It is time to address a topic about causal relation in a workers comp case. This case involves a teacher and school aid in a library, where the desktop computer is being replaced by a laptop. Soon after the switch, both employees begin to complain about neck pain since the height of the monitor on the laptop could not be adjusted from person to person, and extended use was causing some neck pain. The insured wondered if the change to a laptop was causing the neck problems and if these would be considered as workers compensation cases. We discuss the investigation of causal relation here.
- What does the treating doctor say in the medical records?
The most important aspects of this case will be the causal relation statements the physician makes. If the two employees are of the same height and build, why are they complaining of pain, more importantly how is the laptop situated, and how is that causing neck pain? Prolonged sitting in a non-comfortable ergonomic position can lead to strains of the neck, but at a normal desk this should not cause neck pain. Is the laptop screen at eye level or situated down inside the actual top of the desk, where the employees are looking down at the screen? Or is the laptop mounted on top of something where the neck is in a constant extended position? Are other employees complaining of pain or having a hard time viewing the screen of the laptop? WCxKit
It is important to remember in this situation that if an employee comes to an employer and complains of pain and wants to pursue a workers comp claim with supporting medical documentation stating a work injury is present, then it is the employer’s duty to call the claim in to the carrier. The adjuster will make the determination, if the claim is compensable. Certainly more than one employee complaining about the same issue can lead to a more convincing case, but it does not mean it will be automatically accepted. Take pictures of the desk and of these people sitting at the desk as they normally would and send those on to the adjuster as well, so the adjusters can see the setup of the work station and pass that information on to the physician. Being able to actually see the worker sitting as they normally would will help them arrive to the proper decision on the case.
- Does either employee have a history of neck pain from another source?
One of the first questions the adjuster will ask is if either employee has a history of neck pain or prior surgery. This could predispose them to having pain if the neck is positioned in certain ways. Again it does not mean that the laptop setup itself is responsible for the pain. It could be pre-existing post-surgical pain that is the culprit. Prior auto accidents involving whiplash complaints can also contribute to neck pain in the future. Also the employees’ activities outside the workplace are unknown. Maybe one or both of them are engaged in activities that fatigue the neck, and this laptop exacerbated that non-occupational pain. A question about whether the injury could have another cause is part of a normal investigation in just about every workers compensation claim.
- Is the workstation adjustable or not?
If these employees are of different height, can the chair or workstation be adjusted to properly fit them? And if so, are they still complaining about pain? If nothing is adjustable, are other employees of similar builds complaining about the position of the laptop screen? Why or why not? Again, if no other employees are complaining about any problem with the laptop, then go back to these two employees. What is the relationship to each other? Do these two often hang out at the school? Are they in common positions and have similar duties? How long are they actually sitting at this computer and how often are they required to be moving up and around during the day? All of these questions are part of a normal investigation the adjuster will do, and as the employer, try and gather as much of this information as possible to help the adjuster make the proper determination on the claim.
At the same time the claim is investigated by the adjuster, the incidents should be reported to the safety director who should review the workstation design. Consider having an ergonomic consultant review the set up. Ask your TPA or insurance carrier what resources are available for ergonomic consulting. Consider what other equipment could be provided to make the work station more comfortable.
- Has the adjuster performed an IME or peer review yet?
Usually background searches have been completed for prior injuries, and the next thing is to gather all of the medical evidence and set an IME with a qualified physician or occupational medicine doctor to address the causal relation. Is there any objective evidence of degenerative arthritic conditions in the neck that can contribute to this pain? Was an MRI performed, and if so are there any objective results, and, if so, how can they relate to the ergonomics of the workstation? This should all be part of the normal investigation on the claim, and all of these questions should be included in the cover letter to the IME doctor, so that doctor can specifically address these questions with the correct answers, using objective medical evidence to back up the opinion.
- What is the decision–is this compensable or not?
This is the million-dollar question. There are cases like this where these are accepted injuries under workers comp and similar cases where coverage is denied for similar complaints. The lesson here is that no two cases are the same. Maybe one of these employees has no pre-existing condition, and the other one has a prior surgery. This could play a role in which case is compensable and which one is not. It will be up to the adjuster on the file to make a decision on the compensability. Even if the employer disagrees with the decision, there is little to do to swing the case the other way. Let the adjuster do a thorough investigation and stand by the decision. If the worker disagrees with the decision, there are ways to appeal the decision and research to pursue that on their own. That is the choice of the worker. WCxKit
Summary
Ergonomic claims such as this one are going to happen at some point. The key thing to remember as the employer is to do a thorough investigation. Gather as much information as possible, even if it appears to not matter in the final outcome. The adjuster always prefers too much information rather than not enough. Take pictures, and assist the adjuster in any request they have. They will make the proper decision on the claim, since that is an adjuster’s job day in and day out. If, however, you disagree with the decision, make sure to talk this out with the adjuster and the claim supervisor.
