The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) has cited Prolerized New England Co. LLC, doing business as Schnitzer Northeast, for 10 alleged serious violations of workplace safety standards at its Everett recycling facility, where two workers were injured. Proposed penalties total $70,000.
According to OSHA officials, the employees were performing maintenance work inside a large rotating drum used to sort scrap material for recycling when the drum activated, injuring them. OSHA's Andover Area Office conducted an inspection in response to the September incident and identified several serious deficiencies in the facility's hazardous energy control procedures, which should ensure machines are deactivated and their power sources locked out before employees perform maintenance work.(WCxKit)
In this case, the procedures were incomplete and not clearly communicated, training was inadequate, and the procedures were not reviewed to ensure that they were effective and understood by the employees.
The inspection also found that the employees were not trained to work in confined spaces, such as the drum, and were not provided a hot work permit for welding performed in the drum. Finally, the employees were exposed to the hazard of falling into the drum through an unguarded chute opening. OSHA assessed the maximum fine of $7,000 for each of the violations, for a total of $70,000 in fines. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.
"The unexpected startup of machinery during maintenance can injure or kill workers in seconds," said Jeffrey Erskine, OSHA's area director for Essex and Middlesex counties. "Preventing this hazard requires a combination of effective hazard control procedures, training and diligence to ensure that the proper safeguards are in place, in use and understood by workers."(WCxKit)
The company has 15 business days from receipt of its citations and proposed penalties to comply, meet with OSHA's area director or contest the findings to the independent Occupational Safety and Health Review Commission.
OSHA Fines Connecticut Employer for Exposing Workers to Injury
The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) recently cited G.A. Denison & Sons Inc. for 14 alleged willful and serious violations of workplace safety standards at an Old Lyme work site. The New London contractor faces a total of $110,000 in proposed fines, according to an OSHA report.
OSHA's enforcement action follows an inspection opened June 7, when Denison & Sons employees were observed being exposed to falls from heights of 15–26 feet while working without protection on both a scaffold and the roof of a building located at 69 Lyme St. (WCxKit)
In addition, OSHA found employees exposed to fall hazards while improperly climbing ladders and climbing ladders while carrying materials on their shoulders, as well as to head injuries from working without hard hats. These conditions resulted in citations for five willful violations carrying $73,700 in fines. A willful violation is one committed with intentional knowing or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health.
Nine serious violations, with $36,300 in fines, have been cited for several other hazardous conditions, including overloaded scaffolding, a lack of eye protection for employees using nail guns, inadequate scaffold access, a lack of protection against falling objects, and a failure to provide employees with fall protection, scaffold, and ladder training. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known. (WCxKit)
OSHA has placed G.A. Denison & Sons in its Severe Violator Enforcement Program, which mandates targeted follow-up inspections to ensure compliance with the law.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
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Here are five reasons to file a Declaration of Readiness to proceed (DOR)
1. You will resolve an issue. Whether you file a DOR only on one issue, for example AOE/COE, or on all issues, including the nature and extent of injuries, temporary disability, and permanent disability, a hearing on the issue will normally resolve the issue.
2. You will reduce administrative and legal costs. Every day a file is open, administrative and legal costs increase. Vendors can be vultures, picking away profit from employers and carriers.
3. The sooner you file a DOR, the less evidence applicant will have to prove his or her case. And it is the applicant's burden, not the employer's burden, to prove issues such as industrial causation, nature and extent of injuries, temporary disability, and permanent disability.
4. You will send a signal to applicant attorneys that you are not afraid to take an issue to trial, giving you additional negotiation leverage in the current and future cases.
5. Trials are free! You will not get a bill from the trial judge or court reporter.
Caution: The decision to file a DOR should be made on a case-by-case basis depending on the issues and nature of discovery completed; in some cases additional discovery should be completed before filing a DOR.
