Safety National acquired Workers Comp Kit from Amaxx Risk Solutions. This unique online resource helps assess the client’s post-injury Workers’ Comp practices and procedures, recommends improvements, and provides materials and expertise to implement changes.
Safety National policyholders will receive free access to the Workers Comp Kit as part of their relationship with the company. For buyers of insurance, brokers and agents, and other insurance organizations, Safety National has partnered with Advisen to service and support all other parties utilizing this software to help ensure the Workers Comp Kit retains and grows its reputation for reducing workers compensation expenses.
“As the nation’s leading provider of excess workers compensation solutions, we are thrilled to add this tool to the Safety National arsenal as the Workers Comp Kit has clearly become a proven way to lower post-injury cost drivers for our clients,” said David Snodgrass, director – risk control services at Safety National. “Purchasing this program is consistent with Safety National’s philosophy of working in partnership with our policyholders to help lower claim costs.”
Ed Forer, executive vice president at Advisen, elaborated, “The Workers Comp Kit addresses a need that buyers and brokers repeatedly tell us must be met. We are excited to help risk managers develop a consistent approach to managing post-injury procedures at their various business locations, which ultimately saves them money.”
Many employers face growing workers compensation expenses and are placing greater reliance on brokers and insurers to help reverse the trend. The Workers Comp Kit enables an employer, broker and insurer to work collaboratively to improve best practices and reduce expenses. This program’s applications combine interactive tools to perform assessments, highlight areas for improvement, make recommendations, create plan implementations and monitor their post-injury performance.
Safety National is a versatile alternative market insurance provider offering a broad range of risk funding products through independent insurance agents and brokers. Founded in 1942, Safety National is the leading provider of Excess Workers Compensation coverage to self-insured employers and groups nationwide and has provided that type of coverage longer than any other company in the U.S. In addition, Safety National offers its Large Casualty Program, which includes Large Deductible Workers’ Compensation, Commercial Auto and General Liability coverage; Public Entity Multi-Line coverage; Treaty Reinsurance; Loss Portfolio Transfers (LPT); Texas non-subscriber coverage (TEXcess); Self-insurance Bonds and other alternative risk programs. The company is licensed to provide workers’ compensation insurance in all 50 states, the District of Columbia and Canada. Safety National is a wholly owned subsidiary of Delphi Financial Group Inc. (NYSE: DFG) and is rated “A” (Excellent), Financial Size Category XI, by A.M. Best.
www.safetynational.com
Advisen’s data, analytics and news offerings are game-changers for 100,000 commercial P&C professionals. Advisen integrates business information and market data for the commercial insurance industry and maintains critical risk analytics and time-saving workflow tools for over 530 industry leading firms. Advisen delivers actionable information and risk models for Underwriters, Reinsurers, Brokers and Risk Managers at a fraction of the cost to have them built internally. Designed and evolved by risk and insurance experts, Advisen combines the industry’s deepest data sets with proprietary analytics and offers insight into underwriting, marketing, broking and purchasing commercial insurance that is not available on any other system.
www.advisen.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.
In Florida, every employer who has four or more employees, whether full time or part time, is required to carry workers compensation insurance. Corporate officers who have elected to exempt themselves from work comp coverage do not count as an employee, however. There are a couple of exceptions to this rule.
If you are in the construction industry and have one or more employees, you are required to have work comp coverage. Florida farmers who have more than five regular employees, or twelve or more seasonal workers who are employed for 30 days or more, are required to have work comp coverage.(WCxKit)
4 Ways to Obtain Coverage:
To obtain workers compensation coverage in Florida, the employer has several options including:
1. Purchasing a workers compensation insurance policy from a state-approved insurance company.
2. Qualifying as an approved self-insured employer.
3. Contracting with a professional employer organization (employee leasing) that has a group workers compensation policy.
4. Purchasing a workers compensation insurance policy from the Joint Underwriting Association, a Florida state agency that sales workers compensation insurance coverage to employers who are unable to obtain coverage in the open market.
