They Cost Money All lawsuits cost employers money. And, for some reason, workers' compensation claimants seem to also file EEOC claims. The goal of the employer is not to give employees a REASON to file lawsuits – of any kind – thus saving costs all around. It's been my observation it's easier and more cost effect to obey the law. Don't hire undocumented workers. Don't allow discrimination based on age, creed, color or life-style orientation. Don't allow harassment of any kind. And, put a discrimination-free work environment program into place and TRAIN, TRAIN, TRAIN. Let's Look at Two Case Studies Age Discrimination The largest telecommunication company has been sued by the U.S. Equal Employment Opportunity Commission (EEOC), alleging discrimination against workers over the age of 40. The lawsuit filed in U.S. District Court in Manhattan claims the Dallas-based corporation (with revenue of $124 billion last year) had "no legitimate business or reason" for its nationwide policy not to rehire employees who had retired under various retirement and severance programs. At issue in the lawsuit are the company's Voluntary Retirement Incentive Program and the Enhanced Pension and Retirement Program. According to the EEOC, the company's denial of reemployment to older workers, in violation of the Age Discrimination in Employment Act, has been going on since at least the fourth quarter of 2006. Hostile Work Environment The U.S. Equal Employment Opportunity Commission (EEOC) announced a major settlement of a discrimination lawsuit under Title VII of the Civil Rights Act against a major home improvement corporation for $1.72 million and significant remedial relief on behalf of three employees in their twenties who were reportedly subjected to a pervasive sexually hostile work environment and retaliated against for complaining about it. The former employees, two young men and one woman, were reportedly subjected to widespread and repeated sexual harassment by male and female managers and coworkers at store in Washington state according to the EEOC. The sexually hostile workplace, enduring for more than six months, included physical and verbal abuse culminating in one instance of sexual assault by the store manager. In addition, the manager was cited for implicitly propositioning the female employee for sex related to a recent promotion she received. The EEOC said the employer failed to take prompt remedial action to stop the sexual harassment and erroneously fired the three victims when they complained. "Corporate America should be on notice that sexual harassment and retaliation will not be tolerated by the EEOC," said Commission Acting Chairman Stuart Ishimaru. "In this case, severe sex-based harassment of young workers was permitted to run rampant at one of the nation's largest retailers. It is shocking that store managers actively engaged in, and even encouraged, such blatant unlawful conduct and then retaliated against the victims for objecting to it." In addition to the $1,720,000 in monetary relief for the three victims, the three-year consent decree resolving the case requires the company to provide comprehensive training to management, non-management, and human resources employees in all Washington and Oregon stores. Employees will be trained on what constitutes harassment and retaliation, and on their obligation not to harass or retaliate against any individual. Managers and supervisors will be trained on what constitutes harassment and retaliation, their obligation to provide a discrimination-free work environment, and their responsibilities if an employee complains about harassment or retaliation, or if they observe it. Human resources personnel will be trained on what constitutes harassment and retaliation, how to institute policies and practices to correct past discrimination and prevent future occurrences, informing complainants about the outcome of internal investigations, and the steps the employer will take to assure a discrimination-free workplace in the future. (workersxzcompxzkit) In addition to the comprehensive training and monetary relief, the consent decree requires the employer to revise its sexual harassment and anti-retaliation policies, issue an anti-harassment statement to all employees in Washington and Oregon, revise its method for tracking employee complaints of harassment, and report regularly to the EEOC on harassment and retaliation complaints which arise in Washington and Oregon stores during the term of the decree. The EEOC consent decree covers all 50 of the employer's stores in Washington and Oregon. WHAT SHOULD YOU DO? In addition to the above, when you settle workers' compensation claims, make sure to settle ALL potential and current claims. Make sure your TPA works with your legal department on settlement language. PUT THAT IN YOUR account instructions.
