The U.S. Equal Employment Opportunity Commission (EEOC) announced that Judge E. Richard Webber of the U.S. District Court for the Eastern District of Missouri has granted final approval for distribution of a $4,500,000 monetary award to 90 claimants identified during the litigation as part of an EEOC litigation settlement with Allstate Insurance Company under the Age Discrimination in Employment Act (ADEA).
In its lawsuit against the Illinois-based insurance giant, filed in October 2004, the EEOC alleged that a class of older workers at Allstate was adversely impacted based on age during a company-wide reorganization. Specifically, the EEOC charged that in the year 2000 Allstate adopted a hiring moratorium for a period of one year, or while severance benefits were being received, that applied to all its employee-sales agents who were part of its Preparing For The Future Reorganization Program. The program was part of Allstate’s reorganization from employee agents to what the company considered independent contractors.
The EEOC alleged Allstate’s policy, implemented from 2000 to 2002, had a disproportionate impact on employees over the age of 40 because more than 90% of the agents subjected to the hiring moratorium were 40 years of age or older. Allstate denied its hiring moratorium violated the ADEA. In 2005, the U.S. Supreme Court held in Smith v. City of Jackson that a facially neutral policy (such as Allstate’s hiring moratorium) which disproportionately affects those age 40 and over will violate the ADEA unless the policy is based on a reasonable factor other than age. This case was one of the first to apply the holding in City of Jackson, although no decision was made whether or not Allstate’s policy violated the ADEA.
”We at the EEOC are now bringing more and more lawsuits like this one to challenge company-wide policies or practices which discriminate against a large number of workers,” said EEOC Acting Chairman Stuart Ishimaru. “Make no mistake: As this settlement shows, we will insist on significant compensation and meaningful injunctive relief to resolve these cases.”
As provided in the Stipulated Order resolving the EEOC litigation (Civil Action No. 4:04CV01359 ERW), Allstate will pay former older employees who sought employment — or would have sought employment with the company in the absence of its policy — a total of $4.5 million to be divided among the class via a settlement fund. The order also provides for discrimination prevention training, posting of notices, reporting and monitoring, and other relief designed to educate Allstate managers in order to prevent future ADEA violations. (workersxzcompxzkit)
EEOC Regional Attorney Barbara Seely of the agency’s St. Louis District Office, handling the litigation, said, “Regardless of age, these sales agents would have made good employees in other positions for Allstate had it not been for the company’s no-rehire policy, which we believe had an adverse impact on older workers. City of Jackson makes clear that even though an employer may not intentionally discriminate because of an employee’s age, it can still violate the ADEA if it has a policy that has a disproportionate impact on employees age 40 and over.”
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.
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
Many workers in Auckland and Hawkes Bay will soon be able to remain at work, or return quicker after an injury following the introduction of ACC’s Better@Work program through a new partnership with west Auckland’s HealthWEST PHO (Primary Health Organization) and Hawkes Bay PHO. The result will be enhanced patient care from general practitioners (GPs), faster and more effective rehabilitation of injured workers and the retention of workplace skills and productive labor for employers.
Over the past year, Better@Work has been successfully tried at Lake Taupo PHO, with the result that ACC is now actively rolling out the trial program to a selected group of larger PHOs, including HealthWEST and Hawkes Bay PHO. Next year, the program will be further rolled out to more PHOs.
The benefits of Better@Work arise from the program’s collaborative working arrangements, bringing together all parties interested in enabling the client to rehabilitate at work. This happens through the “brokering” activities of the Better@Work co-coordinators employed by the PHO. They bring workers, GPs and employers together to plan a safe stay at, or return to, employment. They manage the process, and make it easy to identify clients’ abilities rather than their disabilities, and provide support to enable them to safely and productively rehabilitate at work.
Depending on need, their return to work plans could include initiatives such as identifying and enabling alternative duties at work, providing workplace supports and treatment, and finding ways for the worker to remain in touch with the workplace when they can’t rehabilitate at work.
This is an evidence-based program. A growing body of local and international research clearly shows workplace rehabilitation provides clinical, social and financial benefits for injured workers, and ACC is partnering with PHOs to ensure it can deliver these benefits to clients enrolled in PHOs.
