OSHA Orders Metro North to Promote, Pay Worker Cheated By Injury Misclassification

 
An investigation by the U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) found the Metro North Commuter Railroad Co. discriminated against an employee by classifying his on-the-job injury as not being work-related and denying him a promotion.
 
 
According to an OSHA report, the agency ordered the railroad, which provides commuter rail service in Connecticut, New York, and New Jersey, to take corrective action by promoting the worker and paying him $125,000 in punitive damages, $5,000 in compensatory damages and $11,651 in legal and medical expenses. The railroad also must pay him the difference between his current rate of pay and that of the new position, plus interest, and correct its records to show his injury as work-related.(WCxKit)
 
 
Additionally, Metro North must post a notice to employees at all 120 of its stations of their protections under the Federal Railroad Safety Act (FRSA) as well as provide all employees with an FRSA fact sheet and information on reporting work-related injuries and illnesses.
 
 
The worker filed a complaint with OSHA in October 2008 after Metro North classified his July 2008 injury as not work-related even though it occurred on the job, which forced him to pay out-of-pocket for injury-related medical expenses. Metro North notified the worker in November 2008 that he was not selected for a promotion for which he had previously applied. That decision was based in part on the worker's injury record, which should not have been considered in evaluating the promotion request. OSHA's investigation determined that both the injury misclassification and the promotion denial constituted discrimination against the worker.
 
 
Metro North and the complainant each have 30 days from receipt of the findings to file an appeal with the Labor Department's Office of Administrative Law Judges.(WCxKit)
 
 
Under the FRSA, employees of a railroad carrier and its contractors and subcontractors are protected against retaliation for reporting on-the-job injuries, reporting certain safety and security violations, and cooperating with investigations by OSHA and other regulatory agencies.

 
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Five Ways to Reduce the Legal Expenses of Workers Compensation

 
Should we use legal expense review companies? An attorney I know posted a joke on a Facebook page that is fairly accurate these days. An adjuster hands a new file to her counsel and tells him, “I do not want to pay anything on this file, including legal expenses.” Upon hearing this, the attorney asks why he should be expected to review, handle, and get rid of a new case for free? The adjuster advises, “That is not my problem it is yours. If you want the business, do as I ask.”
 
 
This is a current trend within the insurance business. Insurance companies have long used outside Medical Bill Review (MBR) companies, or they have internal review departments, to review procedure codes in medical bills and reduce charges per jurisdiction guidelines.
 
 
Legal expense review companies have popped up and are growing rapidly. Their purpose is to do the same bill review on legal fees for cases and reduce charges accordingly. This has led to some aggravation on the part of legal firms, who feel their bills are being reduced more and more. It seems like the carriers want more services for less cost. This can be achieved properly, however, if we use a lot of common sense here. Using the most experienced and attentive attorney on files, not the least expensive, is sometimes the best way to go, because one has to take a "TOTAL cost" approach, not a "short term cost reduction" approach. Sometimes it is better to spend more now to reduce overall expenses in the longer term.
 
 
5 Ways to Reduce your Legal Costs OR Prevent Your Charges from Being Reduced
 
 
1.      Firms should use paralegals or legal assistants to review medical notes and establish a file timeline from start to current.
Certain adjusters have always used dedicated counsel — specific attorneys — to handle their cases. Sometimes the dedicated attorney is advised to handle the case from start to finish. The legal firm will use this as a chance to bill the insurance companies for all activity, including file review and setup.
 
 
The hourly charge between the actual attorney doing all tasks, and what they charge for their assistant doing the same tasks, can be very large. Attorney fees can range up to $300+ an hour, whereas legal assistants doing the same work can be billed up to one quarter of that, if not less, depending on the firm and what the insurance company has negotiated for a rate. These are called "negotiated rates."
 
 
The initial legal file setup, timeline construction, and medical records review are usually the most time-consuming tasks, depending on the size of the file and how complex it is. In one million dollar claim and the medical records took up an entire side of the office. The utilization review expert was reviewing each document, finding inaccuracies and reducing the medical expenses accordingly. An RN with 20 years surgical experience was doing this review. There can be significant cost-savings by making sure the assistant does this task, and not the actual attorney. An RN can be quite helpful on these tasks, and many paralegals are excellent.
 
 
2.      Paralegals can attend mediations and initial negotiations.
The first meetings between plaintiff attorney and defense counsel are usually uneventful. Both sides review the case and offer their stance on the file. They point out differences in the case and why there is a difference in opinion. Legal expense reduction companies state the actual attorney should not be present at these hearings, since nothing of significance happens. This way you do not have to pay larger travel costs, and time charges while waiting for plaintiff counsel to show up. This can be a nice savings in your legal budget.
 

