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.

Investigating and Handling Repetitive Use Injuries

Repetitive use injuries account for a significant portion of claims in many workers’ compensation programs.  While these injuries can occur in any employee, they are becoming more prevalent in the aging American worker force.  It is important for claim management teams to investigate properly these claims to reduce the costs of claims.

 

 

A Case Study: The Anatomy of Repetitive Use Injuries

 

Frank Smith is a dedicated employee and has been working at the Acme Widget Company for over 20 years.  He has never missed a day of work since starting.  During a typical 8-hour shift, he will twist some knobs, pull some levers and walks back and forth along the widget-making machine.  The day after working a longer than normal shift due to high demand for widgets, Frank wakes up and is experiencing numbness and tingling in his arms.  He is later diagnosed with bilateral carpal tunnel syndrome with rotator cuff impingement in his shoulders.  Are these conditions work-related?

 

 

Common Features of Repetitive Use Injuries

 

The legal definition in every jurisdiction varies on compensability for these injuries.  Courts will look at a variety of factors when determining if such conditions are compensable.  There are some common aspects across all states workers’ compensation laws:

 

  • Whether the employee is performing “repetitive activity;”
  • Whether the repetitive motions or activities place stress on certain joints or body parts; and
  • The employee’s work activity must be unusual, in that it brings about a disability that would not occur in normal activities or in another employment.

 

 

Best Practices for Claims Investigation

 

Investigating claims of this nature are difficult given the tricky questions of causation medical experts must answer.  This is especially difficult when a workers’ compensation claimant leads an active lifestyle outside of their work environment.  Such activities as playing musical instruments, gardening, work with tools, equipment, and other activities of daily living place stress on one’s joints and body.

 

  • Define the specific nature of the employee’s work duties and activities. The use of video demonstrations of work activities and workstations can assist medical and vocation experts render credible opinions regarding causation.

 

  • Investigation into the employee’s prior medical, vocational and work history history. This would include obtain a complete history as to bodily movements they performed in the past and associated medical care for any injuries/conditions.  It is also important to find out why people left past positions, and obtain employment records to verify their recollection.

 

  • Determine all the facts surrounding the alleged work condition(s). This should include:
  • The development of symptomology and what work activities gave rise to the alleged symptoms;
  • The employee’s awareness of their condition(s) and at what points they thought they might have a work-related condition;
  • Dates or time periods the employee took time off from work due to their condition(s) and their rationale for taking the time off; and
  • The circumstances surrounding and reports of injury the employee made, why they reported the injury and to whom it was reported.

 

The concept of legal “notice” often comes into play regarding these claimed injuries.  It is important to under the case law and relevant legal definitions when defending a repetitive use injury claim.

 

 

Other Important Considerations

 

Properly defending repetitive use injuries will also include an independent medical examination.  Prior to having the employee seen by a medical expert, it is paramount that as much relevant information is collected beforehand.  It is also important to have an expert who has treated the conditions being alleged in the past.  If the employee is contemplating surgery, it will also be important to determine your doctor’s surgical experience and expertise.

 

The question of workplace ergonomics can also come into play.  It is important to have this angle of the claim examined, as sometimes a condition cannot occur from a physiological standpoint.  Specialists and vocational experts can examine and comment on these issues.

 

 

 

Author Michael B. Stack, Principal, COMPClub, Amaxx Work Comp Solutions. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com, and Founder of the interactive Workers’ Comp Training platform COMPClub. Contact: mstack@reduceyourworkerscomp.com.

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

Effective Use of Employee Recorded Statements

The use of recoded statements is one tool claim management teams have to assist in the discovery process.  Before taking a recorded statement, it important to understand the legal and practical implications of this process.

 

 

Understand the “Rules of the Road”

 

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.

 

 

Develop a Strategy First

 

Once a claim comes into your office, you will have an opportunity to review various documents.  These documents include a First Report of Injury, medical records and other reports.  Before taking a recorded statement, it is important to “size up” the parties involved in the claim.  This can include speaking to the claimant informally as you gather information.

 

During this phase of a claim investigation, it may also be important to talk with an attorney if you feel the claim will result in litigation.  Part of this discussion can also include the development of defenses and subrogation matters.  Following your internal policies and procedures is also important.

 

 

Issues of Admissibility

 

It is important that the recoded statement is admissible later on in the life of a workers’ compensation claim.  This results in many considerations when you anticipate the need for taking this statement:

 

  • Timelines required for when the statement needs to be taken, if any;

 

  • The method in which the statement should be taken. This is an important consideration if the employee has retained an attorney; and

 

  • In most jurisdictions, the recorded statement needs to be signed by the claimant. If this is the case, be aware of any barriers you might have in getting the recoded statement transcribed and sent to the employee.

 

 

Recorded Statement Best Practices

 

Taking a recorded statement costs money and time.  It is important to plan wisely.

 

  • Some attorneys recommend that you wait at least 30 days to take a recorded statement. This allows you to develop defenses and obtain important information.  It is likely that by waiting a short period of time, you will develop key facts it is important to understand later on in the case.

 

  • Receive necessary internal approvals for using a recorded statement. In jurisdictions that require the statement to be signed by the injured worker, it is important to have procedures in place where the timelines can be met.

 

  • Develop effective questions for the recorded statement. Make sure that you obtain the necessary background information about the claimant.  This will include information about their vocational, educational and medical background.  It is also important to have the claimant describe work injury in detail.  This will come in useful when working with a medical expert or at a deposition.

 

  • Listen and be flexible. Remember that everything the claimant is saying is being recorded.  Take some notes as you go, but remember that if you are not listening to what is being said, you could be missing important information.  Use a written outline, but also be prepared to change gears so the statement has a natural flow.

