Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 3

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 1

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 2

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 3

 

Hello, Michael Stack here with Amaxx. So I just got back from New Orleans, Louisiana… I want to talk to you about my top five take-away implementation points from the sessions that I attended. Continued from Part 2…

 

 

Take Away Point #4: Diagnostic Imaging Awareness

 

Point number four. This comes from Dr. Jacob Lazarovic and Stuart Colburn’s presentation on leveraging a medical expert to not get burned on causation. Dr. Lazarovic was talking about this stat of really reading these diagnostic images, and here’s the figures and here’s the really startling statistics when you’re looking at really reading and diagnosing from a MRI image, for example. 30% of the time, given the same image, given to two different doctors, those two different doctors are going to disagree on the diagnosis. 30% of the time, three out of 10 times, those two doctors are going to disagree on the diagnosis from reading that image.

 

 

Here’s the most telling and most interesting stat. Same doctor, given the same image, one week apart without any further identifying information, the doctor reads it one way on day one and reads it a different way on day seven. So the same doctor’s going to disagree with himself or herself 25% of the time and given to two different doctors they’re going to disagree with each other 30% of the time. The take-away point here is just this recognition that it’s not an absolute diagnosis when you get that from the doctor. Have a second opinion ready to go, have this understanding that just one diagnosis is not always the right diagnosis. Those are just bonus take-away from that session, that same session, Stuart Colburn made the point when talking about the selection of your doctor and the defense of your case, he has to question, “Are you selecting the doctor because of the opinion that him or her is going to give you? Or are you selecting a doctor to win the case?” Very important distinction, really, in the selection of those medical providers.

 

 

Take Away Point #5: Jumper Claims

 

Okay, last take-away point here is from Bill Zachry’s presentation. He was talking about jumper claims. Going back and sort of really relating to that same concept that Marcos Iglesias was talking about in his presentation with his bio-cycle social factors. Bill Zachry got into some more of these statistics of what this actually means in terms of cost. We see this as a national trend, but we’re talking specifically about Albertsons when he was the risk manager there. 3% of their claims represented 60% of those claims’ costs. 3% of their claims represented 60% of the claims’ costs. A very small percentage of claims representing a very large percentage of the costs.

 

 

We see this nationally that figure is 5% of claims representing 80% of the costs, but specifically for Albertsons this is how it worked and here were his numbers. He wanted to bring this down in half, cut this 3% in half, effect a very small percentage, 1 1/2% of those claims to bring down the costs in their program by 30%. So all these things that we’re talking about from these take-aways, these weekly meetings, having those medical provider relationships at the start, being able to bring in particularly in these weekly meetings, identifying some of those bio-cycle social factors early in the claim to bring in the resources necessary to influence the outcome of those claims.

 

 

Those were my five key take-away points. A lot of, of course, other information was discussed, but hopefully you’ll review your notes and you work towards implementing at least just one of these points to start to see a dramatic result in your program. Now if you’re watching this video somewhere other than reduceyourworkerscomp.com, go ahead and go to that website, sign up to receive a lot more free information on how to control and reduce your workers’ comp costs. To take it just one step further you can go to workerscompclub.com/livesstreamtraining to join me on my next livestream training. Again, I’m Michael Stack with Amaxx. Remember, your success in workers’ compensation is defined by your integrity, so be great.

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

 

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 2

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 1

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 2

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 3

 

Hello, Michael Stack here with Amaxx. So I just got back from New Orleans, Louisiana… I want to talk to you about my top five take-away implementation points from the sessions that I attended. Continued from Part 1…

 

 

Take Away Point #2: Occupational Doctor Relationships

 

Take-away point number two is occupational doctor relationships, so occupational doctor relationships. This was a very dramatic point and dramatic example given by Laurie English from Excela Health, another Teddy Award-winning presentation. So obviously they’re a healthcare provider. The biggest challenge that they had was all their injured workers going to the emergency room to see non-occupational doctors. They had a relationship often times, they knew who the doctor was, the doctor would say, “Okay, Jane, you’ve got an injury. Here’s a script, you’ve got four days off work,” and then all the problems that start to come with that.

