In Missouri the Labor Department's Division of Workers' Compensation (DWC) reports a significant increase in referrals for fraud and noncompliance for workers' compensation violations. In the first quarter 2010, the Attorney General’s office received 87 cases as compared to 39 cases referred in the first quarter 2009.
The increase is attributed to the Division's enhanced efforts in its ability to analyze more cases and the fact that employers are likely to cut coverage during hard economic times.
“These are staggering numbers, but we will continue to work with the Attorney General to enforce these laws so that Missourians injured on the job receive the benefits they deserve,” said Department Director Larry Rebman. “At the same time, we will work to remind Missouri employers of their obligations under the law.”
Any employer with five or more employees (one or more, if the employer is engaged in construction) must have workers’ comp coverage in Missouri, either by securing an insurance policy or by obtaining authority from the DWC to self-insure its liability.
For the last five years, approximately 80% of the cases referred to the Attorney General involved noncompliance – the failure of an employer to carry workers’ comp coverage. Of the 87 cases referred to the Attorney General this quarter, 67 involved noncompliance, 17 involved fraud by an employer or insurer (e.g. failure to report an injury that occurred), and 3 involved fraud by employees.
Failure to comply with the workers’ comp requirements is a Class A misdemeanor carrying a penalty of up to three times the insurance premium the employer would have paid or $50,000, whichever is greater. (workersxzcompxzkit)
Failure to report an injury is also a misdemeanor with a penalty of $50-$500 per violation.
Making a false representation in order to obtain a benefit is a class D felony carrying a fine of up to $10,000 or double the value of the fraud, whichever is greater.
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. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-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@WorkersCompKit.com
Sunshine Village, a ski and snowboard facility, (Alberta, Canada) is appealing an occupational health and safety conviction for failing to ensure the safety of a worker who died as reported in the Canadian OH&S News.
The trial judge's summary noted 25-year-old mechanic's helper died days after suffering massive head injuries. The man was sitting on the upper work platform of a work chair approaching a terminal building at the resort. He suffered head injuries when the platform's foldable access stairs broke upon entering the terminal.
The judge pointed out "the upper clearance for the work chair . . . did not allow for a person to be seated on the upper work platform." The judge determined the accident was caused by momentary inattentiveness and carelessness by three of the company's employees, including the injured mechanic.
Information from Alberta Employment and Immigration confirmed Sunshine Village Corp. was fined $5,000 (plus a 15% victim surcharge) and ordered to pay an additional $250,000 to the ski hill operations and management program at Selkirk College, a multi-campus community college in British Columbia.
In its appeal, Sunshine Village claims the trial judge "erred in law by failing to address the principle of foreseeability," arguing there was no failure to comply with either a legislative or industry standard and the other two workers involved testified they had been trained properly. The trial judge maintains "the accused's liability arises from the lack of assistance by visual aids or special procedures in place to remind the employees when care is required."
A company spokesperson insisted that the incident was not reasonably foreseeable.
"With the benefit of hindsight you can look back and imagine how you could have foreseen it," he explained. "But we didn't have the benefit of hindsight. This was something that had never happened before at Sunshine and, to our knowledge, hasn't happened with this particular brand of lift anywhere in North America."
He added it was not foreseeable that the three employees would be simultaneously inattentive at the precise moment of the accident, as the judge ruled. "[They were] trained, experienced [and] had done this operation a number of times, including several times that day," he noted, adding the company maintains the absence of signage was not responsible for this incident. In the meantime, however, Sunshine Village has reportedly invoked added precautions to minimize the possibility of future accidents. (workersxzcompxzkit)
Although the company is willing to go beyond mandated legislation in order to protect its workers, the company spokesperson maintains these types of incidents are unpredictable and often unforeseeable. "I think it would be very hard, unless you were just engaging in a what-if exercise, to actually imagine this sort of accident happening," he commented.
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. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-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@WorkersCompKit.com
Iconic Americana employers, like big box stores, supermarkets, wholesale clubs, home and garden warehouses, cannot ignore the “small stuff” in workers’ comp cost containment efforts. Failing in little ways can turn into very large work comp cost expenditures.
