For the most part, workers compensation claims are generally compensable. The general public thinks the opposite — that all insurance companies want to deny injury coverage.

 

In actuality, probably 80 to 90 percent of claims are accepted in the beginning. But, claims can be denied later down the road for various reasons. How does an employer properly dispute a claim when there is a compensability question?(WCxKit)

 

 

 

At the time a claim is reported to the carrier, employers will know more than the adjuster. Once the adjuster receives the file, he or she sets up the claim, contacts the employee and employer, reviews medical records, and only then makes an initial decision.

 

But if the employer calls the claim questionable, it should be marked as questionable right away so the adjuster can file a dispute that the claim’s compensability is under investigation. Most jurisdictions have a time limit on how long the claim investigation can be. If the adjuster fails to file for the extension within the time limit, the claim could be conceded as compensable — at least in the beginning.

 

 

This leads to leakage because claims dollars are being spent on a claim that may not be compensable. It takes time to take statements, get medical records, get past records, do background checks, etc. If an adjuster can file that extension right off the bat, they can take time to really investigate the claim and make the proper decision on compensability.

 

 

Generally, questionable claims receive more of the adjuster’s investigative attention. This is especially true when the employer notes on the first report of Injury that the claim is questionable; this automatically raises a red flag for the adjuster. The adjuster will review the claim’s initial parts and form questions to ask the employee when taking their statement.

 

 

An adjuster’s first call will be to you, the employer, asking why the claim is questionable. Employers can talk to witnesses, and follow up on leads made by other employees that a claim may not be 100 percent compensable and pass that information on to the adjuster in the beginning of their investigation.

 

 

All of these issues greatly help the adjuster, and after the investigation is completed, a proper decision can be made on the claim as to overall compensability.

 

 

A claim can start off as compensable and then change. For example, an employee strains his back while working. There was a witness and it was reported promptly. The worker was sent for treatment the same day. Usually benefits will be conceded and the claim will be accepted into initial stages.

 

 

But, a month later the claimant tells the doctor he hurt his back the weekend before the work injury doing yard work, then he made it worse while working. This should lead to a dispute in all cases. The adjuster has no way of knowing how bad the claimant had injured themselves while outside of work, and most often the injured worker will not be able to go back and say the injury/ongoing disability is 100 percent work related.

 

 

Unfortunately, these cases are hard to come by. Claimants are no dummies, and even if this did occur most do not go to an occupational clinic and tell the doctor about how they injured themselves outside of work. But it does happen, and the adjuster should catch this every time. This can be seen in emergency department records, too.

 

 

For examples like this, adjusters rely on the medical records and the mechanism of injury. For example, a claimant states she sustained a lumbar strain while at work lifting a 20-pound tote of parts. Then the doctor finds all sorts of objective evidence on exam of severe, disabling back pain. Something is not right. Lifting 20 pounds should not have such excessive force that it herniates multiple lumbar discs. The adjuster should set an independent medical evaluation (IME), and let the IME physician comment on the severity of symptoms in relation to the stated work injury.

 

 

This type of scenario is a lot more common than one would think. The general public probably has never had a diagnostic workup on their spine or an MRI test. If a claimant sustains a simple injury and the resulting MRI shows all sorts of issues, it does not mean they all are related to the work injury.

 

 

An employer also has to beware of false positives. Just because someone has multiple levels of disc bulges, does not mean all of those are related to work. Research shows workers of all ages and occupations can have a varying level of degree of spinal issues. It is the adjuster’s job to determine what, if anything, is related to the work injury, treat those issues, and deny ongoing treatment for the rest of the worker’s spinal problems.

 

 

The answer is in all cases is YES. It is the adjuster’s job to determine if an injury occurred out of the course and scope of employment. A human resources professional is not an adjuster (at least not very often), and if a worker comes to you and alleges a work injury, no matter what the circumstances, it should be reported to your carrier. The adjuster has training and certification, and he or she is qualified to deny claims. Some jurisdictions can carry heavy penalties for failure to report a work injury to the carrier. You do not want to be hit with one of those penalties. The company pays a carrier’s premium to be protected in insurance matters. This is what they are there for. The employer should gather all the pertinent details and report the claim promptly. Indicate on the first report of injury that the claim is questionable, and go from there. Follow up with the adjuster, and chances are it will be denied as you suspect.(WCxKit)

 

 

In sum, there are several way to dispute a questionable claim. But the most important thing an employer can do is gather all the information on the claim before reporting it promptly to the carrier. Then, follow it up with a phone call to the adjuster. The more you work together with your carrier, the better chance the questionable claims will be denied.