 

So a very dramatic example, and here’s what they did. they took those ER  doctors, those non-occupational doctors that weren’t trained in workers’ compensation, weren’t trained in occupational medicine, off their panel. They took them off the even possibility to go see them, and if an injured worker does go see them, it costs them $100 co-pay. So they had to do this very dramatically. Not necessarily an easy process to change that culture, but they have done it successfully and seen dramatic results. Now those injured workers go to occupationally medicine-trained nurses who will facilitate their care, and they’ve seen significant results, so very dramatic example in a healthcare situation.

 

Now fast-forward to the return to work presentation given by Anne-Marie Amiel, from the city of Columbus in Georgia, very different type of workforce, public workforce. They don’t have the internal doctors that the employers are going to, very different than a healthcare situation, but the statement she made that I thought was very telling of the success of their program, the success of their return to work program. She said the first six months on the job she went to go personally and visit every one of the providers that they work with. Doctors, physical therapists, etc., talk to them about their program, talk to them about the expectations, talked about how they can work together as a partner to return those injured employees back to work to heal rather than keeping them off to heal before they return to work, that dramatic mindset. That was done by those face-to-face individual meetings, she spent that first six months on the job and then they saw that dramatic success and those dramatic results.

 

 

Take Away Point #3: Weekly Claims Meetings

 

So now let’s talk about the third take-away point, and this is an interesting point, because this is one that was also mentioned when I did my top five take-away points last year. Caryl Russo from Barnabas Health, Jennifer Saddy from American Airlines, both mentioned this concept of weekly meetings, weekly claims meetings as a key to success in their programs, Teddy Award winners. Danielle Hill from Hampton Road Transit, Jennifer Massey from Harder Mechanical Contractors, and Laurie English from Excela Health all talked about this idea of regular claims meetings.

 

 

Here’s the take-away. If all these award-winning programs are using and leveraging this concept, to win these awards, probably something to think about implementing in your program or refining in your program if it’s something that you’re doing or maybe just not doing as well as you possibly could. Here’s the take-away here of really how to get this started. If weekly sounds way too often and that’s something that you could never possibly do, start with quarterly. Start to have some success. Move that then up to monthly, then move that up to weekly. You’re talking about in these meetings where these claims are, how to work together towards a positive outcome and a positive resolution in each one of these individual claims. As the great Zig Zigler said, you don’t have to be great to start, but you do have to start to be great.

 

Continued…

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 1

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 1

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 2

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 3

 

Hello, Michael Stack here with Amaxx. So I just got back from New Orleans, Louisiana; I might be too much of a Northerner to pull off that pronunciation, but nevertheless it was a great time and very valuable time spent at the National Work Comp and Disability Conference last week.

 

 

It’s Not The Time Spent At The Conference, It’s What You Do With That Time

 

We spent a lot of time and we spent a lot of money to attend this conference. Very valuable networking, very valuable meetings, very valuable sessions, but it’s not about the time spent there, it’s about what you do with that time that was spent there, whether it’s follow-up appointments, whether it’s follow-up conversations, or whether it’s taking some of the information from the sessions and now implementing that in your program.

 

 

Take Away Point #1: Return To Work To Heal

 

So I want to talk to you about my top five take-away implementation points from the sessions that I attended. The first point then came from Marcos Iglesias, the medical director at The Hartford. He talked about this idea through his presentation. It was all about really this understanding of the culture of return to work in a program. He talked about return to work to heal, not heal to return to work. So return to work to heal, not heal to return to work. That mindset, that methodology through the workforce, though the medical providers, and through the culture of a company, huge take-away point. Transfer now to the Teddy Award winning presentations.

 

 

Jennifer Massey from Harder Mechanical Contractors. She talked about this idea, and it was very much in the regards to this challenge that a lot of employers have to say, “Well, we don’t have any transitional duty. There’s nothing that we have available for our guys. We would return them to work but we just don’t have any jobs available.” So she took that job, and their company is very unique in that they’re very specialized, highly-skilled, union contractors. Some would say that’s an impossible scenario to deal with, but they’ve had 17 million hours without a lost time plan, very significant stat.

