Do I Have to Have Workers’ Comp Insurance?
Well, like death and taxes, workers’ comp insurance is usually “required.” This is refered to as "carrying" workers compensation coverage. Even if you employ only one person most states require employers to provide workers’ comp insurance. The regulations do vary from state to state. Right now, Texas is the only state allowing voluntary participation and may be considering a change, even as we write. And, even in Texas, it’s strongly recommended employers cover their employees with WC insurance.
State Laws Differ
WC benefits, in general, are awarded on a “no fault” basis, meaning no one is blamed unless the injured worker was under the influence of drugs or alcohol when the injury occurred.
Employee work status categories vary from state to state; some require part-timer employees to be covered and some don’t.
Coverage varies from state to state. In some states, injured employees get lost wages in addition to coverage for medical expenses.
If you are the sole owner and proprietor of your business, you can choose whether or not you want workers comp coverage for yourself.
Senior executives are eligible if they fit the definition of an employee. You must consult the Workers’ Compensation Commission in your state to determine how the rules apply to the states where you do business.
Nearly “everything” about workers’ comp insurance must follow state law in every state an employer does business. We encourage you to review “ State Laws and Regulations” before your begin. (http://www.reduceyourworkerscomp.com/workers-compensation-state-laws-and-regulations.php)
What About My Insurance Premium?
Premiums are determined by the workers; compensation board of each state. The base rates may vary but the process for determining premiums is the same. Every state assigns each job category a code tied to the risk level of the job. Job risk is determined by the frequency of on-the-job injuries and their severity. Severity is measured by medical and indemnity payments. Indemnity payments are paid directly to the injured employee for losses suffered. Jobs with very high risk (coal mining) carry higher work comp premiums. Conversely, jobs with low risk (secretary) carry lower premiums.
Other factors considered when determining your workers’ comp insurance premium includes the total number of people covered; how these individuals breakdown: owners, full-time/part-time workers, subcontractors, consultants, job functions, type of coverage (full, one time, seasonal event), years in business, gross payroll.
How Do I Buy Workers’ Comp Insurance?
Workers’ comp insurance is purchased through an agency or company licensed to write policies. If you are unable to obtain workers’ compensation insurance privately, your state is required to provide coverage. Your state’s workers’ comp commission can help you determine how to apply for coverage.
Self insurance is an option for companies with a hefty net worth. Each state, with a different net work requirement, must approve your application. Until recently, self-insurance an option for big companies. However, smaller companies with similar attributes, are banding together to acquire group self insurance. Group self insurance also needs state approval, but is a great option for smaller companies wanting and needing big company benefits.
Don’t be surprised, but worker’ comp insurance is a cost of doing business employers must pay out of their own pockets. Premium costs may not be passed to the employee, like health insurance. Neither may you deduct the cost from employee wages. Payments are made through the claims administrator not directly from the employer to the treating physician.
Must I Tell My Employees About My Work Comp Policy?
Oh yes! An employer is required to post a notice to employees.” Failure to do so results in a fine. Signs contain information on your workers’ comp program. You get your signs from your insurer and you must post them conspicuously in hallways or cafeterias and any other places where everyone can see them during the work day.
In states allowing the employer to choose the treating physician, the signs tell employees where to go for medical treatment.
In states where employees choose treating physicians, you post signage outlining the procedure for handling the workability form. Post workability cycle procedures in the same place the workers’ compensation signs are posted.
Combine all information together with your post injury response requirements signs, so when a work-related injury occurs, all employees will not only know they have coverage, but also know their post-injury rights and responsibilities. Employee signs include notice of posting, workability form process procedures, and post injury response procedures.
What Do I Do When an Injury Occurs?
