7 Consideration For Selecting Your Work Comp Doctor

Hello. Michael Stack. Principal of Amaxx, founder for COMPClub and co-author of Your Ultimate Guide to Mastering Workers’ Comp Cost. I want to give you a success tip that actually comes out of the 2016 version of Your Ultimate Guide to Mastering Workers’ Comp Cost, it is the fifth step of the five-step system to reduce your cost by 20 to 50%. That step is in regards to medical and pharmacy cost containment.

 

 

7 Considerations To Use in Doctor Selection:

 

When we talk about managing workers’ comp claims and reducing workers’ comp cost, one of the things that we often forget is that these are medical injuries, and they need the expertise of medical providers for the healing and recovery of those injuries. I want to give you seven considerations to use as a reference point for the selection criteria of the medical providers that you work with at your organization.

 

Now, when it comes to doctor selection the laws are going to vary by states. You’re going to want to definitely check with your jurisdiction. It’s either going to be an employee-directed state, an employer-directed state, or often times a blend of those two. There are some states where the employer can have zero input whatsoever, so be sure to check with your state laws. Often times even in an employee-directed state, you can do what’s called soft channeling by setting up relationships with high quality providers and giving a recommendation to your employees to go to see them if they chose.

 

 

Care & Credentials

 

Let’s talk about these considerations and some of these criteria that you should use. Of these seven considerations, there’s really two main categories that they’re going to fall under. The first is care and the second is credentials. The first category is care, how much those providers care, and the second is what are their credentials. Let’s talk about some specifics here.

 

 

Be responsive to employees’ needs and willing to return them to work

 

The first thing that you want to look at in regards to care is you want to talk about how much responsiveness do they have to your employees? Responsive to your employees’ needs and a willingness to return them to work. Responsive to your employees’ needs and a willingness to return those employees to work.

 

 

Visit your organization

 

Second criteria here is that they visit your company. They actually go to your job site to visit your employees and find out what type of work they’re doing on a regular basis, get to know your organization, and at the same time be willing to use your forms in your return-to-work program in order to get the medical restrictions and get them back to work to work within your system. Their responsiveness, their willingness to return them to work, and then also visiting and understanding what those job descriptions are understanding what type of work your employees are doing, and using your forms to feed right into your system.

 

 

Be available to schedule employee’s appointments without delay

 

Selection criteria number three is scheduling appointments. You want to make sure that your employees can get in to see these providers easily. One of the studies that WCRI just recently came out with was in regards to worker outcomes, and the ability for the employees to get the care that they needed was one of the biggest factors in determining whether they would ever come back to work. The ability to get the care that they needed was one of the biggest factors in determining whether they would ever come back to work, so being able to get in to see those providers is a key selection criteria.

 

 

Spend extra time with your employees as needed

 

The last criteria here is time. How much time are those providers able and willing to spend with your employees? If you’ve ever studied human relations, you know that one of those principles is people don’t care how much you know, until they know how much you care. People don’t care how much you know, until they know how much you care. That’s what this first set of criteria (is about), this first selection criteria, is making sure those providers care to work with your organization and they care about your employees and what’s best for them, which is getting them back to work.

 

 

Possess outstanding medical credentials and an excellent reputation

 

Let’s talk about these credentials, because if you have this down, then of course, the quality of those providers is an extremely important piece as well. The first thing you want to look at is their credentials, their actual medical credentials and their reputation in the community. What is their background? What is their expertise? What is their specialty, and then what is their reputation in the community? You obviously want to work with a very high quality provider to provide your employees with the highest level of medical service that’s available.

 

 

Provide medical records and reports timely, be available for consultation with claims team

 

Number two then. In regards to working with your claims management team, you need to be able to get the reports and any records and any communications and conversations that need to be had with your adjuster, with your nurse case manager, and with your claims management team, providing reports, providing records, and having conversations. Their ability to provide that information to ensure your employee is getting the best medical treatment, to get the best medical outcome, getting them back to work, and by the way, that will lead to the lowest amount of workers’ compensation cost.