Claim Reporting:
The employee must report the injury to the employer within 30 days of the occurrence. If the injury is not reported in a timely manner, the insurance carrier has the option to deny the claim. The employer is under a strict time limit of seven days to report the claim to the insurance carrier. The insurance company then has three days to send an informational brochure to the employee outlining the employee's rights and responsibilities under the workers compensation statutes.
Medical Benefits:
The employer selects and authorizes the initial medical provider. All subsequent medical treatment must be at a medical provider approved and authorized by the workers compensation insurance carrier. All authorized medical care and associated expenses (prescriptions, prostheses, mileage reimbursements) are covered by workers compensation.
Temporary Total Disability Benefits:
The temporary total disability (TTD) benefits are calculated as two-thirds of the employee's average weekly wage over the 13 weeks prior to the injury, not counting the week the injury occurred. The maximum amount of TTD benefits that can be paid weekly changes every Jan. 1. The maximum TTD benefits per week for accidents occurring in 2010, was $772. The maximum TTD benefits per week for 2011 is $782. The state minimum weekly benefit is $20, which has not changed since 1972.
The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days. TTD benefits can be paid for a maximum of 104 weeks. There is no provision in Florida law that requires the employer to hold open a job for an employee who is unable to work. (Holding the position for the employee is the smart thing for the employer to do in most cases.)
Temporary Partial Disability Benefits:
Florida work comp also provided for temporary partial disability (TPD). An employee will receive TPD if the medical provider releases the employee to work with restrictions on the number of hours the employee can work. If the employee is unable to earn 80 percent of his wages prior to the injury, the insurance carrier will pay TPD benefits on the hours the employee is unable to work per week.
This is when the employee has been released by the authorized treating physician to return to work in any capacity. The payment is then 80 percent of the difference between 80 percent of the employee's AWW and earnings. This is referred to as the 80/80 formula. If work is available within the employee's restrictions and the employee does not return to work then no benefits are payable.
Impairment Benefits:
When an employee reaches maximum medical improvement, the medical provider will determine whether or not the employee has any permanent partial disability. If the employee receives a permanent impairment rating, a scale is used to establish the number of weeks of compensation the employee is entitled to.
The employee will receive:
1. Two weeks for each percentage point of impairment from 1 percent through 10 percent
2. Three weeks for each percentage point of impairment from 11 percent through 15 percent
3. Four weeks for each percentage point of impairment from 16 percent through 20 percent
4. Six weeks for each percentage point of impairment from 21 percent and up.
If the employee is earning the pre-injury wage or higher, the benefits are reduced by 50 percent.
Permanent Total Disability Benefits:
Florida has a unique way of determining if an employee who has reached maximum medical improvement has a permanent total disability (PTD). If the employee can be placed in a sedentary job within 50 miles of his residence, the employee is not PTD, unless he has a severe injury as defined by the Florida work comp statutes.
Some of the severe injuries include spinal cord injuries that involve paralysis of an arm, leg or the trunk; amputation of a hand, arm, foot, or leg; severe brain injury; and, second or third degree burns over 25 percent of more of the body. If the employee is classified by the Division of Workers Compensation as PTD, the employee will receive PTD benefits which are the same as TTD benefits until the age of 75. If an employee is drawing social security benefits, the PTD benefits are reduced to the point where the social security benefit plus the PTD benefit equals 80 percent of the average weekly wage earned prior to the injury.
Death Benefits:
If an employee dies as a result of an on-the-job accident within one year of the date of the accident, or if the employee dies as a result of an on-the-job accident within five years with continuous disability, funeral expenses up to $7,500 is covered by workers compensation. The spouse is entitled to 50 percent of the average weekly wage, not to exceed $782.00 (for calendar year 2011).
The spouse plus one child is entitled to two-thirds of the average weekly wage, not to exceed $782 (year 2011). If the employee leaves behind one child as the only beneficiary of death benefits, the child receives one-third of the average weekly wage, not to exceed $782 (year 2011). There is no time limit on how long benefits can be paid, but the maximum amount of death benefits is $150,000 (not including funeral expenses). If the spouse remarries, the spouse receives a lump sum payment of 26 weeks as long as the $150,000 cap is not exceeded. The spouse is also eligible for tuition benefits at a vocational technical center or community college.(WCxKit)
Vocational Benefits:
If, due to the employee's on-the-job injury, the employee is unable to return to work because of permanent work restrictions, the employee is entitled to assistance from the Workers Compensation Vocational Rehabilitation Section of the Florida Department of Education. At no cost to the employee, the employee can receive vocational counseling, transferable skill analysis, training on job-seeking skills, job placement, on-the-job training, and formal retraining.
