The U.S. Equal Employment Opportunity Commission (EEOC) announced the settlement of a disability discrimination lawsuit against Pinnacle Airlines Inc. for $20,000 and significant injunctive relief on behalf of a clerk with arthritis who was allegedly fired for walking too slowly on the job. Pinnacle is a Memphis, Tenn.-based airlines carrier operating out of the Detroit Metropolitan Wayne County Airport.
The EEOC’s suit in the U.S. District Court for the Eastern District of Michigan (Case No. 2:09-CV-13300) charged Pinnacle Airlines firing fired the recently hired Flight Operations Clerk because it believed arthritis in her left knee caused her to walk too slowly, despite her competent performance. Such alleged conduct violates the Americans With Disabilities Act of 1990 (ADA), prohibiting employment discrimination against people with disabilities.
An EEOC two-year consent decree resolving the case was signed by U.S. District Judge Marianne Battani. In addition to paying the former Flight Operations Clerk $20,000, the decree prohibits the airline from engaging in any employment practice discriminating against anyone on the basis of disability and from retaliating against employees who oppose discriminatory practices. The company also agreed to:
1. Revise its policies and practices to comply with the ADA.
2. Provide training to its Human Resource Department and all of its managers on disability discrimination.
3. Post an EEOC approved Notice that informs employees how to contact the EEOC if they believe they have been discriminated against.
4. Report any complaints of disability discrimination to the EEOC during the term of the consent decree. (workersxzcompxzkit)
“Pinnacle Airlines should be applauded for working cooperatively with the EEOC in resolving this suit quickly and agreeing to measures that will help ensure similar situations do not reoccur,” said EEOC Trial Attorney Trek Carethers. “We are pleased with the terms of the consent decree and this company’s commitment to prevent disability discrimination going forward.”
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, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. She can be contacted at: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Podcast/Webcast: Occupational Health Strategies
Click Here:
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.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 court ruling notes human resources managers can be held individually liable for violating the Family and Medical Leave Act (FMLA). (Citation: Narodetsky v. Cardone Industries et al., Case #09-4734; February 24, 2010, U.S. District Court, Eastern District of Pennsylvania.
A federal district court judge recently found in favor of an employee who sued three human resource executives who’d allegedly conspired to find a reason to fire him after he requested time off as allowed by the Family and Medical Leave Act. The ruling means HR execs could be on the hook – personally – for damages allowed through the FMLA. Damages can include back pay, monetary loss from a denial of benefits, lost wages and attorneys’ fees.
The case revolved around a tool designer for a large auto parts supply company who suffered a non-job related leg injury and was informed he’d need surgery. His wife made several phone calls to the firm’s HR department, noting the need for FMLA leave and inquiring about short-term disability coverage.
Not long after those conversations, three senior HR execs and another manager embarked on a “forensic” search of the employee’s computer – seeking evidence that would justify his termination, thereby eliminating the need to offer him FMLA leave.
Shortly after that campaign, the employee was called in before the HR reps and another senior manager. He was informed he was fired for having forwarded a pornographic e-mail to a co-worker approximately a year earlier. The employee filed suit, stating the real reason he’d been fired was because he’d asked for FMLA leave and short-term disability benefits.
In the suit, the fired employee named not only the company, but the HR execs and the manager.
The case looked at only the question of whether the company reps could be held individually liable for the allegedly improper firing. The company stated in its defense that the managers weren’t liable, since they didn’t “exercise control” over the employee’s FMLA activities.
The judge disagreed, however saying, “Each of the defendants exercised control over” the employee in the decision to terminate him – in reaction to his FMLA request. (workersxzcompxzkit)
Moving forward, the merits of the case – and any possible damages – will now be adjudicated with a new trial.
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, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
Podcast/Webcast: Occupational Health Strategies
Click Here:
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.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.
Note: The following article is for people new to the workers’ compensation field or as a refresher for those in the field.
