Case Study: How an International Media Giant Reduced Workers’ Compensation Costs

A worldwide publishing business employing 30,000 employees in diverse positions (clerical, reporters, heavy-machine operators, and fleet drivers) was having little success containing workers’ compensation costs, which were rising every year.

 

 

The employer knew they were vulnerable to work comp claims. Back injuries, carpal tunnel syndrome, repetitive stress disorders, slips, trips, falls, and motor vehicle accidents were all common; machinery related accidents resulted in more serious and costly claims for amputation and broken or crushed limbs. Repetitive trauma claims were common among employees such as reporters using computers constantly. Professionals with repetitive trauma syndrome (RTS), fearful of losing their careers, often worked through pain, causing their injuries to become far worse than normal.

 

 

Goal Was To Put The Employer “In Charge Of” The Work Injury Process 

 

The Risk Manager selected our team to help identify their main issues, develop solutions, and create a training program. The goal was to put the employer “in charge of” the work injury process. Once these changes were in place the employer noted improvements with the following:

 

  1. Adjusters learned the program and brokers gained more trust by showing them these resources.
  2. The company reported a 20% reduction in number of claims, and
  3. There was a 30% reduction in workers’ compensation losses in the first year, and in each ongoing year.

 

 

Here’s How They Did It!

 

After surveying their workers’ compensation management practices, the team discovered the company was strong in:

 

  • Hiring Practices: Using background checks, drug testing, and reference checks.
  • Medical Care Coordination: Employing a nurse at the on-site core facility to manage/document injuries; assist in drug testing.

 

 

However, they also identified three areas needing improvement:

 

  • Communication with Employees. (Chapter 7)
  • Reduce Repetitive Injuries. (Chapter 10)
  • Direct Medical Care by improving penetration rate to company PPO network (Chapter 13)

 

The team began by assessing what was currently in place, they then compared their results to industry Best Practices and developed Plan for Action Improvement tailored for the employer’s workplace.

 

 

These areas were revised as described in Chapter 7: Communication with Employees.

 

  • Weekly meetings were scheduled with injured employees. At these meetings, the focus was placed on the return-to-work aspect for the worker, especially setting up a target return-to-work date and assignment of a modified duty job.
  • An experienced technical writer was hired to draft a brochure telling employees what to do when they feel pain — even the very slightest pain. The brochure described how an injury starts when they feel pain; it is then they need to start taking steps such as icing the wrists. Most importantly, they need to do simple exercises such as stretching, and take frequent breaks to avoid injury.
  • Automated computer alerts reminded workers to take a break once an hour and workers were taught mild stretching exercises.

 

 

These areas were revised as described in Chapter 10: Wellness Programs

 

  • The risk assessment team was surprised to learn that repetitive trauma claims (carpal tunnel syndrome and tendinitis) were common among employees such as reporters using computers constantly. Often, employees work through pain rather than seeking treatment immediately and actually end up worsening their condition, due to their job dedication.
  • A wellness program was instituted to teach workers how to both avoid and treat repetitive trauma. An ergonomic specialist was called in to review the chairs and desks and to teach workers how to sit and what aids to use such as wrist supports at the keyboard, small bench under the feet to give correct alignment to the back, and use of light-weight hand “gloves.” Small packets of ice were kept in nearby refrigerators so employees could apply ice to the problematic areas of hands and wrists. They were taught that often the first symptom of carpal tunnel syndrome is pain at night, and that using wrist supports at night is helpful.

 

 

These areas were revised as described in Chapter 13: Directing Medical Care

 

 

  • The employer started using their third-party administrator’s medical reviewer to review medical records on all claims to be sure the injured employee is being treated appropriately and returns to work as soon as medically able either to full duty or in a transitional duty position.
  • A part-time Medical Director was hired for their on-site clinic to treat workers immediately and to track workplace safety. The Medical Director also makes referrals to other medical services as needed, and supervises the return-to-work process.