Author Robert Elliott,executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
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©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
The Workers Comp Kit® Assessment Experience
A captive manager with 50 electrical contractors invited Workers Comp Kit® to give a presentation about assessing workers’ comp post-loss claims management best practices by employers at their annual meeting. As pre-work for the conference, each of the 50 captive members took the assessment on Workers Comp Kit®, and received a National Workers’ Compensation Management Score and List of Recommendations for improving best practices in their workplace. This took each member approximately 30 minutes to answer a series of on-line questions.
As members of the same captive, their scores and recommendations were compiled so they could evaluate how well the group as a whole performed. Scores ranged from 58-92. The Gap Analysis indicated none of the captive members currently had an employee brochure, a communication piece to help educate employees about workers’ compensation procedures and a key to keeping employees in the loop if they are injured.
This gap was used as an opportunity for improvement in a group training exercise that worked as follows.
1. The captive members were broken down into small groups of 8 members.
2. The group as a whole was given a template for an employee brochure from Workers Comp Kit®.
3. Each small group was assigned the task of customizing one section (2-3 paragraphs) of the brochure for their industry.
4. Then the captive manager had their art department design professional artwork for the cover and distributed the enhanced, customized industry-specific brochure to each member of the captive for their own use.
5. On the cover of the brochure space was denoted for each company to insert their name and logo.
6. On the rear of the brochure, workers’ compensation coordinator contact information was included.
In the past, it would not have been possible to determine gaps for a group this size; however, with the automated tool kit, this was all done within a couple hours. (workersxzcompxzkit)
Thus, within a few days each captive member knew what best practices they were missing and began to make changes — starting with the design and development of a customized employee brochure.
Author: Rebecca Shafer, J.D. Rebecca designs and develops workers’ compensation cost containment programs, and is the developer or Workers’ Comp Kit, an on-line automated tool kit with an assessment, benchmarking and improvement plan. Rebecca can be contacted at: 860-786-8286 and email: RShafer@ReduceYourWorkersComp.com. http://www.ReduceYOurWorkersComp.com
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©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
Communications, is key to good inter-personal relationships. Communicating is even more critical when employees are injured and out of work on workers’ compensation. Keeping in mind how easily an injured worker can become “psychologically dis-employed,” managers follow defined post-injury response procedures. See: http://blog.reduceyourworkerscomp.com/?p=213
As part of the post-injury response, the manager/supervisor contacts employees regularly until return to work, either in a transitional duty assignment or full duty is achieved. Contact includes:
1. First Day Phone Call
2. Weekly Meeting at the facility
3. Get Well Card
4. Include in Workplace Activities
How Many Get Well Cards Shall the Employer Send?
Many employers ask this question and the answer is “It depends.” Usually only one card is sent immediately following the injury and after the first day phone call and scheduling the first weekly meeting. (workersxzcompxzkit)
Then, if a worker is out for an extended time, you could send a card “From the Gang at Work” letting them know their co-workers care. If appropriate, the card could be signed by co-workers.
In the case of a very serious injury some employers send food baskets and/or flowers, especially if the injured person is the main breadwinner and hospitalized.
Another nice touch is to include with the get well card a gift certificate for pizza or shopping at the local grocer. The point is to not only maintain contact but to convey the employer’s concern not only for the employee, but for the family when mom or dad is incapacitated and conveys a compassionate attitude on the part of the company.
PS. I had an employer ask “Where do we get THAT card?” This card is not a magic card, but if you want THIS one, it’s available on in Workers’ Comp Kit.com. WorkersCompensation.com also has a get well card online. Seriously, go to any grocery store or card store. One of my clients had Get Well Cards made with their logo. Hopefully, that means they are prepared, not they have so many injuries they need a whole box of cards!
Author Robert Elliott,executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
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©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
In workers’ compensation claims, the employer and employee are supposed to play the role of “opposing parties” with a script (written by attorneys for both sides) calling for no communication, no cooperation and a maximum of hearings, trials, testimony and appeals – all expensive and time consuming (and unnecessary) at best and, in too many cases, permanently destructive of a worker, a worker’s family and a workplace. Even though this example is specific to NY it will have a positive impact in any state.
