Australian Focus Zeroes in on Forklift Safety

Unfortunately, it sometimes takes the deaths of one or more workers to fully grab the attention of employers and workplace safety officials.

 

Two fatal incidents at the Sydney Markets prompted the fresh-food market to recently impose the strict use of seat belts and rollover protection for all forklifts.

 

The incidents, in 2012 and 2013 which claimed the lives of Filipe Hehea and Mark Rushton respectively, have resulted in the mandatory use of seat belts in forklift trucks at the Sydney Markets and prompted them recently to review their safety standards.

 

Every night around 5,000 workers at the largest fresh-food market in the southern hemisphere move around at a frenzied pace and 850 forklift trucks drive around the 43-hectare sheds in Western Sydney hauling fresh produce from delivery trucks to wholesale stalls and to waiting retailer vans.

 

In June 2012, a forklift driver was crushed by his truck hit a curb and turned over.

 

The investigation conducted by safety watchdog, WorkCover found the incident to be a very unfortunate one.

 

Seven months later, two forklifts collided with one tipping over and killed its driver.

 

The incident is still being investigated by the safety watchdog, the police and the coroner.

 

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

Top 10 Employer Complaints About Their Adjuster / Carrier

Over the years I have fielded several complaints from employers about their work comp adjuster or carrier in general.  I think at one point or another we have all heard of the same complaints about how a work comp program is run from the carrier side.

 

What I always find amusing is the fact that these employers just sit back and take it.  The reasoning behind this is usually that the employers accept that this is the way they think work comp is supposed to be.  They always hear the same pitch from each carrier:  Said carrier is different, they are aggressive, they are more hands-on, etc.  But in the end, the employer arrives at the same dissatisfaction, and they jump from carrier to carrier and arrive at the same issue time and time again.

 

But this is not the way it has to be.  The agent/broker is supposed to be fielding these issues for the employer, but maybe that does not happen.  I have compiled the most common complaints below.  Remember, if you are dissatisfied with your results, you have the power to correct this issue.  If you complain, and nothing changes, you must continue your search to find the right fit for your work comp program.

 

1. The adjuster does not act fast enough. 

The main complaint here is that if/when an MRI is ordered, there is no reason it should take 2-3 weeks to complete the testing, start the therapy, see a physician, and so on.  I imagine the reason this takes so long is because the adjuster has 200 files to work, and you are low priority on the list.

 

2. The adjuster does not communicate quickly enough, if ever. 

Again same result as above.  The reality is that the adjuster does not have the time to properly work the file.

 

3. The adjuster does not see the red flags about compensability. 

See above again.  Chances are the adjuster takes the easy way out, because they did not properly investigate the claim properly.

 

4. I talk to a different adjuster every time I have an issue. 

Unless you are a large account, it is unlikely you will have a dedicated adjuster assigned to your account.  This means you have to chase down who your adjuster is, understand their style of handling claims, and take the results as they are.  This should not be accepted.

 

5. Billing issues never get resolved. 

This is due to a breakdown in communication between the adjuster and their bill payer vendor.  The backload in billing is because the adjuster is not approving payment of their bills timely, and this leads to rebilling issues and credit report problems for the claimant.  One of the most important things an adjuster will hear is that they have to work their mail every day.  Failure to complete this task will lead to mail and bills piling up for weeks at a time.

 

6. The adjuster is not aggressive enough. 

This comes again from the adjuster not working the file.  If a claim is questionable, the adjuster should know that right away from their investigation.  Sadly, most adjusters will take the easy way out.  A typical excuse is “The medical report says the injury is work related, so it must be work related.”  We all know that the medical aspect of the claim is only one facet of claim investigation.  Is what the claimant told the doctor correct?  Did the mechanism of injury remain consistent?  Did all of the facts line up with the way the employer reported the injury? 

 

7. I am not updated on claims activity.

This is due to adjuster workload again.  Periodic claim reviews will help to alleviate this problem.  But if you demand to be kept up to speed on your most active claims, chances are the adjuster assigned to your account just does not have the time to complete this task.  Ways around this are to ask for weekly updates, but I imagine what you will get will be very concise, and probably not what you are looking for.

