A local business owner was sentenced for reported failure to make contributions to the unemployment insurance fund and failure to secure workers’ compensation insurance according to Monterey County’s district Attorney.
An investigation was initiated when the DA received information for a former employee injured on the job and was unable to collect workers’ comp benefits. Agents with the Employment Development Department (EDD), the Department of Industrial Relations (DIR), and the Department of Insurance (DOI) joined the investigation when it was discovered the defendant collected payroll taxes from employees but did not reporting or forward the funds to the appropriate state agency.
The man was placed on felony probation for three years and ordered to serve three months in county jail or complete an equivalent work alternative program. In addition to standard terms and conditions of probation, the man was ordered not to conduct business in violation of the law. He must also pay EDD $23,738.84 as restitution; a fine of $41,311.36 to the California Workers’ Compensation Fraud Account; and, a statutory fine of $10,000 to the District Attorney’s Office.
The court also ordered him to maintain and provide proof of workers’ comp insurance for all employees, provide a certificate of insurance to the California Department of Insurance, pay all employees only by check itemizing all appropriate payroll deductions, and to comply and maintain all licenses in any city or county in which he conducts business. (workersxzcompxzkit)
Additionally, the man is ordered to make payments as directed by the Workers’ Compensation Appeals Board for workers’ comp benefits due the injured employee. Further, the defendant is required to contact and make payment arrangements for any administrative fines levied by the DIR and the Division of Labor Standards Enforcement.
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.
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
A survey of what the media, state agencies, insurance companies, and others report in terms of workers’ comp fraud, listing recent arrests, charges, and convictions.
Criminal complaints and indictments are accusations only.
Defendants are presumed innocent until proven guilty.
Independent Contractors Don’t Have Employers
According to the Ohio Bureau of Workers’ Compensation, a former top aide to fallen Attorney General Marc Dann committed attempted fraud by improperly classifying workers, which lowered the premium he owed the agency.
The ruling found that the AG’s former general services director, improperly classified four workers at his construction firm as independent contractors instead of employees. The improper classification reduced the premiums owed the state. The attempted workers’ compensation fraud charge is one of six the former aide admitted to as part of a plea deal reached in August with most charges involving his construction company. He faces a maximum of $6,700 in restitution. The amount he must return to the state is confidential
The aide’s attorney argued to the Bureau of Workers’ Compensation during a hearing earlier this month that the workers failed to meet at least 10 of 20 qualifications, as required by state law, to be considered employees as opposed to subcontractors. He also said despite the plea deal an appeal is planned against the bureau’s findings. After that, he could choose to take an appeal to common pleas court.
The bureau’s report said the “weight of the evidence” indicated the four workers in question were employees.
The report said the workers were paid on a weekly basis, were provided training, faced termination if they did not show up at the required times, and worked only for the man’s construction company.
“In addition, at least one of the workers interviewed by the Bureau reported he was paid a Christmas bonus and recalled the possibility of future health benefits being discussed.
See also: How to Identify and Employee from an Independent Contractor http://blog.reduceyourworkerscomp.com/?p=474
Reposted with Permission: Visit LexisNexis Workers Compensation Law Practice Center for more information and full reports.
Submit articles to 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.
©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 number one goal of any injury management policy is to return injured employees to work just as soon as they are medically able; ideally in their original state of health to their regular duty job. There is a difference between “medically necessary” and “medically unnecessary.”
Coordinating organized systems to reach the goal saves the company money. However, focus should also be on preventing and carefully managing injuries.
First, adopt a corporate-wide injury management transitional duty policy describing your company will implement transitional duty in the workplace. Include in the policy:
1. Length of transitional duty assignments.
2. Circumstances under which employees will perform transitional duty. (For example, TD is tied to continued employment.)
3. Types of transitional duty offered.
4. Circumstances under which employees will be returned to regular work.
5. When employees are eligible for ADA-compliant positions, upon their return to work after their medical or workers’ compensation leave.
Second, develop a job or task bank by identifying jobs and/or tasks accommodating the injuries of employees out of work for the transitional duty program. These can be videotaped and kept online where accessible to doctors and adjusters.
Third, hold weekly meetings with injured employees to monitor progress and document return-to-work obstacles. Discuss obstacles to return to work, or in transitional duty, determine if there are other obstacles such as medical bills not being paid timely. Show possible transitional duty jobs to the employee, ask what they can/cannot do on that job. Ask for medical restrictions on the Work Ability Form from the treating doctor, so you know what restrictions apply.