Why should it be this way? The law, as originally constructed, anticipated few hearings and fewer trials and appeals. The present system grew by unwritten tradition and flowed toward maximum financial rewards for lawyers and carriers, with little regard for the employee and employer. Begun many decades ago, blame serves little purpose now.
A call for reform or a new way of doing business for the workers’ compensation board (WCB) is not likely to produce results any time soon. However, reform “one workplace at a time” is eminently doable. The reasons are:
1. Most positive outcomes are achieved by the employer’s efforts BETWEEN hearings (not by a lawyer’s arguments AT hearings),
2. Efforts off the calendar produce results little noticed by the WCB and, therefore, are not subject to the arbitrary swarm of rulings produced by hearings and appeals.
The Board, in fact, is overwhelmed by the sheer volume of hearings and expresses little objection to parties achieving amicable results on their own.
How can this be accomplished? Only by direct action and communication between the employer and employee and not waiting for a judge to make a ruling. One employer, implementing these procedures, reported an 85% decline in hearings.
The key features are:
1. Investigate thoroughly. Attach all useful documents to the C-2 Employer’s Report of Injury.
2. Send the employee a copy of the C-2 and attached documents. Ask the employee to provide the employer with a copy of the employees claim form (C-3). (These are not automatically exchanged in New York and result in many needless controversies.)
3. Take the employee to the hospital or first provider at the time of the injury. Tell the facility that the bills will be paid by the comp carrier or group medical plan, if necessary. NEVER let an employee wonder if they will have to pay.
4. Insist the carrier consult you BEFORE contesting any claim. Object if you feel a contest is unwarranted. Do so in writing and request a written answer.
5. Attend all hearings where you believe benefits are being delayed or denied without good reason.
6. Insist, in writing, the attorney representing the carrier call the employer BEFORE and AFTER each hearing and that they furnish a copy of the hearing report to the employer. (The attorneys selected by the carrier actually are the attorneys for the employer and owe their primary duty to the employer. They MUST advise the employer of any possible conflict between the carrier and employer and can be disciplined of any breach.)
7. Remain in constant communication with the employee. Make sure the finances of the family are not being harmed by poor handling of the claim. Be your employee’s advocate in communications with the carrier, if need be. (workersxzcompxzkit)
Many employers do these things as a matter of course. They are little noticed by the workers’ comp system since they, and their claims, have little presence at the WCB. Remember: One employer, implementing these procedures, reported an 85% decline in hearings.
Author: 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.
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©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
Focusing primarily on cost containment, Workers' Comp Kit® presents a broad array of topics useful to employers in the United States and Canada. However, since workers' compensation is worldwide we like to include workers' comp issues in other countries. And, since prevention is always the best way to reduce workers' comp costs, we want to provide some education to our clients. New South Wales Focusing on Worker Safety New South Wales (Australia) SW Finance Minister Joe Tripodi said 42 of the State's largest employers will assist 100 small businesses improve safety and productivity in the 2009 WorkCover Mentor Program. Now in its third year, the Safe Business is Good Business Mentor Program allows small businesses to gain industry-specific advice from large employers on how to meet their workplace safety, injury management and workers' compensation obligations. "More than 260 small businesses have taken part in the mentor program since 2006. We have seen a 20% increase in participation this year," Tripodi said. "The program has been expanded to include retail, consumer services, community services, transport and agriculture industries as well as the successful construction and manufacturing industries. Around 70 percent of mentee businesses in the current intake are from regional areas across New South Wales, with the remainder from across the Sydney metropolitan area." (workersxzcompxzkit) Tripodi indicated workplace injuries in New South Wales are at their lowest levels in two decades, commending the 42 mentor organizations for their commitment to passing on their expertise to enable small businesses to develop greater capacity to further reduce the risk of injury. Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
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©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
Weekly Fraud Blotter from Lexis/Nexis: August 15, 2009
Each week we’ll be surveying what the media, state agencies, insurance companies, and others report in terms of workers’ comp fraud. Just like a police blotter, our workers’ comp fraud blotter lists recent arrests, charges, and convictions.
