Nothing is free. There is no free lunch. Someone is paying for it; it just might not be you. There are employees (and people in general) who have an entitlement mentality that has been fostered by politicians and society in general. These people feel they are “owed” something, even if they have not done anything to earn it. This is what my doctor says she sees in her medical practice when I reveal I work "in the workers compensation field." She goes on to explain that daily people sit across the desk and ask to be put on total
disability. She was quite upset by this since she has been working hard for the last 25 years. She welcomes the opportunity to vent about her own experiences. She says, "We're a somethin' for nothin' society."
Unfortunately, way too many employees have no idea of the cost of workers compensation. Employees often think workers compensation insurance is free, as they do not pay anything for the insurance coverage. While they may vaguely know the employer is paying for the coverage, they do not know the true cost of work comp. (WCxKit)
Many an unsophisticated employee will think the employers cost is the hourly rate they receive. The wise employer will educate the employees on their true cost. The employee should know that in addition to their hourly rate, the employer is paying 35% to 40% over the hourly rate to cover the cost of workers compensation, social security, unemployment insurance, medical insurance, dental insurance, life insurance and disability insurance. This is all before the cost of vacations, holidays and sick pay is added to the equation. In addition to all these employer cost, the employer is contributing to a 401k, 403b, or other retirement plans. Plus, there are a few employers who still have defined benefit pension plans where they are funding the employee's retirement.
When an employee, who has the entitlement mentality, is injured on the job, their claim often becomes a much more expensive claim than it should be. As employees pay nothing for workers compensation (one of the very few things in work comp that is the same across all the states), those employees that have the entitlement mentality of something for nothing will often look for the opportunity to abuse the work comp claim system. My doctor says that she "has one employee in particular" who is looking for another job, and she can't wait for her to leave because she is unproductive, but the doctor is afraid to fire her or she'll get sued. What does this say about our society …
While some of the employees with the something for nothing attitude will fake an injury, many of the injury claims start out as legitimate claims. When the employee gets comfortable living on the indemnity benefits paid by the work comp insurer, they decide they do not want to go back to work. They see the TV lawyer advertising the fist full of money they can get for their work comp claim. Or, they hear about a friend of a friend who is living a life of ease and will never have to work again due to their work comp injury. While they may not think of it as fraud, they will do anything they can to delay their
return to work. This can include everything from exaggerating their pain to the doctor to exaggerating the physical demands of their job when they discuss returning to work with their doctor. My doctor says she never gives total disability slips, but she needs information on these employees original job so she knows they can, in fact, safety return to work.
The 'something for nothing' employees paid time off work can often be curtailed or even eliminated by an aggressive return to work program offering modified duty. By getting this worker back on the job before he can settle into the life-without-working routine, the employer can save a lot of workers' compensation cost.
While the employer can often identify the employees who have the something for nothing mentality, there are the employees who never thought of abusing the system until they are off work due to an on-the-job injury. They don't start out faking disability, but do so when neither the employer nor the claims adjuster stays in contact with them. As long as it easy to stay off work, they do. When they start feeling the pressure to return to work by the employer inquiring when they will be back, they end their something for nothing extended time off work.
An experienced work comp adjuster or a knowledgeable claims coordinator with the employer will immediately recognize the “red flag” of the injured employee who states “I don't want something for nothing”. Usually when an employee states this to the work comp adjuster or the employer, it is because they have already been thinking about getting something for nothing. Employers (and work comp claim adjusters, too) need to be exceptionally diligent with the injury claims from employees with the entitlement mentality. (WCxKit)
One of the best ways to combat the entitlement mentality of the something for nothing employee is to educate all employees on the cost of workers' compensation. Employees need to know that the employer takes work comp fraud very seriously and will prosecute any employee who commits fraud. All employees should know that the cost of workers compensation insurance has to be paid for by the employer, and the higher the claim cost, the more the employer pays. When all employees understand that anyone who fakes a claim or stays off work longer than necessary is stealing a part of the pay raises and/or bonuses of their co-workers, the something for nothing mentality can be curtailed.
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.
Individuals are 10 times more likely to die working on an Irish farm than in the general working population, an Oireachtas committee has been told.
