Navigating the ADA Minefield in Work Comp

Interested stakeholders in any workers’ compensation program need to be aware of the many issues when it comes to running an effective program.  One of those includes being aware of how the American with Disabilities Act (ADA) impacts their program and post-injury efforts to return an employee to work.  Failure to do so can result in fines, penalties and lack of good will.  Now is the time to pay attention and prepare.

 

 

What is the American with Disabilities Act?

 

The ADA was passed was signed into law in 1990 as an amendment to the Civil Rights Act of 1964.  The law prohibits certain discriminatory practices based on an individual’s disability.  The law was amended one most recently in 2008, when President George W. Bush signed amendments to the law that expanded the scope of the ADA to include additional areas of coverage.

 

Important matters to consider in the context of workers’ compensation claims include the following:

 

  • Disability: This is defined by the statute to include “a physical or mental impairment that substantially limits one or more of the major life activities;” and

 

  • Qualified Individual with a Disability: The ADA only applies to an “individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the employment position.”

 

 

How Does the ADA Apply to Work Comp?

 

The ADA impacts workers’ compensation once the threshold issue of the law’s mandates are met.  This occurs when the injured employee is considered “qualified” for protections under the Act by demonstrating a reasonable accommodation may be needed in order to perform the essential functions of their job, or a return to work job offer.

 

Consider the following:

 

  • The definition of ‘disability’ includes “…substantially limits one or more major life activities.”
  • A major life activity under this definition includes the ability to work at full-duty.

 

The need for a reasonable accommodation can apply both when an employee returns to work in their pre-injury position, or in a modified capacity.  Failure to make these reasonable accommodations can subject the employer to a variety of penalties and fines.

 

 

Effective Work Comp Claims Handling Consistent with the ADA

 

The first step employers can take in effectively managing their workers’ compensation programs is the consistent application of employment matters to all employees.  This includes the following:

 

  • Have a dedicated in-house point of contact on all ADA and other employment law matters. This will likely be someone in human resources, who is familiar with workers’ compensation and other disability related issues.  Utilize legal counsel when necessary to avoid problems by being proactive.

 

  • Document every employee’s workplace conduct and performance on a consistent basis. This includes the consistent application of punishment for workplace violations, including termination.  This can become an area of concern when an employee arrives late for a scheduled work shift, or does not notify the employer of an absence.

 

  • Conduct a roundtable discussion with internal interested stakeholders including the injured worker for a discussion known as the “interactive process” before offering an employee covered by workers’ compensation and the ADA a return to work job offer.

 

  • Document the necessary requirements of all available positions within the place of employment. This should include the essential functions of a job, the necessary physical requirements and workplace safety issues.  An assessment should also take place as to whether an employee with certain disabilities can be “reasonably accommodated.”  This is a legal standard, not a matter of one’s personal opinion.

 

 

Conclusions

 

It should be the goal of every employer to return an injured employee back to work.  This is sometimes not only a question under the workers’ compensation law, but one that includes ADA considerations.  Interested stakeholders need to understand these matters in order to promote a safe workplace and reduce unnecessary expenses.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

What Is A Workers’ Comp Vocational Consultant?

Vocational consultants are not needed on most of your worker’s compensation claims; just the severe claims. When an employee has a level of permanent partial disability, to the point that the impairment from the injury will prevent the employee from returning to work, a vocational consultant is required.

 

 

Vocational Consultant Evaluates Ability of Injured Employee to Work

 

A vocational consultant evaluates the ability of the injured employee to work and then assist the employee in finding employment within the physical limitations of the employee. The typical course of the vocational process is for the vocational consultant to perform a vocational assessment including vocational testing, perform a labor market analysis, a transferable skills analysis and assistance with job placement.

 

To access the injured employee’s ability to perform a different occupation, vocational testing is used. Testing to measure the employee’s educational achievement, aptitude, interests, and level of intelligence may be used to gauge what the employee’s skills are. These tests are the first steps in a vocational assessment for the employee.

 

The vocational assessment for each employee is done on an individualized basis. To make a complete evaluation of the injured employee’s abilities, the vocational consultant will:

 

  • Complete a detailed interview to obtain the employee’s background information on formal education, trade schools, prior work experiences, interests and hobbies

 

  • Based on the results of the detailed interview of the employee, a transferable skills analysis will be completed

 

  • Vocational testing to verify the level of the transferable skills the employee has will be completed

 

  • Vocational testing to identify other skill sets the employee has but did not express or disclose

 

 

Based on the results of the employee interview and the battery of tests administered to the employee, the vocational consultant assesses the employee’s educational level, skills, interests and abilities. This assessment will include:

 

  • Educational achievement

 

  • Vocational interest

 

  • Vocational function level

 

  • Aptitude/talent level

 

  • Intelligence level

 

  • Personality traits

 

 

Vocational Consultant Identifies Potential Jobs

 

The vocational consultant will analyze all the interview and testing information obtained about the employee and will complete what is known as a transferable skills analysis. Subsequently, the vocational consultant will identify occupations or jobs the employee will be able to perform at the level of permanent impairment the employee has using the transferable skills the employee has.

 

Before the use of computers, the vocational consultant had to manually review numerous (often hundreds) types of jobs to try to find one or more jobs the employee could perform. With the advent of computer programming, the injured employee’s physical limitations, prior training, and vocational testing results are compared to the requirements of thousands of job descriptions. The vocational consultant will obtain a listing of all the jobs the employee can perform with his physical limitations and existing abilities.

 

Utilizing the list of jobs the employee can perform with his impairment, the vocational consultant will complete a labor market survey to locate actual jobs the employee is capable of handling.