$154 Million Medical Insurance Fraud Scheme
Talk about fraud and abuse! Here’s a case study that would make a good stage play.
The Story
$154 Million Scam
19 Defendants
2,841 healthy patients
Unnecessary and dangereous surgeries
Fraudulant billing of medical insurance companies (PPO)
1,0000 Employers in 39 states scammed
The Players
1 Outpatient surgery center
10 Cappers
5 Administrators
3 Doctors
1 Attorney
1 Accountant
The Game – Capping
The defendants in the outpatient surgery center were accused of participating in a $154 million medical insurance fraud scheme by recruiting 2,841 healthy people nationwide and bribing them with money or low cost cosmetic surgery, to receive unnecessary and dangerous surgeries and submitting fraudulant claims to medical insurance companies. “Capping,” the recruitment of patients, is illegal in California.
The cappers targeted employees from businesses in 39 states covered by PPO insurance plans, affecting more than 1,000 employers whose employees became involved in the scheme.
They were accused of arranging transportation for the patients, scheduling the surgeries, and coaching the healthy “patients” on what to say.
In exchange for undergoing surgery, the patients received a cash payment, usually between $300 and $1,000 per surgery, or credit toward a free or discounted cosmetic surgery.
The convicted had no medical training, recruited patients with PPO insurance, scheduled surgical procedures, and coached patients to correctly describe symptoms for the unnecessary surgical procedures. They assisted patients in filling out surgery center paperwork, had them sign a false affidavit stating they had not been offered compensation and had not received any compensation in exchange for using the surgery center’s services.
The Penalty
All participants were arrested, charged with a variety of fraudulent crimes, indicted or pleaded guilty and received various prison sentences for participating in one of the nation’s largest medical fraud prosecutions. for recruiting over 2,841 healthy patients to undergo unnecessary and dangerous surgeries to fraudulently bill medical insurance companies in the amount of $154 million. (workersxzcompxzkit)
The surgery center will be ordered to pay restitution and back taxes for personal and corporate taxes to CFTB. A restitution hearing for all of the convicted cappers is scheduled for December 4, 2009.
Extracted: Press release office of Attorney Tony Rackauckas, 8/11/09.
Reposted with Permission Visit LexisNexis for more information and full reports.
The latest workers’ comp fraud blotter see http://law.lexisnexis.com/practiceareas/Workers-Compensation-Law-Blog/workers-compensation-fraud-/Workers-Comp-Fraud-Blotter-8152009—-Recent-Arrests-Charges–Convictions
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Newfoundland And Labrador Provinces Unveil New Occupational Health and Safety Regulations (OHS) Regulations
New OHA regulations recently unveiled are reported to improve the regulatory conditions under which employers and employees work. The new regulations replace 30-year-old regulations and take effect on September 1, 2009, according to the Provincial Government.
“This is an important day for workplaces in Newfoundland and Labrador,” said the Kevin O’Brien, minister of Government Services. “These new regulations will support the safety culture in all workplaces and will reflect and, in fact, complement the safe work practices that many safety-minded employers already have in place. We wanted to ensure that we have the best possible set of regulations that meet the needs of both employers and employees of the province. I think we have achieved that and have produced a first-rate set of regulations.”
In drafting these new regulations, the department consulted with industry, labor, employers, Provincial Government departments and anyone interested in safe work procedures. The feedback received was positive with all groups agreeing the current regulations were outdated and did not reflect current safety practices. The consultations also highlighted the need to improve regulations related to high-risk activities. The department engaged the Occupational Health and Safety Advisory Council during the consultation process on issues where new policy is being set.
