To study the air workers in auto repair shops breathe, analysts with the SHARP Program, the research group at Washington State’s Department of Labor & Industries, bought a hunting vest and stuffed it with measuring devices, including several filters and three different air pumps.
To show truckers the stress their bodies endure when they jump from the cab of their big rigs, the researchers created a virtual simulation of a ghostly image leaping from several different parts of a truck and placed it on the trucking safety web site. (www.keeptruckingsafe.org)
And when the SHARP team learns of a workplace death, they don’t just add it to their statistics, but they dispatch researchers to the site of the fatality to interview co-workers and employers, examine equipment and try to draw lessons from the tragedy, detailing their findings in reports presented on their web site.(www.Lni.wa.gov/safety/research)
Gathering data, studying the causes behind workplace injuries and deaths, and disseminating information is what the SHARP Program has done now for 20 years. (WCxKitz)
SHARP is an acronym for Safety & Health Assessment & Research for Prevention. SHARP researchers, include epidemiologists, industrial hygienists, safety engineers, toxicologists, ergonomists and experts from other scientific disciplines, who are credited with identifying a host of workplace hazards and offering recommendations to improve workplace safety and health.
“Since its creation, SHARP has proven invaluable in identifying workplace hazards and offering effective solutions having a profound effect on the lives of workers,” said L&I Director Judy Schurke. “The work SHARP researchers produce is renowned, not just in Washington State but both nationally and internationally, for setting the standard in occupational health research. Over the years, this team has opened the eyes of many in a variety of industries.”
Researchers at SHARP have studied everything from construction and trucking to furniture production and agriculture. Their reports have delved into nail-gun injuries, falls from stilts, and lead hazards from firearm firing ranges. Their recommendations have led to new workplace safety rules in Washington State on workplace violence and outdoor heat exposure and a host of other safety and health recommendations. (WCxKitz)
“I am very proud of the innovative work and dedication of the SHARP research team members,” added SHARP research director Barbara Silverstein. “SHARP researchers may move on to other areas, but all of them remain dedicated to the improvement of workplace safety.”
©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 MOST IMPORTANT PART of the initial handling of a workers’ compensation claim is the contacts with the parties involved in the claim. The contacts are often referred to as “three point contacts” which refers to the three principal players the adjuster is involved with in every workers’ comp claim. The three principals are the employee, the employer and the medical provider.
In order to have successful handling of a workers’ comp claim, it needs to be investigated both timely and thoroughly. The contact with the injured employee, the employee's supervisor and the employer's claims coordinator, and the medical provider all provide valuable information to the adjuster in the handling of the workers’ comp claim. Each of the contacts, if properly managed, allows the adjuster to maintain control of the developing claim. (WCxKitz)
Definition of Contact
A recent audit of a claims office found the definition of “contact” was not spelled out in the claims handling requirements or the company's Best Practices. The workers’ comp adjusters were sending form letters to the employer and the employee saying “call me” on the day they received the assignment. Their supervisor was accepting the form letters as contact with the employer and employee. The adjusters and supervisor were bending the meaning of contact to their own purposes and not making proper three-point contact.
Three point contacts are always be handled by telephone, except in severe cases where an in person contact would be justified. With most adults having cell phones and/or home telephones, there is no reason for not making voice contact. If the principals cannot be reached by telephone, a contact letter should be sent while continuing the effort to reach the principals by telephone.
The insurers who have quality Best Practices consider voice contact as “the exchange of information between the principals and the adjusters.” Leaving a message on the employer's voice mail or a message on the employee's home answering machine is not considered contact in the true meaning of three-point contact.(WCxKitz)
Timeliness of Three Point Contact
Each workers' compensation insurer and each third party administrator (TPA) has set their own time frames as to when three-point contact should be completed. Some insurers are requiring their adjusters or TPA to make three-point contact within 2 hours or 4 hours of the time of the accident. Other insurers and TPAs are being less stringent and requiring the three-point contacts to be completed within 24 hours or 48 hours of the time of the assignment.
Workers’ comp adjusters prefer the 48-hour goal of making three point contacts as that is a relatively easy goal to make. Various studies however have shown that immediate (same day) contact has the most positive influence on the outcome of a case.