 

 

Provide detailed medical restrictions for return to work

 

A final point then, and probably most important from an employer standpoint, is be able to get restrictions for return to work. To be able to get restrictions, the medical restrictions, to understand what that employee can do safely and productively at your organization in a return-to-work program. You need to have them sign off that they’re able to go back to work and understand what those restrictions are. For example, they have a 10-pound, a 20-pound, a 30-pound weight-lifting limitation, they can only stand for a certain number of time, etc, so understand what those restrictions are, have it written out in your form, and get those employees back to work as soon as possible.

 

 

That’s the selection criteria for your medical providers. Remember, your success in workers’ compensation will be determined and defined by your integrity, so be great.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

How Much Time Are Doctors Spending On Your IME?

doctor tabletThe independent medical examination is one of the most important components of a successful workers’ compensation claim.  This is because in most jurisdictions, the defense gets one opportunity to see and examine the injured employee by a medical expert of their choice.  One of the most important factors to consider in selecting the correct service provider is seeking out only those that add value to your claim.

 

 

Selecting the Right Medical Expert

 

An important component when selecting an IME service provider is the panel of medical experts they offer.  In the modern workers’ compensation system, there are a whole host of injuries.  This gives rise to the need to work with a service provider that has a wide variety of medical experts.  This also includes connections with specialists in a number of fields.  Some of these areas include orthopedics, neurosurgery, psychology, and psychiatry.

 

Before selecting the right IME doctor, it is also important to know the background of the expert.  Part of this investigation includes and understanding of the doctors medical training, professional experience and other specialties.  It is also important to consider an expert who has written peer-reviewed articles for medical publications and/or hold distinguished lecturing credentials.

 

 

How Much Time Are Doctors Spending On Your IME?

 

It is also important to understand the physician’s perspective performing an IME. The demands on a physician’s day are well documented, and increasing administrative requirements and changes in health care have only made the job more difficult.  An important question to ask is how much time are doctors spending on your IME?  In many instances, providers will fill the doctor’s schedule with appointments, which does not allow the doctor adequate time to complete a thorough exam and determine a thoughtful conclusion.  This detracts from the final and most important product when defending a case—the IME report.

 

Best practice dictates the physician to be fairly compensated, and allowed additional time to complete the exam and IME report.  The end result is a thoughtful report in which the medical opinion becomes a material element in your claim.

 

A second necessity for adequate time from the IME doctor is providing and receiving additional information as required by the adjuster and/or nurse case manager.  A high quality physician that will render a high quality opinion needs to be fairly compensated for this additional time. However, the investment can often lead to a significant return as the opinion is based on adequate information and all parties are able to agree on the proper course of action on the claim.

 

 

Preparation and Turn-Around Time

 

The final element to consider in the relevance of time to your IME is in preparation and turn-around of the report.  There must be the ability for the IME providers to access medical records and reports for review by attorneys and claim handlers prior to the examination. It is also important to have a reliable point of contact to handle issues as they arise throughout the process.

 

Important matters to consider include:

 

  • Turnaround times for the completion of reports; quick turnaround time is important, however, not at the expense of report quality. Waiting a day or two extra for more a comprehensive report that substantiates all requested issues would most likely impact the potential exposure of a case then getting a report back a day sooner;

 

  • Quality assurance measures that include a review of the report for typographical errors; and

 

  • Superior customer service.

 

 

Conclusions

 

The independent medical examination is one of the most important parts of defending a workers’ compensation claim. The main question asked at the deposition or hearing is whether the medical expert has adequate foundation to issue their findings and opinions within a reasonable degree of medical certainty. Increasing demands on physician’s time, along with increased pressures on lower fees often creates a low quality IME report. Ensure your IME physicians are fairly compensated and have adequate time to complete a high-quality, meaningful report.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

Timely Reporting Claims Is First Step In Work Comp Management

Reporting a work injury is an essential component of any successful workers’ compensation program.  Failure to do so can result in various sanctions and adverse admissions.  It also calls into question the integrity of a program.  Proactive claim management teams are able to report all claims in a timely manner and establish a partnership with the employer and other interested stakeholders to get a claim started in the right direction.

