Case Study: Obtaining a Legal Zero MSA

There are many barriers to settling workers’ compensation cases that have placed a significant burden on all programs nationwide.  One such barrier is understanding the complexity of the Medicare Secondary Payer (MSP) Act and specifically the voluntary review and approval process for Workers Compensation Medicare Set-Asides (WCMSAs).

 

The stakes are significant in high exposure claims.  This is often the case in high-dollar cases where settlement requires a certain peace of mind by having an allocation reviewed and approved by CMS.  Issues of primary liability can factor into such claims when it comes to receiving a $0 allocation.  In many instances, it is essential to work with a dedicated service provider who knows and understands the components and documentation required to obtain a “Legal Zero MSA” approval.

 

 

Case Study (provided by Tower MSA Partners): Obtaining a Legal Zero MSA 

 

This case study considers the challenge and solution to obtaining CMS approval of a Legal Zero MSA on a completely denied case.

 

 

Challenge:

 

The employee, who is a Medicare beneficiary, allegedly suffered a left medial ankle and foot injury during his employment. At the time of the claimed injury, the claimant was an insulin-dependent diabetic.

 

  • The treating physician opined the injury as a contusion to the left ankle and toe with no evidence of fracture, and the workers’ compensation claim was denied.
  • During the course of post-injury medical care and treatment, the claimant’s uncontrolled diabetes resulted in a below knee amputation.
  • Following the amputation procedure, the claimant sought care from a new physician who concluded ‘in his professional opinion, there was a direct correlation between the traumatic injury he suffered and the below knee amputation’.
  • The workers’ compensation claim denial was affirmed, and $0 MSA was requested.
  • The total potential MSA exposure was $169,053 if the Legal Zero MSA was not approved.

 

 

Solution:

 

Obtaining review and approval of a $0 allocation provides certainty for all parties involved in the WCMSA review and approval process.

 

The solution in this case study required the MSA legal team to work with the defense attorney and client to prepare the Legal Zero MSA by providing evidence as follows:

 

  • The claim was denied in its entirety and in good faith.
  • No payments for medical or indemnity were made.
  • Medical records provided by Plaintiff’s counsel indicate treatment for a severe diabetic condition dating prior to the 06/25/2014 alleged injury.
  • Formal denial filed to the North Carolina Industrial Commission stating that the claim is denied as the medical records received thus far do not substantiate relationship of any injury on 06/25/2014 to his complaints.

 

 

Results:

 

In its review of the evidence provided by the legal team, CMS concurred with the evidence as proof of no liability and the Legal Zero MSA was approved in full by CMS.

 

Savings achieved in this case totaled $169,053

 

 

Conclusions:

 

The stakes are high when it comes to obtaining a $0 allocation during the voluntary WCMSA review and approval process.  Failing to work with an experienced MSP service provider who understands the process can result in delays, missed settlement opportunities and cases not settling, which will only add costs to your workers’ compensation program.

 

 

Author Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2017 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.

Address 3 Areas of Concern For Chiropractic Care in Work Comp

Chiropractic care has been a mainstay in workers’ compensation systems for some time.  While there are many benefits to this form of care, members of the claims management team should use caution when managing claims involving a chiropractor.

 

 

Are Chiropractors Real Doctors?

 

Chiropractic care is an alternative form of mainstream medicine used to treat a variety of disorders impacting the musculoskeletal system.  By using the spinal cord as a reference point, chiropractors use various manipulations in order to treat not only neck and back pain, but also other conditions that have their origins in the central nervous system.

 

The requirements to become a chiropractor vary in every state.  In some instances, a chiropractor receives more medical based training than the average medical doctor (MD).  The main difference in training is chiropractors concentrate their focus of study in physiology and body mechanics.

 

 

 

Areas of Concern for the Work Comp Professional

 

Chiropractors should be treated with the same professionalism as any other health care professional.  Like anyone else who provides medical care and treatment, a majority of chiropractors are professionals in every sense of the word.

 

Claims handlers do need to educate themselves on how chiropractors operate.  Unlike most medical doctors who work in or associate with larger groups, many chiropractors operate in a solo practitioner setting.  They also offer additional services such as massage and aromatherapy.  When managing claims involving chiropractors, claims professional should employ the following techniques to ensure the injured worker is receiving quality medical care and treatment:

 

  • Review of Billing Practices: Every claims professional should review all medical bills submitted for payment with integrity.  When an employee sustains a work injury and is seen and examined by a chiropractor, it is important to review it under the same standards one would from a medical doctor specializing in orthopedic and neurological care.  This will include identifying billing codes that are consistent with an initial examination.