 

 

Vocation Consultant Continues Until New Work Is Found

 

While the identification of occupations/jobs the employee can perform is a big step forward, if there are no jobs available, the injured employee will continue to receive workers’ compensation indemnity benefits as he remains off work. The vocational consultant then becomes a career coach assisting the employee in locating jobs to apply for, providing guidance on how to interview for the jobs, and providing support and direction to the employee in the job search. The vocational consultant will continue to work with the employee until the employee is hired by a new employer.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Five Factors to Review in Your Workers’ Comp Claim Files

While every workers’ compensation claim is unique, every claim contains certain key events and documents. The best practices established either by the insurer or the third party administrator creates a certain amount of uniformity in the claims.

 

When you review the workers’ comp claims of your employees, you will see established criteria in the handling of the claims. Each claim will contain information on:

 

  • Coverage
  • Contacts
  • Investigation
  • File Documents
  • Evaluation and Settlement

 

 

Coverage: 

 

The very first step the adjuster takes when handling a claim is the verification that there is coverage. This includes checking the policy number to be sure it is accurate; the policy dates to be sure the injury occurred during the time frame covered by the policy; the state(s) covered by the policy; and, any endorsements to the policy or any exclusions of coverage. If any aspect of the coverage verification is missing, the wise adjuster stops any further activity on the file until there is proof insurance covers the claim.

 

 

Contacts: 

 

Once the workers’ comp adjuster verifies there is insurance coverage in effect for the named insured, on the date of the injury, and in a location covered by the policy, the adjuster contacts all involved parties. Whether the adjuster contacts the injured employee first or the employer first depends on the nature and extent of the injury and the time frame of known events. The adjuster also contacts the medical provider’s office to obtain the initial medical treatment information, to provide information to the medical provider on billing for their services, and to provide the medical provider with information on the return to work policy of the employer. Any other parties who may impact the claim are also contacted; for example — witnesses on questionable or severe claims.

 

 

Investigation: 

 

Contact with all parties involved is the start of the claim investigation, but a proper investigation contains many other actions impacting the future outcome of the claim. Some of the investigation steps include:

 

  • A comparison of the details of the accident as provided by the employer, the employee, the medical provider, and any witnesses. Any deviation in the information obtained from the various parties needs to be analyzed by the adjuster.
  • The filing of the Insurance Service Office inquiry to determine if the employee has made prior insurance claims, and if so, do they impact the present workers comp claim. For instance, the employee, who suffered a lower back strained in your claim, also had a lower back injury workers comp claim with a previous employer.
  • A determination if there is a third party responsible for the employee’s injury, and if so, the documentation needed to pursue a subrogation claim.
  • An analysis of the nature and extent of the employee’s injury, the medical treatment plan, and the prognosis for the employee’s recovery.
  • An analysis of the employee’s job duties, equipment used, the return to work restrictions from the medical provider and the modified duty information obtained from the employer to determine if a modified duty job is an option.
  • A determination as to the future course of action needed on the file, also known as an Action Plan.

 

 

File Documents: 

 

Every claim file has basic claim documents to support the claim and the activity taken on the claim. Depending on the extent of the injury, the file may have additional documentation that might not be found in a simple injury claim. The documents you may see in the claim file include:

 

  • The Employer’s First Report of Injury (FROI).

 

  • The recorded statement summary of the employee and possibly the recorded statement summary of the employee’s supervisor and/or witnesses.

 

  • The required state forms filed with the governmental office enforcing the workers’ compensation statutes of the state.

 

  • The wage statement is showing the employee’s earnings during the required calculation period.

 

  • The Insurance Service Office report.

 

  • The medical records.

 

  • Vocational and/or rehabilitation reports.

 

  • Subrogation documentation.

 

  • Correspondence to and from defense counsel, correspondence to and from the employee’s attorney, and correspondence between defense counsel and the employee’s attorney.

 

  • Reserve worksheets used to calculate the cost of the claim.

 

  • File notes (a log of activities undertaken) making a record of every telephone call, piece of mail, e-mail, fax or other communication on the claim.

 

 

Evaluation and Settlement:

 

When the claim file has progressed to the point where the adjuster can start the evaluation process (usually when the employee has reached maximum medical improvement); there will either be a reserve worksheet or an evaluation worksheet establishing the financial exposure of the claim. The evaluation of the claim includes the compensability, the disability rating, the jurisdictional law, and any legal questions that need to be resolved. The file notes should describe the adjuster’s settlement discussions when they have taken place.

 

An essential part of risk management is to know as much as possible about the exposures your company faces. We recommend obtaining electronic access (on a read-only basis) to the insurer’s or third party administrator’s claim file. By knowing what is in your claim file, you can contribute any additional information benefiting the adjuster in bringing your employee’s workers’ comp claim to a satisfactory conclusion.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Important Safety Tips for Outdoor Workers In Hot Summer Months

 Important Safety Tips for Outdoor Workers In Hot Summer MonthsNot everyone has the luxury of spending the hot summer months working inside an air-conditioned office.  A good percentage of the labor workforce has to be outside for hours and hours each day, battling the blazing sun and high humidity.  Every year, thousands of workers become sick from exposure to heat, and some even die. These illnesses and deaths are preventable, usually by taking some simple steps to help your workforce during the summer months.

 

 

Educate Employees on Risks of Working Outside

 

Workers exposed to hot and humid conditions are at risk of heat illness, especially those doing heavy work tasks or using bulky protective clothing and equipment while working outside. Some workers might be at even greater risk than others if they have not built up a tolerance to working in hot conditions.

