Arizona Privatizing State Compensation Fund

 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:  Robert_Elliott@ ReduceYourWorkersComp.com or 860-553-6604.

Podcast: KNOW the New OSHA Recordkeeping Rules — OR Risk Fines and Criminal Penalties.
 Click Here:   http://www.workerscompkit.com/gallagher/podcast/Non_Compliance_with_Recordkeeping_Standards/

Posted in Insurance Issues, Rates, Premiums, Lowering Premiums & Experience Mod |

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The Basics of Assigned Risk Plans – Workers Comp 101

WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php

Posted in Alternative Markets & Captives, Buying Workmans Comp, Insurance Issues, Rates, Premiums |

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Take A Survey – Of Your Own Company

There are a million ways to ask questions in a survey. However, the style of your questions will drive the quality of information you gather. You want to get good answers leading to good results. 

Think of workers’ compensation surveys as an opportunity to audit, assess and educate.  Some examples of the types of questions likely to advance your cause:

1. Quantitative — find out the percentage of employees who return to work within four days.
2. Direct – Do you have written step-by-step procedures for supervisors to follow in the event of an employee injury?
3. Informative – Do you know what a positive Waddell test is? It is a sign of possible dishonesty. If you don't know this medicalese, or your adjusters don't know medicalese, you need to consider a medical director.

Discussions coming from this type of survey help you educate your team on the actions truly driving costs. It’s also a great chance to address things such as a manager’s perception that most claims are fraudulent.

How to get your answers:

DO

1. Ask quantitative questions.
2. Ask direct questions.
3. Ask informative questions.
4. Give and get information.

DON’T

1. Ask trick questions.
2. Ask reverse questions.
3. Ask attack questions.
4. Ask subjective questions.

There’s nothing  worse than participating in an audit or survey and then being left in the dark when it comes to results. Ask “How did I do?”

It’s important  to be sure you have a structured process for reviewing results with participants. Have the material and insights on hand to provide clarification there and then including concrete recommendations for improvement. (workersxzcompxzkit)

Feedback: So how did I do?

1. Review results with participants.
2. Provide recommendations.
3. Educational material.

Posted in Assessment & Diagnostics |

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Airline Grounds Pilot for Reporting Violations

Posted in Employment Law Issues |

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Massachusetts Lowering Workers Comp Rates To Attract Business

Posted in Buying Workmans Comp, Insurance Issues, Rates, Premiums |

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Study Looks at Asbestos Impact on September 11th Workers

A recent study of first-response and recovery workers in the aftermath of the September 11, 2001, attacks on New York reported that the clouds of dust and debris, much of which contained asbestos, has caused severe lung damage and reduced basic lung functions.

The Office of Medical Affairs for the New York City Fire Department authorized the study, to examine over 10,000 firefighters, emergency medical technicians, and cleanup crews who worked at the World Trade Center site. The report is one of the first attempts to quantify the full extent of the damage that first-responders suffered from in the two weeks following 9/11.

As part of their initial applications and continued certifications for their jobs, firefighters and paramedics are required to take basic lung function tests annually. After 9/11, the workers were retested to learn whether the effects of the dust clouds significantly affected regular breathing, lung capacity, and stamina. 

The results of the study, published in the New England Journal of Medicine, found exposure to asbestos-laced dust caused "abnormal lung function" within a "substantial proportion" of the workers who were retested. The study tracks the results of lung function tests from March 2000 to September 2008. The study examined more than ninety percent of the workers who were on site in those two weeks and found the average worker lost ten percent of his or her lung function.

The study determined almost 5,000 workers had persistent respiratory ailments, such as sore throat, sinus drip, coughing or sneezing. Almost a thousand other members of fire crews or emergency response teams were relieved of duty due to "permanent respiratory disability" from bronchitis or asthma triggered by the dust and debris. In all, workers at the scene experienced 10 to 12 years' worth of loss in lung function over a single year.

