An injury duration guideline is a tool employers use to get an idea of how long an injured employee should be out of work for a particular injury. Often, even though carriers know about injury duration guide, employers may not, especially employers with someone new handling workers’ compensation claims. AMA, Dr. Presley Reed are the two most note-worthy sources of this type of guideline. Workers Comp Kit has a one-page that is laminated that's a good quick reference, especially good for training or to show senior management to show the type of tools that enpower the employer.
An injury duration quidelines do not replace a physician’s advice, but it gives the employer a sense of whether the time injured employees are actually out of work or say they need to be out of work matches up with the time the guideline’s gives for a particular injury.
A Scenario
1. An employee has a fractured knee.
2. By replacing heavy work with light work (in your return-to-work program), the employer “saves” six weeks of lost wage indemnity payments.
3. The employee says s/he will be out of work for six months. Because you know this time frame is disproportionate to a normal injury of that type you can dig more deeply into why the employee thinks six months off is needed.
The Transitional Duty Cost Calculator
Using a transitional duty cost calculator allows an employer to calculate the dollar amount (cost of an employee being out of work (OOW)) by multiplying the estimated number of days saved by the estimated average indemnity cost per day. Add this figure to your cost of replacement labor and your grand total cost of an out-of-work employee is quite daunting. (See link below for this FREE tool.)
To make the figure more frightening, divide your dollar amount by the company’s profit margin and you will see the amount of money it takes to “replace” lost expenses from an out-of-work employee.
A Scenario
1. An employee with a fractured knee returning to work in six weeks on transitional duty saves 42 days of indemnity.
2. If the average cost per day is $200, and you pay a replacement worker $3,000, the transitional duty saves your company $190,000.00 if your profit margin is 6%.
Knowing what your true costs are when a worker is out on comp is a huge incentive to return injured employees to work as soon as they are medically able. (workersxzcompxzkit) (See ink below to try this handy tool.) It’s also a good reason to have a solid transitional duty or return-to-work program in place.
Showing the dollar value of the savings of six weeks helps to gain management commitment for a transitional duty program.
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. Contact her: 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@ReduceYourWorkersComp.com
Employees in the bed manufacturing industry suffer manual handling injuries such as back and upper limb disorders twice as often as those in any other manufacturing sector. A good practices industry report cited recent steps bed manufacturers in Great Britain took to successfully reduce manual handling injuries.
Key risk activities were identified by the Health and Safety Executive (HSE), supported by the National Bed Federation. Companies are encouraged in implement solutions most workable for them.
Key Risk Activities
1. Tape-edging – highest risk
2. Handling (generally carried above the head) – high risk
3. Divan assembly and dressing – medium risk
4. Mattress assembly – medium risk
5. Tufting – medium risk
6. Spring assembly and hand stitching of mattresses – medium risk
In a series of seminars, bed manufacturers were given the report findings and asked to produce three-year action plans to show how they could improve health and safety in these areas.
Following this period, HSE noted a range of improvements were made by the seven pilot companies that were revisited, including the introduction of new mechanized equipment and handling aids, and better storage arrangements to reduce the need for manual handling.
One company nearly halved the number of manual handling injuries reported. Other companies noted the new ways of working to reduce manual handling increased their productivity.
Jessica Alexander, executive director of the National Bed Federation, noted, "It is encouraging that a number of bed manufacturers have shown their commitment to the health and safety of their employees by welcoming new ways of working. (workersxzcompxzkit)
"We now want to ensure this good practice is shared across industry with the message that it can also make good business sense not only by reducing the likelihood of injuries, but also by potentially increasing productivity."
\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 him: 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@ReduceYourWorkersComp.com
Fraud Is Everywhere, use all the tools in your arsenal
Not only is fraud everywhere, but sometimes the lengths people go to commit fraud is both amazing and amusing. However, that being said, it’s the employer’s job to jump on every single incident of fraud and take action. Make it very clear fraudulent workplace injuries and workers’ comp claims will not only not be tolerated, but also will be prosecuted. The least problem employees involved in fraud have is losing their jobs.
Fraud Discovery & Assessment Techniques
1. Fraud Endorsement Language
Use affirmative obligation language to notify employees they may be subject to civil or criminal penalties for failing to report earnings while collecting workers’ compensation.