 

8. My claim concerns are not being addressed. 

No matter what your issue with a claim, your adjuster should be listening to your take on where the claim is and what should be happening going forward.  If this is not happening, that is a major issue.  I would think this is also due to adjuster workload, but that should not be an excuse.

 

9. We had light duty available but the adjuster did not work to get light duty restrictions. 

This is a very costly error for the adjuster.  If a worker is labeled to be off work, that should mean total bed rest, usually post-operative.  Outside of that, if a worker can work sedentary jobs and the employer has this option open, the adjuster has to do the legwork to get take care this.  This puts the employee back to work, lessens wage loss, and contributes to overall decreased claim expenses.

 

10. I do not like a lot of the vendors being used, but the adjuster told me that I do not have the choice to pick. 

This again is not correct, at least in my mind.  These are your injured workers, and you should have the power to select who you want, and when you want to use them.  The adjuster can have an opinion on this, and maybe a good discussion can steer you one way or another, but I doubt the choice is a closed one.

 

 

These are 10 examples of common issues I hear between the employer and their carrier or adjuster.  I think the employer has the wrong view with comp programs in general—this is not how it has to be as there are a lot of options.  These issues need to be addressed by the broker.  If your broker is not presenting you with options to correct your issues then maybe it is time to find a new broker.

 

 

 

Author Michael Stack, Principal of Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  As the senior editor of Amaxx’s publishing division, Michael is on the cutting edge of innovation and thought leadership in workers compensation cost containment. http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2015 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

California Man Cooked Up Fraud Scheme

For one California man, the recipe of making up a workers compensation scam is over.

 
Fernando Gallegos, 43, of Los Angeles, was arrested for allegedly collecting workers comp benefits for one job while still working another. Gallegos faces five felony counts of workers comp fraud and one felony count of perjury.

 

Gallegos was allegedly injured while working in a commercial kitchen and claimed the injury made it impossible for him to work.

 

An investigation by the California Department of Insurance revealed that Gallegos was actually employed at two restaurants performing the very job duties he claimed he was unable to perform.

 
Defendant Received Nearly $9K in Comp Benefits

 

Gallegos received workers comp benefits of $8,890 over a nine-month period.

 

During this time, he perjured himself at a deposition by failing to report his other jobs. He also lied to his doctors by claiming he was too injured to work.

 

Gallegos continued to collect benefits while he worked for two different restaurants while double-dipping to receive workers comp benefits.

 

This case was being prosecuted by the Los Angeles County District Attorney’s Office, with bail for Gallegos set at $30,000.

 

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

WCRI 2015 Conference Is Coming…March 5-6 in Boston

One of my favorite Workers Comp Conferences is coming up soon! Workers’ Compensation Research Institute (WCRI) announced their “must attend” 31st Annual Issues & Research Conference taking place on March 5-6, 2015 in Boston, Massachusetts. WCRI is an independent, not-for-profit research organization providing high-quality, objective information about public policy issues involving workers’ compensation systems.

 

The conference theme is Resilience or Renovation and explores whether the systems are sufficiently resilient to adapt to the next wave of major challenges by addressing two questions:

 

  1. What lessons can we learn about resiliency from two decades of reforms?
  2. What are the upcoming challenges facing workers’ compensation that some argue may lead to major renovations? How might the system respond?

 

Who Should Attend

Anyone working to improve workers’ compensation systems or seeking to manage a changing environment will benefit from attending the WCRI Annual Issues & Research Conference. The conference draws attendees from across the nation. Join your colleagues to examine current issues and leave with new insights and actionable take-always to use in today’s competitive environment.

List of attendees.

 

Agenda Topics (Complete Agenda Here)

 

March 5

Impact of the Affordable Care Act (ACA) on Workers’ Compensation – Case Shifting

Physician Dispensing: Costs and Consequences (Panel)

State of the States

 

Impact of Workers’ Compensation Fee Schedules on Prices

Guest Speaker: Professor Gary Orren, Kennedy School of Government, Harvard University,

Perverse Effects of Low Fee Schedules

Findings from New WCRI Studies

 

March 6

Resilience or Renovation?

