California’s DIR/CHSWC Appoint Brady to Commission

California’s Department of Industrial Relations (DIR) and the Commission on Health and Safety and Workers Compensation (CHSWC) recently announced the appointment of Martin Brady to the commission, where he has served since 2012.

 
Governor Brown reappointed Brady as the public employer representative.

 

Commissioners are appointed by the Governor and the Legislature.

 

Labor Code 75 establishes that two of the employer members and two of the labor members of the Commission shall be appointed by the Governor for a total of four members.

 

Brady has been executive director at the Schools Insurance Authority since 1997, where he was a risk management and prevention manager from 1988 to 1997.

 

He is a director of the California Association of Joint Powers Authority and the California Coalition on Workers Compensation.

 

This position does not require Senate confirmation.

 

 

 

 

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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The Smallest Things Make the Biggest Impact In Work Comp Claims Prevention

A majority of work comp claims can be prevented. It would be hard to technically eliminate the total risk of them occurring, but it is possible to decrease the risk.  Oftentimes these are simple safety tasks to implement, not painstaking ones.  Risk managers and safety personnel can sometimes think too much about it, but simplest answer is often the most effective.

 

Slips, trip and fall injuries, and overexertion are responsible for the bulk of claims. Depending on the tasks performed on your work floor, this could be the bulk of a worker’s day from the start of the workweek to the end. 

 

 

Minor Changes Can Significantly Increase Safety

 

Preventing the most common injuries can be as simple as maintaining good housekeeping practices, and a few minor changes can significantly increase safety in the workplace and lower workers’ comp costs.

 

 

6 Tips to Reduce Common Injuries

 

For example, If you live in the Midwest or Northeast, many injuries each year are due to employees slipping on ice and snow.  In addition to that, no matter where you reside, employees can slip on water or grease spills, and also trip over objects, resulting in minor to severe injury.  Here are ways to reduce these risks:

 

  • Fix poor lighting in areas where injuries occur the most.

 

  • Keep floors and stairs clean and free of objects or debris.

 

  • Clean slippery surfaces regularly and make sure machinery is marked off so workers do not get clothing or laces caught up in moving objects.

 

  • Covers hoses and cords or run them out of the path of passing employs in walking areas or work benches.

 

  • Keep aisles clutter free and make sure any spills are promptly cleaned and a product such as Floor-Dry is used to soak up any remaining oils or liquid after a spill.

 

  • Repair uneven surfaces or cracks in your work floor to eliminate tripping or stumbling.

 

 

Overexertion Injuries

 

Overexertion injuries occur mainly due to lifting, pushing and pulling, bending and twisting, repetitive motion, and awkward postures.  Out of those risks, lifting and pushing/pulling tasks will be the cause for the majority of injuries. 

 

To move materials, think about utilizing:

 

  • Conveyers

 

  • Hoists

 

  • Lift-assist devices and equipment designed to reduce material handling and manual lifting.

 

  • Reduce the weight of the materials to be moved or break down pallets into smaller, more manageable loads that are easier on your employees.

 

 

Teach Employees Proper Lifting Techniques

 

Another effective alternative is to invest in teaching employees proper lifting techniques, such as “lifting with the legs and not the back,” or “bending the tool and not the wrist.”  These may seem like no-brainers, but these mottos need to constantly be ingrained in the minds of each employee you have working for you on your work floor.  It really can go a long way in preventing injury. 

 

Even something as simple as implementing a lift-limit, meaning that if material is over a certain weight, a worker has to go get another employee to help.  Install some discipline if a coworker is caught breaking the lifting rules. Even better is implementing a reward system, when another employee is observed helping another employee out.  A $10 gas card mean seem like nothing these days, but everyone loves getting some help at the gas pump, even if it is only $10. 

 

Other common-sense solutions include using handles to lift boxes when they are so equipped, reducing the frequency and distance of lifting and carrying, locating frequently used items as close to the body as possible to minimize reaching, and adding padding to tools that may need it.  These are simple ways that can reduce claims in the long run, and they are simple corrections to longstanding mechanisms of injury.

 

 

Summary

 

These are common sense ways to help reduce risk and injury in the workplace.  Workers face these risks every day, and you could be surprised at what suggestions your coworkers can supply if you ask them.  Reward ideas that you implement, and welcome feedback at any time, not just at the end of the year when you ask your employee.  Sometimes the simplest, most cost-effective answers are right under your nose. 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

Massachusetts Unveils FY 2017 Workplace Safety Application

The Massachusetts Department of Industrial Accident’s Office of Safety recently released the FY17 Workplace Safety Training & Education Grant Program Application for submission by July 1, 2016.

