The U.S. Department of Labor's Bureau of Labor Statistics has reported non-fatal workplace injuries and illnesses among private industry employers declined in 2010 to a rate of 3.5 cases per 100 equivalent full-time workers, down from a total case rate of 3.6 in 2009.
According to the Department’s report, nearly 3.1 million injuries and illnesses were reported among private sector industry employers in 2010, down from 3.3 million reported in 2009. (WCxKit)
Secretary of Labor Hilda Solis noted, "We are encouraged by the reported decline in incidence rates for workplace injuries and illnesses, which is reflective of the joint effort of government, business, unions, and other organizations. Nevertheless, 3.1 million injuries and illnesses in the workplace are too high. Serious injuries and illnesses can knock a working family out of the middle class. Workers should not have to sacrifice their health and safety to earn a paycheck.
"We remain concerned that more workers are injured in the health care and social assistance industry sector than in any other, including construction and manufacturing, and this group of workers had one of the highest rates of injuries and illness at 5.2 cases for every 100 workers. The Department of Labor's Occupational Safety and Health Administration will continue to work with employers, workers and unions in this industry to reduce these risks.”
According to Solis, illness and injury rates for public sector workers also continue to be alarmingly high at 5.7 cases for every 100 workers, which is more than 60 percent higher than the private sector rate. (WCxKit)
"A report like this also highlights the importance of accurate record keeping,” Solis added. “Employers must know what injuries and illnesses are occurring in their workplaces in order to identify and correct systemic issues that put their workers at risk. We are concerned with poor record-keeping practices and programs that discourage workers from reporting injuries and illnesses. That's why OSHA is working hard to ensure the completeness and accuracy of these data, which are compiled by the nation's employers.”
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.
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% .
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
When a work injury occurs most of the time there is no one to blame other than the worker. This could be from lifting too much at one time, trying to work too fast, or from simply doing too much at one time. These types of claims are typically straightforward and easy to investigate. If a person injures their back from repetitive lifting, the lifting of materials is the cause or mechanism of injury. Right? Maybe not.
But what if the injury happened due to some other outside force? Maybe an outside vendor an employer uses from another company is walking through the halls cleaning or waxing the floor and fails to place signs to not walk in that area. And a worker then falls and fractures an arm. So what to do then? (WCxKit)
There are a lot of varying factors and legal issues in the world of subrogation that vary from state to state. But, still it is worth exploring some sort of recovery that can help recoup medical expenses and wage loss paid. Subrogation should be ruled out in every claim, even if it seems the injury was due to simple “employee operation error.” We discuss some of these scenarios below.
First, what is "subrogation"? Subrogation is the right for an insurer to pursue a third party that caused an insurance loss to the insured. This is done as a means of recovering the amount of the claim paid to the insured for the loss.
1. Slips and Falls
When I receive a new claim from a slip or fall, the first question I ask is where the accident occurred. Let us say this happened in a parking lot of the employee’s work place. Why did the employee fall? Was it snowing? Was the lot plowed and salted properly if the fall was in the winter? Was it plowed previously then more snow accumulated? Did any other employees fall or notice slippery conditions?
This is most important when having an outside vendor that is hired to maintain the outside premises during winter months. If this is the case, then there may be a subrogation claim to pursue. If the outside vendor had a duty to maintain the premises, and failed to do so, then it can be argued depending on the jurisdiction.
Now say that an employee fell in a hallway or in a bathroom. Was an outside vendor onsite to wax or clean the floors and forgot to wipe up some water that the employee then fell in? Was the area roped properly with warning signs? Where were the signs located? Did anyone else see the signs? Again, if a maintenance contract exists with this company, there is a claim to pursue. Winning one of these subrogation claims can mean that the outside vendor pays the employer back expenses to get the worker back to full duty.
I know of employers that choose to use outside vendors for this specific reason — this way they can possibly shift the risk to an outside vendor. Any failure to properly mark areas as being worked on or being “wet” can result in the pursuit of a subrogation claim. The same goes for parking lots and sidewalks. Some vendors will allow employers to list demands for winter care when the need for salting, sanding, and snow arrives. The employer can be as rigid as preferred (with some vendors) and this way if an injury does occur, the expense shifts to the other carrier rather than incurring the total cost of the medical and wage expenses under the employer’s carrier. Every carrier usually has a subrogation unit to pursue injuries such as these.
