Drug Trend For Work Comp Increased 9.5%, And Other Top News Tidbits

Express Scripts Drug Trend Report: Cost Increases Drive Higher Drug Trend for Workers’ Compensation

Overall drug trend for workers’ compensation increased 9.5%, according to the Express Scripts Workers’ Compensation Drug Trend Report, primarily from an 8.2% jump in cost per prescription. Compounded medications led the way, with per-user-per-year costs soaring 126% higher. Although these medications account for just 2.7% of pharmacy costs in workers’ compensation, the dramatic rise in price significantly impacted overall trend.  Read more…

 

 

Self Administration Toolkit for WCMSAs

On April 11, 2014 the Centers for Medicare and Medicaid Services added a Self Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements to its CMS.gov website. It can be viewed here. The resource is designed to aid workers’ compensation claimants in the self administration of their MSA accounts with the proper establishment of, and expenditures from, their WCMSA account.  Read more…

 

 

Practice, Why Practice

No, we are not talking about the iconic Allen Iverson whose penchant for missing team practices while the leading scorer for the Philadelphia 76ers throughout his turbulent career became well-documented by his own tattooed admission before a viral TV reporter audience became the stuff of ignorant legend. No, this time we are talking about the invalidation of an IRE physician who had originally been certified by the Pennsylvania Bureau of Workers’ Compensation as a certified IRE physician, by virtue of the physician having initially met the threshold credentialing requirement of being “active in clinical practice” for at least twenty hours per week when originally approved to conduct IREs.  Read more…

 

 

Special Needs Trusts or Pooled Special Needs Trusts

A special needs trust is designed to financially support a disabled individual, providing many benefits to the individual with long-term financial stability. Join Ringler Radio host, Larry Cohen and co-host, Mike Zea, as they join Will Lindahl, MBA, CLPF, National Enrollment Director for CPT Special Needs Trusts,  to discuss the process of setting up a special needs trust, when an individual should consider setting one up the cost and the difference between an individual special needs trust and a pooled special needs trust.  Listen to Podcast…

 

 

Medical Costs per Claim for Injured Workers in Indiana Were Higher and Rising Faster Than Most in 16-State WCRI Study

The costs per claim of medical care for injured workers in Indiana were higher than most states and growing faster, according to a new 16-state report from the Workers Compensation Research Institute (WCRI). The study, CompScope™ Medical Benchmarks for Indiana 14th Edition, found the main reason for higher medical payments per claim was higher and growing prices, like other states with no price regulation. Lower to typical utilization of medical care helped to offset the higher prices paid.  Read more…

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Award Recognizes Companies With 500,000+ Hours Without Injury

Showing that safety does matter on the job, 10 Muskingum County (Ohio) businesses were recently recognized for their success in keeping their employees safe on the job.

 

The businesses were recognized during a meeting of the Zanesville-Muskingum County Safety Council, one of more than 80 across the state that serve as partners in the Ohio Bureau of Workers Compensation (BWC) efforts to educate employers and workers about the importance of workplace safety.

 

Each business received a Special Award, reserved for companies that reached at least 500,000 hours and at least six months without an injury resulting in a day or more away from work.

 

 

Safety is Paramount to Business Success

 

“Their impressive safety records show these businesses have thoughtfully incorporated safety into their operations,” said BWC Administrator/CEO Steve Buehrer. “They recognize that keeping their workforce safe and healthy is not only the right thing to do; it is paramount to the success of their businesses. I applaud them and encourage more participation in safety councils, which provide an outstanding forum for networking, and safety education and training.”

 

Safety councils are organized by local business organizations to inform participants of new safety standards and regulations, products and services, and provide a thorough knowledge of topics, including occupational safety and health, workers’ compensation and risk management education.

 

Each year, safety councils honor members with strong safety records at annual awards events. In addition to the Special Award, the Group Award recognizes the lowest incident rate in each group; the 100% Award goes to employers with zero injuries or illnesses resulting in a day or more away from work in the previous calendar year; and the Achievement Award recognizes employers that experienced a 25-percent reduction in incident rate from the previous year.

