An independent medical examination (IME) should be completed when an employee's recovery from an injury takes longer than normal, or when the employee is released from medical care, but receives a higher than expected disability rating by the treating physician. The IME documents the employee's medical condition. An IME also provides the insurance company or employer with an independent verification as to whether the employee's medical condition is or is not related to an on-the-job injury.
While most treating physicians are honest and reputable doctors, some treating physicians rely on referrals from plaintiff attorneys for the bulk of their business. These doctors have a tendency to overstate the employee's disability and permanency level. They know the attorneys who provide them with patients use their medical evaluations to obtain the highest possible settlement for their clients. Therefore, the independent medical examination documenting the medical status of the employee is essential to the fair settlement of the workers comp claim. (WCxKit)
If the employee has more than one aspect of his/her health in question, more than one IME is necessary. For instance, to evaluate properly the employees workers comp claim, it may be necessary to have IMEs done by an orthopedic surgeon, a neurologist and a physical rehabilitation specialist. Most states limit the number of IMEs to one, two or three in each area of medicine. While a few states allow the insurer as many IMEs as they want, the cost of an IME can quickly add to the overall claim cost. Therefore, use IMEs when needed, but do not abuse the process.
An IME should be performed by a doctor who specializes in the field of medicine routinely treating the type of injury the employee has incurred. The IME doctor should not have been previously involved in the employee's medical care either for the injury in question or for any other medical care. An IME does not create a doctor-patient relationship.
The purpose of an IME in a workers compensation claim is to determine the cause of injury and the extent of the disability from the injury. If the treating physician has not placed the employee at maximum medical improvement (MMI), the IME can be utilized to determine what further treatment the employee needs.
By obtaining an IME, the insurer is better able to make fair decisions on how to handle the claim. The IME provides the workers comp adjuster with the necessary information to discontinue medical treatment, to continue medical treatment, to change medical treatment, and to determine the appropriate permanent partial disability benefit or permanent total disability benefit.
In most states the workers comp adjuster selects the IME doctor. In a few states the adjuster must petition the Workers Compensation Board to have the employee seen by an IME doctor. In some states the workers comp board selects the IME doctor. Whether the doctor is adjuster selected or workers comp board selected, it is imperative the doctor be a specialist in the field of medicine that involves the injury. The proper selection of the doctor results in high quality exams both accurate and medically sound.
To insure the IME is accurate, the adjuster or the nurse case manager assigned to the claim, provides the IME doctor with all the employee's medical records and diagnostic tests results (x-rays, CT scans, MRI reports, EMG studies, etc.). The information needs to be provided to the IME doctor well in advance of the employee's appointment to allow the doctor time to review properly the medical history of the employee. Also, the adjuster or nurse case manager also provides the IME doctor with a detailed job description obtained from the employer – the IME doctor should not have to rely on the employee's description of his/her work (which could overstate the physical demands of the job).
The IME doctor in addition to being provided the medical records, diagnostic test and job description, is informed of the reason the adjuster is requesting the examination — whether it is to establish what further medical care is needed, the level of permanent disability or other concern. By understanding why they are performing the IME, the doctor can then focus on answering the question(s) or concerns of the adjuster and/or the employer.
When the employee is represented by an attorney, the IME is normally set by agreement between the parties. If the employee's attorney is uncooperative about having an IME it is usually a sign the employee's attorney questions or doubt's the veracity of the claim or the extent of the injury. When the employee or the employee’s attorney refuses an IME, an immediate petition to compel the IME is filed with the workers comp board.
During the IME the doctor conducts an interview of the employee, performs the appropriate medical examination, observe the employee's general appearance, the employee's gait, how the employee stands, whether or not the employee has any difficulty climbing onto the examination table, whether or not the employee shows any signs of distress and the employee's weight. The doctor evaluates the employee's subjective symptoms and determines if they are consistent with the manifestations of the injury claimed. The IME doctor looks for any signs of exaggeration or deception by the employee and will include in the IME report if the employee is intentionally exaggerating his/her symptoms or if s/he feels the employee is malingering.
