How to Grade Your Workers’ Comp Adjuster

In school an “A” grade is the standard that everyone wants to meet. Whether you are in elementary school or working on your master’s degree, your performance results in a grade being given to the work you complete. To earn an A grade requires having at least 95 percent of the school work done correctly. Following the same basic grading principles – A, B, C, D, F – you can measure the performance of your workers compensation adjuster.

 

The following is a grading outline you can use to measure the performance of your workers’ comp adjuster on each claim. There are ten categories with 10 points each, or 100 points total. When you review your adjuster’s file on-line, grade each category against the measurements listed here. [If your Best Practices give the adjuster different time lines then what is given here, use your own Best Practice guidelines in grading your adjuster]. Give the adjuster the number of points (zero to ten) earned in each category.

 

 

Category 1 – Employee Contact:

 

The adjuster should contact the injured employee within 24 hours of the receipt of the claim (same day contact would be more points than next day contact). True contact entails an exchange of information between the adjuster and the employee, not just leaving a message on voice mail. If the adjuster was unable to reach the employee within 24 hours by telephone (or in person on severe claims), a contact letter should be sent to the employee along with a medical authorization or any state required forms. On any claim involving questionable compensability or subrogation, a recorded statement should be obtained from the employee. You’re looking for a “quality contact.”

 

 

Category 2 – Employer Contact:

 

The adjuster should easily score all ten points in this category by contacting the employer by phone (in person with extreme employee injuries) within 24 hours of receipt of the claim (same day contact would be better). On any claim involving questionable compensability or subrogation, a recorded statement should be obtained from the employee’s supervisor. Also, any witnesses to the accident should be contacted if the injuries are severe.

 

 

Category 3 – Medical Provider Contact:

 

The office of the medical provider should be contacted within 24 hours of the report of the accident to confirm the nature and extent of the accident, and the ability of the employee to return to work on modified duty/light duty. In the jurisdictions that do not require a medical authorization to obtain the medical records on the employee’s injury, the medical records should be requested during this initial contact.

 

 

Category 4 – Investigation:

 

If the adjuster has done a quality job in the three contact categories, earning points for completion of the investigation should be rather easy. The investigation should address all issues that impact coverage, the nature and extent of the injuries, the benefits owed, subrogation and subsequent injury fund (where applicable). An ISO Index Bureau search should be filed. If the investigation has been completed properly, the adjuster should be able to make a decision on the compensability of the claim. All of this should be accomplished within the first 14 days the claim file is open.

 

 

Category 5 – Average Weekly Wage and Benefits:

 

To earn points in this category, the adjuster should obtain from the employer the wage records or wage documentation on the proper state approved form. It is not acceptable for the adjuster to take the hourly rate off the Employer’s First Report of Injury form and estimate the average weekly wage. The weekly wage and the calculation of the indemnity benefit should be clearly documented in the adjuster’s file. In addition to calculation of the indemnity benefits with proper documentation of the wages, if owed, they are issued timely. Also, all medical bills are reviewed and paid timely.

 

 

Category 6 – Reserves:

 

The initial file reserve should be set by the adjuster within 72 hours of the file receipt, but after completion of the three contacts – employer, employee and medical provider. After the adjuster has obtained the initial medical records, within 60 days of file receipt, the reserves should be reviewed for accuracy. Throughout the course of the file the receipt of any information, medical or otherwise, that would impact the files, the reserves should be updated. On severe claims that remain open for an extended period of time, the adjuster should review the reserves every 6 months to verify their accuracy.

 

 

Category 7 – On-Going Contact:

 

A mistake that many adjusters make is not staying in contact with the employee, the employer and the medical provider. Consistent and on-going contact with the employee will maintain rapport with employee and eliminate many of the reasons that could delay the progress of the claim. The adjuster should maintain the file on diary to ensure all on-going contacts and necessary follow-up is completed. If the adjuster stays in contact with the employee at least monthly until the claim is resolved, and stays in contact with the employer and medical provider as needed, award all 10 points in this category.

 

 

Category 8 – Medical Management:

 

When the adjuster makes the initial medical provider contact, medical management begins. In the initial contact the adjuster should learn the diagnosis, prognosis, the treatment plan and the return to work status. The adjuster should coordinate with the employer and the medical provider to allow the employee to return to work on modified duty as soon as possible. If the injury is severe enough, the adjuster should provide the medical provider with the information on utilization review and pre-certification, plus a nurse case manager should be assigned to the claim timely. If a medical bill review service is used to audit medical bills, the adjuster should ensure all medical bills are sent to the appropriate audit vendor for review and processing.

 

Important note: To grade this portion of the score, have an MD review the file to make sure the injury is, in fact, work-related. Also analyze whether all medical reports are in the file, that complex medical language is recognized, and that medical care is appropriate, e.g. that nurse case management made a difference in the file and did not simply replace duties an adjuster should be doing. My view is that the best qualified person to review a medical file is a DOCTOR. Use TPAs that have appropriate MD resources for services such as peer-to-peer. If the nature of a claim is unrecognized or inappropriate, it won’t matter how many administrative details are done well, because the claim shouldn’t have been paid in the first place. Keep this in mind.

