14 Ways to Prevent Workplace Fatalities

One of the leading — and most preventable — causes of workplace fatalities is being struck by objects. Whether it is falling, flying, swinging/slipping or objects on the ground level, fairly simple precautions can all but eliminate these incidents.

 

Struck-by incidents were recently named the leading cause of work-related deaths in North Carolina last year, at 19. Nationally, the government estimates 10 percent of workplace fatalities each year are due to struck-by accidents. Awareness, education, training and the use of personal protective equipment are generally all that are needed to prevent these tragedies.

 

The vast majority of struck-by fatalities involve trucks, cranes or other heavy equipment. The main hazards are vehicles, falling or flying objects, and constructing masonry walls. Here are ways companies can mitigate the risks.
Vehicles

 

Workers can be pinned between construction vehicles and walls, hit by swinging equipment such as backhoes, or crushed under vehicles that have overturned. Vehicle safety practices should be mandatory at any site that involves vehicles and/or heavy equipment.

 

  • Perform a safety check. All vehicles should have proper safety devices. Before every shift, supervisors and/or workers should make sure all vehicle and equipment parts and accessories are in safe operating condition. The vehicle or equipment should be taken out of service until needed repairs are made.
  • Have a clear view. Vehicles should not be backed up if the driver is unable to see what is behind him. If that’s not possible, an audible alarm should be operational or a designated person should direct the vehicle from the outside. The driver should ensure there are no individuals near his vehicle before dumping or lifting materials with it.
  • Set the vehicle before leaving. Parking brakes should be engaged when the vehicle is not in use, and wheels on an incline should be chocked. End-loader buckets, scraper blades, dump bodies etc., should be lowered on the vehicle when it is not in use.
  • Don’t overload. Workers should adhere to the vehicle’s lift capacity.
  • Set up barriers. For construction sites near public roadways, there should be barricades and/or flaggers and good traffic signs set up. Personnel at these sites must be clothed so they are easily visible to other drivers, including reflective material at night.

 

 

Falling / Flying

 

Being under an elevated work area can lead to falling object injuries, while activities such as pushing, pulling prying or grinding may cause objects to be airborne and strike a worker. Workers under or around such areas, as well as those doing overhead work need to be vigilant about safety.

 

  • Check equipment to make sure it is operating properly. Make sure small tools, such as saws have protective guards that are in good condition.
  • Hard hats should be required of all workers in such conditions. Safety glasses, face shields or goggles are advisable in areas where flying particles could be an issue.
  • Look up. Work should not be done where loads are being moved overhead. Barricades should be set up with warning signs posted.
  • Secure the site. Consider protective equipment such as toeboards, debris nets or canopies to catch falling objects. When the work is completed for the day, make sure all materials and tools are stacked and secured to prevent them from falling. Make sure loads are secured and lifted evenly.
  • Compressed air. Compressed air used for cleaning should be reduced to 30 psi. It should only be used with appropriate guarding and protective equipment, and clothing should not be cleaned with it.

 

 

Masonry Walls

 

Positioning slabs and walls or shoring up structures involves heavy loads that must be supported and can lead to catastrophic results if precautions are not taken. A trained professional should dictate when a concrete structure is strong enough to place construction loads on it.

 

  • Brace the structure. Make sure permanent supporting elements are in place or concrete has been tested for sufficient strength for whatever will be loaded on it. Until such time, brace the structure.
  • Limit the numbers. Anyone who is not essential to the construction or lifting operations should be prohibited from the work area.
  • Secure wire mesh. Make sure mesh cannot recoil by securing the ends or turning the mesh roll over.
  • Check the weight. Avoid loading up lifting devices beyond their weight capacity.

 

 

Conclusion

 

Providing training to all workers at risk of struck-by incidents is vital to protecting them. A few simple and inexpensive steps are all that is needed to save lives and protect your company’s bottom line.

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

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

 

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

3 Factors In Determining If Employee is Independent Contractor

A common issue in the compensability of a workers’ compensation claim includes a determination of whether the injured party is an employee or independent contractor.  This is important for employer stakeholders to understand as the issue is often subject to litigation.

