Communicate Your Work Comp Program So Employees Use It

Having a great workers’ comp program is meaningless if your employees don’t know about it and use it. To get your employees to know about the program, you have to tell them about it, not just once. After initially delivering the information about your workers’ comp program, you need to reinforce and remind them of its importance. And it is not enough that the employees know about it, they have to be willing and able to use the program you have in place. All necessary information must be readily and easily accessible to all your employees and so familiar to them that they instantly know where to find all necessary information.

 

 
Make the Message Fit the Environment

 

Design your workers’ comp materials to fit the environment. A printed brochure may work for clerical employees who work at a desk and can put them in a file folder. But will a brochure work for a factory floor worker without file space? Probably not. A brochure handed to that worker will likely end up in the round filing cabinet, i.e. a waste receptacle after being piled somewhere with other papers.

 

Think about where your employees work, take breaks, gather and socialize when thinking about how and where to communicate your workers’ comp messages. The delivery of information must take into consideration the location where the communication is occurring. An auto visor packet might be good in a company vehicle. Wallet cards might be good for employees who go into the field. Signs near water coolers and restrooms are good reinforcers. Lamination of the materials is important where there is the potential for dirt or moisture in an environment that can ruin plain paper.

 

 
Combine Methods to Maximize Impact

 

Think about how you want to deliver your message. Using a combination of methods may be the best way to continually drive home your messages. For example, you may want to hand out or mail brochures to new employees with an annual update. Then you can also put up posters throughout the work area and in break rooms, give employees wallet or lanyard cards, and put a zippered three-ring mobile folder in all vehicles and toolboxes.

 

Another constant reminder is a sticker label to be put on telephones. This way the name and numbers of who to call when there is an injury or a claim is called in are immediately accessible to those making the calls.

 

 
Tailor the Message to the Audience

 

Think about your audience when designing your message materials. Do you have non-English speaking workers? Then your materials should also be translated into their first language. Are your employees eighth grade or college graduates? Make sure that your messages are clearly communicated in the simplest language possible. Don’t use several ten-dollar words where one ten-cent one will work. Your materials for your supervisors and upper management can be more in depth than is needed for your line workers. Also, the materials in your employee handbooks and safety plans can have much more detail than is needed in your program posters and wallet cards.

 

 
Make the Messages Easy to Read

 

Are your materials well lit and in big and dark enough font to be easily readable? As any middle aged worker in desperate need of reading glasses will tell you, they cannot see the same font size in a lighter color or that is against a non-contrasting background. Test their readability before their final printing. A clearly worded message won’t be read by employees who can’t easily see it.

 

 

 

 

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.

Massachusetts Employer Cited after Supervisor’s Death

The death of one man on the job has led to a sizable fine for one Massachusetts business.

 
A 35-year-old sanitation supervisor at a New Bedford fish processing plant died on Jan. 16, this after he was caught in the rotating parts of the shucking machine he was cleaning.

 
Following an investigation by the U.S. Department of Labor’s Occupational Safety and Health Administration, his employer, Sea Watch International Ltd., was cited for seven serious safety violations, including failure to implement basic safety procedures to protect workers who service or maintain machines.

 
“This worker should not have died. This death was preventable if the company had implemented the required safety practices,” said Brenda Gordon, OSHA’s area director for southeastern Massachusetts. “It is the employer’s responsibility to ensure that all requirements are met and to take effective action to ensure that these hazards, and the dangers they pose to workers, do not occur again.”

 
The company was cited for failing to implement lockout/tagout procedures that protect workers who clean machinery.

 
The violations include failure to provide a lockout device; incomplete lockout/tagout procedures; not conducting periodic inspections of these procedures to ensure that all requirements were being met; and failure to train all affected sanitation employees in lockout/tagout procedures. OSHA found that plant employees were exposed to fall hazards and were not trained in up-to-date chemical hazard communication methods.

 
OSHA also cited Workforce Unlimited Inc., the Johnston, R.I., temporary employment company that supplied temporary workers to the plant, for three serious violations for lack of lockout/tag-out procedures, lack of chemical hazard communication training and for exposing workers to ladder hazards.

 
Workforce Unlimited Inc. was cited as a joint employer because it had a supervisor on-site with knowledge of the working conditions. 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.

