Lowering Workers Comp Best Practices – Follow Up Q&A

Lowering Workers’ Comp Costs – Best Practices webinar attracted over 750 industry professionals, including employers, risk managers, safety directors, brokers, consultants, or producers involved in claims management, specific aspects of cost containment, and/or, the latest workers’ comp strategy issues. The webinar was jointly hosted by Advisen and Amaxx Risk Solutions.

 

A panel of experts speakers, California Pizza Kitchen’s David Williams, Blackstone Consulting’s Mark Newman, Arthur Gallagher’s Bob Walker, Amaxx Risk Solutions’ Rebecca Shafer and Michael Stack, and Advisen’s Dave Bradford, discussed how organizations, big and small, can hone their injury procedures in order to significantly reduce their workers’ comp expenses by applying proven workers’ comp best practices.

 

It was a fast moving event that generated a number of questions.  Here are some of the questions and answers:

 

Q: What are some examples of red flags of fraud?

A: A couple are: claimant moves out of state, claimant is never home, claimant IS home but doesn’t answer phone, claimant’s recovery is longer than the duration guidelines indicate. This is just a few of many. Chapter 15 covers this in great detail and discusses ways to control fraud and abuse.

 

 

Q: How are ADA AA-related (American with Disabilities Act Amendment Act) concerns and activities managed from a Risk Management perspective? What are you advising clients about their legal obligations under the Act?

A: These can be tricky, and state laws can have more stringent requirements than the ADAAA which is federal. My initial response to this question was removed temporarily while we consult the EEOC regarding exactly when an employer’s duty to begin the interactive process to accomodate an injured employee with a transitional duty assignment attaches. Stay tuned. In the interim, the RM department needs to work with HR and Legal to ensure that they are compliant with ALL laws. Once the employee reaches MMI, and in some cases even before that while the employee is on transitional duty, there needs to be an interactive process between employee and employer to determine whether an accommodation is feasible if the employee requests one. Chapter 11 covers this topic.

 

 

Q: Are we suggesting that reporting can be done directly to a triage nurse instead of the traditional carrier input personnel?

A: Yes, in the injury triage program for California Pizza Kitchen, Medcor is the initial point of contact for all claims and everything funnels through them. In this way, all injuries get assessed and on the right track for treatment and reporting. Any information that is not initially available at the time of triage is obtained later by the TPA (as is the case with any reporting process).

 

 

Q: What are the two benchmarks that Becky was using?
A: I like my clients to reduce their incurred losses 50% of the National (or industry) Cost Per FTE ($754) and 90% -100% of injured workers returning to work within 1-4 days after the injury.

 

 

Q: You asked about “Direct to Specialist” Medical Programs.
A: The issue of better care versus cheaper care, is always a hot topic. I would whole-heartedly endorse such a program, even though it might take legislative changes in many states, but it is something I encourage employers to consider as part of their selection of medical providers. Direct to Specialist Programs work best when an employer has in onsite clinic or medical clinician, or an injury triage service for intake.

 

 

Q: Are saving based on incurred or paid losses?

A: Savings are based on Total Incurred Losses as of the same date every policy year. It is an apples-to-apples comparison. We start measuring immediately when we start the program development. 2 months after we begin versus 2 month in prior policy year (or two policy years, etc.) then 3 months, then 4 months, etc. We measure as we go along so if we are not seeing a reduction (this has never happened), we can tweak at that point not wait until we are 12 months down the road to make adjustments. I hope this helps.

 

 

Q: Our Unions in California really push our employees to get attorneys. What can we do about that?

A: I am pretty familiar with problems in CA and have recently been speaking with an IW (injured worker) to find out more about the problems from the IW perspective. Cost of WC claims rises dramatically when IWs hire attorneys. In addition to the cost to the employer, the IWs are not necessarily better off working with attorneys in CA because many give inadequate service and prolong the claim. Also, I have not been impressed with level of care the Information & Assistance Officers provide to IWs.

 

The best way to keep the IW from getting legal representation is to remove all of their possible issues…including:  make sure they get rapid, excellent medical care and the doctors get paid. Stay in touch with IWs constantly — starting with a tight post injury procedure, get well card, transitional duty ASAP, weekly meetings, etc.