Research shows:
1. Suicide in young men six and more months out of work is increased forty fold. (Wessely, 2004)
2. The suicide rate is six times higher in long term out of work. (Bartley et al, 2005)
3. The health risk and associated impact on decreased life expectancy is more than many “killer” diseases. (Waddell & Aylward, 2005)
4. Staying out of work creates a greater risk than some of the most dangerous jobs – such as construction and operating in North Sea industrial sites. (Aylward, 2007)
5. Injuries heal quicker in the workplace.
Over time, the Better@Work program will foster a cultural change in the way general practitioners think about returning injured workers to work and how employers think about keeping injured workers productively involved in their workplaces. This will reportedly result in fewer workers being certified as fully unfit for work because GPs will have the confidence that the Better@Work co-coordinator, the worker and the employer will work together to ensure workplace rehabilitation is safely managed. (workersxzcompxzkit)
ACC’s companion service, called Stay at Work, provides a similar service in communities throughout New Zealand. The key difference being that in Better@Work the PHO GPs who offer the program refer claims directly to their Better@Work co-coordinators, whereas in Stay at Work ACC refers clients to community-based rehabilitation providers.
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.
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
The Ontario Nurses’ Association (ONA) has highlighted “two seemingly small but fundamental flaws” that they say threatens the value of the entire workplace violence legislation created recently in Ontario as the bill passed a second reading in the province’s legislature.
According to The Canadian Press, ONA president Linda Haslam-Stroud recently presented to the legislature’s Standing Committee on Social Policy in relation to Bill 168, the Occupational Health and Safety Amendment Act (Violence and Harassment in the Workplace), 2009.
During her presentation, Haslam-Stroud said that the current definition of workplace violence – “the exercise of physical force by a person against a worker” - is problematic. “Not all workplace violence is directed at a worker, but workers are involved in violent incidents as part of their workplace duties,” the submission reports.
The ONA suggests amending the definition to “the exercise of physical force by a person against a person in a workplace that may cause physical injury.” This amendment, the submission says, “will make employers turn their attention to the root causes of workplace violence when developing prevention policies and programs to capture important risks such as patient weapons or adverse patient/resident interactions.”
The second issue relates to harassment that can escalate into violence, the ONA says, pointing to the fatal workplace stabbing of a nurse at the Hôtel-Dieu Grace Hospital in Windsor in November 2005 by a physician with whom she had a previous relationship. During the inquest into her death, an expert witness talked about her attacker’s threatening and harassing behaviors, such as stalking, that fell short of physical force, but which are “recognizable precursors of physical force,” the ONA indicates.
“If the proposed definition of workplace violence remains confined to the actual exercise or attempt to ‘exercise physical force,’ and ignores the threatening statements and behaviors at the high end of the harassment spectrum, such as stalking, then we will all continue to miss opportunities to prevent the horror that befell this nurse,” the submission says. Instead, the ONA has recommended that “actions at the high end” of the spectrum be included in the legislation.
The nurses’ association is seeking further amendments, including that:
Joint Health and Safety Committees (JHSCs) and the union be notified of threatening harassment, such as stalking; explicit reference be made that requires consultation of JHSCs in violence assessments, as well as in the development of policies, programs, training, education, information and instruction; and, risk assessments be made in writing. (workersxzcompxzkit)
After submissions from ONA and other parties last month, the bill was ordered for a third reading on December 1, 2009. If passed, it is expected to become law next year.
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.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
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
Medical Issues: Offsets and Deductions
As most plaintiff attorneys know, an injured employee can collect both workers’ compensation benefits and social security benefits. To prevent employees from collecting excessive combined workers’ compensation indemnity benefits and social security disability benefits, the statutes normally define a maximum benefit wage or earnings amount the employee can receive. In most states, the amount of social security disability is offset by the amount paid under workers’ compensation indemnity.
For example, the injured employee is drawing Permanent Partial Disability (PPD) at the rate of $300 per week, or for four and one-third weeks in a month, $1,300 per month. The employee applies for Social Security Disability (SSD) and is approved. Based on prior earnings, the employee is eligible to draw $1,500 per month from the Social Security Administration. With the workers’ compensation offset, the Social Security Administration will pay the employee $200.00 per month, ($1,500 SSD minus $1,300 PPD). When the employee’s PPD is exhausted, the SSD will revert back to $1,500 per month.
