When there is an injury at the workplace, you need to know what to do. A lot will depend on the actual type of injury. If the injury is severe and requires immediate surgery and in-patient hospital care, you are probably going to do all possible to get the claim to the carrier/TPA as fast as possible on the day of the injury.
On the other hand, if a guy comes in the office and says he hurt his arm but “it is no big deal,” chances are you are going to forget about it, not make a note about it. And when he
comes back in 6 months and says surgery is needed tomorrow and will be off of work for 6 months, I do not think you are going to exactly recall the brief conversation with him 6 months prior. (WCxKit)
Lag time is an enemy to every claims adjuster out there. It can affect every aspect of the claim, most importantly the compensability. For every day that goes by after someone is hurt without
reporting it to the employer, or even worse he reported an injury to the employer who did not report it to the carrier/TPA, lag time is involved. Lag time is the time between date of injury and the date of reporting to the employer and from the employer to the carrier. Here are some tips to improve lag time. ASK FOR A LAG TIME REPORT FROM YOUR CARRIER. They
should be giving them to you
periodically, but if not, ask for it.
1. Have a system in place
Regardless of the size of the work population, you need to have a system in place. The employer is going to be faced with several different types of workers comp claims: report only, medical only, lost time, advanced lost time, and severe. A claim that is a “report only” or “incident only” should not carry the same urgency as a
severe injury claim.
Every person in risk management will have a certain way of keeping records and reporting claims to the carrier/TPA. Organization is key. The system has to work, or else a claim will fall through the cracks. Get a separate file cabinet, dedicate a certain area of the office to claim paperwork, and keep separate email folders for claims Whatever you do to create a working system stick with it. Think about prioritizing each type of claim and how each issue has to be addressed. Take it one step at a time and walk through what the responsibilities are and where you need to focus.
2. Get those claims called in to the carrier/TPA
A rule should be made that any claim with medical treatment needs to have the State Injury report completed and sent to the carrier/TPA within 1-2 business days. Not only does this prevent lag time from happening, but it will give the adjuster a head start on the claim from early in the injury. This can apply to medical-only claims and non-severe lost time claims. Plenty of claims start off innocently enough as a simple medical only claim. But then, 3 months later after conservative treatment fails, the injured worker is heading for surgery, which is not a guarantee that the employee will be 100% in the near future. The earlier the adjuster is involved in the claim, the better chances you have of it not spiraling out of control. Plus after it is reported and called in to the carrier, that is one less thing to worry about.
3. Call claims in with the correct and complete information
Adjusters dislike it when they receive an injury report and most of the information is missing. Or the injury description reads “back strain.” Maybe the place where the employee was treated is not known, or if the injured worker even went for treatment at all. Maybe you view date of birth, social security number, job title, and complete address, as trivial information. That is okay, but the adjuster needs that information, and it needs to be accurate. It cannot take long to pull a person’s personal information up on the computer, or email the Human Resources person to seek help with that portion of the claim. Any way that it can get done, do it and then get the claim sent. Incorrect or incomplete information produces lag time from when the adjuster receives the injury report to when the TPA makes a first payment on a claim. Or even when the adjuster can make contact with the worker. If you forgot the claimant’s phone number, and did not have a complete address, how can the adjuster contact the injured worker?
4. Include the hourly wage and the gross total from a year prior to the injury date to reduce lag time
If this claim will involve wage loss, the adjuster will need the wage records. Be sure to list the hourly rate for the injured worker, as well as the gross pay from one year backwards from the injury date. This will save the adjuster time, cutting down on the lag time between injury date and date of first payment. Most states will penalize the carrier for a delay in payment after an injury occurs if there is lost time. Due to this statute, the adjuster will be requesting wage records. So why not be ahead of the game and include the records with the claim forms that are sent? The adjuster will appreciate it. And of course it is one less thing you have to do.
5. Keep eyes and ears open on your work floor
As a risk manager or HR person, chances are you are removed from the work floor where a lot of injuries occur. But, the adjuster will be calling you to talk about the injury details. So you have to know about the machines, know the people running them, and also know who the employee’s managers are and how to talk shop with them. Your employees should know that the first contact person after an injury is their supervisor, and then that supervisor should be coming right to you to fill out the injury paperwork after they talked with the employee and sent them off for medical care. Make sure those supervisors know the importance of coming to you to report a claim. If the worker does not tell the employer about the injury, then you are not going to have a report to send.