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.
This week at the Workers Compensation Roundtable on LinkedIn there are two still-active discussions from last week. One is in regards to when first aid crosses the line to workers compensation. Follow this topic
here. The other asks about what to do when an injured employee says they are fine initially and then the problem worsens throughout the day. Read more
here.
Our Group Manager, Bob Wilson president & CEO of WorkersCompensation.com, LLC, posted
this article, “California Supreme Court Reverses Retro-Active COLA's in Baker V WCAB” this week as his manager’s choice. Go to read and comment.
Wilson also posted
this link to a story about cyber liability in Florida.
Alberto Salgado, MPN coordinator/lead client services liaison at GENEX Services, Inc., in Orange County, Calif., asks, “Medicare Conditional Payments and WC – Can reimbursements to CMS be re-calculated at states' WC fee schedules (FS)?” He includes this background: "Under the MSP laws (42 U.S.C. § 1395y(b)), Medicare does not pay for items or services to the extent that payment has been, or may reasonably be expected to be, made through a no-fault or liability insurer or through Workers' Compensation (WC). Medicare may make a conditional payment when there is evidence that the primary plan does not pay promptly, conditioned upon reimbursement when the primary plan does pay. … If the claimant is a Medicare beneficiary, I understand that WC payers are responsible for reimbursement of conditional payments only to medical expenses related the accepted industrial injury and diagnosis. But, can the conditional payment be audited per FS or does it have to be paid at the demanded amounts by CMS?
Jeff Knipper, MSCC, CMSP, medicare services director at CCS Holdings is one of several respondents. He writes, “(In the) Dallas/Fort Worth Area, with few exceptions you're going to find that Medicare's reimbursement rate was lower than WC fee schedule allowances so if the ‘conditional payment’ made by Medicare was made for treatment ‘reasonable, necessary, and related’ to the WC claim then the payer realized savings in this scenario.”
John Link, vice president/Tribal Consulting at Cottingham & Butler in Dubuque, Iowa posted this article:
Workers' comp costs from musculoskeletal disease reach $850B a year. It generated this response from
Jack Kanner, CEO, COO at P.S.R. Corporation [aka] Professional Safeguard Resources, “Cost containment by workforce cultural change. advise reading attached – link to article – sustainable employees in the infrastructure industries. Musculoskeletal disorders are a by-product of work performance demand and therefore 'the attitude' to the work. That may sound like a 'given' but I daresay we are eminently qualified to quantify in that we (PSR) have worked with 10s of thousands of varying workforces over 25 years: e.g., firefighters, paramedics, nurses, law enforcement, utilities, manufacturing, warehouse, freight distribution: 100 cities, 3 federal agencies, fortune 500 companies from Chevron Refineries, and Pacific Gas & Electric Co., to Coca Cola, the Federal Reserve Bank. and Mohawk industries (largest flooring co in U.S. – Work Comp $ losses are down millions within 18 months of installation of licensing PSR and certifying facilitators).” Kanner attached this link to an article published by PERI Public Entity Risk Institute:
https://www.riskinstitute.org/peri/component/option,com_deeppockets/task,catContShow/cat,91/id,1146/Itemid,84/
There is lots more going on at Linkedin's Workers Compensation Roundtable right now and
right here! Better yet,
invite your friends so they too can become informed on hot topics in the Workers Compensation industry.(WCxKit)
Workers Compensation Roundtable is jointly managed by people dedicated to the concept that workers compensation is a manageable line on your expense ledger, and that informed professionals are empowered achievers. Workers compensation is not simply a cost of doing business, it is a cost that can be controlled. Beginning with an assessment of cost drivers, benchmarking data, and integrating the solutions, employers can reduce workers comp costs 20 to 50 percent. With proper information, professionals managing compensation claims can reduce costs and improve outcomes for all stakeholders in the process. This group is for employers, business owners, risk managers, HR managers, insurance executives, and brokers to discuss the obstacles and strategies to overcome them.
