In order to get the best return on investment an employer or claims adjuster should seek out a nurse case manager possessing qualities which make them best suited to manage their claims in the field. Any good nurse case manager should be:
In addition to the seven listed qualities, other desirable qualities for a nurse case manager are: flexibility, excellent written and oral communication skills, and multi-task oriented.
7 Desirable Nurse Case Manager Qualities
1. Available- Nurse Case Managers should be available to attend appointments. The employer and claims adjuster should also be able to reach the nurse by email or cell phone so that urgent issues can be addressed quickly.
2. Experienced- If a nurse is new to workers' compensation case management, look for experience in managed care, discharge planning, or occupational health.
3. Certification-Â There are several certifications for case managers; the most common is CCM (Certified Case Manager). This certification insures that the individual has been able to meet standards set forth for the industry and is required to obtain continuing education in the area of case management each year.
4. Expertise in ortho/neuro/occ- med-Since most injuries received on the job involve these areas, a nurse with expertise in these same areas will improve your return on investment by anticipating the treatment and outcomes in advance.
5. Willingness to- become familiar with the worksite-Any nurse case manager you use should be willing to go to the worksite and be familiar with the equipment, layout, and areas of concern. The nurse should be willing to meet with the employer and obtain specific information about the job.
6. Familiar with- state specific WC laws-Nurses are not expected to be attorneys, but any nurse case manager should be familiar with maximum TTD and PPD rates as well as mileage and waiting period requirements.
7. Able to direct- the claimant to their claims adjuster or state commission for additional information when necessary. (workersxzcompxzkit)
If you get the same information from the nurse case manager you can get by making a few calls, it is time to get a new case manager. If you are not getting quality information from your nurse case manager, visit this list and see what you are missing.
Victoria Powell is the President of VP Medical Consulting, LLC located in Central Arkansas. VP Medical Consulting is a nurse consulting firm providing services to employers, insurance companies, attorneys and the general public. Services include case management, life care planning, legal nurse consulting, ergonomics and patient advocacy. Ms. Powell holds specialty certifications in a variety of nursing specialties. She can be reached through the web at http://www.vp-medical.com by phone at 501-778-3378. We are accepting short articles* (300-800 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues.
©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
Unions are reportedly coming out against a proposed move in Australia to form a national system of workplace safety laws. (See WCK related blog http://blog.reduceyourworkerscomp.com/?p=748.)
According to a report in Australia’s The Age, union members believe most of the benefits from such a move would favor employers and not employees. Among their concerns are that worker safety could be endangered by the changes, mainly that a lack of safeguards in place would not ensure employers were prosecuted over health and safety breaches.
A meeting of state and territory ministers recently agreed to the release of the ”model” laws for six weeks of public comment – although Western Australia, the only non-Labor participant, indicated it was not likely to join the national system as proposed.
According to a number of businesses, complying with different laws in the states and territories has been a big problem, reportedly leading to more ”red tape” or compliance costs. Key employer groups, like the Australian Industry Group, the Business Council of Australia, and the Minerals Council of Australia recently released a joint statement requesting government’s support of a national system. (workersxzcompxzkit)
The Access report, commissioned by regulator Safe Work Australia, reportedly discovered businesses would be the biggest winner from the switch to national laws while employees would experience little or no benefits from the changes.
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.
We are accepting short articles* (300-1200 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com.
Employed But Collecting Workers’ Comp
A worker was arrested and charged with three felonies after he allegedly lied to receive workers’ compensation while employed according to the Washington County Sheriff’s Department following an investigation by the New York State Workers’ Compensation Board.
Authorities say the man filed for workers’ comp after he was allegedly injured at a former place of employment. He received benefits from the state, while reportedly employed at another business. (workersxzcompxzkit)
The man is charged with three felonies: third-degree insurance fraud, first-degree falsifying business records, and third-degree grand larceny and one count of offering a false statement, a misdemeanor.
Penalty of Hiring the Illegal Worker
A restaurant owner pleaded guilty in U.S. District court admitting he allowed nine illegal immigrants to work for him in his restaurants and live on properties he provided. He also admitted he knew the workers were not permitted to legally reside in the United States at the time, according to Assistant U.S. Attorney Tiffany Lee. The plea was the result of an investigation conducted by U.S. Immigration and Customs. (workersxzcompxzkit)
Scheduled for sentencing U.S. District Court, the defendant faces a maximum term of five years in prison and/or a fine of $250,000.
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.
We are accepting short articles* (300-800 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com.
How Would You Decide: If you fall asleep in your car and are injured, who do you sue?