Fourth, hold an initial meeting with managment or include them in your monthly workers’ compensation meetings. At the meeting, cover these points:
1. Present the cost-savings benefits of returning employees to work in transitional duty to build and maintain management commitment.
2. Invite a member of management to join the injury management team.
3. Work with senior management and middle managers to implement a dollar-for-dollar charge-back system to the units where losses occur. (workersxzcompxzkit)
4. Design work-arounds to facilitate a timely return to work.
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: 860-553-6604 or email: RShafer@ReduceYourWorkersComp.com http://www.ReduceYourWorkersComp.com.
Submit articles to: Info@WorkersCompKit.com.
Do not use this information without independent verification. All state laws vary. You should consult with your property casulaty insurance broker or agent about workers’ 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
From the November 6, 2009 Fraud Blotter
Criminal complaints and indictments are accusations only.
Defendants are presumed innocent until proven guilty.
The North Carolina Industrial Commission, its deputy commissioners and appellate courts have taken the unusual step of directing Mission Hospital to pay employees’ attorney fees as a penalty for the way in which it handled at least six disputes over injuries to its workers this decade. The hospital failed to turn over key evidence in workers’ compensation cases, gave employees blatantly incorrect information about the law and repeatedly denied benefits without basis, state officials found.
A local attorney representing employers in workers’ compensation cases, said it is possible that Mission “has been sanctioned more than any other employer in the state in the past five years.”
“This is not usual (for employers) and there’s no reason that it ought to be going on,” she said, adding the cases reflect “a long-term situation that needs cleaning up.”
Mission’s conduct came to light following a September 22, 2009 ruling by Deputy Commissioner George Glenn II in which Glenn referred Mission’s handling of a case to the state Department of Insurance and the state attorney general’s office. He ordered Mission to pay the attorney fees of a former employee “Mrs. Swanson”, as well as an additional penalty of 10% of the benefits due her because of Mission’s “bad faith denial and fraudulent actions.”
A spokeswoman for Attorney General Roy Cooper said attorneys at the Department of Justice and Department of Insurance have been discussing how to handle what she called “an unusual case.”
Mission said earlier this week that it had not been contacted by either agency. It is appealing Glenn’s decision in the “Swanson” case.
In a written response to questions from the Citizen-Times, Mission did not directly contradict allegations that it has deliberately sought to deny valid claims. It has said it welcomes any investigation by the state.
Repeated Problems
State workers’ compensation laws provide that employees are entitled to costs of their medical treatment and two-thirds of their lost wages while out of work because of job-related injuries. Workers cannot collect damages for pain and suffering or punitive damages, but the system is supposed to resolve their cases quickly in return.
Cases in which employees challenge their employers’ denial of workers’ compensation benefits generally go first to informal mediation under the direction of the Industrial Commission, a state agency. Either party can then seek a hearing before one of the commission’s deputy commissioners, whose status is comparable to that of an administrative law judge. Appeals from those rulings are heard by panels made up of three members of the Industrial Commission. From there, either party can appeal to the state Court of Appeals. Cases occasionally go on from there to the state Supreme Court.
A review of decisions in disputed cases suggests that Mission does not always play by the rules when handling cases in which it and the injured employee do not agree. For example:
1. In the “Swanson” case, Glenn found that a Mission employee knowingly made a false statement to “Swanson” as part of an effort to mislead her and deny her benefits. He also wrote that Mission’s decision to deny “Swanson” continued benefits came “in spite of the overwhelming evidence to the contrary.”
2. In a different case, a deputy commissioner found that a Mission official would not authorize payment for medicines prescribed by a physician to combat depression despite knowing the injured employee was entering the psychiatric ward.
3. In a 2002 ruling in another case, a deputy commissioner found that Mission ignored the “unequivocal” findings of its own expert when it denied continued benefits to a medical records clerk who was injured by mechanized shelving that closed on her in a records room. The clerk said she thought she would be killed by the shelves. Mission’s contention that the experience did not cause subsequent psychological problems was based on “no competent medical evidence,” the ruling says.
4. The commission found in 2005 that Mission had withheld videotaped evidence that showed an employee crying after unsuccessfully attempting to return to work.
