One in five construction sites in Scotland were so dangerous that workers lives were being put at risk according to inspectors who visited them during February and March.
In an initiative aimed at reducing deaths and injuries in one of Britains most dangerous industries, inspectors from the Health and Safety Executive visited 288 sites and a total of 53 were found to be so far below required standards that inspectors had to issue formal enforcement notices. They were targeting refurbishment projects – the worst performing sector of the construction industry.
Several of the sites visited received more than one enforcement notice either stopping work activities immediately or requiring improvements to be made. In total, inspectors issued 50 prohibition and 10 improvement notices, with 39 of the notices relating to unsafe work being carried out at height.
The latest figures show that, during 2009/10, 3 workers died while working in construction in Scotland and there were more than 1,100 injuries. Nationally nearly three quarters of all fatalities occurred during refurbishment, repair and maintenance activities.
Jeanette Reuben, head of Construction Scotland, noted, "This was the fifth year of the inspection initiative and it is disappointing to find construction sites taking the same unnecessary risks with their workers lives.
"We know construction is an industry capable of getting it right, as the majority of sites we inspected showed.
"But the fact that we found unsafe conditions on one in five sites is unacceptable. Companies have a responsibility to protect their workers, to help rid construction of its reputation as being one of Britains most dangerous industries."
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. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
A True Story: Names changed to protect the innocent and the employee
Big Star Productions was making a block-buster movie in Atlanta with a cast of thousands. “Extras” have no speaking parts, provide no action – they are just a part of the scenery. Big Star Productions hired Find-a-Star to provide these “extras, as background to the famous stars.
Ima Wantabe wanted to be a movie star from the time she performed in her elementary school play. Ima, unemployed for a few years, answered the casting call for extras. Ima just “knew” if talent agents saw her on the movie screen, they’d come chasing to sign her up. After completing the paperwork she was told to report on Monday at 5:00 a.m. for a job expected to last one-day. (open-ended)
Ima was disappointed to discover 200 other “extras” were also waiting when she arrived at city auditorium to start her “new career.”. She joined a group of 50 extras sitting in the balcony hoping for a glimpse of the movies famous stars. After delivering a series of announcements and instructions to the extras, Find-a-Star announced to be considered for the first scene, the extras needed to move to the auditoriums main floor by 6 a.m.
Not wanting to miss out on her big (and maybe only) chance at stardom Ima, along a group of extras, rushed to the stairwell, where Ima fell to the steps, landed on her knee, fell forward and rolled over. It was unclear how the accident happened. Ima said she was pushed by another extra but a witness said she tripped on the second or third step from the bottom and fell. Only one extra stopped to help her (the witness).
By the time Ima caught up to the other extras, were, Find-a-Star had selected a few of them and told the others to have a seat. Ima sat from 7 to 9 a.m., realizing her knee hurt and thinking her acting career might be over. Or was it? If only, the movie producer or a producer's assistant could see her act . . .
Ima began to moan, she closed her eyes, laid her head back and sobbed. An extras, not realizing t Ima was acting, ran and got — .not the movie producer, but Dan the paramedic who was on duty. Dan asked Ima what was wrong. Ima described how she pushed down an entire flight of steps, was in tremendous pain, and probably broke numerous broken bones. Dan, a trained medic with 25 years of experience, was a bit skeptical, but the easiest thing for him to was to send Ima to the nearby Walk-In Clinic.
Dan declined Ima's request for an ambulance with a stretcher to carry her. She walked on her own to a service van, and a Find-a-Star employee drove her to the clinic. After being checked out, Ima returned to the auditorium and waited fruitlessly to be discovered. It never happened. (WCxKit)
A bright light bulb went off in Ima's headwhen she found out workers compensation would pay for her trip to the Walk-In-Clinic. Her acting career was just beginning! Ima complained again to Dan about her “tremendous pain.” He gave her two aspirin.
Ima returned the following day to the Walk-In Clinic complaining about her “tremendous pain” “all over.” The Walk-In Clinic doctor, to protect himself from a malpractice suit, had X-rays taken of all her limbs, back, neck, and head, finding nothing. The doctor started Ima immediately on daily physical therapy.