Martin O’Halloran, chief executive of the Health and Safety Authority, told the
agriculture committee recently that the number of farm deaths so far this year had rose to 24, or 60 percent of all workplace deaths to date. (WCxKit)
He said considerable progress had been made in recent years in reducing fatalities but there had been a spike in the number of farm deaths so far this year, from 11 in 2009.
However, the trend was downward and, although no death on a farm or any workplace was acceptable, farm deaths here were not the worst in Europe over the past five years.
Ireland currently ranked in the top five for the lowest rates of farm fatalities behind Denmark, Finland, Sweden and the UK, and the authority was looking at the systems being used there.
Minister of State for Labor Affairs Dara Calleary sympathized with the family of the most recent victim in the last 24 hours.
He called for a change of culture in farming attitudes towards farm safety.
“We need a collective effort,” Calleary added. “That is why I am here today. Farm safety is an issue that transcends politics. All arms of Government and all arms of the political system have a part to play.”
O’Halloran told Seán Sherlock (Labor) that inspectors had been switched from the construction sector to the farming sector since the recession.
The authority hoped to increase the number of farm inspections from 1,700 last year to 3,000 this year.
North Tipperary TD and former agriculture contractor Noel Coonan (Fine Gael) said inspections put “the fear of God” in farmers and this was not the way to go.
He added that he had once witnessed a death on a farm and did not want to see the like of it again.
O’Halloran said the inspections carried out by the authority were mainly advisory and he defended its work. (WCxKit)
Committee chairman Johnny Brady said the committee intended to liaise regularly with the Health and Safety Authority is to get updates on the initiatives being taken to tackling this “most serious of problems”.
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.
Canadian National Railway (CN) is asking the Federal Court of Canada to conduct a judicial review of a human rights decision which found that the railway discriminated against three employees on the basis of family status.
According to Canadian OH&S News, CN spokesman Mark Hallman confirms that the company has filed a notice of application with the court following the Canadian Human Rights Tribunal's (CHRT) decision in late September. (WCxKit)
In that ruling, CHRT member Michel Doucet ordered that former worker Cindy Richards be reinstated after she was terminated in July of 2005 for refusing to accept a work assignment to Vancouver.
At the time, Richards – who lived in Jasper, Alberta and had primary custody of her two children, aged 10 and 11 – argued that she could not legally leave Alberta without providing 90 days written notice of the move as part of her custody agreement.
The decision – and related CHRT rulings affecting two other Jasper-based workers – resulted in the reinstatement of the three workers, with lost wages and benefits, Hallman confirms, noting that all three cited "family reasons" for being unable to relocate to Vancouver.
"We, the railway, accommodated the three employees by granting them four months to make arrangements to report to Vancouver instead of the 14 days as provided under the collective agreements," Hallman says. "Nevertheless, the accommodation was not satisfactory for the complainants."
The tribunal ruled that "the evidence clearly establishes that CN was not sensitive to [Richards'] situation. It did not answer her many requests for some form of accommodation and did not even meet or contact her to discuss her situation, even though its own accommodation policy directs that the employee be met as a first step in the process."
In addition to the reinstatement, Doucet ordered CN to review its accommodation policy as it relates to family status. The tribunal also awarded Richards compensation for lost wages since 2006, $15,000 in compensation for pain and suffering and $20,000 for CN's "willful or reckless conduct."
In challenging the ruling, Hallman contends that CN believes the tribunal "applied the wrong test" to determine an employer's duty to accommodate based on family status.” If unchallenged, the precedent set by the rulings could make it difficult for CN to manage its work force effectively," he states. "We are a 24-hour-a-day, seven-day-a-week operation and we have to be able to deploy our work force to meet the transportation needs of our customers."
Richards was hired by CN in 1989 and was on layoff status with her employer in 2005. By February of that year, CN was experiencing a severe shortage of employees in its Vancouver terminal, while the Jasper terminal was in a "surplus situation," Doucet writes. To maintain its operations, CN decided to recall laid-off conductors to protect the shortage affecting the Vancouver terminal.
During this process, "CN had not hesitated to 'accommodate' some employees who were recalled to cover the shortage in Vancouver because of a sick parent," Doucet notes. "But without inquiring into the nature of her request, they decided that the complainant's situation did not qualify as one requiring accommodation. CN's conduct and nonchalant attitude towards her situation was disturbing."