6. Be involved with the process
We have said it time and time again, the employer must be involved. Not only at the initial stages as indicated above, but throughout the whole process. To have an effective workers comp program, there must be proper reporting, proper light duty management, and proper monitoring on all aspects of the claim. You need to communicate with the carrier/TPA for claims reviews. Get up to speed with what is going on, and what the current lag times are. Set goals to reduce lag time from late reporting and keep track of the numbers. Fix your system where it needs to be fixed. There is no perfect blueprint that will work. A program as variable as this also needs to be flexible. Make changes as needed and track to see if they improve numbers or worsen them, and then make further changes. Create the program, and then be involved in it. (WCxKit)
Summary
Carrier/TPAs despise lag time from late claim reporting. They keep track of it for a reason, because the greater the lag time and the later the adjuster is involved, the more the exposure risk increases. Take some of the key points listed above and see if they can be implemented into your risk management system. Keep track of the numbers. If you discover that you have a lag time problem, then you have the room and the resources to save a lot of claim expense money that is spent purely on late reporting. Like it is said, “The numbers don’t lie.” You will be amazed at how much money can be saved simply by getting that correct claim sent in to the carrier for immediate handling.
Author Rebecca Shafer, JD, President of Amaxx Risk 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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
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
I just got off the phone. I had been trying to call the insurance company’s Buffalo office but I could not find a current number, so I called the NYC office.
The operator at the insurance company's NYC office answered and I told her that I needed a number for their Buffalo office. She said, “But you called NYC.” I said, “Yes. I know, I just need the Buffalo number.”
She started going through a list. “Arizona…Colorado…. Connecticut… Delaware…Florida……I do not see Buffalo.”
I said, “You are looking at states. Buffalo is a city.”
She said, “What state is Buffalo in?”
I said, “New York.” Then, I just hung up in exasperation….
Information is the most essential ingredient in compensation claim management, but where does information originate?
The employer tends to see itself as a source of information more than a recipient, believing, or hoping, that the carrier makes all necessary efforts to gather useful facts. But is the carrier doing its job? The answer is a phone call away.
Carriers are equipped to obtain information contained on mandatory forms, such as reports of injury, and to a lesser extent information obtained by investigators. But what about information which appears unannounced and unexpected? That is the sort of information which is often the game changer in difficult claims, especially those involving fraud or undue exaggeration of disability.
Such information comes from sources close to a worker like co-workers, acquaintances, neighbors, and relatives. These sources are understandably cautious in reporting suspicious behavior but sufficiently upset by it to make an effort to report it. A single phone call from such sources can save an employer hundreds of thousands of dollars but only if the phone call can get through. Social Security and IRS go to great lengths to move such calls into dedicated hot lines but does an employer’s carrier?
An employer should find out by making a call to its carrier, avoiding the inside numbers and calling the general numbers found on websites or in phone books, the very places an unconventional source will seek them. What usually follows will in most cases leave an employer troubled, especially if it has a suspicious claim in progress.
Carriers, for nearly two decades, have relied on phone systems which delay a caller in reaching a live employee. Even then, it is usually an operator who directs the call to an answering machine on which a recorded message informs the caller that if they leave a name, phone number and purpose of the call someone will call back.
An employer should test how long it takes to receive a call back when the caller is identified as someone who “has important information” and is reluctant to leave a full name. Most callers with sensitive information are reluctant to do even that, much preferring to hang up as soon as they are connected to an answering machine. If the employer leaves a name and phone number on an answering machine and never receives a return call the employer is only experiencing the same reception given to the most valuable calls.
An employer, therefore, must consider itself the guardian of its claim info and take special steps to see that it is transmitted to and acted on by proper units within a carrier. If the claim has been in progress and the carrier has appointed counsel, then counsel should also be copied with a request for counsel to call the employer to discuss the info. (WCxKit)
An employer should not hesitate to request a conference with the claims supervisor to discuss unanswered calls or claim material which is ignored. Nor should an employer be kept distant from the “carrier’s” attorneys. (The attorney’s primary client is always the employer ,not the carrier, even when the attorney is selected by the carrier.)