 

Being in an MPN is not enough as many MPNs have inadequate coverage. Don’t focus on medical cost control, focus on “how can we provide our IWs with better medical care” even if you pay more for it! For example, don’t allow all treatment requests to go to UR. Does a request for $5.00 Pepto-Bismol really need UR? Make sure in your Account Instructions, you let the TPA know to accept reasonable requests for care, not send everything to UR. You need to WRAP YOUR ARMS AROUND THE INJURED WORKERS, literally, and they will have no need to get legal advice.

 

 

Q: Rebecca talks about benchmarking by looking at the number of employees currently out of work. Does she look at entire history of company and # of employees out or does she take only a current employment census, looking at the current fiscal year.

A: I look at the number of employees OOW (out of work) right now. Of course if you look at it historically and your number of man-hours has gone done, but the number of employees OOW has gone up, that is indicative of a problem, but basically — how many employees OOW NOW tells how big a problem you have. Of all injured workers, 90-100% should be back to work within 1-4 days. Thus, most claims will be small medical-only claims.

 

 

Q: Your questions was about the Cost Per Employee, whether an employer with part-time and full-time employees can use that measurement.

A: The Cost Per FTE (full-time equivalent employee) is based on man hours, thus it equalizes full-time and part-time employees to “equivalent employees” that’s why it is a good measurement for employers with both full-time and part-time employees.

 

 

Q: Your second question was what measurement is best to figure out effectiveness of the RTW Program.

A: The Return to Work Ratio is the best way to measure your success in bringing people back to work. Some carriers RMIS will give you the RTW ratio in increments of days…. you want 90% -100% of injured employees back to work within 1-4 days. The Workers Comp Tool Kit has a calculator for the RTW Ratio if your carrier does not provide that measurement. More information about this is available from mbastone@advisen.com

 

 

Download and listen to the webinar

 

 

For more in-depth answers to these and other questions, reference “Your Ultimate Guide to Mastering Workers’ Comp Costs – Reduce Cost 20% to 50%”.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

Five Ways Employers Reduce Attorney Fees and Legal Costs in Workers Compensation Cases

Workers’ comp legal defense expenses are increasing at an alarming rate. For instance, California Workers Compensation – Aon Advisory Bulletin from a study by WCIRB of California, said allocated costs (mostly attorney payments) increased 7.3% in 2013.”

 

Overzealous defense counsel and untrained (or spineless) adjusters can prolong litigation, increase costs and wreak havoc on the lives of injured workers. Let’s take a look at how risk managers can more closely manage the process.

 

 

1) Review outside counsel financial arrangements.

Consider capped fees, flat fees, or “invoice paid upon file completion. The latter allows outside counsel to defend the claim but discourages runaway fees for unnecessary hearings by having the entire fee paid at the end. With just one bill instead of monthly bills, excessive fees are more noticeable and easier to compare against other cases and law firms. It makes attorneys who are milking the claim more visible.

 

This is a good approach if you use the same attorney frequently.  However, this approach should not be used in a locale where the defense counsel only has one case.  You could end up with an excessive bill with little recourse other than fighting over the bill.

 

 

2) Conduct an independent audit to assess whether an attorney was needed in the first place, or whether they have just been assigned the case to do work the adjuster was too busy to do.

 

A favorite ploy of overworked or lazy adjusters is to let the defense counsel handle everything.  Don’t pay a lawyer to do the adjuster’s job.  An independent claims audit will uncover any such problems.

 

Are the same attorneys requesting hearings on the same issue repeatedly or requesting hearings on issues they are likely to lose? E.g. if terminated benefits are often reinstated at hearings, it indicates that benefits are being terminated without sufficient cause. This is one example of “churning.”

 

Churning is any activity for the sole purpose of increasing the legal bill. It can include unnecessary research, motions and discovery; having another attorney in the firm review the case; and having a paralegal or associate undertake an unnecessary action. Before the hearing, the adjuster should discuss with the attorney the need for the hearing, and the probable outcome. If you know you are going to lose, have counsel resolve the issue with the opposing counsel instead.  It will save both legal fees and unnecessary claim cost (indemnity and medical costs continue while you wait for the hearing).  You’ll move the file faster, at lower cost, to resolution.

 

 

3) Review whetheropportunities for agreement” between counsel are ignored.

For example, in Connecticut a claimant’s doctor can be changed with agreement of counsel, but defense lawyers never agree because it is more profitable to have a junior attorney attend these hearings.

 

Knowledgeable defense counsel will know which doctors are over-treating and over-rating disability, which doctors are known for unbiased treatment and ratings, and which doctors are conservative in their treatment and ratings.

