Two Key Aspects To Controlling Workers’ Comp Medical Costs

Medical costs continue to be a significant driver in workers’ compensation claims across the United States.  This is due to a number of different factors, which include fraud, waste and abuse within the system.  In other instances, the increase in medical specialization is a driver of costs, which can lead to duplicative and unnecessary care.  When this takes place in the context of a workers’ compensation claim, the result is an unnecessary financial burden to the program.

 

Now is the time for members of the claims management team and other interested stakeholders to take control of their programs.  One important way to do this is by being proactive on the medical factors of claims and to direct effective medical care and treatment.

 

 

Responding to Injuries

 

All employers, regardless of size need to take a proactive and immediate approach to every workplace injury.  This includes personnel within the work environment who know how to provide medical care and being responsive to employees who suffer an injury.  Other key elements of an immediate and effective injury response include:

 

  • Rapid response to injury and with 24/7 nurse triage hotline. Time is of the essence to triage the injury and direct the employee to the right level of medical care, whether home treatment or the appropriate medical provider. The ability to use a 24/7 nurse triage hotline is not affected by differences in state laws regarding directing medical care.

 

  • Transportation to a medical facility is also an important component of responding to a work injury. This includes providing a means of transportation for a person who does not need an ambulance.  Instead of making that person drive himself or herself to the appropriate facility, an employer representative should make every effort to provide transportation.  This best practice demonstrates “good will”, and ensures the employee arrives at the medical provider to receive treatment.

 

 

Working with Treating Physicians

 

Having a designated medical facility for initial post-injury care does not preclude an injured worker from seeking future treatment at another location.  It is a general rule that employees suffering from the effects of a work injury have the right to choose their initial medical provider and seek care from a facility of their choosing.  It is important for members of the claim management team to communicate effectively with these treating physicians.

 

When working with the employee’s treating physician, claims handlers and other interested stakeholders should also keep the following factors in mind:

 

  • Professionalism: As a claim hander, you are the “face” of the employer and insurer.  Claim handlers need to understand and respect the doctor-patient relationship.   It is important to be patient and professional at all times. While state and federal privacy laws are relaxed in the context of a workers’ compensation claim, disclosure of information may be delayed.

 

  • Cooperation: This is an essential key when dealing with contentious matters such as workers’ compensation claims.  Building and maintaining cooperation is a two-way street.  Always seek to be a problem solver, not cause them.

 

  • Relationships: People like to do with business with people they like.  This includes working with medical professionals and the injured party.  The expression, “You catch more flies with honey than you do with vinegar,” is something to consider.  An employee suffering from a work injury has a number of worries beyond recovering from the incident.  This includes financial, emotional and family pressures.  Always seek understanding and approach every employee as a person, not just another claimant.

 

 

Conclusions

 

There are no simple solutions to reducing the medical aspects of a workers’ compensation.  Interested stakeholders can take a significant step to addressing this issue through a proactive approach to directing medical care in all injury-related claims.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

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

 

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

Examine 3 Common Disincentives to Return to Work

Understanding the psychology of human nature is an important component to reducing workers’ compensation program costs.  While most employees are genuinely interested in gainful employment, various collateral sources of benefits in the form of workplace perks can promote higher workers’ compensation costs.  In order to run an effective program, it is important for interested stakeholder and employers to evaluate the financial incentives they provide employees to determine possible detriments to return-to-work and reducing costs associated with workers’ compensation matters.

 

 

Common Examples of Collateral Disincentives

 

Employers offer a variety of different benefits to employees to boost morale and encourage employment.  Some common incentives that can drive higher workers’ compensation costs include:

 

  • Salary Continuation Programs: Under these programs, an employer may offer employees suffering any disability, including one resulting from a work-injury, 100% salary or partial wage replacement greater than what they would receive under a workers’ compensation wage loss rate.  In a majority of these instances, benefits are capped at after period.  Studies demonstrate these replacement programs result in longer disability periods for employees suffering work-related disabilities and injuries.

 

  • Disability Benefits: Many employers offer employees short- and long-term disability benefits.  These benefits are paid instead of salary for disability.  While some employers require employees to subsidize the cost of these benefits, others are willing to pay the price.  Depending on the policy language, an employee suffering a workers’ compensation claim can receive a “windfall” recovery by receiving disability benefits under a private program, plus wage loss benefits under workers’ compensation.

 

  • Supplemental Wage Replacement: Some employers offer supplemental pay for employees when they are off of work.  While this is often used in the correct manner, it can be common for employees off work due to a workplace disability to game the system and prolong their recovery.

