In the second year of EU-OSHA’s* Healthy Workplaces Campaign on safe maintenance, the number of official campaign partners rose to 52 as seven more pan-European organizations and multinational companies from a range of public and private sectors joined. They are:
1. The European Association of Paritarian Institutions of Social Protection
2. Standing Committee of European Doctors
3. DuPont Sustainable Solutions
4. European Chemical Transport Association
5. European Operating Room Nurses Association
6. Golder Associates
7. European Aggregates Association
*European Union-Occupational Safety and Health Administration
As many as 20% of all workplace accidents in Europe are connected with maintenance, with organizations across the continent increasingly aware that action is necessary to combat maintenance related hazards. With this in mind, over a quarter (26.8%) of the partners cited the improvement of safe and healthy work conditions for employees and employers alike, as the main reason for their participation in the campaign. (WCxKit)
The partners identified further reasons for their participation, such as aiming to engage their own workers and/or members in managing safety and health (16.01%), or sharing good practices (5.39%). Other partners associated their participation with an opportunity to work closely with like-minded organizations (14.4%).
"Renowned companies, organizations and associations from a wide range of sectors such as the chemical industry, pharmaceuticals, healthcare, manufacturing, and construction, among many others, have joined our Campaign," Jukka Takala, director of EU-OSHA said. "We are delighted that the issue of safe maintenance has been incorporated in industries and workplaces across Europe helping transform the daily lives of workers. I’d like to welcome our seven new 'ambassadors' and look forward to working in cooperation with them for the remainder of the campaign."
Since the start of the campaign in late April 2010, good practice in safe maintenance has been promoted by the partners all around Europe through a wide variety of activities. The many seminars and conferences across Europe touched on specific topics, such as the latest occupational safety and health products and services available to help improve conditions in workplaces throughout the continent.
One of the partners also invented a scheme that develops, assesses, and certifies the competency of personnel responsible for the installation and maintenance of equipment in hazardous areas. Today this tool operates not only within the EU but also in locations across the globe. (WCxKit)
The new Official Campaign Partners will be recognized during a ceremony November 22-23, 2011 in Bilbao, which also plays host to the closing event of the Healthy Workplaces Campaign 2010/11 on safe maintenance.
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@ReduceYourWorkersComp.com.
In recent years, the New York Workers Compensation Board (NY WCB) has begun to enforce rigorously “voluntary withdrawal from labor” as a reason for discontinuing wage loss benefits, even where the worker is found to be permanently partially disabled. But, what if the worker is partially disabled but becomes further disabled from a later condition?
A new decision, Matter of “Bobbitt v Charbonneau Construction,” 2011 NY Slip Op 04790, Decided on June 9, 2011, Appellate Division, Third Department states other medical conditions do not alleviate a worker’s responsibility to continue to seek employment within the worker’s capacities, even though the capacities are diminished. This opinion is uncorrected and subject to revision before publication in the Official Report. (WCxKit)
Therefore, an employer should make sure its carrier/TPA has the means to investigate the effects of unrelated medical conditions to ensure a proper defense can be maintained. At the very least, the carrier should be advised whenever workers are covered by group or individual medical insurance and who the insurers might be. The existence and identity of such plans does not violate principles of privacy or confidentiality. Obtaining the records can be done by lawful means, but only if one knows upon whom to serve the proper papers.
The decision is not, and will not be, an isolated exception. The very workers most likely to become permanently partially disabled are those, especially by reason of age, who are most likely to have other problems. Almost a third of all workers, according to a 1980s federal study, have some form of permanent medical condition. For workers on permanent compensation disability the number well exceeds two thirds.
New York lawyers recently considered every way around the rules for voluntary withdrawal. “Unrelated medical disability” seems to be a possibility. With proper investigation, it need not be. A proper investigation can show many conditions sounding conclusively disabling are, in fact, transitory or do not actually effect work activity.
Every employer has the right to expect its claims to receive proper investigation by its carrier/TPA. A carrier not following up should be alerted to the existence of such decisions as “Bobbitt.” Claimant admitted that he has not worked nor sought employment since shortly after his accident and has failed to participate in vocational and educational services to which he was referred. Thus, substantial evidence supports the Board's determination that claimant's separation from the labor market is voluntary in that it is due to causes other than his compensable injuries. (WCxKit)
Author Attorney Theodore Ronca is a practicing lawyer from Aquebogue, New York. He is a frequent writer and speaker, and has represented employers in the areas of workers compensation, Social Security disability, employee disability plans, and subrogation for over 30 years. Mr. Ronca has 21 years experience in searching and retrieving medical records and many other types of documents for defense of workers compensation claims. Contact
Attorney Ronca at 631-722-2100 or medsearch7@optonline.net.