 
The objective of this program is to promote safe and healthy conditions in the workplace by awarding state funds to eligible applicants who submit responses designed to provide and improve safety education and training in Occupational Safety and Health to employers/employees within the Commonwealth covered by the Massachusetts Workers Compensation Law (M.G.L. Chapter 152). Complete instructions will be detailed in the FY17 Safety Training Grant Application.

 

Business owners should prepare and submit their grant application as outlined in the instructions. Incomplete applications cannot be processed unless all requested documents are included.

 

For their convenience, state officials have created the grant application and contractual documents as writable PDF files. The grant application and supporting documents as outlined in the check off summary must be submitted electronically as one document. Multiple attachments and zip files cannot be accepted.

 

Businesses should remember to apply for and submit a copy of their Department of Revenue (DOR) Certificate of Good Standing with their application and contractual documents. A Certificate of Good Standing less than six months old must be provided at the time of submission.

 

The fastest and easiest way to obtain a Certificate is online through MassTaxConnect https://mtc.dor.state.ma.us/mtc Applicants must be in full compliance with all obligations to the Department of Unemployment Assistance, Department of Industrial Accidents, and any other obligations to the Commonwealth of Massachusetts.

 

Applicants found to be non-compliant will be removed from consideration until all compliance issues have been resolved. Prepare and submit original contractual documents as outlined in the instructions. ALL signatures and dates must be original and in ink. Stamps will not be accepted.

 

If you have questions or need assistance with grant application only, contact Deven Awalt 617-727-4900 ext. 7404 or Maria Pesantes at 617-727-4900 ext. 7376. You may also refer all questions to safety@dia.state.ma.us

 

If you have questions or need assistant with the contractual documents only, contact Diane Lentini at 617-626-5913 or by emailing diane.lentini@massmail.state.ma.us

 

 

 

 

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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7 Ways to Prevent Slips, Trips, and Falls

A common source of accidents in almost any work environment is the slip, trip, and fall. All three types of accidents have the same result where the employee’s feet leave and land on the floor or other surface. Often there is a combination of slip and fall or of trip and fall. The fortunate employee who trips and falls receives a few bruises. The unlucky employee receives one or more fractured bones, torn ligaments, or other soft tissue injury.

 

 

The fact is most slips, trips, and falls can be prevented through a combination of proper risk management by the employer and proper training of the employee on how to avoid accidents.  The employer can reduce or eliminate most of the accidents involving slips, trips and falls by using the following guidelines:

 

 

1) Using the most appropriate flooring materials

 

The flooring material chosen should not be selected based solely on cost or aesthetic issues. The flooring surface should be smooth, but not slippery. There ARE standards for the safest co-efficient of friction on surfaces, so make sure your surfaces meet these standards. It should not have joints, ridges or edges that are one fourth inch in height or greater. Any greater elevation changes than this present the opportunity for tripping. The floor material should be slip-resistant, meaning the material should not accommodate any sliding of the feet. This is especially true in restrooms, kitchen facilities, and at exterior entrances where rain, sleet or snow can be tracked inside the building.

 

 

2) Having the proper floor maintenance

 

Any damage done to the floor surface by the building settling, dropped items, wear and tear, or by movement of supplies or equipment should be promptly repaired. Frayed carpet or missing tile often leads to a slip and fall or a trip and fall. All flooring surfaces should be kept in a state of good repair (and that means no duct tape over a frayed seam as a repair). The uses of floor cleaners and waxes should be in accordance to the product specifications. A slip-resistant floor with an excessive coat of wax will lose it slip-resistant properties.

 

 

3) Having the proper housekeeping rules

 

All materials, supplies, equipment and tools should have their designated locations and the floor is never one of the locations. Litter, debris, and left over production waste should be removed promptly before it can become a slip or trip hazard. Any spills of any type should be immediately cleaned.

 

 

4) Marking and identifying all changes in elevation

 

There are more falls where the change in elevation is one step than there are where the change in elevation is a full set of steps from one floor to another. Whether one step or a dozen steps, the steps need to be properly marked. If the steps have the same color and the same floor covering as the adjacent floor, this is inviting trips and falls. The steps should be clearly marked, well lit, with an even width and height for every step, and be properly maintained. Properly maintained includes no frayed or broken edges, proper handrails, slip-resistant surface and no loose flooring material.

