3 Strategies to Eliminate Chronic Pain Claims

Chronic pain is the most prevalent health condition in the U.S. workforce with cost estimates of more than $100 billion annually in lost productivity, healthcare, and workers’ comp/disability payments.

 

The good news is medical science and research has evolved to enable the workers’ comp community to effectively address this prevalent and costly issue. The bad news is many employers and payers believe the steps needed to move injured workers from chronic pain status to productive individual are too complicated and too expensive. They are wrong.

 

 

Typical case

 

A 45-year old male sustains a ‘minor’ twisting injury while lifting something at work. He’s anxious to get back on the job and optimistic about his recovery, based on what his physician tells him. Seven years later — after umpteen surgeries and a smorgasbord of additional medical procedures — his chronic back pain is such that he cannot stand longer than 2 minutes, uses a walker and is afraid to move off the coach for fear he might cause more damage and more pain. He takes a long list of medications, especially opioids and other drugs to counter their side effects, and his wife is threatening to take the kids and leave. One can only imagine how much is being spent on this injured worker.

 

What could have helped this injured worker soon after his injury — and even years later, is a combination of coordinated care, more accurate diagnoses, and attention to issues beyond just his physical ailment.

 

 

Approaches to Pain

 

In the scenario above as in many other cases, the physician took a biomedical approach, which assumes all pain symptoms have a specific cause and once alleviated, the pain will disappear and the patient will be fully recovered. But for many people, this method just doesn’t work.

 

Research shows that chronic pain is a complex and dynamic interaction of psychological and social factors as well as biological conditions. A biopsychosocial approach is what is needed; a multidisciplinary effort that includes physical therapy, occupational therapy, psychology, neuromuscular massage and other experts. There are several things that could have been done in the above situation..

 

  1. Identify at-risk injured workers

A variety of potential red flags could have alerted the injured worker’s case manager and others involved in his claim to issues that might exacerbate the patient’s pain. Among them are:

 

  • Getting medications dispensed from his physician.
  • Recommendations for implanted devices.
  • Getting medical treatment outside the network.
  • High medication costs and increased use of medications.
  • No functional improvement by anticipated dates, despite various treatments.
  • Adverse childhood experiences — such as verbal, physical or sexual abuse; neglect; family dysfunction.

 

Chronic pain cases require interventions early on to prevent them from digressing to the point of the patient described above. The claims management team should have had weekly conversations with the medical providers to get updates on his progress. A thorough medical history should have been done to find out of the initial medical diagnosis was correct. A look at the injured worker’s family situation and other psychological challenges should have been investigated and addressed.

 

 

  1. Set Realistic Goals

 

All human beings are not alike and treating people for chronic pain should not be a one-size-fits-all method. However, the goals of treatment for anyone with chronic pain should be the same. These should include:

 

  • Ensure the patient has realistic expectations. An injured worker may not be able to be completely pain free, but he can still be a functioning member of society. Patients in pain need to understand that, and be given tools to help them manage their pain.
  • Provide education to help the person gain a locus of control, instead of feeling he is at the mercy of others. The injured worker should be just as involved in medical decision-making as anyone else involved in the claim.
  • Quality medical care that is evidence based. Treatment should be based on scientific studies to guide clinical decision making; ensure consistent, proven medical practices are used; and reduce unproven, ineffective care. The effect is better medical outcomes at lower costs.

 

 

  1. Use elements of Biopsychosocial Approach

 

There are a variety of treatments available that have been shown to help at-risk injured workers in chronic pain return to work. Whatever is used should be a process that helps the person gain the skills, knowledge and behavioral change necessary to avoid medical complications and take charge of his physical and emotional well-being after the injury. Treatments may include:

 

  • Pharmacological interventions to wean the person off opioids.
  • Psychological aspects to assist with psychosocial issues.
  • Cognitive behavioral sessions that focus on function and coping with pain. They may include relaxation training, guided imagery, desensitization, and addressing anger and entitlement issues.
  • Physical and occupational therapy. This may involve aquatics therapy, Tai Chi or Yoga, spine stabilization and stretching, and aerobic conditioning.
  • Follow-up care. Since at-risk workers may be vulnerable to reinjury or lapsing into disability mindset, there should be consistent communication with various referral sources, either face-to-face or by phone.
  • Include family and friends. The home and social lives of injured worker are key factors in recovery, so enlisting family members and friends to support the patient and reinforce positive outcomes should be strongly considered.

 

All treatments should be undertaken within a coordinated, goal oriented, functional restoration approach

 

 

Conclusion

 

Employers and payers that fail to recognize and deal with injured workers with psychosocial issues are doing their companies a disservice. Instead, they should be proactive and identify those with the potential for delayed recoveries, support and encourage early intervention, ensure quality medical providers using evidence-based medicine are employed, and provide whatever elements are needed to help workers in chronic pain regain their functionality.

