Internal Auditing Is Not Just For The Self Insured

There is an understandable need for workers compensation internal audits for the self-insured employer or the high retention employer.  However, insured or low retention employers also need to consider internal auditing for policies, procedures, and monitoring of the claim management department or third party administrator.

 

Further, internal audits can serve as a verification, or factual documentation for challenges, to external audits that are conducted by insurance carriers, state bank examiners or other auditing organizations.

 

 

Policies and Procedures for Injury Management

 

The policy and procedure program requires constant monitoring to be sure it stays in compliance with the workers compensation statute, current medical practice, implementation and proper oversight.  A claim coordinator or injury team should be designated to develop, implement and perform duties at the time of injury. The coordinator needs to be workers compensation claim knowledgeable.

 

An injury team needs to be versatile with workers compensation claims. It should be made up from both labor and management.

 

Personnel directly involved in employer reporting investigating and documenting the injury, need training and proper instruction as to how they must perform their duties.  There needs to be complete reporting to management as often as dictated by the facts of losses or program developments.

 

Claim coordinators or injury teams need access to all necessary areas of the employers business to gather and disseminate their findings. They need to be compassionate yet in control of the loss.  They need to be able to deal with claim adjusters, medical providers, private investigators, attorneys as well as all other entities that are found in the claim process.

 

Internal investigation results, payroll data, authorities, medical needs and other findings must be gotten to the handling claim adjuster as fast as possible. It is necessary to monitor the claim adjuster to ascertain that the coordinator or company team information is properly used.  Conversely, when an adjuster requests information from the employer, the response must be as prompt as possible.

 

The coordinator or team must monitor claim adjusters, .Following adjuster activity for control of investigation payments, controlling expenses and keeping proper reserves on the claim file until final disposition.

 

The entire above item needs to be audited by a senior management officer who has knowledge and ability to see flaws in the program.  At the same time when flaws occur, this person must be able to promptly make corrective change.

 

 

 

Utilization for Future Loss Containment and Job Modification

 

The claim coordinator or injury team needs to audit and review all workers compensation losses for frequency, severity, causation, as well as equipment and employee failure. These studies will be a guide for management to institute measures for future limitation or prevention of such injuries.

 

Claim coordinators or injury teams can also use these causes to develop alternate, temporary, or transitional jobs within the functional capacities such studies will show. A close interface with independent medical providers will help ascertain that the projected job performance meets the function limitations. (This might also be dovetailed with adjusters, and or medical management personnel)

 

All claims need to be reviewed with an eye to recovery from subrogation, second injury funds, re-insurers, restitution on fraud situations.

 

 

Auditing Error Prevention

 

The claim coordinator or the most knowledgeable injury team member should be the main contact person for external auditors to work. When external audits are scheduled, this person needs to be available at all times during the actual audit.  Discussions during the audit as to findings or questions by the auditor need to be conducted at least once or twice a day. A wrap-up meeting is required as soon as the external adjuster completes their physical review. This can help in avoiding improper or erroneous conclusions by an auditor before a formal concluding report is presented. It is best to reach mutual agreement at the wrap-up.

 

 

Annual Claim Purging

 

Claim coordinators or injury teams should obtain workers compensation claim loss run from the insurance carrier or claim handling organization three months before renewal.  Every claim listed should be reviewed for closing, proper reserves, payment errors or duplicates, expected disposition, alternate duty potential, subrogation recovery potentials, and proper recovery from re-insurers.  Files that should have been closed need to be closed.  Settlements or final dispositions should be pushed for closing before renewal. Excess reserves are to be lowered and under reserved files should be increased.  A final loss run with all changes should be reviewed two weeks before the filings to ascertain that all agreed changes are complied with.

 

 

Summary

 

Internal audits and claim handling programs are not just for the larger employers.  All employers need to explore their need for a claim coordinator or injury team to keep a close control of claim cost.  If you do need assistance in implanting such a program, please contact us for a recommendation.