 

 

First Report Requirements

 

State workers’ compensation laws or regulations provide guidance when it comes to filing a report of injury in a timely manner.  This requires members of the claim management team and interested stakeholders to know the laws of the states they work in.  Other important factors to consider include the nature/extent of an injury or even death.  In most instances, an injury that results in death must be reported within 24 hours.

 

Failure to report injuries in a timely manner can have the following adverse consequences:

 

  • Sanctions imposed by the state industrial board or labor commission;
  • Inability to assert various affirmative defenses to deny claims. This can include arguments concerning statute of limitations, statutes or repose and notice defenses; and
  • Assessment of penalties by state and federal OSHA agencies.

 

 

Methods of Reporting Work-Related Injuries

 

State law or regulation also sets forth the requirements for what must be reported and the method of reporting.  The general rule prescribes that a “First Report of Injury” must be filed with the state labor department or industrial commission.  In order to assist clients, members of the claim management team should provide a number of options and tools to help complete this form.  This can include:

 

  • Creation of an electronic workers’ compensation forms database that include a First Report of Injury;
  • An Internet based claim platform that includes direct links to workers’ compensation forms with the option to directly file it with the appropriate state agency upon completion;
  • Telephonic access and assistance in completing forms for those who do not have direct access to the Internet; and
  • Ability to receive all claims for and First Reports of Injury via fax and e-mail.

 

Members of the claim management team should also have the ability to assist employers and other interested parties with common questions on a First Report of Injury.  It is important to remember that this form needs to be fully and accurately.  It should also be done so in a timely manner.

 

 

Going the Extra Mile for Your Clients

 

Any workers’ compensation carrier or third-party administrator can help their clients complete the necessary and routine matters for workers’ compensation claim management activities.  However, the claim management teams that provide value to their services excel in client retention and claims handling best practices.  Here are some “value add” for those wishing to be best in class:

 

  • Provide training on workers’ compensation best practices for employer clients. This includes the necessary elements of claim report on the employer end of claims.
  • Provide reference materials for employees and injured workers in the claims process. While claim management teams have a fiduciary duty to only their clients, helping those suffering from the effects of a work injury adds compassion to the process and buys good will.
  • Triage nurse services are another important component a best practices the claims industry should consider. Nurses in these triage centers can help direct care and reduce the wait time for injured parties in the need of medical care and treatment.

 

 

Conclusions

 

Timely reporting of a workers’ compensation claim is a necessary component of any program.  Successful claim management programs must provide the right type of services to assist their clients to ensure the timely and accurate reporting of all claims.  They can also add value to their programs to ancillary services that buy good will and add a human component to their program, which assists injured workers.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

TDI Offering Grace Period for Non-Insured Employers

The Texas Department of Insurance, Division of Workers Compensation (DWC) recently announced that it is providing a grace period for employers without workers compensation insurance coverage or that terminated their coverage (non-subscribers) to report their non-coverage status to DWC without penalty. This grace period also extends to non-subscribers with five or more employees that have not previously reported on-the-job injuries, illnesses, and fatalities to DWC.

 
Historically, non-subscriber reporting rates are low, and DWC is offering this grace period to increase compliance with required state reporting.

 

This grace period allows non-subscribers that have not previously reported their non-coverage status, to submit the DWC Form-005, Employer Notice of No Coverage or Termination of Coverage (DWC Form-005), without an administrative penalty during the Feb. 1, 2016, through April 30, 2016, reporting period.

 

Additionally, this grace period also allows non-subscribers with five or more employees that have not previously reported their injuries, illnesses, and fatalities, to submit the DWC Form-007, Employer’s Report of Non-Covered Employee’s Occupational Injury or Disease (DWC Form-007) without an administrative penalty for injuries, illnesses, and fatalities occurring on or after May 1, 2016.