 

Does defense counsel make unfounded accusations of misbehavior or wrongdoing against claimants on every claim to obfuscate issues and prolong the litigation? If your lawyer is not totally objective in assessing both the claim and the claimant, get someone else.

 

Red flag research charges. Very little legal research is necessary except in unusual claims.

 

 

4) Adjusters – with sufficient authority – should attend all hearings with defense counsel.

Sometimes there are opportunities to settle litigation during hearings. Often, seasoned adjusters are capable of attending hearings without a lawyer. This is not allowed in some jurisdictions.

 

 

5) An employer representative should be available to testify about job requirements and transitional duty.

To verify you are controlling your legal fees, have a litigation management review by an independent claims auditor to determine the effectiveness of your adjusters in controlling legal expenses.  Second, have an experienced legal bill auditor review legal invoices.

 

 

 
Rebecca Shafer is an expert in workers’ compensation cost containment and the author of 2015 Ultimate Guide to Mastering Workers Comp Costs: Reduce Costs 2%-50%. Shafer has developed training programs for organizations of all sizes to reduce workers’ compensation costs 20%-50%.  Her clients have included CVS, The New York Times, Knight- Ridder, Cablevision, Wyeth, First Group America and many others. She can be reached at Rebecca@WCManual.com or 860-553-6604.

 

 

 

 

Use Vocational Coordination When Employees Are Unable To Return to Work

The Need:

 

There are the claims where the employee will not be able to return to the original job they held at the time of injury.  This may be due to physical disabilities, environmental conditions, or medical restrictions.    As soon as this becomes evident there is need for vocational rehabilitation coordination.

 

Most jurisdictions have some provision for vocational rehabilitation in their workers compensation laws.  Some states have departments devoted to it.  Others require the employer to provide it.  Some states are very proactive and have benefit adjustments and require compliance from employee and employer.  At the same time other states may take mediocre or no actions at all.  As stated by Workers Compensation Judge and Medical Fee Review Hearing Officer, David Torrey, “Oddly, in Pennsylvania, we have no such provision.  In reaction, the Supreme Court created same via common law (1987), but same was abolished in 1996 by the legislature. As to the lack of vocational rehab in PA, see Torrey, “The Common Law of Partial Disability and Vocational Rehabilitation Under the Pennsylvania Workmen’s Compensation Act: Kachinski and the Availability of Work Doctrine,” 30 Duquesne Law Review 515 (1992).

 

There are professional vocational counselors working with workers compensation cases. Some work for the state. Others are employed by private vendors and some are available for use by employers.

 

Most Vocational Counseling Experts are former Registered Nurses, Physicians Assistants, or Nurse Practitioners.  They work with the doctor in determining the Functional Capacity Evaluation.  They seek jobs with the employer or the open job market which meet these Functional Capacities.  They arrange for necessary formal educational needs and costs. They obtain appropriate prosthetic devices.  They may provide some forms of physical-therapy or other minor medical attentions. They arrange for home modification when needed.

 

Due to the length and complexities of Vocational Rehabilitation, it is becoming more important to have someone perform as a coordinator between the employer and the Professional Vocational Counselor.

 

 

Vocational Coordinator:

 

A vocational coordinator provides oversight and expedites the vocational program on behalf of the employer.  The coordinator works with employer, employee, claim adjuster, vocational counselor, and the medical provider to determine the need, and a plan of action that best warrants returning the employee to gainful employment.   The counselor will have strong experience and background in workers compensation medical and claim management.

 

Protocols:

 

  1. The coordinator will know the employer’s business operations and employee policies.
  2. The coordinator will provide regular reports to the employer on vocational progress, will bring to attention any problems or issues related to claim handling, medical needs and employee compliance.
  3. The coordinator will ensure the employee receives excellent care, and that requests for rehab are not unduly submitted to UR. For example, if an employee wants a cane for $20, it is in the best interest of both employee and employer to provide the cane.
  4. Will be in continued contact with the counselor to be sure the agreed plan of action stays on a timely and progressive movement toward conclusion.
  5. Will resolve any issues between employee, employer, vocational counselor, medical provider and claim adjuster.
  6. Will keep adjuster apprised of vocational costs in order to have proper reserves
  7. Will provide vocational progress reports to claim adjuster to report to re-insurers.
  8. Constantly monitors vocational rehabilitation for compliance with state law and reporting.
  9. Supplies reports on vocational rehabilitation cost and evaluation that may impact funding or insuring renewals.
  10. Recognizes the claim where vocational rehabilitation is not cost effective and
  11. Intercedes on behalf of the employer to avoid costly exposures, and suggests with the employer and claim adjuster alternate plans of disposition.
  12. Keeps the claim file posted on all activity for proper documentation.

