Broadspire celebrates its fifth anniversary with Crawford this month.
Broadspire is a third-party administrator that provides workers compensation and liability claim management and related medical management services. It is based in Atlanta, Ga., with 85 locations throughout the United States. Crawford & Company, Broadspire’s parent, is the world's largest independent provider of claims management solutions to the risk management and insurance industry as well as self-insured entities, with an expansive global network serving clients in more than 70 countries.
According to Crawford President and CEO Jeffrey Bowman, the Broadspire brand was formed when Crawford & Co. acquired it in 2006 and merged it with Crawford Integrated Services. The acquisition more than doubled the company’s workers compensation business. It is now a $1 billion company.
The acquisition kept the Broadspire name but rebranded Crawford’s risk and healthcare management operations.
Bowman said his company’s goal was to combine the best of two TPAs into a single, industry-leading organization. “Five years later, I’m happy to say that we have accomplished that, and much more. As the world’s largest independent provider of claims management solutions, Crawford and its global infrastructure help ensure that clients receive consistent service, data analytics and practical solutions,” he said.
The company’s list of accomplishments is long.
For example, Broadspire’s COO in medical services, Danielle Lisenbey, was recently named a LexisNexis workers compensation notable person for 2010 for her exceptional leadership.
Lisenbey is responsible for the daily operations of Broadspire’s medical bill review (MBR), utilization management, telephonic case management and field case management teams and the physician review and medical unit. Her career with Broadspire began in 1991 as an operations supervisor for the MBR unit, and she progressed through that organization, serving at various times as manager, director and vice president.
Her success in MBR operations prompted the promotion to her current position in 2007. She holds a bachelor’s degree in industrial engineering and technology from Western Illinois University. She is a member of The Society of Manufacturing Engineers and The National Association of Women Executives.
Among the company’s recent innovations include:
1. The Broadspire Original Landmark Design (BOLDSM) PPO network that analyzes medical data and outcomes.
2. Their Chronic Pain Management Program helps clients deal with pain through a proprietary system of candidate identification, triage, plan development and follow-up. They can maximize employees’ functionality, reduce dependence on medication and return people to work faster.
3. A durable medical equipment (DME) formulary that applies the cost management principles of a pharmacy formulary to DME, meeting the medical needs of an injured worker while at the same time ensuring a measurable reduction in the cost of equipment and supplies.
4. A comprehensive chronic pain management program that uses an interdisciplinary approach to maximize an injured worker’s quality of life, reduce medication dependence and control costs.
5. Broadspire@HomeSM assists patients with getting the medical support they need, avoiding protracted hospital stays and saving thousands of dollars in healthcare costs.
6. The company has also hosted a number of technology changes since joining with Crawford, including investments in claims and risk management information systems (RMIS) that allow them to handle claims more efficiently and use analytics to improve clients’ business results.
7. RiskTech® is Broadspire’s new claims system. It captures information to improve claims management effectiveness.By moving workers compensation and liability claims professionals to a single claim system, Broadspire is able to streamline processes, improve data flow and produce optimal loss cost results.
8. The company also enhanced e-Triage®, their proprietary web-based application that addresses the biosocial aspects of claims.
9. Dmitri® is Broadspire’s next-generation risk management system. It provides clients with total access to information. It allows clients to access data from any web browser in real time.
According to Broadspire president and CEO Ken Martino, the future holds many things for his company, including:
1. Creating more functionality and delivering more features in the technology that serves customers.
2. Investment in analytical capabilities to offer more benchmarking data and an even greater number of tools.
3. New services that return healthy employees to productivity and help employers control the cost of their workers compensation programs.
4. An expanded global footprint to serve international customers.
5. More education for their 2,000 employees.
Author Rebecca Shafer
, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Oklahoma Insurance Commissioner John Doak, recently reported the company, which manages the nation’s largest database of workers compensation insurance information, has filed a request with the Oklahoma Insurance Department to decrease the cost of workers comp insurance in Oklahoma.
According to Doak, the National Council on Compensation Insurance Inc. (NCCI) filed to reduce workers compensation insurance rates in Oklahoma by 1.7 percent starting Jan. 1, 2012. The Commissioner said NCCI attributed the rate drop to this year’s passage of Oklahoma Senate Bill 878. Before the passage of SB 878, rates were expected to increase again. (WCxKit)
Reforming Oklahoma workers comp law was high on Governor Mary Fallin’s agenda, and SB 878 received overwhelming support from both parties in the Legislature.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
For the employee or the employer unfamiliar with workers compensation terminology, the terms medical management and utilization review sound similar. An employee should be accustomed to workers compensation terminology in case of injury and to understand the medical treatment process. The differences between medical management and utilization review should be understood by the employee and the employer alike. While both medical management and utilization review involve the use of a nurse, the two areas are quite different.
