Workers’ Compensation Costs Can Be Reduced by Implementing Operational Best Practices: Learn How With This New Guidebook.
A company that wants to implement a new workers compensation program or revamp an existing system will find this book helpful. Maybe your company has recently expanded and you realize the need to train a workers compensation manager or regional coordinators how to hold down compensation costs. Whatever your need, here is the answer:
Workers Compensation Management Program: Reduce Workers’ Comp Costs 20%-50%.
Used by more than 150 firms across the country, this is THE book to help every employer develop a more effective workers compensation program to reduce workers compensation costs. It is based on field research and decades of experience in workers compensation from all aspects of the business. Best practices are described in detail for each person in the injury process.
This easy-to-read manual has been updated for 2012. It now includes:
An index for quick topic look-up so you can view a term or a procedure and see all relevant references.
NEW – Workers Compensation Basics
Purpose of Workers Compensation
Who Pays for Workers Compensation?
Parties Involved in Workers Compensation
Benefits for the Employer
Independent Contractors
Benefits for the Employee
Injuries Covered
Types of Workers Compensation
How Losses are Categorized
How Losses are Reported
Calculating Your Premium
How Mod Effects Your Premium
Good/Bad Mod Example
Five Ways to Reduce Your Mod
NEW – Fundamentals of Cost Containment
Reasons Workers Compensation Costs are High
Who is in Charge?
Work Ability Form Properties
Who is Responsible for Managing Workers Compensation Claims?
Who is Responsible for Managing Workers Compensation Process?
Hidden (Indirect) Costs of Workers Compensation
Additional Costs
Calculating WC Costs
External Obstacles to Cost Control
Internal Obstacles to Cost Control
NEW – Working with Your Adjusters or TPA
Account Handling Instructions
MD Participation
NEW- Reporting a Claim
Critical Issues
Essential Intake Considerations
Nurse Triage
NEW- Directing Medical Care
Occupational Health Clinics
Remote Health Services
Directing Medical Care in California
NEW- Return to Work
What to Include in a Transitional Duty Policy
Non-Profit, Volunteer or Charitable Positions
Employees Who Never Return to Work
Coordinating WC with Federal and State Leave Statutes
NEW – Other Indemnity Cost Containment Services
Telephonic Disability Intervention
NEW – Medical Cost Containment
URAC Certification
Mental Health RNs
Chronic Pain Programs
An Aging Workforce
At Home Recovery Services
Medical Fee Schedules
Fee Schedule Coding
ICD-9 and CPT Codes
NEW- Physical Therapy and Physical Rehabilitation
Differences between Physical Rehabilitation Programs
Pharmacy Benefits Management Program
Authorized Drug Formulary
Toxicology Screening
NEW – Fighting Fraud and Abuse
Medical Terminology Used to Identify Malingering
Reviewing Investigation Reports and Videos
Avoid good Day/Bad Day Syndrome
NEW – Claims Resolution and Settlements
Conditional Payment and Final Demand
Pharmacy Component of MSA
California Settlement Process
A 183-page guide covering how to assess your workers compensation program, design program materials, roll out a program to the organization, and monitor and manage the program once implemented.
Written by a national expert on workers compensation cost containment with over 25 years experience helping companies reduce their losses 20% to 50%.
T. Ronca, a workers’ compensation defense attorney from Long Island, NY, said the
book is an invaluable desk reference. “It is one of the tools that should never be out of reach for a risk manager. Direct employer involvement with claims in the first weeks is the difference between success and failure. This manual will guide the conscientious employer through the pitfalls,” Ronca said.
What’s more, the book can be delivered with your company logo on the cover and a full-color ad for your company on the back cover.
Take it out to the field. Text tabs are available to put on each chapter and it is ready to go as your company training manual. All you will have to do is customize the Training Agenda that is in Part I of the book.
Included in the manual are topics such as: Return to work and transitional duty, claim reporting, employee communications, controlling fraud and abuse, directing medical care, medical cost containment solutions, post injury response procedures, reporting procedures, working with your carrier and third party administrator. There is information about physical therapy, pharmacy benefits management programs, training supervisors and gaining management commitment. It also contains concepts of claim settlement and resolution as well as safety and loss control. New areas are identified above.
There are 5 sample worksheets in the manual to help organize an efficient workers’ compensation program. These include: timetable for implementation, the injury coordinator job description, and several sample roll-out letters. We recently received a terrific phone call from a third-party administration firm saying how the manual provided an organized way to train clients at loss prevention and has helped their clients put "layers of better WC management" in place. Everyone benefited.
One large distribution firm wrote to us to say the chapter on safety and loss control led to a company-wide safety change that only cost a few hundred dollars but prevented a specific type of injury that had been draining its budget, says Rebecca Shafer, Esq., President of Amaxx Risk Solution, Inc. who authors the book. Shafer is a national expert on workers’ compensation cost containment with more than 25 years of industry experience helping many companies reduce their losses 20-50%.
When you order your copy of Manage your Workers’ Compensation Program from Advisen at
http://corner.advisen.com/wcbooks, the 183-page guidebook shows how to assess your program, design program materials, roll-out a program to the organization, and monitor and manage the program once implemented.
The workbook is also available with a customized front and back cover for bulk purchases. Discounted rates apply to bulk orders.
One company said, "After reading the manual, we took a look at past workers comp practices and saw that every department did things differently. Manage Your Workers’' Compensation Program 2012 gave us the guidance we needed to standardize our workers’ compensation programs across the country. It was like a pre-prepared lesson plan," according to the risk manager.
A regional hospital in North Dakota wrote that, "Our small company expanded rapidly and we actually didn’t have any official workers’ compensation program in place. This manual gave us step-by-step procedures from the first meetings with management to monitoring the final program. Buying and reading the book was almost like hiring another employee – one who was an expert in workers’ compensation."
Who Uses the Workers’ Compensation Book?
