6 Minimum Expectations For Employer Involvement in Workers’ Comp

6 Minimum Expectations For Employer Involvement in Workers’ CompWe all know it is the employer’s responsibility to purchase workers’ compensation insurance coverage and to report a claim to the claims office when an accident occurs. Unfortunately, way too many employers end involvement in workers’ compensation at this point. It’s expensive to be passive about workers’ compensation.

 

However, being an active, responsible participant in your work comp claims process improves the employer’s financial picture.  Here are the minimum expectations of employer involvement in workers’ compensation:

 

A Safe Work Environment:

 

It is your responsibility as an employer to provide a safe work environment. By doing so, you eliminate many work comp claims because the injuries never happen. A strong safety program in which the employees are actively involved in preventing accidents has a major impact on the financial cost of workers’ compensation.

 

Know the Law:

 

Post in a convenient place state required notices for all employees to see. Notices include their rights under the work comp laws, a list of approved medical facilities (in states allowing the employer to select the medical provider), post OSHA posters and anything else required in your state.

If an employee is injured, allow the employee to seek medical care as quickly as possible. Do not do anything appearing to interfere with the employee’s right to medical assistance.

 

 

Report the Claim At Once & Accurately:

 

It is not enough to report the injury claim to the claims office. Report the injury immediately to the claims office  – just as soon as the employer becomes aware the injury occurred. Not next week, not in a couple of days, not when you “get around to it,” but NOW – when the employee is seeking medical treatment for the work comp injury.

 

All employees and all their supervisors should know that it is a requirement for every work comp claim to be reported to your work comp claims coordinator as soon as medical treatment is needed. The claims coordinator then promptly completes the Employer’s First Report of Injury and immediately sends it to the claims office. Immediately means, “stop whatever you are doing” and report the new injury/claim.

 

All supervisors should be trained on the information needed to complete the Employer’s First Report of Injury form so it is accurate when it is received in the claims office. It is well established in the claims field that fast and accurate reporting of the claim has a positive impact on the outcome of the claim.

 

 

Cooperation with the Insurance Company:

 

The employer who takes the hands-off approach to work comp claims will see a steady increase in their work comp insurance premiums. The smart employer takes the approach of being actively involved in the work comp claims.

 

It is your responsibility as an employer to assist the work comp adjuster in their handling of the claim. As the adjuster investigates the claim, there will be a need for documentation from you as to the employee’s payroll history. The adjuster may need to speak with the employee’s supervisor or co-workers who witnessed the injury. In some situations, the adjuster may need to see the employee’s personnel file or health benefits file. If you are contacted by an attorney for the employee, be sure to notify the adjuster immediately. By providing whatever assistance the adjuster needs on a timely basis you can help to mitigate the cost of the work comp claim.

 

 

Employee Contact:

 

One of the most often over-looked responsibilities of the employer in work comp claims is the human element. The employee’s supervisor or the work comp claims coordinator or both, should stay in contact with the injured employee while that person is off work. By letting the employee know your company is concerned about his/her well-being and by keeping the lines of communication open, the risk of the claim becoming adversarial or the employee employing an attorney, guaranteed to delay resolution of the claim, is diminished.

 

 

Return to Work Program:

 

Study after study show the quicker the employee is returned to work, the lower the overall cost of the workers’ compensation claim. It is imperative the employer have a Modified Duty Program or a Light Duty Program available for all injured employees.

 

In most states you can contact the employee’s medical provider and ask for the conditions under which the employee can return to work. You have the right to know the employee’s medical condition and to have the worker return to work on a light duty program with the medical provider’s agreement.

 

By bringing the employee back to work on a modified duty program, the employee benefits and the employer saves money (remember the more the insurance company pays out, the higher your eventual work comp premium).   When the employee is off work, the insurance company is paying benefits to the employee, but the employer is not receiving anything of value. By returning the employee to work, the benefits being paid by the insurance company stop. While an employee on modified duty may not be as productive as an employee on regular duty, the employee is still producing some benefit to the employer.

