The Four Phases of Employer Involvement In A Workers’ Comp Claim

The Four Phases of Employer Involvement In A Workers’ Comp Claim

As an employer, you often hear the recommendation “stay involved in your workers’ compensation claims.” That is great advice, but way too often it’s where the discussion ends without any explanation as to what “staying involved” means.

 

 

Four Phases of Employer Involvement in Workers’ Comp Claim

 


The employer’s involvement in the workers’ comp claim begins before the injury occurs and ends when the employee is back at work, fully recovered from the injury. Let’s first look at four phases of employer’s involvement in the workers’ comp claim, then we will look at what the employer cannot do in regards to the workers’ comp claims.

 

The four phases are:

 

  1. Pre-injury process
  2. The injury occurrence
  3. The claim process
  4. The claim settlement

 

If you have employees, sooner or later an employee is injured on the job. The following are some suggestions about what you can do prior to the injury occurring that will impact on the outcome of the workers’ comp claim. Make sure you have “touch points” for each phase of the claim.

 

Here is an example of what is appropriate:

 

  • Provide each new hire with an employee accident brochure outlining what the employee should do in case of an accidental injury.

 

  • Have a written transitional duty policy.

 

  • Provide each supervisor within the company a written guide on how they are to report and be involved in workers comp claims.

 

  • Post the injury procedure policy where all employees will see it.

 

  • Have a published returned to work policy.

 

  • Have a strong safety program and tie the manager’s performance evaluation, raise, bonus or promotion to his or her safety record.

 

  • Have a medical provider network in place through your insurance company or join a medical provider network for self-insureds. Make sure all employees know about and use the network. This is called your “penetration” — you should have a penetration rate of > than 90%.

 

  • Prevent fraud by letting all employees know workers comp fraud takes money away from their raises and bonuses.

 

  • Put up posters reminding the employee that workers comp fraud is a crime and will be fully prosecuted.

 

  • Post all the state required notices in a place convenient for all employees to see including workers comp laws, OSHA posters and anything else required in your state.

 

  • Post a list of the required medical providers (where allowed by state statute) or recommended medical facilities (in the states where the employee is allowed to select their own doctor). Consider using an outcome-based network where providers with exemplary performance are included in the network.

 

 

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 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. She is the co-author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:.

Contact: RShafer@ReduceYourWorkersComp.com.

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

 

©2018 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.

 

 

 

5 Ways to Get Management Buy-In for Your Workers’ Compensation Program

5 Ways to Get Management Buy-In for Your Workers’ Compensation ProgramTo have a successful, effective workers’ compensation program requires commitment from the entire organization, starting at the very top. Leaders must not only endorse the program but be engaged as well, for it to be of value to the company.

 

A lack of management support will be apparent to the rest of the workforce which won’t share your goals. But there are steps you can take to get leaders to fully embrace your injury management plan.

 

  1. Speak their language

 

Getting the attention of management is largely a numbers game. Those in the C-suite need to understand the dollars and cents of an effective workers’ compensation program.

 

  1. Play on what is important.

 

  • Find out what matters most. Every organization has some way to determine its financial success. Find out what metric resonates most; the figure management discusses with shareholders, the board of directors or other senior managers. This could be
    • EBITDA: The company’s earnings before interest, taxes, depreciation, and amortization. This is the company’s net income with interest, taxes, depreciation, and amortization added back in. It eliminates the effects of financing and accounting decisions. It shows the company’s current operating profitability, or how much profit it makes with its current assets and its operations on the products it produces and sells, as well as providing a proxy for cash flow.
    • Net income number. This refers to the profit made after the company subtracts its expenses. Where revenue is the company’s total sales and is known as the top line, net income is called the bottom line, or the company’s earnings.
    • Revenue from operations. This is the income generated from an organization’s daily core business operations and is also called operating revenue. It is the revenue posted from selling the company’s products and services.

 

  • Calculate the potential savings. This requires figuring out the cost of a full-time equivalent employee, then determining the possible savings from reductions in workers’ compensation costs. For example, if the important metric is the EBITDA and you know that the cost per FTE over the past three years has been going up, cutting that number in half could potentially reduce the EBITDA number by X percent. You want to use the company’s most important metric to frame the amount of revenue the organization must generate to cover its workers’ compensation losses.

 

  • Define the impact of a claim. Either by your own calculations or through e-mod software.

 

  • Compare the cost of a claim to the expense of something the company wants. Say your company had a recent workers’ compensation claim that cost $575,000 and the company needs certain equipment that costs $500,000. Explain that improvements in your company’s injury management program could have prevented that claim to show the money for the equipment could have been available.

