Georgia Court Orders Employer to Pay Heirs of Killed Worker $5.4 Million

A Georgia court ruling means a trucking company will pay the heirs of a worker $5.4 million.
 
Mack Pitts, who was working as a spotter/flag-man for Archer-Western Contractors at the Atlanta International Airport, was killed in June of 2007 when a fellow employee ran over him with a dump truck. (WCxKit)
 
According to SafetyNewsAlert.com, Sarah Okoro, a driver for A & G Trucking, positioned her truck to back up without waiting for a signal from Pitts.
 
Pitts used his flags to provide Okoro with a stop signal and then turned his attention to another driver. Okoro ignored the signal and started backing up.
 
Other trucks reportedly sounded their horns to let Okoro know that Pitts was behind her truck, but she continued to back up.
 
By the time Pitts realized Okoros truck was coming in his direction, it was too late. The truck hit him, and Pitts died from his injuries.
 
Pitts heirs sued A & G Trucking for negligence.
 
At trial, testimony concluded that Okoro violated a number of safety rules immediately before hitting Pitts, including:
1.      entering the area before being signaled to do so by a spotter
2.      failing to remain still after the spotter directed her to stop
3.      backing up without receiving a signal to do so by the spotter, and
4.      backing up without locating the spotter.
 
The trial court awarded Pitts’ heirs $5.4 million. The company appealed.
 
A & G claimed that the trial court should have prohibited cross-examination of Okoro regarding her employment application. Okoro testified that she had no experience operating dump trucks prior to her employment by A & G.
 
According to additional testimony, an employment application entered into evidence claimed she had prior experience. Okoro stated the application wasn’t in her handwriting.
 
The company later admitted that Okoros actual application was misplaced and that a manager filled out an application for her as part of a workers compensation audit.
 
An appeals court stated the trial court did nothing wrong by permitting Okoro to be questioned regarding the application and affirmed the previous verdict. (WCxKit)
 
The company has again been ordered to pay $5.4 million.
 

 (A & G T rucking v. Pitts,  Court of Appeals of GA, No. A10A1096, 11/5/10.) 


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. Contact:  Info@ReduceYourWorkersComp.com or 860-553-6604.

 
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©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

Immediate Claim Reporting Advantages

Gone are the days of mailing the Employer’s First Report of an accident to the insurer’s claims office. A three or four day delay in starting the claim due to the mail service is not an acceptable claims handling practice like it was a couple of decades ago. Today, with the internet, the claims report will be in the claims office within seconds of it being sent by the employer.
With electronic reporting of claims of claims available 24 hours a day, 7 days a week, 365 days a year, the employer can submit the claim at any time. Therefore, the best time for the employer to report an injury claim or a reported occupational illness is immediately upon learning of the event. Fast, accurate reporting of the claim benefits both the employer and the employee.
When the injury occurs, the employer’s first and foremost duty is obtain the appropriate medical care for the employee. It’s the employer operates in a jurisdiction where the employer selects the medical provider, the employee should be directed to the nearest medical facility appropriate for the injury. If the employer is in a jurisdiction where the employee can select their own medical provider, a list of recommended medical providers should be provided to the employee to select from. When the employer shows immediate concern about the injury to the employee, a higher level of communication about the injury throughout the claim will be established.
There are several benefits to reporting the claim immediately. They include:
1.     It lowers the cost of the claim – studies have shown the faster the claim is reported, the lower the overall cost of the claim.
2.     A study by Firemen’s Fund reported a 3-day delay in reporting a claim added an average of 16% to the medical cost and 38% to the indemnity cost, and increased attorney involvement by 50%.
3.      A study by Hartford Insurance Company showed a week’s delay in reporting the work comp claim increased the overall claim cost by 10%, and a month’s delay in reporting the work comp claim increased the settlement cost of the claim by 48%. Furthermore, the Hartford study showed the longer the delay in reporting the claim, the higher the probability of litigation.
4.     A study by the National Council on Compensation Insurance found that litigated claims cost 40% more to settle than non-litigated claims.
5.     The claims office cannot accomplish anything until the claim is reported – the claims office can get started with their investigation immediately when the claim is reported immediately. (Your claim handling agreement with the insurer or the third party administrator should specify all employees will be contacted the same day the claim is reported to the claims office).
6.     The employee, the supervisor and any witness memories are fresh and important details are not forgotten.
7.     Witnesses to the accident are available.
8.     If an inspection of the accident scene is needed, the accident scene is more likely to be unchanged than it would be later.
9.     If the injury involves equipment failure or machinery failure, expert assistance can be used to establish and maintain subrogation rights.
10.The immediate reporting of the claim allows the adjuster and the nurse case manager the opportunity to take prompt cost reduction steps.
11.The employee can receive the right medical care by having the managed care provider involved in the claim from the start. Trying to change the medical treatment plan of a doctor after the doctor has been treating the employee can result in a disruption of care, confusion or even attorney involvement.
12.It shows the employee you care about the employee’s well being.
13.It allows for the establishment of a modified duty return work process before the employee can contemplate how long he/she can be off work.
14.It perpetuates the employee’s return to a normal lifestyle of working a regular schedule.
15.It minimizes the interruption of your business.
 