 

 

Important Factors to Consider

 

The law concerning employee relationships is defined by each state or jurisdiction, which results in differing interpretations.  It is important to understand the law in the jurisdiction where the claim arises or could be venued.  When in doubt, always consult with an attorney.

 

Here are some common elements found under state workers’ compensation law to consider:

 

1) Financial control.

 

This deals with issues concerning whether the employer has the right of control in the various business aspects of the relationship with the injured party.  Careful inquiry and examination must include:

 

  • How the person is reimbursed for their time. While the issuance of a 1099 tax form is key, it is not always determinative on the issue.

 

  • How the party and employer handle unreimbursed business expenses. In all instances, a true independent contractor are more likely to have unreimbursed expenses than employees.

 

  • The investment of the worker’s time. In a true independent contractor relationship, the only investment the person will have is the actual time they spend on work.

 

 

2) Behavioral Control

 

This inquiry involves the understanding on what instructions the employer will give to the person performing work.  Key questions that need to be asked include:

 

  • When and where to do the work?

 

  • What tools or equipment to use?

 

  • What workers to hire or to assist with the work?

 

  • Where to purchase supplies and services?

 

  • What work a specified individual must perform?

 

  • What order or sequence to follow?

 

Issues of “behavioral control” are often central to investigations in construction workers such as siders, roofers and other work that can be considered seasonal.  Allowing an “independent contractor” to use company tools can be fatal to an assertion the party was not an employee.

 

 

3) Types of Business Relationships

 

Courts will also examine the nature of agreements—both verbal and written.  This includes documents signed between the person and employer.  Merely calling someone an “independent contractor” does little to avoid establishing an employee-employer relationship, and thus compensability should an injury arise.  Having a written document calling someone an independent contractor can give a false sense of security and shattered hopes of defeating a claim at hearing before a compensation judge or industrial commission.

 

  • Written contracts. Courts give little deference to what a person is described as in a written agreement.  The devil is always in the details.  A potential employer should not forget to memorialize the arrangement in writing.  It is still an important piece of evidence.

 

  • Insurance agreements and other fringe benefits. An employee-employer relationship can be established if the person in question receives tangible benefits beyond payment for the labor they perform.  In many instances, court have declared a person to be an employee for purpose of workers’ compensation based on the payment of other benefits or perks such as pension plans, 401K contributions, vacation pay, sick pay or other forms of PTO.

 

  • Tenure of service. The longer a person works an employer, the greater the risk there is for them to become an employee.  In order to avoid this situation, the written independent contractor agreement should be for a defined period, or specific to a particular project.

 

 

Conclusions

 

Central to the determination of whether someone is an independent contractor revolves around issues of control.  The more control a company has over an individual, the more likely they look like an employee and resulting injuries are compensable.  It is important to be aware of these issues to avoid unnecessary costs in your workers’ compensation program.

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

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

 

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

How To Implement An Effect Work Injury Response Plan

 

It goes without saying that in workers’ compensation risk management proactive response to a workplace injury or incident is important.  However, what is often lost in the discussion of this topic is what takes place following the critical minutes following an injury and after the employee receives initial medical care and treatment.  Taking time to think about your long-term response can save your program dollars and can increase productivity in the workplace.

 

 

Lack of Communication and the Post-Injury Dilemma

 

Take a moment to think about a work-injury from the perspective of an injured employee.  The employee is frustrated with a number of issues.  These can include:

 

  • Not understanding the workers’ compensation benefit process and payment structure. They do not want to get an attorney because everything seems right or they do not want to be viewed as a troublemaker.  They are receiving all the benefits they are entitled to, right?

 

  • Time spent filling out forms and seeing a number of medical doctors and vocational rehabilitation counselors. When they do see their doctor, it is a rushed appointment and sometimes not all of their questions are answered.

 

  • The major disruption in their life caused by physical disability. Their routine is in utter chaos.  Instead of spending time with friends at work, they sit at home and recover.

 

  • There is a reduction in income, but not everyday living expenses. Hopelessness and despair set in.

 

Missing from most post-injury response plans is an effective and consistent line of communication between the employer and injured parties.  Workers’ compensation stakeholders serious about their bottom line need to consider the implementation of pro-injury communication with their disabled workforce.  Lack of information breeds contempt.

