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WC Basics 101 – Kansas Workers Compensation

Workers Compensation Laws change frequently. This is only a summary; a complete copy of the most up-to-date version can be found at: www.WorkCompResearch.com , an excellent service.

In Kansas workers compensation coverage is compulsory as to all employment, including corporate executives and employees of charitable organizations.  Coverage is elective for individuals, partners or the self-employed.   There are some exceptions.  Real estate brokers and real estate salespeople on commission are excluded from the compulsory requirements.  Also, farm labor and employees of any employer whose gross annual payroll is $20,000 or less are excluded from compulsory coverage.

 
Obtaining Coverage
To obtain workers compensation coverage in Kansas, the employer has two options which are
 
  • purchasing a workers compensation insurance policy from a state approved insurance company
  • applying to and being approved for self-insurance status with the Kansas Department of Labor.
  • being a part of a group-funded self-insurance plan that has been approved by the Kansas Department of Labor

Claim Reporting
The employee must provide notice of the injury to the employer with 10 days and up to 75 days with just cause.  The actual claim of the employee must be served on the employer within 200 days after the accident, or last payment, or within 1 year of the employee’s death with death occurring within 5 years after the date of the accident.  WCxKit
 

Medical Benefits
In Kansas, the employer selects the medical provider for workers compensation claims.  The employer is required to provide all reasonable and necessary medical care free of any charges to the employee. The employer is also liable for up to $500 of employee incurred medical bills at a non-authorized doctor.  The employee can also apply to the Director of Workers Compensation for a change of doctors. The employee is entitled to all medical treatment needed to cure or relieve the effects of the injury.  Prayer or spiritual treatment is permitted by agreement.
 

Temporary Total Disability Benefits
The temporary total disability (TTD) benefits are calculated as two-thirds of the employee's average weekly.  The maximum amount of TTD benefits that can be paid is $555.00 per week.  The state maximum is subject to annual increase/decrease each July 1st, based on the state’s average weekly wage.  The state minimum weekly benefit is $25.
The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days.  TTD benefits can be paid until a cap of $100,000 has been reached.
 

Temporary Partial Disability Benefits
In Kansas if the employee is able to return to any type of work, but at a lesser rate of pay then the amount the employee was earning prior to the injury, the employee is entitled to temporary partial disability (TPD) benefits.  The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage.  The TPD benefits are paid for up to a maximum of $100,000.  The TPD benefits plus the post-injury pay rate cannot exceed the state's maximum indemnity benefits rate.
 

Permanent Partial Scheduled Disability
Kansas uses a Schedule to establish the value of an injury to all extremities, the shoulders, eyes and hearing.  Each body part has a set number of weeks it is worth with a shoulder being worth 225 weeks of compensation and the number of weeks decreasing with other extremity body parts having lesser value down to a toe, other than a big toe, being worth 10 weeks of compensation.   A 20% loss of use of the arm, which is scheduled at 210 weeks, would result in a permanent partial scheduled disability award of 42 weeks (210 weeks X 20%).

Permanent Partial General Disability

When the employee sustains a permanent partial general disability of a body part not listed on the Kansas Scheduled Injuries list and the employee is not permanent totally disabled, the employee receives permanent partial general disability. If the employee is able to return to work and is earning at least 90% of the average weekly wage, the employee is given a percentage of the whole body impairment based on the AMA Guidelines, Fourth Edition.  The maximum in weeks is 415 weeks.  An employee with a 10% rating would get an award of 41.5 weeks of compensation.  The maximum an employee can collect for permanent partial disability is $100,000.
 

Permanent total disability
Kansas permits the employee to collect a maximum of 415 weeks of indemnity benefits for all types of indemnity combined, but the total amount of benefits collected for permanent total disability is $125,000 instead of $100,000 (the amount of TTD benefits paid to the employee is included in the $125,000 indemnity benefit cap).
 

