After the first visit to the clinic:
Early on after an injured workers visits the clinics, especially during the first 2 weeks, more frequent contact results in better recovery and more rapid return to work. Have your in-house medical providers, medical advisors, and nurses play an active role. If the insurance company or TPA has a medical advisor, that advisor can make these contact. Lowering Workers Comp Costs
As a fall-back position, have the claims adjuster contact the treating provider. Of course, the employee should be required to bring medical restrictions (on your form) back to the facility when he or she returns to the facility to begin the modified duty position. And, the treating provider should fax the medical restrictions to the workers’ comp coordinator after the visit so when the medical advisor contacts the treating physician they have that form in hand for the discussion.
If the company medical advisor can speak to the doctor on the day of follow-up visits, that can be very helpful. You are forming an alliance with the treating doctor, figuring out how how to best help the employee, whether it is ordering an MRI, getting medical restrictions and returning someone to work, referring the injured employee to a specialist, etc. If the company medical advisor has information that might be relevant to the treating doctor such as the employee is very motivated, has a long track record of excellent company service, etc. that is also helpful to the treating doctor.
When there is difficulty getting an employee back work, consider a functional capacity evaluation (FCE): 1) An FCE can help determine what a person is capable of doing, and developing temporary alternate duty within those capabilities, and 2) can suggest symptom magnification.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
What ARE "account handling instructions," you ask? Account service instructions (ASIs) also called "account handling instructions" or "special account instructions" are the instructions your insurance adjusters live by.
They tell the adjusters what must be done when handling your claims. So, make sure you have input into the preparation of these instructions. Every insurance company or third-party administrator has them although the names vary. Items you want in your ASIs will vary depending on the carrier or TPAs best practices; ASIs will be developed "around" what they are already providing.
This is a very abbreviated list from Workers Comp Kit's Improvement Plan. The complete list is 10 times this length…
A 16 Point Account Servicing Instruction Checklist:
1. Settlement Authority Who has settlement authority — the company or the adjuster? A "consult" is totally different than "authority." How much authority you get depends on the type of insurance program you have.
2. Selection of Counsel Do you select your own legal counsel? What type of legal counsel does your company utilize – panel counsel or outside counsel?
3. Reporting How often do you receive status reports for open claims from your insurer? Over 30, 60 or 90 days? Even though you may have been provided access to run reports, if you'd prefer to have them run for you, ask for that.
4. Reserves Does the insurer provide a written explanation each time reserves are raised over $10,000 or more? Do reserves set take into consideration the company's aggressive return-to-work program, probably resulting in lower wage loss?
5. Dedicated Adjuster How many adjusters are dedicated to processing claims for your account? One adjuster with a full-time admin can handle more than an adjuster without an admin.
6. Payment/Review of Legal Bills Do you receive copies of bills for legal services?
7. Investigations How do you request investigations? Will you receive copies of the investigation reports and video for review? Are emergency room records/notes obtained for every worker who is treated in the ER? Are drug test required at the clinic after an Emergency Department visit?
8. Structured Settlements & MSA Set-asides Do you consider structured settlements for all cases over $10,000? Are MSA settlements structured? Who handles compliance?
9. Subrogation Are all cases reviewed for subrogation potential? Who closes a file and waives subrogation recovery? Do you want to be consulted before a lien is waived or compromised?
10. Workers Compensation Do you see copies of payments being made on each open file? Do you review checks or a list of all payments made for accuracy? Are statements tape recorded on all claims where compensability is questionable such as heart-attacks, stress claims, unusual injuries, claims where liability is not clear?
11. Referral to Physician Consultant/Medical Advisor How are outside vendor services activated and coordinated? Are all medical records sent to the Medical Advisor before an independent medical examination is conducted? Does the MD write the IME cover letter and make sure timing is appropriate for an IME?
12. Medical Bill Review How and when are medical bills audited? Who will audit the hospital bills? What level of hospital bills are audited? Do you decide if medical case management is warranted? Is there immediate and automatic referral of complex lost-time cases to medical case management?