Find-a-Star, who employed Ima for an hour before she was hurt, reported the workers compensation claim to Top Notch Adjusters their insurer. Before Top Notch even had the file set up, Ima called demanding to talk to the adjuster. She was transferred to Harden Steele, who listened patiently listening to Ima describe her ordeal, how she was in “tremendous pain,” could hardly move, with every part of her body hurting, even Ima's hair was hurting. Ima wenton to tell Harden that due to her “workers compensation injuries” she probably would “never be able to work again.”
Harden asked Ima where she worked before she started with Find-a-Star. Ima did not answer but described how her injuries would prevent her from ever working again. Harden asked Ima how she was able to drive herself to the Walk-In Clinic everyday and to drive to physical therapy every day. Ima took a sudden turn for the worse and advised Harden she was in too much pain to talk any more.
Once Top Notch created the claim in their computer system, Justin Noway (known in the industry as Mr. Noway) was assigned as the adjuster. To complete his 3-point contact technique, Noway called Find-a-Star to discover the personnel manager knew nothing other than what Dan the medic put on the First Report of Injury. Noway called the medical provider. The Walk-In Clinic was very familiar with Ms. Ima Wantabe, and immediately suggested Mr. Noway find Ima another doctor. Noway then called Ima.
Ima, feeling much better after talking to Harden, proceeded to tell Noway about her “tremendous pain.” Noway expressed his sympathy for her pain, but advised under workers compensation, pain was not paid for, only medical bills and two-thirds of her lost income, with limits on the maximum and minimum indemnity benefits.
Ima asked what the maximum was for her “life time of lost income.” Noway advised he could not say for sure until he obtained more information from her and Find-a-Star. Noway asked Ima for a recorded statement. Ima took a sudden turn for the worse and advised Noway she was in too much pain to talk any more.
The next day Ima called Noway and asked if he had figured out how much her “workers compensation settlement” was going to be. Noway said he needed her recorded statement before he could calculate her “settlement.” Ima reluctantly agreed to the recorded statement. When Noway said she would need to be off her pain meds, Ima said she had taken no medication since the previous day and because she had “just gotten out of bed at noon today.”
Noway obtained all the background information in the recorded interview. When asked about her other employment, Ima told Noway she did not work anywhere else. She was only hurt while working for Find-a-Star. (Noway ruled out concurrent employment for the purpose of calculating benefits). Ima again described the accident and how she laid on the floor in pain until the medics came and helped her up and took her to the clinic (conflicting with the witness and Medic Dan’s versions of the accident.)
Ima listed her injuries as: headaches, back ache, neck ache, pain radiating through both shoulders, butt hurts, pelvis hurts, both thighs hurt, both lower legs had a sharp pain, both knees hurt, numbness in her hands and fingers, difficulty standing, lying down, sitting and was now clumsy where she was not clumsy before this “workers' compensation accident.” She also had a bruised knee requiring her to wear pants so her knee could not be seen. Noway asked Ima with her severe injuries, what other medical professional saw her knee besides the clinic doctor office and physical therapists. Ima took a sudden turn for the worse and advised Noway she was in too much pain to talk any more. (WCxKit)
Ima called Noway the following day and said she really needed to see a specialist. Noway, realizing he needed to put an end to Ima's new acting career, agreed. He asked the telephonic case management nurse (TCM) to schedule an appointment with an orthopedic doctor. Dr. Paine agreed to see Ima, but by the time Ima was seen. it was be sixteenth day from the date of injury.
The TCM nurse, assigned the claim based on the insurer's parameters on all lost time claims, contacted Ima to discuss her medical care. When the TCM nurse noticed inconsistencies between what Ima said during the first part of her interview and the later, Ima took a sudden turn for the worse and advised the TCM nurse she was in too much pain to talk any more.
In the meantime, Ima decided to check herself into the Good Charity Hospital for treatment. When the hospital contacted Noway for approval of the hospitalization, he refused to authorize treatment. Ima checked out.