 

 

Conclusion:

 

There are claim where the employee requires vocational rehabilitation.  This can become a heavy expense to the employer if left unchecked.  The Vocational Counselor usually may not have the employer’s best financial interest in focus.  A Vocational Rehabilitation overseer acting on behalf of the employer is a must in today’s complexity of workers compensation claim handling.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

Communicate, Communicate, Communicate, With Doctor And Injured Worker

As a business owner, there are times when there is nothing you could have done to prevent an employee injury.

 

According to OSHA information:

 

  • Every day, more than 12 workers die on the job – over 4,500 a year;
  • Every year, more than 4.1 million workers suffer a serious job-related injury or illness.

 

Running a business takes much time and effort, but one area of focus that can oftentimes be overlooked is the follow-up time needed to make sure injured workers are recovering properly. If they are not, it ends up costing your business more money.

 

One way to make sure your injured employees are receiving the best care possible is to stay in regular communication with your employee and stay on top of their recovery efforts.

 

 

Develop a Relationship With Medical Professionals

 

It is common that many business owners fail to visit the medical professionals to which they refer injured workers. In dropping the ball on this important task, they miss out on the chance to integrate medical services into their workers compensation cost containment program.

 

So, why do many employers fail in this arena?

 

In a number of cases, they are at a loss as to what to search for and  they do not know what questions to ask.  They can also be under the assumption that the claims administrator has put the relationship in place so a personal one-on-one visit is not needed, or they simply do not understand this is an important best practice.

 

It is best to come up with and adhere to guidelines to meet with your medical providers, including personal visits.

 

 

Relationships are Important

 

The reasoning behind such visits is to formulate a relationship with the doctors who are responsible for treating your injured employees.

 

Face it; the medical personnel must know you are a caring business owner and are as concerned about the health of the employee as the doctor is and that you are a partner in the worker’s rehabilitation.

 

A face-to-face meeting is crucial to establish rapport and to demonstrate you are open to be held accountable for your employee’s recovery. You are holding them accountable, so you must also be accountable so the relationship is viewed as a partnership.

 

With the meeting in place, you should be able to confirm that the medical facility chosen for treatment is a high quality to provide a range of treatments.  If not, your post-injury response should incorporate methods to access off-site treatments when required.

 

Hours of operation are important too. Check to confirm that they are they open the hours your employees are likely to be injured.

 

 

Invite Medical Provider To Your Facility

 

Medical provider visits give you a chance to offer your contact information, go over in detail what your business does, demonstrate what forms of transitional duty are available and seek the medication restrictions on the first visit with the employee.

 

Fees are not as important as the other criteria, as paying a little more for better results is fine.

 

Lastly, the medical providers should be welcomed to your facility to view what you do, meet with your staff and see potential transitional duty assignments.

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

 

 

Cavalcade of Risk #217, Top Risk Posts From The Blogosphere

The WC Roundup is proud to be hosting the 217th Cavalcade of Risk.  This bi-weekly blog is a collection of risk-related posts covering topics from finance, to insurance, to health.

 

 

The Audacity of Dope

Blog:  From Bob’s Cluttered Desk, http://www.workerscompensation.com/compnewsnetwork/from-bobs-cluttered-desk/

Author: Bob Wilson

A court in New Mexico has decided that an employer must now pay for medical marijuana for one of its injured employees. Does this represent an inevitable trend?

 

 

Commercial Auto Insurance: Time For Underwriting Profit?

Blog: The Dec Page, http://thedecpage.com

Author: Paul Dzielinski

Commercial auto underwriters have had a hard time making an underwriting profit in recent years. Is the market turning at last?

 

 

Will Obamacare Increase the share of Part Time Workers

Blog:  Healthcare Economist, http://healthcare-economist.com/

Author: Jason Shafrin

Will Obamacare increase the risk that employers hire only part-time workers to avoid expensive health insurance costs?  The Healthcare Economist investigates.

