Most workers' compensation managers do not think twice about the workers' comp claim for the employee stung by a bee or bitten by a flea. It is usually a first aid only claim or at worse, a medical only claim, right? Wrong! While the majority of claims for biting and stinging insects or spiders (spiders are not insects, they have 8 legs and are technically classified as arthropods) will be minor, there can be some nasty injury claims, especially from spider bites or multiple bees/wasp stings.
Employees that work outside like construction workers and landscapers are the most likely to encounter a bite or a sting, but warehouse workers and others who work around products or inventory where items sit stationary for a while can come into contact with insects and spiders. While office workers, retail employees, and other indoor occupations have less exposures to bites and stings, the risk manager needs to be sure the people in pest eradication do the job, or even office workers can encounter a bite or a sting. (WCxKit)
People often refer to insects and spiders as poisonous, but all insects and spiders are poisonous only if they are eaten. What they are is venomous. Insects and spiders normally inject a venom into the victims either through a bite or a sting. It is the venom that creates the work comp claim, not the actual bite or sting itself.
Rarely are bites or stings serious enough to require hospitalization or are deadly, but there are known cases where people with weak immune systems, elderly or very young children have died from bites or stings. Spider bites create the most work comp claims, especially bites from brown recluse, black widow, brown widow, and hobo spiders.
When a venomous spider bites an employee, the employee will immediately know they have been bitten (has been described as feeling like an unannounced flu shot). The symptoms usually start to develop within a few minutes, but can take hours or days depending on the amount and type of venom. Symptoms will often include pain, burning sensation, itching and swelling. Other symptoms can include vomiting, dizziness, cramps, diarrhea, rash and breathing problems. Anxiety can be a side effect.
An example of a spider bite claim is the truck driver at a warehouse in Washington State assisting in loading the trailer. A few hours later while driving through Idaho, he felt what he thought was a hornet sting on his leg, as he observed hornets in the warehouse. He pulls over at the first opportunity and checks his leg. He sees a small red spot. That evening he checks the spot and it has grown to the size of a quarter. The second evening the spot is the size of a golf ball. When he woke up in pain on the third night, he had a baseball size knot on his leg that was beginning to split open. He goes to a hospital emergency room where it is surgically necessary to remove the baseball size tissue. The trucker is treated for systemic toxicity. He is advised he has been bitten by a hobo spider (located in the northwestern USA). And if he waited another day for treatment he could have died. The tissue around the wound continued to die, requiring daily debridement and wound cleaning for the next couple of weeks, followed by less frequent debridement and wound cleaning. Once the wound stabilized, the trucker had to undergo a skin graft and the time necessary for healing and a total medical expense of $15,000 with 3 months of indemnity benefits.
While a venomous spider can create a serious wound, a single hornet does not. The only trouble is when an employee gets stung by a hornet, it is usually not just one hornet. The whole hive can become agitated resulting in the poor employee getting multiple stings. A Florida landscaper was trimming an overgrown hedge when the hedge trimmers went right through the center of a hornet hive. The landscaper received multiple hornet stings. Having been previously stung by a hornet, the landscaper had an almost immediate allergic reaction including difficulty breathing, difficulty swallowing, dizziness, and fainting. He was rushed to the local hospital where a tube was placed down his throat to allow him to breathe, and he received an antihistamine and a corticosteroid.
For the risk manager, there are steps that can be incorporated into the overall safety program to reduce (but not eliminate) the risk of bites and stings. All buildings, whether an office, a factory or a warehouse, should be regularly treated by trained pest control personnel. Any openings or crevices in older buildings should be plugged, caulked or sealed to prevent insects and spiders from coming in from the outdoors. Employees working in warehouses or other storage facilities where spiders might live should be provided gloves when handling of merchandise is required. (WCxKit)
Many bites and stings can be avoided by teaching the employees to be vigilant. Also, the employees should never place a hand where it can not be seen (underneath an item to be picked up for instance) without checking for insects and spiders. If the employee is going to be often exposed to insects and spiders, for example like the landscaper, proper clothing and gloves should be provided to protect them from exposure to bites and stings. When an employee is bitten, the best thing to do is call Nurse Triage immediately to determine what type of care is needed – emergency care or occupational clinic. Of course, for those employers with an on-site clinic, the employee will immediately be taken to the clinic for assessment and care.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website 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, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
Everyone has opinions on what workers comp is. Some are correct, but most are misconceptions. The commercials seen on TV about people collecting hundreds of thousands of dollars are not true for the average claim. When looking at the bottom of the screen it indicates that the people on the commercial are actors, not even the real claimants. Most of the marketing material surrounds auto and liability accidents, where pain and suffering is translated into a certain dollar amount. This is not exactly true in workers comp. There is no pain and suffering payment. Insurance companies/TPAs are there to provide reasonable and necessary medical treatment, and wage loss. Some states even allow a permanent partial disability payment, or impairment rating, on top of wage loss, but that is it.
Below we discuss the top 5 misconceptions surrounding the mystery world of workers compensation. Not all of these will apply exactly to every jurisdiction but are general. Remember to discuss with the adjuster and counsel any exact questions surrounding certain details regarding. (WCxKit)
1. Workers Compensation is not Welfare
Compensation is not a free payment a worker is entitled. Just because you are injured at work, it does not mean a guaranteed payment or coverage for medical/wage benefits. There are a lot of criteria to meet in order for a claim to be compensable. Even if the claim is compensable, it also does not mean anything can be done. Claimants have to play by the rules, and do as they are told by the adjuster. The adjuster must make the effort and take the time to explain to each claimant what the rights are, and what they can and cannot do. The biggest issue is miscommunication between the carrier/TPA and the claimant, so having an open dialogue will end any misconceptions that a claimant may have in regards to what their rights are, and what is covered; if indeed the claim is determined to be compensable.