 

  1. Produce evidence of wastefulness. Whether it is outright fraud or just a lax attitude toward safety, management responds to pictures and videos of employees that translate to a culture of uncaring about the organization’s resources.

 

  1. Present the numbers. A well-run return-to-work program keeps injured workers on the job or gets them back to work quicker. But company leaders may not truly believe that unless you show them real numbers from research:

 

  • Up to 80 percent of lost work days are unnecessary.
  • Injured workers out of work and receiving indemnity payments are 4X more likely to have an unsatisfactory outcome. The same research found that employees with similar injuries who either stayed on the job or returned sooner had better outcomes.
  • The chances of an injured worker returning to the workforce in any capacity drops by 50 percent after 12 weeks of being out of work.

 

  1. Give hiring advice. Management will be more apt to listen to you if you can present a way to avoid hiring the company’s next workers’ compensation claim. An easy, fairly inexpensive way to make sure the right people get hired is through an integrity test, such as the Merchant’s Integrity Test.

 

This is not a personality test nor does it require complex algorithms to interpret the results. The questions are direct and aimed at predicting the likelihood of problem behaviors from the person.

 

There are 50 questions that have been vetted and updated. According to psychologists who have studied the test, it works because people who engage in ongoing risky behaviors eventually rationalize their behaviors and come to believe there is nothing wrong with their conduct. More than 90 percent of applicants tell the truth about their high-risk behaviors.

 

Avoiding problem hires is one of the best ways of reducing workers’ compensation costs. Tests from Cornell University and elsewhere have indicated applicants who took and passed the test had half as many workers’ compensation claims as those who did not take it.

 

 

Summary

 

Having an injury management program may sound like a good idea to managers, but to understand its true value to the company requires looking at the numbers. Taking those numbers to management to frame a conversation that is meaningful to the organization can get leaders to be onboard with your program.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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/

 

©2018 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.

4 Steps to Transporting Injured Worker After Injury: A Little Planning For a Lot of Impact

Hey, there. Michael Stack here, CEO of AMAXX. So it was about two months ago now that my wife and I made a fairly life altering decision when we decided to homeschool our four young children. So we have a seven year old that’s in second grade, a six year old in first grade, and then five and a three year old who are both in preschool. Now reasons for why we made that move are many, but the main one is that we wanted to be very intense about the values that we’re teaching and the path that we’re on as a family.

 

 

 

Spend Time Coordinating Personal Lives, Work Comp Is Afterthought

 

But while the values, and the motivation, and the path that we want to be on is very pure and very strong, one of the things that we can never get around is the impact, and coordination, and planning for how we will physically transport the children to any activities that they’re involved in. And I think any parent who’s raised children can understand this challenge of getting this one here, and that one there, and this one here to the various activities, and the impact that it has on the day, the week, and the month, and the year for what it is that you’re going to sign up for.

 

But what we spend so much time and coordination and effort on that in our personal lives, let me ask you a question. How does your employee, who’s injured at work, physically get to the medical provider? How does your employee, who’s injured at work, physically get transported to the medical provider? Do you have a consistent plan for that? Do you have a system? Do you have a designated individual for how that happens and what you’re looking to accomplish? I’ll tell you the answer to that, that is most often given is, “Well, we just kind of figure it out most times. You know, sometimes the injured employee will drive themselves, and sometimes it’ll be a supervisor, and sometimes it’s just someone that’s there that can kind of pop them in their car and take them over to the facility.”

 

 

 

Intentional Workers’ Comp Transportation Plan

 

 

The lesson for today is to have a very intentional plan and I want to give you some very specific things that you should be looking for and trying to accomplish in your transportation plan. This doesn’t cost anything and it’s not very difficult to implement, but the impact it can have on that claim can be dramatic.

 

 

4 Steps to Workers’ Comp Transportation

 

 

So there’s the steps.

 

  1. Designate Individual. Step one, designate and individual. Who is it? Who’s the person that’s going to take your injured employee to the medical facility? It’s that same person every time. And, if for some reason, they aren’t available, they’re not there for the day, it’s not Option A, it’s Option B. Usually this is a supervisor, it’s a manager, or it’s another designated individual at your site that you’re going to make sure that that person every time that takes that person to the medical provider.
  2. Correct facility in a timely fashion. The second thing you want to do is you want to make sure they get to the correct facility. Make sure they get to the correct facility in a timely fashion. There’s so many things that could go wrong between point A and point B. You go here, you stop there, did they get into the right facility? Make sure they get to the right provider in a timely fashion.
  3. Stay with Injured Worker. Number three is, that designated individual is going to stay with the injured worker while they’re getting their treatment at the medical provider. So that designated individual stays with the injured worker, makes sure that that provider knows about your transitional duty program, make sure they have the employer brochure, the medical provider brochure, whatever information that you’re conveying, and making sure that they’re getting that treatment that they need.
  4. Return Injured Worker to Job or Home. And number four is, return that individual employee to the job site. And, if for some reason they can’t go back to the job site, then return that individual back to their home.