13. Utilization Review How do you decide which bills and services will be reviewed? Who provides this service?
14. Referral to Vocational Rehabilitation Who decides if vocational rehabilitation is warranted? Do you automatically refer complex lost-time cases to vocational rehabilitation? Will reports be sent to your company?
15. Alternative Dispute Resolution/Mediation Is alternative dispute resolution considered on all claims for all lines? Are you or are subrogating insurance carriers members of the Center for Public Resources (a non-profit organization whose members agree to avoid litigation and try to pursue alternative means of dispute resolution)? If so, is this noted?
16. Miscellaneous Do you have the option to change your account instructions? Do you have the right to review the complete original claim file? Dont be afraid to negotiate for what you want in your account handling instructions. Remember, if you have a large deductible insurance program, its YOUR money!
If you have a guaranteed cost program, you will not have as much leverage as if you are self-insured or in a large deductible program, but don't let that stop you from asking for what you want. Much of the above information applies to litigation managment for product liability claims, etc.
Read the 7 Biggest Mistakes Employers Make when Working with their TPA or insurance company: http://www.reduceyourworkerscomp.com/results-from-your-insurance-company.php
For more cost savings tips go to WC Cost Reduction Tips. I hope this is helpful, and would appreciate your feedback if you have specific examples of where you have been able to use this information. If you need help with your account instructions, I can help you or refer to to another consultant that can.
Author: Rebecca Shafer, J.D. Rebecca is a national expert on workers compensation cost containment and has helped many companies reduce their workers compensation. She is the author of: Manage Your Workers Compensation Program: Reduce Costs 20-50% at www.WCManual.com
RShafer@ReduceYourWorkersComp.com
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment program initiatives.
© Copyrights strictly enforced. 2008-2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Some thoughts from the Md's perspective on how to make your employees' visits with an occupational physician more productive. Find more ideas at: http://www.reduceyourworkerscomp.com/wasteful-workers-compensation-practices.php 1- Establishing a cooperative relationship before-hand is essential. What is key is having the medical advisor available to call the treating physician. This is a step that must be set up in advance so the medical advisor is very responsive and can take quick action when an injury occurs. 2- A Medical Advisor can contact the treating physician prior to the exam: The medical advisor can let him know the patient is coming and ask him to call the medical advisor back after the exam. The medical advisor may ask specific medical questions, such as asking questions and conducting an exam that helps distinguish a work-related injury from non-work related injury. If the treating physician knows he will be speaking to the medical advisor, he may take a more careful history and be more aware of getting the person back to work. 3- The medical advisor can suggest something he may/may not do routinely. Depending on the type of injury, the advisor might suggest a particular Waddell test if symptom magnification is suspected. Giving background such as letting the doctor know the worker is unhappy with the job situation can be helpful. 4- Treating Doctors should give medical restrictions and then the company decides if the employee can return to work, if they can accommodate the physical restrictions. It is helpful to let the doctor know a company can accommodate nearly all restrictions. 5- Ask them to not give "off duty" – just give medical restrictions for every worker. If he or she is contemplating taking someone off work, give us medical restrictions – unless the worker is bedridden. The doctor should keep in mind that a worker may not even know the company can accommodate him; he may be unaware there is a transitional duty program. Once there are medical restrictions, it is then up to the workplace to decide if they want to make those accommodations and how they will make them. 6- Make sure the physical restriction form is easy: it is easier to fills out a simple form with check boxes that nearly all doctors are familiar with such as "Lifting: heavy/ medium/ light, pushing or pulling, sitting, standing and a space for the doctor to write in any additional comments." 7- It does not have to be a "recordable" claim: If the treating physician is familiar with the OSHA rules, he/she will know that if the incident is just first aid, that medications needed by the worker are over-the-counter, and physical therapy (often over-prescribed) is not ordered, then the incident is not OSHA recordable it is first aid. WC Calculator www.ReduceYourWorkersComp.com/calculator.php TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101 www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
As mentioned in the previous blog entry, it is better that the doctor knows head of time – before seeing the patient – that your company has a RTW program. Otherwise, the physician might get a picture of the workplace from your employee that is inaccurate or different from how your workplace actually is. It’s key that you communicate this to him or her.