 

  • History of Chiropractic Care: It is important for every member of the claims management team to obtain a complete set of medical records for a claimant.  This can be difficult when a person has received previous chiropractic care.  Any billing statement from an injured worker’s initial visit should indicate if they are an existing patient, have received chiropractic care in the past or are new to this form of treatment.

 

  • Reviewing Treatment History: While chiropractors use medical terminology in their records, it does differ from what you would typically find in reports generated from a traditional medical doctor.  It is important to note the frequency of care and how long it is recommended.  One should also take note of “flare-ups” listed in medical records and determine if they coincide with the employee’s recollection.  It is also important to scrutinize any medical care with applicable state medical treatment parameters.

 

 

Managing Claim Costs

 

Members of the claims management team will need to take additional steps to address out of control treatment with a chiropractor.  There are steps that can be taken to address this form of medical mismanagement.

 

  • Independent Medical Examination: The IME is the easiest, but sometimes most expensive cost containment method in claims involving chiropractic care.  Given the restrictions most states place on such exams, it is a decision that cannot be taken lightly.

 

  • Record-Only Medical Review: This is also known as a “paper review.”  From a cost perspective, this is an excellent method to obtain an expert opinion regarding the reasonableness and necessity of care.  They can also address whether the chiropractic care is consistent with medical treatment parameters.  A paper review is also less expensive when compared to a full-blown IME.

 

 

Conclusions

 

Members of the claims management team and other interested stakeholders need to understand the benefits and dangers of chiropractic care.  Part of this includes methods and techniques to analyze the care received and making sure it is consistent with workers’ compensation guidelines.  It should also be care to treat the effects of a work injury and make the employee whole.

 

 

Author Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

4 Ways to Minimize Workers’ Comp Indemnity Exposure

When dealing with cost containment in workers’ compensation, focus is often given to the medical issues in claims management.  While medical expenses continue to drive costs in all programs, forgetting about the indemnity aspects of claims can lead unmanageable costs and reduce the effectiveness of overall cost containment measures.  Now is the time to examine the indemnity side of your claims practice to maximize the effectiveness of your workers’ compensation program.

 

           

Average Weekly Wage

 

As a general rule, a majority of indemnity benefits in any jurisdiction are driven by the average weekly wage (AWW).  The AWW is often described as the fair estimation of an employee’s weekly wage.  Knowing the law is the first step in correctly calculating this wage.  Other factors include:

 

  • Status of the employee—whether they are a full-time or part-time employee;

 

  • Other compensation such as bonuses tips, gratuities, employee benefits and other fringe benefits; and

 

  • The nature of one’s employment. Seasonal and construction workers often receive preferential treatment when calculating an AWW due to the fact weather impacts their ability to work.

 

 

Minimizing Your Indemnity Exposure

 

When an employee is off work or working at a reduced wage/number of hours, they are entitled to receive wage loss benefits.  While most jurisdictions limit the number of weeks benefits such as temporary total (TTD) and temporary partial disability (TPD) are paid, failing to return the employee to their same pre-injury status can have undesirable consequences.  These include:

 

  • Payment of permanent total disability (PTD) benefits; and

 

  • Retraining programs. During this time, insurance carriers are required to not only pay for educational instruction preparing the employee for a new career, but they can also be on the hook for costly miscellaneous expenses and additional periods of wage loss benefits.

 

 

Alternatives to Paying Wage Loss Benefits

 

When evaluating the indemnity aspects of your claims program, alternatives to costly benefit exposures should include:

 

  • Aggressive Return to Work: When an employee is injured on the job, the employer’s goal is to return the employee to work as soon as the worker is medically able to return. Transitional duty (TD) enables injured workers to stay in the work world while they recover from the injury.

 

  • Work Hardening: This interdisciplinary approach focuses on a number aspect of the employee.  It can include an assessment of their physical abilities, physical therapy and rehabilitation via simulated workplace activities.  The process involves taking a deconditioned employee who has been out of the workforce and redeveloping their neuromuscular and musculoskeletal functions, which includes one’s strength, power and endurance to return to work.  Professionals involved in this process can include physical therapists, other medical professionals and occupational counselors.

