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.

2 Must Have Concepts For Your Injury Response Message

High quality, and simple. High quality, and simple. High quality, and simple. Those two concepts are the cornerstones of the clothing brand Patagonia’s business philosophy.

 

 

High Quality & Simple

 

 

I’m Michael Stack with Amaxx, and I was recently up in Freeport, Maine with my wife celebrating our eighth year anniversary on a little getaway. Now, she needed a raincoat so we spent some time in the Patagonia outlet, and I picked up the book written by their founder Yvon Chouinard. As I was reading it that day and later following to finish it, these two concepts resonated throughout the 258-page book for their business success and the foundation of that company.

 

 

Employee’s Bombarded With Information

 

It got me really thinking as I was reading this book, is how these two concepts can really be applied to Workers’ Compensation, particularly in the communication and the messaging to our employees. Because the reality is that employees today are just bombarded with information on a day-to-day basis of things that they need to understand, and a lot of times need to put into action. The other reality is that Workers’ Compensation for employees that are not injured, it’s just not that high of a priority. When they become injured it does become a high priority, and then that information that you are giving them needs to be extraordinarily high quality and extraordinarily simple. My recommendation is to have you take a look at your messaging of what you want your employees to do at the time of injury, whether you’re giving them a wallet card, you have posters on the walls at your organization in the shop, or maybe it’s even signs within your trucks. How simple is that information? What information can be taken away to improve the quality of that messaging?

 

 

Injury Triage

 

My recommendation here is to work with an injury triage provider, that you can get an 800 number to call that they can talk to a medical professional 24 hours a day. Then the only message that they really need to remember in the midst of all this overwhelm of information is that any time you have an injury, no matter how minor, just go ahead and call that number and we’ll take care of you from there.

 

Again, I’m Michael Stack with Amaxx. If you’re watching this video somewhere other than reduceyourworkerscomp.com, go ahead and go to that website and sign up to receive a lot more free information about how to control your Workers’ Comp costs. To take it one step further, I’d love for you to join me on my next live stream training. Go ahead and go to workerscompclub.com/livestreamtraining. Remember, your success in Workers’ Compensation is defined by your integrity. This’ll 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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment.

Contact: mstack@reduceyourworkerscomp.com.

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

 

 

©2016 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.

Seven Reasons Med-Only Claims Become Lost Time

stk157065rkeEmployers are often surprised to learn what they thought was a medical-only claim has become a lost-time claim. This unpleasant surprise can often be avoided by basic due diligence on the part of the employer. The following are reasons medical-only claims become lost-time claims and what the employer can do to prevent such an occurrence.

 

 

  1. Inappropriate Initial Medical Care

When an employee is allowed to select the medical provider, he or she usually does not select the best provider for their on-the-job injury. The employee’s personal family physician may be great at caring for the employee’s kids when they have the flu, however, the family doctor will often not understand the ramifications of taking the employee off work “for a few days.” If a family doctor tells the employee to “rest at home” until the muscle strain is better or the laceration heals, no one is thinking about the employer-offered modified or light-duty program.

 

 

In states where the employer has the choice of selecting the medical provider, going to the wrong type of medical provider should never happen. The employer should have an approved medical provider(s) list posted where all employee will know who to go to in the case of an injury. Also, the employer’s work comp coordinator should verify the employee goes to an approved medical provider. In states where the employee can select their own medical provider, the employer should still post a list of recommended medical providers who the employer has pre-screened to verify the medical providers specialize in workers’ compensation and understand the modified duty program.

 

 

  1. Tough It Out

The quick way to make a mild injury more severe is to allow the injured employee to “tough it out.” The macho guy, more concerned about what his co-workers will think, may keep on working. The strained muscle that is already weakened from the initial on-the-job injury gets used and becomes injured to a much greater degree. What would have been two weeks of light duty with the appropriate initial medical care becomes two months of temporary total disability.

 

 

Any time an employee reports an injury with the description, “But it is nothing.” the employee should be sent to the employer’s required medical provider (in the states where the employer selects the medical provider) or to the recommended medical provider (in the states where the employee can select the medical provider). Often the employee is concerned about paying for the medical care and about losing time from work. The employer should tell the employee that the company will pay for the doctor visit and that he or she you will not get docked for time at the doctor’s office. Simple communication, which also shows the employer is concerned about the employee’s welfare, will keep the “tough it out” from becoming the indemnity claim.