 

In many instances, these well-intended incentives can have perverse outcomes.  This is why all parties interested in reducing costs in their workers’ compensation program should evaluate the effectiveness of rewards and fringe benefits on a regular basis.

 

 

Reducing Work Comp Costs and Promoting Efficiency

 

Employers offering generous rewards and other forms of financial compensation to employees should be prepared to expect the worse.  Human nature dictates a certain percentage of the employee population will “game the system,” other otherwise delay recovery.  Concerns regarding a slow recovery should be monitored closely.

 

Employer representatives and other interested stakeholders should pay close attention to employee benefit programs and workers’ compensation costs.  Action should be quick and decisive if it is suspected an injured worker is delaying their return to work.  If this is the case, the following tools can be used to correctly ascertain the true medical status and workability of an employee:

 

  • Independent Medical Examination (IME): There are limitations on when and how an IME can be used.  In many jurisdictions, this type of examination can only be used once.  Other jurisdictions allow for additional visits by a defense medical expert if there is a documented change in condition, or need to properly assess restrictions or maximum medical improvement (MMI) following surgery.

 

  • Independent Vocational Evaluations (IVE): IVE’s are conducted by a trained vocational or rehabilitation expert.  It involves a number of different tests, which can require the employee to undergo physical activities to determine mobility and function.  Other testing can be educational in nature to measure cognitive function and mental abilities.  The timing of the IVE typically coincides with the placement of the employee at MMI.

 

  • Surveillance: This tool can also be used to determine the true physical ability of an injured worker.  It should be performed in a manner consistent with state law and rules governing workers’ compensation proceedings.  Failure to do so can result in adverse consequences to the defense of a workers’ compensation claim, admissions against interest and/or sanctions.

 

 

Conclusions

 

All employees deserve dignity and respect.  However, sometimes attempts to extend courtesy can lead to perverse consequences.  Interested stakeholders in workers’ compensation programs should be mindful of unintended consequences and monitor matters to ensure the true intent of generosity is extended in return.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

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

 

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

How To Implement An Effect Work Injury Response Plan

 

It goes without saying that in workers’ compensation risk management proactive response to a workplace injury or incident is important.  However, what is often lost in the discussion of this topic is what takes place following the critical minutes following an injury and after the employee receives initial medical care and treatment.  Taking time to think about your long-term response can save your program dollars and can increase productivity in the workplace.

 

 

Lack of Communication and the Post-Injury Dilemma

 

Take a moment to think about a work-injury from the perspective of an injured employee.  The employee is frustrated with a number of issues.  These can include:

 

  • Not understanding the workers’ compensation benefit process and payment structure. They do not want to get an attorney because everything seems right or they do not want to be viewed as a troublemaker.  They are receiving all the benefits they are entitled to, right?

 

  • Time spent filling out forms and seeing a number of medical doctors and vocational rehabilitation counselors. When they do see their doctor, it is a rushed appointment and sometimes not all of their questions are answered.

 

  • The major disruption in their life caused by physical disability. Their routine is in utter chaos.  Instead of spending time with friends at work, they sit at home and recover.

 

  • There is a reduction in income, but not everyday living expenses. Hopelessness and despair set in.

 

Missing from most post-injury response plans is an effective and consistent line of communication between the employer and injured parties.  Workers’ compensation stakeholders serious about their bottom line need to consider the implementation of pro-injury communication with their disabled workforce.  Lack of information breeds contempt.

 

 

Implementing an Effective Plan

 

It is important to plan and implement an effective post-injury response immediately after a work injury occurs.  Suggestions to improve these lines of communication and avoid distrust of the injured employee can include:

 

  • Assisting the injured worker in contacting immediate family about the injury and advising these parties about the status of the employee. In some instances, written authorization may be required given state and federal privacy laws.

 

  • Contacting the injured worker immediately after they are out of danger and in a stable condition. Sending a get well card or making a telephone call are a good, visiting the employee at their home or in the hospital is even better. Proactive employers can also offer to take someone home from a hospital or clinic after their release.  Random acts of kindness build trust.

 

  • Empathizing with the employee and explaining to them the workers’ compensation process can also be helpful. Developing literature about the workers’ compensation system can also be helpful if done right.

 

The open lines of communication should not stop there.  Additional follow-up steps can also be taken to build trust and confidence in the employee with the eventual goal of full recovery and return to work.  Other measures should include:

 

  • Weekly conferences with the injured worker to check on their physical and emotional status. These meetings can be in-person at a location convenient to the employee or via telephone.

 

  • Allowing the injured party to visit with friends and co-workers on the employer’s premises can develop a sense of worth.

 

  • Offering a broad selection of return-to-work opportunities.

