Honoring David Depaolo’s Legacy

depaolo

“We, as an industry responsible to society, have some soul searching to do” – David Depaolo – Wednesday, July 13, 2016.

 

This was a quote out of one of David’s blogs written just a few days before his shocking, and untimely death.  In a few words it speaks to his mission of education, leadership, and strong voice in the workers’ compensation industry.

 

He wrote often about doing right, holding organizations and individuals to a high standard of integrity, and calling out those who failed to meet this standard.  He was not afraid to absorb some criticism to bring awareness for the common good.

 

We, as an industry, have lost a great leader. My personal reaction is one of absolutely shock.  I heard the news yesterday morning and over 24 hours later I still don’t think it has really sunk in.  I just can’t believe it. Becki Shafer called to tell me and I told her she must have the name mistaken as I was right in the middle of writing three tribute blogs to another great loss and frequent writer on our Workers Comp Roundup, Attorney Ted Ronca.   Dave Depaolo, no, that’s not right I said.  It was just two days before that I had shared a panel with Dave at the CCWC Conference in Anaheim, where he spoke of the future of our workers’ compensation and attracting the next generation of talent, among other observations spoken with the good of the industry at heart.

 

Becki and I talked how she thought originally the news must have been a joke, speaking to his light-hearted personality, and the fact we were all going to be getting together in Orlando in a few weeks; so this was the start of the ribbing she thought, “Dave Depaolo Dies Laughing At Bob Wilson’s Mistake”.  Unfortunately the news was tragic and sad, the loss of a 20 year friend and colleague is just hard to accept.

 

Everyone copes with grief and loss differently.  For me, I try to find some meaning that could be part of a bigger plan, and how to honor the individual’s legacy.  Maybe the lesson is the soul searching that David referred to last Wednesday. We so often speak of the different sides that are at odds in workers’ compensation; injured workers, payers, claims handlers, attorney’s, etc.  David’s accident is a harsh reminder that there is really only one side, the human side, and that none of us are immune to being involved in a serious accident.  Each accident that occurs affects the lives of individuals and the circle of people they touch, we need to treat these individuals, and the process, with the proper level of care and respect.

 

David Depaolo was a great leader and he stood for what is right in workers’ compensation.  I believe we need to honor his legacy by acting on his lessons. RIP David, you will be missed.

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

6 Ways To Maximize Your Work Comp Adjuster Relationship

The best ways to reduce workers’ comp costs is to reduce claim costs. A major factor in the cost of claims is the quality of claims handling provided by the workers compensation adjuster.

 

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

 

 

  1. Get Your Own Adjuster

 

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

 

 

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

 

  1. Becoming more important to the adjuster as the adjuster knows she/he will be dealing with you frequently.
  2. The adjuster learns what you as the employer considers essential and tailors their work to meet your needs or desires.
  3. The adjuster learns more about your company and knows who to contact with questions or to obtain information, making the claims process flow smoothly.

 

 

2. Create a Partnership

The quickest way to spoil the working relationship with your adjuster is to treat the adjuster as an inferior. Instead of trying to tell the adjuster what to do on the claims, ask the adjuster what would be the best approach for both yourself (the employer) and the adjuster. With your company and the adjuster striving together to move the claim forward, greater progress will be made.

 

 

3. Timely Communication is Key

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

 

 

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

 

 

4. Know What is Needed

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

 

 

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

 

 

5. A *Real* Return-to-Work Program

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

 

 

6. The Magic Words – Please and Thank You

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

 

 

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

 

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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 Circumstances To Review Work Comp Claim Subrogation

When a work injury occurs sometimes 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 falls and fractures an arm.  What to do then?

 

There are a lot of varying factors and legal issues in the world of subrogation that vary from state to state.  But, it is worth exploring some sort of recovery to recoup medical expenses and wage loss paid.  Subrogation should be explored in every claim, even if it seems the injury was due to simple “employee operation error.”

 

 

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 a new claim is received from a slip or fall, the first question to 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 caused the employee fall? 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 a subrogation claims can mean that the outside vendor pays the employer back expenses to get the worker back to full duty.

 

There are many employers that choose to use outside vendors for this specific reason — to 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.

 

 

  1. 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.