 
Sea Watch employs 15 full-time workers at its New Bedford plant; 185 of the workers at the plant were temporary employees supplied by Workforce Unlimited.

 

Concern Over Injuries, Deaths to Temp Workers

 
Concerned about a growing trend of injuries and deaths involving temporary workers, OSHA launched an initiative in 2013 to address the issue. In every inspection, OSHA inspectors determine if every temporary worker at a work site has received the safety training and protections required by law for the job. If not, the employment agency and host employer may both be cited for violations.

 
“Host employers need to treat temporary workers as they treat existing employees. Temporary staffing agencies and host employers share joint responsibility for temporary employees’ safety and health. It is essential that both employers and staffing agencies comply with all relevant OSHA requirements,” said Robert B. Hooper, OSHA’s acting regional administrator for New England.

 
Proposed fines against Sea Watch total $35,410, while fines against Workforce Unlimited total $9,000. Each company has 15 business days from receipt of its citations and proposed penalties to comply, meet informally 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.

 

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Injury Prevention: Look In Mirror, “You’re Looking At The Problem”

All injuries are preventable. If you really think about it, if everyone did everything they were supposed to do accidents probably would never happen.

 

Sure equipment fails, or gets worn out and fails, or tires blow out when you run over a nail, but think about it: That nail maybe wouldn’t be on the road if a worker hadn’t left a box of nails on the bed of their truck then drove away with the tailgate down. That machine would not have failed if it were replaced 2 years ago when the maintenance worker told his supervisor that this machine was old, outdated, and had “a few years left.”

 

 
Tracy Morgan Accident, Like Most Accidents, Was Preventable

 

Think about what happened to comedian Tracy Morgan. This is all alleged at the time I write this, but allegedly the semi-truck driver was up for 24 hours before he crashed into the back of Morgan’s limo. The truck driver is a Wal-Mart employee. No doubt he will have a great defense counsel when this goes to trial, but what if that were your truck driver out there that caused this accident? Do you know how many hours your drivers are logging behind the wheel? Are they compliant with all their reporting of work versus rest periods? How can you really prove they are being truthful and honest should this situation result from your employee? If you are not sure, I hope you have deep pockets to provide as good of a defense counsel as this driver is going to get.

 

Time and time again, we see injuries that are preventable. Most of these injuries get chalked up to “operator error” meaning that this worker knew better than to do what they were doing at the time they were injured. This could be from trying to lift too much, or pull too much in one load, or from operating a machine in the improper manner.

 

 

The Belt Sander That Luckily Missed

 

For example, I saw an injury the other day in which one machine operator lucked out. He was using a big stationary belt sander, to clean and smooth the edges on some metal pieces he was working on. This is a vertical sander, meaning the belt runs up and down, and the operator holds the piece of metal and pushes it into the belt to obtain the desired result.

 

Instead of holding the piece vertically like you are supposed to, he was holding it horizontally. When you hold it horizontally, to work on one edge you have to tilt the piece up. What he forgot to realize was by tilting the piece up, his hands were extremely close to the moving belt. The piece caught in the tiny gap between the platform and the belt, and the force of the spinning belt pulled his hands right in to it.

 

He was very lucky in a sense that he escaped with only some bad abrasions and a few fractured fingers. It surely could have been much worse had his fingers been pulled down and jammed into the platform or had he not had gloves on at the time.

 

But questions begged to be asked. Why was he doing this and holding the part horizontally? Who trained him on how to use this sander? Where was his supervisor, and why was he not seen operating this equipment in an unsafe manner?

 

This is a 100% preventable injury. I’m sure the person reading this right now can think of many claims that resulted from something that should have been preventable in the first place. Think of the costs associated with claims that should have never happened in the first place.

 

 

“Operator Error” Should Not Fully Be Blamed On Operator

 
Every risk manager’s excuse is that it was “operator error” or just overall “bad judgment” on the part of the injured worker. But I look at the greater cause of the injury which is the worker themselves. They know better than to use equipment improperly, so why do they do it in the first place?

 

The answer is that nobody has ever caught them cutting corners. Plus even if they were caught, no discipline was ever handed down to them. So if they are not disciplined, what incentive do they have to change their dangerous ways?

 

They are only going to keep getting lucky for so long. Chances are this belt sander guy learned his lesson, and when he is back to work he will use the sander correctly for a while, until he goes back to his old ways.