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
medsearch7@optonline.net
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 RShafer@ReduceYourWorkersComp.com
Authors: Brian Anderson DC, CCN, MPH and David Radford DC, MSc
In the first article of this series, we discussed the huge impact Occupational Low Back Pain (OLBP) has on both employers and employees. The statistics on prevalence and disability due to OLBP cannot be ignored.
In part two, strategies that employers can take which may prove effective in reducing the burden of OLBP were discussed. Now, in the final article of this series, we will discuss the all-important topic of treatment options for those suffering from OLBP.
There are a few variables related to the treatment low back pain (LBP) that make it particularly challenging. First, it is estimated that approximately 80% of LBP is non-specific, which means there is no well-defined cause. Second, imaging studies (x-ray, MRI) are not particularly helpful in determining those with LBP vs. those who are asymptomatic. A 1994 study in the New England Journal of Medicine concluded, “Given the high prevalence of these findings and of back pain, the discovery by MRI of disc bulges or protrusions in people with low back pain may frequently be coincidental.” Another source states that “The false positive rate for identifying clinically significant herniated discs or degenerative conditions with imaging is so high as to make the tests clinically inappropriate as screening procedures”. Unfortunately, the “biomedical model” employed by the majority of the medical community is dependent on diagnosing an abnormality on an imaging study, and treating this abnormality with medications, rest, injections and surgery. (WCxKit)
What we are recommending, and what the current literature is supporting, is a “bio psychosocial” approach to treating LBP. This model recognizes that the experience of pain has many components, and that all these components must be addressed for long term healing. Patients with LBP experience what is called fear-avoidance behaviors; they anticipate worsening of symptoms with certain activities or movements. This anticipation sets up a vicious cycle, which goes something like this
fear of painàactivity avoidanceàdeconditioningàacute tissue overloadà chronic sensitization to pain
·
Those LBP sufferers with “yellow flags” must get involved in a bio psychosocial program very early on, or are at high risk for developing chronic pain syndromes. These yellow flags are included.
- · radiating (travelling) pain
- · poor self-rated general health
- · anxiety/depression
- · self-perceived inability to control symptoms
- · self-perceived inability to perform normal activities
People with LBP must be educated that hurt does not equal harm; in other words, they should continue to participate in normal daily activities even if there is some pain during these activities. Patients with acute LBP may experience some benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed.
In an ideal situation, a treatment team would be developed to deal with OLBP. This team would consist of: a return to work coordinator; an occupational health provider (MD or nurse); a health psychologist; a Chiropractic Physician; a Physical Therapist; and a Physiatrist/Neurosurgeon/Orthopedic surgeon for possible consultation. We are suggesting that all cases of OLBP be triaged by the occupational health provider and automatically referred for consultation with a Chiropractic Physician, due to their unique expertise dealing with this particular condition. This scenario would no doubt save countless healthcare dollars by preventing unnecessary imaging studies, medication use and interventional procedures such as injections and surgery.
Regarding conservative treatment of LBP, very high quality evidence exists that supports various treatment modalities. Below is a review of some of this research.
- · There is good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or sub acute (>4 weeks' duration) LBP
- · Fair evidence that acupuncture, massage, yoga, and functional restoration are also effective for chronic LBP
- · For acute LBP (<4 weeks' duration), the only non-pharmacologic therapies with evidence of efficacy are superficial heat and spinal manipulation
- · There is moderate quality evidence that post-treatment exercises can reduce both the rate and the number of recurrences of back pain.
- There is moderate scientific evidence showing that multidisciplinary rehabilitation, which includes a workplace visit or more comprehensive occupational health care intervention, helps patients to return to work faster, results in fewer sick leaves and alleviates subjective disability.
- Spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful. It was no more or less effective (but no doubt less costly) than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.
Significant evidence also exists suggesting that invasive treatments, such as injections and surgery, are questionable treatment options for most patients. (WCxKit)
- There is no strong evidence for or against the use of any type of injection therapy for individuals with sub acute or chronic low- back pain.