Indemnity benefits paid to employees for work related disabilities are generally divided into two types—temporary benefits and permanent benefits. Each of the two types, temporary and permanent, are then divided into two additional categories, total and partial. This gives us four categories—temporary total disability (TTD), temporary partial disability (TPD), permanent total disability (PTD) and permanent partial disability (PPD). A fifth category of indemnity benefits is death benefits which some jurisdictions combine with PTD.
Temporary Total Disability (TTD)
The most common indemnity benefit is TTD. In most jurisdictions the amount paid for TTD is based on the formula of two-thirds multiplied by the average weekly wage (AWW) of the employee. A few jurisdictions will use seventy-five percent or eighty percent of the employee's net pay after income taxes to compute the AWW.
A waiting period for indemnity benefits exist in all jurisdictions. Most jurisdictions have a seven-day waiting period before indemnity benefits will start, but a few states have a three-day waiting period. If the employee is able to return to work without any limitations within the waiting period, no indemnity benefits are paid. If the disability continues beyond the waiting period for a set number of days or weeks, almost all jurisdictions will require the insurer to pay indemnity benefits retroactively to the first lost day (or partial lost day) the injured employee was not paid his normal wage.
A lost day due to a work comp injury can be either a full day lost from work or it can be a partial day missed from work. Most employers find it much easier for payroll purposes to pay the employee for the remainder of the day of the accident. For example—the employee works 8 hours per day and normally gets off work at 4:00 p.m., but gets injured at 2:00 p.m. the employer will go ahead and pay the employee through 4:00 p.m. Therefore, the first lost day from work is the day after the accident. However, if the employer elects to pay the employee only through 2:00 p.m., the work comp adjuster calculates the indemnity benefits due from 2:00 p.m. The employee will have a partial lost day on the day of the accident and a full lost day the following day.
Examples of the waiting period and lost days are: The injured employee is off work two days due to the work comp injury and returns to work without limitations on the third day—no TTD is paid. The injured employee is off work nine days and returns to work without limitations, with a seven day waiting period, two days of TTD would be paid. The employee is off work 20 days with TTD retroactive to the first day after two weeks off work, the employee is paid 20 days of TTD.
The AWW is determined by the employee's prior pay history. The jurisdictions vary in the time frame used to calculate the AWW. Most jurisdictions use the previous 52 weeks as a time frame, but some states use the prior 13 weeks or the prior 26 weeks as the time frame. An example using the AWW to calculate the TTD: The employee made $52,000 in the 52 weeks prior to the injury causing the disability. The AWW would be $1,000 with the TTD rate being $666.67 (two-thirds X $1,000).
An employee's AWW in most jurisdictions includes all compensation, not just the wage or salary. The adjuster should include overtime pay, bonuses, commissions or any other form compensation in determining the AWW. Also, some jurisdictions will include the value of benefits if the employer suspends paying for those benefits during the time the employee is off work.
The amount of TTD has an upper limit cap and a minimum amount. The jurisdictions vary in the dollar amount for the upper limit and the lower limit. A jurisdiction might by statute state the maximum amount of TTD is $800.00 per week and the minimum amount of TTD is $100. 00 per week. An executive making $2,000.00 per week would not receive two thirds of his AWW of $2,000.00, or $1,333.34. The executive's TTD would be capped at $800.00 per week. A part-time fast food worker making $120.00 would not be limited two-thirds of his AWW, or $80.00. His TTD rate would be the state minimum rate of $100.00.
Temporary Partial Disability (TPD)
During the course of the medical treatment of the injury, the treating physician may determine the employee can return to work but only for a limited amount of time per day. This is when the TPD benefit would come into play on a work comp claim. For example, the injured employee is allowed to return to work for four hours per day and before the injury was working 8 hours per day. The TPD amount would then be calculated by multiplying the AWW by the amount allowed within the jurisdiction by the fraction of the day the employee is unable to work (4 hours divided by 8 hours = one-half). Let's say the AWW was $900.00 per week prior to the injury. The state statute allows the employee to collect two-thirds of his AWW. The TPD rate would then be $900 X 2/3 X 1/2 = $300. This injured employee on TPD would be collecting half his normal wage or $450 plus his TPD of $300 for a total of $750 per week.