The onset of the claim, is the time when your workers’ comp management practices kick in – at once. Get claim forms from your insurer or (if self-insured) your third party administrator including:
workability form cycle, witness report form, supervisor and employee statements, first day phone call and
flowers/cards, and development of modified duty job description. (workersxzcompxzkit)
Keep in mind when an employee is out for more than four days, weekly open ended conversations, and additional workability forms accompanying the injured employee each time the person visits to the doctor, must be documented and filed. The goal s to get the employee back to work as soon as medically possible, even in a restricted or modified duty capacity.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
A survey of claims managers, examiners, and nurse case managers revealed three key concerns and needs the workers’ compensation claims industry must address in order to perform more effectively in 2010. For more Information: www.reduceyourworkerscomp.com
A survey of claims managers, examiners, and nurse case managers revealed three key concerns and needs the workers’ compensation claims industry must address in order to perform more effectively in 2010.
The series of market research initiatives was conducted by One Call Medical (OCM) a provider of diagnostic testing (MRI, CT scans, electromyography and nerve conduction studies) did the testing primarily to identify key challenges in the workers’ compensation claims industry.
1. Controlling Medical Costs and Outcomes
Across the board, participants experienced a decrease in claims frequency, but a significant rise in the medical cost component of their claims. Increasing at twice the rate of general inflation, medical expenses are the biggest cost-containment challenge.
2. Accountability to a High Level of Performance
At all levels, workers’ comp professionals are under tremendous pressure to demonstrate a high level of performance. Clients are requiring audits and ongoing reports that quantify and meet key performance measures, as they relate to claims handling, utilization of provider networks, and achieving early return-to-work outcomes. As a result, organizations need services and tools to help them offload and manage specialized functions, so they can better focus on the tasks directly impacting client service, costs, and outcomes.
3. Education to Keep Pace with an Ever-Changing Industry
Workers’ compensation is a complex industry. Claims and nurse professionals must become familiar with a number of sophisticated topics, including medical procedures and regulatory changes. Due to the depth of knowledge required, the demand for education is huge, but training budgets have been reduced. Many organizations must supplement in-house training with other cost-effective opportunities to expand expertise, while meeting continuing education requirements.
“By conducting market research, we’re able to hear firsthand about the challenges many workers’ compensation professionals face,” said Bill Colacurcio, director of marketing at One Call Medical. “With these findings, we strive to continually provide our clients and injured workers with the greatest value from our diagnostic specialty network—in terms of quality, accuracy, timeliness, and cost savings. (workersxzcompxzkit)
“Conducting ongoing market research among industry leaders is central to our strategy to identify, address, and raise awareness about the critical claims and medical challenges in workers’ compensation,” Colacurcio concluded.
The series of market research initiatives was conducted by One Call Medical (OCM) a provider of diagnostic testing (MRI, CT scans, electromyography and nerve conduction studies) primarily to identify key challenges in the workers’ compensatio
1. Controlling Medical
Across the board, participants experienced a decrease in claims frequency, but a significant rise in the medical cost component of their claims. Increasing at twice the rate of general inflation, medical expenses are the biggest cost-containment chal
2. Accountability to a High Level of Performance
At all levels, workers’ comp professionals are under tremendous pressure to demonstrate a high level of performance. Clients are requiring audits and ongoing reports that quantify and meet key performance measures, as they relate to claims handling, utilization of provider networks, and achieving early return-to-work outcomes. As a result, organizations need services and tools to help them offload and manage specialized functions, so they can better focus on the tasks directly impacting client service, costs, and outcomes.
3. Education to Keep Pace with an Ever-Changing Industry
Workers’ compensation is a complex industry. Claims and nurse professionals must become familiar with a number of sophisticated topics, including medical procedures and regulatory changes. Due to the depth of knowledge required, the demand for education is huge, but training budgets have been reduced. Many organizations must supplement in-house training with other cost-effective opportunities to expand expertise, while meeting continuing education requirements.
