9 Steps to Integrate Your Absence Management Policies

Navigating the minefield of workers’ compensation and other absences can be a nightmare for employers. The patchwork of policies and procedures overseen by multiple departments or vendors can result in compliance problems as well as decreased morale for workers, plus a waste of money and resources.

 

By integrating leave programs, employers can see significant cost savings, fewer days away from work and improved productivity. But going from a mixture of rules and regulations to a single, streamlined system can be daunting, especially for smaller organizations.

 

 

The Challenges

 

There are a variety of federal, state and municipal programs. The Family Medical Leave Act, Americans with Disabilities Act, short- and long-term disability, and workers’ compensation are just some of them, along with state, county and municipal leave laws and employer-specific leaves. Some may overlap. Some involve payments, while others do not. And they change frequently — through amendments or the implementation of new leave laws. Keeping up to date with them all and ensuring you administer them properly is a challenge for even the largest employers.

 

There are likely multiple contact points, depending on the type of leave involved. Each leave involves forms that must be filled out and, sometimes, require payments. If outside vendors are used, inaccurate information sharing may result in payments being too little or too much. Employees may receive information from multiple vendors, causing confusion and frustration. Finally, it’s nearly impossible for an organization to analyze the data and understand the impact of absences — unless the systems are integrated.

 

Getting a streamlined, integrated system involves collaboration, more than anything. Where there are silos within a company, those within them must be willing to work with one another and share information. At the least, HR, legal, benefits and risk departments must cooperate.

 

 

 

Leave Integration Programs

 

Integrating occupational and non-occupational leave programs can take a variety of forms, from the simple to the highly sophisticated. The more advanced models include wellness, disease management and even employee assistance programs.

 

Whatever type of program is implemented, integrating leaves generally results in overall lower costs and possibly better outcomes. You can start the process by taking stock of what’s already in place at your company.

 

  • Look at your data. Starting an integrated leave program should begin with an assessment of the amount and cost of absences taken annually by employees. Employers who do so typically find their employees are taking off more time than they realized, pointing to the need to take action.
  • Talk to your partners. Third party administrators and insurers, along with any vendors you use should be willing to provide data and other information that sheds light on the management of your leave programs; as well as what they do for other employers..
  • Read the handbook. Take a close look at the policies and procedures already in place for various leaves. You may find some that duplicate or contradict one another.
  • Bring in the troops. Departments that have any responsibility for absence programs should be included in discussions right from the start of the integration process. You might find ways to automate some of the existing processes.

 

 

Building the Program

 

Once you’ve seen a picture of your company’s leave programs and looked at the data, there are several key factors that can help make for an effective IDM program.

 

 

1) Single Claim Intake Source.

 

This will reduce administrative costs and make it an easier, more pleasant experience for employees. Having one phone number is a great way to ensure all leave requests are captured in a single source. This could also allow for a single provider to contact the worker if their leaves constitute more than one, such as short-term disability and FMLA.

 

 

2) Communication 

 

Any and all changes to leave policies should be shared with managers, supervisors and employees. It’s imperative that everyone has the most up to date information.

 

 

3) Collaboration

 

As explained above, integrating your absence management programs should involve personnel from several different departments who must work together. Workers’ compensation, group heath, disability insurers, legal counsel, and any other organizations that manage employee health should discuss how they can combine their data and resources. During such meetings, goals should be set and roles and responsibilities should be discussed and agreed upon.

 

 

4) Data Sharing / Tracking.

 

Employers can look at trends for such things as frequency, duration, cause, occupation and business unit to determine if and where changes could be made to reduce costs and improve productivity.

 

 

 5) Updates

 

Changes in laws that affect any of your leave programs should be brought to the attention of all involved. The team can assess the changes and determine how to proceed. There should be a process established to update leave programs depending on changing needs of your company. In addition to tracking legal and internal changes are technological advancements that should be considered. For example, having an app for employees to report absences might be useful.

 

 

6) Uniformity.

 

It is crucial that leave policies be administrated consistently and clearly.

 

 

7) Evaluating The Program.

 

Depending on how the program is handled, you want to be able to see the effectiveness. It may involve a software system or outsourced organization. Ideally, you should be able to identify lost time, costs and return-to-work rates, and see what if any changes should be made.

 

 

8) Keep Good Records.