How Unusual?
Mission, which has about 6,000 employees, said in its statement that employees filed 4,406 “occurrence” reports of incidents in which injuries could have occurred between April 2005 and October 15, 2009.
The statement says that among those incidents, it found 1,094 instances when an employee was injured on the job and that “only 26 claims or 2.3% were determined not to be compensable” under workers’ compensation rules.
Mission said it has become more common for a deputy commissioner or the Industrial Commissioner to award attorney fees to the losing party in general and that “the awarding of attorney fees does not necessarily suggest an employer has acted in bad faith.” A local attorney who has won attorney fees from Mission, said the fees are assessed “not when someone has fought a case but (when) they’ve fought them unfairly.” The attorney is also chairman of the Buncombe County Board of Commissioners.
State law says attorney fees can be assessed if there is a finding that a case “has been brought, prosecuted, or defended without reasonable ground.”
Mission pointed out that officials have sometimes disagreed over whether fees were warranted in its cases. It says that overall it has won eight cases before the commission since 1995 and lost eight.
The Industrial Commission does not keep statistics on how often attorney fees are awarded. Some attorneys who practice workers’ compensation law in the state said losing parties do have to pay attorney fees more often than in the past, but that it is still rare. (workersxzcompxzkit)
Attorneys representing plaintiffs in workers’ compensation cases agree assessing fees is very unusual and a rare occurrence, saying these sanctions very serious. There is also concern there may be many unknown cases because Mission told injured employs they could not file a workers’ comp claim.
The statistics also do not explain the hospital’s conduct in cases in which it was sanctioned as the hospital, failed to improve their claims handling process.
Mission Hospital Comments
In an October 2009 statement Mission Hospital said: Mission “has been subject to sanctions by three other Deputy Commissioners, based upon unfounded litigiousness. . . . (Its) prior behavior shows (a) pattern and practice of unreasonable defense of these claims and poor responses and conduct regarding injured employees.” – Kim Ledford, deputy commissioner, N.C. Industrial Commission, July 2004
Mission “has a long and well established history in workers’ compensation claims before the Industrial Commission and Court of Appeals wherein they have been found to have unreasonably denied workers compensation cases and sanctioned with attorney fees, and their actions in denying this claim (are) consistent with such practices.”
- George Glenn II, deputy commissioner, N.C. Industrial Commission, September 2009
“We continually evaluate our process and handling of workers’ compensation, and have periodic reviews by outside consultants.”
Reposted with Permission: Visit LexisNexis Workers’ Comp Law Practice Center for more information and full reports.
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©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
New Kit Helps Teachers Prep Secondary School Students on Work Safety
Teachers in South Australia now have a new kit to help them prepare secondary school students in making the transition to work safely. Statistics show young people are more likely to be injured at work and are often unfamiliar with workplace hazards and safety procedures, including their rights regarding working conditions.
The Teachers’ Toolbox was officially launched by the Presiding Member of the SafeWork SA Advisory Committee, Tom Phillips, who noted, “Inexperience, and sometimes anxiety about job security, often puts young workers at greater risk of harm in the workplace. Inexperience means they can’t identify a hazard, while insecurity leaves them afraid to speak up if they see a hazard. We hope the Teachers’ Toolbox will address that, by helping teachers fill that knowledge gap before young people start work experience or part-time jobs.”
The kit can be used either as a stand-alone resource or in conjunction with other planned lessons and features a range of materials to ensure young people are properly informed about their rights and responsibilities regarding their safety at work.
The kit was developed by SafeWork SA with the assistance of the Department of Education and Children’s Services’ Futures Connect Program. Several experienced teachers were also consulted and contributed some of their successful lesson plans and activities. The kit features teaching notes, case studies, student activities and videos. (workersxzcompxzkit)
“This is a good example of a resource developed for teachers by teachers with tried and tested materials,” Phillips added. “Sections of the Toolbox have already been tried in schools, with good response from the teachers and students. Appropriately, the Teachers Toolbox aligns with, and complements, other resources available to students and young workers such as the Passport to Safety learning and test program, for high school students about to enter work or work experience, and the Youth@Work website.”
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 860-553-6604.
Submit articles to: 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.