 

 

Companies recognized recently for hours worked without an injury include:

 

• AK Steel Corporation – 4,465,625 hours worked

• Ardagh Group – 678,811 hours worked

• AutoZone, Inc. – 1,500,190 hours worked

• Dollar General Distribution Center – 2,816,152 hours worked

• Finley Fire Equipment Co., Inc. – 880,261 hours worked

• Genesis HealthCare System – 3,109,257 hours worked

• Miba Bearings US, LLC – 595,492 hours worked

• Mt. Perry Foods, Inc. – 697,714 hours worked

• Muskingum Starlight Industries – 1,697,674 hours worked

• O-I – 1,054,084 hours worked

 

 

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

 

 

How Does Workers Compensation Work?

What is workers compensation?

 

Workers compensation is a type of insurance employers are required to have in order to provide benefits to employees injured on the job or who become ill due to on the job exposures. Workers compensation insurance provides the injured employee with medical benefits and partial wage replacement benefits.

 

Workers Compensation is also called: comp, work comp, workers comp, workmans comp, workmans compensation, and WC.

 

 

Where is there workers compensation coverage?

 

All 50 states, the District of Columbia, American Samoa, Northern Mariana Islands, Guam, the Virgin Islands, and Puerto Rico have workers compensation statutes, each with unique provisions in its workers compensation laws.

 

 

Why was workers compensation created?

 

Workers compensation provides guaranteed medical and wage loss benefits to the injured employee under a “no fault” system. This means that the employee does not have to prove the employer is at fault in causing the injury. In exchange for benefits, the employee gives up the right to sue the employer for negligence. The employee is not compensated for any pain and suffering occurring due of the accident.

 

Companies pay for insurance against this risk and deductibles and premiums usually increase when workers compensation is handled efficiently.

 

 

Who are the workers compensation players?

 

Depending on company size and injury complexity there are many players involved in the workers compensation industry:

 

  • Insurance Company
  • Insurance Broker/Agent
  • Employee
  • Third Party Administrator (TPA)
  • Employer (also called “the Insured”)
  • Service Providers/Vendors
  • State Commission or Board

 

An employer must be familiar with these roles and how they affect the company. Corporate personnel may know what their insurance company does, but few understand the broad duties of a third-party administrator or a medical cost containment vendor.

 

 

What are the types of benefits employees receive?

 

In most states employees receive four primary types of benefits:

 

  • Medical Benefits pay for all types of medical expenses including doctors, hospitals, prescriptions, durable medical equipment, and other medical providers (e.g. nursing services, chiropractors, and physical therapists).
  • Vocational Rehabilitation Benefits are designed to assist the employee who is permanently partially disabled and is unable to return to work by assisting the employee to train for another job or to obtain the education needed to perform other work.
  • Indemnity Disability Benefits are designed to replace a portion of the wages lost when the employee cannot work due to an injury. Indemnity benefits are calculated as a percentage of the employee’s average weekly wage.
  • Death Benefits are paid to the surviving spouse, dependent children, or other dependents of an employee who is killed on the job or dies as a result of an occupational illness.

 

 

What are the types of indemnity disability benefits?

 

In most jurisdictions, indemnity benefits can be broken down into four primary types:

 

  • Temporary total disability (TTD) benefits are the most common. The injured worker receives on a weekly or bi-weekly basis a portion (two-thirds in most jurisdictions) of the average weekly wage until the employee is able to return to work in modified or full time duty.
  • Temporary partial disability (TPD) benefits are awarded when the injured worker is able to return to work part time or at a reduced rate of pay. TPD benefits are provided to make up a portion of the lost income until the employee is able to return to work full time.
  • Permanent partial disability (PPD) benefits occur when an employee is partially disabled due to the injury and permanent partial disability is paid to compensate the employee for loss of future earning capacity.
  • Permanent total disability (PTD) benefits pay the employee who receives a very severe injury and is unable to return to work in any capacity. Benefits are paid, either for a set number of weeks or for life, depending on state law.

 

 

Who determines what types of injuries are covered?

 

State laws determine what types of injuries are covered and not covered. In some states employers may pay for mental injuries. Employee intoxication may void the responsibility to pay compensation.

 

 

How do insurance companies and third party administrators (TPA) categorize claims?