While the goal of the adjuster should be to make the three-point contacts the same day as the assignment is received, in reality the other parties to the claim may not be available. Persistence is an absolute must for the adjuster. If the adjuster has left a voice mail for the employer, employee or medical provider's office, the adjuster should call again if the other party has not responded by the end of the workday. The persistent adjuster will leave at least two voice mails the day the assignment is received and will follow up with a contact letter if a response is not received. The adjuster should continue to try daily to reach each of the principals of the claim until voice contact is made with them.(WCxKitz)
Employer Contact
Upon receipt of the new assignment, the workers’ comp adjuster immediately verifies coverage for the insured/employer. If there are no coverage issues or questions, the adjuster's next step is to make contact with the employer.
The purpose of the employer contact is several fold. The Employer's First Report of Injury has essential information the adjuster needs, but normally does not contain all the information that would be of value to the adjuster in accessing the claim. By discussing the accident with the employer's claim coordinator, the adjuster can learn additional information that may be helpful in the development and handling of the claim. Some of the information the workers’ comp adjuster can obtain from the claims coordinator includes
1. Prior claim history of the employee
2. Verification of the facts on the Employer's First Report of Injury
3. The return to work status or the disability status of the employee
4. Description of job duties
5. Availability of modified duty or light duty work
6. Length of employment
7. Identification of employee's supervisor and witnesses to the accident
8. Subrogation potential
If there are any questions about the circumstances of how the claim happened or any issue of any kind, the adjuster will need to also interview the employee's supervisor about the workers’ comp claim. A recorded statement from the supervisor may be necessary if the facts of the claims are questionable, if the claim appears to be severe, or if there is the potential for subrogation.
If there are still questions about the claim after the adjuster has spoken to the employer's claims coordinator and the employee's supervisor, the adjuster should also interview any witnesses to the accident.
Employee Contact
The adjuster'sprompt contact with the employee will build rapport and assist in establishing a non-adversarial working relationship with the employee. When the adjuster establishes early contact with the injured employee, the probability of future attorney involvement is decreased. The adjuster is also in a better position to identify any compensability issues and to make timely payment of benefits, both medical and indemnity. If the claim is severe, the early contact with the employee will allow for immediate medical management.
When the adjuster makes the initial contact with the employee, the adjuster should consider a recorded statement if the accident is severe or there is potential for subrogation. Also the adjuster should consider a recorded statement if there has already been inappropriate medical treatment or excessive medical treatment, if there is pre-existing condition, if the claim is for a serious occupational disease, if there were other employees injured in the same accident or if there any question of compensability. Whether the interview is recorded or not, the initial conversation with the employee should cover:
1. The facts of the accident
2. The identity of any witnesses
3. A description of the employee's job, including job title, job requirements, equipment utilized, etc.– (this will assist the adjuster in arranging for an early return to work on modified duty or light duty)
4. The details of the injury and the medical provider's proposed treatment plan. This should include the medical provider's diagnosis and prognosis, the employee's comments about pain, medications, prior injuries, treatment issues, etc.(WCxKitz)
5. The employee's attitude about the employer, the accident, the medical treatment, the willingness to return to work, etc.
The adjuster, during the initial contact with the employee, should advise the employee of all state required forms that will be sent to the employee and in those states that require a medical authorization, advise the employee of the importance of signing and returning the medical authorization immediately. The adjuster should request a copy of any off-work notes from the medical provider. The adjuster should also advise the employee of the actions the adjuster will be taking and encourage the employee to contact the adjuster with any questions, issues or problems.
Medical Provider Contact
The medical provider whether an occupational injury doctor, a hospital emergency room or a walk-in clinic, should be contacted by the adjuster as part of the three-point contact. The adjuster purpose in contacting the medical provider's office is to obtain the necessary information to determine the process the claim. They would include:
1. The diagnosis
2. The prognosis
3. The estimated length of time before the employee can return to either light duty or full duty work
4. The date(s) of the next medical appointment(s)
5. Information on any referral to another medical specialist
The adjuster should advise the medical provider to send to the adjuster the complete medical records including the medical history provided by the employee, the doctor's notes, the results of any testing and a copy of any off work slips provided to the employee. (WCxKitz)
Summary
The importance of three-point contact cannot be overstated. Getting the claim file off to a proper start has a major impact on the course of the claim and the adjuster's ability to handle the claim fully and properly. By completing a timely and a thorough three-point contact, the adjuster sets the tone for the outcome of the claim.