A few states have statutes calling for a reverse offset allowing the workers’ compensation carrier to take a credit for the amount paid in social security disability benefits. Be sure your adjuster is experienced enough to know if the state allows a reverse offset for workers’ compensation indemnity benefits paid to an employee who is also drawing social security disability. In the above example, if there is a reverse offset, the workers’ compensation carrier would pay nothing further on the PPD as the SSD is greater than the PPD.
Example for a reverse offset: The employee is drawing PPD of $1,300 per month and is approved for SSD of $1,000 per month. The employee is paid $300 per month ($1,300 PPD minus $1,000 SSD) by the workers’ compensation carrier. When the PPD is exhausted, the employee would then draw $1,000 SSD per month.
A substantial deduction sometimes overlooked is the pre-existing permanent partial disability rating the employee has from a prior injury, often at a different employer. For example, the employee injured his back fifteen years ago while working for another company. He settled his back claim with the prior work comp carrier based on a 10% permanency rating.
A year ago, he reported he had injured his back while working for your company. The treating physician and your IME doctor both now give the employee a 25% permanency rating which includes the pre-existing condition. Most states will allow you to deduct the prior permanency. This allows the adjuster to settle the claim for the value of a 15% rating (25% minus the prior 10% rating).
Don’t count on the employee or his attorney disclosing the prior injury and prior settlement. The adjuster’s best bet to uncover the prior settlement is with the ISO Central Index Bureau or through a proper evaluation by your IME doctor. Thorough investigation should be made to determine whether there are other exposures to be considered.
In those states allowing subrogation by the workers’ compensation carrier, and the employee has filed a lawsuit against a third party such as a product manufacturer or owners of the premises where they were injured, make sure the amount of the judgment or settlement is offset against your settlement.
Pre-existing Conditions/Second Injury Funds
In the twenty or so states with a Second Injury Fund, it is imperative the employer convey to the adjuster what is known of the pre-existing condition, whether the condition is from a prior work injury or some other medical issue.
The Risk Management Department in conjunction with the Human Resources Department should identify every new hire with a pre-existing condition that may impact the cost of a workers’ compensation claim. For example, in Ohio, an employer is entitled to reimbursement for payments to a handicapped employee if the employer notified the board prior to the injury it employed a person with an existing handicap. Ohio Statute 4123.343 Handicap Reimbursement. (workersxzcompxzkit)
At the time the report of the new claim is sent to the adjuster, the adjuster should be made aware of the employee pre-existing work injury or other medical condition possibly affecting the employee’s ability to recover from a new workers’ compensation injury. This allows the adjuster to calculate the appropriate settlement value of the claim and/or file with the Second Injury Fund the necessary paperwork to be reimbursed the additional cost of the claim created by the pre-existing condition.
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.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
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
A Reader Writes:
My company is just starting an injury management program and I’ve discovered several employees who have been out on workers’ compensation “forever.” In fact, I can’t recall the last time anyone got in touch with them. How can I start bringing my out of work employees back into the fold.
Bob Elliott Replies:
A file review is in order for you and your company. Have an independent consultant or your inhouse risk manager, request the files of your out-on-comp workers, open them up and find out what each employee is currently doing. File notes should be available to you online through the RMIS system. Your property/casualty insurance broker should be able to help you get access. For example: Are they ambulatory or bed ridden? If they are the least bit ambulatory, they may be good candidates for modified duty and you can begin to bring them back a few hours a week. You need to consider the following options.
Do you need a Quality Control Medical Review?
A quality control medical review means you obtain a physician consultant with a background in work-related injuries to review, comment and evaluate your open claims. At this time, the physician consultant helps you determine whether your insurers, claims handlers, clinics and medical providers are following the best practices for your industry. In other words, the physician consultant helps you decide whether the people you’ve engaged to handle your claims are dong the best possible job on the medical side of the file, and let’s face it — we are talking about MEDICAL injuries, not simply “claims.”
Here are some earmarks:
1. Is the disability proportionate to the time out of work?
2. What percentage of claims is within boundaries for having a proportionate length of disability to time out of work? In other words, are too many of your claims lasting too long?
3. Have medical treatment services such as physical therapy, chiropractic, diagnostic procedures and surgery been over utilized?
4. How cost effective are your medical cost containment procedures? — nurse management, preferred provider organization (PPO) medical and hospital review services, and others.