 

So these are the four steps. A designated individual. Making sure they get to the correct medical provider in a timely fashion. Stay with them, and return them to work. It doesn’t cost a thing, but the impact that it can have on your program can be dramatic.

 

Again, I’m Michael Stack, CEO of AMAX. And remember, your work today in Workers’ Compensation, it can have a dramatic impact on your company’s bottom line. But it will have a dramatic impact on someone’s life. So be great.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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/

 

©2018 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.

Part 2 – Employer Role in Managing a Workers Comp Claim

As an employer, you often hear the recommendation “stay involved in your workers’ compensation claims.” That is great advice, but way too often it’s where the discussion ends without any explanation as to what “staying involved” means.

 

The employer’s involvement in the workers’ comp claim begins before the injury occurs and ends when the employee is back at work, fully recovered from the injury. Let’s first look at two phases of employer’s involvement in the workers’ comp claim.

 

The four phases are:

 

  1. Pre-injury process
  2. The injury occurrence
  3. The claim process
  4. The claim settlement

 

Phases 1 & 2 covered in:

Part 1 – Employer Role in Managing a Workers Comp Claim

 

 

3. The Claim Process

 

Too many employers allow their involvement in the workers’ comp claim to end when they send the employee to the doctor. That is a bad mistake and will result in a steady increase in the amount of workers comp insurance premiums. The employer needs to have an established post injury process. It should include:

 

  • Report the claim to the insurer, third-party administrator or self-insured claims office immediately. The supervisor or your workers’ comp claims coordinator should be reporting the claim to the claims office while the employee is still en route to the medical provider.
  • Complete the Employer’s First Report of Injury and any other state required paperwork on the claim.   If the injury is severe and the employee will be unable to return to work within the waiting period, provide the claims office with necessary wage information for the calculation of indemnity benefits.
  • Advise the claims office of the claimant’s prior history of workers comp claims. The adjuster’s approach to the claim varies significantly between the employee who never had a prior workers comp claim and the employee who has had 15 workers comp claims in the last ten years.
  • Review your transitional duty program and find a job the employee can do within the treating physician’s restrictions.
  • Be sure the employee’s supervisor (and co-workers if needed) are available to discuss the accident and injury with the claims adjuster and to assist the adjuster with the claims investigation as needed.
  • Don’t alienate the employee – show empathy to the employee. When employees feel the company does not care about them and their injury and the company owes them, the claim will get ugly when employees feel it is time to stick it to the employer.
  • Maintain an open dialogue – call the employee at home to show your concern and to offer assistance in processing the workers’ comp claim with the insurance company. Address any employee problems or issues right away. Also, call the employee on a regular basis until s/he is back at work.
  • If you are contacted by an attorney representing the employee, notify the claims adjuster immediately.
  • Immediately dispute any invalid or fraudulent claim.
  • If the employee has a questionable claim or a subjective claim for neck or back injuries, and immediately goes to the television advertising workers comp attorney or a plaintiff’s attorney-oriented doctor known for excessive disability ratings, advise the employee immediately that you intend to fight the claim as the attorney and/or doctor has a history of inflated claims
  • Monitor the state filings by the adjuster and any other claim related paperwork
  • Monitor the Workers Compensation Board decisions – that means, reading them carefully, not just filing them away. Be ready to protest any finding or order you feel is unfair to you as the employer as all decisions have time limits for disputing the decision, with some time limits as short as 15 days.
  • Monitor the medical progress reports to be sure the treatment is appropriate – for example – no physical therapy for the low back when the injury is a cut finger.
  • Always advise the adjuster when the employee returns to work – the same day.

 

 

4. The Claim Settlement

 

Normally, it is up to the adjuster to negotiate the settlement of the workers’ comp claim. However, there will be occasions when the employer needs to be involved in the settlement discussions. This would include:

 

  • Working with structured settlement consultant and professional administrator in settlement discussion if appropriate.
  • Attending depositions and hearings.
  • Attending the settlement conference (with settlement authority if you are self-insured).
  • Working with the vocational rehabilitation specialist to accommodate the employee’s return to work if there are any ADA concerns.
  • Providing rehabilitation training if necessary.