 

 

Implementing an Effective Plan

 

It is important to plan and implement an effective post-injury response immediately after a work injury occurs.  Suggestions to improve these lines of communication and avoid distrust of the injured employee can include:

 

  • Assisting the injured worker in contacting immediate family about the injury and advising these parties about the status of the employee. In some instances, written authorization may be required given state and federal privacy laws.

 

  • Contacting the injured worker immediately after they are out of danger and in a stable condition. Sending a get well card or making a telephone call are a good, visiting the employee at their home or in the hospital is even better. Proactive employers can also offer to take someone home from a hospital or clinic after their release.  Random acts of kindness build trust.

 

  • Empathizing with the employee and explaining to them the workers’ compensation process can also be helpful. Developing literature about the workers’ compensation system can also be helpful if done right.

 

The open lines of communication should not stop there.  Additional follow-up steps can also be taken to build trust and confidence in the employee with the eventual goal of full recovery and return to work.  Other measures should include:

 

  • Weekly conferences with the injured worker to check on their physical and emotional status. These meetings can be in-person at a location convenient to the employee or via telephone.

 

  • Allowing the injured party to visit with friends and co-workers on the employer’s premises can develop a sense of worth.

 

  • Offering a broad selection of return-to-work opportunities.

 

 

Conclusions

 

Effective injury response goes beyond having a First Aid kit on hand and calling 9-1-1.  For proactive stakeholders, it requires exceeding the minimum expectations to build a bridge of trust and promote a positive relationship with the injured worker.  While this takes effort, it can reduce costs in your program and pay dividends via cost savings.

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

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

 

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

Get Serious About Developing Your Return-To-Work Policy

Imagine the following conversation:

 

Q: What is your policy on “Return to Work?”

A:  Ahh, we are all for returning injured workers back to work?

 

Sadly, this is the typical response of most employer representatives when it comes to an important topic.  A topic so important it can save your workers’ compensation program countless dollars and reduced litigation costs.  If you are one of the many employers or employer representatives who is serious about return-to-work, now is the time to develop a policy that meets the needs of your workforce and keeps the best interests of everyone in mind.

 

 

The Role of Return-To-Work

 

The role of return-to-work in workers’ compensation is multi-faceted.  It involves an employer seeking to do what is best for their employees.  It also includes people ready to seek creative solutions to complex problems.  Time spent on return-to-work is valuable in a number of ways.  These include benefits to the employee and employer:

 

  • Benefits for Employees: Most injured workers would rather be in the workforce than stay at home.  The seclusion of home has many negative psychological consequences and prolongs recovery times.  Additional benefits to the employee include increased earning capacity, a consistent and regular schedule, positive and productive mindset, a strong sense of self-worth and increased security.

 

  • Benefits for Employers: There are numerous considerations beyond increased workers’ compensation premiums that should compel proactive employers to invest in these programs.  Other considerations include controlling the hidden costs of prolonged injury, reducing future exposures (including claims for retraining or permanent total disability) maintaining productive work operations and containing costs.

 

 

Developing a Proactive Return-To-Work Policy

 

Here are some important considerations to developing an effective and proactive return-to-work policy.

 

  • Purpose: The policy should outline the general philosophy of the company. It should include how it views all employees regardless of ability.  It should also inform workers of their rights and responsibilities following a work injury.  It should note that policies covering workers’ compensation issues do not impact or supersede other legal obligations the employer may have under the Americans with Disabilities Act (ADA) or disability/leave programs such as the Family and Medical Leave Act (FMLA).

 

  • Eligibility: This part of the policy will outline the rights and responsibilities of the employer and employee.  It should cover important aspects of being out of work or returning to duty with restrictions or a modified position.  Important elements to cover include time off to attend doctor appointments and restriction requirements, if applicable.

 

  • Availability of Positions: It should be the goal of every return-to-work program to move a worker back to his or her pre-injury position and wage.  In many instances, this is not practical given physical limitations following the work-related incident.  In this case, notifying the employee of other job opportunities within the pre-injury employer and other positions is important.