Ima went to see Dr. Paine who did a complete examination and found nothing objectively wrong with her other than a now-fading bruised knee. Dr. Paine released Ima to return to work with a ten pound weight lifting restriction. He also agreed to let Ima continue her physical therapy as Ima felt “it was slowly helping” her.
In the meantime, Noway contacted Find-a-Star to get a lost wage statement and was advised Ima no lost income, as they paid full $130.00 for her one day employment contract, even though Ima was not chosen to be an extra. Noway asked the employer if the ten pound weight lifting restriction could be accommodate and they said it would not prevent any extra from working. When Noway asked for a comparable or similar employee working for at least thirteen weeks he was told one of the extras worked more than three days. The maximum any extra earned was $390.00.
Noway divided the $390 by 13, for an average of $30 per week. He multiplied the $30 by two-thirds, and got a weekly indemnity benefit of $20. As $20 per week is below the state’s $50 weekly minimum indemnity benefit, Noway utilized the $50 per week for payment of TTD. Ima would be paid for 9 days of indemnity benefits – the sixteen days between the date of injury and the day Dr. Paine released her to return to work, less the 7 day waiting period (Georgia has a 21 day retroactive period).Ima was owed $64.29 in indemnity benefits. (WCxKit)
When Noway contacted Ima to advise her she would be receiving an indemnity benefit check for $64.29, Ima asked in an indignant voice, “That's all per day?” Noway said, “No that was all, forever.” Ima was done acting. She replied “You mean I went through all of this for just $64?” Noway replied, “Yes, this is your workers compensation settlement.” Ima hung up the phone, she was done acting.
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. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
When the State of California Department of Industrial Relations issued its White Paper in January, 2011 on the
Use of Compound Drugs, Medical Foods, and Co-Packs in California's Workers Compensation Program*, An Overview of the Issues, you knew the problem had arrived.
Compound drugs are drugs combined by a pharmacy for a specific medical condition. A medical food is any food that is used to treat pain and other symptoms of an on-the-job injury. A co-pack is a medical food combined with a generic prescription pain reliever and sold in a “convenience pack” with a medical food.
According to the Food and Drug Administration (FDA), a
medical food product must be formulated and processed for use in treatment of an injury (and/or other medical conditions) and be used as a treatment modality. It must be:
1. A food for oral or tube feeding
2. Provide for the nutrient needs resulting from a specific medical disorder
3. Is for use under a physician's supervision
Be labeled with a statement of identity and content (but is exempt from the FDA guidelines for health claims and nutrient content claims (WCxKit)
For workers compensation, the most often sold medical food in California is Theramine. Its stated purpose is to aid in the nutritional management of chronic pain syndromes including fibromyalgia. The ingredients listed on the Theramine packaging states it includes GABA, arginine, choline, glutamine, grape seed extract, cocoa, cinnamon, histidine, serine, 5-HTP, and hydrolyzed whey protein.
Theramine is often sold in the co-pack where it is combined with tramadol with the combination being called Theratramadol for use in management of moderate to severe pain in adults. When Theramine is combined with naproxen, it is called Theraproxen, and is used for pain management for tendonitis and other similar medical conditions. When Theramine is combined with hydrocodone and acetaminophen, it is called Theracodophen and is used to treat moderate to severe pain. As tramadol, naproxen, hydrocodone and acetaminophen have the exact same uses when not combined with Theramine, the question is: should the insurer of the worker's compensation claim pay more for the medical food or co-pack? If Advil is mixed with a casserole, would the insurer be responsible for the cost of the casserole? Maybe so if the need for oral medication is necessary due to the work-related injury.
One question at issue is where will the
injured employee obtains medical foods. Since there are no medical food stores, the medical foods are sold by the treating physician. There is a built-in conflict of interest when the treating physician stands to profit from one treatment method over another.
In the states where the employee can select the treating physician for their workers compensation claim, the use of medical foods is booming. In California, the employer selects the doctor, but after 30 days the employee can select their own doctor. The employee selected physicians are doing a much bigger business in medical foods then the medical providers selected by the employers, regardless of the state.