Risk Managers and Workers’ Comp Managers find it useful learning about the cost containment niche and use it for themselves and to bringing new team members up to speed very quickly. The book becomes a “lesson plan” tool.
Safety Directors use the book to train supervisors in workers’ compensation claims management. They learn more about their area of responsibility — post loss cost containment — adding to their overall knowledge. They also learn what to do after an injury and what steps are supposed to take place during the first 24 hours.
Brokers use it for prospects, as well as, to learn about specific aspects of cost containment, passing their knowledge on to their clients. For example, when discussing how to develop a return-to-work program and a client asks about, “off-site return-to-work programs,” the broker quickly finds the relevant section in the book, reviews it and passes the answer on to the client, along with a copy of the cost containment book with the broker’s logo.
Adjusters use the book to gain a better understanding of the employer’s perspective. Adjusters also want to learn more about cost containment to add to their overall workers’ compensation knowledge in order to grow their careers and stay abreast of new services.
Account Producers give the book to prospects during formal presentations to illustrate their company is on top of the workers’ compensation industry. The book makes an excellent client gift.
Vendors such as doctors, physical therapy networks, occupational clinics and medical management firms learn how their service might fit into the workers’ compensation marketplace, what is important to employers, and what they look for in medical services to enable the vendors to enter the workers’ compensation marketplace.
The manual is a cost-cutting tool to learn more about systematic and operational techniques for reducing workers compensation costs.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Posted in
Claim Audits & File Review,
Communication with Employees,
Coordinating Medical Care,
Federal Workers Compensation,
Fraud and Abuse,
Insurance Issues, Rates, Premiums,
Lowering Premiums & Experience Mod,
Management Commitment,
Medical Cost Containment & Managed Care,
Medicare Set Asides (MSAs),
Professional Development Issues,
Return to Work and Transitional Duty,
Risk Management,
Safety and Loss Control,
Settling WC Claims,
TPA and Claims Administration,
WC 101,
WC in Other Countries (International) |
We are always writing articles to assist the employer in dealing with the complexities of the workers compensation system. We thought for a change of pace we would provide an article to assist the employees in dealing with the tangled web of workers compensation.
The following suggestions will make the workers compensation claim go smoother and alleviate the angst that naturally occurs when an employee is injured on the job. (WCxKit)
1. Report your workers compensation claim immediately, even if you do not need medical care at the moment. What may feel like a pulled muscle today may be a major problem next week. It is better to have a record of your injury when it occurs rather than trying to explain why you are reporting the injury late.
2. Ask your supervisor to prepare a written report of the incident. Your supervisor should willingly do so, but if for any reason the supervisor does not act immediately, submit your own written report providing all the details of what you were doing when you got hurt. Be sure the details of your incident are accurate, as the fastest way to lose credibility is to allow inaccurate information to be reported.
3. Select a medical provider from the list posted. If you do not understand the different specialties, ask for guidance. A medical provider close to work or close to your home is often the easiest one to reach.
4. All the medical care related to your injury will be provided until you have recovered from the injury.
5. If you have a pre-existing medical condition, which can be anything from a prior back injury to diabetes, do not try to hide that fact. To get the appropriate medical care you need, all medical conditions or issues should be disclosed to the medical provider.
6. Keep track of your mileage to and from every medical appointment and to/from the pharmacy. Your mileage can be reimbursed in most states, but only if you have a record of it. Keep a copy of all mileage logs turned into the adjuster.
7. Obtain a written copy of the report your employer submits to the insurance claims office. If anything is incorrect on the report, now is the time to correct it, not later.
8. Attend all doctor appointments and all diagnostic testing. If you do not think you are hurt enough to attend the medical appointments, neither will the adjuster.
9. Provide a copy of all off-work (disability) slips to your employer and to the insurance adjuster, and keep a copy for yourself. Ask your employer if they have a more complete form to use, often called an Injury Treatment Form or Accident Report Form that gathers enough information about your injury so your employer can locate a transitional duty job for you.
10. Keep in touch with the employer and the insurance adjuster. After each doctor's visit, call both the employer and the insurance adjuster and give them an update on what the doctor said about your medical progress and when you may be able to return to work. If you are on transitional duty and your capability increases (it should) let your employer and insurance adjuster know about this.
11. Every work place has co-workers that will want to give you unsolicited advice on your workers comp claim. Follow the real doctor's medical guidance not your friends and co-workers.
12. Every state has a waiting period before lost wage compensation can be paid. Ask the claims adjuster what the waiting period is in your state. If you are out of work longer than the waiting period, you will be paid a percentage (often 66.67%) of your average weekly wage.
13. Ask about your employer's return to work program while your doctor has you off work with restrictions. Often your employer can modify your current job duties so that you can return to work sooner.
14. Do not violate the work restrictions placed on you by your doctor while working light duty. You will most likely end up aggravating your prior injury and extending the period of time it will take for you to recover from your injury.
15. If a nurse case manager is assigned to your claim, keep the nurse informed as to your medical progress and understand he/she is there to make sure you obtain the appropriate medical care. (WCxKit)
Your employer hopes you will never get hurt, but if you do, keep the workers comp claim suggestions in mind to improve the claim experience and the overall outcome of your claim.
If you are an employer reading this, the above items can be included in an employee brochure.
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. Rebecca is the author of Workers Compensation Management Program: Reduce Costs 20-50%. 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.
The cost of prescribed drugs, especially narcotic pain medications, is rising in the world of workers' compensation. This cost increase is due to the fact that a drug company is like any other company: When the demand for your product is high, supply lessens, and costs have to increase. And, these medications are not exactly cheap to manufacture. In fact I saw a news report that some cancer fighting drugs are in short supply due to overwhelming demand.