Resilience: Lessons from Two Decades of Reforms (Panel)

Challenges that Might Lead to Renovation: Opt-Out Legislation; Challenges to the Constitutionality of Workers’ Compensation; Aging, Compensability and Dispute Resolution

 

What People Say

WCRI’s conference and research help attendees to identify the challenges, lessons, strategies, and innovative approaches for key issues in workers’ compensation. Here’s what people say:

 

“As the original source of “big data” for workers’ compensation, I find the WCRI conference unique in that their insights engage all of the parties associated with workers’ compensation in a data-driven discussion on improving the system itself.”Vincent Armentano, Senior Vice President with Travelers.

 

“Our industry has the responsibility to continually improve the workers’ compensation process for all parties involved. An important component of successfully meeting this goal is having accurate and relevant data to rely on. The information provided at WCRI’s conference impressively fulfills this role.”

Steve Perroots, Vice President of Global Claims Marriott International, Inc.

 

“WCRI’s annual conference always addresses the biggest issues facing the workers’ compensation system and helps me keep my eye on emerging trends.”

Michael Fenlon, Senior Director for Corporate Risk Management at UPS.

 

“The Workers’ Compensation Research Institute (WCRI) is always one of my favorite conferences.”

Michael Stack of Work Comp Roundup, Amaxx Risk Solutions, Inc.

 

“Their annual conference, devoid of the usual hucksterism, focuses on the fundamental paradigms of insurance and poses the toughest questions.”

Jon Coppelman, Workers’ Comp Insider.

 

“WCRI’s conference remains the most educational forum and best networking opportunity available in the industry.”

Rick Denning, Shelter Island Risk Services.

 

Register Here

 

Accommodations

WCRI has arranged for a special conference rate of $229 per night (excluding taxes), single or double occupancy, at The Westin Copley Place, Boston. When making reservations, please contact the hotel at 617 262 9600, and ask for rooms in the WCRI block.

 

The “cutoff date” for reserving rooms in the conference block is February 7, 2015. Please make reservations early, as the rooms in the conference block are limited and may well sell out before February 7, 2015.

 

Back to Conference Information Page

 

 

 

Author Michael Stack, Principal of Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  As the senior editor of Amaxx’s publishing division, Michael is on the cutting edge of innovation and thought leadership in workers compensation cost containment. http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2015 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Massachusetts Man Indicted on Comp Fraud Charges

Massachusetts authorities continue to go after those who would rob the Commonwealth’s workers compensation system.

 
A Chelsea, Massachusetts man has been indicted on charges he failed to accurately report the total payroll of his business to avoid paying more than $45,000 in insurance premiums, Attorney General Martha Coakley announced.

 
ElburkeLamson, 50, was indicted on charges of Workers Comp Fraud (2 counts) and Larceny Over $250 (2 counts).
Lamson was operating as the manager of Legal Pro Temps, Inc. (Legal Pro), a now defunct staffing company located in Dorchester.
According to authorities Legal Pro was insured by Atlantic Charter Insurance Company for Workers Comp Insurance and Employers Liability Insurance from November 2007 through November 2009. In an effort to evade high insurance premiums, Lamson allegedly underreported or failed to report his payroll to his insurance company.

 
According to authorities, and contrary to reports made to his insurance provider, Legal Pro operated with a payroll totaling more than $2 million billed through its vendors, but only reported a payroll totaling more than $184,000. As a result of this premium avoidance scheme, Lamson underpaid his workers comp insurer more than $45,000 in premium payments.

 

 

Company Put at Risk
Based on his reporting, Lamson was granted a lower premium rate on his policy. As a result of this alleged scheme, Lamson put Atlantic Insurance unknowingly at risk to cover any undisclosed employees for injuries that occurred or may have occurred during the policy periods.
A Suffolk Superior Grand Jury returned indictments against Lamson on Dec. 11. Lamson was scheduled to be arraigned in early January of this year.