 

  • Vocational Rehabilitation: Employees suffering from the effects of a work injury are generally those who may be precluded from engaging in their “usual and customary” occupation.  This threshold question is typically a low standard and should encourage most defense-oriented stakeholders willing to provide these benefits versus engaging in costly litigation.  A vocational rehabilitation expert assists the injured employee with a number of issues.  This includes explaining medical procedures and options, counseling them on return to work issues, educating the employee on re-employment issues, including work restrictions, and providing guidance on job search matters.  A majority of state workers’ compensation acts preclude this expert from being an advocate or legal representative for the employee.

 

  • Independent Medical Examinations (IME) and Functional Capacity Evaluations (FCE): These procedures can be used separately or together to mitigate indemnity exposure.  While the defense is able to select their experts to perform an IME or FCE, it is wise to select someone who has a sound professional reputation and able to state their findings within a reasonable degree of medical or vocational certainty.  Timing is key and many jurisdictions limit the use of these events.

 

Conclusions

 

Proactive claims management teams and stakeholders need to be proactive in their approach to program cost management.  While a focus on the medical side of claims is important, failure to do the same regarding indemnity benefits can be harmful.  When controlling the indemnity portion of a workers’ compensation claim, there are many opportunities to implement effective and cost-efficient services to accomplish one’s goal.

 

 

 

Author Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2017 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.

Leverage Emotional Intelligence For Successful Claim Settlements

 “Today is a new day, the first day of the rest of your life.” Each of us has certainly heard this statement proclaimed sometime throughout our lives – in the classroom, office, on an athletic field or even possibly during a therapy session. For injured parties, facing the realities of today and the uncertainties of tomorrow are often more painful than the physical injuries themselves.

 

As professionals, this is a simple yet important concept to understand as it drives the value that comes with the use of emotional intelligence when posturing settlements.

 

 

Emotional Intelligence In Settlement Process

 

Emotional intelligence is an ability to recognize, understand, manage and influence one’s emotions and the emotions of others. In practical terms, it is a combination of these abilities along with the use of intuition and street smarts. Regardless of how one chooses to define the concept, incorporating the use of emotional intelligence is important given its value in the settlement process.

 

With all of the priority business demands inherent to managing claims, litigation and settling claims, even if one had the time to fully appreciate the value of applying emotional intelligence, how would one use this to generate better results? Most of us are too busy to even pause for a moment and think about this question. So, please, allow me a minute to offer a few simple thoughts.

 

Unlike most service providers who deliver products and services for the betterment of injured parties, structured settlement consultants are uniquely positioned. Oftentimes, structured settlement consultants are very engaged in the litigation process and meet the injured parties. These opportunities open the door for the use of emotional intelligence which is advantageous to all.

 

 

Settlement to Address Immediate and Future Needs

 

From an injured party perspective, structured settlement professionals address immediate and future needs and provide viable options to bridge the gap to settlement. As objective settlement advisors, they use emotional intelligence to customize creative settlement proposals designed to address the financial needs and uncertainties of tomorrow.

 

From a claims and litigation management perspective, both defense and plaintiff, structured settlement professionals maximize the benefits and value that comes with the settlement dollars paid and assist with achieving desired outcomes. The efforts of structured settlement professionals offer benefits to all parties involved in the settlement process.

 

 

“Color in the Quotes”

 

So, next time you engage a structured settlement consultant, look not at the color of the quotes but rather the “color in the quotes” – in part the product of their use of emotional intelligence.

 

“Engage a structured settlement professional, today.”

 

 

Author: Duke T. Wolpert, Ringler.  Duke is a Broker and Settlement Consultant (CSSC) who owns and operates Ringler Associates of Pennsylvania Inc.  After joining Ringler in 2012, Duke served as Sr. Vice President of National Marketing and was responsible for new business development, national account management, national marketing and corporate partnerships – as member executive management team of the organization. Contact: https://ringlerassociates.com/consultants/duke-wolpert/

 

How To Double Your Odds of Poor Workers’ Comp Outcome

What do these factors have in common: education level, fear of being fired, tenure on the job and English language proficiency? All help determine outcomes for injured workers.

 

While you may not be able to change all the factors that influence outcomes, you can vastly help improve them. Understanding how certain issues affect recoveries and emphasizing best practices can get your injured workers back on the job faster and save your company money.

 

 

Education, Fear of Being Fired, Language

 

According to recent research studies workers with less than a high school education had poorer return-to-work rates than high school graduates, and the gap was more pronounced compared to those with secondary degrees. Injured workers concerned about being fired had worse outcomes and were more likely to hire attorneys, than those without such concerns. Injured workers whose main language was not English were also more likely to have poorer outcomes than those whose primary language was English.

