Missouri Program Honored for Workplace Safety

Keeping workers safe in the Show Me State is no small task.

 
The Missouri On-Site Safety and Health Consultation Program was recently honored with a national award from OSHA for its exceptional outreach, promotion and marketing efforts at the annual Occupational Safety and Health Consultation Conference.

 
“This honor is well deserved by the men and women of the Missouri On-Site Safety and Health Consultation Program whose efforts help improve safety for workers around the state,” said Ryan McKenna, department director.

 
OSHA’s On-Site Consultation Achievement Recognition award recognizes state consultation programs each year for outstanding achievements connected with a special project that was not part of the Consultation Annual Project Plan.

 
The On-Site program aims to help make high hazard workplaces safer for Missouri workers while cutting costs for Missouri businesses through lowered workers’ compensation insurance premiums and is marketed in a number of ways.

 

Employers Wanting to Improve Safety Benefit

 
“The Missouri On-Site Consultation program benefits businesses that want to improve safety,” said McKenna.

 
“The program provides free, confidential inspections that are aimed at correcting hazards and providing the best safety practices for specific industries.”

 
The award recognized continual efforts to make employers aware of the program and its benefits. In the past year alone, those efforts included promotional materials sent to more than 5,000 small employers within OSHA’s Strategic Plan and High Hazard List, 37 in-person presentations to groups and associations and successful use of weekly video newsletters that reach more than 20,000 Missouri businesses.

 
The Missouri On-site Safety and Health Consultation Program offers free and confidential safety and health advice to small and medium-sized businesses across the state, with priority given to high-hazard worksites.

 
Consultants work with employers to identify workplace hazards, provide advice on compliance with OSHA standards, and assist in establishing injury and illness prevention programs.

 
In 2014, Missouri’s On-Site Consultation Program conducted more than 500 visits to small business worksites and identified more than 5,000 workplace hazards across the state.

 

 

 

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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Small Percent Of Claims Create Large Percent Of Costs

Twenty percent of all workers’ compensation cost is incurred on less than one percent of the claims.  These high dollar claims are often referred to as catastrophic claims.  The term ‘catastrophic claim’ applies to the nature of the claim, not the dollar cost, even though the severe nature of the claim and the high dollar cost are closely related.

 

 

Catastrophic Claims Create Permanent Disability

 

A catastrophic claim is defined as any claim that creates a high level of permanent disability.  Catastrophic injuries significantly alter the life of the employee in general. Catastrophic injuries prevent the employee from returning to any type of work, even when occupational therapy and vocational rehabilitation is provided.  Examples of catastrophic claims include:

 

  • Quadriplegia
  • Paraplegia
  • Brain/brain stem injuries
  • Second and/or third degree burns over 50% of more of the body
  • Death
  • Total vision loss
  • Multiple amputations
  • Mesothelioma, asbestosis and other lung diseases
  • Severe damage to internal organs

 

Almost all catastrophic claims result in the employee being classified by workers’ compensation as having permanent total disability.  The cost of the catastrophic claim will be influenced by the state laws.  While all states provide unlimited medical treatment, the indemnity cost can vary widely. Some state provide life time indemnity benefits while other states will cap the indemnity benefits at a maximum number of weeks, often 400 weeks or 500 weeks.

 

 

Employee Income Prior To Injury Is Major Factor

 

A major factor in the cost of catastrophic claims is the income of the employee prior to the injury.  The higher the wages of the employee prior to the injury, the higher the indemnity cost.  For example, the catastrophic claim indemnity payments of an employee who was earning $600 a week would be double the indemnity payments of an employee who was earning $300 a week.

 

The employee’s life expectancy will also impact the cost of a catastrophic claim.  If the employee is 30 years old when the catastrophic injury occurs, the amount of future medical bills, and indemnity cost in a state with lifetime indemnity benefits, will be significantly higher than the cost of the same type injury to an employee who is 60 years old, simply due to the longer number of years the benefits will be paid.

