WCRI Recap: 3 Factors That Most Impact Worker Outcomes

WCRI Recap – 3 Part Series

  1. WCRI Recap – Impact of Donald Trump and 2016 Election
  2. WCRI Recap: 3 Factors That Most Impact Worker Outcomes
  3. WCRI Recap: Single Biggest Factor To Turn-Around Opioid Crisis

It’s been two weeks since the WCRI Conference recently held in Boston. I’m Michael Stack with Amaxx and today I want to give you some highlights and recap from that recent conference, from the notes that I took and the perspective that I had on it. The second session was about worker outcomes and what impacts, based on studies and research to define the best outcome.

 

 

What are those factors that we can address? For me, this was the most interesting and impactful session for what I do, which is work with employers, insurance brokers and educating best in class programs. This session is one that I found extraordinarily valuable to get an understanding of, what are those things that impact the outcomes that we can address at the beginning a claim and make sure our success is that much more likely.

 

 

Single Biggest Factor That Impacts Claim Outcome

 

This is a study I’ve quoted a number of times. It was published by WCRI a few years back and they came out with a study and said, “The biggest single factor based on their research that impacts the outcome of that claim is trust.” The biggest single factor that outcome impacts the outcome of a claim, is the amount of trust between an employee and an employer. Hugely important point. Hugely important factor to understand. Now, we’ve seen that one before.

 

 

 

How Does Supervisor Respond to Injury?

 

Glen Pransky from Liberty Mutual gave a presentation about some of their research and their studies. I found it extraordinarily interesting and valuable. Here’s what they came up with. Two different things that impact their outcomes, one of the biggest factors, all things being equal, if how does the supervisor respond to the injured worker at the moment that claim is reported. I’m going to say that again. How does the supervisor respond to the injured worker at the moment that that claim is reported. Do they respond with blame and anger and frustration? There’s that lack of trust there. They’re not trusting that the employee maybe said they get injured and they say, “Yeah, right. You didn’t get injured. Get back to work.”  Or, “How could you do that wrong? You are now in trouble.” That lack of trust there. So, how does that supervisor respond to that injured worker at the time of injury? All things being equal, if they respond positively, it’s going to have a significantly better claim outcome. If they respond negatively, a significantly worse claim outcome. That was number one, “How does a supervisor respond to the injured worker at the time that claim is reported?”

 

 

 

How Does Insurance Adjuster Respond to Injured Worker?

 

Number two, how’s the insurance adjuster respond or how is that first interaction with the injured worker go? Are they using big insurance words that the injured worker doesn’t understand? Things like adjudication and calling him the claimant and all these different things that really foster this lack of trust that they’re going to be taken care of. So, if there’s all these things that they don’t understand and they don’t know what’s going to happen, what are they going to do? They’re going to make sure their rights are protected. They’re going to call an attorney and they’re going to be going down this path which makes the claim that much more complicated, because they had a poor interaction with a supervisor and their adjuster’s causing him all this adjudication. They say, “I don’t know what’s going on. I better look out for myself.” So, how you responding to the injured worker, how do those communication interactions, things to train on, things to work on.

 

 

 

Do You Think…

 

Here’s the next piece, which I thought was extremely interesting and something you need to input, impact into your program today. Starting today, do this on every single claim. Here’s what it was, they asked this question, it’s a highly predictive question of the outcome of that claim, “Is do you think, you’ll be back to work within four weeks without any restrictions?” Do you think, you will be back to work within four weeks without any restrictions? Do you think you’ll be back to work in four weeks without any restrictions? Highly, highly predictive question to ask of what that outcome of the claim is. If they say, “no” then you get to ask them why. “Why don’t you think you’ll be back to work?” You can bring in additional resources and support to drive that. If they say, “yes” then they’re setting that expectation in their own mind and it’s only going to drive that success to get them back to work. Highly predictive question and response to that claim’s outcome, “Do you think you’ll be back to work within four weeks without any restrictions?” Start asking that question, every single one of your claims today.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

WCRI Recap: Donald Trump and Impact of 2016 Election

WCRI Recap – 3 Part Series

  1. WCRI Recap – Impact of Donald Trump and 2016 Election
  2. WCRI Recap: 3 Factors That Most Impact Worker Outcomes
  3. WCRI Recap: Single Biggest Factor To Turn-Around Opioid Crisis

 

It’s been two weeks and you still haven’t gotten it done, or maybe you have. I don’t really know, but it’s been two weeks since the WCRI Conference recently held in Boston. Just a real friendly reminder. If there were things that you were supposed to follow-up with, conversations you had, business cards you got were sent from someone, or a tasks you were supposed to do, and if you haven’t done it yet, just get that in your calendar today and get that taken care of.

 

I’m Michael Stack with Amaxx, and today I want to give you some highlights and recap from that recent conference from the notes that I took and the perspective that I had on it.