Temporary partial disability is paid until the employee reaches maximum medical improvement (MMI) or is able to return to work full time, whichever occurs first. Some jurisdictions place limits on the number of weeks (or years) an employee can draw TPD.
Permanent Partial Disability (PPD)
When the treating physician determines the employee has reached MMI, the physician will determine the amount of permanent disability, if any, the employee may have suffered due to the injury. The amount of PPD indemnity benefit maybe either a set scheduled amount or it may be percentage of a body part or it can be a percentage of the whole body.
A schedule of injury values is used for the complete lost of a body part in about 40 jurisdictions. Examples of scheduled injuries would be the complete loss of eyesight in one eye or the amputation of one hand. In some jurisdictions the PPD benefit is paid to the employee as a set dollar amount for the complete loss of the body part. For example—the complete loss of the eye is worth $85,000. In other jurisdictions the body part is worth a set number of weeks, for instances, an arm is worth 200 weeks of the TTD rate of $600 per week or $120,000 (200 X $600).
Some jurisdictions will use the schedule for the partial loss of a body part or a partial lost to the body as a whole. The treating physician determines the amount of disability. In many jurisdictions the physician rates the loss of body function using the American Medical Association Guide to the Evaluation of Permanent Impairment. For example—the physician following the AMA Guidelines determines the employee lost 20% of the use of his arm. The employee would receive 20% of the scheduled amount for the value of the total arm. Using the $600 TTD rate, the employee would be paid PPD of $24,000 (200 weeks X 20% = 40 weeks; 40 weeks X $600 = $24,000).
Permanent Total Disability (PTD)
When the treating physician (often in consultation with specialists) determines the employee will never be able to return to work, the employee becomes eligible for PTD benefits. In cases where the employee is rated as 100% disabled to the whole body, PTD is almost automatic.
Determining PTD is less clear cut when it comes to an employee who has suffered severe injuries and is unable to return to work for your company, but who is not classified as 100% disabled. A number of issues will then come into play in determining PTD. The nature and degrees of physical impairment, the educational level of the employee, the age of the employee, and the ability of the employee to be retrained for other suitable work, plus the availability of the other suitable work, are all factors in the determination of PTD.
The amount of PTD varies among the jurisdictions. In some jurisdictions the PTD rate is the same as the TTD rate. In other jurisdictions the PTD rate is lower than the TTD rate and is a percentage of the TTD rate.
PTD benefits are paid until the employee is able to assume work in another field, or until the jurisdiction's maximum number of benefit weeks is met (in most jurisdictions), or until death (in a few jurisdictions), or until the employee reaches his full social security age (in a few jurisdictions).
Death Benefits
Fortunately, the least common type of indemnity benefit is the death benefit. All jurisdictions provide for the cost of burial, up to a maximum amount. The burial amount varies tremendously among jurisdictions from $2,500 on the low end to $10,000 on the high end of the range. (workersxzcompxzkit)
A death benefit will be paid to the spouse or to the spouse and dependent children. If there are no dependents, a death benefit in some jurisdictions will be paid to siblings or parents. The maximum amount per week and the minimum amount per week are set by statute in each of the jurisdictions. Most jurisdictions will pay the death benefits to the spouse until she remarries or for a set period of time, with 400 weeks of benefits or 500 weeks of benefits, being the most common time frames.
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. She can be contacted at: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Podcast/Webcast: Occupational Health Strategies
Click Here:
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.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.
The economic downturn and rising jobless rate appear to have put a brake on employee absences, according to a recent survey.
Rates of employee absences through 2009 are at the lowest recorded since 1985, the year legal and business publisher Bureau of National Affairs (BNA) began its quarterly survey of employers.
Dropping below the 2008 low of 0.9 percent of scheduled worker days per month, the median absence rate in 2009 averaged 0.7 percent. Absence rates have declined consistently since 2005, when they averaged 1.5 percent of scheduled worker days.
Year-over- year absence rates declined in nonbusiness and manufacturing organizations, but were stable in nonmanufacturing concerns. Absences tended to be lower in smaller than in larger organizations.