 

The latest research also shows a correlation between outcomes and the employer’s response to the worker’s initial report of injury. The following were associated with poor outcomes:

 

  • Not being supportive.
  • Blaming the worker for his injury.
  • Expressing anger toward the injured employee.
  • Not believing the person was injured.
  • Telling the injured worker not to file a workers’ compensation claim.

 

When more than one of these responses was present the duration of days out of work was 2 times more than for workers who did not get a negative response.

 

 

6 Steps to Improve Outcomes

 

A lower education level, shorter time on the job and difficulty understanding English all play a part in an injured worker’s concerns about being fired. That particular fear is a strong indicator of when and how well an injured worker will recover.

 

To combat that concern, employers need to adopt many of the practices associated with an advocacy based claims model. Simply put, it means treating the injured worker as you would treat a customer. In some cases that might mean changing the culture of an organization, while in other companies it may involve just tweaking and ensuring certain practices are followed. Building trust with the injured worker is key.

 

Here are steps to help:

 

  1. Early contact. Both the supervisor and claims handler should communicate with the injured worker as soon after the injury as possible. Multiple studies show the benefits of this to both the injured worker and the employer. Average claim costs, claim duration and medical costs are all significantly lower when efforts are made to reach out early to the injured worker. The contact should take into consideration the injured worker’s preference; older workers may appreciate a phone call and/or letter while younger employees may prefer text messaging. Those whose primary language is not English should be contacted by someone who understands and speaks his native tongue. The message should be positive and show concern and caring. The employer should express genuine interest in the employee’s well-being.

 

  1. Constant communication. Injured workers often feel isolated the longer they are away from the workplace. By maintaining regular contact, the employer can help ensure the claim is progressing, answer any questions, and keep the injured worker up to date on the latest workplace happenings. Injured workers need to feel they are still part of the organization and should know the employer looks forward to his return. If nothing else, the social interaction itself can help make the injured worker feel less isolated.

 

  1. Assign specific contacts. Where possible, a nurse or other medical person should interact with the injured worker to discuss any medical issues. A nurse or claims handler should stay in touch with the injured worker to discuss various aspects of the claims process, including return to work.

 

  1. Early access to medical care. Getting medical care to the injured worker as soon as possible not only helps speed his physical recovery, but can also help alleviate his frustrations. It lets him see the process is focused and moving along, rather than being stuck in bureaucracy. Many larger companies have clinics at the work site. Those that don’t may be able to take advantage of companies that send medical providers, such as physical therapists to the work site. Telemedicine is another option companies are increasingly looking to help their injured workers.

 

  1. Coordinate care. Injured workers who have risk factors such as lower educational levels, short-term tenure with the employer, or poor English skills should be targeted for coordinated interventions. The employer, claims handler, and any others involved should hold discussions with the injured worker to ensure they are all on the same page and kept up to date.

 

  1. Beyond the denied claim. A claim denial should not be the end of the communication, as that can result in litigation. Instead, someone should discuss the reasons for the denial with the injured worker. Also, the injured worker should be told about other options, such as general healthcare. A nurse or someone with understanding of the claim process and the healthcare system should contact the injured worker to discuss his options.

 

 

Summary

 

There are myriad reasons why workers’ compensation claims deteriorate and have poor outcomes. Research is increasingly uncovering many of them. One thing for certain is that injured workers who feel valued, supported and who understand and engage in the process are more likely to recover quicker and get back to work sooner. The system does not need to be adversarial. Employers willing to treat injured workers with respect and support will create a trusting atmosphere and have lower workers’ compensation costs.

 

 

 

Author Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2017 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.

3 Times to Consider the ADA in Workers’ Compensation

Workers’ compensation claims professionals and other interested stakeholders face many challenges in their programs.  One important challenge is running a program that is consistent with the applicable workers’ compensation act and not conflicting with the Americans With Disabilities (ADA) Act.  Failing to understand this matter can result in serious legal consequences and impact your bottom line.

 

 

What is the ADA?

 

The ADA is codified under 42 U.S.C. §12101, and is an important civil rights law that prohibits discrimination based on disability.  It was enacted in 1990 and laid the groundwork for greater inclusion of persons with disabilities in American society, which includes those suffering from a work-related injury.