©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 Americans with Disabilities Act (ADA) requires covered employers to provide reasonable accommodations to disabled employees. Despite this requirement, many employers maintain leave policies that are inflexible as to either the length of leave or the ability to request a different work assignment or other accommodation upon return from leave. Over the last few months, the U.S. Equal Employment Opportunity Commission (EEOC) has made headlines for its increased scrutiny of inflexible leave policies. One case in particular illustrates the perils for employers that fail to heed the requirements of the ADA in fashioning leave policies.
Equal Employment Opportunity Commission v. Sears, Roebuck & Co.
On September 29, 2009, the Eastern District of Illinois approved a $6.2 million consent decree, the largest ADA lawsuit settlement in the history of the EEOC. The EEOC initiated the class action due to Sears’ policy of terminating employees out on workers’ compensation leave upon the expiration of the organization’s one-year maximum leave period. According to the EEOC, Sears not only refused to consider reasonable accommodations in the form of extended leave, but also refused to allow employees to return to work in a different capacity. The EEOC claimed to discover over a hundred former employees who wanted to return to work with an accommodation but who were terminated by Sears.
In addition to the record-setting monetary relief, the decree enjoins Sears from any future disability discrimination, as well as retaliation for opposing any unlawful disability discrimination. The consent decree extends for a three year period following the entry of the order, and the district court retains jurisdiction over the parties in the event that either party claims that the decree is violated. The decree provides for significant oversight over Sears’ compliance with both the order and the ADA more generally, including the following:
Notice. The decree provides that Sears must post a one-page notice of the decree on the employee bulletin board in every Sears location. The notice must be posted within 21 calendar days of the entry of the judgment and Sears is required to provide certification of compliance to the EEOC. The notice must remain posted for 3 years from the date of entry of the decree.
Recordkeeping. Sears must now maintain records of all attempts to accommodate employees on workers’ compensation leave within 45 days from the expiration of the maximum leave allowed under Sears’ leave of absence policy. Sears is required to make these records available to the EEOC within 10 days after demand.
Reporting. Sears is also required to submit semiannual reports to the EEOC, beginning 6 months after the entry of the consent decree and extending through 3 years after the decree is entered. The report must document: every individual on workers’ compensation leave within 45 days from the expiration of the maximum leave allowed; healthcare information relating to those employees’ most recent status; a list of all open positions at the Sears location from the time each employee’s leave began through the end of the leave period; and the last known contact information for each employee. Sears must be available upon the EEOC’s request to meet with the EEOC to discuss the report.
Training. All employees of the Centralized Leave Management Team-a team also created by the decree-must be trained by EEOC-approved individuals. The training must include the duty to accommodate under the ADA, the intersection of the ADA and workers’ compensation laws, and Sears’ specific procedures for providing accommodations to employees on leave of absence due to a workers’ compensation injury. The first training must take place within 90 days of the entry of the decree, and the duty to train continues through the following 3 years. Sears must notify the EEOC within 5 days after each training session to certify that the training occurred and that the required personnel attended. Sears must also provide the EEOC with the date, location, and duration of the training, and a copy of an attendance list.
Policies. The decree requires Sears to revise its policies within 28 days of the date of entry of the consent decree. The policies must provide for notification of employees within 45 days of the expiration of the leave period. The notice must inform the employee of the right to request a reasonable accommodation and specifically list reasonable accommodations, such as modified duty, part-time work, reassignment, additional leave, assistive devices, and relocation to other Sears locations. In addition, Sears must establish a centralized leave management team responsible for ensuring ADA compliance of the workers’ compensation leave policy. The termination of employees out on workers’ compensation leave must be approved by the team.
Notice to employees out on leave. Finally, Sears must revise the documents it provides to employees out on workers’ compensation leave within 28 calendar days of entry of the decree. Sears must send such employees a letter 45 days prior to expiration of their leave informing the employees of their ability to request a reasonable accommodation and specifically listing the reasonable accommodations discussed above. In addition, Sears must revise its health care provider certification to be sent at the same time to request the provider to list major life activities in which the employee is limited and identify any recommended accommodations, including reassignment. Finally, for employees who fail to respond, Sears must send a second letter 10 days before the expiration of leave . The letter must restate employees’ right to request reasonable accommodations and warn that failure to respond may result in termination.