Medical management is the coordinating and planning of medical care provided to expedite the employee's return to work or to help the employee maximize medical improvement. Medical management is normally the responsibility of the nurse case manager (NCM). (WCxKit)
Utilization review is the evaluation of medical care being provided to the employee to determine the medical necessity and appropriateness of medical treatment being provided for an injury. The utilization review is conducted by a registered nurse (RN) who has a utilization review physician available for a medical opinion should the nurse be unsure of medical treatment.
8 Responsibilities of the NCM Involved in the Workers Compensation Claim
1. Facilitating the medical rehabilitation of the injured employee.
2. Coordinating the medical care between different providers to achieve the best possible results in a cost-effective manner.
3. Consultation with the medical provider to determine the best treatment plan for the injured employee.
4. Act as a liaison and facilitating the communication between employer, employee, and insurance adjuster.
5. Monitoring the employee’s medical progress.
6. Assisting the employer in identifying the return to work options.
7. Coordinating the employee's return to work, whether full or modified duty, with the employer, the employee, and the medical provider.
8. Insure utilization review is brought in on all medical care and/or medical services when appropriate
Note: not all NCM is alike – look for providers who use licensed RNs and are URAC Certified. Determine how much clinical experience the NCM's have — good ones have 3 years minimum clinical experience and 15 years average clinical experience. Senior Nurse Reviewers (SNR) are a higher level of NCM that provides medical oversight on the file the whole way through. The SNR sees the Triage File, Treater File, 3-point contact, and Duration Guidelines.
4 Types of Utilization Reviews Used by the Nurse Involved in the Workers Compensation Claim
1. Pre-certification reviews occur prior to the medical care being provided. The RN collects all the necessary information including the symptoms, diagnosis, results of tests, and the reasons the physician is requesting the medical service. The RN compares the information against the normal criteria for treating a specific type of injury. If the medical care is deemed necessary, it is approved. If the medical service is not necessary, the utilization review physician is asked to verify the denial of the service requested is correct. Nurses use medical guidelines such as MDGuideines which tell the appropriate length of time out of work or disability for any given injury, co-morbidity and even zipcode. Good TPAs have these guidelines at their fingertips.
2. Concurrent reviews occur during the time medical treatment or service is being provided. This can be either for a patient in the hospital or for on-going outpatient care. The RN follows the same approach with the concurrent review as followed in the pre-certification review.
3. Retrospective reviews occur after the medical service has been provided for either an in-patient or out-patient service. The RN again follows the same criteria as with a pre-certification review.
4. Re-reviews occur when the pre-certification review, concurrent review, or retrospective review result in medical care or medical payments being denied. When a re-review is requested, the utilization review physician will go over all the information to determine if the prior decision was or was not correct. (WCxKit)
Utilization Review provides an objective opinion as well as a client liaison, to ensure the right treatment is received at the right time based on evidence-based medicine. The review considers medical necessity and sometimes causal relationship to the injury, not cost.
It is in the employers and the insurers best interest to provide both medical management and utilization review on any indemnity claim or enhanced medical only claim. By combining medical management with utilization review, the employee receives the best medical care at the optimum cost. This has a positive impact on the employer's future workers compensation premiums and builds employee loyalty as the employee feels he or she is given the best possible medical care, a win-win situation for all. It can be very effective to use Nurse Triage at the time of injury, Senior Nurse Reviewer throughout the life of the claim and Utilization Review
Note: All utilization review and medical management providers should be URAC Certified. This rigorous credentialing process has separate categories of for Utilization Review and Nurse Case Management. Your providers should be certified in both areas if they are providing both services. ASK THEM.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Resist the temptation to sacrifice great service for cheap workers comp insurance. It is certainly good business to watch the bottom line, but you must find a balance between cost and great service. Everyone watches the bottom line – that is just good business. Of course, a “low bid” does not necessarily mean getting bad claim service, and going with the most expensive carrier will not guarantee great service.