 

Workers that live in Wisconsin may not be able to handle the heat as well as some workers in Arizona due to the overall climate and the fact that they just are not used to being around high levels of heat and humidity. Some employers send people around the US for various jobs that need to be done.  Special precautions should be made for those workers who may not be as used to working in the heat. Be sure they know about the conditions and allow them to voice any concerns they may have. Educate them on the risks of working outside, even if they think they know what the job will entail.  Sure, they can complete the job, but are the taking the outdoor conditions into account?

 

 

Body Temperature Can Rise to Dangerous Levels without Precautions

 

The body normally cools itself by sweating. During hot weather, especially with high humidity, sweating isn’t enough. Body temperature can rise to dangerous levels if precautions are not taken. Heat illnesses range from sunburn, heat rash, and heat cramps to heat exhaustion or heat stroke. Heat stroke can result in death and requires immediate medical attention. Some people at risk of heat stroke may not show obvious symptoms until it could be too late to help them, especially if you are working in remote areas far away from proper medical attention.  This risk could increase with new workers, who are afraid to talk to management about feeling ill because they feel that it could cost them their new job.

 

 

Prevent with Water, Rest, Shade, and Good Communication

 

So how can heat illness be prevented? Remember three simple words: water, rest, shade. Drinking water often, taking several smaller breaks, and limiting time in the heat can help prevent heat illness. Also attempt to do the heavier tasks earlier in the morning, when the sun and heat are not at full capacity.  Employers should include these prevention steps in worksite training and plans. Gradually build up to heavy work in hot conditions. This helps you build a tolerance to the heat – or become acclimated. Employers should take steps that help workers become acclimated, especially workers who are new to working outdoors in the heat or have been away from work for a while. Gradually increase workloads and allow more frequent breaks during the first weeks of work. Also, it’s important to know and look out for the symptoms of heat illness in yourself and others during hot weather. Plan for an emergency and know what to do — acting quickly can save lives! Some symptoms include fatigue, dizziness, confusion, blurred vision, heavy breathing, and minor shaking, among others.

 

Communication is key.  Workers outside need to know that they can take breaks as needed if they have to, without fear of being punished for taking too long to complete a job.  Onsite managers should be there to help with this and enforce the break times as needed. Sometimes shade is not readily available, so cooling stations or areas indoors that can be used to take breaks should be made available.  Only use the heavy protective gear as it is needed, you shouldn’t have workers standing around in heavy gear unless they are readily using it for their job. Also, you can have workers complete their tasks in shifts, so a fresh team can move in and out which will give everyone a break from the conditions.

 

 

Use High SPF to Prevent Skin Disorders

 

Exposure to the sun can also be deadly in the form of skin disorders.  Those with fairer skin may burn easier than those with other complexions, and you should always have a stocked supply of sunblock around for your workers to use. Make sure you use a high SPF, and it is always better to provide waterproof and sweat-proof sunblock versus the normal. We have all had a sunburn at one time or another throughout our lives, so remember how bad sunburn can hurt, and how the symptoms often do not set in until you have already had a good amount of sun exposure.  Sunblock should be applied 15-30 minutes prior to the sun exposure, and again a short time after your workers have been outside and working.  Even if your workers claim to “never burn” out in the sun, don’t take their word on it.  Make your workers use the sunblock every day, and remind them to reapply often.

 

 

Summary

 

The dog days of summer are upon us, and special care should be made for your outdoor workers if you have them.  Be sure to remind your workers about the risks of working short and long hours outside, and tell them to voice any issues or concerns they may have when on the job.  As we always say, it is better to be safe than sorry!

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

4 Strategies to Dispute a Workers’ Compensation Claim

For the most part, workers compensation claims are generally compensable. The general public thinks the opposite — that all insurance companies want to deny injury coverage.

 

In actuality, it’s estimated that 80 to 90 percent of claims are initially accepted. However, claims can be denied later down the road for various reasons. How does an employer properly dispute a claim when there is a compensability question?

 

 

4 Strategies to Dispute a Workers’ Compensation Claim

 

 

  1. If a reported claim is questionable, the adjuster needs to know right away so a proper dispute for investigational purposes can be filed.

 

At the time a claim is reported to the carrier, employers will know more than the adjuster. Once the adjuster receives the file, he or she sets up the claim, contacts the employee and employer, reviews medical records, and only then makes an initial decision.

 

But if the employer calls the claim questionable, it should be marked as questionable right away so the adjuster can file a dispute that the claim’s compensability is under investigation. Most jurisdictions have a time limit on how long the claim investigation can be. If the adjuster fails to file for the extension within the time limit, the claim could be conceded as compensable — at least in the beginning.

 

 

This leads to leakage because claims dollars are being spent on a claim that may not be compensable. It takes time to take statements, get medical records, get past records, do background checks, etc. If an adjuster can file an initially extension they can take time to investigate the claim and make the proper decision on compensability.

 

 

Generally, questionable claims receive more of the adjuster’s investigative attention. This is especially true when the employer notes on the first report of Injury that the claim is questionable; this automatically raises a red flag for the adjuster. The adjuster will review the claim’s initial parts and form questions to ask the employee when taking their statement.

 

 

An adjuster’s first call will be to you, the employer, asking why the claim is questionable. Employers can talk to witnesses, and follow up on leads made by other employees that a claim may not be 100 percent compensable and pass that information on to the adjuster in the beginning of their investigation.

 

 

All of these issues greatly help the adjuster, and after the investigation is completed, a proper decision can be made on the claim as to overall compensability.

 

 

  1. What if a claim starts off as compensable then needs to be disputed later on?

 

A claim can start off as compensable and then change. For example, an employee strains his back while working. There was a witness, and it was reported promptly. The worker was sent for treatment the same day. Usually, benefits will be conceded, and the claim will be accepted into initial stages.

