It’s important to know when an employee has reached MMI, the term for maximum medical improvement. If you intent to settle the claim, you’ll want to do it when you know the employee has reached MMI and cannot return to his or her original job and you can not accommodate him or her on the job with a reasonable accommodation.
You can easily develop a template or form letter to draw on to get this information by asking the adjuster or having your medical advisor contacting the treating provider. If you do this through the adjuster, have the adjuster ask the following questions:
1-Is the employee still improving.
2-When will the employee be able to return to his regular job full-time.
3-Will the employee have any permanent job restrictions.
4-Will he ever be able to return to work full-time at full capacity.
5-Has he reached MMI?
6-Please provide a final medical report indicating MMI if employee has reached MMI.
If you are developing a workers’ comp cost containment program, you can develop forms if you have the time and personel to write and design them. If time and resources are a problem, all forms are available as part of Workers’ Comp Kit. For a complete list of forms available in Workers Comp Kit®, go to
FORMS.Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Doctors may use terms you do not understand . They also communicate by what they do NOT say. You must know what to look for in a medical report:
1-Diagnosis-What is wrong with the employee.
2-Prognosis-How long will the injury take to heal.
3-Lost-time Estimation-Will it be necessary for the employee to stay out of owrk to heal. For how long?
4-Work Restrictions-What activities the employee can and can NOT perform. This must be given for work and home environments and is critical to returning an employee to work in a transitional duty job.
5-Next appointment-The date, time and place of employee’s next appointment. Your insurance carrier or your company return to work coordinator may want to call the employee to give a reminder of the upcoming visit, and make sure the employee has a Work Ability Form for the doctor to fill out.
An employer can require an employee to get the correct information from their treating medical provider, so make sure YOUR form is complete to “get” as much information as is needed. For a complete list of forms available in Workers Comp Kit®, go to FORMS.
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
We often recommend having an employee brochure titled, “What to Do If You Are Injured On the Job”.
Every company handles workers’ comp slightly differently, so each brochure will be different, but the categories can be standard. There are 8 topics you should cover in your brochure:
1-What is workers’ comp
2-What happens if an employee is hurt at work
3-How is medical treatment obtained
4-Who pays for medical care
5-What happens after an injury (transitional duty and return to work)
6-Are there additional benefits
7-Fraudulent Claims
8- Contact Information
Cover these main topics in a written communication piece – if you don’t talk to your employees someone else will — an attorney on television, a friend who has filed suit against his or her employer, or another bias party. Provide an even, balanced communication piece telling the employee what he or she needs to know and providing contact information about where the employee can obtain additional information if needed.
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
You are welcome to reprint this material by simply contacting us at Info@WorkersCompKit.com and let us know you are using our material. You must keep our name, copyright and an active link
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.
Legal expert Tom Robinson, J.D. from Lexis Nexis reported to us on an interesting case where bankruptcy rules versus Missouri Rules for Filing Hearing Loss Claims were contradictory.
CAN THE WORKER RECOVER FOR HIS HEARING LOSS?
A worker was diagnosed with hearing loss on February 1, 2001, six days before his employer filed a petition for Chapter 11 bankruptcy in the Bankruptcy Court. A few months later, the plant closed, terminating the worker’s employment. About one month later, the bankruptcy court sent a notice advising creditors that they had 60 days to file proofs of claim. The worker, who had consulted a lawyer shortly after his hearing loss diagnosis, did not file a proof of claim with the bankruptcy court because a statute within the Missouri Workers’ Compensation Act (“the Act”) stated that no hearing loss claims could be filed until at least six months had passed after the worker was removed from the hazardous environment. More than a year later, the filed a formal claim under the Act, alleging injury to both ears. He alleged an injury date of May 15, 2001 (his last day of work). On the date of injury, the employer was self-insured, but after the company’s bankruptcy, its workers’ compensation obligations became the responsibility of the Missouri Private Sector Self-Insurers Guaranty Corporation (“the Guaranty Corporation”).
WHO WON?
In Jones v. GST Steel Co., 2009 Mo. App. LEXIS 6 (January 6, 2009), noting that pursuant to Mo. Rev. Stat. § 287.197.7, the worker’s claim could not be filed until after six months’ separation from the noisy work–until after November 15, 2001–three and one-half months after the close of the bankruptcy claim period, the state court of appeals recognized the unavoidable collision of rules, but noted the general public policy consideration that injured workers should be allowed to recovery for work-related injuries and conditions. The court observed that the purpose of the Guaranty Corporation was to provide some level of benefits for employees whose employers became insolvent and accordingly held that the worker was not barred by his failure to file a bankruptcy claim for his injuries within the time prescribed in the Bankruptcy Court’s notice.