Lessons for Employers
The sheer magnitude of the monetary, injunctive, and other relief provided in the Sears consent decree illustrates the risks faced by employers who maintain inflexible leave policies. But aside from terminating an injured worker whose leave has expired without considering possible reasonable accommodations, what options are available to employers? The parameters of the consent decree offers a few principles to ensure that employers’ leave policies and practices are in line with the ADA:
1. Covered employers should never have a black and white policy on the maximum length leave available to employees. Employers must at least be willing to consider a longer period if necessary to reasonably accommodate the employee’s disability, and employees on leave should be notified of this right.
2. Disabled employees must be considered for open positions that they are qualified for on the same basis as other employees. Any program that restricts certain light-duty jobs to a certain class of individuals, for instance, is likely to run afoul of the ADA. (workersxzcompxzkit)
3. Finally, covered employers should consider providing notice to employees on leave about their ability to apply for reasonable accommodations throughout the leave process. By offering examples of reasonable accommodations, employers increase the likelihood that courts will view the notice process as sufficient.
Given the current economic and political climate, the EEOC’s aggressive enforcement of the ADA is not likely to diminish any time soon. Employers who do not ensure the compliance of their leave policies may face similarly burdensome monetary awards and EEOC oversight of their leave policies and decisions.
Authors: Carl Lehmann and Bryan Seiler http://www.gpmlaw.com
Carl Lehmann is a member of Gray Plant Mooty’s Employment Law practice group and is co-chair of the firm’s Higher Education practice team. Carl’s practice includes advising employers in personnel-related matters, including terminations, discrimination and harassment issues, defamation claims, employment and independent contractor agreements, noncompete and confidentiality agreements, wage-hour compliance, voluntary and mandatory affirmative action policies, and insurance issues. Carl’s practice also includes assisting higher education institutions with various legal compliance issues including student disciplinary proceedings, accreditation, tenure and promotion, faculty manuals, Title IV and Title IX compliance, student privacy, and campus security matters. He can be contacted at Carl.Lehmann@GPMLaw.com http://www.gpmlaw.com
Bryan Seiler is an associate at Gray Plant Mooty and practices in the areas of employment and labor law and litigation. He served as a summer associate with the firm in 2008. While in law school, Bryan was actively involved in myriad organizations at the University of Minnesota including the Christian Legal Society, Minnesota Justice Foundation, and the Public Interest Law Students Association. He also gained experience as a summer law clerk for a plaintiff’s employment law firm in 2007 and for the Southern Minnesota Regional Legal Services’ Housing Equality Law Project in 2006. Prior to going to law school, Bryan worked in the District Office of then-U.S. Senator Barack Obama as a constituent services intern. Bryan is originally from Dallas, Texas and is an avid Dallas-area sports fan. He can be contacted at bryan.seiler@gpmlaw.com http://www.gpmlaw.com
Submit articles to: 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.
©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
A survey of what the media, state agencies, insurance companies, and others report in terms of workers’ comp fraud, listing recent arrests, charges, and convictions.
Criminal complaints and indictments are accusations only.
Defendants are presumed innocent until proven guilty.
Labor Commissioner Levies Nearly $1 Million in Citations During Statewide Enforcement of Car Wash Industry
According to the California Labor Commissioner’s Office investigators issued over $900,000 in fines to businesses in the car wash industry in a two-day statewide enforcement sweep. The penalties included a total of $600,900 issued to 76 unlicensed carwash businesses that were cited for not having a registration.
“Requiring carwash businesses to register with the state allows us to focus on those businesses that undercut their competition, which makes it difficult for legitimate carwash businesses to stay in operation,” said California Labor Commissioner Angela Bradstreet. “As part of the underground economy, these illegal businesses often do not pay state taxes, and take advantage of employees by not providing workers’ compensation coverage or paying proper wages.”
The two-day enforcement sweep, which began on October 28, 2009 involved 42 investigators who conducted 230 car wash inspections and issued 141 citations against 103 car wash businesses with citations issued totaling $916,711.
Investigators found 49 businesses that failed to provide workers’ compensation coverage for their employees. Citations issued totaled $240,000 and businesses without workers’ compensation coverage were issued stop work orders, which prevents them from operating with employee labor.
Also found during the investigations were 12 cases where the employer did not provide employees a wage deduction statement, one case of improper payment of minimum wage and one case of improper payment of overtime. Two businesses were found to have hired minors without having the required work permits on file.