 

 

Category 9 – Litigation Management:

 

Any time a workers’ compensation board hearing or a court hearing is requested by the attorney for the employee, a prompt referral to pre-approved defense counsel should be done. The initial referral to defense counsel should outline the status of the claim, request a litigation budget and provide instructions to defense counsel on how the adjuster wants defense counsel to proceed. (If the adjuster does not instruct counsel on what the adjuster wants done, deduct at least 5 points in this category). The adjuster should continue to provide on-going instructions to counsel throughout the course of the claim.

 

 

Category 10 – File Documentation:

 

Every activity completed by the adjuster should have a clear, concise file note stating what was done and how it impacts the claim. All medical reports, reports from defense counsel and any other file development should be outlined in the file notes.

 

 

Bonus Points:

 

Occasionally, their will be other important activity in the file that is not included in the 10 categories noted above. For instance, the adjuster’s pursuit of subrogation to recover the cost of the claim deserves 5 or 10 bonus points based on your evaluation of how much extra effort the adjuster put forth to recover the subrogation.

 

Another area for consideration for bonus points would subsequent injury funds or other offsets. Any effort made by the adjuster to mitigate the cost of the claim should be recognizes by the award of bonus points.

 

 

Overall Grade:

 

Tally the number of points (from zero to ten) you gave the adjuster in each category. Compile the scores from all the claim files you review. Using the A, B, C, D and F grading system you had in school, does your adjuster deserve an “A”? If not, what category/area(s) did the adjuster consistently fail to earn all ten points? Identify the weak areas and ask your adjuster to strive to comply with your Best Practices in those areas. Some TPA’s grade their own adjusters; this can be valuable information for you to learn.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Poor Workers’ Comp Claims Handling Costs You Money

Each year you receive your bill for the next workers compensation policy year, and for many of companies, each year the bill is higher than the previous year. As you think about your work comp claims, you realize the claims for the current year were not any worse than they were for last year, or the year before. So why does your workers’ compensation premium bill keep going up and up?

 

When the underwriter at the insurer looks at calculating your premium, they use what is known as an experience modification factor. This factor is a calculation used to raise or lower your premium based on the loss experience your company has had. If the loss experience has improved, the premium charged to your company goes down. If you have had more claims than before or the claim cost has gone up, your premiums go up.

 

The loss experience is based on two factors, frequency and severity. The insurance company does not control frequency of claims, your company controls frequency through how well you manage the safety program. As you think back to the previous years, you think “wait a minute, our safety program is working, the number of claims has declined, so why has my premium gone up?” The answer is the other part of the experience modification factor – the severity of the claims.

 

 

Claim Cost Not Discounted Due to Poor Handling

 

There is one thing your insurance broker and your workers compensation insurer will never tell you about the cost of your workers compensation premium. If they do a poor job handling the claims, and spend more money than necessary due to a failure to properly investigate or to return the employees to work, you get to pay for their incompetence. The underwriting department does not discount the severity factor because the claims office did a poor job.

 

If your next thought is: “I’m no expert on how to handle work comp claims, so how would I know if the claims office is doing a good job?  There are ways you as the employer can gauge the effectiveness of the claims office.

 

 

Report Claim Immediately

 

The first thing the employer can do to reduce the severity of the claims is to report them to the claims office immediately. There have been numerous studies that show the longer the delay between the time of the accident and the adjuster contacting the employee, the higher the overall cost of the claim. By reporting the claim to the claims office immediately, you have reduced the amount of time between the accident and the adjuster contacting the employee.

 

Normally when the adjuster contacts the employee, the adjuster also contacts the employee’s supervisor or manager to verify the facts of the accident. If you have a claims coordinator, have the claims coordinator keep track as to when your company hears back from the work comp adjuster. If you do not have a claims coordinator, have the person who reported the claim to the claims office keep track of when you initially hear back from the adjuster. Same day contact from the claims adjuster is best, next day contact is acceptable.

 

 

Sign Adjuster Not Investigating Claims 

 

If your thought is: “We never hear from the adjuster after we report the accident,” that is a major sign that the adjuster is not investigating the claims. If the adjuster is not properly investigating the claims, you as the employer pay for it in your experience modification factor when claims that should be denied are paid, or claims that are fraudulent are paid.

 

There is a sure-fire way the employer can know if the adjuster was in contact with the employee the day the claim was reported to the claims office (or at least the next day). Pick up the telephone and call the employee. Ask the employee how the initial doctors office visit went and what the doctor thinks the employee’s prognosis will be. Then an “oh, by the way, have you heard from the insurance adjuster yet?” will quickly tell you if the adjuster has made timely contact with the employee. Do this on ten claims in a row and you will soon know if the adjuster is giving your claims the proper initial claims handling. [Bonus – by contacting the employee you show the employee that the employer does care about their well being, which builds rapport with the employee, and diminishes the chances of the employee hiring an attorney].

 

 

Lowest Price Often Precludes Service

 

Another definite tip-off that the adjuster is or is not handling the claims properly is when the adjuster calls your office trying to arrange modified duty so the employee can return to work.  If in the initial contact from the adjuster you are asked what light duty assignment you can provide the employee, you have an adjuster who is thinking about how to get the employee back to work, which lowers the amount of indemnity payments and the overall cost (severity) of the claim. A good adjuster will continue to explore light duty return to work until the employee is back at work. A poor adjuster will never ask about light duty return to work and will just pay the employee indemnity benefits until the doctor states the employee is fully recovered. When you bargain for lower-priced TPA or insurance claims adjusting services, consider that you want the adjusters to have the resources to DO this work, and offering the lowest possible price may preclude that  – no matter what they say at the official presentation.