 

 

  1. Machinery injuries and Mechanical failures

 

When there is a claim where a person gets injured while using a machine, the manager will usually say that the employee was not paying attention when the injury occurred.  This may be true, but also machine manufacturers have a duty to design proper, safe equipment.  Sometimes machines have design flaws and can lead an injury. Maybe there should be a guard in a certain area where there is not one, a hand can reach an area it should not be able to reach, or 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 a machine expert, or engineer, but it can be worth the cost, especially in a severe injury.

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.

 

 

  1. 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 severe.  If there is subrogation in a vehicle case, a thorough investigation is worthwhile.

 

 

  1. 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, or the vendor was unloading supplies in the back area and while stacking boxes and the boxes 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.

 

 

Summary

 

Subrogation investigations and claims can come from injuries where employers least expect, and there are many different 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.  The subrogation department should be reviewing every injury to see if a claim can be pursued. And every claim pursued could yield the employer reimbursement from another carrier.

 

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

When Your Workers Compensation Insurer Goes Bankrupt

Work injured employees of self-insured businesses, and workers compensation claimants being handled by insurance carriers, generally have little to fear should the employer or insurance carrier go bankrupt.  Every state and all levels of government have two safety nets, the State Guaranty Funds and Self-Insurers’ Security Funds.

 

Facts Regarding Guaranty & Security Funds:

 

  • These funds step in immediately to take over the handling, paying and settling of claims, and they maintain coverage to protect the corporation or insurance carrier.
  • Both are financed by assessment against self-insured employers and insurance companies. Assessments are based on multiple calculations established and regulated by the States and Governments.

 

 

Operational Practices When Carrier Goes Bankrupt:

 

The Funds are designed, by statute, to protect employee benefits much like the Federal Deposit Insurance Corporation protects the public deposits in banks.  This is extended to lifetime and death cases.

 

Sometimes Guaranty Funds transfer cases to solvent carriers.  However, in most instances they retain enough insurance company employees to maintain polices, coverages and claims.  This includes gathering in unpaid premium, and following for proper reinsurance.

 

As policies expire and claims are finalized, the attending staff is reduced.  Some employees go on to other jobs immediately while others go on unemployment benefits until they obtain replacement jobs. During this period the retained employees are actually state employees.  They receive all the employment benefits the state has in place.  As a result of this operation, the retained employees do not suffer economically.

 

Claims are investigated, documented, processed, and disposed of with all the same dispatch as though the claim unit was still solvent.  Subrogation cases are placed on lien for recovery. Non-compensability, fraud, and any illegal conversion are pursued.  Fraud recoveries are collected.  All controverted cases are pressed for judicial remedy.  Claimant attorney fees honored are maintained as usual.

 

Some Guaranty Funds maintain the legal defense attorneys the carrier used.  Others transfer the cases to State Employed Attorneys designated to handle legal workers’ compensation issues.

 

For the most part claimants seldom realize the carrier no longer handles or pays the claim.  The speed and dispatch for handling workers’ compensation cases is considered to be highly efficient.

 

 

Possible Problems:

 

While the system generally operates with efficiency, there are a few possible downsides. A notable downside is that most funds do not have a cash reserve and are funded on a pay as you go system.   In other words, assessments are not prepaid.  Therefore, payments to claimants or medical providers might fall behind until funds catch up to payments due.

 

Another strain could develop if the number of carrier or employer failures or bankruptcies suddenly surged.

 

According to online reviews, and reports, there is an average of two insurance companies a year.  If you go online and type in “Insurance Company Bankruptcy”, you will be directed to various sources for information.   There are related sites that address Obamacare impact, Annuities, Accident and Health Carriers, as well as many other lines that employers might be concerned with.

 

Some Reasons for Insurance Company failure are:

  • Poor Underwriting by insuring high risk entities
  • Underfunded premiums
  • Poor Investing
  • Excessive Premium Discounts
  • Failure to properly reserve for losses
  • Not perusing 3rd party recoveries
  • Poor investigations allowing claims that might otherwise be defendable
  • Shrinking markets
  • Poor Fraud Prosecution and Recovery
  • Under funded or not reinsured for catastrophic losses
  • Inept staffing
  • Economic impact or collapse

 

 

Summary:

 

The system has been pretty effective and serves its function well.  Most workers compensation claimants have had little, if any, loss of workers compensation benefits and service due to carrier or self-insurer bankruptcy.