 

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

Worksite Wellness Programs: Why Workers’ Comp Insurers and Small Businesses Should Team Up

Robin Kobayashi 65x57By Robin E. Kobayashi, J.D., LexisNexis Legal & Professional Operations

 

Small businesses employ 56 percent of the U.S. workforce. They get pounded each year with the high costs of doing business, and they often lack the financial resources, staffing, expertise, management buy-in, or motivation to help reduce some of those costs by implementing a worksite wellness program.

 

Consequently, small businesses should perk up their ears about a hot-off-the-press study in the Journal of Occupational and Environmental Medicine, in which Pinnacol Assurance, a workers’ comp insurer in Colorado, teamed up with 260 small businesses to help them implement worksite wellness programs. This study was unique because a workers’ comp insurer, and not a health insurer, helped small businesses—at no cost—set up a workplace wellness program and provided continuous guidance on design and execution of the program.

 

What does this study mean for small businesses across the nation? It could mean that an alternative model exists where a “plug-and-play” type of workplace wellness program developed by a workers’ comp insurer could succeed when targeting small businesses.

 

 

Definition of Small Business

 

For the purposes of the study in question a small business had less than 500 employees and no more than $7 million in average annual receipts.

 

 

How the Study Was Set Up

 

The study examined, for a period of five years, Pinnacol Assurance’s “health risk management” (HRM) program, which was offered for free to 55,000 policyholders, 99.6 percent of whom were located in Colorado. The Pinnacol Assurance leadership reasoned that “poor health has a negative effect on workers’ compensation costs” and that “health risk management will become as fundamental to managing risks as safety management is currently.”

 

The HRM program was voluntary. Pinnacol Assurance and insurance agents actively recruited employers to participate. Employers also self-enrolled. In the end, a total of 260 small businesses enrolled in the HRM program. These businesses came from a range of economic sectors.

 

 

Goals of the HRM (Workplace Wellness) Program

 

The goals of the program aligned with the goals of the small businesses which participated in the program:

  1. Improve employees’ healthy behaviors
  2. Reduce workers’ comp rates and costs
  3. Enhance work productivity

 

 

Key Facts and Findings

 

The study is a workplace-wellness bonanza of interesting facts and findings that illustrate “opportunities to address important modifiable health risks in the small business workforce”:

 

  1. The business size of the 260 employers studied ranged from fewer than 10 employees to more than 250 employees; the majority (53.4%) had fewer than 50 employees
  2. The vast majority (70%) were located in the urban “Front Range” of Colorado
  3. 71% remained in the HRM program after 1 year, with 82% of that number remaining in the program through the end of the second year
  4. Small businesses participating in the program definitely wanted more on-site support for implementing and maintaining the program
  5. 6,507 employees at these 260 small businesses enrolled in the HRM program and completed a baseline questionnaire.
    1. The mean age was 41.4 (plus or minus 13 years)
    2. 3% were married
    3. 6% were white
    4. 7% were male
    5. 2% were full-time employees
    6. 7% had completed a 4-year college degree
    7. 3% had some education beyond high school
    8. 9% had an annual income of less than $25,000
    9. 8% had an annual income of less than $50,000
    10. The average “overall wellness score” (OWS) was 66.7, plus or minus 13.3, falling into the “doing well” category (60 to 79 score)
    11. 9% were normal weight, 34.3% were overweight, 25.6% were obese
    12. Less than 17% smoked cigarettes
    13. No data was available for marijuana or illicit drugs
    14. 7% of females consumed 7 or fewer servings of alcohol per week
    15. More than 98% of males consumed 14 or fewer servings of alcohol per week
    16. 62% exercised at least 3 times per week
    17. 1% ate at least 3 servings of fruit or vegetables daily
    18. 7% reported 7 or more hours of sleep each day
    19. 5% reported moderate or high stress in their work, home life, or finances
    20. Common health conditions and risk factors reported by employees were overweight (37.8%), seasonal allergies (34.8%), depression (22%), chronic fatigue (20.4%), chronic sleeping problems (18.4%), headaches (17.2%), arthritis (16.3%), high cholesterol (15.7%), hypertension (15.3%)
    21. Chronic and long-term health conditions included: diabetes (3.8%); cancer (3.3%); osteoporosis (2.9%); coronary heart disease (1.7%); chronic lung disease (0.7%)

 

 

Limitations of Study

 

The study attempted to answer the question of whether it was feasible to target small businesses to offer a workplace wellness program to its employees. It was beyond the scope of the study to determine whether health risk reductions would reduce workers’ comp claims and costs.

