Use These 16 Tips To Plug Work Comp Claim Leakage

The failure by the self insured’s third party administrator (TPA) or in-house staff adjusters to comply with workers’ compensation claim handling Best Practices normally results in higher than necessary claim cost.  Just like in any other business, the failure to manage the cost of doing business – known as leakage – places the self-insured employer at a disadvantage in the market place.  To recover the excess cost of poor claims handling, the company must raise the amount they charge for their products or services to cover the additional cost.

 

Leakage in an insurance claim is any payment on the claim that is more than it should be.  Leakage is normally defined as the difference between what the claims adjuster spent and the amount he/she should have spent.   Leakage has also been defined as the lost opportunity to save money on the claim.  In essence, leakage is excess and unnecessary claim costs.

 

 

16 Tips To Plug Work Comp Claim Leakage

 

There are about as many different types of leakage in workers’ compensation claims handling as there are workers’ compensation subjects to be discussed.  Some common examples of the claims’ handling errors that cause leakage in workers’ compensation include:

 

  1. A failure to properly investigate compensability resulting in paying claims that should be denied.
  2. A failure to timely get a claimant to Maximum Medical Improvement (MMI) leads to leakage because at the point of MMI a claim should be settled.  The failure to do so leads to increased indemnity benefit payments to the claimant.
  3. A failure to adjust medical bills higher than the medical fee schedule down to the medical fee schedule amount.
  4. A failure to utilize the employer’s return to work program leads to excess indemnity benefit payments to the claimant.
  5. An improper denial of a claim leads to the claimant obtaining a lawyer which drives up the cost of a claim.
  6. A failure to properly investigate and tie down the scope of a claimant’s injuries leads to increased claim costs because the claimant can add non-compensable injuries which drive up the cost of the claim.
  7. A failure to run an ISO report or obtain medical records from prior injuries or pre-existing conditions can lead to excess claim costs being incurred for treating injuries which are not part of the claim.
  8. A failure to establish the proper average weekly wage results in miscalculation of the temporary total disability (TTD) indemnity benefits to be paid the claimant, often with a corresponding overpayment of TTD.
  9. A failure to determine that the injury claim was caused by a third-party which results in the cost of the claim not being recovery from the responsible party (loss of subrogation rights).
  10. A failure to select the most qualified defense counsel.
  11. A failure to timely pay medical bills or indemnity benefits results in fines and/or penalties.
  12. A failure to properly manage utilization review opportunities
  13. A failure to control the selection of the medical providers in those states where the employer selects the medical provider results in increased claim cost because the claimant and/or his/her attorney is free to choose a “claimant friendly” medical provider.
  14. A failure to provide a nurse case manager on complex injury claims leads to higher and/or unnecessary medical costs because there is no professional oversight of medical costs.
  15. A failure to read a claimant’s medical reports results in errors including payment for unrelated medical care, providing unnecessary medical care, unnecessary time off work, and various other claim handling mistakes.
  16. A failure to maintain adequate payment records results in duplicate payment of bills

 

 

Independent Claim Auditor Advantageous

 

When the self-insured employer sees the cost of their claims increasing greater than normal, the employer can do a detailed review and analysis of each claim.  However, most self-insured employers find it advantageous to hire an independent claim file auditor to review the work comp files for compliance with Best Practices.

 

The claim file auditor will analyzed the claim handling errors in regard to the financial impact each error had on the claim.  The claim file auditor will assist the TPA or the self-insured’s staff adjusters  to identify areas where leakage is occurring and will provide guidance on how to prevent future leakage.  Plus, when the independent auditor identifies leakage due to the failure to subrogate, or due to duplicate payments, the employer may be able to recover some of the money that has been lost.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

Unions Really Can Be Workers’ Comp Asset

When most people think of labor unions and workers compensation, they think of the role of unions in supporting questionable workers compensation claims. When a factory closes and then most of the union work force files belated worker’s compensation claims, at the encouragement of the local labor union, the union gets a black eye and a soiled reputation.

 

 

It does not have to be this way. Unions can have a positive role. When unions support safety improvements, they are providing an important benefit to their members and they are assisting the employer in lowering the cost of workers compensation. Union support for OSHA programs can be instrumental in improving the safety within an industry. Unions have also promoted the use of safety gear including hard hats and protective eyewear.

