11 Ways Supervisors Can Enhance Your Workers’ Compensation Program

11 Ways Supervisors Can Enhance Your Workers’ Compensation ProgramSupervisors are critically important to the effectiveness of your injury management program. They are often the first person on the scene of a workplace accident and may know the injured worker better than anyone else in the organization. They set the tone for how well the injured worker responds and engages in the recovery process.


Employees in charge of other workers who view their role in the workers’ compensation process as just an annoyance do a disservice to injured workers and the organization. Employers should take steps to ensure supervisors appreciate the value of the workers’ compensation program and have a thorough understanding of how they can positively contribute to it.



Injury Response


While some organizations have detailed step-by-step plans in place for handling workplace injuries, many don’t; or even if they do, most employees are typically not well versed in the protocol. That’s why it is imperative to continually train supervisors on all the various aspects of the workers’ compensation system and how they fit into it.


For example, if one of your workers went to his supervisor after sustaining an injury, how would the supervisor respond? Would he know, or have a list of steps to follow, a medical provider to treat the worker, if needed? Would he know to address the worker’s medical needs first?


Here are some of the initial procedures supervisors should have down pat:


  • Get injured worker medical attention. First and foremost, make sure the worker gets medical attention if needed. If so,


  • Where to go
  • How to get the worker there; i.e., should he drive himself, and, if not, who should drive him
  • What, if anything to take with him


  1. Communicate appropriately. Extensive research has been done on the impact of a supervisor’s language and tone toward an injured worker. Questioning the truthfulness of the worker, for example, can have a dramatic impact on outcomes. Negativity threatens the worker and research has shown the odds are there will be twice as many days out of work than if there is a positive response from the supervisor.


  1. Whom to contact. Is there a department/person/number the organization has for reporting injuries? For example, is there a nurse triage system in place?


  1. Initiate an investigation. While it may not involve a formal inquiry, the supervisor should speak with anyone with possible insight into the accident, such as the injured worker and any witnesses. Having such conversations as soon as possible after an incident is best for getting the most information when it is fresh in people’s minds.


  1. Take good notes. Any information from the injured worker, witnesses or anyone else who may know about the injury should be written down with as many details as possible. Documentation should include at least the basics — who, what, when, where, why and how.



After the Fact


Following-up on a workplace accident — or near miss — is also important, as that can go a long way in preventing recurrences. Some actions supervisors can take at this point include


  1. Determine if any obvious risks contributed to the accident/injury. Walking through the area and talking with other employees who work there can provide insights into potential problems.


  1. Take corrective action. Any hazards that are obvious should be eliminated as soon as possible, if not immediately. This may require notifying and working with a safety person or other managers. Supervisors should know and be given authority to make simple corrections that can prevent future accidents.


  1. Communicate the risks and any changes to staff.



The Recovery/Return Phase


If a workers’ compensation claim has been filed and the employee is not working, the supervisor’s role should be one of support. The injured worker needs to know he is a valued employee and the organization wants him back at work. If the supervisor has a positive relationship with the worker, she can take the following steps:


  1. Initial contact. The supervisor should make the first-day phone call to the injured worker — ask how he is doing, how he feels, and find out what he needs. This is also the time to let the injured worker know what to expect; how/when medical treatment will be provided, who will contact him and for what reason(s), how and when he will receive money, and other aspects of the claims process.


  1. Ongoing communication. The first-day phone call is extremely important, but the contact should not end there. The supervisor should stay in touch with the injured worker on a continuing basis, through conversations and by sending get-well cards. In addition to finding out how the worker is progressing, these conversations can provide insight into the worker’s mood and whether he is engaged in his recovery. The supervisor should also relay the latest workplace happenings, so the worker feels kept in the loop.


  1. RTW/Transitional duty. Supervisors should be trained on the benefits of returning an injured employee to work as soon as possible, that it is not only best for the organization from a financial standpoint, but usually is best for aiding the worker’s recovery. If the employee cannot return to full duty or his usual work tasks, there should be some type of modified or transitional duty available. The supervisor should be an integral part of this — finding/designing opportunities and guide the injured worker through the process, such as getting the medical restriction information from the treating physician.





Well-run workers’ compensation programs protect employees and save money for their organizations. The supervisor is in the best position to make sure a worker who does get injured has a smooth experience. Therefore, it is vital to make sure they are well trained in all aspects of the program.




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


Contact: mstack@reduceyourworkerscomp.com.

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


©2018 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.


Reducing Work Comp Costs through Creative Return-To-Work

Reducing Work Comp Costs through Creative Return-To-WorkThere is a benefit to every workers’ compensation program when an employee returns to work following a work injury.  This is true even in instances where the employee returns to work in a “light duty” capacity.


Creating an effective return to work takes an investment by all interested stakeholders.  It also requires creativity and a willingness to keep employees within the workplace.  In the long run, it also reduces program costs and promotes a better work environment.



Understanding the Benefits of Light Duty Work


Engaging injured workers in light duty work creates a win-win situation for all interested stakeholders.  This includes the following:


  • Employees: A person staying at home following a work injury incurs many psychological barriers.  It not only takes the employee out of their natural schedule, but it creates isolation and boredom.  Countless studies show that employees working in a modified capacity following an injury have better outcomes and a quicker recovery.


  • Employers: Interested stakeholders who own and operate a company can create a positive work environment by offering light duty work options.  It allows the employer to demonstrate a willingness to keep employees working and increases workplace morale.  It also allows them to complete necessary tasks that might otherwise not get resolved promptly.