 

 

Our training manual discusses all of these techniques and suggests ways to bring workers’ compensation practices into line with industry best practices. 2014 Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50% (Comprehensive Edition) discusses all of these techniques and suggests ways to bring workers’ compensation practices into line with industry best practices. Many forms and documents are available through Advisen at mbastone@Advisen.com.

 

 

 

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

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

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

 

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

 

Louisiana Employer Cited, Facing Nearly $78K in Fines

Fines nearing $78,000 is what one Louisiana employer is looking at after a follow-up inspection for safety reasons.

 

The U. S. Department of Labor’s Occupational Safety and Health Administration (OSHA) recently cited U.S. Minerals LLC with 11 safety and health violations from a follow-up inspection that began in September 2013 at the Harvey facility.

 

The manufacturer of abrasive blasting and roofing materials faces $77,770 in fines for failing to train and protect workers when entering hazardous confined spaces, implement safe lockout/tagout procedures when maintaining equipment, provide required protection for workers exposed to dangerously high noise levels and ensure forklift operators knew how to work safely.

 

OSHA’s Baton Rouge Area Office conducted the initial inspection in June 2010 as a referral from OSHA’s National Office and issued 18 serious, 10 repeat and two other-than-serious violations. Fines totaled $118,800. The employer contested the citations, and a formal settlement agreement was reached on Aug. 20, 2012.

 

 

OSHA: Company Continues Jeopardizing Safety of Workers

 

“U.S. Minerals continues to jeopardize the safety and health of its workers by failing to fix these problems,” said Dorinda Folse, OSHA’s area director in Baton Rouge. “OSHA’s safety and health standards exist to prevent injuries and fatalities. It is the employer’s responsibility to protect its workers by following the standards.”

 

Some of the serious violations include failing to provide an adequate retrieval system; training; evaluate prospective rescuer’s competency level; and annually review the confined space entry program.

 

For employees exposed to high noise levels, serious violations include failing to train workers on the hearing conservation program and ensure workers had a choice of suitable hearing protectors. The remaining serious violations include failing to provide adequate forklift training and certification, remove unsafe forklifts from service and ensure adequate egress from the facility. A serious violation is one in which there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.

 

One repeat violation was issued for failing to conduct annual inspections of the company’s lockout-tagout procedures. A repeat violation exists when an employer previously has been cited for the same or a similar violation of a standard, regulation, rule or order at any other facility in federal enforcement states within the last five years.

 

U.S. Minerals LLC, with headquarters in Dyer, Ind., employs about 60 workers and operates other plants in Baldwin and Coffeen, Ill., and Galveston, Texas.

 

The company was provided with 15 working days from receipt of its citations to comply, request an informal conference with OSHA’s area director in Baton Rouge, or contest the citations and proposed penalties 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.

 

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Work Comp And The Indirect Approach – Tips For Employers

Work comp and the indirect approach – tips for employers.

 

There are many tools employers can use to solve their workers comp problems. The answer to the problem can be a traditional solution, but workers compensation is a moving target, so the employer is required to consider all options.

 

Consider the option of “The Indirect Approach”, which in recent years has been described as “thinking out of the box”.

 

The theory of the indirect approach was published in the 1920s. Don’t do the obvious and don’t do what has consistently failed. Otherwise, you are duplicating Einstein’s definition of insanity: doing something a hundred times and thinking you will get a different result on the hundred and first try.

 

 

Consider Workers Compensation’s Relationship With Other Laws

 

Workers compensation coexists with dozens of other laws with which an employer must comply, creating opportunities for the curious. Every new law, and there are thousands of new laws each year, necessarily interact with laws already in existence, but little is written about those countless possible interactions, many of which can solve a comp problem for an employer, as well as its employees.

 

Attorneys who represent workers quickly discover these interactions in benefits awarded from several sources on a comp claim. A single motor vehicle accident might have the work comp attorney juggling through a comp claim, a negligence suit, STD, LTD, social security and unemployment claims. Furthermore, these interactions are quite common. But to the employer, as well as to carriers, the comp claim seems to be isolated and only indirectly affected.