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

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

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

 

Controls Limit Workers Comp Drug Price Rise To 1.9% And Other News Tidbits

Crawford® to Showcase Extensive Range of Claims Management Services at RIMS

Crawford & Company®-and its Broadspire® and Risk Sciences Group® (RSG®) units-will be showcasing their extensive claims management services at the RIMS 2015 annual conference and exhibition in New Orleans, April 26-29, at Booth 521 in the Ernest N. Morial Convention Center. Crawford is the world’s largest independent provider of claims management solutions and operates in more than 70 countries. Broadspire is a leading third-party administrator (TPA) of casualty claim, medical management, accident and health, and disability and leave management solutions, and RSG is a leading provider of risk management information systems (RMIS). Read more…

 

Get to Know the New President of Ringler Associates

On this special edition of Ringler Radio, host Larry Cohen chats with the new President of Ringler Associates, Geoffrey E. Hunt,  about his goals and thoughts on the structured settlement industry in Ringler’s 40th Anniversary year. Listen to the Show

 

 

Controls Limit Workers Comp Drug Price Rise To 1.9%: Express Scripts

Utilization controls for workers compensation pharmaceutical claims have limited opioid painkiller and compounded drug usage and helped contain escalating costs for those drug categories, pharmacy benefit manager Express Scripts Inc. said.

 

Workers comp payers spent an average of $1,583 per injured worker for prescription drugs in 2014, up 1.9% from 2013, the St. Louis-based PBM said Tuesday in its 2014 Workers’ Compensation Drug Trend Report. Read more…

 

 

Summer Strategies For A Better ME!

Summer is around the corner. Medcor’s Better Me Wellness program wants to be a part of your summer plans! Better Me promotes movement, nutrition, and balance for well-being. Read on for your summer wellness strategy for living well. Read more…

 

 

Thomas A. Robinson Named Co-Author of Larson’s Workers’ Compensation Law

LexisNexis is pleased to announce that Thomas A. Robinson has been named a co-author of Larson’s Workers’ Compensation Law (LexisNexis) and Larson’s Workers’ Compensation, Desk Edition (LexisNexis). As such, he will work with Lex K. Larson on these publications.

 

Tom brings a wealth of expertise on the law of workers’ compensation. He is a leading commentator on workers’ compensation and the author of the award winning blog WorkCompWriter.com. He is a frequent speaker, having led seminars at the National Workers’ Compensation and Disability Conference, and for the Workers’ Injury and Law Advocacy Group, Artex Risk Solutions, and the Injured Workers Advocates (South Carolina). Read more…

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Singapore Noting Crackdown on Construction Sites

Officials in Singapore are not wasting any time in cracking down on construction sites where safety is an issue.

 

Recently, the Ministry of Manpower noted a number of unfavorable conditions at a variety of construction worksites across the country.

 

Among the findings:

 

  1. Falling off buildings, being struck by falling tools and debris, and falling through scaffolding structures. These were the common risks that workers faced at some of the worksites that MOM inspected under Operation Sunbird.
  2. Launched in January, the three-week long operation targeted the construction sector, focusing on formwork, work-at-height and lifting operations. This proactive enforcement operation was initiated in light of the fatal accidents during the lead up to the Chinese New Year festive period last year. Investigations into those accidents showed that contractors were rushing construction to keep up with project schedules and had disregarded key Workplace Safety and Health (WSH) procedures then.
  3. Of the 214 construction worksites inspected, 191 had contraventions under the WSH Act. These worksites received 272 Notices of Non-Compliance (NNCs) and 147 fines totaling $156,000. Six worksites were also issued with Stop-Work Orders (SWOs).
  4. Chan Yew Kwong, director of MOM’s Occupational Safety and Health Inspectorate said, “Our inspections found that the majority of worksites had WSH contraventions, the most common of which were open sides of buildings or work areas that were not barricaded, failure to install guard-rails and toe-boards and failure to provide safe access to scaffolding. These hazards should have been addressed by carrying out proper risk management and putting in place the preventive measures to eliminate or mitigate risks. We remind all occupiers of their duty to ensure the safety and health of their workers, and not to cut corners in the interest of meeting project schedules.”
  5. Minister for Manpower, Tan Chuan-Jin added, “The outcome of Operation Sunbird shows that some contractors are still not placing emphasis on the safety and health of their workers. MOM has received feedback and observed that some companies chose to take the easy way out by cutting corners in safety to meet project deadlines. Such an attitude is irresponsible and unacceptable. Tight schedules should not be an excuse to put workers at risk. Deadlines must be met, but never at the expense of our workers’ lives and wellbeing.”
  6. MOM will continue to carry out regular worksite safety inspections, and urges employers, contractors and occupiers to ensure the safety and health of their workers. Members of the public who are aware of poor WSH practices can call the MOM safety hotline at 6317 1111 or email mom_oshd@mom.gov.sg to report these practices. All tip-offs will be kept strictly confidential.
  7. The public can also provide feedback on WSH matters through the Snap@MOM mobile application. Launched in April 2012, the app is supported by both iPhone and Android mobile phones and can be downloaded from the App Store / Google Play Store. All photos uploaded to through Snap@MOM will be sent to participating workplace occupiers for implementation of safety measures.