The immediate reporting of claims allows the adjuster to investigate and validate the compensability of all claims. It allows for immediate medical intervention while providing the appropriate medical care. The immediate reporting of claims also protects the insurers right of recovery from any responsible third party. Also, the immediate reporting of claims puts the employer and the claims office in charge of the claim, preventing a medical provider or plaintiff’s attorney from usurping the direction and control of the claim.
Every department manager and every supervisor should be trained to immediately report all claims to the employer’s work comp claims coordinator. If the employer does not have a work comp claims coordinator, the supervisor or manager for the employer should immediately complete the Employer’s First Report of Injury and electronically submit it to the claims office. When the claim is severe, the claims coordinator or department supervisor should telephone the claims office with the information on the claim. To insure compliance with the immediate reporting requirements, the timely reporting of work related injury should be a component of the supervisor’s performance evaluation and salary increase. (WCxKit)
The immediate reporting of claims will reduce the medical cost, will reduce the indemnity payments, will reduce the employees time away from work, will lower the claim administration cost and reduce the possibility of attorney involvement. The immediate reporting of claims is an essential step every employer should take to control workers’ compensation cost.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: 
RShafer@ReduceYourWorkersComp.com or 860-553-6604.

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
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SUBSCRIBE: 
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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.
 

©2010 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 Post Injury Principles for Effective Claims Management — Employer Role in Managing a Workers Compensation Claim

Even companies with the strongest safety programs experience some workers compensation claims. When an injury occurs, the immediate action taken by the employee’s supervisor or co-workers has an impact on the outcome of the claim. 

Implementing the
next two phases of employment involvement helps to manage claims efficiently and get workers back to work sooner.
 
The Injury Occurrence

The employer must require a tight post-injury process by following these five principles:

1.     Obtain immediate medical assistance for the employee – send the employee to designated doctor or medical facility if statute permits.

2.      Do not permit employee's with minor injuries or soft-tissue strains to wait to obtain medical assistance – most will end up going to the unapproved hospital emergency room or their own doctor.

3.     While the employee is in-route to the treating physician, advise the treating physician of any temporary jobs you can offer during recovery.

4.     Advise the treating physician of modifications you can make to the existing job to accommodate the work restrictions the physician gives the employee.

5.     Have a goal of returning all employees to work within 1 to 3 days after the injury unless they are medically unable to perform any role for the employer.


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.
C
ontact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

15 Things An Employer “Can Do” to Manage Workers Compensation Claims

15 Post Injury Claim Process Activities Every Employer Can Do

Too many employers
 end their involvement in the workers compensation claim  when they send the employee to the doctor. A bad mistake – one resulting in a steady increase in the amount of your workers compensation insurance premium. 

The employer needs to have an established post injury process to include:


1.    
 Report the claim to the insurer, third party administrator or self-insured claims office immediately. Ideally the supervisor or your workers compensation claims coordinator reports the claim to the claims office while the employee is still enroute to the medical provider.  Or, you can start the process by calling nurse triage, a great way to make sure the employee gets the RIGHT kind of medical treatment. In some cases, the injury will not turn into a claim by using nurse triage.