Regulations Highlights
1. Recent Codes and Standards - Requirements to comply with the most recent version of a named code or standard as opposed to a specific version of that code or standard which could be outdated;
2. Confined Space Entry - Procedures to enter an enclosed or partially enclosed space having restricted access and egress;
3. Fall Protection - Addition of general requirements as well as identification of fall arrest systems and construction of guardrails;
4. De-energization and lockout - Proper procedures for de-energizing and locking out equipment prior to performing work on that equipment;
5. Noise Hazards – Requirements to establish and maintain a hearing conservation program where noise exposures exceed permissible levels;
6. Blasting – Clarification of blaster responsibilities and industry-accepted safe blasting practices;
7. Ergonomic Requirements – Requirements to identify and assess risks and provide education and training to workers who may be exposed to musculoskeletal injuries;
8. Working Alone – Requirements to develop a written procedure for checking the well-being of employees who work alone;
9. Crane Operators - New requirements to certify operators who must have the appropriate trade qualification as determined by the Department of Education;
10. Violence Prevention - New requirements to have employers conduct a risk assessment, establish procedures to control the risk and communicate those procedures to the workers.
“The NL Employers’ Council organized a committee of safety professionals that consulted on the development of these regulations,” said NL Employers’ Council Executive Director Richard Alexander. “A number of concerns put forward by the committee were addressed and the position of employers was well represented and well considered. Overall we are pleased with these new OH&S regulations and believe they are a step in the right direction, clarifying a number of grey areas in the previous regulations.” (workersxzcompxzkit)
It is important to note workers’ compensation costs are obviously reduced when employers, employees and government protection agencies work together to design and implement the best possible workplace safety standards.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
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©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
American Society of Safety Engineers (ASSE) Offers New Fall Workplace Standards
As slips, trips and falls continue to represent significant exposures and hazards driving costs up in the workplace, the ASSE announced the approval of three new fall protection standards by the American National Standards Institute (ANSI), aimed at preventing these workplace hazards.
Of the 5,657 fatal on-the-job injuries occurring in 2007, 847 were attributed to falls according to the Bureau of Labor Statistics (BLS)
The ASSE standards (effective November 16, 2009) aimed at preventing injuries and death due to falls are:
1. “Specification and Design Requirements for Active Fall Protection Systems” (ANSI/ASSE Z359.6-2009).
Specifies requirements for the design and performance of complete active fall-protection systems, including travel-restraint and vertical horizontal fall-arrest systems.
2. “Connecting Components for Personal Fall Arrest Systems” (ANSI/ASSE Z359.12-2009).
Establishes requirements for the performance, design, marking, qualification, test methods and removal from service connectors.
3. “Personal Energy Absorbers and Energy Absorbing Lanyards” (ANSI/ASSE Z359.13-2009).
Requires all energy-absorbing lanyards and personal energy absorbers to reduce the forces implied on the user to less than 10 times the normal gravitational pull of the earth. In addition, users of energy absorbing lanyards must weigh within the range of 130 to 310 pounds (59 – 140 kg).
”I applaud the ASSE and the devoted group of professionals on the ANSI Z359 Accredited Standards Committee for their dedication to the development of these ground-breaking standards,” said Randall Wingfield, the ANSI/ASSE Z359 Accredited Standards Committee (ASC) chair and president and CEO of Gravitec Systems Inc.
“Because falls from heights make up a significant portion of workplace fatalities and injuries, the creation of authoritative documents for workers at height and their employers is essential. Years in the making, Z359.12 and Z359.13 expand on existing standards in which connecting devices and personal energy absorbers were initially addressed,” Wingfield added. “Standards devoted solely to these components were necessary because new research and testing have provided us with a better understanding of how these products are used.”
“The new Z359.6 standard tackles fall protection systems design for the first time and is intended for engineers with expertise in this area. The release of these standards marks considerable progress toward the completion of the Z359 Fall Protection Code, a living document that will continue to grow as ten additional standards are drafted and adopted,” he said. (workersxzcompxzkit)
The ASSE Fall Protection Code currently includes six standards:
1. “Definitions and Nomenclature Used for Fall Protection and Fall Arrest (Z359.0-2007).