 

 

Conclusions

 

Effective injury response goes beyond having a First Aid kit on hand and calling 9-1-1.  For proactive stakeholders, it requires exceeding the minimum expectations to build a bridge of trust and promote a positive relationship with the injured worker.  While this takes effort, it can reduce costs in your program and pay dividends via cost savings.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

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

 

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

Get Serious About Developing Your Return-To-Work Policy

Imagine the following conversation:

 

Q: What is your policy on “Return to Work?”

A:  Ahh, we are all for returning injured workers back to work?

 

Sadly, this is the typical response of most employer representatives when it comes to an important topic.  A topic so important it can save your workers’ compensation program countless dollars and reduced litigation costs.  If you are one of the many employers or employer representatives who is serious about return-to-work, now is the time to develop a policy that meets the needs of your workforce and keeps the best interests of everyone in mind.

 

 

The Role of Return-To-Work

 

The role of return-to-work in workers’ compensation is multi-faceted.  It involves an employer seeking to do what is best for their employees.  It also includes people ready to seek creative solutions to complex problems.  Time spent on return-to-work is valuable in a number of ways.  These include benefits to the employee and employer:

 

  • Benefits for Employees: Most injured workers would rather be in the workforce than stay at home.  The seclusion of home has many negative psychological consequences and prolongs recovery times.  Additional benefits to the employee include increased earning capacity, a consistent and regular schedule, positive and productive mindset, a strong sense of self-worth and increased security.

 

  • Benefits for Employers: There are numerous considerations beyond increased workers’ compensation premiums that should compel proactive employers to invest in these programs.  Other considerations include controlling the hidden costs of prolonged injury, reducing future exposures (including claims for retraining or permanent total disability) maintaining productive work operations and containing costs.

 

 

Developing a Proactive Return-To-Work Policy

 

Here are some important considerations to developing an effective and proactive return-to-work policy.

 

  • Purpose: The policy should outline the general philosophy of the company. It should include how it views all employees regardless of ability.  It should also inform workers of their rights and responsibilities following a work injury.  It should note that policies covering workers’ compensation issues do not impact or supersede other legal obligations the employer may have under the Americans with Disabilities Act (ADA) or disability/leave programs such as the Family and Medical Leave Act (FMLA).

 

  • Eligibility: This part of the policy will outline the rights and responsibilities of the employer and employee.  It should cover important aspects of being out of work or returning to duty with restrictions or a modified position.  Important elements to cover include time off to attend doctor appointments and restriction requirements, if applicable.

 

  • Availability of Positions: It should be the goal of every return-to-work program to move a worker back to his or her pre-injury position and wage.  In many instances, this is not practical given physical limitations following the work-related incident.  In this case, notifying the employee of other job opportunities within the pre-injury employer and other positions is important.

 

  • Transitional Work/Assignments: Many state workers’ compensation laws govern the employee’s eligibility for ongoing wage loss benefits should he or she decide not to accept transitional or modified positions.  It is important to spell out the rights and responsibilities of the parties in these situations.  Other elements include legal requirements on how the employee is going to receive the offer of modified work and what procedures are required if they dispute the physical requirements of the position.

 

There is no set template for a return-to-work policy.  Other elements may include information on position expectations, termination of assignments, the number of hours open for a position (part-time or full-time) and rate of pay.  Interested stakeholders should also consult legal counsel given the employment issues that come into play in these complex matters.

 

 

Conclusions

 

Return-to-work is a complex issue that requires more than a mere moment of consideration by employers serious about reducing workers’ compensation costs.  When reviewing your best practices, it is important to consider the development of a policy regarding this issue.  Doing so can substantially reduce your workers’ compensation program costs.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

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

 

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

How To Know When To Expect Your Employee Back To Work

Employers want to know how long an employee will be off work following a workers compensation injury. There are a lot of factors that go into the answer including the nature and extent of the injury, the employee’s age, the employee’s physical conditioning, and the overall state of the employee’s health.

 

The most common types of injuries are sprains and fractures. There are several factors that determine the disability period for sprains and fractures. The first factor to consider is the nature and extent of the injury. A moderate sprained ankle heals much quicker than a compound femur fracture. To get an idea of how extensive the medical provider considers a sprain, look for the adjective before the word sprain or strain.

 

The adjectives most commonly used with sprain and strains are: 

 

  • Slight – it happened, but there is not much to it.
  • Moderate – more extensive than slight – middle range
  • Severe – more extensive than moderate – really hurting

 

To understand how extensive a fracture is, again look for the adjectives the medical provider uses to describe.

