Nurse triage is the process of having an experienced nurse evaluate an employee's medical needs and direct medical care by determining the appropriate level needed. Employers who do not have their own on-site medical clinic are turning to nurse triage as a means of controlling and impacting workers compensation cost.

 

 

Nurse triage companies operate a call center where experienced, trained nurses are available on a 24/7/365 basis. Also, employers who do not staff their on-site medical clinic during all shifts are using nurse triage to cover their employee's medical needs when their clinic is not open. (WCxKit)

 

 

When an employee is injured on the job, the employee and/or supervisor reports the accident direct to the nurse triage company where a trained nurse talks with the employee. The nurse, using proven interviewing techniques, listens carefully to the employee's description of the accident. He or she asks detailed questions and focuses on the employee's medical needs. By using treatment protocols and sophisticated medical software, the triage nurse is able to provide an injury assessment. Based on the triage nurse's assessment of the severity of the injury, the most appropriate level of care and the proper course of treatment can be determined. Then, a decision is made as to where the employee should be sent for medical care.

 

 

If the medical care cannot be provided by the employer's on-site medical clinic or by administering first aid on-site, the triage nurse refers the employee to a preferred medical provider in their network (set up in advance) best suited to provide the medical care needed. By directing the employee to the most appropriate level of medical care, optimum medical care is provided sooner. This also eliminates expensive emergency room visits and prevents the employee from starting medical treatment with a medical provider only to be transferred to a different medical provider later.

 

 

1- A key benefit of using nurse triage is the transfer of making initial medical decisions from the employee's supervisor to a trained medical professional. The employee's supervisor may discourage the employee from having the needed medical care, as the supervisor wants the employee at work, or the supervisor will send the employee to a medical provider not best suited to treat the employee's injury. Triage nurses are experienced RNs with recent clinical experience who are specially trained to do this job, and the training centers are impressive. I have toured Medcor's training facility which is state of the art.

 

 

2- The nurse triage will notify the medical provider of the employee's injury and advise the medical provider to expect the employee's arrival. This is immediately followed by the claim being reported to all appropriate entities including the risk management department, safety, human resources and the work comp claims office. By addressing the injury immediately with the employee, the employer and insurer have the greatest chance of influencing the cost and overall outcome of the claim. If arrangements have been made with the nurse triage company, they can gather all the information needed and file the first report of injury with the claims office and the appropriate state government entity.

 

 

3- Nurse triage can also assist with early return-to-work programs by obtaining an employee's job description and providing the job description to the medical provider. When the medical provider indicates light duty restrictions instead of returning to work full duty, the triage nurse will contact the employer with the details of the light duty restrictions. A timely determination is made on the employer being able to accommodate the restrictions and place the employee back on the job.

 

 

4- A triage nurse’s immediate involvement in a workers compensation claim shows all employees their physical well being is important to the company. The leads to a higher level of morale and trust in the employer. It also provides a big benefit for the employer – bottom line savings on the cost of their workers compensation – as the benefits of nurse triage greatly outweighs the cost for the employer. The nurse triage company can provide your company a cost benefit analysis that will show you the savings generated from using a nurse triage company.(WCxKit)

 

 

5- Nurse triage provides a way for the employer to be proactive in the management of workers compensation claims while at the same time being compassionate to the employee's injury and needs. During a recent assessment of 20 locations of a trucking company using nurse triage, we found that the immediate conversation with the nurses turned many potential lost time claims into either med only claims or "self-care" claims where the employee could ice the injury, for example, and remain at work with his or her ankle inclined.

 

To learn more about nurse triage and other services, please find sources in our Directory.

 

 

Posted in Claim Management, Medical Cost Containment & Managed Care, Medical Issues |

A Warren County, Ohio woman must repay more than $13,000 following an investigation by the Ohio Bureau of Workers Compensation that revealed she was working while collecting workers compensation benefits.

 

 

The BWC said Pamela Meyers pleaded guilty to a felony count of workers comp fraud related to her work as a bus driver while receiving disability payments for a workplace injury she sustained while working as a driving instructor.(WCxKit)

 

 

The BWC said its Special Investigations Department opened an investigation after detecting Meyers was collecting wages while on temporary total disability.