 

Posted in Claim Management, Insurance Issues, Rates, Premiums, Settling WC Claims |

The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) has issued 54 workplace safety and health citations with penalties totaling $1.2 million to gun powder substitute manufacturer Black Mag, LLC, following an investigation into the causes of a deadly explosion in May at the company's worksite in Colebrook, N.H., according to information from OSHA. The explosion took the lives of two workers who had been on the job for only a month.

 

 

May 14, two workers and a plant supervisor were manufacturing a gun powder substitute known as Black Mag powder when the explosion occurred. The workers had been required to hand feed powder into operating equipment due to the employer's failure to implement essential protective controls. The employer also chose not to implement remote starting procedures, isolate operating stations, establish safe distancing and erect barriers or shielding – all of which are necessary for the safe manufacture of explosive powder.

 

 

"The fines levied here pale in comparison to the value of the two lives lost," said Secretary of Labor Hilda Solis. "Nonetheless, this was a tragedy that easily could have been prevented had the employer valued the health and safety of its employees. Employers should not sacrifice their workers' lives for a profit, and no one should be injured or killed for a paycheck."(WCxKit)

 

 

Additionally, the employer chose not to provide the personal protective equipment and other safety measures its employees needed to work safely with such hazardous material. OSHA cited the company with four egregious willful, 12 willful, 36 serious and two other-than-serious violations with total penalties of $1,232,500.

 

 

"Even after a prior incident in which a worker was seriously injured, and multiple warnings from its business partners and a former employee, this employer still decided against implementing safety measures," said Assistant Secretary of Labor for OSHA Dr. David Michaels. "Unfortunately, we see this kind of disregard time and time again across industries. All employers must find and fix workplace hazards so these types of avoidable tragedies do not happen, and workers can return home safely at the end of the day."

 

 

The four egregious willful citations were issued for failure to train each of the four workers involved in the manufacture of the gun powder substitute. In addition to the two workers killed and their supervisor, there was an additional employee who left the job nine days before the explosion. Willful citations are considered egregious when more than one worker is exposed to a single hazard. The citation issued for that hazard is then multiplied by the number of workers exposed.

 

 

Other willful citations were issued for failure to locate operators at safe locations while equipment was operating; separate workstations by distance or barriers and ensure that each worker was properly trained; provide adequate personal protective equipment, such as fire resistant clothing, face shields and gloves; to safely store gun powder; and identify explosion hazards in the company's operating procedures. A willful violation is one committed with intentional knowing or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health.

 

 

Some of the 36 serious citations were issued for failure to separate small arms ammunition from flammable liquids, solids, and oxidizing materials by a fire-resistive wall or by a distance of 25 feet; establish and implement an emergency action plan and provide written procedures to manage changes; provide personal protective equipment including clothing, respiratory devices, protective shields and barriers for workers exposed to lead; train workers on appropriate protective equipment; train workers in electrical safety-related work; address hazards associated with exit routes; and address hazards associated with handling, storing and transporting explosives.(WCxKit)

 

 

The two other-than-serious violations are for a failure to perform respirator fit tests and to ensure that facial hair does not interfere with a respirator seal. An other-than-serious violation is one that has a direct relationship to job safety and health, but probably would not cause death or serious physical harm.

Posted in Risk Management, Safety and Loss Control |

British Columbia’s WorkSafe announced the launching of HiddenKiller.ca, a comprehensive web site on asbestos-exposure prevention and the first of its kind in Canada.

 

 

The site reflects WorkSafeBC’s ongoing efforts to raise awareness about the potential deadly effects of asbestos exposure in the workplace. Asbestos ranks as a leading cause of work-related disease and death in British Columbia. The term “hidden killer” refers to the fact that asbestos fibers — which may be released during demolition or renovation — cannot be seen or smelled when inhaled and yet the damage they cause is irreparable.(WCxKit)

 

 

“Too many workers in British Columbia are affected by asbestos exposures each year,” said Minister of Labor, Citizens’ Services and Open Government Stephanie Cadieux. “This new website is a significant step forward in our efforts to educate and help protect B.C. workers from the dangers of this harmful substance, and hopefully one day, we can eliminate asbestos exposures altogether.”