Think about going to your personal physician for a knee strain you had over the weekend playing football with your family. You probably went to your doctor, and you probably left with a prescription for Motrin buddied up with a short-term prescription for a narcotic pain reliever — even if a cold pack or hot pack and rest would have taken care of the problem. This is the world in which we live. In the past, these pain medications were for extremely acute trauma, such as a car accident or bone fracture. But more and more, medications such as Vicodin, Percocet, Oxycodone, etc are being prescribed for the slightly-above-average diagnosis of lumbar or shoulder strain. (WCxKit)
Below we discuss five ways you can try to control these associated drug costs when it comes to your workers compensation claims. By no means is this an exact science, but it is certainly one you should look into for help controlling your bottom line.
1. Come up with your game plan.
Whether you have five claims a year, or five claims per week, medication cost will be a significant expense of the claim. Many carrier/TPAs are partnering with a Pharmacy Benefit Manager (PBM) to review prescription history and also to provide a reduced cost for medications. These outside vendors attract carrier/TPAs by offering them a discount cost for medications, in exchange for their guaranteed business.
Adjusters set claimants up with a drug card from these vendors, and they are widely accepted at many pharmacies nationwide. Furthermore, the PBM will review the injury and the claimant’s individual medication history. They can recommend medications based on the injury type and location. This is an attempt to stop every John Doe back pain sufferer from walking out of his doctor’s office with an RX for Percocet, when he really does not meet the criteria for needing that strong of a medication to begin with. Most strains can resolve by taking a stronger dose of Motrin, an anti-inflammatory medication similar to Advil or Ibuprofen. The PBM will also monitor duration of medication use and quantity limits. Why pay for 90 pills when John Doe should only need 30? Medication costs are associated with dosage as well, so it doesn’t make sense to pay for 90 pills unless they are needed.
2. Start being aggressive at the first prescribed RX.
When a new claim is filed and the adjuster sets the drug card up to be mailed out to the employee, it may already be too late. This is when proper communication is handy. If you have a worse-than-average claim, you can phone your adjuster with the info, and they can get the PBM info right to the claimant.
This way they are not getting medication from an occupational clinic or hospital, where the costs are typically the highest. Right off the bat they can use the PBM card, and that reduces cost right from the beginning. This also helps manage future spending on RXs, since they already have the card and should be using it for any medication the claimant is prescribed. Sure, not using the card for your first medication fill is no big deal if you only have one or two claims per year, but if you have one or two claims per week, over the course of a year this can lead to a dramatic savings in medication cost. Every little bit of savings will help in the long run, and it is important not to overlook the small savings that you can implement right away.
3. Can you do bulk home delivery?
For those injuries lasting longer than a month, it is worth it to look into home delivery of medications. This increases the discount, because you buy more of the medication at one time, and you do not have to pay the pharmacy overhead for a short-term 30 day fill. Injured workers will appreciate having one less errand to run, especially those who do not have easy transportation readily at hand. At the same point, the PBM will monitor dosage and quantity. Why should you continue to get a medication if it is not helping? Or, if the injured worker is not taking the medication at all? These are leakage costs, and expensive ones at that. The adjuster will ultimately decide if a claim is worthy of needing home delivery, and the delivery will not last forever. If a person has a bad fracture and will need a long-term supply of Motrin, this is a perfect scenario.
Adjusters do frown on home delivery of narcotic pain meds. This gives the claimant a large supply of potentially strong medication, which carries the risk of addiction. Home delivery meds are generally milder. Again, even though these drugs may not cost the most, any sort of savings is better than no savings at all.
4. Are you using prescription utilization review?
PBM companies use a panel of clinical pharmacists to examine prescription data and injury type to make sure appropriate medication is dispensed. This helps control unnecessary costs due to prescribing incorrect medication. Also, PBM utilization review will help to control fraud by monitoring the date and location of refills. Red flags indicating abuse include early refills, a doctor shopping around to get new prescriptions, or a patient changing pharmacies to get refills. Clinical pharmacists also are useful at catching new medication trends, proper quantities of medications, and future costs/needs for ongoing medications.
By using prospective utilization review, done before the product is used, to avoid the cost, consider prior authorization program. By having an MD on the TPA's staff review the file, many of the medication concerns are addressed proactively. The utilization review company you use, should be URAC certified to ensure quality, credentials and training. A good TPA might even have a chronic pain program to discuss pain issues with an interdisciplinary team of experts.
5. Use a Pharmacy Benefit Manager or vendor to help with repeat offenders and duplicate prescription medications.
This use of an outside PBM is effective for many reasons, including catching a doctor prescribing both a short-term and long-term narcotic pain medication, duplicate or similar prescriptions being unnecessarily prescribed, and implementing the use of generics whenever possible. The PBM will also participate in state-wide reporting, which will catch if a claimant has other narcotic pain medication fills before the date of injury. This can show the worker may have a history of requesting certain narcotics — a red flag for abuse.
Surveillance companies usually have a service that can do a background check of pharmacies, to see if your claimant has had fills of certain medications aside from the meds needed for your specific injury. This fights fraud, and can expose someone that may have a prescription drug problem. An easy way to get strong medication is to file a comp claim, and any weapons you have to fight fraudulent claims are worth it.(WCxKit)
In summary, a third-party PBM is a useful tool not only for cost-savings but also for catching the many forms of prescription abuse out there. Doctors get lazy when it comes to prescribing medications. Sometimes the answer to every injury is a prescription of Vicodin, Percocet, or some other narcotic when none are needed. Not only are these medications expensive, but they can carry long-term health problems including addiction, which only increase the overall cost of the claim. Using a PBM is another way of being proactive when it comes to handling your claims, and your carrier/TPA will have more information on what you can do to implement a PBM program for use on all of your claims that require prescription medication.
Ask your TPA what programs they offer.