 

A real quick, just personal story. It’s been an exciting couple weeks for me since that conference. My family and I, I think that some people know that we moved up to Kennebunkport, Maine, just last year. We tried to buy a house, and there were all kinds of challenges. The inspection was a challenge. There were all sorts of other things going on, and it just didn’t work out. We had to move into a short-term rental, and we finally closed on our new house just last Friday. We’re super pumped. It was a great, exciting weekend. The kids are pumped. The families pumped, and the kids took the bus from the new house today. When I was trying to look for my suits this morning, and I couldn’t find them so no suit coat today.

 

 

 

Impact of 2016 Election: Senator Tom Coburn & Congressman Henry Waxman

 

 

Let’s talk about this conference. There’s four sessions that I want to cover here. First one was the impact of the 2016 election. There was really two main points that they talked about. The guests were former Senator Tom Coburn who is a republican persuasion and former U.S. House of Representative’s Henry Waxman which was a democratic persuasion, very strong and polarizing opinions. Two main topics that were talked about. I’m going to try to run through this as quickly as I possibly can and summarize it to hit the main points.

 

 

Donald Trump Relationship With Congress

 

I broke it down really into two main topics. It was Trump they talked about, and they talked about the ACA. I know a lot has happened in the last two weeks with the ACA and the Republicans presenting their new plan. I’m not a hugely political guy so I’m not going to talk about really what those recent events are. It’s out of my area of expertise, but I will cover what they talked about at that conference itself.

 

First top thing they talked about was Trump, and there was two things they talked about were really executive orders that he did. He implemented a lot of executive orders after coming into office and then his relationship of Congress. The question really with this executive order is in the biggest … the first point that they hit during that discussion was one of those orders. Whenever a new regulation is implemented, two regulations have to be abolished so one implemented, two abolished. They weren’t sure what that impact would have.

 

Second thing was really this relationship with Congress. I think it’s something everyone in Washington is watching and trying to figure out how this is going to work between the Executive Branch and the Congress. One thing that they did talk about and really there was this fear, and Congressman Waxman talked about this, was there was this fear that Trump was just going to defer to Congress and rather than driving the ship as maybe past presidents have. There was a fear to defer to Congress but then in the same conversation, they talked about really how power … they felt that power, and Senator Coburn was talking about this, how power has shifted too much to the Executive Branch and how these laws are written. There will be these big, thick laws and the Congress men and women are passing these laws. They don’t understand even what every stipulation has to impact, what the impact will be, or even what it is itself. There’ll be a lot of words that will say, well, whatever the Secretary deems appropriates. They felt like too much power was being given to the Executive Branch. That was basically the discussion. It talked about a lot of different political opinions. It was very interesting discussion, but those were the main points regarding Trump and the Congress relationship.

 

 

Affordable Care Act

 

Next, they moved into the ACA. They were talking about this again very political discussion, Senator Coburn with a republican persuasion and Congressman Waxman with a democratic persuasion. There was basically boil it down to two things to keep it as simple as possible. Senator Coburn said, “We need freedom. People need freedom. We need a free marketplace.” He referenced the Amish community a number of different times. He talked about how the Amish buy healthcare, and they buy it for cash. They go in, negotiate the best price with the best providers, and pay a significantly lower price by negotiating up front in a free market type system.

 

Congressman Waxman said, “The safety net is going to be slashed.” He quoted Trump and said, “It’s going to be a disaster.” You know how this ACA discussion goes, very heated, very interesting to hear their perspectives, and a lot has even happened in the last couple weeks since that presentation. That was very political, but didn’t have much impact on work comp during this discussion.

 

 

Federal Government & Workers’ Compensation

 

The meat of the work comp discussion was talking about this Department of Labor report. This report was issued back in October of 2015. There were eight congressmen and women that signed this and said, “We’re worried about work comp, and the amount of benefits that have been reduced, and how it’s taking from SSDI, and we need to have a renewed interest from the Federal Government in work comp.” Very big concern for us in our industry of what that’s going to impact so the question was asked was now that this new administration is in place, is this sentiment or is this fear still the same? It was an almost comical response.

 

They said, “We got a lot going on. Sure, work comp industry, great, we love you guys but you’re just not that important, and we have a lot of other things on our plate in Washington that we really don’t think we’re going to be getting or having any interest in the work comp industry”, so very short and almost comical response to this Department of Labor report and the Federal Government’s potential interest in the work comp industry.

 

Continued…

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

10 Common Questions Claimants Have When Filing a Worker Comp Claim

Being in the insurance or risk management field we often forget that the workers that get injured do not know nearly as much as we know about claims.  At times, adjusters forget to take the time needed to properly explain what rights injured workers have when these claims occur, and that can lead to a disconnect between the adjuster and the injured worker.  This disconnect can make the claim travel down a bumpy road rather than a nice, smooth, streamlined one.

 

Here are some common questions claimants have when filing a work comp claim.  Please note the answers to these questions can vary by jurisdiction, be sure to consult your adjuster or local legal counsel if you have questions.