FREE TOOLS
©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.
You are at work. An accident happens. So, you qualify for workers compensation coverage, right? Compensating workplace injuries is why the employer pays for coverage – right? Not so fast, it's not that easy.
Sometimes, the answer is “sometimes.” There is a big difference between an injury happening at work, and the injury being
“work-related.” The golden rule is: the injury has to
“occur within the course and scope of employment” and "arose out of the circumstances of employment." Of course, each jurisdiction states the law slightly differently, so check state law. For more information:
Is the injury compensable.
Here are five common examples of questionable compensable “workplace” injuries.
Note: Coverage can vary by jurisdiction. Always check with your adjuster for any scenarios applicable to your particular workers compensation cases.
Example #1: I hurt my back lifting a box.
Back injuries may be the most common of workers compensation claims. An employee, doing normal work duties, feels back pain. Is it covered? Ask these questions:
1. Was the worker doing normal job duties?
2. Was the injury witnessed?
3. Is this an isolated incident?
4. Did the pain start off slowly, then worsen over time or was it more acute in nature?
5. Was it reported promptly and to the proper person?
6. Does the worker have prior back injury claims or prior surgery to the affected area?
The employer may be on the hook for accepting this claim as a strain. However, if later the worker needs surgical intervention to repair ongoing pain, then the claim may be disputed. Reporting the claim late and/or not receiving treatment right away can affect the compensability of the claim. The importance of prompt injury reporting and proper medical treatment can mean the difference between a “back injury” claim being accepted or denied.
Example #2: My shoulder hurts from doing my normal repetitive job duties.
Repetitive job injuries are quite common. The same employee comes to work day after day, doing the same job on the same machine for months, maybe years. But whether the job actually caused the injury is the main question. Some states are much more restrictive allowing repetitive injuries than others — so check state law!
If the worker reports a repetitive job injury, and an MRI later shows all kinds of arthritis in the shoulder, then this claim may not be accepted. Unless the worker can prove the job duties led to an aggravation of the pre-existing degenerative conditions, the claim may not be covered. The employer may be on the hook for a temporary strain or exacerbation, but once a surgical repair is recommended, this claim could be denied by an IME physician.
Everyone has a different degree of ongoing arthritic issues in their bodies. There are 25-year-old workers with shoulders looking like they have been through the mill. And there are 65-year-old workers with perfectly healthy shoulders. It all depends on genetics, the job being done, and for how long. The physician must be able to differentiate between what is a pre-existing degenerative arthritic condition, and what damage is specifically related to the job tasks.
Example #3: I slipped on water on the floor and twisted my knee, but I don’t need medical treatment.
Watch out for these claims. Some workers do not run to the doctor for every little ache and pain. Some are afraid to miss work for financial reasons. Some are afraid to report a claim because they are afraid of being laid off or moved to another job classification.
The most important thing for the employer to do in these cases is to document the incident internally. Workers must know it is “okay” to report an incident, but if they don’t go to the clinic for treatment they run the risk of their claim being disputed down the road.
The workers comp motto for claims adjusters is: “Workers injured at work go for medical treatment because they are injured.” The reality is some people do not want to get treatment at the time of the injury. They may have heard the workers comp clinic has bad service; or they have to wait for 3 hours before being seen. These issues are detrimental to the claims adjuster, since a worker may have a legitimate injury but due to these outside factors does not get treatment at once. Failure of the worker to get medical care does not mean the worker is not hurt. It means delays in
medical treatment complicate the claim down the road potentially leading to a denial.
Example #4: I was injured in a car accident while driving a work vehicle.
Auto accidents in employer vehicles can be tricky. Every state has its own rules when it comes to these types of accidents. Just because a worker is driving a company vehicle does not mean the claim is automatically accepted. A thorough investigation is required. Questions to ask include:
1. What was the worker doing at the time of the accident? Think distracted driving.
2. Where was the worker heading when the accident occurred?
3. What were the worker’s exact job tasks while in the company vehicle?
4. Who was at fault at the time of the injury?
5. Was there a police report?
6. Did the worker get medical treatment at a hospital?
7. Was a drug/alcohol test done at the hospital?
The answers to these and others questions determine if the claim is accepted or not. Sure, if you are on the way to a job site and an accident occurs, you may be entitled to some benefits but there is no guarantee.