 

  • Transitional Work/Assignments: Many state workers’ compensation laws govern the employee’s eligibility for ongoing wage loss benefits should he or she decide not to accept transitional or modified positions.  It is important to spell out the rights and responsibilities of the parties in these situations.  Other elements include legal requirements on how the employee is going to receive the offer of modified work and what procedures are required if they dispute the physical requirements of the position.

 

There is no set template for a return-to-work policy.  Other elements may include information on position expectations, termination of assignments, the number of hours open for a position (part-time or full-time) and rate of pay.  Interested stakeholders should also consult legal counsel given the employment issues that come into play in these complex matters.

 

 

Conclusions

 

Return-to-work is a complex issue that requires more than a mere moment of consideration by employers serious about reducing workers’ compensation costs.  When reviewing your best practices, it is important to consider the development of a policy regarding this issue.  Doing so can substantially reduce your workers’ compensation program costs.

 

 

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

 

Author Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

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

 

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

How To Know When To Expect Your Employee Back To Work

Employers want to know how long an employee will be off work following a workers compensation injury. There are a lot of factors that go into the answer including the nature and extent of the injury, the employee’s age, the employee’s physical conditioning, and the overall state of the employee’s health.

 

The most common types of injuries are sprains and fractures. There are several factors that determine the disability period for sprains and fractures. The first factor to consider is the nature and extent of the injury. A moderate sprained ankle heals much quicker than a compound femur fracture. To get an idea of how extensive the medical provider considers a sprain, look for the adjective before the word sprain or strain.

 

The adjectives most commonly used with sprain and strains are: 

 

  • Slight – it happened, but there is not much to it.
  • Moderate – more extensive than slight – middle range
  • Severe – more extensive than moderate – really hurting

 

To understand how extensive a fracture is, again look for the adjectives the medical provider uses to describe.

 

Fractures are normally described as:

 

  • Simple: it has cracked, but has not done anything more than a little bit of damage to the surrounding tissue
  • Closed: basically the same as a simple fracture
  • Compound: the bone has broken in more than one spot, or the fracture has created significant tissue damage
  • Open compound: the broken bone is exposed through a wound in the skin
  • Compression: in the vertebrae where a brittle bone, due to age or osteoporosis, has cracked

 

 

Other adjectives to describe fractures include (per Wikipedia):

 

  • Complete fracture: A fracture in which bone fragments separate completely.
  • Incomplete fracture: A fracture in which the bone fragments are still partially joined. In such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone.[1]
  • Linear fracture: A fracture that is parallel to the bone’s long axis.
  • Transverse fracture: A fracture that is at a right angle to the bone’s long axis.
  • Oblique fracture: A fracture that is diagonal to a bone’s long axis.
  • Spiral fracture: A fracture where at least one part of the bone has been twisted.
  • Comminuted fracture: A fracture in which the bone has broken into a number of pieces.
  • Impacted fracture: A fracture caused when bone fragments are driven into each other.

 

 

Consider Age & Conditioning

 

In addition to the nature and extent of the injury, the employee’s age is a factor. A 25 year old employee with a simple fracture will heal more quickly than a 55 year old employee with the same injury.

 

 

The employee’s physical conditioning before the injury will play a significant factor in the employee’s disability recovery time. The 50 year old employee who runs in the Boston Marathon will recover from an injury faster than a 20 year old employee who spends all his free time in front of a video game monitor.

 

 

The overall state of an employee’s health will also impact the disability time. An employee with truncal obesity, diabetes, or other comorbidity issues will recover from an injury much slower than an employee who has the same injury, but no other on-going medical issues. Additionally, the non-smoker will recover from an injury faster than a smoker, all other factors being equal.

 

 

For more information, please see:

 

 

Please note that all disability times are normal ranges, and the medical facts will determine the disability period. Hospitalization times vary greatly depending on the severity of the injury. The total disability time range is the expected length of time before the medical provider will allow the employee to return to light duty work. The partial disability time ranges is the approximate amount of time the employee should be in a light duty job.