 

On the incident report, insurance companies and TPAs categorize workers compensation claims as:

 

  • Medical Only
  • Lost Time
  • Catastrophic
  • Enhanced Medical
  • Occupational Disease

 

These categories are further subdivided into types of disabilities, kinds of injuries, what to include in the loss report, the details of a company’s workers compensation claims and costs paid as reported in the “loss run” or “loss report” using the paid + reserved = incurred formula.

 

 

Where can I find more information?

 

Workers compensation laws vary from state to state and territory jurisdiction. Our guidebook gives an excellent overview of what employers are subject to and discusses certain quirks in the system. Knowing these details help management make company-wide business decisions equaling big savings. Read more: http://wcmanual.com/workers-comp-cost-reduction-guide-book/

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Focus On Temporary Worker Safety Drives OSHA Fine Of 3 Employers

A trio of employers will be dipping into their wallets in order to meet recent fines.

 

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) cited Schwan’s Global Supply Chain Inc., which manufactures frozen foods sold under several brand names, including Red Baron pizza and Mrs. Smith’s desserts, for 32 serious safety and health violations at its Atlanta facility. Two other companies providing maintenance and staffing services for Schwan’s, including Cimco Refrigeration Inc. and Adecco USA Inc., were cited for 18 safety and health violations.

 

 

“All workers, whether full-time or temporary, deserve the same commitment and access to a safe workplace”

 

“All workers, whether full-time or temporary, deserve the same commitment and access to a safe workplace. Schwan’s, Cimco Refrigeration and Adecco are not providing that for their employees,” said Bill Fulcher, director of OSHA’s Atlanta-East Area Office. “OSHA standards are there to protect workers from predictable and preventable injuries and deaths. These standards were disregarded at the expense of worker safety.”

 

OSHA inspectors found that the employers did not provide adequate training for employees to work safely with ammonia, a hazardous and corrosive chemical used in refrigeration.

 

The employers also were cited for exposing workers to unguarded machines and damaging noise levels, and for failure to provide properly fitted personal protective equipment. OSHA initiated the inspection at Schwan’s facility in September 2013, following a worker complaint. OSHA’s citations carry $185,700 in penalties for Schwan’s.

 

 

Inspection Reveals Workers Exposed to Dangers

 

The inspection found that Schwan’s exposed workers to dangerous conditions, many created by the company’s failure to follow the OSHA Process Safety Management Standard to protect workers from dangerous exposure to ammonia used in the refrigeration system.

 

The employer was cited for failing to ensure that doors to the ammonia handling machinery fit properly, created a chemical hazard and failed to provide training on safe work practices applicable to the ammonia refrigeration systems used at the facility.

 

Schwan’s was cited for blocked and mismarked exits in hazardous areas, failure to train workers on controlling hazardous energy through standard lockout/tagout procedures during maintenance and services, and exposing workers to electrical hazards. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.

 

The Minnesota-based company employs approximately 14,000 employees nationwide. The Atlanta facility, which produces dough, cookies and pie crusts for popular products, employs approximately 494 workers.

 

OSHA inspectors found that temporary workers in Schwan’s facility, employed by the Adecco staffing agency, were also exposed to hazards. These included noise and unguarded machines and platforms, which created a fall hazard. As a result, OSHA cited Adecco for 12 serious safety and health violations, carrying penalties of $58,500. With headquarters in Melville, N.Y., Adecco employs more than 300,000 workers nationwide. Adecco maintains an office at the Schwan’s facility and provides labor and management of the on-site workforce.

 

 

In April 2013, OSHA announced an initiative to improve workplace safety and health for temporary workers.

 

In April 2013, OSHA announced an initiative to improve workplace safety and health for temporary workers. During the inspection, OSHA inspectors paid special attention to the hazards facing temporary workers to determine the role of the host employer and the staffing agency in failing to eliminate serious hazards.

 

Cimco provided service and maintenance for the ammonia refrigeration system at Schwan’s Atlanta facility. It was cited for six serious safety and health violations, carrying penalties of $20,160.

 

The violations were cited for exposing contract workers to excessive noise levels by failing to implement a noise monitoring program. Cimco also failed to provide necessary training, properly fitted respirators and clearly marked exits.

 

The companies were given 15 business days from receipt of the citations and proposed penalties to comply, request a conference with OSHA’s area director, or contest the findings before the independent Occupational Safety & Health Review Commission.