Example #5: I was horsing around with another employee when I fell and injured my hand.
Believe it or not, some states actually cover a degree of “horseplay.” The hard part for the adjuster is determining the degree of horsing around that will lead to the claim being accepted or rejected. Typically, it is common practice for the adjuster to deny this type of claim, but not always. Statutes involving horseplay are usually vague, and open to interpretation. The employer needs to do a detailed investigation involving all parties, and the adjuster should take statements as well to see if they match up. After the investigation, consult an attorney to see if the horseplay act causing the injury would be covered.
Summary
Just because you suffer an injury at work does not mean you have automatic coverage under the Workers Compensation Act. Every scenario is unique, and most injury details are not the same. The employer plays a very important role in the initial investigation of all claims, and the more details provided to the adjuster, the better decision the adjuster can make as to claim compensability – or not.
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.
The United Steelworkers (USW) recently presented shareholder resolutions at Marathon Oil, Valero, Tesoro, and ConocoPhillips, calling on the companies to improve disclosures on safety at oil refineries.
According to information from the USW, the resolutions, filed by the AFL-CIO Reserve Fund, call on the board of directors at each company to disclose board oversight of process safety management, staffing levels, and the inspection and maintenance of refineries and other equipment. (WCxKit)
A similar proposal was also filed at Sunoco, but was withdrawn when company officials agreed to comply with the request. The Steelworkers say increasing transparency in the industry is an important step in improving refinery safety.
“If these companies had to tell their shareholders and the public how they were staffing their refineries, how much overtime people were working, and how long units were going without basic inspection and maintenance, we know that they would try harder to fix the problems,” said USW International Vice President Gary Beevers, who heads the union’s National Oil Bargaining Program. “We hope that by demanding this information we can force the industry to fix these problems before any more of our members die or are severely injured.”
Last year was a particularly deadly year in the oil sector. In the months of April and May alone there were 13 fires, 19 deaths, and 25 serious injuries in the oil industry. The Deepwater Horizon explosion in the Gulf of Mexico caused 11 of the 19 deaths.
One of the most deadly accidents was the April 2 explosion at a Tesoro refinery in Anacortes, Washington leading to the deaths of seven workers. A 40-year-old heat exchanger blew apart along microscopic cracks in welded areas. Washington State Department of Labor & Industries (L&I) inspectors determined the company failed to correctly test the equipment for cracks. This was the worst industrial accident in the 37 years the L&I have been enforcing the state's workplace safety laws.
L&I Director Judy Shurke informed reporters at a press conference last year, “The bottom line is that this incident, this explosion, and these deaths were preventable.” Washington State Governor, Chris Gregoire added, “I believe this action L&I is announcing today (October 4, 2010) and the record fine ($2.39 million) they have assessed against Tesoro sends a clear message that these tragedies are not acceptable.” Tesoro is appealing the fine.
The reasons Tesoro received the record fine stems from the safety violations the L&I Inspectors uncovered in their investigation of the explosion killing the seven workers. Tesoro was cited for 44 safety violations – 39 “willful” violations and 5 “serious” violations of the Washington State workplace safety and health regulations. A “willful” violation is when the employer knowingly violates a rule and is plainly indifferent to correcting it. A “serious” violation is where there is a substantial probability of serious injury or death.
The L&I inspectors found that Tesoro had a wide variety of workplace safety violations and displayed a lack of concern for the safety of the employees. Some of the issues at Tesoro were:
1. The continuing operation of failing equipment for years.
2. Postponed maintenance.
3. Inadequate testing for potentially catastrophic damage.
4. Ineffective and inadequate repairs of equipment.
5. The failure to ensure each employee was properly trained prior to operating a newly assigned process.
6. The failure to follow “generally accepted good engineering practice” in inspecting and testing its reactor.
7. The most egregious violation – the failure to select “personal protective equipment” – safety gear – for each of the employees. (The employees worked in hard hats, gloves, goggles and basic flame-resistance coveralls, which was inadequate protection for the environment in which they were working.)
The USW is asking for the shareholder resolutions in an effort to appeal to the Board of Directors to institute safety changes that protect the company’s bottom line financial results while providing a safer workplace for the employees. The shareholder resolutions call for:
1. Oversight of process safety management – for the people at the top level of the company to be directly involved in the safety process.