 

Every single business out there that has employees on the road for any type of business should take this Tracy Morgan accident as a brutal wake-up call. No worker wakes up one day and thinks they are going to get behind the wheel of their truck or car and kill somebody.

 

 

Hold Workers Accountable To Safety And Discipline Unsafe Acts

 

At the end of the day, your workers have to be held accountable for their own actions, and they need to be disciplined for unsafe acts. The chain of command and accountability has to be there. Workers are held accountable for their actions, supervisors are held accountable for their workers under their supervision, and so on up the ladder.

 

The failure is when one level of management does not act properly in stopping an unsafe act to begin with. If you as business owners and decision-makers do not step in, you cannot afford to turn a blind eye to whatever problem you are facing.

 

The cost of replacing an unsafe machine or the cost of making sure your workers are complaint with whatever safety protocol you have is not worth the cost of someone being seriously injured, or worse, losing their life.

 

 

 

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.

 

 

Texas DWC Accepting Comments on Injured Employee Ruling

Officials in the Lone Star State are looking at a ruling that would help injured workers.

 

The Texas Division of Workers Compensation (DWC) noted recently that it is accepting public comment on a rule that will assist injured employees seeking Lifetime Income Benefits in the Texas workers comp system.

 

The rule requires insurance carriers to thoroughly review an injured employee’s eligibility for the benefits in a timely manner. It also sets specific time frames for eligibility reviews when the injured employee requests the benefits.

 

Goal is for Those Injured to Receive Benefits in Timely Manner
“Our main purpose is to ensure that injured employees who qualify for Lifetime Income Benefits receive these benefits in a timely fashion,” said Commissioner of Workers Compensation Rod Bordelon. “With better communication among system participants, I think we get a better system that delivers the benefits that are appropriate without unnecessary delays.”
Under the Texas Labor Code, Lifetime Income Benefits are paid if the injured employee has:
• total and permanent loss of sight in both eyes;
• loss of both feet at or above the ankle;
• loss of both hands at or above the wrist;
• loss of one foot at or above the ankle and the loss of one hand, at or above the wrist;
• an injury to the spine that results in permanent and complete paralysis of both arms, both legs, or one arm and one leg;
• a physically traumatic injury to the brain resulting in incurable insanity or imbecility;
• third degree burns that cover at least 40 percent of the body and require grafting, or
• third degree burns covering the majority of either both hands or one hand and the face.
At the informal draft stage of rule making, DWC invites public comment on rules before the formal proposal stage. Public comments are welcome until July 7, 2014 at 5 p.m. Central Standard Time.

 

Comments may be submitted by e-mailing InformalRuleComments@tdi.texas.gov or by mailing or delivering the comments to:

 

Texas Department of Insurance, Division of Workers Compensation
Maria Jimenez
Workers Compensation Counsel, MS-4D
7551 Metro Center Drive, Suite 100
Austin, Texas 78744-1645

 

 

 

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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Grief Counseling For Work Comp Saves In More Ways Than One

Severe injuries can take a tremendous personal toll on a work force, as well as the families of the injured worker.  Employers are also recognizing this grief, associated with workers compensation losses, has adverse cost impact on claims. A few cost items are, lost production, extended disability, extra medical treatment, extended weekly benefits, possible need for temporary employees, higher risks for more disabling situations, possible fraud, and potential fellow employee lost production. A total composite list of cost items, both personally and professionally, will show that the dollar value can be very large.

 

 
Types of Workers Compensation Losses Likely to Cause Grief:

 

Losses involving death of an employee, death of a fellow employee, a serious injury, poor injury recovery, amputations, loss of sight, loss of hearing, mental deterioration during disability, depression brought on by the injury, lengthy loss time from work, feelings of inadequacy for not being able to be a family provider, and inability to return to former occupation can bring on the grieving process.

 

In some instances, the death of a fellow employee can be devastating. Certain key persons or very beloved persons can leave a large void by their passing. This can cause group depression that slows production. Depending on the length of time required for the staff to recover from their grief the cost impact can be significant.

 

Employee grief may have impact on the families, friends, and fellow associates.

 

 
The employee’s reactions to handling grief may be subtle, so may not be easily recognized. The employee is usually the last to recognize any problem. On the other end of the spectrum, employee reaction may be strong enough to warrant intervention by a medical provider, or professional grief counselor.