 

There are many legal nuances to this law, so it is important to consult an attorney if you have questions.  Areas of concern as outlined by the U.S. Equal Employment Opportunity Commission (EEOC) include:

 

  • Whether a person with an occupational injury has a disability as defined by the ADA;

 

  • Disability-related questions and medical examinations relating to occupational injury and workers’ compensation claims;

 

  • Hiring practices concerning a person with a history of occupational injury, return to work of persons with occupational injury, and application of the direct threat standard;

 

  • Reasonable accommodation for persons with disability-related occupational injuries;

 

  • Light duty issues; and

 

  • Exclusive remedy provisions in workers’ compensation laws.

 

 

3 Times to Consider the ADA in Workers’ Compensation

 

Employers and other interested stakeholders need to understand the value anyone with a disability has and how it can impact the work environment in a positive manner.  Contrary to popular belief, people who may be disabled want to work as it provides a number of intangibles that benefit morale and self-worth.

 

Keeping this in mind, employers need to consider the following touchpoints in their hiring and workers’ compensation programs:

 

 

Pre-employment:

 

All hiring polices need to comply with the ADA and its mandate of non-discrimination.  Asking potential new hires about disabilities or work restrictions many result in legal action.  It is also important to keep in mind that a disability is not limited to physical barriers.  Various mental health conditions can qualified as a covered disability under the Act.

 

Issues concerning drug testing also come into play under the ADA.  As a general rule, employers can ask all applicants to submit to a drug test as part of the pre-employment process.

 

 

Post-work injury:

 

Employee’s suffering from a work injury can also be covered under the ADA.  A common misconception is the ADA only applies when an employee reaches MMI, this is incorrect. A person injured at work can immediately be considered a “qualified individual with a disability”. At the time of injury a referral to HR and a discussion, referred to as the “interactive process” regarding reasonable accommodations must occur.

 

Additional areas of concern include job search requirements, return-to-work/employment transitions and light duty.  Employers should work with various professionals within their organization when crafting a return-to-work plan and requires modified job duties or positions.  Additional considerations should also be given to time off from work to attend medical appointments, etc.

 

 

Post-injury Termination of Employment:

 

Problems also arise following a work injury when the employee’s position is eliminated or that individual is terminated.  It is important to document all steps that are taken and involve legal counsel.  Employers should also involve specialized counsel if they are requesting a global settlement of a workers’ compensation claim that involves a voluntary resignation of employment and release of all claims.  Issues to consider include a separate employment release and monetary consideration beyond what is paid for workers’ compensation benefits.

 

 

Conclusions

 

Workers’ compensation claims are complex and require an understanding of the law.  The ADA is an important consideration for those involved in handling claims and the myriad of associated issues.

 

 

Author Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2017 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.

Impact of OSHA’s New Electronic Recordkeeping Rule On Employers & Their TPAs

 

This Interview with Broadspire’s CEO Danielle Lisenbey was originally published in Crawford’s On the FrontLine Magazine – Spring 2017

 

The Occupational Safety and Health Administration (OSHA) implemented a final rule in 2017 requiring employers that must record workplace injuries and illnesses for OSHA to submit reports of such incidents electronically. For the first time, OSHA will post on its website establishment-specific data, rather than only aggregated industry data. The goal is to encourage employers to identify workplace hazards and improve their safety records. We ask Broadspire’s Danielle Lisenbey for her views.

 

 

What does OSHA’s new rule mean for employers and TPAs?

 

OSHA has long required employers to keep a log of certain workplace incidents that result in injury or illness. That basic recordkeeping requirement is not new, but what is new is that OSHA is now asking employers to submit certain forms electronically. That will greatly facilitate the administration’s ability to make employer specific data publicly available. Employers and their third-party administrators (TPAs), including Broadspire, will work closely to make sure the appropriate data is submitted to comply with all applicable OSHA rules. Our mantra as a TPA is “early reporting and early intervention lead to better outcomes.” The new OSHA rule ultimately ties into that.

 

 

Which industries are primarily affected by the new electronic tracking rule?

 

The new recordkeeping rule applies to a significant number of  employers. Under the final rule, employers with 250 or more employees that are required to maintain OSHA injury and illness records must submit their logs, summaries of injuries and illnesses, and  incident reports.

 

Employers with 20 to 249 employees in industries classified as having high rates of occupational injuries and illnesses must submit an electronic summary report. Industries on OSHA’s list include construction, manufacturing, healthcare, transportation and others – all of which are important sources of employment and productivity.

 

Industries that OSHA considers to have lower injury rates, which include insurance and financial services, and some retail businesses, are partially exempt from such reporting. The reality is, however, that OSHA’s new rule will cover a large number of U.S. employers and their workers.