 

Recorded statements can also be taken of lay witnesses.  Be sure to know the procedures and protocols if you plan on taking the statement of a person who is not a party to the workers’ compensation claim.

 

 

Conclusions

 

Recoded statements are an effective tool in workers’ compensation claim discovery.  While this is a rather inexpensive tool, it is important that you understand the law and what it requires when using this method.  Failing to develop a strategy can be costly.

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

Facts Are Most Important Contribution From Employer In Work Comp

Your correspondent has decades of experience with comp claims and, therefore, decades of contact with angry dissatisfied people – mostly employers and employees. Complaining seems to be their first choice, but this is not effective. Participation, even when uninvited, is a far better alternative.

 

 

Facts Are The Most Valuable Contribution An Employer Can Make

 

What is the most valuable contribution an employer can make to a claim? Facts. All claims are supposed to be based on a collection of facts, starting with descriptions by the parties – employer and employee. But the initial set of facts comes from the first report forms and, in most claims, ends there. But complicated, serious or contested claims will need a lot more than the initial report.

 

Employers usually feel that if more than an initial report is required someone will call and ask. That, however, is an act of faith, not participation. Getting a late start on information is a leading cause of lost opportunity – especially for employers. It is far better for the employer to contribute more information to the carrier in addition to the first report of injury.

 

 

See Attached Is Most Important Thing You Will Write On First Report

 

A first report calls for one sentence descriptions of the accident – hardly enough for the important claims. Therefore, a one page narrative is to be preferred. “See attached” is the most important thing you will ever write on a first report.

 

Another attachment should be a list of all other claims made by the worker. In addition to claiming an accident, did the worker apply for unemployment? Disability insurance? Retirement? Discrimination? These can be very important, even when they preceded the accident report by weeks or months. Unreported claims for unemployment which precede the accident report are especially critical, and often unknown to the carrier, TPA and Board.

 

 

Has The Worker Had A History of Poor Attendance?

 

Has the worker had a history of poor attendance prior to the claim? That is very important to know, especially on contested claims. If attendance problems exist – document them. And send to the carrier with the first report.

 

Did the worker have more than one job? You may have an apportionment opportunity. But only if you document and attach. Name address and phone number of employer, please. Also wages and hours, if known.

 

Medical and disability problems? These are always relevant but you are better off first calling for a private off-the-record talk with the carrier about these. The same goes for marital, financial and legal difficulties – which are often the motivations for an exaggerated claim.

 

Do you have documents? Especially prior decisions by government agencies. Unemployment claims which have been decided in the employer’s favor often precede dubious comp clams but are unknown to the carrier and the Board in the majority of cases. Your defense will be far more effective if a copy of that unemployment decision reaches the carrier as soon as possible, preferable with the first report.

 

 

Any Lawyer Can Make Controversy Out of Silence

 

Any lawyer can make a controversy out of silence. Useful communication now will eliminate the need for complaints later.

 

 

 

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

 

©2015 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

 

How Many Claims Justifies Having A Nurse Triage Program?

Curtis Smith HeadshotThis is a good question that seems simple, but is actually complex and can be answered in many ways.

 

How Much You Spend On Claims Bigger Factor Than How Many

 

First, here is a practical rule of thumb based on our experience over many years: most insured’s who have 100 or more claims per year find triage to be justifiable by any measure, regardless of their industry or state.  The savings from avoiding unnecessary claims and by improving in-network utilization far outweigh the cost of the triage call.

 

Also, many organizations with fewer than 100 claims find triage to be financially justifiable.  Here’s an example.  If an insured has 24 claims a year averaging $2,000 each, they would spend $48,000 a year on those claims.  Even a mediocre triage service could help avoid 25% of claims, saving $12,000.  (A top performing triage service could save almost twice as much!)  The 24 triage calls would cost under $2,400, yielding a net savings after triage fees of $9,600 or 4 to 1 on the triage investment.   In actuality, many claims incur much more than $2,000 each, and additional savings in claims administration fees and productivity are often realized.

 

The determining factor in cost justification is usually what an insured spends on claims, rather than its number of claims. High claims costs justify triage faster.

 

 

Here are some other considerations:

 

– Insured’s who are self-insured realize the savings from triage immediately.  Even on referrals which become claims, good triage providers improve in-network utilization, generating savings on medical fees.  Top tier triage providers also direct referrals to the right level of care (e.g. an occ health clinic vs an ER), generating additional savings.

 

– Employers in fully insured programs may think that they cannot benefit from triage because they incur the cost but the savings accrue to their carrier.  In fact, they save in several ways, though it takes time – here is one example: they improve their experience modifier, which significantly impacts their premium cost in the future.

 

– Some insured’s in time-sensitive industries with specialty jobs calculate that triage’s ability to help keep workers on the job is worth more than the claims savings.

 

– One of the most important considerations is the medical outcome – call it the “human factor.”  The best triage service is focused on getting the right care for the injured employee.  Sometimes that means early identification of a serious condition, or an unrecognized risk, and making a referral that creates a claim because it’s the right thing to do for the injured employee.

 

Bottom line: insured’s can justify triage in a variety of ways, not just by cost or claims count.  The quality and consistency of the triage provider is a key factor, too – poor triage risks poor clinical outcomes, disgruntled employees, and extra costs.

 

 

Author Curtis H. Smith, Executive Vice President, joined Medcor in 1995. He helped develop Medcor’s injury triage system and holds several US and foreign patents on injury assessments methods.  Smith has taught and practiced in EMS as a paramedic and dispatcher.  He currently supports Medcor’s business development and marketing teams. . http://medcor.com. Contact: csmith@medcor.com

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