CAVEAT: While this is the advice proffered by legal cost reductions companies, some adjusters prefer to use the more expensive upfront strategy, which is to use the MOST qualified person on the team – usually an experienced defense attorney.

 
 
3.      Legal firms should not have large charges for emails and quick phone discussions.
One thing the legal expense review companies see a lot of is overcharging for simple communication with the adjuster. A quick email response or phone call does not need to cost a quarter-hour fee, even though some firms try to sneak in such charges.
 
 
Granted, if discussion is part of a conference on an action plan or overall case review, the attorney can justify charges, and if it is a detailed discussion important to the case, the adjuster should be charged for that time. But, if the question is a simple issue, there is no need to overcharge for the service. Legal firms will often say simple communication is included in their negotiated cost for the opportunity to handle the case, and if such charges are included in their bill the legal expense company will cut the charge down or eliminate it totally.
 
 
4.      Travel time to court should not be billed separately.
If your attorney goes to local court to handle most of their clients’ cases, they should not be able to bill each carrier separately at maximum rate if they were going to travel there anyway on cases for other carriers. Or, if they do, you should be aware of this practice. Most legal firms will bill separately for this reason, but there are some that will isolate each case and bill accordingly at the maximum rate.
 
 
Legal expense review will often ask, if counsel was heading to court to handle a day’s worth of case negotiations for various clients, why should each carrier have to pay a large charge for this travel? Granted, if this is a special trip, or a trip to another jurisdiction especially for your case, then the charge may be justified. But it is the job of the legal firm to handle their bills accordingly for each carrier or the charge will be reduced by the legal expense firm.
 
 
5.      Law firms should be able to justify ALL billing charges on each bill, and they have the obligation to keep proper records for each case and each task they do for each carrier.
There has been a lot of backlash from legal firms about the billing reductions. One attorney said he had to “fire” his client, because their legal bills were getting reduced so much the firm was losing money by handling the case. Obviously, that is counter productive and not in the best interests of the employer, so make sure to rein in the legal bill reviewers so they do not go overboard.
 
 
Due to carrier demands, and the abundance of files for firms to handle, negotiating power is in the carrier's hands. The consensus is, if a firm does not want to reduce fees to what the carrier wants, the carrier will find a firm who will do what they want. This is creating a bad environment for attorneys since most of them have longstanding relationships with certain carriers and adjusters. They do not want to lose the business, but they have no choice.
 
 
Of course there are some carriers who are trying to cut down legal expense as much as possible, sometimes unfairly. By doing this they are trying to take advantage of legal firms to get as much out of them for as little cost as possible. Larger firms can sometimes absorb this possible loss just to keep the carrier’s business. But smaller firms that cannot compete are losing a lot of business.
 
 
In most cases, the relationship between carrier and legal firm can work if they negotiate an hourly rate, and the associated tasks that go along with it. Tasks need to be clearly defined so no confusion comes when the bill arrives. The legal expense review company should also be informed of certain fees and tasks as negotiated between the carrier and firm so no issues arise. The goal should be to maintain that solid relationship between counsel and carrier, and the associated fees that go along with the handling of a litigated case to overall settlement.(WCxKit)
 
 
Legal expense review companies can be a great asset in reducing your overall legal costs when handling litigated files. But the hourly rates and the tasks that go along with it need to be clearly defined between the carrier and the legal firm. Any confusion on any of these issues can lead to a breakdown of the relationship, which benefits no one. By being proactive and establishing clear expectations at the beginning of the lawsuit, both parties can deal fairly with each other. To get good service, you have to pay a fair price.

Author Rebecca Shafer
, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 

Our WC Book: www.WCManual.com
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Alaska Comp Board Assesses Penalty to Employer Not Carrying Coverage

 
The Alaska Workers Compensation Board assessed a $1.5 million civil penalty to Ultimate Tours, LLC, and Godwin Glacier Tours, LLC, for its reported failure to carry workers compensation insurance, misclassifying employees as independent contractors and violating stop-work orders.
 
 
"Ultimate Tours/Godwin Glacier Tours operates seasonally in the Seward area," said Mike Monagle, director of the workers compensation division.(WCxKit)
 
 
"Division of Workers Compensation staff repeatedly attempted to resolve the situation and bring the employer into compliance with state law, but for six seasons failed to reach an agreement with this employer," Monagle added.
 
 
The tour company, which operates glacier dog sled tours, glacier hikes, and helicopter flight seeing on the Kenai Peninsula, was in violation of stop-work orders for failure to insure its employees for 341 days, from Nov. 7, 2005 to Aug. 30, 2010. Five injuries have been reported to the division of workers compensation.
 