 

 

Summary:

 

The more pro-active the employer is in the work comp claim process, the lower the overall cost of workers’ compensation. Employers who provides a safe work environment, knows the requirements of the workers’ comp laws in their state and who reports their work comp claims quickly and accurately will lower their cost for work comp coverage. The employer who cooperates with the insurance adjuster’s investigation, keeps in contact with the employee and assists the employee to return to work quickly experiences a positive effect on the cost of workers’ compensation.

 

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

Use A Medical Advisor To Maximize Value of Independent Medical Exam

Use A Medical Advisor To Maximize Value of Independent Medical Exam A company medical advisor can be one of the most effective tools for reducing workers’ compensation costs as there is often a need to address specific health issues in regard to an injured employee’s case.

 

 

Leverage Medical Advisor for Independent Medical Exams (IME)

 

An example is leveraging your company’s medical advisor regarding an Independent Medical Exam (IME). Follow these steps:

 

  1. Accompany your adjuster’s letter with a signed cover letter from the medical advisor or director. Doing so results in more comprehensive and conclusive independent medical evaluation and examination (IMEs) reports.
  2. Be sure to include claim number and all relevant addresses and contact information on the letter.
  3. Welcome the physician to ask questions.

 

 

Be sure to ask the independent medical evaluation physician (IME) to answer the following questions or types of example questions:

 

  1. What is the patient’s present diagnosis and work status since it is X months since the original injury?
  2. Has s/he achieved maximal result?
  3. Can s/he perform the job as a painter (or whatever is the usual work task)?
  4. Specifically, please address whether s/he would have difficulty simply walking on a flat surface and going up and down a ladder?
  5. Since the latter involves flexion and extension of the ankle, would the lateral sprain affecting primarily pronation and supination really interfere with performance?
  6. If the worker uses an ankle support, would it be sufficient to allow work performed as a painter?

 

For example, this may be necessary when documentation states:  “Patient may have trouble walking.”  and your company needs to know how long the worker can walk for, at what inclination and duration.  These specifics can be determined by the independent medical examiner but may require some slight prodding to get documented.

 

 

Medical Advisor Often Overlooked

 

As part of an overall workers’ compensation cost-control program, hiring a medical advisor to work proactively on claims is an important, but often overlooked step.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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 to Tell If You Need a Nurse Case Manager for Your Workers Compensation Claim

How to Tell When You Need at Nurse Case ManagerNurse case managers (NCMs) coordinate medical care and determine extent of disability.  However, there are times when the NCM doesn’t serve a specific purpose and is assigned to the claim to get the claim moving.  At times, NCM’s are used to do some of the tasks adjusters are supposed to do. Your job is to clarify when nurse case management is warranted and useful.

 

The injury coordinator can evaluate these aspects of both telephonic case management and field-based case management first of all by emailing the adjuster and stating the above.

 

Also, the injury coordinator should know whether your NCM is an RN or a Licensed Practical Nurse (LPN). You should be charged less for a LPN or a NCM with less experience or fewer credentials.

 

  • Require the NCM to provide you with frequent updates. If you review the insurer’s file notes online and do not see NCM notes, contact the NCM to provide an update.
  • Ask your third party administrator or adjuster to work with you to determine when the use of nurses serves to resolve claims quickly and ensures good quality medical care for the employees.

 

 

Ask the following:

 

  • Do you have any suggestions of when we should use nurses, what types of claims?
  • Can we get a list of all claims which have NCM assigned?
  • Shall we touch base about this on our regular risk management conference call?

 

 

Make use of a Nurse Case Manager:

 

  1. In complex cases with multiple provider coordination.
  2. In new lost-time claims if the length of time out of work is disproportionate to the injury.
  3. When an employee is missing medical appointments.
  4. When surgery, including arthroscopy, is anticipated.
  5. For all hospitalizations.
  6. If there is diagnostic testing including MRIs, CAT scans, or myelograms.
  7. For severe injuries including: severe eye injuries, severs lacerations, back and knee injuries, cumulative trauma cases and severe sprains, strains or dislocations.
  8. And remember:  Not all nurse case managers are equally effective. If your assigned NCM is not effective, ask for a replacement.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

8 Part Email To Send When Transitional Duty Doesn’t Work

8 Part Email to Send When Transitional Duty Doesn't WorkDespite your best efforts to get medical restrictions from all treating physicians and evaluate your employee on a weekly basis, there are times when the medical provider says the injured employee can do more than s/he thinks s/he can.