 

Catastrophic work place events caused by fire, explosion, weather, collapse, or other cause failure, can be stunning and devastating. Normal coping mechanisms for grief can totally shut down or be severely delayed. In these instances professional grief counseling is recommended.

 

 
Employer Grief Policy Steps:

 

When an injury involves a death there is little the employer can do to replace the loss for the family. Expressions of sympathy, offers of support, attending the funeral, providing for prompt payment of insurance, as well as corporate and legal benefits, are important as the family goes through a extremely difficult time.

 

Employees suffering from grief issues or problems also need employer intervention. The employer should establish a grief program that includes the following:

 

1. The seven step definitions of the grieving process: Acceptance, Anger, Denial, Depression, Fear, Guilt and Shock. Aside from listing their definition, be alert for their appearance.

 

2. Keep in constant touch with the employee during lost time disability.

 

3. Reinforce all positives when talking to the employee.

 

4. Listen and acknowledge all of the employees concerns.

 

5. Address all of the employees concerns within the employer’s ability to perform.

 

6. Share all common interests of fellow employees. Encourage fellow employees to talk to the injured employee.

 

7. Keep contact with the employee when returning to work.

 

8. If it was necessary for the employee to take another job, be sure to train, praise, and reinforce all accomplishments positively.

 

9. Encourage communication and show real interest in the responses.

 

10. Offer assistance when needed.

 

11. Provide professional grief counseling as needed.

 

12. Be sure the injured employee is welcomed back by fellow employees and made to feel part of the team again.

 

13. Even if the injury may preclude the employee’s participation in a group activity, extend an invitation anyway.

 

14. Allow and participate in fellow employee discussions about any grieving process.

 

Add any other steps that might be needed for employee closure. Remember, grieving employees, no matter what the circumstance, need to get their feelings expressed in order to heal, reach closure, and recover from grieving.

 

 
Summary:

 

The grieving process is very real. It can be triggered by many workers compensation type injuries and death. There is real increased claim cost associated with grief. An employer policy is necessary to address grief in the claim process.

 

Many types of trauma trigger the grieving process. When incidents are catastrophic grief can be so stunning or devastating that professional grief counseling may be needed. Compassion and real concern for all employee well-being during the grieving process is vital.

 

Employees who know their employer is in tune with these principals will heal quicker personally and professionally providing for increased employee morale, better production and employee stability.

 

 

 

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.

 

Pair of Ohio Men Tagged for Comp Fraud

Authorities in the Buckeye State moved quickly recently to arrest a pair of men on workers compensation fraud charges.

 
In the first case, a St. Clairsville (Belmont County) man pleaded guilty to fraud after investigators with the Ohio Bureau of Workers Compensation (BWC) found he was submitting false paperwork in order to receive workplace injury benefits. Charles Oberdick pleaded guilty June 17 in Franklin County Court of Common Pleas to one count of workers comp fraud.

 
“BWC’s goal is to get injured workers healthy and back on the job as soon as possible,” said BWC Administrator/CEO Steve Buehrer. “Falsifying paperwork in order to continue benefits is not only contrary to that goal, it is a crime that unfairly draws employer premiums dollars from the State Insurance Fund.”

 
Oberdick was receiving non-working wage loss, which is payable to injured workers who are unable to find suitable employment. In order to qualify, the injured worker must demonstrate a good faith effort to secure employment within physical restrictions, and is required to submit job search forms indicating an active searching for employment. BWC’s Special Investigations Unit received an internal allegation from a claims service specialist that Oberdick was not performing job searches and was submitting falsified job search forms in order to continue receiving these benefits.

 
The investigation showed Oberdick knowingly misrepresented the majority of his job searches to BWC. Reviews of his job searches showed the majority of the employers he claimed to seek employment with did not have his resume on file.

 
The investigation also showed Oberdick routinely listed the same business on multiple job search forms for different time periods, and listed contacts on Saturday, Sunday and holidays when the businesses were not open. As a result of the false job search forms, BWC paid benefits to Oberdick he was not entitled to receive.

 
Judge Holbrook sentenced Oberdick to a suspended sentence of 90 days incarceration under the conditions that he pays court costs and restitution in the amount of $2,458.86.