 

 

Investigators said they found Meyers worked as a driver the Little Miami School District in Morrow from July 20, 2006, to Sept. 4, 2006, and from March 12, 2007, to Sept. 16, 2007, in violation of the rules associated with receiving those benefits.(WCxKit)

 

 

Meyers was sentenced in a Franklin County courtroom to five years of community control, ordered to pay restitution in the amount of $11,400, court costs and investigative costs totaling $2,000. Meyers will serve 12 months in prison if she violates community control. She made a payment of $7,000 toward restitution on the day of sentencing, the BWC reported.

 

Posted in Fraud and Abuse |

The owner of a Lowell, Mass., staffing company was indicted for allegedly under reporting the size and scope of his business operations in order to avoid paying approximately $110,000 in workers compensation premiums, according to Attorney General Martha Coakley’s office

 

 

A Middlesex Grand Jury returned indictments against Dara Duong, 53, of Lowell, on three counts of workers compensation fraud; and two counts of larceny over $250.(WCxKit)

 

 

 

 

In October 2010,the Coakley’s office began an investigation after the Massachusetts Insurance Fraud Bureau (IFB) finished its own investigation and referred the matter for prosecution. Duong was the owner of three companies based in Lowell: Middlesex Temporary Agency (Middlesex), Ankgor Staffing, Inc. (Ankgor) and General Labor Services (General Labor). All three companies provided unskilled labor, such as factory workers, to several client companies.(WCxKit)

 

 

 

 

Posted in Fraud and Abuse |

Linden Foods, Ltd., was fined a total of £25,000 ($41,000) plus £1,200 ($2,000) in costs at Laganside Crown Court, after pleading guilty to breaches of health and safety legislation at an earlier hearing at Omagh Crown Court. The case was brought by the Health and Safety Executive for Northern Ireland (HSENI).

 

 

According to information from the HSENI, the case arose out of a Feb. 25, 2010, incident in a store at a Linden Foods meat processing plant at Granville Industrial Estate Dungannon.(WCxKit)

 

Lucas Da Costa, a 33-year-old worker, suffered severe head injuries when stacked packing crates collapsed on top of him. Da Costa was lifting the stacked crates using an electric pallet truck which had no overhead protection against falling objects.(WCxKit)

 

 

After the hearing, Anne Cassidy, an inspector with the HSENI’S major investigation team, noted, “Companies must use lift trucks which have overhead protection where there is a possibility of items falling. Care must be taken when stacking goods to ensure the stacks are stable and suitably spaced so as to prevent accidents such as this one. A risk assessment must be carried out to identify these hazards and the most suitable means of controlling the risks.”

 

Posted in Medical Cost Containment & Managed Care, Risk Management, Safety and Loss Control, WC in Other Countries (International) |

Self-insured employers (SIE) for workers compensation take on the role of claims management in exchange for the cost savings self-insurance brings. Whether you elect to self-handle all of your workers compensation claims or to hire an independent third party administrator (TPA) to handle them, you need to be able to verify claims are handled properly. Rather than reviewing the adjuster’s every activity and item of documentation, it is more time efficient if the SIE claims manager requires the adjuster to submit written reports on all efforts to move the claim forward.

 

 

The initial report, (First Report) and subsequent reports, (Status Reports) are submitted on a predetermined frequency schedule. Most self-insured employers opt for the First Report submission within 14-15 days of the report of the claim to the claims office. Sometimes a SIE elects to have the First Report submitted by the 30^th day of the claim. Status reports are routinely placed on a 30-day reporting cycle, with older claims moved to a 60-day or even a 90-day reporting cycle, depending on the amount of activity on the claim. (WCxKit)

 

 

For consistency in reporting and ease in reading the reports, the establishment of a reporting format is standard protocol. The First Report is all inclusive covering all aspects of the claim. In the initial report, the adjuster discusses each of these areas:

 

1.      Coverage – policy number where applicable, policy dates, applicable deductible for loss location.

2.      Accident description – date and time of accident, location within the insured's premise or if away from the premise, where and why away from the premise.