 

  • For example, a bus driver injured his right arm in a work-related accident. The doctor finds the muscles and bones have mostly healed and the patient should no longer be feeling pain and may return to work for four, rather than an eight-hour day.
  • But in your weekly reviews, the employee complains that opening the bus door is still so painful he cannot drive home at the end of the day.

 

In this situation, write an email from the injury coordinator to the adjustor asking if a functional capacity evaluation (FCE) may be needed. Also, consider options for alternate work for a while longer.

 

 

8 Part Email To Send When Transitional Duty Doesn’t Work

 

  1. Be sure to include claim number and all relevant addresses and contact information on the letter.
  2. Include the supervisor in any discussions.
  3. Clearly explain the situation: who is injured, what the injury is, what the current complaint is and what the physician says the worker should be able to do
  4. Explain the company’s medical advisor reviewed the reports and the employee’s complaints do not mesh with the current medical diagnosis.
  5. Acknowledge the pain could be imagined (but without judgment) or the result of the employee being fearful of additional injury. Be aware that the pain might be very real also, and don’t minimize the likelihood of this possibility. Anyone who has ever had repetitive arm injury knows how painful it can be and often even a small amount of use can trigger painful symptoms.
  6. Ask your adjustor if an (FCE) is needed and, depending on results, perhaps an off-site work hardening program is in order.  In work-hardening the employee is allowed to build up to his regular job capacity in a supervised setting, removing the fear of re-injury.
  7. Ask the adjustor for suggestions of work-hardening centers in the area.
  8. Acknowledge the difficulty of this claim and ask the adjustor for a timely response.

 

Real or imagined, pain while doing one’s job benefits neither the company nor the employee. There are programs designed to help your employee work through these issues.

Vigilant attention to the employee will ease this process.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Two Very Important Steps When Managing A Catastrophic Injury Claim

When you say catastrophic injury, many people in the insurance field think of brain injuries, spinal cord injuries, severe burns, amputations, loss of eyesight or neurological injuries. While these are the more common types of catastrophic injuries, any injury requiring extensive medical treatment and has a long-term and/or permanent impact on a person’s life can be a catastrophic injury.

 

Catastrophic injuries make up only a small fraction of the total number of workers’ compensation claims but account for a significant portion of the dollars spent on medical care and treatment of employees. The proper management of these high dollar claims makes a significant difference in the cost of the workers’ compensation program.

 

 

Here are two very important steps to take to minimize the financial impact of the catastrophic injury claim, as well as create best outcome for the injured worker.

 

 

Step #1: Immediate Attention

 

When the work comp adjuster receives an obvious catastrophic injury claim, it is imperative for the adjuster to act immediately. The adjuster needs to drop everything else and concentrate on the catastrophic injury claim.

 

  • The work comp adjuster contacts the employer and interviews the supervisor and/or other employees who were present at the time of the injury to get a comprehensive understanding of what occurred.
  • Then the adjuster contacts the employee if the employee is able to speak with the adjuster. If the employee is unable to speak, the adjuster must make immediate contact with the spouse or another family member who represents the employee’s interest.
  • The adjuster makes arrangements to personally meet with the employee and/or the employee’s family member at the hospital, preferably the same day of the injury. The adjuster also arranges for the nurse case manager assigned to the claim to attend the initial meeting with the employee and/or employee’s family.
  • Contact by the work comp adjuster and the nurse case manager with the employee or family member the same day as the accident is reported is critical to the outcome of the claim.
    The employee’s most pressing concern is surviving the injury.
  • Once the employee is reassured by the medical facility s/he will live, the next thoughts are: “Will I be able to work in the future and how will this accident impact my life with my family and my family’s life?

 

 

Attorney Alert!

 

  • It’s at this point the employee or a family member remembers the late night television commercial for the local attorney. If the work comp adjuster or the nurse case manager reassures the employee and/or the family the injured person will receive all the medical care needed, and that indemnity benefits will be paid, the probability of the employee hiring an attorney to represent the employee is greatly diminished.
  • Hence, it is critical the work comp adjuster meet with the employee and/or family and establish rapport with them while reassuring them all their medical needs will be meet and the indemnity benefits will be paid.