Tip: Don’t send checks via direct-deposit.
2. Use Anonymous Toll-free Fraud Tip Lines & Posters
Obtain posters from TPA or insurance company.
Tip: Use phone or on-line tip reporting services.
3. Use Repeater Reports & Fraud Investigations
Get reports of employees who are not physically/medically able to safely perform the job.
Tip: Consider fraud profile investigations.
4. Use Surveillance & Security Cameras
You don’t know what you don’t know! Dig In!
Consider using store safety cameras.
Use a surveillance firm.
5. Use chair side visits for injured employees.
Understand process and find out where things start to get off track.
Tip: Sit chairside to learn about your claims, the adjusters and the process in general.
6. Use a Vendor Day to keep management and staff informed.
Learn all products, including those related to fraud control. Ask adjusters to join your cost containment team to brainstorm. Even pharmacy benefit programs can detect fraudulent claims, for example, employees getting multiple prescriptions in a variety of pharmacies in the surrounding area.
Tip: Integrate all selected products.
7. Use a medical doctor for a file review.
Do adjusters know medicalese? See if the degree of disability is disproportionate to the mechanism of injury. See if there is "medicalese" for a doctor to tell another doctor there is possible evidence of malingering?
Tip: Are medical resources timed properly? Are treatment and return to work appropriate?
Tip: Use Injury Duration Guidelines
The Story
At mid-year, the district attorney filed criminal charges against nine individuals in a sweep of insurance cheaters. The arrests followed a joint investigation involving four insurance companies, the U.S. Postal Inspector's Office, the National Insurance Crime Bureau, the State Insurance Department, the State Insurance Fund, and the New York State Workers’ Compensation Board.
“Alfred V.” claimed to the management of a supermarket where he worked as a night stock clerk he fell on a spill, cut his arm while falling and injured his wrist.
He submitted multiple medical bills for reimbursement to the Workers’ Compensation Board. In fact, a videotape in the store recorded him staging the fall by creating the spill and deliberately slashing his left arm with a box cutter. (workersxzcompxzkit)
The employee was charged with insurance fraud in the fourth degree and offering a false instrument for filing in the first degree.
Author Rebecca Shafer, Consultant/Attorney, Amaxx Risk 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 her: 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@ReduceYourWorkersComp.com
Many companies successfully implement workers’ compensation cost containment programs. Here's a tale of three companies achieved significant cost reductions utilizing various cost reduction tools. The fourth company, below, is making a huge dent in their losses. All four programs are works in progress.
Co #1 A pharmaceutical company reduced its cost by 15% and increased its best practices by 43%. This company started by having all business unit (20) get their WC Management Score on Workers' Comp Kit. In less than 5 days, all 20 divisions were ranked by score from 0-100, and all gaps had been identified.
Co #2 A theme park with more than 10,000 employees reduced lost days by 20%.
Co #4 A high-profile concession vendor had 40% loss reduction.
Each company is very different, with its own set of obstacles. The pharmacy company has 200 smaller locations; the theme park has two huge locations. The employee populations are diverse and vary from part-time adult workers, high school students, non-English speaking persons, retirees, and even homeless employees.
They are insured, with major carriers. Yet, the carriers did not tell them how to reduce their losses. They didn't tell them because …. well, because they didn't ask. Why didn't they ask? They didn't ask becuase they didn't know what to ask for. A circular situation where finally that a broker got me involved and I guided them on the cost reduction path.
In one case studies, the carrier employed work-injury coordinators, called WICs, to help employers develop return-to-work programs and conduct training, but the company never worked with the WICs and never asked for WICs because they didn’t know what a WIC was.
STARTING
These three employers achieved significant cost reduction by STARTING. That’s right – they did not have the perfect solution, the perfect team, perfect RMIS system, but they worked with what they had and started.
Think of it this way. If there are 5 stop lights on Main Street in your town and you are at the first light, do you wait until all the lights are green at each stop light to start driving down Main Street? No. It works real well if you drive through town one stop light at a time.
Co. #4 One company, employing 50,000 people at 500 stores has about 2,600 workers’ compensation accidents annually. With 2,000 open claims at year end, their cost was $100 million. This company used Workers Comp Kit to customize materials because they didn't have the time or staff to develop the materials internally, so they used Workers' Comp Kit as a base — a very good decision. And, their TPA paid for the service to supplement their already good service. THAT's great customer service.