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.
Doctors and other providers who defraud the system for their own financial benefit are few, amounting to less than 4 percent. Yet, these few account for millions of dollars spent unnecessarily and without improved outcomes. Moreover, you could be helping these doctors defraud the system.
Fraudulent providers use tactics such as increasing the frequency and duration of medical services, billing at the highest levels regardless of state fee schedules, and billing repeatedly hoping to generate duplicate payments. Even more subversive are those who add multiple diagnoses to their exaggerated billing to avoid exposure by bill review systems. Such perpetrators also shrewdly submit bills using slightly altered names and addresses so their excesses are not easily noticed by electronic systems.
Modifying names and addresses is an easy and effective way to obfuscate data. Computer systems are literal, meaning they accept the data as it is. Consequently, adding a comma, reversing first and last names as they appear in one field, and adding or omitting a suite number, and abbreviating are all common ways to cause the system to create multiple records. Each iteration of the information is treated as unique by most computer systems so each becomes a separate record representing the same person or entity. While providers are sometimes dedicated perpetrators of these data deceptions, payers often contribute to the problem.
1. Data quality is a people problem
Data quality in the provider demographic record in a computer system is critical to analyzing provider performance. How can individual provider performance be evaluated using analytics when multiple records representing the same person are present in the data? How can individual providers be identified when several hide behind the same TaxID number? Some providers use different names for the same office location or claim different specialties. Differentiating the good and bad is challenging.
Accurate data entry is critical to data quality, yet little attention is paid to this basic operational process. Good and bad doctors, as well as payers, are all guilty. A policy requiring names and addresses be pulled from a drop-down list of providers would prevent creating multiple entries caused by name reversals, misspellings, and key entry errors. This is basic software design. For those unable to create a hard-coded list from which the data entry person can select, a copy and paste policy should be established and enforced.
Manually typing information for each bill guarantees errors, record duplication, and confusion. Aggressive process management will significantly reduce the data entry problem.
Developing software interpretive rules to automatically correct and combine multiple records is fraught with uncertainties. For instance, a software rule might be written to interpret name reversals by looking for a comma indicating the last name is first. However, a comma is often not present, so even more confusion is created. Commas and periods, present or not, in names and address are a common issue of data quality and impossible to correct programmatically. It is a people problem.
2. Unique identifier
Still, the best way to resolve the problem, whether it results from provider billing practices or data entry at the payer level, is to require unique provider identifiers such as NPI or state license numbers. NPI (National Provider Identifier) is a system required by CMS (Centers for Medicare and Medicaid Services). Individual providers must have an NPI number to be reimbursed by Medicare. Workers compensation payers should require the number on bills, a simple way to clarify provider identity. Of course, the same data entry rules must apply — either choose providers from drop down lists displaying NPI numbers or use the copy paste method to avoid inaccurate NPI number entry.
Most medical providers currently have NPI numbers because they want to be reimbursed by CMS for non-workers comp services. NPI numbers in the bill and in payers computer systems would eliminate the disguise offered by deliberate or unintended data duplication.
3. Fighting medical fraud
Fighting medical fraud is more than challenging. But it is not only providers who contribute to the problem. Clean and complete provider records where the data are entered exactly the same way for every bill received from a provider will go a long way to correcting the problem. Duplicate records would be avoided and individual performance more accurately and fairly analyzed.
Evaluating provider performance and rating providers analytically depends on correct individual identification. Multiple records in the data for the same provider generated by sloppy data entry practices simply perpetuate and exaggerate the problem.
Author Karen Wolfe, BSN, MA, MBA, President/CEO, MedMetrics®, LLC. Karen is founder and president of MedMetrics® LLC, an Internet-based Workers Compensation medical analytics company. She applies her medical knowledge to gathering, understanding and applying Workers Compensation data to the operational process. MedMetrics imports, integrates, and analyzes its clients’ medical billing and claims level data. MedMetrics uses several tools such as Predictive Intelligence Profiling and Medical Provider Performance Assessment to gather and analyze data. Contact: Phone: 541-390-1680; Karenwolfe@medmetrics.org; www.medmetrics.org.