 

 

5) Maintaining the sidewalks and walkways

 

All sidewalks need to be smooth but not slippery.  Any damage to the sidewalk from settling, tree roots, or machinery traversing across the sidewalks should be repaired quickly. Any elevation change of a ¼ inch or higher needs to be clearly marked or corrected. Any accumulation of water from water sprinklers, rain, ice or snow needs to be removed before an accident can occur.

 

 

6) Maintaining parking garages and parking lots

 

A pothole in the parking lot can cause a lot more than a damaged hubcap or messing up the wheel alignment. The surface area of the parking lot or parking garage needs to smooth without ridges, edges or joints greater than ¼ inch to prevent trips and falls. Any potholes, broken pavement of other irregularities should be promptly repaired. Marked walk areas or sidewalks should be provided to reduce the potential for slips and trips. The parking area should be properly illuminated for night or bad weather use. Parking bumpers, speed bumps, and other potential trip hazards should be brightly painted to reduce the risk of trips.

 

 

7) Requiring proper footwear

 

If the employees are to be working in an area where there is occasionally water on the floor, spills or other causes of slippery conditions, the employer should require all employees to wear shoes designed with a skid resistant sole and heel.  A good rule of thumb is low heels and good tread on all work footwear.

 

 

By using good risk management techniques, the potential for slips, trips and falls can be greatly reduced. We recommend these safety tips be included in your safety program.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

Australian Construction Company Convicted After Worker Seriously Injured

An Australian construction company was recently convicted and fined $50,000 over an incident in which a concrete truck tipped over and seriously injured a worker after unknowingly setting up on top of a temporarily covered ventilation shaft.

 

Ducon Pty Ltd. was found guilty by the Melbourne Magistrates Court on one charge of breaching the Occupational Health and Safety Act 2004 for failing to ensure the workplace was safe. It was also ordered to pay $20,000 in costs.

 
The company was the principal contractor at the construction site of a 36-story apartment block at Hughesdale in Melbourne’s south-east.

 
The court heard that a shaft, which was to be fitted later with a ventilation system for an underground car park, was covered with 100mm of concrete which made it appear like part of a capping beam.

 
A capping beam is a solid concrete structure supported by piles and is commonly used as a place for heavy machinery with outriggers such as cranes and concrete pumping trucks to be set up.

 
The court heard that Ducon Pty Ltd. knew that the shaft had been covered in concrete but failed to mark the location.

 
In April of 2012, the subcontractor engaged to fill columns at the site with concrete was advised by the site foreman to set up their concrete pumping truck on the capping beam.

 
A worker was on a mobile scaffold, holding and directing the concrete pour hose into the columns when an outrigger stabilizing the truck penetrated the 100mm layer of concrete over the shaft. It tipped the truck over, causing the boom to come down and hit the scaffold where the worker was standing.
The worker suffered a fractured spine, crushed right hand, broken right ankle and foot. He also required skin grafting.

 

 

 

 

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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Learn To Diagnose Your Diagnostic Test Diagnosis

When an injury fails to resolve within 4-8 weeks (sometimes sooner) physicians will likely order a diagnostic test to be performed.  The test will give them an inside look at what is going on structurally, and provide evidence to injury or pain generator, so they can focus care on resolving the issue.

 

Surprisingly enough, these tests are open to physician interpretation.  If the answer is not a clear silver bullet, such as a massive disc herniation or radically pinched nerve, you will see some difference in opinion on what could actually be wrong and how it is related to the work injury.

 

This is where the adjuster plays a key role.  Their relationship with a diagnostic provider or certain physicians can be what can swing a claim one way or another.  It can mean the difference if the injury is surgical or not, and even bigger, whether the claim and ongoing treatment is related to this work injury rather than an ongoing degenerative issue.

 

 

EMG Should Be Performed By Independent Physician

 

If a worker claims on occupational injury that was not traumatic in nature, chances are the injury was caused by repetitive motion within the course of their employment history.  After treating for a period of time and the worker has made no progress, the physician will likely perform an EMG to see what is going on.

 

Believe it or not, every doctor is not an EMG expert.  Even though they perform EMG tests and they make it a part of their regular practice, this doesn’t make them effective at interpreting the results.  It is typically not in your best interest to have the treating doctor performing the EMG.  A physician is in business to treat people. This is how they make money.  And by giving “positive” EMG results, this leads to possible surgery, more physical therapy, more treatment and overall more money for this doctor and for their practice.  We would like to think that all doctors are ethical and would do the right thing, but unfortunately this is not always the case.  If this is going on with your claim, the adjuster will likely get an outside opinion from another physician, likely one that is credentialed by the “American Association of Nueromuscular Medicine (AANEM). These physicians have strict criteria for performing EMGs and interpreting their results.  And since they have no financial interest in the overall treatment plan in the claim, they can give you an objective opinion without bias.