 

 

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

 

Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

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.

 

Do High Heels Mean A Compensable Workers’ Comp Claim?

Navigating issues of compensability in workers’ compensation has become a complicated task for members of the claims management team and interested stakeholders.  This is highlighted by developing case law that scrutinizes the facts surrounding work-injuries when they occur at special events, company meetings or special occasions outside the employee’s usual work functions.  It also stresses the importance of a careful investigation of the facts and elements connected to the work-injury

 

 

Dykoff:  An All Too Common Scenario

 

The facts of Dykhoff v. Xcel Energy, 840 N.W.2d 821, 73 W.C.D. 865 (Minn. 2013), read like a law school hypothetical or test question meant to challenge students.  The employee in this case was a middle-aged journeyman electrician, whose job duties included electronically monitoring power and transmission lines.  Her work duties were performed at a desk, where she usually wore jeans and other casual clothes to work.  Presumably, this did not include high heels.

 

On the date of injury, Ms. Dykhoff was instructed to attend a training session.  Employees attending this event were advised to wear “dress clothes.”  While attending the event, the employee wore two-inch high heels.  She suffered a knee injury while walking on a dry floor.  A post-injury investigation noted there was no debris on the floor.

 

The case was found not compensable after initial hearing.  These conclusions were reversed at the first level of appeal.  Ultimately, the Minnesota Supreme Court upheld the hearing judge’s determination of non-compensability after a close evaluation of the facts and application of developing case law.  Central to the Court’s conclusions were three common tests used in many workers’ compensation cases when the law and careful review of the facts drive issues of compensability:

 

  • Increased Risk Test: The employee must show that she is exposed to a greater risk than the general public;

 

  • The Positional Risk Test: The employee need only show that her employer placed her in the position where she was injured; and

 

  • The Work-Connection Balancing Test: Where the arising out of/course of elements are evaluated.

 

In reversing the lower court decision, the Minnesota Supreme Court noted, “the employment creates a special hazard from which injury comes, then, within the meaning of the statute, there is that ‘causal relation’ between employment and the injury.”

 

 

Lessons Learned and Application

 

There is obviously no way an employer or other stakeholders can prevent a claim from being filed in instances like those described above.  On the other hand, there are important take-aways anyone can implement to avoid adverse findings and increased workers’ compensation program costs:

 

  • Maintaining a safe and properly functioning workplace environment is the surest way to prevent injuries. This includes making sure all walking surfaces are clear of debris and spills are immediately cleaned up in a proper manner.  All employees within an organization should receive annual safety training and understand the importance of their role in the process.

 

  • Setting proper expectations of employees when they attend meetings or other special functions during customary work hours or outside the normal workday. It is unclear what role the employee’s healed footwear played in the minds of judges when considering the Dykhoff  Notwithstanding its significance or lack thereof, it is something important to employers and other stakeholders to consider when holding workplace meetings where the posted attire exceeds those set during normal business hours.  This includes footwear.

 

  • A careful and complete investigation of all work injuries after they occur is important. Due to the interest in workplace “risk” by the Minnesota Supreme Court and other judicial bodies, it is important to note an uneven walking surface, a missing floor tile or floor mat can result in paying for someone’s medical bills and wage loss benefits under a workers’ compensation program.

 

Conclusions

 

Members of the claims management team and other interested stakeholders should take note of ways to keep their workers’ compensation costs in check.  Part of this includes an analysis of employee expectations and an awareness to dangers that lurk around the corner.  This includes an awareness to workplace safety and demands on employees.

 

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

 

Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

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 Foster a Mentally Healthy Workplace

Mental health, especially depression is one of the leading causes of workplace absenteeism and lost productivity.  Estimates are that around $12 billion in lost workdays annually are attributed to depression-related illnesses. Injured workers are often susceptible to depression, especially those who have been prone to it previously.

 

There are a variety of factors that can lead to depression; life events, physical conditions, medication, stress and lack of sleep. The workplace itself can by a source of, or exacerbate depression — unless employers take a proactive approach to the issue.

 

Employers can help their employees and their own bottom lines by promoting a culture of overall well-being, encouraging personal growth and empowerment among workers, and ensuring benefits adequately address mental health needs.

 

 

Workplace Environment

 

A culture of wellness that includes emotional and mental health can go a long way toward reducing the stigma attached, leading workers to get the help they need sooner.

 

  1. Inclusive language. Mention of depression, anxiety, post-traumatic stress disorder and other mental health-related conditions should be as common as diabetes, hypertension and heart disease. The environment should be one that supports and encourages people to seek help. People suffering are more likely do so when they feel supported rather than embarrassed.

 

  1. Engage leaders. Managers and other supervisors should be trained to use language that does not project negative attitudes about mental health issues. They should also understand how to identify emotional distress and respond promptly and constructively to behavioral performance issues.