 

AM Best is one of the industry watch dogs that tracks insurance carriers for solvency and performance.  Their rating system is a bench mark that should be reviewed periodically.

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

Using A Funcational Capacity Evaluation to Defend Your Work Comp Claim

Using a Functional Capacity Evaluation (FCE) as part of defending a workers’ compensation claim can reduce exposure on your claim and save money to the program.  This is especially important in high exposure cases such as matters with significant disability, retraining claims and those instances where the employee is seeking permanent total disability benefits.  Part of this process is timing the FCE correctly and coordinating it with other defense experts.

 

 

Functional Capacity Evaluations in Injury Cases

 

Employers and insurers started using FCEs in the 1980s to assess the functional ability of injured workers in disputed workers’ compensation claims.  FCEs have developed over the years and become essential in reducing costs and prompting resolution of complex issues.  It includes a number of different components and are performed by experts with a background in industrial rehabilitation, social work and other human resources.

 

During the course of the FCE, the injured worker is required to perform a series of physical and cognitive tests.  These specialized tests are used to assess the types of physical functions a person can perform post-injury.  It also measures their endurances, resilience and transferable job skills to move into a different line of work if return to the pre-injury position is not possible.  The final product is an assessment, coupled with findings and opinions within a reasonable degree of vocational certainty about return-to-work ability.

 

 

Should an FCE Be Used in Every Workers’ Compensation Case?

 

Not every case requires the use of an FCE.  FCEs are typically used in cases where the functional ability is in dispute.  This includes instances where the injured worker is claiming that he or she is not able to return-to-work given their restrictions, education and vocational experiences and transferrable jobs skills.  Examples of cases that one should consider using an FCE include claims for retraining benefits or instances where the employee is seeking permanent total disability (PTD) benefits.  They can also be used where there are significant disputes regarding work restrictions or cognitive impairments (TBIs, head injuries, etc.)

 

 

Other Factors to Consider Before Scheduling a FCE

 

Prior to scheduling a FCE, it is important to evaluate where the employee claims to be in the healing process.  If the employee will likely require additional medical care, having them undergo a FCE will not benefit the defense of a claim.  A FCE can be useful if there is a suspicion the employee is malingering.  Functional testing with the correct vocational expert can detect symptom magnification.  The results can also be used with a credible independent medical examination report to promote a prompt settlement or advance litigation toward a favorable result.

 

FCEs can also be useful in cases where the injured party suffers from co-morbid conditions.  Such conditions include high blood pressure, hypertension, diabetes and obesity.  In these instances, the non-work related condition may be the real barrier to the claimant from gainfully employment.

 

 

Picking the Right Expert

 

Picking the correct expert to conduct a successful FCE contains similar steps to selecting an acceptable independent medical expert.  There are a number of important factors to consider.  These include the vocational experts:

 

  • Education, training and background;

 

  • Professional reputation; and

 

  • Their professional mannerisms and ability to write a credible FCE report and provide believable testimony.

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

Ringler Associates Announces New Chief Strategy and Business Development Officer: Melissa Evola Price

melissa RinglerAliso Viejo, California, July 5, 2016 – Ringler Associates Incorporated, the largest company of structured settlement advisors in the United States, is proud to announce that Melissa Evola Price, President of Structured Financial Associates (SFA), will be joining Ringler as Chief Strategy and Business Development Officer effective immediately.

 

Melissa Price, from the Greater Detroit area, has a longstanding reputation as a leader in the profession. She joined SFA in 1999 as a Structured Settlement Consultant/Corporate Marketing Consultant, expanding her role to National Account management, marketing/communications, IT infrastructure, corporate business development planning. Prior to that, she worked for eleven years in the Electronic Commerce (EC) industry, where she specialized in strategic planning, product management and sales management  focusing on emerging product markets. She    has

Life, Health and Accident Insurance licenses in multiple states and is a member of the National Structured Settlement Trade Association (NSSTA). She also holds the Certified Structured Settlement Consultant (CSSC) certification.