Regionally, median monthly absence rates from 2008 to 2009 fell two-tenths of a point in the Northeast (from 0.9 percent to 0.7 percent) and three-tenths of a point in the North Central states (from 1.1 percent to 0.8 percent). There was no change in the South (0.7 percent), while in the West, median monthly absence rates increased only marginally, from 1.1 percent to 1.2 percent.
Similarly, employee turnover (voluntary median monthly separation rates excluding layoffs, reductions-in-force, and departures of temporary staff), in tandem with slowing economic growth and rising rates of unemployment, has plunged from 1.0 percent of employers’ workforces per month in 2008 to 0. percent in 2009. (workersxzcompxzkit)
The weakening economy and job market appears to discourage employees from seeking other job opportunities, as turnover rates shrank for employers in every category of industry and workforce size, and in every region of the country.
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.
Podcast/Webcast: Occupational Health Strategies
Click Here:
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.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.
When you go on-line to review the adjuster's file notes on your company's lost time work comp claims, do you know what you should see in the adjuster's Action Plan? If you have not been a work comp claims adjuster, it would be easy for you to miss items overlooked or missed by the adjuster. The adjuster's file notes should state what was accomplished and what needs to be accomplished to move the file forward.
Each of the items that need to be accomplished should be given a due date and placed on the adjuster's diary (calendar) for completion. You should see at minimum the date due and the date completed for each of the items in the adjuster's Action Plan.
If your adjuster is following the Best Practices set by most insurers and third party administrators, the initial claim handling was completed the day the claim was received in the claims office. You should see file notes reflecting coverage was verified for the claim, that the employer contact, employee contact and physician contact was completed and the initial reserves were placed on the file.
All of these items should have been completed before the adjuster does the initial Action Plan. If for any reason coverage has not been verified, contacts not completed or the reserving cannot be done, the adjuster's Action Plan should reflect the item(s) that are outstanding from the initial handling and provide the due date for the follow up on those items to be completed.
Assuming the first day's claim handling was completed, the initial Action Plan for the work comp claim should contain:
1. A follow up date for further contact with the employee (ability to return to work).
2. A follow up date for further contact with the employer (availability of a modified duty position if the employee is unable to return to full duty).
3. A follow up date to verify the receipt of the initial medical report.
4. A follow up date to verify the receipt of the documentation of the average weekly wage (should be within 14 days or less depending on the jurisdiction—in order for the adjuster to issue the first TTD payment or issue a denial of claim).
5. A follow up date to complete any further investigation of the claim (should be within 14 days of the date the claim was received).
6. If subrogation is appropriate based on the investigation, a date to put the responsible party on notice of the subrogation claim.
7. A date to verify the claim is accepted for compensability or the date the claim will be denied.
8. A date for the TTD benefit payments to be calculated and the first TTD check issued, if applicable.
9. A date for the completion of the ISO filing (within 14 days of the receipt of the claim).
10. A follow up date to verify all state required forms have been filed with the state work comp board.
11. If the file is reportable to an insurer, excess carrier or any other party, the date the reporting will be completed.
12. A date for the next Action Plan to be completed (usually 30 days after the first Action Plan but the time frame can be shorter or longer depending on the severity of the claim).
By the time the second Action Plan is due, most or all of the items outlined in the first Action Plan were completed. Any items not completed are carried over to the second Action Plan with a new due date for each carried over item. Activities you can expect to see on the second Action Plan include:
1. A date for reevaluation of the file reserves (usually 60 days from the date the claim was received in the claims office).
2. A date for evaluation of the need for a Nurse Case Manager on the claim, if the employee has not returned to work, and assignment of the Nurse Case Manager, if needed.
3. A date for coordination of the return to work full duty or modified duty, if needed.
4. A date for the obtainment and evaluation of the disability rating.
5. If the file is reportable to an insurer, excess carrier or any other party, the date the second report will be completed.
6. A date for the next Action Plan to be completed (usually 30 days after the second Action Plan but the time frame can be shorter or longer depending on the severity of the claim).