Per the FDA, the medical food must be “intended for the specific dietary management (of an injury) for which distinctive nutritional requirements, based on recognized scientific principles, and are established by medical evaluation.” If these guidelines were being universally recognized, then you would anticipate the dispensing of medical foods by physicians chosen by the employers and physicians chosen by the employees would be approximately the same.
Consider for example the treatment of pain. When the choice is between prescription drugs available only in a pharmacy, referral of the injured employee to a pain management clinic, or selling the employee either medical foods or co-pack (medical foods + a generic prescription pain reliever), is the doctor making the best choice for the injured employee, or is the doctor selling the medical foods or co-pack making the best choice for the doctor's income?
There is medical evidence that proper nutrients can speed healing and improve outcomes. The treating physician has always been allowed and willing to tell the injured employee the benefits of proper nutrients in the appropriate amounts. However, the question with medical foods is does the cost of medical foods outweigh the additional benefit they provide?
Medical foods also present other issues including safety concerns as they are not required to meet the FDA drug regulations. Another issue (and definitely associated with the physicians selling medical foods) is their price is not controlled by medical fee schedules. Also, until recently the medical food utilization has been outside the normal cost restraints of utilization review. Some pharmacy benefit management (PBM) programs are beginning to audit the use of medical foods by tracking the use. The PBMs are looking for duplication of therapy, being prescribed by multiple physicians and excessive duration or excessive use.
If your injured employee is being sold medical food that is in turn being billed to the workers compensation insurer, it is eventually going to have an impact on the cost of your workers compensation coverage. When the medical food cost begins to rise, consider another strategy besides the PBM program. Ask your utilization review company to address the issue with prospective, concurrent and retrospective utilization reviews. (WCxKit) (open-ended)
Medical foods look like they are going to be an issue in the future in workers compensation. Knowing how to manage medical foods and the associated issues will be necessary. Now where is my Snickers bar?
If you would like more information about the product or the issues surrounding it, the Director of Marketing and Distributor Relations is Marcus Charavastra who can be contacted at:
marcusch@ptlcentral.com
Mr. Charavastra emailed us and wanted to point out the following, so in an effort to make this article balanced, we have included his comments and contact information:
"Our products are regulated by the FDA, and do not require FDA approval because they contain only GRAS ingredients. Our products are also regulated by the California Medi-cal fee schedule. I think the confusion here is that the RAND study has really confused the issues and has succeeded in lumping medical foods and compound creams together, when in fact they are much different. Medical Foods, ours specifically are quite regulated by the FDA, as they visit our facility once every two years; inspect all of our labels, bottles, and marketing material as well as analyze our products compared to the certificate of analysis. Compound creams are not regulated or inspected by the FDA for safety and or efficacy."
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
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. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Some litigation can drag on forever. As time goes by, the expense of litigation keeps piling up and between attorney fees, expert fees, lost worker wages, and medical expenses it can seem like the case is going nowhere. Below are some ways to speed up the process and get those cases settled and off your loss run.
1. Report New Litigation Promptly to Your Carrier
Sometimes the first notice of an injury is a Notice For Hearing. These may come from past employees or current ones. Since carriers usually have a dedicated adjuster just for litigation the sooner the new litigation notice arrives at the carrier’s office the better. Be sure to send the carrier all documentation and follow it up with a phone call or email to make sure the proper person received it. (open-ended) (WCxKit)
2. Get the Complete Personnel File Over to Your Carrier – fast.
If the first notice of injury is a hearing notice, both the carrier and you share the same information — the hearing notice. The adjuster calls the employer first as part of the investigation, so be prepared having the claimant’s personnel file pulled, copied, and ready for mailing. Include anything else pertinent to the claim, such as safety records, job applications, any disciplinary write-ups, time sheets, medical records or invoices, and so on that may be helpful to the investigation. Also send the claimant’s job description and any witness or coworker statements just to cover all bases. Work on your defense before the first hearing.