Light Duty Work:  Finding Creative Solutions to Keep Employee Working


There are numerous light-duty positions available for employers willing to keep employees working.  This applies to companies of any size.  All it takes is interested stakeholders willing to invest in their workforce:


**When reviewing this list, keep in mind the best light duty position is to modify the employee’s current position. If this is not an option, be creative to make transitional work meaningful for both employee and employer.***


Sedentary Work Opportunities:


  • Sort incoming and outgoing mail. This can also include the delivery of intra-office mail using a cart or other assistive devices;
  • Security guard positions;
  • Inventory parts, supplies, and tools;
  • Answering telephones and other clerical work;
  • Ordering of office supplies. This can also include making sure safety, and first-aid cabinets are fully stocked;
  • The labeling of packages and parcels;
  • Driving a work vehicle to make deliveries. In other instances, employees can be trained to operate equipment such as a forklift;
  • Train new employees and complete necessary training; and
  • Update MSDS manuals.


Lighter Duty Positions with Weight Restrictions:


  • Picking up trash around the office, work area and on the premise. Other forms of work can include sweeping and light cleaning to ensure a safe workplace;
  • Inspecting fire extinguishers, eye-wash machines, and other safety equipment;
  • Light housekeeping and dusting in office spaces;
  • Engage in workplace quality control and other necessary inspections;
  • Shredding of company documents that are confidential; and
  • Maintain the company premises using snow removal equipment and lawns during the summer months.


Light Duty Positions with Greater Weight/Mobility Restrictions:


  • Perform assembly work using machines;
  • Working in a shipping department that requires light lifting and use of assistive devices;
  • Washing company vehicles;
  • Work a normal job, but at a slower pace; and
  • Working normal position within specific limitations.



Other Creative Solutions to Light Duty Work


In some instances, an employer might not be able to offer an employee a light duty position within their workplace.  If this is the case, employers should seek other opportunities to help in the recovery process by keeping an employee working in another capacity.  Creative solutions can include:


  • “Work on Loan” programs: Under this type of program, the employer will collaborate with another employer or non-profit organization.  The employee will remain an employee of the date of injury employer, but perform work duties for the other organization; or


  • Paid volunteer work: In some instances, a charity might have volunteer work for people to perform, which matches an employee’s work restrictions.  The date of injury employer will pay the employee to perform work duties as assigned by the charity.




An effective return to work program requires all interested stakeholders to be engaged and seek to keep injured workers active and in the workplace.  By keeping an injured worker engaged, they can reduce costs through better injury recovery and reduced exposure for various wage loss, medical or vocational rehabilitation benefits.




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


Contact: mstack@reduceyourworkerscomp.com.

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


©2018 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.

A Winning Approach in Workers’ Compensation

Article originally published in On the Frontline Magazine


A winning approach to workers' compensation

An injury or illness arising out of one’s work can be costly. For claimants and their employers, a complete recovery and return to work, as quickly as possible, are ideal, but how do we ensure this happens? The answer lies in medical management programs.


Historically, the longer a workers’ compensation or employers’ liability claim remains open, the greater its expense. As occupational health care costs rise, employers and health care payers want to contain expenses.


“Medical management programs enable early engagement on a claim and a faster return to work, which is good for both the employer and the employee. It’s a win-win for everybody,” says Danielle Lisenbey, president and chief executive officer of Broadspire, a Crawford company.


In medical management, the aim is to get the patient on the right track. This involves a combination of the right price, care coordination and optimizing outcomes. Broadspire also encourages employers to have a return-to-work plan in place, with senior management support, and clear responsibilities for the injured worker and employer.


“Medical management is not about securing the cheapest care; it’s about securing the most appropriate care,” said Jim Andrews, executive vice president of prescription benefit management services at Healthcare Solutions, an Optum company. The company, which provides data and care management services to Broadspire, focuses on improving care coordination, which ultimately produces better outcomes at less cost.


“Care coordination is a problem, especially in workers’ compensation. If you can coordinate care in a workers’ compensation claim, you can reduce the redundancy of services,” he says. “It’s a win for the employer because they get the injured workers back to work sooner.”


In workers’ compensation claims especially, medical management is an effective way to contain costs. “The medical component is becoming the dominant factor in a workers comp claim,” explains Paul Braun, managing director at Aon Risk Solutions. “From a concentration standpoint, it used to be that about 70% of the claim was for indemnity, and 30% was for medical. Now, it’s almost reversed.”


There has been a significant rise in medical costs over the past decade. Currently, U.S. healthcare spending is on track to hit $10,000 per person or $3.207 trillion in total in 2015, according to a Forbes report. “With the rise in medical costs, there has been a greater focus and need for medical management in all aspects of claims,” says Lisenbey.


“Claimants often are confronted with a lot of different information, from their doctors as well as employers,” she continues. “We help them understand what’s going on with their case, we engage them at the family level and help them understand what questions to ask in order to get the right care.”




Joining the Dots


Medical management services also deliver advanced analytics to employers, Lisenbey notes. Broadspire uses e-triage, a detailed interview process that captures claimant information including co-morbidities that might not be observable. “For example, the e-triage process might reveal that a claimant has a smoking habit, and medical evidence shows that smokers take longer to heal from injuries,” she explains.


That kind of data can help in applying different strategies to further improve the outcome. Similarly, provider analytics enable employers to maximize their physician networks by comparing factors such as durations and costs related to services the physicians provide.