Death Benefits
The burial expenses in Kansas are covered for a work-related death up to $5,000.  The death benefits for a dependent spouse and children follow the same guidelines as TTD benefits – two-thirds of the average weekly wage – currently a maximum of $555 week, and a minimum survivor’s benefit of $370 per week, except there is a dollar maximum for death benefits in the amount of $250,000 with children, or $200,000 without children.  If there is no spouse and no dependents, the death benefit is reduced to $25,000.  WCxKit
 

Vocational Benefits
Vocational Rehabilitation is on a voluntary basis in Kansas. However, once it is started, it cannot be terminated without the agreement of the employee.  The vendor of the vocational rehabilitation may be changed for good cause supported by substantial evidence.  If so, the employee may select the replacement vendor from a list of three qualified vendors provided by the employer.
 

Author Rebecca Shafer
, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
 

NEW 2012 WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Posted in WC 101 |
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Texas Man and Maryland Woman Sentenced on Workers Comp Fraud Charges

Texas Mutual Insurance Company reported recently that a Travis County district court sentenced Thomas Mikulenka of League City, Texas on workers compensation fraud-related charges.
 
 
The court sentenced Mikulenka to three years deferred adjudication and 100 hours of community service. Mikulenka was also ordered to pay $7,221 in restitution to Texas Mutual. (WCxKit)
 
 
Mikulenka reported a job-related injury while working as an electrician for IGC Construction, Inc. in Houston. He claimed he was unable to work as a result of the injury, and Texas Mutual began paying income benefits to him.
 
 
Meanwhile, Texas Mutual uncovered evidence that Mikulenka was working as a laborer while receiving income benefits.
 
 
Investigators call this type of scam double-dipping because claimants collect benefits for being too injured to work when, in fact, they are gainfully employed. Texas law requires claimants to contact their workers comp carrier when they return to work. (WCxKit)
 
 
Left unchecked, double-dipping and other workers comp fraud can lead to higher premiums for all Texas employers.
 

 

Maryland Woman Sentenced in Nevada Workers Comp Fraud Case 

A Maryland woman has been sentenced to 2 ½ years in a Nevada state prison for attempting to defraud her employer’s workers compensation insurer of $20,000 while at a professional conference at the Las Vegas Hilton, according to Nevada Attorney General Catherine Cortez Masto’s office.

 
 
Tamara Thompson-Johnson, 45, was ordered to pay $20,000 in restitution, $4,000 in extradition costs and serve 2 ½ years in a Nevada prison after pleading guilty to making false statements to obtain workers comp benefits from her employer, officials say. (WCxKit)
 
 
According to officials, Thompson-Johnson claimed she was injured at the Las Vegas Hilton when a vase, dislodged by an intoxicated person, fell from its pedestal. Although she refused medical treatment at the scene, she reported to security that she had been struck by the vase and checked herself into a hospital.
 
 
The Nevada General Attorney’s office says Thompson-Johnson hired a lawyer and requested a claim for compensation from the Las Vegas Hilton. Her claim was turned down when surveillance footage of the incident surfaced showing that the vase narrowly missed Thompson-Johnson.
 
 
Although her lawyer ceased representing her Thompson-Johnson filed another claim through her employer’s workers comp carrier Travelers Insurance, claiming the vase hit her on the back of her head, neck and back, leaving her disabled. As a result she was paid $20,000 on her fraudulent claim.
 
 
According to the Nevada Attorney General’s office, Thompson-Johnson was extradited from Maryland when she did not appear for court hearings in Las Vegas.
 
 
She pleaded guilty to one felony count of making false statements or representations to garner benefits and was sentenced in November. (WCxKit)
 
 
Along with a 2 ½ year jail sentence, she was ordered to pay $20,435 in full restitution to Travelers Insurance, $4,005 in extradition costs and to reimburse the state $1,000 for costs in connection to the case and was ordered to disclose her conviction to present and future employers and insurers.
 
 
 
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.

NEW 2012 WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Posted in Claim Management, Fraud and Abuse, Medical Issues |
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Why Are Half of British Workers Treated Poorly

According to new research conducted by a team from Cardiff University (Wales), half of those British workers surveyed have been ill-treated in the last two years.