3.      Insured location – includes the department or unit, the street address and the type of work performed at the location.

4.      Employee – name, age, social security number (edited if required by state law), how long employed, years experience in the current job, number of dependents (if the number of dependents might impact the indemnity rate), prior injuries including both workers comp and non-workers comp injuries, summary or recorded statement when appropriate.

5.      Jurisdiction – the state where the injury occurred or federal benefits.

6.      Investigation – a discussion of the investigation and all the applicable information learned about the accident.

7.      Compensability – why the claim is compensable or why it is being controverted.

8.      Reserves – the expected cost of the claim divided into indemnity benefits, medical benefits, and expenses for the anticipated life of the claim.

9.      Nature of injury – the treating physician's diagnosis.

10.  Medical care – the treating physician's prognosis, the expected recovery time, plus any information on surgeries, hospitalization, and projected length of recovery.

11.  Indemnity benefits – the average weekly wage, the indemnity benefit rate, the availability of light duty work, the estimated return-to-work date.

12.  Rehabilitation and Physical Therapy – the reasons for rehabilitation, whether it is physical or vocational, the length of rehabilitation and the facility or provider of the rehabilitation service.

13.  Subsequent injury fund – in states where available, the anticipated amount that can be recovered from the state fund.

14.  Subrogation – whether or not there is a third party from whom the cost of the claim can be recovered, and if so, the identity of the responsible third party, the theory of negligence, the preservation of evidence, the employee's right of recovery vs. the employer's right of recovery.

15.  Action Plan – steps to be taken to move the claim forward and the potential barriers to resolving the claim. These are often called Specific Plans of Action (SPOA). An SPOA is a "real" plan, not just the adjuster saying they are trying to close the claim…

16.  Litigation – if the claim is being contested, the name and address of the defense attorney, the issues in contention, the probable outcome of the claim, and the anticipated legal budget.

17.  Future report date – when the claim will be reported again.

18.  Attachments – any pertinent information to the claim the adjuster believes the claims manager may wish to review or all documents to the claim if the reporting guidelines dictate same.

Note: If Nurse Triage is employed, a report from the triage nurse will be sent to the carrier automatically before the claim is even made. This type of immediate medical advise often obviates the need for medical care at a clinic or prescription medication, and the injury may never turn into a "claim." This is especially true if the injury is treated with "self care" by the employee .e.g. ice your lower back, etc.

 

 

Status Reports normally do not repeat all the information covered in First Reports. It is standard protocol for status reports to be limited to the topics that have changed or are the subject of change. For instance, the status reports would not repeat the information on coverage, accident description (unless new information becomes known), insured location, employee, jurisdiction, compensability, or the nature of injury.

ASK for the "grades" of your adjusters. Yes, "grades," some TPAs score or grade the adjusters files each month and post the grades on the bulletin board! You want the adjusters with high grades!  If the adjusters do not have grades above 80, they are sent for remedial training; if their score is > 85 they receive a cash bonus and if higher than 95 they receive a larger cash bonus in their paycheck that month.

 

 

However, the status reports usually restates the reserves and explains any changes in the reserves, the status of the indemnity benefits, the status of the medical care, the progress in rehabilitation (when applicable), the status of the subrogation claim or second injury fund claim (when applicable), the status of the litigation (when applicable), the action plan and the next report date. (WCxKit)

 

Posted in Claim Management, TPA and Claims Administration, WC 101 |

The NY workers compensation board has in existence four new sets of treatment guidelines for the back, neck, knee and shoulder. These sites account for the majority of all serious claims. The guidelines can be seen on the Board website.

 

 

All four sets contain an identical section A.19 which provides that a treating physician may request a chance to inspect the work site “to obtain information regarding the demands of the patient’s pre-injury job”. The physician can then estimate a level of disability based on actual job duties rather than the old, universal “mild, moderate or marked” disability. (WCxKit)

 

 

The guidelines recognize that few doctors will trouble to actually view the worksite, even though that provides the most accurate information.

 

 

The employer, whenever there is a serious injury, should immediately send the treating doctor a letter asking if the doctor will be requesting an “on-site inspection”. Copies should be sent to the Board and carrier. In nearly every case, no inspection will be requested.