2.    
Complete the Employer's First Report of Injury and any other state required paperwork on the claim. If the injury is severe and the employee is unable to return to work within the waiting period, provide the claims office with necessary wage information for the calculation of indemnity benefits.


3.    
Advise the claims office of the claimant's prior history of workers compensation claims. The adjuster's approach to the claim varies significantly between the employee who never had a workers compensation claim and the employee who with 15 workers compensation claims in the last ten years.

4.  Provide the adjuster with relevant information about the employee. In many situations this may include employee information such as employment application, job description, list of medical absences, list of disputes with employee/employer disputes.


5,    
Review your transitional duty program and find a job the employee can do within the treating physician’s restrictions. Have a job bank with tasks in multiple departments set up and ready to go, so there is no delay in placing every injured employee in a transitional duty task. In most states, it is best to  pay as close to their original pay as possible to reduce indemnity payments.


6.    
Be sure the employee's supervisor (and co-workers if needed) is available to discuss the accident and injury with the claims adjuster and to assist the adjuster with the claims investigation.


7.    
Don't alienate the employee – show empathy to the employee. When employees feel the company does not care about them and their injury and the company owes them, the claim gets ugly if employees feel it is time to stick it to the employer.


8.    
Maintain an open dialogue – call the employee at home to show your concern and to offer assistance on processing the workers compensation claim with the insurance company. Address any employee problems or issues right away. Also, call the employee on a regular basis until s/he is back at work. Make this contact procedure the same for all employees.


9.    
If an attorney representing the employee contacts you, notify the claims adjuster immediately.


10.    
Immediately dispute any invalid or fraudulent claim. Assume every employee who reports an injury is injured, but when you notice things don't add up, let your adjuster know. Using nurse triage services greatly reduces fake injury reporting because a nurse specialized in triage will ask many questions about the medical condition, and most employees faking an injury will look for easier prey.


11.
If the employee has a questionable claim, or a subjective claim for neck or back injuries, and immediately goes to the attorney advertising workers compensation on television, or a plaintiff's attorney-oriented doctor known for excessive disability ratings, advise the employee immediately of your intention to fight the claim as the attorney and/or doctor has a history of inflated claims


12.
Monitor the state filings by the adjuster and any other claim related paperwork.


13.
Monitor the Workers Compensation Board decisions – that means, reading them carefully, not just filing them away. Be ready to protest any finding or order you feel is unfair to you as the employer as all decisions have time limits for disputing the decision, with some time limits as short as 15 days. (WCxKit)


14.
Monitor the medical progress reports to be sure the treatment is appropriate – for example – no physical therapy for the low back when the injury is a cut finger.


15. Always advise the adjuster when the employee returns to work – the same day. Double-check to make sure the indemnity payments stop when the employee returns to work.

Stay involved with the adjuster, the employee and the medical providers. As long as it's an open claim, it can affect your experience rating, so dropping the claim on the adjuster's desk is the WORST thing an employer can do. Ask your broker's claim VP and the adjusters to discuss the open claims during a roundtable discussion often, perhaps bi-weekly.


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.
C
ontact:  RShafer@ReduceYourWorkersComp.com.