 

In addition, the authors of the study were unable to determine the rate of small business adoption.

 

The study didn’t undertake to examine the factors affecting employee participation. Nor did the study know which incentives each of the small businesses used to encourage employee participation. So the study wasn’t able to pinpoint any “healthy worker bias” among the participating employees. Given the possibility of a healthy worker bias in those employees participating in the program, it raises the question of just how bad the health risks and chronic illnesses could be for the entire population of employees working for small businesses.

 

 

Still…A Big First Step

 

This initial study shows that the barriers for small businesses to implement a workplace wellness program can be overcome. As the authors of this study point out, we need further studies that show exactly how a workplace wellness program can address health risks in employees, workers’ compensation costs, and employee loss of productivity due to illness or injury.

 

© Copyright 2015 LexisNexis. All rights reserved. Reprinted with permission.

 

 

Author Robin E. Kobayashi, J.D., Workers’ Compensation Practice Area Lead at LexisNexis. She is the site coordinator for the LexisNexis Legal Newsroom Workers’ Compensation Law. She has been a Sr. Legal Editor at LexisNexis specializing in workers’ compensation law for over 28 years. She also serves as the Editor-in-Chief of theLexisNexis Workers’ Compensation eNewsletters and the Co-Editor-in-Chief of Workers’ Compensation Emerging Issues Analysis, a 50 state survey of workers’ comp legislation and trends. Contact: Robin.E.Kobayashi@lexisnexis.com

Saskatchewan WCB Backs 2015 Premium Rate

The Saskatchewan (Canada) Workers Compensation Board (WCB) recently approved the 2015 average employer premium rate for 47,069 employers covered by workers comp.
In 2015, the average employer premium will decrease from the 2014 level of $1.51 to $1.46, a 3.3% decrease. The 2015 average WCB premium will be the lowest in twenty-nine years.
WCB Chairperson GordDobrowolsky said it is the lowest rate schedule approved since 1986.
“Better safety performance records in 33 industry rate codes have resulted in lower 2015 premium rates for 37,060 employers. The decreases range from 0.5% to 14.5%. The average decrease is 5.4%,”Dobrowolsky commented.
In October, the WCB gathered feedback in its annual public rate setting consultation meetings. Saskatchewan employers will receive letters in the coming weeks with the specifics of their 2015 premium rate.
Dobrowolsky added that by lowering the 2015 average premium from 2014 level ($1.51), the WCB is recognizing the increase in reported payrolls and the improving safety performance in the province.

 

Decreasing Injury Rate at Workplaces
WCB CEO Peter Federko explained that while several factors have contributed to the continued trend in lower premium rates, none is more important than the decreasing injury rate in Saskatchewan workplaces.
“Keeping Saskatchewan workers safe will always be our first priority. We have more people working and fewer people getting hurt but we can’t become complacent. We are forecasting a slight increase in our time loss injury rate for 2014, but our ten-year trend has stayed positive. Saskatchewan is becoming safer. In 2013, 86 percent of employers in the province achieved Mission: Zero.” Federko said.
There is a financial gain for employers who implement successful safety programs and maintain injury-free work places.
Under the WCB’s Experience Rating program, employers with above-par safety records earn premium discounts while employers with poor safety records pay a surcharge.

 

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

London Employer Fined, Worker Injured in Fall

Falls are one of the most common ways for workers to be injured on the job.
A building firm in North West London was recently fined for neglecting safety after a carpenter broke his collarbone and a rib when he fell through an unprotected rooflight opening.