2. Tripping over something
Did an employee fall over a mat that was not placed down properly? Did a worker stumble and fall due to a rug or placemat that had holes in it or it was not in proper working/functioning order? Again, using an outside vendor to maintain these areas and rugs can help if an injury occurs. These vendors have a duty to properly place the rugs or mats, and these floor coverings have to be in proper working order. Now it can be asked “How can a rug not be in proper working order?” If a rug is down on the floor, it is in working order. But, maybe these rugs are old and worn out in certain areas, and therefore they are not as productive as they should be. They are ineffective for the purpose. Employers use entry and exit rugs and carpets, relief mats in front of machines, anti-slip strips on steps, etc. If any of these are in disrepair or appear in poor shape, and an injury occurs, it could be a subrogation claim. This vendor may be responsible for failing to replace these worn items, again shifting the risk and expense from you the employer to them.
3. Machinery injuries and Mechanical failures
When I have a claim where a person gets injured while using a machine, the manager I talk to about the accident usually says that the employee was not paying attention when the injury occurred. This may be true, but also these machine manufacturers have a duty to design proper, safe equipment to sell to the employer. Sometimes these machines do have design flaws and can lead a person to injury. Maybe there should be a guard in a certain area where there is not one. Maybe a hand can reach an area it should not be able to reach. Maybe the machine does not turn off all the way, even though the switch is turned fully to the off setting. All of these issues can result in injury, and the company that makes the machine can be held responsible. This will involve the carrier bringing in some sort of machine expert, or engineer, but it can be worth the cost. Especially if the injury is a bad one. Typical machine injuries are laceration or crush injuries, and even worse amputations. So the exposure is there. Do not be so quick to point out operator error as the sole cause to an injury involving a machine. The operator may have made a mistake, but the problem may stem from deeper design issues.
4. Vehicle Accidents
In certain states the driver that causes an accident can be held liable. The worker may have been doing nothing wrong other than driving down the road, when another vehicle slammed into the vehicle from behind. Maybe the vehicle that hit the employee’s vehicle is from another company. Even though the van may not be marked as a commercial van, it still could be a business van used for company purposes. Who owns this vehicle that hit the employee? What was the driver doing? Where were they going, and why did the accident occur? Motor vehicle accidents can be nasty as well. If there is subrogation in a vehicle case, a thorough investigation into is definitely worthwhile.
5. Injuries from other vendors on your premises
If a vendor is on the premises conducting normal business, and an injury happens, there could be subrogation potential. Maybe the cart slid away and hit the employee. Maybe a vehicle or other mode of transportation on the jobsite was being used, lost control and hit another worker. Maybe the vendor was unloading supplies in the back area and while stacking boxes the boxes fell and landed on the employee. The subrogation unit will determine if this vendor is responsible for the injury, and they could have to reimburse you, the employer, for the cost to heal an injured worker. (WCxKit)
Summary
Subrogation investigations and claims can come from injuries where employers least expect. Do not be so quick to chalk the injury up to the employee’s error. There could be a lot of other circumstances that caused the injury. Talk with the carrier about subrogation and if the carrier has a unit dedicated to only subrogation investigations and the pursuit of subrogation claims. It can save a substantial amount of claims expense, especially on those severe injuries. Subrogation should be reviewing every injury to see if a claim can be pursued. And every claim pursued could yield the employer some sort of reimbursement from another carrier.
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. Rebecca is the author of Workers Compensation Management Program: Reduce Costs 20% to 50%. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The killing of a convenience store employee in Saskatchewan in June has spurred the provincial labor federation to support a petition to change regulations for retail employees working alone, according to a report from the Canadian OH&S News.
Many delegates attending the Saskatchewan Federation of Labour's (SFL) annual Occupational Health and Safety Conference recently strongly supported and signed a petition calling for the introduction of "Jimmy's Law" into the provincial legislature, says Larry Hubich, president of the SFL. The proposed law is named after Jimmy Wiebe, who was murdered at a gas station convenience store on June 20 in Yorkton. (WCxKit)
It would require employers to schedule two employees to work together between the hours of 10 or 11 p.m. and 6 a.m. or provide protective barriers between lone workers and the public.