 

  1. Provide information. The entire workforce should be educated about mental health issues. Your workers’ comp insurer and/or third-party administrator can help with various programs.

 

  1. Work/life balance. Time off for rest and relaxation is essential to a balanced life. Employers should provide adequate vacation time and consider a policy that encourages, if not mandates it be taken. Also, companies should make sure the workload is not continuously extreme, as a large workload without adequate time to complete tasks is viewed as a big stressor among many workers..

 

 

Personal Development

 

  1. Encouragement and support. Employees should have access to a variety of opportunities to improve their competencies, as it helps them with their current positions and can prepare them for promotional opportunities, and acquiring new skills and career development has been shown to enhance well-being. Learning new personal and interpersonal skills also contributes to a person’s overall psyche.

 

  1. Recognition. Everyone likes to be appreciated for a job well done. Employers should acknowledge such employees, whether through financial rewards, time off, or just celebrations during the workday. Such actions help build self-esteem and motivate workers to exceed expectations.

 

  1. Inclusion. Where possible, include workers in decisions about how work is done, whether their own or the organization as a whole. Encouraging workers to ask questions, suggest new ideas and provide feedback gives them a sense of pride in the workplace. Employees who have input into their work lives feel more empowered and have improved morale, along with psychological wellbeing.

 

 

Benefits

 

Individuals with depression and other emotional challenges can be valued employees — if they get the help they need. As an employer, you can make sure workers know where and how to seek help.

 

  1. Employee Assistance Programs. While many larger companies have Employee Assistance Programs, few employees actually use the services. Many don’t know they exist or understand how to access them. If your company has an EAP, make sure your employees are well informed about what is included and how to access the offerings.

 

  1. Health insurance. If your company offers health insurance, review it to see if and to what extent mental health programs and services are included. Where possible, make any necessary changes to foster engagement by workers, especially for early intervention. Educate workers about your health insurer’s mental health services through an intranet, pamphlets, and meetings from an insurer representative. If there are no mental health benefits included for workers, learn about community resources and inform workers about them.

 

Mental illnesses cost employers through direct and indirect costs and can be significant. Make sure your company does everything possible to encourage workers with depression or other mental health challenges to seek help early.

 

 

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

 

Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

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.

Business Map to Workers Comp In Enterprise Risk Management

Once a company is successfully able to implement the foundation of their Enterprise Risk Management program, the attention soon shifts to having an effective map that allows important connections to be made.

 

Almost all companies have organizational charts. Most companies, however, do not have a holistic view that outlines business processes, relationships and resources and how it all fits together. In short, a map that uses technology to support meeting organizational objectives.

 

Maps give options and technology provides insight that allows getting places quicker and more efficiently. As you are leaving work on a Friday at 5 PM it is certainly helpful to know what alternative routes are available. When your GPS takes you a different route because it can identify bottlenecks due to an accident, it just gave you another advantage.

 

Organizations are complex. They involve things like business processes, resources, people, policies, relationships, physical assets, applications and data repositories in the midst of dealing with risk, performance and readiness issues. When these things are captured and aligned in business silos it makes your commute (business objective) from point A to B even more challenging.

 

Business maps, unlike organizational charts, take into consideration the complete picture with a purpose, by design, to efficiently get you somewhere.

 

 

Making the Connections

 

No one knows everything in your organization. There is too much happening and it is constantly changing. To make good decisions, the goal is to find the critical paths, priority and resources that need to be involved.

 

Start by organizing by resource rather than by use or department. Once the resources are organized and defined, it makes it much easier to establish important relationships. For example, if your resources are defined and you use your business map to draw the lines/make connections between a “risk” that affects 3 different business processes in your organization and turn the solution into a collaborative vs. silo’d effort, you made progress.

 

Forward thinking companies take advantage of technology that allows important connections to be made.

 

 

A Natural Starting Point

 

As noted by Michael Stack, a principle at AMAXX, workers’ compensation takes a village. When you have and need a village working together, a map is essential. In this very specialized business process area, you are traveling through some very complex neighborhoods and any wrong turn can be costly.

 

Wrong turns such as poor communication and delayed actions translate into missed opportunities.

 

How the processes, relationships and resources tie together in workers’ compensation is a system/map that works best when it is defined in a way that is transparent to the team involved.

 

When a holistic picture is concisely captured and communicated, it makes it much easier for stakeholders to contribute, provide support and make connections that translates into continuous improvement of your program.

 

Capturing the collaborative efforts of a village takes a clear map in the workers’ compensation space. For companies who have not made the leap to Enterprise Risk Management (ERM), this area becomes a perfect landing spot.

 

Applying ERM concepts to workers’ compensation programs allows organizations to demonstrate success and milestones that are transferable and build momentum to a broader ERM initiative.