Employers do not want to sacrifice service for cost so here are five tips to be mindful of when dealing with the lowest bidder. (WCxKit)
1-The lowest bidder may have the least amount of staff
Less staff equals less cost. Less cost means the bidder can offer a lower premium and still make a profit on the claim ratio — premium collected vs claim expense paid out.
Fewer adjusters to handle more claims are good claims adjuster’s biggest enemy — high pending claim count. Get to know your claim adjusters and see what their pending caseload looks like. The higher the caseload, the more likely something will fall through the cracks. You do not want it to be your claims.
2-All the adjusters may be in one location
You want an adjuster who will be on top of all local aspects of your claims. Adjusters in your local jurisdiction know about local doctors, judges, attorneys, vendors, etc. They know the good from the bad. Adjusters in other states may not be as privy to this information, and that can prolong a claim or affect the compensability. If you do business in California, and your adjuster is in Florida, the adjuster misses local information crucial to the claim.
3-The lowest bidder may want any premium possible
Some carriers need premium dollars so badly; they underbid their competition just to collect premiums. They gamble on not paying off on a severe workers comp claim under their coverage. You might get decent service, but the stereotype is that the lowest bidder from the smallest carrier usually results in mediocre service to the employer. Make them prove this wrong.
4-Does low bidder have a poor reputation?
Ask these questions of your peers, broker and others you trust:
1. How does this carrier stack up against their competition?
2. Are they known for denying every case or settling every case?
3. Do they have poor communication?
4. Do other employers avoid this carrier at all costs?
5. Are they familiar to local judges pre-conditioned on how to decide the case?
6. Does the carrier pair underbidding premiums with poor adjusting?
7. Does the plaintiff’s attorney know your carrier settles and does not push cases to trial? If so, that means anyone coming into their law office with a disputed workers comp claim will ask for the moon – benefiting the claimant and the attorney, but not you, the employer.
5-Make sure your broker provides broad spectrum of pricing
At renewal of your workers comp insurance policy, ask for a spectrum of premium costs from cheapest to most expensive, from a variety of carriers. Agents affiliated with only a few carriers (or only one) limit an employer’s choices. If you only get two choices, and you choose the cheapest, you may be missing another carrier perhaps slightly more expensive, but with a better reputation for service.
Do your homework. Look around, do some research, ask people in the business. Most carriers have established a reputation. Find out how they do business. You want to be represented by the best of the best. You do not cut corners in your business and you do not want a carrier cutting corners at your expense. (WCxKit)
Summary:
Even if a carrier has a lower price than their competition it does not necessarily mean you will get poor claims service; but, history shows a good reputation is not always on the side of the lowest bidder when it comes to handling claims. Do your research. Ask questions. Make sure the carrier you select will work diligently on your behalf. You have enough to worry about as an employer; do not make your insurance needs another item on the list.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
A Professional Employer Organization (PEO) offer employers the opportunity to outsource a variety of services including workers compensation insurance, other types of insurance administration, payroll administration, management of human resources, employee benefits and taxes. The PEO takes over the administration of these employer functions, allowing the employers to focus on their core business. This allows the employer/client to reduce their administrative cost and to provide access to lower cost benefits.
1- PEOs are utilized by many types of small businesses, but are especially prevalent in industries where there is high risk of workplace injuries, like the construction industry. PEOs are often used by temporary staffing agencies due to the staffing agencys ever changing workforce. PEOs frequently take over the hiring and recruiting of employees for employers. By hiring the employees, the PEO becomes the employer of record for workers compensation purposes and tax purposes. This is often referred to as co-employment as the employee is performing his work functions for the PEOs client, but is an employee of the PEO for insurance and tax purposes. (WCxKit)
2- A promotional point PEOs use to obtain clients is their ability to obtain workers compensation insurance cheaper than the employer can obtain on their own. The PEO obtains workers compensation coverage for both the PEO itself and and for it employer clients. This is allowed because the PEO is the co-employer of the employees of the client companies. The PEO uses economies of scale to purchase the workers compensation insurance at a lower cost than a small employer would pay for the coverage. However, the various different types of employee classifications in a PEO can make underwriting of the PEO difficult for the workers compensation insurance company.
3- PEOs also promote they can improve the clients cash flow by reducing or eliminating the down payments associated with the purchase of workers compensation insurance. Depending on the size of the client employer and the amount of other insurance, employee benefits, taxes, etc that are taken over by the PEO, the client employer may not incur any finance charges for their work comp insurance premiums. In some cases, PEOs will utilize a pay-as-you-go work comp program (monthly work comp premium payments with coverage extended month by month).