 

If the adjuster fails to obtain another opinion, and decides to go with the treating doctor’s opinion, this can lead to huge surgical costs and other medical costs that may not be related to this work injury.  This practice over time leads to thousands and thousands of dollars wasted by the insurance carrier or TPA, otherwise known as “Leakage.”  The worker puts themselves through possibly unnecessary surgery, rehab, medication, and so on.  Your adjuster should get a second opinion every time. It is better to be safe than sorry, especially when it comes to claims and surgical costs.

 

 

 

MRI More Difficult to Interpret

 

It is typically more difficult to interpret the results of an MRI.  If 20 people off the street that had no back pain took an MRI, many of them would have arthritis, bulging discs, herniated discs, and so on.  Just because these things are present on an MRI does not mean that they are pain generators, or that they are related to whatever work injury may have occurred.

 

A treating physician may or may not decide to interpret the MRI themselves.  Some will rely on the radiologist’s opinion, and just repeat the conclusion to the patient.  Others will ask to see the actual films, and they will draw their own conclusions, in addition to whatever the radiologist concluded.

 

 

Results Should Be Confirmed With Second Opinion

 

This can lead to an ethical treatment issue.  The key is the doctor relating a positive MRI back to the work injury.  This should not just be stated, they should be using objective medical evidence and the mechanism of injury to tie it together.  Even if this done properly, a good adjuster will obtain another opinion from a qualified physician or get the MRI read by another radiologist with credentials to interpret the results.  If you have ever viewed an MRI report, two radiologists can read the same films and one report may be three paragraphs, and the other may be three pages long.  This depends on the style of the radiologist. Your adjusters should have certain ones that they like and whose opinion they trust.

 

Despite the radiologist’s opinion, they will only read the MRI.  It is typically up to the surgeon to determine the cause of the injury. A radiologist may offer an opinion, but it is rarely a clear yes or no answer. There are too many variables involved since everyone’s body and function in day to day life is different.  It is up to the adjuster to work on the treating doctor, using thoughtful objective questions, to push him to make a decision on the causal relationship of the injury. If this correlation cannot be made, then by no means should a surgery proceed with authorization by the claims adjuster.

 

Failure to Obtain Causal Relation Statement Can Cost You

 

Failure to properly obtain a causal relation statement can yield thousands of dollars spent in error.  Once a surgery is performed, there is no taking it back.  Your worker had an invasive surgery performed, and medical complications are always a risk. In addition, a surgery doesn’t always mean a cure for all of ailments.  Significant leakage can occur if a positive MRI is not work related and your adjuster deems a claim, surgery, rehab, etc. compensable.  If the surgery was a multilevel spinal fusion, then you have medical cost leakage, wage leakage, vocational issues, further surgeries, and so on.

 

Before you authorize any surgery, take the time to get a few other opinions from not only qualified physicians, but qualified radiologists as well.  Most IME vendors and diagnostic providers will also have a radiologist on their roster, and this person can oftentimes be an overlooked resource. In the end, it could save you tens of thousands of dollars, if not hundreds of thousands upon the lifetime of a particular claim.

 

 

Summary

 

Remember just because a person is a physician, it doesn’t make them automatically qualified to properly read and interpret diagnostic reports.  Unreliable interpretation of diagnostics can lead to costly results for you and the worker.  Communication with the worker at this point is critical.  The injured worker may know nothing about medical, and they are going on the advice of their treating doctor.  Facing a surgery or major injury is a scary thing, and you want to relay to the worker that you are taking the time to get all of these extra opinions for their benefit, not only for the overall compensability of the claim.

 

Some injured workers respond to this as “Doctor shopping until you can find one that will deny my claim” but this is not the truth.  Adjusters have to have a clear, concise answer to causal relation. My response to the “doctor shopping” question is to respond by saying that the worker is the one that has to undergo the surgery, the lost wages, the rehab, the medication, the travel time, and the overall stress of dealing with an injury.  Whether it is work related or not, I’m going to want to cover all of the bases so you get a proper diagnosis and treatment plan.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

California Adult Entertainment Company Fined for Safety Hazards

Cal/OSHA recently cited adult film producer Kink.com with proposed penalties of $146,600 to for 13 violations of safety laws that exposed workers to blood and other potentially infectious materials.