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California Attorney: Albert A. Navarra is a practicing lawyer from Newport Beach, CA, a Board Certified Specialist in Workers Compensation law, and a partner at Sapra & Navarra, LLP. Navarra is a frequent speaker about workers compensation issues, and has represented employers in the area of workers compensation for over 10 years. He is also an expert in constitutional law, the author of The Elements of Constitutional Law, and a frequent guest on radio stations across the country. He can be reached at: (866) 384-4891 or Albert@snworkcomp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Manhattan District Attorney Cyrus Vance, Jr. recently announced the indictment of American Standard Testing and Consulting Laboratories, (ASTC) its owner, Alan Fortich, 44, and five other defendants for falsifying concrete testing and inspection reports, as well as manipulating government programs to obtain jobs for which they were otherwise ineligible.
According to a report from the DA’s office, the defendants are charged with Enterprise Corruption in the First Degree, Scheme to Defraud in the First Degree, Offering a False Instrument for Filing in the First Degree, and Falsifying Business Records in the First Degree. (WCxKit)
Documents filed in court said ASTC is a company hired by contractors, engineers, architects, and others to perform tests and inspections relating to the strength and quality of concrete, as mandated by the New York City Building Code. For more than 10 years, the defendants submitted thousands of fraudulent test reports, regularly skipping vital safety tests and creating false reports to create the impression that the tests were performed.
During the same period, ASTC is also charged with lying about its credentials in order to obtain licenses from the New York City Department of Buildings it was otherwise not entitled to obtain, and about its small business qualifications to obtain work it was otherwise not eligible to perform. During the time period covered in the indictment,
ASTC is charged with falsifying testing on private and public projects, including:
1. Yankee Stadium
2. The Intrepid at Hudson River Park
3. Jacob Javits Center
4. Memorial Sloan Kettering Cancer Center
5. Weill Cornell Medical College
6. Columbia University
7. Air Control Tower at LaGuardia Airport
8. East Side Access
9. Port Authority Bus Terminal
10. Lincoln Tunnel
11. Metro North Croton-Harmon Locomotives Shop
12. New York City public schools
13. Second Avenue Subway
14. Fulton Street Transit Center
In these cases, additional steps have been taken to ensure the safety and stability of the projects.
The victims of ASTC’s fraud include the:
1. Metropolitan Transportation Authority MTA and its associated agencies New York City Transit, Bridges and Tunnels, MetroNorth, and Capital Construction
2. Port Authority of New York and New Jersey
3. New York City Department of Design and Construction
4. New York City School Construction Authority
5. New York City Department of Buildings
6. Numerous private owners and engineers
Under the New York City Building Code, before any construction project can start pouring concrete, a structural engineer must specify the strength of concrete needed. An independent testing lab must obtain the raw materials for the concrete from suppliers and test four different proportions, or recipes, and create a report known as the “mix design test report,” which makes a recommendation as to which mix should be used. These reports are valid for only one year from the date of testing because many of the basic ingredients of concrete sand, stone, water and cement are natural and change over time. Strength results for concrete can vary vastly depending on the type of sand or cement that different supplier’s use. If the size of the sand or stone changes, it can impact the quality and strength of concrete.
Over a 12-year period, the indictment charges ASTC, Alan Fortich, and professional engineers Michael Rabkin, Shamim Akond, Richard Kasparian and Bruce Pumo, with creating, signing, and certifying thousands of false concrete mix design test reports, in which they did not actually test the four proportions of concrete reflected in these reports. None of the close to 3,000 test reports in ASTC’s computer database contained legitimate test results.
According to documents filed in court, Fortich created the false mix design test reports and then Rabkin, Akond, Kasparian, and Pumo certified the reports accuracy. ASTC then filed the false reports with professional engineers, who relied on these false reports in assessing their projects.
Additionally, under the NYC Building Code, any concrete poured at a project must be tested, and the lab is required to report the results of this so-called “cylinder testing” to the project engineer. The reliability of this testing is essential to the integrity of the project.
According to court documents, ASTC, Fortich, Rabkin, Akond, Kasparian and Pumo created, signed, and certified thousands of false concrete cylinder test results and reports over an 8-year period.