 
 
The survey reports 4.9 percent of workers were victims of violence while 22.3 percent said they were treated in a disrespectful or rude way. Twenty-seven percent said they felt ignored. The study used data from face-to-face interviews with 3,979 workers, and the data, provided for the Economic and Social Research Council (ESRC), was to be presented at a London conference.(WCxKit)


The report
, "Insight into ill-treatment in the workplace: patterns, causes and solutions," was written by academics from Cardiff University's School of Social Sciences and Prof Duncan Lewis at the University of Plymouth Business School. It is based on data from the British Workplace Behaviour Survey, obtained in 2008 from interviews by the market research company TNS Global.
 

The team also looked in-depth at four large employers, using them as case studies. Workers in the public sector were reported to be "particularly at risk" of rudeness, disrespect, violence and injury. (WCxKit)

 
 
The majority of attackers involved in violent incidents were said to be from outside the workplace, with 72% of assailants being customers, clients or members of the public. Workers in health, social work, education, public administration and defense faced the highest risk.
 

Meantime, staff in the private sector was more likely to suffer assaults by colleagues, while disabled employees, those with long-term health problems and younger staff are all more likely to experience ill treatment at work, as were lesbian, gay and bisexual workers.

The survey found that permanent staff with managerial responsibilities is more likely to experience what was described as "unreasonable treatment" and violence in the workplace.(WCxKit)

The report notes some 7,000,000 to 8,000,000 British workers suffer from "impossible workloads" and "not being listened to". Managers and supervisors were blamed for two-thirds of incidents of unreasonable behavior but could also be victims of the same treatment.


Author Robert Elliott
, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
 

NEW 2012 WORKERS COMP BOOK:  www.WCManual.com
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Posted in Risk Management, Safety and Loss Control, WC in Other Countries (International) |
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Out of State Insurance Coverage for Workers Compensation

As any employer with locations in more than one state knows, the workers compensation policy is written specifically for the states where the employer has physical facilities.  On the Information Page that comes with each new policy or policy renewal, is Item 3.A (for most insurance carriers) which designates the states where the workers compensation policy is applicable.  Workers compensation coverage does not apply to claims filed in other states.

 
While the insurance carriers attempt to limit the exposure to claims occurring where they may not have claims offices, or knowledge of the workers compensation statutes, the states take a much broader approach. The workers comp statutes of most states specify when and how the workers comp act applies out of state.  Normally, the state statute will indicate that if the contract to hire was negotiated within the state, the workers comp laws apply regardless where the injury occurs. (WCxKit)
 
 
Most state workers comp statutes will have extraterritorial provisions that state if the principal place of employment is within the jurisdictional boundaries, a workers comp injury occurring outside of the state boundaries is still covered by the state law.  The workers comp statutes also normally specify that any work related injury occurring within the borders is subject to the workers compensation statutes, even for employers and employees whose place of business is not within the state line boundaries.
 
 
When the employee is injured in another state where the employer does not normally do business, the extraterritorial provisions of the state workers comp act work great, as long as the employee elects to utilize the benefits of the home state workers compensation act.  The problems occur when the employee elects to file the claim in a state where the employer does not have a physical location and the employer does not have workers compensation coverage. 
 
 
The usual reason an employee files for benefits in a state other than the home state is the amount of temporary total disability (TTD) benefits that will be paid.  Consider the highly successful salesman from Georgia earning $1,500 per week.  If he is injured in Iowa with its high maximum weekly TTD rate, he will receive $1,000 per week while he is unable to work, if he elects Iowa for workers comp benefits.  If he elects Georgia benefits, the TTD rate is capped at $500 per week.
 
