Here is a description of how Medical Triage program works:
1. As soon as an injury occurs, the company’s medical doctor contacts each worker.
2. If the nature of the injury is not serious and the worker prefers not to go to see the doctor, the doctor follows the worker’s progress anyway.
3. If the worker goes to the clinic, the company physician speaks to the treating doctor, frequently ahead of time – prior to the appointment, giving whatever additional information given about the company and modified duty is needed.
4. The company doctor speaks again to the treating doctor after the worker is seen.
Benefits:
1. Workers feel looked after and reassured. The company looks good.
2. About 25% fewer visits to the clinic or emergency room. (For example; almost every back strain).
3. The company is in control of the situation right from the beginning, sometimes even before a claim is established. There is far less likelihood of a claim getting out of control.
4. There is less possibility of either over treatment (unnecessary physical therapy) or under treatment. (Example: If the company physician knows the injury will ultimately need to be seen by a hand surgeon, there is no point in having the primary care doctor do a lot of conservative treatment).
5. The treating doctor is well informed and in the best position to make knowledgeable decisions. (Example: A worker with a questionable injury asked the doctor for time off). The treating doctor found the information given by the company doctor, that the worker was just been laid off, very useful.
6. When a relationship is established with the worker to be getting better as soon as possible, it is less likely the worker will become a symptom magnifier. (workersxzcompxzkit).
Cautions: Have an experienced clinician with the right kind of background doing triage. It must be very clear the company doctor’s role is to answer questions and speak generally about what might be happening; the company doctor is not the treating doctor; the company doctor never tries to dissuade someone from going to the clinic.
Author: David Dubin, MD. is an emergency room physician who serves as a medical advisor for several companies. Formerly president of Aon Medical Consultants, he has been helping employers and insurance companies develop innovative cost containment programs and reduce workers comp costs for over 20 years. He can be reached at: MD@WorkersCompKit.com or 860-553-6604.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
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
Colorado’s state-created workers’ compensation insurance company head, Kevin Ross, believes the organization would run more efficiently if it were privatized.
Speaking before state lawmakers this week, CEO Ross stated Pinnacol Assurance paid $347 million in dividends to policyholders dating back to its creation. In Ross’ mind, Pinnacol could do even better by becoming a mutual insurance company.
Pinnacol Assurance traces its history back to the state fund created in 1915 to take care of injured workers. However, state lawmakers agreed to spin it off in 2002. It’s viewed officially by law as a political subdivision of Colorado, but the company, not the state, has power over its funds. workersxzcompxzkit)
Colorado lawmakers this year attempted to tap into the company for money to balance the state budget, but decided to put off discussions until later in the year.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
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
Texas Court Refuses to Strike Forum Selection Clause From Employment Contract
Affirms Dismissal of Retaliatory Discharge Claim Without Prejudice
Here’s What Happened
Welch, a Texas resident, signed an employment contract with Nightingale Nurses, LLC, a Florida company, to work as an EEG technician at a Texas hospital. She suffered a work-related injury and, when the pain became unbearable, sought treatment in the hospital’s emergency room.
She was advised to file a workers’ compensation claim and did so, also notifying her supervisor of the claim. Her supervisor indicated she needed to continue to work because the hospital was short-handed. Welch contacted her orthopedic surgeon, who hesitantly released her for light duty work.
In an affidavit, Welch contended that within four hours of giving notice of her light duty status, a nurse manager informed her that her employment contract was being cancelled and that she was being let go. She subsequently filed suit against her former employer for retaliatory discharge.
The former employer moved to dismiss, pointing to a contractual forum selection clause in Welch’s employment contract that required suit to be filed in Palm Beach County, Florida.
Welch countered on a number of grounds. In relevant part, she contended that her claim arose out of the workers’ compensation laws of Texas, that strong public policy considerations favored a determination of the issues within Texas courts and not in Florida, and that enforcement of this particular forum selection clause would be unreasonable and unjust.
The trial court dismissed the case without prejudice to file in Florida and Welch appealed.
Here’s How the Court Ruled
In Welch v. Nightingale Nurses, LLC, 2009 Tex. App. LEXIS 3822 (June 2, 2009), the Court of Appeals of Texas (Seventh District, Amarillo) affirmed, holding that Welch had not demonstrated that the forum selection clause was unenforceable due to fraud or overreaching, nor did Welch show that the selected forum would be seriously inconvenient for trial.
The court acknowledged that a forum selection clause is not binding and may be disregarded by a trial court if public policy strongly favored jurisdiction in a forum other than the one to which the parties had agreed. Here, there was no strong public interest involved.
Welch assumed Texas law would not be applied by the Florida court, indicated the court. That assumption was incorrect. The court indicated there was no cited authority supporting the idea that a contractual forum selection clause should be ignored in a workers’ compensation claim and the court declined to find that a “strong public policy” existed under these circumstances.
See generally Larson’s Workers’ Compensation Law § 104.07.
Author: Tom Robinson, J.D.