ASTC and Fortich are accused of lying about ASTC’s credentials to city agencies and public authorities in order to work on the very same projects where they are accused of falsifying thousands of concrete tests. They did so in two different ways.
First, ASTC and Fortich are accused of defrauding the MTA through the Disadvantaged Business Enterprise DBE program, a federal program that provides funding to the MTA by the United States Department of Transportation. The DBE program was designed to help businesses owned by women or a member of a designated minority group whose personal net worth, excluding his or her personal residence and the equity stake he or she owns in the company, does not exceed $750,000. For at least four years, ASTC and Fortich are accused of consistently lying to the MTA about his net worth in order to qualify for projects such as the Fulton Street Transit Center and the MetroNorth Croton-Harmon Locomotives Shop.
Second, the indictment also charges that for more than five years, ASTC committed a similar fraud to qualify for work with the City of New York as a Local Business Enterprise LBE. Specifically, Fortich recruited a legitimate LBE to pose as a front for ASTC so that ASTC could continue to work on City projects it was ineligible to perform. Fortich paid tens of thousands of dollars in kickbacks to the other company.
In order to obtain a license to test concrete from DOB, a lab must employ a director who is either a professional engineer or a registered architect, and who personally supervises the technical aspects of the lab’s testing of concrete. Upon receiving the license, the lab director certifies to DOB that he or she and the lab will follow the NYC Building Code.
The indictment charges that Rabkin, Akond, Kasparian and Pumo falsified their licensing applications as a result of the testing fraud described above.
A slight variation on the scheme occurred when Fortich, his brother, Alvaro Fortich Jr., 32, and Rabkin formed HT Laboratories, a separate, short-lived fraudulent venture and falsely obtained a concrete testing license.
This investigation previously led to the October 2008 indictments of Testwell Laboratories and its top executives, V. Reddy Kancharla and Vincent Barone, and several other employees and professional engineers associated with the company. Testwell, Kancharla, and Barone were convicted after trial of Enterprise Corruption and related counts. In addition to monetary fines, Kancharla was sentenced to 7 to 21 years in prison, and Barone was sentenced to 5 1/3 to 16 years in prison. Testwell was also ordered to pay millions of dollars in reparations for its fraud. Several other Testwell employees pled guilty to related crimes. (WCxKit)
In July 2010, Stallone Testing Laboratories and its lab director, professional engineer William Bayer pled guilty to Scheme to Defraud and were fined thousands of dollars.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The NY workers compensation board has in existence four new sets of treatment guidelines for the back, neck, knee and shoulder. These sites account for the majority of all serious claims. The guidelines can be seen on the Board website.
All four sets contain an identical section A.19 which provides that a treating physician may request a chance to inspect the work site “to obtain information regarding the demands of the patient’s pre-injury job”. The physician can then estimate a level of disability based on actual job duties rather than the old, universal “mild, moderate or marked” disability. (WCxKit)
The guidelines recognize that few doctors will trouble to actually view the worksite, even though that provides the most accurate information.
The employer, whenever there is a serious injury, should immediately send the treating doctor a letter asking if the doctor will be requesting an “on-site inspection”. Copies should be sent to the Board and carrier. In nearly every case, no inspection will be requested.
However, if there will be medical testimony taken, the carrier/employers examining doctor should make a brief visit to the work site prior to testimony. The doctor will then be in a position to answer what the doctor saw in the workplace that supports the report’s conclusion.
Such testimony will be far more powerful that merely assuming (or guessing) or taking the word of the worker as to what the activities are, even though such speculation has been the rule for decades.
If a treating physician should make a rare appearance they should be welcomed. Treating physicians are seldom accorded such treatment and are more likely to be sympathetic to the employer’s point of view when they receive it. (WCxKit)
An end to the practice of having experts testify “in a fog or a vacuum” will be beneficial to both the employer and the employee.
Author Attorney Theodore Ronca is a practicing lawyer from Aquebogue, New York. 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. Mr. Ronca has 21 years experience in searching and retrieving medical records and many other types of documents for defense of workers compensation claims. Contact Attorney Ronca at 631-722-2100 or medsearch7@optonline.net.