 

 

However, if there will be medical testimony taken, the carrier/employers examining doctor should make a brief visit to the work site prior to testimony. The doctor will then be in a position to answer what the doctor saw in the workplace that supports the report’s conclusion.

 

 

Such testimony will be far more powerful that merely assuming (or guessing) or taking the word of the worker as to what the activities are, even though such speculation has been the rule for decades.

 

 

If a treating physician should make a rare appearance they should be welcomed. Treating physicians are seldom accorded such treatment and are more likely to be sympathetic to the employer’s point of view when they receive it. (WCxKit)

 

 

An end to the practice of having experts testify “in a fog or a vacuum” will be beneficial to both the employer and the employee.

 

 

 

MODIFIED DUTY CALCULATOR:  http://www.LowerWC.com/transitional-duty-cost-calculator.php

Posted in Claim Management, Litigation Management, NY Workers Comp Issues, Settling WC Claims, WC 101 |

New Zealand’s Accident Compensation Corporation (ACC) welcomed the conviction of Kerol Ann Smith-Goodwill who pleaded guilty in the Pukekohe District Court this month to defrauding ACC.

 

 

According to an ACC report, Smith-Goodwill, unemployed of Waiuku, was convicted of six charges – five for making a false statement to ACC, and one for willfully misleading ACC. (WCxKit)

 

 

Smith-Goodwill pleaded guilty to all charges and was sentenced to 80 hours of community work. She was also ordered to pay reparation of $16,658.14.

 

 

The charges related to a nine-month period between July 2008 and March 2009 during which Smith-Goodwill worked fulltime while continuing to receive weekly compensation from ACC.

 

 

Weekly compensation was paid by ACC on the basis that Ms Smith-Goodwill was fully unfit for work, as the result of a back injury received in July 2008.

 

 

When weekly compensation was granted, Smith-Goodwill was advised she must tell ACC if she resumed any type of employment and was reminded of this obligation in subsequent meetings with ACC staff. However, during these meetings she made no mention of the fact that she had started fulltime work with Ecomist Systems Ltd. as a sales representative.

 

 

While working full-time, Smith-Goodwill continued to supply medical certificates to ACC, declaring she remained fully unfit for work.

 

 

ACC launched an investigation into Smith-Goodwill’s situation as a result of information received. When interviewed by an ACC representative, Smith-Goodwill said she understood the requirement to advise ACC if she returned to work. (WCxKit)

 

 

She also said she knew she should not have been working while obtaining medical certificates saying she was unable to work.

 

Posted in Fraud and Abuse, Legal Doctrines, WC in Other Countries (International) |

We often provide employers with recommendations on the things employers can do to reduce workers' compensation cost. The best ways to reduce work comp cost is to reduce claim cost. A major factor in the cost of claims is the quality of claims handling provided by the workers compensation adjuster.

 

There are at least six things an employer can do to improve the results the adjuster obtains for you:

 

 

Too many employers allow the insurance company or the third party administrator (TPA) to chose their adjuster. If you have more than just a few open workers compensation claims at any one time, you soon to begin to evaluate the effectiveness of adjusters working on your claims. When you know who is the best adjuster or the best two adjusters are, ask the insurer or TPA to assign all your future claims to the adjuster you have selected. Express appreciation for the adjusters not selected, but put some emphasis on why you are requesting a certain adjuster, whether it is better overall results, quality communications or some other reason. (WCxKit)

 

 

In the claims office, when an adjuster handles all the claims for a particular client, but also handles claims for other clients, the adjuster is referred to as the designated adjuster. If you have 100 plus claims in one claims office, ask for a dedicated adjuster who handles claims only for your company. Know the difference between these two types of adjusters.

The benefits of having either a "designated" adjuster or a "dedicated" adjuster include:

1.      Becoming more important to the adjuster as the adjuster knows she/he will be dealing with you frequently.

2.      The adjuster learns what you as the employer considers essential and tailors their work to meet your needs or desires.

3.      The adjuster learns more about your company and knows who to contact with questions or to obtain information, making the claims process flow smoothly.