 

 

Here’s how they do it. They engage their workforce to work together to define and create meaningful transitional duty jobs. So if you look at their work force, very skilled labor, maybe they have a highly trained skill in Skill A. But maybe they also have a skill in Skill B or Skill C, and they can work together to engage their workforce, there’s a high level of trust, they have this idea embedded in their culture that return to work to heal for the benefit of the employee and the benefit of the company.

 

 

Both sides get it and both sides are engaged in this creative process to engage the workforce, understand what their skill set is, match them up with a need in the company that’s meaningful for the company and meaningful for the individual to now get that person returning to work so that they can heal. So very significant take-away point in really that mindset, and then action of how you do that in a program.

 

Continued…

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

Understand The Work Comp Heart Attack Presumption

fire-fire-fighter-brand-delete-feuerloeschuebungThe grand bargain of the workers’ compensation system requires employees who allege work injuries or conditions to prove compensability of their claim.  This includes the initial threshold question that it “arose out of” and occurred within the “course of” their employment activities.  While this threshold question applies to all employees equally, there are various presumptions that allow firefighters, police officers and other emergency personal to obtain compensation for heart attacks or other exposures with a lesser degree of evidence.  This is known as the “heart attack presumption,” and is something all members of the claims management team should understand.  They should also be aware as to how to deal with these cases and rebut the presumption when appropriate.

 

 

Origins of the Heart Attack Presumption

 

Employees that work in emergency situations deal with a constant flow of stressful situations during the course of every workday.  This includes rushing to various emergencies, working prolonged and abnormal hours and being subject to constant peril.  The result was a recognition in multiple jurisdictions that these professionals should receive additional protections that while rebuttable, allow them to peruse legitimate claims without having to prove issues of causation to the extent that other employees are required.

 

 

Application of the Presumption

 

It is important to note that the occurrence of a heart attack by a firefighter, police officer or other emergency responders does not automatically trigger compensability.  In order for the presumption to be successful, there is typically a requirement of “an absence of contrary or conflicting evidence on the point and the circumstances which form the basis of the presumption must be of sufficient strength from which the only rational inference to be drawn….”[1]  In other words:

 

  • The employee must fall into the “protected class” given their employment;

 

  • There must be some medical evidence that demonstrates a connection between the heart attack and the employee’s work activity; and

 

  • The connection must be rational or reasonable.

 

In all jurisdictions that have such statutory presumptions, the employer/insurer are able to rebut it with evidence to the contrary.  Other jurisdictions have imposed pre-employment physical requirements and limited the applicable qualifying conditions.

 

 

Rebutting the Heart Attack Presumption

 

When reviewing any workers’ compensation claims, members of the claims management team have a duty to their insured to investigate fully the allegations made before rendering an opinion on compensability.  This includes instances where a qualifying employee suffers a heart attack.  In those instances, the ability to rebut the presumption is defined in statute or interpreting case law.  Examples of the presumption rebuttal include:

 

  • Proof of causation that a non-work related event took place at the same time as the heart attack and was manifested itself in the alleged condition;

 

  • Contemporaneous medical evidence that demonstrates the existing of a condition, which was not related to the employment and resulted in the heart attack; or

 

  • Evidence that the employee died from a condition other than a heart attack, and the death was not related to one’s employment.

 

 

Practice Tips and Pointers

 

Any workers’ compensation investigation should be ethical and diligent.  In instances of a heart attack, the following additional steps should be taken:

 

  • Obtain a complete medical history and set of medical records for the claimant;

 

  • Obtain complete pharmacy records for the claimant. The use of medications for high blood pressure, cholesterol or other conditions are important to the claims investigation; and

 

  • Schedule an independent medical examination with a board certified cardiologist to determine issues of causation. In instances of death, an autopsy may be necessary.

 

 

Conclusions

 

The existence of a heart attack presumption is part of the grand bargain to ensure fairness in compensation for emergency workers.  While this may result in the payment of a claim under a lesser standard of scrutiny, it is important for members of the claim management team to understand how it works and rebut the presumption when evidence suggests non-work related factors were the real result of the condition or death from a heart condition.

[1] Hopson v. Hungerford Coal Co., 187 Va. 299, 305, 46 S.E.2d 392, 395 (1948).