Our WORK COMP BOOK: www.WCManual.com
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
In Tennessee, every employer who has five or more full or part time employees, is required to carry workers compensation insurance. Employers in the construction or coal mining industry must provide workers compensation coverage if they have any employees. Corporate officers may decline workers compensation insurance. But they are included in the count of employees. Family members working in the business are also included in the count of employees. State and local governments are exempt from the workers compensation law, as are employers of farm laborers and domestic help. But all can elect to purchase workers comp coverage.
Obtaining Coverage
To obtain workers compensation coverage in Tennessee, the employer has 4 options
1. purchasing a workers compensation insurance policy from an insurance company licensed to do business in Tennessee
2. self-insurance for the employer who has sufficient assets to self insure
3. purchasing insurance from the state owned Tennessee Workers Compensation Insurance Plan
4. setting up a self-insurance trust (WCxKit)
Claim Reporting
The employee must report the injury to the employer within 30 days in writing. when the employee receives medical care outside of the employer's premise. If the employer does not have actual notice, the employer must report the injury to the Tennessee Department of Labor within 14 days
Medical Benefits
The employer must provide the employee a panel of three physicians. From this panel, the employee will choose a medical provider. If it is a back injury, the panel must include a chiropractor. However, chiropractic visits are limited to a maximum of 12 visits under the workers comp law. If specialized treatment is needed, the selected medical provider will make a referral. At this time, the insurer or employer is required to form another panel of three physicians that offer the specialized medical care needed.
There are neither time nor monetary limitations on medical care. The medical care will continue as long as the authorized panel physician deems it necessary. Mileage to and from medical treatment facilities is reimbursed only if exceeding 15 miles. The mileage rate is set by the state.
Temporary Total Disability Benefits
The temporary total disability (TTD) benefits are calculated as two-thirds of the employee's average weekly wage earned over the 52 weeks prior to the injury. The TTD weekly maximum and minimum is adjusted each year on July 1st. The weekly maximum is capped at $867.90 for injuries occurring from July 1, 2011 to June 30, 2012. The weekly minimum TTD amount is $118.35. TTD benefits are paid every two weeks and can be for a maximum of 400 weeks.
The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 14 days.
Temporary Partial Disability Benefits
In Tennessee, temporary disability (TPD) benefits are paid if an employee is able to return to any type of work but is earning less than prior to the injury or working fewer hours per week. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage.
Permanent Partial Disability Benefits
Tennessee employees who incur a permanent partial disability (PPD) are entitled to two-thirds of their average weekly wage, not to exceed a maximum of $789 per week. The minimum for PPD is equal to the minimum TTD benefit. For non-scheduled injuries, the maximum period of payments is 400 weeks. For scheduled injuries, the loss of a body part has a maximum of 200 weeks of benefits for a limb. The number of weeks declines based on the body part to only ten weeks of benefits for a toe other than the great toe.
Permanent Total Disability Benefits
Permanent total disability (PTD) benefits are set identically to PPD benefits. The exception is that if the worker is 100% disabled, the PTD benefits are payable to age 65 and may be offset by social security benefits. (WCxKit)
Death Benefits
Burial expenses in Tennessee are covered for a work-related death up to $7,500. The death benefits for a surviving spouse and dependents follow the same guidelines as TTD benefits. They are two-thirds of the average weekly wage up to a maximum of 400 weeks. If the spouse remarries, the spouse loses the benefit. But the children continue to receive the death benefit. until they are 18 years old, or 22 years old if enrolled in an accredited educational institution. When the deceased employee does not have any dependents, $20,000 is paid to his or her estate.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Requirements
In Missouri, every employer, not in the construction industry, who has five or more employees, whether full time or part time, is required to carry workers compensation insurance. Employers with less than 5 employees may elect to purchase workers compensation. Employers with less than 5 employees and without workers compensation insurance are subject to tort claims from employees who are injured on the job. Employers in the construction industry must provide workers compensation coverage if they have even one employee. Certain employers are exempt from the requirement of having workers compensation insurance coverage. This includes employers of farm labor, domestic servants in a private home, occasional labor performed for a private household, qualified real estate agents and volunteers of a tax-exempt organization. Family members working in the business must be covered unless they elect to opt out.