“By conducting market research, we’re able to hear firsthand about the challenges many workers’ compensation professionals face,” said Bill Colacurcio, director of marketing at One Call Medical. “With these findings, we strive to continually provide our clients and injured workers with the greatest value from our diagnostic specialty network—in terms of quality, accuracy, timeliness, and cost savings. (workersxzcomp
“Conducting ongoing market research among industry leaders is central to our strategy to identify, address, and raise awareness about the critical claims and medical challenges in workers’ compensation,” Colacurcio co
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
Safe Work Australia members met recently following a full-day strategic planning workshop led by Dr. Keith Suter. The workshop members discussed and identified key themes, priorities and challenges for Safe Work Australia for the next three years.
The members agreed, in the spirit of national coordination, on broad themes to underpin the Safe Work Australia strategic 2010-2013 plan. These themes are the basis of the strategic plan being sent to the Workplace Relations Ministers’ Council (WRMC) for endorsement.
Model Work Health and Safety Act
Although WRMC endorsed the Model Work Health and Safety Act in December 2009, Safe Work Australia was permitted to make technical and drafting amendments. The members noted the progress in finalizing the act and said they made a number of amendments to improve and clarify the operation of the provisions.
1. Removing overlap, unnecessary prescription and unintended consequences;
2. Achieving consistency with WRMC determinations, and
3. Ensuring the provisions are effective and in practice operate as intended.
Prior to the April 2010 meeting, members will receive the amended draft of the model Act for final approval during the meeting.
Model Work Health and Safety Regulations
Members noted progress in the development of the model work health and safety (WHS) regulations and the draft structure.
The Strategic Issues Group on Occupational Health and Safety (SIG-OHS) is progressively considering various parts of the draft WHS regulations as received from the Parliamentary Counsel’s Committee. By June 2010, the SIG-OHS expect to receive, for consideration, a first draft of all matters subject to regulation.
Members discussed particular issues with the building and construction industry and agreed to ask the SIG-OHS to consider the creation of a Temporary Advisory Group or another mechanism to address these matters.
Safe Work Australia members will receive an exposure draft of the WHS regulations for approval in September 2010. If approved, the draft goes to WRMC for endorsement and release for public comment for a period of four months.
National Code of Practice for the Prevention of Falls in Housing Construction
Members agreed, by a majority, to begin the process to publish the National Code of Practice for the Prevention of Falls in Housing Construction.(workersxzcompxzkit)
Strategic Issues and Advisory Group Report
Members noted the progress of the SIG-OHS, SIG-Workers’ Compensation, Communications Advisory Group and Research, Evaluation and Data Advisory Group.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
Employers must provide adjusters with a set of “rules” or guidelines clearly showing how they want their litigated workers’ comp claims handled. Following a guideline fosters good communication between the adjuster(s) and employer and ensures all bases are covered.
1. Responding to the Complaint
Upon receipt of a litigation notice or an industrial commission hearing notice, the employer immediately faxes or e-mails a copy of the complete litigation notice to the adjuster to handle as an answer to the complaint or to file the request for a hearing with the appropriate court or industrial commission.
The work comp adjuster contacts the employee's attorney and requests an extension of time to answer the complaint be granted in writing. The extension of time allows the adjuster and the employee's attorney to explore settlement possibilities without incurring defense cost.
If the adjuster is unable to facilitate a settlement of the claim, the adjuster explores with the employee's attorney the use of arbitration or mediation to resolve the claim.
If the employee's attorney refuses to agree to an extension of time to answer, or to agree to arbitration or mediation, or if the claim cannot be resolved, the adjuster then refers the claim to defense counsel for the filing of a timely answer to the complaint.
2. Claim Handling
The work comp adjuster reviews the file reserves to be sure they are adequate for the anticipated settlement value of the claim. If an expense reserve for the cost of litigation is needed, the additional reserve are added.
If the employee's attorney is willing to settle the claim, but is demanding an amount greater than the adjuster's evaluation of the claim, the adjuster should consider the overall cost of settling the claim now versus the cost of defending the litigation and obtaining a possible more reasonable settlement later.
The adjuster reviews the complaint to make sure all aspects of the claim are covered by the workers' compensation coverage. If there are any allegations made by the employee's attorney not covered by the workers' compensation insurance, the adjuster makes the employer aware of the possible exposure outside of the workers' compensation coverage. For example: an employer's liability claim, or an ADA complaint.