Risk Managers must be at the top of their game when an employer fits into the “mega-employment” category. We are talking about businesses with:
1. $10+ Billion in income.
2. Multiple store sites.
3. 45,000 to 50,000 plus employees, unionized or not.
4. Workplace injuries hovering around 4,000 a year.
5. Open Claims between 2,500 to 3,000+
For BIG Savings, Review These Eight Areas TODAY!
1. Handbooks and/or Brochures
It’s essential to keep the employee handbook and/or brochure updated. Outline in simple, easy to understand language exactly “what to do when you are hurt” — not only in English but also in other major languages the employees speak.
Make handbooks/brochures available to every new hire, on-line, and at the workers’ locations. Hold workshops periodically to review and update employees about the employer’s policies on injury management and return-to-work programs.
Train managers and/or supervisors in the use of safety packets, especially in workers’ compensation policies and procedures. Emphasize the employer’s firm policy of return-to-work, including modified duty positions.
2. Communicating with Injured Employees
Make employee communication a required top priority. Use personal involvement (go with the injured worker to the doctor; drive them home, etc.); telephone (follow-up on the worker’s progress; review the return-to-work policy); send get well cards; as soon as the worker is able, require on-site weekly check-in meetings at the workplace.
3. Overcoming Supervisor/Manager Resistance to Modified Duty Programs
The most effective post-accident workers’ compensation cost-control program an employer can directly influence is a well-managed return-to-work program. Encourage supervisory personnel to focus on what injured workers can do by using the work ability form and working closely with the treating physician to identify when the worker is medically able to return to modified duty.
4. Medical Care
Medical care of injured workers must be well managed. Work with the TPA to identify areas of concentration where better coverage may be provided and take steps to implement coverage. Medical triage of injured workers, often using nurse case managers, is an effective cost-cutting tool.
5. Report Injuries Immediately
Goal: 24 hour reporting. Studies show a marked increase in workers’ comp costs for claims reported up to 10 days after an injury occurs, compared to claims reported within 2 days of the accident.
When claims are reported within 24 hours employers see a decrease in lost workdays and wage replacement benefits; better management of medical treatment; modified duty (RTW) often occurs during the “waiting period” required by state laws.
6. Workers Likely to be Injured
Identify those workers most likely to be injured. Are they younger, older, less experienced, newly hired, untrained, long-time employees growing apathetic.* Once you know the who implement training in best safety practices. Actually, the worker’s compensation people and the safety folks need to be running on parallel tracks in the efforts to achieve cost containment.
* Keep clearly before your eyes all laws and regulations falling under EEOC, ADA, OSHA, union contracts, et al, both state and federal, applying to your industry, work environment and employees.
7. Performance Metrics
If you don’t employ, on a regular basis, at set intervals, an assessment of your overall workers’ comp program, then you will not know what you don’t know. Not knowing is a sure way to drive costs UP rather than down. (workersxzcompxzkit)
8. Implement a Fraud Program
Fraud is like the poor – it’s always with us. The first rule of fraud prevention is to send the message “ fraud will not be tolerated” to every employee. If an employer is “just a little guy” maybe fraud is not an issue or is easily noticed and prevented. However, when dealing with multi-thousands of employees, uncontrolled fraud is going to take a big bite out of the bottom line, i.e., profit.
Let’s Wrap It Up
Keep in mind, these ideas, suggestions, and outcomes are not made up. In fact, real employers actually implemented some or all of these work comp tools and achieved significant cost containment, better medical claims management; returned employees to work sooner, reduced workplace injuries and lowered their insurance premiums.
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. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-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@WorkersCompKit.com
An order denying in part the motion of Hibbing Taconite Company for summary judgment in a disability discrimination lawsuit brought by the U.S. Equal Employment Opportunity Commission (EEOC), was issued by Judge Richard Kyle of U.S. District Court for the District of Minnesota.