Here’s what Tom Robinson, J.D., writer for Lexis Nexis Workers Comp Law Center reports.
Worker Injured in Company Parking Lot While Snoozing in Car May Not Proceed Against Co-Worker for Alleged Negligence
Here’s What Happened
Kulik was employed by Sears and began each work shift at 6:00 a.m. He drove his vehicle to work one day and arrived half an hour before his shift began. He took a “cat nap” in his car while waiting for the shift to begin. As Kulik slept and waited, his car was struck from behind by another vehicle driven by a co-worker. Kulik filed a negligence action against the co-worker and Kulik’s spouse also sued to recover for loss of consortium.
The defendant contended Kulik’s civil action was barred by the exclusive remedy provisions of Pennsylvania’s Workers’ Compensation Act. The trial court agreed and granted summary judgment in favor of defendant. Kulik and his wife appealed.
Here’s What The Court Decided:
In Kulik v. Mash, 2009 PA Super 188, 2009 Pa. Super. LEXIS 3285 (Sept. 16, 2009), the Superior Court of Pennsylvania agreed with defendant that the personal injury cause of action (as well as the derivative consortium claim) was barred by exclusivity. Observing that the injury occurred within the employer’s parking lot, the court stated the general rule that even though not actually engaged in the employer’s work, an employee will be considered to have suffered an injury in the course of employment if the injury occurred on the employer’s premises at a reasonable time before or after the work period.
The court held that the 30-minute interval before Kulik’s shift was to begin was a reasonable interval of time, that once an employee was on the employer’s premises, actually getting to or leaving the employee’s work station was a necessary part of that employee’s employment, and thus, definitively furthered the employer’s interest. The court stressed that just because Kulik arrived early, perhaps because traffic was not as bad as expected, and he took advantage of his early arrival to take a cat nap, it did not mean he was “off on some enterprise of his own before going to work.” Kulik did nothing extraordinary before heading into work. (workersxzcompxzkit)
According to the court, ”[t]he vicissitudes of traffic should not make the difference as to whether or not there is a bar.” The court refused to accept defendant’s argument that in other cases where the tort action had been barred by exclusivity, the employee had actually been moving toward the employee’s work station at the time of injury, whereas here, Kulik had been stationary. That was too fine a line to be drawn, said the court. The court reiterated the normal rule: a person on the employer’s premises a reasonable period of time before or after work is considered to be within the course of employment.
See generally Larson’s Workers’ Compensation Law, § 13.01, 13.04, 111.03.
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
FREE WC Best Practices IQ Test: http://www.workerscompkit.com/intro/
WCBooks: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: www.reduceyourworkerscomp.com/calculator.php
A NEW Article: Return to Work in Unionized Companies
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workman’s comp issues.
©2009 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 goal of case management in workers’ compensation should be to achieve wellness through advocacy, communication with the claimant, education, identification of resources, facilitate services and to contain costs.
The goals are much more than simply reaching MMI (Maximum Medical Improvement) or obtaining an impairment rating.
The case management goal is for the claimant to achieve wellness and become as functional as possible whether or not he or she returns to work.
The nurse case manager is always assessing the claimant and identifying issues which will delay healing or become costly.
By combining these goals we create happier claimants, adjusters, attorneys and employers.
6 Key Goals of Nurse Case Management
1. Advocacy- active support of an idea or case, especially the act of pleading or arguing for something.
2. Communication- reciprocal sharing with others of written oral and non-verbal information.
3. Education- instructing; activities that impart knowledge or skill.
4. Resource Identification- obtaining the means of meeting a need or deficiency especially an economic of social need or deficiency.
5. Facilitation- guided process of decision making; an act of assisting or making easier the progress or improvement of health. (workersxzcompxzkit)
6. Cost Containment- strategies to control the rising cost of health care.
Victoria Powell is the President of VP Medical Consulting, LLC located in Central Arkansas. VP Medical Consulting is a nurse consulting firm providing services to employers, insurance companies, attorneys and the general public. Services include case management, life care planning, legal nurse consulting, ergonomics and patient advocacy. Ms. Powell holds specialty certifications in a variety of nursing specialties. She can be reached through the web at http://www.vp-medical.com by phone at 501-778-3378.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©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 Job Search Challenge
Employers are often faced with the challenge of not being able to bring all injured employees back to work in their workforce. Many employers just do not have appropriate light duty positions for their injured workers. The challenge is, then, locating suitable positions for these permanent partial disability (PPD) cases. A permanent partial disability case is one where the injured worker has permanent restrictions. I’ve found employers are not aware of the firms specializing in finding REAL open positions for their injured workers. This is not an easy task in this economy; cases can remain open if there are no suitable positions available, regardless of the cause. A diligent job search firm is different than home-based employment or charitable work.