 
Responding to a complaint, Cal/OSHA inspected Kink.com facilities in San Francisco in November of 2015.

 
Investigators found the employer did not require performers to use condoms during production of at least five films, in violation of California’s bloodborne pathogens standard.

 

“The use of barrier protections, such as condoms, is required during adult film production,” said Cal/OSHA Chief Juliann Sum. “Cal/OSHA will continue to enforce California’s health and safety regulations, which exist to protect workers from job-related harm.”

 

The two condom-related violations are classified as willful serious, and carry the largest penalties. A willful violation is cited when evidence shows the employer either knowingly violated the law or took no reasonable steps to address a known hazard. Serious violations are cited when there is a realistic possibility that death or serious physical harm could result from the actual hazard created by the violation.

 

Cal/OSHA also cited Kink.com for 11 general safety violations. These violations included failure to guard the blades of a table saw on the premises and failure to ensure first aid materials on site were in usable condition.

 
Not the First Time Employer Has Been Cited

 

This is the second time within the last five years that Kink.com, also known as Cybernet Entertainment, has been cited for failing to provide adult film performers with condoms and require their use during production.

 

Cal/OSHA previously inspected Kink.com facilities in August 2013, and subsequently issued three serious citations, as well as three general and five regulatory violations. Two of the three serious citations were for condom violations. Kink.com appealed these citations, which were then upheld by an Administrative Law Judge of the Occupational Safety & Health Appeals Board.

 

Workers in the adult film industry should know current laws protect them from injury and illness on the job, and where to go for help if their employer doesn’t follow those laws.

 

 

 

 

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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Ingress/Egress: Issues of Compensability Outside The Normal Workday

Questions concerning compensability under any workers’ compensation act starts with a simple question.  Did the personal injury arise out of and occur in the course and scope of employment?

 

While it may seem very basic, the reality is there are many gray areas that lurk beneath the surface.  One such issue involves the “ingress and egress” of employees as they enter and leave the workplace.  This is a challenge the claims management team must master in order to be effective.

 

 

The Origins of Ingress/Egress Compensability

 

When dealing with these questions of whether a personal injury is “work-related” courts early on recognized that employees need to first enter the workplace on time in order to perform the necessary functions of their work duties.  The result of this was an acknowledgement that employer’s obligations under a workers’ compensation act sometimes start even before the workday begins.

 

It is important to remember that claims involving these matters are fact specific.  The result is members of the claims team need to investigate these issues on their own merits and sometimes consult with an attorney before they accept or deny primary liability.

 

 

Understanding Unique Scenarios

 

There are an infinite number of possibilities when it comes to the ingress and egress of an employee.  Here are some of the common situations that take place:

 

  • Beginning/Completion of a Work-Shift: Generally, employees are covered under a workers’ compensation act from the time they arrive on company property until the time they leave.  Injuries that occur during these times are generally compensable when they take place within a reasonable time before or after work in entryways/cloakrooms, bathrooms, parking lots and sidewalks on or near the company premises.

 

  • Unpaid Work/Rest Breaks: Just because an employee is not being paid, does not mean they are not covered under a workers’ compensation act.  Examples of compensable injuries include taking breaks on company premise and even when the employee is walking to a nearby restaurant or convenience store.  Most jurisdictions also recognize injuries that take place when employees are smoking cigarettes.

 

  • Traveling Employees: This type of employee should send fear down any claim handlers spine.  They typically receive “portal-to-portal” coverage, which means they are covered from the minute they leave until they return.  The possibilities for mischief are endless as they go out to eat, engage in the entertainment of clients and countless other activities not directly related to their work.

 

When determining issues of compensability for these types of injuries, courts will look at a number of factors.  The circumstances that generally lead to an injury being compensable are as follows:

 

  • If the injury occurs at a location that could be constructed as the employer’s workplace, or an area under their control; or

 

  • When the employee is furthering the interests of the employer or engaging in activities necessary for the human condition. Common examples are eating food, drinking a non-alcoholic refreshment or situations involving necessary bodily functions.

 

 

Other Factors to Consider

 

The doctrine of “special hazards” can sometimes serve as the lynchpin for whether a claim is compensable.  Examples of these hazards people encounter inside and outside the workplace are numerous.  A review of case law has noted many examples where people are struck by a batted baseball, stray bullets or assisting in the rescue of unknown third parties become compensable injuries.  In these instances, the courts will generally use a balancing test to determine compensability.  Issues examined under this test will often include whether the hazard is unique to the workplace itself or if its origins rest in risk the employee would encounter in everyday life.