In its lawsuit, EEOC v. Hibbing Taconite Company, Civ. No. 09-729 (RHK/RLE), the EEOC charged Hibbing Taconite Company discriminated against a deaf applicant by denying him employment at its mine. The EEOC contends that Hibbing Taconite rejected the man, who formerly worked for LTV Mining, because of his hearing impairment, in violation of the Americans With Disabilities Act (ADA).
Hibbing Taconite filed a motion for summary judgment alleging it was entitled to an immediate judgment in its favor and without trial because, it contended, there were no disputed issues of fact, and that the applicant was not qualified because of his deafness for the positions for which he applied, including three in the plant and two in the open pit mine,.
Although the court granted summary judgment as to the jobs in the plant, it found there was ample evidence on which a jury could find the man could have performed the jobs in the open pit mine with a reasonable accommodation: “The very fact that (the applicant) successfully worked at the LTV mine pit is strong evidence that a reasonable accommodation could have been possible,” the judge said.
The court also concluded a jury could find Hibbing Taconite acted in bad faith when it initially reversed its decision to interview the man after it learned he was deaf: “Hibbing demonstrated bad faith when it rescinded its interview offer immediately upon learning of the man’s disability,” the judge wrote. (workersxzcompxzkit). A trial date is set in Duluth, Minnesota for July 26, 2010.
“Employment discrimination cases are often fact-intensive and, like this one, cannot be resolved without trial,” said the EEOC’s regional attorney in Chicago, John Hendrickson. “After all, resolving issues of fact is what juries do. But Hibbing Taconite proposed, wrongly, that everything in this case so favored the company there was no reason to have a jury decide anything. That proposition could not be sustained, and the court rejected it, clearing the way for a jury trial. So, now we move to that stage, and we are, of course, pleased that this disable worker will have his chance to tell a jury exactly what happened to him.”
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. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-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@WorkersCompKit.com
Back pain costs more in terms of time off and lost production than any other health issue in the workplace. An estimated 60% to 90% of people suffer some type of lower back disorder during their working life. Workers in the healthcare sector are particularly prone to back injuries.
In light of such reports and to provide a suitable replacement to the “Lighten the Load” booklet, the Health and Safety Executive for Northern Ireland (HSENI) in partnership with NI Back Exchange, produced “Backs in Action,” a new guide to further assist the healthcare sector in achieving their goals of reducing incidences of musculoskeletal disorders (lower back pain) among their staff.
“Analysis of RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) statistics received by HSENI between April 2006 and February 2010 show approximately one third of all ‘over-three-day’ and major injuries reported each year to HSENI by health sector employers are of a sprain/strain nature,” said Ronan Magee, HSENI inspector responsible for the development of the guidance.
“This new guidance should be used as a practical resource for those employees whose job involves the moving and handling of people and objects. There is a legal obligation on employers to ensure that where manual handling is necessary, the hazards associated with such tasks are assessed and control measures implemented to reduce the risks involved. It is vital that employers and employees work together to successfully reduce the human and financial cost of back pain among employees in the healthcare sector,” he added, (workersxzcompxzkit)
Recommendations from the new guidance for healthcare staff include:
1. Know how your back works and know how to look after it.
2. Familiarize yourself with manual handling risk assessments.
3. Follow safe systems of work.
4. Attend manual handling training.
5. Use the techniques you have been trained to use.
6. Use appropriate manual handling equipment properly.
7. Refresh your training regularly.
8. Report incidences and near misses.
The guidance is available to trust staff attending manual handling and ergonomics training.
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. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-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@WorkersCompKit.com
When an injury happens at the workplace it’s only natural people are stressed out and may not be thinking clearly. Preparing your employees and supervisors before an injury occurs is an excellent communication technique.
A brochure stating clearly what do when an employee is hurt at work is an important step in managing your workers’ compensation cases. Whether your design and write your own brochure or ask your third-party administrator or carrier to provide the material, brochures must meet certain goals.
According to the 2009 RIMS survey, only 54% of companies have such a brochure or communication piece. So, 46% of employers have an easy opportunity to fill this important communication gap.