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

12 Step Pre Injury Process – Employer Role in Manging a Workers Compensation Claim

As an employer you hear the recommendation “stay involved in your workers compensation claims.” Great advice, but often the discussion ends without any explanation as to what “staying involved” means.
Employer involvement in a workers compensation claim begins before the injury occurs and ends when the employee is back at work, fully recovered from the injury. (WCxKit)
The Pre-injury Process
Sooner or later an employee is injured on the job. Here are 12 steps an employer can take prior to an injury occurring. Taking these steps impacts the outcome of the workers compensation claim. (WCxKit)
1.       Provide each new hire with an employee accident brochure outlining what the employee will do in case of an accidental injury.
2.       Have a written transitional duty policy.
3.       Provide each supervisor within the company a written guide on how they are to report and be involved in workers compensation claims.
4.       Post the injury procedure policy where all employees will see it.
5.       Have a published returned to work policy.
6.       Have a strong safety program and tie the manager's performance evaluation, raise, bonus or promotion to his or her safety record.
7.       Award each month (or quarter) the department with the best safety record with recognition and prizes to the employees.
8.       Have a medical provider network in place through your insurance company or join a medical provider network for self-insureds.
9.       Prevent fraud by letting all employees know workers compensation fraud takes money away from their raises and bonuses.
10.    Put up posters reminding employee that workers compensation fraud is a crime and will be fully prosecuted.
11.    Post all the state required notices in a place convenient for all employees to see including workers compensation laws, OSHA posters and anything else required in your state. (WCxKit)
12.    Post a list of the required medical providers (where allowed by state statute) or recommended medical facilities (in the states where the employee is allowed to select their own doctor).
 Implementing these first pre-injury 12-steps starts the employer down the path of efficient injury and claim management toward happier, healthier employees and work comp cost reductions.

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.
C
ontact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Medical Billing and Coding — A Work Comp Cost Cutting Tool

Employers need every edge in reducing their costs of workers compensation, given our stagnant economy. Medical billing and coding is perhaps an overlooked area of cost control. One tiny error can lead to a very big problem in a medical bill — i.e., kicking the bill back for re-processing thus delaying payment.
 
An employer can do one of two things:  rely on an outside source,–  billing departments of doctors, nurses, therapists, hospitals, etc.– to produce correct, timely medical invoicing with accurate coding and risk paying more, paying for the wrong procedure, or waiting longer for a work comp claim to close. However, an employer still need to provide oversight, will be one of many other clients, must be sure the staff understands workers comp issues – in other words, you’ll be bird-dogging. (WCxKit)
 
Another and better way is to have your own in-house staff whose job is to review and analyze all medical bills submitted by health care providers before they are approved for payment. Either hire or train a person to vet all medical bills. Training a current employee has the advantage having someone already familiar with the company’s workers comp procedures and works only for the employer.
 
Whether you hire or train, there is a high demand for workers who are medical billers and coder, a field described as “recession proof.” Look for a person with a:
 
Certification of Completion in Medical Billing and Coding
Someone with this certification comes ready to start work with these skills:

1.     Knowledge of the universal alphanumeric medical coding system.

This is a system used in all areas of health care so there is little discrepancy or room for errors. Doctors and nurses uses these codes to know more about the patient's medical history and current afflictions, while insurance agencies use these codes to determine how much to pay their clients on their insurance claims.

2.     Training in basic medical terminology to understand medical terms in the fields of biology, anatomy, physiology and pharmaceuticals.

3.     Training in the latest billing technologies, every-changing in today’s healthcare climate.

4.     Good organizational skills for implementing and maintaining filing systems.

5.     Detailed oriented and very accurate. Remember, just one tiny error can delay a bill “forever” so to speak.

6.     Basic computer skills in word processing and spreadsheets for record keeping. (WCxKit)

7.     Good communications skills for dealing with healthcare personnel.

 If you decide to train from within there are affordable and flexible one- or two-year MBA programs, many offered on line allowing an employee to continue in a current position.
 
Worker Comp Kit Blog thanks and welcomes Jenna Devoss who helps run and maintain MedicalBillingandCoding.org, for her insightful contributions. MedicalBillingandCoding.org is a reliable source for medical billing and coding training programs, careers and future job outlooks.
 