 

 

Step 2: Medical Management

 

The intensive involvement of the work comp adjuster in the initial stages of the catastrophic injury claim is of paramount importance. However, as the claim progresses, and new work comp claims arrived on the adjuster’s desk, the need for a medical specialist to continue to assist the employee becomes necessary.

 

  • Early medical management is essential to achieve the best possible medical outcome. The highly trained nurse case manager (NCM) who was with the adjuster at the initial meeting with the employee and/or the employee’s family takes over the day to day medical management of the claim.
  • The NCM becomes responsible for insuring the employee receives proper medical care throughout the life of the claim. This continuity of the medical care is critical to the best possible medical outcome for the employee. It also prevents the medical care from drifting and prevents the work comp claim from becoming an even bigger claim.
  • The NCM works with the employee to guide the employee and the employee’s family through the significant life changes following a catastrophic injury.
  • As the employee goes through hospitalization, rehabilitation, return to home and community and, hopefully, an eventual return to work, the NCM controls the pace of the step-downs in medical facilities and medical care.
  • Along the way to recovery, or maximum medical improvement short of recovery, the NCM continues working with the treating physicians, medical specialists, consultants, therapists, rehabilitation provider and life-care planners, if the employee is unable to return to work.
  • For those employees who are permanent and totally disable and never able to return to work, the continuing involvement of the NCM is necessary. The expertise of the NCM in managing the medical aspects of disability and in determining the appropriate home-based care will impact the overall cost of the catastrophic work comp claim.

 

 

Summary:

 

Catastrophic injury claims not appropriately managed by the work comp adjuster and the nurse case manager quickly spiral out of control, drastically increasing the overall cost of the claim.

 

Immediate attention to the employee’s medical needs by the work comp adjuster and the nurse case manager, along with the continuing control of the medical care by the nurse case manager, has the positive impact on the overall cost of the work comp claim.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

Is Your TPA Recovering Every Subrogation Dollar It Should?

Do you ever wonder if the claim handling quality of your insurer or third party administrator (TPA) is as good as it should be?

 

  • Do you ever find your insurer or TPA making large reserve changes just before it settles a work comp claim?

 

  • Is your insurer or TPA recovering every subrogation dollar it should?

 

  • Is your insurer or TPA doing everything it should to resist fraudulent claims?

 

If you have any of these concerns, you can consider four types of file review for workers’ compensation claim files .

 

 

1 – Claim File Quality Audits

 

Your company’s service agreement with your insurer or TPA should specify the claim handling standards — the Best Practices– that apply to all of your workers’ comp claims. An audit of the work comp claim file quality focuses on the components of claim handling that optimize the claim resolution results.

 

The work comp claim file review compares your files against the Best Practices standards you agreed to with your insurer or TPA. The experienced auditor reviews and analyzes how the various aspects of the file interrelate to give your company a total picture of how each individual file is/was handled.

 

When the audit is concluded, your auditor provides you with an Executive Summary Report outlining the audit findings.  The Executive Summary Report outlines your claim handlers strengths and weaknesses. The report provides you with valuable information and recommends solutions allowing your company to avoid future difficulties. The completed claims audit provides your risk management department with peace of mind, or it assists your company to know where your claims are deficient, allowing you to take the appropriate action before you incur extra claim cost.

 

 

2- Reserve Audits

 

When reserves are set too high on your work comp claims, your company’s ability to undertake new business is unnecessarily limited and it may impact your company’s ability to get financing. When reserves are set too low, your company’s available assets are overstated, eventually resulting in unanticipated shortfalls.

 

Reserves need to be state accurately and they need timely adjustments —  soon as information impacting the reserves becomes available. The independent claims auditor evaluates the reserve accuracy and timeliness of reserves for individual claim files and for the entire work comp claim inventory.

 

Whether you need a reserve audit for underwriting and renewal, retro premium adjustment, a merger/acquisition, collateral adjustment, the professional claims auditor provides you with the accuracy of reserves you need. The reserve audit gives you an objective analysis of your financial funding needs.