 

An easy way to get your work comp adjuster(s) on the ball in their claim handling is to ask for a copy of their service standards (Best Practices) for workers compensation. Advise the adjuster(s) that you will be reviewing your files to see if they are complying with the Best Practices. If by chance you are told they do not have a set of service standards, it is time for you to talk to your broker about finding another insurance company who is concerned about doing a quality claims handling job.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

11 Red Flags of Workers’ Compensation Fraud

As an employer, you must be vigilant in your efforts to protect your company from the few employees who do commit workers compensation fraud.   Adjusters often refer to possible fraud in a workers comp claim as looking for “red flags.” A “red flag” is anything standing out from the ordinary.

Any one of the items on the following list of “red flag” do not prove a workers comp claim is fraudulent. However, if you have several “red flag” on a single claim, it’s a good idea to consult with both the adjuster and the SIU unit about the claim.

 

 

11 Red Flags of Workers’ Compensation Fraud

 

  1. Late Reporting
    1. If an employee is really injured on the job, it is unlikely the employee will wait days or weeks to report the injury.
  2. Accident Details
    1. The accident details are sketchy, vague or fuzzy.
    2. The employee has difficulty in recalling what happened.
    3. The employee changes the description of the accident when inconsistencies are pointed out.
    4. The nature of the injury is not consistent with the nature of the work done by the employee.
    5. The date, time and location of the accident is unknown or forgotten.
    6. The accident details are inconsistent with the employee job duties.
  3. More Than One Version of the Accident
    1. The employee gives completely different versions of the accident to the employer and the adjuster and to the doctor.
    2. The employee keeps modifying the story of what happened.
    3. The employee leaves out pertinent information.
    4. The accidents details vary from medical report to medical report.
  4. Witnesses
    1. There are no witnesses to the accident and the employee normally works around other people.
    2. There are witnesses but their version of the accident differs from the employee’s version of the accident.
    3. The accident occurs at a location away from where the employee would normally be working.
    4. The nature of the injury is unusual for the employee’s line of work.
    5. The employee’s co-workers express doubt that the accident occurred.
  5. Unhappy Employee
    1. The employee is disgruntled about some aspect of his/her job requirements.
    2. The employee was demoted or passed over for a promotion.
    3. The employee is on the list to be laid-off.
    4. The employee is on “positive improvement needed” status and is about to be terminated.
    5. The employee has had numerous prior employers.
    6. The “accident” occurs immediately prior to a strike, plant closing or the end of seasonal employment.
    7. The employee is a new hire.
  6. Monday Morning Claims
    1. The employee has an early Monday morning accident before the supervisor or other employees see him on the job (accident occurred off the job over the weekend).
  7. Injured Worker is Never at Home
    1. The injured employee is not at home during the normal workday.
    2. The employee is always sleeping when the adjuster calls or cannot be disturbed.
    3. The employee’s family member is vague or noncommittal about when you can reach the employee.
    4. The employee is “away” but quickly returns all calls from a cell phone, not the home phone.
    5. The employee uses the address of friends or family members and has no definite address or uses a Post Office box as an address.
    6. The spouse or other family members do not know about the workers comp injury.
  8. Financial Reasons
    1. The employee’s spouse is not working and drawing workers comp indemnity benefits, social security disability payments, welfare or unemployment insurance and the  employee wants the same life style.
    2. The employee inquires about a settlement early in the claim process.
    3. The employee was having prior financial problems.
    4. The employee is nearing retirement age.
    5. The employee files for benefits in a state other than where the accident occurred.
    6. In the states where an employee can collect workers comp indemnity benefits based on the amount of combined wages from both the workers comp employer and a second job employee.
    7. The failure to report other work income while drawing indemnity benefits.
    8. The employee took excessive time off just prior to the injury.
    9. The employee is in the middle of a divorce or other family disturbance.
    10. The social security number used by the employee belongs to someone else.
    11. The employee applies for Social Security benefits before the injury occurs.
    12. Income from workers comp, disability or other sources exceeds the employees prior after tax income.
  9. Medical Care
    1. All the injuries are subjective — pain without trauma, soft-tissue, emotional.
    2. The employee changes doctors frequently “doctor shopping” or changes doctors when released to return to work.
    3. The employee has excessive treatment for soft-tissue injuries.
    4. The medical treatment reported by the employee is different from the medical care stated in the medical reports.
    5. The nature of the medical treatment changes from one body part to another after the employee has been treating for a while.
    6. The employee misses medical appointments.
    7. The employee fails to show up for an independent medical examination.
    8. The employee refuses or delays diagnostic testing.
    9. Whiteouts, corrections, erasures on medical forms submitted by the employee.
    10. Exaggerated pain symptoms.
    11. The employee has a history of multiple workers comp claims and/or reporting subjective claims of injury.
    12. The injury relates to a preexisting medical condition or health problem.
    13. The medical reports provided by the employee appear to be second or third times photocopied.
    14. The length of recovery is excessive for the nature of the injury.
  10. Inconsistent Physical Ability
    1. The employee who has been off work for a while has calluses on hands or grime under the fingernails
    2. The medical reports reflect “muscular” “tanned” or other adjectives to reflect the employee is in good health.
    3. The employee is unable to work due to the injury but is seen painting his/her house, mowing the lawn, carrying heavy objects, etc.
    4. The employee has a high-risk hobby or does other physical exertion activities.
    5. Surveillance reflects physical activity greater than what is reflected in the medical reports.
    6. You learn the employee is working elsewhere while drawing indemnity benefits, especially where the work requirements exceed the capabilities reflected in the employee’s medical reports.
  11. Miscellaneous Red Flags
    1. The employee is unusually pushy to settle the workers comp claim
    2. The employee has extensive medical knowledge but no training in the medical field, or has extensive insurance terminology but no work experience in the insurance field.
    3. The employee was referred by a friend who name he does not know to a particular doctor or attorney.
    4. The employee is a part of a group of employees using the same doctor and the same attorney for their workers comp injuries.
    5. The attorney’s letter of representation is the same day of the injury or even dated before the “injury.”