2. “Safety Requirements for Personal Fall Arrest Systems, Subsystems and Components” (Z359.1-2007)
3. “Minimum Requirements for a Comprehensive Managed Fall Protection Program;” Z359.2-2007
4. “Safety Requirements for Positioning and Travel Restraint Systems” (Z359.3-2007)
5. “Safety Requirements for Assisted-Rescue and Self-Rescue Systems, Subsystems and Components” (Z359.4-2007)
6. Historical ANSI/ASSE Z359.1-1992 (R1999).
The ANSI/ASSE Z359 ASC for Fall Arrest/Protection is working on 10 additional Z359 standards projects aimed at protecting workers from falls.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
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©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
Workers Compensation Diary of a Consulting Project -I will share some of my experiences from a work comp cost reduction consulting project. My goal is to advise the company about ways to reduce their overall workers' comp costs. The Importance of Visiting the Third-Party Administrator It's been my experience consulting projects work best and are most productive when they proceed in an orderly, logical way. Most workers' compensation assessments follow a predictable pattern. However, every now and then there is the one client/employer whose business and needs don't fit into a neat little box. Consideration must then be given to the "special" or "unusual" nature of the client's particular business and needs. Such was the case of a mid-western trucking enterprise. The company, incorporated in one state, has employees carrying on job duties nationwide. That is to say, the employees don't have a "place" or "site" to report to work. This becomes significant later on, as you will see. Observing How the Medical and Indemnity Claims Are Handled My first action of any consulting engagement is a visit to the third-party administrator (TPA) to dig for "soft spots" and observe and let each party touching the claim educate me about what they do, how the claim is handled, any problems they have with the employer, and problems they have with the employees, why claimants seem to retain an attorney, what resources they need to better handle the claim, what resources they currently are using. Think of it as "job shadowing." I call it "sitting chair-side." I always suggest visiting the TPA because invariably when I work with a risk manager to help reduce workers' comp costs, the RM has not visited the TPA offices with a fresh eye in quite some time. My role is to take a fresh look at the system in place to spot opportunities for improvement. Here are some things I observed: 1. An opportunity to improve the intake process by adding medical input to the process. 2. There were two companies at the TPA doing intake totally differently. The adjuster mentioned that another client was using another technique, and my company could possibly do this also. 3. The client is doing intake without medical triage. But, I don't jump to conclusions thinking it is a problem until my medical advisor reviews the files to see how they are being handled from a medical perspective; whether medical triage would be helpful or necessary. 4. The claims are reported by the employer to a vendor who reports the claims to the carrier. 5. The claim office manager initially evaluates the claim and then hands it off so administration can begin. 6. Administration reviews the initial details (zip code, confirms policy coverage, determines whether the employee is out of work) and assigns the claim a claim number and passes it to the appropriate adjuster (either medical-only or lost time). What it Means To Be "Site-Less" Although the employer is physically located in only one state, the injury took place in a different state, meaning the claim must be handled according to state law where the employee resides. Multiply that by 15 or 16 states where employees actually live, and you begin to see how complicated things can become. As I sit "chair-side" with the adjuster, I observe how lost time claims are handled and question whether it is impossible to have a return-to-work (RTW) program on site, since there is no "site" for the employees to participate in modified duty. A major challenge is discovered and thus, we must look for other options for injured employees, depending upon their skill sets and how these skill sets might transfer to modified duty. Med-Legal Meetings- As I sit with the adjuster I learn that in the state I am visiting, regulations permit a meeting between the defense counsel and the claimant's treating doctor to "get to the bottom" of medical discrepancies. Interesting. I will explore whether the attorney can be prepped by an MD. This visit is allowed prior to depositions and/or hearings, but is apparently generally used in the later stages of a claim. Options to enhance this meeting are worth exploring, and I begin by getting the regulations and calling the local attorney to introduce myself. Return-to-Work programs are a key and essential part of reducing costs and I am NOT prepared to consider the option of leaving employees out of work indefinitely because they lose motivation, become depressed, healing takes longer, and as they lose their daily routine they become isolated from the workforce. There are many other benefits also, but we can't do into all of there here. They are all listed in Workers' Comp Kit modules www.ReduceYourWorkersComp.com. This employer does not want a light duty program, and I will turn over every stone looking for other options. I may eventually suggest these options for the no-site nature of this employer: 1. Structured Volunteering. Perhaps at a school, hospital, Goodwill Industries or senior center. 