- There is serious lack of scientific evidence supporting surgical management for spinal arthritis
- There is no acceptable evidence of the efficacy of any form of fusion for spinal arthritis, back pain or instability
- 38% of surgeries performed in two university based neurosurgical units were prospectively evaluated and were determine to be inappropriate
As mentioned in the opening of part I of this series, employers are unlikely to find another issue that leads to more absenteeism and detracts from productivity in the workplace more than OLBP. We hope that, after this three part series, readers are more educated as to how to prevent and treat this serious issue. We encourage safety managers and coordinators of care to consider a comprehensive approach to dealing with OLBP. For further information or questions, please contact the authors.
Dr. Anderson works as a supervising clinician and instructor at National University of Health Sciences in Lombard IL. He has been in private practice, as well as part of a team in a University based Integrative Medicine setting. In addition, Dr. Anderson has experience in the medico-legal field, serving as an expert for various insurance companies and legal firms. He earned a Masters Degree in Public Health, as well as a Certified Clinical Nutritionist designation. He is currently working toward a specialty diplomate in Functional Rehabilitation. Contact Dr. Anderson for more information at banderson@nuhs.edu
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.
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
A South Los Angeles grocer accused of buying EBT cards from welfare recipients at a cut rate, then using the cards to purchase items from other markets to stock his shelves and resell merchandise for higher prices was charged with fraud, the Los Angeles County District Attorney’s office announced recently.
Sabino Reynoso Cedano, 59, is charged in case No. BA387794 with four felony counts: food and nutrition benefits fraud, computer access fraud, access card benefits theft and multiple access card theft. The complaint alleged the crimes occurred over the past year.(WCxKit)
Cedano was arrested by investigators with the District Attorney’s Bureau of Investigation when a search warrant was served at his two stores on South Normandie Avenue and his home in Inglewood. He was freed on $20,000 bail. The case against him was filed by Deputy District Attorney William Clark of the Public Assistance Fraud Division.
Investigators said Cedano purchased Electronic Benefit Transfer (EBT) cards and the welfare recipient’s PIN number at less than the card actually was worth. He used the cards to purchase items such as sodas, chips and candy, which he resold at higher prices at his South Los Angeles markets, investigators added.
The EBT cards are issued to those who apply for aid through the Department of Social Services (DPSS) and the amount placed on the cards is to be used only by the recipient to purchase food. They are not to be sold or used by anyone other than the recipient.
Investigators with the DPSS and the U.S. Department of Agriculture are participating in the case.(WCxKit)
If convicted as charged, Cedano faces a possible maximum state prison term of five years.
Author Robert Elliott, executive vice president, Amaxx Risk 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.
A new national survey of 42,000 Australian workers in 2011 found they are under more pressure than ever before, working longer hours than they are paid for, and increasingly having work invade their home life, totally shattering the myth that employees are to blame for the nation’s productivity. According to a report from the Australian Council of Trade Unions, the largest survey of Australian workers found that while the modern workplace is for some less physically demanding than in the past, working hours have increased and new forms of stress have emerged.
ACTU President Ged Kearney noted, "Work is bleeding into the rest of a worker’s life, and we do not have the means of recognizing or dealing with this in a way that suits workers. Instead we have an increase in stress and insecurity for workers. This is particularly the case for people in casual jobs, who fear they will lose shifts if they do not comply. Business is shifting more and more financial risk and responsibility onto the workforce. We have a 'productivity squeeze,' meaning that we are achieving productivity through unpaid work and greater pressure on (our) workers. It is a wake-up call at a time when we are saturated with urging from employer and business groups about the need to effectively take away more rights and reduce pay and conditions to improve productivity and flexibility."(WCxKit)
The Census found:
1. 73 percent are regularly contacted outside of work hours about their job.
2. 61 percent work more hours than they are paid for.
3. 47 percent receive no compensation for their extra hours.
4. 58 percent have paid for work-related expenses and not been compensated.
The Census also found many workers were concerned about job security, with 22.3 percent of respondents saying the issue as among their greatest concern and one in seven (14.3 percent) of employed census respondents were in a form of non-permanent work arrangement. And one in six (16.5 percent) respondents said they were in non-permanent work part time arrangements because they could not find full time work. (WCxKit)
It has confirmed the existence in the modern Australian workplace of three distinct groups: women aged 45-54 who are juggling caring responsibilities for children and parents while continuing to work full-time; men aged 45-64 who cannot find permanent work because they are told they are too old; and workers under 25 years old who are employed and living out of their home, facing labor market and financial stress because of insecure and unstructured work.