3. Once Counsel is Assigned, Give Them a Call
The counsel on the case may have different questions than the adjuster, and you should make contact to make sure you know what is needed and to keep the attorney up to date. Counsel may know nothing about your company and has no idea what your jobs include. It is helpful to educate the attorney about your company and what the medical/wage exposure could be.
4. Don’t Abandon the Claim for Counsel to Handle
Be proactive. Sometimes when a case is in litigation little follow-up is done until after a hearing date and then only to find out the next hearing date. Leave yourself notes to follow up with the attorney on a regular basis to be sure you know what is currently going on and what is coming in the near future. That way you are kept up to date, and can address any concerns raised on a timely basis.
Note: if you do not have a solid litigation management system to manage every aspect of your lawsuits (whatever type that might be) you should consider putting one in place so that YOU, the employer, manages them.
Sometimes, depending on the size of the case, adjusters overlook the seriousness of a claim. As mentioned before, carriers employ litigation adjusters who tend to focus on the larger, more exposure-heavy claims. That shouldn’t mean your claim is not important and shouldn’t be handled proactively. Being involved on all ends pushes your claim to resolution.
5. Make Yourself Available to Testify as a Witness
Nobody knows the ins and outs of the job duties as you, the employer, do. So, get both counsel and carrier good detailed job descriptions. In medical reports, the claimant may tell the doctor one thing, and the truth may be totally opposite. It is not unusual for claimants to inflate their job duties which lead them to injury and your testimony can be helpful is putting the tasks they did at their job back into reality. This helps the defense of your claim and shows you, as the employer, are involved in all aspects of the claim.
6. Ask Your Current Employees What They Have Heard About the Lawsuit
In smaller communities it is common for everyone to know a lot about everyone else. Most times depending your relationship with the claimant and the claimant relationship with other workers, information may can be hard to gather. But chances are, someone knows something so its worth checking out.
7. Look at Other Information You Know About the Claimant that Could be Helpful
Other types on information can include the type of house the claimant has; hobbies; type of car; what the spouse or relatives do for employment; bars/restaurants frequented, etc. Surveillance may be initiated to get a gauge on the claimant’s activity level. The more information provided the better the result of litigation. (open-ended)
8. Be Open to Settlement Early on in the Case
No matter how hard you defend a claim; sometimes the only option is to settle the case. Carriers take fewer cases to trial because of the risk of losing and incurring the full costs of medical and wage exposure. At times it is best to come up with a global settlement. While only pertaining to certain cases, be open to early settlement. Early settlement decreases defense costs, and speeds up the process. Pick and choose your battles. If the case doesn’t entail a lot of complications and is fairly straightforward, the sooner you can get rid of it the better. Who wants to spend $5,000 defending a case worth $2,500? (WCxKit)
Note: Some companies make a practice of settling in only the most extraordinary and clear-cut circumstances because they fear it sets a bad precedent for future claims.
Summary
Litigation costs for Insurance claims can be quite daunting, but if you handle them promptly and gather as much information as you can early on, the process can be speeded up generally end up in resolution earlier rather than just send the case on to counsel and leave it up to the attorney to take care of it. Be sure to stay involved in all aspects, and make yourself available in whatever facet needed to resolve the case and get it off the books.
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. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com or 860-553-6604.
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.
©2011 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 Saskatchewan government is adding esophageal cancer to the list of cancers considered occupational diseases for the province's full-time, professional firefighters.
Workplace Safety Minister Don Morgan says the amendment to the Workers Compensation Act signals the government's intent to cover risks posed by toxins, carcinogens and cancer-causing agents in the daily work of firefighters. (WCxKit)
There will be a minimum employment requirement period. No incremental costs to the Workers Compensation Board are expected with this legislation, since esophageal cancer claims are already accepted by the board if there is sufficient evidence establishing a causal link to the work performed.
There are close to 700 full-time, professional fire fighters in Saskatchewan.
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. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
With medical cost inflation far exceeding inflation in general over the last two decades, everyone wants to control the cost of medical care. In workers compensation, medical management is justifiably used to control medical care cost. However, when you see the large expense for triage, nurse case management or pharmacy benefit management, do you wonder if you are getting your money's worth? The answer is an absolute yes — IF you are using highly trained, qualified and skilled medical management firms.