 

 

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

 

 

Defense In Depth On Work Comp Claims: The Employer’s Role

“Defense in depth” is a principal from conflict theory which promotes using several defenses in coordination instead of seeing them as separate defenses to be used one at a time. Sometimes, the phrase “mutually supporting” is used.

 

In work comp hearings, defense issues often are identified and documented but they are not processed so that the use in hearings is enhanced. In addition an investigation will be halted when “enough” evidence is obtained or, worse, when one defense has so much evidence that an investigation will be halted before additional issues are located.

 

 

In Hearings Nearly All Doubts Are Resolved in Favor of Injured Worker

 

In hearings such as work comp, where nearly all doubts are resolved in favor of the worker, it is hard to imagine that the defense could grow so comfortable as to settle for less than a reasonable maximum of information, but comp is a bulk process with highly repetitious fact patterns, leading to fact and law burn-out.

 

What can the employer do about all of this? The role of the employer in many states has been minimized without much complaint by carriers. However, the employer is the first and best source of information.

 

The sticking point, where useful information is stopped in its tracks, is the employer report to the carrier and/or comp board of the alleged workers comp incident. That is nearly always due to the fact that the forms given to employers have many questions but little space to write detailed explanations and itemize a list of objections to the claim. An employer who is given only one line or less to “describe the incident” may think that all claims can be fully described in twenty words or less, or that it’s a rule of the comp board that twenty words are the most that will be tolerated.

 

 

 

“See Attached” Is The Best Answer, “Unknown” is the Worst

 

 

The employer can enhance its reporting skills by simply inserting “see attached” as the answer to complex questions. Your correspondent has seen claims won where the employer attached a five page explanation, with lists of names of witnesses and sources of information. This in turn, led to a carrier putting a retired police detective to perform further investigation and search for evidence. In one notable case, the detailed explanation by an employer actually led to the carrier obtaining a copy of a confession to murder for reasons completely unrelated to the employer’s work, resulting in a dismissal of a death claim. (The claim was paid by a different employer, whose employee had a grudge and knew the victim from that job.)

 

Detailed reporting by employers, using those “see attached” documents, leads to a far more complex presentation and, therefore, to mutually supporting issues.

 

“See attached” is the best of answers. What is the worst? “Unknown”!!! Yet it is the most common answer which appears on employer reports.

 

Nothing is truly unknown, but an employer can say that after a full investigation no facts emerged which could corroborate the claim.

 

 

 

Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

OSHA Does Not Tolerate Disregard For Safety, Imposes Fines

Safety on the jobsite will likely become more in focus for a pair of Colorado employers; this after they were levied with a substantial fine.

 

 

“OSHA Will Not Tolerate Disregard For Worker Safety”

 

Reconstruction Experts Inc. was cited by the U.S. Department of Labor’s Occupational Safety and Health Administration for three safety violations, including one willful. Chivas Contractors was also cited for three serious safety violations during a November 2013 complaint inspection of an unsafe trenching work site in Aurora. The combined proposed penalties total $81,400.

 

Reconstruction Experts solicited help from a framing subcontractor, Chivas Contractors, to locate a damaged water pipe for an apartment complex that was being renovated. Workers dug a trench that exceeded 11 feet in depth without the use of a cave-in protective system.

 

“Employers continue to expose workers to trenching hazards that can end a life in a matter of seconds when a trench caves in. OSHA will not tolerate disregard for worker safety,” said David Nelson, OSHA’s area director in Greenwood Village. “During the last 20 years, OSHA has provided a number of resources for employers to eliminate trenching hazards.”

 

 

Willful Violation Amounts to $63K Fine

 

The willful violation for Reconstruction Experts, with a penalty of $63,000, was cited for failing to ensure workers were protected from cave-in hazards while working in a trench that exceeded 5 feet in depth. A willful violation is one committed with intentional, knowing or voluntary disregard for the law’s requirements, or with plain indifference to worker safety and health.

 

The two serious violations, with a penalty of $10,800, were cited for failing to provide a fall protection system for workers leaning over the edge of the trench while hoisting up excavated material from the bottom of the trench and for failing to provide an access ladder that extended 3 feet above the landing surface. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.

 

Chivas Contractors was cited for three serious safety violations, with a penalty of $7,600, for similar failures to provide a cave-in protective system and a fall protection system for workers leaning over the edge of a trench.