 

 

 

Unions Can Implement Highly Effective Return to Work Program

 

 

While unions have often promoted safety in the work place, unfortunately some public sector unions have fought against return to work of employees, resulting in unnecessary workers compensation expense for the employers. However, some unions in the private sector have worked with employers to develop and implement highly effective return to work programs.

 

 

In the states where the employers do not have to hold open a job for an injured employee, unions can make a difference. Often the union will have a labor agreement requiring the employer to hold open the injured employee’s job until the employee can return to work. In addition, the union can track workplace accidents and make recommendations on ways to reduce the number of accidents.

 

 

The union representative or steward will normally guide the injured employee through the work comp process, starting with arranging immediate medical care for an employee hurt on the job. This is a good thing as the sooner the employee is treated for an on-the-job injury, the higher the probability of a faster recovery. However, the union involvement can quickly go from good to bad when the union encourages an employee to stay off work longer than necessary because the union has a quarrel with management.

 

 

 

Perceived Union Benefit Drives Poor Workers’ Comp Outcomes

 

When unions boast that the union members receive more in workers compensation payments than non-union employees do, they may think that sounds like a good thing, but in reality, it is stating they create more waste in the workers compensation system. Every state requires the exact same benefits for medical, indemnity and vocational rehabilitation for non-union members as they do for union members.

 

 

Contrary to what some union leaders tell their members, employers do not have unlimited funds for workers compensation. Unions often err when it comes to workers compensation by putting the “rights” of one injured worker ahead of the best interest of all employees and the employer. When a union files a grievance on behalf of an injured worker who is overstating his/her injury or an injured worker who is trying to commit workers compensation fraud, any benefits paid to the injured worker reduces the amount of money the employer will have to provide benefits to legitimately injured workers

 

 

The same logic applies when the union representative or union steward automatically requires (“request”) all injured employees to go an attorney chosen by the union to represent the employee in their work comp claims. The additional expense that the attorney creates in the claim comes out of the employer’s pocket whether the employer is self-insured, or pays it latter through higher insurance premiums. The additional cost of the represented workers compensation claim reduces the amount of money the employer has for work comp and other employee benefits.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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 Post-Settlement Professional Administrators Can Provide Peace of Mind

Injured workers with long-standing claims and ongoing medical concerns are often hesitant to settle their case because they fear running out of money too soon and potentially having no one to turn to for help. Increasingly, injured workers and their advocates are finding they can alleviate both concerns — by working with a professional administrator.

 

 

Professional Administration

 

Professional administrators are not new to the workers’ compensation system; however, few injured workers know or understand what they do and how they can help. Meanwhile, a growing number of claim settlements now involve a professional administrator.

 

Recent advancements in pricing and capabilities have made administration a more cost-effective and elegant solution. Those who go with a professional administrator find they have more freedom of choice than under the workers’ compensation system, but can still take advantage of expert assistance and discounted prices for their medical needs.

 

Companies that excel in professional administration have large medical networks to offer discounts — for medical office visits, medications and durable medical equipment. The individuals that settle their cases, also known as “members,” save an estimated 20-30% on their annual medical care. These organizations also offer personal expertise to help navigate the complex healthcare system. Members can reap these benefits, without giving up precious dollars.

 

What members do give up are the restrictions of the workers’ compensation system; such as

 

  • Utilization review
  • Being required to see providers in inconvenient locations
  • Difficulty contacting someone who understands their case and needs

 

Professional administrators also handle government regulations for Medicare, Medicaid, and other government benefit programs. They take care of all reporting requirements.

 

 

Control of Funds

 

Some professional administrators are now using technology to simplify and assist members to get the benefit of expert oversight while maintaining full control over their money. Here’s how it works:

 

The professional administrator provides the member with a healthcare savings card that is used to pay for all medical care. The injured party or “member” receives their settlement money and deposits it in their own personal bank. Then, the member places the debit card for that account on file with the administrator for use for medical expenses. All subsequent medical bills go directly to the professional administrator, which applies its discounts and pays the bills from the debit card on file. There are no co-pays or out-of-pocket expenses involved.

 

However, the member has complete control over the account at all times. He or she can deposit and withdraw funds at any time. Activity on the account can be tracked by the professional administrator and available for viewing at any time by the member — including the discounts generated by using the card.