 

 

But, a month later the claimant tells the doctor he hurt his back the weekend before the work injury doing yard work, then he made it worse while working. This should lead to a dispute in all cases. The adjuster has no way of knowing how bad the claimant had injured themselves while outside of work, and most often the injured worker will not be able to go back and say the injury/ongoing disability is 100 percent work-related.

 

 

Unfortunately, these cases are rare. Claimants are often intelligent, and even if this did occur most do not go to an occupational clinic and tell the doctor about how they injured themselves outside of work. But it does happen, and the adjuster should catch this every time. This can be seen in emergency department records, too.

 

 

  1. What if a worker is injured doing a simple task, and the diagnosis is worse than it should be in relation to what the worker was doing at the time of injury?

 

For examples like this, adjusters rely on the medical records and the mechanism of injury. For example, a claimant states she sustained a lumbar strain while at work lifting a 20-pound tote of parts. Then the doctor finds all sorts of objective evidence on exam of severe, disabling back pain. Something is not right. Lifting 20 pounds should not have such excessive force that it herniates multiple lumbar discs. The adjuster should seek an opinion of a peer-review physician or medical advisor to comment on the severity of symptoms in relation to the stated work injury.

 

 

This type of scenario is a lot more common than one would think. The general public probably has never had a diagnostic workup on their spine or an MRI test. If a claimant sustains a simple injury and the resulting MRI shows all sorts of issues, it does not mean they all are related to the work injury.

 

 

An employer also has to beware of false positives. Just because someone has multiple levels of disc bulges, does not mean all of those are related to work. Research shows workers of all ages and occupations can have a varying level of degree of spinal issues. It is the adjuster’s job to determine what, if anything, is related to the work injury, treat those issues, and deny ongoing treatment for the rest of the worker’s spinal problems.

 

 

  1. If you know the injury is not legitimate, should you file the claim anyway?

 

The answer is in all cases is YES. It is the adjuster’s job to determine if an injury occurred out of the course and scope of employment. A human resources professional is not an adjuster, and if a worker comes to you and alleges a work injury, no matter what the circumstances, it should be reported to your carrier/TPA. The adjuster has training and certification, and he or she is qualified to deny claims. Some jurisdictions can carry heavy penalties for failure to report a work injury to the carrier. You do not want to be hit with one of those penalties. The company pays a carrier’s premium to be protected in insurance matters. The employer should gather all the pertinent details and report the claim promptly. Indicate on the first report of injury that the claim is questionable, and go from there. Follow up with the adjuster, and chances are it will be denied as you suspect.

 

 

Summary

 

There are several ways to dispute a questionable claim. But the most important thing an employer can do is gather all the information on the claim before reporting it promptly to the carrier. Then, follow it up with a phone call to the adjuster. The more you work together with your carrier, the better chance the questionable claims will be denied.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Practical Tips for Implementing Urine Drug Testing

Identifying and intervening with at-risk injured workers can save payers a bundle. These are the so-called “creeping catastrophic’ claims; the seemingly minor injuries expected to resolve within weeks that go south and before you know it, have been on the books for months or longer. They typically involve a variety of expensive medical procedures and medications, all of which are unsuccessful in alleviating the person’s pain.

 

This small fraction of workers’ compensation claims encompasses a majority of costs for payers. In recent years, the industry has done a better job of red-flagging these claimants earlier in the process. But an oft-overlooked tool to help is urine drug testing.

 

Urine Drug Testing helps physicians whether the patient is compliant with prescribed medications and/or using non-prescriber or illicit drugs.

 

But UDT has been ignored in many cases or overused in others. Using UDT judiciously can be a tremendous help.

 

 

The Stats

 

Recent research shows fewer than half the injured workers prescribed opioids received UDT – 17 percent to 50 percent. However, it also showed that of the top 5 percent of claims, UDT was conducted in 7 out of 10 physician visits.

 

Guidelines from the American College of Occupational and Environmental Medicine, the Official Disability Guidelines and the Washington State Interagency vary regarding UDT frequency recommendation. But they all call for UDT at baseline when opioids are initially prescribed, then at various times throughout the year based on the injured worker’s risk stratification. Those at low risk may only need UDT every six months to annually; while high-risk claimants might need to be tested monthly.

 

The testing provides objective information to support improved clinical decision making, and helps medical providers:

 

  • Monitor and support their decisions about medications.
  • Identify recent use of prescription and illicit substances.
  • Detect medications that may negatively interact with other drugs.
  • Better communicate with their patients about their treatment plan.
  • Identify possible medication abuse and misuse.

 

A recent national sampling of more than 11,000 testing specimens revealed that fewer than half – 47 percent – adhered to their treatment regimens. That means more than half were not taking their medications as prescribed, taking other medications that were not prescribed, or used illicit substances. It is, therefore, incumbent on organizations to include UDT as part of their treatment plans for injured workers prescribed opioids – especially those at higher risk.

 

 

Whom to Test

 

Testing all injured workers might not be feasible or practical. However, there are certain injured workers who should undergo UDT. Identifying those at risk for delayed recovery can involve several steps. One is risk factors for substance abuse disorders, such as:

 

  • History of substance abuse disorder.
  • Family history of substance abuse.
  • Major psychiatric disorder.
  • Cigarette smoking.
  • Preadolescent sexual behavior.
  • Poor family support.

 

Injured workers with no history of substance abuse – their own or their families, and no psychiatric history or other risk factors would be considered at low risk for substance abuse disorders. They should undergo UDT when opioids are initially prescribed, then yearly. It should be noted, however, that a person’s risk level can change. Medical providers should be instructed to watch for aberrant behavior or any signs of a problem.

 

Injured workers with substance abuse histories of non-opioids, and/or factors such as family history of substance abuse or psychiatric histories would be considered at moderate to high risk and should be tested two to four times per year, as well as when they initially prescribed opioids.