Another tool that Broadspire utilizes is the ‘virtual peer’, a composite of data points that enables comparisons of employers’ experiences and claims trends, even among organizations in different industries. Data that is helping produce better outcomes also involves prescription drugs – one of the fastest-growing components of medical claim costs.


Danielle Lisenbey, President and CEO, Broadspire®


“Our data is available in almost real time, which means it becomes available for analysis in near real time,” says Healthcare Solutions’ Andrews. “Paper-based medical bills take much longer to receive and analyze. Although data analysis on prescriptions can quickly show trends, “it doesn’t always mean that you can do something about it immediately.”


Worrisome drug-related trends in workers’ compensation include: physician dispensing, increasing use of compound pharmaceuticals and use of narcotics to relieve pain. “With narcotics and opioids, it’s important to manage those from an injury and recovery standpoint. You need to offer other services to help people with intractable pain. You can’t just say no to the drugs without offering something else, or coordinating care with the primary physician,” says Andrews.



Modern Day Nursing


Broadspire’s senior nurse reviewer (SNR) program has also driven significant savings since its launch in 2005. It reviews cases and determines an appropriate medical management intervention, with periodic review until a favorable outcome is reached. Among its benefits are: an average reduction in claim payments exceeding 10%, improved closure rates, and reduced litigation rates.


“In workers’ compensation, a cost-saving factor is a return-to-work program,” Aon Risk Solutions’ Braun says. “Return to work is critical, and getting someone like a nurse case manager to assist and support that model is very important.”


In the UK, Broadspire provides medical management services that help employers and claimants navigate the single-payer National Health Service. “The NHS is the first port of call for anyone who’s injured, and hospital and point-of-service medical treatment is covered,” says Deborah Edwards, head of rehabilitation at Broadspire.


“As patients progress through the NHS, the rehabilitation and recovery process becomes patchier,” she continues. “If someone is out of work, they might be waiting six months for surgery in the NHS that could be performed in a week if privately paid. We juggle those services with the goal of rapid return to work.”




Danielle Lisenbey became chief executive officer of Broadspire in 2012. Immediately prior to this role, she was chief operating officer for Medical Services, responsible for the operation of all of Broadspire’s medical and case management services. In this position, she drove the continued development and delivery of products and services that have generated cost containment results typically 10 to 15 percent better than those produced by other TPAs and medical management companies.


During her tenure as chief operating officer, many new service offerings were developed, including: the BOLD® Network, a unique, state-stratified, multi-tiered approach to a preferred provider organization (PPO) strategy; a durable medical equipment (DME) formulary that applies the cost management principles of a pharmacy formulary to medical equipment; and a new chronic pain protocol, a multidisciplinary approach to addressing the complex chronic pain conditions that drive the duration of workers compensation and disability claims.



You Can Find Workers’ Comp Gold in 8,000 Hours

Hey, there. Michael Stack here, CEO of Amaxx. I’m generally fairly handy. I worked in a wood shop in college for four years and I’ve always enjoyed sort of doing little projects. So will have a lot of fun doing projects around the house or working with the kids, teaching them some things, et cetera. There’s a lot of things that I can do, but there’s also a lot of things that I can’t do.


We’ve been working on expanding our bathroom for the last several months. It’s sort of a different story for why it’s taken so long. But about two weeks ago, my wife’s cousin is a licensed plumber, and he came out to help us install the new plumbing. We’re expanding our bathroom into some new closets and putting a new shower in, et cetera.


He comes out for the weekend, stays with us and brings a friend of his. And so we have a nice time. We get the project done, and all goes great. And while they were here, the plumbers were here, I was talking with my wife’s cousin’s friend, and he’s been in training to become a licensed plumber. And I asked him, well, how long does it take to become a licensed plumber? How many hours that you need.



8,000 Hours to Become Licensed Plumber


And he told me. It takes 8,000 hours of training to become a licensed plumber. 8,000 hours of training to become a licensed plumber. I want that number to sink in with you. I want that concept to sink in with you. And I want you to think about what it takes for your, particularly your skilled labor at your organization, of why you hired them. The training that they have to go through in order to get up to be a valued employee and the experience that they’ve had in working for you.


One of the biggest challenges that companies often face, particularly with skilled labor, is that they say, well, we just don’t have any transitional duty for these guys. They’re not that good at office work and we just can’t really find anything for them to do. And maybe that’s true. Maybe they’re not that very good at office work.



Think Creatively Regarding Transitional Duty


But ask yourself this question. Over the course of this 8,000 hours, or whatever the training looks like for your organization, do you think they learned anything? Do you think they picked up any intricacies about how to do that job better than the average guy that may come in, filling in as a replacement? Do you think that the value that they can bring to your organization can be still substantial even if they’re not at 100%?


I want to challenge your paradigm, challenge your thinking to put this number, or whatever it is at your organization, into some perspective. I want you to get creative in regards to your transitional duty, leverage the skills, leverage the experience, leverage the knowledge, leverage the expertise that your employees do have. Put them back to work, bringing value to your company and to themselves, as well. Dramatically improving their recovery. Dramatically driving down the cost of their claim.


Again, I’m Michael Stack, CEO of Amaxx, and remember your work today in worker’s compensation can have a dramatic impact on your company’s bottom line. But it will have a dramatic impact on someone’s life. So be great.




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


Contact: mstack@reduceyourworkerscomp.com.

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


©2018 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.