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.
http://law.lexisnexis.com/practiceareas/Workers-Compensation
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
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
Health Strategy Associates (HSA) www.healthstrategyassoc.com has unveiled its First Annual Survey of Workers' Compensation Bill Review. Principal Joseph Paduda conducted the survey, soliciting opinions about the role of bill review (BR) in workers' compensation from a variety of payers. The survey explored pricing, vendors, internal-versus-outsourced BR processing and other aspects of the industry determining reimbursement for $30 billion in workers' compensation medical care each year. The 24 respondents were executives at 23 workers' compensation payers, including insurance carriers, third-party administrators, large employers, state funds and managed care firms. According to Paduda, a pair of overarching issues emerged from the survey: a lack of electronic integration and a sense the industry is generally mediocre. Overall, respondents indicated the industry centers more on processing speed and throughput than on effective medical management and is more reactive than innovative. However, they also noted there have been several vendor acquisitions, mergers and management changes that could improve BR performance. According to the survey, one of the most troubling issues for payers is the lack of connectivity between BR and medical management. "As difficult as it is to believe," Paduda said, "very few BR systems are fully and seamlessly connected with medical management systems and processes, such as utilization review, pre-certification, case management, or networks." Among other things, this means many non-approved medical treatments are performed and reimbursed simply because the system cannot link the determination to the bill, provider or claimant. "Compensation payers spend hundreds of millions of dollars a year on medical management and a significant portion of that money may be wasted due to a lack of effective electronic integration," Paduda noted. This, too, may be changing. Several vendors and at least one third party have developed technological solutions addressing the issue: a sophisticated business rules engine greatly streamlining processes, increasing the number of bills automatically adjudicated and enforces "best practices." As connectivity improves, Paduda believes bill review will become more sophisticated and viewed by payers as less as of a commodity and more of a strategy tool. (workersxzcompxzkit). HSA is currently conducting its Sixth Annual Survey of Prescription Drug Management in Workers' Compensation and will conduct a survey of provider networks later this year. Author: Robert Elliott, J.D. Click on these links to try it for yourself. WC Calculator: www.ReduceYourWorkersComp.com/calculator.php TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php 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
Employers Considering Drug Testing Find Laws Available
It’s all about reducing workers’ compensation costs. At ReduceYourWorkersComp.com, we continue to offer very useful cost reduction methods. As part of the effort to reduce workers’ compensation costs many companies perform drug testing using pre-employment (post-offer) drug and alcohol testing, and post-accident and random drug testing.
By special arrangement with The Center for Drug Test Information (CDTI), our readers can view current statutes and regulatory rules for state drug testing laws, where applicable. Follow this link, http://www.reduceyourworkerscomp.com/drug-testing-state-laws.php to read that state’s drug testing regulations.
The source of this information is the state regulations and/or case law in each state. To the best of our abilities we keep the information current and normally update twice a year. Be aware, however, statutes and case law may change more frequently than we are able to catalog them so check with your own attorney or corporate counsel to make sure the information is current and applicable to your situation.
Author: Director, Amaxx Risk Solutions, Inc.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
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
Employers have a vested interest in assisting workers injured at work to promote their healing and return to work. One of these ways is by making sure they receive the workers' compensation due them in a timely manner, with a minimum of hassle. HR 2641 addresses this in terms of workers' compensation Medicare set asides and payments. A coalition of attorneys representing injured workers, employers, insurance carriers, defense attorneys, and other interested parties are applauding the introduction by House Representative John Tanner (D-TN) of HR 2641. HR 2641 is designed to resolve the serious delays and confusion in the review of workers' compensation Medicare set aside by the federal agency responsible for administration of Medicare, the Centers for Medicare and Medicaid Services (CMS). "The Medicare Secondary Payer and Workers' Compensation Settlement Act of 2009 will provide clear and consistent standards for CMS' administrative process," according to Douglas Holmes, president of Strategic Services on Unemployment and Workers' Compensation (UWC) and coordinator of the Coalition for Medicare Secondary Payer (MSP) Reform. According to Holmes, "CMS takes too long to review proposed set-asides, fails to provide consistent standards for determining amounts to be set aside, and provides no avenue for appeal of their determinations. The process results in injured workers not receiving funds, additional costs for states and workers' compensation payers, and additional liability for employers, insurance carriers, (italics added) and attorneys in contravention of the state workers' compensation exclusive remedy principle. A legislative solution to this problem is needed." Ed Romano, president of the Workers' Injury Law and Advocacy Group (WILG), the national association of attorneys representing injured workers in workers' compensation cases, noted that too often, injured workers bear the brunt of the delays caused by the current system and reforms are needed now. "This bill is about process improvement and fair treatment of all parties," Romano remarked. "We applaud Representative Tanner for taking on this issue. "In case after case we hear of delays in approval, uncertainty of the amount to be reimbursed by injured workers, and changes in amounts to be set-aside after settlements have been approved." Holmes believes the current MSP procedure does not allow for any recourse, noting, "There is no avenue to compel a timely decision or appeal a bad one. The legislation introduced by (workersxzcompxzkit) Representative Tanner corrects this situation and many other costly problems and delays, for the benefit of all parties involved – most importantly the injured workers." To view the entire bill, visit: http://www.govtrack.us/congress/billtext.xpd?bill=h111-2641. Click on these links to try it for yourself. WC Calculator: www.ReduceYourWorkersComp.com/calculator.php TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php 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
Goals, Planning and Implementation
or ”Let’s Just Take the Assessment”
Sometime ago a well-respected and very knowledgeable workers’ compensation consultant told a very interesting story. A high-profile pharmaceutical employer engaged the consultant’s services to ”solve” their out-of-control WC costs. After a good bit of back and forth, traveling to and fro and lengthy discussions, the consultant told the client it was now time to get the ball rolling by figuring out where they were now and where they needed to go. You can imagine the surprise when the client said they wanted their problem “fixed,” they needed a “plan” they could ”implement” but were NOT going to take a best practices assessment! Well, that brought everything to a screeching halt.