Author Rebecca Shafer, Consultant/ Attorney, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, 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.LowerWC.com/workers-comp-books-manuals.php
WC Calculator: http://www.LowerWC.com/calculator.php
TD Calculator: http://www.LowerWC.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
A dramatic drop is seen in workers killed (3) at work in Great Britain’s North East between April 1, 2009 and March 31, 2010, compared to an average of 8 work-related deaths in the past five years in the region, and 9 fatal injuries in 2008/09 according to new figures released by the Health and Safety Executive (HSE).
Across Britain, the number of people killed at work has fallen to a new record low with 151 workers dying at work in 2009/10 – down 15% on the previous lowest total of 178 in the year before.
The North East's top health and safety official, Pam Waldron, Head of Operations, noted, "It is heartening to see such a reduction in the number of work-related deaths across the North East, but it is still unacceptable three people failed to return home from work last year. (WCxKitz)
"Many of these deaths could have been avoided if simple and sensible precautions had been in place, and if workers were more involved in devising the solutions to reduce risks.
"We will continue to promote a sensible approach to health and safety and take action to improve standards of risk management in the workplace."
According to Judith Hackitt, the HSE chair, "It's really very encouraging to see a further fall in workplace fatalities in the past year. This is performance which owes much to good practice, leadership and employee engagement. No doubt the recession has resulted in lower levels of activity in some sectors and a decrease in the numbers of new inexperienced recruits has also contributed to this fall in fatalities.
"Being one of the best health and safety performers in the world means continuing to strive to drive these numbers down further – not getting complacent about what we've collectively achieved and recognizing the new challenges as we emerge from the recession.
"As with all health and safety statistics, today's announcement is a combination of encouraging news about improvement but also a salutary reminder of the tragedies of lives lost at work."
©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 workers' comp coordinator for a multi-site organization, your responsibility is to ensure all sites are coming into compliance with the workers' comp management program. If you have work sites all over the map, your workers' comp management program will be largely dictated by various state statutes. And, of course, each worksite has its own personality and culture. The workers' bring different skill sets, educational levels, attitudes toward work, and even different languages. English may or may not be the first language.
As different as each of your worksites is, the good news is workers' comp management cost drivers never change (well, almost…). The same interrelated ten factors come into play when a person is injured on the job although as technology changes the tactics to use during implementation may change. Among them are communication strategies, establishing and meeting performance goals, and the level of management commitment to bringing injured employees back to work in a timely fashion.
The degree one cost factor or another is being implemented may change. For example, one worksite may have good alignment with your insurer, but a poor post-injury response program. Another worksite may have a great post-injury response program, a great communication program, but their medical care program is still uncoordinated and could use some reining in. But you can find the presence of all workers' comp management factors in play and impacting your bottom line for better or worse. But you're never going to know this until you conduct a uniform assessment straight across each of your work sites.
Uniform Multi-Site Assessment
Regardless of multi site variables, all work sites must be measured using the same yard stick to ensure valid measurements. Assessing workers' comp cost factors involves gathering the same information about a worksite's performance in the ten key cost drivers. Then and only then can you plot the numerical scores to determine which work sites score high or low in which areas of workers' comp management.
Now you have the nucleus of a master action plan. You can see where the strengths and weaknesses of each site are. Plot your action plan along a time line beginning with researching recommendations, and bringing these to a kick off meeting where you have invited the decision makers from each site to come on board.
Together, working from the master action plan, develop constituent action plans for each work site that, when achieved, will tie into the goals of the master plan. With the backing of senior management, you can spearhead an initiative to bring the worksites into alignment. (workersxzcompxzkit)
Everything begins and ends with the assessment. After six months or a year passes, re-assess using the same comprehensive yardstick. Your scores will tell you how far the units have progressed and what areas still need work. Then you can develop an action plan for Phase Two and so on, until you have a uniform workers' comp management plan up and running for every worksite.