 

This newer online system can be easily accessed through smartphones and other electronic devices to see activity on the account. They also provide notifications, about advanced trending, for example, to monitor the account spending over a specific time period.

 

The platform functions similar to a clearinghouse by managing transactions and ensuring money is available to support any charges. Support personnel is available to answer any questions.

 

Some of the country’s largest companies offer the service at settlement to give their employees a better experience and to show goodwill. The healthcare savings card is just the latest service to simplify the injured worker’s post-settlement experience.

 

 

What to Look For

 

As with any industry, some professional administrators are better able to assist members than others. When looking at these companies, here are some of the issues to consider:

 

  1. Experience. The professional administrator should be comprised of people with solid backgrounds in all aspects of insurance, finance, and healthcare.
  2. Large networks. The more robust the medical networks, the better the savings for the injured party. The company should be contracted with multiple providers, pharmacies, and durable medical equipment companies throughout the country.
  3. Price comparisons. Ideally, the company should be able to provide a comparison report showing the retail prices for the injured worker’s specific medications and the discounts currently offered through the professional administrator.
  4. Medicare expertise. Since a majority of workers’ compensation settlements involve Medicare Set-Asides, the professional administrator should be able to competently handle all reporting aspects required by the Centers for Medicare and Medicaid Services.
  5. 24-Hour Help. The company should provide easy access to support personnel who can help coordinate medical care and recommend qualified providers.
  6. Expansive Resource Outreach. Each injured worker has different needs, and the professional administrator should have access to a wide network of people and organizations that can assist.

 

 

Summary

 

Injured workers seeking to settle their claims now have an option to get the support they need to manage their funds and comply with various regulations. A competent professional administrator can ensure these injured workers move forward with their lives.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

 

Artemis Emslie Joins Ametros’ Board of Directors And Other Top News Tidbits

Artemis Emslie Joins Ametros’ Board of Directors

Artemis Emslie has become an independent member of the board of directors of Ametros. As a highly regarded thought leader in the industry, she will provide strategic insight and guidance for the company to ensure products and services align with the company’s overall vision.

 

“We are very excited to have Artemis on the board,” said Marques Torbert, the CEO of Ametros. “Her experience as a senior leader of a fast-growing and successful company in our space gives her a unique perspective to add to our board.”

 

 

5 Easy Steps to Foster Loyalty and Positive Culture

Developing a positive culture and inspiring loyalty requires a delicate and sometimes complicated balance between intentional interventions and behavioral modifications. In a day and time when the word loyalty has somewhat lost its meaning, maintaining a high retention rate and creating a positive work environment is critical and complicated.

 

Creation of a positive working culture, and the ever-elusive loyalty, requires leaders that are sincere, heartfelt and real. The best leaders are able to effectively communicate with the generational spectrum and inspire loyalty through their approachability, their communication style and their interaction at a guttural level.

 

 

Don’t Get Taken Advantage of by Medicare Advantage

If the title of this article has drawn you in, then you likely are somehow touched by Medicare Secondary Payer (MSP) compliance, whether as an attorney representing a claimant or carrier or claims professional working with no-fault, workers’ compensation or liability claim. The question going through your mind is what has Medicare come up with now to make my job more difficult?

 

Indeed, MSP compliance has significantly expanded over the last 17 years. Since the advent of the Medicare Set-Aside review process in 2001, the Centers for Medicare and Medicaid Services (CMS) has added policies and contractors to its enforcement mechanisms under the Medicare Secondary Payer Act. MSAs led to an extensive growth in CMS’s Medicare conditional payment recovery efforts, including the 2010 launch of Section 111 Mandatory Insurer Reporting for liability, no-fault and workers’ compensation insurance.

 

 

Facetime with Phil – Generic Substitution

Generic substitution is one of the most effective strategies you can implement to maximize drug savings. It is the job of myMatrixx to monitor and develop strategies to ensure you are not exposed to the unnecessary cost of a brand name prescription. Join myMatrixx Chief Clinical Officer Phil Walls in his final vlog of a five-part series regarding drug prices vs. drug costs. In this vlog, Phil talks about the various marketing strategies that brand name companies are using to maintain market share.