 
The Health and Safety Executive (HSE) prosecuted Brent-based Charles Henderson Construction Ltd at Westminster Magistrates’ Court in early December after finding the roof openings and the roof edges were unprotected.

 
The court heard the 43-year-old carpenter, from Camden, was carrying insulation material across the single-story roof of an extension they were building when he fell through the opening. He landed on open joists on the ground floor some two and a half meters below.

 
The worker, who does not wish to be named, suffered concussion and a head wound as well as the fractures, and needed surgery to insert a metal plate in his shoulder. He has since been able to return to work.

 
Measures Not in Place to Prevent Falls

 
HSE’s investigation into the March 2014 incident identified that Charles Henderson Construction had failed to put suitable measures in place to prevent workers falling from height. This was attributable to the firm’s lack of managerial health and safety competence, and its failure to put into practice the findings of its risk assessment.

 
Charles Henderson Construction Ltd., of North Circular Road, Brent, London, was fined more than $7,800 and ordered to pay more than $1,700 in costs after admitting a breach of the Work at Height Regulations.

 
After the hearing, HSE Inspector Stephron Baker Holmes noted “This was a preventable incident. The risks of falling during roof work are easily understood, even from a single-story level. The company needed to do something about these risks, but it failed to put in place the safeguards that are standard practice in the industry as well as common sense – edge protection, covers over roof openings.

 
“As a result, a worker suffered painful injuries and, had he landed on his head when he fell, it could have been much worse. Falls from height by workers in construction are far too commonplace and fatalities happen too often.”

 

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

Employers Take Notice, You Have Active Role In Claims Management

More and more employers are developing workers compensation claim handling instructions to claim units and adjusters.  This is especially true where adjusters and claim departments have fallen short in following best practices of claim handling.

 

High profile or serious injury cases are usually investigated and documented very well.  On the other hand, day to day claims are often left lacking in some form or step of the claim handling process.  As a result, when the everyday claim develops into a major issue, it is often too late to gather information that might have prevented the higher value from occurring.

 

 

Example for Need of Employer Intervention:

 

A classic example is:  Employee has onset of back pain while lifting an object at work.  The employee continues to work a few days.  Several days later lost time begins.  Initial diagnosis is strain of lumbar area.  The doctor attributes it to the lifting at work.  The employer confirms the pain started on the job because that is what the employee presented as fact. The doctor gives a sprain diagnosis.   On the surface for the routine handling claim technician, all these items appear to point to a compensable injury that should be of short duration.  The case is accepted.  Benefits and treatment are started.

 

As soon as the lost time was reported, the adjuster failed the first duty by not taking a statement from the employee.  The statement should have clarified the mechanics of the incident.  There was no employee interview for past injuries, underlying pathologies, possible subrogation or even fraud. (Especially if this was an early Monday Morning history).

 

No independent medical examination was arranged to determine causal relationship, future course of medical care and expected disabilities.   Meanwhile the attending doctor continues with conservative office visits and medications.  A Medical Authorization was not obtained and no medical background investigation was done.

 

All of the above handling generally takes place within the first five to six weeks after the injury.

 

About the seventh or eighth week the attending Doctor asks for permission to do an MRI.  Several more weeks may go by until the results reach the adjuster.  It is discovered that there were prior back problems with ruptured discs and maybe even surgery.  Future disabilities and extended treatment are now paramount.

 

The adjuster scrambles to obtain an Independent Medical Examination.  It returns an opinion that the problem was not caused by the lifting incident alone.  A petition is filed by the adjuster raising the issue of causal relationship.  However, the compensation judge, having no other facts or evidence to weigh, continues the case as compensable and the employer is now forced to accept full responsibility for the case.

 

Reserves are increased, medical and vocational management may be required, and a permanent disability rating will be made.

 

 

Employer Input:

 

Most claim technicians want to, and do, serve their employer clients very well.  However, day to day job pressures, workloads, and unexpected situations can allow even the most dedicated adjuster to fail in some steps of claim processing.    The burden of proof is always on the employer when a claim controversy develops.  Any innocuous step overlooked today may be tomorrow’s catastrophe.