 

In addition to the high cost of medical care and the high cost of indemnity benefits, the claim handling expenses can be significant on catastrophic claims.  The expense factors can include:

 

  • Nurse case managers
  • Rehabilitation specialists
  • Actuarial experts
  • Remodeling of the home to make it handicap accessible
  • Home attendants
  • Defense attorneys
  • Specialized equipment

 

 

Catastrophic Claims Often Resolved With Structured Settlement

 

 

Due to the high cost of catastrophic claims, the claims are often resolved with a structured settlement, a type of life time annuity that the workers’ compensation insurance company purchases to make periodic future payments.  This often benefits the injured employee by providing the employee with a higher level of income, or in states where the number of weeks of indemnity benefits has a cap, a life time income stream not tied to the maximum number of weeks.  It also provides the insurer with a known fixed cost for the claim, allowing the insurance company to free up its reserves for other claims.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, and founder of COMPClub an interactive training program teaching workers’ comp cost containment best practices.  Through this platform he is in the trenches on a monthly basis with risk managers, brokers, consultants, attorney’s, and adjusters teaching timeless workers’ comp cost containment strategies, as well as working with members to develop new tactics and systems to address the issues facing organizations today. This unique position allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

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

 

Employers/Carriers/TPAs/Brokers/Vendors looking for additional information FREE resources for Workers Comp cost containment best practices are invited to access Amaxx Workers’ Comp Cost Containment Essentials training series

 

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

 

Ontario Officials Zero-in on Mine Safety

Ontario (Canada) officials are focusing on motor vehicles and mobile equipment during a two-month enforcement blitz at underground and surface mines across Ontario this summer.

 
In July and August, 2015, mining inspectors and engineers are targeting traffic control hazards that could result in workers being injured or killed. Inspectors will check that employers are complying with theOccupational Health and Safety Act and its regulations. This includes checking that the mines have good traffic control policies and procedures in place to protect workers.

 
Mines use motor vehicles such as locomotives and haulage trucks, and mobile equipment such as loaders and excavators.Traffic control measures are used when the vehicle or equipment operator’s visibility is limited, a situation that can put “pedestrians” (workers on foot) at risk of injury.

 
Good preventative measures can include:

 
• proper reflective clothing for workers
• effective illumination
• monitoring work conditions
• good education and training

 

Protecting mine workers is part of the government’s continued commitment to prevent workplace injuries and illness through its Safe At Work Ontario strategy.

 

Looking at some facts:

 
• Between 2000 and 2014, 12 workers died in Ontario mines as a result of incidents involving motor vehicles and mobile equipment.
• Since 2008, ministry inspectors have conducted more than 345,000 field visits, and 70 inspection blitzes and inspectors have issued more than 560,000 compliance orders in Ontario workplaces.

 

 

 

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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Understand And Improve Your Experience Modifier

To calculate your workers compensation insurance premium, the insurance company takes into consideration three things – the type of business you are in, the total amount of your company’s payroll and your experience modifier.  The only one of the three things the employer has control over (without reducing payroll) is the experience modifier (also referred to as the experience modification factor).  The experience modifier factor is a calculated adjustment based your company’s loss experience.

 

 

Workers Comp Is A Long Tail Business

 

When the workers’ company insurance company establishes the premium for the employer’s next policy year, it will include in its calculations the results of previous loss experience with the employer.  Workers’ compensation is considered a long tail business, meaning that many workers’ compensation claims are open for an extended period of time.  Therefore, the insurer cannot just use the most recent claim history and claim reserves to calculate the loss experience.

 

The insurance company will look at the employer’s claim history for the three years prior to the current policy year.  For example, on 5-1-15 the insurer starts the premium calculations for the policy year of 7-1-15 through 6-30-16.  As some of the workers’ compensation claims are still open two, three of four years later, the insurer will analyze the claim cost of the three previous policy years not counting the current policy year.  The cost of workers’ compensation claims from 7-1-11 through 6-30-14 is used in calculating the experience modifier.