 

 

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

2 New Tricks for New Workers’ Comp Claims

Published originally on February 6, 2017 on WorkComp Wire

 

As discussed in last week’s article, old dogs can be taught new tricks. A proactive settlement initiative can not only get legacy claims off the books, but it can also dramatically reduce costs and improve patient care. In one case, a man who suffered a minor back injury at work more than 25 years ago was weaned off fentanyl, hydrocodone, and several other drugs. The claim’s pharmacy spend went from $1,200 to $600 a month and a settlement is planned.

 

An employer that inherited legacy claims in an acquisition initiated an aggressive settlement program that produced $6.5 million savings on 43 MSAs during a 10-month period.

 

Yes, the settlement initiatives produce excellent outcomes for old dog claims. But the lesson here is that these so-called new tricks are available throughout claims handling. Adopting a settlement mindset from day-one can prevent claims from spiraling out of control and becoming old dogs. Think of the medical and indemnity cost savings as well as litigation costs that can be saved as a result of settling these claims short of attorney referral.

 

Remember these two new tricks:

 

  • Proper medical documentation of a file results in better claims handling. If medical treatment records are missing from the file, prescription history is absent or inconsistent with the medical records, or medical care is left open ended, it is difficult to assess the appropriateness of ongoing and future medical care.
  • Pharmaceutical intervention does not need to wait. A claim must be consistently evaluated for the appropriateness of recommended and ongoing prescription medication use. The addition of opioids weeks into the claim is a red flag. Do not wait until on the brink of settlement negotiations to intervene on prescription medications use, do it now.

 

Clinical and legal partners must drive a successful outcome for employer and employee. Every stakeholder (nurse case manager, adjuster, pharmacy benefit manager, defense attorney, or physician) should watch for red flags and intervene themselves or relay issues to the claims handler to determine the necessary action plan to right the ship before the claim gets more difficult to control.

 

When pursuing a settlement initiative involving complex, “old-dog” claims, savvy payers price out future medical exposure, identify cost drivers, and decide which claims to settle right away and which warrant intervention. The smart payers also learn from these old dog claims and put best practices in place to address cost drivers early on in claims handling. What is the impact of pursuing such a claim strategy? Here are the results from an employer who converted an old-dog settlement initiative into a standard for new claims handling:

 

  • 29% reduction in open claims after one-year
  • 43% reduction in open claim after three years
  • 14% reduction in total costs after one-year
  • 26% reduction in total costs after three years
  • 40% reduction in attorney referrals after three years
  • 25% reduction in pharmacy costs after three years
  • 55% reduction in CMS-approved MSA amounts after three years

 

It’s never too early or too late for clinical intervention on a claim with the purpose of driving a successful resolution to the claim. While old dogs can be taught new tricks, the best strategy is to incorporate settlement initiative protocols into claims handling best practices.

 

 

About Dan Anders

 

Daniel M. Anders, Esq., MSCC is the Chief Compliance Officer for Tower MSA Partners. A certified Medicare Set-Aside Consultant and attorney, he oversees the Medicare Secondary Payer (MSP) compliance program. Mr. Anders is responsible for ensuring the integrity and quality of the MSA program and other services and products and he provides education and consultation to Tower MSA clients on all aspects of MSP compliance.

 

Mr. Anders is the former Senior Vice-President of MSP Compliance for ExamWorks Clinical Solutions and he has extensive litigation experience from his prior position with the Chicago law firm of Wiedner & McAuliffe. He holds a Juris Doctor from Chicago-Kent College of Law and a Bachelor of Arts degree from Loyola University Chicago.

 

Contact Mr. Anders at 847.946.2880 or daniel.anders@towermsa.com

 

 

About Tower MSA Partners
Tower MSATower MSA Partners is a national provider of Medicare Secondary Payer services, including Section 111 Reporting and Conditional Payments along with Medicare Set-Aside preparation, submission and oversight. Its proprietary MSP Automation Technology Suite drives MSP compliance best practices and provides end-to-end visibility into each activity. Tower’s other services include pre-MSA Triage, physician peer reviews, MSA administration, medical cost projections, and life care plans. With more than 50 years combined experience in pharmacy, legal oversight and medical care, Tower proactively stages claims and works collaboratively with clients to identify issues and intervene to modify outcomes. Tower remains involved in the claims, through final resolution, MSA and/or other settlement. This model enables Tower’s clients to provide better care to injured workers, reduce claim and MSA costs, and obtain CMS acceptance of the MSA. For more information, visit www.towermsa.com and subscribe to Tower’s www.mspcomplianceblog.com.

WCRI Preview: Impact of Trump, Congress, & Legislature on Workers Comp

 

Donald Trump, the House, the Senate, 68 out of 99 State Legislative Chambers, and the highest number of Governors since 1922. I’m Michael Stack with Amaxx, and what I’m referring to is the amount of political control for the Republican Party as the result of the 2016 election.