 

 

What You Cannot Do

 

Occasionally employers go overboard in their efforts to control the cost of workers comp claims. There are some actions you cannot do including:

 

  1. Going without workers compensation insurance. This is a criminal offense in most states, you will pay fines, you will pay the claim out of company funds and you could end up paying your own cost to defend a lawsuit from the injured employee.
  2. You cannot terminate the employee for filing a workers comp claim.
  3. You cannot refuse to hire an employee solely because of prior workers comp claim history (unless the prior injury(s) makes it impossible for the employee to do the job under consideration).
  4. You cannot charge an employee for any part of the workers’ comp premium.
  5. You cannot pay the small claims out of company funds and not report them to the workers’ comp insurer.

 

By staying involved in the workers’ comp claim from before the claim happens to the time the claim is concluded, you will have a strong, positive impact on the cost of your workers’ compensation insurance.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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/

 

©2018 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.

Part 1 – Employer Role in Managing a Workers Comp Claim

As an employer, you often hear the recommendation “stay involved in your workers’ compensation claims.” That is great advice, but way too often it’s where the discussion ends without any explanation as to what “staying involved” means.

 

The employer’s involvement in the workers’ comp claim begins before the injury occurs and ends when the employee is back at work, fully recovered from the injury. Let’s first look at two phases of employer’s involvement in the workers’ comp claim.

 

 

The four phases are:

 

  1. Pre-injury process
  2. The injury occurrence
  3. The claim process
  4. The claim settlement

 

  1. Pre-injury

If you have employees, sooner or later an employee is injured on the job. The following are some suggestions about what you can do prior to the injury occurring that will impact on the outcome of the workers’ comp claim.

 

  • Provide each new hire with an employee accident brochure outlining what the employee should do in case of an accidental injury.
  • Have a written transitional duty policy.
  • Provide each supervisor within the company a written guide on how they are to report and be involved in workers comp claims.
  • Post the injury procedure policy where all employees will see it.
  • Have a published returned to work policy.
  • Have a strong safety program.
  • Have a medical provider network in place through your insurance company or join a medical provider network for self-insureds.
  • Prevent fraud by letting all employees know workers comp fraud takes money away from their raises and bonuses.
  • Put up posters reminding the employee that workers comp fraud is a crime and will be fully prosecuted.
  • Post all the state required notices in a place convenient for all employees to see including workers comp laws, OSHA posters and anything else required in your state.
  • Post a list of the required medical providers (where allowed by state statute) or recommended medical facilities (in the states where the employee is allowed to select their own doctor).

 

 

2. The Injury Occurrence

Even companies with the strongest safety programs will have some workers comp claims. When an injury occurs, the immediate actions taken by the employee’s supervisor or co-workers have an impact on the outcome of the claim. The employer must require a tight injury process, including:

 

  • Obtain immediate medical assistance for the employee – send the employee to designated doctor or medical facility if statute permits
  • Do not permit employee’s with minor injuries or soft-tissue strains to wait to obtain medical assistance – most will end up going to the unapproved hospital emergency room or their own doctor
  • While the employee is in-route to the treating physician, advise the treating physician of any temporary jobs you can offer during recovery.
  • Advise the treating physician of modifications you can make to the existing job to accommodate any work restrictions the physician gives the employee
  • Have a goal of returning to work all employees within 1 to 3 days after the injury unless they are medically unable to perform any role for the employer

 

Phases 3 & 4 covered in:

Part 2 – Employer Role in Managing a Workers Comp Claim

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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/

 

©2018 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.

4 Reasons For Spike In Workers’ Comp Claims

4 Reasons for Spike in Workers Comp ClaimsEvery day employers can introduce increased risk for worker injury. At any given time, outside or internal forces can create a new hazard for injury. With the injury comes medical cost, lost wages, decreased production, decreased profit margins, more strain on current workforce, and other negative issues.

 

Below we will discuss a few factors involved in the increased risk of worker injury and the way to decrease the hazard when these forces are present in your workplace.

 

 

1) New Equipment in the Workplace:

 

Your workforce has a span of experience that varies by employee. Some workers are new to your industry, whereas others may have decades of experience. But new equipment is a great equalizer.

 

When there is hazardous equipment on the work floor unknown to your operators, the risk of serious injury increases dramatically. Your workers are unfamiliar with these machines, and, without proper training, a severe injury may occur.

 

The way to prevent injury is to take the time to properly train each employee on proper use of the new machine. Make sure they complete the training course and can pass a safety test before operating the equipment. This should decrease your risk, and make your workers safe.

 

A lot of employers ignore training, letting experienced workers train others. Managers can be surprised that older workers typically do not have the advanced technological experience to know these new machines inside and out, and therefore, without a properly trained workforce, you run the risk of increased worker injury.