 

 

The quickest way to spoil the working relationship with your adjuster is to treat the adjuster as an inferior. Unless you have been an adjuster yourself in the past, the adjuster will know more about how to handle a workers compensation claim. Instead of trying to tell the adjuster what to do on the claims, ask the adjuster what would be the best approach for both yourself (the employer) and the adjuster. With your company and the adjuster striving together to move the claim forward, greater progress will be made.

 

 

You do not need to contact the adjuster daily on each file. The best time to contact the adjuster is immediately after you learn some new information the adjuster does not have. This includes everything from calling the adjuster to discuss the details of the accident – which should be done immediately after the employee leaves the accident scene and is going to the doctor – to keeping the adjuster informed about off-work slips. If you learn today that the employee needs a MRI or some other test, notify the adjuster today, not next week, or even tomorrow.

 

 

It goes both ways. Let the adjuster know you expect the same timely communications. If the adjuster receives a surprise letter of representation from a lawyer or a medical report obtaining significant new information, the adjuster should be sharing it with you. If the adjuster knows you expect to be kept in the loop on a timely basis, he/she will do so.

In addition to calling the adjuster whenever you have new information, provide the adjuster with all information at your disposal to assist the claim. If the employee is going to be off work longer than the state waiting period, know how many weeks of earnings history are needed, and provide it on the appropriate state form without the adjuster having to ask for it. If the adjuster will need a job description to assist in getting the employee back to work, forward it to the adjuster before the adjuster has to ask for it.

By providing the information the adjuster needs with the minimal of delay, the adjuster will began to think of you as their favorite client/employer/insured, and the good will results in your files getting the adjuster's attention first.

 

 

Adjusters understand better than anyone the sooner the employee returns to work, the easier it will be to resolve the claim. Plan ahead when you have an employee off work due to an injury. Ask for the return-to-work restrictions immediately after the employee's first medical visit. If you can accommodate modified duty for the employee, do so. It will make the adjuster appreciate you and your company (and it will save your company a lot of money in the long run). If you cannot accommodate the first set of restrictions placed on the employee, keep in touch with the adjuster and as soon as the medical provider raises the restrictions to a level you can accommodate, do so.

 

 

The job of the adjuster is one of the most unappreciated jobs in the universe. If you want to make your adjuster's day, try a heart-felt thank you when the adjuster investigates the questionable claim, or continues to pursue a modified duty release from the medical provider, or does anything better than it was done before on your claims.  Also, when you do need to make a request, a “Would you please call the employee?” goes a lot further toward getting something done than a command of “Call the employee.” (WCxKit)

 

 

The results of taking these approaches – in working with your adjuster – will be workers compensation claims that get settled quickly and cheaply. This will translates into lower workers compensation cost for your company.

Posted in Claim Management, TPA and Claims Administration, WC 101 |

 

Obesity is a chronic disease that involves three simultaneously occurring interactions. These include a genetic predisposition that is estimated to contribute to about 30% of the problem. The other 70% includes the individual’s behavior and environment. Let us break this complex interplay down into these individual components and think about how, as employers, we can help reduce the incidence of this epidemic affecting more than a third of our nation, and driving our cost for healthcare into the unsustainable range. We know that smoking and tobacco costs our nation about $2 billion a year in lost time, decreased productivity, and cost of illness. Obesity is far more expensive, costing American business an estimated $13 billion dollars a year in lost time decreased productivity, and cost of illness, and the cost to our nation is approaching $300 billion. While obesity now affects more than a third of the entire US population, more than 50 percent of the injured workers with low back pain are obese. 