 

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

 

©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.

Can You Authorize Up To $6,000 For A Winning IME?

doctor-imeThe cost of litigation in workers’ compensation is a driving factor that can impact a claim.  Most claim management teams require defense attorneys to submit detailed litigation budgets and hold their counsel to it.  While budgets are unavoidable in today’s marketplace, flexibility can be given in certain situations when it comes to costs associated with an Independent Medical Examination (IME).

 

 

Why Are IMEs Important?

 

The IME can make or break your case.  It can determine the direction of your claim and is used to defend issues concerning causation, the reasonableness/necessity of medical care, treatment parameters or other medical related issues.

 

Failing to use the right IME service provider will impact your claims based on a number of important issues.  These include:

 

  • Available panel selection of medical experts;

 

  • Quality control issues; and

 

  • Customer service issues, including the timeliness of IME reports.

 

 

Developing Trust with an IME Service Provider

 

When dealing with these matters, it is important to evaluate an IME service provider on how they perform in the following areas:

 

  • Service support during the examination process. This includes turning around reports in a timely manner and superior customer service;

 

  • Their panel selection and variety of medical experts. This is important in many instances where an area of specialization is vital to defending a claim; and

 

  • Other intangibles. This includes “best in class” service, the ability of medical experts to clarify issues and add value during all aspects of the examination process.

 

Having confidence in your IME service provider is paramount.  The IME service provider can assist attorneys, members of the claim management team and other interested stakeholders when it comes to evaluating their case and selecting a medical expert.  This is especially important in high exposure cases.

 

 

High Exposure Cases Require Trust & Flexibility

 

An IME cost will range between $500 – $1,800 depending on the provider and the state. This can include a review of all medical records and other documents pertinent to the employee’s background.  In most instances, this includes a summary of the employee’s deposition that has a description of their everyday work activities and specifics concerning the mechanism of injury.

 

Some cases, however, are not average cases and require more than the average IME, with potentially more than one expert opinion.  It is these situations where flexibility and a trusted IME provider relationship is paramount.

 

 

Can You Authorize Up To $6,000 To Get This Done?

 

The timing and execution of an IME requires a medically sensitive determination, and the selection of the right physician expert to make this determination is critical.  The best IME vendor relationships will be trusted and authorized to spend additional funds when necessary to select the right expert from their physician panel at the right time in a high exposure case. This expertise and specialized knowledge makes the IME vendor an invaluable partner to the claims management team.

 

This can be the case when you are dealing with the following issues:

 

  • Cases that include claims for mental/mental or physical/mental injuries. In cases involving a mental component, IME’s will often include multiple medical experts and an array of tests and procedures;

 

  • Instances where the employee has suffered significant physical injuires to multiple body parts. In other matters, future surgical procedures that are complex in nature often drive the cost of an IME; and

 

  • The prior claims history of the employee is also important to consider. When dealing with “experienced claimants,” it may be imperative to select an IME doctor who is not hindered by a budget and can go the extra mile to drive the matter toward settlement.

 

 

 

Conclusions

 

Litigation budgets are an important component of workers’ compensation cost containment.  When it comes to an IME, it can be an invaluable asset to allow for flexibility when defending a high exposure claim.  Develop a trusted relationship and leverage the expertise of your IME vendor as an invaluable partner to your claims management team.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

 

©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.

MedSource National Announces Two Executive Appointments And Other News Tidbits

news tidbits 1Adva-Net Announces Partnership with Broadspire

 

Sarasota, FL. (Nov. 14, 2016) – Adva-Net, the nation’s largest workers’ compensation, comprehensive pain management network, is pleased to announce its partnership with Broadspire®. Broadspire is a leading global third-party administration (TPA) of claims and medical management services and a subsidiary of Crawford and Company®.

 

Read more…

 

 

New 2016 Workers’ Compensation Benchmarking Study Identifies Differentiators of Higher Performing Claims Organizations

 

For the first time in its four year history, the annual Workers’ Compensation Benchmarking Study identifies which claims best practices are generating better outcomes. Findings from the just published 2016 study reflect results from a nationwide survey of 492 claims leaders who report on methods that drive success in their organizations.