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©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Four Do’s and Don’ts When Settling a Claim — Employer Role in Managing a Workers Compensation Claim

The Claim Settlement
Normally, it is up to the adjuster to negotiate the settlement of the workers compensation claim. However, there will be occasions when the employer needs to be involved in the settlement discussions. In one situation, a large retail corporation, the risk manager attended and had settlement authority to settle all the claims. In another, the CFO had settlement authority and the adjusters had to contact him for EVERY settlement (and there were a LOT of claims so this was a big task.)  The employer will have set parameters in the account instructions to spell out how they want their claims handled.  This would include:

Do This:

1.      Attend depositions and hearings.

2.      Attend the settlement conference (with settlement authority if you are self-insured).

3.     Work with the vocational rehabilitation specialist to accommodate the employee's return to     work if there are any ADA concerns. (WCxKit)

4.      Provide rehabilitation training if necessary. 

Occasionally employers go overboard in their efforts to control the cost of workers compensation claims. Going without workers compensation insurance. This is a criminal offense in most states possibly resulting in your paying fines, paying the claim out of company funds and ending up paying your own costs to defend a lawsuit from the injured employee.
Don’t Do This:
1.     You cannot terminate the employee for filing a workers compensation claim.
2.     You cannot refuse to hire an employee solely because of prior workers compensation claim history (unless the prior injury(s) makes it impossible for the employee to perform the job under consideration with accomodations. CHECK WITH LEGAL COUNSEL ABOUT THIS.
3.     You cannot charge an employee with any part of the workers compensation premium.
4.     You cannot pay the small claims out of company funds and not report them to the workers compensation insurer.(WCxKit) There is still a lot of debate about this one, but it's against the terms of most insurance policies to do this.
 
By staying involved in the workers compensation claim from before the claim happens to the time the claim is concluded, you will have a strong, positive impact on the cost of your workers compensation insurance and enjoy the prospect of effectively reducing your WC costs. Not a bad bargain for implementing a few rules and policies.

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.
C
ontact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604. 

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  
http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Know the 7 Reasons a Work Comp Claim Should NOT Be Closed

A few years ago a large national third party administrator (TPA) got into a lot of trouble when a Fortune 500 client noticed some major irregularities in the closing and re-opening of claim files. The client noticed that an abnormal number of claims that were closed were being re-opened by the TPA. The risk manager of the client decided to find out why. (WCxKit)
The TPA had instituted a salary bonus program where adjusters who met different performance criteria received a small monthly bonus. One of the performance criteria was to close as many old claims each month as new claims received. The purpose of this particular performance criteria was to move files to closure as quickly as reasonable. What the adjusters figured out was a way to circumvent the intent of the performance measurement in order to make their numbers look good.
In the last week of each month the adjusters who had not closed as many old claims as new claims received would select files that had little current activity and close them in the computer system. The following week in the new month, the adjusters would re-open the claim files and continue to handle them. Obviously, this was not the proper way to handle file closings.
A workers' compensation claim should not be closed for any reason other than when all known activity to be completed on the file has been completed. If any of the following situations exist on a work comp claim, it should be left open:
1.      the employee has not completed all medical treatment
2.      the temporary total disability indemnity has been paid and concluded, but the employee is continuing to treat with the medical provider
3.      the employee has completed the medical treatment, but all medical bills have not been paid yet
4.      the employee has temporary total disability benefits that have not been paid
5.      the employee has completed all medical treatment and all medical bills have been paid but the employee is still receiving weekly or bi-weekly payments for permanent partial disability or permanent total disability
6.      the widow(er) is still receiving weekly, bi-weekly or monthly death benefits
        7.   the medical bills have all been paid, all indemnity benefits have been paid, but there are still outstanding bills on the claim for the defense attorney, nurse case manager or other provider of service(WCxKit)
If there is a possibility that another dollar can be spent on the claim, the file should not be closed.
During a recent claim file audit, the worker's compensation claims manager wanted to argue whether or not claims with all indemnity benefits paid, but with on-going medical maintenance treatment should be classified as open or closed. The claims manager had several old-dog files where the employees had permanent medical problems and occasionally went to the doctor. In several of the old-dog claims, the employee was making a once a year visit to the doctor. The claims manager had closed the files and was making payments on the closed files each year. This was another situation where the manager's performance was being evaluated based on the number of files closed. 