 

Ringler President and CEO Geoffrey E. Hunt commented, “We are absolutely delighted to have Melissa join our executive team.  Melissa has long been known as one of the distinguished thought leaders in our industry now dedicated to assuring Ringler reaches new levels of innovation and growth. I could not be more excited to have Melissa as my partner as we write the next chapters of Ringler as the continued leader in settlement advisory. Melissa has the intelligence, energy and creativity to make outstanding contributions to our future.”

 

Upon accepting the position Price says “I have admired Ringler as a company and I am very pleased to be able to become part of the leading firm in our industry. Joining Ringler provides an opportunity to work with Geoff, the leadership team and Ringler board to execute on our strategic plan that delivers the advances so necessary for us to continue advising our clients as well as injured parties and their families for the best possible outcomes.”

 

Hunt also notes that James M. Early, Executive Vice President and National Sales Director at Ringler has decided to retire at the end of the year, notifying the Ringler leadership several months ago.  Early will

 

continue working on the executive team to assist in the transition through 2016 and he will continue in an advisory role as he takes the reins as President of NSSTA in 2017.

 

And Ringler Chairman of the Board, W. Ross Duncan adds that, “Melissa is well respected across our profession and all of us at Ringler look forward to working with her in this important position as we look toward the future. We welcome Melissa, her husband Chris and his son, Harry, to the Ringler family.”

 

 

About Ringler

Ringler is the largest structured settlement company in the United States with over 120 Consultant in 61 offices since it was established in 1975. The Ringler team consists of over 250 experienced professionals who have earned the trust of all parties involved in the settlement process. Every Ringler Consultant takes an individualized, customer-focused approach to each case, backed by the strength and resources of a national brand to collaborate with injured people, attorneys and insurance professionals providing the best settlement solutions for claimants and their families. Ringler continues to expand its expertise in financial markets with a steadfast mantra of innovation and leadership in the profession.

12 Tips To Effectively Use Attorneys in Workers Compensation

Litigation cost is a factor calculated into premium as an allocated expense. Each state retains a record of all allocated cost expenses. Through the various state formulas, all allocated expenses become a part of the experience modification code. The experience modification code sets the stage for premium calculation.

 

 

Fee Determination

 
Plaintiff attorney fees are generally capped as a percentage of the employee’s benefits awarded in contested claims. They also become a part of the final ruling by the judge or mediator. When paid they are paid as part of the indemnity benefit. Since indemnity benefits are already part of the experience modification process there is no separate impact as an allocated expense.

 

Defense costs are based on billable hours at the attorney’s hourly fee rate. Defense attorney fees are payable regardless of a win or a loss of the case. The defense attorney bills are paid on the file in separate direct payment. Legal reserves are required to cover the payments.

 

Billable time includes: telephone calls, legal research, investigative steps, reporting, deposition time, trial time, and trial preparation, witness briefing, consultation time with fellow counsel and or witnesses, as well as negotiating time with plaintiff counsel.
In addition to the lawyer’s time fee, a defense legal bill may include clerical time charges, photocopying fees, postage, subpoena service cost, investigative cost, messenger service, witness fees, paralegal service time, travel time and cost. Some bills may even go so far as to charge for filing time and paper supplies.

 

 

Retaining Defense Counsel

 

All too often there can be a scarcity of local defense counsel. Fewer legal firms are taking defense work in rural areas or smaller towns. This limits legal counsel choices. All local claim units may be using the same attorneys. Fee rates and costs may become non-negotiable, and quality and quantity of defense work may be weak. Worst of all, the judges and mediators might give little credence to their defensive presentations. Larger communities might have more defense counsel choices, but all too often there is still a tendency to rely on the same legal firms.

 

Contacting the local legal bar association is one step to locate new attorneys. The association can advise of the current practicing and newly licensed counsel. They will also advise field of practice.

 

Attending a workers compensation court hearing and observing the defense counsel is a second way to search for new legal counsel. Probably the most used method, however, is to obtain a recommendation from professional associates or employers.

 

Before fully engaging any attorney, obtain their resume and request references. After reviewing the resume and contacting the references arrange for a personal interview. Discuss fees, reporting requirements, and all other expectations desired from the attorney. Do not be afraid to offer fees lower than those being asked as many attorneys will adjust fees to obtain business.