 

 

2) Benefit Reductions:

 

As the economic environment continues to evolve, employers are scrambling to find ways to stay competitive.  Some are experimenting with decreasing fringe benefits made available to employees, or by decreasing the employer contribution which increases employee cost for the same benefits package they may have had for years.

 

The backlash against this can lead to an increase in workers compensation claims. It is not going to be across the board, but some people may adopt the attitude they want to show the employer what happens when they alter the benefits. This is done by workers who stop caring about their jobs. They do not do safety checks or machine checks before operation. They do not clean up as they used to. They do not work as hard as they once did. The result is other workers injured by someone else’s carelessness.

 

 

3) Demotions Within the Company:

 

Workers who are demoted or moved to another job title may hold a grudge. They become upset and want to sabotage their employer through a lackluster work performance, decreased safety awareness, decreased work productivity, etc. All of these are detrimental to the employer, and another employee may become injured inadvertently by the disgruntled employee’s issue with the employer.

 

When job titles change, or people get moved around to other job duties, watch for an increase in claims. If this happens, employers should talk to employees immediately. Let them know that these moves are not a personal attack and may not be permanent. You need to make those workers feel like they are part of the team again, so they stay on board and on top of their safety protocol.

 

 

4) Plant Shutdowns / Layoff Notices:

 

Probably the most common time a claim count increases is when workers are notified of a potential layoff or worse — an entire plant shut down. Workers with any injury feel if they do not report it now they will miss out. Often any worker who has ever had any pain while working is going to come forward to tell you how injured they are, and how they kept working to try and be of some benefit to the employer and keep earning a paycheck.

 

Not all of these types of last-minute claims are fraudulent. In fact, some long-term employees may have an occupational claim that is compensable. All claims need to be reported to your workers comp carrier so the adjuster can investigate the claims and get them taken care of, whether they are denied or compensable. Any delay can cause an increase in claim cost, especially if said employee is laid off, or terminated when the shop closes down. The sooner the adjusters get the claims, the better your company will be protected.

 

In conclusion, several issues can contribute to a spike in an employer’s claims count. But with proper communication, thorough training, and a good safety team you should be able to weather the storm and keep your claims count in check.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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/

 

©2018 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.

9 Costly Mistakes Employers Make in Controlling Workers Compensation Costs

9 Costly Mistakes Employers Make in Controlling Workers Compensation CostsWorkers’ compensation is often viewed simply as a cost of doing business.   Unfortunately, this mistake in philosophy as well as other common challenges cost the employer money and negatively impact the claim outcome for the injured worker.

 

Here are the top 9 mistakes that employers make when it comes to controlling the cost of their workers’ compensation insurance.

 

  1. Lack of a Strong Safety Program

 

The failure to provide the employees with a safe work environment. Employers who:

 

  1. utilize safety training,
  2. have completed a job hazard analysis for every job position within the company,
  3. complete work-site evaluations and inspections, and
  4. have a safety specialist and/or a safety committee

 

…will have significantly fewer on-the-job injuries, resulting in lower workers compensation costs.

 

 

  1. Lack of Return to Work Program.

 

The lack of an established Return to Work Program is the probably the second most expensive mistake an employer can make. The longer the employee is allowed to remain off work and drawing indemnity benefits, the higher the cost of the claim and the higher the resulting workers’ compensation premiums will be.

 

By returning the employee to modified duty or light duty work until the employee is able to resume his regular duties, the employer receives the benefit of some production from the employee. Also, light duty work will speed the employee’s recovery and lower the extent of any permanent disability rating, resulting in a lower disability award.

 

 

  1. Alienation of the Employee

 

The alienation of the employee after an injury is a major mistake made by employers. Way too many employers simply forget about the employee once they have reported the injury to the claims office. Everyone has a certain amount of need for reassurance of their value to the company.

 

If the employee never hears from the employer after the accident, they tend to think the worst. Employees who have regular contact with the employer after an accident seldom become adversarial and hire an attorney. By keeping the lines of communication open with the employee after an accident, the employee recognizes the employer is concerned about their well being.
 

 

  1. Failure to Timely Report a Workers’ Compensation Injury

 

A mistake an employer should never make, but occurs too frequently, is the failure to timely report a workers’ compensation injury to the claims office. An employer who saves up all their work comp claims for the week to report to the claims office each Friday is being penny wise with their time and pound foolish with their money.

 

Every department supervisor within your company should know that as soon as they have arranged transportation of the injured employee to a medical facility, the next step before they do anything else is to report the claims to the company’s workers’ compensation claims coordinator or to report the claim directly to the claims office. The sooner the claim is reported, the faster the adjuster can start the claim investigation, and provide the required benefits to the employee, if appropriate.