Summary:

Remember, even if the employee’s claim has every one of these “red flag,” it still does not prove fraud. However, if the work claim has more than one of these “red flag,” you definitely want to bring in a fraud investigator to delve deeper into the claim. The more fraudulent claims you identify and deny, the lower your overall cost will be for workers compensation insurance.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

 

Workers’ Comp File Review Checklist for Initial and Subsequent Adjuster Action Plans

When you go on-line to review the adjuster’s file notes on your company’s lost time work comp claims, do you know what you should see in the adjuster’s Action Plan? If you have not been a work comp claims adjuster, it would be easy for you to miss items overlooked or missed by the adjuster. The adjuster’s file notes should state what was accomplished and what needs to be accomplished to move the file forward.

 

 

Each of the items that need to be accomplished should be given a due date and placed on the adjuster’s diary (calendar) for completion. You should see at minimum the date due and the date completed for each of the items in the adjuster’s Action Plan.

 

 

 

Initial Claim Handling Completed Day Claim Received

 

 

If your adjuster is following the Best Practices set by most insurers and third party administrators, the initial claim handling was completed the day the claim was received in the claims office. You should see file notes reflecting coverage was verified for the claim, that the employer contact, employee contact and physician contact was completed and the initial reserves were placed on the file.

 

 

All of these items should have been completed before the adjuster does the initial Action Plan. If for any reason coverage has not been verified, contacts not completed or the reserving cannot be done, the adjuster’s Action Plan should reflect the item(s) that are outstanding from the initial handling and provide the due date for the follow up on those items to be completed.

 

 

Initial Action Plan Checklist

 

Assuming the first day’s claim handling was completed, the initial Action Plan for the work comp claim should contain:

  1.  A follow up date for further contact with the employee (ability to return to work).
  2.  A follow up date for further contact with the employer (availability of a modified duty position if the employee is unable to return to full duty).
  3.  A follow up date to verify the receipt of the initial medical report.
  4.  A follow up date to verify the receipt of the documentation of the average weekly wage (should be within 14 days or less depending on the jurisdiction—in order for the adjuster to issue the first TTD payment or issue a denial of claim).
  5.  A follow up date to complete any further investigation of the claim (should be within 14 days of the date the claim was received).
  6.  If subrogation is appropriate based on the investigation, a date to put the responsible party on notice of the subrogation claim.
  7.  A date to verify the claim is accepted for compensability or the date the claim will be denied.
  8.  A date for the TTD benefit payments to be calculated and the first TTD check issued, if applicable.
  9.  A date for the completion of the ISO filing (within 14 days of the receipt of the claim).
  10.  A follow up date to verify all state required forms have been filed with the state work comp board.
  11.  If the file is reportable to an insurer, excess carrier or any other party, the date the reporting will be completed.
  12. A date for the next Action Plan to be completed (usually 30 days after the first Action Plan but the time frame can be shorter or longer depending on the severity of the claim).

 

 

Second Action Plan Checklist

 

By the time the second Action Plan is due, most or all of the items outlined in the first Action Plan were completed. Any items not completed are carried over to the second Action Plan with a new due date for each carried over item. Activities you can expect to see on the second Action Plan include:

 

  1. A date for reevaluation of the file reserves (usually 60 days from the date the claim was received in the claims office).
  2. A date for evaluation of the need for a Nurse Case Manager on the claim, if the employee has not returned to work, and assignment of the Nurse Case Manager, if needed.
  3. A date for coordination of the return to work full duty or modified duty, if needed.
  4. A date for the obtainment and evaluation of the disability rating.
  5. If the file is reportable to an insurer, excess carrier or any other party, the date the second report will be completed.
  6. A date for the next Action Plan to be completed (usually 30 days after the second Action Plan but the time frame can be shorter or longer depending on the severity of the claim).

 

 

 

Third & Subsequent Action Plan(s) Checklist

 

The third and subsequent adjuster’s Action Plans will vary more in the items that will be included in the Action Plan. Some things to look for in the subsequent Action Plans including their due dates, are:

 

  1. Medical records being obtained and evaluated for all on-going treatment.
  2. Regular scheduled follow-ups with the employee, the employer and the medical providers.
  3. Regular scheduled contact with the Nurse Case Manager when there is one.
  4. The completion and filing of all state forms.
  5. The scheduling and obtaining of independent medical evaluation or a peer review.
  6. Offsets and deductions being calculated and applied.
  7. Second Injury Fund (in the jurisdictions that still have one) being placed on notice
  8. A settlement evaluation that is explained and properly justified, including both the strengths and weaknesses of the claim.
  9. A Litigation Plan and a Litigation Budget, if the claim is in suit or in a contested board review.
  10. All required waivers and/or releases obtaines.
  11. CMS notification if a MSA is considered or needed.
  12. A re-evaluation of the reserving accuracy.
  13. Subsequent filing of the claim with the ISO/Index Bureau.
  14. If the file is reportable to an insurer, excess carrier or any other party, the date the next report will be completed.
  15. A date for the next Action Plan to be completed (usually 60 or 90 days after the third Action Plan but the time frame can be shorter or longer depending on the severity of the claim).