 

Now if you’re a Democrat, and frankly even if you’re a Republican to some degree and even if you voted for Donald Trump, there is a little bit of fear, even if it’s for you it’s just a tiny bit, of how that change is going to impact our country and if you’re in the workers’ comp industry, how that change is specifically going to impact us in our industry, and the answer to that is frankly, I’m not really 100% sure. It’s not my area of expertise but I’m looking forward to learning about it at the upcoming WCRI Conference, which is going to be held March 2nd and 3rd in Boston.

 

 

Impact of the 2016 Election

 

The first session is the Impact of the 2016 Election on the Work Comp industry. I will be there in attendance and I will be taking a lot of notes because it’s something that I want to learn about and add to my toolbox and my bag of resources. Now, the second session at that conference is called Worker Outcomes and Return to Work. This topic is right in my wheelhouse. I get questions a lot of times from people. They’ll send me and e-mail and say, “Hey, Mike, do you have a study? Anything that I can reference about X, Y, Z topic?”

 

 

Worker Outcomes and Return to Work

 

Depending on the topic, sometimes I’ll have a study that I can reference and sometimes I won’t, but WCRI is one of my favorite resources and one of my often, most often quoted resources for studies and this is one I am sure I will be quoting often because they’re going to be taking a look at Return to Work and Worker Outcomes from the employee perspective, the employer perspective, medical providers, insurers of how different things really impact the outcome of those particular individuals in those claims, so that’s a session I’m very much looking forward to.

 

 

Opioids, Value Based Health Care, & The Grand Bargain

 

The rest of the agenda is going to be hitting some very important and timely topics like opioids, does value-based healthcare work in work comp and really an appraisal of the entire work comp system and if the grand bargain is still the right answer, so WCRI is one of my most highly respected organizations. I love that conference. It’s one of my favorite to attend all year. It also happens to be a local conference for me, which is great. I’m Kennebunkport, Maine so a short drive down to Boston. I’m looking forward to being in attendance and I hope that you will too and I look forward to seeing you there.

 

 

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

 

Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

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.

3 Strategies To Reduce Workers Comp Legal Costs

Litigation management is a crucial element of controlling your workers’ comp costs. Otherwise, you may be paying significant dollars for a variety of seemingly miniscule costs — all of which are easily avoidable. Your company’s mindset toward a layer should be that of a partner who can bring value to your worker’s comp program.

 

 

The Right Fit

 

Partnering with the right lawyer is the first step to reigning in legal costs. Rather than hiring someone ‘off the rack,’ your defense attorney should be someone who understands and shares your company’s culture and works with your organization to find ways of achieving best outcomes while keeping an eye on costs. You want someone with whom you can easily communicate — even on cases that are not being litigated.

 

Here are some factors to consider in deciding on a lawyer:

 

  • Ask for recommendations. Seek input from others in similar businesses to yours. L-ook for attorneys who are considered part of the team.
  • Get references. Especially if you are not sure whom to ask for recommendations, talk to clients of attorneys you are considering.
  • Do a meet-and-greet. Don’t rely on phone or email interviews. You want to feel comfortable with the person you hire and vice versa. Bring him to your company, show him your facilities and see how he interacts with others involved in your workers’ comp program and other areas of your organization. Also, see how your TPA gets along with the person and vice versa.
  • Ask questions. Find out the fees he charges as well as overall litigation costs.

 

 

Best Bang for the Buck

 

Once hired, your attorney should help you manage claims by showing what he can and should do and what you and your company can do.

 

  • Accident investigations. Work with your attorney to find out what information you should obtain immediately following an injury that will help in the long run. Interviewing all relevant witnesses, taking recorded statements and creating a paper trail are among the best practices. These actions will cut down on the amount of work required of the attorney or other outside vendors later on, should the claim be litigated.
  • Approvals/denials. Your attorney can help your claims adjusters better understand which claims can be defended if they are denied, and which are clearly compensable. You don’t want to waste time and money fighting losing battles.
  • Determine who has responsibility for what. Defense counsels should do the work that is in their areas of expertise; likewise the claims adjuster, nurse case manager, TPA, etc. Completing wage forms, for example, should be the duty of the adjuster in most cases; however, they attorney may be better served taking on this responsibility if, say, the injured worker was employed for only a short period of time or was paid in a nontraditional manner. In that case, the attorney may be better able to calculate the wages. While nurse case managers and others are aptly qualified to complete many forms, the attorney should at least be consulted if the injury is complex or multiple body parts are involved. An attorney should be the one to obtain medical records when a case is in litigation — even if a nurse case manager has already obtained them. By using a subpoena, an attorney can get a more complete set of records.