 

 

Fresno jury says Chipotle owes former manager $7.97 million for wrongful termination

For years, Jeanette Ortiz was a loyal, hardworking general manager for Chipotle Mexican Grill on Shaw Avenue across from the Fresno State campus. But in January 2015, Ortiz was fired, accused of stealing $626 in cash from the restaurant’s safe, said a lawyer for Chipotle Mexican Grill Inc. There was even video evidence to prove Ortiz’s theft, the lawyer said.

 

But when Ortiz denied stealing the money and asked to see the video evidence, her bosses at Chipotle declined. Instead, the company destroyed the video evidence, said Fresno attorneys Warren Paboojian and Jason Bell, who represent Ortiz in a wrongful termination case she brought against the fast-food giant.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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 More Ways to Spring Clean Your Workers’ Comp Program

Spring is here and it’s time to clean out the junk in your garage and trim the bushes. As we go through our annual spring cleaning ritual at home, it’s also time to take a look at tuning up your workers’ compensation practices.

 

See 5 Ways to Spring Clean Your Workers’ Comp Program

 

Here are 4 additional ways to spring clean your workers’ comp program:

 

 

Cooperate Fully with the Claims Adjusters

 

Stay in contact with all your injured employees who have not returned to work. In addition, make the commitment to stay in contact with the claims adjuster(s) handling your work comp claims.

  • You work comp claims coordinator should be exchanging information with the adjuster(s) on all claims on a regular basis. You may know important information that will assist the adjuster in bringing the claim to a speedy conclusion.
  • Or, the adjuster can coordinate with the nurse case manager on the information you provided about the employee’s medical concerns.

 

 

Update the Medical Treatment Panel

 

If you have not revisited your posting on required medical providers (or recommended medical providers in the states where the employee selects the medical provider), now is an excellent time to do so. Set up a conference call and consult with the work comp adjuster(s) and the nurse case manager(s) on your work comp claims.

 

  • Do any of the doctors on your medical treatment panel list seem to keep employees off work longer than others?
  • Do any of the doctors seem to have to operate on employees more than other doctors?
  • Do any of the doctors on your medical treatment panel fail to provide timely medical reports to the adjuster(s) or nurse case manager(s). .
  • Are there any doctors the adjuster(s) or nurse case manager(s) would recommend to be added to your medical treatment panel?

 

Use the Expert Panel if your TPA has one.  If your TPA doesn’t have one, consider changing your TPA.

 

 

Fight Fraud Religiously

 

An excellent spring renewal is to fight fraud. In addition to your anti-fraud posters, start a fraud hotline for other employees to report fraud anonymously to a tip-line.

 

  • Offer a reward for anyone who reports a work comp fraud that results in a criminal conviction.
  • Make sure all your employees know about your Return To Work Program that will prevent them from being off work any longer than is necessary.
  • Always report any suspicious claim to the Special Investigations Unit of the insurer.

 

 

Improve Your Medical Management Program

 

Make the commitment to maximize your medical management program. Review all your programs to control medical cost.

 

  • Consider ways you can improve your use of nurse case managers, utilization reviews, pharmacy benefit managers, medical fee bill reviews, durable medical equipment, independent medical examinations and peer reviews.
  • Seriously consider Injury Triage for all injuries. Employees love it and it will reduce your claims volume significantly.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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 Spring Clean Your Workers’ Comp Program

Spring is here and it’s time to clean out the junk in your garage and trim the bushes. As we go through our annual spring cleaning ritual at home, it’s also time to take a look at tuning up your workers’ compensation practices.

 

 

Improve Safety

 

A safe workplace is the best way to reduce workers compensation cost. Now is an excellent time to renew your commitment to safety.

  1. review your safety program for ways to improve your safety training,
  2. update the job hazard analysis of every job position within the company,
  3. review the qualifications of the members of your safety committee
  4. schedule the work-site evaluations and safety inspections for the year
  5. update the safety manual to cover new equipment, new machinery or new job positions
  6. review your safety posters, safety brochures and other employee safety communications

 

 

Report All Claims Timely

 

If a review of your loss run reflects that you have claims that were not reported the same day as the accident, a great spring cleaning task is to review your claim reporting procedures to be sure all claims are reported timely (the day of the accident). All department managers or location supervisors should be trained to report all injuries to the company’s claims coordinator or directly to the claims office immediately after they have arranged transportation to the medical provider. Timely reporting allows the work comp claims adjuster to investigate properly, establish compensability and better control the course of the workers’ compensation claim.