 
This creates a coverage issue for the employer.  When the workers comp policy is purchased, the employer should have the insurance agent or broker specify in Item 3.C of the Information Page the other states for which coverage is requested.  Some agents will approach this by listing every state and territory except North Dakota, Ohio, Washington, Wyoming, Puerto Rico and the US Virgin Islands (the four monopolistic states and two monopolistic territories where the state/territorial governments provide the workers comp coverage). This can result in an accidental oversight where the agent leaves out a state. 
 
 
A better approach is to insert the following on the Information Page in Item 3.C: “All states and US territories except North Dakota, Ohio, Washington, Wyoming, Puerto Rico and the U.S. Virgin Islands and those states listed in Item 3.A of the Information Page.” While this is the best approach to out of state coverage, some insurers, especially single state insurers or small regional insurers, will object to providing workers comp coverage in other states where they are not licensed to do business.
 
 
Most employers think of the workers compensation policy and the workers compensation coverage as one and the same.  Actually, the workers comp policy is divided into several sections with Part 1 being the actual workers comp coverage.  Part 2 is employer’s liability insurance which covers injuries to employees when workers comp coverage does not apply. Part 3 is Other States Insurance.  With this coverage, workers compensation and employers liability insurance is provided for incidental exposure in states not listed in Item 3.A of the Information Page.
 
 
It should be noted that Other States Insurance covers only incidental exposures.  When the employer starts to have employees in a state on a regular basis, the states needs to be included in those listed in Item 3.A of the Information Page. If your business has employees who occasionally travel out of state, it is a good idea to routinely review your coverage with your insurance agent to confirm that your policy provides for incidental out of state exposures.
 
 
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
NEW 2012 WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php
WC GROUP:  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 or agent about workers comp issues.
 
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Posted in Insurance Issues, Rates, Premiums, WC 101 |
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How Morale Hazards Affect Workers Compensation Behavior

 
Morale hazard is loosely defined as the presence of an outside item or system that affects typical behavior. I like to use an example of SUV-type vehicles. Because of added safety features and the enormity of the vehicle, drivers report feeling safer and often take more risks then when driving smaller, less-safe vehicles. For example, an SUV driver may be more aggressive during dangerous snowy conditions, or drive more aggressively in general simply because she feels safer.   WCxKit
 
 
To put this in a Workers Compensation context, the morale hazard is the comp system itself. The system’s rules and laws make people behave differently than if they were presented with the same injury and medical scenario outside of the work comp atmosphere. We further discuss these scenarios below:
 
 
1. Increased pain behavior
Within the WC world, adjusters often complain about claimants overreacting to pain and complaining about the presence of pain with even the most trivial injury. This is thought to happen due to the nature of the claimant feeling that they have to prove their injury to the doctor and to the carrier. Even though, as adjusters, we understand injuries occur and most times they do indeed hurt, the need presents itself for the claimant to feel as if they have to be sure to state how unbearable this particular injury is, in order to make the injury seem more believable.
 
 
If you take WC  presence away, when a similar strain injury occurs, outside of the workplace, for example, the reaction may be wildly different. Claimants may shrug off the pain as “age-related” or due to overdoing it instead of feeling the need to play up the pain to their doctor, as is often the case in workers compensation claims. Adjusters will rely on physicians using the “Waddell’s signs” to evaluate pain behaviors in relation to the severity of injury. As you see, the mere presence of the work comp system can provide the means to making claimants overplay pain as much as possible to make their case more concrete or believable.
 
 
2. Increased drug-seeking behavior
Minor strain injuries generally resolve with modified activity and time. But when a work comp case is present, some claimants feel the need to seek out certain types of medications, typically opiate in nature, to cement the legitimacy of their injury. The thought process is, “If I did not have a bad injury, why would I need these stronger medications? Therefore, my claim must be legitimate.”
 
 
One factor muddling this is physicians who are quick to prescribe opiate medication even when the clinical need is not present. Strain type injuries can heal with assistance from anti-inflammatory medication, not necessarily stronger opiate classifications of prescriptions. Many resolve with hot/cold compresses, several special deep knee bend type exercises, rest and 1-2 chiropractic treatments. I speak from experience.
 