 

 

Check the Facts

 

Even if you have hired the best workers’ comp defense attorney who is doing a great job helping your company, you still need to understand his bill and see if there are areas for reductions. Audit companies can help review the numbers. If anything looks too legalese or vague, ask questions until you are clear on what is being charged for what. Make sure you are paying for actual time spent on your claims and not on administrative tasks.

 

 

Summary

 

Instead of a necessary business expense, your attorney should be an asset to your company — someone who helps streamline the claims process.

 

 

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

 

Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

©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 Keys to Keeping Employees Safe Behind The Wheel

With fuel prices still low, many experts predict 2017 will see increased road travel. Employers need to be aware of the risks to workers who drive and take steps to protect them.

 

Transportation incidents are the No. 1 cause of workplace fatalities, claiming nearly 40 percent of all occupational deaths in the most recent year for which data is available from the government. They are also the top risk for business travelers abroad, especially in Africa and the Eastern Mediterranean.

 

Workplace crashes can be expensive for a company in terms of lost productivity, as well as workers’ comp costs. The good news is the risks can be greatly reduced by taking action.

 

1. Safe driving policy

 

Every organization has different needs and may have differing ways to protect employees who drive. However, there are several components that transcend all companies. Having a Safe Driving Policy that is well thought out, supported by all levels of the organization and communicated to employees is key. Among the elements to consider are the following:

 

  • Use of technology. Texting and using hand-held phones while driving should be verboten by all organizations. Many states do not have laws supporting a ban, but research strongly indicates the risk of a crash is greatly increased when drivers text or use hand-held phones.
  • Seat belts. These should be required of all drivers. Nearly every state mandates seat belts for drivers.
  • Prevent drowsy driving. Accidents involving tired drivers occur most often between the hours of 12 – 2 a.m., 4 – 6 a.m., and 2 – 4 p.m. Companies should allow workers to take breaks for brief naps and to stop for the night if they are too tired. Providing information on good sleep habits is also helpful.
  • Alcohol and drugs. Driving after drinking and/or using illegal drugs should be strictly prohibited. The issue can be dicey when prescription medications are involved. At the very least, workers should be given information about the potential effects of certain drugs.
  • Plan the trip. The worker and his supervisor together should determine the destination, route and travel schedule. Before sending a driver out, the worker and/or supervisor should check for any adverse road conditions and/or closings.

 

 

2. Driver selection

 

Before putting any employee behind the wheel of a company vehicle, it’s imperative to make sure the person has a valid driver’s license. Employers should also check driving records before hiring employees who are likely to drive for the company, and recheck them annually.

 

 

3. Training

 

All new hires should be required to undergo driver training. Classroom instruction can address new equipment, regulatory updates, and changes in procedures. If possible, behind-the-wheel training should also be included. A driving expert or trained supervisor can ride with the employee and evaluate his skills and behaviors. Workers should be coached on any unsafe driving behaviors. The employee’s driving performance should be reevaluated at least annually.

 

Training on particular vehicles is important, as company cars may include equipment and safety features unfamiliar to the worker. Workers should also be informed about any in-vehicle monitoring systems present, including why they are there.

 

Refresher training can be done periodically to reinforce best practices. Drivers involved in an accident attributed to them should be provided remedial driver training.

 

 

4. Vehicle selection/Maintenance

 

Employers should buy or lease vehicles with high safety ratings. Employers can supply each vehicle with emergency supplies, such as flashlights, flares, blankets and bottled Water.
Vehicles should be inspected on time and maintained according to manufacturers’ timeframes. Also, someone — a designated person or the worker who has most recently driven the vehicle — should ensure tires are properly inflated, and other safety procedures are followed.

 

 

Conclusion

 

The best way to protect employees from motor vehicle crashes is to limit their driving. Employers should consider whether work can be done without travel. If driving is unavoidable, schedules should be established to ensure workers have adequate time to get to their destinations while obeying speeding and other traffic laws. Establishing a company-wide culture of safe driving can reduce risks drivers face.

 

 

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

 

Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

©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.

How Old Dog Workers Comp Claims Can Learn New Tricks

Published originally on January 30, 2017 – WorkCompWire

 

By Dan Anders, Chief Compliance Officer, Tower MSA Partners

 

Dan AndersThe saying goes you can’t teach old dogs new tricks. But when it comes to clinically driven settlement initiatives involving complex “old dog” workers’ compensation claims, old dogs can be taught new tricks. What’s more, the lessons learned from old dog claims can become a foundation for “new tricks” that can be applied in the management of all claims, building a best practices model that stops the cycle.

 

“Old dog” claims refer to legacy claims or claims which have been open for some time and continue to draw down on the indemnity and medical reserves as a result of ongoing time off work and/or continued medical care. Old dog claims can come from a merger or acquisition, especially if the companies have different claims management and settlement philosophies. Complex claims that were once in front of an adjuster on a regular basis may also become old dogs when shunted aside by an influx of new claims.