 

Proper documentation will ensure your company is not on the losing end of a complaint.

 

 

9) Consider Outsourcing

 

Many employers have taken this option due to the complexity of coordinating leave programs. It may not be appropriate for your company, but you might at least want to shop around.

 

 

 

Conclusion

 

Integrating your leave policies can reduce costs, improve outcomes, and streamline efficiencies. It is not a quick process; but companies that have done so report improved compliance, increased control and higher employee engagement.

 

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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.

Warning For Employers: Social Security Problems & Consequences For Workers Comp

The trust funds for the Social Security disability benefits program are nearly exhausted and will be gone by 2016. What consequences are there for an employer’s workers compensation costs?

 

 

Laws Do Not Exist In a Vacuum

 

Laws do not exist in a vacuum. They are likened to a spider web – put tension on one strand and all the others move. If the Social Security system is in crisis, which it soon will be, the only options are to reduce benefits or increase costs, probably both. Which means that an employer’s workers will search for other programs to supplement or replace Social Security. Since nearly all Social Security lawyers handle workers’ compensation claims, the results will be obvious – more workers compensation claims against employers.

 

However, employers can greatly reduce the number of workers compensation claims which might otherwise occur if they take a vital step. Any time a worker or former worker is seriously disabled offer to assist in the Social Security disability claim.

 

Your correspondent learned decades ago that a worker who receives assistance from an employer on Social Security disability will hardly ever file a compensation claim for the disabilities that are not obviously past of any accident – principally chronic back disorders or cardiovascular events, both of which are common in older workers.

 

 

What An Employer Can Do To Assist on a Social Security Claim

 

What can an employer do to assist on a Social Security claim? Provide vital information which no medical or vocational expert can offer – details of the workers job, its requirements (physical task, frequency, etc.) and a first person description of what limitations the worker faced in the final months on the job. Surprisingly, in most Social Security claims the judge must rely on educated guesses at best since most workers, even though they try hard, are not the best source of information.

 

It is also permissible for an employer to suggest to the worker that it would be a good idea if the Social Security attorney assisting the worker give the employer a call. The results of such cooperation and team work are impressive.

 

No claim is hurt by the addition of high quality information, yet most disability claims of any sort have an employer’s presence. Don’t be afraid to volunteer for the task.

 

 

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

 

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

 

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

 

 

Little Used Federal Laws Give Employer Disability Management Control

Employers interact with employee disability through a number of laws. Until now, there has been little attention focused on how to coordinate statutory compliance to achieve better overall results. Workers compensation, in particular, has operated with little or no coordination with other laws.

 

Recent efforts, however, have demonstrated that dramatic lowering of new filed comp claims and lowered x-mods can be achieved with inexpensive measures that are only slight extensions of measures already being taken by employers in high comp rates industries such as transportation, construction and many types of manufacturing.

 

The new efforts require training of key people to slightly modify practices already in place. Virtually nothing has been written about the possibilities. The entire field of simultaneous disability interactions through two or more laws contains surprising results, no longer theoretical since a small group of employers are presently using the methods with entirely favorable results.

 

 

Methods for Improving Disability Management

 

There are several key methods that improve disability management.

 

 

1. Improved reporting of first reports of injury.

 

The number of employer first reports of injury that are filed with gaps in vital information is too large to be due to occasional oversight. The unanswered questions on first report of injury forms (FROIs) is one of the primary reasons for unnecessary delay, and late investigations of questions that should have been answered within a day or so following an injury.

 

This problem can be solved with a short period of training and a follow up period of working with the employer on actual new FROIs.

 

 

2. Coordination of workers compensation with other laws.

 

Certain types of employers have powers under federal laws which are unappreciated. Transportation companies have the power, under DOT regulations and construction companies, under OSHA, to schedule IME examinations to investigate new claims. Such exams can be done within the first week after an accident report, far faster than the several weeks to several months (and even several years) common in workers compensation claims. These examinations restore the primary control to the employer.

 

The employer must schedule and pay for the exams. There is no outside control or interference by the carrier/TPA, a comp board, or attorneys; they are not even notified of such exams and the results are sealed without a HIPAA or a valid subpoena.

 

In addition, other laws, such as FMLA, UI, SSDB, STD, LTD, negligence, no fault MVA, discrimination, ADA and a wide variety of other state and local laws and ordinances contain similar provisions for investigation by the employer.