2. Proper staffing levels – to know how much overtime people are working and what the risk of fatigue is.
3. Inspection and maintenance of the refineries and other equipment – to know if there is a risk of a deadly explosion. (WCxKit)
The proper safety protocols will protect the employer from accidents and the resulting legal cost, reputation cost, and workers compensation cost. Safety is one of the best financial investments a company can make.
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@ReduceYourWorkersComp.com.
A new report from the Centers for Disease Control and Prevention (CDC) reports that the U.S. is on pace to eliminate tobacco smoke in all public indoor spaces through state laws by 2020, if smoke-free advocates can accelerate progress in the states that still do not have smoke-free laws in effect.
"The progress made during the past decade in enacting comprehensive state smoke-free laws is an extraordinary public-health achievement. In the span of 10 years, smoke-free workplaces, restaurants, and bars went from being relatively rare to being the norm in half of the states and the District of Columbia," the CDC states in an update on smoke-free policies published April 22, 2011 in Morbidity and Mortality Weekly Report. The report is based on data in the CDC's Prevention's State Tobacco Activities Tracking and Evaluation (STATE) System database. (WCxKit)
The number of states with comprehensive smoke-free laws banning smoking in bars, restaurants, and indoor work sites increased from zero to 26 from 2001 through 2010. There are also 10 states with laws that prohibit smoking in one or two but not all three of these types of locations. Eight states have less restrictive laws, such as laws allowing for smoking in designated areas or areas with separate ventilation, and seven states have no statewide smoking restrictions in place for private work sites, restaurants, or bars.
The report points out that no southern state has a comprehensive public indoor smoking ban in place, but a large number of communities in these states have adopted comprehensive local smoke-free laws, so the authors of the CDC report believe "the Healthy People 2020 target of enacting smoke-free indoor air laws that prohibit smoking in public places and work sites in all 50 states and D.C. can be achieved if such laws continue to be adopted at the current pace, and activities are intensified in southern states." (WCxKit)
One of the CDC's Healthy People 2010 objectives unveiled in 2000 called for every state and D.C. to enact laws eliminating smoking in public places and work sites, and this goal has been retained in the Healthy People 2020 goals. The effort picked up steam in 2006 when the Surgeon General concluded that no level of exposure to secondhand smoke is risk-free and that the only effective way to eliminate the risk is to completely eliminate smoking in all indoor areas.
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
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.
One of the scariest parts of expanding a business into a new state for the self-insured employer is learning the workers compensation laws and state mandates in the way of forms, filings, hearings, etc. While an employer can hire a third party administrator (TPA) to handle claims, or a law firm to guide you through all the steps of workers comp claims handling, it is in your best interest to learn the basics of the workers comp system in the new state quickly. Or, get a good resource that has such information. Ask your TPA what resources they use. Even though they have professional resources, similar resources can be very helpful for the self-insured company.
Self-insured employers have two choices: spend weeks/months learning the new workers comp system or, to borrow a video game phrase, get “cheat sheets” to speed up the learning process. (WCxKit)
Many law firms specializing in insurance defense work sometimes offer “cheat sheets” to new adjusters and potential new clients as a way of building business. Instead of the employer spending “forever” learning the basics of the new state’s workers comp law, the cheat sheets give a synopsis of important information the self-insured employer needs to know.
If you want a jump of learning this information and don't want to rely on free cheat sheets, excellent information – in easy to use tables – is available from
www.workcompresearch.com.
Common cheat sheets/reference tools include:
1. A list or a table of state forms and when each is to be filed.
2. Explanations of state forms and rules associated with each form.
3. Table of temporary total indemnity benefits by calendar or fiscal year.
4. Table of temporary partial indemnity benefits by calendar or fiscal year.
5. Table of permanent partial disability benefits.
6. Table of scheduled injuries.
7. Charts for combining two or more
impairment ratings.
8. Death benefit tables.
9. Table on statutes of limitations on filing claim, appealing claims, etc
10. Calculation of indemnity benefit guidelines.
11. Checklist of defenses to claims.
12. Charts or tables on how the judicial system works.
13. Claim settlement guidelines.
14. Guidelines on the selection of medical providers.
15. Guidelines on posting a panel of physicians
16. Forms for:
· New employees/transferred employees to sign acknowledging the selection of a physician.