Author Rebecca Shafer, Attorney/Risk 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: 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
Larson’s Workers’ Compensation Law, Chapter 9, which discusses the general rule that Injuries arising out of risks or conditions personal to the claimant do not arise out of the employment unless the employment contributes to the risk or aggravates the injury, has been revised.
A recent Iowa decision, Benco Mfg. v. Albertsen, 2009 Iowa App. LEXIS 72 ((Iowa Ct. App. Feb 4, 2009), illustrates several of the issues involved in these sorts of cases. In Albertson, the employee had first walked to the employer's cafeteria to get a cappuccino and then walked toward the employer's restroom. After she opened the restroom door she fell backward, striking her head on a concrete wall screening the restroom from the work area. Acknowledging that the state did not follow the positional risk rule, the Iowa court nevertheless approved an award of benefits, finding that the employment conditions-specifically, (WCxKitz) the concrete wall-increased the severity of the employee's idiopathic injuries. The claim was, therefore, compensable. See Larson’s Workers’ Compensation Law, Ch. 9, § 9.01[2][] n.14.1
Decisions in these cases are extremely fact-dependent. Thus, in a Kentucky case, Vacuum Depositing, Inc. v. Dever, 2009 Ky. LEXIS 150 (June 25, 2009), the court determined that the employee's fall was caused by her two-inch high heels and clumsiness, not by a condition of the employment.
Similarly, in a Maryland case, Youngblud v. Fallston Supply Co., 180 Md. App. 389, 951 A.2d 118, writ denied, 406 Md. 114, 956 A.2d 203 (2008), the employee, an insulin-dependent diabetic, was denied workers' (WCxKitz) compensation benefits after he fell down the stairs at work. The court held that the fall was likely due to a hypoglycemic attack and was not brought about by a hazard of the employment.
© Copyright 2010 LexisNexis. All rights reserved. This material is excerpted from Larson’s Workers’ Compensation Law. Reprinted with permission. See LexisNexisStoreCatalog
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.LowerWC.com/workers-comp-books-manuals.php
WC Calculator: http://www.LowerWC.com/calculator.php
TD Calculator: http://www.LowerWC.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
A business owner was arrested for failing to provide workers’ compensation insurance for an employee who was raped and murdered in 2007 according to an investigation by the New York State Insurance Department’s Frauds Bureau and the Workers’ Compensation Board Office of the Inspector General.
The man is accused of failing to insure the woman whom he employed as a property manager when she was killed. He is also accused of lying by testifying at a Board hearing saying the worker did not work for him. He could be sentenced to up to seven years in prison if he is convicted. (WCxKitz)
Authorities learned the individual failed to carry insurance when the deceased employee’s estate filed a death benefit claim with the Workers’ Compensation Board. The Board paid the woman’s estate $50,000, an amount the man reimbursed to the Board earlier this year. The money was paid from the Board’s Uninsured Employers’ Fund, which pays claims for people whose employers neglect to carry workers’ comp insurance.
In addition, the employer paid $5,000 for the woman’s funeral and another $6,000 in penalties to the Board for failing to carry insurance. (WCxKitz) He also has an outstanding $30,000 penalty for operating without insurance this year. He is disputing the penalty, saying he doesn’t have any employees.
©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
One of the largest apple producers in the United States has been placed under a temporary restraining order (TRO) filed by the U.S. Equal Employment Opportunity Commission (EEOC).
The federal agency was motivated by the immediate danger of “substantial and irreparable injury” to class members and potential witnesses in the EEOC’s sexual harassment suit against Cowiche, Wash.-based Evans Fruit Company, filed at the same time as the agency’s TRO request.
U.S. District Court Judge Lonny Suko ordered the company and all its agents to stop all retaliatory activity against those involved and those who may become involved in the lawsuit. Under the terms of the TRO, Evans Fruit supervisors — including Juan Marin, Alberto “Camello” Sanchez, and Simon Ramirez — must avoid further contact with class members and potential witnesses. They must immediately cease any attempts to intimidate or tamper with current or potential witnesses, such as paying to influence testimony. (WCxKitz)
The EEOC filed suit on behalf of three individuals and a class of women, alleging sexual harassment by the ranch manager and crew leaders at the grower’s Sunnyside ranch.