 

 

E-Mod Considers Both Frequency & Severity Of Claims

 

The experience modifier takes into consideration both the frequency and the severity of claims.  The insurance company places a greater weighting on the frequency of claims than they do on the severity of the claims.  Five workers’ compensation claims costing $5,000 each, or $25,000 total, have a greater impact on the calculation of the experience modifier than one $50,000 claim. The reason for this is frequency of claims is a reflection of the safety practices of the employer, and a high level (number) of claims reflects a lack of management control of safety.

 

The insurer will compare the results calculated for your company with other employers in the same type of business.  If you have an average safety program and an average number of claims – loss experience exactly in the middle of your industry, your experience modifier is 1.0 and your insurance premium will be the average premium for your industry.

 

If you have a good safety program and have had fewer than average claims during the three policy years preceding the current policy year, your experience modifier will be less than 1.0 and your insurance premium will be reduced accordingly.  For instance, your experience modifier is calculated to be 0.75.  With everything else be equal, your workers’ compensation premium will be 75% of the average premium.  The flip side of this is, if your loss experience is poorer than others within your industry, your insurance premium will be higher than average.  For example, your company’s experience modifier is 1.5; you will pay 50% more than the average employer in your industry.

 

A strong safety program where everyone in the company is safety conscious and participates fully in the safety program is the best way to lower your cost of workers’ compensation.  By lowering the frequency of claims you will have greatest impact on the experience modifier.

 

 

Steps The Employer Can Take

 

In addition to controlling the frequency of claims, there are several steps the employer can take to reduce the severity of the claims that do occur.  This includes:

 

  • An established Return to Work program
  • An ergonomics program
  • A best practices claim handling guidelines
  • Best Practices claim file audits
  • A drug testing program including pre-employment, post accident and random.
  • Medical management of claims including
    • Nurse triage
    • Early intervention
    • Medical case management
    • Utilization review
    • Medical fee schedule utilization
    • Medical provider networks

 

By understanding how the insurance company calculates your workers’ compensation premium, you can take the necessary steps to have a positive impact on your loss experience.  This will assist you in lowering your experience modification factor and lowering your work comp insurance premium.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, and founder of COMPClub an interactive training program teaching workers’ comp cost containment best practices.  Through this platform he is in the trenches on a monthly basis with risk managers, brokers, consultants, attorney’s, and adjusters teaching timeless workers’ comp cost containment strategies, as well as working with members to develop new tactics and systems to address the issues facing organizations today. This unique position allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

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

 

Employers/Carriers/TPAs/Brokers/Vendors looking for additional information FREE resources for Workers Comp cost containment best practices are invited to access Amaxx Workers’ Comp Cost Containment Essentials training series

 

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

 

Texas DWC Updates System Participants on Code Rule

The Division of Workers Compensation (DWC) recently reminded all system participants that 28 Texas Administrative Code § 127.10(a)(3) requires treating doctors and insurance carriers to provide all required medical records and any analyses to the designated doctor no later than three business days prior to a designated doctor examination.

 

Additionally, if the required medical records are not received within one business day prior to an examination, the designated doctor shall reschedule the exam to occur no later than 21 days after receipt of the records.

 

A new e-mail address for system participants to request assistance with medical records is listed at the end of this memorandum. Failure to provide medical records in accordance with the agency rule is an administrative violation and prevents the designated doctor from completing a certifying examination of the injured employee.
Rescheduled examinations may result in unnecessary delays when processing a claim and bring increased cost to the system.

 

Designated doctors are encouraged to reach out to the DWC for assistance obtaining medical records prior to examinations.

 

DWC staff may contact treating doctors and insurance carriers that have not yet provided a complete set of required medical records to the designated doctor at any time before a scheduled examination, and will take necessary action to ensure all required medical records are received.