 
The tour company was assessed the penalty on 1,215 uninsured employee work days and additional penalties for knowingly misclassifying employees to evade workers compensation premiums.
 
 
Alaska law requires all employers to carry workers compensation insurance.
 
 
Employers who fail to comply with the law may be liable for civil penalties up to $1,000 per uninsured employee per workday.
 
 
Employers, who violate a stop work order issued by the Alaska Workers Compensation Board or the division of workers compensation, may be liable for an additional civil penalty of $1,000 for each day the employer is in violation of the stop work order.(WCxKit)
 
 
Officials also point out that employers who knowingly misclassify employees for the purpose of evading payment of workers comp premiums are not only subject to civil penalties for failure to insure, but may also be subject to criminal penalties for fraud.

 
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Labor Department Marks 10th Anniversary of Act to Help Workers

 
The U.S. Department of Labor recently marked the 10th anniversary of administering the Energy Employees Occupational Illness Compensation Program Act.
 
 
As the DOL points out, the EEOICPA provides compensation and medical benefits to eligible workers and their survivors who became ill as a result of working in the nuclear weapons industry. The department has administered Part B of the EEOICPA since the program's inception in 2001, and was charged with the implementation of Part E, created by an amendment to the EEOICPA, Oct. 28, 2004. To date, the department has paid more than $7.2 billion in compensation and medical benefits to over 71,400 eligible individuals.(WCxKit)
 
 
"Since the EEOICPA's inception, the Labor Department has been committed to fulfilling the promises made to Cold War veterans," said Rachel Leiton, director of the Division of Energy Employees Occupational Illness Compensation, which administers the EEOICPA. "I am very proud of the hard work and dedication of our employees. The benefits paid to eligible workers and their families have far exceeded the original expectations from the time the program began. I encourage all individuals who may be entitled to benefits to contact us toll-free at (866) 888-3322 and file a claim."
 
 
Part B of the EEOICPA covers current or former workers who have been diagnosed with cancers, beryllium disease or silicosis, and whose illness was caused by exposure to radiation, beryllium or silica while working directly for the U.S. Department of Energy, DOE contractors or subcontractors, designated Atomic Weapons Employers or beryllium vendors.
 
 
The Labor Department has approved 51,576 claims under Part B of the EEOICPA. Part E of the EEOICPA provides federal compensation and medical benefits to DOE contractors and subcontractors who worked at covered DOE facilities and sustained an illness as a result of exposure to toxic substances. The Part E benefit payout has exceeded $2.3 billion.(WCxKit)
 
 
The EEOICPA also provides additional compensation for uranium workers who worked at facilities covered by the Radiation Exposure Compensation Act, which is administered by the U.S. Department of Justice. Additionally, certain survivors of nuclear weapons industry workers are eligible for benefits under Parts B and E. To assist individuals regardless of where they live, the department has 11 stationary resource centers located throughout the country. These resource centers provide an initial point-of-contact for individuals interested in filing a claim under the EEOICPA, and staff provide both in-person and telephone-based assistance.

 
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Cancer Still Not Covered for World Trade Center Responders

 
After the New York City World Trade Centers fell, images of responders rushing in unprotected to help victims of the terrorist attach Sept. 11, 2001, are burned into the memories of every American.
 
 
Discussion loomed immediately about toxins in the air from particulate matter, burning materials, airplane fuel and more. Of course there was nothing victims could do to protect themselves and first responders, in a rush to help as quickly as possible, did not stop to assess the danger they put themselves in.
 
 
Now, a National Institute for Occupational Safety and Health (NIOSH) report indicates there is not enough evidence to link the collapse of the World Trade Center (WTC) towers to cancer in responders and survivors. The study means those groups will not be able to collect federal money for treatment or compensation
 
 
However, the report also does not indicate evidence of the absence of a causal association. And another review is scheduled for early 2012.
 
 
Under the James Zadroga 9/11 Health and Compensation Act of 2010, there must be periodic reviews of scientific and medical evidence. If a causal association were established, recovery workers and others with cancer diagnoses could be compensable.
 
 
The Zadroga Act provides funds for a specific list of illnesses, such as asthma and other respiratory diseases linked to the 911 attacks. Cancer could be included if a link was found.
 
 
The initial review was based on three information sources, according to NIOSH:

1.     
A systematic search of peer-reviewed findings on exposure and cancer resulting from the terrorist attacks that have been published in the scientific and medical literature between Sept. 11, 2001, and July 1, 2011.

2.     
Findings and recommendations related to cancer from the WTC Clinical Centers of Excellence and Data Centers, the WTC Health Registry at the New York City Department of Health and Mental Hygiene, and the New York State Department of Health.