The incident that prompted the petition occurred in the early morning hours. Members of the Yorkton RCMP received a report of a man who had been found deceased in the Shell Canada convenience store by a customer, says Corporal Rob King, a spokesman for the Saskatchewan RCMP division. Four days after, King says, the Yorkton RCMP detachment charged Kyle Furness, 20, with first-degree murder in connection with the homicide of the 50-year-old worker, an employee of the store for more than 10 years.
Jimmy's Law is modeled after similar working alone regulations in British Columbia which were introduced in 2008, but have not yet come into effect because of the complexity of the issue, according to Megan Johnston, a spokeswoman for WorkSafeBC. That year, however, BC introduced a separate pay-then-pump requirement following the death of a young gas station attendant.
"Grant's Law" – named after Grant De Patie, who was dragged to his death while trying to prevent the theft of gas from a station in Maple Ridge, BC – requires mandatory pre-payment of fuel at all gas stations in BC, Johnston says.
Wayne Hoskins, president of the Western Convenience Stores Association (WCSA) in Surrey, BC, says it's important to note the distinction between mandatory pre-payment of gas and the requirement for multiple workers or barriers. "While Grant's Law was well-intended, it refers to outside, or ex-store, and not in-store coverage," Hoskins explains.
In British Columbia, the working alone regulations – known as the Late Night Retail Safety Procedures and Requirements – consist of an engineering control (barrier) or administrative control (extra staff), Johnston says. Hoskins says that a third option has also been proposed: additional training, testing and certification. This option, a combination of both engineering and administrative controls, will be presented to WorkSafeBC's board of directors in October. (WCxKit)
Ontario is another jurisdiction considering a mandatory pre-paid policy for gas stations following a recent gas-and-dash incident. A gas attendant Hashem Rad, 62, was struck by a vehicle that took off with unpaid gas at a Petro-Canada station in Mississauga, Ontario. Rad was taken to hospital, where he succumbed to his injuries the following day.
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.
The Clinton County (New York) District Attorney’s office recently announced an arrest associated with workers compensation and insurance fraud.
Robert Deyo, 34, of Plattsburgh was arrested and arraigned in Plattsburgh City Court before the Honorable Penelope Clute and charged with one count of Perjury in the First Degree and one count of Committing a Fraudulent Practice. (WCxKit)
The charges stem from allegations that Deyo was receiving workers comp benefits he was not entitled to by continuing to work as a contractor, and not reporting that fact to his employer or the insurance carrier.
“Workers compensation fraud takes hard-earned money from honest businesses, workers and consumers alike,” said New York State Insurance Fund Chief Executive Deputy Director Dennis Hayes. “Through the assistance of local law enforcement and cooperation with our partner agencies, NYSIF has and will continue to aggressively fight workers compensation fraud.”
Deyo was remanded to the Clinton County Jail in lieu of $2,000 bail – $4,000 bond.
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.
The average active measures used by an employer on a New York comp claim consist of filling out the three most common forms (C-2, C-11 and C-240) and little else, unless they are called to testify.
Employers are rarely asked to do more. But doing more lowers costs, reduces litigation, prevents fraudulent claims and gets the proper benefits faster to the honest workers. (WCxKit)
There are many things an employer can do, but the five most basic are:
1. Have a plan for dealing with the worker, starting as soon as a report of injury is received
2. Know how to fully complete the first report (C-2) and know what additional document should be attached to the C-2 and forwarded to all parties.
3. Have a plan for a return to work (RTW) meeting with an employee out of work due to a work related (or allegedly work related) injury.
4. Have a plan for communicating with the law firm that will be handling the comp hearings for the carrier.
5. Know how to detect and make inquiries about possibly fraudulent activity on the work comp claims.
There are many other things that an employer can do, but the above are indispensably important.
A full description of how the above five can be carried out will vary from employer to employer but the basic measures will serve the following purposes:
1. Dealing with the worker.
Many claims that are filed are due to improper understanding of comp by the employee, or poor leadership by the employer. A surprising number of potential claims are never pursued with proper employer handling. This is called the post injury process, by cost containment experts such as Rebecca Shafer, and should be a tightly controlled process of each step that takes place after an injury. Of course, the process must be in place before the injury occurs, so planning ahead is critical.