In most of these cases, the responder has recovered either very little or none at all in the intervening years. Dr. David Prezant, the study's author and chief researcher, said the persistent nature of the reduction in lung capacity "demonstrates. . . a need for continued monitoring.” Dr. Prezant also serves as the chief medical officer for the Office of Medical Affairs and has examined many of the current and former firefighters who were on duty during and after 9/11.

The World Trade Center towers, as well as many of the surrounding buildings, were constructed during the late 1960s and early 1970s. In those decades, construction workers often handled asbestos-laced materials, such as pipe insulation and roofing tiles. When the towers came down, so did much of the asbestos bonded to the construction materials. Asbestos mixed in with the other dust and debris could also have devastating effects.

Over the last few decades, researchers have established a positive link between asbestos exposure and a number of lung diseases and respiratory disorders. The most serious consequence of asbestos exposure is mesothelioma, a cancer targeting the soft tissue surrounding the lungs. (workersxzcompxzkit)

 Mesothelioma patients often do not display symptoms of the disease until several years after the initial exposure period. However, when symptoms do appear, the disease spreads quickly throughout the body. 

Posted in Medical Issues, NY Workers Comp Issues |

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Critical Concepts to Improve Your Workers Compensation Program

In the 2009 RIMS Benchmark Survey, more than 60% of companies were found to need moderate to significant improvement in workers’ compensation cost-containment strategies. 

The same  study showed  30% to 40% of most companies’ risk-management dollars are spent on workers’ compensation.

Employers think they need to wait for the claims administrator to tell them what to do next.

1. Stop waiting — ask questions, get in the game.
2. The claims adjuster can only do so much.
3. Claims adjusters need and want your participation. 

There are a million combinations of changes an organization can make to reduce WC costs. For now, let's focus on items applying universally to most organizations.

Just because you have a top-notch third-party administrator and broker handling workers’ comp does not mean you should sit back and wait.

One of the first things to do is sit down with your TPA to have a discussion about some of your larger lost-time claims. He or she will have a list of a ton of little things your company could do as the employer to help the injured employee help you!

These costs are controllable and not just by your TPA. The employer has a significant role to play —  “Take Control.”

Some ideas  for being a proactive employer are:

1. Send injured the employee to the doctor with Work Ability Form (WAF) in hand.
2. Develop a transitional duty job bank — focusing on ABILITY as much as on DISability — and list 10 TD jobs in the job bank (as a start.)
3. Make these available to the adjusters. Note in the account instructions that TD is available.
4. Incorporate a “return-to-work theme” into call scripts.

By sending  the WAF with the injured employee to the doctor on the first visit, the doctor keeps this person fresh in her mind when filling out a form. You don’t wait days for the doctor to receive the form and several more days for her to re-open the forgotten file and offer general suggestions.

Instead of  generic restrictions like “Can’t lift more than 20 lbs,” you get specifics geared toward the type of work your employee does – because the worker is right there when the doctor is filling out the form. (workersxzcompxzkit) and find out what the employee CAN do as well as what they can't do.

If just one  employee during one year has a WC claim grow from $10,000 to $20,000, your company has wasted $10,000 or, if you have a 10% profit margin, and you let one WC claim grow by $10,000, you need to find an extra $100,000 in sales to recover the cost.

Posted in WC 101 |

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Nurse Staffing Agency Head Nabbed in Workers Comp Scam

A Diamond Bar, California man pleaded guilty to insurance fraud for underreporting the number of employees at his nurse staffing agency to the State Fund. The underpayment of required workers’ compensation insurance resulted in his being ordered to repay the state $1.38 million as part of his sentence, the District Attorney’s office announced.

The man, who runs a company called Nurse Connection Inc., was investigated by the California Department of Insurance after it received a referral in September 2008 from State Fund involving alleged underreporting workers’ comp on quarterly payroll reports.