 

When reaching an agreement with an attorney follow through with a written confirmation.

 

 

Effective Use of Attorneys

 
Since attorney fees and bills are charged by the hour, it is incumbent on the claim technician to limit those hours. The following list of ideas should help:

 

  1. Keep telephone calls to a minimum. Know what you are going to discuss before calling. During the call gather the necessary information and terminate the call as quickly as possible. Document the telephone call information in the claim file notes.
  2. Use e-mail as much as possible and limit them to necessary information. This automatically documents the claim file and reduces time to document a telephone call. Use formal letters and regular mail only as necessary.
  3. Limit the attorney’s need for additional investigations. This is accomplished by the claim technician obtaining all defense and claimant statements. The adjuster should supply all personnel records that may be needed, arrange and forward all information from independent medical examinations, as well as supplying claim file reports and investigation information.
  4. Require a legal cost estimate and follow up on this for necessary revisions. Use the estimates as a basis for legal reserving.
  5. Require the attorney to obtain permission to do any additional investigations, hire private investigators, and schedule depositions (if statements are in the file defense depositions should be minimal).
  6. Limit verbosity in reporting. Once the attorney has made initial assessment (which should include a full review of the loss facts) and given a plan of action, it will only be necessary to comment on current happenings. It is not necessary to have the attorney copy the claim file on interrogatories, depositions etc. These are seldom needed if the attorney is reporting on the findings and results. The cost of reproduction and mailing can be eliminated.
  7. Obtain all information the attorney may request as promptly as possible.
  8. Try to employ more than one attorney. Competition generates better results in litigation and disposition.
  9. Negotiate settlements and agreements as much as possible. Attorney negotiating should be limited to court house steps, pretrial conferences, arbitration, and trial.
  10. When the attorney does negotiate, set limits and authorities. Require a telephone request for additional limits and authorities. If possible, serve subpoenas for the attorney.
  11. Require regular and timely billing by counsel. Audit each bill line by line to ascertain accuracy. It should also conform to the written agreement. Charges should coincide with legal information in the claim file records. If any reductions are necessary, let the attorney know why. Pay the bill promptly to avoid late fees and charges. Check to ascertain that a paralegal fee is not accidentally submitted as the attorney’s fee.
  12. Due to inflation and other impacting factors fees may need to be increased. This should always be done by mutual agreement and direct negotiation.

 
Summary

 

Litigation costs impact premium as allocated expenses. Controlling litigation cost is vital and requires the proper choice and use of lawyers.

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

 

Selecting the Right MSP Compliance Service Provider

Selecting the right Medicare Secondary Payer (MSP) compliance service provider is an important part of any claims operation.  These service providers are essential when it comes to making sure a claim complies with all aspects of the Medicare Secondary Payer Act by providing suggestions to help resolve troublesome cases.  This must include a focus on selecting someone who provides innovative solutions to complex problems.

 

 

Understanding the Medicare Secondary Payer Act

 

The Medicare Secondary Payer Act was passed into law in 1980, but was largely ignored until the late 1990s.  Since that time, claim management teams have paid considerable attention to compliance with the Act by considering Medicare’s interests in all workers’ compensation claims.

 

One part of MSP compliance is the projection of future medicals related to injury-related claims.  This includes the careful review of medical records related to the injury and projecting costs associated with future medical care reimbursable by Medicare.  The result should be a medical cost projection that is reasonable.  Another factor is an acceptable approval rate for those allocations submitted for review and approval under the voluntary workers’ compensation Medicare Set-aside submission process.

 

 

Threshold Factors for Consideration

 

There are several threshold factors for consideration when selecting a MSP compliance service provider.  When making this decision, it is important to answer the following:

 

  • How would you describe your current MSP compliance program for workers’ compensation?

 

  • What is the MSP compliance provider’s experience and expertise including legal/compliance, and pharmaceutical/medical?

 

  • How are clinical interventions handled? Is the process seamless?

 

  • What is your criteria for success? (or how do you measure success?)

 

  • What is the level of communication your current MSP partner provides during the Medicare-related processes?

 

By answering these questions, the leadership within a claims management team will understand the importance of a provider that offers innovative services.