Hena Singh, an associate with Rubin Thomlinson LLP in Toronto, claims that case law considers family status as that of "being in a parent-child relationship," whether the "parent" is biological or otherwise.
With regards to accommodation, Singh says that there is a "reasonableness component" to consider, and employers should continuously attempt to accommodate. "It's not that they've done one thing and that alleviates their requirement to continue to accommodate her," Singh commented. "The reasonableness of this is that she has to go to court to continue working." (WCxKit)
Singh adds that the way the law is developing is that "if there is some unusual circumstance that is now a change… that is causing you to require an accommodation, an employer needs to accommodate to the point of undue hardship."
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.
The American College of Occupational and Environmental Medicine (ACOEM) has released a guide to the best physicians to provide care for people who have suffered work-related injuries and illness. It is titled
A Guide to High-Value Physician Services in Workers Compensation: How to Find the Best Available Care for Your Injured Workers.
The publication was created in partnership with the International Association of Industrial Accident Boards and Commissions. It includes advice, checklists, and other tools to help identify doctors who adhere to best practices and are most likely to provide the best medical outcomes. (WCxKit)
“Most participants in the workers compensation system want to direct workers to high-quality medical care, but rarely have access to accurate and comprehensive data about physician practice patterns,” said ACOEM Executive Director Barry Eisenberg. The new guide provides a practical alternative that helps users ask the right questions to ensure excellent care, Eisenberg adds.
Free copies of the guide are available at www.acoem.org. From the top page menu, go to Policy & Position Statements, then Reference Material. (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.
Larson’s Workers Compensation Law, Chapter 32, which repeats one of the axioms of workers compensation law, that misconduct of the employee-whether negligent or willful is immaterial in determining compensability unless it takes the form of deviation from the course of the employment, or unless it is of a kind specifically made a statutory defense by a jurisdiction, has also been revised. Fault can sometimes work its way into the issues in subtle fashion, however.
For example, in a North Carolina case, Hassell v. Onslow County Bd. of Educ., 362 N.C. 299, 661 S.E.2d 709 (2008), the state supreme court, in a divided opinion, affirmed a denial of benefits to a teacher who claimed her general anxiety disorder condition was compensable because it was caused by the stresses and strains of dealing with her unruly classes.
One justice dissented, noting that while the majority had disavowed any language from the state Industrial Commission premising compensability on the absence of fault-the Commission had indicated the cause of the teacher's anxiety disorder was her "inadequate" job performance-the majority's findings had failed to address whether the Commission, and the state's Court of Appeals, had relied upon the erroneous premise. [See Larson's Workers Compensation Law, Ch. 32, § 32.02 n2]
©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.
Gone are the days of mailing the Employer's First Report of an accident to the insurer's claims office. A three or four day delay in starting the claim due to the mail service is not an acceptable claims handling practice like it was a couple of decades ago. Today, with the internet, the claims report will be in the claims office within seconds of it being sent by the employer.
With electronic reporting of claims of claims available 24 hours a day, 7 days a week, 365 days a year, the employer can submit the claim at any time. Therefore, the best time for the employer to report an injury claim or a reported occupational illness is immediately upon learning of the event. Fast, accurate reporting of the claim benefits both the employer and the employee.
When the injury occurs, the employer's first and foremost duty is obtain the appropriate medical care for the employee. It's the employer operates in a jurisdiction where the employer selects the medical provider, the employee should be directed to the nearest medical facility appropriate for the injury. If the employer is in a jurisdiction where the employee can select their own medical provider, a list of recommended medical providers should be provided to the employee to select from. When the employer shows immediate concern about the injury to the employee, a higher level of communication about the injury throughout the claim will be established.
There are several benefits to reporting the claim immediately. They include:
1. It lowers the cost of the claim – studies have shown the faster the claim is reported, the lower the overall cost of the claim.
2. A study by Firemen's Fund reported a 3-day delay in reporting a claim added an average of 16% to the medical cost and 38% to the indemnity cost, and increased attorney involvement by 50%.