5. How complete are the cover letters you send to Independent Medical Examiners(IME)? Are you making the best possible use of every diagnostic service related to the employee’s injury? During the IME did the employee magnify symptoms? Did the adjuster recognize the language indicating symptom magnification?
6. How cooperative is the employee’s treating physician with respect to returning workability forms, and moving the employee toward return-to-work and transitional duty.
Do You Need a Quality Control Claim Review?
Quality Control Claim Review is more aggressive claims management. A claims expert(s) reviews, comments and evaluates your claims to identify aggressive claims management strategies such as investigation, determination of compensability, how benefits are managed, and case management issues.
The team documents claim resolution efforts, and develop strategies for bringing the claim to a close, focusing on negotiation and settlement.
In instances where an injury might be related to third party causal factors, subrogation and recovery might be an option for settling the case. (workersxzcompxzkit)
Your goal in performing a file review is to bring old, out-of-control claims to closure because these types of claims hemorrhage money and send your experience mod skyrocketing. You must develop an action strategy for closing claims (old and new) and begin contacting out-of-work employees and easing them back into modified or full duty employment.
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.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
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
Advisen reported this week, in their “Did you Know Column,” that it really is easy to design a worker’s compensation program by follow these five key steps.1. Find out where you are. Before you know where you need to go, you will need to know where you are now. Finding out the cause of the problems is an excellent way to start. Many employers misdiagnose the cause of the problem. Often, high costs are blamed on poor quality claims handling by the insurance company or TPA, when that is not the cause of the problem. Many times, the problem lies with lack of operational procedures at the company level. To get a flavor of how the assessment works, take the free, Workers’ Comp IQ at: http://www.workerscompkit.com/intro/
2. Compare your current best practices to the industry best practices. The top 10 workers’ comp key cost drivers are in the 2009 RIMS Benchmark Survey® and include how many companies have company-wide return to work programs, chargeback systems, visit their medical providers, have employee brochures, and others. Resource: http://www.reduceyourworkerscomp.com/advisen-commercial-insurance-information.php
3. Planning Tools: Use a management convincer. Show management how much in sales it takes to pay for workers comp and it will be a lot easier to convince them to give you the resources to buy a book, attend a conference or get other resources you may need. It puts everything into perspective. For example, if your total incurred costs were $1,500,000 this year, and your profit margin is 6%, it will cost you $25 MILLION to replace that loss on the bottom line.
Find out your numbers at: http://www.reduceyourworkerscomp.com/calculator.php
4. Document Development: At minimum, you need an employee brochure, post injury response documents, letters to medical clinics and claims handlers, and a communication strategy. (workersxzcompxzkit)
Resource: Document Gallery http://www.reduceyourworkerscomp.com/gallery/index.htm
5. Present to Management a prioritized list developed from the assessment and recommendations and a calendar plan of action items, together with a cost estimate so you can ask for and receive adequate resources to develop a successful workers’ compensation program. You get a list of recommendations with your National Workers’ Compensation Management Score®, but it helps to brainstorm a bit about the recommendations, and then prioritize them for management.
Resource: http://reduceyourworkerscomp.com//documents/Action_Plan.pdf
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.
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
Five people in Wales died as a result of work-related incidents in 2008/09, and more than 1,600 suffered major injuries at work. Over the same period, 1.5 million working days were lost in Wales due to workplace injury and work-related ill health.
Due to these facts, First Minister for Wales, Rhodri Morgan recently signed the Health and Safety Executive (HSE) pledge on behalf of the Welsh Assembly Government – an initiative aiming to bring organizations together to commit to reduce the number of work-related deaths, injuries and ill-health.
“The Welsh Assembly Government has responsibility for business, economy and the health service, all of which are adversely impacted by work-related ill health,” Morgan commented. “We call on employers to make the investment in good health and safety and better manage workplace risks. The fact that more than 1,600 people have suffered serious injuries in the workplace in the last year is shocking. Work related accidents can be avoided and it is important that people are made to feel safe while going about their job.”