Author Robert Elliott, executive vice president, Amaxx Risk 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.
When an employee has a musculoskeletal injury keeping the employee from returning to work, it is routine practice for orthopedic doctors to recommend a physical therapy program. The purpose of the physical therapy program is to assist the injured employee to restore function, to restore the pre-injury level of mobility, to control pain, and to limit or prevent permanent physical disability. This can be accomplished with physical therapy providing both range of motion exercises and strengthening exercises.
The orthopedic doctor treating the injured employee will prescribe the amount of physical therapy the employee should have. Some orthopedic doctors are very good at estimating the number of physical therapy sessions an injured employee will need and will prescribe accordingly. For instance, the doctor will prescribe physical therapy for the lumbar spine “3 x 4," which tells the physical therapy facility to treat the injured employee three times per week for four weeks. The return appointment with the doctor’s office is normally scheduled after the anticipated date of the last physical therapy treatment. This allows the doctor to assess the benefits of the physical therapy treatment program, but it is after the fact. (WCxKit)
Unfortunately, some orthopedics will prescribe the same amount of physical therapy for just about every patient they see. If every patient is "3 x 4” or “3 x 6,” some injured workers end up having too much physical therapy and some end up not having enough. When the injured employee does not get enough physical therapy, they return to the doctor before they have not recovered from their injury. The doctor then prescribes more physical therapy and sets up another return visit to the doctor’s office.
When the orthopedic describes physical therapy, the physical therapy facility wanting to insure payment, will normally call the workers compensation adjuster for approval to provide the treatment. The adjuster does not know whether the physical therapy is needed or not. Most adjusters will not question the need for physical therapy, figuring if the doctor requested it, it must be needed. This often results in the injured employee receiving more physical therapy then is needed.
One approach to the adjuster’s dilemma of whether to approve physical therapy or not, is to refer the request for physical therapy to utilization review. Utilization review can eliminate some excess physical therapy treatment, but utilization review makes their judgment calls based on the information in the doctor’s medical notes. Utilization review will not know if the injured employee recovers faster than normal resulting in the injured employee continuing to go to physical therapy when the physical therapy is not providing any further benefit.
A recent innovation in managing the physical therapy treatment is the development of results based treatment approach. Instead of the injured employee going to the physical therapy office 15 times because the doctor wrote a “3 x 5” script, the injured employee goes to the physical therapy office for as many or as few times needed for the employee to make a proper recovery from their musculoskeletal injury.
In the traditional fee for services model of physical therapy treatment, it is in the financial best interest of the physical therapy facility to continue physical therapy treatment until the doctor sees the injured employee again. This often results in excess treatment. The results based approach to physical therapy aligns the interest of the employer and the insurer with the physical therapy facility, where the timely recovery and return to work benefits all parties including the employee.
A results based approach to physical therapy allows a single flat fee for service. This reduces a lot of paper work for the adjuster, by having one bill to pay, rather than many physical therapy bills. (WCxKit)
Results based physical therapy treatment appears to be an innovative way for employers and insurers to manage the physical therapy treatment process and to provide the injured employee with the treatment needed in a timely manner. The management of physical therapy through results based treatment benefits everyone.
Author Rebecca Shafer, JD, President of Amaxx Risk 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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
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
Few people realize the workers’ compensation industry is actually 100 years old. It’s one of the most-successful public-private partnerships in U.S. history.
Since 1983, the Workers Compensation Research Institute
(WCRI) has been providing the public with research on WC public policy issues. Based in Cambridge, Mass., the organization includes among its members employers, labor organizers, public and private insurers, health care providers, managed care companies, and state government representatives from the U.S., Canada, New Zealand, and Australia.
Dr. Richard Victor, WCRI executive director, oversees the institute’s studies and analysis that has added ammunition for the reforms to various aspects of the workers' comp system. Prior to working at the institute, he spent seven years conducting research at The Rand Corporation in Washington , D.C., and Santa Monica , Calif. His law degree and Ph.D. in economics is from the University of Michigan.