The statewide enforcement action included the counties of Alameda, Butte, Contra Costa, Fresno, Humboldt, Imperial, Kern, Los Angeles, Monterey, Napa, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, Shasta, Solano, Sonoma, Stanislaus, Sutter, Tehama, and Yolo. (workersxzcompxzkit)
“Recently, AB 236 was signed by the governor, extending the law to 2014, to protect those workers in the carwash industry and to provide businesses the opportunity to come into compliance with labor laws,” added Bradstreet. “This registration allows us to better monitor situations where we have traditionally seen labor violations.”
Reposted with Permission: Visit LexisNexis for more information and full reports.
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NEW ARTICLE Return to Work in Unionized Companies
http://reduceyourworkerscomp.com/Return-to-Work-Programs-Unionized-Companies.php
Do not use this information without independent verification. All state laws vary. You should consult with your workman comp insurance broker about workers’ 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
Your National Workers’ Comp Management ScoreTM will tell how you stack up.
To get your company’s National Workers’ Compensation Score, the planning team answers and discusses, as a team, the questions in WorkersCompKit®. Take the IQ Quick Check to see how it works and what you get. RIMS 2009 Benchmark Survey has a best practice section, so you can find out how your company stacks up to other companies. The WC Section is new in 2009.
When you take the full score, you receive a personalized National Workers’ Comp ScoreTM and customized recommendations for improvement.
To ensure validity of the score it is important to discuss the questions as a team. Members will have their own experiences and views regarding personnel, policies and procedures.
Review your Recommendations
In a formal team meeting review the recommendations you receive and discuss the priority of recommendations, potential challenges, and ways to overcome obstacles. Your leader team will serve as facilitators and appoint a team member to record action items, responsible parties and completion dates on the timetable for each recommendation. Include a consultant from the broker in the meeting to offer insight into ways to overcome obstacles.
Analyze Benchmarks and Develop Program Goals
Once the data is entered in the benchmark form, the benchmarks will be automatically calculated. Print all benchmarks and bring copies to team meeting.
As a team, discuss and compare the benchmarks to your company’s current baselines. Based on these comparisons establish goals for performance and improvement by setting preliminary injury rates, return-to- work ratios, and lost workday goals.
Even if injury rates are consistent with industry benchmarks, your goal is to beat the industry average to become best-in-class.
Use a Weekly Timetable
Your lead team needs to maintain a timetable (i.e., a project plan) to organize all activities and hold each team member accountable for completing assigned tasks in a timely manner. This will help ensure consistent project progress and keep focus on milestones. This timetable should be distributed to all team members weekly.
Determine your Program Name
As a team, determine an appropriate name for your program, such as Claims & Transitional Duty Program, abbreviated “CAT Program” or Injury Management & Prevention Plan, abbreviate “IMP Plan,” etc. A name gives the program an identity and it can easily be referenced via multiple parties. Catchy names also catch people’s attention.
Select your Injury Coordinator
One member of your company will be responsible for managing daily claims and corresponding with the claims adjuster to develop strategies for each claim in the program. This person will be given a title of Injury Coordinator (IC) or Return-to-Work Coordinator (RTWC).
The IC or RTWC must be a “get-things-done” type of person who is already familiar with the workers’ compensation process.
Ideally, this person must have experience with your company’s policies and procedures so changes are consistent with your corporate culture, also very important to the implementation phase.
The claims management component of your new program provides an organized and pre-planned process the employee passes through from the time of the injury until the employee is back to work full duty. A claims management process is very, very different from the way claims are handled in many companies in where employee is on his own and at the mercy of confusion by medical, legal, personal and other influences.
Schedule a Diagnostic File Review
Medical review is an important diagnostic tool, it is also important for your medical advisor to review a sampling of your files as part of an overall assessment. Start by submitting five to ten individual claims.(workersxzcompxzkit)
Medical review is also one of those areas not addressed in claims handling in other companies. Once again, the injured employee is left out in left field trying to figure it all out and at the mercy of medical, legal, personal and other influences – read “hires an attorney.” We guarantee, litigation is not going to lower your workers’ comp costs.
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 860-553-6604.
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http://reduceyourworkerscomp.com/Return-to-Work-Programs-Unionized-Companies.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ 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 Workers’ Compensation Board of Nova Scotia (WCB) is making it easier for injured workers to fill prescriptions as they recover from workplace injury or illness.