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.
After the New York City World Trade Centers fell, images of responders rushing in unprotected to help victims of the terrorist attach Sept. 11, 2001, are burned into the memories of every American.
Discussion loomed immediately about toxins in the air from particulate matter, burning materials, airplane fuel and more. Of course there was nothing victims could do to protect themselves and first responders, in a rush to help as quickly as possible, did not stop to assess the danger they put themselves in.
Now, a National Institute for Occupational Safety and Health (NIOSH) report indicates there is not enough evidence to link the collapse of the World Trade Center (WTC) towers to cancer in responders and survivors. The study means those groups will not be able to collect federal money for treatment or compensation
However, the report also does not indicate evidence of the absence of a causal association. And another review is scheduled for early 2012.
Under the James Zadroga 9/11 Health and Compensation Act of 2010, there must be periodic reviews of scientific and medical evidence. If a causal association were established, recovery workers and others with cancer diagnoses could be compensable.
The Zadroga Act provides funds for a specific list of illnesses, such as asthma and other respiratory diseases linked to the 911 attacks. Cancer could be included if a link was found.
The initial review was based on three information sources, according to NIOSH:
1. A systematic search of peer-reviewed findings on exposure and cancer resulting from the terrorist attacks that have been published in the scientific and medical literature between Sept. 11, 2001, and July 1, 2011.
2. Findings and recommendations related to cancer from the WTC Clinical Centers of Excellence and Data Centers, the WTC Health Registry at the New York City Department of Health and Mental Hygiene, and the New York State Department of Health.
3. Information from the public solicited through requests for information published in the Federal Register earlier this year.
The report said there was little evidence because few published research studies on the attack mention cancer and only a small number of those are peer-reviewed. Further, cancer is a common disease, making linkage difficult, the report said. (WCxKit)
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.
Texas often leads the nation in workers compensation cost containment and narcotics legislation. The state recently continued their history of reform by adopting a new pharmaceutical formulary that will reduce the amount of money spent on workers compensation medications and improve the overall health of the state's employees. How does it work? What can you do to remain in compliance?
Broadspire is conducting a webinar to provide answers about the new Texas formulary August 23. Speaking on compliance issues was formulary co-creator Ralph Kendall, PharmD., vice president of clinical services at Healthesystems.
Also Jacob Lazarovic, MD, chief medical officer at Broadspire, will discuss the clinical implications of the formulary and Lynn Sergeant, RN, team manager of utilization management at Broadspire, will be discussing how Broadspire is operationally responding to the formulary.
For 4 p.m. Aug. 23, either click the following link or copy and paste it into your Web browser:
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.
Employers are often surprised to learn what they thought was a medical-only claim has become a lost-time claim. This unpleasant surprise can often be avoided by basic due diligence on the part of the employer. The following are reasons medical-only claims become lost-time claims and what the employer can do to prevent such an occurrence.
1. Inappropriate Initial Medical Care
When an employee is allowed to select the medical provider, he or she usually does not select the best provider for their on-the-job injury. The employee’s personal family physician may be great at caring for the employee's kids when they have the flu, however, the family doctor will often not understand the ramifications of taking the employee off work “for a few days.” If a family doctor tells the employee to “rest at home” until the muscle strain is better or the laceration heals, no one is thinking about the employer-offered modified or light-duty program. (WCxKit)
In states where the employer has the choice of selecting the medical provider, going to the wrong type of medical provider should never happen. The employer should have an approved medical provider(s) list posted where all employee will know who to go to in the case of an injury. Also, the employer's work comp coordinator should verify the employee goes to an approved medical provider. In states where the employee can select their own medical provider, the employer should still post a list of recommended medical providers who the employer has pre-screened to verify the medical providers specialize in workers' compensation and understand the modified duty program.
2. Tough It Out
The quick way to make a mild injury more severe is to allow the injured employee to “tough it out.” The macho guy, more concerned about what his co-workers will think, may keep on working. The strained muscle that is already weakened from the initial on-the-job injury gets used and becomes injured to a much greater degree. What would have been two weeks of light duty with the appropriate initial medical care becomes two months of temporary total disability.