 

 

Keep in Touch with All Injured Employees

 

Make the commitment to show your injured employees that your company has a human side and does care about their well-being. For every injured employee who has not returned to work, mark on your calendar when you want to contact them. A contact schedule that you can modify as needed would be to:

 

  1. contact the injured employee the day of the accident (First Day Phone Call)
  2. contact the employee 2 days after the accident to make sure they understand the WC procedures and process, and answer any questions they have. Make yourself available. (Follow-up Phone Call)
  3. invite the employee to attend all workplace functions even if they are not working in the workplace temporarily.
  4. have the employee attend a Weekly Meeting until the employee is back to work. Use Weekly Meeting Guidelines to structure these meetings and make notes.

 

 

Stay Current on All Work Comp Claims

 

Closely related to staying in touch with the injured employee is staying current on ALL of your work comp claims. Make the commitment to do so.

 

  • During these contacts with the employee ask the employee the status of their medical treatment and when the doctor may be able to let them to return to work either full duty or on modified duty.
  • Stress to the employee that the work they do for your company is important and that you need them, not some new hire, doing their job. If you have employees you haven’t communicated with, now is the time to reconnect with them.
  • We worked with a large bread company and when the risk manager started his job there were 45 employees out of work. We directed him to invite each to lunch and ask them when they could come back to work. Twenty said they could come back to work “now” but that no one had asked them to return to work up until that lunch. A good lesson about why to stay on top of all of your claims.

 

Do not rely solely on the employees for information about their work comp claims, call the adjuster on a regular basis to discuss treatment status, return to work status and any permanent partial disability which will require modification of the employees job position. Hold bi-weekly or weekly roundtables with the adjuster to discuss a rotating selection of claims.

 

 

Improve Your Return To Work Program

 

If your idea of light duty return to work is to have the employee count paper clips, now is the time to commit to improve your Return To Work Program. A good place to start would be to review our website and all the information we provide to employers on managing your Return To Work Program.

 

 

Your commitment to RTW should include:

 

  • On every lost time claim to take the time to contact the medical provider and ask that the employee be allowed to return to work on light duty.
  • Make sure to provide the medical provider with a complete job description so the medical provider can place the appropriate restrictions on the employees workability.
  • You should have > 95% returning to work within 1-4 days after the injury.

 

 

Summary:

 

Spring is a time for renewal. If you follow through with your commitments, your workers’ compensation program will bloom and prosper.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

Effectively Use Mediation to Settle More Workers’ Compensation Claims

The use of mediation as a means of effective alternative dispute resolution in workers’ compensation is gaining momentum across the United States.  Given the highly litigious nature of many workers’ compensation claims, mediation promotes the involvement in all interested stakeholders and allows parties to resolve their claims in a timely manner.

 

Members of the claims management team who fail to prepare for mediation will not see its benefits.  Anyone seeking to promote efficiency and reduce workers’ compensation costs must take proactive action in order to make the most of a mediation session.

 

 

Effective Use of the Mediation Process

 

Alternative dispute resolution in workers’ compensation systems can be used even if it is not required or endorsed by a state industrial commission.  The process starts when the employee and employer/insurer agree to use a neutral third party to help resolve their dispute.  When agreeing to do so, it is important to invest time and effort in reaching a settlement.  Terminating the mediation session at the first sign of tension is never helpful.

 

Preparing for medication is key.  All interested stakeholders must take the following steps:

 

  • Evaluate the claim and set realistic expectations for settlement. While issues such as “pain and suffering” are important to any injury-related case, this is something that does not add value to the underlying claim;

 

  • All interested stakeholders must be present and willing to work hard toward settlement. This includes being physically present at the mediation settlement and willing to sometimes work through lunch or late into the day.  Be prepared for downtime and keeping occupied and focused; and

 

  • Include interested parties and settlement services in the mediation session. Effectively settling a workers’ compensation claim involves many complex issues and considerations. Leverage the following services to prior to and during mediation:

 

– Defense attorney: Attorneys must play an active role in managing the emotional nature of settlement negotiations, and are a key relationship to leverage early in the claim.

 

– Settlement Consultant: A settlement consultant can assist the parties to understand the different options available, help identify the true wants and needs of both sides, and provide a negotiation tool to help bridge the gap of negotiations and bring about a successful resolution to the case.