 

Fractures are normally described as:

 

  • Simple: it has cracked, but has not done anything more than a little bit of damage to the surrounding tissue
  • Closed: basically the same as a simple fracture
  • Compound: the bone has broken in more than one spot, or the fracture has created significant tissue damage
  • Open compound: the broken bone is exposed through a wound in the skin
  • Compression: in the vertebrae where a brittle bone, due to age or osteoporosis, has cracked

 

 

Other adjectives to describe fractures include (per Wikipedia):

 

  • Complete fracture: A fracture in which bone fragments separate completely.
  • Incomplete fracture: A fracture in which the bone fragments are still partially joined. In such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone.[1]
  • Linear fracture: A fracture that is parallel to the bone’s long axis.
  • Transverse fracture: A fracture that is at a right angle to the bone’s long axis.
  • Oblique fracture: A fracture that is diagonal to a bone’s long axis.
  • Spiral fracture: A fracture where at least one part of the bone has been twisted.
  • Comminuted fracture: A fracture in which the bone has broken into a number of pieces.
  • Impacted fracture: A fracture caused when bone fragments are driven into each other.

 

 

Consider Age & Conditioning

 

In addition to the nature and extent of the injury, the employee’s age is a factor. A 25 year old employee with a simple fracture will heal more quickly than a 55 year old employee with the same injury.

 

 

The employee’s physical conditioning before the injury will play a significant factor in the employee’s disability recovery time. The 50 year old employee who runs in the Boston Marathon will recover from an injury faster than a 20 year old employee who spends all his free time in front of a video game monitor.

 

 

The overall state of an employee’s health will also impact the disability time. An employee with truncal obesity, diabetes, or other comorbidity issues will recover from an injury much slower than an employee who has the same injury, but no other on-going medical issues. Additionally, the non-smoker will recover from an injury faster than a smoker, all other factors being equal.

 

 

For more information, please see:

 

 

Please note that all disability times are normal ranges, and the medical facts will determine the disability period. Hospitalization times vary greatly depending on the severity of the injury. The total disability time range is the expected length of time before the medical provider will allow the employee to return to light duty work. The partial disability time ranges is the approximate amount of time the employee should be in a light duty job.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

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

 

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

WCRI Recap: 3 Factors That Most Impact Worker Outcomes

WCRI Recap – 3 Part Series

  1. WCRI Recap – Impact of Donald Trump and 2016 Election
  2. WCRI Recap: 3 Factors That Most Impact Worker Outcomes
  3. WCRI Recap: Single Biggest Factor To Turn-Around Opioid Crisis

It’s been two weeks since the WCRI Conference recently held in Boston. I’m Michael Stack with Amaxx and today I want to give you some highlights and recap from that recent conference, from the notes that I took and the perspective that I had on it. The second session was about worker outcomes and what impacts, based on studies and research to define the best outcome.

 

 

What are those factors that we can address? For me, this was the most interesting and impactful session for what I do, which is work with employers, insurance brokers and educating best in class programs. This session is one that I found extraordinarily valuable to get an understanding of, what are those things that impact the outcomes that we can address at the beginning a claim and make sure our success is that much more likely.

 

 

Single Biggest Factor That Impacts Claim Outcome

 

This is a study I’ve quoted a number of times. It was published by WCRI a few years back and they came out with a study and said, “The biggest single factor based on their research that impacts the outcome of that claim is trust.” The biggest single factor that outcome impacts the outcome of a claim, is the amount of trust between an employee and an employer. Hugely important point. Hugely important factor to understand. Now, we’ve seen that one before.

 

 

 

How Does Supervisor Respond to Injury?

 

Glen Pransky from Liberty Mutual gave a presentation about some of their research and their studies. I found it extraordinarily interesting and valuable. Here’s what they came up with. Two different things that impact their outcomes, one of the biggest factors, all things being equal, if how does the supervisor respond to the injured worker at the moment that claim is reported. I’m going to say that again. How does the supervisor respond to the injured worker at the moment that that claim is reported. Do they respond with blame and anger and frustration? There’s that lack of trust there. They’re not trusting that the employee maybe said they get injured and they say, “Yeah, right. You didn’t get injured. Get back to work.”  Or, “How could you do that wrong? You are now in trouble.” That lack of trust there. So, how does that supervisor respond to that injured worker at the time of injury? All things being equal, if they respond positively, it’s going to have a significantly better claim outcome. If they respond negatively, a significantly worse claim outcome. That was number one, “How does a supervisor respond to the injured worker at the time that claim is reported?”

 

 

 

How Does Insurance Adjuster Respond to Injured Worker?