2. Completing and documenting the first report (C-2).
A C-2 form must be filed for all reports of an injury involving more than first aid. However, much more information is usually required for proper handling. That can only be put into the WCB’s, or the carrier’s, file if additional documents are attached. The C-2 form simply does not have enough space to properly report for all claims. Never leave spaces blank because that gives the other side an opportunity to provide such information, and that might not be good for the employer.
3. A return to work (RTW) meeting.
In the past, return to work discussions rarely occurred until after a major claim was settled and closed. That, however, is far too late to achieve positive results. A return to work meeting should be held with the worker no later than 6-9 months after the date of accident and ALWAYS before the carrier makes a settlement offer for a serious claim.
4. Communicating with the carrier selected law firm.
If there are hearings, and most claims have hearings, the employer will be represented by a law firm selected by the carrier. In NY, the law firm represents the employer, not the carrier, but that is frequently forgotten and the employer then loses most of its opportunities to engage in a useful way.
The employer should always know who is representing their company and should communicate frequently.
5. Being active in reporting and suppressing fraud.
Most information necessary to defeat a pattern of fraud will come from the employer’s files. Employers frequently suspect fraud, but few are trained in how to detect it and defeat it. Anti-fraud measures require a certain amount of special training to be effective. (WCxKit)
An employer who incorporates the above into its workers comp plan will see a dramatic decrease in comp costs. The measures do not cost much and do not require much effort, with proper training.
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 Info@ReduceYourWorkersComp.com.
A building contractor from South East London is fined for running a construction site exposing workers to asbestos-containing materials, according to a report from the Health and Safety Executive (HSE). Fadil Adil, of Coniston Road, Bromley, was prosecuted by HSE for the way work was carried out on a construction site he was in charge of on Bromley High Street. The project involved the demolition of a building housing a restaurant on the ground floor and flats above. Asbestos insulating boards in the restaurant's ceiling broke up during the demolition overseen by Adil. Three workmen demolished the building using sledgehammers and hand-operated breakers exposing them to asbestos fibers.
The HSE investigation found the defendant without a license to work with asbestos, nor was he trained in construction management. At no point did the defendant carry out an asbestos survey, nor did he provide any guidance to the workmen regarding the presence of asbestos. HSE Inspector Ian Seabrook noted, "Sadly, this kind of incident is all too familiar because the defendant's actions meant that his colleagues were more than likely exposed to asbestos fibers. The dangers of asbestos are well known; it is the single greatest cause of work-related deaths in the UK with around 1,000 tradesmen dying each year from asbestos-related diseases. (WCxKit)
"Anyone working with these sorts of materials has to commission an asbestos survey to ascertain the level of work needed and then have asbestos removed in a controlled manner by a licensed contractor." (WCxKit)
At the City of London Magistrates' Court, Adil pleaded guilty to breaching the Control of Asbestos Regulations 2006, and the Construction (Design and Management) Regulations 2007. He was fined £19,300 ($30,000) and ordered to pay costs of £7,654 ($12,000).
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.
The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) recently cited Spincraft in North Billerica for 38 alleged violations of workplace safety standards.
According to an OSHA report, an inspection was opened after the agency learned that a worker sustained serious eye and facial injuries when the grinding wheel of the portable grinder he was operating ruptured and kicked back in his face. Inspectors found that the grinder was not guarded or set up properly, and steps had not been taken to ensure that it was operated at the proper speed. The metal fabrication plant faces a total of $175,500 in proposed penalties. (WCxKit)
The inspection also uncovered other hazards throughout the plant, including obstructed exit access, improper propane storage, failure to inspect cranes on a frequent and regular basis, failure to inspect crane running ropes and test crane upper limit switches, a lack of hazard communication training and numerous electrical hazards, as well as unguarded ladder way openings, floor holes, and open-sided floors and platforms.