 

– Professional Administrator: A professional administration handles many of the administrative tasks on behalf of the injured worker once they’ve settled their Workers’ Compensation claim and can provide piece of mind to address many of the injured worker’s fears and concerns prior to settlement.

 

 

Be Prepared; Be Willing to Compromise

 

Preparing for mediation is key for all involved parties.  Steps members of the claims management team must take include:

 

  • Receiving an updated case analysis from your settlement team. Request that this be provided in advance so one can receive clarification, properly set reserves and provide adequate settlement authority;

 

  • Communicate with defense counsel and settlement services well in advance of mediation and develop a strategy. Make sure a confidential mediation statement is also sent to the mediator in advance.  This statement should outline the claims, defenses, and evaluation of the case.  It may also be helpful to provide a statement as to how you see the issues being resolve; and

 

  • Be realistic and willing to compromise. In a settlement via mediation, all parties are able to have a role in resolving a case and be heard.  It is important that there be a willingness to find a happy medium – a “win” for everyone.

 

 

Effectively Working with the Mediator

 

It is important to work with your settlement team to select the right mediator.  This is because each mediator has their own style.

 

The style of a mediator may also be important depending on the unique facts of a case.  Some of these could include matters involving a pro se claimant, a claimant who is a recent immigrant (cultural sensitivity is an important consideration), someone who is older (or younger) or one who has had many prior workers’ compensation cases.

 

It is also important to be open and honest with a mediator.  If there is information a party does not want to be disclosed to the other side, make sure you are clear when sharing this information.  Never lie and do not be evasive.

 

 

Conclusions

 

Mediation is a great tool to use when settling workers’ compensation cases. In many instances, it provides for fast and effective resolution to reduce program costs.  When using this tool, it is important to prepare for and be willing to compromise.  It is also important to work with the mediator in an effective manner.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

26 A-B-C’s of Safety to Eliminate Workers’ Comp Costs

26 A-B-C’s of Safety to Eliminate Workers' Comp CostsThere are many ways interested stakeholders can reduce workers’ compensation costs in their programs.  Running a more effective program and reducing costs starts with a safe work environment that can be as simple as the A B Cs…

 

Avoid unnecessary risks in the workplace.  Educate all workers on how to be safe.

 

Be aware of common pitfalls that drain program costs.  This includes not making sure all employees are aware of safety.

 

Caution all employee’s to be careful during the workday.

 

Do not delay in reporting work injuries.  Provide resources for employees to report claims and provide appropriate First Aid.

 

Employers are usually the party required to complete the state-mandated First Report of Injury.

 

Falls in the workplace lead to serious work injuries.  Always make sure employees are provided with the proper safety equipment.

 

Get an ergonomic workplace assessment for all employees.  Repetitive use injuries are common in any occupation or job.

 

Help all injured employees in their return-to-work efforts.  Studies show the best way to reduce workers’ compensation costs is to get people back in the workforce as soon as possible.

 

Idiopathic work injuries are generally not compensable.  A careful investigation is required to determine if this is the case so liability can be denied in a timely manner.

 

Just because an employee claims a work injury does not mean it is always compensable.  A proper investigation starts immediately after the injury occurs.

 

Keep your First-Aid kit properly supplied.  This can be the responsibility of a safety committee member to check safety supplies frequently.

 

Letting garbage sit around the workplace can result in injuries.  Encourage all employees to clean up messes – even if they are not responsible for it.

 

Making safety rules is important and the first step to avoiding work injuries.  The next step is consistently enforcing them for all employees.

 

Never miss a deadline when it comes to filing a workers’ compensation document.  Failure to do so can result in penalties assessed to a workers’ compensation program, higher insurance premiums and the payment of additional benefits.

 

Open blades and moving machinery are dangerous.  Make sure all safety equipment is in place and functioning correctly on a daily basis.

 

Prepare for all types of emergencies – think outside the box.  What is your company’s safety plan to deal with severe weather, workplace violence, harassment, or acts of God (e.g., flooding, earthquakes or tornados).

 

Questions need to be asked constantly to improve workplace safety.  A safety officer or committee can be a great resource for employees wanting to learn more.

 

Required workplace safety posters alert employees to common dangers.  Some of the required posters are available to employers for free through state labor and industrial commissions.