3. A study by Hartford Insurance Company showed a week's delay in reporting the work comp claim increased the overall claim cost by 10%, and a month's delay in reporting the work comp claim increased the settlement cost of the claim by 48%. Furthermore, the Hartford study showed the longer the delay in reporting the claim, the higher the probability of litigation.
4. A study by the National Council on Compensation Insurance found that litigated claims cost 40% more to settle than non-litigated claims.
5. The claims office cannot accomplish anything until the claim is reported – the claims office can get started with their investigation immediately when the claim is reported immediately. (Your claim handling agreement with the insurer or the third party administrator should specify all employees will be contacted the same day the claim is reported to the claims office).
6. The employee, the supervisor and any witness memories are fresh and important details are not forgotten.
7. Witnesses to the accident are available.
8. If an inspection of the accident scene is needed, the accident scene is more likely to be unchanged than it would be later.
9. If the injury involves equipment failure or machinery failure, expert assistance can be used to establish and maintain subrogation rights.
10.The immediate reporting of the claim allows the adjuster and the nurse case manager the opportunity to take prompt cost reduction steps.
11.The employee can receive the right medical care by having the managed care provider involved in the claim from the start. Trying to change the medical treatment plan of a doctor after the doctor has been treating the employee can result in a disruption of care, confusion or even attorney involvement.
12.It shows the employee you care about the employee's well being.
13.It allows for the establishment of a modified duty return work process before the employee can contemplate how long he/she can be off work.
14.It perpetuates the employee's return to a normal lifestyle of working a regular schedule.
15.It minimizes the interruption of your business.
The immediate reporting of claims allows the adjuster to investigate and validate the compensability of all claims. It allows for immediate medical intervention while providing the appropriate medical care. The immediate reporting of claims also protects the insurers right of recovery from any responsible third party. Also, the immediate reporting of claims puts the employer and the claims office in charge of the claim, preventing a medical provider or plaintiff's attorney from usurping the direction and control of the claim.
Every department manager and every supervisor should be trained to immediately report all claims to the employer's work comp claims coordinator. If the employer does not have a work comp claims coordinator, the supervisor or manager for the employer should immediately complete the Employer's First Report of Injury and electronically submit it to the claims office. When the claim is severe, the claims coordinator or department supervisor should telephone the claims office with the information on the claim. To insure compliance with the immediate reporting requirements, the timely reporting of work related injury should be a component of the supervisor's performance evaluation and salary increase. (WCxKit)
The immediate reporting of claims will reduce the medical cost, will reduce the indemnity payments, will reduce the employees time away from work, will lower the claim administration cost and reduce the possibility of attorney involvement. The immediate reporting of claims is an essential step every employer should take to control workers' compensation cost.
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.
According to a recently released audit, mismanagement of workers compensation claims in Los Angeles by the City Attorney's Office could be costing taxpayers millions of dollars. (WCxKit)
The Daily News was reporting that the audit — which former City Attorney Rocky Delgadillo tried to stop by suing then-City Controller Laura Chick — discovered that during his administration, the Workers Compensation Division referred only 4 percent of claims to fraud investigators when the industry standard is 17-21 percent.
The lack of oversight could be costing the city $5.4 million a year in benefits that should never have been transferred, according to the audit.
The division was also cited for collecting only 6 percent of the claims to which the city was entitled, potentially keeping the city from approximately $3 million in revenue each year.
Another $1-2 million is potentially going without collection due to a practice of adjusting disability payments to mask errors committed by the Personnel Department, according to the audit.
Finally, the audit discovered that the division used some 5.8 years to resolve cases, when the industry standard is a year or two. One case had been open for more than 20 years before being closed, according to the audit. The delay was attributed in part to the division being understaffed. (WCxKit)
The auditors reported that the City Attorney's Office persuaded the City Council to hire lawyers and investigators to handle workers comp cases, but actually had them undertake other duties.
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.
Even companies with the strongest safety programs experience some workers compensation claims. When an injury occurs, the immediate action taken by the employee’s supervisor or co-workers has an impact on the outcome of the claim.
Implementing the next two phases of employment involvement helps to manage claims efficiently and get workers back to work sooner.
The Injury Occurrence
The employer must require a tight post-injury process by following these five principles:
1. Obtain immediate medical assistance for the employee – send the employee to designated doctor or medical facility if statute permits.