Proven 5 Step System to Master WC Costs Plus Bonus Avoiding Litigation and Using IMEs Training



Learn More: 2018 Version – Your Ultimate Guide to Mastering Workers’ Comp Costs


Now there are many things in our world today that we just can’t seem to figure out. Some of the most advanced medical treatments, the greatest challenges our country is currently facing, as well as when you’re trying to have a conversation with someone. They just can’t seem to look up from their phone. I can never seem to figure that one out. But while those things are going to continue to be a challenge, there is no mystery in how to drastically reduce worker’s compensation costs and create significantly better outcomes for the injured workers, creating truly a best case scenario for the employer and the employee. In this proven five-step system, this process, these strategies, these tactics, as well as the sequence of how to implement them has been documented in detail in the 2018 version of Your Ultimate Guide to Mastering Worker’s Comp Costs.



No Mystery in How to Control Workers’ Comp Costs


Hello, my name is Michael Stack. I’m the CEO of Amaxx and also the co-author of this comprehensive manual. Now the system, these strategies, these tactics, the sequence was created out of my business partner and co-author’s almost 30-year career in worker’s compensation, implementing this system at some of the largest and recognizable companies in the country. Hundreds of organizations realizing those exact results of drastically reduced costs, significantly better outcomes for their injured workers. This manual was created out of my almost 10-year career in working with Becky and continuing to refine this system and improve it and create more efficiencies and making it more effective. And new just this year out of our medical advisor, Dr. Jacob Lazarovic’s almost 20-year career as Chief Medical Officer at Broadspire, one of the world’s leading third-party administrators. And I can confidently state to you that there is no better source, no more complete source, no more easy to understand source of how to create those outcomes of drastically reduced costs, significantly better outcomes for the injured workers than exists in this 2018 version.


What I want to do today is I want to give you an overview of those five steps, and then I’m going to teach a little lesson about the information and some of the updates that I did in this latest version. Because the last thing that you need is more information. The last thing you need is another book to sit on the shelf. Where this information becomes valuable is when you actually use it, when you learn it, when you implement it. I want to give you a little preview of that today covering two of some of the biggest pain points that employers often will face in worker’s compensation, which is how to avoid litigation and then how to best utilize the independent medical exam for controlling medical costs.



Proven 5 Step System to Reduce Workers’ Comp Costs


Let’s do a real quick overview of these five steps. Now again, this is a sequence. This is a process and this is a system so each one of these steps is going to build upon itself, and the better that you do at step number one is the better that you’ll do at step number four and five.


Step 1: Build Program Foundation

Step number one is to build your program foundation. This includes creating who are these people that are going to be responsible at the employer site? What are their rules? What are their responsibilities? What are the basics of worker’s comp? What is the experience mod? How does that all kind of come together? That’s building that program foundation.


Step 2: Injury Prevention

Injury prevention them. That’s safety and that’s wellness. The least expensive work comp claim is certainly the work comp claim that never happens. That’s what goes into that injury prevention chapter and section within the book.


Step 3: Post-Injury Systems

Post-injury systems. Now this is the bread and butter. This is the engine that’s going to drive those results. This is the area where companies get realized drastic results very quickly because this is post-injury response, this is return to work, this is communication, this is the foundation of the entire process, and if a company can get these elements correct, they’re going to realize significant results very quickly and this could create those reduced costs and create those better outcomes.


Step 4: Claims Management Best Practices /  Step 5: Control Medical & Pharmacy Costs

Now if this post-injury system step number three is the engine, then steps number four and five is a higher-octane gasoline that gets poured into that engine because this is leveraging your claims management partners. This is leveraging your vendors. This is leveraging the service providers, your medical providers, your pharmacy benefits management company. And how do you put that all together to help this all work in a very consistent system that runs like a top creating these better outcomes at a significantly reduced cost? That’s what we cover in detail in this comprehensive manual.



How to Avoid Litigation


What I want to do now is I’m going to erase this board and we can dive into some of these tactics, the avoiding litigation and using IMEs. Let’s dive into this topic of avoiding litigation. In the manual itself, we go into much greater detail referencing studies from the work comp research institute, as well as from the Liberty Mutual Research Institute. We have input from a plaintiff attorney and defense attorney in talking about this entire process. But I want you to lock in with me here because this one concept of why injured workers hire attorneys, and avoiding litigation is extraordinarily simple and it comes down to one word, which is fear. The number one reason and the main driver for why injured workers hire attorneys is fear, the fear of the unknown.


And if you could lock in on this concept, understand this concept, have empathy for this concept of putting yourself in the shoes of the injured worker and looking at it from their perspective, then you’re going to be well on your way to this process of mastering worker’s compensation. You’re going to be almost halfway there if you understand the why, then the how to avoid that, the how to improve upon it becomes significantly easier. And all you have to do then if follow the steps of the how that’s documented in the manual itself.


Let’s talk about how you alleviate this fear, and there’s a couple of different things that the injured employees really want to know, and all you have to do is communicate these couple things. One, how am I going to get paid? Two, who’s going to handle my medical and how is that all going to work? Am I going to have to pay a deductible and what doctor am I going to see and am I going to be able to recover? And the last thing, and this is probably one of the most significant, is work. Am I going to be able to continue to work? Am I going to lose my job? Does anyone even want me back at work, and does anyone even care that I got injured? If you could put yourself in these shoes, if you could answer these questions, if you could communicate the answers to these questions for your injured workers, for your employees, you are significantly far down the path to mastering worker’s compensation.