 

 

Patients Found Abusing

 

Those who are currently abusing or addicted to substances and/or have psychiatric histories or other factors present would be considered high-risk patients. These patients should no longer receive opioids from their primary physician and be referred for addiction therapy.    These injured workers should be tested at least three times a year and possibly as much as monthly, according to the guidelines.

 

Data from pharmacies can also be helpful in identifying injured workers at higher risk. Pharmacy benefit managers can help identify at-risk claimants based on their patterns of medication use, for example.

 

Once an injured worker has undergone testing, it’s important to have an expert interpret the results and help determine whether and what type of intervention may be necessary. Expert interpretation is generally provided by the testing lab. An employer may also consider consulting with a medical advisor.

 

 

Practical Tips for Employers / Payers Implementing UDT

  • Avoid poor quality and abuse by not letting doctors complete their own testing.
  • Contract for a panel of tests with a reputable lab.
  • Direct testing from physicians to the preferred lab.

 

Conclusion

 

There are a variety of tools that can help early identification of injured workers at risk of poor outcomes. UDT can be valuable when it is done with the proper frequency, and when the results are accurately understood and acted upon.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

[CASE STUDY] Lump Sum vs. Structured Settlement

Lump Sum vs Structured SettlementThe combination of professional administration with a structured settlement (annuity) is often the best way to protect an injured party’s settlement dollars in the event of an unexpectedly very costly year due to higher-than-anticipated medical needs after settlement. The combination of these services in a costly scenario allows the injured party to access more coverage from Medicare and pay less out of their own pocket.

 

What Is Professional Administration?

 

Professional administration involves the use of a professional third party to help manage the injured party’s medical settlement funds or Medicare Set Aside (MSA) after settlement.

 

“Professional administration achieves two important goals,” says Marques Torbert, CEO of Ametros. “It saves the injured party significant money on their medical expenses by providing them with access to discounted medical network prices, and it ensures that all their reporting to Medicare for a Medicare Set Aside account is done properly.”

 

When an MSA account runs out of funds and reaches a zero-dollar account balance, as long as it is administered properly Medicare agrees to step in as the secondary payer covering the continuing and needed medical expenses. Medicare “highly recommends” the use of professional administration to make sure that funds are extended as long as possible through discounts, used appropriately for medical care and ultimately reported properly so that Medicare will know when to step in as the payer.

 

 

What Is a Structured Settlement?

 

A structured settlement is a stream of periodic payments paid to an injured party by the defendant primarily through the purchase of annuity (fixed and determinable) issued directly by highly rated life insurance companies. In the case of an MSA, the annuity will enable the issuance of annual payments that cover the entire MSA amount.

 

As Eric Vaughn, executive director of the National Structured Settlements Trade Association, explains, “Structured settlements provide an injured party with a reliable, stable source of income which can be critical to cover their ongoing medical costs. A structured settlement removes the variability of the markets and guesswork out of funding their future expenses.”

 

The Centers for Medicare and Medicaid Services (“CMS” or “Medicare”) is accustomed to the use of annuities with MSAs. Medicare has provided clear guidelines for how the MSA should be set up when annuities are involved, with two years of costs funded upfront and the rest of the cost broken out annually over the injured person’s lifetime. When an MSA is sent to Medicare for approval, Medicare will review and approve MSAs with structures.

 

When assessing future medical costs in an MSA, it’s important to take a very conservative approach.

 

Using a structured settlement and professional administration for the MSA can provide valuable protection to an injured party should they have a costly year. The combination of these services will allow the injured party to properly get coverage from Medicare in the event their MSA funds run out. That Medicare coverage can, in many cases, ensure that the injured person pays less out of their own pocket.

 

As Vaughn points out, “Annuities are a natural fit with MSAs, given the annual medical expenses are already budgeted over the individual’s lifetime.” Torbert adds, “Attorneys and adjusters alike are recognizing the power of combining the annuity with administration not only to assist the injured party in saving money, but also to provide them with support for their medical care over the long run.”

 

It’s important to keep in mind, not all professional administrators and annuities are the same. Choose an administrator that provides the best service and saves the injured party most on medical expenses. When choosing annuities, it’s important to work with a trusted broker and to select a reliable, highly rated life insurance company. Speak with experts in both administration and structures to make sure you and your client make the right selection to ensure you have the most financial protection.

 

 

Case Study

 

Let’s take a look at an example of how an injured party, Joe, can leverage these two important services to protect his settlement dollars in the MSA.

 

Let’s assume that Joe accepted a settlement with an MSA and has a life expectancy of 10 years.

 

Scenario #1

 

In the first, good scenario, Joe is doing well and is using professional administration to receive discounts so he has relatively low spending of a few thousand dollars a year on MSA medical items.

 

Both a lump sum and structured account would have the same amount spent at the end of Joe’s life expectancy.

 

 

Scenario #2

 

Let’s take a look at the unique protection that professional administration and a structured settlement together can offer Joe in the scenario where he undergoes a costly surgery or other adverse outcomes.

 

Let’s assume that Joe is offered the exact same MSA settlement amount and starts out on the same pace. Unfortunately, three years after settlement, Joe needs to pay for a complex surgery.

 

With a lump sum account, Joe ends up having to pay for the remaining cost of the surgery after using what funds he currently has in his MSA account. Unfortunately, with a lump sum settlement, he will never receive MSA funds again. If he is Medicare-eligible, Medicare will cover about 80% of the remaining balance, and Joe will have to pay 20% out of pocket for all future treatment costs for the rest of his life (such as Medicare premiums and his regular treatments).