 

 

Advancements in human genetics and human genome-wide association approach have isolated 20 genes that are associated with obesity and type 2 diabetes. Alone, these genes only have a modest effect, but if we couple genetics with a poor diet and a sedentary lifestyle, we have the prescription that has led to our current healthcare disaster. Obesity results when body fat accumulates over time as a result of a chronic energy imbalance (calories consumed exceed calories expended). Obesity is a major health hazard in our nation and it is associated with several relatively common diseases such as Metabolic syndrome, leading to insulin resistance and Type 2 diabetes, hypertension, heart disease, Vitamin D deficiency, osteoarthritis of the lower extremities, gallbladder disease, and gout as well as several types of cancer. In women these cancers include endometrial, cervical, ovarian, breast, and colorectal. In men, obesity increases the incidence of prostate and colorectal cancers. In both men and women obesity contributes to sleep apnea, morning headaches, daytime sleepiness, and decreased productivity. (WCxKit)

 

 

Integrative medicine and cooperation between different types of healthcare providers is required to provide a solution. Patients need cost effective conservative primary care, using evidenced based methods for weight loss coupled with preventive medicine. Physicians, nurses, and dieticians need to work one on one to encourage patients to move towards a healthier life style. Treating obesity is a process that requires making lifestyle changes.

 

 

As a physician treating obesity and working to prevent chronic illness today, I have witnessed rapid and spectacular advances in medical research in the fields of biochemistry, physiology, biophysics and genomic medicine. We know the cause and cost of obesity and its consequences are not just taxing our resources, the increased incidence of obesity and its related problems are rapidly bankrupting our nation’s healthcare programs under Medicare and Medicaid. Obesity is driving the costs for private insurance through the roof. Physicians fees are not to blame. It is the high cost of managing the co-morbidities associated with obesity, which fuels the development of chronic diseases by the systemic inflammation that is caused by morbidity.

 

 

The question is how do we get employers and employees to buy into addressing obesity? There are preventable contributors of a chronic illness like obesity, and making changes to address obesity will lower our healthcare costs. What will motivate the person to lose weight? I like to use the BMI (body mass index) to start the discussion. Obesity is defined as a BMI greater than 30. I use serum biomarkers (objective laboratory tests) to monitor progress. These lab tests are covered by health insurance. Sitting with a patient and reviewing these results allow goals to be set and progress can be tracked. Seeing improvement in an objective measurement and positive feedback reinforce the goal.

 

 

Developing interest can be particularly difficult for those living in poverty.  As they face a far greater and more challenging environment. Access to a variety of fresh foods can be challenging, and payment vouchers for food often lead to bad nutritional choices. Returning to grassroots education at the community level through public health clinics will help. It is important that all county, state, and our federal government address this epidemic of obesity, as well as the Type 2 diabetes and Vitamin D deficiency. As these are related problems that increased the morbidity of obesity, and we all pay for this epidemic through higher taxation.

 

 

For the employed, the incentive that seems to hold great promise is a financial benefit for buying into preventive medicine. A financial incentive to lower the employee’s contribution to their insurance premium cost is a good starting point. Patient’s using a health savings account and having a higher deductible learn that some of the burden of care is their personal responsibility to themselves and their families.
 

 

An onsite exercise area or a negotiated group discount to local area health clubs will encourage greater activity. Group instruction to teach healthy eating pays off quickly, and employees may need some guidance to learn how to live a lifestyle that normalizes weight. The weight loss process starts by reducing the refined carbohydrates in the diet. These calories from simple starches, sugar, and high fructose corn syrup pack on the pounds. Eating plenty of fruits, vegetables, nuts, seeds, fresh and dried herbs and spices create a strong anti-inflammatory response in the body. The extra pounds of fat in obesity drive inflammation, good bacteria in the gut counteract this process, so that eating fermented foods that contain healthy live bacteria like yogurt and kefir are very beneficial. I have found patients with lactose intolerance, gluten intolerance, constipation, IBS or irritable bowel syndrome, yeast infections, allergies and even asthma benefit from a probiotic if they lack the good bacteria in the gut. (WCxKit)

 

 

Finally, we all need to make sure that we are getting enough vitamin D. Teaching our employees how to eat sensibly can be the first step in reducing our employees healthcare costs.
 

 

Dr. Radford is in private practice. He is a third generation Doctor of Chiropractic Medicine. He earned a Master’s Degree in Advanced Clinical Practice and he provides conservative primary care. He has treated work related injuries for more than 30 years. Dr. Radford has found that treating the co-morbidities that often accompany injured workers like obesity, medication overuse, and addiction lead to a more complete recovery. He was a founding member of the Cleveland Orthopaedic and Spine Hospital, Cleveland, Ohio.  Contact for more information at DCR8888@aol.com or phone: (440)-248-8888.