 

Non-Subscribers Must Make Notification

 

By law, non-subscribers must annually notify DWC of their decision not to obtain workers comp insurance coverage by submitting the DWC Form-005 and must also report each on-the-job injury, occupational illness, or fatality resulting in more than one day of lost time to DWC by filing DWC Form-007. Nonsubscribers that fail to comply with state requirements are subject to administrative penalties.

 

Non-subscribers can file the DWC Form-005 with DWC online, by fax, or by mail. The DWC Form-007 may be filed by fax or by mail.
A non-subscriber must file the DWC Form-005, Employer Notice of

 

No Coverage or Termination of Coverage to DWC:

  • Between Feb. 1 and April 30 each year;
  • Within 30 days of hiring its first employee; or
  • Within 10 days of DWC’s request. Non-subscribers with five or more employees must report each fatality, occupational disease, and on-the-job injury that results in more than one day of lost time to the DWC.

Non-subscribers must submit the DWC Form-007, Employer’s Report of Non-Covered Employee’s Occupational Injury or Disease to the DWC within the seventh day of the month following the month in which:

  • The death occurred;
  • The employee was absent from work for more than one day as a result of the on-the-job injury; or
  • The employer acquired knowledge of the occupational disease.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@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/

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6 Techniques To Avoid Lifting Injuries

One of the most common causes of workers compensation claims is the improper lifting of a heavy object by an employee. It is also one of the easiest workers compensation claims to avoid. When an employee injures a back, it is usually not the heavy weight, but the method of lifting the weight that was improper. These back injuries can be avoided. The teaching of proper lifting techniques, to any employee who may be called upon to physically move objects, is an essential part of any good safety program.

 

There are at least 6 common things that employees do that cause them to hurt their back. They are (this is not an all inclusive list)

 

  1. Twisting while lifting
  2. Holding the object too far away from the body
  3. Lifting with the back bent
  4. Contorting the body to lift in an unnatural way
  5. Losing their balance while lifting
  6. Not coordinating their lift with other co-worker(s)

 

 

Twisting while Lifting

 

When a heavy object needs to be moved from a floor or other level to a higher level, the employee will often be paralleled to the higher level when the object is picked up and will have to twist to set the object on the higher level (shelf, cart, conveyor belt, etc.). The employee should approach the object perpendicular to the higher level where the object is going to be placed, with the employee, the object and the higher level in a straight line. This puts the object in the middle between the employee and the higher level, allowing the employee to lift the object without twisting. It also allows the employee to have the head facing straight forward to keep all parts of the spine in a straight line.

 

 

Holding the Object Too Far from the Body

 

Sometimes employees just do not want to get dirty. If the object is dirty, greasy, oily, etc., the employee may be inclined to try to lift the object while holding the object away from the body. This is difficult to do with light objects and a recipe for an injury with heavy objects. The further the object is from the body, the harder it is too lift and the more strain it places on the body. The employees need to be taught to hold the object they lift as close to the body as possible to avoid strain on the back.

 

 

Lifting with the Back Bent

 

When employees have not been taught the proper lifting techniques for heavy weights, they are often inclined to keep the legs straight and the back bent. This is backwards of the proper way to lift. The employee should be facing the object with the feet shoulder width apart. The employee should keep the back straight and bend the knees to lower the body closer to the object. This allows the employee to lift the object with the strength of the legs instead of placing tremendous strain on the back by trying lift with the back bent.

 

 

Contorting the Body to Lift in an Unnatural Way

 

Often the box of supplies, or bucket of parts or other heavy object is surrounded by other objects that are in the way of the employee trying to lift the object needed. When the employee contorts the body to lift a load in a cluttered area, the worker is inviting injury. While it takes a little longer, the employee should be taught to move other items out of the way (using proper lifting techniques) before trying to lift a heavy object. The employee should be sure the area around the object and the pathway from the object is clear prior to lifting it.