 

The DWC asks all insurance carriers and treating doctors for full cooperation when contacted for assistance in obtaining medical records.

 

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

Understanding Medicare Advantage Plans in Your Work Comp Case

Medicare Advantage Plans (MA Plans) are growing in popularity and currently cover about 30% of all Medicare beneficiaries.  This is partly due to the fact MA Plans provide numerous coverage options for people with various medical needs.

 

The increasing use of these Plans has created confusion for claim management teams as they handle workers’ compensation cases.  These are some of the more common questions they face in their daily practice.

 

 

What is a MA Plan?

 

In 1997, Congress expanded Medicare coverage options by creating “Medicare+Choice,” or Medicare “Part C” coverage.  Under this new system, private insurance carriers were given authorization to provide Medicare Parts A and B coverage, with the ability to provide other coverage options.  Medicare was again expanded in 2003 under the Medicare Part D program to provide a prescription drug benefits.  In doing this, “Congress’s goal in creating the Medicare Advantage program was to harness the power of private sector competition to stimulate experimentation and innovation that would ultimately create a more efficient and less expensive Medicare system.  It was the belief of Congress that the MA program would continue to grow and eventually eclipse original fee-for-service Medicare as the predominant form of enrollment under the Medicare program.”  In re: Avandia,  685 F.3d 353, 362 (3rd Cir. 2012).

 

 

How Do I Determine What Interests a MA Plan Has in My Case?

 

When dealing with Original Medicare (Parts A and B), the conditional payment resolution process is clear and defined under statute, regulation and CMS policy.  The consolidation of the COBC and the MSPRC into the Benefits Coordination & Recovery Center (BCRC) has resulted in a more efficient system.  Parties have a better understanding of the process when working with the BCRC, and the SMART Act is improving the process.

 

Unfortunately, the BCRC does not collect claim and payment information for Medicare beneficiaries covered by a MA Plan.  This is the responsibility of the private insurance plan.  To make matters worse, beneficiaries have numerous options through a number of different carriers.  Beneficiaries can also switch policies on a yearly basis.  The end result is during the life of a workers’ compensation claim, multiple MA Plans can make payments on one claim.

 

Here are some tips to identifying an MA Plans’ interest:

 

  • Use discovery tools to identify what MA Plans may have made payments related to the workers’ compensation claim. Be sure to update this information during the course of a claim.
  • Communicate with opposing counsel and your attorney so they understand how MA Plans differ from Original Medicare. Creating cooperation early on can help resolve matters in a timely manner.
  • When settlement is under consideration and notice is made to the BCRC to request conditional payments, also ask the claimant to confirm or deny in writing the existence of a MA Plan. If one or more is, or has been in place during the life of the claim, obtain plan name, contact and plan identification number(s).

 

 

What Rights of Recovery Do MA Plans Have?

 

The rights of Original Medicare are clearly defined for the most part under the Medicare Secondary Payer Act.  Notwithstanding the common understanding of what rights Medicare has in workers’ compensation, questions of recovery rights are less certain when dealing with MA Plans.  This has resulted in questions and uncertainty from attorneys and claims management teams handling workers’ compensation cases.

 

While case law around the country varies as to an MA Plan’s ability to utilize a private cause of action to recover monies paid on behalf of an injured party, it is important to follow these words of advice:

 

  • Determine if the injured party is a beneficiary under Original Medicare, or through an MA Plan.
  • When it is determined that a MA Plan exists, treat it as you would any other intervener or interested party—put them on notice of their rights.
  • Understand how case law varies across the country and determine if the federal courts in your state have recognized the ability of MA Plans to recover using the private cause of action provisions under the Medicare Secondary Payer Act.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, and founder of COMPClub an interactive training program teaching workers’ comp cost containment best practices.  Through this platform he is in the trenches on a monthly basis with risk managers, brokers, consultants, attorney’s, and adjusters teaching timeless workers’ comp cost containment strategies, as well as working with members to develop new tactics and systems to address the issues facing organizations today. This unique position allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

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

 

Employers/Carriers/TPAs/Brokers/Vendors looking for additional information FREE resources for Workers Comp cost containment best practices are invited to access Amaxx Workers’ Comp Cost Containment Essentials training series

 

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

 

Ohio Appoints New SID Head

Ohio Bureau of Workers Compensation (BWC) Administrator/CEO Steve Buehrer recently announced the appointment of a 25-year Ohio State Highway Patrol veteran as director of BWC’s Special Investigations Department.