 

 

  1. How do I get paid?

 

If your case is deemed compensable, you will receive a workers compensation check, probably in the mail or direct deposit, every week or two after the waiting period has subsided.  This check is meant to replace your lost wages from work.  It will not be 100% of the pay you are accustomed to receiving but rather a percentage of your gross wages based on whatever formula the state of jurisdiction uses.

 

 

  1. When will I get paid?

 

Generally wages are paid after your case has been deemed compensable by the adjuster handling the file.  Usually this can range from a period of a week or two to maybe a month or so.  Other factors can delay payment, including the investigation of the claim and the gathering of the pertinent medical records.

 

 

  1. How much will my work comp check be?

 

This will depend on your jurisdiction.  Typically you will receive anywhere from 66% of your net pay to up to 80%, maybe even more. Fringe benefits that you receive from your employer can also affect the amount of your work comp check.  Anything that you are responsible for regarding your personal medical insurance or 401k may still have to be paid by you, the injured worker.  Work comp pay is not taxable income, and you will not receive a W2 for work comp wages paid out for whatever year you received benefits.

 

 

  1. Can I go to my primary care physician?

 

This will vary by the jurisdiction, but generally the answer is yes. After a certain period of time, you can go to an appointment with your primary care doc, and usually the first one will be paid for by the insurance carrier that is handling the work comp claim.  Whether or not you can continue to treat with your personal doctor is up to your adjuster, and if your personal doctor accepts work comp patients and does proper work comp billing.

 

 

  1. Do I have to go to “your” doctor all the time?

 

Maybe, depending on the jurisdiction and if your adjuster authorizes you to treat with your physician instead of the occupational medicine doctor.

 

 

  1. Why is the work comp doctor’s opinion more important or more crediblethan my doctor?

 

This will depend on what each doctor is saying in their medical reports. Sometimes personal physicians will say one thing with you in the exam room, and meanwhile when they dictate their notes they may mention diagnoses and findings not essentially shared with you personally.  The same is true for the occupational doctor.  The best way to stay the most informed is to request a copy of your medical records from both doctors, this way you can see all of the information that the adjuster is seeing, in regards to the medical chart.

 

 

  1. What if I have two jobs? Do I receive lost wages for both jobs?

 

Usually yes, but again this will depend on the jurisdiction. You will have to provide your adjuster with a copy of your personnel file and wage records from your second employer, and be sure to tell this other employer than you sustained a work comp injury at your other job and that you may not be able to work your job during your healing period until you are fully released from medical care with no more restrictions.

 

 

  1. The light duty job assigned to me pays less than my normal job. Is this legal?

 

Yes it is legal, but the insurance carrier will be obligated to pay you a “partial” wage.  This means that they take the reduced wages you will earn and issue you a supplemental check for the difference.  The amount of this check will depend on the jurisdiction the claim is in.  If you have questions about how this supplemental check is determined, contact your adjuster and have them walk you through the process.

 

 

  1. Why isn’t my adjuster returning my calls?

 

Adjusters can handle and be responsible for hundreds of files, of which you are one of.  These files are all in different stages, and are of varying complexity.

 

Give your adjuster a day or so to have a chance to return your call.  One thing an adjuster hates is someone that calls them every hour. Sadly, the squeaky wheel rarely gets the grease.  Be patient, and allow your adjuster the professional courtesy to get to your claim.  But, you also have to be persistent.  If you have left a few messages and 3-4 days go by without a callback, you can call and ask for their supervisor.  Every adjuster has an obligation to return calls to their claimants, no matter how insignificant the question may be.  Failure to return calls can be considered “bad faith” on the part of the adjuster, and they or their company can incur penalties or fines if they do indeed fail to return your call within a reasonable timeframe.

 

 

  1. Should I consult an attorney?

 

There is no right or wrong answer to this question.  The only person that can answer this question is you.  If you will feel more at ease by talking to a legal professional, then by all means do so.  Having a phone consultation with an attorney doesn’t mean that you are filing a lawsuit against your employer. If it makes you sleep better at night knowing you talked to an attorney, then by all means do so. Better yet, talk to a few attorneys if you have to.

 

 

Summary

 

These questions are normal questions every claimant will have with their work comp claim.  Some people know more about the work comp system than others, but don’t take your fellow coworkers advice about what to do with your claim.  Many coworkers that have a vast experience in dealing with work comp situations will not always give you credible or correct advice.  Your adjuster is the one handling your claim, and they will be there to walk you through the process.

 

If you feel that the adjuster did not answer your question good enough, feel free to consult an attorney.  You want to make sure you are very involved in how your claim is handled.  After all, being injured doesn’t mean that you do not need to know anything about how the process works and what rights you have as an injured worker.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

14 Points To Discuss With Your Injured Worker For Win-Win Outcome

A big mistake made by employers is leaving the injured employee to fend for himself / herself in the world of workers’ compensation.  For most injured employees, the injury is their first workers’ compensation claim and they do not know what to do or what to expect.  Fear of the unknown and not knowing what to expect creates a lot of angst in the employee.