What Does a Job Search Firm Do?
Simply put, a job search firm finds open positions for injured employees. Job finding or job search locates positions for permanent partial disability (PPD) case files.
It allows you, the employer, to quickly and efficiently reduce your overall workers’ comp costs by reducing indemnity (lost wage) expenses. Job finding is not necessarily appropriate for all workers’ comp PPD cases. It is appropriate when the case has challenges such as geographical location, physical limitations or financial restrictions.
What Claims Qualify for Job Search?
Adjusters are generally working on a caseload of 100-150 files at any time. When time is precious, it is natural for adjusters to devote their time to files where they can make some headway. The claims a job finding company takes are those many adjusters are unable to make significant progress on, such as carpal tunnel, lower back soft tissue damage, or rotator cuff injuries.
A job search service is often used to find appropriate positions for construction, transportation, shipping and other physical, relatively high-paying positions in states having wage loss exposure after a case reaches Maximum Medical Improvement (MMI) and the employee still has work restrictions.
Why Turn Claims Over to Job Search?
Going back to the case load of your average case manager, if an adjuster has 100-150 active files, 30% of cases may be difficult to advance to the next level. For this reason, these files can go on much longer than necessary.
It takes 20+ hours per successfully scheduled interview and an average of 4.5 interviews per case to successfully close a case. It would be impossible for an adjuster to include this in their daily or weekly routine. And, spending all their time on 30% of the most challenging claims would not be an effective use of an adjuster’s time.
A firm whose business is to locate jobs for employers has an established network of contacts and employers. They also cold-call employers in appropriate geographical and industry niches until they find an unlisted, hidden position suitable for each worker. This type of firm keeps extensive notes and maintains a record of everything from the initial pre-interview session with HR personnel, to the interview results and follow-up.
Job finding is appropriate for about 30% of cases and works best in any state where the insurer has wage loss exposure after the employee has fully recovered and reached MMI.
In other words, it is most appropriate for PPD cases. Certainly, it is better to put your PPD cases into the hands of a job hunt service as soon as possible after MMI is established. The sooner the better because every day you wait to find suitable employment opportunities, the more indemnity payments will be lost. �
Success Story and Savings Potential
A PPD case in Michigan costs an average of $72,000.00 PER CASE between months 13-36. These are cases that have ALREADY been active for 12 months. If case managers waited 12 months before sending a case to a Job Finder they would still save an average of $65,000.00 per case. (workersxzcompxzkit)
Resource
One job finding company is: http://www.nationaljobfinders.com/. They can be reached at 207-583-6464. Call to discuss whether this strategy would work for some of your “old-dog” claims.
Author: Rebecca Shafer, J.D. coaches and trains mid-market and national accounts to do assessments, data review, benchmarking, and development of Workers’ Compensation Programs. Projects center on development of training and education programs, document design, evaluation and integration of insurance claims administration and TPA services. Contact her are: RShaferB@ReduceYourWorkersComp.com
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workman’s comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Kentucky Employers’ Mutual Insurance (KEMI) Lowers Rates for Fourth Straight Year
Employers in Kentucky received good news recently, as the state’s largest workers’ compensation insurance provider reports it will lower its rates for companies statewide for the fourth consecutive year.
The rate reduction from KEMI will lead to an overall average drop of 6%. Businesses eligible for KEMI’s preferred tier could see rates fall by as much as 30%, saving policyholders more than $9 million for the coming year according to the insurer. Rates will change on October 1, 2009 and apply to both new and renewal policies.
KEMI (www.kemi.com) is also lowering its minimum premium requirements from $700 to $500, saving KEMI’s small business accounts an additional $200 for their premiums. (workersxzcompxzkit)
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.
We are accepting short articles* (300-800 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workman’s comp issues.
©2009 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 Nova Scotia Workers’ Compensation Board of Directors approved a new program policy entitled “General Entitlement – Arising out of and in the Course of Employment”.
The new General Entitlement program policy establishes the principles to guide decision-making regarding the work-relatedness of an injury. This program policy does not change, expand or limit the existing criteria for determining the work-relatedness of an injury.