 
James Wernecke began his duties recently, overseeing 123 employees who work to deter, detect and investigate workers comp fraud. The department pursues cases of claimant, medical provider and employer fraud by identifying savings, disallowing claims and referring criminal matters for prosecution.

 

“With more than 25 years of law enforcement experience, Jim is a public safety and criminal investigation expert who is exceptionally qualified to lead our fraud prevention efforts,” said Buehrer. “We look forward to having Jim join our outstanding team of skilled, professional investigators and take the lead in identifying wrongdoing to protect the State Insurance Fund, keep employer premiums as low as possible and provide the best care possible to Ohioans injured on the job.”

 

A Tuscawaras County native, Wernecke began his career as a trooper in Massillon in 1990 and later served as an investigator in Massillon and Bucyrus, and commander at the Mansfield Patrol Post. He was appointed in 2012 commander of the Ohio Investigative Unit, which is charged with enforcing the state’s liquor laws and is the only state law enforcement agency specifically tasked with investigating food stamp fraud crimes.

 

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

Determine Proper Medical Treatment With Utilization Review

Utilization review in workers’ compensation is the process by which an outside medical expert reviews the medical provider’s diagnosis and medical treatment to determine if the proposed or completed medical treatment is medically necessary for an injured employee.  There are three primary types of utilization review.  Pre-certification review occurs before the medical procedure or treatment is provided.  A concurrent review occurs during the time the medical treatment or service is being provided, for example during a hospital stay.  A retrospective review occurs after a medical service has been provided.

 

 

Utilization Review Determines If Medical Procedure is Necessary

 

The utilization review will be completed by a highly experienced nurse who will thoroughly review the medical records to determine if a medical procedure is necessary for the injured employee.  The nurse will also verify there is a causal relationship between the medical procedure and the workers’ compensation injury.

 

Utilization review is not second guessing or just the opinion of a nurse.  The utilization review company should be certified by the Utilization Review Accreditation Commission (URAC) which establishes uniform standards throughout the medical field for utilization review.  An insurer or self-insured employer should not consider a utilization review company that does not have URAC certification.

 

The various states have all gotten involved in what is acceptable or not acceptable for utilization review.  The utilization review company should be willing to verify that it will comply with each state’s individual requirements.  If the utilization review company does not comply with the jurisdictional requirements of a state, the medical provider can contest the utilization review.  Lack of compliance with the jurisdictional requirements can result in the utilization review being thrown out.

 

 

Utilization Review is Not Black and White

 

While the states have jurisdictional guidelines, few utilization reviews are clear cut, black or white.  It takes an experienced nurse to review all the criteria for a medical service request and to verify the criteria for the medical service has been met.  The nurse will also review the jurisdictional guidelines to see if the medical information supports the requested treatment.  If the jurisdictional guidelines are silent on a particular medical treatment, the nurse will review standard treatment guidelines.  All utilization review decisions are based on the medical documentation provided by the employee’s medical provider.

 

If the utilization review nurse does not agree a medical service is needed, the nurse will escalate the review to a physician for review.  The peer review should be completed by the same type of medical provider who is treating the injured employee. For instance a utilization review of an employee with an injured knee should be completed by a physician who is a knee specialist.  (For this reason it is always important to select a utilization review company that is large enough to have a wide variety of specialists on staff)

 

 

Peer-to-Peer Discussion Will Follow Any Treatment Disagreement

 

The peer review physician will follow the jurisdictional guidelines and standard medical treatment guidelines to determine whether or not he/she agrees with the medical service under review.  If the utilization review physician disagrees with the medical procedure, the review physician will deny the request and provide a detailed explanation as to why the procedure is denied.  Also, if the review physician is in doubt, the physician will set up a peer-to-peer discussion to see if there is a rational reason for the medical procedure, before denying or approving a procedure.