 

 

Fear of Unknown Creates Angst in Injured Employee

 

The smart adjuster during the initial contact with the injured employee will take all the time necessary to answer the employee’s questions about medical treatment, lost wages, light duty return to work, and any other questions the employee might have.  The smart employer will also contact the injured employee and answer all the questions the employee might have about their work comp claim.  When neither the adjuster nor the employer answers the employee’s questions and concerns, the employee will usually find someone who will – an attorney.

 

We always recommend for the employer to call the injured employee immediately after the initial medical treatment.  They will want to ask what the doctor’s diagnosis and prognosis are, when the employee will be returning to work, and if the return to work date is not known, what the work restrictions are.

 

 

14 Points to Discuss With Your Injured Worker

 

  1. The injured employee should be asked to submit a detailed report of how the claim happen, preferably written
  2. Ask the injured employee who were the witnesses to the accident
  3. Verify the injured employee is treating at an employer selected medical provider, if your state allows the employer to select the medical provider
  4. Ask the injured employee if he has ever injured the same body part before, and if so, when
  5. Tell the injured employee you will send him/her a copy of the First Report of Injury being submitted to the insurance company, and ask them to review the Report and advise you if anything is inaccurate
  6. Ask the injured employee if he has discussed all pre-existing medical issues with the doctor (some medical issues like obesity will be obvious, others like hypertension or diabetes need to be disclosed to the medical provider)
  7. Explain to the injured employee how mileage to medical appointments is reimbursed in your state, and the mileage rate
  8. Explain to the injured employee the importance of attending every doctor’s appointment, diagnostic test and physical therapy session (if needed)
  9. If the injured employee is going to be off work, explain to him what the state’s waiting period is for indemnity benefits
  10. Explain to the injured employee how the indemnity benefits will be calculated by the insurance adjuster
  11. Ask the employee to call you after each medical appointment to let you know the doctor’s current plan of treatment
  12. Advise the injured employee to obtain an off-work slip at each doctor’s appointment
  13. Ask the injured employee if he has any questions in regards to how the transitional duty program works
  14. Ask the injured employee if he has any questions about any other aspect of how their workers’ compensation claim will be handled

 

Yes, this is a lot of information to review, and it will take you an extra five minutes.  However, the extra five minutes spent making sure the employee understands how everything will work in their workers’ compensation claim can be the most productive five minutes of your day.  By taking the concerned and caring approach, you will eliminate most of the hassles and headaches that occur when a work comp claim goes bad and save a lot more time later in the claim process.

 

 

On-Going Contact Will Avoid Many Problems

 

Managing and assisting the injured employee does not end with the initial follow up phone call to the employee.  The employee should be encouraged to call you after each medical appointment, and he does not do so, you should call the employee.  Any questions the employee has during the recovery period can be addressed timely in this manner.  By maintaining on-going contact throughout the time the employee is off work, you will avoid most of the problems that can occur with a work comp claim.  You will also be assisting the employee in returning to work the minimal amount of time.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

4 Areas To Manage Workers’ Comp Medical Costs

Medical treatment has comprised the bulk of workers’ comp claim costs in recent years, and the trend seems to have no end in sight. Where indemnity used to be the main expense, medical now represents 60% or more.

 

There are a variety of tools to help manage medical costs; medical bill review, utilization review, provider networks, nurse case management, nurse triage, Medicare Set-asides, and the list goes on. While any of these tools can be effective, they might actually be costing you more than they are saving. You need to look at your return on investment and make sure the medical management services you are using are truly helping your organization save money on medical.

 

 

  1. The Doctors: Costs vs. Outcomes

 

Low-cost medical networks were all the rage in the workers’ comp system for a while. But in recent years, there’s been more and more evidence to show that going cheap on medical providers may come back to bite you.

 

The latest indication comes from a study in which a 63-year-old woman with low back pain was sent for MRIs at 10 facilities in the New York area to see what, if any differences there would be. Sure enough, not a single diagnostic finding out of 49 distinct findings reported was identified by all 10. The woman’s actual diagnosis was stenosis; she was given physical therapy and education and is said to be doing just fine. But had one of the 10 interpretations of her MRI been used, she might have been sent for unnecessary surgery and/or drugs — big expenses with a poor outcome.

 

The adage ‘you get what you pay for’ is as true of medical providers as it is for anything. Try to partner with area providers that A: understand the world of workers’ comp — and if there are none, start educating area physicians; and B: have low litigation rates and high return-to-work outcomes.

 

Likewise for other medical providers, such as physical therapists. Look at the number of treatments, their average cost, and the outcomes.

 

Once you’ve identified the best providers, partner with them and direct injured workers to them where possible. In states where the employer cannot direct care, you can still provide information that lets the injured worker know who the top providers are.

 

 

  1. Pharmacy Benefit Managers

 

Pharmacy benefit managers with good track records can be invaluable to a workers’ comp program. But again, you need to make sure you’re getting one that adds value to your company.

 

Where PBMs initially added value through lower prices, many have implemented clinical management programs to lower costs further and improve outcomes. It’s important to look at a PBM’s overall program to make sure you’re getting the best for your money.