2. Telecommuting from home via computer, doing home-based work. 3. Local network of work-hardening rehabilitation centers that simulate a work environment. Research Services - There are vendors providing both of these services. I have also asked the AE (account executive) from the TPA for copies of all brochures of all services the TPA offers and I am directed to their website. Hum. I would rather have hard copies I can mark up with my yellow highlighter. I put this issue on my list of "to-do" items for future follow up, then start researching the two intake triage companies I have just learned about. My logic has nothing to do with the economics. Well, OK, maybe it does a little bit, but primarily I want the employees back to work because staying out of work isn't good for them personally or their families. Anyone who works, knows that they have a pattern, a routine that they live by; when that routine is gone, their life changes — for the worse usually. It's better to have a destination to go to each day. If they don't have a destination to go to each day, they often become depressed and isolated. So, we'll be looking for other options for injured employees of this company. (workersxzcompxzkit) While the substance of my findings are interesting, the important point I want to make is the offices of your TPA's must be visited at least once each year to learn, learn, learn about the claim process and establish a relationship with your partners at the TPA/claim administrator's offices. Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
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Having loss runs is not a privilege, but a right of the policyholder. If your company is unable to have online access to your claims, at least the loss run will contain some very pertinent information. If any insurance carrier has a claim open from even 20 years ago, your company should be provided a loss run for that claim.
This may be a good time to pull out your company’s loss run and look at the numbers. Recently when reviewing one for a transportation company it was discovered their E-Mod (experience modification factor) increased from .9 to 1.6 in two years.
One of the main pieces of advice to give to an employer is that the E-Mod cannot be fixed in one year. It usually takes 2 – 5 years. Why? The E-Mod is calculated from claims that have been open for less than four years. That is not an exact statement, but an effort to keep this as straightforward as possible.
The main number to examine is the outstanding reserve, reserve, unpaid funds, etc. The outstanding reserves may be named with different terms. Regardless, it is the $ that has not yet been paid out on a workers’ compensation claim.
The outstanding reserves are the forecasted payouts by the adjuster for the lifetime of the file. And, as it is often said, even though the money has not been spent, it is charged off directly to your E-Mod, which in turn heavily affects your premium.
The basic formula is Paid Funds + Outstanding Reserves = Total Outstanding Reserves.
The total outstanding reserves are the figures your insurance carrier reports to the NCCI or the State Rating Board.
There is little you can do about what has already been paid. There are a few specialists who can review the paid funds to see if there were very many overpayments.
The quickest way to cover the claims affecting your company’s E-Mod is to look at claims that are five years old or less. The outstanding reserves for these claims need to be reviewed. If you look at any of these claims and the $ amount of the outstanding reserves seems too large for the injury, you may have found a way to cut your workers’ comp costs. (workersxzcompxzkit)
Author James J. Moore, AIC, MBA, ChFC, ARM is a national Workers’ Compensation premium and reserve expert. He is the founder and principal of J&L Risk Mgmt Consultants, Inc., a Workers’ Comp advisory company. http://www.cutcompcosts.com/www/blog.html. Mr. Moore has allowed WCK Blog to reprint the above blog with minor edits. Thanks, Jim.
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All state laws vary.
©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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