Employing an independent claim program audit (TPA vs. Self- Administration Model), it was recommended they use a third-party administrator. The chose a dedicated claims unit which allowed the company to reap these benefits:
1. Low turnover of an experienced claims staff.
2. The claims staff handled their account exclusively.
3. The onsite nurses triage reviewed workers’ comp claims daily.
4. Custom service standards were monitored.
5. Risk management remained onsite, improving communication.
6. TPA claims staff said they felt as if they worked for the company.
Every employer has a choice – save money and muddle along with injured workers out “forever,” or spend a little more to control the high work comp claims by hiring the most effective TPA available — it's all about "cost effectiveness," not "cost."
Choose wisely.
\Author Rebecca Shafer, J.D., Consultant, 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 her: 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@ReduceYourWorkersComp.com
An Interview by: Rebecca Shafer, President, Amaxx Risk Solutions, Inc.
I recently interviewed Dr. Jennifer Christian about an employee satisfaction, er . . . dissatisfaction survey program her company offers. This program was of interest to me because it is an excellent way to assess the gaps in an employer's injury process. The program gathers feedback about employees’ experiences with the claims process shortly after an injury — while there is still time to change the outcome. Here’s what she says …
The purpose of our new Distress & Dissatisfaction Detection program, also called “3D’s,” is to alert customers to situations that have gotten off on the wrong foot while the situation is still fluid enough for them to do something about it.
Webility reaches out by phone to injured workers within a short time after injury (typically 10-14 days) to see how they are doing and if they are satisfied with how things are going so far. These calls serve as a fail-safe step following behind whatever early claims response process the employer already has in place.
Underlying this program is the assumption that a small but very important number of workers are experiencing distress or dissatisfaction at this interval. Distressed claimants may keep seeking medical care beyond what is needed, and dissatisfied claimants tend to get lawyers. A small number of problem claims generate the bulk of loss costs. Getting just a few situations back on the right track before they really go south could make a big difference.
The employer establishes the criteria for which workers should be contacted and how long to wait after the injury to make the calls. Trained interviewers with experience in the workers’ comp injury care process conduct a short and carefully scripted survey. Call time is usually less than 5 minutes unless there is a problem. The surveyors ask a series of questions designed to reveal which injured workers are: (a) in distress and/or (b) have experienced a service failure of some sort and are dissatisfied/upset. The questions also yield actionable information.
If distress or dissatisfaction is detected, the interviewer documents the details and analyzes the nature of the issue. Then, based on internal protocols and customer instructions, a call report is sent to the appropriate party or parties. The customer reviews the call report and decides whether and how to intervene. Some situations may be amenable to immediate corrective action. Others may not.
Webility’s surveyors also record and classify all answers in a database in Webility’s system in order to permit reporting of aggregate results. Customers can use survey program results to identify patterns such as staff/vendor performance, process improvement opportunities and employees’ overall satisfaction with all involved parties’ response to their needs.
Dr. Christian has piloted the disSatisfaction Survey with a regional workers’ comp carrier who felt it was very helpful. Although originally worried about what the results would show, they were gratified that satisfaction levels were HIGHER for the claims organization than for either the employer or medical provider. A number of claims with early trouble were identified and interventions were conducted. The client learned a lot during the pilot and changed several steps of their post injury process.
Author: Dr. Christian is a well-known strategic thinker and innovator in the field of workers’ compensation and injury care. For more information, contact Jennifer Christian, President of Webility Corporation at Jennifer.christian@webility.md
The current recession is the second longest in our country's history. Per the National Bureau of Economic Research (NBER), the recession started in December 2007. In April 2010 the NBER let an internal split become public, some of the economists wanted to call the recession over but others did not, they wanted more data. For everyone related to the workers’ comp field, the recession is still here.
The Insurance Journal reports the combined loss ratio for workers' compensation insurers for 2008 was 101. [That means for every $100 the insurance companies took in, they paid out $101]. In 2009 the combined loss ratio for workers’ comp insurers jumped nine points to 110. It is hard to stay in business when you spend $110 for every $100 you earn.