2. Nobody gets rich from Workers Compensation
Depending on the jurisdiction, employees give up the right to sue in civil court in exchange for what are essentially no-fault benefits. Workers compensation pays lost wages, medical care, and vocational rehabilitation. Pain and suffering as an additional payment is not available or applicable to a compensation claim. The amount of money a person receives is a percentage of average gross pay. There are typically no increases for inflation, and each state has a maximum limit that a person can get per week as workers comp payments.
Michigan, for example, has a maximum rate of $742 per week. Wisconsin has $820 per week. So even grossing $2000 per week as an average weekly wage, that amounts to $820 per week in Wisconsin. High-wage employees that fall into this criteria are usually not very happy when they find this out, but the rules are the rules. These statutes are set up within the workers compensation system, and they have to be followed by all parties. Even if a claim is settled for a certain amount of dollars, it is typically not a retirement jackpot. It may end the exposure for the carrier/TPA, but these claims that settle for very high amounts of money are the result of a very serious, extremely disabling injury. And even those are few and far between.
3. Workers compensation benefits will be stopped if the worker declines reasonable employment.
If the employer offers up a light duty job, within the injured employee's medical restrictions, a claimant cannot refuse it and still get paid wage loss benefits. This opens a Pandora ’s Box, because an issue will come up about whether this light duty job is something an injured worker is trained to do, or is the job offer seen as an insult to their professional skills, etc. If there is a welder sitting in a chair staring at a clock for a job, then maybe a case could be made that this work is not a benefit to the company. For light duty jobs, they have to be deemed something that the employer gets a “gain” from performing, and almost all jobs within an employment facility can fall within these parameters. Certainly if you provide a degrading job that is of no benefit, then you may get into legal trouble. But in all reality I do not think any employer would take a risk in stopping a compensable case by trying to make a person sit outside and stare into space.
The bottom line is any light duty job, that provides a service to the employer, must be performed if it is offered to the injured worker. If the worker declines, then wage benefits will cease.
4. Workers comp fraud is extremely low
I would venture to say that actual workers comp fraud is less then 10% of all claims. And that number may even be high; I would go as low as 5% or less. For a case to be deemed as fraudulent, it must meet a certain criteria within whatever state statutes are in the jurisdiction. That is hard to meet, and most cases will not even come close to being worth the pursuit of fraud in a legal court case. If a certain worker is claiming to be out of work, and you get surveillance of them outside roofing their house, this may not make the case actual “fraud,” it falls more within the injured worker not following their medical restrictions and going outside of their treatment plan as deemed appropriate by their treating doctor. This will provide the adjuster with the ammo to dispute ongoing benefits, but not exactly to pursue the case as overall fraud.
Workers comp fraud, as a whole, is not a major problem within the worker comp system. Sure there are a lot of people that do not follow their medical restrictions, or they may miss doctor appointments, or ignore physical therapy demands, but this provides only a dispute for ongoing medical benefits, not fraud. There is a difference between the two. If you think you have an actual fraud case, you need to discuss it right away with the carrier/TPA and counsel before taking any such action to pursue official fraud in a legal venue.
5. The vast majority of workers comp claims are paid, and do not go to court
Generally, most comp cases are accepted, the injured worker gets treatment, and eventually goes back to work. The idea that someone stays home and avoids work when they are able to actually work is not the norm. Sure, there are those people out there who try to do what they can to avoid going back to work, but after an IME is performed, or after some surveillance discovers them being active out and about running errands, they are quickly flushed out and denied ongoing benefits.
Typically after a denial, and wage loss payments stop, these workers get on the wagon and get their treatment, so they can return to work and have their comp case end. Some will run to plaintiff counsel and try to get what they feel they are entitled to, and they will file for mediations and hearings, but the litigation usually is settled before a case is tried in front of a judge. Doctors can disagree on the causal relation of an injury, and this can speed up the case to go into litigation, but these cases are typically settled within 2-6 months. A low percentage of claims will stay in the litigation system, and go on for months or years, but these cases are usually quite complex and can involve several defendants and several employers, and that contributes to the complexity and the duration of the litigation. For the most part, on the normal workers comp claim that gets disputed and goes into litigation, these cases resolve themselves in the early stages of litigation and the files eventually close. But even those cases are not the common ones. The common claims are legit injuries, where benefits are paid and the worker returns back to work at full duty within whatever timeframe is needed dependent upon the severity of injury. (WCxKit)
Summary
Everyone may have heard of someone that tried to get away with milking the comp system. Most of these people are caught through good investigation, and their cases get resolved. The stereotype of work comp being a total pain can be true in some cases, but for the most part, work comp claims are legit, paid, and the worker returns back to work. There are always some exceptions, but if all parties communicate, know what their rights are, and know what they can and cannot do, their claims are resolved as quickly as possible and everyone can move on with their respective lives.
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 website 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, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
Often overlooked in the on-going battle to control workers compensation cost is the cost of prescriptions. Pharmacy Benefits Managers (PBM) offer the self-insured employer, insurer or third party administrator a way to manage and control the cost of drugs. While PBM provide a cost savings by obtaining a discount on the cost of drugs, the good PBM goes a lot further.
The PBM that will provide the best results is the one that keeps track of not only the cost savings provided, but also the utilization of prescriptions, especially narcotics. The better PBMs will alert the medical provider and adjuster when there is over-utilization of drugs. (WCxKit)
The PBM you select should have a national network covering most of the 70,000+ drug stores in the United States. The PBM should have a working relationship with the three major drug store chains which include CVS, Walgreens and Rite-Aid, as well as the local independent drug stores.
The effectiveness of the PBM can be judged by three different criteria which are the rate of use by the employees, the ease of use for the adjuster, and their technology interface ability.