An Action Plan for the future handling of the litigation is completed and each aspect of the Action Plan is placed on the adjuster's diary for follow-up.
3. Defense Counsel Selection
The adjuster refers the litigation complaint to the defense counsel previously selected by the employer or the employer's insurer. (The time to select defense counsel is before one is needed).
An attorney assignment letter is sent to the defense counsel with the pertinent information from the claim file with a copy of the litigation complaint. The assignment letter requests a litigation budget in the format previously provided by the employer or the insurer to the defense counsel. All reporting requirements for the defense counsel are outlined in the assignment letter.
4. Acceptance by Defense Counsel
The adjuster should receive from defense counsel a letter acknowledging receipt of the claim, confirming counsel filed an answer with the appropriate court or industrial commission. The acknowledgment letter also must outline the defense attorney's evaluation of the claim, the proposed course of action and the recommended litigation budget.
5. Litigation Budget
The work comp adjuster reviews the detailed litigation budget prepared by defense counsel. The litigation budget includes not only court time but also the need for discovery, any research or other extra legal expense. If the adjuster has any questions or qualms about the proposed legal expense in defending the litigation, the adjuster addresses the issues with defense counsel prior to the litigation defense proceeding. The litigation budget may also be used to establish or change the expense reserving on the file.
6. Further Claim Handling
The adjuster remains responsible for the work comp claim. The adjuster never abandons the claim to defense counsel because it is being litigated. The adjuster performs any additional investigation the defense attorney recommends. The adjuster also hires any outside vendors or experts the defense attorney believes necessary in the handling of the litigation. The adjuster keeps the employer informed of the status of the litigation and the anticipated outcome.
While the employer relies on the expertise of the workers’ comp adjuster and the defense attorney, the employer must be willing to offer advice, opinions or guidance, if needed.
7. Status Reports from Defense Counsel
All significant developments on the claim are reported by defense counsel to the adjuster. If progress on the litigation is slow, the defense attorney is required to report at least every 90 days on the actions taken to resolve the claim. The defense attorney's status reports cover only developments since the last prior report and do not repeat content of prior reports. Each report from the defense counsel includes an action plan on how the attorney plans to move the claim forward.
8. Directions to Defense Counsel
Each time the defense attorney reports to the adjuster, either by written report or telephone, the adjuster reviews the progress being made on the claim. Extensive discovery, depositions or other time consuming activities are avoided if there is a potential to resolve the workers’ comp claim. The adjuster advises the defense attorney as to the course of action the adjuster wants the defense attorney to follow. The adjuster maintains rapport with the defense counsel while directing the activities on the litigation. Litigation can be best controlled by preparing a set of templates which can be customized for each claim or case. Documents such as who your company is, how you expect the claim to be handled, possibly even a set of suggested interrogatories.
9. Trials or Final Industrial Commission Hearings
When a trial date or final hearing date is received by the adjuster, the adjuster incorporates the date into the file diary and the file action plan. The defense attorney is directed to provide a pre-trial or pre-hearing report at least 30 days prior to the set date. The adjuster discusses strategy for further handling of the work comp claim with the defense attorney.
If further settlement authority is needed, the adjuster discusses the additional settlement authority with the employer and/or the insurer upon receipt of the trial date or final hearing date, not at the start of the trial or final hearing.
During any trial or hearing lasting longer than a day, the defense attorney provides the adjuster with a daily verbal report on the significant events that have occurred.
10. Legal Bills
Prior to the payment of any legal bills through the course of the litigation, the adjuster reviews the legal bills to verify they are in accordance with the litigation strategy and the litigation budget agreed upon with defense counsel.