 

 

 

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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Missouri Worker Killed, Employer Receives Dozen Serious Safety Violations

The death of one worker in Missouri has led to serious fines for his employer.

 
A 58-year-old maintenance worker was killed after he was pinned between a scrap metal table and a railing at Hussmann Corp.’s Bridgeton facility, an investigation by the U.S. Department of Labor’s Occupational Safety and Health Administration found. OSHA said the company failed to prevent the table from lowering unintentionally.

 
As a result, Hussmann received three willful and 12 serious safety violations after the Sept. 6, 2014, incident. The company was also placed in OSHA’s Severe Violator Enforcement Program.

 
“This tragic loss could have been prevented,” said Bill McDonald, OSHA’s area director in St. Louis. “OSHA inspectors found workers at risk of life-threatening hazards because Hussmann Corp. failed to train its workforce to prevent unintentional operation of dangerous machinery. This company needs to fix safety procedure deficiencies, so no other family is forced to suffer.”

 
OSHA cited Hussmann Corp. for three willful violations for not placing devices on machinery to prevent the sudden startup or movement of equipment during service and maintenance, a procedure known as lockout/tagout. The company also failed to correct numerous problems related to its lockout/tagout procedures, such as using electronic gate switches as a substitute for an energy-isolating device.

 
A willful violation is one committed with intentional, knowing or voluntary disregard for the law’s requirement, or with plain indifference to employee safety and health.

 

Lack of Proper Training Also Noted

 
Hussmann Corp. also failed to train workers on safety procedures and lacked effective safeguards for moving parts on machinery.

 
Inspectors identified unsafe practices related to powered industrial trucks, including allowing employees to work under a load held aloft by the vehicle, exposing them to crushed-by hazards. OSHA also discovered electrical safety hazards involving cabinets that were not closed properly to prevent contact with energized wires and using damaged electrical cables. In total, OSHA cited the company for 12 serious violations.

 
A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.

 
OSHA has proposed penalties of $272,250.

 
Hussmann Corp. employs about 5,000 workers worldwide and 580 at its headquarters in Bridgeton. The company’s products include refrigerated and non-refrigerated display merchandisers, specialty display cases, self-contained display cases, LED lighting, glass doors and lids, refrigeration systems and other related products.

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

 

 

 

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

 

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

 

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

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Employers Critical Role In Work Comp Claims Handling

More and more employers are developing workers compensation claim handling instructions to claim units and adjusters.  This is especially true where adjusters and claim departments have fallen short in following best practices of claim handling.

 

High profile or serious injury cases are usually investigated and documented very well.  On the other hand, day to day claims are often left lacking in some form or step of the claim handling process.  As a result, when the everyday claim develops into a major issue, it is often too late to gather information that might have prevented the higher value from occurring.

 

 

Example for Need of Employer Intervention:

 

A classic example is:  Employee has onset of back pain while lifting an object at work.  The employee continues to work a few days.  Several days later lost time begins.  Initial diagnosis is strain of lumbar area.  The doctor attributes it to the lifting at work.  The employer confirms the pain started on the job because that is what the employee presented as fact. The doctor gives a sprain diagnosis.   On the surface for the routine handling claim technician, all these items appear to point to a compensable injury that should be of short duration.  The case is accepted.  Benefits and treatment are started.

 

As soon as the lost time was reported, the adjuster failed the first duty by not taking a statement from the employee.  The statement should have clarified the mechanics of the incident.  There was no employee interview for past injuries, underlying pathologies, possible subrogation or even fraud. (Especially if this was an early Monday Morning history).

 

No independent medical examination was arranged to determine causal relationship, future course of medical care and expected disabilities.   Meanwhile the attending doctor continues with conservative office visits and medications.  A Medical Authorization was not obtained and no medical background investigation was done.