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

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

 

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

20 Common Adjuster Mistakes And What To Do About It

One thing seldom heard from the either the insurance company or from the third party claims administrator (TPA) is “we / I made a mistake”. Mistakes happen. The difference between the excellent adjuster and the so-so adjuster is the number of mistakes made. Claims management , supervisors ,and managers also make errors in judgment, or unwittingly commit an oversight. There will not be a list of common claims handling mistakes on the insurance company’s website or TPA’s website. Therefore, we present what are common claims handling errors seen when the claims are audited by an independent claims auditor.

 

20 Common Adjuster Mistakes

 

  1. The failure to thoroughly investigate the claims including the establishment of the nature and extent of the injuries.

 

  1. The failureto properly document the average weekly wage and to properly establish the TTD rate.

 

  1. The failure to maintain the files on a diary (a regular scheduled file review by the adjuster to ensure all needed activity has been completed).

 

  1. The failureto recognize and document subrogation.

 

  1. The failureto have Action Plans.

 

  1. The failureto read medical reports.

 

  1. The failureto monitor and control medical treatment.

 

  1. The failureto conclude claims in a timely fashion when the opportunities were presented.

 

  1. The failureto know the workers compensation laws in their jurisdiction.

 

  1. The failureto file the appropriate state forms with the Industrial Commissions and Workers Compensation Boards.

 

  1. The failureto maintain contact and rapport with the claimants.

 

  1. The failureto record in the file notes the documentation received on the file.

 

  1. The failure to utilize Independent Medical Examinations when appropriate.

 

  1. The failureto utilize nurse case managers when appropriate.

 

  1. The failureto deny unrelated medical treatment or unrelated body parts when introduced into the claim.

 

  1. The failureto attempt to return injured employees to light duty work when the medical providers approved same.

 

  1. The failureto respond to important developments on the claims.

 

  1. The failure to provide proper litigation management on the litigated claims.

 

  1. The failureof management to provide supervision or guidance to the adjusters handling the claims.

 

  1. The failureof management to maintain continuity on the claims by changing the assigned adjuster on the claim during the course of the claim. (Occasionally it is necessary on a few files but not on a majority of the claim files).

 

What To Do About It

 

When mistakes occur in claims handling, the cost of the claim goes up. The insurance premium paid by employers is impacted by both the frequency and the severity of claims. While frequency of claims carries greater weight in calculating the insurance premium, the severity of the claims – what the claims cost – also impacts the insurance premium.

 

 

There are several things employers can do to limit the mistakes made on workers compensation claims, including:

 

  • Having a published set of Best Practices and insisting the claims office abide by them.’
  • Having a designated adjuster or dedicated adjuster(s) to handle all your claims.
  • Verifying the adjuster has reviewed the Employer’s First Report of Injury and has filed all appropriate forms on every claim.
  • Verifying the adjuster has obtained the proper wage/salary information for the calculation of indemnity benefits (calculate the indemnity benefit yourself and compare with what the adjuster is paying weekly or biweekly).
  • Providing to the adjuster any information you have or receive about the claim, whether it is medical documentation, the employee’s personnel file or even scuttlebutt heard around the office.
  • Establish a regular file review. (What get’s reviewed gets done).  If you do not have the time to review the adjuster(s) work yourself, hire an independent claim file auditor to review the files and identify the strong and weak points of the claims handling on your claims.

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

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

 

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

8 Ways to Prepare For The Next Healthcare Reform

The great healthcare debate in Washington, D.C., left many in our industry wondering what the ultimate impact would be on the workers’ comp system.  While the proposed republican bill has failed to pass, employers and payers can still take steps to ensure they are in the best position for the status quo – or whatever future legislation may be proposed.

 

Here are some areas to consider.

 

Employee Safety & Health

 

  1. Wellness programs. If your company does not have one, this is a good time to consider the idea. Healthier employees are less likely to sustain workplace injuries or illnesses and more likely to recover quickly when they do. If your company has a program, look at its effectiveness. How do you measure its success? What is the participation rate? What kind of feedback have you received about it? Even if your wellness program is doing well, it may be time to try some new features or change it up a bit to encourage increased buy-in. If possible, connect wellness initiatives with nurse case management.

 

  1. Focus on older workers. If you’ve thought about taking steps to increase safety and health among aging workers, now is a good time to do so. Improve the lighting, implement efforts to ensure hallways are free of obstacles, and look into assistive devices to reduce bodily strain.