4- As PEOs are in the business of managing the benefits, taxes and insurance for employers, they have the expertise to effectively manage and control workers compensation claims for their clients. PEOs will normally require their client employers to have a return to work program that puts employees back to work on modified duty as soon as the treating physician will allow the employee to do so.
5- Another PEO benefit that impacts workers compensation is the PEO will provide and verify the safety programs of their clients. While the client company will be responsible for administering the safety program, the PEO will retain the right to perform safety inspections to verify the client employer is complying with the safety program and is providing a safe environment for work. This benefits all employers within the PEO by lowering the number of work comp claims for the PEO.
6- Some PEOs will turn down potential new clients if they have a poor claims experience history or if the client has a substandard safety program and is unwilling to accept the safety inspections and safety requirements of the PEO. If the PEO is not protective of their loss experience history, the work comp insurance rates will increase, negatively impacting the PEOs ability to attract new clients.
7- Employers who are considering the utilization of a PEO to manage their administrative programs, taxes, benefits and workers' compensation insurance, should evaluate the PEO on its:
1. experience in their industry
2. its safety program and risk management assistance
3. its return to work program required of all clients
4. its financial stability
5. its workers compensation insurance program cost
6. its workers compensation insurer (A or higher rating with A.M. Best)
7. its workers compensation third party administrator (if the claims are not handled by the insurer)
8. the cost of all of its other administrative functions (WCxKit)
8- PEOs can reduce the cost of workers compensation and other administrative requirements of the employer. The client employer does give up some control over administrative functions (which can be a good thing). PEOs charge a service fee for handling the workers compensation and other administrative functions which most PEOs will claim is more than offset by the savings they provide on the cost of workers compensation and other employee benefits.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
One area of workers compensation that varies significantly from state to state is how volunteers are treated by the workers compensation statutes. While employees are almost always covered for workers compensation, work comp coverage for volunteers is not mandatory in most states. The different states do not even agree on whether or not a volunteer is entitled to workers compensation benefits. In the states that do allow workers compensation benefits for volunteers, there is no uniformity of what constitutes a volunteer. Therefore, this discussion of volunteers and workers compensation will be generic.
While volunteers can be found in almost any type of business, they are most often associated with charitable organizations, religious organizations, non-profit organizations,
hospitals and governmental departments – like volunteer firefighters, paramedics, forest service and parks. (Some states that do not recognize volunteers as employees make exceptions for volunteer firefighters covering them as employees while not covering other volunteers). (WCxKit)
Workers compensation is meant to cover employers for employees who are injured while working. A volunteer, is not an employee, but is providing a benefit to the employer. By definition, a volunteer is a person who provides services without the expectation of compensation or any kind. To be a true volunteer, the person providing the volunteer service – not the employer – determines when the volunteer works, both how often and how long. If the employer is setting precise hours, and treating the volunteer as an employee in every way except compensation, some states will consider the individual an employee not a volunteer.
The first question the workers compensation insurer will ask when a work comp claim is presented for a volunteer is: Does the volunteer receive any form of compensation? Compensation does not mean a salary or hourly wages. Compensation in the case of a volunteer can be anything – a living allowance, a discount not available to others, vouchers, room and board, a stipend, certificates, credits, etc. If the volunteer receives any benefit in exchange for the volunteer service being provided, the volunteer will be treated as an employee. If the volunteer does not expect to receive anything of value for the services being provided, than the person is truly a volunteer for the purposes of workers compensation.
When a volunteer is covered by the workers compensation statutes of the state, the medical benefits provided by workers compensation will be the same as the medical benefits of a regular employee. The question that often comes up is how are indemnity benefits handled for a volunteer that is unable to resume their volunteer duties for the employer? Different states handle this in different ways. Some states will require the insurer to pay the volunteer the state minimal indemnity amount per week. In some states the employer and/or insurer will try to calculate the value of the volunteers services to establish a value for disability payments. Other states provide the volunteer with no indemnity compensation, just medical benefits.
Some states, for instance California, allow employers to “opt in” for workers compensation coverage of their volunteers, regardless of whether or not the volunteers receive any benefit from their volunteer work. This is beneficial to the employer as it eliminates the potential for an injured volunteer bringing a tort claim against the employer for an injury.
