How the Medical Advisor Communicates with the Treating Physician
Your company’s medical advisor may, from time to time, need to address specific health issues in regard to an injured employee’s case.
Accompany your adjuster’s letter with a signed cover letterfrom the medical advisor or director. Doing so results in more comprehensive and conclusive independent medical evaluation and examination (IMEs) reports.
- Be sure to include claim number and all relevant addresses and contact information on the letter.
- Welcome the physician to ask questions.
Be sure to ask the independent medical evaluation physician (IME) to answer the following questions or types of example questions:
- What is the patient’s present diagnosis and work status since it is X months since the original injury?
- Has s/he achieved maximal result?
- Can s/he perform the job as a painter (or whatever is the usual work task)?
- Specifically, please address whether s/he would have difficulty simply walking on a flat surface and going up and down a ladder?
- Since the latter involves flexion and extension of the ankle, would the lateral sprain affecting primarily pronation and supination really interfere with performance?
- If the worker uses an ankle support, would it be sufficient to allow work performed as a painter?
While Workers’ Comp Kit expects you to request and receive work ability forms, some injury cases may need more specific follow-ups. (workersxzcompxzkit)
For example, this may be necessary when documentation states: ”Patient may have trouble walking.” and your company needs to know how long the worker can walk for, at what inclination and duration. These specifics can be determined by the independent medical examiner but may require some slight prodding to get documented.
Author: Robert Elliott, J.D. Executive Vice President, Amaxx Risk Solutions helps companies reduce workers’ comp costs 20-50%. He can be reached at Robert_Elliott@ReduceYourWorkersComp.com
WC Best Practices Quick Check: http://www.workerscompkit.com/intro/
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A Story in Several Parts – 2 2) Corporate Structure The systemic way a company handles their work injuries is the most critical aspect of a solid workers' compensation control process. The same process can, of course, be used for all absences in the workplace including short and long term disability. Who is responsible for work-related injury reporting and procedures at your company? Is that person familiar with risk management and workers' compensation cost control? If not, they should attend conferences such as RIMS and the National Disability Conferences. They will need management support while they learn the ropes. The person responsible should have adequate resources to become familiar with the types of services available to companies to tightly control the injury process; this type of knowledge is gained through attendance at industry conferences where they attend seminars on point and also browse through the exhibit hall to see the range of services available to them. The person responsible for workplace injuries should receive at least one monthly newsletter or magazine to gain a broad understanding of the subject area. I've worked with several clients where the legal department was responsible for handling workers' compensation claims yet counsel had not had the opportunity to learn risk management techniques. Having started in the risk management field as in-house counsel for a large international company, I learned about risk management by accident. Law schools do not normally teach risk management although the two fields are closely related and most lawyers do not know the field of risk management is a specialized occupation. Corporate personnel often do not ask to attend conferences or subscribe to publications because they do not know these tools exist – they don't know what they don't know! Your structure should fuse different departments into a workers' comp team with one captain. The team leader should be a ‘get it done' person who has a strong workers' comp background. Determine which departments in your company deal with employee injury and absence. All relevant departments should report to the same executive, usually the CFO. There must be communication with all departments handling areas as safety, personnel/human resources, labor relations and the medical department. A good starting place for inter-departmental communication is a brainstorming session to discuss worker safety and injuries. Each department brings any written materials and forms they use for employee injuries and absences. The people responsible for WC must understand the operational side of their business. If they haven't been out into the ‘field' to see the actual operations, that is the first step – head out to see what your company does. While it sounds almost too simplistic to say this, it is an often overlooked step. (workersxzcompxzkit) It is important to have union buy-in so include the director of labor relations; important contract provisions may need to be changed during the next negotiation. Labor relations much coordinate closely with the risk management and medical departments, yet they may be unaware of the important role they play. Author: Rebecca Shafer, J.D. Rebecca is a cost containment consultant with over 20 years experience working with even the most challenged employers helping them implement workers' compensation cost containment solutions. Whether the problem is unions, decentralized workforce or lack of management commitment, our team can help you overcome the challenges. We can be reached at RShafer@ReduceYourWorkersComp.com or 860-786-8286.
Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/ WC Best Practices Quick Check: http://www.workerscompkit.com/intro/ (free quick score) WC Calculator: www.reduceyourworkerscomp.com/calculator.php Do not use this information without independent verification. 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
In a recent Tweet it was noted the only game in town when it comes to workers’ compensation is cost containment. Cost containment arises out of the many and diverse ways an employer maintains a safe work environment. A safe work environment is the jumping off point for reducing the overall costs of injuries in the workplace, resulting in lower work comp costs. It’s like a mantra:
Implement a superior WC plan » Practice “Safe” work environment techniques » Workplace injuries drop » the COST of WC drops!
Awards Prove Safety Works in Cost Containment and Workers Comp Programs
Tennessee Company Wins Workplace Safety Award
McKenzie Valve & Machining Company Inc. received the SHARP (Safety and Health Achievement Recognition Program) award from the Tennessee Department of Labor & Workforce Development, according to Commissioner James Neeley.
One of the state’s highest honors for workplace safety and health, the SHARP award is designed for employers with fewer than 250 workers in high-hazard industrial classifications. The main incentive for participation in the SHARP award program is the desire by employers to promote a safe and healthy workplace. The program also allows employers to be removed from programmed compliance inspection lists for a period of 12 months. (workersxzcompxzkit)
Or, you can be this employer
CANADA: How Workplace Safety Violations Raise Work Comp Costs
A provincial safety inspection of some 20 Calgary high-rise building sites discovered a number of violations–including workers improperly securing materials — in a review ordered following the death of a three-year-old girl by heavy steel roofing that blew off a building, also injuring the girl’s father and brother according to the Calgary Herald.
While the final numbers are not in, an Occupational Health and Safety spokesperson said inspectors discovered few safety threats with the exception of a few orders to secure materials and improve protection to keep employees from falling. OSHA did not issue a stop-work order. (workersxzcompxzkit)
Although the article didn’t say, here’s a lawsuit in the making, because it doesn’t matter what OSHA didn’t find, a child was killed and someone must pay and most likely that someone will be the employer.
Author Robert Elliott, senior 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.
WC Best Practices Quick Check: http://www.workerscompkit.com/intro/
WC Manuals: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
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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
Wisconsin Notes $2 Million Job Training Hiring Initiative
Wisconsin Department of Workforce Development (DWD) Secretary Roberta Gassman announced a $2 million On-the-Job Training Hiring Initiative, funded under the American Recovery and Reinvestment Act (ARRA), to pay 50% of the wages plus fringe benefits for up to 90 days when employers hire people with disabilities.
”We have nearly 6,000 consumers who are ‘job ready,’ and this recovery-funded effort will help them reach their employment goals,” Gassman said. “These individuals have much to offer. I encourage employers in search of dependable, dedicated workers to consider hiring these individuals.”
The On-the-Job Training Hiring Initiative will be administered through the DWD Division of Vocational Rehabilitation (DVR). Job candidates will be referred from DVR’s pool of job-ready customers. The DVR provides employment and training services for people with disabilities.
DVR Administrator Charlene Dwyer called the program a “win-win” for DVR customers and employers. While DVR customers gain employment, the initiative lets employers train the DVR customer for half the company’s usual training cost per worker. The employer also becomes eligible for tax benefits in hiring an individual with a disability. (workersxzcompxzkit)
Dwyer added the process is easy for employers. Employers simply hire a DVR referral and process their employment paperwork as they would for any other employee. A one-page agreement with DVR, completed by the employer, will secure the employer’s OJT Hiring Initiative payment.
Author Robert Elliott, senior 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
PPD Claims in New York and Claim Strategy Effects on Employers
The March 13, 2007 changes in the New York work comp law regarding permanent partial disability (PPD) claims will trigger radically new claims strategies. Employers should be aware of the changes as they will have a profound effect on comp costs.