 

 

3- Subrogation Audits

 

Every dollar recovered by subrogation is a dollar added to your firm’s bottom line. Often busy adjusters overlook subrogation opportunities. Subrogation must be looked for in every work comp claim. While your work comp adjuster knows to pursue subrogation on clear-cut automobile accidents, the work comp adjuster often does not have the liability expertise to recognize the potential for recovery when the work comp claim involves elements of general liability or products liability. The professional claim auditor identifies these potential recovery opportunities and maximize your recoveries.

 

Subrogation audits are considered for all open files and for closed files still within the statute of limitations. Subrogation audits pay for themselves by bringing in otherwise missed recoveries.   When the subrogation audit can be done electronically, your independent work comp claims auditor may often perform the audit for a percentage of the identified file review recoveries.

 

 

4- Fraud Audits

 

Nothing hurts the bottom line of your business more than a fraudulent claim, as it is a theft of the amount of money paid on the claim and, as we all know, the company’s loss history is used as the basis for future premium charges.

 

Separating the fraudulent claims from the legitimate claims can be difficult. The professional auditor can assist in identifying those claims where more can be done to disprove the fraudulent claim.

 

 

Summary

 

The professional claims auditor provides your company with the information you need to determine the claim handling quality of your files. The auditor assists you in verifying or correcting the accuracy of file reserves.   A subrogation audit pays for itself in additional identified recoveries, while a fraud audit save your company from paying fraudulent claims. All four types of audits improve the financial status of your company.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

Develop Defense Attorney Relationships to Settle Work Comp Claims

Leaders of claim management teams are constantly seeking solutions to solve problems.  This includes surrounding themselves with like-minded individuals who have a mindset that empathizes with the injured worker while at the same time advocating for the bottom line.  When seeking to accomplish this goal, interested stakeholders should evaluate their program and settlement procedures.  Another area of focus should include the development of relationships with defense attorneys that share the same vision as the claims management team.

 

 

Evaluate Cases Early and Attempt to Settle

 

All members of the workers’ compensation claim management team needs to develop the skill of evaluating a case and driving it toward timely settlement.  This involves several steps that need to be taken before referring a case for legal assistance.  Necessary steps include:

 

  • Conducting an effective initial investigation and, if necessary, issuing a denial of primary liability grounded in the facts of the claim and the law. Failure to do so in a timely manner will only add to the cost of each claim;

 

  • Accurately calculate the average weekly wage (AWW) to determine properly the employee’s benefits and future exposure. Most workers’ compensation benefits are grounded in the AWW.  Failure to calculate it correctly can significantly increase the time and money spent on a clam; and

 

  • Obtain the necessary background information on the claimant and work injury. In many instances, even seasoned claim handlers are not able to settle a case given their lackluster efforts in doing basic research on a claim.

 

 

Identify Defense Counsel with Similar Values

 

Members of the claims management team need to expand their horizons and continually develop relationships with members of the defense bar.  This investigation needs to go beyond where an attorney went to law school or the name of their law firm.

 

  • Build relationships: There are countless opportunities to meet defense attorneys.  This can include bar association functions, claims association meetings or involvement in community programs.  Claim handlers serious about seeking creative solutions need to be proactive when it comes to finding the right attorney.  A factor should not include who is offering a free lunch or tickets to the big game.

 

  • Ideals Consistent with Your Program: Part of getting to know a defense attorney needs to go beyond that person’s favorite restaurant.  Members of the claims management team who want to find the best fit for their program need to understand the defense attorney’s strengths, opportunities to become a better lawyer and their views on how to handle claim.

 

 

 

Claim Updates and Consistent Status Reporting

 

Knowing what is going on in a case is important for anyone involved in handling workers’ compensation claim.  This is due to the speed at which claims are handled, litigated and moved toward final resolution.  Effective claim handlers need to seek out attorneys dedicated to keeping them involved and apprised of claim developments.

 

  • One effective tool to do this is a status report. A typical status report should include information on the facts of the case, a clear and concise legal analysis and proactive recommendations for further handling.  There should be no surprises.  This includes matters concerning case evaluation, the exposure of a claim and what likely will happen.