 

 

On Medicaid expansion poor states are subsidizing rich one

Blog: Health Business Blog, http://healthbusinessblog.com/

Author: David E. Williams

States opposing Obamacare sued for ideological reasons, so when the Supreme Court upheld the law but said Medicaid expansion couldn’t be forced on them, they decided to opt out. That’s led to an ironic situation where poor states are voluntarily subsidizing rich ones. It’s kind of like what happens with state lotteries, except in this case it’s all risk with no chance for reward.

 

 

RISK & INSURANCE

Blog: Insurance Morality, http://www.insurancemorality.com/

Author: Francis Winters

My blog is new and will be dedicated to teaching the public the basics of auto insurance and its importance.  This blog post explained the very basics of how risk is used to evaluate an auto policy.  I try to keep my terms easy enough for the average person to understand so the public learns how there rate may be formulated.

 

 

I.I.I. Report: Actuarially Sound Rates Key To Residual Property Market

Blog: Terms+Conditions blog, http://www.iii.org/insuranceindustryblog/

Author: Claire Wilkinson

Just in time for the peak of hurricane season, an updated I.I.I. paper on the residual property market is hot off the press. The I.I.I. warns that a major hurricane could expose residents in certain states, many of whom live nowhere near the coast, to billions of dollars in post-storm assessments.

 

 

Of Risk Stratification, Health System Variation and “Stupid” Decision-Making

Blog:  The Population Health Blog, http://diseasemanagementcareblog.blogspot.com/

Author: Jaan Sidorov, MD, MHSA

In this post, Dr. Sidorov builds on a just-published editorial to ask if the emerging science of risk stratification will increase health care variation and enable health care consumers to make a “wrong” decision.

 

 

Calling a dog’s tail a leg does not make it a leg

Blog: Workers Comp Insider, http://www.workerscompinsider.com/

Author: Julie Ferguson

At Workers Comp Insider, Julie Ferguson looks at some recent court rulings that dealt a serious blow to the FedEx premise that its ground drivers are independent contractors, an important decision that could have wide-ranging repercussions.

 

 

Remember What Mama Taught You For Work Comp Claimant Success

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

Author: Michael Stack

Dealing with injured workers can create many challenges for claims professionals and defense attorneys.  These difficulties arise from a number of factors and are a reality of the adversarial workers’ compensation system.  It is important to remember this issue when dealing with claimants.  This article contains some tips that can help your practice handle claims in an effective manner.

 

The next cavalcade of risk will be hosted by David Williams (http://www.healthbusinessblog.com/)

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 

 

Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

Is Your Comp Medical Provider Brochure Complete?

If it seems like there is a never-ending trail of paperwork and computer files to go over, that is likely the case.

 

One of the many facets of running a business is looking out for your employees, especially there physical well-being. It is almost a given that some of them will suffer some sort of injury while under your employ. As a result, it is critical that you have plans in place to quickly and effectively treat them.

 

With that in mind, it is more than a good idea that you have in place a brochure for the doctors and clinics that will ultimately care for your injured workers.

 

Make sure these 10 items are part of the brochure:

 

  1. Company description – This can be brief, but should be an overview of what your business does;
  2. Company location – In the event the company is nearby, it doesn’t hurt to encourage provider visits;
  3. Company job descriptions – This is where you want to explain the original work that was undertaken;
  4. Company description for transitional duty program – In this arena, be sure to include the purpose behind and importance to your business;
  5. Company necessity for medical limitations/abilities on initial visit – Keep in mind that this is very important so that the claim does not turn into a lost-time claim;
  6. Company sample transitional duty job descriptions – Here is where you describe possible modifications and alternative positions as examples. Make sure you are clear to customize positions to fit whatever restrictions are in place;
  7. Company how-to-referral specialists – The goal here is to provide an easy process;
  8. Company procedure on paying bills – It is important to make sure the treating physicians know that their bills will be paid promptly and the procedures for such. In the event you offer extra pay for extended office visits, be sure to mention that. Instead of decreasing the bills, look at paying a little more to receive the quality care your employees’ need and is required to place them on transitional duty;
  9. Company medical advisor, RNs, PT, etc. on-site or on retainer. Doctors respond the fastest when contacted by fellow physicians. Best practice companies typically have in-house medical advisers or part-time contract medical advisers. Both prove cost-efficient. In addition to letting you to get accurate restrictions in a fast manner, establish causation (or not), having a medical advisor can also work to deter workers who may be trying to malinger or exaggerate said symptoms;
  10. Company contact info for Adjuster, Work Comp Manager, Medical Advisor -including phone, fax and email – Last but not least, companies need to avoid missing the chance to set the stage with the medical professionals that treat their workers. Up front planning can make the medical treatment portion of a claim much smoother and ultimately more effective.