 

If Joe has a structured account managed by a professional administrator, his funds will take a large hit at the time of his surgery, but the administrator will have ensured the funds were spent appropriately so Medicare will step in as the primary payor. Medicare will pay for 80%, and he will take care of 20% out of pocket for the remaining balance of the surgery only for that year. After that year, his account will continue to replenish annually, and he can use his MSA funds to pay for future treatment.

 

 

Summary

 

In summary, the outcomes for Joe can be strikingly different. With the lump sum settlement, he is losing personal funds, and he never again has the chance to build value in his MSA account. With the structured settlement, Joe is better off over time. The way Joe settles his case has a very powerful impact on his finances, and the combination of a structured settlement and professional administration protects the injured party more effectively.

 

 

 

Author Porter Leslie, President of Ametros. He directs the growth of Ametros and works with its many partners and clients. He built his career leading customer-focused businesses in the healthcare and financial services industries. Prior to Ametros, he worked in investment banking, private equity, and corporate development. Leslie earned a B.A. in economics from Columbia University, as well as an MBA from the Wharton School and an M.A. from the Lauder Institute at the University of Pennsylvania. He is fluent in Spanish and Portuguese.

Your Adjuster Has a Critical Role in Legal Defense Management

 Your Adjuster Has a Critical Role in Legal Defense Management With the public bombardment of attorney advertisements, it is becoming harder for the claims adjuster to work directly with an injured employee.  The plaintiff attorney advertising is designed to get the public to think that they need attorneys for everything. However, with proper claims handling, the claims adjuster can still control the workers’ compensation claim.

 

 

Once Attorney Hired, No Further Contact with Employee

 

Once the employee has retained counsel the adjuster can have no further direct contact with the employee.  The adjuster cannot advise the employee to terminate a relationship with their legal counsel.  The adjuster cannot tell an employee not to retain legal counsel.  While some employees can be very difficult to deal with and extremely demanding, the adjuster can never tell an employee to get an attorney.  If asked about getting an attorney, the adjuster should tell the employee it is their decision on whether or not they hire an attorney.  The adjuster should request a letter of representation from the employee’s attorney as soon as notified of their existence.

 

The adjuster may reevaluate the claim when an attorney appears, but the adjuster should not be stampeded into an excessive change of opinion.  Claims have been settled for less with attorneys than they might have been settled with the employee direct.

 

The adjuster will price the settlement values of the workers’ compensation claim based on the facts and exposures regardless of legal representation.  The injured employee will determine after the disposition of the claim whether or not the attorney was worth it and needed.

 

 

Adjuster to Maintain Positive Contact with Employee Before Attorney Representation

 

Prior to an attorney representation, the adjuster should maintain a direct dialogue and interface with the claimant.  This is accomplished by showing empathy and concern for the person and injury.  The adjuster should not allow sympathy to overrule the facts and necessities of the loss.

 

The adjuster can maintain control of the claim by prompt contact, kept promises, returned telephone calls, and questions answered with fact, law, and honesty.  Explanation of all steps as to what will happen, when it will happen and how it will happen, builds confidence of the employee in the adjuster’s professionalism.

 

All of these steps may not keep the employee away from an attorney.   Nor may it prohibit a request for a hearing, even if the adjuster works in the same professional manner with the claimant’s attorney.  Many attorneys receiving such consideration will usually delay filing for a hearing and are more apt to be receptive to a prehearing resolution of the claim.  (Some jurisdictions have hearings in front of an official from the work comp board, while others will have an industrial commission, and others used the court system of their state).

 

 

First Notice of Claim Could Be Request for Hearing

 

On the other hand the first notice of a claim may be by a request for a hearing.

 

Regardless of when or how a hearing request arrives, the adjuster is under the gun to process the legal papers as fast as possible.   Most hearing requests must be answered in a specific time frame, often 30 days, but some jurisdictions have a shorter time frame of 20 days from the date the employer is notified.  If the answer period is going to expire before an answer can be given due to investigation needs, the adjuster should request an extension of time from the employee’s attorney.  The adjuster should attempt any disposition that might be possible before referring to defense counsel.

 

The hearing request should be sent to defense counsel at once by the adjuster.  The adjuster will need to keep the claim file on a daily diary until the employee’s attorney agrees to an extension of time, or until the adjuster has employed defense counsel to respond to the hearing request.

 

The adjuster should send defense counsel a copy of the file with a covering letter outlining legal steps to take, and the adjuster’s summary assessment of the file.  The adjuster should provide written litigation management guidelines to the defense attorneys. The adjuster should request a litigation plan and a litigation budget. The adjuster should set a legal reserve for the defense cost. The legal plan should be the guide for setting the legal reserve.  However, until a litigation plan arrives from defense counsel, the adjuster can use an average of past legal costs for similar losses to set the legal reserve.

 

 

Stay with File Before and After Referral is Made to Defense Counsel

 

The adjuster should keep the file on a daily diary until the claim referral is acknowledged by defense counsel and an answer has been filed.

 

The adjuster should not abandon the file handling and management to defense counsel.  The adjuster is responsible for gathering the facts for the defense counsel.  If the file has recorded statements from the injured employee and other employees as witnesses, the adjuster should defer expensive depositions until absolutely necessary.  The adjuster should prevent needless litigation steps and not allow the defense attorney to use outside investigation without prior approval and need.

 

All specialist investigation or experts needs the adjuster’s approval. They are to be coordinated with the adjuster, the employer and the defense counsel.  The adjuster should control cost by the pre-agreement of fees and cost.  The adjuster should audit the billing by outside investigators or experts to be sure it is in keeping with the agreements.

 

If defense counsel needs information from the employer, the adjuster should obtain it. When a meeting or conference is necessary, the adjuster should be present with defense counsel and the employer.  If the self-insured employer needs to be contacted for disposition authority, it should be done through the adjuster.