 
Guilty Plea, More Than $13K in Restitution Ordered

 
Meantime, a former Mentor (Lake County) man was ordered to pay more than $13,000 in workers comp restitution.

 
Russell Whitman pleaded guilty June 12 to workers comp fraud, a fifth-degree felony, after an investigation by the Ohio Bureau of Workers Compensation (BWC) revealed he and his wife concocted an elaborate scheme to submit false documents to the agency, so he would continue to receive workers comp benefits while incarcerated.

 
“A quick-thinking claims service specialist spotted a newspaper article about the incarcerated injured worker, and reported it to our Special Investigations Department,” saidBuehrer. “We often rely on tips from the public and from our own staff to report instances of suspected fraud, which we investigate in order to protect Ohio employers and the State Insurance Fund.”

 
The Northeast Region 1 Special Investigations Unit (SIU) began investigating Whitman, and his wife, Regina Whitman, after receiving the allegation. Both worked for a family-owned business in Lake County and were suspected of embezzling a large amount of money from there.

 
By reviewing hours of recorded jail phone calls between the Whitmans, the SIU confirmed that his wife, who was the payroll manager for the business, submitted false payroll reports to the BWC on behalf of her husband. Those records allowed Whitman to collect workers comp benefits he was not entitled to receive.

 
Whitman was ordered to pay $13,696.27 in restitution to the BWC and was sentenced to serve six months in prison, which will run concurrently with his current five-year sentence at the Belmont Correctional Institution for the embezzlement of more than $285,000. His wife was previously sentenced.

 

 

 

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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Why NY Workers Comp Proceedings Sooooo Slow”

New York comp claims, even the simplest ones, can take a shocking amount of time to work their way through the claims process. No one is more shocked, and too often financially ravaged, by the unexpected glacially slow flow than the injured workers and their families. But what accounts for this?

 

The law used to have an obscure section that required a decision to be formally made by the Board no later than 30 days after it received notice of a claim. If the Board backlog exceeded 30 days, the commissioners could be required to work extra hours, six days a week, until the backlog was eliminated. That section mysteriously disappeared sometime in the late 90’s.

 

 
Abuse of the System

 

One abuse, nearly universal with copying services, can serve to show how clear provisions of law can be ignored with resulting disasters to workers and the employers, and why such abuses result in inexplicable delays.

 

Comp claims exist on medical records. Without the records proceedings and decisions are meaningless. Therefore, the NY Board sees hundreds of thousands of requests for medical records each year. But before a custodian of records will comply it must receive the copy fee. The Public Health Law provides for a payment of 75 cents per page.

 

However, copying services, which are NOT legally the owners of such medical records and act only on behalf of the custodian, regularly charge three times that, also adding arbitrary miscellaneous charges. If the request for records is made by subpoena, these charges are entirely in violation of the law.

 

This abuse alone can add months to the life of a claim. But what is the redress? There are two: first, a motion in Supreme Court for contempt can be made, second, the Board has the power and the obligation to notify and refer to the Attorney General patterns of widespread abuses for widespread investigation and enforcement procedures. The Board, unfortunately, only suggests that the maker of the subpoena enforce one violation at a time in Supreme Court. The costs per contempt proceeding are far more than simply paying the extortionate charges. The elevated costs, eventually, become part of the employers’ premiums.

 

This is an isolated example of work comp abuse, which has been allowed to grow into a lucrative industry. But the abuse also adds to delay of benefits and increases the number of hearings per claim.

 

 
Abuses In The Court System

 

The point is that abuses of the system are many and that each type of abuse, each in its own way, adds to delay. Judges for decades have resorted to the expedient of making no decision, especially where wrongdoing might be involved, and simply granted “adjournments” hoping that the parties will just pay the charges and move on.

 

Other types of abuse have resulted in eyebrow raising consternation. A key stroke error by a Board typist placed the wrong carrier on notice. The error could have been corrected with a simple phone call by the judge or any party. Instead, two law firms “tried” the case, from start to finish, for NINE years. (If this seems unbelievable, see “Manticoff v American Building Maintenance”, 63 AD3d 1308 (2009))

 

Another abuse, which can serve as an example for tens of thousands of others, was a claim in which a worker was granted 11 “final” opportunities to appear. This went on for years. Neither the lawyer nor the judge knew where the claimant was, and what, if anything, he might be doing.