· Injured employees to acknowledge the attending physician requirement(s).
· Requesting a new physician.
· Employee to decline medical treatment.
17. Samples of required state notices for posting.
18. Recent changes in the state law.
In addition to the cheat sheets, get a glossary of workers compensation jargon and terms as used in a particular state. This type of glossary also assists you in understanding the abbreviations often used within the state, for example – DOAH (Florida Division of Administrative Hearings), BRC – Benefits Review Conference, or IW – injured worker. (WCxKit)
Summary
A new employer in a state can spend time learning the workers comp system, contact some of the law firms specializing in insurance defense work or consider
www.WorkCompResearch.com as eventually learning the system in the new state definitely has it benefits, but
quickly learning the basics summarized by experts speeds up the learning curve and assists in understanding the workers comp system.
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.
A recently released indicator report shows while health and safety management is improving, New Zealand can do better to reduce death and injury rates at work.
Minister of Labour Kate Wilkinson said, for the first time, key health and safety statistics have been brought together in an annual State of Workplace Health and Safety in New Zealand report. It follows progress in five key areas: (WCxKit)
1. fewer injuries and fatalities;
2. less occupational disease;
3. lower economic cost;
4. improved industry and employee engagement;
5. increased response to government activity;
“This is the first snapshot of the state of workplace health and safety in New Zealand, showing about 9,500 incidents are reported to the Department of Labour annually,” Wilkinson commented. “We want to see that number declining, particularly with regard to serious harm injuries. Over time this report will allow us to better monitor the rate and costs of workplace harm and what effect safety campaigns or initiatives are having.”
The sectors with consistently high work tolls are construction, agriculture, forestry, fishing, and manufacturing – and that’s why the Department of Labour is reportedly developing specific action plans for each industry. The first plan for construction was launched in the last few weeks.
“Today’s report also shows that industry and employee engagement in health and safety is generally high, with most medium to large businesses encouraging employee participation in health and safety and providing training for staff,” Wilkinson added. “We’ve already seen more than 125 leaders from business and government sign up for the Business Leaders Forum with the goal of achieving zero harm workplaces, which is a good start.” (WCxKit)
The report is compiled by the Department of Labour and will be released annually. For further information, visit: http://www.dol.govt.nz/whss/state-of-workplace/index.asp.
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@ReduceYourWorkersComp.com.
Vehicle manufacturer Land Rover has been prosecuted by Great Britain's Health and Safety Executive for failing to take into account the risks associated with workers at its Solihull plant using vibrating hand tools.
Land Rover pleaded guilty to the charges brought against it in relation to activities at its plant in Lode Lane, and was fined $33,266 and ordered to pay $100,805.96 costs. (WCxKit)
The firm was prosecuted after a HSE investigation in 2007 into the working practices concerning two employees in the weld destruct section where air chisels were used to undo welds on cars to test the strength of them.
Two cases of Hand Arm Vibration Syndrome (HAVS) had been reported in December 2006. The subsequent investigation found that vibrating hand tools were being used across the plant with a lack of assessment and management of risk and when a health surveillance regime was then made effective, other cases came to light.
Solihull magistrates also heard there was no system in place to measure how long was being spent using the tools by each employee or the levels of vibration. The recommended amount of time for one of the tools to be used was one hour per day per person, but it had been in use for three hours per day.
In all, 10 employees were thought to be affected by ill health attributable to the use of vibrating hand tools at the Solihull plant.
The lack of assessment of risk or time spent working with the tools appears to be an oversight on the company's behalf. There was no previous record of this happening and an improvement notice was served in 2007 which was complied with. None of the employees appear to have been prevented from continuing in the job. (WCxKit)
Land Rover pleaded guilty to breaching section 2(1) of the Health and Safety at Work Act 1974.
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.
As long as there are workers compensation claims and ways for attorneys to make money from workers comp claims, attorneys will be involved in the processing of some of these claims. There will always be employees enticed by television commercials with the attorney holding fistfuls of money and saying, “Call me. I will make you rich.” or words to that effect.
Employers cannot do much about the greed factor. However, they can do quite a lot to keep otherwise honest employees from hiring an attorney. When employees hire attorneys, the cost of workers compensation goes up as the attorneys seek to maximize both the employees' and their own financial well being. (WCxKit)
There are three primary reasons employees hire an attorney in the workers comp claim process. The employee (1) does not know what to expect; (2) is fearful for themselves and their families; (3) a controversy develops between the employee and the employer, or between the employee and the claims adjuster. Of course when the employee's attorney files a petition with the workers compensation commission, they do not list “greed” as the reason; rather, they attempt to cloak the greed by creating controversy.