 

All of the above handling generally takes place within the first five to six weeks after the injury.

 

About the seventh or eighth week the attending Doctor asks for permission to do an MRI.  Several more weeks may go by until the results reach the adjuster.  It is discovered that there were prior back problems with ruptured discs and maybe even surgery.  Future disabilities and extended treatment are now paramount.

 

The adjuster scrambles to obtain an Independent Medical Examination.  It returns an opinion that the problem was not caused by the lifting incident alone.  A petition is filed by the adjuster raising the issue of causal relationship.  However, the compensation judge, having no other facts or evidence to weigh, continues the case as compensable and the employer is now forced to accept full responsibility for the case.

 

Reserves are increased, medical and vocational management may be required, and a permanent disability rating will be made.

 

 

 

Employer Input:

 

Most claim technicians want to, and do, serve their employer clients very well.  However, day to day job pressures, workloads, and unexpected situations can allow even the most dedicated adjuster to fail in some steps of claim processing.    The burden of proof is always on the employer when a claim controversy develops.  Any innocuous step overlooked today may be tomorrow’s catastrophe.

 

It is suggested that employers develop basic procedures and protocols for how they want all their claims to be processed.  These protocols should be reasonable, in keeping with best claim handling practices, spell out authority levels, and legally acceptable.  They need to become a written part of the Third Party Authority contract, or policy between employer and insurer.

 

A check list needs to be developed and made a part of every claim created by the claim unit. Since more and more claim files are now handled electronically, some type of flag or block should be on each item listed so that the adjuster cannot proceed to further handling without documenting that the item has been properly addressed.

 

 

A partial sample listing:

 

The following list is just a few of the items that should be developed.

  1. All lost time claims must have an employee statement or interview confirming fact and developing proper health and background information.
  2. Obtain a signed all-encompassing a medical authorization.
  3. Advise employee of o benefits and responsibilities.
  4. Settlement or disposition inputs where the employer needs to be involved.
  5. Needs for Independent Medical Examinations, Medical Management, and Vocational Management.
  6. Reporting Procedures to the Employer.
  7. All cases should have professional medical triage as soon as the claim is presented.

 

 

Summary:

 

In the everyday handling of workers compensation claims, it is extremely easy for the claim technician to overlook vital investigative steps during the early stages of what might appear to be a routine case.  The employer needs to develop a program that places checks and balances to limit this potential.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Washington State Man Tackled in Comp Fraud

For one Washington State resident, the game is over.

 

A Spokane Valley, Washington man has been charged with faking on-the-job injuries and using the last names of Seahawks players to obtain narcotics and other prescription drugs.

 

Jeffory Leonard Mock Jr., 34, faces 12 felony charges alleging he obtained controlled substances and prescription drugs by fraud. He was scheduled to be arraigned in Spokane County Superior Court in early March.

 

According to charges filed by the Washington Attorney General, Mock visited eight Spokane-area hospitals and urgent care clinics 17 times to pull off the scheme from March 2013 to May 2014. Each time, he claimed to have been hurt on the job, usually injuring his back and buttocks while working for a moving, roofing or interior design company or retirement home.

 

At the medical facilities, he filed workers compensation claims using variations on his first name or another first name that usually started with “j.” For the last name, he typically signed the surname of a Seattle Seahawk or another pro ball player or coach.

 

Borrowed names include Sherman, Okung, Harvin

 

Among the last names of football players and coaches he’s accused of using: Harvin, Largent, Sherman, Mora, Richardson, Hollenbeck, Robinson, Okung, Marino, Bledsoe and Henderson. He also used the surnames of stars from other sports: Malone, Langston and Duckworth.

 

Four of the employers listed on claim documents don’t exist.

 

The health care facilities administered a variety of medications to Mock, including Valium, hydrocodone and hydromorphone.

 
L&I began investigating the case when an employer listed on one of the workers comp forms said they might have been filed by Mock, a former employee.

 

Investigators gave a handwriting expert the bulk of the injury accident reports, and the expert confirmed that each one matched samples of Mock’s writing. Staff from several of the facilities later identified Mock in photo montages as a patient they had treated under a different name.