A Good Brochure begins with these basics:
- Written at a 6th grade level.
- Written in several languages.
- Visually inviting; i.e., simple, clear style and formatting.
And answers these 7 employee questions:
- What to do to receive care.
- Will they lose their job if they are injured?
- Who pays the medical bills?
What the employer wants the employee to know:
- Temporary duty available.
- How they participate in TAD.
- There are other obligations such as weekly meetings.
- What happens to those who abuse the system?
By removing the “mystery” from the process, your employees know you are their first point of contact. (workersxzcompxzkit) And, you will see your litigation rate will drop because plaintiff’s attorneys say the number one reason injured employees come to them is because they’ve been unable to get information from their employer.
Author Rebecca Shafer, J.D.. 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. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-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@WorkersCompKit.com
The New York State Insurance Department plans a public hearing on June 23, to go over a proposed 7.7% increase in the state’s workers’ compensation loss cost. State law requires the insurance department to hold a public hearing if the rate increase would surpass 7%.
The NYCIRB, a non-governmental entity that serves as the advisory rate service organization for workers’ comp in New York State, filed the requested increase after compiling and evaluating loss cost changes in the state. (workersxzcompxzkit)
If the rate increase is approved, the proposed change, filed by the New York Compensation Insurance Rating Board (NYCIRB), would take effect October 1, 2010. The approved loss cost is used by workers’ comp insurers in setting rates.
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. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-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@WorkersCompKit.com
Following the death of a disabled patient Basildon and Thurrock University Hospitals NHS Foundation Trust was fined £50,000 ($72,708) for failure to have patient risk assessment measures in place.
The boy’s death was a result of failure of staff to properly monitor and care for the severely disabled 20 year old during his hospital stay. The patient suffered other injuries during a previous stay at the hospital.
During the admission when he died, no assessment of his needs was carried out and staff had no knowledge of the previous incident. The man, disabled from cerebral palsy, was placed in a single room without one-to-one care and only monitored at irregular intervals.
HSE investigation found following four problems/defects:
1. The Trust had no systems in place on each ward for assessing the risk to patients from bed rails. People with cerebral palsy are known to be particularly at risk of entrapment and the issue was highlighted in Department for Health guidelines published in 2001.
2. The Trust's practice for obtaining, recording and disseminating information about the patient’s needs was poor. Staff did not formally share knowledge of individual patients.
3. There was no system in place to alert staff to his particular needs or habits, instead staff were relied upon to remember him from previous visits or to retrieve records to read through his past medical notes.
4. Although the man’s body was the size of a 12 year old boy, he was placed in a bed with adult spacing bed rails. Had the rails been suitable for his size it would not have been physically possible for him to get his head through any gap.
The NHS Foundation Trust was sentenced after it admitted failing to ensure the health and safety of patients in its care, breaching Section 3(1) of the Health and Safety at Work etc Act 1974. It was fined £50,000 ($72,708) and ordered to pay £40,000 ($58,166) in costs. (workersxzcompxzkit)
Sue Matthews, HSE Inspector, noted, "This was an entirely preventable incident that resulted in the death of a vulnerable and much-loved young man. Hospitals are subject to the same safety regulations as any other organization and HSE will ensure that those who breach health and safety requirements, or fail in their responsibilities, are held to account."
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. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-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@WorkersCompKit.com
The purpose of the waiting period is to eliminate the administrative work involved for the claims handler in paying an employee for a very short period of time. The purpose of the retroactive period is to pay the employee indemnity benefits for all time missed from work when the claim is significant enough to cause the employee to be off work a greater period of time.
Every employee injured on the job knows workers' compensation pays the medical bills and pays indemnity benefits. However, when an employee is injured and talks to the work comp adjuster for the first time, the employee is almost always dismayed to hear there is a waiting period before indemnity benefits are paid for time missed from work. There is no waiting period for medical benefits.