Worker’s comp can be very complex. There’s a lot of layers to it. There’s a lot of different stakeholders involved, but at its core, it’s extraordinarily simple of meeting these basic needs and alleviating this fear within your injured workers. It’s not all sunshine and roses. Your expectation of them is high. You’re running a high integrity program. You’re going to do your best to communicate. Do your best to get them back to work, do your best to set the expectations. Hold up your end of the bargain, and expect them to do the same. And when they don’t, there’s that hard line of integrity that you’re going to then move to potentially deny that claim, move to litigation, prove fraud, etc., etc. We cover a lot of that in the book as well.



Realize Significant Savings on IMEs


So the next thing I want to cover now is the IME process. Let’s talk about the IME, the independent medical exam. This is a vital tactic in medical cost containment best practices. But what we find is that it’s also a significant area of opportunity to create these lower costs and drive these better outcomes because it’s often utilized in the wrong scenarios. IME is a vital piece of medical cost containment, but it also takes a long time for it to be scheduled. It takes a long time for the doctor to generate the report and the injured employee actually has to physically go to the physician’s office. A peer review on the other hand is significantly faster. This is done by a peer review physician at your managed care company. It’s significantly less expensive and can be done often within just a couple of days versus multiple weeks for the IME. Two vital pieces of medical cost containment when they’re used at the right time, so I want to talk about when that is.


Peer Review vs. IME

Let’s talk about peer reviews and when we should be using these. First, if there’s a question of causation. You’re going to have a peer review physician review that information. Next is if you’re finding that you’re not sure whether or not that injured employee can get back to transitional duty, can get back to work, and there’s a little bit of a discrepancy there and you need that medical opinion, peer review is a fantastic solution for that. Along those same lines, if the duration of the injury falls outside of the injury duration guidelines in evidence-based medicine, and you need that medical opinion in order to determine what to do because the adjuster’s not a medical doctor. They’re not medically trained. The employer is not medically trained, and you can’t make that determination of what is appropriate in that scenario. Tremendous option to leverage a peer review.


And the final thing is if you just need a medical opinion on really any other issues within the case. Again, every claim that happens in worker’s compensation needs medical attention to some degree, whether it’s very minor or significant, and many times you need that medical expertise in order to help you make a proper decision on what to do with that claim. So all tremendous times to leverage this peer review option which again is significantly faster and significantly less expensive. Again, IME though is a very vital piece. It’s a vital tactic in medical cost containment when it’s used at the right time.


Let’s talk about these times when that’s needed. If there’s advanced issues in the claim that can’t be handled with a simple peer review, tremendous time for an IME to be leveraged. If you need a formal impairment rating on a case. If it’s going to settlement and you need a formal impairment rating, tremendous time to use an IME. If there’s a legal that’s going to be coming down the pipe and you need that doctor, and then sometimes it’s required by the state law, by the state worker’s compensation boards. So both tremendous tactics. It’s just a matter of deploying them in the right scenarios to drive down those costs and create those better outcomes.


I hope you’ve been able to learn some information on these just real quick sessions that I did in avoiding litigation and then on the IMEs. The key to this entire system, to this entire process, of all the information that’s documented in this comprehensive manual is taking it and implementing it, and when you do that, when you implement this information, when you learn it and you take it one step at a time, you will realize exceptional results.



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


Contact: mstack@reduceyourworkerscomp.com.

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


©2018 Amaxx LLC. All rights reserved under International Copyright Law.


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

5 Ways to Get Management Buy-In for Your Workers’ Compensation Program

5 Ways to Get Management Buy-In for Your Workers’ Compensation ProgramTo have a successful, effective workers’ compensation program requires commitment from the entire organization, starting at the very top. Leaders must not only endorse the program but be engaged as well, for it to be of value to the company.


A lack of management support will be apparent to the rest of the workforce which won’t share your goals. But there are steps you can take to get leaders to fully embrace your injury management plan.


  1. Speak their language


Getting the attention of management is largely a numbers game. Those in the C-suite need to understand the dollars and cents of an effective workers’ compensation program.


  1. Play on what is important.


  • Find out what matters most. Every organization has some way to determine its financial success. Find out what metric resonates most; the figure management discusses with shareholders, the board of directors or other senior managers. This could be
    • EBITDA: The company’s earnings before interest, taxes, depreciation, and amortization. This is the company’s net income with interest, taxes, depreciation, and amortization added back in. It eliminates the effects of financing and accounting decisions. It shows the company’s current operating profitability, or how much profit it makes with its current assets and its operations on the products it produces and sells, as well as providing a proxy for cash flow.
    • Net income number. This refers to the profit made after the company subtracts its expenses. Where revenue is the company’s total sales and is known as the top line, net income is called the bottom line, or the company’s earnings.
    • Revenue from operations. This is the income generated from an organization’s daily core business operations and is also called operating revenue. It is the revenue posted from selling the company’s products and services.


  • Calculate the potential savings. This requires figuring out the cost of a full-time equivalent employee, then determining the possible savings from reductions in workers’ compensation costs. For example, if the important metric is the EBITDA and you know that the cost per FTE over the past three years has been going up, cutting that number in half could potentially reduce the EBITDA number by X percent. You want to use the company’s most important metric to frame the amount of revenue the organization must generate to cover its workers’ compensation losses.


  • Define the impact of a claim. Either by your own calculations or through e-mod software.