 

Number two, how’s the insurance adjuster respond or how is that first interaction with the injured worker go? Are they using big insurance words that the injured worker doesn’t understand? Things like adjudication and calling him the claimant and all these different things that really foster this lack of trust that they’re going to be taken care of. So, if there’s all these things that they don’t understand and they don’t know what’s going to happen, what are they going to do? They’re going to make sure their rights are protected. They’re going to call an attorney and they’re going to be going down this path which makes the claim that much more complicated, because they had a poor interaction with a supervisor and their adjuster’s causing him all this adjudication. They say, “I don’t know what’s going on. I better look out for myself.” So, how you responding to the injured worker, how do those communication interactions, things to train on, things to work on.

 

 

 

Do You Think…

 

Here’s the next piece, which I thought was extremely interesting and something you need to input, impact into your program today. Starting today, do this on every single claim. Here’s what it was, they asked this question, it’s a highly predictive question of the outcome of that claim, “Is do you think, you’ll be back to work within four weeks without any restrictions?” Do you think, you will be back to work within four weeks without any restrictions? Do you think you’ll be back to work in four weeks without any restrictions? Highly, highly predictive question to ask of what that outcome of the claim is. If they say, “no” then you get to ask them why. “Why don’t you think you’ll be back to work?” You can bring in additional resources and support to drive that. If they say, “yes” then they’re setting that expectation in their own mind and it’s only going to drive that success to get them back to work. Highly predictive question and response to that claim’s outcome, “Do you think you’ll be back to work within four weeks without any restrictions?” Start asking that question, every single one of your claims today.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

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

 

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

14 Points To Discuss With Your Injured Worker For Win-Win Outcome

A big mistake made by employers is leaving the injured employee to fend for himself / herself in the world of workers’ compensation.  For most injured employees, the injury is their first workers’ compensation claim and they do not know what to do or what to expect.  Fear of the unknown and not knowing what to expect creates a lot of angst in the employee.

 

 

Fear of Unknown Creates Angst in Injured Employee

 

The smart adjuster during the initial contact with the injured employee will take all the time necessary to answer the employee’s questions about medical treatment, lost wages, light duty return to work, and any other questions the employee might have.  The smart employer will also contact the injured employee and answer all the questions the employee might have about their work comp claim.  When neither the adjuster nor the employer answers the employee’s questions and concerns, the employee will usually find someone who will – an attorney.

 

We always recommend for the employer to call the injured employee immediately after the initial medical treatment.  They will want to ask what the doctor’s diagnosis and prognosis are, when the employee will be returning to work, and if the return to work date is not known, what the work restrictions are.

 

 

14 Points to Discuss With Your Injured Worker

 

  1. The injured employee should be asked to submit a detailed report of how the claim happen, preferably written
  2. Ask the injured employee who were the witnesses to the accident
  3. Verify the injured employee is treating at an employer selected medical provider, if your state allows the employer to select the medical provider
  4. Ask the injured employee if he has ever injured the same body part before, and if so, when
  5. Tell the injured employee you will send him/her a copy of the First Report of Injury being submitted to the insurance company, and ask them to review the Report and advise you if anything is inaccurate
  6. Ask the injured employee if he has discussed all pre-existing medical issues with the doctor (some medical issues like obesity will be obvious, others like hypertension or diabetes need to be disclosed to the medical provider)
  7. Explain to the injured employee how mileage to medical appointments is reimbursed in your state, and the mileage rate
  8. Explain to the injured employee the importance of attending every doctor’s appointment, diagnostic test and physical therapy session (if needed)
  9. If the injured employee is going to be off work, explain to him what the state’s waiting period is for indemnity benefits
  10. Explain to the injured employee how the indemnity benefits will be calculated by the insurance adjuster
  11. Ask the employee to call you after each medical appointment to let you know the doctor’s current plan of treatment
  12. Advise the injured employee to obtain an off-work slip at each doctor’s appointment
  13. Ask the injured employee if he has any questions in regards to how the transitional duty program works
  14. Ask the injured employee if he has any questions about any other aspect of how their workers’ compensation claim will be handled

 

Yes, this is a lot of information to review, and it will take you an extra five minutes.  However, the extra five minutes spent making sure the employee understands how everything will work in their workers’ compensation claim can be the most productive five minutes of your day.  By taking the concerned and caring approach, you will eliminate most of the hassles and headaches that occur when a work comp claim goes bad and save a lot more time later in the claim process.