The question then becomes how will you really know if the medical management companies you hire are the highly trained, qualified and skilled medical management companies you need? None of the companies you consider will claim anything else. Fortunately, for workers compensation insurers and self-insured employers, there is a way of knowing – check their accreditation. (open-ended) (WCxKit)
URAC is the largest and best known organization in the medical care accreditation industry. Its purpose is to set the standards for qualification, credentials, and deliverance of health care. URAC’s original name was Utilization Review Accreditation Commission. URAC serves the health care industry in general; not just workers compensation; however it does provide accreditation in several key areas of medical cost management for workers compensation.
Areas of interest to the workers compensation community include: (Note: Being accredited in one category does not mean a company is qualified in any other category.)
1. Nurse Case management.
2. Independent review organizations.
3. Health utilization management.
4. Health call centers (triage).
5. Worker's compensation utilization management.
6. Pharmacy benefit management.
For accreditation to be worthwhile, it must entail a lot more than a company paying a fee and getting an accreditation seal issued to them. Accreditation must be based on a medical management company meeting strict standards set high enough to ensure competency and expertise in their area of specialization. URAC accomplishes this by developing its standards through committees of experts. The experts come from a broad spectrum of the health care industry including insurers, health care organizations, medical providers, employers, regulators and other areas.
An effective accreditation organization, is independent of any of the parties be accredited. URAC is not owned or controlled by any party being evaluated for accreditation. The company has over 500 committee volunteers — experts from medical providers, employers, insurers, and regulators, plus its paid management staff.
When new standards are added or existing standards changed, URAC provides a copy of the proposed standards to all interested parties. Everyone involved can make recommendations for improvements or clarification in the standards development. All standards are reviewed every three years. If rapid changes/developments in the medical field necessitate a review of standards in a shorter period of time, URAC does so. (open-ended)
Effectiveness of the accreditation standards are ensured by URAC controlling the process with its own guidelines, including:
1. Quantitative measurements.
2. Analysis and reporting of measurements.
3. Surveys to obtain additional input.(WCxKit)
On the URAC website,
www.urac.org, you can look up the accreditation of the various medical management companies you use. You can search by either their area of expertise, by their name or by a particular state (California takes a while to load as it is a very long list). If your workers compensation medical management company is not listed, it does not mean they are unqualified, but serves as a warning to further check their qualifications. (
Note: Qualifying in one area, like case management, does not mean a company is qualified in another specialty, like triage.)
Make sure to include in your RFP's that nurse case management, nurse triage, and physician review is URAC certified.
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. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
Montana Commissioner of Securities and Insurance Monica Lindeen reported that workers compensation claims in the state have fallen by more than 5% during the past year.
The news comes as Montana continues its effort to abdicate from its reign as the state with the highest workers comp premium rates in the United States. (WCxKit)
The National Council on Compensation Insurance recently made a filing with the Montana Department of Securities and Insurance requesting an overall loss cost decrease of 5.6% effective July 1, 2011, according to Lindeens announcement.
Under Montana law, the NCCI analyzes industry trends, prepares workers comp insurance rate recommendations, determines the cost of proposed legislation and provides a variety of services and tools to maintain a healthy workers comp system. Private insurers in Montana adopt the loss cost and file the end rates with the commissioner’s office.
The figures released by the NCCI does not include the impact of legislation that has worked its way through Montana's Senate and House of Representatives in recent months.
Just recently, both chambers sent a bill to Gov. Brian Schweitzer, a Democrat, which would make a number of cost-cutting changes to the states workers comp. Among the changes included in H.B. 334 is a provision that would end medical benefits 60 months after the date of the injury. The bill includes a provision that would allow injured workers to appeal the end of their benefits.