The penetration rate is a measure of how extensively the employees use the pharmacy program. The PBM will often mail the employee a pharmacy benefit card with a cover letter on the pharmacy benefit card use. Most employees will opt to use the PBM card rather than out of pocket and then having to seek reimbursement. The adjuster should have the ability to suspend the use of pharmacy benefit card when the claim is denied or concluded.
The PBM should coordinate the prescription with the employee, the pharmacy and the medical provider without involvement of the adjuster. The easier the process is to use, the less the involvement of the adjuster. The better PBM will make the process totally seamless resulting in no involvement for the adjuster, while the adjuster can be assured the cost of the prescriptions and the utilization of the prescriptions is being properly controlled.
The PBM should provide the user of the service with the ability to review on-line all transactions and to obtain all necessary management reports. The technology interface should allow you to quickly know and understand the prescription drug usage of any employee. This will allow you to identify both the high cost employees and the doctors who prescribe the medications.
There are numerous ways the PBM can control cost. Some of the techniques used by PBMs include: (WCxKit)
-The use of generic drugs wherever substitution for patent drugs is permitted.
-A comprehensive, standard formulary specific to workers compensation injuries.
-A pre-negotiated price for each drug in the formulary.
-The ability to provide home delivery for employees who are unable to pick-up the prescribed drugs.
-Mail order services for maintenance drugs.
-The ability to approve or deny the “off-label” use of a drug.
-The ability to prevent consumption of drugs faster than manufacturer recommendations.
-The prevention of multiple, overlapping prescriptions from multiple doctors.
-The prevention of multiple pharmacies filling the same prescription.
-The prevention of filling non-injury related prescriptions.
The use of a PBM is a great way to reduce the cost of prescriptions and to lower their cost impact on your workers compensation program. To learn more about PBMs and how you can utilize their services to reduce your workers compensation cost, read the chapter on Implementing a Pharmacy Benefits Management Program in our new 2012 edition of Manage Your Workers Compensation Program, Reduce Costs 20-50%. To obtain your copy, please contact us.
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 website 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, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
A lot of employers strive to maintain a safer, more productive workplace for their employees. Every business would love to reduce costs and increase profit margins. The cost of claims can account for a big chunk of money losses, especially for the self-insured or self-administered employer.
So how do you get started? Where do you start, or better yet when do you start? The answer is RIGHT NOW, and here is how:(WCxKit)
1. Know where your risk lies
Observe your workplace. Go through department statistics and see how they compare to each other regarding losses. Perhaps 75 percent of your injuries occur in the shipping department. Go down there and talk with the supervisor. Find out what the issues are and why they think injuries are happening. Then work together to solve the problem.
Another helpful thing to look at is your loss run. Talk to your carrier or adjuster and see if they notice any trends in injuries. Which people are getting injured? Maybe newer hires account for a lot of injuries. This may show that a focus needs to be directed toward training and safety right from day one of employment.
Look at your business. What do you do? What are the risks involved? You could have risks from several areas, stretching from workers comp, to automotive issues with your fleet and the drivers, to liability risk from customers in your store. Break it down and track your statistics. Identify issues. Work on ways you can reduce your injuries or occurrences from happening in the first place.
2. Plan your attack
OK, so you have identified a few areas where you could improve on reducing some injuries or claims reports. So, what do you do to fix it? Planning is important, but the most important thing is to start, even if that is with very small steps.
The answer lies in the resources you have all around you. The first step is to talk to your carrier. Chances are the carrier has loss prevention specialists ready to help you work with what needs to be fixed. Ergonomic professionals can be brought in to address workstations and to suggest solutions to reduce exposure. Utilize your medical clinic contacts to see if occupational physicians can watch employees working. They can then identify potential issues with certain movements or repetitive-motion injuries. Utilize your local counsel by having them come in to explain the risks and costs associated with potential serious injuries, automotive accidents, failure to drug test your employees, etc. Any or all of these will help you reach your goal of reducing risk exposure.
3. Implement your solution
Now, if you identified what needs to be fixed, and how it should be fixed, now it is time to fix it. Get rid of old equipment and bring in new equipment with better safety features. Newer equipment costs less to maintain and repair and is quicker to operate. Most new machines use less energy than old ones, reducing utility bills and creating worker ease of operation. Get some padding on the floor for workers to stand at their workstations (also known as “fatigue mats.”) This reduces strain on feet and legs, and reduces body fatigue, potentially making employees more productive after long hours at work.
Whatever the fix may be, get it done. Out with the old — in with the new.
4. Measure your success statistics
So now your new equipment is installed and in place. Now it is time to measure your reductions. Take a two, four, and six month stretch and measure your numbers. Do you see a drop in claim activity? Or, did claims increase, meaning your plan backfired? You have to see how you did, and most importantly you have to give it time. Change is disruptive to employees, but they do get used to it. Give it time, and measure your numbers post-change against the ones you first noticed back when you were figuring out where your risk was coming from. Measure lost-time days, and post your progess at the front entrance.
5. Get feedback from your workers
After all you did, you left out the most important thing: To talk to your staff of workers about the changes. How do they feel it impacted their workday? Were the changes helpful, or did they hurt production? How do they feel at the end of the day? Do they feel less sore or are the new workstations worse than the old ones?
Ask as many questions as you can. This makes your staff feel that their input is important, and taken in to account. After all who better to talk to about the implemented changes than those who are directly affected day after day?(WCxKit)
A supervisor once said, “It is hard to fully embrace change. To make things easier, you have to ‘lean’ into it a bit at a time until you have accepted the entire package of change.” This is true on many levels. Even though it is hard work to find out what your risks are, discover how to attack them, implement changes, measure success, and get worker feedback, in the end it will be worth it. Lean in to the task. Do not try to tackle it all at once. As I have always said, "Don't eat elephant in one bite."