 

 

On-Going Contact Will Avoid Many Problems

 

Managing and assisting the injured employee does not end with the initial follow up phone call to the employee.  The employee should be encouraged to call you after each medical appointment, and he does not do so, you should call the employee.  Any questions the employee has during the recovery period can be addressed timely in this manner.  By maintaining on-going contact throughout the time the employee is off work, you will avoid most of the problems that can occur with a work comp claim.  You will also be assisting the employee in returning to work the minimal amount of time.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

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

 

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

3 Steps to Discover the Root Cause of Work Injury

A near miss may be the best thing that ever happens at your company. Depending on what you do afterward, it can be a huge opportunity to save money and headaches.

 

After the initial ‘phew!’ reaction, it’s time to get down to business and find out what happened and why and, most importantly, what you can do to prevent a recurrence that could result in an injury and comp claim the next time.

 

Fact is, most (probably all) workplace accidents have multiple causes. Even the seemingly simple-to-explain incident likely has several underlying factors going on. By getting to the real root of the problem you can avoid potentially costly and preventable claims.

 

Root Cause Analysis

 

Delving into the true causes of workplace injuries requires a team effort, though it doesn’t need to be all that complicated. There are a variety of frameworks for ‘root cause analyses.’  There are templates to make it easier to organize the information. Some organizations use a fishbone diagram to group causes into major categories to identify variation sources. Whatever system is used, there are several keys to successful root cause analysis.

 

  1. Do NOT assign blame! This is the most important aspect in getting to the real root of a problem. It’s tempting to blame someone, punish him, and move on, but that doesn’t fix the underlying problems. Root cause analysis must be done without any finger pointing. Remember, most workplace accidents are the result of a confluence of contributing factors. The job of RCA is to identify and correct them.

 

  1. Ask questions. Then ask more. And a few more after that. The main questions to ask: WHY? You may feel like a 2-year-old asking ‘why, why, why’ – but this is key to getting to the crux of the analysis. As an example, let’s say “Fred” fell off a ladder and, luckily, was not seriously injured. It might be easy to say, ‘well, Fred was being careless, he was in too much of a hurry, so it’s his fault.’ But asking ‘why’ will uncover important details that would prevent future such incidents. The answer to the first ‘why’ could be that one of the rungs on the ladder broke. ‘Why,’ you ask again, and find out it could not hold Fred’s weight. If the rungs were designed to hold 350 lbs. and Fred weighs only 170, what was the extra weight? You discover Fred was carrying materials up the ladder and the combined weight exceeded 350 lbs. But the company has a hoist truck for such jobs, so why was Fred not using it instead of carrying the materials himself? Turns out the hoist truck was being used elsewhere. So why didn’t Fred wait until the hoist truck was available? Because he was under the gun to get the job finished on time and would have missed the deadline otherwise.

 

From the example, several problems come to light. There were not enough hoist trucks available, the ladder’s weight restrictions were ignored, and the deadline did not allow for the job to be done properly. Those are only some of the issues. With continued delving, there would likely be additional factors that contributed to the accident.

 

  1. Get all relevant information — and then some. In addition to the obvious details such as interviews with witnesses, examining any video footage of the incident, and speaking with the injured — or nearly injured — worker, other considerations include:

 

  • The environment. Was the ladder properly placed on the floor? Was there anything surrounding it that might have contributed?
  • Training and skill level. Did Fred have training on using the ladder? Did he understand the weight limit? Had he ever used the ladder before? Was he instructed to avoid carrying materials up the ladder (which, aside from the weight limit, could have caused him to fall)?
  • Was there a specific procedure in place for using ladders? If so, was that procedure communicated to Fred and other employees? Was the procedure ever updated, and the updates communicated? Were workers known to circumvent the procedures?
  • Was it properly maintained? Was there enough available? Had any relevant equipment been updated as needed?
  • Human behavior. We found out Fred was in a rush due to deadline pressure. But why — what were the consequences of not meeting the deadline? Were there too few employees working on the particular job?

 

The Fix

Once you’ve ascertained all the causes (and potential causes) of the incident, it’s time to figure out corrective action. All the ‘why’ questions should end with something that indicates what and how something should be changed.

 

In our Fred scenario, several things could be changed to make the organization run more efficiently and with less chance for an injury. Training would be one area, for example. Fred clearly did not understand (or did not care) that carrying materials on the ladder could exceed the weight limit of the rungs. Procedures may need to be reviewed and changed to prevent people from carrying heavy or awkward items while climbing a ladder.

 

Equipment might need to be upgraded, perhaps with an investment in an additional hoist truck would be warranted. Communication might need to be ramped up to ensure that, while meeting a deadline is important, attention to safety is more important.

 

Conclusion

Workplace accidents, unfortunately, happen and may result in injuries and workers’ comp claims. However, the same incident should never be repeated within an organization.

 

By digging deep you can identify a variety of factors that could lead to an injury. Taking corrective action will help ensure workers stay safe, the job gets done, and you’re not wasting money on preventable problems.