Rather, it improves transparency and accountability regarding the WCB’s decision-making process by documenting and communicating the general principles and questions the WCB considers when determining if an injury is work-related. It also lays the foundation necessary for potentially developing more complex adjudicative policies in the future as identified by stakeholders. (workersxzcompxzkit)
In concluding policy development on “General Entitlement – Arising out of and in the Course of Employment”, the WCB prepared the paper entitled:
“General Entitlement: Arising out of and in the Course of Employment – Final Policy Decision and Supporting Rationale” outlining these points:
1. Key issues raised by stakeholders during Stage 2 consultation on the proposed new program policy.
2. The rationale for why the WCB did or did not revise the draft new program policy “General Entitlement: Arising out of and in the Course of Employment”, in response to stakeholder submissions received as a result of Stage 2 consultation. (workersxzcompxzkit)
3. A summary of feedback received during Stage 2 consultation.
4. The WCB’s final policy decision as reflected in the final version of the program policy in Appendix D.
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.
We are accepting short articles* (300-800 words) on WC cost containment. Contact us at: Info@WorkersCompKit.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workman’s comp issues.
©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com
Stopping Fraud with Video Proof
3 Action Steps to Use When Contacting Your TPA
Once you suspect an injured employee of lying about an injury, launch an investigation. With video proof the injured employee’s range of motion is not as stated, you document these facts with a doctor.
The next step is legal and it’s time to contact your third party-administrator (TPA).
1. Send a letter stating the nature of the employee’s fraud by:
Overnight priority mail.
With a confirmation receipt and tracking.
Enclose the investigation report and video.
Enclose a completed transitional assignment form.
2. Next the injury coordinator needs to include a cover letter detailing the situation. This letter must include the employee’s name, claim number, your company name and contact information, with an explanation:
That the company’s policy is to verify that employees who tell us they cannot perform a transitional duty job are actually unable to perform such work because you accommodate any restrictions provided to the company by the treating doctor.
Tell your TPA the company paid for this investigation directly and will keep a copy in the files in case there are any subsequent employment-related claims.
Explain the investigator’s report indicates Mr. X can do strenuous yard work for an extended period of time. Thus, he has more ability than he has told his doctor.
Note the company will make good on its offer to give Mr. X a transitional duty position in the transitional duty program based on the report.
Explain if Mr. X refuses the job offer, your company will notify the TPA immediately and request they file a Motion to Discontinue Benefits according to state law.
Note a copy of the new job offer is attached.
3. Lastly, you must ask your TPA about legal recourse. One way of phrasing this is as follows:
“We are also interested in pursuing any criminal and/or civil action and ask you to request the head of your Special Investigation Unit to contact me immediately to discuss whether this claim rises to the level of fraud in our state.” (workersxzcompxzkit)
4. Request a Meeting with the SIU (special investigation unit) at the carrier to see if additional evidence is likely to be needed.
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 Calculator: www.reduceyourworkerscomp.com/calculator.php
TD Calculator:www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Follow Us On Twitter: www.twitter.com/WorkersCompKit
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©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
When working with management, make your presentations SHORT – 20-30 minutes maximum. Remember senior managers are busy and don’t like to sit through long presentations. 20 minutes is ideal, and leave time for questions at the end of the presentation. If it’s longer, you’ll lose their attention.
First, when giving any presentation, it is best to let your audience know ahead of time what you are going to be telling them about. This outline will not only help viewers retain information, but it will also hold their attention.
Nothing is worse than sitting at a long meeting with complex information and having no idea how much more you will be expected to learn or how much longer the presentation might go.
Let your staff know your presentation only take 30 minutes and covers the following:
1. What is Workers’ Compensation?
2. Who is covered?
3. Who pays for the insurance?
4. How are premium costs calculated?
5. Workers’ Comp fraud
6. Controlling Workers’ Comp costs
By starting with the basics, you ensure even those who have no idea will have their questions covered without having to ask. This eliminates an “I don’t care” response, which is often the result of “I don’t know.”
Another point to remember is under the section “Who pays” to include the actual numbers your company pays to keep your employees insured. This establishes trust. The company’s insurance premium, deductibles and administration cost may be included.
Include graphs. This is visually interesting and also is a very good way of showing what is expected and comparing it to your company’s reality. (workersxzcompxzkit)
For example, show a graph indicating you would like to get 90% of injured employee’s back to work, and compare it with a graph of your company’s’ current return to work results.
Remember: Review the outline at the end and thank your audience.
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 Calculator: www.reduceyourworkerscomp.com/calculator.php
TD Calculator:www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
Follow Us On Twitter: www.twitter.com/WorkersCompKit
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©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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Coordinating Medical Care, Medical Cost Containment & Managed Care, Medical Issues |