 

Utilization review is not used for emergency medical services where a delay in medical treatment is life threatening. In a life-threatening emergency, the focus is on doing everything possible to save the life of the injured employee.

 

To achieve maximum savings from utilization review, many insurers and self-insured employers will select a utilization review company that can integrate other medical cost savings programs like medical triage, medical bill review, nurse case managers, senior nurse reviewers, physician review services, peer reviews and pharmacy reviews into a seamless package.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, and founder of COMPClub an interactive training program teaching workers’ comp cost containment best practices.  Through this platform he is in the trenches on a monthly basis with risk managers, brokers, consultants, attorney’s, and adjusters teaching timeless workers’ comp cost containment strategies, as well as working with members to develop new tactics and systems to address the issues facing organizations today. This unique position allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

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

 

Employers/Carriers/TPAs/Brokers/Vendors looking for additional information FREE resources for Workers Comp cost containment best practices are invited to access Amaxx Workers’ Comp Cost Containment Essentials training series

 

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

 

Cal/OSHA Online Resources Now Option for Workers, Employers

Educating employers and workers about workplace safety should be a never-ending process.

 

Cal/OSHA recently released two new fact sheets that expand upon resources available to the public.

 

Health & Safety Rights: Facts for California Workers details ways for employees to work with employers and Cal/OSHA to keep their jobs safe. Protecting Temporary Agency Employees provides information on the requirements in California for temp agencies, professional employer organizations (PEOs), and host employers to protect workers from safety and health hazards in the host employer’s workplace.

 

“These new online educational tools are part of Cal/OSHA’s ongoing efforts to help employers and employees access critical information on workplace safety,” said Christine Baker, director of the Department of Industrial Relations (DIR). Cal/OSHA is a division within DIR.

 

The workers’ rights fact sheet is the first Cal/OSHA publication to focus primarily on workers’ basic rights to a safe and healthful workplace and how to work with Cal/OSHA before, during, and after an inspection. Cal/OSHA will distribute printed versions at community events, training sessions and during onsite visits.

 

The temp agency worker factsheet is the first to explain California-specific legal obligations of multiple employers that employ the same workers and is based on recent case law and Cal/OSHA’s Injury and Illness Prevention Program (IIPP) requirements. It is timely given the rise in temporary workers, who are particularly vulnerable to hazards on the job.

 

“Cal/OSHA developed this workers’ rights fact sheet with input from a broad range of employers, employees and interested parties to help ensure safe and healthful workplaces,” added Juliann Sum, chief of Cal/OSHA.

 

Employers should call (800) 963-9424 for assistance from Cal/OSHA Consultation Services. Employees with work-related questions or complaints may call DIR’s Call Center in English or Spanish at 844-LABOR-DIR (844-522-6734), or the California Workers’ Information Hotline at 866-924-9757 for recorded information in English and Spanish on a variety of work-related topics. 

 

 

 

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

 

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

 

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

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

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

SUBSCRIBE: Workers Comp Resource Center Newsletter

Use Claim Investigation Tools To Uncover The Truth

If you have ever felt an adjuster assigned to one of your workers’ compensation claims was not making a proper effort to investigate a questionable injury claim, you are not alone.  Every large claims office has some really good adjusters, some acceptable adjusters and some unmotivated adjusters who are just going through the motions to make it to the next weekend.

 

If you contact an unmotivated adjuster about the status of their claims handling, the adjuster will tell you, that she is doing everything she can on the claim.  The reason the adjuster will say that is because the adjuster knows that the employer most often does not know what can be done on the claim.  If you want to really shake up the unmotivated adjuster and to get the adjuster moving forward full speed on the investigation of the claim, review the following list of investigation suggestions with the adjuster.