According to the National Council on Compensation Insurance (NCCI), 2009 was really not that bad. The combined loss ratio would have been 107 except for one large carrier adding $1 billion to its excess workers’ comp reserves. Still, for all the other workers’ comp carriers, spending on average $107 for every $100 taken in is not a good thing.
The NCCI also reported net written workers’ comp insurance premiums dropped by 23% from 2007 to 2009. The primary cause of the downturn in premiums was the downturn in the economy. Among the companies hit the hardest by the recession were the employers in the construction and manufacturing fields. Both of these fields have higher than average workers’ comp premiums.
As the workers’ comp premium calculation is based on payroll, a great way to reduce premiums is to lay off workers. [Of course if you take that approach too far, you go out of business!]. The impact of employers laying off workers was less premiums being paid to the workers’ comp insurers, At the same time the premium collection was being reduced, the existing workers’ comp claims being paid. Hopefully, the workers’ comp insurers have adequate reserves set up on each claim, but if one company is adding $1 billion to reserves…it makes you wonder.
Workers’ comp insurers with loss ratios in excess of 100 know how to correct the loss ratio — they raise the workers’ comp premiums they charge to employers. However, they have to remain competitive in order to keep existing business and hopefully obtain new business.
The employers on the other hand should see some positive impacts on workers’ comp besides lower premiums due to fewer employees. The employees who are still employed tend to be the more experienced employees who have fewer accidents and injuries then less experienced employees. This results in the experience modification factor improving over time, resulting in a lower workers’ comp premium in the future.
The biggest impact of the recession on workers’ comp may be the psychological impact it has on employees. There are well-documented spikes in the number of workers’ comp claims for employers who close a factory or make other wholesale personnel reductions. Unscrupulous employees, believing they are about to be terminated, prefer the two-thirds of their average weekly wage from workers’ comp over the one-third of their average weekly wage from unemployment insurance (both workers’ comp indemnity benefits and unemployment insurance benefits vary by state).
Old injuries not a bother to the employee for years suddenly take a severe turn for the worse the week before the lay-off. Or, the employee who rarely works alone was working alone and strained his back the day before the lay-off. Or, the employee reports she was hurt months ago, and tried to tough it out, but can no longer stand the pain, and needs to go to the doctor now. Lay-offs are a challenge for the workers’ comp claims office as the claims come in a bunch and all the claims need to be investigated at the same time.
The flip side to workers’ comp fraud is the recession also spawns a drop in workers’ comp claims. There are the employees who have a legitimate workers’ comp injury, but in their effort to 'stay in good with the boss,' don't report their claim for fear it will move them closer to the top of the layoff list.
Another psychological impact is on the employees with an obvious injury and must report their claims. They do so reluctantly. These employees, who might have taken a few days off when they got hurt, decide they do not want to do anything to jeopardize their job. They chose to be at work when they could legitimately stay home. What would have been a workers’ comp indemnity claim becomes a workers’ comp medical only claim.
Of course there are also the employees who were truly injured and were out on disability benefits before a factory closing or layoff was announced. The psychological impact on them is a reluctancy to recover from their injury, as they know once they return to work, they will be terminated for lack of work. They are aware of the recession and are very concerned they will not be able to find another job.
The psychological impact also works the opposite way for the employee out on disability benefits. If they are not concerned about being terminated as soon as they return to work, they may try to convince their doctor they are ready and able to return to work. They fear if they stay out of work too long, it could cost them their job. (workersxzcompxzkit)
Hopefully when the National Bureau of Economic Research gives their next assessment all the economists will be in agreement that the recession is over. Even if the recession is over, it will take a while for the impact of the recession on workers’ comp to dissipate.
\Author Robert Elliott, J.D., Consultant/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 her: 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@ReduceYourWorkersComp.com
As the Risk Manager of your company you feel most of your claims are well handled by the third party administrator, but from time to get you get some nasty surprises in the way of huge jumps in the reserves or settlement request far above what you expected. It is normal to wonder what went wrong and why didn't anyone see this coming.
While you cannot eliminate every nasty surprise, if your workers' compensation claims coordinator and your designated adjuster/dedicated adjusters are conscientious about their work, they can recognize most potentially bad claims before they become a nasty surprise. With nearly 100 years of workers’ comp claim history, adjusters should recognize certain situations are like a storm on the horizon — trouble is brewing.