As a treating physician, I have always been of two minds about reading detailed job descriptions. First, they can be technical and laborious to read, particularly if you are not familiar with the workplace, do not know the abbreviations, and do not have the context for what the worker really has to do.
Video job banks are quite useful way to familiarize the doctor with the job. The doctor can log in to the video job bank website, view the job, and THEN see the injured employee. This way during the visit the doctor knows exactly what the movements the worker is required to perform. It takes more time to go through a detailed description, ask questions, and then come to a decision with regard to what parts of the job the worker should continue doing. Go to Return To Work America at: www.rtwamerica.com/ to learn about video job banks.
For more cost savings tips go to WC Cost Reduction Tips.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
Establishing a cooperative relationship with an occupational clinic convenient to your worksite is very important. Even though not many of your injured workers will ultimately visit the clinic, you as the employer are often in a good “bargaining” position to get the most attention and the best service possible. If the clinic is doing pre-employment physicals, drug testing, etc. your company is a valuable source of revenue.
Next, involve your Medical Director. If your Medical Director is local, he or she should attend the initial meeting to set up the relationship. Establishing a doctor-to-doctor relationship will be an important component of getting injured workers back on the job. A treating physician is more comfortable sending an employee back to the workplace knowing that another physician is also concerned with the worker’s safety. If your Medical Director is not local, he or she should have a phone conversation with the clinic’s Medical Director to establish a good rapport.
In your meeting with the Clinic Manager and Medical Director ahead of time, make sure that the clinic is aware of whom to contact at your company whenever an employee is treated. It is essential that the employer contact be made before anyone is taken off work. This should be part of a clear, stated policy with regard to return to work (RTW). Ideally, the work status should be determined by the employer and not by the treating doctor. This is a key point that is often missed. While the treating physician determines the physical restrictions, as long as the workplace can accommodate a worker’s restrictions, it should be up to the company whether or not to bring the worker back. Always involve your legal department in setting up return to work parameters. For more ideas of how to coordinate medical care click here: http://www.reduceyourworkerscomp.com/wasteful-workers-compensation-practices.php
One way to reemphasize these key points is to use a Brochure to the Physician like the one in Workers’ Comp Kit — a “leave behind” communication reminding the doctor and clinic employees about the employer’s transitional duty program. Dr. Dave is happy to answer questions from the comments box below or thorugh his email at MD@ReduceYourWorkersComp.com.
For more cost savings tips go to WC Cost Reduction Tips.
David Dubin, MD, will be doing a three-part series on Working with an Occupational Medical Clinic:
Part I: Before the Visit
Part II: During the Visit
Part III: After the Visit
When developing a workers’ compensation cost containment program, you need to think chronologically about how to work most effectively with your occupational medical clinic. Integrate all steps of your post injury response into the protocol for working with the occupational medical clinics.
Ask Yourself and the Provider: What needs to be done before the first visit, what needs to occur during the visit and what steps should be done after the visit?
Dr. Dubin is a long-standing expert in workers’ comp cost containment and serves as Medical Advisor for several companies.
Functional capacity testing is a useful tool to help determine a worker’s capacity, but it can also help screen for symptom magnification. For example, in most strength tests a worker has to repeat his effort three times. While it is possible to exaggerate disability one time, it is virtually impossible to have the exact same amount of disability three times in a row. The wording in the report usually refers to an “inconsistent effort”, and this is typically more than 15%.
For the 7 Biggest Mistakes Companies Make, click here: http://www.reduceyourworkerscomp.com/lower-reduce-workers-comp-costs.php
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