The workers compensation insurer bases its premium calculation on the gross payroll for the employer. The volunteer, who is receiving no pay, is not included in the premium calculations, but increases the insurers exposure to claims. This can create issues with the insurer when they are paying the work comp claim of an injured volunteer. If an employer knows it will have volunteer workers, the employer should make that fact known to the insurer to prevent a coverage dispute from erupting after a work comp claim is filed.
While adding volunteers with the work comp insurer will increase your work comp premium, it is better to have the workers compensation coverage than to be exposed to the volunteer bringing a liability lawsuit against your company. If the volunteer brings a tort action against your company, their potential monetary recovery is much higher than it is under work comp. In a tort claim, not only does the volunteer have the potential to recover their medical cost, they can recover for any pain and suffering they have endured as a result of the injury. (WCxKit)
If you have volunteers working for your organization or business, you need to familiarize yourself on how your state treats volunteers when it comes to workers' compensation. Please consult with your state workers' compensation agent, broker, board or industrial commission on how volunteers are handled for the purpose of workers' compensation in your state.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. www.LowerWC.com
Contact: RShafer@ReduceYourWorkersComp.com .
WC IQ TEST: http://www.workerscompkit.com/intro/
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
A Jacksonville, Florida man was taken into custody recently for his alleged role in a workers comp scheme. According to a statement from the office of Chief Financial Officer Jeff Atwater, 49-year-old David Rodriguez-Socarras cashed nearly $3 million in payroll checks through a "shell " company in order to avoid paying payroll taxes and workers comp premiums. (WCxKit)
The bureau of Worker's Compensation Compliance served a stop work order on his business, HMV Construction Incorporated, and discovered 57 certificates of insurance had been issued to companies statewide.
Atwater's office said shell companies are frequently created for money service businesses, such as check cashing stores, to cash payroll checks without paying the taxes and premiums. "Unlawful acts, such as these, hurt honest business owners, our state's economy and Floridians who bear the cost of these crimes," said Atwater. (WCxKit)
Socarras faces felony charges including application fraud, workers comp fraud, criminal use of personal identification information, fraudulent application for a Florida driver's license or ID card and possession of a fraudulent Florida driver's license or ID card. If found guilty, Socarras could be looking at 20 years in prison.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
© 2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. Reformating or rewriting articles and using them as your own is a violation of copyright law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
In Georgia, every employer who has three or more employees, whether full time or part time is required to carry workers compensation insurance. There are some exceptions – work comp coverage is elective for planning commissions, partners, sole providers, licensed real estate agents and brokers, agricultural and domestic workers. All county and municipal governments and all school districts must carry workers compensation insurance.
Obtaining Coverage:
To obtain workers compensation coverage in Georgia, the employer has two options which are:
1. purchasing a workers compensation insurance policy from a state approved insurance company
2. qualifying as an approved self-insured employer and posting a surety bond or a letter of credit with the state
Claim Reporting:
The employee must report the injury to the employees supervisor within 30 days of the occurrence. The employer is required to file the Employers First Report of Injury form, WC-1 with the Georgia State Board of Workers Compensation. If the employer fails to file the WC-1, the employee can report the claim to the Board of Workers Compensation by filing state form, WC-14, Notice of Claim. (WCxKit)
Medical Benefits:
The employer must provide a list / panel of at least 6 doctors (at least one doctor must be an orthopedist) for the employee to select from. If the employer fails to post a panel of doctors for the employee to choose from, the employee is allowed to select his own doctor. The employee has the right to switch one time to another doctor on the panel. A unique aspect of Georgia law is the employee who is being paid indemnity benefits can demand a “claimants independent medical examination” by the a doctor of the employees choice (i.e., employee's attorneys choice) within 60 days of the start of indemnity benefits, paid for by the work comp insurance company.
All authorized medical care and associated expenses (prescriptions, prostheses, mileage reimbursements) are covered by workers compensation. All billing of medical services by medical providers must be in compliance with the Georgia Workers Compensation Medical Fee Schedule, which is updated on April 1st of each year.
Temporary Total Disability Benefits:
The temporary total disability (TTD) benefits are calculated as two-thirds of the employees average weekly wage over the 13 weeks prior to the date of injury, not counting the week of the injury. The maximum amount of TTD benefits that can be paid weekly is changed by the Georgia Legislature from time to time. There is no automatic cost of living increase. The maximum TTD benefits per week for injuries are $500.00 per week. The state minimum weekly benefit is $50.