 

 

Losing Balance While Lifting

 

There are different ways the employee can lose his balance while lifting a load. Common mistakes include placing the feet too close together, picking up an irregularly shaped object where the load is uneven, trying to pick up a stack of two or more objects at the same time, or trying to pick up an object that is too heavy. The employees should be taught that the feet need to be at least shoulder width apart, or slightly wider. If the load is unevenly balanced, the employee should redistribute the weight of the load if more than one object, or to get someone to assist in lifting the object if the weight of the object is unevenly distributed.

 

 

Not Coordinating the Lift with Others

 

When two or more people are lifting a heavy object at one time, not only is there a strong probability of a back injury if done incorrectly, the employees may badly smash toes. When it takes more than one person to lift an object, and a forklift is not option, it is imperative that all the parties to the lift communicate where they are holding or grasping the object, where they are moving the object to, and when they will lift simultaneously.

 

 

Proper lifting can easily be taught to all employees involved in any type of manual labor. The basic points each employee needs to know include:

 

  1. Keep the back straight at all times
  2. Keep the load as close to the body as possible
  3. Keep the feet at least shoulder width apart with the toes turned slightly outward
  4. Bend the knees, not the back
  5. Keep the object to be lifted directly in front of you to avoid twisting
  6. Keep your head forward facing the object
  7. Breathe out as you lift

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

New Foundland/Labrador (Canada) Surveying Workers and Employers

Beginning the week of Feb. 1, WorkplaceNL (New Foundland/Labrador, Canada) was to conduct its 2015 fourth quarter client service satisfaction survey. This is part of WorkplaceNL’s strategy to further improve client service.

 
A random sample of injured workers and employers were slated to be contacted. In the event a client is selected for surveys, WorkplaceNL assures its clients that they will only be called once per year.

 

The surveys will gauge satisfaction levels among clients. The outcomes of the surveys will be made public annually, and used to develop action plans and enhancements to programs affecting client services.

 

If you are an injured worker or employer, you may receive a call about WorkplaceNL’s services from Corporate Research Associates, an independent research company with an office in Newfoundland and Labrador. Your individual comments and answers are absolutely confidential and will not be provided on an individual basis to WorkplaceNL. WorkplaceNL will only be provided with a final report on overall survey results.

 

Should you receive a call, we would appreciate you taking the time to answer the questions in order to help us serve you better. If you choose not to participate, simply tell the researcher that you are not interested in responding.

 

If you have any questions about this survey, call (709) 778-1000.

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@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/

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5 Proven Steps To Reduce Work Comp Costs 20-50%

Hello. Michael Stack here, principle of AMAXX, founder of Comp Club, and coauthor or ‘Your Ultimate Guide to Mastering Workers’ Comp Costs.’

 

Now there’s no mystery in how to reduce workers’ comp costs. That code was cracked over twenty-five years ago, and the system has been implemented in hundreds of organizations throughout that time frame, consistently achieving a 20%, and oftentimes greater than 50% reduction in workers’ compensation costs. That proven five-step system has been documented in detail in the 2016 version of ‘Your Ultimate Guide to Mastering Workers’ Comp Costs.’ I want to give you an overview of each of the five steps to hopefully set you on a path to reducing your work comp costs by 20%, and hopefully greater than 50%.

 

 

Step 1: Build Your Program Foundation

 

The first step then is to build your program foundation. Now if you’ve ever built a home or you’ve ever purchased a home, you know that the most important piece of that house is the foundation itself. If that foundation isn’t done well, it can put into question the integrity of the entire structure. The same is true in your work comp management program. You need to build a solid foundation on which to build the rest of your program. Now in step number one this includes things like getting your management onboard, gaining management commitment, and understanding the roles and responsibilities of all the different parties within your company. This also includes understanding key pieces of workers’ compensation information: things like your experience mod, the experience mod formula, and the different levers that go into that, including your payroll, and properly classifying your employees, as well as the insurance structure itself. Step number one is building a solid foundation on which to build the rest of your program.