According to the agency’s investigation, these supervisors often singled out women for sexual advances, with work assignments that isolated them from friends and family members. The women were forced to quit, the EEOC charged, in order to get away from the ongoing sexual comments, propositioning and physical groping.
One of the workers who filed charges with the EEOC described how the ranch manager refused to let her work on the same crew as her 15-year-old daughter, whom he then targeted with unwelcome verbal and physical sexual attention. She said, “My daughter was just a child. That man should not have been touching her or whispering in her ear. There weren’t any other jobs in town, but we could not work there any longer. I do not want what happened to my daughter to happen to anyone else.” (WCxKitz)
EEOC Regional Attorney William Tamayo said, “Filing for a temporary restraining order is not a common action for us. But in this case, we saw an urgent need to do all in our power to protect the farm workers who participate in this case. We hope this lawsuit and the power of the court’s restraining order will encourage workers to be able to step forward with information about the discrimination with the knowledge that the law protects them and their jobs.”
“Our investigation revealed sexual harassment at Evans Fruit was so widespread and accepted that it became a condition of employment for these women,” said Luis Lucero, director of the EEOC’s Seattle Field Office. “The EEOC has filed and resolved similar lawsuits in the Pacific Northwest last year. We hope this case will alert employers in this industry to stop predatory sexual behavior and abuses of supervisory power.”
Last June, EEOC filed a lawsuit against Willamette Tree Wholesale Inc. located in Molalla, Ore., alleging that Latina workers there were sexually harassed, threatened, and in one case, repeatedly raped. In October, EEOC sued Eastern Washington winery La Pianta L.C.C., which does business as Frenchman Hills Vineyard, on behalf of a Latina worker targeted for escalating sexual attention by the vineyard manager at its facility in Othello, Wash. (WCxKitz)
In the fall of 2009, EEOC resolved two separate sexual harassment and retaliation suits: Wilcox Farms, which operates dairy and egg production facilities in Oregon and Washington, agreed to pay $260,000 to a female worker at its Aurora, Ore., facility, and Schiemer Farms of Nyassa, Ore., paid $14,500 to two farm worker women who alleged being fired immediately after reporting sexual harassment on their first day of work.
©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
If you are like me, you were never quite sure what durable medical equipment was …
“Durable Medical Equipment” is Medicare and Social Security terminology adopted into the workers' compensation vocabulary of most states. According to Medicare, durable medical equipment must be necessary on the basis of the individual's medical and physical condition, be used in the injured employee's home* (home includes a long-term medical institution) and be reusable. If it is not reusable, it is not considered durable medical equipment (with a few exceptions).
For this discussion, we will look at durable medical equipment and its use in workers' compensation. To better understand what qualifies as durable medical equipment, the following are some examples:
*However, be aware, Medicare is disinclined to pay for these items if it’s the intent of the user to use these items primarily to take a spin around the mall, i.e., outside usage. Albeit, if usage is primarily for the home, then the item certainly can be used outside the home also.
- Transcutaneous electronic nerve stimulators (TENS units)
- Prosthetics and orthotics
- Iron lungs
- Oxygen tents, oxygen tanks and other breathing apparatuses
- Ventilators
- Hospital beds (WCxKitz)
- Air beds or air fluidized beds
- Wheelchairs, whether motorized or not, including power chairs and scooters
- Crutches, canes and walkers
- Nebulizers
- Infusion pumps (and some of the medicines used in them
- Suction pumps
- Continuous positive airway pressure machines
- Blood-glucose monitors (and the strips used in them)
- Chair lifts
- Patient lifts
- Commode chairs
Any medical equipment the employee would use repeatedly in the home because of medical necessity would be considered durable medical equipment.
Medical supplies like disposable gloves, bandages, gauze, catheters, needles and irrigating kits which can be used at home are not considered durable medical equipment as they are designed for one time use.