Also during the IME the doctor performs various test to verify the symptoms alleged by the employee conform to the normal symptoms for the injury claimed. The doctor questions the employee about his/her ailment(s), the treatment the employee has had for the injury, whether or not the employee had a prior injury or an injury subsequent to the workers comp injury and discusses any underlying pathologies to the injury. The IME doctor determines if the employee smokes, drinks, uses illicit drugs or has other health or lifestyle issues that will impact the employee's ability to recover from the injury or the employee's level of permanent disability. (WCxKit)
The independent medical examination should be used by the insurer or the employer to document the medical status of the employee at that moment in time. The information obtained from the IME is used either to provide the employee with the full medical care needed, or to determine the employee's level of disability, or both
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com.
©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.
About two-thirds of managersin New Zealand found courses improved employees’ literacy, numeracy and increased their understanding of health and safety issues, and subsequent compliance with requirements around them. (WCxKit)
This result came out of an evaluation report for the Department of Labor’s Upskilling Partnership Programme showing overall mixed results.
The program ran from 2006 to 2009 with the goal of helping working-age adults without the language, literacy, and numeracy (LLN) skills necessary for sustained employment. It was developed to increase the engagement of employers in workplace literacy programs.
Evaluation of the program found no conclusive quantitative evidence the courses improved participants' reading and writing skills, although apparently this wasn't entirely surprising as similar international schemes found the same results.
Tests apart, the participants themselves felt their LLN skills had improved. Their managers and supervisors also reported improvements in the participants' performance at work, including increased personal confidence and improved communications, teamwork, attitudes towards work, understanding and compliance with health and safety, and completion of paperwork. Productivity improvements tended to be on the small side, with reports of "some" rather than "a lot" of impact.
Twelve comments from participants related to a greater understanding and application of policies and procedures, especially around health and safety. They reported improved abilities in dealing with chemicals, writing memos and an increased awareness of why operating procedures were in place.
According to the report, employers discovered that the need for LLN courses was much greater than they had expected, and many planned to continue with LLN initiatives in their workplaces.
The evaluation found that workplace LLN programs were generally viable in New Zealand, across a range of industries and companies. But challenges included obtaining key stakeholder commitment, locating quality tutors, overcoming the stigma around having poor LLN skills in the selection processes, fitting course logistics around the demands of workplaces, and transferring the new skills to jobs.
Tertiary Education Minister Steven Joyce recently commented that more than a million New Zealand adults were held back because they lacked essential literacy and numeracy skills. At a symposium for adult educators he said it was a Government priority to improve New Zealand’s record in this area. (WCxKit)
Joyce said opportunities for adults to learn skills while in the workplace were vital to improvements and noted these improvements, in turn, led to other gains like staff retention, product quality and health and safety.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com.
©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.
Amaxx’s Workers Comp Cost-Containment Resource Center for Employers now provides workers compensation insurance-related information twenty-nine industry groups.
The industries covered are:
agriculture,
amusement parks, banks,
casinos, construction,
commercial fishing, logging and sawmills, oil and gas exploration, longshore and harbor workers, industrial equipment manufacturers,
telecommunications, food and beverage manufacturers, restaurants, professional services, schools, state and local governments, insurance companies, temporary staffing agencies, hospitals and nursing homes, entertainers, sports teams, printers and publishers, janitorial services, hotels and motels, transportation companies, retail chain stores, and horseracing. (WCxKit)
The new material includes sample transitional duty jobs for each industry. Transitional duty reduces unnecessary employee time out of work, cutting costs dramatically and is also called modified duty, alternate duty or light duty. Over 40% of workers compensation costs are related to indemnity payments (lost wages) paid when employees lose time from work so controlling these costs is paramount when developing a work comp cost-containment program.
Companies with effective transitional duty programs have lower experience modification factors. Companies with the highest return to work ratios – 95% of injured employees returning to work within one to four days - have the lowest mods, according to the 2010 RIMS Benchmark Survey. The new information in the Resource Center can be used to start a return to work program for your company. (WCxKit)
The Resource Center is located at
http://www.LowerWC.com and focuses on helping employers get a grip on decreasing their workers compensation costs. It contains several free resources including the Work Comp IQ Test, Transitional Duty Cost Calculator and Work Comp Sales Calculator.