 

Set up regular safety training.  While it is important for new employees to learn about the dangers of a workplace, it is especially important for even seasoned employees to be made aware of ongoing risks and dangers.

 

Talk about workplace safety at every company meeting.  This not only reinforces important messages, but it demonstrates a stakeholder’s commitment to safety.

 

Unlit areas and workplaces are dangerous.  This can include slips/falls and even eye strain.  Make sure that all employees have adequate lighting.

 

Violence in the modern workplace is an important issue to address.  This includes teaching employees how to recognize the signs of depression or isolation in a coworker.

 

Walkways and stairwells are common places for injuries.  It is important to make sure these surfaces are free of debris and have proper lighting.

 

Xerox machines can cause work injuries.  Yes, even paper cuts could be compensable.  Make sure all cuts and wounds are properly irrigated and bandaged.

 

You play an important role in workplace safety.  Never pass up the chance to improve your workplace.

 

Zzzzzzzzz.  Getting a good night sleep is important.  Countless work injuries are the result of employee drowsiness.

 

Everyone needs to commit to workplace safety.  It not only reduces workers’ compensation costs but also promotes workplace morale.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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.

Put It in Writing: Crafting Effective Written Job Offers

Put It in Writing: Crafting Effective Written Job OffersOne of the goals of every workers’ compensation program should be to get the employee back to work following an injury.  When returning the employee to work, interested stakeholders and those seeking to reduce workers’ compensation costs should seek to do so by finding employment at the date of injury employer.  When seeking to return that person to work, it is important to have an effectively written job offer.  Failure to do so can cause delay and be met with ongoing and unnecessary litigation costs.

 

 

Understanding Written Job Offer Requirements

 

The requirements of a written job offer are outlined in greater detail in statute and regulation.  There are also other factors to consider based on developed case law.  Members of the claims management team and employer representatives should understand these jurisdictional specific requirements and carefully follow them.  Always consult with an attorney when there are questions.

 

 

Back to the Basics: Preparing an Effective Written Offer

 

It is referred to in workers’ compensation as a “written job offer” because the most important requirement is that the offer for future employment following a work injury must be in writing.  The nature of that written (paper copy versus e-mail) may also be subject to judicial interpretation.  The result is the best offers are on a piece of paper and either directly handed to the employee or sent via certified mail/receipt request to ensure it was delivered.  There is developing case law that suggests the offer can also be sent via email or tax.

 

There are also other basic requirements.  These often include the following:

 

  • The job offer must be suitable: There are varieties of issues to consider in this element.  The offer must be something that is available at the date of injury employer at a wage commensurate with ability and skill;

 

  • The job offer must be defined: These standards are often outlined in statute/regulation with supporting case law interpretations.  General factors to include are that it be a part of an approved vocational rehabilitation plan, within the employee restrictions and produces an economic status as close as possible to the employee’s pre-injury condition;

 

  • The job offer must be offered at the right time: It is important to understand if this job offer can be made before an employee reaches maximum medical improvement.  This is an essential requirement in many jurisdictions with “timing” requirements; and

 

  • The job offer must include detailed information: Important parts of any job offer should include a job title, wages and hours, physical demands of the position (detailed description of the work one would perform) and whether the employee is capable of performing this job with success given their physical and vocational limitations.  This is often subject to a battle of vocational experts.

 

 

Failure to Accept an Appropriate Written Job Offer

 

The failure of an employee to accept or reject a valid written job offer can have significant implications for a workers’ compensation program.  In many jurisdictions, this can include discontinuance of, or complete future forfeiture of one’s wage loss and vocational rehabilitation benefits.  Most states do not limit an employee’s ability to receive future medical care and treatment based on the rejection or failure to accept a valid written offer.  An attorney knowledgeable in a jurisdiction’s workers’ compensation law can provide a legal opinion on these matters.

 

 

Conclusions

 

Members of the claims management team and other interested stakeholders should seek creative ways to place an injured worker back to work to reduce workers’ compensation program costs.  One such tool is preparing and giving an injured worker an effectively written job offer.  When preparing this written offer, it is important to ensure it is received by the employee and meets the legal requirements of a workers’ compensation act.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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 Facilitate Better Return-to-Work Rates

5 Ways To Facilitate Better Return-to-Work RatesThe longer an injured worker is off the job, the more it costs the company and the less likely he is to return — ever. Since that can add up to major expenses for an organization, the goal should be to keep injured employees on the job or, if that’s not possible, get them back to work as soon as possible.