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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
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
Back again with the final part of the series on medical provider red flags. This could be 50 red flags, but these are some of the most common. This is to provide continued awareness that not all medical clinics are on your side. The caveat again is that this is not the norm. This article is just meant to raise awareness. Because these issues, while uncommon, really do happen. That is about as politically correct as I can make it. Here are the physician red flags you should be watching for. This article is summarized from an interview with an adjuster I met recently.
1. The medical records are “template” style, or barely exist at all. Out of all of the red flag issues we discuss, this one does not indicate a shady doctor. It could just be that the doctor is very poor at note taking. But the two go hand in hand. Great doctors do great analysis, and back up opinions with objective medical facts. They arrive at this point by walking through the medical records, and creating a great conclusive medical report. Doctors that get by by pairing up subjective history from a patient’s mouth are another story. (WCxKit)
2. Missing dates of service, or no date labels on the medical notes. I suppose if the “template”style medical record, is paired with one that is similar to a fill-in the-blank system (Patient came in with complaints of _______ which they attribute to work causing them _____ pain out of 10, with 10 being the worst pain imaginable) and pair it up without a date of service, I guess you could use that medical record for every date of service you ever have. If anyone is watching, a physician will not get far by doing this. But, if nobody is paying attention, thousands of dollars could be paid and for who knows what. Make sure the notes are clearly labeled, dated, and legible. If not, you need to contact the physician’s office right away.
3. Different handwriting or inks on same dates of service. Granted again, that may be the nurse or the medical assistant jotting some notes down before the doctor jots the notes down, but if you get the feeling that something is not adding up, then call them. Their patient may be contacting them and coaching them what to put in the record, which we all know is not OK.
4. The medical provider office will not send medical records or state that they do not keep a medical “record”. I cannot think of one legit company that does not keep a note or record of some sort, for whatever reason. Even the most trivial of companies store records of some sort. So using that as a comparison, the medical record is very important. And for a clinic to say they do not keep a record is unbelievable. As a matter of fact, you should not pay any bill ever without a medical record attached to it. How do you know what is being paid and for what? If a doctor’s office ever tells you that they do not keep a record on a patient, my advice is to alert your counsel and have them step in right away.
5. The medical notes showed continued high levels of pain. I have never broken my arm, but I anticipate that it hurts quite a bit. Enough to be uncomfortable anyway. So if it is 2 months later and you still have “10 out of 10” pain, that is just not correct. If the pain is so unbearable, and you have treated with this doctor for 2 months, why go back there? And how is the worker driving to these appointments? And how can the worker go to the bank and cash your check, all with “10 out of 10” pain that has not lessened? The doctor should be stating in the medical notes that the objective indicators for pain do not match the subjective complaints of “10 out of 10” pain. If the physician is not doing anything about it, or the person is no better, then you have to find out what is going on medically and get that person to a specialist or set up an IME to address these ongoing complaints.
6. Consistent improper billing practices. Your Carrier/TPA usually cannot process a payment off of an invoice. Usually the bill has to be printed on an HCFA-1500 form so the Carrier/TPA can process it. This is standard. A lot of offices that handle any type of insurance work know this. So if they keep trying to submit their bills improperly, something is going on. Why are they doing this? Have any others had this sort of problem with this provider? Coding errors, print errors, ICD-9 code errors, etc. should be correct and correlate to the claim. A few errors are to be expected. But if it is constantly going on and on and on, you have to dig a little deeper.
7. Conflicting medical reports or conflicting subjective complaints that are not addressed. Let us say you are the adjuster and you are reviewing a stack of medical records on your claimant. One day your claimant states they are in very bad pain, 8 out of 10. It is hard to bend, and walk. The next day they show up for therapy and they tell the therapist they are doing great, and they think treatment is really helping them. 2 days later they go back to the doctor and say they feel the same, about 7-8/10 pain. Then the same day they have therapy and tell the therapist they feel great, and are looking back to getting back to work. I believe in the fact that people have good days and bad days. But if you are hurt, and in legit pain, your symptoms should not yo-yo up and down like that. Therapy can flare pain up a bit, but over the course of a few weeks the pain should be gradually lessened. If you start to notice yo-yo pain complaints and pain out of proportion to the injury, think about getting your IME in order because the claimant is trying to extend their time out of work.
8. Consistent excessive referrals or quick referrals to physical therapy where it may not be needed. I know of a very popular occupational clinic. A very large one. And I have handled a ton of claims where the clinic is the treating provider. And over the course of a year or 2, I wager to say that everyone that walks through their doors with a comp case had a referral to go to the same physical therapy facility after the first or second visit. These were strains, sprains, lacerations, contusions, etc. Every injury you could think of and they were all sent for therapy. We had to call and talk to the doctor to find out the rationale. This took a lot of time, but after a while they go the point and started to go by the medical norm for a referral for physical therapy. This is meant to be a very loose example, but a lot of times personal doctors or practices also own therapy companies or diagnostic laboratories, or they have partial ownership in them, so they get to make money twice; once when you go to see them, and again when you go to their therapy facility. So trust your instinct. If you think a referral is questionable, call and talk to the doctor. Make that doctor defend their decision and ask them questions. After all they have a service to provide to you, and you have rights too in these work comp scenarios. Depending on your jurisdiction anyway. NOTE: Make sure your company is aligned with a high-quality independent physical therapy network, perhaps even a national network, and put that in the account handling instructions, then monitor compliance and make sure the adjuster is helping monitor compliance.
Summary
Again this is not every doctor, at every clinic, attempting to get extra. These questionable doctors are few and far between. But they are out there, and your adjuster and counsel know of some of them. Physicians will say that they can only treat what the patient is telling them, and if the patient states they are in pain, then no matter what doctors are going to do what they can to help them. So part of this problem is on the doctor, and part is on the claimant or patient. However, all of it can be questioned by you in a workers comp scenario. Keep names of doctors and group practices that you had trouble with in the past. If something does not seem right call and talk to the doctor about it and share your concerns. Remember the doctors or practices that caused you problems–chances are you will cross paths with them again. Continue to stay proactive, and trust those instincts.