 

 

Fraud Concerns

 

  1. Step up investigations. You want to make sure you’re not hit with claims that are not work related; so when an injury does occur, make sure you don’t skip steps to uncover what really happened. Talk to witnesses, review any video footage, look at the timeline of events.

 

  1. Scrutinize bills. To the extent possible, make sure your providers, attorneys, and others are not trying to cushion their potential income losses at your expense. If anything on a bill raises a question — ask about it. Any reputable vendor should be able to easily explain changes in billing.

 

 

Claims Management Processes

 

  1. Use workflow automation to better manage your loss trends and reduce claims leakage. You might consider data warehousing to integrate legacy systems and multiple data sources to identify fraud and cost shifting, and to better manage performance.

 

  1. Intervene early. Don’t let potentially high risk claims deteriorate. Work with your insurer or third party administrator to identify claims that could go south. Leverage clinical and specialty resources early in the claim cycle.

 

  1. Use quality providers. Make sure you’re working with high quality partners, to help expedite claims and get your injured employees back to function and work. Medical providers should be outcomes-based with good track records of delivering the best care. They should also have a comprehensive understanding of occupational health. If not, look for new providers or educate those in your network.

 

  1. Check the paperwork. Make sure your policies and procedures relating to employee health and safety are up to date and easily available to employees. If you have a drug-free workplace policy, for example, make sure it includes any recent related changes in your jurisdiction. Any relevant portion of the employee manual should also be reviewed and changed where needed.

 

 

Conclusion

 

At the moment it seems healthcare is going to remain unchanged.  However, whether or not there are future changes proposed, it behooves stakeholders to be prepared.

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

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

 

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

5 Strategies to Avoid Mega Problems in Large Deductible Policies

Large deductible insurance policies can be a tremendous advantage for employers. Significant cost savings and increased control over expenses and safety are among the benefits for companies that are aptly suited for this tool. However, they are not appropriate for all employers and can have catastrophic consequences. Increased costs, legal disputes and insolvencies – its own and/or the insurer’s – can result if a company is ill equipped or misunderstands the complexity of these arrangements.

 

Employers considering large deductible policies need a deep understanding of their own companies and a thorough vetting of the contract before signing up. There are several strategies that employers should undertake before considering a large deductible policy.

 

 

The Policy

 

These arrangements include a set deductible amount for each claim. However, those in the workers’ compensation system differ from those in other insurance lines. The typical such policy has the client paying a claim up to the deductible amount, at which point the insurer takes over the claims payments. In workers’ compensation, the insurer generally pays the entire claim and is then reimbursed by the employer for the agreed upon deductible amount. In a typical large deductible workers’ compensation policy with a $2 million claim and a $100,000 deductible, the insurer would pay the entire claim and then seek reimbursement of $100,000 from the employer.

 

The laws and rules covering these policies differ among jurisdictions and are often somewhat vague. For example, there is no standard as to what constitutes a ‘large’ or ‘mega’ deductible amount. Some jurisdictions define large deductibles as $100,000 or more and mega deductibles as at least $750,000. Nevada, however, requires any deductible over $25,000 to be reported to the state. Some companies set the mega deductible amount at $10 million. Mega deductible policies generally involve more underwriting and regulatory oversight than large deductible policies.

 

When used successfully, employers can see premium reductions, tax savings, increased efforts toward safety to prevent claims, and incentives to care for and get injured workers back to work quickly.

 

 

Potential problems

 

Problems can arise when employers do not understand the risks involved, experience unexpected revenue shortfalls, or overestimate their company’s financial strength, especially for the long term. Because of the long tail nature of workers’ compensation claims, reimbursement may extend for years. Companies that cannot pay run into trouble.

 

Often the policies involve ‘side agreements’ that make them even more complicated and, sometimes, misunderstood by the employer. There are a variety of reasons and requirements in these. Some, for example, basically eliminate the operation of experience modification factors. Others may substitute a unified overall rate for the typical classification system. Some include language about the premium charges that effectively contradict the actual policy terms. Some may actually change the provisions of the policy without being endorsed onto the policy, leading to conflicts.