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

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

 

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

Leverage 2 Super Bowl Tactics To Drive Your Work Comp Comeback

Hello. Michael Stack here with Amaxx. So yesterday was Superbowl 51. If you missed the game or you went to bed early, kind of like my wife did, you missed the most exciting and improbable comeback in Superbowl history by one of the greatest teams and greatest quarterbacks in history as well. Of course the New England Patriots were down 28 points to 3 late in the third quarter, a 25 point deficit, but Tom Brady was able to rally the team together. Tied up in regulation, and then of course they went on to win in overtime.

 

 

2 Tactics Patriots Levered to Win Super Bowl

 

What are those things? What are those tactics? What are those characteristics that the Patriots were able to tap into that led to that extraordinary comeback? It’s going to be talking about in today’s video and how you can use those same tactics to have extraordinary success in your Worker’s Comp Management Program.

 

Let’s talk about what these things are. The two elements that they leveraged were momentum and expectation. Momentum and expectation. Momentum and expectation. Now, love the Patriots or hate them, they have an expectation to win. Tom Brady has an expectation to win. When their team was down late in the third quarter and they scored that first touchdown to make it 28 to 9, they started to capture some of that momentum. When Tom Brady in the huddle said, “We’re going to win this game,” the expectation was that I believe you. You don’t have to convince me, because that expectation has been ingrained in their heads for years and years as part of the Patriots culture. They captured that momentum and they continued to ride that through the end of the game. You knew when it went to overtime, it was almost guaranteed that the Patriots were going to win that game, because they had captured such strong momentum.

 

 

How Timely Are You Making Safety Repairs?

 

Let’s talk about your Workers Comp Management Program and how this looks and how this can be applied. I have a question for you. I want you to answer this question honestly for yourself. If you asked your workforce on a scale of one to ten how timely are system safety repairs and changes being made, that’s your expectation. Let me ask that one more time. If you were to ask your workforce on a scale of one to ten how timely are system safety repairs and changes being made. This is an an example of, say the guard needs to be replaced, say there’s water that’s spilled on the floor, say your workforce makes other safety recommendations for changes. How timely are you actually physically making those repairs? You’re setting your employees’ expectation for how much you care about them.

 

If they don’t see you making the changes, if you haven’t replaced the guard in six months, if there’s water spilled on the floor and no one addresses it or no one puts up the signs, that’s the expectation for care. When that individual gets injured, they think well these guys could give a _____ about me because they never fix the guard. You’re telling them about your return to work program and how much you care about them and how you’re going to work together to get them back to work, and they say, “Yeah, right. You couldn’t even fix the guard in the first place.” They’re carrying that momentum with them into the injury.

 

 

Create A Winning Culture of CARE At Your Organization

 
Can you imagine, then, if Tom Brady didn’t have this winning culture, this winning history, that winning expectation and he’s in the huddle, and he tells his guys, “We’re going to win this game.” They’re going to say, “Yeah, right. We’re down 25 points. It’s the end of the third quarter. There’s no way that’s going to happen.” That’s the expectation. They had that carried into and they were able to win that game.

 

Let’s talk about that addressing those points, addressing those safety points, keeping that, building that positive momentum, so that you care about them. You’ve made all the safety changes. You’re on top of it. Then their expectation is that you’re going to care about them and you’re going to work together for much more successful Workers Compensation Injury Management Program.

 

Again, I’m Michael Stack with Amaxx, and if you’re watching this video somewhere other than http://reduceyourworkerscomp.com go ahead and go to that website. Sign up for our newsletter for a lot more free information and tips on how to control your workers comp costs. Let’s take it one step further. You can go to http://workerscompclub.com/livestreamtraining and sign up for my next live stream training.

 

Again, I’m Michael Stack. Remember, your success in Workers Compensation is defined by your integrity. So be great!

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining.com

 

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

 

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

NIOSH Webinar Q&A: Not Everyone Wants To Return To Work

NIOSH Center for Workers’ Compensation Studies recently hosted a webinar, Return to Work: A foundational approach to return to function, based on the IAIABC Return to Work whitepaper (access whitepaper here).  The goal of this session was for speakers to share the benefits and possible strategies for workers’ compensation stakeholders to work toward developing, implementing, and/or supporting return to work as an integral part of return to health.

 

There were many questions from the audience, find response below:

 

Question: Do we see any plans to try to include the employee’s general practitioner in a case to be a part of the team with a goal of function? 

 

Michael Stack: The recommended best practice in working with medical providers is a working partnership between the employer, employee, and provider. 