The third and subsequent adjuster's Action Plans will vary more in the items that will be included in the Action Plan. Some things to look for in the subsequent Action Plans including their due dates, are:
1. Medical records being obtained and evaluated for all on-going treatment.
2. Regular scheduled follow-ups with the employee, the employer and the medical providers.
3. Regular scheduled contact with the Nurse Case Manager when there is one.
4. The completion and filing of all state forms.
5. The scheduling and obtaining of independent medical evaluation or a peer review.
6. Offsets and deductions being calculated and applied.
7. Second Injury Fund (in the jurisdictions that still have one) being placed on notice
8. A settlement evaluation that is explained and properly justified, including both the strengths and weaknesses of the claim.
9. A Litigation Plan and a Litigation Budget, if the claim is in suit or in a contested board review.
10. All required waivers and/or releases obtaines.
11. CMS notification if a MSA is considered or needed.
12. A re-evaluation of the reserving accuracy.
13. Subsequent filing of the claim with the ISO/Index Bureau.
14. If the file is reportable to an insurer, excess carrier or any other party, the date the next report will be completed.
15. A date for the next Action Plan to be completed (usually 60 or 90 days after the third Action Plan but the time frame can be shorter or longer depending on the severity of the claim). (workersxzcompxzkit)
As long as the work comp claim remains open, the adjuster continues to have an Action Plan outlining the steps to take to bring the claim to a conclusion. The final entry on the adjuster's last Action Plan for the claim is actually the activity the adjuster looks forward to doing. The final Action Plan activity should read: “Close file.’’
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.
Saying their health was impacted while on the job, more than a dozen workers sickened two years ago at a southern Minnesota meat-processing plant by inhaling bits of pig brains are seeking compensation.
According to Minnesota Public Radio News, the workers are among 21 employees at Quality Pork Processing in Austin who were diagnosed with the neurological disease.
All of the workers filed claims for medical expenses and lost wages. While all received medical benefits, plant officials report 13 still have claims pending for the rest. (workersxzcompxzkit)
Quality Pork CEO Kelly Wadding said, the entire matter has dragged on because the workers' comp process is slow but, he added, the company is committed to getting the workers the benefits they deserve.
Author Rebecca Shafer, J.D. 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. She can be contacted at: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.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.
The toll on the body occurring when playing in the National Football League is being tested off the gridiron these days.
A claim was filed in California by the wife of a retired NFL player, alleging the dementia he developed in his late 50s, necessitating his being placed in an assisted living facility at age 64, is a direct result of his time spent as an NFL lineman from 1966 to 1973. The man played for the Pittsburgh Steelers and later the San Diego Chargers and during that time he "sustained more concussions than he could count," The New York Times reports.
Medical science has tied concussions with heightened rates of depression, mental decline and Alzheimer's disease. In fact, The Times reports researchers at "Boston University and West Virginia University have found chronic traumatic encephalopathy — a disease caused only by head trauma that typically results in progressive cognitive decline — in the brain tissue of many deceased players."
The player’s wife filed a claim in California, where the state's workers’ compensation system tilts in favor of retired athletes. According to state records, some 700 former NFL players are pursuing cases in California, with most of them in line to receive routine lump-sum settlements of about $100,000 to $200,000.
While most of these cases focus on knee and shoulder injuries sustained as a result of an NFL career, as well as other orthopedic conditions, this player’s case is likely to be precedent setting, in that it alleges the reason for dementia lies with work-related injuries, and thereby with the NFL itself.
His wife's main reason for pursuing the claim is to make guaranteed care for retired players who require it and do not qualify for the 88 Plan. 88 Plan is a “program run jointly by the NFL and the players’ union that reimburses medical costs of families of former players with dementia up to $88,000 a year." (workersxzcompxzkit)
At the present time, families receive cost reimbursements, but the bigger issue is that some players may not be able to get long-term care insurance because they are at risk for considerable cognitive or neurological damage, and therefore the families have to deal with the expenses.
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. She can be contacted at: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.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.