 

 

  1. No Triage

If there is no post-injury process to keep an employee in the loop — such as making sure his or her medical care is coordinated — things can go wrong that keep the employee out of work. A triage nurse will do an initial assessment of the injury by phone using medical protocol, and will provide the names of doctors to the employee and advise the employee of the name, location, and directions to the medical provider. Triage will determine whether emergency care is necessary, whether a clinic visit in 2 days is OK, or whether the employee needs to ice the injury and rest the swollen ankle. In short, the employee receives the right kind of care at the right time. In states where panels are provided, the names of all doctors on the panel are sent to injured employees immediately.  Use triage nurses that are URAC certified.

 

 

  1. Inattention

The fastest way for both the employer and the claims office to turn a medical-only claim into a lost time claim is to ignore the medical-only claim, thinking it is insignificant. If the adjuster and the employer do not tie down the nature and extent of the injury early on, it often invites trouble. The employee who strains his back and is just “sent to the doctor” with no follow up, can take advantage of the situation. The employee who has had a neck problem for years, and the doctor is already treating back strain, is given the opportunity to advise the doctor that the neck was hurt in the accident as well, resulting in enough issues that the doctor takes the employee off work, with the work comp insurer paying for the medical care and lost time due to a pre-existing injury. If many claims are converting to lost time claims, evaluate the post injury response carefully.

Note: Make sure the employee has a Work Ability Form to take to the doctor on the FIRST MEDICAL VISIT. This is the #1 reason medical claims convert to lost time claims — employers do not have the right forms in the hands of the employee and doctor at the right time. Without the Work Ability Form to provide medical restrictions for transitional duty, the employee must return to the doctor, waiting another week or so, thus turning the medical only claim into a lost time claim.

 

 

  1. Questionable to Begin With

When the employee decides ahead of time to have an “accident” that will be unwitnessed and consist of subjective complaints of strain and pain, it is up to the employer and the adjuster to cut off the fraudulent claim before it can be built up to a lost-time claim. Any time the employer thinks to herself, “That is unusual,” the adjuster should be immediately notified to be sure to do an in-depth investigation. The most effective thing an employer can do to stop potential fraudulent claim is to contact the doctor’s office immediately — even before the employee arrives for the initial visit — to advise the doctor’s office of the modified-duty program awaiting the employee’s speedy return. And, it also helps the employee to know that all work comp fraud is prosecuted. Post anti-fraud posters in the workplace.

 

 

  1. Something for Nothing

Similar to the “questionable- to-begin-with” claims are claims in which the employee has a valid injury (for instance, a trip and fall that results in bruises) but the employee figures now is the time to “Take a vacation on work comp.” When an employee thinks, “Let me see what I can get out of this,” failure to control medical and to offer light duty will result in a minor injury becoming a lost-time claim. The employer should have an employee brochure in the workplace advising of obligations when an injury occurs letting employees know transitional duty is available and expected of all injured employees.

 

 

  1. Medical Severity

There are times when the medical severity of an injury is greater than originally suspected. Sometimes conservative medical care is not enough. An MRI may reveal what was thought to be a strained shoulder is actually a torn rotator cuff, or the strained back is a herniated disc. In these situations there will be some justifiable lost time. It can still be minimized however by having the appropriate transitional duty program in place and working with medical providers to ensure prompt, quality medical care.

 

 

By being involved in all your workers compensation claims, not just the severe ones, the employer can prevent many medical only claims from turning in to indemnity claims. We always recommend the employer has a work comp management program as a part of the overall risk management program in place to control situations like this.

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

Create A Workers’ Compensation GPS

Few managers would consider travel to a distant location without a global positioning system (GPS) on how to get to their destination.  The GPS provides precise information on the directions to travel and when to make a turn which impacts reaching the final destination. When precise directions are not available, it is easy to get lost.

 

Employers who attempt to handle their workers’ compensation claims without precise guidelines on how to get from the initial injury to the conclusion of the claim often get lost along the way, causing the injury claim to take longer and cost the employer additional time and money.

 

 

Written Claim Handling Protocols Should Be Established

 

Written claim handling protocols should be established by each employer outlining exactly what will be done on every workers’ compensation claim by the workers’ compensation coordinator, by the employee’s supervisor and by the employee.  While all the duties, responsibilities and steps each party should take in the handling of a worker’s compensation claim is beyond the scope of this blog, the following is a general overview of the most important steps.