Some of the issues within the claim file where your workers’ comp claims coordinator and the adjuster must take immediate and highly aggressive action to control the claim include:
- A delay of more than two weeks between the date of injury and the date the injury is reported to the employer. This can be a claim where the employee tried “to tough it out”, but often it is an injury that occurred away from work. A detailed recorded statement should be obtained from both the employee and the employee's supervisor in regards to the facts of the claim. A medical authorization should be obtained from the employee and medical records obtained from both the employee's personal doctor and the workers’ comp doctor. Both the claims coordinator and the adjuster need to closely scrutinize the medical reports before accepting this claim.
- A history of previous injuries to the same affected body part, especially spinal injuries. The employee may have re-injured himself while doing household chores or some other non-work related activity. A medical authorization, recorded statements and a review of the personal and workers’ comp medical history should be accomplished before accepting the claim.
- An injury that occurs the first day on the new job. It could be the new employee is a klutz or really, really unlucky. Most often, especially for musculoskeletal injury claims, the employee joined your company for the sole purpose of having someone to pay for the medical care she already needed. Again, a detailed investigation into the facts and the medical history of the employee is required.
- The employee is unhappy with the medical care provided by the doctor(s) and keeps changing doctors. Doctor shopping is almost always either (a) an effort to find a doctor who will keep the employee off work, or (b) an effort to find a doctor who will prescribe the pain medications the employee wants. Either way an aggressive early return to work program is necessary. The employer and the adjuster need to be talking to whoever the current doctor is and describing the light duty job(s) available to the employee. Also, if needed, a nurse case manager should be assigned to control the medications being prescribed.
- The employee early in the claim — before the doctor has placed him/her at maximum medical improvement –inquires as to what type of settlement s/he will receive. This is a red flag that should put both the adjuster and the employer on edge. It is a clear indicator the employee's interest is to maximize the settlement, not to recover and return to work. This is another situation where the adjuster and the employer should be working with the doctor to return the employee to a light duty job. Also, a nurse case manager should be involved in the medical care as the employee is probably magnifying his symptoms in an effort to maximize his settlement.
- The employee has a true, undisputed injury but begins to over utilize pain medications. The employee took one pain pill and it only helped some. He took two pain pills together and felt great. He took three pain pills together and experienced a trip he had never been on before. It is absolutely essential in a situation like this to have a nurse case manager to work with the treating doctors to make sure the employee is not duplicating his pain medications by using multiple doctors. The nurse case manager can also prevent the refill of prescriptions before the prior allotment should run out.
- The employee works in a state allowing her to select her own doctor and selects a doctor known to be “pro-plaintiff” or “pro-surgery.” This is a difficult one. The adjuster should place an aggressive nurse case manager on the claim right away. The nurse case manager should request a second opinion prior to any surgery. The adjuster should review the state statutes on when and how many independent medical examinations can be had, and use them judiciously. The adjuster, the employer, and the nurse case manager should be encouraging a modified duty or light duty return to work for the employee.
- The employee is within two years of the retirement age. The employee enjoys his time off work and begins to think this is what retirement will be like. The workers’ comp weekly indemnity benefit is greater than what the retirement pension and/or social security will pay. A light duty program is essential in a case like this. The nurse case manager can work with the doctor to get the employee released to return to work as quickly as possible. The sooner the older employee is back at work, the less likely the employee is to start comparing disability leave with retirement.
- The employee has recovered enough that the medical care amounts only to a once a month or less frequent visit to the doctor. This often happens when the adjuster has the file on a long diary and is not actively monitoring the claim. When the employee gets to the point of monthly visits, and is not already back at work, the adjuster should be inquiring with the doctor as to when the employee will be released to light duty or modified duty. If the doctor is reluctant to release the employee to return to work, the adjuster should inquire as to why. An independent medical examination may be needed to compel the employee to return to work if the treating doctor will not release the employee to work. (workersxzcompxzkit)
There other file situations the experienced adjuster should recognize and take steps to control before the claim gets out of hand. If your company has experienced more than its share of claims going bad, please contact us. We will be glad to arrange a file consultant to review your files and identify those that need extra attention before they get out of hand.
\
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 him: 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@ReduceYourWorkersComp.com
The number of employees who work some or all of their time from a home office is not new, but is growing rapidly.