 

 

Conclusions

 

Running an effective claims management team and handling individual claims is demanding work.  This requires the individual claim handler to be proactive in the early part of a case as they investigate the injury and make determinations regarding liability.  Another important point is for claim handlers to develop relationships with attorneys to drive claims to settlement.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

Comprehensive Solution to Reduce Opioid Abuse & Other Top News Tidbits

A Comprehensive Solution to Reduce Opioid Abuse

In a recent pilot study of just more than 100,000 Express Scripts members new to opioid therapy, we observed a 38% reduction in hospitalizations and 40% reduction in emergency room (ER) visits in the intervention group versus control group during six months of follow up. Half of patients received an educational letter from the Express Scripts Neuroscience Therapeutic Resource Center (TRC) and half no intervention at all. A subset of patients receiving the TRC educational letter who had high-risk patterns of opioid use also received a counseling call from a Neuroscience TRC specialist pharmacist.

 

 

Best Practices from our Care Advocate Team

Ensuring the injured party is taken care of after settlement so that they can get the treatment and guidance they need is our number one priority.  Our Care Advocate team takes on this critical responsibility.

After settlement, the injured individual becomes our client (or “member”) and works directly with our Care Advocates.  We’d like to highlight a few of the services and practices we’ve implemented to go above and beyond for our members to help make the transition to their post-settlement care seamless.

 

 

Not So Secret Tips for Quick and Successful MSA Submissions

It’s no secret quick and successful Medicare Set-Aside submissions to the Centers for Medicare and Medicaid Services (CMS) are driven by medical records which meet CMS requirements for review and approval of the MSA. At Tower MSA Partners we strive to work with our customers to prepare and submit to CMS MSAs meeting these requirements. By doing so, we limit the time for CMS to review the MSA and avoid unexpected MSA counter-highers which may jeopardize settlement of a workers’ compensation case or at least delay resolution.

 

 

Ringler Associates President Geoff Hunt Talks about the Acquisition of Galaher Settlements

Geoff Hunt, president of Ringler Associates, discusses the company’s recent acquisition of Galaher Settlements and explains how the move will benefit everyone, including purchasers of structured settlements.

 

 

 

 

 

The Difference Between Active and Passive Injury Care

There are two possible approaches to injury care – active and passive treatment. While both can help get your employees on the road toward recovery, only active treatment limits long-term impact and keeps employees in the work environment as much as possible.

 

 

 

 

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

 

 

6 Elements To Review In Your Adjuster’s Action Plan

Workers' comp Plan of ActionThe old adage “Time is Money” definitely applies to the handling of workers’ compensation claims.   Experienced claim professionals know the longer a work comp claim remains open, the higher the overall cost to conclude the claim. Every delay along the path from the start of the work comp claim to its conclusion costs your self-insured program or your insurer money (eventually coming back to your company as higher work comp insurance premiums).

 

Here are some tips and suggestions on ways that you, the employer, can speed up the processing of your workers’ comp claims.

 

 

Pre-Accident Training

 

Every employee needs to know what to do in the case of a work comp injury. Your company needs to set the stage for your involvement in the work comp claim process from the very beginning.

 

Your new hire package must include instructions on the proper and timely reporting of the work comp injury. The accident reporting instructions must specify that the injury must be reported immediately, to whom the employee reports an injury, who are the approved medical treatment providers (in the jurisdictions where this is permitted) and information informing the employee of the return-to-work program your company uses.

 

Display, where all employees can see them, posters and/or billboards clearly showing these requirements, including the importance of immediately reporting the work comp injury. Be sure to post these materials in the employees’ prime languages in addition to English.

 

Remind supervisors and managers on a regular basis that all work comp injuries are to be immediately reported to your work comp claims coordinator. The supervisors and managers should be familiar with the information required to complete the First Report of Injury form required in their state.

 

 

Prompt Reporting

 

When the work comp claims coordinator receives the information about the new work comp injury, the claims coordinator immediately reports it to the claims handling office. If for any reason the claims coordinator does not have all the information necessary, the claim is still reported to the claims office with a note indicating the rest of the information will be forthcoming as soon as it is available. This allows the work comp claims adjuster to go ahead and get started on the claim.