 

 

When asbestos fibers lodge in the lungs, the results can appear decades later and potentially lead to debilitating chronic diseases, such as asbestosis, or a form of lung cancer known as mesothelioma. Asbestos exposure is British Columbia’s number one occupational disease. Of the 143 accepted fatality claims last year, 75 were the result of occupational disease, and the majority of these can be attributed to exposure to asbestos. This trend is expected to continue.

 

 

“We are committed to educating workers, employers, and the general public about the dangers of asbestos,” added Diana Miles, senior vice president, worker and employer services operations, WorkSafeBC. “This site will present one comprehensive source providing key information and resources on asbestos to help in our exposure prevention initiative.”(WCxKit)

 

 

The HiddenKiller.ca website includes information on what asbestos is, where it can be found, and how it should be handled, along with real-life stories about workers and families dealing with the consequences of asbestos exposure, and information about how to file a work-related exposure claim.

 

Posted in Canada Workers Comp |

A global car components manufacturer has been fined after a Staffordshire, Great Britain, woman fractured and burned her left middle finger while operating a welding machine.

 

 

The Health and Safety Executive (HSE) reported that it prosecuted ThyssenKrupp Tallent, Ltd., following the incident at the company's factory at Quadrant Point, Cannock, in August of 2010.(WCxKit)

 

 

The 43-year-old agency worker from Burntwood, who did not want to be named, was using the machine to weld nuts onto car parts when her left hand middle finger became trapped between the electrode and another part of the machine.

 

 

South Walls Magistrates' Court heard the woman fractured her finger and suffered a severe electrical burn, which has left her with continuing numbness. She was unable to return to work for four months and was in a great deal of pain during her recovery, needing help with day-to-day tasks including washing, dressing, and preparing food.

 

 

An HSE investigation found the machine had no jig fitted to hold the work piece in place and was set to single-hand operation control. Workers had to hold the work piece in place with their left hand, while using their right hand to press the control button to operate the machine. This meant the left hand was very close to the unguarded moving parts and could become caught.

 

 

ThyssenKrupp Tallent, Ltd, of Aycliffe Trading Estate, Darlington, pleaded guilty to breaching Regulation 11(1) (a) of the Provision and Use of Work Equipment Regulations 1998 and Regulation 3(1) of the Management of Health and Safety at Work Regulations 1999. The company was fined £16,000 ($25,500) and ordered to pay £5972 ($9500) in costs.(WCxKit)

 

 

The court also heard the company had been fined as a result of a prosecution by HSE in 2009, following a previous incident relating to machinery guarding at the Cannock site.

Posted in Risk Management, Safety and Loss Control |

 

 

 

Nobody knows more about the difficulties of day-to-day tasks than employees working day after day, week after week, year after year. Listening to your employees about how to make their jobs easier is free. Involving them in workplace ergonomic solutions can also make them feel more involved, while at the same time improve morale which can lead to decreased claims and their associated costs. This can be as simple as lowering supplies stored overhead, raising work benches, making bins easier and lighter to handle, reinforcing handles on containers, and many other simple, inexpensive changes. Almost every employee will already have some ideas on how their work can be done easier and more productively by correcting a few issues in the workplace.(WCxKit)

 

 

The vast majority of insurance companies/TPAs have a loss-control consultant, or possibly an ergonomics specialist on staff. This may even be a free or low-cost service. Having specialists perform a workplace evaluation or to watch workers while they complete their tasks can lead to simple corrections in ergonomics. Since these individuals already do work with similar employers, they may already have simple fixes readily on hand. The feedback they produce can be priceless given their experience in your industry.

 

 

Do you see any trends? Does one particular workstation produce more injuries than another? Look at the dates of hire on these claims, are these long-term employees getting injured or is it the newer employees that are getting injured due to lack of experience? Numbers and history will often speak for itself, and you can notice any injury trends according to department, hire date, workstation, etc., and this can create a “to-do list” for what you want to correct and how to correct it.