 

 

 

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

 

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

 

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

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Florida Man Ousted in Comp Fraud Case

Receiving benefits he was not entitled to, one Florida resident could be staring at more than a decade behind bars.

 
According to the Florida Department of Financial Services, James “Mike” Millard was recently arrested for workers compensation fraud.

 
An investigation by the agency discovered that Millard reportedly obtained more than $20,000 in benefits from Dec. 9, 2012 through Feb. 7, 2014, when he filed numerous reports claiming he had no earnable income.

 
After an investigation began, it was discovered that Millard was in fact employed and compensated by a concrete construction business during this time period.

 
Millard was facing a second degree felony charge that could lead to a maximum of 15 years behind bars.

 

 

 

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

 

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

 

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

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

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How Tony Robbins Can Improve Your Work Comp Claims

Problem:

 

Employees with a poor work ethics or performance records can be an extra cost and burden on the workers compensation system when they have an on job injury. This type of employee usually lacks natural tendency, parental training, public educational influence, possible religious guidance, self-motivation, habit forming skills, as well as other personal abilities for self-improve.

 

Unmotivated employees can exaggerate their injury, become non-compliant in medical treatment, malinger, add non related medical pathologies, as well as outright lie and even commit fraud.

 

Today’s social entitlement attitude, weak criminal-judicial system, as well as the societal overlooking or acceptances of such practices seem to make any relief from this problem almost insurmountable.

 

It is a tough job to change personal behavior.  However, there are opportunities and suggested programs that can work.

 

 

Planning:

 

Begin with a plan. This will be a motivational program (just like those created by the great Tony Robbins); therefore the action plan must be doable, simple, yet comprehensive enough to accomplish the goals of improvement and change.  Much of the weak work ethic is driven by personal habit, mental attitude, and personality.  Occasionally a physical condition may influence the poor behavior.

 

Every human being is different and will respond to various motivational stimuli.   Therefore, the program must allow for various changes in approach and implementation.  For example: John may just accept a verbal suggestion to incorporate a change in his behavior.  On the other hand, Pete may need a reward or discipline before incorporating the change of behavior.

 

 

Gather Facts and Data:

 

Take time to study each problem employee on an individual basis as they are working. This should be done in such a manner so as not to arouse the employee’s angst or suspicion.

 

Watch their attitudes as they perform their job function.  Observe their interface with fellow employees.  Listen to how they discuss home environments.  Watch body language for negativity.   This may require the assistance of professional counselors.  It will be necessary to have an existing profile on the employee before beginning the implementation phase.

 

 

Implementation:

 

Once the employee profile is developed, obtain professional counselor ideas or suggestions as to how best approach and start working with the individual.  Be friendly. Advise the employee that the program is meant for their sole benefit. Give all suggestions and instructions in clear manner.  Be sure the employee understands what is expected.  Reinforce by adding that the expected results will also improve personal life activity as well.

 

Keep sessions short and limit times for instruction or training.  Even if professional counselling is used do not allow it to overburden or overwhelm the employee.  Interface on a friendly manner with the employee as much and as often as necessary.  Reassurance is as necessary as the program itself.

 

 

Follow Through:

 

Congratulate every positive progress point the employee reaches.  Give rewards, privileges, extra appreciation comments, or any other provision that will help boost the employee’s morale. This assures continued improvement and should limit any backsliding.

 

Consider the merits of doing these things publically.  This could have a positive impact on fellow employees and raise their esteem for the treating employee. It might also bond the unit together as a team.  Further the other employees will get to see that the employer cares about them as well.

 

Since this is a comprehensive issue with complex potential it is recommended professional behavioral experts be utilized in the development for this behavioral modification.

 

 

Conclusion:

 

Poor work ethics and performance issues can adversely impact workers compensation programs and add excessive cost.  They also impact day to day operation, limit production, cause employee morale issues and may develop hostile workplace environments.

 

These issues delve into employee personal traits.  They are a challenge for employers to develop delicate improvement programs.  However, successful programs can lead to better employer employee relationships.  Increased production and fewer workers’ compensation claims could also be a fringe benefit.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

 

 

 

 

 

 

 

 

 

 

Pay Particular Attention To Work Comp Claims That Overlap With Other Laws

“Flexibility” when you’re involved in a claim of any kind, gives you options – and that means having several ways to deal with a problem. But flexibility can mean much more. It can also give an employer freedom of action; in addition all others involved in a claim do NOT have the same advantages that the employer has.