 

Consider such things as pharmacy charges vs. pharmacy costs; the percentage reductions below the state’s fee schedule; the PBM penetration rate; cost per script; percentage of medications dispensed by pharmacies vs. physicians; and first fill rate.

 

 

  1. Involvement of Nurses

 

Nurses can be brought in to help with a claim — nurse case managers; or they can be the initial source to help determine medical treatment — nurse triage.

 

NCMs are the point person for the injured worker and medical providers. Those who do it in-office are telephonic case managers, whereas those who go out of the office are field case managers. Evaluating the effectiveness of NCMs is easiest with a large database, to compare things like the cost of claims and number of lost workdays with and without a NCM. Your insurer and/or third-party administrator may be able to help.

 

To find the value of nurse case triage, you can look at the number of calls divided by the number of claims actually reported for workers’ comp, to get the number of claims avoided by percentage.  It’s also important to look at the training and experience of the nurses involved. One thing to be aware of is how invested the triage nurse is involved in the claim. Triaging is at the initial stage of the claim, not manage the claim — which is the job of the NCM, if there is one.

 

 

  1. Bill Review

 

Medical Bill Review fees can be hidden and pricey, so it’s important to look for transparency from the claims administrator. There are many claim service providers now that have modified their BR fee structures so the costs are more obvious. Ideally you want a lower administrative cost for BR, combined with maximized savings.

 

You can find the net savings of your BR service by taking the gross savings (total charges minus total paid) and subtracting the BR service fees. Additional things you can measure to ensure you’re getting value are the percentage of net savings, the turnaround time, and the denied bill rate.

 

 

Conclusion

 

Price alone should not be the deciding factor for medical management tools; a holistic view of your services is best. However, you also want to make sure you aren’t shelling out more money than you are saving. Whether you are evaluating your current tools or looking for new ones, just make sure they lead to improved outcomes and lower costs, to get the best from your investment.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

3 Steps to Discover the Root Cause of Work Injury

A near miss may be the best thing that ever happens at your company. Depending on what you do afterward, it can be a huge opportunity to save money and headaches.

 

After the initial ‘phew!’ reaction, it’s time to get down to business and find out what happened and why and, most importantly, what you can do to prevent a recurrence that could result in an injury and comp claim the next time.

 

Fact is, most (probably all) workplace accidents have multiple causes. Even the seemingly simple-to-explain incident likely has several underlying factors going on. By getting to the real root of the problem you can avoid potentially costly and preventable claims.

 

Root Cause Analysis

 

Delving into the true causes of workplace injuries requires a team effort, though it doesn’t need to be all that complicated. There are a variety of frameworks for ‘root cause analyses.’  There are templates to make it easier to organize the information. Some organizations use a fishbone diagram to group causes into major categories to identify variation sources. Whatever system is used, there are several keys to successful root cause analysis.

 

  1. Do NOT assign blame! This is the most important aspect in getting to the real root of a problem. It’s tempting to blame someone, punish him, and move on, but that doesn’t fix the underlying problems. Root cause analysis must be done without any finger pointing. Remember, most workplace accidents are the result of a confluence of contributing factors. The job of RCA is to identify and correct them.

 

  1. Ask questions. Then ask more. And a few more after that. The main questions to ask: WHY? You may feel like a 2-year-old asking ‘why, why, why’ – but this is key to getting to the crux of the analysis. As an example, let’s say “Fred” fell off a ladder and, luckily, was not seriously injured. It might be easy to say, ‘well, Fred was being careless, he was in too much of a hurry, so it’s his fault.’ But asking ‘why’ will uncover important details that would prevent future such incidents. The answer to the first ‘why’ could be that one of the rungs on the ladder broke. ‘Why,’ you ask again, and find out it could not hold Fred’s weight. If the rungs were designed to hold 350 lbs. and Fred weighs only 170, what was the extra weight? You discover Fred was carrying materials up the ladder and the combined weight exceeded 350 lbs. But the company has a hoist truck for such jobs, so why was Fred not using it instead of carrying the materials himself? Turns out the hoist truck was being used elsewhere. So why didn’t Fred wait until the hoist truck was available? Because he was under the gun to get the job finished on time and would have missed the deadline otherwise.

 

From the example, several problems come to light. There were not enough hoist trucks available, the ladder’s weight restrictions were ignored, and the deadline did not allow for the job to be done properly. Those are only some of the issues. With continued delving, there would likely be additional factors that contributed to the accident.

 

  1. Get all relevant information — and then some. In addition to the obvious details such as interviews with witnesses, examining any video footage of the incident, and speaking with the injured — or nearly injured — worker, other considerations include:

 

  • The environment. Was the ladder properly placed on the floor? Was there anything surrounding it that might have contributed?
  • Training and skill level. Did Fred have training on using the ladder? Did he understand the weight limit? Had he ever used the ladder before? Was he instructed to avoid carrying materials up the ladder (which, aside from the weight limit, could have caused him to fall)?
  • Was there a specific procedure in place for using ladders? If so, was that procedure communicated to Fred and other employees? Was the procedure ever updated, and the updates communicated? Were workers known to circumvent the procedures?
  • Was it properly maintained? Was there enough available? Had any relevant equipment been updated as needed?
  • Human behavior. We found out Fred was in a rush due to deadline pressure. But why — what were the consequences of not meeting the deadline? Were there too few employees working on the particular job?