 

Still other problems may arise when employers are mistakenly led to believe they are responsible for paying the claims in order to get lower up-front costs and avoid experience modifications for claims within the deductible limits. That may result in errors in claims handling – even unintentionally.

 

Large deductible policies are not regulated to the extent of self-insurance; however, some employers may use them as such, whether knowingly or unknowingly. Employers that view large deductible policies as a form of self-insurance may mistakenly believe they should or can manage their companies’ own claims. They run the risk of violating state laws regarding such things as choice of healthcare provider or retaliation for making a claim. That can lead to delayed care and more harm to the injured worker, disputes with the insurer, claims handling abuses, civil penalties, and ultimately significantly higher costs.

 

In one case for example, a small company contracted with a professional employer organization for its human resource services. The PEO purchased a workers’ compensation policy with a $1 million deductible – which lowered its premium and the costs billed to the company. The problem arose when a worker filed a claim and, despite assurances that all was fine, the PEO went out of business and the insurer was declared insolvent. The company turned to the Minnesota guarantee fund for payment. However, due to statute language, the company was ultimately found liable for the $1 million deductible.

 

Additional problems can occur if employers fail to accurately report all claims in a timely manner. Delayed reporting may leave the insurer under reserved, leading to its insolvency. Failing to report claims may result in enforcement by a state regulatory agency, leading to civil penalties for each violation.

 

 

What to do

 

Employers either considering or just starting to use a large deductible policy have a much better chance of reaping the benefits by following a few simple steps.

 

  1. Read the fine print. Make sure you truly understand your obligations and those of the insurer.
  2. Check side agreements. Understand all details about any side agreement.
  3. Know your financials. Make sure your company has the financial ability to reimburse the insurer when payment is due. Past claims history and your company’s overall financial strength should be scrutinized before considering a large deductible policy.
  4. Report injuries. Report them accurately and timely. Delayed, under-reporting and non-reporting of injuries can cause myriad problems for the insurer and employer. As mentioned above, the potential for under-reserving by the insurer could have grave consequences. Noncompliance with state reporting requirements can lead to fines against the employer and insurer.
  5. Don’t circumvent policy language. If the policy calls for the insurer to pay the losses, as most of these do, adhere to it. Not doing so can lead to claims handling abuses and extra costs.

 

 

Conclusion

 

Large employers that are well capitalized may be prime candidates for large or mega deductible policies, which can substantially reduce costs. However, it’s important to make sure your company has the financial ability and wherewithal to strictly adhere to such a policy in order to see the benefits.

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

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

 

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

WCRI Recap: Single Biggest Factor To Turn-Around Opioid Crisis

WCRI Recap – 3 Part Series

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

 

It’s been two weeks since the WCRI Conference recently held in Boston. I’m Michael Stack with Amaxx. Today I want to give you some highlights and recap from that recent conference from the notes that I took and the perspective that I had on it.

 

The next session that I took some detailed notes on was how are states battling the opioid epidemic. I took a lot of different notes in this session, but Dwight Lovan who was formerly with the Kentucky Department of Workers Comp Claims made one statement that I think is the only statement that really needs to resonate with our industry and with state lawmakers.

 

 

 

Single Biggest Factor To Turn-Around Kentucky Opioid Crisis

 

We all know, or a lot of people know, that Kentucky was the epicenter of opioid overdose deaths and opioid drug problem, so they took this head on. He talked about really how they addressed it in Kentucky and the progress that they’ve made, which has been significant. He made one comment, and he said, and he kind of almost said it in passing, but I wrote it down and I highlighted it and I starred it and I bolded it, because he said, “The biggest impact and the one thing that they did that made the biggest difference was they required their physicians to check the PDMP data.” They made a mandate that required their physicians to check the PDMP data. If you’re not familiar with the prescription drug monitoring program it’s a database that basically doctors can check. It takes maybe 5-15 seconds to see what other drugs that injured worker is taking so they don’t overprescribe, so prevents doctor shopping. A lot of those biggest challenges that cause overdose deaths, so they made a mandate that required the physicians to check this PDMP data before they prescribe the drugs.