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact:  RShafer@ReduceYourWorkersComp.com 
 
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©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

4 EASY Ways An Employer Can Stay Involved When Settling Work Comp Claims

The Claim Settlement
Normally, it is up to the adjuster to negotiate the settlement of the workers comp claim. However, there will be occasions when the employer needs to be involved in the settlement discussions. This would include:
1.      Attending depositions and hearings – right from the start, participate in all hearings.
2.      Attending the settlement conference (with settlement authority if you are self-insured). This lets all parties in the process know your company is interested in the outcome of the process.
3.      Working with the vocational rehabilitation specialist to accommodate the employee's return to work if there are any ADA concerns. (WCxKit)
4.      Providing rehabilitation training if necessary. Not only will this possibly reduce the amount of a settlement it may increase the outcome of the medical and work potential of the employee.
What You Cannot Do
Occasionally employers go overboard in their efforts to control the cost of workers comp claims. There are some actions you cannot do including:
1.      Going without workers compensation insurance. This is a criminal offense in most states, you will pay fines, you will pay the claim out of company funds and you could end up paying your own cost to defend a lawsuit from the injured employee.
2.      You cannot terminate the employee for filing a workers comp claim.
3.      You cannot refuse to hire an employee solely because of prior workers comp claim history (unless the prior injury(s) makes it impossible for the employee to do the job under consideration).
4.      You cannot charge an employee with any part of the workers comp premium.
5.      You cannot pay the small claims out of company funds and not report them to the workers comp insurer.(WCxKit)

Although some companies DO self-pay the small claims it remains a controversial practice. Peter Rousmaniere, a writer for LRP's Risk & Insurance Magazine, is currently researching this practice, and the results of that will be interesting. 

By staying involved in the workers comp claim from before the claim happens to the time the claim is concluded, you will have a strong, positive impact on the cost of your workers compensation insurance.   If you have any questions about handling your workers comp claims, please contact us.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
C
ontact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604. 
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©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

The Employer Role in Managing a Workers Comp Claim

As an employer you often hear the recommendation “stay involved in your workers compensation claims.” That is great advice, but way too often it’s where the discussion ends without any explanation as to what “staying involved” means. (WCxKit)
The employer's involvement in the workers comp claim begins before the injury occurs and ends when the employee is back at work, fully recovered from the injury. Let's first look at four phases of employer's involvement in the workers comp claim, then we will look at what the employer cannot do in regards to the workers comp claims. The four phases are:

1.      Pre-injury process

2.      The injury occurrence

3.      The claim process

4.      The claim settlement

 I.        Pre-injury
If you have employees, sooner or later an employee is injured on the job. The following are some suggestions about what you can do prior to the injury occurring that will impact on the outcome of the workers comp claim. 

1.      Provide each new hire with an employee accident brochure outlining what the employee should do in case of an accidental injury.

2.      Have a written transitional duty policy.

3.      Provide each supervisor within the company a written guide on how they are to report and be involved in workers comp claims.

4.      Post the injury procedure policy where all employees will see it.

5.      Have a published returned to work policy.

6.      Have a strong safety program and tie the manager's performance evaluation, raise, bonus or promotion to his or her safety record.

7.      Award each month (or quarter) the department with the best safety record with recognition and prizes to the employees.

8.      Have a medical provider network in place through your insurance company or join a medical provider network for self-insureds.

9.      Prevent fraud by letting all employees know workers comp fraud takes money away from their raises and bonuses.

 10.  Put up posters reminding employee that workers comp fraud is a crime and will be fully prosecuted.

11.  Post all the state required notices in a place convenient for all employees to see including workers comp laws, OSHA posters and anything else required in your state.

12  .Post a list of the required medical providers (where allowed by state statute) or recommended medical facilities (in the states where the employee is allowed to select their own doctor).

II. The Injury Occurrence

Even companies with the strongest safety programs will have some workers comp claims. When an injury occurs, the immediate actions taken by the employee's supervisor or co-workers have an impact on the outcome of the claim. The employer must require a tight injury process, including:

1.      Obtain immediate medical assistance for the employee – send the employee to designated doctor or medical facility if statute permits

2.      Do not permit employee's with minor injuries or soft-tissue strains to wait to obtain medical assistance – most will end up going to the unapproved hospital emergency room or their own doctor

3.      While the employee is in-route to the treating physician, advise the treating physician of any temporary jobs you can offer during recovery (WCxKit)