For further information, see Larson’s Workers’ Compensation Law, Ch. 102, § 102.04. or go to LexisNexis Workers’ Compensation Law Center. This entry was written for Workers’ Comp Kit Blog, and we appreciate the helpful insight this brings to our readers.
Tom Robinson, J.D. is the primary upkeep writer for Larson’s Workers’ Compensation Law (LexisNexis) and Larson’s Workers’ Compensation, Desk Edition (LexisNexis). He is a contributing writer for California Compensation Cases (LexisNexis) and Benefits Review Board – Longshore Reporter (LexisNexis), and is a contributing author to New York Workers’ Compensation Handbook(LexisNexis). Attorney Robinson is an authority in the area of workers’ compensation and we are happy to have him as a Guest Contributor to Workers’ Comp Kit Blog. Tom can be reached at: compwriter@gmail.com.
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Selection of medical providers is an area of workers’ compensation regulated by state law, and there are many variations of how providers may be selected. The basic arrangements are:
1- Employer selects provider
2- Employee selects provider
3- Employee selects from a pre-approved panel or network
4- Employer has 30 days to treat the employee then employee may change providers
5- Combination or variation of the above.
While is is not necessary to memorize how medical providers are selected in every state, as long as you know where to get this information, you SHOULD know how providers are selected in the states where you have many operations or employees. Chamber of Commerce and WorkersCompResearch both provide excellent resources. Adjusters will know the law in your state. Your broker’s claim advocate are a good source of information also.
In most states where the employee may choose their own provider, the employer usually (althogh not always) may coach or steer the employee to another provider such as the employer’s occupational clinic. Make sure to check the laws in your state before you do this though because several states have strict penalties for employers who do this and an employer can unknowingly fall into this trap.
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
What is a Worst-to-Best List?
When assessing your workers’ compensation program using benchmarks is very effective, but it is better if you rank business units from Best-to-Worst. Rankings let you allocate resources appropriately and provides a corporate-wide overview. When calculating the Cost Per Employee, Lost Work Day Totals or other workers’ compensation metrics, make sure to analyze the data BY division, BY operating unit, BY location, etc. to see which operations have the best and worst track record.
For example, when an operation in one city, Los Angeles for example, looks highest, the operation in another city may actually BE the highest when analyzed by manhour, by mile, etc. Then post this data to management from Worst to Best — this is a huge incentive for those on the top of the list to get on board and implement the type of programs cost containment experts have been recommending.
Here’s an example of the Best-to-Worst List from Workers’ Comp Kit® which can be presented as either Best-to-Worst or Worst-to-Best.
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Lemonade Out of Lemons
In New York, there are some things the employer can do to see that their employees’ doctors are not driven away. These actions can cut medical costs and lost time in half. Workers’ compensation claims cost less and resolve quickly if local medical practices are encouraged to treat comp patients. They might be happy to do so except – their bills are frequently unpaid.
1. Keep a supply of Treating Physician’s report form C-4 on hand. These can be downloaded from NY Workers’ Comp Board site.
2. Following a work injury, ask employee who is treating and call the medical office to make sure bills are being paid.
3. If, as frequently happens, the bills are not being paid, make sure the medical office has C-4 forms. Requests for payment where a C-4 report is not submitted are often ignored.
4. If the reports and bills have been properly submitted, tell the medical office to complete and submit form HP-1 to the WCB. This form can also be found on Board website.
5. Make sure your employee knows you are trying to assist.
Benefits of Being Involved
1. The most frequent reason an employee retains a lawyer on a comp claim is the possibility of unpaid medical bills. If your employee knows you are helping, litigation and costs will be significantly lower.
2. Assisting a local medical group will result in less lost time and other costs on a comp claim.
3. The NY work comp law directs the employer, not the comp carrier, to ensure that appropriate medical treatment is provided. It is entirely appropriate for the employer to call the medical group.
4. A steady stream of communication is the single most powerful deterrent to fraudulent exaggeration later in a claim.
5. Carriers will inevitably provide better handling of claims where the employer is directly involved.
6. All workers of a company, and their families, whether injured or not, greatly appreciate such efforts.
Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Do you think every injury taking place in the workplace environment automatically rises to the level of a compensable Workers’ Compensation claim? If you do, you’d be wrong! Sometimes employer’s feel as though workers’ comp is a lost cause, that they lose no matter what the circumstances…
Here’s what Happened
A shipping clerk, who usually took a lunch break walk around the employer’s property, tripped and fell, injuring her shoulder. She filed a workers’ compensation claim, arguing before the Workers’ Compensation Commission the walks were “incidental to” her employment. She argued her claim by citing the health benefits of walking, which in turn made her a healthier worker and prevented absences as she suffered a number of health problems. The Commission agreed with her.
