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When Silence is MONEY Rather than Golden in Workers Comp


What is money made of? In workers compensation the answer is SILENCE. Indeed, the more silence the more money the employer pays. Certainly, the employee must say something, but not much. Legal presumptions, always benefiting the employee, mostly take the place of facts.
 
 
Workers comp lawyers profit from this well known fact. Other than partially completing a report of injury (C-2) or sometimes testifying in a contested claim, the employer remains unheard from. Unheard, in spite of the fact that the employer is almost always in possession of more than enough information to make a difference. The difference does not necessarily mean defeating a claim; it means getting to the correct result as soon as possible. Delay in workers comp claims means a loss of money to the employer, even if a claim is “won.” (open-ended) (WCxKit)
 
 
Employers are generally reluctant to volunteer information and they are not encouraged to do so. When employers do speak out their input is nearly always helps rather than hurts so long as it’s truthful. In large part, the problem lies with a workers compensation system permitting the employer to believe in a decades old misconception that they are without control over the defense.
 
 
Actually, the law firm selected by the carrier represents the EMPLOYER, not the carrier, in work comp proceedings. If the law firm fails to consult with the employer before and after each hearing, the basic obligations to the employer are not fulfilled.
 
 
An employer can remedy these failings in a number of ways. First, in sending initial information to a carrier, understand that the first report of injury is the barest minimum legally demanded and is seldom enough to take a claim to a positive outcome. Therefore, include other relevant documents or notify the carrier of the existence of same.
 
 
A failed attempt to receive UI, followed by a compensation claim, cries out for documentation of the reasons for the denial. The same can be said for discrimination claims or a disability benefits claim. Have there been serious claims for illness in the year prior? An unrelated accident claim?
 
 
The employer must not assume these prior incidents will automatically come to the attention of the carrier. Even self-insured employers, without carriers, have been known to have communications failures within thei
Posted in NY Workers Comp Issues, WC 101 |


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Misssissippi Worker Wins 322 Million Asbestos Suit


In what attorneys report was the largest ever single-plaintiff asbestos verdict in U.S. history, a Mississippi jury has awarded $322 million to a former oil field employee who reportedly inhaled asbestos dust while mixing drilling mud.
 
 
According to fairwarning.org, Thomas “Tony” Brown Jr., 48, worked in the oil fields from 1979 to the mid 80s as a roughneck on rigs in Mississippi and offshore in the Gulf of Mexico. He sued Chevron Phillips Chemical Co., which sold the drilling mud, and Union Carbide Corp., the manufacturer, for causing him to develop asbestosis, a lung disease caused by asbestos exposure. He is now on oxygen daily. (WCxKit)
 
 
The jury award was for medical expenses, pain and suffering, and punitive damages down the road.
 
 
“Although the asbestos was known to cause cancer and lung disease, Chevron Phillips and Union Carbide continued to market these almost 100 percent pure asbestos products long after they knew the dangers,” Allen Hossley, a lawyer for Brown, told The Wall Street Journal.
 
 
Both Chevron Phillips and Union Carbide said they would appeal the verdict. “The credible medical evidence introduced at trial clearly demonstrates that while Mr. Brown suffers from shortness of breath, such [a] condition is not attributable to asbestos exposure,” a Union Carbide spokesman informed the Jackson Clarion-Ledger. The companies also contended that because Brown was illiterate and could not read the hazard statement on the drilling mud additives, he was not entitled to argue that they had provided inadequate warnings.
 
 
If the verdict is upheld, Brown will be entitled to an amount close to equal to Union Carbide’s yearly net income, which was $459 million in 2010. Union Carbide is a subsidiary of The Dow Chemical Co. (WCxKit)
 
 
Asbestos products were used in drilling mud due to the fact asbestos is fire-resistant and a strong bonding agent.
 

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.
Posted in Legal Doctrines, Medical Issues, Product Liability, Safety and Loss Control, Union Issues |


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Manitoba Initiatives for Safer Workplaces for Nurses and Healthcare Workers


The government of Manitoba says it is introducing initiatives to support safer workplaces for nurses and other health-care workers.
 
 
Labor Minister Jennifer Howard says the risk for violence exists in all health-care facilities. She says new rules will require that all such facilities work with health-care employees to develop a violence prevention policy. She says that will include ensuring that security assistance is rapidly available for staff should the need arise. (WCxKit)
 
 
According to Howard, the initiatives will be developed in partnership with the Manitoba Nurses Union. Final recommendations are expected by the end of June and amendments will be in place by the end of August.
 