HSE Director for Wales, Terry Rose, added, “This year we have seen a reduction in workplace fatalities and serious injuries in Wales, but this will be little comfort for those directly affected by what should have been preventable incidents. We are delighted that the Welsh Assembly Government has pledged its support to our initiative and hope that together we can take steps to reduce the numbers even further.” (workersxzcompxzkit)
In signing the pledge, the Welsh Assembly Government is agreeing to take a commonsense and practical approach to health and safety, looking at what it can do internally as well as it acting as a call to other organizations and businesses in Wales to make the same commitment.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/
Workers Comp Kit: www: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
Everyone understands the purpose of proper reserves on workers' compensation* insurance claims, is to have money available to pay the claim when needed, but as most claim file audits reflect, there is almost always room for improvement on claim file reserving. As a consultant to employers with high workers comp costs, this is a question I have heard numerous times…. is the insurance company over reserving?
It is often debated whether reserving is an art or a science. The workers' compensation adjuster has to be both an artist and a scientist, both flexible and accurate. To be accurate the adjuster needs to know what the exposure is for wages, permanent disability and medical. To be flexible, the adjuster needs to know when to change the reserves, either up or down.
When the work comp claim is assigned, the adjuster should set the initial reserves within 24 hours of the claim creation. This should included reserves for indemnity, medical and expense. The experienced adjuster should evaluate the nature and extent of injury to set the initial reserves and avoid the use of "formula" reserves where every medical-only claim is assigned the same dollar reserve and every lost-time claim is assigned the same dollar reserve.
The most accurate way for the work comp adjuster to set the initial reserves, as well as subsequent reserves, is through the use of a reserve worksheet, whether electronic or paper. The reserve worksheet should provide breakdowns of the claim cost into the three primary areas:
1. Indemnity Temporary Partial Disability (TPD)
Temporary Total Disability (TTD)
Permanent Partial Disability (PPD)
Permanent Total Disability (PTD)
Rehabilitation/Vocational Expense
Death Benefits
Dependent's Benefits
2. Medical Physicians Hospitals Diagnostic Testing
Specialist
Medication
Transportation Expense
Attendant Care
3. Expenses Medical Reports
Experts Peer Reviews and/or IME's Attorneys Court Cost
Surveillance
Other expenses
During the course of the investigation, the adjuster learns more about the nature and extent of the employee's injury. Once the initial investigation is completed, the adjuster should evaluate the reserves to see if they are appropriate for the injury, and if necessary adjust the reserve set at the time of case creation.
Unfortunately, some adjusters don't revisit the reserves when they complete their investigation. They only notice the reserves when the reserves become inadequate to pay the TTD or the medical bills received; then they raise the reserves a small amount to cover the current expense. This approach to reserving has become known as "stair stepping" because if you place the reserves on a graph, it looks like a set of steps. "Stair stepping" the reserves is not a good approach to reserving.
The best way for the work comp adjuster to set the reserves is for the adjuster to review the most current medical reports, both the treating physician's report and any IME report, and evaluate the value of the claim based on the nature and extent of the injury. With the medical information and the use of the reserve worksheet, the adjuster can calculate the probable ultimate value of the claim. The ultimate value of the claim is the amount for the proper reserve of the claim.
On the more complex lost time claims, there will be a need to adjust the reserves as the information available to the adjuster changes. When the adjuster receives the medical report placing the employee at maximum medical improvement, the adjuster then reevaluates the reserves to see if they are still correct for the file.
Most reserve changes are increases, but there are situations where the reserves should be decreased (not just when the claim is closed). For instance, when the adjuster did the initial reserve at case creation, the employee's fractured tibia was a compound fracture and the adjuster, based on prior experience, set the permanent partial disability (PPD) rating at 25%. The final medical report is received and the treating physician gave the employee a 10% rating. As the adjuster realizes an IME or a peer review could result in a higher rating for the employee, the adjuster accepts the treating physician's rating. Barring jurisdictional practice that would raise the physician's rating, the adjuster would need to lower the PPD reserve.
Note: The PPD reserve should be lowered the same day the adjuster reviews the treating physician's report, not a month or months later when the file is finalized and closed.
Another example of when to lower a reserve is when the TTD reserve was set initially for the employee to be off work for 12 weeks, but the employee convinces the treating physician and the employer to allow him to return to work full time on light duty. Again, the adjuster lowers the reserve on the TTD to reflect the actual status of the claim. (workersxzcompxzkit)
While the debate whether reserving is art or science will continue, the good work comp adjuster is flexible and accurate by adjusting the reserves up or down in a timely way to reflect the known information about the nature and extent of the employee's injury.