About Amaxx: Amaxx Risk Solutions publishes the website www.LowerWC.com an online publication which provides suggestions, articles and resources for managing workers compensation costs. Amaxx is the developer of The Workers Comp Kit®, a comprehensive workers comp cost-containment resource for employers sold by Advisen Ltd. The Workers Comp Kit is an easy-to-use assessment, benchmarking and improvement plan with all the tools to reduce your company’s workers comp costs. The application is a best-in-business process that is based on 20 years of experience lowering workers compensation costs while improving overall program efficiency.
©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 Washington Department of Labor & Industries has put on hold the unveiling 2011 workers compensation premium adjustments until November, following an election that includes a proposal that would drastically change the program.
According to the Spokesman-Review, Director Judy Schurke informed legislators recently the department has not run the numbers, normally put out in September because, if Initiative 1082 passes, they would have to be removed. Releasing any numbers, she commented, might “confuse” business owners. (WCxKit)
According to business interests they are prisoners of one of the last remaining state workers comp monopolies, and one moving down the road of insolvency at that.
Businesses accuse L&I of “hiding the ball” in not unveiling large premium increases that would work to the benefit of I-1082 supporters. They also chastise the department for permitting prolonged, expensive worker absences that grossly top the norm in other parts of the country.
The most damaging claim made is centered on a December 2009 independent audit of the program’s accident fund, which pays no medical costs such as lost wages and pensions. The auditors claimed insolvency was a 74.4% possibility within two years, and a 90% possibility within five years.
Business interests claim the alternative to the problems is I-1082, which would permit employers to purchase coverage from private insurers, not only the state. And the way rates are to be calculated would change.
The non-partisan public policy think tank, Washington Policy Center (WPC), recently released a report explaining how passage of the business community-backed Initiative 1082 will be a boon to business owners and workers in Washington State.
The study, Citizens Guide to Initiative 1082: To Reform Workers Compensation in Washington, concludes that terminating the state monopoly on workers comp and allowing competition from private insurers will “help keep premium increases in check, encourage innovation in rehabilitating injured workers, and most importantly, provide safer workplaces.” (WCxKit)
According to the Washington State Labor Council, business exaggerates the damage from a pair of extraordinarily bad years.
Workers comp premiums went up only 8% during the 2004-2009 periods, and fell in eight of the last 15 years.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
©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.
Vegas Western Cab Company, which provides taxi services in Nevada, will pay $30,000 to a disabled job applicant and furnish other relief to settle a disability discrimination lawsuit filed by the U.S. Equal Employment Opportunity Commission (EEOC), the agency announced.
In its lawsuit (EEOC v. Vegas Western Cab Company, Case No. 2:09-cv-01888-GMN-PAL), the EEOC asserted that the taxi cab company refused to hire Joel Walden, a single-arm amputee who applied for a taxi driver position in 2006, due to his disability. (WCxKit)
Walden was rejected although he met all of the requirements stated in the job announcement, had experience as a driver and an unblemished driving record, the EEOC said. The EEOC further charged that the company commingled the medical records of employees, such as doctor’s notes, with other personnel records, thus failing to maintain the confidentiality of those medical records.
The EEOC argued that the conduct was in direct violation of the Americans With Disabilities Act (ADA). The EEOC originally filed the lawsuit in September 2009 on the applicant’s behalf after first attempting to reach a pre-litigation settlement.
Aside from the monetary relief, the parties entered into a three-year consent decree, which requires Vegas Western Cab to provide clear protocols for handling applications from disabled job applicants; revise and disseminate its EEO policy and procedures; include a non-discrimination statement in all job postings and application materials; provide annual ADA training; and report training and complaints of disability bias to the EEOC. (WCxKit)
“In this case, the applicant was ready, willing and able to do the work,” said Anna Park, regional attorney for the EEOC’s Los Angeles District Office. “When evaluating a disabled job applicant, the sole consideration should be whether the applicant can do the job. It is plainly and clearly illegal to deny employment to a qualified individual based on disability-related assumptions.”
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, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©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 largest amount of money awarded in NY comp is for “permanent partial disability” claims. These are the claims that have the largest settlement figures at the end of the claim (frequently over $100,000) and generate nearly half of the legal fees.