 

 

As long as the work comp claim remains open, the adjuster continues to have an Action Plan outlining the steps to take to bring the claim to a conclusion. The final entry on the adjuster’s last Action Plan for the claim is actually the activity the adjuster looks forward to doing. The final Action Plan activity should read: “Close file.’’

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

4 Things to Consider in Complex Work Comp Causation Cases

work comp causationMembers of the claims management team are challenged daily to run an effective operation.  One of these issues claim handlers confront are questions of medical causation before admitting primary liability on a workers’ compensation claim.  Unfortunately, most members of the claims management team do not have a medical degree, but they do have many resources at their disposal to meet these challenges and make even complex decisions with certainty.

 

 

To Admit or Deny Primary Liability

 

Questions of medical liability for a work injury are often more complex than those that involve a “legal” basis for denial.  When reviewing questions of medical causation, claim handlers need to consider the following issues:

 

  • Evidence of clinical medical findings to substantiate a work injury;

 

  • Evidence of the requisite workplace exposure—which are often complicated by claims or repetitive use allegations; and

 

  • Medical literature that connects or links the work activity to the alleged injury.

 

In many instances, claims handlers are left to rely on training, experience and gut instinct to make decisions.  Time is of the essence given statutory parameters following receipt of the First Report of Injury.  Failure to do so can result in admissions against interest and/or penalties.

 

 

4 Things to Consider in Complex Work Comp Causation Cases

 

Members of the claims management team need to be proactive when it comes to admitting or denying a workers’ compensation claim that boils down to issues concerning medical causation.  There are important steps one can take to make a reasonable and well-informed decision.

 

  • Investigate the mechanism of injury: This consideration includes the question of “how” an injury occurred.  The claim handler will have medical records that detail how the injury took place.  In other instances, they may have the opportunity to conduct a more in-depth investigation.  This can include a recorded statement from the injured worker or witnesses.

 

  • Determine the exact medical diagnosis: This includes obtaining as many medical records as possible immediately following the work injury.  This starts with learning where the employee received post-injury care and the names of prior medical providers.  In many instances, state and federal privacy laws allow claim handlers to receive medical records without a signed authorization.

 

  • Review all diagnostic tests and studies: Reviewing the reports from medical studies can provide insight into the origin of an injury.  Examples of this include injuries to the upper extremities, shoulder areas and cervical spine.  A review of EMGs, CT scans and MRI can narrow the point of injury and its origin.

 

  • Roundtable with the claims team: This is a value resource to review the facts and question the plausibility of a claim. Roundtable sessions with a claims management team are important for many reasons.  This includes the ability of claim handlers to learn from each other’s experience and plot claim strategy.  It can also be an opportunity to poke holes in the employee’s version of events and plan a defense.

 

 

Battle of the Medical Experts

 

In many litigated claims involving injury causation, there is a “battle of the experts.”  While the employee always carries the burden of proof, many jurisdictions view the evidence in a light most favorable to the employee.  The result in the need to provide the medical expert with as much information as possible prior to the adverse examination.  A well written IME report and excellent bedside manner for courtroom testimony is a must.

 

 

Conclusions

 

In every workers’ compensation claim, a strong defense starts with the claim handler working the file.  This requires that person to use their skills and resources to conduct a diligent investigation and examine the important issue of medical causation.  Claim handlers have many resources.  By using them, they can position their file load for success and reduce costs in their workers’ compensation program.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

6 Steps to Mitigate PTSD Workers’ Comp Claims after Trauma

Escape, hide, fight back. Those are the suggested reactions — in order — to an active shooter situation provided to employees of one of the nation’s largest supermarket chains. In a dramatic, realistic-looking video, a man with a gun walks into a grocery store and begins shooting.

 

The fact that the video is part of required training for all company employees underscores the very real threat of violence in many workplaces. While employers can and should take any and all precautions to prevent violent incidents from occurring, there are still situations that arise all too often.

 

One thing companies can do is prevent such a situation from escalating into long term claims involving post traumatic stress disorder. Identifying and intervening early after a workplace trauma will help ensure employees recover and get back to work as quickly as possible.

 

 

Who Gets PTSD

 

Just about everyone will have stressful reactions to a traumatic event, such as workplace  violence. But the vast majority will recover and have no symptoms within several months.

 

A segment of the population — around 7 to12 percent will have a more difficult time recovering. They may improve, only to see their symptoms recur with a new stressor. Some may develop a lifelong illness that affects every aspect of their lives.