 

 

A Workers Comp Claim Can Overlap With Many Other Laws

 

Let’s focus on comp claims. Normally, an employer surrenders control of the handling of a comp claim to others, mostly the comp board and the carrier. The employer’s role is generally limited to being a witness or a source of a few documents, principally the first report of injury. But it sometimes happens that another claim is simultaneously in progress with the comp claim, often a negligence or unemployment claim or both. Those are just the tip of the iceberg.

 

A comp claim can overlap with negligence, unemployment, short term disability, long term disability, Social Security, discrimination, private disability, FMLA. ADA OSHA, DOT and many, many other laws. How does that help an employer faced with a difficult comp claim?

 

 

Good Chance That Answers Contradict

 

 

For starters, all of the above have some kind of an initial claim report, usually initiated by the employer. The initial report requests that one or two pages of questions be answered. The questions differ in some ways from claim to claim, but they overlap on questions involving disability and causes. The chances that the answers contradict those made on other claims rises exponentially as the veracity drops. Bad claims are rarely consistent when more than one recitation of facts is necessary.

 

The employer has great opportunities for proper handling of claims when it notifies the carrier of inconsistencies. Is this done frequently? No it is not. In fact it is the rarest of exceptions. Which is why it is so effective when it is used.

 

 

Employer Can Contain Claims With Pro-activity

 

Inconsistencies occur because claims by an employee are often months, even years, apart and most people do not check to make sure that the statements are not contradicted by earlier, or later, versions. Your correspondent defeated several claims because the allegations in the unemployment claim bore no resemblance to later statements in the comp claim. In all of those claims it was the curiosity of the comp lawyer that uncovered the existence of the unemployment claims. How many more unemployment claims were undiscovered on other comp claims? In NY, thousands per year, maybe even ten thousand per year. With proactivity by the employer those claims can be contained.

 

Understandably, the employer usually groans at a multiplicity of claims by a single employee. Instead, the employer can use them as a new claim tool, a tool that has been available all along.

 

 

 

 

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

 

©2015 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

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

 

 

Australian Employer Fined $75K, Contractor Injured

One Australian employer found out how expensive it can be when workplace safety is not followed all the time.

 
The Bibra Lake, Australia steel fabrication business was fined $75,000 over an incident in which a contractor was seriously injured when a crane struck a scissor-lift on which he was working.

 
Metwest Steel Pty Ltd pleaded guilty to failing to provide and maintain a safe workplace for a contractor carrying out work and, by that failure, causing serious harm to an employee of the contractor, and was fined in the Fremantle Magistrates Court recently.

 
In October 2011, an employee of Total Hoists and Cranes Pty Ltd attended Metwest Steel to carry out repairs on one of two cranes in the workshop.

 
The worker stood on the work platform of a scissor-lift in order to access the control box for the crane on which he was working. The platform was raised to about six metres and the handrail was above the bottom edge of the crossbeam on the crane.

 
At the same time, an employee of Metwest Steel used the other crane in the workshop to lift and place a steel beam on a shelf. This moving crane collided with the stationery crane on which the Total Hoists and Cranes employee was working.

 
The collision moved the crane, which then pushed the handrail of the scissor-lift and tipped it over, causing the man standing on it to fall around six meters.

 
An employee of Metwest Steel who was welding approximately four meters away was knocked down by the falling scissor-lift, but was not seriously injured.

 
The Total Hoists and Cranes employee suffered complete paraplegia.

 

Commissioner Notes Shocking Example of Safety Failure

 
WorkSafe WA Commissioner Lex McCulloch said recently the case was a shocking example of a failure to ensure that safe systems of work were in place.

 
“The court heard that anti-collision devices were fitted at a cost of little more than $2,000 after this incident,” McCulloch said.

 
“It would have been entirely practicable and not overly expensive to have had these devices fitted earlier, avoiding the tragic incident that ultimately took place and the devastating permanent injury that was caused.

 
“This case should serve as a reminder that thorough risk assessments need to be undertaken in every workplace and that safe systems of work need to be in place.

 
“It is also a reminder that anyone who is in control of a workplace is responsible for the safety and health of not only their own employees, but also workers from other companies contracted to undertake tasks in their workplace.”

 

 

 

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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