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 website 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. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
As members of a management team, around the winter season, reevaluate for the upcoming year. Set goals, benchmarks, implement new techniques, purchase new materials, etc. But there is one area that seems to be focused on more than others: And that is ‘how can we use what we have to be better?’.
Chances are in a medium to large shop, there is plenty of talent, in more than one form. The workers can be your most important capital. So why not focus on how to better use that talent? (WCxKit)
1. Provide the best tools so employees can perform efficiently
As an example, if you drive cars, this does not mean that all all drive a top of the line Cadillac. But this is meant more to show how to provide the best output for workers. Make workstations adjustable so workers can perform at the levels they need to. This will increase output and performance, not to mention that it will make workers less prone to injury, especially in repetitive-motion workstations. Extra lighting can provide clarity and precision. Hand trucks and dollies can make moving heavy materials easier and quicker, and so on and so on.
2. Don't run it like a prison
The workplace does not have to run hard-nosed and rigid. As an employer allows some flexibility such as flex work hours, rotating job tasks, allowing hourly breaks, then you can best utilize workers time at work for production. A rested workforce is your best workforce. Sometimes having job rotation can provide breaks for those that do heavy duty work day in and day out. Also this can reduce injury since those workers that just do heavy lifting or moving of materials can get a much needed break from time to time throughout the day. You could also discover that one of your workers may be better suited for another type of job task, versus the one they are currently in now. This could lead to increased production, and better efficiency.
3. Keep an open mind
Time and time again we recommend listening to employees and their suggestions as to how changes can be made to make production better. Discuss alternative job tasks and how things could be done quicker and easier. Remember these are the people that do these jobs all day, sometimes for years. They have ideas and suggestions and you have to make management become approachable. If someone knows that you will take the time to listen to them, you may get an idea that you can implement. Not everyone will hit the ball out of the park every time, but you could stumble upon something that can really make a difference, and it could change the way things are done on a daily basis.
4. Encourage healthy lifestyles and reward those that make a change
A healthy body is one that comes ready and able to work, and able to take on the challenges of the day. Healthier employees also have less sick time away from work, and have fewer injuries. A lot of companies now offer discounts to local gyms, reduced medical premiums for wellness exams, smoking cessation programs for free, etc. The HR department probably has a lot of ideas and plans that are already in place to promote a healthier lifestyle, and the incentive programs to go with it, so check in to some of them and try to implement some over the course of a year. Provide some incentives for the workers to participate, and see what happens. I bet that more will participate than you thought.
5. Launch a return to work program
It has been well documented that the longer a person is out of work, the harder it is to get them back to productive employment and there is a strong correlation between a high return to work ratio and a low mod. Older employees also take longer to heal than younger ones, so consider home-based employment. If you provide some light duty work, employees know that even though they have an injury, they can still work and make a decent wage. This will help them transition back into full time work once they are released from medical care, and will reduce claims dollars that are spent on lost wages while injured. It will also free up full duty employees to do something more productive, while those with medical restrictions can take care of the lighter tasks you need done day in and day out. Make a "wish list" of tasks you wish you had someone to help perform, then use the wish list to create transitional duty tasks. For instance, I wish I had someone to proofread my writing.
6. Set up a mentoring program
It is always hard to start a new job. Nobody wants to be the new person, so set up a mentoring program to help those new or less-experienced employees. Shadowing programs work well also. The new employee can gain some great knowledge from the veteran worker, including how to do things quicker, properly, and more efficiently. A good mentoring program will improve productivity of the newer, younger employees while making veteran workers feel like they can contribute more to the company other than just cranking out their job tasks day after day. The more you make workers feel like they are involved, the better, harder, and more dedicated they will work for you.
7. Do not be afraid to hire experienced workers
There are many benefits to hiring experienced workers. These workers already have sound work habits, years of experience in the field, and the skills the company needs to take you to the next level of competition. These workers also have less out of work distractions, such as needing more time off for child care or more time off for school commitments. Experienced workers will also add some diversity in workforce, contributing their ideas and experience to the team projects and ideas. If you utilize their assets, the workplace will benefit. (WCxKit)
Summary
A New Year means it is time to reflect on the year to date, and focus on what you can do better for the upcoming New Year. But you should also think about what the veteran workers can bring to the table for the company. Experienced workers are a great untapped resource, and their ideas and work ethics can be beneficial in more ways than one, especially in fields other than just being at their workstation. Tap the greatest free resource- the employees. Listen to their ideas, and make the management team approachable when someone has an idea about how something may be able to be done better. If you make this one of several things to focus on, accomplishing the rest of the goals could just be that much easier.
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 website 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, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
Back again with the final part of the series on medical provider red flags. This could be 50 red flags, but these are some of the most common. This is to provide continued awareness that not all medical clinics are on your side. The caveat again is that this is not the norm. This article is just meant to raise awareness. Because these issues, while uncommon, really do happen. That is about as politically correct as I can make it. Here are the physician red flags you should be watching for. This article is summarized from an interview with an adjuster I met recently.
1. The medical records are “template” style, or barely exist at all. Out of all of the red flag issues we discuss, this one does not indicate a shady doctor. It could just be that the doctor is very poor at note taking. But the two go hand in hand. Great doctors do great analysis, and back up opinions with objective medical facts. They arrive at this point by walking through the medical records, and creating a great conclusive medical report. Doctors that get by by pairing up subjective history from a patient’s mouth are another story. (WCxKit)
2. Missing dates of service, or no date labels on the medical notes. I suppose if the “template”style medical record, is paired with one that is similar to a fill-in the-blank system (Patient came in with complaints of _______ which they attribute to work causing them _____ pain out of 10, with 10 being the worst pain imaginable) and pair it up without a date of service, I guess you could use that medical record for every date of service you ever have. If anyone is watching, a physician will not get far by doing this. But, if nobody is paying attention, thousands of dollars could be paid and for who knows what. Make sure the notes are clearly labeled, dated, and legible. If not, you need to contact the physician’s office right away.