 

 

It is probable that you already work with a vendor or have your own contacts for medical case management. These vendors may have someone on staff or they will have a contact to give to you so you can set up an ergonomic assessment. If they do refer you, that particular company or individual has already gained their trust in providing quality work at a reasonable cost. Finding the right contact for this job is priority #1. A thorough evaluation can awaken you to hazards you did not know were lurking in the shadows. The cost associated with an ergomomics evaluation or with workstation adjustments will result in an overall cost savings versus paying for injured employees who are out of work.

 

 

If you have an occupational clinic to which you send injured employees, it is probable they have a physician or ergonomic specialist on staff to assist you in your quest for ergonomic solutions. This will include a site visit and worker observation in their workplace environment. What better resource than a physician to take a look at the layout of your workspace and suggest corrections to common ergonomic problems? Plus, if they can’t recommend the exact solution, they can probably point you in the direction of someone who can, which leads to a quality contact for you, the employer. Consider using an on-site occupational clinic if you have many employees in one location or are in a remote workplace where medical care is not easily accessible.

 

 

It is rare that all employees are of the same size and stature, but workstations are often all the same height and size. This presents an issue. If you have one receptionist who is 5’1” tall, and another who is 6’1”, a cubicle of standard issue may be too tall for one employee and too low for the other. Adjustable desks and chairs can provide a common solution to this problem. This way, when you have turnover or gain new employees through growth, you can automatically adjust these new workstations to the employee-specific requirement, making them more comfortable while working.

 

 

Big names in office supply furniture are up-to-date on new trends and advancements in workstation design and implementation. This can open the door to a resource from a place where you already order supplies and equipment. Many of these companies also collect feedback and opinions from their customers, so they can present you with positive and negative feedback on your potential purchases depending on your situation and needs. This prevents you from making a bad purchase and investing in bad capital. If you attend national conferences, such as RIMS Annual Conference in the Spring, you'll find ergonomics resources in the Exhibit Hall.

 

 

In summary, ergonomic resolutions and improvements should not be overlooked no matter how long you have been in business. These corrections can lead to decreased injuries, which, in turn, provides a lower claim costs, less insurance costs, and a more profitable, safer company for you and your employees.

 

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.

 

 

Posted in Safety and Loss Control, WC 101 |

U.S. Transportation Secretary Ray LaHood recently announced that individuals with disabilities will have greater access to inter city, commuter and high-speed train travel as a result of a new rule requiring new station platform construction or significant renovation to enable those with disabilities to get on and off any car on a train, according to a report from the agency.

 

 

“This will help give passengers with disabilities better access to rail travel across the country,” said LaHood. “By putting this protection in place, passengers with disabilities will be able to get on and off any accessible car that is available to passengers at a new or altered station platform.” (WCxKit)

 

 

The U.S. Department of Transportation (DOT) is amending its Americans with Disabilities Act (ADA) regulations to require inter city, commuter and high-speed passenger railroads to ensure, at new and significantly renovated station platforms, that passengers with disabilities can get on and off any accessible car of the train.  Passenger railroads must provide level-entry boarding at new or altered stations in which no track passing through the station and adjacent to platforms is shared with existing freight rail operations. 

 

 

For new or altered stations in which track shared with existing freight rail operations precludes compliance, passenger railroads will be able to choose among a variety of means to meet a performance standard to ensure that passengers with disabilities can access each accessible train car that other passengers can board at the station. These options include providing car-borne lifts, station-based lifts, or mini-high platforms. 

 

 

The Department will review a railroad’s proposed method to ensure that it provides reliable and safe services to individuals with disabilities in an integrated manner. 

 

 

The rule also requires that transit providers carry a wheelchair and occupant if the lift and vehicle can physically accommodate them, unless doing so is inconsistent with legitimate safety requirements.  (WCxKit)

 

 

In addition, it codifies the existing DOT mechanism for issuing ADA guidance and makes minor technical changes to the Department’s ADA rules.

 

 

Posted in ADA (Americans with Disabilities Act), Medical Issues |

In the world of insurance, it is hard to tell if your carrier or third-party administrator (TPA) is doing a good job if you do not interact with them often. Of course, the goal is to have as little interaction with them as possible — if you do not have to file any claims that is a good thing.