Telecommunications have made such arrangements highly advantageous to both the employer and the employee but create an entirely new set of work comp problems.
The vast majority of employees who could perform much of their duties from home are in executive or specialized clerical capacities. Publishing houses have long had proofreaders and editors who do their best work from a home setting, often late at night or early in the morning. As long as contacts with customers or co-workers is minimal a home setting carries no great disadvantages.
Workers’ compensation problems, however, are insidious. First, only the employee and members of the immediate family are likely to be witnesses, which raises a host of problems in defending suspicious claims. Second, although a specific room may be designated as the “office” an accident occurring virtually anywhere could be considered covered.
Work files are not necessarily stored in a small office room. The attic, or the basement, are also appropriate. A person tripping anywhere in the home just might be, and certainly will be during testimony, going to or from the “office” to or from the file storage area.
Accidents outside the home also are easily linked to work activity. The post office is the weak link, since any trip during most days could be said to be going to or from the post office with a work related letter, even if the rest of the trip is for groceries or mall shopping.
New York compensation lawyers recognized this long ago and the prudent always had a box of files in their cars to make every trip in some way work related.
Travel to and from a business meeting, if it originates from a home office, is “door to door” work related. The usual exclusions for travel to a business address do not apply to “outside” workers, which a worker is considered when the home is often the site of work.
The advantages of telecommuting appear to outweigh the workers’ comp disadvantages. Reducing co-worker contacts virtually eliminates “stress” claims, almost always the result of personality friction. Work from home greatly increases the time available for personal errands and recreation by eliminating the time and cost of commuting – a most significant advantage in a megalopolis setting – and therefore makes for a happy workforce.
A major disadvantage, which employers should anticipate, is the tendency for carrier defense counsel to litigate every claim where the injury has any chance of being described as “unwitnessed” or part of a “personal” activity.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers' compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
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@ReduceYourWorkersComp.com
Entitlement to benefits can vary, depending upon one's status as fully or only partially dependent. There is some variation among the states as to what date controls-the date of the accident or the date of death. Larson’s Workers’ Compensation Law: Chapter 98, which discusses the dependent's right to death benefits as an independent right derived from statute, is being revised and updated for the June 2010 release.
In one recent case from Arkansas, Estate of Slaughter v. City of Hampton Mun. League WC Trust, 102 Ark. App. 373, 285 S.W.3d 669, review denied, 2008 Ark. LEXIS 786 (2008), the executrix and employee were not married at the time of the compensable injury. They were, however, living together, and the executrix was dependent on the employee. Shortly before the employee died, he and the executrix were married. The Commission denied widow's benefits to the executrix because she was not married to the employee when he suffered his injury. The executrix argued that the mere fact that she was married to and wholly dependent on the employee for her support when he died entitled her to widow's benefits. (workersxzcompxzkit)
Construing Ark. Code Ann. § 11-9-527, the appellate court held that the executrix did not need to prove that she was legally married to the employee when the injury occurred; she was required, however, to prove (a) that she was a widow and (b) that she was dependent on him at the time of the injury. The court indicated that since the Commission failed to make any finding regarding whether the executrix was actually and wholly dependent on the employee when he died, the matter had to be remanded [See Larson’s Workers’ Compensation Law: Ch. 98, § 98.05[3] n7].
© Copyright 2010 LexisNexis. All rights reserved. This material is excerpted from Larson’s Workers’ Compensation Law. Reprinted with permission.
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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
This past week there was a report in the news of seven workers who were hospitalized in Louisiana for vomiting, nausea and headaches after working on a boat trying to contain the Gulf of Mexico oil spill. While all seven workers were released from the hospital, government officials pulled 125 boats from the area where the seven people had been working until an assessment of the safety of the situation could be completed.
A spokesman for British Petroleum (BP) stated they were providing protective equipment to the workers. Boots, hardhats, protective glasses and protective suits were being provided to the workers when needed. BP was also running air quality test and checking for irritant exposures.
One news account indicated the sick workers would be covered by workers' compensation. Not exactly. The Louisiana workers' compensation statutes do not apply to injured workers who are on a boat (“vessel”) working in the Gulf of Mexico. These injured boat workers or any seaman would be covered by a federal law known as the Jones Act.