3. Different handwriting or inks on same dates of service. Granted again, that may be the nurse or the medical assistant jotting some notes down before the doctor jots the notes down, but if you get the feeling that something is not adding up, then call them. Their patient may be contacting them and coaching them what to put in the record, which we all know is not OK.
4. The medical provider office will not send medical records or state that they do not keep a medical “record”. I cannot think of one legit company that does not keep a note or record of some sort, for whatever reason. Even the most trivial of companies store records of some sort. So using that as a comparison, the medical record is very important. And for a clinic to say they do not keep a record is unbelievable. As a matter of fact, you should not pay any bill ever without a medical record attached to it. How do you know what is being paid and for what? If a doctor’s office ever tells you that they do not keep a record on a patient, my advice is to alert your counsel and have them step in right away.
5. The medical notes showed continued high levels of pain. I have never broken my arm, but I anticipate that it hurts quite a bit. Enough to be uncomfortable anyway. So if it is 2 months later and you still have “10 out of 10” pain, that is just not correct. If the pain is so unbearable, and you have treated with this doctor for 2 months, why go back there? And how is the worker driving to these appointments? And how can the worker go to the bank and cash your check, all with “10 out of 10” pain that has not lessened? The doctor should be stating in the medical notes that the objective indicators for pain do not match the subjective complaints of “10 out of 10” pain. If the physician is not doing anything about it, or the person is no better, then you have to find out what is going on medically and get that person to a specialist or set up an IME to address these ongoing complaints.
6. Consistent improper billing practices. Your Carrier/TPA usually cannot process a payment off of an invoice. Usually the bill has to be printed on an HCFA-1500 form so the Carrier/TPA can process it. This is standard. A lot of offices that handle any type of insurance work know this. So if they keep trying to submit their bills improperly, something is going on. Why are they doing this? Have any others had this sort of problem with this provider? Coding errors, print errors, ICD-9 code errors, etc. should be correct and correlate to the claim. A few errors are to be expected. But if it is constantly going on and on and on, you have to dig a little deeper.
7. Conflicting medical reports or conflicting subjective complaints that are not addressed. Let us say you are the adjuster and you are reviewing a stack of medical records on your claimant. One day your claimant states they are in very bad pain, 8 out of 10. It is hard to bend, and walk. The next day they show up for therapy and they tell the therapist they are doing great, and they think treatment is really helping them. 2 days later they go back to the doctor and say they feel the same, about 7-8/10 pain. Then the same day they have therapy and tell the therapist they feel great, and are looking back to getting back to work. I believe in the fact that people have good days and bad days. But if you are hurt, and in legit pain, your symptoms should not yo-yo up and down like that. Therapy can flare pain up a bit, but over the course of a few weeks the pain should be gradually lessened. If you start to notice yo-yo pain complaints and pain out of proportion to the injury, think about getting your IME in order because the claimant is trying to extend their time out of work.
8. Consistent excessive referrals or quick referrals to physical therapy where it may not be needed. I know of a very popular occupational clinic. A very large one. And I have handled a ton of claims where the clinic is the treating provider. And over the course of a year or 2, I wager to say that everyone that walks through their doors with a comp case had a referral to go to the same physical therapy facility after the first or second visit. These were strains, sprains, lacerations, contusions, etc. Every injury you could think of and they were all sent for therapy. We had to call and talk to the doctor to find out the rationale. This took a lot of time, but after a while they go the point and started to go by the medical norm for a referral for physical therapy. This is meant to be a very loose example, but a lot of times personal doctors or practices also own therapy companies or diagnostic laboratories, or they have partial ownership in them, so they get to make money twice; once when you go to see them, and again when you go to their therapy facility. So trust your instinct. If you think a referral is questionable, call and talk to the doctor. Make that doctor defend their decision and ask them questions. After all they have a service to provide to you, and you have rights too in these work comp scenarios. Depending on your jurisdiction anyway. NOTE: Make sure your company is aligned with a high-quality independent physical therapy network, perhaps even a national network, and put that in the account handling instructions, then monitor compliance and make sure the adjuster is helping monitor compliance.
Summary
Again this is not every doctor, at every clinic, attempting to get extra. These questionable doctors are few and far between. But they are out there, and your adjuster and counsel know of some of them. Physicians will say that they can only treat what the patient is telling them, and if the patient states they are in pain, then no matter what doctors are going to do what they can to help them. So part of this problem is on the doctor, and part is on the claimant or patient. However, all of it can be questioned by you in a workers comp scenario. Keep names of doctors and group practices that you had trouble with in the past. If something does not seem right call and talk to the doctor about it and share your concerns. Remember the doctors or practices that caused you problems–chances are you will cross paths with them again. Continue to stay proactive, and trust those instincts.
Your responsibility as an employer is to establish procedures, select vendors, and make sure you are actively involved in who treats your employees and the results they get from treatment, assuming this is allowed in your state. Working with a good TPA is important; ask them how they control these issues and learn what they are doing to prevent over treatment.
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 website 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, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Chiropractors may receive a bad rap. If anyone mentions excessive treatment that may not heal a patient, chiropractors are first on the list. But, there are certain medical practices, in every medical specialty, in every medical area, that may have a “chiropractor” of the known group. This group may be known within the medical community for having liberal treatment styles pairing up with liberal prescription dosage, and that is never a good combo in a workers comp matter. Workers comp adjusters can probably list a good handful of doctors or practices that fall within this realm, and cringe when seeing that letterhead come across their desk.