3.     
Information from the public solicited through requests for information published in the Federal Register earlier this year.
 
 
The report said there was little evidence because few published research studies on the attack mention cancer and only a small number of those are peer-reviewed. Further, cancer is a common disease, making linkage difficult, the report said. (WCxKit)
 
 

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Eleven Ways to Learn about Workers Compensation at a National Workers Compensation Conference

 
Work Comp Roundup attends the National Workers Compensation and Disability Conference® & Expo (NWCDC) at least every other year.
 
 
As seasoned conference goers, we offer some hints and tips on how to make the most out of our experience.
 

 You might
wonder why those already established in the industry attend still attend conferences…

The reason is
that the workers compensation industry is always evolving – new players, new laws, and new equipment.  We recommend everyone who is new to our field attend industry conferences often. This time of year, it's the National
Workers Compensation and Disability Conference® in Las Vegas in November to learn what is new.

At Roundup, we always learn new techniques, meet new vendors, and discover the latest service enhancements. In fact, when I began, I learned this field from the ground up — NWCDC was a part of that education! 20 years ago, in Chicago — my, how time flies.

 
A conference of this scale can help you expand your knowledge and gain new solutions directly related to:
1.Workers compensation,
2.Disability management,
3.Return-to-work programs,
4.Better Claims Management,
5. Health/Medical Management,
6. Solving Legal/Regulatory Issues, and
7. Strategic Views
 
The National Workers Compensation and Disability Conference® & Expo Nov. 9-11 in Las Vegas is the nation's leading event for dedicated to the workers' comp and disability management industries. Hundreds of our colleagues gather each year to expand their knowledge and gain new solutions directly related to their workers' comp, disability, and return-to-work programs.
 
Celebrating its 20th anniversary, the conference offers more than 30 breakout sessions organized by type and level. Plus, there will be an in-depth pre-conference symposium, “Awesome New Technologies: What You Need to Know to Drive Improvement.” The Expo portion of the conference hosts more than 260 exhibitors providing an additional venue to gather knowledge to take home plus numerous opportunities to network and glean insights from top experts on how to solve your problems in claims management, strategic program planning, health/medical management, plus legal and regulatory issues.
 
As a seasoned conference goer and industry leader, here are ideas about how to get the most out of this large national conference:
 
Eleven Ways to Get the Most Out of the National Conference:
 
1. Attend the Opening Session. This is a large session for all attendees where awards are given to the best companies in the industry. Don't miss this because the award recipients will describe their programs, what works, what doesn't, how they overcame challenges specific to their industry and company, and likely the same obstacles YOU are also encountering. You will hear many ways to reduce costs, and you will take many notes.
 
2.  Focus on your specific goals, for example, attend sessions about return to work programs or allocation systems, if you need to learn more about how to implement these cost containment techniques. I use my Program Planner like a lesson plan, circling the first and second choices.
 
3. Read the brochures you collect when you return home; use them as your own private educational program to LEARN what is available. How could you possibly request an off-site vendor be added to your list of service providers if you do not that such as service exists? You can't!  How could you ask for nurse triage if you do not know the service exists? You can't.
 
4. Pass your business card out and do not be afraid to network – that is part of this business. Meeting knowledgeable people gives you a resource when you encounter a problem. Sitting at the round tables encourages discussion. Don't be afraid to tell people at your table you are new. They may be too, and if they are experienced, they'll be happy to help you. We've all been new at some point in our career.  
 
5. Learn what you don’t know you don’t know. We often find employers who have misidentified the cause of their high work comp costs. They think it is nurse case management or bill review that is driving costs, when it is really poor management and operational practices. Being exposed to new ideas presents an opportunity to learn things you don’t even know you are missing!
 
6. Chat with people who do the same things that you do and see where you differ. One thing I like about the conference is that some of the most popular sessions are repeated at different times, and if I begin a session that does not interest me, or isn't applicable (which doesn't happen often), it is not a problem to quietly sit in another session down the hall. CAVEAT: Be courteous if you think you might do this as it's not fair to distract the speakers or other participants by being noisy or disruptive, so take care to come and go quietly, and sit in the back of the room near the door. Many sessions are very close in proximity to each other — in the same large hallway – which makes entering another session easy.
 
7. Learn Key Cost Drivers. Find people who work in workers compensation departments you know next to nothing about and ask them whether they are satisfied with their workers comp vendors. Ask them what drives their costs. We speak daily with companies unhappy with their TPA or insurance carrier, but are only guessing about what is driving their costs. If you are even thinking of changing carriers or TPAs, I suggest you attend the sessions at the conference to make sure you are on the right track.
 