 

 

Check List of Investigation Tools:

 

  • Employer’s First Report of Injury form
  • Employee’s written report of claim form (in states where it is required)
  • Insurance Services Office filing (formerly known as the Central Index Bureau)
  • Contact with claim adjuster(s) on claimant’s prior work comp claims
  • Contact with prior employer(s) on claimant’s prior work comp claims
  • Medical records from claim files of prior work comp claims
  • Contact with work comp board/industrial commission for their records on prior claims (some states will not cooperate, other states do cooperate)
  • Employee’s detailed recorded statement
  • Recorded statement of any witnesses to the accident
  • Supervisor’s recorded statement
  • Police report on vehicle accidents
  • OSHA reports, whether federal OSHA or a state OSHA
  • Any other government agency records
  • Discussion of the claim with the employee’s attorney, if the employee is represented
  • Contact with any third party involved in the claim – driver of other vehicle in auto accidents, manufacturer of machinery that injured employee, manufacturer of defective product that caused employee’s injury, etc
  • Telephone contact with each medical provider to have the most recent medical report(s) faxed to the adjuster
  • Medical records for all medical appointments
  • Photographs of the accident scene
  • Diagram of the accident scene
  • Having the claimant call the adjuster after each doctor’s appointment to report on medical progress
  • Nurse case manager’s input on serious injury claims
  • Field case manager to meet with the employee and doctor, and to attend medical appointments with the employee
  • Review of claimant’s social media sites – Facebook, Twitter, LinkedIn, etc.
  • Employer’s personnel file on the employee, including job application, new employee forms, disciplinary records, etc.
  • Employer’s safety records for the accident location
  • Employer’s public notice of plant location closing, lay-offs, union issues, etc.
  • Referral of the claim to the Special Investigation Unit (the unmotivated adjuster may be quick to do this, as this passes the buck to someone else to do a complete investigation).
  • Outside Vendor Services (Investigation steps that can be taken, but not normally performed by the adjuster, but overseen by the adjuster).

    • Surveillance
    • Activity check
    • Neighborhood canvass
    • Background check
    • Credit check
    • Public records review / civil records searched
    • Criminal records check
    • Skip tracing
    • Clinic records sweep (checking for medical treatment at all clinics in the area of the employee’s address)
    • Hospital records sweep (checking for medical treatment at all hospitals in the area of the employee’s address)
    • Pharmacy records sweep (checking for prescriptions filled at all drug stores in the area of the employee’s address)
    • Video re-enactments of the accident
    • Examination under oath

 

Unfortunately, there is no central system where an adjuster can check to see if the employee is currently working another job.  The use of a private investigator for surveillance can fill this void, but without knowing where an employee might be working, this is often a hit-and/or-miss approach.

 

 

Key To Investigation Taking As Many Steps As Needed

 

It would be a very rare claim where it is necessary for the adjuster to take all of the investigation steps listed above.  The key to an investigation is for the adjuster to take as many of the investigative steps as needed to verify the validity of the claim, or to disprove the claim.

 

We realize this checklist of the investigation steps your adjuster can take is incomplete.  We welcome our readers to contact us with additional investigation techniques they would add to our investigation checklist.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, and founder of COMPClub an interactive training program teaching workers’ comp cost containment best practices.  Through this platform he is in the trenches on a monthly basis with risk managers, brokers, consultants, attorney’s, and adjusters teaching timeless workers’ comp cost containment strategies, as well as working with members to develop new tactics and systems to address the issues facing organizations today. This unique position allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com

 

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

 

Employers/Carriers/TPAs/Brokers/Vendors looking for additional information FREE resources for Workers Comp cost containment best practices are invited to access Amaxx Workers’ Comp Cost Containment Essentials training series

 

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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