If the legal cost is substantial or if the adjuster has concerns about the accuracy or appropriateness of the legal bills, the legal bills are referred to a legal bill audit company for review. (workersxzcompxzkit)
The claim file notes include the receipt of all legal bills and confirmation by the adjuster that the legal bills were reviewed and approved by the adjuster. If there is any question regarding the legal bills, the adjuster outlines in the file notes the steps being taken to resolve the billing question before paying the legal bill.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
OHIO. The owner of a business compiling medical reports for law firms representing injured workers received a four-year prison sentence for workers’ compensation fraud, following prosecution for unusual reporting practices.
The man pleaded guilty to one count of workers’ comp fraud, a fourth-degree felony; two counts of tampering with records, a third-degree felony; and 10 counts of forgery, a fifth-degree felony. He was ordered to pay $139,558 in restitution and $56,340 in investigative costs to the BWC.
The Bureau of Workers' Compensation (BWC) became suspicious of the man’s medical reports and, suspecting fraud, notified the Special Investigation Department (SID).
SID exercised a search warrant of the man's business and found evidence he altered medical reports used by the BWC and the Ohio Industrial Commission (IC) to determine the percent of permanent partial (%PP) awards (also known as C-92 awards).
BWC’s %PP compensation is available to injured workers with permanent injuries to a body part caused by a work-related accident or an occupational disease. (workersxzcompxzkit)
Investigators found the man inflated percentages submitted by medical providers and/or embellished medical conditions within the final report in an attempt to raise percentage PP awards and ultimately increase his business.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
AUSTRALIA: Asbestos Exposure and Compliance Study of Construction and Maintenance Workers
SafeWork Australia recently released a new report designed to determine the current levels of awareness, worker compliance with legislation, the attitudes of workers and exposure levels to asbestos in construction and maintenance workers, according to Chair Tom Phillips.
Phillips said the study adds significantly to the knowledge of the awareness of and compliance with occupational health and safety legislation by tradespersons in relation to asbestos.
Study Findings
1. Most tradespersons were aware of the potential health risks of asbestos.
2. A high level of general awareness is not accompanied by knowledge of how to recognize asbestos or control the risks when working with it. Although tradespersons believe they can identify asbestos materials, in practice their ability to reliably identify the materials was limited. Generally, this seemed to insufficient identification skills, asbestos registers were often absent or inaccurate and few premises labeled materials and/or areas containing asbestos.
3. Almost all trades people surveyed thought they could protect themselves from the risk of asbestos. However, the overall level of compliance with safety procedures was much lower than was estimated by these workers.
4. There was inappropriate disposal of asbestos and contaminated materials.
5. Atmospheric monitoring of a limited number of selected work tasks showed that all exposures were below the workplace exposure standard.
“It is concerning that although trades people have a high level of awareness and confidence in being able to protect themselves, this is not matched with the use of necessary safety precautions when working with asbestos," Phillips commented. (workersxzcompxzkit)
“The results of this study will be used to inform effective strategies to eliminate, or reduce, worker exposure to asbestos. Local, state and federal governments must work together to improve worker education and information on asbestos, particularly the development of practical advice on how workers can protect themselves from exposure to asbestos, and on safe asbestos removal and disposal. This will help to reduce both individual suffering and the substantial cost to families and the community,” Phillips added.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
Capstone Mining acted quickly to ensure the safety of its workers when alerted to a mold problem at a mine in south-central Yukon according to The Canadian Press.
The mold issue was raised during a staff meeting when an employee asked for assurances that the mold did not pose a health risk, Randall Thompson, general manager for the mine, said. Following a meeting of the mine safety committee, two staff wings were vacated.
Forty-six employees and contract workers at the mine were bussed out due to the loss of 78 beds in the 194-bed camp. The workers affected were part of a construction crew, cut to 40 from the original 69 employees, according to Stephen Quin, president of Capstone Mining. He said the mine is working with the construction company to find temporary camp accommodations so the crew returns to work as soon as possible.
Quin said disruption at the open-pit operation due to mold found in the bathrooms of two bunkhouses is expected to be minimal to one. The new water treatment plant is essentially finished and workers are scheduled to leave, he added.