 

 

3. Searches for prior medical records.

 

Obtaining prior medical records as soon as possible is the single greatest asset in disability control. However, most comp carriers make little or no efforts until a claim has become large and dangerous. Even then, efforts are hampered by state work comp laws. An employer using investigations allowed under other laws can quickly obtain HIPAA releases and have prior medical records in a few weeks, sometime as quickly as a few days, after an injury.

 

These records will prevent inconsistencies, concealment, exaggeration and incorrect causal relationship from being introduced into other records, such as a workers compensation claim file.

 

 

4. Central control of communications and records.

 

An employer using proactive measures, becomes the center of communication and the central repository of information. This leads to an entirely different role for the employer, which replaces having the comp carrier/TPA as the sole party interacting with a worker.

 

 

5. Retaining a proper relationship between the employer and employee.

 

A proactive employer, using several laws, retains an active role in the disability process. Employees with legitimate claims are pleased to have the employer involved. Often the employer can defuse needless delays and controversies caused, not by the employer, but by the carrier/TPA. Without the employer’s assistance, many unnecessary delays can result in disastrous delays in benefits to a family.

 

Exaggerated claims, on the other hand, are often dropped when the employer is the first to ask the correct questions and schedule the first exams.

 

The benefits of improved employer involvement cannot be overestimated.

 

 

 

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

 

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

 

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SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

A New Opportunity in Workers Compensation For Trucking

In the first decades of the 20th Century, work comp was the only game in town for disabled workers. This was the time before unemployment benefits, Social Security disability, FLMA, ADA, etc.

 

As the new laws appeared, the employer saw no advantages – they thought – and, instead, were burdened with an avalanche of compliance paperwork. Few bothered to read the full text of the new laws, and the volumes of regulations that accompanied them. (Nearly all are federal laws)

 

 

Federal Laws Mixed With State Laws Create Inconsistencies

 

When these federal laws are compared to provisions in state comp laws, surprising things emerge – such as inconsistent definitions of disability and fitness to work. Compare work comp laws with the Americans with Disabilities Act (ADA). In NY, work comp presumes an inability to work which the employer/carrier can overcome only with overwhelming medical evidence (or some “gotcha” surveillance videos showing undisclosed work).

 

After 1993, however, the comp laws had to co-exist with ADA, which presumed that most disabled people were capable of full earning capacity, with reasonable accommodation. So one law was presuming disability, and awarding billions in benefits, while another was presuming no loss of earning capacity, and threatening the employer who actually believed the comp board findings with penalties.

 

 

 

Opportunity With DOT Medical Exams In Workers Compesation for Trucking

 

A few years ago, your correspondent discovered that many, if not nearly all, serious comp claims by truckers had workers who successfully renewed their DOT driving certificates with a medical exam showing no inability to drive a heavy vehicle. Yet, the exams came in the middle of comp claims alleging ongoing damage to limbs that would have made it impossible to drive a heavy vehicle.

 

The “unexpected consequence” moment came when, after much paperwork to obtain releases, the DOT medical exam was compared with the comp medical records. The worker had to choose. Which version of the facts that he gave to the doctors was the truth? Most had to opt for continuing to keep the DOT certificate and forego further disability on the comp claim.

 

A careful review of two laws governing disability, especially when one is federal and one is a state law, shows many cases of inconsistent definitions. But it also provides unique opportunities to discover inconsistent statements, since few people believe that anyone will take the considerable trouble to locate and produce the inconsistencies (both made under penalty of perjury).

 

 

 

Few Attorneys Knowledgeable of Both Laws

 

Few comp lawyers have been required to read the co-existing laws. And the specialists who deal with the other laws are grateful that they have nothing to do with comp. As a result, little, or nothing at all, has been written about the possibilities of comparing the data contained in each file. And each file is protected from release by HIPAA and various state laws. However, the barriers can be overcome by those willing to do the extra work

 

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

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.  

 

©2013 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

If Obesity Is A Disease – What Are The Work Comp Consequences?

The American Medical Association (AMA) has recently listed obesity as a medical condition, as opposed to it being a result of easting choices. Can that result affect work comp claims?