Your responsibility as an employer is to establish procedures, select vendors, and make sure you are actively involved in who treats your employees and the results they get from treatment, assuming this is allowed in your state. Working with a good TPA is important; ask them how they control these issues and learn what they are doing to prevent over treatment.
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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
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@WorkersCompKit.com
Occupational therapy is a medical practice that promotes the health of a person to recover from an injury or illness in a way that allows them to return to some degree of self sufficiency after a severe medical condition. Occupational therapy should not be confused with physical therapy which is designed to restore the loss of function to a specific body part. Occupational therapy will assist the severely injured employee to rehabilitate from a disabling injury physically, mentally, and emotionally as they adjust to the permanent loss of function.
Occupational therapy is utilized in various
medical situations including: inpatient rehabilitation, acute care hospitals, assisted living facilities, hospices, skilled nursing facilities, and rehabilitation hospitals. For the purpose of this article, we will limit the discussion of occupational therapy to workers compensation and the assistance occupational therapists provide to the severely injured employee. (WCxKit)
When an employee incurs a life altering injury like a spinal cord injury, traumatic brain injury, limb amputation, loss of use of a limb or hand, or any injury that prevents the employee from returning to the prior level of employment, occupational therapy is designed to assist the employee to adapt to the permanent loss of function. Occupational therapy is more than just medical recovery. It will also entail psychology, sociology, and other aspects of daily living.
Occupational therapy will assist the severely injured employee in numerous ways. The occupational therapist can assist the employee in the following ways.
1. Stabilizing the employee's medical condition so the medical condition does not continue to deteriorate
2. Facilitating mobilization
3. Restoring function (overlaps into the area of physical therapy)
4. Compensating for mobility impairment
5. Learning/relearning sensory processes
6. Learning skills to adapt to the loss of function
7. Coordinating care from medical providers of various disciplines
8. Returning the injured employee to a meaningful life
9. Teaching adaptive skills for eating, bathing, grooming, dressing, etc.
10. Teaching the use of adaptive equipment – wheelchairs, artificial limbs, shower benches, etc.
11. Regaining the ability to live independently
Occupational therapy can also be utilized when the employee's injury is severe, but not life altering. It is often used in conjunction with physical therapy to optimize the use of a severely damaged hand or arm. The occupational therapist will work with the injured employee to teach the employee to compensate or adjust to biomechanical issues. The occupational therapist will tailor the treatment plan to the individual's needs.
When the employee has the ability to regain enough physical capacity to return to the former job, or to some time of employment, occupational therapy will provide “work hardening”. Work hardening is a customized approach to recondition the employee's cardiovascular, neuromuscular, and biomechanical systems. Work hardening will use either real or simulated work activities along with exercises to assist the employee in the transition from non-working to working. It will often start with the employee “working” 2 to 4 hours a day, 2 or 3 days a week. The time frame, both sessions and days, is gradually increased until the employee is able to work 8 hours a day, five days a week.
Occupational therapists are often called upon to provide a functional capacity evaluation (FCE) after the course in work hardening. In an FCE, the employee goes through a series of testing to determine what the employee can safely do in a variety of tasks. The FCE will also be used to establish what level of accommodations, if any, the employer will need to make in order to return the employee to full duty or permanently modified duty. The FCE is also used in some states to establish the level of permanent impairment rating that will be assigned to the employee. (WCxKit)
Occupational therapy is often the employee's “last stop” in the medical recovery process between injury and the return to work. Or it will be the last stop between injury and the permanent total disability status where the employee will never be able to return to work. The skill level of the occupational therapist can impact the overall outcome. Therefore, it is imperative the employer and the claims office understand the importance of occupational therapy and select the most qualified and skilled occupational therapy facility for the injured employee.
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. Shafer is the author of the leading book on workers compensation cost control www.WCManual.com 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.
When an adjuster is faced with a new and severe claim, it requires immediate attention. The injured worker may have a life-altering injury at work requiring emergency surgery, before the adjuster even sees the claim. These injuries are crush injuries, severe fractures, spinal injuries, or closed-head injuries.
First the adjuster needs to gather medical records to determine the patient’s prognosis. Questions the adjuster may ask are: Does the injured worker require an extended hospital stay? Does the patient have adequate in-home medical care or is an outside vendor recommended? Will the patient require more surgery? These are questions that must be answered, and if the adjuster is unavailable for whatever reason, a field nurse case manager (FNCM) can be very useful in helping to answer these questions. (WCxKit)
1. The FNCM can help ease the transition from hospital to home and beyond.
Sometimes in the insurance world, injuries are thought of only in a financial view with short-term glasses rather than total loss costs (less expensive in the long run; greater value.) It is easily forgotten workers sustain serious trauma affecting virtually every aspect of life. These injuries often cause major concern like how does compensation work now? How long will I be off of work? Am I going to be ok? How will I be able to provide for my family?
These answers are addressed by the field nurse case manager. FNCM workers go to the hospital to visit and talk with the patient and the patient’s family. Or the FNCM meets at the family’s home after a patient is discharged from the hospital. This eases the fear the family may have about the future. The FNCM will have the carrier and adjuster’s contact information as well as other simple, yet comforting information, for the family. The family’s questions are often medical questions about the loved one’s injury rather than other aspects.
2. The FNCM can secure medical records faster than the adjuster.
An adjuster calls to request medical records, but the request is sent directly to the records department and onto a stack of other requests. However, FNCM are typically registered nurses with advanced medical knowledge and know the paperwork required by the adjuster. This paperwork can include admission papers, doctor’s dictation and transcription, prognosis, diagnosis, diagnostic testing reports, and discharge plans.
By having someone on-site, the records reach the adjuster quicker. Nurses know how to talk to other nurses. The FCNM knows where to go in the hospital, and who to talk to in order to get this much needed info. Adjusters rely on the ability to get medical records quickly, and the FNCM can accomplish this task.