Before approving any durable medical equipment, the workers’ comp adjuster should ask themselves:
1. Is the equipment customarily used to serve a medical need?
2. Can the equipment be used correctly in the home? (WCxKitz)
3. Would the equipment be necessary if the employee was not injured?
Depending on the answers to these questions, the adjuster will accept or deny payment for durable medical equipment.
In some liberal workers’ comp jurisdictions, the term durable medical equipment has been expanded to include:
- Hot tubs
- Spas
- Whirlpools
- Swimming pools
- Exercise equipment
- Household recliner chairs
- Hearing aids
- Air conditioners
- Dehumidifiers
We recommend a knowledgeable workers' compensation defense attorney in your state be consulted before accepting any request for these items to be paid for by workers' compensation insurance.
When the medical provider recommends durable medical equipment, the nurse case manager (NCM) or the workers’ comp adjuster if there is no NCM, needs to review the medical diagnosis and the medical prognosis to ascertain the medical necessity for the durable medical equipment. The durable medical equipment must be considered reasonable and must be needed for the injured employee for specialized use in the employee's home or long-term care institution. (WCxKitz)
The question is sometimes asked by new workers’ comp adjusters as to how to classify durable medical equipment—should it be paid from the medical reserve or should it be paid from the expense reserve. Most insurers and third party administrators will pay for durable medical equipment from the medical reserves, as the purpose of the durable medical equipment is to provide for the medical needs of the employee.
If the need for the equipment will be short-term, the durable medical equipment should be rented or leased. If the need for the equipment will be long-term, an analysis of the rental cost versus the purchase cost should be completed to determine the best option. (WCxKitz)
Fortunately, durable medical equipment is not needed on most workers’ comp claims. When it is needed,
there are various companies specializing in providing durable medical equipment. If the equipment is necessary to assist the employee during their recovery from the accident, the adjuster should verify its necessity and determine whether it is better to rent or buy the equipment for the injured employee.
Author Rebecca Shafer, J.D./ Amaxx, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, 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.LowerWC.com/workers-comp-books-manuals.php
WC Calculator: http://www.LowerWC.com/calculator.php
TD Calculator: http://www.LowerWC.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
It is unknown by many that some private employers have to buy federal workers' compensation insurance coverage for their employees. Approximately 500,000 employees in the United States are excluded from coverage under state statutes as these employees are covered under a federal statute, the Longshore and Harbor Workers' Compensation Act (LHWCA).
However, workers' compensation insurance carriers are very aware of this market and some 400 plus work comp insurers offer coverage. In addition to these 400+/- insurance carriers, there are approximately 200 large companies self-insuring for coverage required by the LHWCA.
LHWCA coverage requirements are very broad and do not only apply to the stevedores loading/unloading ships. Coverage is required of employers emploing workers for maritime work or in a maritime profession on the navigable waters of the United States and in adjoining waterfront areas. These employers could include:
1. commercial ports
2. ship builders
3. barge builders
4. ship repairers
5. ship breakers
6. dock workers other than stevedores
7. barge loading facilities of products such as coal, grain, gravel, sand
An oddity of the LHWCA is employers also must buy a second state workers' compensation insurance policy to cover workers excluded from coverage under the LHWCA. The excluded workers would include:
1. workers who build, repair or dismantle recreational vessels under 65' in length
2. the master or member of any vessel crew
3. workers who load or unload or repair any vessel under 18 tons
4. office clerical or secretarial
5. security guards
6. data processors
7. club, camp or recreational workers on a navigable water way
8. restaurant workers
9. retail outlet employees
10. museum workers
11. marina workers who are not engaged in construction, replacement or expansion
12. workers who are temporarily doing business on the premise of a maritime employer
13. aquaculture workers
When an employee is injured while working for an employer covered under the LHWCA all medical cost are paid by the LHWCA insurer. The employee can select any physician to treat the injury, as long as the physician is pre-approved by the office of the Secretary of the U.S. Department of Labor.
The weekly benefit for temporary total disability and permanent total disability is two-thirds of the employee's average weekly wage. The indemnity benefits under the LHWCA have a very high maximum weekly amount of $1,224.66. The employee has to be making in excess of $95,000 per year to max out on the weekly benefit. The weekly benefit is adjusted each fiscal year by the Department of Labor.