 

 

How does Broadspire see this new rule benefiting employers and workers?

 

The intent of OSHA’s new final rule is to increase workplace safety and motivate employers to reduce injury and illness  for  their workers.  That is a noble goal and we not only support it; it is at the heart of our business.

 

Broadspire exists to help employers reduce claims frequency and severity. We believe that the more data an employer has, the better it can plan ahead and mitigate situations that can cause injury or illness. OSHA’s new rule will make more workplace data accessible, which will encourage employers to focus more attention on the causes of occupational injuries and illnesses. That’s a positive thing for  all concerned.

 

Workers will benefit because they will be healthier and safer. Employers will benefit from reduced downtime and increased productivity, which in turn will benefit communities through economic growth. Truly, improving workplace safety pays big dividends, well beyond an employer’s door.

 

 

What are the downsides or unintended consequences of the new OSHA rule?

 

Some observers have expressed concern that online publication of employer-specific reports could create cyber exposures, increase litigation and might even discourage some employers from tracking minor incidents to artificially improve their safety results. While public disclosure may not be the preferred method to motivate employers to improve safety, greater transparency and competitiveness are likely to accelerate changes.

 

It is our belief that the vast majority of employers required to report to OSHA will submit injury and illness reports fully and accurately. We also believe that the general population of employers will see the data points as helpful to keeping them focused on the big picture, which is to make workplaces safer. We certainly hope that OSHA has considered the implications of this final rule and will swiftly address any problems should they arise.

 

 

What is Broadspire doing to help prepare its clients to comply with the rule?

 

Broadspire is deeply invested in helping employers to improve their claim outcomes and to reduce the costs of workplace injury, illness and disability. Early access to data is key, and TPAs can step up and help employers build out their data sets.

 

Between the data and benchmarking that we provide, and the reports that OSHA intends to make available, the ultimate objective is to reduce loss costs for the employer and improve the care of the injured worker. It’s a win-win for both employer and employee. Compliance is a big part of what we do every day for our clients, and we are having ongoing conversations with our clients to ensure they submit the appropriate data to OSHA by the July 1, 2017, deadline.

 

Read more On the FrontLine Magazine.

 

 

Danielle Lisenbey, Broadspire President & CEO. As president and CEO, Lisenbey’s goal is to make Broadspire the number one choice for companies seeking claim, disability and medical management services to help increase their employee productivity and contain costs. On the road to excellence, however, Lisenbey knows you don’t have to sacrifice integrity for achievement. She believes in always doing the right thing. Although tough when called for, she prides herself on being fair and demonstrating integrity in everything that she does.  https://choosebroadspire.com/us/

Avoid Ethical and Legal Pitfalls In Workers’ Comp Surveillance

Surveillance can be an effective tool to reduce costs in a workers’ compensation program.  While many service providers can show “injured” employees doing some crazy activities, it comes with a price and often does not produce the desired results.  Before hiring a service provider to engage in surveillance activities, claims handlers and their managers should understand how to use it in an effective manner.

 

 

Use of Surveillance in the Right Case

 

The sheer volume of workers’ compensation claims coupled with the cost of surveillance limits the amount of cases that can use this discovery tool.  A proactive claims management team must set parameters on when it is to be used and for the length of time to conduct surveillance on a suspect employee following a work injury.  Cases that are prime for using surveillance often include:

 

  • Cases where the claimant is likely to or has made a claim for permanent total disability cases. It is understood that these are the cases with the most exposure.  This can also include catastrophic work injuries and their resulting complex claims;

 

  • Instances where you receive a report of possible fraud or other information the employee may be engaging in suspicious activity that exceeds their stated limitations or abilities. Tips should obviously be carefully vetted.  This is especially the case where the tip is anonymous.  Always consider the source; and

 

  • Instances where the information being reported by the employee does not coincide with verifiable information.

 

 

Avoiding Ethical and Legal Pitfalls

 

There are ethical and legal implications to surveillance that may impact your cases.  It is important to act within the confines of the law and other regulations governing a workers’ compensation act.  This also applies to the service providers you hire.

 

Before hiring a service provider, it is important to do your homework.  Before hire them, it is important to verify the company has the requisite licenses or permits to engage in surveillance activities, if applicable.  It is also important to verify the people conducting work on your behalf know the law and follow them.  Checking with state agencies or business bureaus regarding complaints or infractions is a necessary step.