A total of 32 serious violations carrying $173,000 in proposed penalties were cited. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known. (WCxKit)
Six other-than-serious violations with $2,500 in fines were cited for undocumented energy control procedures and additional machine guarding, crane, electrical and hazard communication issues. 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.
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 Scottish laborer broke two ribs after falling off the edge of a temporary staircase after a colleague removed the guardrail.
According to a report from the Health and Safety Executive (HSE), David Tourish, 38, from Moodisburn, was working for Walker Group (Scotland), Ltd., on the site of a new build house in Ravelston Dykes, Edinburgh, when he and a colleague were asked to carry some doors upstairs to keep them out of the way during building work.(WCxKit)
A temporary staircase with half landings had been put in while the house was built, and there was a gap between one of the half landings and the wall, with a feature window behind it. For most of the project, this gap had been protected by a guardrail, but two days before Tourish's fall, this had been removed by a joiner to allow him to fix plasterboard to the wall. He did not replace it.
Tourish and a colleague started to carry the doors upstairs. They managed to carry seven or eight doors up the stairs without a problem, with Tourish's colleague in front, and him behind.
However, as they carried the next door up the stairs, Tourish stepped off the edge of the half landing and through the gap, falling nearly 10 feet to the landing below. He was taken to hospital, where he was diagnosed with bruised kidneys and two fractured ribs. Tourish was off work for three months while his injuries healed and needed physiotherapy after he went back to work.
A Health and Safety Executive investigation found that the work had not been planned properly as an adequate risk assessment had not taken place; that the site manager was aware the guardrail had been removed and should have known there was a risk to his team, and that the work was not carried out in a safe manner. Thirty-eight people in Britain died after work-related falls from height.(WCxKit)
At Edinburgh Sheriff Court Walker Group (Scotland), Ltd., pleaded guilty to breaking Regulation 4 of the Work at Height Regulations 2005 and were fined £8,000 ($13,000).
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Most workers' compensation managers do not think twice about the workers' comp claim for the employee stung by a bee or bitten by a flea. It is usually a first aid only claim or at worse, a medical only claim, right? Wrong! While the majority of claims for biting and stinging insects or spiders (spiders are not insects, they have 8 legs and are technically classified as arthropods) will be minor, there can be some nasty injury claims, especially from spider bites or multiple bees/wasp stings.
Employees that work outside like construction workers and landscapers are the most likely to encounter a bite or a sting, but warehouse workers and others who work around products or inventory where items sit stationary for a while can come into contact with insects and spiders. While office workers, retail employees, and other indoor occupations have less exposures to bites and stings, the risk manager needs to be sure the people in pest eradication do the job, or even office workers can encounter a bite or a sting. (WCxKit)
People often refer to insects and spiders as poisonous, but all insects and spiders are poisonous only if they are eaten. What they are is venomous. Insects and spiders normally inject a venom into the victims either through a bite or a sting. It is the venom that creates the work comp claim, not the actual bite or sting itself.
Rarely are bites or stings serious enough to require hospitalization or are deadly, but there are known cases where people with weak immune systems, elderly or very young children have died from bites or stings. Spider bites create the most work comp claims, especially bites from brown recluse, black widow, brown widow, and hobo spiders.
When a venomous spider bites an employee, the employee will immediately know they have been bitten (has been described as feeling like an unannounced flu shot). The symptoms usually start to develop within a few minutes, but can take hours or days depending on the amount and type of venom. Symptoms will often include pain, burning sensation, itching and swelling. Other symptoms can include vomiting, dizziness, cramps, diarrhea, rash and breathing problems. Anxiety can be a side effect.
An example of a spider bite claim is the truck driver at a warehouse in Washington State assisting in loading the trailer. A few hours later while driving through Idaho, he felt what he thought was a hornet sting on his leg, as he observed hornets in the warehouse. He pulls over at the first opportunity and checks his leg. He sees a small red spot. That evening he checks the spot and it has grown to the size of a quarter. The second evening the spot is the size of a golf ball. When he woke up in pain on the third night, he had a baseball size knot on his leg that was beginning to split open. He goes to a hospital emergency room where it is surgically necessary to remove the baseball size tissue. The trucker is treated for systemic toxicity. He is advised he has been bitten by a hobo spider (located in the northwestern USA). And if he waited another day for treatment he could have died. The tissue around the wound continued to die, requiring daily debridement and wound cleaning for the next couple of weeks, followed by less frequent debridement and wound cleaning. Once the wound stabilized, the trucker had to undergo a skin graft and the time necessary for healing and a total medical expense of $15,000 with 3 months of indemnity benefits.