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 author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. 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.
©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.
Texas Mutual Insurance Company reported recently that a Travis County district court sentenced Thomas Mikulenka of League City, Texas on workers compensation fraud-related charges.
The court sentenced Mikulenka to three years deferred adjudication and 100 hours of community service. Mikulenka was also ordered to pay $7,221 in restitution to Texas Mutual. (WCxKit)
Mikulenka reported a job-related injury while working as an electrician for IGC Construction, Inc. in Houston. He claimed he was unable to work as a result of the injury, and Texas Mutual began paying income benefits to him.
Meanwhile, Texas Mutual uncovered evidence that Mikulenka was working as a laborer while receiving income benefits.
Investigators call this type of scam double-dipping because claimants collect benefits for being too injured to work when, in fact, they are gainfully employed. Texas law requires claimants to contact their workers comp carrier when they return to work. (WCxKit)
Left unchecked, double-dipping and other workers comp fraud can lead to higher premiums for all Texas employers.
Maryland Woman Sentenced in Nevada Workers Comp Fraud Case
A Maryland woman has been sentenced to 2 ½ years in a Nevada state prison for attempting to defraud her employer’s workers compensation insurer of $20,000 while at a professional conference at the Las Vegas Hilton, according to Nevada Attorney General Catherine Cortez Masto’s office.
Tamara Thompson-Johnson, 45, was ordered to pay $20,000 in restitution, $4,000 in extradition costs and serve 2 ½ years in a Nevada prison after pleading guilty to making false statements to obtain workers comp benefits from her employer, officials say. (WCxKit)
According to officials, Thompson-Johnson claimed she was injured at the Las Vegas Hilton when a vase, dislodged by an intoxicated person, fell from its pedestal. Although she refused medical treatment at the scene, she reported to security that she had been struck by the vase and checked herself into a hospital.
The Nevada General Attorney’s office says Thompson-Johnson hired a lawyer and requested a claim for compensation from the Las Vegas Hilton. Her claim was turned down when surveillance footage of the incident surfaced showing that the vase narrowly missed Thompson-Johnson.
Although her lawyer ceased representing her Thompson-Johnson filed another claim through her employer’s workers comp carrier Travelers Insurance, claiming the vase hit her on the back of her head, neck and back, leaving her disabled. As a result she was paid $20,000 on her fraudulent claim.
According to the Nevada Attorney General’s office, Thompson-Johnson was extradited from Maryland when she did not appear for court hearings in Las Vegas.
She pleaded guilty to one felony count of making false statements or representations to garner benefits and was sentenced in November. (WCxKit)
Along with a 2 ½ year jail sentence, she was ordered to pay $20,435 in full restitution to Travelers Insurance, $4,005 in extradition costs and to reimburse the state $1,000 for costs in connection to the case and was ordered to disclose her conviction to present and future employers and insurers.
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
Most states allow an injured worker to seek care with whatever physician the employee prefers. There are some rules to follow, but as long as the doctor cooperates there usually is not a problem.
But when there is a problem, it is a big problem. When the adjuster is working with a doctor that does not want to cooperate and respond to certain questions, that is a major issue. This issue will affect the injured worker by affecting care and time off of work. It can cause the claim to go to litigation, etc. So something as simple as going to the doctor for an injury can morph into a really big deal. Here are some warning signs that a claim could be heading down the bumpy road. (WCxKit)
1. The physician places the worker off of work with no restrictions and no explanation
This one item frustrates adjusters more than any other. If a person comes in with a hand laceration, and the doctor places them off of work for 4 weeks, how is that legitimate? The worker has another hand that is perfectly fine. Even if the workplace is a dirty environment it does not mean it is risky to be at work with a hand laceration to one hand.
Physicians familiar with workers comp know better. They know if they place a worker totally off of work and do not address restrictions, the adjuster will call. In the world of workers comp, if a worker is on total off work status that means the employee either just had surgery or sustained a major injury.
There are 2 roadblocks to return to work: (1) the employer does not cooperate with creating light duty work for the injured workers, and (2) the doctor totally disables the employee for no good reason. But it depends, if this injury is acute and very severe, then certainly some time off of work is warranted for rest. But the doctor has to explain why. There is nothing the adjuster hates more than to see a back injury, and the worker is totally disabled, but in physical therapy. So the worker is good enough to go to therapy, but not good enough to go do some light desk work for the employer?