 

 

The workers’ compensation coordinator’s road map would include:

 

  • Oversee pre-injury training of supervisors on what to do in case of an injury
  • Oversee pre-injury training of employees on what to do in case of an injury
  • Reporting of the injury claim to the claims office
  • Coordinating with all involved parties to insure compliance with the workers’ compensation claim protocols including:
    • Post-injury response
    • Verifying a complete investigation into the cause of the injury is completed
    • Arranging for transitional duty
    • Overseeing the return-to-work program
  • Verify compliance with the proper filing of all state forms
  • Verify compliance with the paper work requirements including:
    • Employee Report of Incident
    • Work Ability Form
    • Witness Report Form(s)
    • Supervisor Report
  • Keep on-going contact with the injured employee until the claim is concluded

 

 

The key points on the supervisor’s road map would include:

 

  • Arrange immediate medical attention for an employee when an injury occurs
  • Provide the employee with a Work Ability Form to take with them to the medical provider
  • Accompany the employee to the initial emergency treatment
  • Arrange for the medical provider to return the Work Ability Form to the employer within 24 hours of the initial medical visit
  • Arrange transitional duty work for the employee who has work restrictions

 

 

The employee’s road map would include:

 

  • Participation in all safety training to prevent injuries from occurring
  • Review and study of the employer’s requirements of the employee when an injury occurs
  • Know the required (or recommended) medical provider(s)
  • Present the Work Ability Form to the medical provider at the first medical treatment
  • Participate in the return-to-work transitional duty program
  • Keep the workers’ compensation coordinator and the supervisor advised of the medical progress

 

 

Many Work Comp Problems Can Be Prevented With Proper Education

 

The establishment of written protocols that have been provided to the employee will eliminate the “I didn’t know that” excuse and is a major control point in preventing the employee from getting lost on the road to recovery.  By educating the employee on what is expected if a workers’ compensation injury occurs, many of the problems that can develop on a work comp claim will be prevented.

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

Unwitnessed Accidents And NY Workers Compensation

A recent decision, Siennikov v. Professional Grade Construction Corp., restricts presumptions in favor of compensability, greatly assisting employers with unwitnessed accidents. While the decision does not change existing law it halts a gradual drift, through misinterpretation, regarding what is to be assumed in the absence of actual evidence.

 

 

Merely Filing a Work Comp Claim Does Not Mean It’s Compensable

 

Section 21 of the NY Workers’ Compensation Law, presumes that an accident which occurs at a workplace during work hours is work related, absent substantial evidence to the contrary. But in recent decades that has been incorrectly broadened to mean that every claim filed, even if unwitnessed, in presumptively correct.

 

The new decision reaffirms that old rule. The presumption applies only to accidents which are shown to have actually occurred. There is no presumption that an unwitnessed accident has actually taken place. Merely filing a compensation claim does not mean that anything is presumed to have actually occurred.

 

How should this affect the way an employer reports accidents to the Board and carrier? If an employer in filing its own report of injury (C-2) merely repeats what the employee stated it will appear that the employer has done some investigation and sees no reason to doubt the claim. If that is ever to be unraveled it will involve trials, testimony and appeals.

 

How does an employer deal with this?

 

 

Investigate Unwitnessed Accidents ASAP

 

As soon as an unwitnessed accident is reported contact the carrier by phone, email and surface mail (all three!) and inform the carrier that an unwitnessed  accident has been reported BUT CAN NOT YET BE VERIFIED. Say that an investigation will be done ASAP.

 

If an investigation verifies that an accident has occurred, so notify the carrier. This will limit unnecessary issues and focus attention on issues that can be developed.

 

If an investigation still cannot confirm, by objective evidence, that an accident has occurred send a written addendum to the carrier by email and surface mail. AND include a phone call. Make a detailed summary of what efforts were made to investigate the claim.

 

When mailing material do so by certified mail, return receipt requested, and carefully save your copy with proof of mailing.

 

Unwitnessed accident account for a large percentage of workers compensation contested claims. Early efforts by the employer will greatly improve results.

 

 

Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net

 

©2016 Amaxx Risk Solutions, Inc. 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.

 

 

Easiest Way To Make Immediate Impact On Work Comp Costs

Hello Michael Stack here with Amaxx. Today I want to talk about one of the easiest ways to make an immediate impact in your worker’s compensation costs, as well as increase the level of care that you’re demonstrating to your injured employees and your workforce as a whole; and that’s using injury triage.

 

 

What Is Injury Triage?