 
Removing the comp system again can show the normal behavior. If a person injures themselves mowing their lawn, if they do not like going to the doctor in general, they may take over the counter medications and feel just as good the next day as if they did indeed take a stronger medication prescribed to them by their physician. So you see, drug-seeking behavior is rampant in work comp cases due to the need for the claimant to seek approval from their comp carrier for that injury.
 
 
3. Poor work quality in light duty work classification
If you have the capability for light duty at your factory, when claimants get injured and have work restrictions, proactive employers place them in lighter duty jobs until they get released by their doctor to full duty. A common situation in comp is the worker complaining even the light duty work makes their pain worse. This can happen even when it seems impossible the light work could cause pain. This is due to the presence of workers compensation. Had the worker not been injured, and you placed them in this light-duty job, it is doubtful they would be making the same complaints.
 
 
4. Increased work absences due to pain
Similarly, employers may see an increase in work absences due to alleged pain complaints. Workers will say, no matter what job they do, they just cannot get out of bed and back to work due to injury pain. In the example of the lawn-mowing injury – when the comp system is removed, it is probable this worker will show up as scheduled and ready to work as if it were any other day. This again may be due to the claimant feeling the need to legitimize their claim to the carrier. True, sometimes it's not.
 
 
5. General avoidance with the employer
Sometimes outright avoidance becomes apparent. Missed phone calls, voicemails not returned, and an employee not bringing in medical slips to the HR department as instructed may start to happen. Remove the comp system and injury, and this wouldn’t happen. A responsible worker injured outside of work keeps the HR department up to date with medication restriction slips. Once you introduce the work comp system to this same scenario, avoidance behavior may come to fruition.  WCxKit
 
 
To review, morale hazard is the presence of a particular system or entity that can affect a person’s behavior negatively. This is made clear within the presence of workers compensation. Adjusters see these behaviors day in and day out. What the employer calls a “great, dependable employee” could be to the adjuster a claimant who exaggerates pain, has drug-seeking behavior, and exhibits typical avoidance maneuvers in general. This all negatively impacts the claim, and actually makes it more difficult in the long run. From the workers point of view, these behaviors make their claim more legit — just the opposite occurs.
 
 
 
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
NEW 2012 WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php
WC GROUP:  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 or agent about workers comp issues.
 
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Posted in Claim Management, Fraud and Abuse, Settling WC Claims |
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How Nurse Triage and Nurse Case Management Work Together to Reduce Workers Compensation Costs

Employers are continually searching for ways to reduce workers compensation costs. Triage, where a nurse immediately assesses the employee's medical condition and in some cases arranges for the medical care, is growing rapidly as one of the most effective ways employers can control workers comp cost. In triage, the nurse is involved at the very beginning of the claim. The triage nurse evaluates what medical care is needed through a phone call with the injured employee at the time of injury, provides a list of approved in-network doctors or medical clinics, then passes the claim to a nurse case manager who follows through with the medical provider, the employee, and the employer to ensure the needs of each are met. Companies using nurse triage consistently have very high "penetration rates" meaning that a very high percentage of employees utilize in-network providers; penetration rates for companies using nurse triage are frequently higher than 90%, many approaching 100%.
 

 
Triage in workers compensation is a concept that has been borrowed from hospital emergency rooms where the triage nurse is responsible for immediate assessment of the individual's injury and organizing the treatment based on the seriousness of the injury. In workers compensation, the triage nurse immediately evaluates the nature and type of the employee’s injury and directs the employee to the proper level of medical care whether it is first-aid, a walk-in clinic, or an urgent care facility. Sometimes the employee is given home-care instructions. (WCxKit)
 
 
The proper use of triage eliminates lag time and indecision. The injured employee, the employee’s supervisor or a co-worker (in an emergency situation) can report the occurrence of the injury to the triage nurse by phone. Most triage organizations provide a toll-free “hot-line” number for workers compensation claims to be reported and are staffed 24/7. The triage nurses that answer the calls are trained to obtain all necessary information in order to perform a comprehensive evaluation of the medical needs of the injured employee. The triage nurse will use treatment protocols and algorithms to identify the proper course of treatment. The employee is then directed to the nearest appropriate level medical facility. These nurses are specially trained and have had a minimum of 10 years of clinical experience.
 