The new system is mathematically far more complex than the old and results will often be counterintuitive. For example, return to work in the old system worked immense disadvantages on workers only because of entrenched practices at the Board which rewarded claims in which there was no work activity.
The new system will give substantial advantages to claimants who return to low paying work rather than levels close to their pre-injury wages. Therefore, an early return to work program at the same or similar wages must become the center of efforts to reduce comp costs.
For workers with wages higher than $900/wk the differences are dramatic. A permanently partially disabled worker can receive lifetime payments of $315,000 returning to a minimum wage or part time job. However, that can be reduced to $21,000 if modified work at $765/wk can be provided by the employer.
It can be anticipated that many workers will be advised to engage in limited work by their attorneys to get the higher settlement. Earnings from actual work are presumptively correct as a measure of disability. New medical guidelines will be used when there is no work record to establish a level of disability.
An employer should realize that in New York work comp minimal levels of disability are often preferable to attorneys representing workers since settlement is done quite quickly, often without litigation. Although the legal fees are lower, the time spent is so small that these claims often produce the highest hourly returns for attorneys; $3,300 for a minimal permanent disability.
The maximum fees realistically obtainable will be approximately $45,000 for near total disability of a worker with pre-injury wages above $900/wk. However, the number of claims that fit that profile is statistically quite small. The bulk of fees will come from workers with wages in the range of $500-600/wk who have 50% disabilities, meaning a residual earning capacity of minimum wage work.
A workers’ compensation law practice is subject to the same immutable laws of economics as any other business. In time, emphasis must be placed on those claims that are the economic engine. An employer who provides for effortless settlement of comp claims will find the same incentives that apply to the worker’s lawyer – lower costs and less effort on claims. (workersxzcompxzkit)
So, the lesson for employers is to return their employees to modified duty at the same or similar wages as pre-injury.
Increased litigation costs may be an adverse result as carriers invoke the new law to limit their liabilities; lengthy litigation to avoid the unwarranted establishment of PTD can be anticipated.
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.
WC Best Practices Quick Check: http://www.workerscompkit.com/intro/
WC Manual: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
Do not use this information without independent verification.
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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
How Would You Decide: The Biscotti Incident Here's what Tom Robinson, J.D., writer for Lexis Nexis Workers Comp Law Center reports. Immigrant's Tort Claim for Intentional Injury Filed Against New Jersey Cookie Maker Is Barred by Exclusive Remedy Provisions of the State's Compensation Act Here's What Happened A New Jersey worker, a Vietnamese immigrant who could not speak, read, or understand English, sustained significant injuries when her hand came into contact with a sharp blade inside a biscotti machine at the employer's baking facility. To prevent a hand from entering the area in which the blade operated, the back of the machine had a ten-inch wide sheet metal guard located about one-and-one-half inches above the area where workers removed the biscotti pieces for further processing. The guard itself was about nine inches from the location of the sharp blade inside the machine. The worker was injured on her first day working at the machine. She filed a tort action against the employer, contending her employer's inadequate training and faulty safeguards amounted to an intentional tort, and her civil action was not, therefore, barred by the exclusive remedy provisions of the state's workers' compensation law. There was some question as to whether warnings on the machine, printed in English, were actually present on the machine at the time the worker was injured. According to the worker's expert, even if the warning labels were present on the day of the accident, they would not have provided any meaningful information to an individual who could not speak or read English. The expert also observed the metal guard could not prevent a person from inserting his or her hand into the area containing the blade. The expert opined this danger presented such a high risk "it was not only reasonably foreseeable but substantially certain somebody would have been seriously injured by this machine without appropriate training." [Author's note: New Jersey is among the states utilizing the "substantially certain" rule- in order to avoid the exclusivity defense the injured employee must allege sufficient facts to demonstrate his or her employer knew its actions were "substantially certain to result in injury or death to the employee." New Jersey's "substantially certain" rule is more restrictive, however, than most of the other states utilizing it. Under a doctrine laid out in Laidlow v. Hariton Mach. Co., Inc., 170 N.J. 602, 605, 790 A.2d 884 (2002), a second prong is added. The employee must