Obtaining Coverage
To obtain workers compensation coverage in Missouri, the employer has only two options which are:
1. Purchasing a workers compensation insurance policy from an insurance company licensed to do business in Missouri.
2. Obtaining approval from the Missouri Department of Labor and Industrial Relations, Division of Workers Compensation to provide self-insurance. (WCxKit)
Claim Reporting
The employee must report the injury to the employer within 30 days in writing providing details of where, when and how the accident occurred. The employer must then report the injury to the insurance company or third party administrator within 5 days. The claims office is responsible for reporting the claim to the Missouri Division of Workers Compensation within 30 days of being notified of the injury.
Medical Benefits
The employer selects the medical provider. The employer must provide “medical, surgical, chiropractic, and hospital treatment; including nursing, custodial, ambulance and medicines”. For medical coverage to be provided, the accident must be the prevailing factor in causing the resulting medical condition.
There are no time limitations or monetary limitations on medical care. The medical care will continue as long as the physician deems it necessary. Mileage to and from medical treatment is reimbursed at the rate of $0.50 per mile.
Temporary Total Disability Benefits
The temporary total disability (TTD) benefits are calculated as two-thirds of the employee's average weekly wage to the injury. The TTD weekly maximum and minimum is adjusted each year on July 1st. The maximum is capped at $811.73 for injuries occurring from July 1, 2011 to June 30, 2012. The weekly minimum TTD amount is $40.00. TTD benefits can be paid for a maximum of 400 weeks.
The first 3 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 14 days.
Temporary Partial Disability Benefits
In Missouri, if the employee is able to return to work, but at a lesser rate of pay than the amount the employee was earning prior to the injury or can only work fewer hours, the employee is entitled to temporary partial disability (TPD) benefits. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage, but is subject to the maximum TTD rate.
Permanent Partial Disability Benefits
Missouri employees who incur a permanent partial disability (PPD) are entitled to two-thirds of their average weekly wage, not to exceed a per week maximum. The weekly maximum is adjusted each year. The weekly maximum PPD rate for the period of 7-1-11 thru 6-30-12 is $425.19 per week. For non-scheduled injuries, known as Permanent Partial General Disability, the maximum period of payments is 400 weeks. For scheduled injuries, the loss of a body part has a maximum of 232 weeks of benefits for an arm at the shoulder, with the number of weeks declining based on the nature of the body part, down to 14 weeks of benefits for a toe other than the great toe.
Permanent Total Disability Benefits
Permanent total disability (PTD) benefits are paid weekly for life-time of the injured employee. The employee and the insurer are also allowed to negotiate a lump-sum settlement. The weekly benefits are based on two-thirds of the average weekly wage not to exceed the maximum cap set each year. (WCxKit)
Death Benefits
The burial expenses in Missouri are covered for a work-related death up to $5,000. The death benefits for a surviving spouse and dependents follow the same guidelines as TTD benefits – two-thirds of the average weekly wage – for one year. The spouse loses the death benefit if the spouse remarries, but the children continue to receive the death benefit. Children can receive the death benefit if they are under 18 years old, or 22 years old if enrolled in accredited educational institution.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Age discrimination in Western Australia workers compensation legislation has been abolished by state parliament, according to a report from the Government of Western Australia.
Commerce Minister Simon O’Brien said changes to the Workers Compensation and Injury Management Act 1981 passed in August, come into effect on Oct. 1, 2011, giving all employees the same entitlement to workers comp regardless of age.(WCxKit)
O’Brien said the Act had clearly been unfair to workers over the age of 64, previously entitled to only one year of income payments.
“The change means contributions older workers make to the WA economy and society are recognized in the workers compensation legislation,” he said.