*Note: Workers' compensation is one type of property/casualty insurance.
Author Rebecca Shafer, J.D. 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: Becki@ReduceYourWorkersComp.com or 860-553-6604.
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
As you move into implementation of your company's new workers compensation program, keeping a weekly timetable helps each player to stay on task and separates responsibilities clearly for all to see. Sometimes the simplest tasks are the most effective… The timetable is a graphic organizer, clearly showing where each team member and department must be by a given date. The timetable, by nature of being a public document, functions as a form of peer review. Everyone knows what everyone else is supposed to do and whether they complete their tasks – or NOT! It is human nature not to want others to know when we fail. The timetable helps everyone do what is expected. It's been determined where there are procedural gaps and benchmarks were established as to where you plan to take the company's workers' comp program. Now, you will require a roadmap to mark your journey toward the company's goals. A timetable or time line is a graphic way to itemize each goal and mark estimated times of achievement. The team leader maintains the timetable (i.e., project plan) and organizes all activities and holds each team member accountable for completing assigned tasks on schedule; thus ensuring consistent project progress and keeping the team's focus on milestones. Distribute the timetable weekly to all team members. Breaking Down Responsibilities – 5 Responsible Players 1. Upper management — Appoints program manager, team leaders, and all subsequent members of team. Asks division presidents for list of candidates, then circulate to team for feedback. 2. Program management — Develops organization chart for the project team. Names program. 3. Risk manager — Determines weekly meeting conference call time. 4. Team leader — Hosts kick-off meeting. 5. Team members — Begins program analysis to determine current state of workers' compensation program at your company. (workersxzcompxzkit) Remember, organization is key in not only setting up your workers' compensation program but also in keeping it running. Timetables are the best way to keep on task. Here's one example: Timetable
Author: Rebecca Shafer, J.D. can be reached at RShafer@ReduceYourWorkersComp.com or 860-553-6604
"FRAUD PREVENTION" PODCAST click here: http://www.workerscompkit.com/gallagher/mp3 By: Private investigator with 25 years experience.
©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
If you’re self insured or carry a large deducible or retention, chances are a third party administrator (TPA) is handling your workers’ compensation claims and you’re paying for their services. Your TPA is fundamentally a service provider. Understanding what to expect and holding your TPA accountable are significant components of successfully managing your program.
Your TPA is a business partner who not only handles your claims and provides service but also should be engaged in protecting your bottom line. While it’s the job of your TPA to handle and manage claims, vigilance in the oversight of those claims internally will contribute toward the overall success of your program and in reducing claim costs. That’s best accomplished by an experienced claim professional working at your organization to hold your TPA accountable and ensure dollars are spent appropriately.
Your TPA handles claims according to their best practices and complies with your service instructions. Any deviations of either is an exception, not the rule. There’s a lot of very detailed work involved requiring the entire team to perform well together to successfully accomplish the goal (a well handled file with a cost effective, prompt closure) so work with your TPA to have the right players involved.
Pay only benefits owed and no more. Partner with your TPA to help them prevent payment errors. Let the adjuster know immediately the names of employee’s who have returned to work so benefits are suspended in a timely manner and talk about any suspicious claims at the on-set of worker injuries.
The TPA treats all of your employees fairly and respectfully including injured workers and anyone else contacted in the course of the investigation or handling of the claim. Adjusters with the proper level of expertise are assigned to match the complexity of the claim. Supervision in your files should be visible. Open and frequent communication is critical to the successful handling of your claims. Your TPA needs to keep you well informed and you need to keep your adjusters informed, also, to prevent surprises and end claim results must be accurately forecasted.
Scoring Adjusters and teams If a TPA provides numerical scores for their adjusters expertise, it’s an excellent indication the organization has confidence in their capability to provide excellent service. Adjuster scores should be part of the internal quality control program.
Your TPA detects and shares trends with you for collaboration in determining improvement focused solutions. Assistance in negotiating pricing with vendors is another area where your TPA also lends their expertise including possibly taking advantage of existing relationships the TPA has with vendors. (workersxzcompxzkit)
You should expect top-notch service and partnering from your TPA so all your service needs are met, your claims are well handled and expenses are controlled by negotiating vendor fees. Remember, it’s your money the TPA is spending.
“FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
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