8. Roam through the exhibit hall speaking to vendors and learning about the types of services that are available to reduce workers comp costs. THIS will be the best education you will ever get!
 
9. Wear comfortable attire. Bring comfortable shoes. I call my black flats my "conference shoes." You will be on your feet a lot, so be comfortable. The first day, people are a bit more dressed up than the following days. The last day is more casual because people are traveling back home. You will definitely want to dress professionally because some of the people you meet with become lifelong contacts, so making a good impression is important, but you can be comfortable, too. For an ounce of prevention, bring moleskin to protect the areas of your feet most likely to get blisters.
 
TIP: Visit the Exhibit Hall and the Educational Sessions. Attend both. Try to visit every single vendor in the exhibit hall. Start on the right, and move systematically through the rows.
 
TIP: Start early, leave late, and remember … although your feet may hurt, this is only once a year!
 
TIP: Before the Exhibit Hall opens, have breakfast in the Continental Breakfast Hall to network with new friends. You will find people are very friendly and helpful. I love the 8-round tables which make it so easy to introduce yourself to those at your table. 
 
HINT: Bring band-aids – you will do a lot of walking, and you may get a blister or two, so come prepared.
 
10. It is affordable. If the CEO or business owner does not want to spend the money for you to attend the conference, show them the TRUE cost of your workers’ compensation losses with the Sales To Pay For Accidents Calculator to gain management commitment here: http://www.reduceyourworkerscomp.com/calculator.php.
 
For example, if you have just one $40,000 loss, it will take your company $666,666.00 in new sales to replace the $40,000 lost on that single claim. Learning how to reduce your costs is a wise business investment. It also makes you more valuable in the marketplace.
 
Yes, it is in Las Vegas, and if your CEO bemoans the fact that the conference is in a city more known for partying than workers’ compensation, let him or her know that Las Vegas is one of the most affordable travel destinations, which is undoubtedly one of the reasons the conference organizer chose that destination this year.
 
11. Keep your conference guide for future reference. You may want to have this handy on your desk for the time you want to try a new service or ask a question about a new service. Or, if you are putting out a Request For Proposal, this will be your ultimate list of those companies to bid on your project.
 
See you there!
 
 
Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation, and has attended the National Workers Compensation and Disability Conference® many times. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 
 

Our WC Book:  http://www.wcmanual.com
WORK COMP CALCULATOR: http://www
.LowerWC.com/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.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

5 Times to Just Settle That Workers Compensation Claim File

There are times while engaged in a workers compensation file that you are better off just settling the file out, redeeming all costs for medical, wages, and future medical exposure. Some files will not necessarily call for a full settlement, maybe it is better to settle either wages or medical, or both, but it has to be done when the scenario calls for it. Some examples are below.

Note: These are general examples, and all actual claim situtations should be reviewed by your legal counsel.

 

1.   The injured worker has been terminated by the employer
The cause of a good percentage of litigated files comes when the employer terminates employment with the claimant during the course of their injury and subsequent rehabilitation. The claimant feels they were terminated unfairly due to their injury, and this will send them directly to a plaintiff attorney. This will open up significant exposure for ongoing wage loss, and it will extend the life of a claim. (WCxKit)
 
 
On most occasions you are better off waiting to drop the axe on termination until the claimant has either reached their end of healing, or the end of the case. This way, if you want to settle the file, you can include the voluntary resignation of the claimant from the employment. 

Note: consult with legal counsel before settlement, having them review voluntary resignation to make sure it meets requirements of state law as "voluntary" and that it complies with all other requirements.

 
 
2.   The injured worker has no job to return to within their permanent medical restrictions
This scenario happens a lot when a major surgery or amputation is involved. The job the worker once did can no longer be done by that worker. You have the option of moving the employee to another department or position, but often with smaller companies the option is just not there.
 
 
This is a good time to settle the wage portion of a claim. If you know for sure the worker can no longer do the job they once did, and you do not want to spend the cost of vocational retraining or vocational job placement, then you should settle out the wage portion of their claim. Again it is best to wait until their medical situation stabilizes before you approach this topic. You do not want to pursue this too early, as the claimant may try to stretch out their medical recovery, further securing their wage loss benefits and adding to the cost of the claim’s wage loss.
 
 
Depending on the job, some claimants will know they have little to no hope of returning back to work at their old position. But not every injured worker is easy to deal with. Changing jobs or losing your job is a major roadblock in a claim, and it can be costly to settle out the wage portion of these claims. But in the long run, it is worth it. Vocational training and placement is not a guarantee, and you do not want to incur those costs and then also have to settle the wage portions out when you cannot find the injured worker a job.
 