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

 

 

Reducing Workers’ Compensation Costs through Managed Care

In the quest to reduce costs and maintain the quality of care an injured worker receives, managers of workers’ compensation programs seek the assistance of managed care programs.  By using managed care techniques, managers can provide quality medical services to injured workers, while at the same time promoting the objectives of their company.

 

 

What is a Managed Care?

 

The term “managed care” has been around in American society for quite some time.  In the 1970s, the term was coined as a concept to describe a methodology used to reduce the overall costs of health care benefits through organizations or techniques from organizations within the health care system.  At the core of any managed care program is the ability of a program such as workers’ compensation to finance and deliver services while at the same time meeting statutory requirements as set forth in law.

 

 

Managed Care through a Preferred Provider Organization

 

A Preferred Provider Organization or PPO is a type of managed care program that is similar to other network-based managed care program such as a Health Maintenance Organization (HMO), Private Fee-For-Service (PFFS) or Point Of Service (POS) program.  In the context of a PPO, in order to remain competitive, that organization must seek out medical facilities that will provide medical services at a discounted rate.  These medical facilities are able to offer such discounts based on the volume of clients and the number of people they serve.  While services are typically only offered at “preferred” medical facilities, the standard of care is the same based on the ethical obligations of medical providers.

 

 

Features and Advantages of PPOs

 

PPOs generally evaluate the need for ongoing care based on utilization review of medical services and care provided to an injured worker.  The use of utilization review examines the nature and extent of an injury and analyzes the care one typically would receive based on information collected over a long period of time.  The use of utilization review is especially important when it comes to the use of narcotic pain medications and diagnostic procedures that continue to be a driver of rising medical costs.

 

Unlike other forms of managed care, PPOs maintain their advantage as follows:

 

  1. Membership tends to provide substantial discounts for routine medical services;
  2. Networks create a number of options, including primary care doctors and specialists for injured workers to receive medical care and treatment;
  3. Treatment received outside a PPO network is generally not as expensive when compared to the same care received in other managed care formats;
  4. They have broader networks than HMOs and allow injured workers to receive care within a greater geographical area.  This is especially helpful to employers with workers in rural areas.

 

Conclusions

 

Although workers’ compensation claims in general have been in a decline for the last few years in the United States, employers and insurers are seeing a steady uptick in more severely injured persons.  As a result, effective workers’ compensation programs need to be creative in how they approach the complex claims environment to control costs, which is really the bottom line for any programs.  By using a Preferred Provider Organization, claims and risk management teams are able to address these issues without sacrificing the quality of care an injured worker receives.

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Get The Most Out of The 2014 National Workers’ Compensation and Disability Conference®

Come join us November 19th–21st at Mandalay Bay in Las Vegas at this innovative conference. There is truly no better place to find solutions to your workers’ comp and disability management challenges.You will get proven guidance from top industry professionals and ample time to network.

 

The 23rd annual conference offers breakout sessions for

  1. Claims Management
  2. Medical Management
  3. Program Management
  4. Disability Management
  5. Legal/Regulatory Issues

 

The expo features a host of exhibitors ready to answer your questions and demonstrate the latest products and services available in the workers’ comp and disability industries.

 

 

Among the highlights will be:

 

Integrating Employees’ Health and Well-Being to Improve the Bottom Line

 
Medical Case Management: How to Position Your Program for Best Outcomes

 

Strategies for Overcoming Operational Challenges and Benchmarking Program Performance

 
Apply Post-Loss Claims Data to Structure Your Pre-Loss Safety Culture Program

 

Risk ScenariosTM Live! Navigating the Challenging Claim

 
Going Beyond a “Hunch”:How Analytics and Predictive Modeling Can Identify and Prevent Drug Abuse

 
Healthcare Reform: Strategies You Can Apply Now

 
Harley-Davidson Saves $3.5 Million Through Injury Prevention, Management Program

 
Ethics for HR Specialists, Risk Managers and Claims Adjusters

 
Improving Outcomes: Cost-Effective Expedited Processes and Communications

 
Approaches to Managing Nontraditional Claims Including Unions, Legacy Claims and Co-Morbidities

 
The Industry’s Top Bloggers Return to Inform and Entertain

 
Loss Mitigation of High Value Workers’ Compensation Claims

 
Managing the Maze of ADA, FMLA and Workers’ Comp

 
Top 10 Ways to Reduce Your Legal Expenses NOW

 
Continuing Education Credit: The conference is routinely approved for AAOHN, CDMSC, CCMC, CRCC, CWCP and HRCI credits – so you know you’re getting quality education.