2. Do not permit employee's with minor injuries or soft-tissue strains to wait to obtain medical assistance – most will end up going to the unapproved hospital emergency room or their own doctor.
3. While the employee is in-route to the treating physician, advise the treating physician of any temporary jobs you can offer during recovery.
4. Advise the treating physician of modifications you can make to the existing job to accommodate the work restrictions the physician gives the employee.
5. Have a goal of returning all employees to work within 1 to 3 days after the injury unless they are medically unable to perform any role for the employer.
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.
The cost of drugs is the fastest growing component of medical care cost and often one of the most neglected areas of workers compensation cost control. It is estimated that workers compensation pays $5 billion in drug cost each year. While there are numerous pharmacy benefit managers (PBM) in the work comp arena, they are often either totally ignored or only partially utilized by the insurers, self-insureds and third party administrators (TPA). Other areas of medical cost control like fee bill schedules, medical provider networks, medical management and utilization review get more attention than PBM, but proper utilization of PBM can result in substantial savings in the cost of work comp.
What PBM Can Do?
Unfortunately, many claim adjusters think of PBM only as a way of saving money by getting a discount on the cost of prescriptions. With some PBM that
is all they do. However, if the insurer (or the self-insured employer who is paying attention to the factors in the cost of their work comp coverage) shops around among the PBM providers, they should be able to locate a PBM that has a national presence and a focus on proactive utilization control. Key service points and cost control solutions to consider for a PBM include:
1. The flexibility to coordinate the medical prescription benefit in the most efficient manner between the employee, the pharmacy and the medical provider with minimal involvement of the adjuster
2. The ability to comply with all the workers' compensation rules and regulations of each state, which can vary tremendously from state to state, and to stay current/up to date
3. The technology to process the prescription in real time – without delay when presented by the employee to the pharmacy – with the appropriate pricing (WCxKit)
4. A national network covering most of the 70,000+ pharmacies in the United States. This will provide convenience and hassle-free access for the employees regardless where they live (also to prevent non-compliance with the required use of the PBM). The PBM network should definitely include the three major chains – Walgreens, CVS Pharmacies and Rite-Aid
5. A comprehensive standard formulary that can be customized and injury-specific and/or patient-specific to manage utilization (even customized down to the ICD-9 codes)
6. A pre-negotiated price (network discount) for each drug (a 25% discount off a price that is 50% higher than it should be is not a cost savings)
7. The ability to provide home delivery by the Postal Service, Fed Ex or UPS at minimal extra cost
8. The willingness to provide 24 hours a day, 7 days a week customer support service
9. The ability to identify generic substitution opportunities
10.The identification of newer drugs that provide greater benefit
11.The ability to process – approve or deny – the off-label use of a drug
12.Utilization review — before the prescription is filled - to prevent of overuse of narcotics – consumption faster than manufacturer recommendations or faster than the medical provider's prescription amount
13.The prevention of multi-physician (“doctor shopping”) prescriptions from being processed for the same drugs or duplicate use drugs
14.The prevention of multi-pharmacy involvement in filling the same prescription (for example – the employee takes the paper prescription to one pharmacy to be filled, then called the medical provider, claims to have lost the prescription and has the prescription called into another pharmacy)
15.The technology to recognize when inappropriate or non-compensable medication is being dispensed (for example – a non-injury related medication is being presented to the pharmacy) and the ability to stop it from being filled
16.The ability to be electronically integrated with the insurers', TPAs or self-insured's bill review system to eliminate the manual processing of individual prescription payments
17.The ability to provide ancillary services like durable medical equipment (nice to have, but not absolutely essential)
18.The ability to provide reports on cost savings, utilization and trending
19.The ability to provide correct pricing for any drugs dispensed from the doctor's office which often are over billed
20. Accreditation by the Utilization Review Accreditation Committee reflects the PBM promotes quality and efficiency of health care delivery
A Growing Problem:
The use of PBM does result in a reduction in the abuse of pain medications. However, some employees who become pain medication junkies have found a way to circumvent the PBM. A growing problem is the medical providers who will perform office injections for the employee. The medical provider gets paid for multiple office visits and the pain medication junkie keeps on abusing the pain medication. (WCxKit)
Summary:
The appropriate management of medications by the PBM can lower the overall cost of medical care and shorten the return to work time. The employee benefits from the PBM by receiving the necessary medications locally (or home delivery) while the employer benefits from the employee receiving the appropriate medications in a timely manner. The insurer or self-insured benefit from the medical savings the PBM provides.