To determine if an injured worker may be treating with a “red flag” clinic, check the criteria below. If you have concerns, discuss with the adjuster.
1. The diagnosis is inconsistent with the treatment. Maybe this started out as a simple enough back strain, but the diagnosis reads “multilevel disc herniation with severe radiculopathy” … that could be an issue.
2. The Practice is known for questionable/suspicious treatment. Is this practice featured on billboards? Are their TV commercials on all the time? When you mentioned them to the adjuster, is there an audible groan? If the answer is yes, you should be talking about the plan of action on this claim with the adjuster.
3. The doctor will not release the patient from care. Sometimes doctors will keep a patient on a rotation of coming back to the clinic, maybe every 3-4 months or twice a year. If so, this should raise an eyebrow. Not only is that excessive, but it is probably unnecessary.
4. The clinic treats without prior approval or authorization. This will vary by jurisdiction, and by treatment, but if the doctor rushes a potential workers comp case into surgery without verifying any information or taking an insurance card, then that is a problem. “Slash for cash” doctors will operate first, ask questions later. They know they will be paid by somebody, and they do not care who it will be. It could be comp, personal insurance, Medicare, etc. As long as they get paid, that is their main concern. Check with the counsel about rules regarding invasive treatment without authorization and make sure to be as proactive as possible so the company is protected against unnecessary expense.
5. The bills include extra body part codes. The worker has an injured left arm, but the clinic bill states they performed treatment on the arm, wrist, elbow, shoulder, neck, and head. Be sure to read the records carefully, the billers may be trying to slide in some extra body parts and extra treatment that is already covered. Known as “unbundling,” this is where a clinic tries to bill separately for services that are usually combined into one already negotiated rate.
6. Unexpected high cost. The worker goes to the chiropractor for 12 visits to resolve a lumbar strain. He is a lot better, and it appears this doctor did a great job but then the bill arrives for $8,000.That is not so great and should prompt a call to the doctor for explanation. Sometimes when doctors see that a workers comp case is involved, the costs go sky-high.
7. Doctors that steer patients to plaintiff counsel. Every now and then you will see in the medical notes a doctor that flat out tells a patient to go see someone for a legal opinion. That is a red flag. The doctor is not there to give out legal advice. Some doctors have a tie in with certain plaintiff counsel, and they pass people back and forth to create new business. Beware.
8. The doctor will not answer the questions or return phone calls. Why is the doctor dodging calls from the claims adjuster? Doctors that have a practice know they have a business to run. An empty waiting room means you are a great doc and a poor businessman. The doctor wants that waiting room to be full all day and everyday. And the more they can do to keep a person coming back, the doctor may try and do.
9. The physician refers patients to specific medical specialists. Now, this one is not all bad. Sometimes this doctor knows which specialist docs are successful and have a good track record, and will refer the worker to this doctor with confidence. But there are those docs who are just passing a patient on to a pal, and chances are these docs do this a lot between the two practices. Just be on alert if this is happening frequently between clinics.
10. The physician prescribes unneeded and/or unnecessary durable medical equipment (DME). And the reason why the doctor does this is because they are probably getting some sort of kickback (referral fee) from the DME provider, such as paid golf, concert tickets, etc. When entering the doctor’s office and he has one drug company calendar, pen, paper, clock, and poster, then I think I know which medication you will be receiving….
Part 1 of this 2-part series should raise the awareness of the red flags that can affect the workers compensation cases. Do not be alarmed as this does not happen in a a huge number of cases. But it can happen, and the more vigilant you are, the better you can protect the company. To find out more about questionable physicians or clinics in the area, contact your adjusters or attorneys.
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 website 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, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Occupational therapy is a medical practice that promotes the health of a person to recover from an injury or illness in a way that allows them to return to some degree of self sufficiency after a severe medical condition. Occupational therapy should not be confused with physical therapy which is designed to restore the loss of function to a specific body part. Occupational therapy will assist the severely injured employee to rehabilitate from a disabling injury physically, mentally, and emotionally as they adjust to the permanent loss of function.
Occupational therapy is utilized in various
medical situations including: inpatient rehabilitation, acute care hospitals, assisted living facilities, hospices, skilled nursing facilities, and rehabilitation hospitals. For the purpose of this article, we will limit the discussion of occupational therapy to workers compensation and the assistance occupational therapists provide to the severely injured employee. (WCxKit)
When an employee incurs a life altering injury like a spinal cord injury, traumatic brain injury, limb amputation, loss of use of a limb or hand, or any injury that prevents the employee from returning to the prior level of employment, occupational therapy is designed to assist the employee to adapt to the permanent loss of function. Occupational therapy is more than just medical recovery. It will also entail psychology, sociology, and other aspects of daily living.
Occupational therapy will assist the severely injured employee in numerous ways. The occupational therapist can assist the employee in the following ways.
1. Stabilizing the employee's medical condition so the medical condition does not continue to deteriorate
2. Facilitating mobilization
3. Restoring function (overlaps into the area of physical therapy)
4. Compensating for mobility impairment
5. Learning/relearning sensory processes
6. Learning skills to adapt to the loss of function
7. Coordinating care from medical providers of various disciplines
8. Returning the injured employee to a meaningful life
9. Teaching adaptive skills for eating, bathing, grooming, dressing, etc.
10. Teaching the use of adaptive equipment – wheelchairs, artificial limbs, shower benches, etc.
11. Regaining the ability to live independently
Occupational therapy can also be utilized when the employee's injury is severe, but not life altering. It is often used in conjunction with physical therapy to optimize the use of a severely damaged hand or arm. The occupational therapist will work with the injured employee to teach the employee to compensate or adjust to biomechanical issues. The occupational therapist will tailor the treatment plan to the individual's needs.