3. A FNCM can help make a discharge from hospital to home easier.
If a worker sustains a severe injury, discharge to home can be one of the most complicated aspects. Who is going to care for the injured worker? How will the worker be transported to therapy? Is someone going to help with medication or resuming daily activities? Will wheelchairs, crutches, shower rails, or a raised toilet seat be needed?
The FNCM arrives with a vendor in mind to handle these durable medical equipment (DME) requests. Chances are the adjuster has already authorized the FNCM to select DME the patient needs at home. The injured worker is going to spend a lot of time at home recovering, so proper care is crucial. Several vendors offer various home assistance including but not limited to assistance with meals, food preparation, medication pick-ups, and housecleaning. If an injured worker has no family available to assist, this will ease the fears of being alone. This is the best approach in a life-altering situation.
4. A FNCM will stay on the case until the injured worker is stabilized.
The FNCM assists not only with the patient’s initial needs of moving from the hospital to home, but also with ongoing issues and care. If the patient is unable to reach the doctor, the FNCM can address medical questions or meet the patient at the doctor’s office for appointments. Again, it is about being an available resource to the injured worker in the first stages of injury recovery.
If the injured workers has chronic pain issues or mental health issues, special FNCM will recognize these issues and assemble a multi-disciplinary team of doctors, psychologists, adjusters pain management specialist, and others at a roundtable to develop action plans with goals and timetables to resolve these problems.
Psychologically, it can help the worker focus on healing and not on worrying about all the other daily tasks such as picking up medications. Whatever the need may be, the FNCM can make it easier on the injured party by providing resources and assistance.
5.The FNCM provides the injured worker resources of care.
A traumatic serious injury has many questions from all parties involved. The primary concern of the injured worker is to have needs met by the carrier and employer. By setting the claimant up with assistance from a FNCM, it resolves many fears. The goal is to get the worker back on track and focus on healing. The injured worker must not feel neglected in the hospital or at home. By assigning a FNCM, the claimant recognizes the employer is trying to provide the best care possible. The FNCM provides answers to questions, DME assistance, arranges in-home medical care, and seeks to improve the claimant’s daily life especially for injured workers with little family support. (WCxKit)
Summary
FNCM workers have a special job coming to a severely injured worker needing help . They provide assistance in many areas, not only to the injured party but also to the family. The FNCM help the carrier by obtaining much needed information about the injury. They help the employer by providing updates on the injured worker and what to expect medically in the future. Most importantly, the FNCM helps the worker focus on healing by providing quality service that only a nurse can provide.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
When an employee has a musculoskeletal injury keeping the employee from returning to work, it is routine practice for orthopedic doctors to recommend a physical therapy program. The purpose of the physical therapy program is to assist the injured employee to restore function, to restore the pre-injury level of mobility, to control pain, and to limit or prevent permanent physical disability. This can be accomplished with physical therapy providing both range of motion exercises and strengthening exercises.
The orthopedic doctor treating the injured employee will prescribe the amount of physical therapy the employee should have. Some orthopedic doctors are very good at estimating the number of physical therapy sessions an injured employee will need and will prescribe accordingly. For instance, the doctor will prescribe physical therapy for the lumbar spine “3 x 4," which tells the physical therapy facility to treat the injured employee three times per week for four weeks. The return appointment with the doctor’s office is normally scheduled after the anticipated date of the last physical therapy treatment. This allows the doctor to assess the benefits of the physical therapy treatment program, but it is after the fact. (WCxKit)
Unfortunately, some orthopedics will prescribe the same amount of physical therapy for just about every patient they see. If every patient is "3 x 4” or “3 x 6,” some injured workers end up having too much physical therapy and some end up not having enough. When the injured employee does not get enough physical therapy, they return to the doctor before they have not recovered from their injury. The doctor then prescribes more physical therapy and sets up another return visit to the doctor’s office.
When the orthopedic describes physical therapy, the physical therapy facility wanting to insure payment, will normally call the workers compensation adjuster for approval to provide the treatment. The adjuster does not know whether the physical therapy is needed or not. Most adjusters will not question the need for physical therapy, figuring if the doctor requested it, it must be needed. This often results in the injured employee receiving more physical therapy then is needed.
One approach to the adjuster’s dilemma of whether to approve physical therapy or not, is to refer the request for physical therapy to utilization review. Utilization review can eliminate some excess physical therapy treatment, but utilization review makes their judgment calls based on the information in the doctor’s medical notes. Utilization review will not know if the injured employee recovers faster than normal resulting in the injured employee continuing to go to physical therapy when the physical therapy is not providing any further benefit.
A recent innovation in managing the physical therapy treatment is the development of results based treatment approach. Instead of the injured employee going to the physical therapy office 15 times because the doctor wrote a “3 x 5” script, the injured employee goes to the physical therapy office for as many or as few times needed for the employee to make a proper recovery from their musculoskeletal injury.
In the traditional fee for services model of physical therapy treatment, it is in the financial best interest of the physical therapy facility to continue physical therapy treatment until the doctor sees the injured employee again. This often results in excess treatment. The results based approach to physical therapy aligns the interest of the employer and the insurer with the physical therapy facility, where the timely recovery and return to work benefits all parties including the employee.
A results based approach to physical therapy allows a single flat fee for service. This reduces a lot of paper work for the adjuster, by having one bill to pay, rather than many physical therapy bills. (WCxKit)
Results based physical therapy treatment appears to be an innovative way for employers and insurers to manage the physical therapy treatment process and to provide the injured employee with the treatment needed in a timely manner. The management of physical therapy through results based treatment benefits everyone.