 

 

But, accidents will eventually happen. Property damage happens. Workers get injured. Customers get injured. So how can you tell if your carrier or TPA is doing a great job and looking out for your bottom line?  (WCxKit)

 

 

Your injured worker should have had plenty of interaction with their adjuster during the course of the file. The amount of interaction depends on the severity of the injury, but they should at least be able to name their adjuster and give some feedback on how the claim went.

 

 

If your injured employee’s claim was denied, you may not get a truthful answer. But, for a normal, routine claim that was accepted and uncomplicated, the worker’s responses should be a good indicator of how their claims process went.

 

 

Was the adjuster helpful?

Did he or she explain you worker’s rights as defined by the Comp Act?

Did he or she explain your medical condition to you?

Did the adjuster return phone calls promptly?

Did the adjuster listen to your questions and answer them to your satisfaction?

 

 

Any negative responses to these questions is usually a good indicator of how your carrier is doing while handling your claims. A lot of negative responses from your workers could indicate it is time to explore using another carrier or TPA.

 

 

If you have a good-sized agency, or broker, that handles your insurance needs, it should be more than familiar with their clients' companies. If you ask for an unedited opinion, chances are they will give it to you. Agents hear a lot about the pros and cons of certain carriers and TPAs from other clients. Issues an agent speaks of may or may not be of importance to you, but, the more information you have the better.

 

 

What is the carrier’s reputation with other agents?

What does your agent hear about the carrier or TPA’s litigation response; do they deny and fight every claim, or accept and pay out on every claim? (either is bad – there should be a balanced approach)

How are their reserving practices? Do they constantly bump or stair-step reserves? Do they inflate reserves in an effort to raise premiums?

How are their adjusters? Do they return calls and help agents with questions or are they impossible to reach?

How is the carrier’s local management? Are they knowledgeable and experienced?

Does your carrier/TPA write a lot of businesses like yours, similar in size?

Does this carrier/TPA only like to write very large national accounts or do they prefer lower-level, local markets?

How are your TPA’s underwriters? Are they usually accurate or do they have to do a lot of work when submitting a premium estimate?

 

 

All of these questions will give you a feeling about how your business fits in with the other businesses your carrier/TPA writes for. A smaller company that uses a carrier/TPA that prefers large national accounts may find their business needs are not tended to when you need them.

 

 

The best option is a team handling your account within your immediate community. If it is a major road trip to meet with your insurance team, question if they are the right fit for you; if it's a flight, question it even further. Some businesses want that local presence so they can physically meet with them when issues arise. Some businesses do not really care about the location, as long as their needs are met immediately. It is your choice. Consider TPAs that will provide a dedicated unit ON SITE at your location if you wish; yes, there is a price for such a high level of service, but the overall value may have an excellent ROI. Short-sighted companies concerned only with today's price rather than total price might want to reconsider the price-first approach.

 

 

Every Carrier/TPA knows who would be handling your claims if any were to happen, so meet with this person. Get to know him or her and find out about their industry experience. Find out if you mesh with them or not. If you get a good vibe, then there should not be a lot to worry about. But, if you walk away feeling less than confident, you already know you should start shopping around before it is too late. Check their "grades" – the best TPAs score their adjusters.

 

 

This will not apply to everyone, but typically if you are a niche business and know your competition, ask your peers about their experiences. Ask how their claims were handled and if they were satisfied. All business competition aside, most managers run into the same people from their competition at certain events, trade shows, etc. If you are amicable with any of them, it will not hurt to ask. It is almost like a test drive. If your competitors had bad experiences with certain carriers/TPAs, chances are you would as well. This can save a when it is your turn to file a claim with your Carrier/TPA.

 

 

Most Carriers/TPAs will have websites that show their capabilities, office locations, new technology, agent relationships, etc. Do some searching around to see who you like.

 

 

Who has cutting-edge technology for claim handling?

Who has invested time and effort into research and hiring practices to ensure they have the best of the best in staffing adjusters and counsel?

Who has local offices in your area?

Which agents are partnered up with your carriers/TPAs of choice?

Is your carrier/TPA involved in local charities and in giving back to their community?