 

 

Moving Beyond the Basics of MSP Compliance

 

Countless MSP service providers do an excellent job providing precise medical allocations.  While this is an important component of effective compliance efforts, it is important to seek a provider who is able to offer innovative services that take the extra steep.

 

  • A sophisticated service provider utilizes technology that drives all compliance related processes.  This includes the ability to manage in an effective manner the three main components related to the MSP Act: conditional payment resolution; Medicare Set-asides; and Section 111 Mandatory Insurer Reporting.

 

  • Pre-MSA Triage. Stopping problems before they occur is an important component missing in most MSP compliance programs.  When selecting the right service provider, it is essential to work with a provider that can identify barriers to settlement and provide specific intervention recommendations.  This should include physician peer review, drug utilization review and clinical oversight.

 

  • Compliance automation and tracking services. Automation allows interested members of the claim management team to track Medicare related activity on a claim from the time a beneficiary is identified through final settlement via end-to-end visibility.  It also allows team members to view in real-time what actions the MSP service provider is taking and what additional steps will occur in the future.  This includes communication with physicians, pharmacists, conditional payment searches, and medical/pharmaceutical interventions.  This not only give claim handlers peace of mind, but also frees them to address issues that require attention.

 

Conclusions

 

Effective MSP compliance includes a service provider that goes beyond the basics.  These providers will offer services that allow members of the claim management team to focus on their job and provide information and resources to comply with Medicare regulations in workers’ compensation claims.

 

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

Waivers of Statutory Immunity Impact on Workers Compensation

When used properly, transferring risk for workers compensation exposure and losses can be an excellent tool for cost control. One such tool is known as Waiver of Statutory Immunity.

 

A Waiver of Statutory Immunity is: the abandonment, relinquishment, rejection, renunciation, surrender, release, cancelation, or loss (by implied conduct) of any known statutory or contractual legal right.  There are dozens of legal phrases outlining the various types of waiver and additional definitions.

 

While most waivers of immunity are in the construction industry, any employer using Sub- Contractors, Professional Employee Contractors, Leased Employee Vendors, Volunteers, Individual Specialists, or Temporary Help Agencies can face similar exposures.  The purpose is these entities take over exposures from the entity using their services.

 

Governments generally have almost full Statutory Immunity for negligence by either constitutional or legislative act.  Yet, if the loss is egregious enough, has major impact, or is not properly asserted, this immunity can be lost.

 

Hold Harmless and indemnification contracts (with or without Statutory Waiver) not properly written and designed to meet normal public practices, can held null and void by the courts, and/or workers compensation judicial ruling.

 

For purposes of this discussion two descriptions will apply.  Indemnitee: is the person or organization wanting to transfer risk.  Indemnitor: is the person or organization assuming or taking the risk.

 

 

Example of Exposure:

 

Company A (the Indemnitee) hires company B (the Indemnitor) to perform some computer adjustments.  The work is done on A’s premises.  A and B entered into contract with a standard hold harmless and indemnification agreement.  B also furnishes insurance endorsements naming A as an also insured.

 

Company B’s employee is injured and alleges A to have been negligent and cause of the injury.   B’s employee is paid compensation benefits by B’s insurance carrier.

 

B’s employee then sues A for negligence.

 

A, relying on the hold harmless clause and endorsements for liability coverage turns the lawsuit over to B for defense and disposition.

 

A is astounded when B’s liability carrier uses employer immunity as defense since B’s workers’ compensation carrier paid benefits.  Because the hold harmless and indemnity clause did not have a Waiver of Statutory Immunity, A is left without defense or coverage under B’s liability policy.

 

A may be denied coverage under its insurance policies.  A’s carriers may assert that A made its own assumption of risk.

 

The situation can be progressively worse depending on the number and type of insurance carriers, and parties involved, but most of these cases are resolved without lengthy litigation.  Records show that Indemnitees generally lose the most in exposure and cost.

 

There are numerous situations where Statutory Immunity is lost.  A few are:

 

  1. Violation of Public Practice.
  2. Late Reporting.
  3. Failure to properly assert.
  4. Vague or Cross interpretation of contract wording.
  5. Missing litigation time tables.
  6. Judicial or Administrative Ruling
  7. Indemnitor fails to Waive Immunity in proper written format.