 

Reconstruction Experts in Arvada is a general contractor employing about 180 workers. It provides renovation and remodeling services for properties in Colorado, California, Texas, Arizona, Nevada and Wyoming. Chivas Contractors in Aurora is a framing contractor employing about 10 workers.

 

The companies were given 15 business days from receipt of their citations and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission.

 

 

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

 

 

How To Make Unions An Asset To Workers Comp Cost Savings

Many employers may be suspicious of working with unions, thinking that they support the filing of questionable workers’ comp claims. However, in some cases working with labor unions may lead to decreases in workers’ comp costs. Unions are usually strong supporters of improved safety policies, like following OSHA guidelines, use of safety gear like hard hats and protected eyewear and improved ergonomics. Unions can track workplace accidents and make suggestions over ways to improve safety.

 

 

Workers’ Compensation Policy Planning

 

Bring labor unions into your workers’ compensation policy planning. After all, a good company cares for its employees and wants them to be treated fairly. Leaving unions out of the process creates an “us vs. them” mentality that can drive up long-term costs. Including union input builds buy-in to the company’s workers’ comp process.

 

Here are some suggestions for working with labor unions:

 

  • Talk to union representatives early in the planning process.
  • Ask for the union’s perspective on issues such as how seniority affects injury management and their policies on things such as supplemental pay for the injured worker. Does the union have “collateral source benefits” that are a disincentive to returning to work?
  • Listen to the union’s input on issues such as safety planning and how to return employees to work post-injury.

 

 

Drug Testing

 

One area where unions and employers have disagreed is over the use of drug testing. Unions may object to drug testing as infringing on its members’ privacy rights or question the science behind drug testing. If employers work with the unions to explain how drug testing protects the safety of members, everybody wins. Unions may respond to the employer’s rationale of keeping intoxicated, unsafe workers from endangering the safety of the workforce, provided that the drug testing policy promotes employee treatment rather than termination. Having a written drug testing policy that is fair and equitable can go a long way towards convincing a union that your concern is for safety, not punishment.

 

 

Union Representatives Can Guide Injured Workers through the Workers’ Compensation Process

 

Union stewards or representatives can help guide injured employees through the workers’ compensation process, starting with arranging immediate medical care. This can help reduce costs as the sooner the injured employee is treated, the higher the probability of a quicker recovery. Make sure that communication with the union remains positive and proactive so that a disgruntled union representative does not urge the employee to stay off work longer because the union has some non-related dispute with management. Also, keeping communication positive and flowing can keep the employee from hiring a lawyer out of frustration over miscommunication or unreturned phone calls.

 

 

Complying with Labor Relations’ Laws

 

Make sure that your company complies with all required federal and state labor laws. Employees have the right to join together with co-workers to address issues at work, with or without a union. Most employers are required to post notices advising employees of their rights under the National Labor Relations Act (NLRA). You do not want to give unions ammunition to attack your company by forgetting to do a simple thing such as hanging a poster in the workplace. You can find out more about employers’ obligations under the NLRA at http://www.nlrb.gov/rights-we-protect/whats-law/employers.

 

 

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

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

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

Georgia Employer Cited Following Worker’s Death

For one Georgia employer, a workplace tragedy has led to a sizable fine.

 

A 42-year-old worker fell approximately 19 feet off scaffolding to his death while applying stucco to a pre-existing building that was being renovated as a college dormitory for East Georgia State College in Swainsboro. As a result, the U.S. Department of Labor’s Occupational Safety and Health Administration conducted an investigation following the Sept. 20, 2013, fatality and cited Jack Smiley, doing business as Smiley Plaster Co., for five safety violations, including a willful violation of the law.

 

 

Employer Knowingly Failed To Provide Properly Built Scaffold System

 

“A worker died after the employer knowingly failed to provide a properly built scaffold system to protect employees from fall hazards,” said Robert Vazzi, OSHA’s area director in Savannah. “Falls are the leading cause of fatalities in the construction industry. Employers must ensure their workers are protected.”

 

OSHA issued a willful citation to the employer for its failure to provide fall protection to employees who work from scaffolding at heights over 10 feet. A willful violation is one committed with intentional, knowing or voluntary disregard for the law’s requirements, or with plain indifference to worker safety and health.