 
3.   The injured worker still works for their employer, but their case is denied coverage under workers compensation
In this case you do not have to settle the wages and medical to include a voluntary resignation, unless you want to add it in. If the adjuster denied the case as being compensable, but the worker filed their claim under their disability coverage, and then filed for hearing after returning to work once released from medical care, this is a case to settle after all the exposure for wage loss and medical bills are gathered.
 
 
This case gives you the total exposure, since the lost wages are known, and the medical cost to full duty is known. This is known as a “closed period” settlement.
 
 
Typically the adjuster will have to negotiate a lien with the medical carrier, and a compromise will be made on the wage loss the worker incurred. Unless you have a fantastic denial and can take your defense all the way to trial, it is best to make the compromise and settle for a portion of the exposure. This is probably the most common litigation example in the world of workers compensation.
 
 
4.   The worker's case was disputed by the comp board, and then they were laid off due to workforce reductions. The injured worker was paid unemployment, and their medical carrier paid the medical cost to full duty
Here we have an example of taking a wage loss offset, and negotiating a medical lien. This is a fairly simple case to settle. Most states will allow a claimant to get unemployment pay when they are laid off. Even when they are off on a medical leave. This is a "collateral source benefit" because the employee may be making more when not working than when working.
 
 
However, if this person files for litigation, the insurance company can offset what the full-wage loss would have been, so, in essence, they get a credit for the wage loss, and only have to deal with the medical lien from the carrier. These medical carriers are usually easy to negotiate with, and most liens can be settled for easily up to 50 percent of their cost.
 
 
Medical carriers will also get a better fee reduction than workers compensation insurance carriers, so not only does the workers compensation carrier get a credit for the unemployment pay the worker received, they also get cheaper medical cost for all the medical expenses the injured worker incurred during their treatment and recovery. These are also usually closed-period settlements, and can be redeemed for a relatively low legal cost.
 

5.   The injured worker files for an occupational injury claim, naming several employers as the defendants
Occupational injury claims are usually filed by seasoned workers who have spent their lives working for several employers.  When their shoulder or back finally gives out and they need surgical repair, if they seek out an opinion at a plaintiff attorney’s office. The counsel will usually file a hearing for an occupational injury claim, and they will list all of the claimant’s past employers, since they will assert that each period of employment lead to the accelerated degeneration of the worker’s body, which lead to the ultimate injury they incurred.
 
 
In this case, each employer will contribute an amount towards a global settlement. The exposure of each employer will depend on the duration of employment, types of jobs the claimant performed, and the associated risk involved in relation to the injury. The hardest part about these claims is figuring out how much each adjuster should have to contribute. Once the adjuster takes all the past employers and the exposure into consideration, they will nominate a general amount for the represented employer’s exposure, and once all parties agree on all the amounts the case can be settled. It can take some time for all carriers and adjusters to agree, but they eventually get there and the case can be resolved.(WCxKit)
 
 
Workers compensation claims are settled all the time, usually for one of the reasons outlined above. As you can see, you have a number of opportunities where a settlement is the best option, and you should discuss with your adjuster if this is the road you should explore, instead of incurring other costs to bring an injured worker back to work at your place of employment. This differs from my normal opinion of bringing every able employee back to work.
 

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 

 

Our WC Book: http://corner.advisen.com/partners_wctoolkit_book.html

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Beware of The Medicare Secondary Payer Act When Paying Workers Comp Claims

 
Fast changing and complicated laws relating to self-insured employers’ responsibilities under the Medicare Secondary Payer Act make it difficult for employers to keep up with the latest changes and regulations. There is one thing that is easy to understand – the Centers for Medicare and Medicaid Services (CMS) are aggressively pursuing recovery of payments they have made from any viable source including self-insured employers.
 
 
Employers need to be aware of the risk involved when an injured employee is also a Medicare or Medicaid beneficiary. Any expense paid by CMS for workers compensation-related medical care can be recovered from the self-insured employer, even if the workers compensation claim has been settled and closed. Therefore, if the injured employee is collecting Medicare benefits for non-work-related medical expenses, the self-insured employer should verify that CMS has been paid for any medical cost they have incurred due to work-related medical care.(WCxKit)
 
 
In routine workers compensation claims, the employee treats with the medical provider and the medical provider submits the medical bills to the claims office or medical fee schedule reviewer where they are processed and paid. The workers compensation claims where the self-insured employer gets into trouble are long-term claims where the employee is treated by more than one medical provider and often for both a work-related injury and non-work related medical issues. It is almost a certainty that sooner or later the employee gives his/her Medicare or Medicaid card to the workers compensation medical provider, resulting in CMS paying for the medical care.
 