When the employee has the ability to regain enough physical capacity to return to the former job, or to some time of employment, occupational therapy will provide “work hardening”. Work hardening is a customized approach to recondition the employee's cardiovascular, neuromuscular, and biomechanical systems. Work hardening will use either real or simulated work activities along with exercises to assist the employee in the transition from non-working to working. It will often start with the employee “working” 2 to 4 hours a day, 2 or 3 days a week. The time frame, both sessions and days, is gradually increased until the employee is able to work 8 hours a day, five days a week.
Occupational therapists are often called upon to provide a functional capacity evaluation (FCE) after the course in work hardening. In an FCE, the employee goes through a series of testing to determine what the employee can safely do in a variety of tasks. The FCE will also be used to establish what level of accommodations, if any, the employer will need to make in order to return the employee to full duty or permanently modified duty. The FCE is also used in some states to establish the level of permanent impairment rating that will be assigned to the employee. (WCxKit)
Occupational therapy is often the employee's “last stop” in the medical recovery process between injury and the return to work. Or it will be the last stop between injury and the permanent total disability status where the employee will never be able to return to work. The skill level of the occupational therapist can impact the overall outcome. Therefore, it is imperative the employer and the claims office understand the importance of occupational therapy and select the most qualified and skilled occupational therapy facility for the injured employee.
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 website 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. Shafer is the author of the leading book on workers compensation cost control www.WCManual.com See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Let me first point out this article is written from the Claims Adjuster’s point of view. This will point out a disturbing new trend in the world of insurance where the employer is not being honest about injury details or other information surrounding the injury. Not all of you will fall in to this category, but some unknowingly may. So take that in to consideration, and I hope it impacts you to change the way losses are handled.
Over the years I have investigated workers compensation losses and have heard bizarre stories of personal injury and the circumstances surrounding accidents. If someone asks me if I have seen everything in workers comp, I have to answer an emphatic no Chances are a bigger and more unbelievable instance has yet to cross my desk, and it will be my job as the adjuster to determine what happened. For those employers without the luxury of video surveillance, I have to go by witness accounts ( if there are any) and attempt to piece the circumstances of the injury together.
Sometimes this is a difficult task. Given the job environment in recent years, I have noticed a new trend where employers are being dishonest with me about the details of an injury. This is probably happening for many reasons, but in any case it is never acceptable nor helpful. The carrier is on your side and needs to hear the truth. Below I discuss a few questions I ask on claims where I have heard questionable responses in the past.
1. What do you know about the injury details?
Every employer has a designated person to call a claim in to the carrier. This person’s name is at the bottom of the report. The first phone call I make after getting the claim is to this person. Today, we will call her Sally. I call Sally and ask her if this is all that is known about the injury. She says yes, and that all details are included in the injury report she completed.
That may be correct, but I know the report is missing information. So I rephrase the question about the exact timeline of events. Who was injured? Did the worker tell someone? Did the worker go to the clinic alone or did someone drive? Do you know about any prior injuries to the claimant’s knee ( for example)? Keep in mind one and two word answers do not assist in creating my report. If you the employer do not know the particulars about the injury then be clear on that at the outset. I will attempt to find someone who is. Perhaps this will be a floor supervisor, field manager, or you can direct me to the appropriate person.
2. Are there any witnesses?
I can name countless times where an employer reports to me there are no witnesses to an injury. Then I interview the claimant who provides several names as witnesses. Next, I talk to those individuals and ask about their account of events, and more times than not they have seen something or arrived shortly after the accident after hearing the claimant’s calls for help. If there are witnesses, I will learn about it from the claimant and others interviewed.
Perhaps the employer did not ask about witnesses at the time of reporting and was not aware of any. Maybe the internal injury questionnaire does not have the space to write witness names no witnesses. In some cases, the employer may intend for the claim to sound less substantial.
Whatever the case may be, if there are known witnesses, name them. The employer should know the employee will be ready to list as many witnesses as they can remember to substantiate the claim. In the end, finding out there are witnesses makes us question the validity of the employer not the claimant. It makes us question you. And in the case where the employer’s internal report does not have a space for witnesses, that should be immediately added as it will help in any claims going forward.
3. Why was the claim not called in a timely manner?
Sometimes I get a claim with an injury date months earlier or even a year. Maybe this is an error. But if someone approaches you as an employer and reports being hurt, a claim should be immediately filed. Do not wait and see if they are actually injured or not. Do not wait to see if they file it under personal insurance to avoid a WC claim. Do not let it sit on a desk for 3 months or more. Call in the claim.
The employer needs to call it in because I will question the claimants about dates. If the claimant reports telling the boss on that date a year ago then again four more times. And that was all before the paperwork is filed, then that is not going to behoove you to the carrier. In fact, the employee also will be displeased , and it is going to make them that less motivated to return to work in the first place.
Maybe the report was completed on the injury date and was sent to your agent or broker. That works well, if the agent calls the claim in to us. Agents receive a lot of paperwork from their clients. They do not know the priority of addressing various documents. Maybe the claim was sent to the wrong agent. Or the wrong person at the agency got your fax, and there was no confirmation call to the carrier. Just call it in, and if it is sent to your agent, follow up with them. The sooner the claim reaches the carrier the better.
4. Do you know of any outside activities the claimant is involved in?
I like to ask employers this question to see how much they know about their employees. In one case, an employer revealed the injured worker helped coach his son’s soccer league. So I conducted some surveillance and recorded the claimant coaching and standing for long periods of time on the sidelines coaching. That kind of tip proves very helpful in a case and investigation. However, if you as an employer cannot be sure about a tip, then tell us. Even a lead can be helpful, because we can investigate the tip. The bottom line is we trust what the employer tells us as we do not know the claimants at all, so answering questions in the most honest and complete way is critical to the success of our investigation.