 
''Hospitals are not only a place where people go when they need health care, they're also a workplace for thousands of front-line nurses and other health professionals,'' said Health Minister Theresa Oswald. ''We're continuing to work with nurses to ensure their safety and help reduce workplace violence in facilities across the province.''
 
 
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.
Posted in Safety and Loss Control, WC in Other Countries (International) |


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17 Ways to Win Your Claims in Workers Compensation Litigation


 
Statistics prove litigated workers compensation claims cost the most. In this article we will use the broad definition of litigation to include any claim where the employee has hired an attorney, regardless of how the claim is settled, whether by agreement, workers compensation board decision, or in the courts. Here are some suggestions on how the employer and/or the insurer can have a positive influence on the overall cost of the claim.
 
 
The First Steps in Controlling Litigation:
Any time an injured employee hires an attorney, you should immediately begin to prepare for the possibility of a long, drawn-out process. Some of the steps you can take include:
 
1.      Employ the defense attorney early on as the employee's attorney will start maneuvering the claim in the most favorable direction for the employee if they are allowed to do so. Assemble your defense BEFORE the first hearing.  Yes, do it early!
 
2.      Assist the defense attorney in preparing to defend the claim by providing the defense attorney with the first report of injury, the wage records of the employee, the personnel records of the employee, any witness statements you obtained immediately after the accident, and any other information that you have that relates to the employee or the injury.
 
3.      Get over your reluctance to offer a modified duty job to the employee. By putting the employee back to work, you diminish the plaintiff attorney's arguments that the employee is unable to work, will never be able to work, etc. Also, if handled correctly, a modified duty job offer will make the employee feel more appreciated and less likely to hold out for a “big settlement."
 
4.      In states where an employer can request multiple independent medical examinations (IME), an IME should be scheduled immediately. Have an M.D. prepare the cover letter to the IME doctor. Yes, it's going to cost money, but in the end, it will save money.
 
In states where the employee selects the medical provider and you only get one IME, an independent medical examination should be scheduled immediately after the employee has reached their maximum medical improvement. I repeat, have your MD prepare the cover letter. This will provide medical documentation that the employee has recovered from their injury and to limit the exaggeration of the injury you can expect from the plaintiff attorney. 
 
5.      If you have any doubt about the validity of the injuries claimed by the employee, consider surveillance to verify or disprove the validity of the injuries. Have the employer review the surveillance.
 
6.      If you do not already have medical case management on the claim, add it if you can. Consider peer-to-peer medical review — this is a doctor who reviews the medical portion of the file.
 
7.      Another way to reduce future disability value placed on the claim is to hire a vocational rehabilitation specialist to assist the injured employee in returning to work. physical therapy networks may have rehab specialists. Consider using one.
 
8.      Do not let your feelings be hurt; the plaintiff attorney is in for the money, and the employee is thinking about his own welfare, not what is in the best interest of the employer or the insurer.
 
 
As the Claim Progresses:
The employer's involvement in claim defense continues after the initial flurry of activity at the beginning of the litigation process.
 
6 additional steps you should take:
1.      After the defense counsel has obtained all the initial information, but before the discovery process begins, review with defense counsel their initial evaluation of the claim. Is the claim one that should be denied and fought all the way, or is the claim one that should be settled? Know what you defense attorney thinks before a lot of money is spent on discovery. Get ALL prior medicals early, before the first hearing if possible. Subpoena them if necessary. Yes, you can do that in most states.
 
2.      If the defense counsel thinks you are going to lose based on his or her initial evaluation, do not be afraid to go ahead and settle the claim before the legal bills escalate.
 
3.      If the defense attorney recommends the claim be defended, or recommends discovery to clarify the defense of the claim, have him to proceed timely. 
 
4.      Do not delay the discovery process. This will only allow the employee to stay off work longer drawing indemnity payments and going to additional medical visits (even if the medical visits are not needed, the plaintiff attorney will encourage the employee to continue to treat to push up the settlement value of the claim).
 
5.      Keep in touch with defense counsel as the status of the claim dictates. More is better than less. If she/he isn't responsive or aggressive, get a new attorney.
 
6.      Always promptly cooperate with your lawyer. It will move the claim along faster.
 
When the Claim is Concluded:
Regardless of whether you settle the claim or the claim is adjudicated by the work comp board or the courts, there are certain steps you need to take including:
 
1.      Pay the claim quickly. Incurring penalties and attorney fees on top of the claim value does not do anyone (except the lawyers) any good.
 