 

Whether triggered by a merger, a change in management or the sheer volume of legacy claims, an aggressive settlement initiative can push many old dog claims to closure, and if not closure, there is clear communication that changes will occur. Whether through settlement or a change in treatment, the “old dog” will learn “new tricks.”

 

Successful settlement initiatives involve multiple partners, first to identify and analyze cost drivers across a large number of old open claims, then match them with appropriate interventions (file review, physician peer review, clinical oversight, legal action) to resolve all issues blocking settlement. Once the obstacles are addressed, the next step is to work with the settlement partner to create an incentive for both injured worker and payer. If settlement can be achieved, it is a win, win for all stakeholders. If settlement isn’t possible, injured workers and their physicians are challenged within the context of jurisdictionally approved treatment guidelines to improve care.

 

If executed consistently as part of a strategic plan to identify, intervene and remain involved until closure, the lessons learned from this type of settlement initiative will become imbedded into the claims management culture of the payer.

 

 

Identifying and Analyzing Claim Cost Drivers
Consider the case of an employer with longstanding open medical and legacy claims. Some of these claims may involve injured employees who are actively treating, even if it is just maintaining medications, while others may involve patients whose current medical condition is unknown. In either case, the employer’s first step is a file review that identifies claims in need of addressing for case settlement. The next step is the employer involving a strategic clinical partner to properly assess ongoing and future medical exposure, if any.

 

The best methods for analyzing future medical exposure are through a medical cost projection or a Medicare Set-Aside (MSA) if the claimant is a Medicare beneficiary or close to becoming one. An MSA has the added benefit of limiting medical care to treatment and medications that are Medicare-covered, thus potentially reducing future medical exposure for settlement. The goal of either method is to identify any red flags, such as:

 

  • Use of opioids, muscle relaxants and NSAIDS
  • Multiple prescribers of medications
  • Open-ended recommendations for surgery
  • Spinal cord stimulator recommendation
  • Prescription history that is inconsistent with the medical records
  • Most recent treatment date is so old that it leaves medical care open ended
  • Indication outside of medical records that injured employee continues to treat, but not through the workers’ compensation claim

 

The clinical partner needs to understand how the legal aspects of a claim (denied body parts and conditions and legal determinations) impact the assessment of future medical care and to be able to work effectively with defense counsel to limit ongoing and future medical care. Once the clinical partner projects future medical care and identifies red flags, the partner and employer should separate the claims into those that can immediately move to settlement negotiation, those that could settle after clinical or legal intervention, and those that are unlikely to benefit from intervention and thus cannot settle.

 

 

Appropriate Clinical Interventions
One size does not fit all when it comes to the right intervention to impact the medical care on a claim. If old medical records indicate open-ended medical care, then the intervention plan may involve the clinical partner contacting the last treating physician to confirm there has been no medical care delivered since the last date of service. If there has been medical care, the partner may track down additional medical records and assess future medical care based upon those records.

 

If there is a significant medication spend, a physician peer review may be the most appropriate claim intervention. A physician peer review is conducted by a practicing physician who performs an in-depth analysis of an injured employee’s medication regimen, comparing it to evidence-based medical and pharmaceutical guidelines. The physician peer reviewer then contacts the treating physician and discusses the drug regimen and current guidelines and asks the treating physician to change the pharmacy treatment or the medical treatment plan. The clinical partner obtains the treating physician’s written agreement to change the course of medical treatment and drug regimen. The partner follows up with the physician to ensure that changes actually occur and secures copies of medical records documenting the changes prior to preparing a settlement document.

 

 

Claim Closure
Once changes to medical and pharmaceutical care take place, the clinical partner works with the employer or carrier to revise the initial projections of future medical care whether contained in a medical cost projection or an MSA. If the latter, the MSA should be submitted to the Centers for Medicare and Medicaid Services (CMS) for approval. A settlement team should be assembled to work with the adjuster or a manager to complete negotiations and finalize the settlement.

 

 

About Dan Anders
Daniel M. Anders, Esq., MSCC is the Chief Compliance Officer for Tower MSA Partners. A certified Medicare Set-Aside Consultant and attorney, he oversees the Medicare Secondary Payer (MSP) compliance program. Mr. Anders is responsible for ensuring the integrity and quality of the MSA program and other services and products and he provides education and consultation to Tower MSA clients on all aspects of MSP compliance.

 

Mr. Anders is the former Senior Vice-President of MSP Compliance for ExamWorks Clinical Solutions and he has extensive litigation experience from his prior position with the Chicago law firm of Wiedner & McAuliffe. He holds a Juris Doctor from Chicago-Kent College of Law and a Bachelor of Arts degree from Loyola University Chicago.