“With Western Australia facing an aging workforce, record low unemployment and a need to maintain skilled and experienced people, the removal of any barriers to working past 65 will have a positive economic and social impact.”
The changes are part of a number of Liberal-National Government legislative reforms to take effect on Oct. 1 and result from a 2009 Government review of workers compensation.
The other significant change is the extension of the safety net which ensures seriously injured workers are protected if their employer is uninsured.
“Injured workers should not have to pay for the unlawful business practices of the very small number of employers who fail to take out insurance,” the Minister said.
“The changes mean that in these cases WorkCover WA will meet the costs of damages awarded by the Court if negligence is proven and the employer does not have insurance.”
The workers comp dispute resolution system is also improved through the amendments, creating more accessible and timely conciliation and arbitration services.
“These changes have been made in response to strong stakeholder feedback about the need to improve the dispute resolution arrangements,” O’Brien added.(WCxKit)
“Only a small number of workers compensation matters end up in a dispute between the parties. When this happens it is important the matter can be dealt with in a straightforward and transparent way.”
Changes to the dispute resolution system take effect from Dec. 1, 2011.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Following the electrocution death of an employee, an employer participating in the federal government’s subsidized home insulation program was fined $100,000 for unsafe workplace practices Queensland (Australia) Workplace Health and Safety.
Mitchell Sweeney, 22, died in February 2010 while working on the ceiling of a home at Millaa Millaa, south of Cairns. He was electrocuted when he stapled a metal fastener through the foil and into a live wire. (WCxKit)
Sweeney was working for Gold Coast Company Titans Insulation, a participant in the federal government’s subsidized home insulation program. Following Sweeney’s death, the company was charged with failing to conduct its business in an electrically safe way.
After initially indicating it would defend the charge, the company pleaded guilty in the Industrial Magistrates Court in Brisbane.
The court heard the company did implement a number of strategies aimed at employee safety, including distributing plastic staples to workers. However, the court said these strategies did not go far enough to mitigate risk of death or serious injury to employees because, for example, the employer failed to ensure the plastic staples were actually being used.
Prosecutor Andrew Herbert, representing Queensland Workplace Health and Safety, said it was true Titans provided some training to staff and gave a number of directives that they were not to use metal staples. (WCxKit)
‘‘
There was a complete absence of a system for detecting and understanding whether the workers were in fact complying with the directions,’’ Herbert said. ‘‘Any cursory inspection of their work by Titans would have revealed exactly what was going on.’’
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
For the employee or the employer unfamiliar with workers compensation terminology, the terms medical management and utilization review sound similar. An employee should be accustomed to workers compensation terminology in case of injury and to understand the medical treatment process. The differences between medical management and utilization review should be understood by the employee and the employer alike. While both medical management and utilization review involve the use of a nurse, the two areas are quite different.
Medical management is the coordinating and planning of medical care provided to expedite the employee's return to work or to help the employee maximize medical improvement. Medical management is normally the responsibility of the nurse case manager (NCM). (WCxKit)
Utilization review is the evaluation of medical care being provided to the employee to determine the medical necessity and appropriateness of medical treatment being provided for an injury. The utilization review is conducted by a registered nurse (RN) who has a utilization review physician available for a medical opinion should the nurse be unsure of medical treatment.
8 Responsibilities of the NCM Involved in the Workers Compensation Claim
1. Facilitating the medical rehabilitation of the injured employee.
2. Coordinating the medical care between different providers to achieve the best possible results in a cost-effective manner.
3. Consultation with the medical provider to determine the best treatment plan for the injured employee.
4. Act as a liaison and facilitating the communication between employer, employee, and insurance adjuster.
5. Monitoring the employee’s medical progress.
6. Assisting the employer in identifying the return to work options.
7. Coordinating the employee's return to work, whether full or modified duty, with the employer, the employee, and the medical provider.
8. Insure utilization review is brought in on all medical care and/or medical services when appropriate
Note: not all NCM is alike – look for providers who use licensed RNs and are URAC Certified. Determine how much clinical experience the NCM's have — good ones have 3 years minimum clinical experience and 15 years average clinical experience. Senior Nurse Reviewers (SNR) are a higher level of NCM that provides medical oversight on the file the whole way through. The SNR sees the Triage File, Treater File, 3-point contact, and Duration Guidelines.