 

It is suggested that employers develop basic procedures and protocols for how they want all their claims to be processed.  These protocols should be reasonable, in keeping with best claim handling practices, spell out authority levels, and legally acceptable.  They need to become a written part of the Third Party Authority contract, or policy between employer and insurer.

 

A check list needs to be developed and made a part of every claim created by the claim unit. Since more and more claim files are now handled electronically, some type of flag or block should be on each item listed so that the adjuster cannot proceed to further handling without documenting that the item has been properly addressed.

 

A partial sample listing:

 

The following list is just a few of the items that should be developed.

  1. All lost time claims must have an employee statement or interview confirming fact and developing proper health and background information.
  2. Obtain a signed all-encompassing a medical authorization.
  3. Advise employee of o benefits and responsibilities.
  4. Settlement or disposition inputs where the employer needs to be involved.
  5. Needs for Independent Medical Examinations, Medical Management, and Vocational Management.
  6. Reporting Procedures to the Employer.
  7. All cases should have professional medical triage as soon as the claim is presented.

 

 

Summary:

 

In the everyday handling of workers compensation claims, it is extremely easy for the claim technician to overlook vital investigative steps during the early stages of what might appear to be a routine case.  The employer needs to develop a program that places checks and balances to limit this potential.

 

 

 

Author Michael Stack, Principal of Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  As the senior editor of Amaxx’s publishing division, Michael is on the cutting edge of innovation and thought leadership in workers compensation cost containment. http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Safe Work Australia Continues to Strive for Safer Workplaces

Safe Work Australia Members met in Sydney recently, with the goal continuing to be finding ways to make workplaces safer.

 
Key outcomes of the meeting included:

 
Model work health and safety (WHS) laws
Members provided an update on implementation of the model WHS laws in jurisdictions and noted the final report on the examination of the model WHS laws requested by the Council of Australian Governments will be sent to Ministers for their consideration.

 
Members also agreed to consider proposals to improve the model WHS Regulations and to report back to Ministers by end of April 2015.

 
Model Codes of Practice and Guidance Material
Members agreed in principle to revised guidance material on Cranes and Plant in rural workplaces subject to further amendment. Members did not agree to guidance material on tree trimming and removal – crane access method. These were the three topics not agreed by Members at their meeting in June of 2014. A Guide to handling isocyanates was also agreed by Members. This material will be published on the Safe Work Australia website shortly. Some further practical material on isocyanates will be developed in the future.

 
Members approved a number of minor amendments to approved codes of practice.

 

Development of nationally consistent explosive laws
Members noted the project plan for the development of nationally consistent explosive laws including the proposal for a Consultation Regulation Impact Statement to be released for public comment in February 2015.

 
Australian Strategy Virtual Seminar Series
Members noted an evaluation report on the Australian Strategy Virtual Seminar Series which was run throughout Safe Work Australia Month in October 2014. The program reached more than 11,500 people both nationally and internationally and Members agreed a similar event will be held in 2015. Videos and transcripts are still available from the Safe Work Australia website.

 

Communications and Stakeholder Engagement Strategy
Members agreed by majority to the Communications and Stakeholder Engagement Strategy developed following a review of Safe Work Australia’s stakeholder engagement activities. The Strategy is designed to reflect Safe Work Australia’s position as a high level national policy body and outlines a number of strategic focus areas.

 
Workers compensation
Members endorsed the template for the National Guide for the Assessment of Permanent Impairment (the Guide) and the draft Terms of Reference for the National Permanent Impairment Coordinating Committee which will provide expert and considered advice to Safe Work Australia in maintaining and updating the Guide.

 
Members agreed to the publication of the Australian Workers Compensation Statistics, 2012–13 report which is the 21st report in the series. The report contains an analysis of the preliminary data for 2012–13 and features a comparison of patterns of serious claims for younger and older workers, highlighting differences in the causes of serious claims between age groups.

 

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

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