To significantly reduce the number of employees hiring an attorney avoid making these five mistakes driving an employee into the arms of a waiting workers comp attorney.
1. Failing to Provide Immediate Medical Care
Being lazy about providing medical care to the injured employee is one of the biggest mistakes an employer makes when an employee is hurt. When an unknowing or untrained supervisor does not want to bother with the workers comp claim and tells the employee to “give it a few days,” it is almost a guarantee the employee is going to hire an attorney.
Think! – The employee is in pain, medical care is not being provided, the employee's attitude quickly becomes “they don't care about me” which quickly switches to “I don't care about them either.” The only remaining question for the employee is whether to go to a doctor on their own or not. To answer that question they turn to the Internet/TV attorney or the yellow pages attorney. Keep in mind these cases are taken on contingency so the injured worker does not have to come up with a retainer for attorney fees. If the employee “wins” the case, the employer pays the attorney.
The solution – Everyone in the company, including employees, should know immediate medical care is to be provided on all work-related injuries. Every supervisor and manager must ensure medical care is provided immediately upon learning an injury occurred. Of course, if your company used nurse triage, this would go a long way toward allevaiting this issue because employees would call the triage nurse immediately.
2. Late Reporting
It is always amazing to workers comp adjusters, defense attorneys, and the Board of Workers Compensation when they see an injury occurred a week ago, a month ago or even longer before it is first reported.
Sure, the time and paper work of reporting a workers comp claim is a hassle, and the employer's person(s) in charge of reporting workers comp claims has more important things to do (like office gossip time, personal e-mails, or even actual work responsibilities). However, as the employee sits at home not hearing from the workers comp adjuster, medical triage or the employer, fear sets in and questions arise about how bills are going to be paid and the family taken care of. When no one explains how much the indemnity check will be, or consults about medical care, (since no one reported the claim to the claims office) the employee starts to think about hiring an attorney to enforce “their rights.”
The solution – The person(s) in charge of reporting claims to the claims office must consider the immediate reporting of the claim as THE number one priority over all other job responsibilities.
3. Ignoring the Employee
After the supervisor obtains immediate medical care for the employee and the claim is reported on the same day to the claims office, the employer must continue to be involved in the claim. If the employer "forgets" the employee works for them after the claim is reported to the claims office, the employee will develop the attitude that the employer no longer cares about them, and then seeks out an attorney. The attorney is then the one who patiently listens to the employee’s tale of woe and assures them “everything will be okay.”
The solution – Instead of paying an attorney to reassure the employee, the employer should do so. Whether it is the claims coordinator, the employee's manager, or someone else within the company, a person representing the employer must maintain regular contact with the employee following the initial medical care and at regular intervals until the employee is back at work full duty. That means regular phone calls, meetings and get-well cards. Make a First Day Phone Call the evening after the injury to make sure all bases are covered. Consider using "Early Dissatisfaction Surveys", a service Jennifer Christian, M.D. provides, to find out how your employees are treated when they are injured.
4. Under-reporting the Compensation
Regardless of how state laws require temporary total disability compensation to be calculated (13, 26 or 52 weeks) the average weekly wage includes all compensation, often more than the amount of salary or wages paid each week. If the employee normally receives commissions and bonuses, or is provided housing, meals, or paid health care benefits, include all types of compensation in your report of income to the claims office. When the employee sees the indemnity check does not include the bonus, commissions or health insurance coverage, these omissions can become a reason to seek out an attorney to obtain all due benefits.
The solution – know your state law and what should be included in the calculation of indemnity benefits. If some type of benefit you have been paying to or for the employee is not included in the compensation reported to the insurance company, then it needs to be discussed with the employee so the employee knows why they are not receiving that part of the compensation.
5. Not Complying with the Medical Restrictions on Modified Duty
Too many employers willingly accept the employee back at work on modified duty status from the treating doctor, and put the employee right back to work doing the previous job. If the doctor states the employee cannot lift more than 10 pounds, and you assign the same job duties where 40 pound lifting was routine, expect problems. First, you are going to re-injure the employee and extend both the medical treatment and the time off work, plus you are going to create that “they don't care about me” attitude with the employee.