The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days. TTD benefits can be paid for a maximum of 400 weeks.
Temporary Partial Disability Benefits:
In Georgia, the employee will receive TTD benefits as long as the employee is off work from the injury (up to 400 weeks). If the employee is able to return to any type of work, but at a lesser rate of pay then the amount the employee was earning prior to the injury, the employee is entitled to temporary partial disability (TPD) benefits. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage. The TPD benefits are paid for up to 350 weeks from the date of injury. The TPD benefits plus the post-injury pay rate can not exceed the state's maximum indemnity benefits rate.
Permanent Partial Disability Benefits:
Georgia employees are paid permanent partial disability (PPD) benefits for any permanent disability suffered as the result of an on-the-job injury. Once the employee has reached maximum medical improvement, the authorized treating doctor assigns a disability rating based on the American Medical Association Guidelines. Georgia uses a schedule of injuries for limbs, vision and hearing. The loss of an arm or leg is worth 225 weeks of indemnity benefits (with a week calculated the same as TTD). The schedule decreases as the size of the limb decreases with a small toe being worth 20 weeks. A person with an injury to body as a whole is worth up to 300 weeks of indemnity benefits. For example, if the treating doctor gives the employee a 10% disability rating to the back, and the employees TTD rate was $500 per week, the employee will receive $15,000 ($500 X 300 X 10%).
Catastrophic Disability Benefits:
Georgia permits the employee to collect a maximum of 400 weeks of indemnity benefits for all types of indemnity combined, unless the employee is classified as having a catastrophic injury which is defined as:
1. Spinal cord injury causing paralysis to an arm, leg or trunk
2. Amputation of an arm, leg, hand or foot involving the effective loss of use of the body part
3. Severe brain injury
4. Second or third degree burns over 25% or more of the body, or third degrees burns to 5% or more of the face or hands
5. Total or industrial blindness
6. Any other injury that prevents the employee from being able to work (employees attorneys love this one)
If the employees injury is designated as a catastrophic injury, the employee can draw indemnity benefits for life.
Death Benefits:
The burial expenses in Georgia are covered for a work-related death up to $7,500. The death benefits for a dependent spouse and children follow the same guidelines as TTD benefits – two-thirds of the average weekly wage – currently a maximum of $500 per week, up to a maximum of 400 weeks, except there is a dollar maximum for death benefits in the amount of $150,000. If there is no spouse or dependent children (includes step children and adopted children), death benefits can be paid to dependent parents, college students and disabled adult children. (WCxKit)
Vocational Benefits:
Georgia workers compensation law also includes rehabilitation benefits / vocational benefits. If the injured employee is unable to return to their prior job due to disabilities from their on-the-job injury, Georgia requires the employer / insurance company to pay for the cost of retraining the injured employee to perform another job. In addition to job retraining, vocational benefits include:
9. Vocational evaluation
10.Vocational counseling
11.Psychological testing and evaluation
12.Job analysis and job modification
13.Job placement
Vocational rehabilitation is in the best interest of the employer, the employee and the insurance company as placement in a new job reduces or eliminates the amount of TPD that will be paid, and stops the employee from making a claim for catastrophic indemnity benefits.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
Normally, workers compensation is considered an exclusive remedy. The employee can not sue the employer and the employer can not deny a claim because of the negligence of the employee. In the monopolistic state of Ohio (meaning the state government is the provider of workers compensation, not private insurance companies) there is a unique law that allows the employee to make a claim directly against the employer for violation of specific safety requirements (VSSR).
Ohio state government, as the primarily insurer for workers compensation (Ohio does allow some large companies that have the financial resources to self insure) understands that safety rules and regulations prevent accidents. The Ohio Bureau of Workers Compensation and the Ohio Industrial Commission (two separate state agencies) promotes safe working conditions and provide hundreds of resources to Ohio employers on how to operate their business in a safe manner. It also awards employers with lower insurance premiums for having a good safety records. (WCxKit)
Ohio uses the carrot and stick approach to moving the donkey. If the carrot (lower insurance premiums) does not get the donkey (employer) to have a safe work place, there is the stick (VSSR Awards). Ohio employers are required to provide a safe workplace and to comply with the specific safety requirements set forth in the Ohio Administrative Code. The Ohio Administrative Code is too long to summarize adequately in this article, but it is somewhat similar to OSHA safety requirements. Much of the Ohio Administrative Code safety requirements are common sense – if you are high up on a scaffold you have protective railings, you don't operate cranes under high voltage lines, you wear a hardhat at construction sites, you have machine guards to keep hands out of the hydraulic press, etc.