 

Diagnosing PTSD is not an exact science, as its symptoms often mirror other conditions. Generally, experts say having the following for more than one month are clues:

 

  • Reliving the event. Internal or external cues that resemble any aspect of the incident may cause images, perceptions, dreams, or dissociative flashback episodes.
  • Avoiding certain stimuli. The employee may refuse to discuss the incident, or avoid places or people associated with it, including coworkers.
  • No interest in participating in group activities.
  • Feeling detached from others.
  • Emotional overload. The worker may be irritable or have outbursts of anger, or trouble concentrating, and may be easily startled.
  • Physical symptoms. Headaches, high blood pressure or gastrointestinal issues may be present as well.

 

The risk of developing PTSD depends on many factors, including the presence of psychosocial issues. Even many of those who recover slowly and are at increased risk can be helped and recover, often within 8 to 12 weeks. The key is to get them into appropriate treatment as soon as possible.

 

 

Crisis Intervention

 

Traumatic incidents can happen in any industry, but are especially prevalent in certain ones. Employers in fields such as healthcare and retail are wise to consider implementing a post trauma crisis intervention protocol to help employees immediately after a traumatic event.

 

The plan should include the following elements:

 

  1. Early contact. Within 24 hours of a workplace trauma, employees should be contacted by a trained trauma specialist. That contact should continue until there is a face-to-face meeting for acute psychological intervention. Responding early shows the employer cares about the employees, which can help prevent delayed recovery and require less use of medical and mental health services.
  2. Face-to-face assessment. A psychologist should perform an assessment and begin trauma recovery of care. In most cases, no more than three visits will be needed before the employee can return to work.
  3. PTSD determination. If symptoms persist for more than one month, the psychologist should conduct a criterion-based PTSD diagnostic assessment to help determine whether the workplace trauma was the actual cause of the employee’s symptoms.
  4. Trauma interventions. An employee diagnosed with PTSD may find his work and daily living is disrupted. Increased absenteeism and decreased productivity may be among the results. Once a PTSD determination is made, the worker should be referred for specific treatment.
  5. Long, drawn-out therapies are not necessarily needed to help injured workers with PTSD. Cognitive behavioral therapy, for example, has been shown to help. It includes principles of learning and conditioning to help injured workers change their negative beliefs about themselves while gradually exposing them to the thoughts and situations they fear. Exposure/desensitization therapy is also effective in treating PTSD. This may involve imaginal exposure, where the worker is exposed to the traumatic event through mental imagery; or in vivo therapy, in which the worker confronts the actual scene or similar events associated with the trauma.
  6. Short term use of certain medications may be helpful, depending on the severity of the symptoms and the worker’s preference. Some antidepressants have been approved by the Food and Drug Administration to treat PTSD. However, benzodiazepines such as Valium and Klonopin should be avoided, as there is no evidence they are beneficial and can even increase the likelihood of developing PTSD when they are prescribed in the acute aftermath of trauma exposure.

 

Conclusion

 

Workplace trauma can take a devastating toll on all affected employees and an organization as a whole. But it does not need to result in long term disabilities.

 

The vast majority of people who are exposed to traumatic events recover with limited help. Of those who need further follow up, many will be able to return to work and function. Employers who are proactive about identifying and intervening can better protect their workers and their bottom lines.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

4 Keys to Successful Workers’ Comp Vendor Management

workers' comp vendor managementBusiness success relies on having the right people in the right jobs. Often that means outsourcing aspects of the business that are best handled by others. To maximize these relationships, you need to ensure your vendors’ goals are aligned with yours and they are giving you the best value for your money.

 

Too many organizations in the workers’ compensation system fail to appropriately manage their vendors and instead assume they are doing what is expected. These companies miss out on opportunities to positively impact their workers’ compensation programs and their bottom lines.

 

Vendor partners should be just that: partners in your business. Their relationship with you should be transparent and cost effective. Rather than outside entities, they should be considered part of your overall team.

 

 

Select the Most Appropriate Vendor

 

The first step in creating effective partnerships with vendors is to choose the ones that are best for your particular organization. Whether you seek a third-party administrator, medical providers, pharmacy benefit manager, medical bill review company, or something else, the process is generally the same. You need to first understand what you want from a particular vendor.

 

Analyzing your business requirements is a good first step, as that can lead you to the type of vendor(s) you need. Form a diverse team that will be working most closely with the vendor and brainstorm over the most important requirements that will benefit your organization. Come up with an outline of the ideal vendor, and include questions to ask prospects. Then identify prospective vendors that at least meet your minimum requirements.

 

In evaluating the vendors make sure you keep to the goals outlined by the team, so you don’t get swayed by those offering all sorts of bells and whistles that you really don’t need. Ask questions about the services the vendor provides and the success rates. You can also ask for a client list or at least a couple of clients to speak with.

 

You may also ask if the company conducts internal audits and, if so, if it will share the findings with you on a regular basis. While the vendor may not routinely share all aspects of an audit you can at least get a sense of challenges the company faces.

 

 

Set up the Contract

 

This part is crucial as it sets the tone for the partnership. Consider using a service level agreement (SLA) and/or risk/reward strategies. A SLA defines the level of service expected, and includes things such as time frames for various reports. You want to include performance measures so you can hold the vendor accountable to them.  The contract may also include incentives for the vendor to meet or exceed expectations, and penalties for failing to meet them.

 

Before you enter into a final agreement, decide how long or short of a term you want and whether you want an exclusive relationship with the vendor. It’s also important to look for hidden costs. Find out, for example, if a price quoted includes data capture or reporting.

 

 

Communicate Regularly


Now that you have the vendor on board:

 

  • Are you getting timely reports that are clear and actionable?
  • Is the vendor keeping you in the loop when challenges arise?