 

Read more…

 

 

Workers’ Compensation Expert Praises Reforms, Red Tape Reduction Initiative

 

In line with Governor Bevin’s effort to reign in unnecessary regulatory burdens on businesses in the Commonwealth through the Red Tape Reduction initiative, the Department of Workers’ Claims has reduced the number of required claims forms. As a result, noted workers’ compensation expert Robert Wilson from WorkersCompensation.com has hailed these efforts to simplify the claims reporting process as major breakthroughs for companies trying to navigate the labyrinth of workers’ compensation regulations.

 

Read more…

 

 

Exploding E-Cigarettes and Litigation

 

Reports that e-cigarettes have been exploding resulting in severe burns, allegedly due to a battery malfunction, is resulting in litigation.  Ringler Radio, host Larry Cohen joins attorney William R. Sutton from the Beasley Allen law firm, as they take a look at e-cigarette explosions, what’s causing it and litigation surrounding these products.

 

Read more…

 

 

MedSource National Announces Two Executive Appointments

 

MedSource National, one of the country’s leading privately owned independent medical examination (IME) provider companies, announced today the addition of two executives to leadership roles. James Molloy, a workers’ compensation industry veteran with more than 20 years of experience has been named chief sales officer, and Thomas Kelly, an IME executive for 16 years, has been named vice president, quality assurance.

 

Read more…

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

 

©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.

 

 

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%.

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

 

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

 

©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.

 

 

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%.

Contact: mstack@reduceyourworkerscomp.com.

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

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

8 Steps To Assess Your Workers Comp Program

When you are the one in control of your business’s workers comp program, it is important to assess it periodically to make sure the program is running within reasonable cost to the company.  There are several different steps to take in order to assess costs.  The process may be time consuming, but well worth the effort if it can reduce claims and keep costs to a minimum.

 

Whether you are starting your business’s initial workers comp program or you are new to the already established position, these tips can help lower your workers comp costs.

 

  • Review the current workers comp insurance policy. Check payroll information and class assignments to make sure you are getting the right rate.  If you are unsure, contact your insurance agent or underwriter for clarification.

 

  • Brush up on state and federal laws. Before preparing or revising your workers comp program, be sure your new plan will fall within state and federal guidelines for each of your business’s locations.  Your best option for finding out information is to contact each state’s insurance department.

 

  • Study company loss data. Which areas have the most claims?  Are conditions better in one location than another?  Loss data can sometimes help pinpoint problems that can easily be remedied.

 

  • Prepare self-evaluation questionnaires. Send questionnaires to all employees in every area of the business.  Find out how they feel about company procedures by asking open-ended questions.  Encourage thorough answers by eliminating questions that could be simply answered with a yes or no.   Follow up with phone interviews for more in-depth answers.

 

  • Review company procedures, employee brochures. Be sure that everything used as a teaching tool for employees is up to date and completely pertains to each area of the business.

 

  • Conduct focus groups to find out how employees feel about not only loss procedures, but about working for the company in general. You may find that unhappy employees sometimes use workers comp claims as a way to indirectly express frustration with the job.  Simple changes in employees’ work environments can have a dramatic effect on workers comp costs.  Example: allowing music or having morale boosting events can not only reduce workers comp costs, but could also increase production.

 

  • Utilize your insurance carrier’s loss control department. Your insurance carrier’s loss control department is always available to help.  It is in their best interest as much as yours to keep claims down.  A loss control rep can help assess hazards and offer suggestions to reduce claims and make the workplace much safer.

 

  • Consider an independent consultant. In some cases, it is wise to have an impartial outside source completing evaluations.  However, having an internal source who knows the company inside and out may also be more effective.  Discuss the options with the business’s owners to decide.

 

Once you have all your data including self-evaluations, loss data, current policy review, employee focus group results, etc. you can begin to develop your program so it fits your specific company profile.  Before implementing any program, have it reviewed by your company’s legal counsel.  After the program is developed, be sure to reevaluate periodically to stay up to date on workers comp laws, procedures, and your company’s budget.

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

 

©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.