 

 

Prior Medical Conditions Can Be Apportioned

 

Yes. Prior medical conditions can, occasionally, be apportioned with disability in a later comp claim. And concealing a prior medical condition can result in loss of future wage loss payments. Neither of these can interact with a comp claim if the prior condition is seen only as the result of voluntary choices.

 

The consequences for claims would be larger if second injury funds were not vanishing, since obesity affects one third of all people with serious comp claims, and would have resulted in far more successful applications by carrier for reimbursements.

 

However, apportionment remains a possibility. Recent case law in New York expands apportionment of comp claims with prior conditions, even if they are not the subject of prior comp claims. And “morbid obesity” was permitted as a pre-existing condition which would permit recovery from second injury funds. So, obesity may become a new, major, issue in comp claims.

 

 

Prior Obesity Must Be Disclosed

 

What about concealment of obesity? Concealment of significant conditions can result in loss of benefits. But concealment does not apply to obvious conditions, such as an amputated limb. And obesity is obvious and cannot be concealed, or so it would seem.

 

But prior obesity which has been treated can now be considered an illness which must be disclosed in a comp claim. And that can be an embarrassing intrusion if it becomes a new subject for claim investigations.

 

 

 

Significant Change Similar to Alcohol & Drugs

 

Prior substance abuse, alcohol and drugs, were also considered personal failings, rather than disease, until they began to be described as “obsessive-compulsive disorders”, often resulting in hospitalization at medical facilities. And sympathy for the conditions was far less than for obesity, even as substance abuse became the basis for successful reimbursement claims.

 

This is another change which , originally, seemed to have no effect on work comp. But the history of work comp is cluttered with unintended consequences.

 

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

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.  

 

©2013 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

Should SSDI Approval Equal Work Comp Total Disability Approval in NY

A proposal is pending to make a Social Security approval of SSDI benefits proof of total disability under the NY work comp law. Presumably, it is believed that this will reduce needless duplication adjudications of disability in work comp claims.

 

If so, the Board may be in for a series of rude surprises. The differences between SSDI entitlement and NY Workers Compensation law “total” are so great that they bear little resemblance to each other.

 

 

Differences in SSDI and Workers Compensation Total Disability:

 

  1. The burden of proof is different. WC decisions must be supported by a “scintilla of evidence. SSDI requires “preponderance of the evidence.

 

  1. Causes of disability may not be the same. SSDI considers the cumulative effect of all conditions. NY work comp considers only those disabilities related to the comp claim.

 

  1. Definitions of disability are not the same. SSDI permits payments unaffected by casual earning of several hundred dollars a month. Work comp permits no earnings while on total disability, except for a person’s claim that results in 100% loss of vision.

 

  1. Duration of disability requirements are different. Work comp requires evidence of permanency into the indefinite future for permanent total. SSDI requires only one year of total and none of that is required to extend into the future. At many SSDI hearings, the applicant has already returned to work.

 

  1. In SSDI, payments can overlap full work activity for nine months during a trial work period, even though the earning may be greater than the pre-disability levels. Work comp permits no trial work period with concurrent payments for total disability.

 

 

Board Should Decline Proposal

 

In addition, a full transcript of the SSDI hearing may be necessary and, although obtainable, the process is neither swift nor easy.

 

The Board may discover that the road to this goal is partly paved with good intentions, but mostly mixed with sharp edged boulders.

 

 

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

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2013 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

3 Types of Medical Exams Employers Have Not Heard Of

Employer Claim Handling Tools Not Available to Carrier
 
Employers who are willing to make better use of claim tools already in existence around them can achieve precisely what they have been hoping, in vain, that their carriers will do for them.
 
The tools are:
 
  • Occupational Health and Safety Administration(OSHA) physical exam
  • Department of Transportation (DOT) medical exam
  • Americans with Disabilities Act (ADA) medical exams

 

None of these exams can be done by a carrier (which is limited to work comp).

 
Why it works – employer indirect involvement in comp claims.
 
Never heard of these exams? Or, more likely, confused them with “fitness for work” exams? That is due to the fact that these exams are permitted under the federal statutes, but are discovered only after a bit of digging, with added phone calls to the respective federal agencies, just to be sure.
 
What do the exams do? They permit the employer to be involved in the evaluation of disability process independent and separated from the work comp laws, carrier, boards and attorneys.
 
 
Reasons These Exams Work:
 
First, they are far faster than any work comp procedure – they are doable within days, not weeks or months.
 