 

But the worker’s attorney, after a few years in the business, learns how to coordinate handling of multiple claims to produce more fees for fewer hours worked – but only with proper coordination.

 

 

 

Regulatory Laws Provide Additional Investigative Options For Employer To Reduce Claim Costs

 

For the employer, regulatory laws from both state and federal, provide additional opportunities to investigate work comp problems within the first week after a reported injury, without interacting at all with the comp system. The opportunities include medical exams, HIPAA releases, as well as numerous opportunities to open and maintain independent channels of communication with the worker and the medical providers.

 

Medical examinations of drivers of heavy vehicles, under the federal Department of Transportation (DOT) regulations are usually done every two years to keep a driving certificate active. What is not generally known is that the employer may schedule its own exam anytime the driver’s medical condition may have changed. This is what precisely arises whenever a comp claim is filed. The exam is under the sole control of the employer and outside parties, other than the driver, may not be informed.

 

Many other laws have similar provisions for exams. Surprisingly, these have the effect of reducing the number and severity of comp claims.

 

In many med exams, HIPAAs are necessary since prior conditions must always be considered. Here, too, is an opportunity for employers.

 

 

Largest Positive Effect Is Employers Engagement in Employee Communication

 

But the largest positive effect of the employer engaging with alternate Federal and State laws comes from the chance an employer has to communicate with a worker and the worker’s family. The communications can involve the possible causes of the injury, but can also involve early discussions about return to work. Involving the spouse in the discussions reduces disability duration, since spouses are rarely supportive of extended disability.

 

All these things are produced by an indirect approach handling of employee disability.

 

 

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.

 

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

 

Massachusetts Employers to See Savings in Work Comp Deal

With many companies struggling to stay in the black these days, there is some good news coming out of Massachusetts.

 

Massachusetts businesses will save $75 million in a deal reached recently with the State Rating Bureau and the Workers Compensation Rating and Inspection Bureau (WCRIB) that prevents a proposed plan to increase workers compensation insurance rates by an average of 7.7 percent across the state, Attorney General Martha Coakley announced.

 

Following opposition from Coakley against the increase initially proposed by the insurance industry, the Commissioner of Insurance approved the settlement that eliminates the industry’s proposed plan for increases, saving Massachusetts employers, including small businesses, a total of $75 million.

 

In January, the AG’s Office argued before the Commissioner of Insurance that the rate request was unjustified because it was based almost primarily on an increased profit load.

 

 

Attorney General Felt Proposed Rate Hike Was Unjustified

 

“As the Commonwealth continues to address high unemployment, this is not the time to unfairly increase these costs for the private sector, especially for the small business community,” Coakley said. “We believe the proposed rate hike was completely unjustified and are pleased to see that rates will now be applied more fairly.”

 

Rates for workers comp insurance are set at least every other year in an administrative rate hearing before the Commissioner of Insurance. Massachusetts businesses are required to purchase workers comp insurance to provide coverage for expenses and lost wages of workers injured on the job.

 

Through the industry trade group, WCRIB, insurance companies including giants Liberty Insurance, AIG, Traveler’s Insurance Co., and other insurers planned the proposed rate hike and sought approval from the Commissioner of Insurance.

 

In 2012, the AG’s Office successfully blocked a previous unjustified attempt by insurers to hike rates for Massachusetts businesses by an extra $175 million.

 

In order to stop the rate hike, the AG’s Office litigated the matter through an administrative rate trial, which ended with a decision that rejected the proposed rate hike in its entirety.

 

 

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

 

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

 

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Complex Regional Pain Syndrome – Red Alert!

Even when I type those words in the title, I cringe a little bit. But before I start to discuss this topic and what adjusters should do at the first mention of this diagnosis, let me give you my normal disclaimer:

 

I am not a doctor, nor do I claim to be one. I have no formal medical school credits. Please do not consider this medical literature in any way, shape, or form.