Controlling the cost of medical care for workers' compensation is an on-going issue. Most states have now adopted a medical fee schedule to set limits on the amounts that can be paid to medical providers for the services they furnish. The medical fee schedules will also cover the cost of medical equipment and medical supplies. The medical fee schedules vary in complexity and services covered but also have many similarities.
1- All jurisdictions using a medical fee schedule will attempt to apply it to all work comp injuries. Issues arise as to which medical fee schedule will apply when employees, like truck drivers and traveling sales people, are based in one state and have an injury in a different state. Normally, the fee schedule of the state where the employee receives medical treatment applies. However, some jurisdictions require their medical fee schedule to be used if the employee is claiming indemnity benefits in their jurisdiction.
2- The date of medical service determines the medical fee schedule used. This allows the medical providers to be paid the current value of their medical services. (If the medical providers had to keep track of the medical fee schedules to be used for each employee's date of injury it would be a nightmare of billing problems for both the medical providers and the work comp insurance companies, especially on older claims.)
3- Normally the medical fee schedules starts with the existing medical coding of the American Medical Association. The Current Procedural Terminology (CPT) code is universally used — hence it provides a format that can be adopted for use in workers' compensation. In conjunction with the CPT code, the medical provider will use a diagnosis code, the International Classification of Diseases (ICD-9) from the World Health Organization. (Most jurisdictions used ICD-9, but some jurisdictions have adopted the expanded/updated ICD-10 version).
4- In addition to the CPT codes and the ICD-9 codes, the medical fee schedules will include National Drug Code (NDC) for medications, Relative Value Units (RVUs) and in some jurisdictions HPCPS codes from the Health Care Financing Administration Common Procedure Coding System. [If you want an in-depth review of the coding systems, the Centers for Medicare and Medicaid Services (CMS) has a lot of information available at http://www.cms.hhs.gov/ ].
5- The medical fee schedules will combine the various coding with the terminology “usual and customary” which means what the medical providers of a general type would normally charge for the service. The medical fee schedules of some jurisdictions will cover 100% of usual and customary, while other jurisdictions may limit the amount paid for medical services to 75% or 80% of usual and customary.
6- Some jurisdictions will have a set amount in their work comp medical fee schedules that can be paid for every combination of CPT and ICD-9 codes. Other jurisdictions will have a maximum amount that can be paid, but will allow payment of a lower amount. This allows the work comp insurance companies to negotiate with and contract with the medical providers for payment amounts below the maximum.
Even with all the CPT codes and the ICD-9 codes, there will still be occasions when the medical care provided does not fit the coding system. The medical fee schedules will address this by either referring to usual and customary or they will utilize the amounts that would be paid by CMS for such services.
7-Some of the medical fee schedules will have exceptions for unusual or severe injuries like severe burns, brain injuries, major amputations, etc. These exceptions normally require the injured employee to be treated in an intensive care situation. But even these exceptions may have a cap of 125% or 150% of the normal medical fee schedule amount.
8-Due to the complexity and variety of medical services available, the medical fee schedules have been expanded to cover cost of almost every type of medical service including injections, anesthesia services, dentistry, skilled nursing facilitates, home healthcare, radiology services, pathology services, physical therapy, chiropractic services, prosthetic devices, speech therapy, hearing aids, etc.
9- Penalties and/or fines can be accessed to medical providers who intentionally bill more than what is called for in the medical fee schedule. However, often there will be more than one CPT code or ICD-9 code that could apply to a service, which normally results in the higher paying code combination being billed by the medical provider.
This has been the basis for the development of medical bill review companies in ever jurisdiction, who will review and adjust the medical bills for a percentage of the savings over what the insurance company would have otherwise paid. The medical fee schedules will also not allow the medical providers to bill the injured employee for any reduction in their charges by the medical bill review company. Most jurisdictions will have a state office that will attempt to resolve disputes between the medical providers and the medical bill review companies (or insurance company) as to the correct amount to be paid per the medical fee schedule.