LowerWC recently asked Victor for his impressions of the industry. What follows are some of his comments:
“One of the most important, and troubling, areas for workers’ compensation systems is to find the appropriate ways to use narcotics – and to discourage abuse and diversion. A second critical issue is to find new and innovative ways for help workers return to productive employment,” Victor says.
To this end, WCRI is conducting several research phases to help find answers for WC narcotic use and return-to-work issues, he says.
Victor says the latest trends in workers’ compensation also include medical cost management. “Medical costs now represent more than half of workers’ compensation costs in most states. There is increasing focus on pharmaceutical costs and utilization and the payments made to hospitals and ambulatory surgery centers,” he says.
Further, everyone wants to know how to save the employers money. Victor says, “Most large employers are focused on three legs of the four-legged cost containment table – risk financing, injury prevention, and claim management. The fourth leg is a large opportunity because employers have underinvested in it – improving the ‘rules of the game’ to make the system more effective for workers and more cost effective for employers.”
He continues, “This requires that employers join together to formulate political positions and strategies and gather available evidence about how a given state system is performing, how it might be improved, and what lessons can be learned from other states.”
California and Texas are good examples of where employers have taken collective action and costs have fallen significantly, Victor says. One of the chief objectives of the WCRI CompScope benchmarking studies is to help stakeholders and public officials set priorities and debunk myths.
One important part of this research is an upcoming conference. The WCRI Annual Issues and Research Conference will be Nov. 16-17 in Boston with keynote speaker Peter Barth, professor of economics emeritus at the University of Connecticut. This will be its 28th year.
The goal there to present new ideas and alternative views, Victor says. “Whether you are managing workers’ compensation claims, involved in strategic planning, concerned with medical costs and utilization, or just looking for a better understanding of workers' compensation – this is the conference for you.”
All of the sessions highlight the first presentations of the latest research findings from WCRI while drawing upon the diverse perspectives of highly-respected workers’ compensation experts and policymakers from across the country, he says. “Attendees tell us that they value the large attendance because it allows them to leverage their time while at the conference. There are also opportunities to meet and interact with WCRI researchers.”
“The most important advice I can give remains a secret until the WCRI conference, when I (present) ‘The Elephant in the Room.’ It will highlight some things that are underappreciated, but are likely to shape workers’ compensation systems for the next decade. The future is not always like the past,” Victor says. “Of course, I would like to see your readers attend to stretch their thinking, gain a competitive edge, and network with peers.”
Author Rebecca Shafer
, JD, President of Amaxx Risk 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. She is the author of Manage Your Workers Compensation: Reduce Costs 20-50% on cost containment techniques. www.WCManual.com.
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
Posted in
Assessment & Diagnostics,
California Workers Comp,
Communication with Employees,
Drug, Alcohol & Impairment Testing,
Employment Law Issues,
Federal Workers Compensation,
Implementation and Rolling Out Your Program,
Management Commitment,
Professional Development Issues,
Return to Work and Transitional Duty,
Seminars and Courses |
An investigation into a deadly plane crash In 2010 in Miramichi, New Brunswick exposed vulnerabilities in how Canada's transportation regulatory body evaluates a pilot's health and physical fitness, according to a report from the Transportation Safety Board of Canada (TSB).
Pilot Ron Clowes, an employee of Forest Protection Limited, was taking a Grumman fire-fighting plane out for a practice water drop in the early afternoon. He suffered a heart attack and the plane began to descend, colliding with several trees and then crashing into the ground just minutes after taking off from Miramichi Airport, says the TSB report, released earlier this month. No radio contact was made after the pilot took off. (WCxKit)
An autopsy showed Clowes suffered from ischemic heart disease, which causes reduced blood flow to the heart. The TSB report found that despite the "defenses built into the Civil Aviation Medicine system," his heart disease wasn't identified, leading to the accident.
The plane – manufactured in 1954 and converted to add fire-fighting capabilities in 1993 – experienced no mechanical defects or system failures and the weather did not contribute to the crash, the report notes. It had almost 4,000 hours flight time.
Clowes worked for Forest Protection Limited for about 10 years. He held his commercial pilot license and had well over 13,000 hours of flight experience, about 260 of those on planes like the Grumman.