 

 

Step 2: Injury Prevention

 

Step number two then is injury prevention. The least expensive work comp claim is the work comp claim that never happens. Injury prevention includes safety and wellness. Safety needs to be equal in priority to quality and production at your company; a hugely important piece to prevent claims from ever occurring in the first place. Studies show from a wellness standpoint that each dollar invested in wellness has a three to four dollar return on investment. Step number two is injury prevention. The least expensive work comp claim is the work comp claim that never happens.

 

 

Step 3: Post-Injury Systems

 

Step number three is post injury systems. This is the bread and butter at the employer site of your work comp management program. It’s the engine that’s going to drive success, the engine that’s going to drive the outcomes that are going to reduce your work comp costs and improve the environment for your injured workers. This includes things like communication systems, your post injury response procedures, your return to work procedure, as well as your reporting claims timely. All these post injury systems at the employer site are the engine that’s going to drive everything post injury.

 

 

Step 4: Claims Management Best Practices

 

If step number three is the engine, step number four is pouring a higher level of octane gasoline into that engine to further improve outcomes and further reduce workers’ compensation costs. Claims management is step number four and it’s all about leveraging the service provider relationships. This includes your adjuster, as well as detailing your account handling instructions, as well as when to use various vendors, things like an IME, when you’re going to use surveillance to help prevent fraud, as well as planning and preparing for settlements, including Medicare set-asides and structured settlements. Step number four puts a higher level of octane gas into the employer management systems.

 

 

Step 5: Control Medical and Pharmacy Costs

 

Step number five then is medical and pharmacy. The highest growing, and the fastest growing piece of workers’ compensation costs is in step number five, the medical and pharmacy components. NCCI projects that by 2017 over 70% of workers’ compensation costs will be driven by this step number five, and the medical and pharmacy components. This includes things like building out your medical provider relationships, leveraging a medical advisor, as well as using nurse case management. From a pharmacy standpoint, we know that the pharmacy and overdose of prescription drugs is the number one killer in the United States. It passed car accidents a number of years ago. From a safety standpoint, and a cost management standpoint, how to leverage that pharmacy benefits management relationship.

 

That is the proven five-step system, a very quick outline of how to achieve results. One tip is to follow these steps in sequence. Each step is going to build upon each other, and the better you do in the previous step the better your outcomes will be in the following steps. Start in sequence, identify your gaps, and you will achieve workers’ compensation success.

 

Again, I’m Michael Stack, coauthor or ‘Your Ultimate Guide to Mastering Workers’ Comp Costs.’ For further details on how to purchase the 2016 edition, go to http://wcmanual.com.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

Californian’s Comp Fraud Case Results in Felony Count

A Hemet, California man was recently arraigned on insurance fraud charges following an investigation conducted by the San Bernardino County District Attorney’s Workers Compensation Insurance Fraud Unit.

 
Raymond Chastain, 23, is charged with one felony count of Insurance Fraud.

 

On Oct. 26, 2012, Chastain filed a workers comp claim alleging that he sustained injuries while performing his job duties as a worker for TPG Staffing.

 

“Our investigation revealed that Mr. Chastain failed to report additional earned income while receiving total temporary disability benefits,” said Senior District Attorney Investigator Rodney Tamparong, who is assigned to the case.

 

After obtaining an arrest warrant, investigators arrested Chastain at his place of residence in Nov. 2015.

 

He was booked into the West Valley Detention Center on $50,000 bail.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@reduceyourworkerscomp.com.

 

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

 

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Control Defense Council Costs With Alternative Fee Arrrangements

The effective claim management team should continually seek opportunities to reduce costs of managing and defending workers’ compensation claims.  This delicate dance needs to balance the interests of the client against the bottom line.  Part of this analysis includes the area of litigation costs and defense attorney referrals when a workers’ compensation claim is placed into litigation.