While a venomous spider can create a serious wound, a single hornet does not. The only trouble is when an employee gets stung by a hornet, it is usually not just one hornet. The whole hive can become agitated resulting in the poor employee getting multiple stings. A Florida landscaper was trimming an overgrown hedge when the hedge trimmers went right through the center of a hornet hive. The landscaper received multiple hornet stings. Having been previously stung by a hornet, the landscaper had an almost immediate allergic reaction including difficulty breathing, difficulty swallowing, dizziness, and fainting. He was rushed to the local hospital where a tube was placed down his throat to allow him to breathe, and he received an antihistamine and a corticosteroid.
For the risk manager, there are steps that can be incorporated into the overall safety program to reduce (but not eliminate) the risk of bites and stings. All buildings, whether an office, a factory or a warehouse, should be regularly treated by trained pest control personnel. Any openings or crevices in older buildings should be plugged, caulked or sealed to prevent insects and spiders from coming in from the outdoors. Employees working in warehouses or other storage facilities where spiders might live should be provided gloves when handling of merchandise is required. (WCxKit)
Many bites and stings can be avoided by teaching the employees to be vigilant. Also, the employees should never place a hand where it can not be seen (underneath an item to be picked up for instance) without checking for insects and spiders. If the employee is going to be often exposed to insects and spiders, for example like the landscaper, proper clothing and gloves should be provided to protect them from exposure to bites and stings. When an employee is bitten, the best thing to do is call Nurse Triage immediately to determine what type of care is needed – emergency care or occupational clinic. Of course, for those employers with an on-site clinic, the employee will immediately be taken to the clinic for assessment and care.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. 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
Info@ReduceYourWorkersComp.com.
Everyone has opinions on what workers comp is. Some are correct, but most are misconceptions. The commercials seen on TV about people collecting hundreds of thousands of dollars are not true for the average claim. When looking at the bottom of the screen it indicates that the people on the commercial are actors, not even the real claimants. Most of the marketing material surrounds auto and liability accidents, where pain and suffering is translated into a certain dollar amount. This is not exactly true in workers comp. There is no pain and suffering payment. Insurance companies/TPAs are there to provide reasonable and necessary medical treatment, and wage loss. Some states even allow a permanent partial disability payment, or impairment rating, on top of wage loss, but that is it.
Below we discuss the top 5 misconceptions surrounding the mystery world of workers compensation. Not all of these will apply exactly to every jurisdiction but are general. Remember to discuss with the adjuster and counsel any exact questions surrounding certain details regarding. (WCxKit)
1. Workers Compensation is not Welfare
Compensation is not a free payment a worker is entitled. Just because you are injured at work, it does not mean a guaranteed payment or coverage for medical/wage benefits. There are a lot of criteria to meet in order for a claim to be compensable. Even if the claim is compensable, it also does not mean anything can be done. Claimants have to play by the rules, and do as they are told by the adjuster. The adjuster must make the effort and take the time to explain to each claimant what the rights are, and what they can and cannot do. The biggest issue is miscommunication between the carrier/TPA and the claimant, so having an open dialogue will end any misconceptions that a claimant may have in regards to what their rights are, and what is covered; if indeed the claim is determined to be compensable.
2. Nobody gets rich from Workers Compensation
Depending on the jurisdiction, employees give up the right to sue in civil court in exchange for what are essentially no-fault benefits. Workers compensation pays lost wages, medical care, and vocational rehabilitation. Pain and suffering as an additional payment is not available or applicable to a compensation claim. The amount of money a person receives is a percentage of average gross pay. There are typically no increases for inflation, and each state has a maximum limit that a person can get per week as workers comp payments.