 

Vickie Kennedy: This partnership can be supported by the regulator, and facilitated through services offered by the insurer. 

 

Michael Stack: Each party plays an active role in returning an injured employee to work.  Depending on state law, this medical provider may or may not be an employee’s general practitioner or a provider of their choice. In addition, this practitioner may or may not have an understanding of occupational medicine, or the employer’s pro-active return to work program, if there is one.

 

Employers are encouraged to gain cooperation from medical providers by developing a good working relationship with a local clinic; invite the provider to your facility, provide job descriptions, and demonstrate commitment to returning employees to work.  When an employee is treating with their general practitioner, this physician should absolutely become a part of the team with a goal toward return to function.  Employers can help form a relationship with this provider by providing information about your company, transitional duty program, and commitment to employee’s well-being.

 

Vickie Kennedy: Insurers can assist this effort by helping employers develop return-to-work programs and light-duty jobs before injuries happen, and by offering incentives for bringing a worker back to a job while they heal.  These services are particularly critical for smaller employers.  They can help workers maintain motivation through relationships with claim managers and by providing vocational support and counseling.

 

 

Question: An example: a clinical patient care RN tears a rotator cuff, department accommodates the restrictions during the slow season, shows up late and spends much of the time texting. After surgery the worker is again accommodated with restrictions but shoulder outcome goes downhill resulting in encapsulation and restrictions of no movement away from body and lifting only 5-10 lbs. Then the restrictions went to no use of the arm.

 

Our hospital had no deskwork outside of her department, you’re not saying that a job should be created to accommodate a worker are you? The department had to fill her position after 6 months as there was not improvement on the horizon.

 

Michael Stack:  The three keys to return to work are Individual, Creative, and Flexible. 

 

First, an employee that is on transitional duty should not be treated any differently than an employee on full duty. What is the consequence of showing up late and texting on full duty?  This same consequence should apply on light duty.

 

Second, while this hospital has a return to work program, it is not effective. Employees should be put in a position that is productive for them and the company.  What are this person’s individual talents and skills? What are some productive tasks that can be completed that no one has time for? ASK the employee and supervisors for ideas, there are likely many productive jobs she can do. Without knowing the circumstances of this case, the failure of the first return to work position could have impacted the failure of this employee’s recovery.

 

Finally, your question regarding creating a new position falls under the ADA laws.  For workers’ compensation purposes, light duty should last no more than 90 days and be progressive throughout that time frame.  Under the ADA, can she perform full duty with a reasonable accommodation? If the person does reach MMI and still can’t return to full duty, even with a reasonable accommodation, then the employer must consider reassignment to an existing vacant position, as a reasonable accommodation.  If there is no work that the person can do, even with a reasonable accommodation, then he/she may be terminated.   

 

 

Question: It seems that you risk an employee claiming a new exacerbation when they are returned when they would rather not be at work, sad to say, not everyone wants to work.

 

Michael Stack: The assumption that an injured employee wants to be out of work may or may not be accurate.

 

Vickie Kennedy: There are several factors that may be at play here: the worker’s fear of re-injury, their relationship with the supervisor and the supervisor’s support for the employer’s return-to-work program are just a couple of examples.

 

Michael Stack: The best way to ensure compliance with a return to work program is to communicate your policy before an injury occurs, then reinforce the process at the time of injury.  Most employees have not had a previous workers’ compensation injury, so they don’t know what to expect.  A simple employee brochure outlining your policy, the employers’ role, and the employees’ role is an effective tool.

 

If the employee truly doesn’t want to return to work and has accrued annual or sick leave, then he or she has the right to use it just like other employees.  And if the employee is entitled to FMLA leave, then the employer would need to provide the required leave.  But if the employee has no leave available, and if everyone agrees that the return-to-work assignment is consistent with the employee’s medical needs, then the employer can require the individual to return.  It would be just like requiring someone who hasn’t been injured to come to work, even if he or she would prefer to stay home.*state laws vary, please consult your attorney.

 

 

Access IAIABC Whitepaper: Return to Work: A Foundational Approach to Return to Function 

 

 

Author. Vickie Kennedy, Assistant Director of Insurance Services for the Washington State Department of Labor and Industries in the US. Vickie manages one of the nation’s largest workers’ compensation insurers. She oversees approximately 1,000 employees involved with L&I’s State Fund workers’ compensation functions including Claims Administration, Employer Services (Policy and Account Management), Health Services Analysis (management of provider fee schedule and medical cost containment efforts), Office of the Medical Director, and the Self-Insurance program. Contact: Victoria.kennedy@lni.wa.gov.

 

 

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

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining.com

 

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

 

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

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