Second, they are not adversarial – they are not part of litigation; they are in compliance with safety regulations.
 
Third, the information is not disseminated to a vast bureaucracy. Unless a HIPAA is granted for release, the only copy of the exams is with the employer and employee.
 
Fourth, the parties are not strangers to each other – it is the employer’s staff and the employee.
 
Fifth, lawyers are not involved.
 
Sixth – the most important feature – workers do not become frightened that their work situation will be in the hands of a slow, remote, incomprehensible and adversarial administrative body.
 
Seventh, a workers family is assured that they can get answers from people they know in words they can understand.
 
Recent articles published by work comp research facilities have mentioned the importance of fear and uncertainty in driving comp to expensive, slow litigation and making large claims out of simple situations.
 
An employer using alternative methods will find that the time spent managing their claims correctly will exponentially save time in comp litigation. And, their experience modifiers will tumble.
 
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net  
 
Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.  
 
©2013 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

Temporary Total Disability Cap Major Development in Florida Workers’ Compensation

104 Week Cap of Temporary Total Disability Deemed Unconstitutional

 

On 2-28-13, the First District Court of Appeals (DCA) ruled Florida’s 104 week cap on temporary total disability benefits to be unconstitutional as a denial to courts and a denial of administration of justice without delay.

 

Bradley Westphal, a firefighter and paramedic for the City of St. Petersburg injured his back and knee while working in 2009. Mr. Westphal had back surgery and incurred nerve damage in his leg.  The claimant exhausted 104 weeks of temporary total disability before he reached a level of maximum medical improvement. As the claimant had not reached MMI after exhausting temporary total disability, he was not eligible for temporary partial disability (TPD) or permanent total disability (PTD). The City of St. Petersburg ceased temporary total disability payments.

 

Westphal applied for permanent total disability benefits but was denied by a work comp judge as he was not at maximum medical improvement and it was considered too speculative to award the claimant with PTD benefits. Nine months after the temporary total disability benefits had been exhausted, enough medical evidence was available for the claimant to be awarded permanent total disability. The employee then brought suit against the City of St. Petersburg and the State of Florida for temporary total disability benefits during the nine month statutory gap in disability benefits.

 

 

Question of Gap In Benefits Between Temporary Total Disability and Temporary Partial Disability

 

In a previous DCA case, Matrix Employee Leasing, Inc. vs. Hadley, the DCA had ruled there is a statutory gap in benefits between the expiration of 104 weeks of temporary total disability benefits and temporary partial disability benefits when the employee does not reached MMI after 104 weeks. The question of the constitutionality of the law was not raised in Hadley, so it was not addressed. Westphal’s attorney seeing the opening the Hadley decision had created, questioned the constitutionality of the 104 week limitation on temporary total disability benefits.

 

 

New Law Required 260 Weeks of Temporary Total Disability

 

The DCA when given the opportunity to review the constitutionality of the 104 weeks of temporary total disability benefits decided the statute could not stand as written. The DCA decision was based on workers’ compensation being the exclusive remedy for injured workers without giving the injured worker a system to redress for the economic damages incurred after the 104 weeks of temporary total disability are exhausted. By declaring the temporary total disability limitation as unconstitutional, the court revived the 1991 temporary total disability law requiring employers/insurers to pay 260 weeks of temporary total disability benefits.

 

In what was probably an oversight by the DCA, they did not address the constitutionality of temporary partial disability being limited to 104 weeks, only temporary total disability. The affect the temporary total disability decision will have on TPD is unknown at this time, but we would speculate an enterprising employee’s attorney will now definitely question the constitutionality of TPD being limited to 104 weeks and will achieve the same results as Westphal.

 

Fortunately, the DCA did rule that their decision applies to the Westphal case and future cases, but declined to make their decision retroactive to prior work comp claims that have become final. The DCA decision is final and binding.  However, in Florida, whenever a District Court declares a statute to be unconstitutional, there is an automatic Supreme Court review. Unless, the Supreme Court overrules the DCA, all open and future claims will be governed by this DCA decision.

 

 

Employers Face Increase in Indemnity Exposure

 

Employers and insurers who have open temporary total disability claims where the employee now seeks to continue temporary total disability benefits beyond 104 weeks should have their defense attorney stay or continue any hearings on the issue until the Supreme Court rules.