 

Due to the willful violation, the company has been put into OSHA’s Severe Violator Enforcement Program, which focuses resources on inspecting employers that have demonstrated indifference to their legal obligations by committing willful, repeat or failure-to-abate violations.

 

Three serious violations were cited for the employer failing to provide adequate scaffolding foundation; failing to brace the scaffolding; and failing to provide debris protection, such as toe boards, for employees working on scaffolding. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.

 

 

269 Fall Related Fatalities Out of 775 Construction Related Fatalities

 

The company was also cited with one other-than-serious violation for failing to report the fatality within eight hours of the incident. An other-than-serious violation is one that has a direct relationship to job safety and health, but probably would not cause death or serious physical harm. OSHA has proposed $57,000 in penalties.

 

In 2012, there were 269 fall-related fatalities out of the 775 construction-related fatalities. OSHA’s fall prevention campaign provides employers and workers with lifesaving information and educational materials about working safely from ladders, scaffolds and roofs. The campaign was developed in partnership with the National Institute of Occupational Safety and Health and NIOSH’s National Occupational Research Agenda program.

 

Smiley Plaster Co., a stucco and masonry construction company in Twin City, was given 15 business days from receipt of the citations and proposed penalties to comply, request a conference with OSHA’s area director, or contest the findings before the independent Occupational Safety & Health Review Commission.

 

 

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

 

 

Who Is To Blame For An Unreported Injury?

Most workers that are injured are quick to blame their employer if an issue arises with coverage or denial of their work comp claim. Once you break away the layers of the injury details it can start to tell a different story. Oftentimes the failure to communicate will fall on the shoulders of the employee, who should know better to begin with.

 

For example, take a case of a knee injury in which the worker banged his knee on a metal frame while working. At first he thought the pain would go away, so he didn’t say anything right away. Later on in his shift, while his supervisor was walking by he shouts out to him that he hurt his knee, and that was it. The supervisor barely hears him in passing, and continues about his day. A week later he limps over to the HR department and wants to go to the clinic to treat. This is the first the HR person or work comp supervisor is hearing of an injury.

 

 

Who Is To Blame For An Unreported Injury?

 

So where is the fault in this scenario? Is it the injured worker who fails to actually talk to his supervisor and fill out an accident report? Or is it the supervisor who fails to follow up with the worker to find out what he said?

 

In my opinion, the fault is on the worker. Most carriers and employers are soft on this issue. If someone casually reports an injury, then waits a week to start treating it, you have no way of confirming what happened during those days he was allegedly injured and not treating with a doctor. In the end it becomes the workers version of the story versus the supervisors. In my book, if both sides fail to agree, then it is a disputed file and no benefits should be paid out.

 

The worker has the burden of proving that he was injured in the course and scope of employment. He also has to show how he was injured, what injured him, who he told, if he had witnesses, and all the other tidbits that go in to proving and having a claim. If the worker fails most of these issues, then how can an adjuster in good faith deem a claim like that compensable?

 

It should be an open and closed denial, but it is not. More often I see claims like this accepted, treatment is covered, and then surgical costs and wage loss benefits are paid out on a claim that had no business being paid. Leakage all over the place! Plus if you are self-insured or on a high-deductible plan, that is your money going right out the window.

 

 

Avoid Problems With a Clearly Communicated Accident Protocol

 

To avoid these situations, you have to have a clearly communicated air-tight accident protocol process. Steps have to be laid out and communicated to your workers on what their responsibilities are should an injury occur. You have to stick to your process you have in place, and any non-compliance should result in a claim denial and also disciplinary actions for failure to report a claim handed down to the allegedly injured employee.

 

This is what will get the attention of your workforce on the floor. Discipline and enforcement are the only two options you have. If you give one guy a break on the protocol, then you have failed your own system that is set up to protect you.

 

Enforcement of these measures will have to be drilled in to the heads of your supervising staff. They have to know if a worker comes to them with an injury, they have to stop what they are doing and complete the incident paperwork. Creating this paper trial is essential to the work comp process. Failure to comply on the supervisor’s part should lead to the same disciplinary measures that your other workers are held to. This makes it fair for everyone, and keeps the chain of communication running. Any breakdown of that line of communication fails the system.