4.      Advise the treating physician of modifications you can make to the existing job to accommodate the any work restrictions the physician gives the employee

5.      Have a goal of returning to work all employees within 1 to 3 days after the injury unless they are medically unable to perform any role for the employer 

 III. The Claim Process

Too many employers allow their involvement in the workers comp claim to end when the send the employee to the doctor. That is a bad mistake and will result in a steady increase in the amount of workers comp insurance premiums. The employer needs to have an established post injury process. It should include:

1.      Report the claim to the insurer, third party administrator or self-insured claims office immediately. The supervisor or your workers comp claims coordinator should be reporting the claim to the claims office while the employee is still enroute to the medical provider.  

2.      Complete the Employer's First Report of Injury and any other state required paperwork on the claim.   If the injury is severe and the employee will be unable to return to work within the waiting period, provide the claims office with necessary wage information for the calculation of indemnity benefits.

3.      Advise the claims office of the claimant's prior history of workers comp claims. The adjuster's approach to the claim varies significantly between the employee who never had a prior workers comp claim and the employee who has had 15 workers comp claims in the last ten years.

4.      Review your transitional duty program and find a job the employee can do within the treating physicians restrictions.

5.      Be sure the employee's supervisor (and co-workers if needed) are available to discuss the accident and injury with the claims adjuster and to assist the adjuster with the claims investigation as needed.

6.      Don't alienate the employee – show empathy to the employee. When employees feel the company does not care about them and their injury and the company owes them, the claim will get ugly when employees feel it is time to stick it to the employer.

7.      Maintain an open dialogue – call the employee at home to show your concern and to offer assistance on processing the workers comp claim with the insurance company. Address any employee problems or issues right away. Also, call the employee on a regular basis until s/he is back at work.

8.      If you are contacted by an attorney representing the employee, notify the claims adjuster immediately.

9.      Immediately dispute any invalid or fraudulent claim.

10. If the employee has a questionable claim, or a subjective claim for neck or back injuries, and immediately goes to the television advertising workers comp attorney, or a plaintiff's attorney-oriented doctor known for excessive disability ratings, advise the employee immediately that you intend to fight the claim as the attorney and/or doctor has a history of inflated claims

11. Monitor the state filings by the adjuster and any other claim related paperwork

12. Monitor the Workers Compensation Board decisions – that means, reading them carefully, not just filing them away. Be ready to protest any finding or order you feel is unfair to you as the employer as all decisions have time limits for disputing the decision, with some time limits as short as 15 days.

13. Monitor the medical progress reports to be sure the treatment is appropriate – for example – no physical therapy for the low back when the injury is a cut finger.

14. Always advise the adjuster when the employee returns to work – the same day.

 IV .The Claim Settlement
Normally, it is up to the adjuster to negotiate the settlement of the workers comp claim. However, there will be occasions when the employer needs to be involved in the settlement discussions. This would include:

1.      Attending depositions and hearings.

2.      Attending the settlement conference (with settlement authority if you are self-insured).

3.      Working with the vocational rehabilitation specialist to accommodate the employee's return to work if there are any ADA concerns.

4.      Providing rehabilitation training if necessary.

V. What You Cannot Do Occasionally employers go overboard in their efforts to control the cost of workers comp claims. There are some actions you cannot do including:

1.      Going without workers compensation insurance. This is a criminal offense in most states, you will pay fines, you will pay the claim out of company funds and you could end up paying your own cost to defend a lawsuit from the injured employee.

2.      You cannot terminate the employee for filing a workers comp claim.

3.      You cannot refuse to hire an employee solely because of prior workers comp claim history (unless the prior injury(s) makes it impossible for the employee to do the job under consideration).

4.      You cannot charge an employee with any part of the workers comp premium.

5.      You cannot pay the small claims out of company funds and not report them to the workers comp insurer.(WCxKit)

By staying involved in the workers comp claim from before the claim happens to the time the claim is concluded, you will have a strong, positive impact on the cost of your workers compensation insurance.   If you have any questions about handling your workers comp claims, please contact us.

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
C
ontact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

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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.
 
©2010 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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