You can’t know where you are going in the workers’ compensation cost cutting arena if you don’t assess where you are (as the cliché goes) “at this point in time.”
Three steps are necessary and can’t be avoided. Goals, Plans, Implementation.
Goals:
They are not wants, needs, desires, wishes. “I’d like to lose weight,” is not a goal.
They are: Concise, direct, time limited and achievable. “I’m going to lose 10 pounds in 10 weeks” is a goal.
Planning:
Not: “I think I’ll eat less.”
But: ”I need to lose one pound per week to reach my goal.” “I’ll eliminate snacks and sweets after meals. “I’ll weigh myself daily to monitor my progress.”
Implementation: Putting the plan into action, picking a start date, following the plan, monitoring progress and making adjustments to reach the goal.
A Lot of Work!
Fortunately, ReduceYourWorkersComp.com has done all the work for employers who are serious about cutting workers’ compensation costs. RYWC provides a detailed Best Practices Assessment consisting of 81 questions covering 10 key WC areas — The National Workers’ Compensation Management ScoreTM and Action Plan. After taking the Assessment, you receive a Score ranking your company in the 10 key areas with Recommendations for improvement. (workersxzcompxzkit). You will know exactly what areas need improvement and how to go about it.
Even better, before purchasing the full Best Practices Assessment, you may take for free, The Workers’ Comp Best Practice Quick Check, a sample of the National Workers’ Compensation Management ScoreTM and Action Plan to learn your gaps and soft spots.
Start today. Visit http://www.workerscompkit.com/intro/ — take the quick check assessment and start reducing your company’s workers’ compensation costs.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
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
Saying a proposal to increase workers’ compensation premiums by 23 percent is much too high, advocates for injured workers spoke out Monday in California.
During a press conference prior to a hearing on examining insurers’ claims of increased “medical costs,” the advocates, including doctors, claimed the insurance industry misleadingly tagged the costs of turning down and delaying medical care as “medical costs.”
According to the advocates, the insurance industry’s own data reports “cost controls” and “medical-legal” expenses doubled in recent years, while payments to physicians fell by 40 percent from 2003 to 2007.
Workers’ compensation insurance rates have dropped through last year, and at $2.25 per $100 of payroll, are down 65% from their peak of $6.45 at year-end 2003, the lowest rate in a number of decades. The decline has reportedly trimmed insurers’ premium by more than half, from $23.5 billion in 2003 to $10.4 billion in 2008. Employers are reportedly saving $14 to $15 billion per year, while advocates claim insurers have recorded tens of billions in profits. (workersxzcompxzkit).
Figures unveiled recently by the National Association of Insurance Commissioners (NAIC) show California workers’ compensation insurers posted a 12.1% return in 2007. The figures indicate that workers’ compensation insurers recorded solid profits from 2004-2007, peaking at 16.4% in 2006.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
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
Employers with high-risk workplaces must take extra care and precautions to make their workplace as safe as possible and this is especially true of construction companies where workers frequently are working on roadways, in and around heavy, moving equipment.
It has been a year since a man died on an Interstate 495 construction site in Massachusetts after being struck by a truck backing up in the closed travel lane.
His death has lead to a campaign for greater safety awareness among construction employers, subcontractors and trucking firms and employees.
Laws are being proposed, known as “Rob’s Law,” to outfit trucks with rear motion sensors and other safety devices. (workersxzcompxzkit).
Effective “due diligence” by ALL high-risk workplace employers implemented BEFORE a tragic workplace accident happens, is the most effective way to protect workers and promote the safest workplace environment.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
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
A New York employer of a construction worker (Mr. AB) who worked as a flagman at 140 West Street for some four months following the September 11 attack on the World Trade Center (WTC) has been ordered to pay $20,000 in back payments and $400 a week and to provide health coverage by the New York state's Workers' Compensation Board, following a year-long compensation investigation. The worker was diagnosed as having severe lung disease, something experts claim comes from the toxic dust and vapors Mr. AB and countless other individuals inhaled at Ground Zero. Doctors at Mount Sinai Medical Center's WTC Medical Monitoring clinic also found Mr. AB was suffering from bronchitis and gastric reflux. Author: Robert Elliott, J.D. Click on these links to try it for yourself. www.ReduceYourWorkersComp.com/calculator.php TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php 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. WC Calculator: ©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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