Any time an employee reports an injury with the description, “But it is nothing.” the employee should be sent to the employer's required medical provider (in the states where the employer selects the medical provider) or to the recommended medical provider (in the states where the employee can select the medical provider). Often the employee is concerned about paying for the medical care and about losing time from work. The employer should tell the employee that the company will pay for the doctor visit and that he or she you will not get docked for time at the doctor's office. Simple communication, which also shows the employer is concerned about the employee's welfare, will keep the “tough it out” from becoming the indemnity claim.
3. No Triage
If there is no post-injury process to keep an employee in the loop — such as making sure his or her medical care is coordinated — things can go wrong that keep the employee out of work. A triage nurse will do an initial assessment of the injury by phone using medical protocol, and will provide the names of doctors to the employee and advise the employee of the name, location, and directions to the medical provider.
In In In states IN states Triage will determine whether emergency care is necessary, whether a clinic visit in 2 days is OK, or whether the employee needs to ice the injury and rest the swollen ankle. In short, the employee receives the right kind of care at the right time. In states where panels are provided, the names of all doctors on the panel are sent to injured employees immediately. Only about half of all calls require medical care by a doctor, thus the claims converting to lost time claims is less than half.
Triage will also advise the medical provider of light-duty work available for the employee and follow up with the medical provider to obtain any work restrictions, the return to work date for the employee, and the date and time of any future medical appointments. The triage nurse follows through to be sure the employer is aware of the employee’s medical status when the employer can expect the employee back at work either on full or modified duty. Use triage nurses that are URAC certified.
4. Inattention
The fastest way for both the employer and the claims office to turn a medical-only claim into a lost time claim is to ignore the medical-only claim, thinking it is insignificant. If the adjuster and the employer do not tie down the nature and extent of the injury early on, it often invites trouble. The employee who strains his back and is just “sent to the doctor” with no follow up, can take advantage of the situation. The employee who has had a neck problem for years, and the doctor is already treating back strain, is given the opportunity to advise the doctor that the neck was hurt in the accident as well, resulting in enough issues that the doctor takes the employee off work, with the work comp insurer paying for the medical care and lost time due to a pre-existing injury. If many claims are converting to lost time claims, evaluate the post injury response carefully.
Note: Make sure the employee has a Work Ability Form to take to the doctor on the FIRST MEDICAL VISIT. This is the #1 reason medical claims convert to lost time claims — employers do not have the right forms in the hands of the employee and doctor at the right time. Without the Work Ability Form to provide medical restrictions for transitional duty, the employee must return to the doctor, waiting another week or so, thus turning the medical only claim into a lost time claim.
5. Questionable to Begin With
When the employee decides ahead of time to have an “accident” that will be unwitnessed and consist of subjective complaints of strain and pain, it is up to the employer and the adjuster to cut off the fraudulent claim before it can be built up to a lost-time claim. Any time the employer thinks to herslf, “That is unusual,” the adjuster should be immediately notified to be sure to do an in-depth investigation. The most effective thing an employer can do to stop potential fraudulent claim is to contact the doctor's office immediately — even before the employee arrives for the initial visit — to advise the doctor's office of the modified-duty program awaiting the employee's speedy return. And, it also helps the employee to know that all work comp fraud is prosecuted. Post anti-fraud posters in the workplace.
6. Something for Nothing
Similar to the “questionable- to-begin-with” claims are claims in which the employee has a valid injury (for instance, a trip and fall that results in bruises) but the employee figures now is the time to “Take a vacation on work comp.” When an employee thinks, “Let me see what I can get out of this,” failure to control medical and to offer light duty will result in a minor injury becoming a lost-time claim. The employer should have an employee brochure in the workplace advising of obligtations when an injury occurs letting employees know transitional duty is available and expected of all injured employees.