Most Common Workers’ Compensation Errors

Companies with exorbitant workers’ compensation costs are doing several things wrong, however, the most common error is not properly managing their programs. Too many companies sit back, assume nothing more can be done and wait for the legislature to introduce problem-solving laws. There certainly are some laws that could be changed, but most companies don’t take advantage of the options already available to them.

 

 

Common Workers Compensation Errors

 

Employer Directed Care

 

For instance, some states allow the employer to select the doctor who will treat employees injured on the job. These are “employer directed” states. In these states employers enjoy a special opportunity to use physicians experienced in industrial/occupational medicine and also familiar with the employer’s workers’ compensation program. Despite the opportunity, only about 20 percent of employers in these states are using this tool.

 

 

Failure To Follow Up With Injured Work

 

Another common error is failure of companies to follow up on injured workers after they become disabled. The employer assumes the worker’s doctor will give the word when the employee is ready to come back to work. These employers neglect to consider the doctor probably doesn’t know about the employer’s modified duty program or an employee’s job might be changed to accommodate the applicable medical restrictions.

 

These employers typically neglect to contact the employee, a grave mistake. Without contact, the employee may lose the incentive to return to work and become “psychologically disemployed.” (As typically happens to all of us after a few weeks on vacation). The proper focus, to return the employee to work, is lost.

 

 

Lack of Workers’ Comp Understanding

 

Employers that make the most common errors often don’t know enough about the workers’ compensation system and the options that are available to control their programs.  The lack of understanding makes it relatively easy for employees so inclined to abuse the system.

 

Example: A company has operations in 15 states with “fee schedules” (a special lower rate physicians must charge for treating employees injured on the job.) for industrial accidents. No one was assigned to make sure medical bills were audited for compliance with the fee schedules in the various states. Result: The company paid out hundreds of thousands of dollars in excess medical fees.

 

 

The First Step

 

Companies need to establish an orderly process beginning in the first moments after an injury. The process must ask and answer such questions as where the employee received treatment, how the employee gets to the doctor, who contacts the employee to make sure medical care is appropriate, when the employee is expected to return to work, and so forth.

 

 

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

 

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

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

Control Workers Comp Losses To Control Premiums

photo-1459257831348-f0cdd359235fPremiums, being “loss-sensitive” are set according to the volume of losses. When losses are under control and at acceptable levels, the employer’s experience modification factor falls and premiums drop too. Therefore, the key to controlling premiums is controlling losses. Enlightened employers use pre-loss management techniques, such as safety programs, along with post-loss strategies like injury management to control workers’ compensation costs.

 

 

Employer Involvement Key To Success

 

Cost containment essentially comes down to how well a company proactively manages its workers’ compensation programs. The kind of management an employer needs to reduce workers’ compensation costs does not come from turning all control of claims over to the insurance carrier working entirely outside the control of the client/employer. Few managers would pass on to outside managers the responsibility for quality control, human resources or internal auditing. Unfortunately, with workers’ compensation external management is typical. These employers assume the outside firm, i.e., the insurance company to whom they pay premiums, is managing their claims programs responsibly. In fact, there is very little incentive for an insurance company to decrease a client’s losses when premiums are based on the customer’s loss volume.  Remember:  the key to controlling premiums is controlling losses.

 

 

Substantial Savings Should Be Expected

 

Substantial savings can be realized and should be expected.  Recently, a Fortune 500 corporation experienced 30 million dollars in annual losses. The company maintained very little control and allowed an independent adjusting company to make most of the decisions about the way its claims were handled. The company instituted an injury management program and reduced its incurred losses by 84 percent in the first year.

 

 

Assess & Measure Performance

 

An organization should start by gaining a basic understanding of key metrics and performance measures.

 

  1. Reporting Lag Time

For each claim, determine the number of days from the date of the injury until the claim is reported to the workers’ compensation coordinator within your company.  Total the number of days for all claims in the last 12 months and divide by the total number of claims reported. {The average should be under 1 day}.

 

  1. Annual Cost Per Full Time Equivalent Employee

To establish the annual cost per employee, use the total claim cost over the prior 12 months, divided by the total number of full-time equivalent employees.

