company is not on the losing end of a complaint.

 

 

9) Consider Outsourcing

 

Many employers have taken this option due to the complexity of coordinating leave programs. It may not be appropriate for your company, but you might at least want to shop around.

 

 

 

Conclusion

 

Integrating your leave policies can reduce costs, improve outcomes, and streamline efficiencies. It is not a quick process; but companies that have done so report improved compliance, increased control and higher employee engagement.

 

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

14 Ways to Prevent Workplace Fatalities

One of the leading — and most preventable — causes of workplace fatalities is being struck by objects. Whether it is falling, flying, swinging/slipping or objects on the ground level, fairly simple precautions can all but eliminate these incidents.

 

Struck-by incidents were recently named the leading cause of work-related deaths in North Carolina last year, at 19. Nationally, the government estimates 10 percent of workplace fatalities each year are due to struck-by accidents. Awareness, education, training and the use of personal protective equipment are generally all that are needed to prevent these tragedies.

 

The vast majority of struck-by fatalities involve trucks, cranes or other heavy equipment. The main hazards are vehicles, falling or flying objects, and constructing masonry walls. Here are ways companies can mitigate the risks.
Vehicles

 

Workers can be pinned between construction vehicles and walls, hit by swinging equipment such as backhoes, or crushed under vehicles that have overturned. Vehicle safety practices should be mandatory at any site that involves vehicles and/or heavy equipment.

 

  • Perform a safety check. All vehicles should have proper safety devices. Before every shift, supervisors and/or workers should make sure all vehicle and equipment parts and accessories are in safe operating condition. The vehicle or equipment should be taken out of service until needed repairs are made.
  • Have a clear view. Vehicles should not be backed up if the driver is unable to see what is behind him. If that’s not possible, an audible alarm should be operational or a designated person should direct the vehicle from the outside. The driver should ensure there are no individuals near his vehicle before dumping or lifting materials with it.
  • Set the vehicle before leaving. Parking brakes should be engaged when the vehicle is not in use, and wheels on an incline should be chocked. End-loader buckets, scraper blades, dump bodies etc., should be lowered on the vehicle when it is not in use.
  • Don’t overload. Workers should adhere to the vehicle’s lift capacity.
  • Set up barriers. For construction sites near public roadways, there should be barricades and/or flaggers and good traffic signs set up. Personnel at these sites must be clothed so they are easily visible to other drivers, including reflective material at night.

 

 

Falling / Flying

 

Being under an elevated work area can lead to falling object injuries, while activities such as pushing, pulling prying or grinding may cause objects to be airborne and strike a worker. Workers under or around such areas, as well as those doing overhead work need to be vigilant about safety.

 

  • Check equipment to make sure it is operating properly. Make sure small tools, such as saws have protective guards that are in good condition.
  • Hard hats should be required of all workers in such conditions. Safety glasses, face shields or goggles are advisable in areas where flying particles could be an issue.
  • Look up. Work should not be done where loads are being moved overhead. Barricades should be set up with warning signs posted.
  • Secure the site. Consider protective equipment such as toeboards, debris nets or canopies to catch falling objects. When the work is completed for the day, make sure all materials and tools are stacked and secured to prevent them from falling. Make sure loads are secured and lifted evenly.
  • Compressed air. Compressed air used for cleaning should be reduced to 30 psi. It should only be used with appropriate guarding and protective equipment, and clothing should not be cleaned with it.

 

 

Masonry Walls

 

Positioning slabs and walls or shoring up structures involves heavy loads that must be supported and can lead to catastrophic results if precautions are not taken. A trained professional should dictate when a concrete structure is strong enough to place construction loads on it.

 

  • Brace the structure. Make sure permanent supporting elements are in place or concrete has been tested for sufficient strength for whatever will be loaded on it. Until such time, brace the structure.
  • Limit the numbers. Anyone who is not essential to the construction or lifting operations should be prohibited from the work area.
  • Secure wire mesh. Make sure mesh cannot recoil by securing the ends or turning the mesh roll over.
  • Check the weight. Avoid loading up lifting devices beyond their weight capacity.

 

 

Conclusion

 

Providing training to all workers at risk of struck-by incidents is vital to protecting them. A few simple and inexpensive steps are all that is needed to save lives and protect your company’s bottom line.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

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