 

 

Manuscript Policy

 

Standard insurance policies are seldom written to extend coverage for Waivers of Immunity, and State Insurance Departments may not have premium structures for the coverage.   Few carriers recognize waivers without specific endorsement, therefore, a manuscript policy may be necessary.

 

A Manuscript Policy is written to conform to tailored needs of the insured, or joint venture.  Policies can grant coverage for almost every legal operation.   Premiums may be negotiable, and shared among the various entities.  The policy generally defines every entity exposures and limits, and will define how the insured is to comply with the policy provisions. The policy is generally written for a single use and will expire or be cancelled when the use is completed.  An extending endorsement may be added to allow for injuries or claims incurred but not reported.

 

Most agents, brokers, and underwriters are not experienced enough to write a manuscript policy, therefore, a manuscript policy is usually prepared by the home office insurance carrier department. The same will apply to endorsements accepting Waivers of Immunity.

 

Manuscript policies are seldom offered to smaller organizations as premiums are generally expensive or have high retention limits.  Such retentions may be spread across all participants, therefore, it will be crucial that all participants are fiscally sound enough to absorb their share of retentions.

 

 

Summary:

 

Obtaining a Waiver of Immunity from another is a good way to transfer and protect against workers’ compensation claims and subrogation challenges by non-employees, or independent contractor relationships.  However, they must be prepared by properly experience lawyers, in conjunction with all entities and insurance carriers.

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

Create A Workers’ Compensation GPS

Few managers would consider travel to a distant location without a global positioning system (GPS) on how to get to their destination.  The GPS provides precise information on the directions to travel and when to make a turn which impacts reaching the final destination. When precise directions are not available, it is easy to get lost.

 

Employers who attempt to handle their workers’ compensation claims without precise guidelines on how to get from the initial injury to the conclusion of the claim often get lost along the way, causing the injury claim to take longer and cost the employer additional time and money.

 

 

Written Claim Handling Protocols Should Be Established

 

Written claim handling protocols should be established by each employer outlining exactly what will be done on every workers’ compensation claim by the workers’ compensation coordinator, by the employee’s supervisor and by the employee.  While all the duties, responsibilities and steps each party should take in the handling of a worker’s compensation claim is beyond the scope of this blog, the following is a general overview of the most important steps.

 

 

The workers’ compensation coordinator’s road map would include:

 

  • Oversee pre-injury training of supervisors on what to do in case of an injury
  • Oversee pre-injury training of employees on what to do in case of an injury
  • Reporting of the injury claim to the claims office
  • Coordinating with all involved parties to insure compliance with the workers’ compensation claim protocols including:
    • Post-injury response
    • Verifying a complete investigation into the cause of the injury is completed
    • Arranging for transitional duty
    • Overseeing the return-to-work program
  • Verify compliance with the proper filing of all state forms
  • Verify compliance with the paper work requirements including:
    • Employee Report of Incident
    • Work Ability Form
    • Witness Report Form(s)
    • Supervisor Report
  • Keep on-going contact with the injured employee until the claim is concluded

 

 

The key points on the supervisor’s road map would include:

 

  • Arrange immediate medical attention for an employee when an injury occurs
  • Provide the employee with a Work Ability Form to take with them to the medical provider
  • Accompany the employee to the initial emergency treatment
  • Arrange for the medical provider to return the Work Ability Form to the employer within 24 hours of the initial medical visit
  • Arrange transitional duty work for the employee who has work restrictions

 

 

The employee’s road map would include:

 

  • Participation in all safety training to prevent injuries from occurring
  • Review and study of the employer’s requirements of the employee when an injury occurs
  • Know the required (or recommended) medical provider(s)
  • Present the Work Ability Form to the medical provider at the first medical treatment
  • Participate in the return-to-work transitional duty program
  • Keep the workers’ compensation coordinator and the supervisor advised of the medical progress

 

 

Many Work Comp Problems Can Be Prevented With Proper Education

 

The establishment of written protocols that have been provided to the employee will eliminate the “I didn’t know that” excuse and is a major control point in preventing the employee from getting lost on the road to recovery.  By educating the employee on what is expected if a workers’ compensation injury occurs, many of the problems that can develop on a work comp claim will be prevented.

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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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