An environmental expert, hired by Capstone Mining, is expected to arrive shortly to assess the mold and determine a course of action. (workersxzcompxzkit)
The Yukon Workers' Compensation Health and Safety Board was notified of the situation immediately, according to Kurt Dieckmann, the board's director of occupational health and safety. Dieckmann said exposure to mold does not usually cause any significant or long-lasting issues for a typical, healthy person. He said chances are if an employee hasn't already felt sick, he probably won't become ill.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
A new Employers’ Liability Insurance Bureau is under consideration by Great Britain's Department for Work and Pensions. The bureau will trace employer liability policies and, if they cannot be traced, provide an insurance fund of last resort. The Employers' Liability Insurance Bill has had its second reading in the House of Commons.
Insurers are concerned the proposed bureau may have a negative effect, saying some employers may feel less obliged to make adequate health and safety provisions for their employees. A spokesperson for one insurance broker said, "We are concerned about the effect a dedicated Employers' Liability Insurance Bureau will have on the attitudes of some employers who may then decide not to take the health and safety of their employees seriously. However, setting up a tracing system could help thousands of employees receive the compensation they deserve."
The Association of British Insurers (ABI) also opposes the bureau fearing it could cause a "serious moral hazard." They also objection the grounds of fairness since the fund is to be financed by the insurance industry, meaning reputable firms would pay for the failings of others.
However, the ABI said it recognizes the usefulness of a system for tracing insurers, pointing out ABI introduced such a code 10 years ago. (workersxzcompxzkit)
The Trades Union Congress (TUC) welcomes the principle of a system to assist those whose original insurers cannot be found, such as asbestos victims.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
Whether you are a self-insured, a TPA or an insurer, you need to be able to measure objectively the quality of your workers' compensation claim handling system. For an internal workers' compensation claim quality control program to succeed, it has to measure effectively the performance of each adjuster on an on-going basis. To achieve this goal you must repeat the quality control file reviews on each adjuster within a stated time frame. The following framework is useful in creating an internal claim quality control system or using it to improve your existing claim quality control system.
Risk Management Information System
If the claims handling company, whether a self-insured, an insurer or a TPA, has a sophisticated Risk Management Information System (RMIS), the collection of the necessary data to measure the performance of each adjuster is easier, but not simple. If the RMIS is not state of the art, then it becomes necessary to have internal quality control auditors to review individual claim files to measure/record the performance of the adjusters. The claim quality of each individual workers’ comp adjuster is measured, whether by a RMIS system, a manual file review or a combination of the RMIS and manual review.
Performance Goals/Benchmarks
Each obtainable measurement has a benchmark to be compared to. Obtaining performance measurements without knowing if the results are good, average or bad, does not benefit your company. Knowing the performance goals set by your company allows you to determine if the performance of the adjusting staff is meeting the criteria set for your claims handling program. Each work comp adjuster, supervisor, branch manager, regional manager and home office VP of claims needs to have their claim quality criteria plainly stated in their performance objectives/performance evaluation.
Measurements on Every Level
All of the measurements for adjusters working for one workers’ comp supervisor are combined to reflect the overall performance of the supervisor's unit. All measurements for the supervisors working for one branch manager are combined to reflect the performance of the branch. All measurements for the branches within a geographical region are combined to measure the performance of the regional manager. The regions are combined to reflect the performance of the company.
Time Frames
Easy time frames to measure against are months and years. By providing monthly data, the internal claim quality control system allows management to see trends in performance, improvements or declines, on a month-to-month basis. The same is true with a roll-up of monthly data into an annual total, allowing management to see improvements in performance or declines in performance from year to year. Monthly or quarterly scores can be given to each adjuster and also to the unit manager. The best adjusters can be receive cash bonuses to reward excellence.
Measurement Reports
Measurement reports reflects current month results, year-to-date results and year-to-date results versus a predetermined performance goal. The performance data of each individual workers’ comp adjuster is shown, with the adjuster's performance data combined into the performance of the supervisory unit, branch office, region and company-wide.