 

Minor problems like these can be avoided or easily cleared up with ongoing communication.

 

 

Evaluate

 

The vendor’s performance should be monitored, especially once the contract is implemented. Qualitative or outcome based performance measures agreed to by your internal team and included in the contract should be met. For example, are the providers in your network using evidence-based medicine? Do they meet the expected return-to-work rates?

 

Quality assurance audits conducted by independent reviewers can also be used to point out problems that may be hindering your workers’ compensation program.

 

Finally, make sure you are getting the aggregate data that you need, when you need it. Review reports the vendor gives you to make sure they provide valuable information that will help you further improve your overall workers’ compensation program.

 

 

Conclusion

 

Outside vendors can save you money and help ensure the best outcomes for injured workers. But they need to be part of your organization. By finding the best ones and working with them closely vendors can and should be a valuable asset to your organization.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

3 Instances to STOP Unnecessary Temporary Total Disability Benefits

Members of the claims management team need to be mindful of their files when the injured worker is receiving wage loss benefits, including temporary total disability (TTD) benefits.  While these benefits are mostly capped, failure to pay only these benefits the employee is entitled to can significantly raise the cost of a claim and negativity impact your program’s bottom line.

 

 

Payment of TTD Benefits

 

The majority rule is TTD benefits are paid to a claimant at two-thirds of their average weekly wage.  In some jurisdictions, there is a three- to seven-day waiting period before the payment of TTD is to commence following disability.  These benefits are payable to the employee following an injury when based on their physical condition, in combination with age, training and experience and the type of work available in this community, they are unable to secure anything more than sporadic employment.  A cap on the number of weeks TTD benefits are payable is in force under most workers’ compensation acts.

 

 

Discontinuing the Payment of TTD Benefits

 

There are a number of instances where employers/insurers can terminate the payment of TTD benefits.  These defenses to the payment of wage loss benefits are defined by statute and subject to limitations and other due process considerations.  In some instances, benefits will terminate once a condition is met and or post-discontinue period expires.  Statute will also define how the payment of TTD benefits will recommence.

 

Being proactive claims handlers requires a diligence in looking for legal and ethical opportunities to discontinue the payment of TTD benefits.  Some common instances include:

 

  • Refusal of job offer: Injured workers sometimes lose the ability to choose what type of work they perform following a work injury.  Refusal of an offer of gainful employment within the employee’s physical restrictions or a rehabilitation plan can result in loss of ongoing TTD benefits.  This is based on the premise that the injured party must mitigate their losses.

 

  • Withdrawal from the labor market: Following a work injury, an employee is required to remain in the labor market provided they are not completely restricted from work.  Simply put, sustaining a work injury does not entitle someone the opportunity to take a vacation, spend time at his or her cabin, or move to a warmer climate.  (subject to applicable FMLA laws)

 

  • Attainment of maximum medical improvement (MMI): Reaching the end of one’s healing can serve as a basis for discontinuing TTD benefits in many jurisdictions.  MMI signifies the end of healing, assignment of permanent restrictions, if any, and a determination regarding permanent partial disability (PPD) benefits.  This can be determined via the employee’s treating doctor or following an independent medical examination (IME).

 

 

Conclusions

 

Termination of wage loss benefits is dependent upon each jurisdiction’s workers’ compensation act and case law interpretations.  Claim handlers need to understand what events can trigger a discontinuation of benefits.  They also must understand the nuances within the law to effectivity make such determinations.  Understanding these concepts can lead to significant savings in any program.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

9 Steps to Get the Best Out of Your Workers’ Comp Adjuster

Having a great claims adjuster can be invaluable. Claims are processed smoothly, timely, and satisfactorily.

 

But getting the ideal adjuster is not always possible, and employers often blame adjusters when things don’t go as efficiently as they could. Should you seek a different adjuster, or just accept that you’re stuck with a dud? Actually, you may be able to avoid both. By taking a step back to gain some insight into the adjuster’s world and using a few simple strategies, you may be able to turn things around.

 

 

Set Realistic Expectations

 

The adjuster’s role is the fair and reasonable settlement of claims. First step is to figure out what that means to you and how it fits in with your company’s claims handling plan. Setting up expectations is important. If there are no clear directions or goals, you really can’t blame the adjuster for failing to meet your expectations.

 

For example, do you want the adjuster to be in constant contact with you, or do you want communication only when absolutely necessary? You need to determine that and let the adjuster know.

 

If you expect the adjuster to resolve claims within a certain period of time, are you doing all you can to facilitate that? How soon are injuries reported? Is that on a consistent basis? Do you have a timeframe for when and how investigations are performed?

 

Other factors can also affect the resolution of claims. Not having a return-to-work program or light duty/transitional work can make more work for the adjuster, along with the lack of a fraud prevention program. Make sure your actions and goals are in line with your expectations of your adjuster.

 

 

Understand the Adjuster

 

It can be upsetting when the adjuster doesn’t get back to you when you think he should, or denies treatment on a claim with no explanation or approves a questionable claim. But seeing things from the adjuster’s standpoint can help.

 

Instead of lambasting the adjuster, consider what is happening on his end. Being an adjuster can be a thankless job;

 

  • There are constant questions, emails and phone calls, often from disgruntled employees, employers or others.
  • His caseload may be overwhelming.
  • There are constant deadlines that may or may not be achievable.
  • The turnover for the profession is such that his office may be understaffed at any given time.
  • While you might be easy to work with, others may not be.