 

Good adjusters know the value of the claim, can negotiate the settlement themselves, and should try to keep defense counsel out of settlement negotiations to limit legal fees.  However, when a case is in a hearing, arbitration, or statutory judgment the attorney may have to settle on the spot.  The adjuster should provide defense counsel with the necessary settlement authority. Telephone discussions for additional authority can prevail in these situations. If the self-insured employer input is required, the adjuster should comply.

 

The adjuster should control defense counsel reporting. It is not necessary for the attorney to parrot back factual information already in the file.  All that is necessary for the attorney to do is state how the facts will be used in the litigation process.  The attorney’s report should contain an opinion as to disposition.  A request for any additional investigation is necessary.  A time frame and necessary legal steps should be in the report.

 

 

Adjuster Critical in Management of Attorney Costs

 

Once the initial assessment report is completed by defense counsel, it is necessary for the adjuster to receive supplemental reports for current activities and opinions.  If legal research is necessary the attorney must discuss and get the adjuster’s approval.  Limitations must be set to avoid runaway costs.

 

The adjuster should have defense counsel eliminate from their reports all, or at least surplus copies of interrogatories, pleadings, depositions, and other legal information.  The attorney generally reports on the contents of these items and their impacts, so it is seldom, if ever, necessary for copies to come to the adjuster’s file.  Not only will this save attorney copy cost, it will reduce a cumbersome file.  If a need arises for these actual documents, the adjuster can always request them.

 

All defense counsel legal billings should be reviewed and approved by the adjuster.  The adjuster should check the defense counsel bill line by line to be certain there is no duplicity, overlap, or non-authorized handling.

 

The adjuster should be cognizant of excessive telephone and other uses.  The adjuster should supply photocopies of documents to counsel when possible so they do not have to copy.  The adjuster should before sending any file to defense counsel go through the file page by page and eliminate any duplicates, or needless paper.

 

When a case goes to a hearing and an adverse decision gives grounds for appeal, the adjuster should handle the appeal response period on daily diary until the defense counsel has filed the appeal.

 

 

 

Multiple Defense Relationships Should be Engaged

 

The adjuster should develop relationships with several defense counsel firms. It is recommended that the different firms be used simultaneously. This generates competition between the firms, allows for spreading work, and keeps the assignments on a fresh approach for service and thinking.

 

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

The Power of a Good Settlement Consultant

The Power of a Good Settlement ConsultantWhich unappealing situation would you prefer?

 

A. You must seek permission to see any medical provider; then, you may have to wait and/or travel far distances to visit the physician. Any medications, surgeries, or procedures must first be approved, and there’s a good chance some will be denied.

 

B. You have to navigate a complex healthcare system yourself — meaning you’re on your own to find the right specialists and ensure they charge according to your state’s ‘fee schedule.’ You pay full retail prices for doctor visits and all medications and treatments. You must fully comply with the myriad Medicare requirements or risk ultimately losing that benefit. You are extremely worried you won’t have enough money to pay for your medical care, your mortgage and send your child to college. Short of paying excessive fees for expert advice, there is no one to guide you.

 

 

Complex Issues Can Prevent Settlement

 

Neither scenario is appealing; yet, those are the choices facing many injured workers with long-standing, complex workers’ compensation claims. While many would like to settle and finally leave the workers’ comp system; issues such as lien resolution, financial planning, legal issues, and insurance concerns are just some of the challenging hurdles which are seemingly too difficult to overcome.

 

Fortunately, a solution to these challenges can often be found that meets the injured worker’s unique needs, along with those of the attorneys, employer, payers, and others involved.  Finding the right people to work with can get claims off payers’ books and ensure the injured worker’s financial and medical needs are taken care of throughout his lifetime.

 

 

The Settlement Consultant

 

A settlement consultant is a settlement expert with knowledge and access to various settlement tools to address the most challenging workers’ compensation claim issues. For example, a consultant that works with insurance planners can provide comparative information on insurance products, such as disability or long-term care insurance. Having the benefit of an expert in Medicare Set-Asides available can ensure compliance and reporting issues are addressed, so future benefits are not put at risk.

 

These experts can be brought into the process early on, so the settlement is set up appropriately. Rather than just running quotes, the settlement consultant should act as the general contractor in identifying, bringing and managing the best experts to the table to address the issues preventing a positive outcome for all parties in the case.

 

 

Settlement Consultant as General Contractor

 

If you were building a house, you would need workers to lay the foundation and put up the walls, electrical and plumbing specialists, roofers, and HVAC professionals. You might want a home theater with the latest equipment and would need an expert for consultation and installation. Maybe you’d opt for a decorative pond on the property, and would need someone experienced in grading the land.

 

You would want a general contractor to oversee the entire project and make sure things were done according to your specifications and timeframe.

 

A settlement consultant should function as a general contractor who coordinates all the moving parts to the settlement. Just like the best general contractors, a settlement consultant should be able to identify and coordinate all the right players needed to create a truly win-win settlement.

 

Among the qualifications of the best settlement consultants are:

 

  1. Vast experience and deep connections. The best settlement consultants have vast experience and deep connections with many vendors. They can find the right ones for each injured worker.

 

  1. Whole-person approach. Superior consultants look beyond the amount of the settlement. They work closely with the injured worker, to ascertain not only his medical needs, but other considerations; such as unique legal issues to be resolved, insurance concerns; retirement needs, and college funding for children or grandchildren.

 

  1. Ability to uncover lifetime needs. The most qualified settlement consultants spend time getting to know the injured worker and identifying his needs; then bringing in experts to address them.