7. Medical Severity
There are times when the medical severity of an injury is greater than originally suspected. Sometimes conservative medical care is not enough. An MRI may reveal what was thought to be a strained shoulder is actually a torn rotator cuff, or the strained back is a herniated disc. In these situations there will be some justifiable lost time. It can still be minimized however by having the appropriate transitional duty program in place and working with medical providers to ensure prompt, quality medical care. (WCxKit)
By being involved in all your workers compensation claims, not just the severe ones, the employer can prevent many medical only claims from turning in to indemnity claims. We always recommend the employer has a work comp management program as a part of the overall risk management program in place to control situations like this.
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 number of on-duty firefighter deaths is the lowest since 1977, according to the National Fire Protection Association’s (NFPA) annual Firefighter Fatality Report, showing a total of 72 on-duty firefighters died in the United States in 2010.
Officials reported this is a sharp drop from the 105 on-duty deaths in 2008 and 82 in 2009 and it is the lowest annual total since the NFPA began conducting this annual study in 1977. (WCxKit)
This is the fifth time in the last decade the total number of deaths was below 100. While the number of total deaths dropped sharply, the number of cardiac-related deaths did not. Heart attack deaths were remarkably stable over the past six years.
According to the report, the areas in which the deaths fell is diverse. The year 2010 saw the lowest number of fire ground deaths ever (21) and deaths while responding to or returning from alarms (18), the second lowest death number. Deaths related to training activities (11) and while engaged in other non-emergency duties (18) about matched the average numbers from the previous 10 years.
Other key numbers in the report included: Nine deaths in crashes of road vehicles in 2010 and 2009, the lowest since 1983. There were 44 volunteer firefighter deaths in 2010, continuing a downward trend. The ages of all U.S. firefighters who died ranged from 20 to 86 with a median age of 52.5 years.
Each year, the NFPA gathers information on all firefighter fatalities in the U.S. resulting from injuries or illnesses occurring while the firefighters were on-duty. The term “on-duty” means being at the scene of an alarm, whether a fire or non-fire incident; responding to or coming back from an alarm; or participating in other fire department duties.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Our Workers Compensation Book: www.WCManual.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.
Australian federal work health and safety regulator Comcare has highlighted several occupational health and safety issues, including bullying and drug and alcohol harm at work, in its Work Health and Safety Plan for the current financial year.
According to a report from Comcare, the plan commits to improving work health and safety across federal employers by focusing on four key priority areas: worker health, preventing harm, stronger enforcement, and a smooth transition to national work health and safety laws.(WCxKit)
Comcare’s Work Health and Safety General Manager, Neil Quarmby, said this is a major change in the way Comcare delivers its services.
“Our new regulation model highlights the importance of preventing workplace injuries. This year we’ll deliver strong enforcement outcomes, but also commit to stopping workers getting harmed in the first place,” Quarmby said.
This includes an initiative to target federal employers with poor workplace cultures with relation to drug and alcohol harm.
Also on the agenda is a workplace bullying campaign which will address the recent growth in mental stress claims.
“We’re targeting workplaces where bullying is just ‘how things work,’ and we’ll be working with employers where alcohol harm is a known risk in the workplace. We’re sending the message that it is not OK — that it’s unacceptable,” Quarmby says.
Harmonized work health and safety laws due to start on Jan. 1, 2012, are also a major priority. Comcare will re-train its inspectors to exercise new powers under the laws, such as providing assistance to victims and families involved in workplace harm.(WCxKit)
Quarmby adds harmonization will reduce red tape on a national level and help regulators such as Comcare improve the way it deals with workplace incidents.
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@ReduceYourWorkersComp.com.
Workers Compensation Adjusters get new claims every day. Most days they receive many claims, depending on the type of adjuster they are. For the most part, medical-only adjusters and lost-time adjusters receive the most new claims per day.
Good adjusters can tell if a claim is going to be trouble right away. They base this on several criteria, including: Type of injury, if the worker is still working or off-work, date of birth, hire date for that employer, the city the worker lives in, and additional comments made by the insured calling the claim in.
1. Type of injury:
This is the most obvious. Of course, an adjuster is going to scan right to the injury comments to see how bad the claim is going to be. This also determines how much attention the claim will get. If an adjuster gets the claim and the injury is a simple laceration or contusion, it is probably not going to get a super-thorough investigation. These claims are normally compensable since lacerations and contusions are generally sustained in the course and scope of employment. They usually do not include any lost time away from work, and bills are simple to read through and process.