  • Compare the cost of a claim to the expense of something the company wants. Say your company had a recent workers’ compensation claim that cost $575,000 and the company needs certain equipment that costs $500,000. Explain that improvements in your company’s injury management program could have prevented that claim to show the money for the equipment could have been available.


  1. Produce evidence of wastefulness. Whether it is outright fraud or just a lax attitude toward safety, management responds to pictures and videos of employees that translate to a culture of uncaring about the organization’s resources.


  1. Present the numbers. A well-run return-to-work program keeps injured workers on the job or gets them back to work quicker. But company leaders may not truly believe that unless you show them real numbers from research:


  • Up to 80 percent of lost work days are unnecessary.
  • Injured workers out of work and receiving indemnity payments are 4X more likely to have an unsatisfactory outcome. The same research found that employees with similar injuries who either stayed on the job or returned sooner had better outcomes.
  • The chances of an injured worker returning to the workforce in any capacity drops by 50 percent after 12 weeks of being out of work.


  1. Give hiring advice. Management will be more apt to listen to you if you can present a way to avoid hiring the company’s next workers’ compensation claim. An easy, fairly inexpensive way to make sure the right people get hired is through an integrity test, such as the Merchant’s Integrity Test.


This is not a personality test nor does it require complex algorithms to interpret the results. The questions are direct and aimed at predicting the likelihood of problem behaviors from the person.


There are 50 questions that have been vetted and updated. According to psychologists who have studied the test, it works because people who engage in ongoing risky behaviors eventually rationalize their behaviors and come to believe there is nothing wrong with their conduct. More than 90 percent of applicants tell the truth about their high-risk behaviors.


Avoiding problem hires is one of the best ways of reducing workers’ compensation costs. Tests from Cornell University and elsewhere have indicated applicants who took and passed the test had half as many workers’ compensation claims as those who did not take it.





Having an injury management program may sound like a good idea to managers, but to understand its true value to the company requires looking at the numbers. Taking those numbers to management to frame a conversation that is meaningful to the organization can get leaders to be onboard with your program.




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


Contact: mstack@reduceyourworkerscomp.com.

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


©2018 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.

NCCI Report Recap: How Professional Administration Factors In

NCCI Report Recap: How Professional Administration Factors Innew research brief on MSAs and Workers’ Compensation by the National Council on Compensation Insurance (NCCI) reveals significant opportunities to help injured parties, especially through use of support systems like a professional administrator.


The brief updates a previous report published in 2014. That document considered data on MSA submissions to the Centers for Medicare and Medicaid Services (CMS) between September 2009 and November 2013. The latest version also includes information from 2014 and 2015 submissions, based on 11,500 MSA submissions.


As Medicare is a secondary payer for work-related injuries, insurance carriers must protect Medicare’s interests when settling claims. Many insurers create MSA funds to help pay for injury-related costs that Medicare might otherwise pay. There is no legal requirement to submit a proposed MSA to CMS; however many insurers choose to do so. Once the CMS-approved set-aside amount is spent and properly accounted for to CMS, Medicare will pay for future covered expenses.


Findings and Discussion


  • “The largest share of MSAs are submitted about four years after the injury. The number of submissions gradually decreases after that, but it is not uncommon to have a submission 20 or 25 years from the accident.”


The amount of the MSA increases with each passing year. As NCCI’s report notes, in the first year, the average amount of an approved MSA is $53,213; by year 5, that has increased to $105,430; and by year 20, it is $168,469.  Clearly, it makes sense for payers to settle claims as soon as possible. It also benefits the injured party, who is in a better position to move on with his life and not dwell in a disability mindset.


  • “Almost 95% of submissions are for claimants who are Medicare-eligible.”
  • “Almost all MSA settlements are self-administered. Larger MSAs are more likely to be professionally administered than smaller MSAs.”


In fact, only 2 percent of MSAs are handled by professional administrators. This is discouraging, as that means 98 percent of injured parties with MSAs are themselves responsible for complying with all the Medicare requirements, including:­


  1. Maintain line item detail for the duration of eligibility
  2. Use the fund only for Medicare covered expenses
  3. Pay according to the appropriate fee schedule
  4. Prepare and submit annual accounting report to CMS
  5. Deposit the fund into an interest-bearing account
  6. Use the fund only for treatments related to the injury


Failing to comply with all six requirements puts the injured party at risk of being denied benefits by Medicare.


In addition to compliance, having a professional administrator involved can also extend the life of the MSA fund. Savings on provider bills, durable medical equipment, medical treatment, and prescriptions are only available to injured parties who have a professional administrator involved with their post-settlement scenario.


  • “While many MSAs have been approved by CMS as submitted, CMS often requires that the MSA be increased.” In fact, the gap between the average amount submitted for an MSA and the amount approved by CMS increased slightly from 2013 to 2015.
  • 2013 — Submitted amount: $101,260; approved amount: $111,793 – a difference of $10, 533.
  • 2015 — Submitted amount: $88,911; approved amount: $103,288 – a difference of $14,377.


Much of the increase in this gap is due to prescription medications.


  • “Overall, drugs are about half of MSA amounts, but for more than one-third of MSAs, drugs are less than 10 percent of the MSA value.”


Working with a professional administrator can entitle injured parties to significant discounts on medical costs. Injured parties who are shown the cost differences through a professional administrator compared to the retail prices they would otherwise pay are often pleasantly surprised to see how much they can save.


  • “More than half of MSA claimants seek claimant attorney assistance when establishing MSA arrangements”


54 percent of MSAs involve an attorney, while the remaining 46 percent do not.