 

 

Not all of these items may play a factor in learning if you have the right carrier/TPA for your business needs, but it cannot hurt to find out the answer to some of these questions. (WCxKit)

 

 

The goal is to not ever have to file an insurance claim. But, as we all know, that is unlikely. You will have to cross paths with your carrier/TPA at some point. Making sure you have the right one who will take care of your needs when you need it the most is worth the effort. Ask around; do your research, and take time to meet with your prospective team of insurance professionals. This will help you know you made the right choice, and not a choice you will regret when you need help or have questions about your insurance needs.

 

Posted in Assessment & Diagnostics, Broker Issues & Relationships, Claim Management, TPA and Claims Administration |

Two employers, Massey Energy and Peabody Energy were ordered to produce audit records requested by the U.S. Department of Labor's Mine Safety and Health Administration (DLMSH) by Administrative Law Judge Kenneth Andrews with the Federal Mine Safety and Health Review.

 

 

According to the department, the cases concern the refusal of the controlling companies to provide accident, injury, and illness data during audits conducted by MSHA between October and December 2010. These audits were conducted in an effort to determine if specific mines met the criteria making them eligible to receive notifications of a potential pattern of violations. Eight mines were named for refusing to come forward with the necessary records. (WCxKit)

 

 

In the Peabody case, Andrews agreed with MSHA that the agency has a right to review records maintained by the operator that are "relevant and necessary" to determine compliance with accident, injury, and illness reporting requirements. He rejected the operator's argument to withhold the records based on their "sensitive and private" nature. In so doing, he concluded that such a disclosure to a public health agency such as MSHA is a "reasonable exercise of government responsibility" and that MSHA's "interest in promoting mine safety far outweighs any interest the mine operators may have in privacy."

 

 

The pair of mines in the Peabody Energy suit are Big Ridge, Inc.'s, Willow Lake Portal and Peabody Midwest Mining LLC's Air Quality #1 Mine. However, Willow Lake Portal previously was placed on potential POV status due to injuries it had properly reported and successfully reduced its violations during the evaluation period.

 

 

In the Massey case, MSHA argued that the role of 30 Code of Federal Regulations Part 50 in advancing miner safety and health cannot be overstated, as it identifies the aspects of mining requiring intensified attention with respect to health and safety legislation. Part 50 regulations cover the primary reporting and record-keeping obligations for mine operators, including as these relate to accidents, injuries, illnesses, and quarterly employment.

 

 

The six mines in the Massey Energy suit are Independence Coal Co., Inc.'s, Justice # 1 Mine, Inman Energy Corp.'s Randolph Mine, Process Energy's Mine # 1, Spartan Mining Co.'s Road Fork # 51, Road Fork Development Co.'s Love Branch South Mine and Knox Creek Coal Corp.'s Coal Creek Prep Plant. The judge's decisions affirm the violations and orders that MSHA issued to the operators for their failure to provide the requested records.

 

 

"This move has unnecessarily delayed MSHA's review of the POV process for seven of these mines," said Joseph Main, assistant secretary of labor for mine safety and health. "Mine operators should be aware that we are not going to rely on what they report to make such critical determinations. We will check those records ourselves." (WCxKit)

 

 

Of the 32 mines where audits were completed, MSHA issued more than 100 citations for irregularities in reporting and/or record keeping. As a result of those findings, Maple Coal Co.'s Maple Eagle No. 1 Mine was moved to potential POV status. The mine operation initially was not flagged as a candidate for a potential POV due to under-reporting of injuries. The subsequent audit discovered 12 unreported or under-reported injuries and 241 unreported lost workdays.

 

 

Posted in Safety and Loss Control, WC 101 |

The European workforce's well-being is key to a sustainable economic recovery, according to the head of the European Agency for Safety and Health at Work (EU-OSHA).

 

 

Introducing his last annual report as agency director, Dr. Jukka Takala emphasized the danger that the economic crisis might push people out of employment permanently, and huge numbers may find themselves excluded from the job market because of long-term ill health. “For the whole of the E.U., we can estimate the production loss from people being excluded from work on health and disability grounds at Є30,000 billion – every year. For comparison, the emergency measures that were introduced to stabilize the Greek economy cost in the range of Є110 billion, and those for Ireland, Є85 billion, just as a one-off.” (WCxKit)

 

 

According to Dr. Takala, it is important that future economic growth should be inclusive, creating conditions that enable people to continue at work, safely and healthily. “We need to ensure not just that current jobs are safe, healthy, and productive; we should strive towards a safe, healthy, productive, sustainable, satisfying, and motivating working life,” he said.