 

 

Claim Service Standards

 

When your company starts an insurance program, the insurer or third party administrator (TPA) should provide you with information on their claim handling service standards. Those service standards usually specify within how many hours the adjuster will contact the employee once the claim is reported to the claims office. Great service standards specify the employee will be contacted within 2 (or 4) hours, while good service standards specify the employee will be contacted within 24 hours. If the service standards are silent on how fast the work comp adjuster will be in contact with the employee, ask them to make the 2-hour contact with the employee a claim-handling requirement on your files. If the insurer or TPA is reluctant to require prompt contact with the injured employee, it is time to get another insurer or TPA.

 

 

Employee Follow-up

 

When employees are injured, they are concerned about their future with your company, their future income and their ability to care for their families. When the employee’s supervisor or your company’s work comp claims coordinator contacts the employee shortly after the accident, the employee knows and feels s/he is valuable to the company.

 

When the employee initially reports the claim to the employer, the employee is instructed to keep the employer informed of medical treatment and medical progress. Emphasize the employee can expect to hear from the employer if the employee does not provide timely updates to your company.

 

Keeping in contact with injured employees lets the employees know the employer cares about them and their well-being. Employees who feel valued by their company are less likely to malinger off work when they could return to work, or hire an attorney.

 

For employees who are off work for an extended period of time, the claims coordinator should be contacting them on at least a monthly basis to inquire about their condition, their treatment and their expected return-to-work date.

 

 

Medical Follow-Up

 

In the majority of states the employer is allowed to contact medical providers in regards to when the employee is medically able to return to work. Regular follow up with medical providers reinforces the importance of the employee returning to work.

 

 

Return to Work Program

 

Employees should know the expectation is they will return to work as soon as medically able. Often an employee is willing to return to work, but the treating physician is concerned that the employee may be re-injure by attempting to return to work before full recovery from the accident.   Or, the employee is afraid to return to work because of concerns for his/her own safety. To protect themselves from malpractice claims, doctors often keep employees off work longer than is necessary.

 

The best way to alleviate both the fears of the employee and the fears of the doctor is to have a modified duty return-to-work program available to accommodate the employee. A modified program allows them to return to work before they are 100% recovered from their injury. The return-to-work program is structured to remove from the employee’s regular routine the activities the doctor feels could possibly cause the employee to be re-injures, whether it is a lifting restriction, standing restriction, bending restriction, etc.

 

The sooner the employee is back on the job, the sooner the employee fully recovers from the injury. A modified duty program provides the employee with physical reconditioning for the work they will be doing when the job restrictions are lifted by the treating physician.

 

The return-to-work program has a major impact on the amount of temporary total indemnity benefits are paid to the employee, reducing your overall work comp cost. Plus, when the treating physician states the employee has reached the maximum medical improvement, the employee who is back to work will normally receive a lower permanency rating then the employee who is still off work. The lower permanency rating also translates into lower work comp cost for your company.

 

 

Summary

 

Follow the proper steps throughout the work comp claim process from before the accident occurs, to when the employee returns to work. The time saved translates into savings for the employer through lower workers’ compensation cost and improved productivity by the employee being back on the job sooner.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©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.

Surveys Results: People Often Regret Choice of Lump Sum Settlement

There is significant opportunity to increase the level of satisfaction and security in workers’ compensation settlement cases.  According to a pair of studies, it’s just a matter of better education regarding the use of Structured Settlements.

 

A study three years ago echoed the findings of a survey six years before; when people are informed about the benefits of structured settlements, the majority will at least consider the option. The reports also show that the people who are most influential to individuals faced with an injury award — attorneys — are either unaware of, or just don’t tell their clients about alternatives to lump sum payments. The surveys also found that many people who choose lump sum payments become increasingly sorry about that choice as the years go by.

 

 

Many Not Aware Of Structured Settlements

 

People often speculate about how they would take the millions they would get if they won a state lottery. Often the response is they would take the cash upfront instead of getting an income stream via an annuity.