 

 

  1. Hands Off Approach to Your Workers’ Compensation Claims

 

A hands-off approach to your workers’ compensation claims will result in higher insurance cost. The employer should make the employee’s supervisor available to the adjuster to discuss the details of the accident and assist the adjuster with the investigation in any way needed. The smart employer will not only stay in contact with the employee after an injury, the smart employer will also stay in contact with the work comp adjuster.

 

The employer should convey to the adjuster all information about the work comp claim that is given to them by the employee. While some of the information will be a duplication of what the adjuster may have already obtained, there will be information that will assist in the processing of the claim.

 

 

  1. Failure to Manage & Control What Happens Before & After a Claim

 

The failure to manage and control what happens before and after a claim happens is a mistake many employers make. All supervisors should be trained on what to do when a claim happens. All employees should be provided a brochure, both when they are hired and annually, with a written guide on what the employee should do when an accident occurs. The injury procedure policy should be posted where all employees can see it. All state required notices, OSHA notices, required (or suggested) medical providers and fraud prevention posters should be posted.

 

 

  1. Not Controlling the Medical Provider Selection

 

A costly mistake some employers make is not controlling the selection of the medical provider in the states where the employer can do so. If the state allows the employer to select the medical provider, the approved medical facilities should be posted where every employee will know who they are in the case of an accident. In the states where the employee is allowed to select the medical provider, the employer should post a list of suggested medical providers.

 

More often then not, in a non-emergency situation, the employee will select from the suggested list of medical providers, especially if the employer has managed and controlled the work comp claim process (see # 6 above).

 

 

  1. Failure to Fight Workers’ Comp Fraud     

 

According to the National Insurance Crime Bureau, up to 25% of all workers’ compensation claims have some element of fraud. The failure to fight fraud can be a costly mistake for the employer. Every employer should have a fraud prevention program and know the red flags (indicators) of potential employee fraud. All employers should make it clear that workers’ compensation fraud is a crime and will be fully prosecuted. Plus all employees should know that work comp fraud takes money away from their raises and/or bonuses.

 

 

  1. Incomplete Medical Management Program

 

An incomplete medical management program will definitely add to the cost of workers’ compensation. Every employer should make sure their workers’ compensation insurer or self-insured program uses all the medical cost reduction techniques available including medical fee schedules, bill reviews, nurse case, utilization review, pharmacy benefit managers and medical provider management networks. By utilizing all available medical cost management techniques, the overall cost of workers’ compensation can be lowered.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a 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/

 

©2018 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.

Know Your Role To Take Control of Work Comp Costs

If you leave the management of the workers compensation claims to chance, the chances are you will not have good results.  To have good results in the control of the workers comp claims, it is important that everyone involved – the workers compensation claim coordinator, the floor or field supervisors, mid-management, medical personnel, legal, senior management and even the employees know what roles and responsibilities are in the management of the workers comp claims.

 

Take Control

 

Start by assigning roles and responsibilities to one or more parties in the process – it is a step that can be taken to get things on track. You do not need to assign ALL roles immediately, just take it one step at a time.

 

The duties of every person involved in the workers comp claim from the claim coordinator to the employee should be defined and written down for each participant.  This includes both the pre-accident responsibilities, as well as, the post injury response.  By knowing what is expected of them, each person will be able to take the appropriate action when an injury occurs.

 

 

 

Claims Coordinator Responsibilities

 

The workers comp claims coordinator, whether a full-time job at a medium-size or large employer, or a part-time job at a smaller employer, is the pivotal person in controlling the workers comp claims.  The claims coordinator can be a part of the risk management department or a part of finance or human resources.  The important thing is the claims coordinator has access to all information necessary to control the claim.

 

  1. Establishing a transitional duty program prior to injuries occurring
  2. Providing all new hires and providing annually to current employees the employee brochure on what to do in case of an accident
  3. Arranging immediate medical care at the required medical provider or at the recommended medical provider
  4. Providing the medical provider with a detailed job description prior to the employee arriving for the initial medical treatment
  5. Interviewing the injured employee to obtain a detailed description of how the injury occurred.
  6. Interviewing the employee’s supervisor to verify the description of the accident and what could have been done to prevent the accident from occurring.
  7. Completing the First Report of Injury and providing it to the claims office on the day of the injury
  8. Contacting the employee immediately following the initial medical treatment for the diagnosis, prognosis and expected period of disability, if any
  9. Arranging for light duty / transitional duty / modified duty for the injured employee
  10. Sending the employee a get well card when the employee will be off work
  11. Maintaining weekly telephone contact with the employee while the employee is treating weekly and telephone contact following each medical visit thereafter.
  12. Facilitating on-going contact with the claims adjuster and the nurse case manager.
  13. Coordinating and completing all necessary paper work related to the claim.