Injured parties leery of settling their claims often feel overwhelmed by the various requirements for compliance, as well as the fear of managing their money so they don’t run out too soon. Professional administrators can help guide injured parties (and all involved parties) through the settlement maze, and stay with them after settlement.




Author Leah Fusco, Chief of Staff, Ametros. Leah manages all of Ametros’ clients and partners, manages and supports the sales team, analyzes trends, and provides reporting and analytics. She brings over a decade of claims, settlement consultation and account management experience to Ametros. Prior to joining Ametros, Leah was a manager within the Medicare Compliance Department at Sedgwick, a leading third-party claims administrator. Before working with Sedgwick, she worked in Claims Management at PRM Claim Services, and Triad Group. Leah obtained her A.A. in Humanities and Social Sciences from Schenectady County College, and her B.S in Business Management from The Sage Colleges. She is CMSP certified, and is also a licensed New York Independent Adjuster, and a licensed life broker. Leah is an officer of the Albany Claims Association. She currently resides in Albany, New York with her husband and son.

How Prescription Drugs Impact Your Company and What You Can Do About It

How Drugs Impact Your Company and What You Can Do About ItMore than 70 percent of employers say they have felt the impact of prescription drug usage. That sobering statistic from the National Safety Council highlights the fact that, despite successful efforts by some employers and Pharmacy Benefit Managers to stem the abuse and misuse of opioids and other legal drugs among injured workers, the workplace continues reeling from the effects of legal medications.


The NSC’s survey of employers shows there are many areas where employers can take action to address the issue, and for each employee helped, employers can save more than $3,200 annually. Representatives of the NSC, United Airlines, and the Workers Compensation Research Institute will unveil the latest research on how opioids are impacting employers, and the duration of disability for injured workers, during WCRI’s upcoming annual conference.



Substance Use Disorder


‘Substance use disorder’ is the current term to describe the recurrent use of alcohol and drugs that cause clinically and functionally significant impairment, including health problems, disability and a failure to meet major responsibilities at work, school or home. The terms substance abuse and substance dependence are no longer used, according to the latest version of the Diagnostic and Statistical Manual of Mental Disorders.


In 2014, there were an estimated 1.9 million people with opioid use disorder related to prescription pain relievers and an estimated 586,000 with an opioid use disorder related to heroin use. There are a variety of symptoms, such as an inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after stopping or reducing use, such as negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and insomnia.



Impact on Employers


Absenteeism is cited as the #1 impact of prescription drugs in the workplace, according to the NSC survey. Workers who have substance use disorders miss almost 50 percent more work days than their peers — up to six weeks annually.


Using pain relievers at work, having a positive drug test and being impaired or having decreased job performance were also included on the list of ways prescription drugs have impacted companies.


‘Near miss or injury’ was named by 15 percent of the respondents as a problem among prescription drug abusers. 84 percent of the employers cited concern over the costs of workers’ compensation because of prescription drug use.


Here are some additional findings from the survey:


  • 76 percent are not offering training on how to identify signs of misuse.
  • 81 percent lack a comprehensive drug-free workplace policy. Of those that do a drug test, 41 percent don’t test for synthetic opioids.
  • 19 percent feel ‘extremely prepared’ to deal with prescription drug misuse.
  • 70 percent would like to help employees return to work following appropriate treatment.
  • 88 percent are interested in insurance coverage for alternative pain treatments


The NSC conducted the survey of more than 500 HR decision makers for companies with at least 50 employees. Looking at specific industries and demographics, the Council said construction, entertainment, recreation and food service sectors have twice the national average of employees with substance use disorders.


Industries dominated by women or older adults had a two-thirds lower rate of substance abuse, and industries that have higher numbers of workers with alcohol use disorders also had more illicit drug, pain medication and marijuana use disorders


Employers were most concerned about the costs of benefits associated with substance use disorders, and their ability to hire qualified workers. They were less concerned about drug misuse and illegal drug sales or use.


The NSC also said that workers who are in recovery have lower turnover rates and are less likely to miss workdays, less likely to be hospitalized and have fewer doctor visits.


While 71 percent of employers say prescription drug misuse is a disease that requires treatment, 65 also feel it is a justifiable reason to fire an employee.



Action Steps


Healthcare costs for employees who misuse or abuse prescription drugs are three times higher than for other employees. And the annual cost of untreated substance use disorder ranges from $2,600 to as high as more than $13,000 per employee.


The good news is employers can take steps to protect their companies and employees. They include:


  1. Recognize prescription drugs impact the bottom line
  2. Enact strong company drug policies
  3. Expand drug panel testing to include opioids
  4. Train supervisors and employees to spot the first signs of drug misuse
  5. Treat substance abuse as a disease
  6. Leverage a best-in-class Pharmacy Benefits Management provider relationship




Nearly 21 million are living with substance use disorders of one type or another; more than the entire population of the state of New York. Most of those people are employed.
The problem costs the U.S. economy more than $400 billion per year. Employers can play a significant role in reducing this epidemic. In fact, employer-supported and monitored treatment yields better-sustained recovery rates than treatment initiated at the request of friends and family members.



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


Contact: mstack@reduceyourworkerscomp.com.

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


©2018 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.