 

 

A Work Comp Case is Either 100% or 0% Compensable

 

Going back to the adjuster’s point of view, I always say a compensable work comp case is either 100% or 0%. It can’t be a case where you think the worker is 70% legit and then pick up the case as compensable based on that. Even if the injured worker has a compelling story, if the employer cannot give the same injury details or scenario then they had a breakdown in communication somewhere. They have to figure out what went wrong before you can move the case forward one way or the other. I tell employers that disputes can be filed asking for more time to investigate the case. Sometimes the supervisor finally admits that yes, the worker came to them with an injury and they failed to complete the paperwork. The worker has witnesses, an objective injury, and no secondary motive to lie about it. One side will eventually have to give.

 

As claims professionals, we cannot be everywhere at once. In my opinion, you are always better off letting the investigation proceed, than just picking up the case as compensable only later to find out that the employer had tons of issues regarding the compensability of the case after completion of their own investigation.

 

Use investigative means wisely, and hold the employer to their own due diligence on their investigation as to what happened and why it happened. Remember, if it is not 100% clear and compensable, it is 0%.

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Registration Open For MSP Compliance Session And Other News Tidbits

Broadspire(R) Deploys the Client Advocate Model for Disability and Absence Management

Broadspire(R) has launched its new Client Advocate Model. The model provides a comprehensive and inclusive approach to help employees return to work while providing employers with the tools to manage overall disability and absence costs. The Client Advocate provides clients with a single point of contact and functions as a subject matter expert on the complexities of the disability environment. The Client Advocate provides education, guidance and coordination of Broadspire services on behalf of employers and client, consequently giving employers a more favorable experience and tangible outcomes.   Read more…

 

 

Registration Open For National Institute for Medicare & Medicaid Education

Wondering where to start when it comes to Medicare Secondary Payer (MSP) Compliance? We’ve brought together industry experts to provide 2 full days of invaluable education relating to MSP, MMSEA Section 111 Mandatory Insurer Reporting, and Medicare and Medicaid.  Undecided about attending, here are just a few of our previous attendees: Plaintiff, Defense and Corporate Counsel,  Risk Managers/Directors, Workers’ Compensation & Liability Professionals, MSP Compliance Professionals, RREs, Auto & General Liability Professionals
Subrogation Specialists, Captive Managers, Self-Insured Entities, Third-Party Administrators   Read more…

 

 

Legaltronix:  A Rating System in the Legal Services Profession

In the structured settlement industry, relationships are very important. We interact with mediators, judges, experts, arbitrators and more, on a daily basis. So, it is extremely helpful to have some background on those experts before we walk into negotiations.  On this Ringler Radio podcast, hostLarry Cohen welcomes John B. Willcox, Co-founder ofLegaltronix, a comprehensive rating system with detailed information on parties involved in litigation. Listen and learn about the benefits of this collaborative tool.  Listen to Podcast…

 

 

News From LexisNexis

 

Health Behaviors Contribute to Socioeconomic Differences in Mortality

“The panoply of interrelated research on longevity appears to be coalescing around a consensus that socioeconomic status (“SES”) is an important indicator of life expectancy. Data suggests that those on the lowest rungs of the socioeconomic ladder tend to have a correspondingly lower life expectancy than those on the upper rungs. And the gap between the two has apparently been on the rise over the past 30 years. This trend, coupled with its societal implications and resultant policy decisions, has made the urgency of finding out what is driving these statistics more acute. A group of researchers, Arijit Nandi, Maria Glymour and S.V. Subramanian, set out to test the effect of health behaviors such as smoking, alcohol consumption and physical inactivity on socioeconomic differences in mortality”…read more.

 

 

Comppharma is Bearish on Compound Drugs

“Prescriber beware! That’s the takeaway message from a recent white paper, “Compounding is Confounding Workers’ Compensation” authored by representatives of CompPharma’s member Pharmacy Benefit Managers. Their research looks at the cost, safety and efficacy of compound drugs and concludes that the prudent course of action is to exercise all appropriate due diligence before prescribing and making payment for these drugs. First of all, what are compound drugs? There is, apparently, no nationally recognized official definition, but they are generally accepted to be either topical or sterile compound drugs which”…read more.

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Professional Development Resource

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

Please don't print this Website

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

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

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