The solution – Review the modified duty restrictions imposed by the treating doctor and know exactly what the doctor expects in the way of modified duty. During the first minutes the employee is back at work on modified duty, review what the doctor states can and cannot be done, keeping modified duty in compliance with the doctor's restrictions. (WCxKit)
By treating the employee properly, you can expect to lose fewer employees to attorney representation and the associated cost of attorney involvement. Plus, you will have a happier and more productive employee as the employee understands you care.
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.
Carriers have classes of adjusters usually correlating with each adjuster’s amount of experience. Although class names vary, they are usually divided into medical-only, lost time/Indemnity, litigation, and catastrophic adjusters.
1 – Medical-only adjusters
Medical-only adjusters, an entry level position, are trainees with little to no experience. They handle minor medical claims involving simple lacerations and minor strains/sprains not involving any lost wages or complicated medical injuries/conditions. When an employee has a few clinic visits the employer sends the claim in with the bills and the adjuster sets up the claim, processes the bills, and closes the claim.
Medical-only adjusters conduct the initial interview with the employer and the employee. The interview itself does not go into great detail or investigation as the injuries are usually minor with uncomplicated outcomes.
When claims are time limited (60 to 90 days) and the claimant continues to receive medical treatment, the claim may be transferred to the lost time adjuster. Look upon extended claims as a “red flag” indicating a possible reason the employee is not returning to transitional or full duty work. Sometimes Lost Time adjusters handle medical-only claims, especially when they are "enhanced situations" where there is a complexity such as ongoing medical expenses.
2 – Lost time/indemnity adjuster
Lost-time/indemnity adjusters are more experienced, with knowledge of local legal statutes and a high degree of medical training in handling occupational claims. Their expertise is with claims running past 90 days involving more severe injuries such as a complicated lacerations, level 2/3 sprain/strains, surgical repairs, or pending surgeries. When employers question claim compensability, the claim is immediately assigned to the lost time/indemnity adjuster.
The adjuster takes a recorded, detailed statement, and interviews the employee and any witnesses to the injury. Sometimes a visit to the premises is needed to investigate certain claims. (WCxKit)
Claims are handled until the claimant is either released from care, or the claim goes into dispute. These claims may remain with the adjuster for months or even years.
3 – Litigation adjuster
Litigation adjusters handle claims involving lawsuits. These adjusters share the same level of experience as the lost-time adjuster. However, they have advanced training in legal issues and in investigating the compensability of occupational claims.
When a compensable claim is disputed, and the claimant retains counsel and files a Notice for a Hearing, the claim goes from the lost-time adjuster to the litigation adjuster. The litigation adjuster works with in-house or outside counsel gathering details on the injury, and appears for hearings and mediations to quickly resolve the claim at minimum legal expense.
The litigation adjuster usually cannot speak directly to a claimant due to the retainer of plaintiff counsel. Therefore, the adjuster relies heavily on the employer’s investigation and facts of injury, if known, and works on gathering medical records, witness statements, police records, prior plaintiff litigation history, and any other facts about the claim, gathering evidence to use in defending the claim. The claim is handled through settlement or trial and then closed.
4 – Catastrophic adjuster
This level of adjuster is the most complex, handling very difficult claims, usually ones where the claimant has a severe injury requiring multiple surgeries, amputations, loss of sight, hearing loss, or internal medical issues such as asbestosis or chronic joint degeneration due to occupational exposure, etc. Employers hope for few of these type claims, but it is a bullet that cannot be dodged forever.
General/catastrophic adjusters have many years of experience in the Insurance industry, combined with advanced medical and litigation training and experience. They also have advanced claim investigation training, and may possess a law degree or are licensed attorneys. They delve very deeply into the complexities of the claim in an attempt to resolve all issues of medical treatment expense and ongoing incurred wage loss. Sometimes they suggest large settlements or annuities to avoid ongoing claim costs for life or advanced vocational retraining, a very expensive proposition lacking a guaranteed positive outcome.
These types of serious claims may last for years, and sometimes involve vocational retraining and job placement for the claimant when the sustained injury is so severe return to work is impossible.
Summary
Carriers typically have four levels of adjusters, ranging from the newly appointed claims trainee to the severe/catastrophic claims veteran. The important thing for the employer to know is in the event of a severe claim, your carrier retains the proper adjuster to handle all aspects of the claim in order to protect your best interests.
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.
Posted in