Because Clowes was over 40 years old and had his commercial pilot license, Transport Canada (TC) regulations require him to have a medical examination every six months and an electrocardiogram to test his heart every year, which he had done.
But the pilot's doctor had neglected to report factors that put the pilot at a high risk of heart attack. The doctor was unaware he had to report any medical conditions that could affect flight safety, and because of this oversight the pilot was considered at a medium risk of cardiovascular problems and no further health assessments were ordered.
Officials say the lack of reporting from physicians to TC could be a widespread issue plaguing the Canadian flight safety system, leaving civil aviation medical examiners without enough information to accurately determine if a pilot is able to fly safely.
When compared to the United States, Canada has a much higher number of aircraft incidents caused by cardiovascular issues. From January 1976 to October 2008 there were 38 incidents in Canada, 28 resulting in fatalities. In the US, there were only 13 such incidents from 1982 to 2011.
After the incident, Forest Protection Limited spoke with their pilots for the 2011 season about the need for their family doctors to share information with TC and took steps to ensure that the medical examiners from TC have full access to medical and prescription records from their pilots, Davies reports. (WCxKit)
Forest Protection Limited has been operating since 1951. The province of New Brunswick, JD Irving Ltd. and other forestry stakeholders own the company, the company's Web site reports.
Author Robert Elliott, executive vice president, Amaxx Risk 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
An Australian dock worker was found guilty of workers compensation fraud after a WorkCover investigation found that he had lied about working up to 50 hours a week as a security guard while being too injured to carry out his first job, according to a report from Work Cover Authority of New South Wales.
Ronald Perrine, a 46-year-old store man from Welby, west of Wollongong, received a suspended jail sentence, was ordered to repay almost $20,000, and was fined $1500. Perrine alleged that in September 2000 his left wrist had become too damaged to continue working after repeatedly driving a forklift. His employer accepted his claims and Perrine began receiving weekly compensation totaling $19,059.05 from August 2004 to April 2007. During this time, Perrine took on a second job as a security guard and was receiving cash payments in envelopes. (WCxKit)
The WorkCover investigation found Perrine had been dishonest on numerous occasions in deliberately misleading representatives acting to protect the Workers Compensation Scheme. Perrine said he was working around 12-16 hours a week when he was in fact working around 50 hours and not informing WorkCover. His pay slips and group certificate did not reflect the true income he was receiving from his second job. These had the effect of pushing the compensation payments he was receiving through the Workers Compensation Fund.
WorkCover staff requested to interview Perrine during the investigation however the requests were declined. Perrine was prosecuted for offenses under the Crimes Act 1900.
The Court sentenced him to an eight month jail term, fully-suspended, and a 6-month good behavior bond. (WCxKit)
In addition, he was ordered to repay the $19,059.05 he had fraudulently received in compensation, fined him $1,500, and ordered to pay WorkCover’s legal costs.
Author Robert Elliott, executive vice president, Amaxx Risk 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.
Many employers in Manitoba use the services of employer representatives to help them manage their interactions with the Workers Compensation Bureau. Given that fact, the WCB requires current authorization on an employer’s file before information about that employer can be shared with these individuals.
According to information from Manitoba’s WCB, employer representatives may include employer consultants, accountants, bookkeepers, payroll services, lawyers and/or other service providers not employed by the employer. (WCxKit)
Authorizations are valid for a duration specified by the employer for up to two years. If you use the services of an individual or firm and you would like them to have access to your employer file information, you must have an up-to-date authorization on file with WCB Assessment Services.
If you wish to confirm who is authorized to access information on your account, call WCB Assessment Accounts at (204) 954-4505 or toll free in Canada at 1-800-362-3340.
Written authorization can be submitted to WCB Assessment Services, 210-363 Broadway, Winnipeg, MB, R3C 3W4 or by fax to (204) 954-4900 or toll free in Canada at 1-866-245-0796.
Employers should ensure the authorization letter is produced on your company letterhead and contains the following information. (WCxKit)
1. WCB Account Number and correct legal name of the firm;
2. Name, position and signature of person authorizing access (must be an authorized representative of the firm);
3. Individual consultant (or their company) name and address;
4. Indicate if there are any limitations to the access (information you do not want them to have access to);
5. Current date.
Author Robert Elliott, executive vice president, Amaxx Risk 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.