At the other end of the spectrum are pending surgeries and subjective strain-like soft tissue injuries. The adjuster knows if the word “surgery” is included in the injury description, a lot of work is going to lie ahead. This is especially true if the word “surgery” is paired up with a strain injury to the low back, shoulder, or knee. This means the injury sustained was bad enough to warrant the need for a surgical procedure, and that will include lost time from work and a thorough investigation to see if the claim will be compensable.
2. Still working or off of work:
If the worker is still working, either on restrictions or not, the adjuster will breathe a sigh of relief because that roadblock has already passed. Getting a worker to remain working is half the battle. If the injured employee is working it means the adjuster can focus on gathering statements from all parties and securing medical records first and then determine if the claim is compensable or not.
If the worker is off work, the adjuster knows she has to hurry, since every day is another day of accrued lost-time wages. Most jurisdictions have a time limit for the investigation of the claim, so the adjuster must hurry to gather all the information needed to figure out if the claim will be accepted.
3. Date of birth:
After looking at the injury, the adjuster will then peer toward the date of birth. This will also hold a lot of clues if the claim is going to be a problem. A rule of thumb is the higher the age, the longer it will take to get back to full duty because it takes an older body longer to heal when an injury occurs. If a 25-year-old worker sustains a strain injury, they will typically be able to rehab faster than a claimant who is 75-years-old. The younger worker will also have fewer prior medical problems to have to overcome, including arthritis, prior surgeries, scar tissue, diabetes, etc. All of those issues will lead to longer rehab time, which stretches out the life of the claim.
Age also plays in factor in recovery post-surgery. If a 60-year-old worker falls on his arm and fractures his wrist, you automatically know it is going to cost more medically than if the same injury occurred to a worker who is 23-years-old.
4. Date of hire:
This factor will come in to play more often with subjective injuries. If a new hire sustains a back strain, the adjuster will perhaps raise an eyebrow, wondering if this new hire is trying to pull off a fake injury. But, you can also look at it the other way. Newer hires are less experienced, and they may be trying to do too much at once to impress their employer, leading to the injury. Newer hires also may not have the experience operating machinery, leading to lacerations or contusion-type injuries.
5. City employee lives in:
This factor will tell the adjuster what doctors are around the area where the employee lives. If it is a rural area, maybe the town does not have an occupational clinic, which leads the worker to seek out treatment with their primary care physician. This can cause an issue gathering documentation, medical records, and medical restrictions for work, etc. The primary care docs are not that familiar with work comp, so they do not document as well as occupational clinics. This leads to delays in getting the correct info to the adjuster to review for claim compensability.
Workers living in more urban areas also have a benefit because there are more specialty doctors to choose from. It will not take a claimant a month to see an orthopedic doctor or a hand specialist. This will speed the claim up, because the worker is being directed to the right physician who can treat appropriately, without delay. Medical care is less accessible in rural areas.
6. Additional comments:
The last thing the adjuster glances at is to see if the person that called the claim in has anything else to add. This is where the employer can really help an adjuster out. If the employer knows there are some outside issues potentially making the claim not compensable, it will give the adjuster a running start that the claim just does not add up. Plus the adjuster can raise the red flag that there needs to be a proper, detailed investigation right off the bat. The adjuster can also file the paperwork with the State for an extension to their investigation, so penalties do not get handed out to the carrier for delays. Or the claim can be "paid without prejudice."
The employer can also indicate other items that will help the adjuster out. Examples are the claim was filed to process bills, or the injury was not questionable and the worker is ok. This helps the adjuster know the claim is not questionable, and they can set it up, make their contacts, process the claim, and close the claim down without keeping it open longer than it needs to be.(WCxKit)
In summary, when an adjuster gets a new claim, he or she looks at the above criteria before picking up the phone. The employer can greatly help the adjuster by completing all the information on the First Report of Injury, and adding any comments that would be helpful to the adjuster in their investigation. This will help steer the adjuster in the initial phase of the file, leading to the desired outcome.
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.
Our Workers Compensation Book: http://www.wcmanual.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