4 Types of Utilization Reviews Used by the Nurse Involved in the Workers Compensation Claim
1. Pre-certification reviews occur prior to the medical care being provided. The RN collects all the necessary information including the symptoms, diagnosis, results of tests, and the reasons the physician is requesting the medical service. The RN compares the information against the normal criteria for treating a specific type of injury. If the medical care is deemed necessary, it is approved. If the medical service is not necessary, the utilization review physician is asked to verify the denial of the service requested is correct. Nurses use medical guidelines such as MDGuideines which tell the appropriate length of time out of work or disability for any given injury, co-morbidity and even zipcode. Good TPAs have these guidelines at their fingertips.
2. Concurrent reviews occur during the time medical treatment or service is being provided. This can be either for a patient in the hospital or for on-going outpatient care. The RN follows the same approach with the concurrent review as followed in the pre-certification review.
3. Retrospective reviews occur after the medical service has been provided for either an in-patient or out-patient service. The RN again follows the same criteria as with a pre-certification review.
4. Re-reviews occur when the pre-certification review, concurrent review, or retrospective review result in medical care or medical payments being denied. When a re-review is requested, the utilization review physician will go over all the information to determine if the prior decision was or was not correct. (WCxKit)
Utilization Review provides an objective opinion as well as a client liaison, to ensure the right treatment is received at the right time based on evidence-based medicine. The review considers medical necessity and sometimes causal relationship to the injury, not cost.
It is in the employers and the insurers best interest to provide both medical management and utilization review on any indemnity claim or enhanced medical only claim. By combining medical management with utilization review, the employee receives the best medical care at the optimum cost. This has a positive impact on the employer's future workers compensation premiums and builds employee loyalty as the employee feels he or she is given the best possible medical care, a win-win situation for all. It can be very effective to use Nurse Triage at the time of injury, Senior Nurse Reviewer throughout the life of the claim and Utilization Review
Note: All utilization review and medical management providers should be URAC Certified. This rigorous credentialing process has separate categories of for Utilization Review and Nurse Case Management. Your providers should be certified in both areas if they are providing both services. ASK THEM.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
An investigation by the U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) found the Metro North Commuter Railroad Co. discriminated against an employee by classifying his on-the-job injury as not being work-related and denying him a promotion.
According to an OSHA report, the agency ordered the railroad, which provides commuter rail service in Connecticut, New York, and New Jersey, to take corrective action by promoting the worker and paying him $125,000 in punitive damages, $5,000 in compensatory damages and $11,651 in legal and medical expenses. The railroad also must pay him the difference between his current rate of pay and that of the new position, plus interest, and correct its records to show his injury as work-related.(WCxKit)
Additionally, Metro North must post a notice to employees at all 120 of its stations of their protections under the Federal Railroad Safety Act (FRSA) as well as provide all employees with an FRSA fact sheet and information on reporting work-related injuries and illnesses.
The worker filed a complaint with OSHA in October 2008 after Metro North classified his July 2008 injury as not work-related even though it occurred on the job, which forced him to pay out-of-pocket for injury-related medical expenses. Metro North notified the worker in November 2008 that he was not selected for a promotion for which he had previously applied. That decision was based in part on the worker's injury record, which should not have been considered in evaluating the promotion request. OSHA's investigation determined that both the injury misclassification and the promotion denial constituted discrimination against the worker.
Metro North and the complainant each have 30 days from receipt of the findings to file an appeal with the Labor Department's Office of Administrative Law Judges.(WCxKit)
Under the FRSA, employees of a railroad carrier and its contractors and subcontractors are protected against retaliation for reporting on-the-job injuries, reporting certain safety and security violations, and cooperating with investigations by OSHA and other regulatory agencies.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
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Legal Doctrines, Litigation Management, Management Commitment, Uncategorized |