 

 

The 2010 annual report emphasizes the ways in which the agency has continued to work to protect the safety and health of European workers, in spite of these difficult economic conditions. One highlight has been the opening of the Healthy Workplaces Campaign on Safe Maintenance – the agency’s two-year health and safety campaigns are now the largest of their kind in the world. The Safe Maintenance Campaign has seen record numbers of partner organizations involved.

 

 

The agency also published results of the European Survey of Enterprises on New and Emerging Risks (ESENER), which, for the first time, provide real-time data from enterprises across Europe on what they are doing to tackle occupational risks (specifically psychosocial risks).

 

 

Another highlight of 2010 was the agency piloting the Online interactive Risk Assessment tool (OiRA), the legacy of the Healthy Workplaces Campaign on Risk Assessment 2008-09. The OiRA tool, which the agency is making available for free, will help many thousands of small companies across the E.U. carry out risk assessments in a simple and cost-effective way.

 

 

Looking ahead, 2011 will be the second year of the Safe Maintenance Campaign, including the closing event in November.(WCxKit)
 

 

The agency continues with the detailed study of the results of the ESENER survey, and planning is has begun for the 2012-13 Healthy Workplaces Campaign on the subject of working together for risk prevention.

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

 

An employee’s failure to recover to pre-injury physical condition is not medical malpractice. For medical malpractice to exist, there must be some degree of professional negligence. Other than the physicians, there can be medical malpractice by hospitals, therapists, dentists, nurses, chiropractors, and other medical providers. (WCxKit)

 

 

1.      The doctor, hospital, or other medical provider is assigned to provide the medical care requested.

2.      The doctor, hospital, or other medical provider has failed to provide the medical care at the same level of medical expertise that another medical provider in the same medical specialty would have provided.

3.      Failure to provide the expected medical care resulted in an injury to the employee.

4.      Failure to provide the medical care at the appropriate level resulted in damages (Note: if there are no financial damages the employee will be unable to find a lawyer to pursue the claim).

 

 

In those instances where a surgeon performs a laminectomy that fails, or the employee develops reflex sympathetic dystrophy or fibromyalgia, it does not mean there is medical malpractice. It usually means the employees physical condition was not sufficient to withstand the stress the surgical procedure caused his body.

 

 

However, in the rare cases when a medical provider gave inferior medical service, the employee is right to obtain an attorney to pursue a medical malpractice claim. Unfortunately, the attorney will usually talk the employee into allowing the attorney to also represent them in their workers' compensation claim.

 

 

When the attorney for the employee starts pursuing a medical malpractice claim in conjunction with the workers' compensation claim, it is absolutely essential that the adjuster and nurse case manager work closely with a utilization review specialist. The reason for this is to keep the medical care for the workers' compensation claim, and the cost associated with it, separate from the cost of the medical care needed to correct the alleged medical malpractice. The reason to do this is to document what can be recovered through subrogation. If the adjuster does not carefully document the additional cost due to the medical malpractice, the workers compensation insurer can get shut out of any financial recovery from the professional liability insurer when the medical malpractice claim is settled.

 

 

All states will compel the workers compensation insurer to pick up the cost of additional medical care needed due to a failed effort to medically treat an injury. The workers compensation board or industrial commission will not get involved in the question of medical malpractice.

 

 

Because damages an injured employee can recover from a medical malpractice will greatly exceed the potential recovery for the workers compensation claim, the attorney handling a medical malpractice claim will generally spend most of her time and attention on the medical malpractice claim. However, to maintain the value of the medical malpractice claim, the attorney will delay the settlement of the workers compensation claim for as long as possible. This has a negative impact on the workers compensation claim as the longer the claim stays open, the more it will cost. (WCxKit)

 

 

If you hear an employee threatening to sue the doctor over “medical malpractice,” suggest to the adjuster and to the employee the need for another doctor to evaluate the employee. When the second doctor evaluates the employee's medical condition, in 99 percent of the cases they will find the first doctor acted with appropriate medical care.

 

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