The new guidelines will measure the amount awarded for permanent disability claims not subject to a “schedule loss”. Usually this means back claims. “Schedule loss” claims are for fingers, toes, arms and legs (as well as vision and hearing). (WCxKit)
The new guidelines call for a three-step evaluation measuring
a. severity of injury,
b. loss of functional abilities, and
c. loss of wage earning capacity.
It is the loss of wage earning capacity that is causing problems since New York for many decades has ignored measuring wage earning capacity.
This presents a unique opportunity for employers to submit evidence which can substantially reduce comp costs. Most employers have several job titles for their employees; larger employers have dozens of titles. By selecting the least strenuous job, documenting its physical requirements and pay scales the employer can often document that wage loss is less than 10% of pre-injury wages – or, in fact, that there is no wage loss at all.
An employer would have to coordinate closely with a carrier to achieve these results. Waiting to be asked is courting a certainty of losing an opportunity.
The employer is uniquely qualified to document the wage earning capacity and is, in fact, an “expert witness” whose testimony is difficult to refute. Even more difficult to refute is documents proving what the pay is for these jobs – documents which are always available to an employer. (WCxKit)
Decades ago, the employer had an active role in providing just this type of testimony. It fell into disuse by the expedient of substituting “minimal, mild, moderate or marked disability” (nowhere defined in the law) instead of measuring actual wage loss.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, New York. 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.
©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.
Ontario's Workplace Safety and Insurance Board (WSIB) announced that it will undertake a year-long funding review to tackle its unfunded liability, which is currently projected at more than $12 billion.
Chaired by Harry Arthurs, the former dean of Osgoode Hall Law School and president emeritus of York University in Toronto, the review's advisory committee will gather expert advice and input from workers, labor and employers related to the WSIB's financial future, including a plan on how to eliminate the unfunded liability, according to a WSIB release. (WCxKit)
Unfunded liability refers to the difference between the total cost of claims in the system and funds in the system to pay for them, the WSIB explains. It has increased to over $12 billion due to "insufficient premium revenue, rising claims and health care costs and declining investment returns following the recent economic downturn."
To help slow the growth of the unfunded liability, the WSIB has decided to increase the average premium rate by two percent for 2011 and another two percent in 2012. Now, the average premium rate will rise from $2.30 to $2.35 for every $100 of insurable earnings in 2011 and to $2.40 in 2012.
The WSIB stresses that the increase is being applied to the average premium rate, meaning more than half of registered employers will see little to no increase, while other employers in high-risk industries with a history of costly claims may see increases of more than two percent.
But Satinder Chera, vice-president for Ontario with the Canadian Federation of Independent Business (CFIB), questions the necessity of a review. "If you are going to do a review, then the last thing you want to do is to predispose what the outcome will be, which is essentially what they've done by increasing rates," he contends. "What's the point of the review if you've already decided that you are going to have to increase rates?"
For CFIB members, the "payroll hit" will make it more difficult for employers to grow their businesses, Chera argues. "What it will mean is some will have to delay hiring while others may be struggling just to hold onto the employees that they do have."
While Chera understands that the increases affect the average premium rate, he argues that certain industries will see a much greater increase over the next two years.
The WSIB acknowledges this, noting that the premium rate for 2011 will increase by 20 percent over this year's rate for the 'motor vehicle fabric accessories' sector; 19.5 percent the poultry farms and agricultural services sector; and 19 percent for the fruit and vegetable products sector. Workplaces such as gold and nickel mines, machine shops and foundries, on the other hand, will see no increase. (WCxKit)
Christine Arnott, a media relations specialist with the WSIB, says that if a company's health and safety performance has been good or better than the rate group average, they may still be eligible for performance rebates under the WSIB's incentive-based experience rating programs. But the lack of reduction
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
©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.
Officers from Great Britain’s Health and Safety Executive and local authorities in Dorset will be carrying out a program of inspections to businesses associated with the motor vehicle trade during October and November, including motor vehicle repairers, body sprayers/repairers, tire and exhaust fitting premises and vehicle showrooms.