 

 

The Mayo clinic describes Complex Regional Pain Syndrome as:

 

Complex regional pain syndrome is an uncommon form of chronic pain that usually affects an arm or a leg. Complex regional pain syndrome typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury.

 

The cause of complex regional pain syndrome isn’t clearly understood.

 

Signs and symptoms of complex regional pain syndrome include:

 

  • Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
  • Sensitivity to touch or cold
  • Swelling of the painful area
  • Changes in skin temperature — at times your skin may be sweaty; at other times it may be cold
  • Changes in skin color, which can range from white and mottled to red or blue
  • Changes in skin texture, which may become tender, thin or shiny in the affected area
  • Changes in hair and nail growth
  • Joint stiffness, swelling and damage
  • Muscle spasms, weakness and loss (atrophy)
  • Decreased ability to move the affected body part

 

Symptoms may change over time and vary from person to person. Most commonly, pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first.

 

For those who may not know, CRPS used to be known as RSD, or Reflex Sympathetic Dystrophy.

 

 

A Real World Example of Complex Regional Pain Syndrome

 

I can also give you a real world example. A friend of mine, who is an insurance attorney, has had to live through this nightmare. But she was not the one diagnosed with it, it was her husband.

 

He stepped on a nail at a construction site. What happened next was 3 years of torture, and his work comp claim spiraled into a disaster. It took a normal, active, hardworking, fun loving husband and reduced him to a secluded and depressed shell of a man. They have now finally settled his work comp claim, but the condition lives on.

 

This did not happen because of adjuster error, or a lack of getting proper treatment. They tried everything. He saw countless doctors and specialists. He tried tons of different medication, most of them leaving him in a drug-induced haze that was so bad he stopped taking them.

 

 

Early Diagnosis of Complex Regional Pain Syndrome Yields Better Results

 

As insurance professionals, we have to be aware of the fact that even the most normal of claims can turn in to a real big claim real fast. In addition to that, we have to fight the fact that some doctors can use this diagnosis to describe pain that they cannot locate or control, be it objective or subjective in nature. This is where adjusters we can utilize their resources.

 

As the Mayo Clinic notes, early diagnosis and treatment of CRPS will yield better success in treating and controlling the symptoms. Most of the time when a claimant starts to have odd pain complaints, the adjuster will consider malingering or secondary gain rather than potential early CRPS symptoms.

 

Some of these symptoms include pain in the opposite limb, uncontrollable pain complaints, and other subjective pain complaints that on the surface seem crazy. If you have a person that had trauma in the left leg, and all of the sudden they have right leg pain complaints, 95% of adjusters will be quick to disregard it as CRPS. Instead they will label the claimant as a malingerer and one that is only interested in trying to extend the life of their work comp claim for whatever reason.

 

But what adjusters should do is set an IME right away, with a doctor that is certified to diagnose this condition. If you are lucky, and CRPS is there, you can catch and treat it right away. If it is not there, then you have at least ruled it out and can address your next step of case defense at that point.

 

 

Adjusters Job is Use Your Resources to Solve the Medical Mystery

 

Not all of your cases with wild pain complaints are going to be diagnosed and certified CRPS claims. In fact, it will probably be a small percentage of them. But the chance is there, and as adjusters you have to step outside of the box and take an outside look at chronic pain complaint cases and consider a potential CRPS diagnosis as the culprit.

 

If CRPS is there and you catch it early, then you have solved the mystery and can start treating it and moving the claim towards a hopeful resolution. If you just ignore it, then you have failed not only the claimant, but your employer as well because you did not do your job.

 

Your job as adjusters is to use your resources to solve the medical mystery and to put the pieces of the puzzle back together to correlate pain complaints back to a work injury. Use the doctors and resources you trust, because either way it is your job to investigate and handle claims accordingly, no matter how crazy the pain complaints may be.

 

 

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.

 

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

 

 

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.

 

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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

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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.

 

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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.

 

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