The first question the work comp adjuster hears from the employee is “what is a waiting period?” The adjuster's answer will be something like, “Employees who are injured on the job receive no wage replacement during the first X number of days they are off work due to their injury, unless they are off work more than Y numbers of days.”
The X number is the waiting period, which varies by jurisdiction. The Y number of days is the retroactive period. This is the length of time the employee must miss from work before indemnity benefits are paid retroactively for the days missed during the waiting period.
An Example
1. The employee is injured. At the time of the first contact between the adjuster and the employee, the employee does not know how long before the doctor will allow him to return to work on either light duty or full duty. However, 15 days after the accident, the employee is still out of work.
2. If the jurisdiction has a 7 day waiting period and a 14 day retroactive period, the adjuster will pay indemnity benefits retroactively for the first 14 days the employee was unable to work, plus continue the indemnity benefits until the employee is able to return to work.
3. If the employee only missed 4 days in the above example and the waiting period is 7 days, no indemnity benefits would be paid to the employee.
4. If the employee missed 10 days from work in the above example and the waiting period is 7 days, the employee would be paid indemnity benefits for 3 days. The retroactive period does not apply as the employee did not miss the required 14 days of the retroactive period.
Of the 54 jurisdictions (50 states, District of Columbia, Puerto Rico, Virgin Islands, and Guam) where there are United States style workers' compensation systems, only one jurisdiction, Virgin Islands, does not have a waiting period. Twenty-four jurisdictions have a 3 day waiting period and twenty-three jurisdictions have a 7 day waiting period. Four states—Idaho, Massachusetts, Mississippi, and Nevada—have a 5 day waiting period. Two states, North Dakota and Montana, have a 4 day waiting period.
Just as there is variance among the jurisdictions for the waiting period, there is even more variance in the length of the retroactive period. The retroactive period varies from zero days to 42 days. Some jurisdictions state their retroactive period in days, for example 14 days, while other jurisdictions will state their retroactive period in weeks, for example 2 weeks. For the purpose of this blog 2 weeks will equal 14 days and all information will be given in days.
Five jurisdictions, Hawaii, Montana, Oklahoma, Puerto Rico, and Rhode Island, have no retroactive period. Two states, Nevada and North Dakota have a 5 day retroactive period. Seven states have a 7 day retroactive period—Connecticut, Delaware, New Jersey, South Dakota, Vermont, West Virginia and Wisconsin. Wyoming has a 9 day waiting period. Two jurisdictions, Minnesota and Puerto Rico have a 10 day waiting period.
The most popular period of time for a retroactive period is 14 days with 25 jurisdictions having a 14 day retroactive period. Eight states—Alabama, Florida, Georgia, Indiana, Kansas, Massachusetts, North Carolina and Virginia, have a 21 day retroactive period. Two states, Alaska and New Mexico, have a 28 day retroactive period. The longest retroactive period of 42 days is in the states of Louisiana and Nebraska.
Some states make special exceptions to their waiting period. For instance in New Jersey, the waiting period does not apply to volunteer firefighters, rescue squad workers, and fire marshals. In Illinois the 3 day waiting period applies only to temporary total disability benefits, but it is the rare claim where it is known in the first three days that the employee would collect permanent partial disability or permanent total disability in the first days after the accident.
Most employers will allow the employee to use sick leave time or vacation time if the disability days do not exceed the waiting period. Check with your state work comp board or industrial commission before doing so to be sure it is permitted.
The two federal programs, the Federal Employees' Compensation Act and Longshore and Harbor Workers Compensation Act, both have a three day waiting period and a 14 day retroactive period. (workersxzcompxzkit)
The best way to be fully informed on all matters of workers’ comp jurisdiction for workers covered by United States style workers' compensation systems is to review the “Legal Library” at ReduceYourWorkersComp.com entitled: Workers' Compensation State Laws and Regulations Resources for Employers from Workers' Comp Kit™.
\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. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-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@WorkersCompKit.com
A utilization review allows the adjuster to know if the medical care being provided to the employee is medically necessary and appropriate for the treatment of the injury or occupational disease and is one of the best weapons an adjuster can use to control workers’ comp costs.