 

Most injured workers are back on the job within 4 days. But there are times when that is not the case — even if the injury itself is not that severe. There are myriad reasons employees don’t return to the job. Using a few simple strategies can aid the process.

 

  1. Stay in network. The medical providers that are part of your network should be well versed in occupational health issues, especially when it comes to returning the injured worker to work. Physicians in the know understand that it is not only in the employer’s best interests, but the employee’s as well. Research clearly shows people recover and heal faster when they are participating in constructive activities, rather than sitting on the couch. Physicians who are part of the employer’s medical network understand these factors and are more likely to pursue returning the worker to the job site, at least in some capacity.

 

However, it does not always work out that way, and the employee may go to a physician of his choice for various reasons. Even in states without employer-directed healthcare, the employer can at least recommend certain providers. Someone from the company should also be designated to drive the person to the physician’s office. Doing so will make the worker more likely to agree to be seen by the provider recommended.

 

Some injured workers say they are ‘fine’ at the time of injury but later seek medical care. All injured workers should be provided with a list of in-network or recommended providers. If the employee later decides to head to a physician, he may be more likely to go to one suggested to him.

 

Employers need to be clear about the workers’ compensation process and demonstrate their caring and concern for the injured worker. This can be done with effective communication — both formal and informal (see ‘communicate’ and ‘brochures’ below).

 

  1. Job Descriptions. Whether the injured worker is treated by an in-network provider or one of his own choosing, it’s vital that the physician has a clear understanding of what the person’s job entails. Providers need to be fully aware of a worker’s job duties in order to determine whether he can or should return to work. While most injured workers want to return as soon as possible, there are some who would rather ‘take some time off’ or believe they need to stay off work to recover. A thorough, detailed job description will help the physician see whether the work is as onerous as the employee has described.

 

  1. Communicate. This is, perhaps, the most effective strategy an employer can use to facilitate return-to-work. Injured workers are typically confused about the workers’ compensation process and feel alone. A simple phone call the day of or one day following the injury is a vital step. The call should be initiated by the worker’s supervisor or a manager the employee knows well and trusts. The call does not need to be long and complicated, but it needs to include the following messages:

 

  • We are sorry you were hurt. How are you doing?
  • You are a valued employee of the organization, and we want you back to work as soon as you are able.
  • Here is what you can expect and what you need to do.

 

Injured workers want to know how and when they will receive medical care and whether and how they will be paid. These issues should be addressed in the first call.

 

Beyond the initial phone call, there should be weekly conversations along with ‘get well’ cards and contact from those close to the worker.

 

  1. Peer-to-peer Providers. Despite your best efforts to reassure the worker and steer him to an in-network provider, the employee may visit a physician who is determined to keep the worker off the job for as long as desired. Or, the treating physician may recommend treatment that seems in contrast with evidence-based guidelines.

 

The best thing to do in those situations is have another provider get in touch with the treating physician, preferably one in the same specialty. A provider who is independent but associated with the employer can review the worker’s medical records and discuss the treatment with the treating doctor. That may require explaining the benefits of returning the injured employee to work, or highlighting best practices of treatment for the particular injury. Physicians are more likely to pay attention when conversing with another physician.

 

  1. Brochures. Most people have no concept of how the workers’ compensation system works, including injured workers. This complicated process needs to be explained and understood to get the injured worker engaged in his recovery. An employee brochure is one of the best ways to accomplish this.

 

Upon hiring, all employees should be given a brochure that lays out in simple steps what to expect. It should explain:

  • How medical treatment is provided.
  • How bills are paid.
  • The return-to-work process, including transitional duty.
  • That the employer wants to return the injured worker and will not punish him for getting injured.
  • That there will be a post-accident investigation to determine if there is ann acceptable workers’ compensation claim.

 

The same information or a shorter version of it should be provided to any worker upon injury. Most workers either will not have read the brochure initially or won’t be able to find it once they are injured. Giving it to employees when they start employment at the company shows them there is a process and expectations; giving it to them when they are injured ensures they will have a step-by-step guide for the process.

 

 

Conclusion

 

The transition from injury to RTW can and should be smooth and seamless. This can be accomplished by clearly laying out the process and expectations and showing ongoing concern for the worker.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2018 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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