 

That made the biggest impact at the epicenter of opioid overdoes deaths and the significant progress that they have made. I checked this research. I researched it a little bit online. I’m not sure how accurate this data is, but it said 16 states have since implemented this mandate and it should be implemented in every single state, in all 50 states. If this made the biggest impact at the biggest problem area in our country, it’s an easy fix and it only takes five to 15 seconds to save a life, so hugely important point on this how states are combating opioids. If you have not implemented this in your state talk to our lawmakers. Let’s make this mandatory across the board.

 

 

Non-Pharmalogical Treatment of Pain

 

The last session was non-pharmacological treatment of pain as alternatives to opioids. This was a fantastic session. The information covered was very impactful and very moving for the results that it can give for each individual injured worker.

 

Dr. Dawn Ehde and I apologize because I’m probably pronouncing that wrong, from the state of Washington. She gave a tremendous presentation. Here’s the highlights of what she covered. She covered the idea that this medical model, or the currently medical model as far as the treatment of pain. It just doesn’t work. It doesn’t work because the biopsychosocial factors in all the different elements that go into how an individual perceives their own pain. This reinforces that idea of the do you think you’ll be back to work in four weeks. It reinforces that same idea, the perception of that individual person is such a huge factor on how well they’re going to do, and a huge predictive indicator of how well that claim’s going to go.

 

She talked about some of the current different options of what’s currently being used out there today. She talked about cognitive behavior therapy and she talked about mindfulness, so two different popular options which you may or may not be familiar with. What she went into a more detail, which I thought was extremely interesting and compelling was this idea of collaborative care. That’s what I want to cover here today.

 

 

Collaborative Care Model

 

It’s very much in sync with the best practice that I recommend, which is the weekly claims round table. It’s about looking at an individual claim, bringing in perspective some different experts to collaborate and come up with the best solution for that individual person because the solution for Tom’s going to be different than the solution for Sally is going to be different than the solution for Joe. Each individual person needs their own path and their own direction. You get the perspective from different experts to work together, collaborate for that outcome. That was really what she reinforced here.

 

She drew out this picture of the injured worker really being at the center of this model. You’ve got the providers up here. You have a care manager down here, and over here you have what she called consultants, and these consultants and everyone ties into here to service the injured worker. These consultants are psychiatrists, they’re different experts that can bring in and share some expertise with this care manager and with this provider to all work together to collaborate on the different elements that maybe needed to suit that person’s needs, to meet them where they are, to move them towards this positive outcome.

 

I’m oversimplifying this conversation, I’m oversimplifying this presentation, but you get the idea of what we’re trying to accomplish here and what she’s talking about and how they’re addressing this in the state of Washington to hopefully provide a model for the rest of the country to follow for these outcomes. The idea is to collaborate, connect with this injured worker regularly, have conversations with him, set those expectations. We talked about that in the worker outcome studies of how trust is such a huge factor so you build this huge level of trust with this care coordinator and they’re talking to them, that injured worker, about their expectations that do you think you’ll be back to work question is a huge factor in how they’re dealing with their pain, and how they’re going to recover.

 

They implemented, they haven’t done a ton of studies on this idea yet, but they implemented in a case of multiple sclerosis patients. There was 188 patients and it achieved what the medical community deems is the triple aim, which is better outcomes, lower cost, and higher satisfaction. That was the only study and they’re starting to roll this out in work comp, so very exciting for the solutions that can be brought to the table. Very impactful, very practical information as always from the WCRI Conference. I hope that you can take this information and put it into practice today.

 

 

Pick One Idea & Implement!

 

My recommendation is to start with one thing, start with one thing. What is it from that conference that you want to implement today and build that momentum, which is how significant change happens. Again, I’m Michael Stack with Amaxx, remember your success in Workers Comp is to defined your integrity, so be great!

 

 

 

WCRI Recap: 3 Factors That Most Impact Worker Outcomes

WCRI Recap – 3 Part Series

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

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

 

 

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

 

 

Single Biggest Factor That Impacts Claim Outcome

 

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

 

 

 

How Does Supervisor Respond to Injury?

 

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

 

 

 

How Does Insurance Adjuster Respond to Injured Worker?

 

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

 

 

 

Do You Think…

 

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

 

 

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

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

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

 

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

 

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

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de