Through a partnership with Medavie Blue Cross, the WCB now has PayDirect allowing approved, prescription medications, including over-the-counter drugs (workers must have a prescription) to be directly billed at the point of sale. The system was launched for all injured workers November 2, 2009. The service improvement is significant as it eliminates the need for workers to pay up front for medication and wait to receive reimbursement from the WCB.
Susan Radford, WCB’s director, Health and Extended Benefits said programs like this are an indication to those we serve and the public that we’re committed to ongoing improvements to our service. This service will make dealing with the impact of a workplace injury or illness just a little easier. (workersxzcompxzkit)
By using PayDirect, drug costs are covered directly at the point of sale in any Nova Scotia pharmacy. Information is available at pharmacies across the province and on the WCB Web site or at 1-800-870-3331
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 860-553-6604.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ 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
One thing you learn quickly in today's highly competitive business environment is never rest on your laurels. The same holds true for workers' compensation results. Imagine this scenario: Your claim management program has finally gotten traction, and frequency (claim counts) and severity (claim costs) are trending downward. Lost workdays have also decreased. Outcomes are improving, and you know executive management is going to be pleased with these results. You report the news to executive management, and they give you a big pat on the back for a job well done, and then they instruct you to set new, "stretch" claim frequency and severity reduction goals. Welcome to the new "top line/bottom line"-centric world! To meet the goals and set expectations you have to look beyond your internal team and take a broader view of your service providers. Your claim administrator is not the only service provider who can help improve your outcomes. What about your broker? Are you exploring, and then effectively using, the brokerage services available to you? If not, you may be missing out on services and resources that can help you drive better outcomes. Many brokers offer the following services and resources, and they can serve as an extension of your staff where you need help the most. 1. Claim Services a. Technical experts to assist on complex, high-dollar claims b. Claim audit and file review protocols, automated programs and assistance c. Recommendations on how to develop the most effective claim administrator account handling instructions that facilitate success, rather than impede it d. Assistance with claim administrator performance agreements and service contracts e. Guidance on claim administrator service delivery model options 2. Jurisdictional legislation, case law and reform experts a. In addition to providing you with information, interpret what it means to your organization, and if appropriate, how to optimize cost savings related to state reforms 3. Return-to-Work programs a. Ideas on how to develop an effective program, how to implement it and how to measure results b. Consulting-level expertise may be available 4. Loss control/safety a. Claims analysis: A deep dive into why accidents are happening, to whom, where, when, how, and ultimately, how to prevent them b. Safety program assessment, design, implementation, training, communication and monitoring c. Industrial hygiene and OSHA expertise 5. Workers' Compensation cost allocation models a. Ideas on how to charge claim costs back quickly, consistently and equitably, driving awareness and accountability within your business units, divisions and locations 6. Service Provider marketing, assessment and selection a. Assistance with Request for Proposals (RFPs), automated RFP response collection and assessment, selection of finalists, interviews and site visits, reference checks, negotiations and program implementation. Brokers work with a variety of claim administration, medical management and risk management information system (RMIS) providers, and they know which of them consistently finishes on top in terms of outcomes and quality. 7. Benchmarking and customized reports a. Comparison of your outcomes to your industry peers (by Standard Industrial Classification Code (SIC) or North American Industry Classification System (NAICS) b. Customized reports to help you proactively identify and address claim trends 8. Risk financing feasibility studies a. Should you consider qualified self-insurance, higher retentions, self-administration or a captive to reduce the cost of your workers' compensation program?� b. What option(s) will give you the greatest control over how your claims are handled? 9. Research, reference materials a. Brokers typically have extensive libraries of reference materials and often publish white papers based on research they have conducted. Information is power, so make sure to avail yourself of these resources. Knowing that you have a variety of resources upon which you can draw makes the challenge a little less daunting. And, by drawing on the experts, you will develop a state-of-the-art program that will drive progressively improving outcomes. It's a win-win! Another article about broker selection: http://reduceyourworkerscomp.com//choose-insurance-broker-wisely.php More FREE TOOLS: WC Calculator: www.reduceyourworkerscomp.com/calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php Follow Us On Twitter: www.twitter.com/WorkersCompKit View the Entire Blog: http://blog.reduceyourworkerscomp.com/
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' 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
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