 

The situation is similar for an injured person who is offered money to finalize a workers’ compensation or other type of claim. While a judge may mandate a structured settlement in rare cases, the injured person typically has a choice between a lump sum payment minus taxes, or a stream of tax-free payments paid out over the long term to pay their future medical expenses and basic living needs.

 

Structured settlements became legal as a way of compensating injured individuals in 1982. But the surveys show many people have little or no idea they exist or how they work.

 

 

Survey 1: 73% Choose Structured Settlement When Informed of Benefits

 

The first survey, sponsored by American General Life Structured Settlements was conducted in the Fall of 2007 and included more than 1,000 Americans, most of whom had not received or been connected to anyone with a major injury claim. They were given two scenarios and asked to choose a payout option.

 

  • Scenario I: A 35 year old married worker with three kids is paralyzed from the waist down following an auto accident and is ultimately awarded $750,000. The respondents were given no information about structured settlements vs. lump sum payments, but were asked how they would take the money.

 

Sixty-five percent said they would take the lump sum payment while the other 35 percent opted for the structured settlement. Nearly half of the lump sum respondents did so because they believed they could make their own financial decisions. Another big reason was to pay off major debts, along with the flexibility of not being locked into an annuity.

 

  • Scenario II: The 22-year-old widow of a husband killed in a construction accident is offered $2.5 million. But in this scenario, the respondents were given descriptions of structured settlements vs. lump sum payments.

 

The vast majority — 73 percent chose the structured settlement. Their main reason was that it provided a regimented stream of income for monthly expenses.

 

Interestingly, both groups cited two of the same reasons for their decisions: “guaranteed financial independence,” and “to avoid living on public assistance.”

 

 

More Than 50% Said Never Informed of Option

 

About 20 percent of the respondents to the survey either had been injured or had a family member who was. Most of them — 86 percent — had chosen a lump sum. More than half of them did not know what a structured settlement was, and said their attorneys had not informed them of the option.

 

Sadly, the majority of those who had taken lump sums said the money was gone. That mirrors the findings of a survey conducted in 2013, in which people who took lump sums found they had less money than expected as time went by.

 

 

Survey 2: Wished Had Taken At Least Some In A Structured Settlement

 

The second study involved 400 injured workers who had received settlements of at least $100,000 within the prior 10 years. It was produced by Prudential Global Strategic Research in conjunction with Prudential Structured Settlements. The sponsors wanted to know why someone would choose either payout option.

 

 

Lump Sum Chosen for Perceived Financial Independence & Pay Large Debts

 

The main reasons injured workers said they took a structured settlement were the tax advantages and a guaranteed rate of return, according to the Prudential study. Of those who said they were “very familiar” with the structured settlement option, 75 percent said they had considered it.

 

Those who opted for lump sums had done so largely because they hadn’t been informed about structured settlements. About 20 percent said the insurer had not offered a structure settlement as an option.

 

 

Financial Independence & Pay Off Debts Goal Most Likely To Regret Decision

 

Those who took the lump sums also said they did so to have financial independence and to pay of large debts. However, they were the most likely to regret their decision later and many said they wished they had taken at least some of it in a structured settlement.

 

The survey asked recipients of lump sum payments about their expectations regarding the money they had, within the first year of receiving the payment, 1 – 3 years after, 3 – 5 years after, and 5 – 10 years after getting the cash.

 

Within the first year, 35 percent said they had “much more than I expected,” and 5 percent said they had “must less than I expected.” But the figures were nearly reversed later. Among those who had received lump sums 5 – 10 year prior, just 6 percent said they had “much more than I expected,” while 25 percent had “much less than expected.”

 

 

Conclusion

 

Despite the belief by many that they can best manage a large sum of money, the reality is often different. Some spend money much more quickly than they envision; others make poor investment choices; while others discover that paying off large debts does not always result in financial independence.

 

Structured settlements are a compelling option for injured workers and others who want financial security throughout their lives. However, the lack of awareness and misconceptions lead too many people to choose lump sum payments, only to regret the decision later. It behooves all advisers of injured workers including attorneys, claims handlers, employers, and the population in general to understand the different payout choices and opt for the one that offers the best benefit.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

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