The main focus of this work – part of this year's Work Well Dorset work stream – will be to reduce the incidents of ill health from the use of hazardous substances such as isocyanate paints (also known in the trade as 2-pack, twin pack, or '2K'), which are one of the biggest cause of occupational asthma in the UK, with 50 sprayers being diagnosed every year, resulting in a lifetime cost in the range of £94,000 to £138,000 or ($148,844 to $218,515). (WCxKit)
Other topics areas, where inspectors will provide advice on practical solutions while seeking business compliance, include reducing accidents and injuries associated with petrol draining, segregation of the public from work areas, musculoskeletal injuries sustained from lifting and carrying, training of young workers, preventing injuries from slips, trips and falls, and seeking to improve worker involvement on health and safety.
Cllr Don Collier, a member of the Champions Panel of Work Well Dorset tasked with strategic overview of the initiative, noted, "The campaign is targeted at both employers and employees. They both have a responsibility to help reduce the problem, which resulted in over 150 new cases nationally of debilitating occupational ill health during 2006-2008 to those working in the motor vehicle repair trade. This is a very valuable piece of work being undertaken by the Work Well team." (WCxKit)
The Motor Vehicle Repair project is just one example of the joint work that the Work Well Dorset team will be carrying out this year.
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, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©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.
WorkSafeBC (British Columbia) recently hosted an information session to support the health care industry in defining care practices that will keep workers safe when caring for people with dementia. The session took place in the Alice MacKay room at the Vancouver Public Library. (WCxKit)
“This session features experts in the field who provided some tools and strategies to help workers and employers care for people with dementia,” said Donna Wilson, WorkSafeBC vice-president of Industry Services and Sustainability. “Each year, 1 in 10 workers in residential care miss time from work due to a work-related injury.”
Dementia affects about one in three people over the age of 85 years. About 70,000 people in B.C. live with some form of dementia, and more than 15,000 new cases are diagnosed in the province each year.
The cognitive and physical losses caused by dementia are the main reason why people move into residential care, and more than 80 percent of people in residential care live with some level of dementia. Symptoms of dementia include challenging behaviors, and it is critically important that health care workers understand proper care techniques and learn how to use good practice guidelines.
“As the population ages, the number of people suffering some form of dementia will dramatically increase,” said Jean Blake, CEO of the Alzheimer Society of B.C., a keynote speaker of the session. “With awareness, knowledge, and proper planning, health care providers will gain the education they need to provide high quality, evidence-based care, as well as the skills to facilitate respectful interactions that ensure the dignity of a person living with dementia in residential care.”
The information session was videotaped and is available online, along with WorkSafeBC’s DVD, Working with Dementia: Safe Work Practices for Caregivers, and the handbook, Dementia: Understanding Risks and Preventing Violence. To find these items, visit the Safety@Work Centre for Health Care at www2.worksafebc.com/Portals/HealthCare/Violence.asp. (WCxKit)
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, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©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.
Manufacturers can’t just install their equipment in a business and walk away without checking the equipment for safety in the workplace according to the New Zealand Department of Labour.
The comments came after the sentencing of an Auckland meat processing systems manufacturer over an accident in which a meat worker broke his leg. (WCxKit)
Realcold Milmech Ltd was fined $44,000 and ordered to pay reparation of $9,000 in the Tauranga District Court for its role in the accident which Department of Labour Waikato/Eastern Regional Manager Ona De Rooy says involved several failures by Realcold Milmech.
“It didn’t do a risk assessment after installing the equipment or ensure the equipment couldn’t operate when people needed to access danger areas for maintenance and cleaning. In addition to this there were no guards in place preventing access when the equipment was operating and the equipment didn’t have automatic locking devices,” she says.
De Rooy says appropriate guarding of machinery has been law for more than a century “but people still ignore it or forget about it.”
“Manufacturers have to give safety for users top priority, because unsafe machinery is the cause of a high number of serious harm and fatal injuries. (WCxKit)
“We have a three-year machine guarding project underway to improve this aspect of workplace health and safety and this case involving Realcold Milmech is a good reminder that manufacturers are liable for the ongoing safety of the equipment they produce. Responsibility doesn’t end at the point of sale and installation,” De Rooy added.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Work Comp Calculator: http://www.LowerWC.com/calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
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