 

 

 

Conclusions

 

All work-related injuries require members of the claims management team to conduct a diligent investigation.  In circumstances involving ingress/egress or other hazards they must redouble their efforts.  This includes knowing the law and in other cases, coordinating their efforts with appropriate legal counsel.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

California Woman Surrenders, Booked on Comp Fraud Charge

Melissa Halsell, 48, of Pomona, California surrendered recently to detectives of the California Department of Insurance Fraud Division at the Pomona Police Department and was booked on one felony count of workers compensation fraud and one count of attempted perjury after allegedly filing a workers comp claim for a pre-existing medical condition and denying she had received prior treatment.

 

After working at MV Transportation for three months, Halsell filed a workers comp claim alleging she was injured on the job.

 

An investigation by California Department of Insurance detectives revealed Halsell had pre-existing injuries and had received prior medical treatment for them. During a deposition Halsell denied ever receiving treatment.

 

The claim was ultimately denied after her extensive, undisclosed medical records were discovered.

 

 

 

 

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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Personal Comfort Doctrine Does Not Provide Comfort In Workers’ Comp

Under any workers’ compensation act, an injury is compensable if it “arises out of” and occurs within “the course and scope” of an employee’s work activities.  One area that is subject to frequent litigation is instance where an injury occurs during work breaks, or other non-work related activities. These personal comforts give members of the claims management team pause as to whether such an injury is compensable.

 

 

A Not So Uncommon Scenario

 

It is break time at the Acme Widget Company. Joe Friday missed breakfast and the company cafeteria is not yet open for lunch. Thankfully, there is a great coffee and donut shop across the street, which is frequented by employees before, during and after work. Joe decides to head over and grab a fresh jelly donut and cup of coffee. While carefully crossing the street he is struck by a car that did not stop for a traffic signal and suffers a broken leg. Would this claim be compensable?

 

 

Understanding the “Personal Comfort” Doctrine

 

The “personal comfort doctrine is a legal principle created by the courts to address the nature of typical workplace environments. Under this doctrine found in most jurisdictions, employees can engage in activities to provide personal comfort and still be covered under the protections of a workers’ compensation act. Such common activities include using a restroom, smoking or coffee breaks, eating food and drinking non-intoxicating beverages.

 

Application of this doctrine varies in every jurisdiction. In reviewing such matters, courts will examine various issues. These factors include:

 

  • Whether the activity was “contemplated” as part of the employment;

 

  • The nature of the activity prior to the accident; and

 

  • Any benefit to the employer when the employee engages in the activity resulting in injury.

 

 

Application of the Doctrine

 

Most workers’ compensation acts are interpreted in a light favorable to the employee. This result in injuries occurring during normal work hours, but off the employers premises or not directly related to one’s position, to be compensable.

 

Examples of injuries successfully using the personal comfort doctrine are numerous. In one example, an employee was crossing a street to get a pack of cigarettes. Although the injury did not occur on the employer’s property, the court found injuries similar to Joe Friday’s to be compensable.  Holly Hill Fruit Products, Inc. v. Krider, 473 So. 2d 829 (Fla. Dist. Ct. App. 1st Dist. 1985).

 

The reasons for this finding include the following:

 

  • The employee’s conduct was an “inevitable attendant danger;”

 

  • The actions of the employee were conducive to a pleasant work environment; and

 

  • While the employee was off the worksite for a short period, he did not remove himself from his employment activities.

 

 

Avoiding Unnecessary Workplace Exposures

 

Proactive members of the claim management team can work with interested stakeholders to reduce exposures and avoid “personal comfort” doctrine issues. Proactive steps can include:

 

  • Providing or making essential items available to employees on the worksite or premises. This includes having refreshments available free of charge or at an on-site store. By doing so, they maintain more control of their worksite;

 

  • Prohibiting smoking on company premises. Employers are recognizing the health benefits of tobacco-free workplaces. They can also coordinate with their health plan providers on accessibility of smoking cessation products or services to reduce the dependence on cigarettes; and

 

  • Establishing clear company policies regarding departure from the company premise during the workday. This can include a clear statement that leaving the workplace for any non-work related reason removes them from their employment and workers’ compensation activities.

 

 

Conclusions

 

It is important for interested stakeholders to understand the “personal comfort” doctrine.  This can assist with properly managing a claim where it is at issue and help employers minimize their risks to promote a safe work environment.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

 

 

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