 

The major immediate impact of the DCA decision is the increase in indemnity exposure to employers and insurers. This will increase settlement value of all open temporary total disability claims as the plaintiff attorneys will know the employer/insurer has much more to lose if they do not settle with the injured employee. A secondary impact is the impetus it will provide to seriously injured employees in Florida to malinger.

 

 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com.  Contact: mstack@reduceyourworkerscomp.com.

 

©2013 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

Costs and Benefits of Integrated Disability Management

 

Protecting the Bottom Line and Increasing Productivity

 

Integrated Disability Management (IDM) is a coordinated, consistent approach to an employer’s disability benefits programs. It includes:

 

  • short-term disability (STD)

 

  • long-term disability (LTD)

 

  • workers’ compensation

 

  • Family Medical Leave Act (FMLA) 

 

In an IDM program, employee absences due to illness or injury, regardless of the reason, use the same claim reporting, claim and medical case management and return-to-work protocols. Using these simplified processes can result in direct program cost savings and improved operational tracking of claims and absences.

 

Many companies that have thought of trying an IDM program have not actually implemented the programs. About 20 percent run some sort of parallel program with either a single point of contact or a single claims administrator paying and coordinating short and long term disability. Salary continuation is often paid instead of lost wages, then at 12 -16 weeks (depending on the plan) short term disability takes over. There are many type of programs, each slightly different, depending on the companies’ philosophy. For example, will there be wage replacement instead of workers compensation? Do they offer short and/or long term disability benefits?

 

The objectives of all the programs, however, are to get the employee back to work as quickly and as effectively as possible, to maximize productivity, and to mitigate costs. Three key areas must all work together to achieve success: the potential benefits of IDM; the key components of a successful program and the steps involved in an efficient implementation.

 


The Potential Benefits of an IDM Program
An effective IDM Program benefits an organization in several ways, including reducedoverall disability claim costs.  But how are these figures comprised?

The total costs of an employee disability are the:

 

  • Direct Costs, such as wage replacement, medical expenses, benefits expenses and litigation costs.

 

  • Indirect (Hidden) Costs, including temporary employee replacements, overtime, lost productivity and reduced employee morale.

 

  • Administrative expenses to manage multiple programs, either internally, or through vendors.

 

  • Increased productivity resulting from shorter disability durations and quicker return to work.  Studies show that the longer an employee is off work, the less likely the employee is to return.

 

  • Enhanced, consistent claim management processes for both occupational and non-occupational injuries and illnesses.

 

  • Integrated data collection, sharing and reporting across benefit lines and policy years.

 

  • Reduced chancesto submit multiple claims and “double dip” due to single source claim reporting and management. (WCx)

 

  • Increased employee satisfaction from simplified claims services.

 

  • Medical management of all disability lines. A medical director could potentially have a great impact since the employee is using all benefits available.

 

  • Modified duty and transitional work assignments with internal accounting. While having modified duty has a cost, NOT having one has an even higher cost -100 percent loss of one employee’s productivity plus replacement wages for another employee, plus workers comp, STD or LTD.

 

 

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 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

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

 

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.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

Physical and Occupational Therapy Management Basics Explained

 
 

What is therapy management?

Therapy management is a system aimed at controlling costs of physical medicine such as but not limited to physical and occupational therapy. An entity utilizing clinical and non clinical personnel; contracts with a network of skilled therapy clinicians and actively arranges for and coordinates the most appropriate physical medicine services for patients and employers alike. To learn more about the topic, Roundtable sat down with Greg D'Ambrosio, vice president of client services for the Network Synergy Group to give us an insight to the world of therapy management.
 
 

Why do therapy services need to be managed?

Physical and occupational therapy is no different then other medical costs that have skyrocketed over recent years. Proper management of therapy services can ensure appropriate and medical necessary treatment by expediting scheduling, monitoring patient care and compliance, reimbursing network providers fairly and timely. The result should be a positive outcome and experience for the payor and patient. Better outcomes result in lower costs.

 

Is this a new concept?

Conceptually, managed care arrangements date back to the early 1920s when insurance companies began using prepaid insurance arrangements for specific employee populations. However, the term managed care became popular in the 1980s. The need and development for physical therapy management had its origins in the following decade around mid- to late 1990s.
 