The unintentional consequence of workers’ comp paying 100% of all medical expenses is, unfortunately, the employee is unconcerned about the cost of medical care he received. To be fair, the employee normally does not know the medical ramifications of the treatment provided. Both the employee (and often the adjuster) do not know if prescribed medical treatment is repetitive of care already provided, is not appropriate, or inadequate for the injury.
Utilization reviews vary in usage by different work comp insurers. Some insurance companies require a review of all planned treatments. Others require a utilization review only for specific types of medical care such as hospital admissions, inpatient surgery, ambulatory procedures, skilled nursing and rehabilitation services, planned prescriptions, and durable medical equipment.
In most companies, the utilization review is conducted by a registered nurse (RN), who determines if the treatment is medically necessary. If the RN believes the medical treatment should be denied, or is unsure if the medical treatment is necessary, a physician conducts a second review of the information before approving or denying care.
Either the utilization review is in-house by the insurer or third party administrator, or done by an outside organization specializing in utilization review services. Ideally utilization reviews should always be completed within 7 days and preferably within 3 days. In some situations an expedited review may be needed; for instance when the physician wants to immediately admit an employee to a hospital for further care.
Utilization review includes pre-certification reviews (also referred to as utilization management or prospective review), concurrent review, retrospective review, and re-review (also referred to as an appeal). The purpose of each type of review is to control the cost of the medical treatment without interfering in the employee's medical recovery. After each type of utilization review, all parties are notified of the review decisions.
Pre-certification Review
When first hearing the term “utilization review” most people think of what is actually the “pre-certification review.” In a pre-certification review, before medical care is provided, the RN collects all the necessary information including symptoms, diagnosis, test results, and the reasons the physician is requesting the medical service. The RN compares the information provided against the normal criteria for treating a specific type of injury or occupational disease.
If the medical service is necessary, it is approved. If the medical service is not necessary, then a physician at the utilization service reviews the medical information again to verify the denial of the service is correct.
Concurrent Review
Concurrent reviews occur during the time the medical treatment or service is being provided. The employee either can be an inpatient in a hospital or have on-going outpatient care. The RN approaches the concurrent review in the same way as the pre-certification review.
This type of utilization review is often overlooked by the workers’ comp adjuster, especially for outpatient care. The concurrent review verifies the medical necessity of the treatments and/or services provided to the employee and verifies the employee is receiving the right, most cost effective care. The workers’ comp adjuster who consistently utilizes the concurrent review of outpatient treatment shortens the time the work comp claims are open.
When the concurrent review is for inpatient care, it can shorten the hospital stay be limiting it to the amount of time the employee needs to be hospitalized. It can also be very helpful in identifying the medical care needed when the employee is discharged from the hospital.
Retrospective Review
The retrospective review is used for either inpatient or outpatient services. A retrospective review, as the name implies, occurs after the medical services are provided. The procedure for the retrospective review by the RN as the other reviews.
While physicians and hospitals recognize the need for pre-certification reviews and concurrent reviews and accept them, they are less accepting of the retrospective review, especially if the medical care or medical service is denied. When a retrospective review denies a service the physician or hospital provided, they do not get paid, as they cannot bill the employee. [They often will request a re-review].
Re-reviews
When a medical service is denied by a pre-certification review, a concurrent review, or a retrospective review, the employee or the medical provider can appeal the denial. When a re-review is requested, the physician at the utilization review service goes over all available medical information to determine if the denial should be reversed. Often the physician will bring in a second physician specializing in the type of medical care needed. The specialist will confirm the denial or reverse it. (workersxzcompxzkit)
Summary
Utilization review is a win-win process for all involved. The self-insured employer or the workers’ comp insurance company can eliminate the cost of unnecessary medical services through the utilization review process. The physician and employee benefit by not wasting time on medical care that does not expedite the employee's recovery.
\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. Contact: Robert_Elliott@ReduceYourWorkersComp.com or 860-553-6604.
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