Coverage under the Jones Act covers “vessels” which can include:
1. ships
2. boats
3. barges
5. helicopters (transporting seamen to or from an offshore vessel)
6. offshore oil rigs (the workers who were injured or killed when the BP oil rig exploded will be covered under the Jones Act)
A seaman is defined as any one employed on a vessel but excludes scientific personnel, sailing school instructors and sailing school students.
The Jones Act limits the time to bring a claim to three years from the date of the accident. The seaman must be a United States citizen or a permanent resident alien. While the Jones Act covered the workers on the BP offshore oil rig when it exploded, the Jones Act excludes the BP employees who did the drilling, mapping, surveying, diving, pipe-laying, maintaining, repairing and constructing of the oil rig before it was put into service.
The Jones Act resembles workers' compensation in that it pays for both medical care and some indemnity benefits while the employee recovers from his injury or occupational illness. It differs significantly from work comp by not being an exclusive remedy for work related injuries or illnesses.
The seven injured boat workers, regardless of who is at fault for their illness, have the legal right to what is referred to in the Jones Act as “maintenance and cure”– indemnity and medical benefits. “Maintenance” is not the 66% of the average weekly wage workers in most states received. It is a “daily living allowance” paid on a weekly basis. Of course when bureaucrats and congressmen write laws they forget to define terms like what a daily living allowance is.
“Maintenance” was originally intended to cover the cost of room and board while the seaman was ashore recovering from his injury. For a long time employers would pay as little as $10 to $40 per day and some employers still try to pay that amount. This has resulted in the courts getting involved and broadening the definition of maintenance to include the actual cost of basic necessities including rent, utilities, transportation cost and food. Employers and seamen still get into disagreements as to what the “maintenance” amount should be resulting in a bonanza for attorneys.
“Cure” is the requirement that the employer pay for all necessary medical care for the seaman including physician services, hospitalization, rehabilitation services and related medical expense until the seaman reaches maximum medical improvement.
Under the Jones Act the obligation to provide “maintenance and cure” ends when the seaman reaches maximum medical improvement. There is no obligation on the employer to pay for permanent partial disability, or permanent total disability, or vocational rehabilitation even if the seaman is unable to return to work. However, under the Jones Act, the injured seaman can file suit for past and future lost wages, disability indemnification, vocational rehabilitation, and pain and suffering.
If the seaman elects to file suit against the boat owner, the handling of the claim under the Jones Act is much more like the handling of a liability claim than it is like the handling of a workers’ comp claim. For the injured seaman to prevail in his lawsuit, he must be able to show either negligence on the part of the employer or be able to show the vessel was unseaworthy.
This is the key difference between work comp claims and Jones Act claims. If the employee/seaman is negligent and responsible for his own injuries, the employee is unable to recover from the employer. Of course a good plaintiff lawyer will not let a little thing like a lack of negligence stop him from filing a lawsuit. The way around the employer's defense of “no negligence” is to claim the vessel was unseaworthy.
For a vessel to be seaworthy it has to be reasonably fit for it intended use (shrimp boats are probably not seaworthy as their intended use is not to clean up oil spills). The seaworthy vessel must have the appropriate equipment and safety gear, have a competent crew and be a safe place to work. The plaintiff lawyers will claim any of the following as reasons a vessel is not seaworthy:
1. Improper design of the vessel
2. Improper construction of the vessel
3. Improper maintenance of the vessel
4. Lack of elevators and proper lifting equipment
5. Worn out ropes or lines
6. Any mechanical malfunction
7. Slippery decks and stairways
8. Hatches, portholes or doors that do not fit
9. Worn cranes, winches, pulleys or hoists
The clean up of the gulf oil spill will produce a lot more Jones Act claims before the clean up is complete. It will also produce a lot of state workers' compensation claims and Longshoremen and Harbor Workers Act claims for the workers who are working on the shore cleaning up the oil spill. (workersxzcompxzkit)
Any employer who may be involved in any way in the oil spill clean up process needs to review with their broker their insurance coverage. The employers may need Jones Act coverage, state work comp coverage or Longshoremen and Harbor Workers Act coverage, or a combination of two types of coverage, or all three types of coverage to protect themselves from claims an injured employee could bring.
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 him: 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@ReduceYourWorkersComp.com
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