The Deep Cut That Got Deeper Due to Poor Injury Response Procedure

The best time to develop defense strategies is before a claim is even filed. Employers that implement proactive tactics toward injury response management will see reduced attorney involvement and lower overall claim costs.

 

Instead of leaving things to chance, employers need to take control of all facets of a post-injury situation. Employers who do so also exude competence, which helps set expectations for the injured worker and can reduce much of the animosity typically present in the workers’ compensation system.

 

 

The Problem

 

The less control an employer exerts following a workplace injury, the longer the time off work — leading to higher costs.

 

Consider the following example;

 

A worker gets a fairly deep cut in her arm rounding a corner at work as she’s carrying a heavy load of paper. Neither she nor her supervisor know what to do, so the supervisor calls someone in HR who asks if the injury is ‘life threatening.’ Since it is not, the HR person spends 20 minutes asking a series of questions before sending the employee to a physician’s office.

 

In the meantime, the injured worker and a coworker have covered her wound with paper towels from the restroom. The cut is deep and she loses enough blood to make her feel dizzy.  

 

Appalled at the presence of unsanitary paper towels on the employee’s cut, the physician prescribes antibiotics as well as stitches and suggests she take a few days off work because of her dizziness and to see if there is an infection.

 

She is not contacted for several days and becomes increasingly disgruntled. Ultimately, she files a workers’ compensation claim.

 

This scenario shows the disorganization and wasted time, energy and expense that occurs all too often following the injury. Having a formal, post-injury procedure in place can avoid much of that.

 

 

The Strategies

A post injury response plan that is fully communicated to managers, supervisors and employees is a must to avoid the scenario described above. It should incorporate a series of action steps to be taken after any workplace injury.

 

  1. Supervisor’s responsibilities. Immediately after the injury the employee should contact her supervisor, as she did in the case above. However, the supervisor should understand and follow a specific protocol. She should know that the employee’s injury is the most immediate need. If the company employs a triage nurse, he should be contacted immediately to determine the severity of the injury and next steps. If the case is an emergency, the employee should be taken to the closest emergency room. In the absence of a triage nurse, the employee should be given the names and locations of the company’s workers’ compensation physicians. The supervisor should escort the worker to the physician’s office; if not possible, she should designate someone to drive her there.

 

  1. Information. A packet should be readily available for the supervisor to give to the injured worker. It should include instructions and phone numbers on whom to call, how to file a claim and what to expect in the days ahead. It should also contain a ‘work ability form,’ for the physician to fill out.

 

  1. Investigation. The supervisor should immediately begin an incident investigation, that includes statements from any witnesses to the incident. If immediate medical attention is unnecessary, the supervisor should speak with the injured worker about the incident.

 

  1. WC designee. A workers’ compensation coordinator should be available to meet with or speak with the employee upon her return to the office. The coordinator should review the physician’s notes and restrictions — if any — and determine if transitional or modified duty is required.

 

  1. Communication. If the employee cannot return to work immediately, she should be contacted by her supervisor, a manger or the workers’ compensation coordinator on day 1. The communication should continue on a regular basis.

 

  1. Documentation. The designated workers’ compensation coordinator should fill out and send to the insurer or third-party administrator a first report of injury that includes statements from the worker and any witnesses, as well as photos of the incident site. A detailed job analysis should also be provided to the carrier/TPA.

 

  1. Monitoring progress. The workers’ compensation coordinator should meet with and/or contact the employee at least weekly to discuss the employee’s progress, and when she might return to work in some capacity.

 

Establishing such a procedure requires up-front leg work to be effective. A workers’ compensation coordinator must be designated and properly trained in workers’ compensation issues, including alternative leave plans; the injury response plan should be formally written up and presented to all employees; treating physicians should be identified and working with the company to understand its culture and the focus on returning the employee to work as soon as possible; and transitional work assignments should be outlined.

 

 

Conclusion

 

Workers who are injured on the job do not typically start out being angry toward their employers. But the failure to have a formal, structured, well-understood post-injury response plan can lead to confusion and anxiety and, ultimately, an expensive claim.

 

Employers can cut disability durations, hostility and costs with a well thought-out plan that addresses the employee’s needs as well as the company’s.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO 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/

 

©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.

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.

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.

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.

 

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