 
The triage nurse does not stop after directing the employee to the medical facility. The triage nurse can then contact the medical facility to inform them the patient will arrive soon. Or, this can be done by the employer's workers compensation coordinator. The triage nurse provides the medical facility with the information on the employee’s injury along with the employee’s name, address, phone number, date of birth, social security number, employer's name, address, phone number, and contact information. The triage nurse will also provide the medical provider with billing information and adjuster contact information. Reports of daily activity is sent to the carrier/TPA and the employer, if requested.
 
 
After the employee has had time to be treated, the triage nurse will again contact the medical facility the same day and determine the nature of the medical treatment. Sometimes, this can be done by a senior nurse reviewer or the employer's medical director. A senior nurse reviewer is a nurse who reviews and follows all claims from beginning to end; they monitor all claims within an insureds book of claims. A nurse case manager will inquire to see if there are any prescriptions that need to be filled, if there is any diagnostic testing (MRI, CT scan, EMG, etc.) that needs to be done, and if there is a need for durable medical equipment. The case management nurse will then advise the workers compensation adjuster of the prescriptions, diagnostic testing, and durable medical equipment that is needed. Once the adjuster approves the requested prescriptions, testing or equipment, the case management nurse will assist in arranging for it.
 
 
The case management nurse will also ask the medical facility for the return-to-work restrictions placed on the employee by the medical provider. If the employee can return to work with restrictions, the case management nurse obtains all the information on the work restrictions and contacts the employer to see if the employer can accommodate the return-to-work restrictions. IF the employer has a return to work coordinator, the return to work coordinator can make contacts related to transitional duty capabilities.
 
 
The recommendations of the medical facility for future medical care and the date the employee will be returning to the medical provider will be obtained by the case management nurse. If the employee needs diagnostic testing prior to the return appointment being scheduled, the case management nurse can follow up with the medical facility providing the diagnostic testing and provide the test results to the medical provider. 
 
 
The case management nurse (NCM) will facilitate and expedite the communication between the medical provider, the employer, and the workers comp adjuster. NCM also has the responsibility of keeping everyone informed about the medical status of the employee. The NCM will be in regular contact with the employee, the employer, the medical provider(s), and the workers comp adjuster. All information about the medical treatment, medical progress and return-to-work options are shared with all parties.
 
 
The length of time the triage nurse will continue to work on the new workers claim is determined by the arrangement between the employer and the triage company but generally the triage nurse will hand the case to the case management nurse once the initial care is evaluated. The case management nurse will normally continue on the case until the employee returns to work full time however there may be a need for a nurse case manager depending on the severity of the injury or the employee's inability to return to work even in a modified duty capacity. (WCxKit)
 
 
Integrating the triage nurse into the initial medical treatment allows the employer or insurer to set the tone and level of medical care and ensure the employee gets the appropriate level of care immediately. Then the nurse case manager helps to coordinate employee's return to work before the employee has the opportunity to adjust to the idea of not working. By providing medical management at the beginning of the workers comp claim, the triage process improves the return-to-work program results, reduces days lost from work, lowers the cost of indemnity payments, and lowers the cost of medical care. Normally, nurse triage can reduce the number of lost time claims by up to 40%. 
 
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
 

NEW 2012 WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Posted in Claim Management, Medical Cost Containment & Managed Care |
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New Washington State Law Battles Immigration Related Fraud

A new Washington state law, protecting consumers from immigration-related fraud, went into effect, according to a report from the Attorney General’s Office.