The bill would also create a list of doctors that injured workers can see for treatment; as opposed to letting them request their personal doctor. The National Council on Compensation Insurance has estimated that H.B. 334 would save $84 million to $183 million in the first year alone — a drop of between 20% and 44% (BestWire, Feb. 23, 2011). (WCxKit)
The 60-month cutoff date was a major sticking point for many industry observers who said that window was too short for situations where a worker was significantly injured. Montana Rep. Scott Reichner, R-Bigfork, who introduced the bill, argued that putting a hard deadline for benefits to be cut off was the only way to ensure that "people aren't going to enter the system and never leave."
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. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
A Pennsylvania court has ruled that videotape surveillance of an injured worker during an Islamic prayer service did not violate the worker's privacy [Tagouma v. Investigative Consultant Servs., Inc., 2010 PA Super 147, 4 A.3d 170 (Pa. Super. Ct.2010).
The employer's workers compensation carrier hired the defendant investigation firm to perform surveillance on the worker. An investigator observed the worker as he stood inside an Islamic Center near a window and prayed.
The investigator stood some 80 yards away and for 45 minutes videotaped the worker by means of a zoom lens. After the videotape was shown to a workers compensation judge, the worker filed a tort action alleging invasion of privacy against the investigation firm.
A court of common pleas granted the defendant summary judgment and dismissed the case. The worker appealed. The Superior Court of Pennsylvania agreed with the trial court, indicating that the worker failed to show that he had a reasonable expectation of privacy while praying, that he had a diminished expectation of privacy based upon his filing the workers compensation claim, and that the Islamic Center was open to the public and the worker prayed directly in front of a large window. The court also indicated that the use of the telephoto lens was not unreasonable nor was it intrusive. Larson's Workers Compensation Law [See Ch. 127 ]
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
Many companies simply don’t offer light duty. Instead, they say to their injured workers, “If you are not 100 percent then you are no good to me.” These same employers then complain when they go over their loss run about how much they are spending on shorter (10-30 days) lost time claims.
Typically wage expense on these claims is an employer’s biggest expense. Some higher wage earners can rack up a hefty wage cost in a short amount of time. Meanwhile, the medical cost for their claims may be a few thousand dollars, tops. (WCxKit)
Here are seven ways to keep those little lost-time claims from adding up in the long run.
1. Create Light Duty Work for All Restrictions
Depending on company size, there are a lot of easy jobs a person with restrictions can do — freeing up a healthy employee to do non-restrictive tasks. Light cleaning, inventory, answering the phone, ordering parts and supplies — all of these are necessary tasks in every company. A person with
short-time, restricted duty may be assigned to help on these jobs or other light work until they are able to return to full duty, always dependent on the restrictions. Light duty keeps the employee working, and makes it easier to transition back to full-duty work.
2. Make Detailed Job Descriptions for All Available Light Duty Positions
Physicians usually ask for a job description before they release an injured worker
back to work. If you have a good breakdown of what the various job tasks are, it makes it easier for the doctor to decide if the employee can do those jobs. Pay attention to the details of these jobs as well, you don not want an injured employee making the injury worse through their light-duty assignment.
3. Make Sure the Employer Contacts the Clinic to Say Light Duty is Available
Who knows what the employee is telling the doctor about the day-to-day job duties? Some claimants wanting to remain off work inflate their job duties to make it sound like there is no way they could
return to work until they are at full ability.
If the employer calls or faxes over a job description the doctor may feel more at ease about releasing an injured worker back to light duty. Also, some doctors flat out ask the employee if there is light duty available and most the time the employee will say no, even when it is known there is light duty, in an effort to remain out of work longer and collect a check before returning to full duty. Employers must follow up and make sure they talk to the right person at the clinic about getting the employee back to work in an assignment consistent with their medical restrictions.
4. Offer Full Pay for Light Duty Work Instead of Partial/Reduced Pay
A common deterrent to an employee not wanting to come back on light duty is the employer drops the wage rates to coincide with the light-duty job tasks. This action defeats the purpose of bringing the employee back to work on light duty. Even though the tasks are below the employee’s experience level, think of light-duty assignments in the short-term, and be flexible with the pay. The injured worker is not going to be on light-duty work forever and getting the worker back to work is the important thing.