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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
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
Have you ever had an employee turn in a “work status note”, “off work slip”, “ disability note” or even a “functional capacity worksheet”, and the only thing you know is the employee will not be at work? The purpose of disability slips is to advise the employer when the medical provider does not believe the injured employee is able to do any work in their current medical status or is able to work only in a restricted capacity. If the disability slip is properly formatted, it will provide the employee's limitations for restrictive duty.
The quality of the disability slips covers the spectrum from telling the employer everything about the injured employee's injury and disability to telling the employer nothing at all, or only that the injured employee will not be at work. The lack of uniformity can create issues for the employer in tracking the status of the injured employees. (WCxKit)
Florida's Division of Workers Compensation mandates every medical provider use the same Medical Treatment Status Reporting Form, DWC-25, which does double duty as the off work status report. Most states, however, do not mandate the use of a particular disability slip.
When the medical provider does not provide the off work slip and the employer does not ask for one, the employee becomes the person determining when the employee will return to work. Usually that is not a good situation. The employer should require a disability slip be turned in by the employee after every medical appointment. What happens when the employer does not require an off work slip is the employee recovers from the injury beyond the point where the employee could return to work. But the employee continues his “vacation on workers comp” until the doctor refuses to see the worker again.
CRITICAL POINT: If the employee does not bring a Medical Treatment Status Form to the doctor ON THE FIRST MEDICAL VISIT, the claim will almost surely become a LOST TIME CLAIM….because the employee will need to go BACK to the doctor to get the disability form completed and this will require additional time to make and attend the next medical visit.
If the medical provider treating the employee is sending an off work slip that states “no work until seen by this office again” with no further information than the employee's name, the employer needs to take charge and advise the medical provider's office that is insufficient. At a minimum, the off work slip should provide the date of the next office visit and the employee's current physical limitations. If the medical provider is giving inadequate information, contact the medical provider's office and tell them an off work or disability slip is required after every employee visit that provides the following information.
1. the employee's name
2. the date of the office visit
3. whether or not the office visit was work related
4. objective findings
5. diagnosis
6. whether or not it is a pre-existing condition
7. the specific nature of any functional limitations, for example
no bending
no carrying over ____ pounds
no climbing
no kneeling
no lifting over _____ pounds
standing limitation ________
sitting limitation _________
walking limitation _________
other limitations
8. date of next office visit
9. anticipated full duty date
10. anticipated MMI date
11. date of next appointment
12. anticipated treatment plan
13. doctor's signature
The medical provider is in the business of providing medical care. Often the medical provider will have no knowledge about the type of service or product the company provides. The medical provider who does not receive any input from the employer has only the employee to describe the employee's job and the job’s physical requirements. It is highly probable that the employee will overstate, not understate, the physical requirements of the job.
By requesting the medical provider provide a disability slip that specifies the employee's restrictions and/or limitations, the employer can receive a more honest assessment of the employee's ability to work rather than letting the employee specify the requirements of the job,. A properly formatted disability slip can be an excellent way for the employee to maintain the proper level of physical activity while working transitional duty during recuperation. (WCxKit)
If the medical provider has an inadequate off work slip, feel free to create an off work/disability slip using the information outlined above. The medical provider office does not get paid extra for completing the off work slip, so make it simple and easy to fill out, yet informative. Offer to let the medical provider's office copy and use this off work slip for the employee's of other companies.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Given recent economic turmoil, many are having a hard time meeting financial obligations. This especially rings true for injured workers, who already have a strike against them — they are receiving workers compensation wage loss benefits at 66 percent to 80 percent of their previous income, and they are injured.
The situation worsens when an injured worker faces situations such as elimination of their job, permanent physical restrictions, or a long recovery after a major surgery. These factors mean pending workers compensation claims are being held open much longer, inflating claims counts for adjusters across the board.(WCxKit)
Below, are five situations that contribute to delays in closing workers compensation files:
1. Claimants trying to milk the system.
In the minds of most injured workers, having some money coming in is better than having no money coming in. The injured worker may not have a job to return to or may fear termination because of an on-the-job injury, so they maximize the symptoms of their injury; this is called malingering.
Whatever the reason, a current trend involves injured workers
stretching claims out as long as possible. Some purposefully take longer to recover by doctor hopping, trying non-conventional forms of treatment, and exaggerating pain complaints. The
length of time out of work must be proportionate to the
degree of disability.
Most physicians will catch this and mention something in medical records, which should alert the adjuster to set an independent medical evaluation (IME) or to do some surveillance on the file. Using the
MDGuidelines is also helpful; since that offers a range of times a worker should be approaching maximum medical improvement (
MMI). If the worker is not back to work within the guidelines, it is time for an IME. Be proactive on the claim or the months will continue to go by and the claimant will achieve their goal.
2. Injured workers have no job to return to for light duty, let alone full duty:
As mentioned above, a common scenario for an extended compensation claim is when the position the worker was in is eliminated, or when the employer does not have a transitional duty program. Since the job market is tight, some injured workers let their accepted workers compensation claim go on as long as possible.
Employers should alert adjusters before job cutbacks so they can discuss strategy on who will be affected. The adjuster can form an action plan to get the claimant back to full duty without letting him or her slip through the cracks.
3. Claimants choose to litigate because they have no other choice and nothing to lose:
When claims are denied, workers may think they have nothing to lose by filing for a hearing or seeking counsel. This causes the claim to be open for several months or years while the litigation ensues and parties work toward an eventual settlement. The wheels of the legal system often move slowly, and this contributes to the number of open claims out there. If you take a slow-moving legal system and overload it with everyone filing for a WC claim hearing, you get a backlog of claims and the system barely moves. Stay in touch with counsel to make sure he or she is trying to settle the claim and move negotiations forward. The very best way to avoid litigation is to communicate with the employees. Have an employee brochure, a written transitional duty policy, have employee's acknowledge receipt of the policy, have a brochure for your network physicians, and most importantly have an Injury Treatment Medical Information Form, a/k/a Work Ability Form. THIS gathers information from the injured employee's doctor at the first medical visit. Employees contact attorneys because they can't get information from their employers about their claims or their medical bills are not paid.