 

Contact Mr. Anders at 847.946.2880 or daniel.anders@towermsa.com

 

 

About Tower MSA Partners
Tower MSATower MSA Partners is a national provider of Medicare Secondary Payer services, including Section 111 Reporting and Conditional Payments along with Medicare Set-Aside preparation, submission and oversight. Its proprietary MSP Automation Technology Suite drives MSP compliance best practices and provides end-to-end visibility into each activity. Tower’s other services include pre-MSA Triage, physician peer reviews, MSA administration, medical cost projections, and life care plans. With more than 50 years combined experience in pharmacy, legal oversight and medical care, Tower proactively stages claims and works collaboratively with clients to identify issues and intervene to modify outcomes. Tower remains involved in the claims, through final resolution, MSA and/or other settlement. This model enables Tower’s clients to provide better care to injured workers, reduce claim and MSA costs, and obtain CMS acceptance of the MSA. For more information, visit www.towermsa.com and subscribe to Tower’s www.mspcomplianceblog.com.

Leverage 2 Super Bowl Tactics To Drive Your Work Comp Comeback

Hello. Michael Stack here with Amaxx. So yesterday was Superbowl 51. If you missed the game or you went to bed early, kind of like my wife did, you missed the most exciting and improbable comeback in Superbowl history by one of the greatest teams and greatest quarterbacks in history as well. Of course the New England Patriots were down 28 points to 3 late in the third quarter, a 25 point deficit, but Tom Brady was able to rally the team together. Tied up in regulation, and then of course they went on to win in overtime.

 

 

2 Tactics Patriots Levered to Win Super Bowl

 

What are those things? What are those tactics? What are those characteristics that the Patriots were able to tap into that led to that extraordinary comeback? It’s going to be talking about in today’s video and how you can use those same tactics to have extraordinary success in your Worker’s Comp Management Program.

 

Let’s talk about what these things are. The two elements that they leveraged were momentum and expectation. Momentum and expectation. Momentum and expectation. Now, love the Patriots or hate them, they have an expectation to win. Tom Brady has an expectation to win. When their team was down late in the third quarter and they scored that first touchdown to make it 28 to 9, they started to capture some of that momentum. When Tom Brady in the huddle said, “We’re going to win this game,” the expectation was that I believe you. You don’t have to convince me, because that expectation has been ingrained in their heads for years and years as part of the Patriots culture. They captured that momentum and they continued to ride that through the end of the game. You knew when it went to overtime, it was almost guaranteed that the Patriots were going to win that game, because they had captured such strong momentum.

 

 

How Timely Are You Making Safety Repairs?

 

Let’s talk about your Workers Comp Management Program and how this looks and how this can be applied. I have a question for you. I want you to answer this question honestly for yourself. If you asked your workforce on a scale of one to ten how timely are system safety repairs and changes being made, that’s your expectation. Let me ask that one more time. If you were to ask your workforce on a scale of one to ten how timely are system safety repairs and changes being made. This is an an example of, say the guard needs to be replaced, say there’s water that’s spilled on the floor, say your workforce makes other safety recommendations for changes. How timely are you actually physically making those repairs? You’re setting your employees’ expectation for how much you care about them.

 

If they don’t see you making the changes, if you haven’t replaced the guard in six months, if there’s water spilled on the floor and no one addresses it or no one puts up the signs, that’s the expectation for care. When that individual gets injured, they think well these guys could give a _____ about me because they never fix the guard. You’re telling them about your return to work program and how much you care about them and how you’re going to work together to get them back to work, and they say, “Yeah, right. You couldn’t even fix the guard in the first place.” They’re carrying that momentum with them into the injury.

 

 

Create A Winning Culture of CARE At Your Organization

 
Can you imagine, then, if Tom Brady didn’t have this winning culture, this winning history, that winning expectation and he’s in the huddle, and he tells his guys, “We’re going to win this game.” They’re going to say, “Yeah, right. We’re down 25 points. It’s the end of the third quarter. There’s no way that’s going to happen.” That’s the expectation. They had that carried into and they were able to win that game.

 

Let’s talk about that addressing those points, addressing those safety points, keeping that, building that positive momentum, so that you care about them. You’ve made all the safety changes. You’re on top of it. Then their expectation is that you’re going to care about them and you’re going to work together for much more successful Workers Compensation Injury Management Program.

 

Again, I’m Michael Stack with Amaxx, and if you’re watching this video somewhere other than http://reduceyourworkerscomp.com go ahead and go to that website. Sign up for our newsletter for a lot more free information and tips on how to control your workers comp costs. Let’s take it one step further. You can go to http://workerscompclub.com/livestreamtraining and sign up for my next live stream training.

 

Again, I’m Michael Stack. Remember, your success in Workers Compensation is defined by your integrity. So be great!

 

 

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

 

Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

©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.

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de