 

 
Stay Informed And Active On Your Claims To Avoid Problems

 

An employer would be wise to stay involved with its claims. An occasional attendance at a hearing, especially if delays are developing, can work wonders. Not to mention a polite letter and phone call.

 

 

 

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.

Get a Handle on Your Account Handling Instructions

Whether you a large or small business or organization, the goal of making sure you stay on top of the financial books is essential. In the event you do not do so, you can find yourself in a financial whole sooner rather than later.

 

With that in mind, getting a handle on your finances also involves monitoring any claims made on workers compensation cases. While your goal should always be to emphasize workplace safety, you will almost undoubtedly have to deal with a workplace injury or injuries at one time or another in running your establishment.

 
There are a handful of factors that you should never overlook when it comes to making sure you are properly handling your accounts.

 
They include:

 
1. Account servicing – Instructions (ASIs) allows you to properly oversee workers comp claims and litigation.

 
It is important that company heads know exactly how medical billing and other related factors will be processed, allowing them to formulate a clear ASI to provide their company with the upper hand.

 

 
For those not entirely up to speed on ASI, it represents the deal and/or understanding between both the insured and the field adjusters at the insurer’s satellite locations that direct the handling of each and every suit and claim, both litigated and those not litigated.

 
Once the ASI are negotiated, the insured has to come to terms with all internal claims handling personnel with the provisions of the ASI, providing them with a written copy to make sure they fully realize the responsibilities for critical aspects of claims handling.
Additionally, along with containing policyholder data and information regarding coverage and dissemination of data (loss runs), ASI can also contain other lesser-known guidelines.

 

 

Address and Incorporate These Items

 
When looking at what should be discussed and/or incorporated into ASI for a business to have more of a say in the situation, look at:

 
Medical Bill Review – Who is auditing medical bills in regards to your open claims? Also look at how and when are medical bills audited? Who will audit the hospital expenses? Also, what level of hospital bills is audited? Do you determine if medical case management is warranted? Lastly, is there immediate and automatic referral of complex lost-time cases to medical case management?

 
Utilization Review – In this area, how do you determine which bills and services will be reviewed? Also look at who you have retained to provide this service.

 
Referral to Vocational Rehabilitation – Who determines if vocational rehabilitation is warranted? Also ask yourself, do you automatically refer complex lost-time cases to vocational rehabilitation? Finally, will reports be passed along to your company?

 
Alternative Dispute Resolution/Mediation – Make sure you know whether or not alternative dispute resolutions are considered on all claims for all lines.

 
Some Other Items to Go Over – Finally, check to see if it is possible to alter your account instructions. Also determine whether or not you have the right to review the complete original claim file? Are you or are subrogating insurance carriers’ part of the Center for Public Resources (a non-profit organization whose members sign-off on avoiding litigation and try to pursue alternative means of dispute resolution)? If that is the case, is this noted?

 

 

Knowing the rules and regulations makes it much easier to handle your accounting needs, especially as it relates to workers comp claims.
 

 

 

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.

 

 

Eight New State-Specific Studies Note New Predictors

In an effort to better identify post-injury workplace outcomes, the Workers Compensation Research Institute (WCRI) unveiled a recent report.

 
Eight new state-specific studies from WCRI identified new predictors of worker outcomes that can help public officials, payors, and health care providers improve the treatment and communication an injured worker receives after an injury – leading to better outcomes.

 
The studies, Predictors of Worker Outcomes, found trust in the workplace to beone of the more important predictors that has not been examined before. To describe the level of trust or mistrust in the work relationship, the studies’ interviewers asked workers if they were concerned about being fired as a result of the injury.

 

Concerns Over Post-Injury Firing Impact Return to Work

 
The following are some findings from the studies regarding this predictor:

 
• Workers who were strongly concerned about being fired after the injury experienced poorer return-to-work outcomes than workers without those concerns.
• One in five workers who were concerned about being fired reported that they were not working at the time of the interview. This was double the rate that was observed for workers without such concerns. Among workers who were not concerned about being fired, one in 10 workers was not working at the time of the interview.
• Concerns about being fired were associated with a four-week increase in the average duration of disability.