 

The Fix

Once you’ve ascertained all the causes (and potential causes) of the incident, it’s time to figure out corrective action. All the ‘why’ questions should end with something that indicates what and how something should be changed.

 

In our Fred scenario, several things could be changed to make the organization run more efficiently and with less chance for an injury. Training would be one area, for example. Fred clearly did not understand (or did not care) that carrying materials on the ladder could exceed the weight limit of the rungs. Procedures may need to be reviewed and changed to prevent people from carrying heavy or awkward items while climbing a ladder.

 

Equipment might need to be upgraded, perhaps with an investment in an additional hoist truck would be warranted. Communication might need to be ramped up to ensure that, while meeting a deadline is important, attention to safety is more important.

 

Conclusion

Workplace accidents, unfortunately, happen and may result in injuries and workers’ comp claims. However, the same incident should never be repeated within an organization.

 

By digging deep you can identify a variety of factors that could lead to an injury. Taking corrective action will help ensure workers stay safe, the job gets done, and you’re not wasting money on preventable problems.

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Worldwide Business Network Chronic Pain Management & Other News Tidbits

Worldwide Business Network w/ Kathy Ireland: Chronic Pain Management

For many injured workers chronic pain can give way to the overuse of pain medications, prolonging the functional restoration and well-being of the individual.  Watch Broadspire Executive VP of Medical Management on a Fox Business segment discuss pain management and early intervention services which put the right processes in place to successfully return injured workers to work.

 

 

 

Tower MSA Partners Selects Patricia Smith as EVP, Clinical Operations

Patricia Smith, RN, BSN, MSCC, CDMS, CLCP has joined Tower MSA Partners as executive vice president of Clinical Operations. In this role, Smith reviews and monitors clinical trends related to Medicare coverage criteria within the confines of Medicare Secondary Payer compliance, develops clinical strategies to support company’s pre- and post-Medicare Set-Aside intervention workflow and manages all clinical and pharmaceutical oversight teams.

 

 

Chicago Area Settlement Planning Consultant joins Ringler

Ringler, the nation’s largest settlement planning company in the nation, is pleased to announce that Derek J. Perkins, CSSC, of Rockford, Illinois, is joining Ringler as a Settlement Planning Consultant.  Mr. Perkins joined the Structured Settlement industry after an extensive career in Finance as a former CPA and having held a management position at Protiviti’s Credit Risk Management practice. His success in settlement services is directly attributed to his financial background that helps to bring credibility to the table.

 

 

4 recent updates to the drug pipeline

Over the past month, Express Scripts’ Emerging Therapeutics team focused on four new drug approvals. n February 6, the U.S. Food and Drug Administration (FDA) approved Gammaplex® 10% (immune globulin intravenous [human], 10% liquid). It is indicated to treat adults who have primary immunodeficiency (PI) or chronic immune thrombocytopenic purpura (ITP). The manufacturer, Bio Products Laboratory, also markets Gammaplex® 5% (immune globulin intravenous [human], 5% liquid in the U.S. Intravenous immunoglobulins (IVIGs), are used as replacement for patients who have immunoglobulin deficiencies. They are dosed by weight. For treating PI, one Gammaplex 10% infusion is recommended every three to four weeks.

 

 

Do What You Love, Where You Love Doing It

Work and play is what life is all about. Wouldn’t it be great to take care of people who work in all types of industries and not worry about billing them?  While doing what you love, where you love to be?

 

 

 

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Eliminate 20% Of All Workplace Injuries

Major drivers in workers’ compensation programs continue to be injuries resulting from slips/falls and when working at heights.  While these injuries will never be eliminated, employers can take a proactive approach to reducing their prevalence in the workplace.

 

 

Caution: Slippery When Wet

 

Injuries sustained from slips/falls continue to be the most common workplace incident.  The result of this ongoing trend is that employers pay countless dollars every year in increased workers’ compensation premiums for incidents that are preventable.  Employers seeking to reduce their workers’ compensation costs must become serious in addressing this issue.

 

The National Safety Council has opined based on research that slip/fall injuries account for over 20% of all work-related injuries in the United States.  The actual impact is hard to quantify given the varying resulting injuries.  These incidents can be as minor as a sprain/strain-type injury to severe trauma that includes traumatic brain injuries (TBIs) and back injuries requiring spinal surgery.

 

There are many common elements in any slip/fall workplace injury.  These often include:

 

  • Liquid on the walking surface that was never cleaned up properly or in a timely manner;

 

  • Cracks on flooring, carpeting, or uneven surfaces;

 

  • Failure or of an employer to place required signage warning people of danger;

 

  • Inadequate lighting;

 

  • Exposed cables that result in someone tripping; and

 

  • Stairs, ladders or scaffolding that is not properly maintained.