10- As medical bill review companies have impacted what the medical providers can charge for medical services, the medical providers have looked at other ways of being compensated. Physicians and other medical providers will charge for medical reports, for completion of state required workers’ compensation form, for copying of medical records, for depositions, for missed appointments and for independent medical evaluations. Of course this has resulted in the medical fee schedules being expanded to cover the cost of these other charges. (workersxzcompxzkit)
Medical fee schedules are a necessary evil. They provide some measure of cost control in workers' compensation but also complicate the medical bill process. Employers should have an understanding of what the medical fee schedules are and how they operate.
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, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. She can be contacted at: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.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.
People with chronic low back pain that keeps them sidelined from work can recover an average of four months earlier if they take part in a specific type of rehabilitation program, a new study suggests.
According to The Times of India, researchers based in The Netherlands and Canada evaluated the effectiveness of an integrated care program in 134 patients with chronic low back pain. All patients were aged between 18 and 65 years and had been absent from work due to low back pain for almost half a year on average.
Patients were randomly assigned to either usual care or integrated care. Integrated care consisted of adjustments to the workplace and a graded exercise program to teach patients how to move safely while increasing activity levels. The main aim of the program was to restore occupational functioning and to achieve lasting return to work for patients in their own job or similar work.
The usual care group received normal pain treatment with usually little or no workplace involvement.
Patients completed questionnaires at the start of the study and after three, six, nine and 12 months. Sickness absence data was collected every month.
Over the 12-month study period, patients who received integrated care returned to sustainable work after an average of 88 days compared with 208 days for patients receiving usual care, an average reduction of 120 days.
After one year patients in the integrated care group also reportedly improved significantly more on functional status compared to patients in the usual care group. No statistically significant differences in pain improvement were found between the two groups. (workersxzcompxzkit)
The integrated care program was reported to reduce substantially disability due to chronic low back pain in both working and private life, according to the authors.
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.
Discovering Issues Invalidating Workers' Comp Claims Such as Substance Abuse and Failure to Comply with Safety Requirements Is Balancing Act
Taking a proactive stance in monitoring all workers' comp claims helps you not only reduce your insurance expenses, but also helps alert you to employee issues and behavior possibly costing you money and putting other employees at risk.
In most work environments your area
managers, supervisors, and team leaders know their employees well and how they perform at work and, sometimes, they even know a bit about their personal lives outside of work. This information can prove to be invaluable in situations where injury claims could be non-compensable due to mitigating circumstances such as substance abuse, an undisclosed preexisting condition at the time of employment, injury from failure to use protective equipment, or not following proper safety procedures.
Some people may say using knowledge of an employee’s personal life habits or confidential reports of inappropriate activities while at work invade the employee’s privacy. While using this information to engage in gossip would be less than ethical, information exposing work habits or activities that not only endangers the employee, but also places other employees in danger or harm is information that can save lives. On the other hand, information ignored could open the company to legal problems for negligence if they ignored relevant information.
If company safety is a top priority then when an employee is injured because of
failure to follow safety procedures or was drunk on the job, it is bad for the company and everyone around the worker. There are resources to help employees struggling with addictions, whether it is substance abuse treatment, or disciplinary action for safety violations followed up with training. To let these situations continue is inviting trouble. Many
If, as an employer, it is discovered an employee falsified a claim, immediately document the incident and inform your insurance adjuster. Few people realize how fraud substantially hurts a company; especially true in the event of a fraudulent claim being reopened, but based on an undisclosed previous condition — the result of a routine task or spontaneous occurrence.
Another valuable tool is diligent and detailed record keeping of every employees conduct and accident/injury claims. You may be able to spot a fraudulent claim by examining employee records and medical histories that disclose repeated or similar behavior. (workersxzcompxzkit)
Preventable comp claims, and those from violation of safety standards, take a serious toll on company finances. Serious accidents or injuries involving multiple workers, the result of employee negligence or violation of safety standards, or while under the influence of drugs or alcohol, can substantially hurt a company or even put it out of business. In some companies, workers comp is the second highest expense after payroll, so increasing those costs or failing to control them can have serious financial implications for a company.
Note: Each state has different laws affecting the above issues, it is importnat to discuss the issues with your legal counsel before making any changes to your program.
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.
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