 

 

Practice Pointers and Effective Techniques

 

Given the costs of most surveillance activities, it is important for claims handlers to do their homework in advance.  They should know when the claimant will be in public and report that information to the service provider.  Key events can include:

 

  • When the employee has a doctor appointments or will be seen by an independent medical examiner;

 

  • Civic groups or organizations they belong to and when certain events they may attend will take place; and

 

  • Other activities they like to do outdoors such as exercising or even if they get the mail, go to the grocery store or visit a local coffee shop.

 

 

Selecting the Right Private Eye

 

Other tips for effective surveillance include:

 

  • Selecting a service provider with a track record or proven results; and

 

  • Authorizing a service provider to conduct surveillance activities for at least two to three days in a row. It is also important to allow the investigator to work for at least eight to 10 hours per day to maximize the chance of better results.

 

 

Conclusions

 

Surveillance can be an effective tool to resolve workers’ compensation claims in a timely manner.  It is costly so it is important to use this tool wisely and within the bounds of the law.

 

 

Author Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 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.

6 Ways to Avoid Ransomware

Imagine walking into your office, turning on your computer, and seeing nothing but a message demanding bitcoins in return for unlocking all your company’s files. The nightmare known as ‘Ransomware’ recently became all too real for more than 200,000 computers in more than 150 countries, bringing some hospitals and other organizations to a halt. While those affected were primarily outside the U.S., experts say the perpetrators are ramping up their efforts and they warn all businesses to take steps to prepare.

 

The information typically available within the workers’ compensation system — social security numbers, personal health information, etc., — makes it a must for the industry to take notice of the situation. The good news is there are ways to shield and prevent such attacks from infiltrating your company.

 

 

What Is Ransomware

 

Ransomware takes the idea of hacking to a whole new level. Those spearheading the efforts are not necessarily interested in stealing your data, they really just want to hold it hostage until you pay up — hence the term.

 

Businesses large and small may be equally at risk. In fact, small businesses may be even more at risk than larger ones because of their often more relaxed attitude about cyber security.

 

Ransomware is sophisticated malware that blocks access to a computer by encrypting the data or system until it is unlocked. ‘WannaCry,’ the malware used in the recent incident, is not the only ransomware out there and, in fact, there are even copycat versions of WannaCry now available on the black market.

 

The wrongdoers look for the easiest way to infect a system or network and use it as a means to spread the malicious content. Often, it is through an unwitting employee. Phishing is one of the main ways of accessing a computer, where someone sends emails that that appear to be from legit companies, but are not.

 

Another method is for someone to send a fraudulent email that appears to come from a high-ranking company official seeking sensitive information or money transfers. Lost devices, such as laptops, phones and physical files are another way to break in to a company’s network.

 

 

Ransomware Preventive Measures

 

  • Back it up – twice. An external hard drive should be used for backing up all your files and data; then it should be disconnected from the computer. The cloud may be used for a second backup, such as Dropbox, Google Drive, or OneDrive. However, the cloud application should not be turned on except once per day to sync the data. Another backup source can be an ‘air gapped’ computer or server, that is secure and isolated from other networks.

 

  • Train employees. Unfortunately, unwitting employees may be the most vulnerable part of your cyber security. It’s imperative they understand and are kept up to date on what and how cyber-attacks and ransomware occur and how to prevent them. You can then periodically test employees with mock phishing emails. The training should be ongoing and should include the following:

 

– Review emails closely to make sure they are from a trusted and known sender before links or attachments are opened.

– Never download attachments from spam or suspicious emails.

– Bring Your Own Device (BYOD) training to highlight the risks in downloading suspicious apps on them. On smartphones, only official materials should be downloaded.

– Don’t store important data on the PC, if possible.

 

  • Update software. Computers and software that are outdated are more likely to crash and face cyberattacks. Security updates for Microsoft and other operating systems should be applied immediately, including any patches released to combat WannaCry or malware. Antivirus and anti-spam filters should also be kept current.

 

  • Implement/update security policies. Passwords should be strong; meaning they should contain upper and lowercase letters as well as numbers and symbols; and they should be changed at least every 90 days. A companywide password policy should be strictly enforced. Computer browsers’ security and privacy settings should be adjusted for better protection. Outdated plugins and add-ons should be removed from the browser. An ad blocker should be used to prevent potentially malicious ads.

 

  • Check your policy. If your company does not have a cyber policy, explore the idea of getting one. These typically cover the cost of notifying those whose data has been affected, and even hiring a public relations firm to combat reputational damage. If you have a policy it’s vital to inform the insurer if and when a breach occurs. Other policies that may include coverage are kidnap and ransom, or property policies. In the event of a breach these may help pay for legal costs, data restoration, business interruption and the ransom, if paid.