 

You can find out what’s going on by talking with the adjuster.

 

Build a Relationship

 

Developing a bond with the adjuster can go a long way toward having a better connection with him. Working better with the adjuster can involve a few simple steps:

 

  1. Pay him a visit. A ‘chairside visit’ is a great way to establish a good relationship with an adjuster. For this informal meeting, you literally sit at his desk to understand the demands of his day. You can also take the opportunity to learn how he handles claims; the intake process, medical-only and lost-time claims, and catastrophic claims.

 

  1. Get to know him on a personal level. While you don’t need to be best friends, you can find out a little about him — his home life, kids, hobbies, etc.

 

  1. Realize he is the expert. Even if you don’t like the way he’s handling a claim show him respect. That said, find out his expertise level. If he’s new to the profession, he’s probably not the right person to handle complex claims. On the other hand, a highly experienced adjuster might be bored handling simple, medical only claims.

 

  1. Ask questions. There may be good reasons for the way he’s handled certain aspects of a claim. Don’t just get angry, find out why. Ask open-ended questions that are not accusatory. Putting him on the defensive won’t help your relationship, and it likely won’t get you answers.

 

  1. Give praise when warranted. If the adjuster does a particularly good job with a claim, tell him so. He’s probably much more used to hearing negative comments than true appreciation. Doing so will make things much easier when you later have concerns about a claim.
  2. Listen to what he says. You may have ideas to solve some of the challenges he’s facing.

 

  1. Offer to help. There may be things you can do that would help him expedite the claims process.

 

 

Conclusion

 

If you’re having problems with your adjuster, first look at your own program. Having an organized plan for claims handling and relaying that sets up realistic expectations.

 

Then, work with the adjuster. Develop a bond so you can easily find out the reasons for any problems and set up strategies to avoid future challenges.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

4 Items Claims Handlers Want From Their Defense Attorney

Workers’ compensation defense attorneys may lay awake at night wondering what their claims handler really wants.  Besides getting their files closed in a timely manner, they want to work with defense attorneys committed to a zealous defense of the file in an ethical and cost-effective manner.  Here are some tips that can help defense attorneys sleep better at night knowing they are giving their claims handler what they want.

 

 

Calculate the Average Weekly Wage (AWW)

 

The AWW is the basis for most indemnity benefits in a workers’ compensation claim.  Failing to calculate it correctly can increase the cost and exposure of the claim.  A seasoned defense attorney needs to communicate with the employer and receive additional explanation from the employee on a number of issues.  The list can be endless, but some special considerations include:

 

  • Whether the employee was a full or part-time worker;

 

  • Whether the employee was working any additional jobs outside the employer involved in the claim;

 

  • Investigation into the nature of any fringe benefits the employee was receiving. This includes tips, bonuses, insurance benefits and other forms on potential income; and

 

  • Special circumstances concerning the employee’s employment. This is especially the case when the injured worker in a seasonal employee, construction worker or part of a union collective bargaining agreement.

 

 

Calculate and Evaluate the Indemnity Exposure

 

Once the AWW is correctly calculated, the defense attorney can provide an accurate analysis to the claims management team about wage loss exposure.  This includes information on the following benefits:

 

  • Temporary Total Disability (TTD)—Benefits paid when the employee is temporarily off work due to injury or disability;

 

  • Temporary Partial Disability (TPD)—Benefits paid when the employee returns to work, but at reduced hours or rate of pay;

 

  • Permanent Partial Disability (PPD)—Typically a hybrid benefit based on the AWW and the number of weeks disability assigned by statute or rule to an injury; and

 

  • Permanent Total Disability (PTD)—Benefits paid when the employee is permanently precluded from returning to gainful employment based on their age, training and experience, and the type of work available in the geographical area. Various presumptions may apply concerning an employee’s receipt of Social Security Disability benefits.

 

 

Aggressive Defense Strategy That is Cost-Effective

 

Members of the claims management team also appreciate an aggressive defense strategy that moves a case toward settlement in an efficient and cost-effective manner.  Considerations for such planning include:

 

  • An immediate status report upon receiving the claims file, with periodic reports that are robust and evaluate the strengths and weakness of various defenses, a reasonable strategy and probable outcome;

 

  • Identification of missing information that needs to be discovered in order to provide an accurate analysis and defense. This includes a plan on how to uncover this information and whom might be a witness at hearing; and

 

  • Recommendations on how to move a case toward settlement. This includes information concerning the timing of an independent medical examination or independent vocational evaluation.

 

 

Medicare Secondary Payer Compliance

 

Medicare Secondary Payer compliance is an important part of any workers’ compensation claim analysis.  This includes recommendations on the following topics:

 

  • Whether a service provider should be utilized to prepare a Medicare Set-aside allocation;

 

  • If the Medicare Set-aside should be included for review and approval under the voluntary CMS process; and

 

  • Matters concerning conditional payment identification and repayment.

 

 

Conclusions

 

The wants of a workers’ compensation claims handler are quite simple.  They expect professionalism and responsive defense counsel to assist them on all claims.  While the defense attorney might not have all the answers, they need to assist the claims handler in discovering the information and reporting on it timely.  This also includes a reasonable analysis, while being a zealous advocate.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

 

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

 

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

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de