4. Claimants have severe injuries:
Due to company cutbacks as mentioned above, one worker may be doing the work of three. This leads to employers trying to do more with less. Injuries are bound to happen, especially in more heavy-duty, manual-labor positions. Employees working longer hours and doing more strenuous activity are leading toward a musculoskeletal injury and a probable surgery, if not worse.
These workers may be reluctant to report an injury for fear of losing their job. So they try to work thorough the pain, until the injury gets so bad it needs immediate attention. Workers need to know to promptly report injuries no matter what the circumstance, so they can be treated before it gets worse. Workers with wrist pain wait until they have full-blown carpal tunnel before reporting the pain; whereas if it had been reported sooner, full recovery would have been more rapid and less traumatic; waiting is prevalent when pay is conditioned on production-based pay.
5. Some injured employees wait for the Centers for Medicare and Medicaid Services (CMS) to approve the Medicare Set-Aside (MSA):
The dreaded MSA. If an injured worker is eligible for Medicare and the case is in litigation or parties want to settle, in order to settle the claim, an MSA is necessary. This will pay the employee what Medicare would have paid for the continued treatment of the injury. The employee then pays for future treatment from this account. He or she then files paperwork with CMS that tracks the claimant’s continued medical treatment long after the workers compensation carrier settles.
Getting CMS to approve an MSA can take from eight months to two years as there are numerous payment issues to be ironed out. Carriers and CMS employees are adjusting to this new system and, so far, it has not been a smooth transition, according to Gould and Lamb, experts in MSA issues. An adjuster or counsel can further explain how this works in individual jurisdictions.(WCxKit)
In summary, workers compensation claim closure rates have slowed nationwide with multiple forces to blame. But, with a good action plan, some persistence, and a bit of patience, these issues can be resolved and the file can eventually be closed for good.
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 WORK COMP 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.
When you have a high-exposure file that turns out better than you had expected and costs come in way under what you had budgeted for, it is easy to see the cost-savings that are associated with that loss. If you saved $50,000, that’s a nice lump of savings for your balance sheet.
But those little savings you make throughout the course of a year add up as well. It’s difficult to see it in the short-run, or by the month, but looking at it over the course of a year, it can really add up to a nice savings in your budget. We discuss some ways those little savings can add up below. (WCxKit)
1-Using quality vendors to get better results:
Sometimes the better vendors just cost a bit more than others. This is usually due to the fact that they have better talent working for them, and there are associated costs included with that. However, if these more expensive vendors get your workers back to you ready for work quicker, then you save again on the wage loss issue. This means that these vendors have already paid for themselves if you weigh their costs versus the cost of wage loss for your injured worker. Talk with your carrier about who the best vendors are in your area for IMEs, surveillance, and nurse case management. Don’t shy away from them just because their costs are a tad higher than their competition. They can save you money in the long run by providing you with excellent service, and by getting those injured workers back to work quicker than their counterparts.
2-Enhanced communication with your TPA/Carrier:
Lack of proper communication can lead to increased claims expense. If the adjuster doesn’t know that you have light duty work available, they may not be pushing hard enough to get work restrictions for your injured worker. Maybe the adjuster doesn’t know you have a dedicated medical clinic and/or physical therapy facility and failed to direct the injured party to treat at those clinic locations.
Maybe the injured worker took vacation time or sick pay for their time off of work, and they didn’t tell the adjuster that so they got paid twice-once by your company and once by the Carrier. Although most times the adjuster will catch this, sometimes they do not. This leads to an overpayment that the carrier must try to recoup, and if they fail to do so the cost of that ultimately gets pushed to you in the result of a higher premium due to increased claim costs. Whatever the event may be, you need to be in regular contact with your adjuster.
Perform claims reviews and ask the adjuster on each claim what their plan is for getting the claim resolved. The more you discuss the claim, the more ideas you both can come up with, and that may be what is keeping your worker off of work. By working together, you will save costs. Most adjusters would prefer too much communication versus not enough, plus this will keep the adjuster on their toes and they will be keeping a close eye on your claims, preventing one from falling through the cracks which will further waste claims dollars.
3-Using the other departments your TPA/Carrier has to offer:
Most Carriers/TPAs have multiple departments that will work with you to reduce your exposure. Loss prevention, ergonomics, dedicated adjusters to your account, medical/nurse resources, medical bill review, etc. All of these services may be provided free of charge by your Carrier/TPA, and the end result of utilizing these services will be lower claim cost to you. Implementing the action plans that these departments come up with is designed to lower your costs. So talk with your Carrier/TPA and find out what resources they have to help you reduce cost. They will be happy to work with you, and you will be happy since your claims expense will decrease over the course of a year.
4-Utilizing a 3rd party company for all of your RX needs:
Pharmacy costs are constantly rising. Almost every injured worker comes out of their doctor's appointment with a prescription for some medication in their hand. There are a lot of 3rd party pharmacy companies out there willing to work with you to reduce these costs if you funnel your injured workers to their pharmacy programs. Find out what kind of pharmacy management program they provide. The best sell their services unbundled. Look for prospective as well as retrospective elements of the cost control program. This can lead to huge cost savings, even on the minor claims, and will help the most with the more severe claims, since those injuries usually require prescriptions that cost more, and they length of the prescriptions last longer. This is a significant way to reduce your costs, and you will see large savings at the end of the year. (WCxKit)
Summary:
There are a lot of ways to reduce your costs. Not only in the larger higher exposure claims, but in the small minor claims as well. If you think about it, every little savings you can make can add up to a lot by the end of the fiscal year. Remember there are ways to cut costs on every claim, no matter how insignificant the claim may be at the time. You have to think both ways, in the short term and long term. Whatever it may be, the end result is you saving money, and that is never a bad thing
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