 

Employers and other interested stakeholders need to take proactive measures on this issue.  Taking time to inspect visually a worksite is an important first step.  This should also include measures where employees can report situations that are unsafe.  Management must then take immediate corrective action to remedy the situation.  Doing so creates a positive safety environment and forces employees to see value in safety measures.

 

 

Look Out Below!

 

Falls from heights are a frequent hazard that result in countless injuries.  A majority of the injuries that occur while working at heights cause catastrophic claims.  According to the Bureau of Labor Statistics, falls from heights in the workplace account for roughly 14% of all workplace deaths.  It is also a frequent source of citations from OSHA.  These mainly occur when work is performed on scaffolding and ladders.

 

Working from heights can never be eliminated in the workplace.  Proactive employers can prevent these incidents by taking the following steps:

 

  • Educating all employees on the dangers working at height presents and how to be safe when working in these environments;

 

  • Reducing the amount of time and number of employees that need to work on ladders and scaffolding; and

 

  • Educating all employees on the use of proper safety equipment. This includes exercising caution before working at heights and using only equipment that is free from defect that fits correctly.

 

Management and other interested stakeholders need to be proactive on this issue.  In many instances, this not only includes ethical obligations, but legal standards.  This is also includes making sure employees are given equipment that works.  Other steps include replacing equipment that is outdated or replacing something when it breaks.  Quick fixes do not relay confidence in employees and may be illegal.

 

 

Conclusions

 

All employers must take proactive steps when it comes to a safety work environment and reducing the probability of work injuries.  Two areas of focus should be in the reducing of slip/fall incidents and providing the proper equipment and training for those working at heights.  The immediate benefits of following these best practices will be a reduction in workers’ compensation costs.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

5 Ways to Get to the Bottom of Work Injury Causation

Some things were a lot simpler back in the day, like determining whether an employee’s injury or illness should be compensated through workers’ comp. Workers tended to stay with the same employer throughout their careers, creating a solid trust level on both sides. Employees also were more inclined to retire earlier, before the onset of age-related and comorbid conditions.

 

But things are more complicated now and proving causation can be a tricky business. You want to ensure that injured workers who sustain work-related injuries at your company are duly compensated, but you certainly don’t want to pay for injuries that did not result from your employ. While determining causation is not an exact science, there are some tools you can use to assure you pay only for those injuries truly related to your workplace.

 

  1. Investigate

The best place to start is at the beginning, as soon as you get word of an injury or illness. Work with your team to find out what happened. In addition to speaking with the injured worker, talk to any witnesses. Drill down to the details. Ask lots of questions – of witnesses and others who may have been aware of potential problems in the area in question. Take pictures of the area, since that may shed some light on what was happening at the time. If nothing else, you may at least uncover a festering problem in your workplace that can be corrected to prevent another injury.

 

 

  1. Look at the mechanism of injury

The MOI can reveal valuable details to medical professionals about injuries to the bones, skin, muscles and organs. Did the person fall from a height? How high? Or, was it a ground level fall? If it involved a motor vehicle accident, what speeds were involved? Get as many details as possible as soon as possible after the injury is reported.

 

 

  1. Understand chronic vs. acute

While the medical nuances are best left to those in the biz, you can at least have a general idea so you can speak the lingo with medical providers, adjusters and others. The problem with chronic conditions is that they affect just about everyone on the planet in some way, at some time, and often we don’t even know it’s happening to us. Degenerative changes may build up somewhere in the body yet the person has no awareness of it until an awkward movement at work renders him wracked with pain. Of course, he assumes it is work related. But maybe it’s not.

 

For example, arthritis is not typically aggravated by soft tissues trauma, so check that out before you agree to pay for a knee replacement in such cases. Researchers have found that low back pain — one of the most common ailments among injured workers — often has a genetic basis rather than a link to an occupational activity. A rotator cuff injury may be chronic, especially if it is associated with muscle atrophy; however, such a tear may become larger after acute trauma.  And, contrary to what many believe, carpal tunnel syndrome does not necessarily result from keyboarding. It behooves you to request and get medical evidence to help identify what is your responsibility under workers’ comp and what is not.

 

 

  1. Use quality providers

Seek medical providers who use evidence based medicine, especially in jurisdictions where you have a say in the physician the injured worker sees; look at their credentials — board certification, etc., and check out their educational backgrounds. Same with other providers and medical facilities — you want to make sure the MRI that’s the basis of your decision on a claim is of high quality and read by a top notch radiologist.

 

If you use a medical expert in a challenge to a claim denial, find one that is believable. Ask questions such as how the provider arrived at a certain diagnosis, whether the MOI was accurately described and applied, and how EBM pertains to the case.

 

 

  1. Know the law

 

Causation standards have changed in a number of states in recent years, with many requiring work to be the major contributing cause of injury. However, some injured workers and their attorneys have become more adept at challenging those standards.