2.      Only consider an appeal if the defense counsel thinks you have a viable chance at winning the appeal.   Appealing the board decision or the court decision simply because you do not like it is an expense you do not need.
 
3.      If the injured employee does return to work, either with or without work restriction accommodations, treat them the same as all the other employees and like nothing ever happened. If you treat the returned and litigated employee like they have the Black Plague, it won't be long before they understand they are not welcome. The employee attorney will be filing another petition for additional benefits claiming the employee is unable to work or the injury has been aggravated with the employee going back off work drawing additional indemnity benefits and incurring additional medical expense. (WCxKit)
 
Note: I usually fight long and hard before I settle if I have any inkling the claim is exaggerated. Settling quickly sends the wrong message. I always VERIFY the extent of the disability with surveillance before I settle. Seeing is believing.
 
 
By planning your involvement in the defense of the workers compensation claim, you can reduce the overall defense cost and possibly the settlement value of the claim. The employer should always take part in the defense, as the cost of the workers compensation litigation will be your cost eventually through your work comp insurance premium. Act now to control the long-term 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. 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.
Posted in Litigation Management, Settling WC Claims, WC 101 |


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Italian CEO Sentenced Following Worker Deaths


In an historic ruling on voluntary homicide, ThyssenKrupp's CEO for Italy was sentenced to 16 ½ years recently in prison on charges related to the deaths of seven workers in December 2007 in a fire at a steel plant in Turin, Italy.
 
 
Five other company officials were also convicted on manslaughter charges and sentenced to up to 13 1/2 years in prison. The German company received a 1 million euros fine. (WCxKit)
 
 
Also, the company will not be permitted to benefit from Italian state subsidies for six months. During the same period, ThyssenKrupp will also be prohibited from advertising its products in Italy.
 
 
At the time of the incident the company was gradually eliminating the factory, with only 200 of the former 400 employees remaining, and failed to maintain health and safety standards.
 
 
The prosecution's investigation into the incident showed that the CEO was fully aware of the risks and decided not to take the minimum measures necessary by law at the plant.
 
 
The court's ruling, which can be challenged, is historic as it sets an important precedent in recognizing the CEO as responsible of voluntary homicide, a first in Italy for a workplace accident.
 
 
One worker died on the scene in the blaze at the plant in Turin, while the other six died later in hospital. (WCxKit)
 
 
The deaths prompted a nationwide campaign for improved safety measures in the workplace.
 

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.
 
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.
Posted in Safety and Loss Control, WC in Other Countries (International) |


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Korean Court Weighs In On Stress Claim For Dismissal


A Korean court recently ruled that the family of a deceased worker can receive industrial disaster compensation since his death was caused by stress due to a warning of dismissal, a court official said Thursday.
 
 
According to the Yonhap News Agency, the man, surnamed Ji, who was employed at a fish processing company since 1998, collapsed at work and died from a cerebral hemorrhage in 2008. Court officials did not give further details of his identity. (WCxKit)
 
 
After his death, his family requested the state-run Korea Workers Compensation and Welfare Service to acknowledge the case as an industrial death and grant them medical expenses. They said he passed away from stress after his employer saw Ji arguing with his colleague and threatened to fire him.
 
 
Their claim was turned down. They then filed a petition with the Seoul Administrative Court, which deals with appeals against administrative decisions by the government.
 
 
The Seoul Administrative Court acknowledged the link between his disease and stress at work, considering the fact he died the day after he was warned.
 
 
It also noted medical staff's opinion that said his disease was caused by a sudden jump in blood pressure believed to be linked to emotional stress, not to deteriorating health due to a chronic disease. (WCxKit)
 
 
"Because his employer warned him that he would be fired if he kept having quarrels, he is believed to have come under much pressure and stress," the presiding judge Kim Do-kyun said in a ruling. "The court acknowledges a causal relationship between his disease and work."
 
 
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.
Posted in Employment Law Issues, Safety and Loss Control, WC in Other Countries (International) |


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Massachusetts Worker Report Does Not Bode Well for Hispanics


An average of nearly one worker death occurred each week in Massachusetts in 2010, including five firefighters who died from work-related cancer and heart disease, according to a recently released report from the Massachusetts AFL-CIO and the Massachusetts Coalition for Occupation Safety and Health.
 