Fourteen Steps Employers Can Take to Manage Workers Compensation Claims

Fourteen Steps Employers Can Take to Manage Workers Compensation ClaimsToo many employers allow their involvement in the workers’ comp claim to end when they send the employee to the doctor. That is a huge mistake and will result in a steady increase in the amount of workers comp insurance premiums. The employer needs to have an established post injury process. It should include:


  • Report the claim to the insurer, third-party administrator or self-insured claims office immediately. The supervisor or your workers’ comp claims coordinator should be reporting the claim to the claims office while the employee is still en route to the medical provider.


  • Complete the Employer’s First Report of Injury and any other state required paperwork on the claim.   If the injury is severe and the employee will be unable to return to work within the waiting period, provide the claims office with necessary wage information for the calculation of indemnity benefits.


  • Advise the claims office of the claimant’s prior history of workers comp claims. The adjuster’s approach to the claim varies significantly between the employee who never had a previous workers comp claim and the employee who has had 15 workers comp claims in the last ten years.


  • Review your transitional duty program and find a job the employee can do within the treating physician’s restrictions.


  • Be sure the employee’s supervisor (and co-workers if needed) is available to discuss the accident and injury with the claims adjuster and to assist the adjuster with the claims investigation as required.


  • Don’t alienate the employee – show empathy to the employee. When employees feel the company does not care about them and their injury and the company owes them, the claim will get ugly when employees think it is time to stick it to the employer.


  • Maintain an open dialogue – call the employee at home to show your concern and to offer assistance in processing the workers’ comp claim with the insurance company. Address any employee problems or issues right away. Also, call the employee on a regular basis until s/he is back at work.


  • If you are contacted by an attorney representing the employee, notify the claims adjuster immediately.


  • Immediately dispute any invalid or fraudulent claim.


  • If the employee has a questionable claim or a subjective claim for neck or back injuries, and immediately goes to the television advertising workers comp attorney, or a plaintiff’s attorney-oriented doctor known for excessive disability ratings, advise the employee immediately that you intend to fight the claim as the attorney and/or doctor has a history of inflated claims.


  • Monitor the state filings by the adjuster and any other claim related paperwork.


  • Monitor the Workers Compensation Board decisions – that means, reading them carefully, not just filing them away. Be ready to protest any finding or order you feel is unfair to you as the employer as all decisions have time limits for disputing the decision, with some time limits as short as 15 days. The board will learn YOU are an employer who takes part actively.


  • Monitor the medical progress reports to be sure the treatment is appropriate – for example – no physical therapy for the low back when the injury is a cut finger.


  • Always advise the adjuster when the employee returns work – the same day.



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


Contact: RShafer@ReduceYourWorkersComp.com.

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


©2018 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.




The Real Value of Injury Triage

The real value of injury triageInjury triage has become more common over the last several years. Although the market is still in the process of adopting the service as a best practice, there are fewer risk managers that start off a conversation regarding triage by asking: “What’s that?” Indeed, injury triage is no longer a service only utilized by early-adopting, forward-thinking risk professionals. The service has proven its value in enough settings and employer types that adoption of the service will continue on to virtually all employers who have exposure to work-related injuries.



Looking at Triage Simply to Reduce Claims Could Miss Bulk of Savings


So, what is the reason why more employers, insurers, and carriers are beginning to use the service? The easy answer is that injury triage reduces the number of claims that are produced. By reducing claim volume, one can easily assume that overall claim costs for an employer or insurer will also decrease. This seems logical, right? While that may be true, looking at triage simply as a means to reduce claim frequency might be missing the bulk of the savings and efficiencies gained from use of injury triage.


Rather, a strong argument can be made that the real value is delivered through the use of the service from what might be referred to as “second-tier savings.” These are ancillary savings that are often unique to an employer’s situation. Many times the real value of utilizing injury triage has much to do with the specific challenges faced by an employer. For example, an employer that operates on a 24-hour basis or during late-night hours might have a significant dilemma regarding Emergency Room visits. ER’s are typically the only place where medical treatment is available at night. This type of medical treatment is expensive and not conducive to the overall goals of a well-managed workers’ compensation program. The ability of injury triage to greatly reduce the frequency of ER visits would be far more significant to that employer than an employer who operates during normal business hours when there are other accessible healthcare options.



Evaluate Real Value by Examining All Savings


Another example of injury triage’s real value demonstrated through “second-tier savings” would be a contractor or similar business, that is highly sensitive to OSHA recordables. In many cases, these types of businesses must be able to prove that their OSHA recordable rate is below a certain level in order for them to be able to obtain new projects and earn new business. The ability of injury triage to reduce OSHA recordables by making sure that injured employees access the proper level of care can be more valuable than any other benefit. This would not necessarily be the case for employers who are not as sensitive to OSHA recordables; so the real value of injury triage for some contractors lies in ancillary benefits.


A strong Return on Investment can be shown simply by looking at injury triage as a means to reduce the number of claims that are produced in any given time period. However, evaluating the real value of injury triage should be done by examining all of the savings the service provides on an employer-specific basis.



Author Craig Deneau, Medcor, National Practice Leader-Triage Services. Medcor helps employers reduce the costs of workers’ compensation and general health care by providing injury triage services and operating worksite health and wellness clinics. Medcor’s services are available 24/7 nationwide for worksites of any size in any industry. Headquartered in McHenry, Illinois, the company operates 174 clinics and provides triage services to over 90,000 worksites across all 50 states and US territories. Medcor’s triage methods are covered by U.S. & foreign patents, including U.S. No. 7,668,733; 7,716,070; & 7,720,692; other patents pending. Medcor is privately held. Learn more at www.medcor.com.



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