 
 
The recently enacted Immigration Services Fraud Prevention Act, requested by the Attorney General’s Office, prohibits anyone from engaging in the unauthorized practice of law in an immigration matter, unless that person is a licensed attorney or is otherwise authorized to provide legal services under federal immigration law. (WCxKit)
 
 
Designed to protect consumers from deceptive business practices, the new law prohibits non-lawyers and unauthorized individuals from engaging in several other activities.
 
• Selecting or assisting another in selecting an immigration-related government form;
• Advising another as to his or her answers on an immigration-related government form;
• Soliciting to prepare documents for another for submission in a judicial or administrative immigration proceeding;
• Charging a fee for referring another to a person licensed to practice law;
• Drafting or completing legal documents affecting the rights of another in an immigration matter;
• Referring oneself as an “immigration assistant,” “immigration consultant,” “immigration specialist,” or any other term in any language (including the Spanish term notario publico), that conveys or implies that the person possesses professional legal skills in the area of immigration law
 
 
While the law does not prohibit the provision of translation services, the law does prohibit non-lawyers and other unauthorized persons from advising customers as to their answers on immigration forms.
 
 
As the new law goes into effect, the Attorney General’s Office warns consumers to be careful who they trust when it comes to immigrant assistance.
 
 
In Washington and around the country, people advertising immigration services use the title notario publico on business cards and in their business dealings to deceive consumers into thinking that they have special legal training in immigration affairs,” said Attorney General Rob McKenna. “However, a notario publico is not a lawyer and is not authorized under state or federal law to provide you with legal assistance in your immigration case.”
 
 
In several Latin American countries, the term notario publico refers to an individual who has received extensive legal training over the course of several years.
 
 
In the United States, a “notary public” is an individual who has the authority to administer an oath or affirmation or witness the signing of papers. The title is relatively simple to obtain. (WCxKit)
 
 
Many people use this linguistic accident to deceive Spanish-speaking customers into thinking that they are experts in immigration law. Do not be deceived by a person described as a notario or notario publico. He or she is probably just a “notary public” with no legal skills whatsoever, according to McKenna.

 

Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
 

New 2012 Our WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Posted in Employment Law Issues, Fraud and Abuse |
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Ohio BWC Awards Grants to Decrease Worker Injuries and WV reports workplace Deaths double in 2010

The Ohio Bureau of Workers Compensation recently awarded grants to a handful of businesses in an effort to reduce worker injuries.
 
 
According to information from the Ohio BWC, more than $217,000 in safety intervention grants was doled out to 10 businesses. (WCxKit)
 
 
Private and public employers are eligible for the grants, which provide a 2-to-1 matching amount up to a maximum of $40,000. The BWC conducts follow-up studies to gauge effectiveness and establish best practices.
 
 
“Safety grants not only help employers reduce workplace injuries and illnesses, and their related costs, a majority of employers report improved productivity and product quality,” said Stephen Buehrer, BWC administrator/CEO. (WCxKit)
 
 
“On the back end, we are able to collect data that helps us focus our efforts in needed areas by determining the effectiveness of interventions and establishing best practices to share with other employers with similar safety concerns.”

West Virginia Workplace Deaths more than double in 2010 

Ninety-five workers died in on-the-job incidents in West Virginia in 2010, more than double the 41 workplace deaths that occurred the previous year, the U.S. Bureau of Labor Statistics recently reported.
 
 
The preliminary 2010 total, which includes 29 coal miners who were killed in an explosion at the Upper Big Branch mine, was the highest since the annual Census of Fatal Occupational Injuries began 19 years ago. The lowest total was 40 in 2002.
 
 
Across the U.S., there were 4,457 workplace fatalities in 2010, a drop from 4,551 the previous year. (WCxKit)
 
 
Thirty-three of West Virginia’s fatalities were the result of fires, including the Upper Big Branch deaths. Due to the infrequency of workplace fire deaths, the only other year for which figures are available is 2006, when nine fatalities occurred.
 
 
Twenty workers died as a result of fatal injuries in highway incidents, up from 11 in 2009. Eight workers died after being struck by an object or equipment, compared to seven in 2009.
 