Facets to Measure
Two of the important items to measure in a claim quality control system are timeliness and completeness.
The claim activities measurable against the time standards stated in your company's best practices include
· Initial contacts
· On-going contacts
· Initial reporting
· Status reporting
· Initial supervisor's futurity
· Ongoing futurity
· Average Claim Cost (comparison to the industry)
· Closings
The claim activities measurable against the completeness of the file handling include
· Files on diary
· Claim file notes usage
· Initial reserves
· Initial index filings
· Supplemental index filing
· Payments made on closed files
· Closed file payments as a percentage of all payments
· Percentage of data errors
· Medical bill processing timeliness
Other areas of importance to the TPA, insurer or insured can be included in the measurements if there is the ability to calculate and measure the performance on the adjuster level. (workersxzcompxzkit)
Summary
A significant amount of time and effort is necessary to build an internal claim quality control system for your workers’ comp claims. However, once your claim quality control system is up and running, your company will quickly begin to reap the benefits of superior performance by the claims adjusting staff. Not only will the adjusters provide better service to the employees on their work comp claims, but also the higher quality of claim handling is reflected in a reduced cost of claims, faster return to work and improving your company's bottom line.
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.
Podcast/Webcast: Claim Handling Strategies
Click Here:
http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
An employee was injured when safety mat malfunctioned. Here's what happened:
An employer ("the employer") determined it should install special safety mats around a shear cutting machine to eliminate hazards presented when a worker stood too close to the machine. The safety mats functioned by shutting the cutting machine down when a certain amount of pressure was applied to the mats, i.e., when anyone stepped on them.
The employer hired a machinery company ("the company") to modify the machine and install the mats. In spite of the installation, an employee's left arm was severed when the employee attempted to clear a jammed piece of metal from the machine.
The employee filed a civil action against multiple parties, including the company, alleging various causes of action, including negligence for failing to properly and adequately repair, maintain and inspect the safety mat system.
In turn, the company filed a third-party complaint against the employer, seeking indemnification and/or contribution. The employer filed a motion for summary judgment, contending in relevant part that the company's third-party action was barred by the exclusive remedy provisions of the Delaware Workers' Compensation Act.
Here's What the Court Decided
In Thompson v. Murata Wiedemann, Inc., 2010 Del. Super. LEXIS 50 (Feb. 19, 2010), the Superior Court of Delaware, New Castle initially indicated that under Del. Code Ann. tit. 10, § 6302, the right of contribution existed between joint tortfeasors. The court held, however, that the employer could not be a joint tortfeasor with the company, that the exclusivity provision of Del. Code Ann. tit. 19, § 2304 precluded the assertion of any contribution against it by the company.
The exclusivity provision did not, however, bar the company's contractual claim for indemnification against the employer if it could show a breach of contract, express or implied. In Diamond St. Tel. Co. v. University of Del., 269 A.2d 52 (Del. 1970), the Delaware Supreme Court held that contractors may be liable on a theory of implied indemnity if they breach "an obligation to perform [their] work with due care" [269 A.2d at 57].
Specifically, the Diamond State court identified three factual scenarios where an employer could be liable to a third party for implied indemnity: (1) where the employer creates a dangerous condition on the third party's premises and injury results; (2) where the employer knowingly permits the employee to work under dangerous conditions caused by the third party and injury results; and (3) where the employer activates a latent dangerous condition created by the third party and injury results. (workersxzcompxzkit)
Viewing the record in the light most favorable to the company, the Superior Court indicated that the record was not fully developed, that the court could not rule out the possibility that the company might establish liability under an implied contract. Summary judgment was, therefore, appropriate only with regard to the contribution claim.
See generally Larson's Workers' Compensation Law, §§ 121.02, 121.05.
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
Podcast/Webcast: Claim Handling Strategies
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http://www.workerscompkit.com/gallagher/podcast/ Claim_Handling_Strategies/index.php
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ ReduceYourWorkersComp.com.
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