 

  • Incident response plan. Your company should consider forming an action plan that would kick into effect in the event of a security breach, to help limit costs and damages. It should guide personnel at all levels to help manage the breach. Once implemented, you can run simulated attacks to test your company’s level of preparedness.

 

 

Author Michael Stack, Principal, 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 & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

©2017 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.

Express Scripts & myMatrixx Combine to Offer Best In Class Pharmacy Services

ST. LOUIS, May 17, 2017 /PRNewswire/ — Express Scripts (NASDAQ: ESRX) today announced it is taking an important step in expanding its customized workers’ compensation pharmacy solutions by acquiring myMatrixx, a pharmacy benefit solutions provider for the workers’ compensation industry. The companies will merge core capabilities to deliver best-in-class clinical expertise, advanced analytics, and customized client experiences to serve workers’ compensation clients and injured patients.

 

Express Scripts, St. Louis, Missouri. (PRNewsFoto/Express Scripts)

 

Terms of the transaction were not disclosed. Bryan Cave LLP and Skadden, Arps, Slate, Meagher & Flom LLP served as legal counsel to Express Scripts. SunTrust Robinson Humphrey acted as myMatrixx’s exclusive financial advisor and Akerman LLP served as myMatrixx’s legal counsel.

 

The combination of Express Scripts and myMatrixx will make enhanced pharmacy services offerings available to current and prospective workers’ compensation clients. The combined workers’ compensation team will be led by Artemis Emslie, currently Chief Executive Officer of myMatrixx.

 

“We are proud to create best-in-class pharmacy services for workers’ compensation programs by combining our deep expertise with the market-leading myMatrixx customer experience and technology,” said Express Scripts President & CEO Tim Wentworth. “We are well-equipped to address our clients’ evolving needs. Our unique combination of scale, technology, and a customized client experience sets the standard for workers’ compensation programs.”

 

“myMatrixx’s industry knowledge, technology and client experience have put us at the forefront of pharmacy services for workers’ compensation programs,” said Ms. Emslie, myMatrixx CEO. “With the demand for customized pharmacy solutions only growing, now is the right time to partner with Express Scripts and leverage the size and scale of the nation’s largest PBM to benefit our clients.”

 

With more than 83 million members, Express Scripts brings an ability to invest resources into advanced analytics. Express Scripts will leverage its clinical expertise innovation, client services, and strong marketplace footprint on behalf of its workers’ compensation program. myMatrixx’s strong reputation in the market for client services and agility will generate new growth opportunities and the combination will create more customer value.

 

Underlining the growing need for novel workers’ compensation solutions, earlier this month, Express Scripts released new data finding that the company’s innovative solutions lowered prescription drug spending for workers’ compensation payers overall by 7.6 percent in 2016. Much of this reduction can be ascribed to a sixth consecutive year of decline in overall opioid trend. In 2016, opioid trend decreased 13.4 percent due to a combination of Express Scripts’ clinical solutions, aggressive client management, and state and federal opioid regulatory trends.

 

 

About Express Scripts

 

Express Scripts puts medicine within reach of tens of millions of people by aligning with plan sponsors, taking bold action and delivering patient-centered care to make better health more affordable and accessible.

 

Headquartered in St. Louis, Express Scripts provides integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery pharmacy care, specialty pharmacy care, specialty benefit management, benefit-design consultation, drug utilization review, formulary management, and medical and drug data analysis services. Express Scripts also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

 

For more information, visit Lab.Express-Scripts.com or follow @ExpressScripts on Twitter.

 

About myMatrixx

 

myMatrixx® is a full-service workers compensation pharmacy benefit management company focused on patient advocacy. By combining agile technology, clinical expertise, and advanced business analytics, myMatrixx simplifies workers’ compensation claims management while providing safer medication therapy management. Located in Tampa, Florida, myMatrixx has positioned itself as a thought leader in the workers’ compensation industry.

 

Media Contact:

Ellen Drazen

(314) 684-5355

evdrazen@express-scripts.com

 

To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/express-scripts-and-mymatrixx-combine-to-offer-best-in-class-pharmacy-services-for-workers-compensation-programs-300459277.html – See more at: http://phx.corporate-ir.net/phoenix.zhtml?c=69641&p=irol-newsArticle&ID=2273690#sthash.1V3b2ynl.dpuf

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