Author Rebecca Shafer, 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. Info@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.
15 Post Injury Claim Process Activities Every Employer Can Do
Too many employers end their involvement in the workers compensation claim when they send the employee to the doctor. A bad mistake – one resulting in a steady increase in the amount of your workers compensation insurance premium.
The employer needs to have an established post injury process to include:
1. Report the claim to the insurer, third party administrator or self-insured claims office immediately. Ideally the supervisor or your workers compensation claims coordinator reports the claim to the claims office while the employee is still enroute to the medical provider. Or, you can start the process by calling nurse triage, a great way to make sure the employee gets the RIGHT kind of medical treatment. In some cases, the injury will not turn into a claim by using nurse triage.
2. Complete the Employer's First Report of Injury and any other state required paperwork on the claim. If the injury is severe and the employee is unable to return to work within the waiting period, provide the claims office with necessary wage information for the calculation of indemnity benefits.
3. Advise the claims office of the claimant's prior history of workers compensation claims. The adjuster's approach to the claim varies significantly between the employee who never had a workers compensation claim and the employee who with 15 workers compensation claims in the last ten years.
4. Provide the adjuster with relevant information about the employee. In many situations this may include employee information such as employment application, job description, list of medical absences, list of disputes with employee/employer disputes.
5, Review your transitional duty program and find a job the employee can do within the treating physician’s restrictions. Have a job bank with tasks in multiple departments set up and ready to go, so there is no delay in placing every injured employee in a transitional duty task. In most states, it is best to pay as close to their original pay as possible to reduce indemnity payments.
6. Be sure the employee's supervisor (and co-workers if needed) is available to discuss the accident and injury with the claims adjuster and to assist the adjuster with the claims investigation.
7. Don't alienate the employee – show empathy to the employee. When employees feel the company does not care about them and their injury and the company owes them, the claim gets ugly if employees feel it is time to stick it to the employer.
8. Maintain an open dialogue – call the employee at home to show your concern and to offer assistance on processing the workers compensation claim with the insurance company. Address any employee problems or issues right away. Also, call the employee on a regular basis until s/he is back at work. Make this contact procedure the same for all employees.
9. If an attorney representing the employee contacts you, notify the claims adjuster immediately.
10. Immediately dispute any invalid or fraudulent claim. Assume every employee who reports an injury is injured, but when you notice things don't add up, let your adjuster know. Using nurse triage services greatly reduces fake injury reporting because a nurse specialized in triage will ask many questions about the medical condition, and most employees faking an injury will look for easier prey.
11. If the employee has a questionable claim, or a subjective claim for neck or back injuries, and immediately goes to the attorney advertising workers compensation on television, or a plaintiff's attorney-oriented doctor known for excessive disability ratings, advise the employee immediately of your intention to fight the claim as the attorney and/or doctor has a history of inflated claims
12. Monitor the state filings by the adjuster and any other claim related paperwork.
13. Monitor the Workers Compensation Board decisions – that means, reading them carefully, not just filing them away. Be ready to protest any finding or order you feel is unfair to you as the employer as all decisions have time limits for disputing the decision, with some time limits as short as 15 days. (WCxKit)
14. Monitor the medical progress reports to be sure the treatment is appropriate – for example – no physical therapy for the low back when the injury is a cut finger.
15. Always advise the adjuster when the employee returns to work – the same day. Double-check to make sure the indemnity payments stop when the employee returns to work.
Stay involved with the adjuster, the employee and the medical providers. As long as it's an open claim, it can affect your experience rating, so dropping the claim on the adjuster's desk is the WORST thing an employer can do. Ask your broker's claim VP and the adjusters to discuss the open claims during a roundtable discussion often, perhaps bi-weekly.
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.
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Absence Management, Buying Workmans Comp, Communication with Employees, Insurance Issues, Rates, Premiums, WC 101 |