also show, "the resulting injury and the circumstances of its infliction on the worker" constituted "more than a fact of life of industrial employment" and were "plainly beyond anything the Legislature intended the Workers' Compensation Act to immunize."] The trial court dismissed the worker's complaint against her employer, finding in relevant part the plaintiff did not present sufficient evidence to overcome the intentional wrong exception to the workers' compensation exclusivity bar. Here's How the Court Ruled In Cong Su v. David's Cookies, 2009 N.J. Super. Unpub. LEXIS 2145 (August 10, 2009), the Superior Court of New Jersey (Appellate Division) agreed with the trial court and affirmed. The appellate court observed there was no evidence anyone had ever been injured by the machine prior to the worker's accident, there had been no employee complaints regarding the machine or any safety aspects associated with it, and the defendant employer had never received any citation from the Occupational Safety and Health Administration (OSHA) regarding the machine. Concerning the failure to train allegations, the appellate court agreed with the trial court that an employer could assume a rational person would not stick his or her hand in a machine being operated by electric power without turning it off or seeking assistance from others. The trial judge also found the allegations of failure to train, failure to supervise, failure to warn, as well as the type of injury sustained by the worker clearly fell within the workplace hazards intended to be covered by the Worker's Compensation Act. The trial judge had been satisfied this was a typical workplace accident that did not differ in any significant way from the types of industrial accidents the Legislature intended to compensate exclusively through the provisions of the workers' compensation law. The appellate court agreed and indicated under such circumstances no tort action could be maintained against the employer. The worker's sole remedy was within the workers' compensation system. (workersxzcompxzkit) See generally Larson's Workers' Compensation Law, § 103.04. 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). 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
WC Calculator: www.reduceyourworkerscomp.com/calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. 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
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.
Federal Employee’s Compensation Scam
Former Senate Employee Scams Government of $259,000 in Federal Employees Compensation Benefits
A former federal employee was convicted of receiving $259,000 in FEC benefits while owning and operating several business, according to a recent press release from the office of Acting United States Attorney Channing D. Phillips.
As a printing and reprographics specialist at the United States Senate the man filed a notice of an on-the-job knee injury for which he collected total disability benefits for the past nine years.
While working at his privately owned business, the defendant repeatedly filed, by mail, certification documents (required by federal law) declaring he was still totally disabled and did not have nor could he perform “any outside work activities or income, volunteer work, self-employment, or involvement in a business enterprise.” The defendant also devoted a substantial amount of time to coaching a traveling flag football team.
Charged with mail fraud, the man faces imprisonment of 21 to 27 months. As part of the his guilty plea he admitted wrongfully receiving $259,645.11 in wage-loss compensation benefits for total disability from the United States government. (workersxzcompxzkit)
Extracted from: Press Release. 8/7/09 – Office of
Channing D. Phillips, Acting United States Attorney for the District of Columbia
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
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification.
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
Workplace safety issues are in the hands of employers and, through good communication their employees – everyone being aware of and complying with all safety laws and regulations. Good safety practices = lower work comp cost. And, workers’ compensation has global implications.
Australia Campaigns for Improving Scaffolding Safety
Workplace Safety Authorities across Australia are undertaking a campaign to improve scaffolding safety in the construction industry.
The national campaign will see workplace safety inspectors from all states visit residential and commercial construction sites to ensure safe work procedures are in place to address the risks of erecting and using scaffolding.
John Watson, chair of Heads of Workplace Safety Authorities said recent scaffolding related incidents in Queensland, New South Wales and Victoria highlighted the need for vigilance with the erection, use and dismantling of scaffolding to ensure the safety of workers and the public.
“On-site advisory visits will raise awareness of safety issues relating to scaffolding and improve the ability of contractors, employers and workers to identify, assess and control the hazards and risks associated with scaffolding.” Watson said.
“People must be cautious when erecting, altering, using and dismantling scaffolding. The targeted intervention program provides a coordinated national approach to address safety issues and will provide jurisdictions with an understanding of the current level of compliance in the construction industry.