Michigan, for example, has a maximum rate of $742 per week. Wisconsin has $820 per week. So even grossing $2000 per week as an average weekly wage, that amounts to $820 per week in Wisconsin. High-wage employees that fall into this criteria are usually not very happy when they find this out, but the rules are the rules. These statutes are set up within the workers compensation system, and they have to be followed by all parties. Even if a claim is settled for a certain amount of dollars, it is typically not a retirement jackpot. It may end the exposure for the carrier/TPA, but these claims that settle for very high amounts of money are the result of a very serious, extremely disabling injury. And even those are few and far between.
3. Workers compensation benefits will be stopped if the worker declines reasonable employment.
If the employer offers up a light duty job, within the injured employee's medical restrictions, a claimant cannot refuse it and still get paid wage loss benefits. This opens a Pandora ’s Box, because an issue will come up about whether this light duty job is something an injured worker is trained to do, or is the job offer seen as an insult to their professional skills, etc. If there is a welder sitting in a chair staring at a clock for a job, then maybe a case could be made that this work is not a benefit to the company. For light duty jobs, they have to be deemed something that the employer gets a “gain” from performing, and almost all jobs within an employment facility can fall within these parameters. Certainly if you provide a degrading job that is of no benefit, then you may get into legal trouble. But in all reality I do not think any employer would take a risk in stopping a compensable case by trying to make a person sit outside and stare into space.
The bottom line is any light duty job, that provides a service to the employer, must be performed if it is offered to the injured worker. If the worker declines, then wage benefits will cease.
4. Workers comp fraud is extremely low
I would venture to say that actual workers comp fraud is less then 10% of all claims. And that number may even be high; I would go as low as 5% or less. For a case to be deemed as fraudulent, it must meet a certain criteria within whatever state statutes are in the jurisdiction. That is hard to meet, and most cases will not even come close to being worth the pursuit of fraud in a legal court case. If a certain worker is claiming to be out of work, and you get surveillance of them outside roofing their house, this may not make the case actual “fraud,” it falls more within the injured worker not following their medical restrictions and going outside of their treatment plan as deemed appropriate by their treating doctor. This will provide the adjuster with the ammo to dispute ongoing benefits, but not exactly to pursue the case as overall fraud.
Workers comp fraud, as a whole, is not a major problem within the worker comp system. Sure there are a lot of people that do not follow their medical restrictions, or they may miss doctor appointments, or ignore physical therapy demands, but this provides only a dispute for ongoing medical benefits, not fraud. There is a difference between the two. If you think you have an actual fraud case, you need to discuss it right away with the carrier/TPA and counsel before taking any such action to pursue official fraud in a legal venue.
5. The vast majority of workers comp claims are paid, and do not go to court
Generally, most comp cases are accepted, the injured worker gets treatment, and eventually goes back to work. The idea that someone stays home and avoids work when they are able to actually work is not the norm. Sure, there are those people out there who try to do what they can to avoid going back to work, but after an IME is performed, or after some surveillance discovers them being active out and about running errands, they are quickly flushed out and denied ongoing benefits.
Typically after a denial, and wage loss payments stop, these workers get on the wagon and get their treatment, so they can return to work and have their comp case end. Some will run to plaintiff counsel and try to get what they feel they are entitled to, and they will file for mediations and hearings, but the litigation usually is settled before a case is tried in front of a judge. Doctors can disagree on the causal relation of an injury, and this can speed up the case to go into litigation, but these cases are typically settled within 2-6 months. A low percentage of claims will stay in the litigation system, and go on for months or years, but these cases are usually quite complex and can involve several defendants and several employers, and that contributes to the complexity and the duration of the litigation. For the most part, on the normal workers comp claim that gets disputed and goes into litigation, these cases resolve themselves in the early stages of litigation and the files eventually close. But even those cases are not the common ones. The common claims are legit injuries, where benefits are paid and the worker returns back to work at full duty within whatever timeframe is needed dependent upon the severity of injury. (WCxKit)
Summary
Everyone may have heard of someone that tried to get away with milking the comp system. Most of these people are caught through good investigation, and their cases get resolved. The stereotype of work comp being a total pain can be true in some cases, but for the most part, work comp claims are legit, paid, and the worker returns back to work. There are always some exceptions, but if all parties communicate, know what their rights are, and know what they can and cannot do, their claims are resolved as quickly as possible and everyone can move on with their respective lives.
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.
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