 

OUR BOOK: www.WCMANUAL.COM

 

 

Posted in Medical Issues, Wellness Programs and WC |

When you have a high-exposure file that turns out better than you had expected and costs come in way under what you had budgeted for, it is easy to see the cost-savings that are associated with that loss. If you saved $50,000, that’s a nice lump of savings for your balance sheet. 

 

But those little savings you make throughout the course of a year add up as well. It’s difficult to see it in the short-run, or by the month, but looking at it over the course of a year, it can really add up to a nice savings in your budget. We discuss some ways those little savings can add up below. (WCxKit)

 

 

Sometimes the better vendors just cost a bit more than others. This is usually due to the fact that they have better talent working for them, and there are associated costs included with that. However, if these more expensive vendors get your workers back to you ready for work quicker, then you save again on the wage loss issue. This means that these vendors have already paid for themselves if you weigh their costs versus the cost of wage loss for your injured worker.   Talk with your carrier about who the best vendors are in your area for IMEs, surveillance, and nurse case management. Don’t shy away from them just because their costs are a tad higher than their competition. They can save you money in the long run by providing you with excellent service, and by getting those injured workers back to work quicker than their counterparts.

 

 

Lack of proper communication can lead to increased claims expense. If the adjuster doesn’t know that you have light duty work available, they may not be pushing hard enough to get work restrictions for your injured worker. Maybe the adjuster doesn’t know you have a dedicated medical clinic and/or physical therapy facility and failed to direct the injured party to treat at those clinic locations. 

Maybe the injured worker took vacation time or sick pay for their time off of work, and they didn’t tell the adjuster that so they got paid twice-once by your company and once by the Carrier. Although most times the adjuster will catch this, sometimes they do not. This leads to an overpayment that the carrier must try to recoup, and if they fail to do so the cost of that ultimately gets pushed to you in the result of a higher premium due to increased claim costs. Whatever the event may be, you need to be in regular contact with your adjuster.   

Perform claims reviews and ask the adjuster on each claim what their plan is for getting the claim resolved.  The more you discuss the claim, the more ideas you both can come up with, and that may be what is keeping your worker off of work. By working together, you will save costs. Most adjusters would prefer too much communication versus not enough, plus this will keep the adjuster on their toes and they will be keeping a close eye on your claims, preventing one from falling through the cracks which will further waste claims dollars.

 

 

Most Carriers/TPAs have multiple departments that will work with you to reduce your exposure. Loss prevention, ergonomics, dedicated adjusters to your account, medical/nurse resources, medical bill review, etc.   All of these services may be provided free of charge by your Carrier/TPA, and the end result of utilizing these services will be lower claim cost to you. Implementing the action plans that these departments come up with is designed to lower your costs. So talk with your Carrier/TPA and find out what resources they have to help you reduce cost. They will be happy to work with you, and you will be happy since your claims expense will decrease over the course of a year.

 

 

Pharmacy costs are constantly rising. Almost every injured worker comes out of their doctor's appointment with a prescription for some medication in their hand. There are a lot of 3^rd party pharmacy companies out there willing to work with you to reduce these costs if you funnel your injured workers to their pharmacy programs. Find out what kind of pharmacy management program they provide. The best sell their services unbundled.  Look for prospective as well as retrospective elements of the cost control program. This can lead to huge cost savings, even on the minor claims, and will help the most with the more severe claims, since those injuries usually require prescriptions that cost more, and they length of the prescriptions last longer. This is a significant way to reduce your costs, and you will see large savings at the end of the year. (WCxKit)

There are a lot of ways to reduce your costs. Not only in the larger higher exposure claims, but in the small minor claims as well. If you think about it, every little savings you can make can add up to a lot by the end of the fiscal year. Remember there are ways to cut costs on every claim, no matter how insignificant the claim may be at the time. You have to think both ways, in the short term and long term. Whatever it may be, the end result is you saving money, and that is never a bad thing

 

 

Posted in Claim Management, Communication with Employees, Coordinating Medical Care, Implementation and Rolling Out Your Program, TPA and Claims Administration, WC 101 |