“The campaign is also designed to increase the capability among trades linked to construction such as form workers, brick layers, tilers, painters and to identify, assess and control the risks of working with scaffolding,” Watson added.
A strong focus on ensuring construction site scaffolding comply with Australian Standards AS 1576 and AS 4576 for prefabricated, aluminum, trestle and swing stage scaffolds is another aspect of the campaign.
“The campaign is another example of the states and territories working in unison to develop a nationally consistent approach to workplace safety,” Watson noted. (workersxzcompxzkit)
The campaign supports the National OHS Strategy 2002 – 2012 to facilitate the development of consistent approaches to agreed Australian and New Zealand workplace safety priorities.
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.
WC Kit Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
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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
Department of Labor (DOL) Gears Up for “Drug-Free Work Week”
DOL has designated October 19 through 25, as “2009 Drug-Free Work Week.” See their website for a variety of resources for employers, workers, associations, unions, neighborhood groups, and community coalitions to take part. http://www.dol.gov/asp/programs/drugs/workingpartners/DFWW-Introduction.asp
An annual event, drug-free work week highlights the productivity, safety, and economic benefits of drug-free workplace programs which, as we all know, reduce the costs of workers’ compensation and provide a better, safer environment for all employees. In some states, a company recieves a discounted premium when they implement a drug-free workplace program. Check with your insurance broker to see if you are in these states and whether your company qualifies.
Working drug free works is DOL’s major promotional goal because:
1. Accidents are prevented.
2. Workplaces are then safer.
3. Productivity improves.
4. Costs are reduced.
5. Encourages people with alcohol and drug problems to seek help
DOL reports significant data on drugs/alcohol and the workplace.
1. 75% of the nation’s current illegal drug users are employed.
2. 3.1% say they have used illegal drugs before or during work hours.
3. 79% of the nation’s heavy alcohol users are employed.
4. 7.1% say they have consumed alcohol during the workday.
Employers MUST encourage employees with drug and/or alcohol problems to seek help because recent research by DOL shows “it’s a message people need to hear.” (workersxzcompxzkit)
A Drug-Free Work Week Tool Box and links to ideas for various types of organizations are available on the DOL website.
Also see http://reduceyourworkerscomp.com/drug-testing-state-laws.php for the only FREE set of drug laws covering individual states.
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
A bucket, a ladder and a nail caught the judges’ attention at the annual communications awards presented by the American Association of State Compensation and Insurance Funds (AASCIF). The three objects have starring roles for the Workers’ Compensation Board of Nova Scotia (WCB) and its latest marketing campaign, recently named Best of Show.
Workers’ compensation organizations throughout Canada and the United States, including large jurisdictions like New York, California and Texas are members of AASCIF. The association’s communications awards recognize the most effective and creative communications programs in the North American industry. The campaign, (also winning first place in the External Communications Campaign category) includes television ads featuring stories of ignored safety hazards.
A protruding nail, a misplaced bucket and a broken ladder literally call out for someone to do something about them before they cause an injury. The television ads were produced in partnership with the Workplace Health Safety and Compensation Commission of Newfoundland and Labrador, and the Workers’ Compensation Board of Prince Edward Island.
“These ads mark an important shift in our social marketing campaign, from raising awareness to inspiring action,” said Mary Kingston, director of communications. “With an injury occurring in the province about every 15 minutes Nova Scotians need to do something – no matter how small – to prevent the human suffering associated with workplace injury.”
The campaign also features radio, print and online ads as well as an interactive Web site, http://www.worksafeforlife.ca/ where workers and employers can take safety into their own hands in an innovative environment including customizable workplace posters, downloads and e-cards based on safety and return to work messages.
This is the second time the WCB has won Best of Show at AASCIF. In 2006 it received the honour for its campaign targeting young workers. (workersxzcompxzkit)
“Winning awards is always exciting, but the true measure of success comes from results,” said Kingston. “Our research shows that more Nova Scotians feel they can do something to make their workplace safer and fewer Nova Scotians believe workplace injuries are an inevitable part of life. That’s something worth celebrating.”
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