If an employee believes his/her injury was due to the employers failure to comply with a specific safety requirement set forth in the Ohio Administrative Code, the employee may apply for a VSSR Award – an additional award of compensation over and above what the Ohio Bureau of Workers Compensation will pay in indemnity benefits. If the employee contributes to their own injury by not following the safety guidelines for their job, or if the employee failed to use the safety equipment provided by the employer, the employee is not eligible for a VSSR Award.
In Ohio, the maximum weekly temporary total wage loss benefit for the year 2010 is $775.00 per week and the maximum in 2011 will be $783.00 per week, with minimums of $258.33 in 2010 and $261.00 in 2011. The VSSR award will be no less than 15% and no more than 50% of the maximum weekly compensation rate. It is paid weekly over the life of the claim. [For example, the VSSR award is 50% of the $775 weekly temporary total benefit or $387.50 per week. The employee is off work for 20 weeks, the VSSR Award is $7,750 ($387.50 X 20). The stick – the employer must pay the award to the employee, not the Ohio Bureau of Workers Compensation.
But wait, it gets worse. The Industrial Commission can impose an additional penalty against the employer of up to $50,000.00 if the employer has had two or more safety violations in the preceding 24 months.
Fortunately, the employee can not just make an accusation of a violation of a specific safety requirement and get a VSSR Award. The employee or the employees attorney must file state form IC-8/9 with the Ohio Bureau of Workers Compensation within two years of the injury. The Industrial Commission will send a notice to the employer after it has received the application for a VSSR award. The employer is required to file an answer within 30 days of notification.
The Bureau of Workers Compensation has a safety violations investigation unit (SVIU) which will assign the investigation to an impartial investigator. The SVIU sends a request to the employer listing common information requested. The employee is required to provide the SVIU with the names of people who can provide additional information about the alleged safety violation. The SVIU investigator will do an inspection of the accident site, interviews with fellow employees and supervisors, obtain affidavits and any additional information relevant to the investigation. The investigator then files a report with Industrial Commission.
The Industrial Commission forward copies of the SVIU report to all parties of interest. Everyone has 30 days for any additional information or documentation anyone wants to submit. After the 30 days, a hearing is held where the employer and the employee meet to discuss a possible settlement. If the employer and employee agree on what the VSSR Award will be, the VSSR Award is paid by the employer. If the employer and employee can not agree, the Industrial Commission schedules a hearing at which the Industrial Commission renders a decision based on the merits of the case of what the VSSR Award will be, if any award. (WCxKit)
If you are an Ohio employer, now is a good time to review your safety program to be sure you are in compliance with all safety requirements for you industry. (Even if you are not an Ohio employer, now is a good time to be sure you are maximizing your safety procedures). Any employer who needs assistance with their safety program should contact us.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
Workers Compensation Laws change frequently. This is only a summary; a complete copy of the most up-to-date version can be found at: www.WorkCompResearch.com an excellent service.
Ohio has a very unique workers compensation system. It is a monopolistic state meaning the Ohio state government provides the workers compensation insurance through a state insurance fund. There are no private workers compensation insurance companies. Ohio does allow employers to self-insure their workers compensation coverage, if the employer has the financial resources to do so and is approved by the state for self-insurance.
Workers Compensation is handled by two state agencies. The Ohio Bureau of Workers Compensation (BWC) administers the insurance program. The BWC pays the medical bills and the indemnity payments. In the case of any dispute with the BWC, the dispute is referred to the Industrial Commission (IC). The IC is responsible for resolving all contested issues. (WCxKit)
In Ohio, every employer, including farm owners and operators, with one or more employees must have workers compensation insurance. It does not matter if the employee is full time or part time. It does not matter if the employee is a seasonal worker. Even family members who work for the small employer must be covered by workers compensation insurance. The only exception is the single domestic employee who makes less than $160 every 3 months.
In Ohio, independent contractors must carry their own workers compensation insurance. If an employer in Ohio hires an independent contractor, the employer should obtain a copy of the independent contractors Certificate of Premium Payment and verify the dates of coverage.