An ESSENTIAL RTW Program
An odd thing occurs when the weekly indemnity benefit is $1,200+ a week. The work comp indemnity benefit is often higher than the net pay the employee took home including all the deductions from the paycheck for federal income tax, state and local income tax, social security tax, Medicare tax, medical benefits, 401k contributions and union dues (most stevedores are union members).
When the employee's work comp check is bigger than the paycheck, it is often difficult to get the employee back to work. No surprise there! It is essential for the employer to have a light duty return-to-work program, with the adjuster and the employer working with the treating physician to get the employee back to work.
The LHWCA requires a 3 day waiting period before indemnity benefits start. If the employee is off work more than 14 days, the initial 3 day waiting period for benefits is paid retroactively.
The LHWCA has a permanent partial disability schedule for loss of body parts—finger, hand, arm, toe, foot, leg, sight and hearing. Permanent partial disability for non-scheduled body parts is based on two-thirds of the average weekly wage or the loss of wage earning capacity.
Death benefits are also provided under the LHWCA including reasonable funeral expenses up to a maximum of $3,000. The death benefit is paid to the spouse or other eligible survivors. The spouse receives 50% of the average weekly wage for life or until remarriage occurs If there are dependent children, they share 16.66% of the average weekly wage, until they are 18 years old or 23 years old if enrolled in higher education.
Vocational rehabilitation is also provided under the LHWCA. If an employee is unable to return to prior employment, the worker may be eligible for retraining and job placement. The vocational rehabilitation expense is paid for by the U.S. Department of Labor, not by the work comp insurer. (workersxzcompxzkit)
If an employer has anything to do with maritime work or has facilities on or adjacent to navigable water, consult with your insurance broker to see if you need to have the federal workers’ compensation coverage required by the LHWCA.
Author Rebecca Shafer, Risk Consultant / Attorney, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. She serves on the Executive Committee of Lexis Nexis Workers' Compensation Law Center. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
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Questions and Answers from Dr. Jacob Lazarovic, Chief Medical Officer at Broadspire about urine testing program done in conjunction with prescription of controlled substances.
Recently, there has been a growing concern about the significant misuse, abuse and diversion risk associated with the prescribing of controlled substances. A national study found that 71% of workers’ compensation claimants on chronic opioid therapy (>3 months) aren’t taking their pain medication as prescribed1. Dr. Jake and his medical management team have worked on creating a urine drug monitoring (UDM) program and Dr. Jake has answered questions on the subject.
1Bulletin to Management, 12/5/2002, BNA Professional Information Center
Q: How do you identify workers who need urine drug monitoring?
We mine our data and flag those claims with chronic opioids, excessive pain management/addictive substances, high cost outliers, and several other criteria. Our claims professionals and senior nurse reviewers also single out appropriate claims for the program. We then confer with the providers to decide whether UDM should be recommended.
Q: What is the process for drug monitoring and who performs the tests?
After we identifiy the claimant for UDM, we send a request to our partner Ameritox and the provider. Only the treating doctor can order the test and the patient must agree to comply. The physician then collects the specimen and ships it to the lab. After the tests are complete, the lab sends a report to both the physician and the Broadspire team. If there are inconsistencies or concerns, our medical management team confers with the provider about resources and interventions available. The provider discusses the tests results and options with the employee. (WCxKitz)
Q: What resources help combat prescription drug abuse or misuse?
We have a gamut of services that can help depending on the case. Our telephonic or field case management may be appropriate to help educate an employee on proper prescription use. We have Chronic Pain Management where a panel of specialists creates full treatment plans to help employees deal with their pain. Our Narcotics Program can help manage opioid usage. Many of these options include psychological services such as behavioral therapy or addiction management available to employees.
From the BROADSPIRE REVIEW – June 2010. Printed with permission
Author: Withover 25 years of experience, Broadspire’s Chief Medical Officer, Dr. Jacob Lazarovic, is one of the most respected physicians in the workers’ compensation medical community. Contact at:
AskDrJake@choosebroadspire.com
©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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