 

 

These are our tips for getting the most out of this important national conference:

 

Attend the Opening Session

Don’t miss this because L. Casey Chosewood, M.D., Senior Medical Officer, Director, Office for Total Worker Health Coordination and Research, for the National Institute for Occupational Safety and Health will speak from experience about how health problems employees bring to work affect workers’ comp and disability costs. As a regional medical director who oversaw occupational health services for a multinational telecommunications giant with 30,000 employees, he saw the impact firsthand. Now he’ll show you how to reduce that impact and lower costs by integrating the traditionally segmented roles of occupational health and safety with health promotion and post injury management — a tactic already adopted by some large employers but that can be implemented in an organization of any size.

 

Focus on specific goals

For example, attend all the sessions in the track that will bring the most value to your program.

 

Read the brochures

Read the brochures when you return home to learn about service providers.

 

Pass out your business cards

Pass out your business cards and network, network, network. Meeting knowledgeable people gives you resources to use when you encounter a problem.

 

Learn what you don’t know

Being exposed to new ideas presents an opportunity to learn things you don’t even know you are missing!

 

Chat with people

Chat with people who do the same things that you do and see where you differ.

 

Ask about key cost drivers

Attendees come from organizations of varying industries. Find people who work in workers’ compensation departments you know next to nothing about. Ask them whether they are satisfied with their workers’ comp vendors. Ask them what drives their costs.

 

Roam through the exhibit hall

Speak to vendors and learn about the types of services that are available to reduce workers’ comp costs. THIS will be the best education you will ever get!

 

Wear comfortable attire

Bring comfortable shoes. The first day, people are a bit more dressed up than the following days. The last day is more casual because people are traveling back home. Definitely dress professionally because some of the people you meet with become lifelong contacts, so making a good impression is important, but you can be comfortable, too. For an ounce of prevention, bring moleskin to protect your feet from blisters.

 

Join the group breakfast

Join the group breakfast to network with new friends. You will find people are very friendly and helpful.

 

Keep your materials for future reference

You may want to have this handy on your desk for the time you want to try a new service or ask a question about a new service. Or, if you are putting out a request for proposals, this will be your ultimate list of those companies to bid on your project.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

Communicate Your Work Comp Program So Employees Use It

Having a great workers’ comp program is meaningless if your employees don’t know about it and use it. To get your employees to know about the program, you have to tell them about it, not just once. After initially delivering the information about your workers’ comp program, you need to reinforce and remind them of its importance. And it is not enough that the employees know about it, they have to be willing and able to use the program you have in place. All necessary information must be readily and easily accessible to all your employees and so familiar to them that they instantly know where to find all necessary information.

 
Make the Message Fit the Environment

 

Design your workers’ comp materials to fit the environment. A printed brochure may work for clerical employees who work at a desk and can put them in a file folder. But will a brochure work for a factory floor worker without file space? Probably not. A brochure handed to that worker will likely end up in the round filing cabinet, i.e. a waste receptacle after being piled somewhere with other papers.

 

Think about where your employees work, take breaks, gather and socialize when thinking about how and where to communicate your workers’ comp messages. The delivery of information must take into consideration the location where the communication is occurring. An auto visor packet might be good in a company vehicle. Wallet cards might be good for employees who go into the field. Signs near water coolers and restrooms are good reinforcers. Lamination of the materials is important where there is the potential for dirt or moisture in an environment that can ruin plain paper.

 
Combine Methods to Maximize Impact

 

Think about how you want to deliver your message. Using a combination of methods may be the best way to continually drive home your messages. For example, you may want to hand out or mail brochures to new employees with an annual update. Then you can also put up posters throughout the work area and in break rooms, give employees wallet or lanyard cards, and put a zippered three-ring mobile folder in all vehicles and toolboxes.

 

Another constant reminder is a sticker label to be put on telephones. This way the name and numbers of who to call when there is an injury or a claim is called in are immediately accessible to those making the calls.