 

How does this help reduce my workers compensation costs?

Physical and occupational therapy is often the last form of treatment prior to a claimant receiving a disability status, reaching maximum medical improvement and returning to work. Therefore, since workers’ compensation is predicated on either restoring the claimants functional capacity prior to the injury and/or returning the claimant back to work, a therapy management program that ensures medically necessary and appropriate care is critical in reducing the overall medical and indemnity costs of a claim.
 


Who should be using therapy management?

Any entity that has a stake and interest in reducing their overall cost of their workers’ compensation claims should be using a therapy management program. This would include self insured employers, insurance carriers, captives and pool arrangements, municipalities, public entities and third party administrators.

 

Why is it advantageous?

Other than the obvious reduction in overall claims costs, the management company should alleviate many of the administrative burdens of an adjuster and or nurse case manager that would have to manage therapy on a case- by-case basis. This allows them to focus on other aspects of a claim.
 

 

Can all companies use this type of service?

There are no restrictions as to what type of companies can use this service. Many companies use this service simply by contracting with their insurance carrier or third party administrator.
 
 

Are there times it might not be beneficial to use such a service?

In workers’ compensation there are always unusual circumstances whereby an adjuster may have a need to manage therapy themselves. However, an overwhelming majority of claims are handled by a therapy management company.
 
 

How does an employer find a good therapy management company?

However, management companies vary significantly in their approach to how therapy is managed. Insurance carriers and TPA’s (third-party administrators) often are affiliated with a therapy management company, but that does not necessarily mean it is the best fit for the client. With the proliferation of the internet and maturation of the industry it would be easy to locate a therapy management company. I would search specific workers compensation sites and blogs such as reduceyourworkerscomp.com to obtain information. Organizations should also identify the best fit for them by speaking with others references in similar industries and positions. Conferences and associations offer great opportunities to speak with peers to obtain information.
 
 

What should a company do if their TPA or insurance company objects to using a therapy management service?

This is simple — ask “Why?” Large employers with high deductibles that assume all or most of their workers’ compensation risk should be able to dictate which service providers are the most appropriate for them. Transparency is critical. A company should ask, “Does the carrier and or TPA somehow benefit in the arrangement by using a therapy management company they have contracted with?” A company should also ensure contractually that they are not limited in selecting service providers when negotiating their workers compensation program or TPA services.
 
 

As a service provider what are the biggest obstacles you encounter with implementation of a new client?

Adjusters are busy and even more so in today’s environment. Scheduling time to fit into adjusters’ schedules to properly implement a program is our biggest challenge. Although not as effective as in person meeting, video conferencing, webinars, and conference calls can help alleviate this.
 
 

As a client, how will I determine the return on my investment?

A client should always focus on outcomes. It is up to each individual client to define what a good outcome is. Patient satisfaction, number of visits per treatment, the duration of care, and the functional capacity status of the patient upon discharge are just a few outcome driven metrics. In addition, there are many overlooked costs associated with therapy management such as bill review and percent of savings charges that need to be contemplated when evaluating the cost benefit of a therapy management program. The customer has to place a value on outcomes that meet or exceed their expectation. Then the analysis becomes simple. If outcomes are meeting or exceeding expectations at what the client can define as a fair price, then the return on investment is a positive one.
 
 

 

 

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 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 

Greg D’Ambrosio joined Network Synergy Group in 2010 as Vice President of Client Services.  His responsibilities include directing client training and ensuring NSG's therapy management programs are delivered with ease, efficiency and support. Greg has over 20 years of experience in the insurance and PEO industries.  Greg has also been a featured speaker for the NAPEO and Florida Workers' Compensation conferences. He can be reached at: gdambrosio@network-synergy.com or (888) 533-0727 x. 160.

Pat Merrill joined NSG as Vice President of Network Development and Provider Relations in 2011. Pat is currently responsible for the strategic and operational leadership of NSG's Network Development and Provider Relations Departments. She has over 25 years of experience working with large employers; providing solutions for their occupational medicine and workers’ compensation injury care needs.  Pat is a member of the Southern Association of Workers’ Compensation (SAWCA) and the Georgia Self Insured Association. She can be reached at: pmerrill@network-synergy.com or  (813) 207-0727 x. 120 or (404) 314-3225 (c).
 

WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

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

 

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.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

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