After an investigation, the case was turned over to the District Attorney’s office, where a criminal complaint was filed against the individual on August 12, 2009.

Deputy District Attorney Ellen Aragon of the Healthcare Fraud Division said the man was ordered to pay the restitution by Superior Court Judge David Horwitz as part of five years of supervised probation. He will be electronically monitored for the first 90 days of probation. Horwitz suspended a five-year prison term. (workersxzcompxzkit)

Aragon said the judge also ordered the defendant to pay the state Department of Insurance investigative costs of $110,000. The individual must submit his annual corporate tax returns to the Department of Insurance and the District Attorney’s office, as well as submit proof of current worker comp insurance when he returns to court for a progress report on November 8.

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:  Robert_Elliott@ ReduceYourWorkersComp.com or 860-553-6604.

Podcast: KNOW the New OSHA Recordkeeping Rules — OR Risk Fines and Criminal Penalties. 
Click Here:   
http://www.workerscompkit.com/gallagher/podcast/Non_Compliance_with_Recordkeeping_Standards/

Posted in California Workers Comp, Fraud and Abuse |

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New Regulations Focus on Protecting Workers from Artificial Light

New regulations further protecting workers in Great Britain from the dangers of hazardous sources of artificial light have gone into effect.

The Control of Artificial Optical Radiation at Work Regulations meets a European Union Directive to ensure that standards are set and harmonized across Europe to protect workers from harm arising from exposure to hazardous sources of artificial light.

Some sources of artificial light, particularly UV radiation and light from lasers can harm the eyes and skin of workers and must be properly managed.

Workers in Great Britain are generally well protected from dangerous sources of light and the majority of businesses know how to manage the risks effectively. Therefore the regulations will mean few practical changes for most businesses, including those who are already managing the risks.

To help those businesses who are not already managing the risks understand what's required and what they need to do, Health and Safety Executive (HSE) is producing guidance to ensure workers can remain appropriately protected. (workersxzcompxzkit)

Common sources of light in the workplace such as office lights, photocopiers and computers are not affected by the regulations.

     WC Calculator:   http://www.reduceyourworkerscomp.com/calculator.php 

Posted in Risk Management, Safety and Loss Control, WC in Other Countries (International) |

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Chronic Pain Management Causes Long and Costly Payouts

In a recent claims audit of workers' compensation claims for a Texas municipal pool, the claims auditor was astonished by the number of lifetime medical claims.  The indemnity benefits had been paid out, sometimes years ago, but the former employees were still treating on a regular basis.  In most of the claims the reason the employee had been seeing the medical provider for years was due to chronic pain. 

Chronic pain refers to the medical condition where the injured party continues to suffer pain from the injury six or more months after the injury occurred and the pain is not relieved by medical or surgical care.  For the treating physician, a patient's chronic pain and the management of it can be a difficult process.  Chronic pain can be hard to detect which makes it a difficult diagnosis for the physician. 

The condition of chronic pain can continue for years or even the lifetime of the employee.  In some cases the injured employee can return to work with the pain and 'live with it.'   However, often the pain can be severe enough to be debilitating, preventing the injured employee from returning to work.

Chronic pain is often associated with Reflex Sympathetic Disorder (RSD) but can be present without RSD.  When an employee develops RSD pain is often describe as a severe burning pain.  While pain is very difficult to measure, there are physical symptoms of RSD the physician can see and measure including skin temperature changes (warmer or cooler than other parts of the body), skin color changes, stiffness and swelling in affected limbs, and decreased ability to move an affected extremity. 

It is the work comp claims where the employee develops chronic pain without a RSD diagnosis that create a difficult situation for the work comp adjuster.  Chronic pain can develop from various types of injuries including herniated and/or ruptured disc, amputation of a body part, joint injuries like carpal tunnel syndrome, torn ligaments and torn cartilage injuries and even traumatic brain injuries.