 

We’re going to define what injury triage is, talk about some of the benefits, as well as some of the risks and things to look out for. So what is injury triage? It’s certainly grown in popularity over the past 10-12 years. It’s defined as a formal process to assess the medical needs of an injured employee at the time of injury. This is done either telephonically or through an on-site clinic.

 

Here’s how this looks in practice. Let’s say I work for you. You’re my supervisor and I work on your loading dock. One day, I’m picking up one of the boxes and ow, I hurt my back. I go to you as my supervisor to report the injury and together we’re going to call the injury triage hotline and you’re going to immediately connect me to a trained nurse.  If you’re using a best in class provider, they’ll have a clinical algorithm to consistently and accurately assess my injury, right at the time of injury, right as it happens.

 

 

Injury Triage Benefits

 

Backs Up Supervisor

Let’s talk about what some of the benefits are of that scenario. The first benefit is it backs up the supervisors. In that scenario if I’m reporting my injury to you, unless you’re a trained medical professional you’re going to have a tough time assessing my injury. Typically, you’re going to either over-react or under-react and you’re going to say, “Oh Mike, rub some dirt on it. I thought you were a pretty tough guy go back to work” or you’re going to overreact and you’ll say, “oh my gosh, you have to go to the emergency room right away.”

 

Neither one of those is going to lead to the best outcome. If you send me back to work, my back injury which may have been a simple strain and can now turn into something more significant and more costly. If you send me to the ER it could be a $2,000 bill for what could have been a $200 bill at the walk-in clinic. It backs up the supervisor and takes that onus off of what to do next.

 

Immediately Connect With Medical Professional

The second thing is that it connects me immediately to a medical professional and I’m going to get immediate medical advice. At the time of injury: I’m feeling some pain. I’m feeling nervous, I’m feeling anxious, I’m feeling a bit scared of what’s going to happen next. If I talk immediately to a medical professional, my level of anxiety is going to come down much lower because there is a level of trust with the medical community, the trained medical community of what is going to happen to me next. You’re immediately connecting me to that medical professional.

 

Direct To The Right Level Of Care

Third thing, along those same lines, that medical nurse, the trained medical provider, is going to direct me to the right level of care. We talked about either going back to work or going to the ER or somewhere in between. It could be recommended that I have in-home treatment which is going to save claims from even happening. It could be recommended that I go to the clinic, it could be recommended that I go to the ER depending on my injury and the assessment of the trained nurse of what to do next.

 

 

Facilitate Claim Reporting

The final point is certainly not an insignificant. It’s going to help facilitate claim reporting. Tell me your lag time number and I’ll tell you how well you’re doing in your work comp management program. How quickly you’re reporting claims, what percentage of your claims are being reported immediately should be a leading indicator for your program. That’s a number that you should know. If you’re working with the best in class injury triage provider, that number is going to improve because you’re going to make that a part of your company culture to be reporting those claims immediately.

 

 

Risks & Selecting Your Triage Provider

 

Injury Assessment Algorithm & Software

The final thing to cover then is some of the risks and things to look out for when you’re selecting a triage provider. The first one is certainly the algorithm and the software that that organization is using. Now, as we talked about earlier, there are inherent risks in assessing an injury whether that’s at the supervisor level or whether that’s at the triage level discussing the injury with the nurse. Particularly, telephonically that nurse is not there to take the blood pressure or to check vital signs. That algorithm becomes exceedingly important to be able to accurately and consistently assess injuries.

 

There are certainly inherent risks in under-assessing as well as over-assessing the injury as we discussed earlier. As well as with the software, that’s something to certainly ask some questions about, particularly with things like privacy and security of information. Be sure to ask questions about the software, the algorithm as well as privacy issues.

 

 

Conflicts Of Interest

The final point then is conflicts of interest. Just like anything, you’re going to want to look at the revenue stream and where the money is derived. If the revenue is derived from either the claims or from the network provider or if the triage provider is only billing the claim files. There may be a financial incentive that creates a significant conflict of interest that may not lead to the best outcome for you or your work comp management program.

 

Now remember in worker’s compensation and worker’s compensation management your success will be defined by you integrity, so be great.

 

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

What Do You Do Immediately After An Employee Is Injured?

As an employer, you must TAKE CHARGE because workers’ compensation has a huge financial impact on your company. There must be a tight post-injury process describing exactly what happens after an injury.

 

Most employers don’t have a cohesive process for handling injuries. Thus, employees decide which doctor to see and how long they need to be out of work. Post a list of your required medical providers (where allowed by state statute) or recommended medical facilities (in states where the employee is allowed to select their own doctor).