 
Tailor the Message to the Audience

 

Think about your audience when designing your message materials. Do you have non-English speaking workers? Then your materials should also be translated into their first language. Are your employees eighth grade or college graduates? Make sure that your messages are clearly communicated in the simplest language possible. Don’t use several ten-dollar words where one ten-cent one will work. Your materials for your supervisors and upper management can be more in depth than is needed for your line workers. Also, the materials in your employee handbooks and safety plans can have much more detail than is needed in your program posters and wallet cards.

 
Make the Messages Easy to Read

 

Are your materials well lit and in big and dark enough font to be easily readable? As any middle aged worker in desperate need of reading glasses will tell you, they cannot see the same font size in a lighter color or that is against a non-contrasting background. Test their readability before their final printing. A clearly worded message won’t be read by employees who can’t easily see it.

 

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

How Well Are Your Claims Performing?

Keeping tabs on your financial books is probably the utmost important task for any business owner and/or organization.

 

In the event you are “loose” so to speak with the books, you can quickly find you and your company or organization in quite a financial pickle. With that said, not only should you be measuring the financial performance of the business you oversee, but also that of your employees and quite frankly yourself.
On way to go about making sure you’re properly self-measuring your performance in the workers compensation arena is by setting a number of benchmarks.

 

In the event you hit or surpass those benchmarks, things should be in good hands for you. If not, you certainly by all means have some work to do.

 

 

Review Your Efforts

 
As part of what should be in an annual “review process” for your business or organization, review your financial numbers and overall work performance. If things are not where they need to be then set a goal by the time your next review arrives to get them there or beyond.

 
Among the benchmarks to look at:

 
Claim Financial Benchmarks – With this, review the changes in the average claim expense. Use a comparison of the typical expense for medical benefits, indemnity benefits and claim expenses. The data should not be hard to obtain, and it gives you the ability to compare your claim expense with the prior month and quarter, along with the previous year among other time periods;

 
Average Claim Expenses Within the Industry – One facet you want to key in on is your typical claim cost is representative of others in your business sector. When looking for relative data, keep in mind that a number of bigger TPAs and sizable workers comp insurers have a portion of data available. The National Council on Compensation Insurance (NCCI) does gather payment statistics in the 35-plus/minus states wherein they are active;

 
Ratio for reserves and payments (three months before closing) to final claim expense – When you compare what the adjuster has compiled for reserves along with claim payments made three months before the claim closing date, with the final figure paid for the claim, you can better determine the accuracy for your large claim reserve. [Exclude the claims closed in less than 180 days]. The ratio of reserves along with the dollars previously paid on the claim, to the final claim cost should be about 1.0. In the event the ratio is below 1.0, the overall claims are under reserved. If the ratio is higher than 1.0, there is on average additional funds sitting in reserves.

 

 

 

Claim Handling Process Benchmarks

 
While there are a variety of options to gauge your claim handling, here are some suggestions for measuring claim-handling performance:

 
Average bill process time –Here you will have a comparison of days between the date the medical bill, legal services bill or other cost was obtained in the claims office, and the date the payment in fact was processed. This permits you to measure the timeliness of your bill payment process and gauge the progress provided by your staff.

 
Closing ratios – This is the ratio of files open during each month, quarter or year in comparison to the files closed during the same time frame. The goal here is for a figure of 1.0 or better.

 
Percentage of closed files with payments higher than $1,000 – This indicator is set to make the claim office honest on the closing ratios. Unfortunately, it is too easy to manipulate closing ratios, so this gives you the claim office close files prematurely when the number of closed claims with payment increases.

 
Average time to input initial reserve – Even though different claim offices have different standards as to how quickly the initial reserve should be in the computer system, by comparing the present average length of time to a previous month, quarter or year, you can gauge how soon the adjusters are inputting initial reserves.

 
Files on diary – This involves measuring the files that are being actively worked on the diary. Ideally, the claim office has every file on diary to prevent the files from stagnating.

 
Files with missed diary – This benchmark can in turn be a list of the files where the diary has not been updated the diary due date has passed, or it can be a percentage of the files for a claim handling due date that has since expired. This provides you with insight into how current the claims office is in when it comes to handling of the claims.

 

 

Your company’s claims’ performance should always be of importance to you.
If you are falling behind in this arena, you very well could see your financial books go from black to red in a short amount of time, something no business owner or organization will want.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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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