 

There are also legislative proposals in several states that would ensure first responders are compensated for instances of post-traumatic stress following an incident on the job. Still other statutes or proposals would guarantee benefits to firefighters who contract certain cancers. It would be a mistake to assume all states have the same types of allowances for workers’ comp benefits.

 

 

Conclusion

Weeding out the legitimate claims can be tough, as there is often no black and white answer. By being proactive when a claim is first reported and using the right experts, you can save yourself headaches, time and money.

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

3 Actions to Weed Out Marijuana-Related Workers’ Comp Challenges

The trend of legalizing marijuana for medical and/or recreational use is growing and may soon affect nearly all states. The recent election brought the number of ‘medical marijuana’ states to 28 plus the District of Columbia; while eight states now allow it for recreational use. Add to that the fact that several states have seen cases that allow injured workers to obtain the drug through their workers’ comp systems, and you’ve got a veritable nightmare for employers — especially those in multiple jurisdictions.

 

But employers don’t have to sit by and watch your workforce go up in smoke. You can — and should — take steps to keep your workers, property and the business itself safe.

 

 

Drug testing

 

The most effective way to prevent drug-related workplace injuries and illnesses is to avoid hiring drug users. While passing a drug test certainly doesn’t guarantee an employee won’t use marijuana or other drugs down the road, it is at least a way to eliminate habitual users from entering your workforce.

 

Even in states where marijuana is legal — for medicinal or recreational purposes — private employers still have the right to test conditionally-hired job applicants. How you handle a positive test result, however, likely differs among states; so it behooves you to understand the laws in your jurisdiction.

 

Beyond pre-employment testing, employers may also do drug testing randomly, based on reasonable suspicion, for return-to-work screening and post-accident. OSHA’s new injury reporting rule has raised many questions about whether employers that conduct post-accident drug testing may run afoul of the agency.

 

OSHA has tried to clarify the confusion by saying drug testing policies should be limited to situations where drug use is “likely to have contributed” to the incident, and for which the test can “accurately identify impairment.” Injuries such as bee stings, repetitive strain injuries or one caused by a machine malfunction would not qualify for mandatory testing, under OSHA’s explanation. Federal drug testing has not changed.

 

There are generally three types of drug tests:

 

  • Urinalysis. The first and still most widely used, this is less expensive than some other test methods. It detects most drug use for the previous 2–3 days and is the only type allowed for federal testing. On the downside, it is easily manipulated and cannot measure the frequency of drug use.
  • Oral fluid. These are collected under supervision, making tampering impossible. It determines drug use for up to 48 hours and is generally inexpensive. It also does not measure frequency of use.
  • Hair. Perhaps the best for pre-employment tests, as its detection window is generally 3 months. However, it is the most expensive type of test. Also, it typically takes longer — up to 10 days versus 1 or 2 — for the results.

 

 

Create/Update Drug-Free Workplace Policy

 

Lower job performance, reduced productivity, absenteeism and higher workers’ comp costs are among the results of workers who abuse drugs. As an employer, you are obligated to provide a safe work environment for all employees. Those are among the biggest reasons to have a workplace drug and alcohol policy — and communicate it clearly to your workers. A policy can include the following:

 

  • Basic assumptions. The policy should spell out why the company is establishing it, what is expected of employees and the consequences for violations, including dismissal.
  • Broad statement. The policy should clarify that employees may not perform their job duties under the influence of alcohol, illegal drugs, or mind-altering prescription medications — including marijuana. In states where marijuana is legal you should include a section with clear guidelines devoted to that drug.
  • Drug testing. If your company conducts drug tests, that should be included with the specific procedures outlined. It should also say that workers with prescribed medical marijuana may not use the drug while at work. The policy should be similar to that for narcotic prescriptions.

 

Workers in states that have medical and/or recreational marijuana laws on the books are likely confused about their rights to the drug in the workplace. Therefore, you should train supervisors on it and ensure all employees understand it. Employee handbooks, posters, intranet messages and other technology-related approaches are ways to disseminate the policy.

 

 

Know the law

 

Before drafting or changing a policy you need to understand the specifics of all the jurisdictions in which you operate. Much like the workers’ comp system itself, marijuana laws vary by state. Statutes may have vastly different provisions, especially when it comes to the workplace.

 

In states where the drug is legal, courts have taken different actions as to whether marijuana is reimbursable through the workers’ comp system. Following several court rulings, New Mexico passed a reimbursement rule.

 

In other states, however, laws say workers’ comp payers are not compelled to pay for the drug. They include Arizona, Colorado, Michigan, Montana, New York, Oregon and Vermont.

In some states, employers that can prove the drug is the cause of a work-related injury are off the hook for reimbursement. In others, the injured worker may be entitled to payment even if the drug caused the accident.

 

Summary.

The laws surrounding marijuana are changing rapidly. Employers are well advised to stay abreast of this constantly changing situation through legislation and case law; review and update workplace substance abuse policies often; and consider drug testing — at least for pre-hiring.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

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