 

  1. Average Claim Duration

To determine the average claim duration, take the total number of days – for all reported claims during the last 12 months – from the date of injury to the date a claim is closed, divided by the total number of claims reported.

 

 

The utilization of these measurements will provide your company with insight on how the baseline, as well as how your workers’ compensation cost control efforts are working.  Over time all 3 measurements will show improvement.  Also, by tracking your workers’ compensation program performance over an extended period of time, you will be able to pin-point areas where performance of your cost control efforts can be improved.

 

 

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

 

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

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

 

 

Use Non-Therapeutic Pharmacy Changes to Reduce Your MSA Costs

Prescription drug costs represent both a source of national attention and a major cost driver of workers’ compensation claims dollars.  This trend will only continue.  Failure to use creative ideas to reduce the pharmacy portion of a claim can impact the bottom line and efficiency of your program.  One such creative solution all claims management teams should seek is service providers that identify non-therapeutic pharmacy changes that can yield significant MSA savings.  This is especially the case when your claim has a long tail medical treatment plan and includes a Medicare Set-aside.

 

 

Pharmacy Costs and Work Comp

 

A September 2016 NCCI research brief states “for every $100 paid for medical services provided to workers injured…$17 will be paid for prescription drugs.” They continue to state…”the prescription drugs portion of medical costs increases rapidly as claims age. For every $100 of medical services paid on claims older than 10 years, approximately $45 to $50 will be for prescription drugs.”

 

 

Non-Therapeutic Pharmacy Changes

 

The rapid increase in the prescription drug portion of medical costs in aging claims makes review of the pharmacy treatment plan compounded in importance when creating a Medicare Set-Aside for future medical costs.

 

Non-therapeutic pharmacy changes include:

 

  • Switching treatment from a brand name drug to generic.
  • Confirming discontinuation of a prescribed drug when the medical records are ambiguous
  • Requesting that the physician consider moving from a prescribed drug to over-the-counter.

 

 

Medicare Set-asides: Case Study – $774,583 Savings

 

Step 1: MSA Triage

 

  • Injury:
    • Struck by Lighting: Electric shock, difficulty sleeping, pain, depression, seizure activity

 

  • Prescription & Treatment Plan
    • hydrocodone/apap, baclofen, Topamax, duloxetine, Keppra, naproxen, and clonazapem, sleep apnea equipment

 

  • Original Projected MSA Cost 
    • $1,416,513 with brand new drugs and sleep apnea equipment

 

 
Step 2: Identify & Execute Intervention Strategy

 

  • Original Projected MSA Cost
    • $1,416,513 with brand new drugs and sleep apnea equipment

 

  • Non-Therapeutic Physician Follow Up Strategy
    • Identified opportunity to switch to generic, facilitated communication with physician, employee, and attorney to execute switch

 

  • Savings Realized
    • Future medical reduced from $1.4m to $641,930 by substituting generic; accepted by CMS and saved $774,583.*


*case study provided by Tower MSA Partners

 

The main driver in this MSA allocation was the cost of the brand name prescription drugs Topamax and Keppra.  In the above example, the MSA provider identified the opportunity for savings, facilitated the successful switch to generic drugs among all stakeholders and obtained the written evidence of the change in treatment necessary to secure CMS approval. The result was a $774,583 MSA savings that was accepted by CMS. It is important to note that communication and coordination among all parties allowed the switch to occur and the savings to be realized.

 

 

 

Review Non-Therapeutic Pharmacy Changes – Fees

 

The opportunity to realize dramatic savings without altering the clinical outcome for the patient warrants that non-therapeutic physician changes should be reviewed as a standard part of every MSA case file.

 

When evaluating your MSA vendor, ask the question if this service is included in the standard fee, or if it’s an additional charge? A vendor that provides the service at an additional charge will not utilize it as often and will realize significantly less savings than one in which it’s included in the standard fee.

 

 

Conclusions

 

Medical treatment and prescription drugs will continue to be a driver in the cost of all workers’ compensation claims.  Alterations in prescriptions via non-therapeutic pharmacy changes can mean savings for the parties, as well as other benefits in workers’ compensation claims. Opportunities for these changes should be reviewed on every MSA case file.

 

 

 

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

 

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

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