 
It is not enough to accept the employee's statement they have not used their Medicare benefits or they have reimbursed Medicare or will reimburse Medicare. All known workers compensation medical bills should be paid directly to the medical provider. When settling the claim with an employee who has Medicare or Medicaid benefits, as a part of your pre-settlement procedure, run a query with CMS. Guidelines on how to submit a query are a part of the CMS Secondary Payer Act guidelines published on the CMS website: https://www.cms.gov/MandatoryInsRep/Downloads/NGHPUserGuideV3.1.pdf
 
 
It will not do the self-insured employer any good to include wording in the Compromise and Release, or Release and Settlement Agreement that the claimant will be responsible for the repayment to CMS for any medical expenses they have paid as a result of the workers compensation claim. The agreement is between you and the employee. CMS is not a part of the agreement. They can still enforce their recovery rights and will do so. It is also much easier for CMS to go after the deep pockets of the employer than the employee who has already spent the money that was supposed to cover any medical bills that were not previously paid by the workers compensation insurance.
 
 
CMS must be protected or you are not protecting your self-insured workers compensation program from paying the cost twice. Intentional misrepresentation by the employee or an honest mistake on your part will not prevent you from having to reimburse CMS for the medical care for which they have paid. CMS takes the position that it is your responsibility to know the requirements of the Secondary Payer Act and to comply with them. 
 
 
While the CMS manual is difficult and takes some time to read, learn, and understand, if you are going to be involved in processing workers compensation, you must read the manual. Become acquainted with the CMS guidelines. Most importantly, this is a very specialized area of workers compensation, so it's best to work with a firm that has expertise in this area. Let's the experts do what they do best – making sure all of the bases are covered.

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.

 

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Learn One Excellent Method to Stay On Top of Workers Comp Claims

King Arthur is often credited with creating the roundtable discussion concept where various parties with different points of view were brought together to discuss an issue and to obtain consensus on how they should proceed. In the modern day of world of workers compensation claims administration, the roundtable concept is often used within the claims office where the work comp adjuster, the supervisor, the nurse case manager and possibly others sat down together and discuss the best approach to take on a difficult or complex claim.
 
 
As the employer, you should request to be included in the roundtable discussions of your more serious workers compensation claims. The roundtable discussion provides a forum where the members of the roundtable can provide input that will benefit everyone involved. (WCxKit)
 
 
Whether you want to have a roundtable discussion on a weekly basis or a monthly basis will depend on the number and complexity of your work comp claims. Once you have agreed with the claims office on when you will have the roundtable discussion, be prepared for it. Please remember the roundtable discussion is for the purpose of fostering approaches to moving the work comp claim forward, not to educate you about the claim. The fastest way to end the roundtable discussion practice is for you as the employer to join the discussion unprepared. If you have to ask the nature of the employee's injury, when the last doctor's visit was, or what the impairment rating is, you will be perceived as not involved. The purpose of the roundtable discussion is to advance the claim, not to answer basic questions you should already know.
 
 
You will need to know beforehand the participants in the roundtable discussion. Beside your participation, do you want others from your company involved? Would it be beneficial to have the workers compensation claims coordinator involved? The risk manager? The employer's claims manager? Someone else? You will also need to know who from the claims office will be participating. Will it include the nurse case manager, the adjuster, the supervisor, the claims manager? Will defense counsel be participating?
 
 
In a roundtable discussion is does not hurt to have a moderator who keeps the discussion on point and makes sure everyone contributes. Other than that, the roundtable discussions are generally free flowing without a formal structure on who can speak and/or when someone will speak. The agenda can be loosely defined as the list of claim files to be reviewed.
 
 
To be prepared for the roundtable discussion, you should thoroughly familiarize yourself with the claim(s) to be discussed. This means accessing the carrier's or TPA's claim management system and reading all the claim file notes, all of the medical reports and all of the defense attorney's reports beforehand. It is okay to ask questions in the roundtable discussion that are not answered by the claim file, as those are often the issues holding back the progress of the claim.  
 
 
Be ready to share your concerns, thoughts, suggestions and recommendations about the claim. Also, be ready to listen to the ideas, suggestions and remarks of the other roundtable participants, keeping in mind that the claims adjuster, claims supervisor and the other involved in the roundtable specialize in workers compensation claims. A quick way to end the roundtable discussion practice is to mandate your approach to the claim is the only approach that can be followed.
 