But, not so fast! The Compensation Review Board overturned the WCC decision saying the worker’s shoulder injury was not related to her work as a shipping clerk. The case went to the State Appellate Court. The Appellate Court upheld the Compensation Review Board’s decision.
Here’s Why
The three judge panel said the employee’s argument stating walking was good for her health and prevented absences thus benefitting her employer was invalid because:
“This argument ignores that (workers compensation) coverage does not turn on whether the activity is beneficial to one’s health. Coverage in such cases turns on whether the activity in question is incidental to one’s employment and has nothing to do with whether the activity is recreational in nature.”
In addition, the Appellate Court found no supporting evidence the employee “in undertaking her physical fitness regimen . . . intended to benefit her employer,” even though employer “acquiesced” to employees’ walking during the lunch hour. The employer did not promote or encourage employees to do so. In essence, during lunch break employees are considered “off the clock” and on their own time.
Extracted from: “A Walk in the Park” by Howard French, Journal Inquirer, Saturday, 2/7/09; Workers’ Compensation Commission-2006; Compensation Review Board-2007; Appellate Court, Feb. 2009; (All in State of Connecticut)
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
I have had many companies want me to let them use the training programs developed for other companies. There is a reason I do not loan or reuse training materials — it is NOT effective way to train. Each training program is designed based on each company’s specific needs. Often this is determined by a corporate-wide “needs assessment. When you are designing a training program for your company, make sure to do a needs assessment, then design the curriculum and then the training exercises. Validation of learning mastery is also important to ensure participants understand the curriculum.
A training program is designed according to what the “learners” will “do differently” after the training. Contrast a decentralized company with 20 workers’ comp claims coordinators with a training program designed for a centralized company with 1 risk manager and 3 return to work coordinators. These 3 return to work coordinators will do a very different job than the 20 workers’ comp claims coordinators. The later may be more hands-on thus the training program may be a workshop rather than class-room style training.
Curriculum is designed according to the needs of the “learners”. First, we determine what the particpants will “do differently” after the training. For example, will they need to contact an injured worker after the training, or will they need to monitor claims adjusters but make no contact with injured workers? The training needs of these two different participants is very different. Course content will be different. The exercises needed to teach these skills are different. So, the training programs are likely very different.
Your training program will be designed depending on a needs assessment of your company. Take this approach, and you will likely save your company a significant amount of money. Our average cost reduction is 20-50% reduction in loss costs based on year over year figures taken at point-in-time snapshots.
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Is intense problem-solving needed: A consultation at times determines that a company requires intense problem-solving and a team approach. I call my solution an Expert Panel Review (EPR). This is a team approach using a multi-disciplinary team of experts to identify obstacles and simultaneously find ways to overcome the obstacles. I have used this technique with many companies including two newspaper/publishing conglomerates.
The Expert Panel Review approach combines an education with an assessment and implementation. It’s a full-court press brainstorming session facilitated by a workers’ compensation expert.
The team can include the following:
1. HR Expert/Attorney
2. Labor Expert if the company has unions
3. Workers Compensation Consultant
4. Claims Expert with expertise in states with operations
5. Account Executive/Insurance Underwriting Expert
Company representatives should include: Workers Comp Manager, Risk Manager, Nurse, Medical Advisor, Benefits, Safety/Loss Control, Legal, Insurance and any other departments involved in workers’ compensation or injuries.
Also, an experienced risk manager with a Best-in-class workers’ comp program can be included as an “independent” expert. You may offer to pay the independent risk manager for his time (actually, you’d be paying his employer.)
The goal of the session is to convene strategic personnel in a planned, directed atmosphere to target critical workers’ compensation issues. Using flip charts, dry erase boards and other workshop tools, participants are lead through cost containment steps and many “what if” scenarios are discussed.
At the end of the session – usually a day-long meeting – an Action Plan is completed with steps defined for the next several months…. it’s the start of implementation of your new Workers’ Comp Program. If you received your National Workers’ Compensation Management Scoreâ„¢ prior to the session, bring the recommendations for improvement to the Expert Panel Review as a starting point for the discussion. These recommendations are prioritized during the EPR.
If you would like more information about the Expert Panel Review, contact RElliott@ReduceYourWorkersComp.com or call 860-553-6604.
Try the WC Cost Calculator to show the REAL COST of work comp.
Look at WC 101 for the basics about workers comp.
Workers’ Comp Kit® is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com�
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