As chronic pain cannot be seen and is very difficult to measure, it is sometimes used as an excuse to stay off work by unscrupulous employees.  The employee, who had a valid injury,  becomes adjusted to receiving compensation without working and finds the claim of chronic pain to be the path to long-term benefits.  The adjuster becomes suspicious of the employee's delayed recovery due to chronic pain, sends out surveillance and finds the employee playing golf or performing strenuous work (away from the job).   It is these fraudulent claims that give chronic pain a negative connotation. 

Of course there are many totally legitimate injury claims with chronic pain. The challenge for the adjuster then becomes separating the valid chronic pain claims from the bogus claims, and then providing chronic pain management for those employees who truly need it.

Usually the first step the work comp adjuster takes to verify the employee's chronic pain is to have an independent medical examination (IME).  In some situations the IME doctor can verify the existence of chronic pain, but often the IME doctor cannot state with certainty whether or not the employee has a chronic pain condition.

After the IME, the next step for the adjuster is often to have a nurse case manager (NCM) assigned to the chronic pain claim, if a NCM has not already been working with the employee.  Chronic pain management can become very expensive and take a considerable amount of medical knowledge to properly control.  The NCM can discuss with the treating physician and the employee the best course of chronic pain management.  The NCM should remain involved in the chronic pain claim until the employee is able to return to work or it is determined the employee will never return to work.

In most claims the treating physician initiates the use of pain medications, usually opioids (narcotics), to control the chronic pain.   There are several problems with using opioids to control pain.  The first one faced by the treating physician is to established the proper dosage for the employee.  If the dosage is too low, the employee continues to suffer the pain.  If the dosage is too high, the employee can become addicted to the pain medication. 

Addiction is a problem with opioids for chronic pain management.  The employee who started taking the opioids for the chronic pain likes 'feeling no pain' and become addicted to the opioids.  With the addiction the employee becomes accustomed to having the narcotics in his body, and to continue to achieve the same effect, the dosage has to be increased.  This leads to dependency on the drugs.  It also creates withdrawal symptoms when the opioids are reduced or stopped.

The NCM must work with the physician to go beyond the use of narcotics to control the chronic pain.  Instead of the narcotics the physician may consider electrotherapy with a transcutaneous electrical nerve stimulation (TENS) unit.  Similar in effect to the TENS unit are pain pacemakers that can be implanted in the body to deliver low-level electrical stimulation to the spinal cord.

Another method to control chronic pain is the use of trigger point injections.  A local anesthetic sometime with a steroid is injected into the painful area to relieve the pain.  In some cases in only takes a few injections to resolve the chronic pain.  Trigger point injections are often combined with physical therapy to recondition the muscles while the pain is being alleviated.

In the last few years some doctors have turned to anticonvulsants to control chronic pain. How anticonvulsants reduce pain is unclear but appears to be effective in some types of chronic pain control.  Another recent approach being used to control pain is low dosage antidepressants which influence the level of certain chemicals in the brain.   

Also, as there appears to be a mind-body connection when it comes to chronic pain, alternative treatments like psychotherapy and relaxation techniques are being tried with some success.

A pain management specialist/clinic can be utilized to assist the employee.  The NCM can coordinate the treating physician, the pain management specialist, and any other medical providers including orthopedists, anesthesiologists, psychologists, and physiatrists.  The NCM will review the medical and psychological aspects of the employee's case with the pain management specialist to determine the best course of action.   (workersxzcompxzkit)

Fortunately chronic pain workers' compensation claims are infrequent, but when they do occur, they tend to be very expensive and can last for years.   Learning how chronic pain claims should be managed will save the insurer or self-insurer significantly on these large dollar claims.  The experienced work comp adjuster working with a dedicated NCM can control these claims for the benefit of both the employer and the employee. 

Posted in Coordinating Medical Care, Fraud and Abuse, Medical Cost Containment & Managed Care, Medical Issues |

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