 

 

Post-Accident Responsibilities of the Supervisor

 

The employee’s supervisor has pre-accident responsibilities to ensure all employees work in a safe and prudent manner.

 

  1. Accompanying the injured employee to the required or recommended medical provider.
  2. Providing the medical provider with the Work Ability Form and obtaining the completed form from the medical provider’s office
  3. Submitting the Work Ability Form, the Supervisor’s Report of Accident, the Employee Report of Injury and the Witness Report Form to the workers compensation claims coordinator.
  4. Enforcing compliance with the transitional duty program and verifying the work done by employees on modified duty is in accordance to the medical provider’s limitations.
  5. Training all his/her employees on what to do in case of an injury.

 

 

Employee’s Role and Responsibilities

 

The employee needs to be involved in the control of workers compensation claims.

 

  1. Participate in post-injury response training.
  2. Participate in the return-to-work transitional duty program
  3. Attend all employee weekly meetings/office meetings unless physically unable to get to the work-site
  4. Provide the Work Ability Form to the supervisor or claims coordinator after each doctor’s visit.

 

Management Roles and Responsibilities

 

The Best Practices for Injury Management also applies to middle and senior management. Management should have defined roles and responsibilities.

 

  1. Providing a strong safety program and implementing the necessary risk management practices to keep as many workers comp claims from occurring as possible.
  2. Knowing the monthly and on-going cost of workers compensation.
  3. Communicating to the employees how many additional sales or how much additional production is necessary to cover the cost of workers compensation claims.
  4. Determining the medical providers that will be used
  5. Determining the insurance carrier or the third party administrator.
  6. Tracking and reporting lost work days.

 

In addition to the Best Practices for Injury Management noted above, there are best practices for risk managers, medical directors, in-house medical clinics and in-house legal.  These sample best practices listed here are far from complete.  Contact us to learn more about how to control workers comp cost through Best Practices for Injury Management.

 

 

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.

10 Ways to Kick Start a Workers’ Comp Stewardship Program

If you’re trying to improve your workers’ comp program, ask for an annual stewardship meeting with your insurer/third-party administrator. But if you really want to see game changing results, initiate a stewardship process. It’s a collaborative approach that takes some leg work and elbow grease, but can truly push your workers’ comp program to the next level.

 

In a typical stewardship meeting a representative for the employer and insurer or third party administrator discuss a pre-prepared report that shows your claims and program trends from the previous year and discuss goals for the next year. While it can be beneficial to get this snapshot of your workers’ comp program, there is much more that can be done.

 

Best outcomes for injured workers, optimized claims performance, and a reduction of your total cost of risk should be the goals. Savvier companies find more value and better outcomes through an intensive coordinated approach that starts long before the actual stewardship meeting.

 

Prep Work

Conversations with a multitude of people ahead of time can help you define what you want included in the report, the metrics you want analyzed and the parameters. Among those you may want to consult with are your carrier or TPA account manager, risk management information systems personnel and data analysts; claim and safety consultants; your insurance broker or agent; and others within your own organization.

 

Key steps in the process at this point include:

 

1. Set the date. Decide when you want the report completed.

 

2. Review past reports. This can help you establish a baseline.

 

3. Formulate a concept for the report.

 

4. Discuss the format and content of the report; set goals, objectives, metrics, deliverables, ideal takeaways, and the list of attendees.

 

5. Review preliminary data. Easily available analytical reports can be your starting point until you determine what needs to be customized, depending on what you are trying to accomplish. Not all data is going to be relevant. Some examples of the types of data may include:

  • Frequency analysis: claim volume, litigation, examiner caseload and lag time.
  • Severity analysis: average/total incurred, average/total paid, loss stratification, lag analysis, litigation, subrogation/recovery.
  • Ratio analysis: closure, medical vs. indemnity, payment analysis.
  • Managed care analysis; case management, PPO penetration, diagnostic, physical therapy, bill review.

About two months before the meeting, you can conduct a preliminary data review and determine what additional data you need.

 

6. Draft a preliminary report. Conduct a collaborative review of it and make any changes based on feedback.

 

7. Finalize the report.

 

The Meeting

 

A key to a truly effective stewardship process is to avoid the inclination to only see the positive trends of your workers’ comp program. Equally, or even more important are the areas for improvement, which is where you can make a significant impact. Often carriers or TPAs will avoid showing you potential problem areas, for fear they might be held liable. But it’s important to see both. For example, an increase in frequency does not necessarily signify a problem — if your payroll has increased through company growth. You need to see all of the trends.

 

8. No finger pointing. Honesty and openness are imperative among all parties to the stewardship process for better analysis and improvements. Each should have a sense of collective buy in to the purpose and outcome of the session.