 

 

Supervisors Play Pivotal Role in Post-Injury Response Management

 

Your supervisors play the most pivotal role in post-injury response management.  Supervisors should take charge immediately after the event. They direct the actions of the injured employee and witnesses. Since supervisor judgment is critical to the outcome of the injury, training must focus on making wise decisions. After training, test supervisors mastery by creating role-playing scenarios where the supervisors make decisions based on the information they have and what the protocol permits. Provide each supervisor within the company a written guide on how they are to report and be involved in workers compensation claims.

 

Unfortunately, many employees try to stay out of work the entire time they are in pain. In reality, current medical thinking is that injured employees should return to work as soon as possible because they will recover faster. Just like in hospitals, post-surgical care requires most patients to be ambulatory within the first 24 hours after surgery. Have a published returned to work policy so that employees know what is expected of them before an injury occurs.

 

 

Companies Need a Clear System for Post-Injury Response

 

Although many companies have good intentions and want to reduce their costs, they do not actually know how to do so. It is important to give managers tools and explain how to use forms and sample letters to closely manage each of their claims. A toolkit of resources contains communication tools so that managers can communicate with their employees, their third party administrators (TPA), their medical providers and corporate workers’ compensation manager. A few items which are essential are employee brochures, brochures for medical providers, a transitional duty policy and a transitional duty job bank or task bank. We can help you develop your procedure.

 

Your Post Injury Procedure should spell out in detail what occurs after the injury. Your procedure should answer:

 

  • Who should the employee report the injury to?
  • Who should take the injured employee to medical clinic?
  • Should initial care be at a local clinic or at the hospital, or will it differ depending on the degree of the injury?

 

 

Employer’s Communication Is Critical

 

The most important part of this procedure is the employer’s communication contact. The employer must have a responsible employee to serve as the primary contact point who is willing to take charge of immediate contacts and keeps this communication loop flowing. Of course, all your employees, managers and supervisors must know the name and phone number of this key contact person. Make sure the key contact’s name and contact information is posted prominently in all policy manuals, workers’ compensation communications and employee bulletin boards.

 

An important part of any workers’ compensation program is an effective transitional duty program (TD). Yet many managers do not know how to get an employee back to work in a modified capacity if they are unable to return to work full duty until they are completely recovered. Provide each manager with the tools they need. Have a written transitional duty policy that is provided to all employees and supervisors. Keep a job bank of modified duty assignments.

 

 

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. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 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.

 

Why Caring For Your Injured Workers Is Just Like Car Tires

Catching an injury when it first happens is like catching some worn tires on your vehicle—it can save you a lot in collateral damage.  It is the best analogy I have heard of the years.  Similar to tires, your workers are the ones doing the heavy lifting.  Disregard your tires, and if one blows out on the highway at 80mph you are going to incur a lot of other damage.

 

The importance of early reporting has to be driven home to the floor level employee.  Reporting an injury is not going to lead to punishment, termination, or loss of current title.  If this worker is in the course and scope of employment and something happens or doesn’t feel right, they have to feel that it is OK to report it to their manager.  Dire consequences can occur should they continue working injured, until their back or shoulder finally fully gives out.

 

So what are some tips to help you to accomplish this goal?

 

  • Empower the employee to feel comfortable reporting any problems.

 

The main culprit that stops workers from early reporting is a negative consequence.  Whether it is real or just shop floor gossip, workers need to be told that it is OK to report an injury or incident.  Not only does this help you pilot a better ship on the work comp risk front, but it also will empower your employees.  The worker is the only one that knows if something does not feel right.  This doesn’t mean they have to go to the clinic, but it is better to be safe than sorry.  I would rather have a worker go and get checked out and come back with a clean bill of health versus not tell anyone and further compromise themselves.

 

 

  • Make sure the workers know that you care about their health and well-being.

 

This seems so simple, but goes a long way.  The common stance that production needs must be met and must be put above worker health is a mistruth.  If you show workers that you care about their well-being, they will feel like a well-needed piece of the puzzle that gets the job done.  Injuries are going to happen, and you want to have an action plan in place that will deal with injuries once they occur.  This should not mean if someone comes to you and says that they are hurt that you tell them to get back to work because they do not look hurt.

 

 

  • Early treatment costs less and yields a better result. 

 

If you catch an injury when it first happens, especially a sprain/strain, stats show that the worker will respond better to conservative treatment.  Plus not only will they heal better but they will also miss less time from work, if any time at all.  However, if the worker ignores the warning signs from their body and continue to soldier on, that is what will cost you much more down the road.