5. Talk to the Clinic/Physician About Your Workplace and the Work it Performs
In addition to faxing a job description, ask to talk directly to the physician. This will surely make the doctor feel better about releasing an employee back to work. Talking to the employer reassures the doctor the tasks assigned will be performed properly within the medical restrictions, and that the employer will provide help on certain jobs if the injured worker needs it. In addition, most physicians can provide work restrictions over the phone instead of waiting until the next appointment to release the worker back to light duty.
If you cannot reach the doctor ask for the office manager or medical/nurse assistance. Tell them a job description was faxed and that you want the doctor to address whether or not the employee is able to perform the light duty tasks; and if not, why. The more persistent you are, the quicker the doctor will be to provide restrictions. The squeaky wheel gets the grease.
6. Light Duty Work Tasks Can Motivate Workers to Get Back to Full Duty
Most people don’t like cleaning, phone work, or simple mundane tasks for very long. If workers know these tasks are a consequence of injury, they are less likely to milk their claim. Good workers hate being hurt and want to return to normal as soon as possible. If they know they will not be sitting at home idle, and instead will be answering the phone at work, it will shave time off of their claim and motivate them to be released from the doctor to full duty.
7. Think Of The Bigger Picture
Even if you do not have a lot of claims at your workplace, think about the cost in the big picture. Think quarterly and/or annually about the savings you will realize come the end of the year. As mentioned, wages are the biggest cost in short-term, lost-time claims. By keeping the injured employee working so they do not lose any time at all, you provide them with a job while they are injured, and also provide a service to the company. Before you know it they will be full duty without incurring any further lost time from their normal work duties. (WCxKit)
A good light-duty work program has a ton of benefits and you can get injured workers back to work utilizing the tips outlined above. This will not only save costs, but will also make the workplace more functional for injured workers. It is important to create and have on-hand, up-to-date, detailed job descriptions, as well as someone at your workplace following up with clinics to make sure they have the correct information regarding your light-duty work program. Once everyone is on the same page, your workers and your assigned occupational clinic will know what is expected of them when workers have a minor injury.
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. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
A year after an attempted car bombing in Times Square, the federal agency that governs workplace safety is placing theaters across New York on notice that future inspections will include reviews of emergency-action plans—which instruct employees how to respond to crises, including evacuations.
According to The Associated Press, in an April 15 letter sent to 63 theaters, the U.S. Occupational Safety and Health Administration said: "Recent events, such as last summer's attempted car bomb in Times Square, have highlighted the need for increased vigilance and ongoing emergency preparedness." (WCxKit)
Several theaters were evacuated in May 2010 after a smoldering car was discovered close to the Minskoff Theatre, where "The Lion King" is performed. The bomb was later traced to a Connecticut man with ties to the Pakistani Taliban. The letter didn't target particular theaters; rather, OSHA attempted to send the letter to every theater in New York, according to an agency official familiar with the matter.
The agency's change in protocol comes because of a December report on emergency preparedness in New York's theater district by the New York state Assembly subcommittee on workplace safety, chaired by Queens Assemblyman Rory Lancman, and the committees on labor, governmental operations and cities.
The report was issued after the workplace safety subcommittee held a roundtable in the wake of the attempted bombing to discuss "concerns among theater district employees that existing emergency preparedness and evacuation plans and procedures present a workplace safety hazard and are in need [of] careful reexamination."
It recommended that OSHA "issue clearer guidance on which theaters are required to establish Emergency Action Plans," and increase inspections to ensure theaters compliance. An OSHA deputy regional administrator, Richard Mendelson, said the agency has "enhanced" its protocol. "When we get to a facility, this is what we're doing in addition to whatever we're already there for," Mendelson remarked.
The agency conducts random inspections of high-hazard venues from time to time and usually conducts an inspection in the event of an accident. (WCxKit)
Written emergency action plans, required in venues with more than 10 employees, must outline possible emergency scenarios, as well as specify which employees should stay behind to assist in an evacuation.
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. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
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.
©2011 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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