 
Other causes included exposure to harmful substances or environments, falls and being caught or compressed by equipment or objects. (WCxKit)
 
 
The most fatalities took place in the mining industry, which noted 37 deaths. Construction accidents led to 10 fatalities.
 
 
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
 

NEW 2012 WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Posted in Safety and Loss Control |
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Labor Union Vows to Get to Bottom of Workers Death

Great Britain and Ireland’s Unite labor union has vowed to ‘leave no stone unturned’ in its efforts to get the answers to vital safety questions as its members and workers at the Port of Tilbury grieve the loss of a comrade and union representative who was tragically killed in a recent workplace accident.

 
 
"A close and loving family has lost a husband and father and his colleagues have lost a truly wonderful friend, Unite spokesperson Andy Green stated in a release. “They only want to help in this tragedy and to learn what happened and why, that is not too much to ask. (WCxKit)
 
 
Our members are deeply shocked that the Health and Safety Executive (HSE) has not responded to calls from Unite representatives at the port to launch an investigation, and that the company has chosen not to conduct a joint investigation alongside the Unite safety representatives, as set out in the company's own health and safety policy.
 
 
"We are at a loss then to know why the HSE will not speak to us; its behavior is nothing short of shameful. However, we have been touched by the kind words of condolence from dockworkers in every port throughout the UK. Our union will always fight for truth and justice and to help the loved ones left behind who have to bear the real burden of workplace deaths."
 
 
Speaking on National Inspection Day, which is supported throughout Europe, Unite's national officer for docks, Julia Long, called for health and safety action across all ports to reflect the dangers within the port industry. "The government has set the ports as a 'low risk' industry. This tragic incident shows that the government needs to have a rethink on its position. We are calling for the company to carry out a full investigation with our health and safety reps fully involved,” Long remarked. (WCxKit)
 
 
Unite will leave no stone unturned in its efforts to understand how this terrible accident was able to happen. We now call on the HSE and port management to work with us and immediately launch an urgent joint investigation into what happened,” Long added.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
 

NEW 2012 WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Posted in Safety and Loss Control, WC in Other Countries (International) |
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Physical Therapy Management Company Celebrates 15 Years, Expands

2012 is Network Synergy Group (NSG)’s 15th anniversary. Its physical therapy management programs started in 1997 and this year expands to Illinois, Indiana, Louisiana, and Mississippi. NSG now offers a Therapy Management Solution to self-insured employers, insurance companies, and Third Party Administrators throughout those states and others – 25 in all.
 
 
According to NSG employees, the company broke the fee-for-service model in which medical providers were rewarded for more, not better, services. “NSG’s idea was simple – realign the financial incentives of the therapy providers to do the right thing, and reward them for providing better care, not more care. This idea would grow into a unique concept known as NSG’s Condition Rate Program,” the company writes.
 
NSG provides management services for physical therapy, occupational therapy, functional capacity evaluations, work hardening and other medical management services. Having a firm manage providers of these services ensures that networks will be more tightly controlled and follow rigorous guidelines for management, cost and monitoring. It also ensures they will provide a solid return on investment for the money employer's invest in their services.
 
 
NSG partners with therapy providers across the country and won the Tampa Bay Chamber of Commerce: Small Business of the Year Finalist in 2010. It also was acquired by GENEX Services, Inc., one of the nation’s leading providers for managed care solutions in 2010.
 
 
NSG now offers a Visit Rate model that gives payers and providers a reimbursement method that improves clinical outcomes and results in claims cost reductions. Greg D’Ambrosio, vice president of client services, said, “We are pleased to provide our services in these states with a keen focus on expanding our network nationally in 2012. This product offering allows us to maintain our core philosophy and values while meeting our clients needs to manage therapy on a national level.”(WCxKit)
 
 
To learn more about their products or to join the provider network, visit NSG’s website www.network-synergy.com or email us at info@network-synergy.com.
 
 
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
 
 
 
New 2012 WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php
WC GROUP:  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 or agent about workers comp issues.
 
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
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