 


Access Premium Content – FREE Work Comp Manual Excerpt – Post Injury Response: Guidelines, Implementing On The Road, & 6 Essential Steps


 

  • Early injury intervention means reduced lost production time. 

 

Similar to the medical costs, if a worker gets the care they need early on chances are they will not miss much time from work, if any.  They can still come to work in a reduced capacity in your light duty work program.  I would rather have my injured worker on light duty for a period of 2-3 weeks versus 2-3 months, or worse result of them never returning to work for you at all.

 

 

  • At the end of the day, if the worker declines medical treatment have them sign off on it.

 

It is not essential that every person with a strain must go and get medical treatment.  This is a judgement call that the employer and the carrier have to make.  However should they decline medical treatment that you offer, you should have them sign something verifying that treatment was offered and declined.  I have reviewed countless files where the employer states that treatment was offered and declined, later to have the employee state that they were never offered medical care and forced to return back to work.  This creates the “he said-she said” scenario which nobody wins.  But if you have a paper trail that the worker signed off on, now you have some evidence that can come in handy later down the road.

 

 

Statistics show that early intervention is very important when stacked up against lost work days and severity of injury.  Do not disregard the injuries your workers present you.  Take them all seriously, and create that paper trail.  You never know when you are going to need it later on.

 

 

 

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 founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a monthly basis working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2015 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.

Making Use of Your Recorded Statement

Use of recorded statements is an effective and cost-efficient tool of discovery for members of the claim management team.  Before you take a recorded statement of an injured worker, a member of the claim management team needs to understand the legal implications.  As with most things in workers’ compensation cases, it is important to understand how the law in one jurisdiction varies from another.  Failing to understand this issue can impact the admissibility of the recorded statement later on in the case.

 

 

Important Questions to Ask

 

A recoded statement can serve as the basis for ongoing discovery and witness identification efforts.

 

  • Claimant Background Information
    • General background information (DOB, height/weight, etc.)
    • Education history
    • Work and vocational history (including wages, job duties, work-related injuries, and reasons for departure)
    • Military service
    • Smoking history
    • Prior litigation experience
    • Criminal convictions
    • Driver’s license status
    • Medicare and Social Security status/applications

 

  • Prior Medical History
    • Locations of regular medical treatment, including care in the past
    • Surgical history
    • Diagnosis and treatment of chronic or ongoing conditions
    • Physical therapy and chiropractic care
    • Emergency room visits
    • Motor vehicle accidents and other personal injuries
    • Chemical/substance abuse treatment
    • Mental health
    • Marital status and children, including information on children/dependents with special needs

 

  • Potential Interveners
    • SSDI, SSI benefits and Medicare/Medicaid
    • Pensions and 401K
    • Public assistance
    • Veterans benefits
    • Unemployment compensation and history
    • Out-of-pocket medical expenses
    • Medical mileage
    • Child Support obligations

 

  • Work with the employer on the Date of Injury
    • Supervisor/manager
    • Co-workers and worksite personnel
    • Description of work duties (physical aspects; required lifting; motions and movements required with employment)
    • Hours worked, including overtime
    • Wage history
    • Absences from work/disability
    • Previous workers’ compensation injuries
    • Verbal or written reprimands

 

  • Injury related information
    • Description of injury
    • Emergency personnel and first-responders
    • Immediate injury symptomology
    • Post injury symptoms
    • Aggravations with various activities: Sitting – how long; Standing – how long; Walking – how long; Lifting – how much; Twisting; Bending; Driving – how long
    • Present medical care and treatment along with understanding of future care

 

  • Miscellaneous information
    • Hobbies and recreational activities
    • Musical instruments
    • Leisure activities such as reading
    • Activities of daily living and around the house

 

Other Considerations

 

It is important to know and understand all applicable rules and statutes related to recorded statements.  In most instances, the statements must be accurately transcribed and sent to the claimant for their review and signature within a specified timeframe.  Failure to do so may impact the ability of counsel to use that recorded statement as evidence or impeach the testimony of the person giving the statement.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, and founder of COMPClub an interactive training program teaching workers’ comp cost containment best practices.  Through this platform he is in the trenches on a monthly basis with risk managers, brokers, consultants, attorney’s, and adjusters teaching timeless workers’ comp cost containment strategies, as well as working with members to develop new tactics and systems to address the issues facing organizations today. This unique position allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

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