 

 

Referring a Claim to Defense Counsel

 

The first step in correctly managing defense claims includes the threshold decision of referring files out for defense.  This is a careful analysis that needs to consider a number of factors.  These items include the following:

 

  • Procedural posture of a claim;
  • The likelihood of litigation and benefits of referring a case to counsel;
  • Complexity of legal issues presented in the case (and those reasonably anticipated); and
  • The overall utility of managing the claim compared to benefits of having legal assistance and representation.

 

Another factor to consider is the experience the attorney representing the employer/insurer on the claim and their existing fee structure.

 

 

Insurance Defense Billing Structures

 

There are generally two types of billing structures used by attorneys in the defense of a workers’ compensation claim.  Each methodology of billing has its pros and cons.

 

  • Hourly billing with defined billing increments; and
  • Flat fee billing arrangements.

 

Regardless of what billing methodology is agreed upon when referring a file for defense, it is important to agree with counsel on the basic terms.  All fee arrangements should be in writing.  Important defined terms should include:

 

  • The nature and scope of representation;
  • The obligations of the parties. This can include the frequency of status reporting and file budget matters;
  • Post-hearing expectations, including appeals;
  • Whom may work on the file? This can include whether multiple attorneys can work on a file, and what roles are permissible for support staff; and
  • Billing increments and fee parameters. While “block billing” is generally considered outdated, it is important to define whether this practice is acceptable.

 

Defining the billing rates for associates, senior associates and shareholders is also necessary.

 

 

Moving Beyond the Billable Hour

 

Current trends indicate that insurance defense firms are interested in accepting flat fee or alternative fee structures.  Under such arrangements, insurance defense attorneys accept workers’ compensation cases for defense that do not include rates billed upon time worked on the matter.  They will instead bill the workers’ compensation insurance carrier or third-party administrator based on the service performed.  An example of these services include:

 

  • File in-take and initial preparation of a status report. This will include a review of the information known about the claim, what additional information would be helpful to better analyze the case, legal issues present or to be anticipated and recommendations for further handling;
  • Written discovery and obtaining medical/other records;
  • Other discovery, including the deposition of any witnesses, the employee and experts;
  • Independent medical examination cover letter preparation and post-report analysis;
  • Hearing or mediation preparation;
  • Attendance at any necessary conferences, mediations and hearings; and
  • Post-hearing disposition of a case.

 

Deciding what type of fee structure works for a claim management team depends on a number of factors.  This includes anticipated costs of each billing methodology and buy-in from component legal counsel.

 

 

Conclusions

 

Alternative fee arrangements can reduce the costs associated with a workers’ compensation program.  Before implementing alternative fee arrangements, there are a number of important considerations.  This should include a complete review of your program and the impact on retaining efficient and capable legal counsel.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

California Man Driven to Comp Fraud

A Fontana, California man was arrested on insurance fraud charges in early February following an investigation conducted by the San Bernardino County District Attorney’s Workers Compensation Insurance Fraud Unit.

 
Jamie Gallardo, 45, is charged with a violation of Insurance Code § 1871.4, Workers Compensation Insurance Fraud.

 

It is alleged that on or about April 21, 2010 through April 19, 2014, Gallardo was employed at California Coach & Body located in the City of Walnut. During this time, Gallardo filed a workers comp claim alleging he sustained injuries to his chest and back while performing his job duties.

 

According to Senior District Attorney Investigator Rodney Tamparong, an investigation into possible fraud resulted in the current allegation that Gallardo presented a knowingly false or fraudulent statement in order to obtain workers comp benefits.

 

After obtaining an arrest warrant, investigators–with assistance from officers from the Fontana Police Department–arrested Gallardo at his place of residence Feb. 2. Gallardo was transported and booked into the West Valley Detention Center.

 

If convicted, Gallardo faces five years in county prison.

 

 

 

 

Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com.  Contact: kstack@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

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