 
As the Boston Globe reported, Hispanic workers, an increasing population in Massachusetts and the nation, experience workplace deaths at a much greater rate then that of white, non-Hispanic workers. In 2010, 3.5 Hispanic workers passed away on the job per 100,000 versus 1.2 deaths per 100,000 for white, non-Hispanic workers, the two organizations noted. (WCxKit)
 
 
What's more, workplace violence continues to be a prime employment hazard, responsible for the deaths of three workers who passed away during the performance of their work in 2010, the report's authors wrote.
 
 
The report is titled, "Dying for Work in Massachusetts: The Loss of Life and Limb in Massachusetts Workplaces." And one conclusion of the report is that not enough safety precautions and workplace oversight are costing workers their lives.
 
 
Compared to other parts of the nation, Massachusetts is one of the safest states to work in the country, in part due to a high concentration of low-risk injuries, the national AFL-CIO reported. (WCxKit)
 
 
Robert Haynes, president of the Massachusetts AFL-CIO, noted, "Of the 47 families who suffered the pain of losing a loved one at work this year, many have to struggle with the fact that an existing safety regulation could have saved their loved ones' life. All an employer had to do was care enough to properly implement it.”
  
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.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©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.
Posted in Medical Issues, Safety and Loss Control |


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Illinois Retailers Request Enhanced Causation Requirement


Illinois Gov. Pat Quinn’s plan to reform Illinois workers compensation system appears to include some form of a key provision sought by Republicans and business interests, according to a recent talk he gave.
 
 
According to several media outlets, Quinn’s plan, outlined for the Illinois Retail Merchants Association and the Illinois Manufacturers Association on May 4, would require that a worker would not obtain benefits for an injury if it did not incur on the job. Businesses have sought a “causation" requirement in workers comp claims, meaning the workplace must be the primary contributing cause of a compensable claim. It is unclear whether Quinn’s proposal matches up with what Republicans and the state’s business interests want. (WCxKit)
 
 
Quinn could not point to a bill number or a legislative sponsor for his plan, so the exact language could be examined. Quinn, who indicated he seeks a reform bill enacted prior to the legislature's May 31 adjournment date, would not label his provision “causation,” although the presentation included the requirement that any compensable accident arise out of and in the course of employment.
 
 
Workers comp premiums cost companies $3 billion annually, and Quinn noted his plan, which also includes cuts in Illinois medical fee schedule, enhances review of how care is utilized, reduces permanent disability payments, limits compensation for carpal tunnel syndrome and limits the wage differential – how long workers can obtain benefits based on their pay prior to and after their injuries – would save companies $500 million.
 
 
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.
Posted in WC 101 |


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CEO Gets $12 Million Retirement Package: Offers Miners Families $3 Million Settlement


A filing with the U.S. Securities and Exchange Commission shows Massey Energy Co. has offered families of the 29 miners killed in a 2010 coal mine explosion $3 million apiece to settle their claims.
 
 
According to The Associated Press, the Virginia-based company publicly revealed the offers for the first time in a proxy statement filed in conjunction with rival coal producer Alpha Natural Resources' proposed $7.1 billion takeover. The deal is set to culminate after shareholders of both companies vote June 1. (WCxKit)
 
 
One family member of a deceased coal miner, Michelle McKinney, daughter of Benny Willingham, indicated she has no interest in settling. "My dad didn't have a price tag on him," she remarked. Massey presented a financial package that it claims would free the families from ever worrying about money.
 
 
The offer included life insurance (five times the miner's annual salary), health insurance, and additional payments to surviving spouses and scholarships to children. Massey board director Robert Foglesong said accepting those benefits would not halt a family from suing.
 
 
The April 5, 2010 Upper Big Branch explosion was the deadliest in the U.S. coalfields dating back to 1970, remaining the target of civil and criminal investigations. (WCxKit)
 
 
The filing cites the retirement last year of Massey Chief Executive Don Blankenship, who agreed to a $12 million retirement package.
 
 
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.
Posted in Safety and Loss Control, Settling WC Claims |


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6 Ways Medical Treatment Can Be Stopped or Disputed in a Work Comp Claim


 
First of all, every state is different and has different statues to follow regarding when and how medical treatment can be terminated. Check with your adjuster or insurance carrier to verify how these suggestions apply specifically to your workers compensation claims. Not all techniques apply to all states; stated another way, the techniques you want to use may not apply to your state.
 
 
Six Ways An Employer Can Dispute Ongoing Medical Workers Compensation Treatment(s).
 
1. Medical Treatment Plan Non-Compliance
Usually non-compliance by the injured employee in following the treatment plan is, in some aspect, covered in all states.
 