 
In the roundtable discussion, the participants often share experiences they have had in similar situations and relate how their prior experience can affect the outcome in the present claim under discussion. When several members share approaches that have worked in the past, the members of the roundtable can compare the different approaches and select the method they think will work best in the present situation with the claim being discussed. Decisions should be made by consensus of the roundtable members. (WCxKit)
 
 

Roundtable discussions will improve the claim handling skills and job performance of everyone involved by presenting the roundtable members with different ideas and approaches they many not have previously used. If you are asked to participate in a roundtable discussion about your work comp claims, do so. If you have not been invited to participate in a roundtable discussion on your claims, ask the claims office to start a roundtable discussion on your serious work comp claims


Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com

Book: Manage Your Workers Compensation Program:
Reduce Your Costs 20-50%

http://corner.advisen.com/partners_wctoolkit_book.html

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Workers Compensation Funding Loans Are High Risk Lending

A small but growing trend in personal injury liability cases is beginning to make an appearance in workers compensation claims, “lawsuit funding loans.” In a lawsuit funding loan, also known as “worker compensation funding”, a third party “lender” advances to the injured employee a non-recourse loan against their future settlement proceeds. 
 
 
Workers compensation funding loans are designed to provide the injured employee who is short on cash a quick lump-sum in exchange for the employee giving up a portion of their future settlement. The loan structure varies depending on the company providing the funding. With some funding companies, they loan 10% or 15% of the projected settlement, and charge interest at a high rate until they are repaid. Others provide the loan in exchange for a set percentage of the future settlement. (WCxKit)
 
 
The workers compensation funding companies look for claims where:
 

1.     the employee has received a disability rating, or the nature of the injury is such that the employee will definitely received a disability rating

2.      the entire settlement proceeds are paid to the employees attorney

3.      the state allows liens to be placed on the workers compensation settlement

 

 
Many people will wonder “why would the employee give up a substantial part of their future settlement for a relatively small loan, comparatively speaking?”   It goes back to human nature. In most states, the temporary total indemnity benefits are paid at 2/3 of the employees average weekly wage. For lower earning employees, two-thirds of their average weekly wage is less than they normally take home. If the employee does not alter their lifestyle and spending habits, they soon find themselves short of money, especially if they were living paycheck to paycheck before they got hurt.
 
 
Workers compensation funding companies, like payday lenders, prey on the employee who needs cash now. They will claim they are providing valuable assistance to the injured employee. Some of the workers compensation funding companies will not even call the money they are giving the employee a loan, they will refer to it as a “cash advance” or “pre-settlement funding." 
 
The workers compensation funding companies are in high risk lending, so they usually have some stringent guidelines to control who they will loan money to. Their guidelines will include:
 

1.      the injured employee must be represented by an attorney (so that the attorney will have control of the settlement funds and will honor their contact with the employee)

2.      they will only make loans in the states where the employee has the right to demand a cash settlement for their permanent partial disability or permanent total disability

3.      they will tell the employee that he/she does not have to pay the loan back if they do not receive a settlement (but they will absolutely not loan money on any claim of questionable compensability)

4.      reviewing all first report of injury, doctor reports, MRIs. CAT scans, surgical reports, x-ray reports, emergency room records and any other medical documentation available

 
 
The states where workers compensation funding companies are making loans include Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont and West Virginia. The workers compensation funding companies do not make loans in the states where the employee and the employee's attorney receive separate checks. Therefore, the workers compensation funding companies will make loans in Michigan and Oklahoma if the retainer agreement between the employee and the attorney specifies the entire settlement will be sent to the attorney, who will then in turn write the injured employee a check.
 
 
In most cases, the workers compensation funding company is unknown to the employer or the insurance company. It is a secret between the employee, the employees attorney and the loan company. The workers compensation funding companies will tell the employee that by taking advantage of their service, the employee is not financially pressured to settle their claim for less than it is worth.   However, like with the payday loan companies, the employee eventually will spend the entire loan amount, and will be back at the workers compensation funding company asking for another loan……ugh, cash advance. 
 
 
There are a couple of problems that can develop when an employee utilizes a workers compensation funding company. They are:
 

1.      The settlement value turns out to be lower than the funding company had originally anticipated. The attorneys fee plus the funding company loan and fees leave nothing or a small amount for the injured employee. This results in the injured employee refusing what would otherwise be a fair settlement from the insurance company.

2.      The employee's medical care takes longer than anticipated and the cash advance was in exchange for a percentage of the settlement. The funding company recognizes their return on their investment is being reduced and they began to pressure both the employee and the employees attorney to settle the claim.(WCxKit)

 

 
There is little employers can do about workers compensation funding loans. As the workers compensation funding company will tell the employee that the “cash advance” is none of the employers business, the employer will usually never know the employee has been taken advantage of by the funding company. When the employer does learn of the workers compensation funding loan, it is normally because the employee is in a position where he/she can no longer afford to settle the work comp claim for the claim's true value and the claim begins to vanquish.
 
 
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com.
 
 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

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