5. Were the guards in place?
For those employers with moving machinery, just admit if the guard was off at the time of injury. The employee is going to tell us either way. The guard is there to protect workers, so the worker is fully aware if it is missing. Maybe this leads to a design flaw that our subrogation department can investigate so we can recoup claims dollars spent on this injury.
I know a lot of employers remove or modify machine guards in order to be more productive or in order to have the machine fit whatever kind of material you are working on for your client. Please only have those machines do what they are supposed to do. Modifying the guards can lead to very serious injury, and the costs associated with that loss are far more than any profit you can attain by changing the functionality of machinery. Not to mention the potential impact it has on the life of the worker who may lose a finger or hand, or worse. I have seen a lot of severe injuries from this. And if you do not think it will happen to you as an employer, the only advice I can give you is that every person I talk to that had this type of injury involving a guard removal or modification told me the same thing: “I have done it like that a million times before and never had any problems until now.”
6. Did you complete an internal accident report and investigation?
As an employer if you have internal reporting or accident investigations then I commend you. You are on the way to becoming more proactive at handling losses. We discuss frequently about reporting, trends, and identifying injury areas.. If you are not internally reporting, then that is okay also. Although, the employer will find it beneficial to do so in the end.
For employers who do not do any type of reporting, please do not tell me you do and then provide me nothing. I will want to see that report to get its information, and I will keep asking for it to put it in my file. If you did not do one, just tell me you do not have one. I will keep calling and emailing until the employer finally tells me there is not an internal report. This does not assist in creating my report. (WCxKit)
.
Summary
In the world of workplace injuries a lot of people on the outside think that the carrier has to worry only about the injured worker’s honesty. Sadly the carrier has more to be concerned with in the claim. It is a combination of the two other parties involved in the claim. I have had cases where the claimant has not been honest. I have had claims where the employer has not been honest. In any case, the truth will prevail. If all parties are honest in the beginning, it makes handling the claim that much easier for everyone involved.
Contributed to Work Comp Roundup by an Ajuster who wishes to remain anonymous however he works for a major carrier.
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 website 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. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Stuart Colburn
Stuart Colburn, an attorney for Downs
Stanford recently shared a blog regarding a November 2011 Centers for Disease Control and Prevention (CDC)
report that described prescription painkiller abuse as “a public health epidemic.”
Colburn noted the CDC feels that changing the the way prescription painkillers are prescribed would reduce misuse, abuse and overdose but still allow access to safe, effective treatment.(WCxKit)
Colburn frankly citizens the workers compensation system as contributing to these addictions and indirectly by contributing to lost time and injuries “attributable to decreased alertness and other ill effects of working while abusing prescription drugs.”
Colburn continues, “America's prescription drug abuse (PDA) problem is not nearly as well known as our War on Drugs. No war has been declared and yet American lives are being lost. The statistics are well known. American citizens make up 4 percent of the world's population. Yet, we consume 66 percent of the world's illegal drugs.”
His blog continues to site fascinating drug statistics not only from the CDC but also the U.S. Military, various states and many others. It is well worth a read.
Brian J. Caveney
He concludes that the Patient Protection and Affordable Care Act (PPACA) of 2010 has changed much for the workers compensation industry including The United States Department of Health and Human Services adding eight substances to its Report on Carcinogens.
“Formaldehyde and aristocholic acids are now listed as known human carcinogens, and six other substances-captafol, cobalt-tungsten carbide, inhalable glass wool fibers, onitrotoluene, ridelliine, and styrene-are now considered as reasonably anticipated to be human carcinogens. This brings the total to 240 identified substances in the listings demanding thoughtful approaches to minimize exposure to workers,” Caveney wrote.
He also said the Fukushima Daiichi nuclear power plant in Japan has had great affect on the WC industry. “Readers of Occupational Injuries and Illnesses (LexisNexis) can refer to Chapter 44 for recent updates on the physics of radiation contamination and possible human health effects of exposure,” he wrote.
For WC matters regarding low back claims, Caveney directs readers to the updated Chapter 15 in Occupational Injuries and Illnesses (LexisNexis. And, lastly, he noted 2011 is the 30th anniversary of the identification of the human immunodeficiency virus (HIV). “The infection has transcended its original death sentence upon diagnosis to a chronic disease state when adequately treated with the panoply of various treatment options these days. Once widespread fears of transmission in a host of occupational situations has thankfully now been limited to mostly preventable scenarios. Chapter 46 of Occupational Injuries and Illnesses (LexisNexis) reflects these advances,” he wrote.
To read more, follow the above link to Caveney’s article.
She cites physician Nortin M. Hadler, MD new book
Rethinking Aging: Growing Old and Living Well in an Overtreated Society. “Dr. Hadler continues his no-holds-barred approach, warning that the Baby Boomer Generation and Generations X and Y hold unrealistic notions about defying the aging process with medical technology, thereby making them more susceptible for ‘medicalization and overtreatment,’ “ she wrote.
Kobayashi notes that marketing has become “sophisticated and pervasive in playing off people’s fears about health and longevity. … It’s no secret that Dr. Hadler has had it with insurance companies and even the AMA Guides for that matter. He once argued that attempts to adhere to the AMA Guides to quantify impairment were, in his opinion, ‘an unappealing, if not Orwellian, exercise, and not just for musculoskeletal diseases but for all diseases.’ “(WCxKit)
Read more of Kobayashi’s research and opinion by following the link above. She concludes, “Here, in our world of workers’ compensation, we can’t deny the fact that workers’ compensation medical costs are soaring. Whether you’re an injured worker, attorney, judge, or claims adjuster, we need to make the right choices about medical care, to educate ourselves, and to stop being conditioned into believing that medical treatment can always help/save us.”
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 website 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, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
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