 

9. Evaluate the results. Discuss the reasoning behind any emerging trends to see what they mean and what might be done to ensure they lead to best outcomes. Look at any services, initiatives and program enhancements that may be impacting them. Changes to the company’s financial stability, openings or closings of new facilities, or natural disasters may have occurred that could affect trends.

 

10. Set measurements. Determine goals and metrics to better understand the success of strategies you have implemented. Create a detailed action plan with target dates.

 

Summary

 

The stewardship process can be a rich tool to raise the bar on your company’s workers’ comp program. But failing to properly plan, having unreasonable expectations, inviting the wrong attendees and having an inability to be completely open can make the stewardship meeting a disaster. Getting commitment from all parties to a specific plan with responsibilities and due dates will lead to a successful stewardship process and best outcomes for your injured workers and your company.

 

 

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.

Keep Work Comp Costs Grounded With Travelling Employees

Urban legend and stereo-type opinion says traveling employees have it made.  They see large parts of the country or world, use the finest lodgings and restaurants, and entertain clients or customers in lavish ways.

 

 

Reality:

 

Nothing could be further from the truth.  Most traveling employees are sardined on airplanes, use moderately priced hotels and rental cars, eat at chain restaurants, and generally work very long hours.

 

 

Workers Compensation Exposure:

 

Traveling employees can suffer from:

 

  • Lack of Sleep (primarily from reporting to the home office on their daily activity in their hotel room in the evening)
  • Long Periods of inactivity from having to work in an office setting
  • Travel Fatigue and jet lag
  • Poor restaurant diets of fatty and salt laden food
  • Loneliness from family separation
  • Exposure to the public in terminals, restaurants, for possible contraction of illness or disease
  • Fatigue from having to prepare for the job accomplishments that must be obtained
  • Circulatory problems from having to sit on planes, trains, long vehicle rides and office sitting

 

This list could go on.  These conditions are enough to show employees suffering from hypertension, obesity, mental depression, physical depravity, and a host of other medical issues.

 

 

Workers Compensation Cost: 

 

Courts have well established that any accident, illness, and death, can be compensable since the employee is deemed in the course and scope of employment during the entire trip.  This includes portal to portal (or Door to Door) from the employee’s home.  Hence the employee might be in a car accident on the way to the airport and the injury would be held compensable.

 

Some exception may mitigate or preclude compensability if the loss is due to willful, wanton, or intentional acts.  However, even when such possibility occurs the burden is on the employer to prove the denial with very strong evidence.  Suicide might fall into this category.  However, it can be held compensable when evidence shows that the job travel and pressure caused the depression that triggered the act.

 

Drug, alcohol, or any substance abuse that triggered the loss might be defensible as willful, wanton, or intentional.  But again, corporate policy and very strong evidence must be produced.

 

 

Jurisdictional Problems:

 

There can be jurisdictional issues.   Almost every jurisdiction has extraterritorial provisions in their acts that allow a non-resident employee to present the claim.  It is not surprising to find many employees have chosen jurisdictions with higher benefits or better conditions than their home jurisdiction.  This requires employers to have an all-state endorsement on their workers’ compensation policy.

 

Should the employee have to stay in another jurisdiction for medical care or recovery; controlling, monitoring and processing the claim become large obstacles.

 

In such instances the claim unit should transfer the loss to their local claim office in that jurisdiction.   If the employer or claim unit does not have their own office, consideration must be given to hiring a local adjuster claim service.

 

 

Some Solutions:

 

Begin by reviewing if the travel is necessary; can the project be accomplished from afar?

 

Today’s electronic capabilities are excellent.  Conference meetings online with video conferencing are available, as well as the ability to share screens to view files and records with security for these uses well placed.

 

If physical attendance is necessary consider:

 

  1. Making the time away as short as possible.
  2. Try to avoid employees traveling on weekends and over holiday periods.
  3. Chose the most comfortable mode of travel.
  4. Chose hotels and motels close to the site.
  5. Arrange for gym memberships as most hotel gyms are limited in equipment.
  6. Encourage family contact be done daily. Allow at least 15 minutes.
  7. Ask the location to suggest restaurants that feature healthy food choices.
  8. Designate a company person be a travel planner and coordinator.
  9. Reduce daily reporting time to highlights only.
  10. Encourage sleep time, and arrange some free time.
  11. Allow same or similar pursuits the employee does at home.
  12. Provide all necessary and proper tools to allow the task to be done comfortably and efficiently.
  13. Assigned employees that like to travel for the task.

 

These few items are the beginning of the items needing to be addressed.   Conference with employees, travel agents and clients to establish the travel program.

 

 

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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