Claimants can end up losing their medical coverage for their claim when they
1.     Miss scheduled medical appointments.
2.     Often reschedule appointments.
3.     Miss or reschedule physical therapy dates.
4.     Treat for their condition using non-conventional methods.
 
They may get coverage back when they are compliant with the treatment plan and treat when and where they are supposed to.
 
 
Some claimants try these tactics in an attempt to extend the life of the claim, especially when return-to-work is looming and they do not want to go back. Discuss with your adjuster/carrier those defenses in place to prevent this scenario for happening.
 
 
2. The Physician Does Not Properly Notate the Medical Chart
Chiropractors, unfortunately, seem to fail in this category. Some (not all) do not even keep an actual medical chart with notes. Sometimes they briefly chart pain complaints and indicate pain progress. Overall, the notes are not detailed and fail to show medical improvement (progression).
 
 
Physicians must keep detailed notes showing objective and subjective complaints, and the causal relation back to the injury. They must do this to properly treat their workers compensation patients. Without this crucial information, you, the employer, will not know what is being treated, how treatment correlates back to the workplace injury, and what progress the worker is making toward full recovery and returning to work.
 
 
3. The Physician’s Office Ignores Adjuster Requests for Information
Adjusters often fax a request or call the treating doctor asking for answers to specific questions or for medical notes. Every doctor's office is different, but at times weeks, even months, can go by and the adjuster will still be waiting for the doctor to address their questions.
 
 
When this happens, (depending on jurisdiction) further treatment may be suspended since requests for information pertinent to the claim are being ignored by the physician. Lack of physician response happens especially when an adjuster asks a physician to address the causal relation of the injury to the medical evidence found on exam. Sometimes doctors don’t want to address this question because they fear involvement in a potential lawsuit. Doctors feel their job is to treat the patient regardless of the complaints or how the injury occurred in the first place. Your adjuster knows what defenses you may employ, usually this is the time for an Independent Medical Evaluation (IME) to clarify medical issues.
 
 
4. Claimants Treat with the Incorrect Physician Specialty for Their Injury
If a worker has a basic laceration with sutures, there is no need to see a chiropractor, acupuncturist, or psychologist. As straightforward as this seems, surprisingly, in states where patients have the freedom to seek treatment with whomever they want, incorrect and inappropriate treatment options are frequently selected. Look at inappropriate treatment choices making no medical sense as a warning sign and “assume” something bizarre is going on.
 
 
5. Physicians Do Not Discharge the Patient After Reaching End-of-Healing
Sometimes doctors ask to see patients two to three months following discharge of patients to regular duty as a follow up on their treatment. Depending on the injury, a follow up may be appropriate.
 
However, using our laceration as an example, a doctor wanting to see the worker five times after discharge is fishy. Physical therapists can be guilty of this charge. The doctor releases the patient to full duty without restrictions, but the therapist recommends more treatment and tries to get away with more unneeded therapy. If this is going on, intervene and ask the physician why the treatment is going on and how this relates to the injury and return to work status. It is important to work with a reputable physical therapy and rehab network.
 
 
6. Claimants Try to Treat After They Have Been Discharged By an IME
An independent medical exam (IME) is one of the adjusters best tools. Adjusters usually send patients for an IME because something is not adding up medically. Either the treatment is going on a lot longer than expected, or something in the medical notes does not make sense. Typically, claimants tell the doctor they have tons of symptoms, and the physician’s job should be to sort out what is work-related, what is not, and what makes no medical sense. Oftentimes, the doctor mentions allegations only to ignore them, and does not discharge patients when their subjective complaints do not match their objective signs of evidence.
 
In spite of an IME releasing a claimant to full duty and advising no further treatment is needed, the patient sometimes tries to return to the original physician for more treatment. Most states have good defenses for the insurance company in these scenarios and most times you are well-protected. However, it is always a good idea to follow up with your adjuster to stay on top of the file. Keeping up is especially important if certain forms have to be filed with the state in order to exempt ongoing treatment from coverage under workers compensation benefits.
 
 
Every state is different, and it is very important to clarify with your carrier or adjuster which laws apply in both your state and your circumstances. Employers must be aware even though workers may be released to full duty or may not have a severe injury, they may still try to get away with a lot medically. Treatments beyond medical necessity will increase both the costs and extend the life of your claims. If you remain vigilant and know what defenses are at your disposal, you can remain proactive and aggressive in making sure injured workers receive appropriate treatment, with the proper physician, for the right amount of time.
 

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.
Posted in Medical Cost Containment & Managed Care |


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