 
The studies also identified workers with specific comorbid medical conditions (existing simultaneously with and usually independently of another medical condition) by asking whether the worker had received treatment for hypertension, diabetes, and heart problems. The medical condition may have been present at the time of the injury or may have manifested during the recovery period.

 
Among those findings:

 
• Workers with hypertension (when compared with workers without hypertension) had a 3 percentage point higher rate of not working at the time of the interview predominantly due to injury.
• Workers with heart problems reported an 8 percentage point higher rate of not working at the time of interview predominantly due to injury and had disability duration that was four weeks longer.
• Workers with diabetes had a 4 percentage point higher rate of not working at the time of the interview predominantly due to injury than workers without diabetes.

 
The studies are based on telephone interviews with 3,200 injured workers across eight states. The eight states are Indiana, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, Virginia, and Wisconsin.

 
The studies interviewed workers who suffered a work place injury in 2010 and received workers compensation income benefits. The surveys were conducted during February through June 2013—on average, about three years after these workers sustained their injuries.

 

 

 

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

Avoid Penalties in Work Comp Claim Denials and Errors

Over the last several years, states have taken a proactive approach to penalizing “frivolous” denials of primary liability in workers’ compensation claims. As a result, claims management teams need to take heed and evaluate their best practices.

 

 

What Is Required Before I Deny?

 

The proper legal requirements to deny primary liability in a workers’ compensation claim vary in each jurisdiction. If you are a part of a claim management team that handles claims in multiple states, it is essential to understand the differing requirements. Proper timing and the completion of specific forms may also be part of the process.

 

General Rules for Issuing a Denial

 

There are several general rules one should follow and incorporate in their best practices.

 

• Understand what forms you require, the timelines they need to be completed in and what parties are required to receive these documents. It is also important to make sure paperwork is submitted to the appropriate state agency.

 

• Every form and document completed should contain only accurate information. This information typically includes the name of the employee, SSNs, injury related information and other pertinent information on how the injury occurred.

 

• Denials of primary liability usually require a specific legal reason as to why the injury is being denied. A common form of claim penalties occur when a claims professional states things like, “The injury did not take place. Denied.”

 

• Stating the specific reason for the denial in language easily readable and understandable to a person of average intelligence and education and a clear statement of the facts forming the basis for the denial are also a standard legal requirement.

 

• Most states require that insurance carriers and TPAs also provide instructions to injured workers on what steps they can take if they disagree with the denial, as well as the availability of rehabilitation benefits, the statute of limitations for filing a workers’ compensation claim, and the address and telephone numbers of the state division responsible for administering workers’ compensation enforcement.

 

Never disclose Protected Health Information (PHI) unless you receive written permission to do so or are required to do so under law.

 

 

Mistakes Happen. Deal With it Without Delay!

 

Nobody is perfect and mistakes to happen from time to time. However, ignoring the mistake and not correcting the error can be costly. In order to avoid penalty situations, there are ways one can go about properly handling these issues:

 

• Cooperation with the state agency assessing the penalty is important. While you might not be able to avoid completely a penalty, cooperation can mitigate the situation. State agency employees appreciate a timely return of all phone calls and letters.

 

• Provide complete and detailed responses when being audited by state agencies regarding potential penalty issues. When an initial claim is received, it is important to conduct a complete investigation and keep detailed information on facts that will serve as a basis for the denial. Obtaining specific names of witnesses or locating medical records is essential.

 

• Remember the required timelines. Note when and how to pay various indemnity and medical benefits. If problems arise such as the receipt of paystubs when paying temporary partial disability benefits, it is important to document your file as to the dates that phone calls are made, to whom those phone calls were made, and any additional follow-up after the telephone call. If problems arise due to the receipt of mail, fax transmissions or email communications, document those problems and continue to follow up. It is also important to make sure someone is checking your mail when you are out of the office. Make sure payments are sent to the correct recipient and address.

 

• When in doubt – ask someone in your office or an attorney. The various statutes and rules for workers’ compensation laws are a complex framework filled with forms, deadlines, and payment schedules. Additionally, voluminous case law exists on penalty issues.

 

 

Conclusion

 

All members of the claim management team need to take proactive steps to avoid penalties. While mistakes do happen, taking responsibility for the error and cooperating can help reduce exposure to you and your clients.

 

 

 

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.

 

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