Claim Reporting:
The employee must file a claim within two years of the occurrence or knowledge of the injury or the occupational disease. Ohio has its own First Report of Injury form that is used to file the claim. The employer must report the claim to the BWC within 7 days of notice of the claim. A unique twist is the claim can also be reported to the BWC by the medical provider.
Medical Benefits:
All medical expenses are covered by Ohio workers compensation. The medical bills are paid directly to the medical provider as long as the medical provider has been certified by the BWC or the self-insured employer. The employee can select the medical provider of their choice, as long as the medical provider is a part of a managed care organization selected by the employer.
Temporary Total Disability (TTD) Benefits:
Another unique characteristic is the way TTD benefits are calculated. During the first 12 weeks of TTD, the employee is paid 72% of his/her gross wages. After 12 weeks, the percentage of TTD drops to two-thirds of the gross wage. The weekly maximum for 2010 is $775 and for 2011 the weekly maximum is $783. The weekly minimum TTD benefit is $258.33 in 2010 and $261.00 in 2011. TTD benefits are paid until:
1. the employee has returned to work
2. the employee has reached maximum medical improvement
3. employment is made available to the employee within the physical restrictions given by the MCO provider (think modified duty return to work)
4. the employees physician gives a written statement that the employee can return to work performing the same duties as prior to the injury
Wage Loss (WL) Benefits:
In other states this is known as temporary partial disability. If the employee is returned to work in a light duty capacity and is unable to perform the same duties as before, or is returned to work with reduced hours, WL is paid to offset a reduction in earnings as a result of the injury.
Permanent Partial Disability (PPD) Benefits:
The BWC uses a schedule of injuries to determine the amount of PPD benefits that will be paid for specific body parts like fingers, legs, eyes, etc. For non-scheduled injuries, payments are limited to one-third of the average weekly wage for a maximum duration of 200 weeks. There is a 26 week waiting period from the last payment of TTD before PPD benefits can start.
Permanent Total Disability (PTD) Benefits:
If the medical provider determines the employee can never return to work, the employee will be classified as PTD. The PTD rate is the same as the TTD rate, and it is payable to the employee for the rest of the employee's life.
Living Maintenance (LM) Benefits:
Another unique aspect of Ohio workers compensation is the LM benefit. If the employee is unable to return to the prior position at the same employer, and is participating in an approved rehabilitation plan, the BWC will continue to pay the employee for up to six months while they complete their vocational rehabilitation.
Death Benefits:
In the event of a work related death, there is a burial allowance of $5,500 payable to the estate. If the employee has a surviving spouse or dependents, the spouse and dependents receive two-thirds of the average weekly wage up to the state maximum, with a maximum cap in 2010 of $775.00 per week and $783.00 per week in 2011. The minimum is one-half of the maximum, $387.50 per week in 2010 and $391.50 in 2011. The Hearing Officer determines how the weekly amount will be split between the spouse and other dependents. The spouse can receive the weekly benefit for life if the spouse does not remarry. If the spouse remarries, the spouse receives a lump sum equal two years of benefits, with the remaining dependents continuing to receive the weekly amount.
Lump Sum Settlements:
If the BWC and the employee agree they can enter into a lump sum settlement for the value of the future medical benefits. When the employee accepts a lump sum settlement, the employee becomes responsible for all future medical care.
Violation of a Specific Safety Requirement (VSSR) Awards:
If an employee believes his/her injury was due to the employers failure to comply with a specific safety requirement set forth in the Ohio Administrative Code, the employee may apply for a VSSR Award – an additional award of compensation over and above what the Ohio Bureau of Workers Compensation will pay in indemnity benefits. If the employee contributes to their own injury by not following the safety guidelines for their job, or if the employee failed to use the safety equipment provided by the employer, the employee is not eligible for a VSSR Award. (WCxKit)
The VSSR award will be no less than 15% and no more than 50% of the maximum weekly compensation rate. It is paid weekly over the life of the claim. [For example, the VSSR award by the IC is 50% of the $775 weekly temporary total benefit or $387.50 per week. The employee is off work for 20 weeks, the VSSR Award is $7,750 ($387.50 X 20). If the investigation by the IC determines the employer failed to properly provide for the safety of the employee, the employer must pay the award to the employee, not the Ohio Bureau of Workers Compensation.
If you are an Ohio employer and have questions about your workers compensation system, Here is a link to the updated laws feed for more infromation http://reduceyourworkerscomp.com/laws_and_regulations.php
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
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