 

  1. No cost to the injured worker. The consultant’s services should also be completely fee transparent, and come at no cost to the injured worker.

 

 

Use Settlement Consultant Early

 

A settlement consultant should be brought into the case as early as possible, even before the worker has agreed to settle the claim. By forming a relationship with the injured worker and understanding his needs, the consultant can present a variety of customized solutions to focus on his particular situation and help reach an optimal settlement

 

 

Conclusion

 

Settling a workers’ compensation claim can be a nerve-wracking experience for an injured worker, especially one who has been in the system for an extended period of time. Working with a truly qualified settlement consultant can help settle the claim and empower the injured worker to lead the life they deserve.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Know Two Types of Functional Capacity Evaluations (FCE)

Know Two Types of Functional Capacity Evaluations (FCE)When a physician is treating an employee for a back injury or other job related injury, the decision on when to return the injured employee to work is often a subjective decision. The physician who is unsure of the employees physical capability will often turn to the physical therapist for an objective opinion of the employees ability for work. The physical therapist will provide a Functional Capacity Evaluation (FCE) by administering various tests to determine the employee’s functional capacities and limitations.

 

 

Comprehensive Examination and Evaluation

 

The FCE is a comprehensive examination and evaluation by the physical therapist that objectively measures the employees level of functioning. The testing will document the employees ability, or the lack of ability, to perform the essential job related task over a specific time frame. The FCE will provide objective information to the physician in several areas:

 

  1. the employee’s functional abilities and job demands
  2. the disability evaluation
  3. when to return the employee to work
  4. whether or not the employee can return to the job held prior to the injury
  5. the employee’s functional abilities away from the job
  6. to information to design a rehabilitation plan, if needed
  7. the need for other medical intervention and/or treatment

 

While most workers compensation adjusters and employers will look at a FCE as a way of proving the employee is able to return to work, it serves a much greater function.   The results of the FCE will often limit the disability rating of the employee, preventing the physician from assigning a higher disability rating than is justified. Furthermore, the FCE will determine physical limitations the employer will need to know to modify the employee’s job, preventing a needless re-injury of the same body part.

 

 

Job Specific & General Purpose FCE

 

There are two types of FCE, the Job Specific FCE, and the General Purpose FCE. The Job Specific FCE measures the employee’s ability to perform the task and physical demands of a specific job. It can be performed at the physical therapist’s clinic, but the physical therapists can go with the employee to the actual job site and evaluate the employee’s ability to do the essential task of the employee’s job. The job-specific FCE will determine if the employee can safely do his prior job or if modifications of the required work are needed.

 

The General Purpose FCE is normally used when there is no longer a job for the employee to return to or when the job functions have not been determined. The General Purpose FCE consists of a group of standardized test and measurements that can be used to establish the employee’s overall physical capabilities. The results of the General Purpose FCE can be used to evaluate the employee’s ability to perform specific jobs that may come available to the employee.

 

 

Determine Medical Status of Employee 

 

Prior to starting the FCE, the physical therapist will review the medical records of the employee to determine the medical status of the employee. The physical therapist will establish a baseline for the employee based on the known job demands. The job demands of the employee will be characterized per the US Department of Labor’s “Selected Characteristics of Occupations as Defined in the Revised Dictionary of Occupational Titles” as:

 

  1. sedentary – exerting up to 10 pounds of force occasionally,
  2. light – exerting up to 20 pounds of force occasionally or up to 10 pounds of force frequently
  3. medium – exerting 20 to 50 pounds of force occasionally or 10 to 25 pound of force frequently
  4. heavy – exerting 50 to 100 pounds of force occasionally or 25 to 50 pounds of force frequently
  5. very heavy – exerting in excess of 100 pounds of force occasionally or in excess of 50 pounds of force frequently or in excess of 20 pounds of force constantly

 

Both the Job Specific FCE and the General Purpose FCE measure the employee’s ability to perform various motions, movements, and skills. The ability to do the accomplish the physical demands of the job will be measured in these areas:

 

  1. Balancing           Carrying                  Climbing                 Crawling
  2. Crouching          Far vision                Feeling                   Finger dexterity
  3. Fingering           Handling                 Hearing                   Kneeling
  4. Lifting                Manual dexterity   Motor coordination Near vision
  5. Pulling               Pushing                  Reaching                Sitting
  6. Standing            Stooping                 Talking                    Walking

 

Again, using the US Department of Labor guidelines, the employee’s tolerance level during an eight hour work day for the above activities is categorized as:

 

  1. Not Present (Never) – The activity does not exist in the job (example: Crawling could be classified as Not Present in the job)
  2. Occasionally – The activity exists less than 1/3 of the time (example: Climbing – occasionally)
  3. Frequently – The activity exists from 1/3 to 2/3 of the time (example: Carrying – frequently)
  4. Constantly – The activity exists 2/3 or more of the time (example: Walking – constantly)

 

Document Evaluation Results 

 

When performing the FCE, the physical therapist is responsible for ensuring the test are appropriate for the employee and the test can be done safely. The physical therapist will review the musculoskeletal condition of the employee as reported by the treating physician.   The physical therapist will screen the employee for any underlying medical pathology that would limit or prohibit the employee from participating in the FCE.

 

Upon completion of the FCE, the physical therapist will document the evaluation results. The FCE report will confirm the employee can return to work without job modifications or will confirm the employee can return to work with specific job modifications, or the need to delay the employee’s return to work.   The FCE may also address the need for work hardening or other interventions that would improve the employee’s physical abilities. Properly utilized, a FCE can provide the treating physician with the necessary information to return the employee back to work.

 

 

 

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

Contact: RShafer@ReduceYourWorkersComp.com.

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

 

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

 

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

 

 

 

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