Physicians have to explain the diagnosis and work restrictions, and they have to have good objective evidence to support the decisions. The adjuster has the right to demand that the doctor answer specific questions, and if the doctor disregards that, then it can affect the benefits being paid out on the file. So warning sign #1 if there is an off work slip with no real explanation as to why.
2. Makes a return appointment in 3-4 week intervals
A doctor that is monitoring a condition on a comp claim knows the worker’s main goal is to get back to work. So they closely monitor the situation. They schedule to see the injured party at least once every week, if not sooner depending on the injury. A warning sign for a complacent doc is a return visit in 4-6 weeks. That is a long period of time to go without being evaluated. If it is a surgical claim, and this worker is post-surgery, and starting rehab, then this may be ok. But for early on in a comp claim, anything over 7-10 days I would raise an eyebrow. He will drag out the claim costing the employer more money.
3. Everyone at work knows the physician or has treated there
If the injured worker goes to Dr. Smith, and everyone knows Dr. Smith at the shop, and everyone treats with Dr. Smith both for personal medical issues and for workers comp injuries, I would be concerned. Maybe Dr. Smith prescribes a lot of Vicodin for simple injuries. Maybe Dr. Smith disables them from working for a longer time than anyplace else. It could be anything, but if this particular clinic is a place where 85% of your workplaces treat, something is awry. It may not be “illegal” activity, but there is some trend that this doctor does that nobody else in town will do. And that is always cause for concern in an insurance claim.
4. The doctor prescribes narcotics for minor strain injuries
This is perhaps the most popular trend these days. I have observed countless claimants going to the doc for a simple strain and walk out of the clinic with a 30-day RX for Vicodin. That is never a good sign. I am not a physician. I did not go to med school. If Vicodin is needed for 3-5 days, that is warranted. But for an initial visit, for a simple strain, that is not really all that severe, a 30 day supply is unnecessary. RX stands for "prescription."
The cost of the RX is determined by quantity and type of drug. If you look at the work slip and the doctor prescribed Vicodin and Percocet, Valium, and Motrin, that is not acceptable. Not only did this doc over-prescribe by giving the worker 2 similar narcotic drugs (Vicodin, Percocet) but also prescribed Valium, which may or may not even be needed for this particular case. Probably the only RX a simple strain needs is the Motrin. All the other RX’s are warning signs that this doctor is happy to prescribe anything at will, and these medicines are not cheap, and some are not even necessary.
5. Recommend physical therapy (at his clinic) for everything
I recall a while back there was a large occupational clinic that would give anyone that walked in a script for physical therapy (PT). You can have sprained your hand, and you were going to go for 4 weeks of PT. Back injuries, finger lacerations, elbow pain, the answer was PT. They were using PT as a stall tactic, not the way it should be used by reputable doctors. Finally enough people must have stepped up and said “This is ridiculous! You mean to tell me every person that walks in needs PT?”
But this shows a crucial point. Some physicians are also financially tied in to therapy facilities as well as to other testing facilities. So not only do they make money off office visits for evaluating the patient, but they make even more money billing for 12-16 PT visits. Then they will probably see the patient again at the clinic for another evaluation. And maybe more PT is needed. And, before you know it, the cycle begins. In most states this is illegal and unethical. Excessive PT is an indicator that something fishy is going on, and you can use your tools, such as an IME, to deem if more PT is really reasonable and necessary treatment in your given claim. Employers can eliminate the risk of using the wrong PT facilities by using the services of a Physical Therapy Management Company instead of simply working with the least expensive PT network. Physical therapy can be extremely effective in facilitating recovery and return to work when used appropriately. I know, I've been there, done that.
6. Hesitant to refer out to a specialist
This is a warning sign because the physician wants to keep seeing the patient and wants to keep billing the carrier/TPA. As soon as the patient goes to an ortho or other specialist, that patient no longer treats at this clinic. So, the doc has incentive to keep that patient around for a longer period of time. Repeat business is what makes money, and if the patients are continually coming back, that is more money in someone's pocket. So if it has been a few months and the injured party is no better, it is way beyond time to be evaluated by a specialist. And if the treating doctor is not bringing this up, you may need to force the issue.
7. No dictation and very few hand-written notes
The adjuster will always want to see the doctor’s actual notes or transcribed dictation. This is where the adjuster can see exactly what the patient said, what the doctor saw on examination, and what the doctor’s plans are for resolving this medical condition.
If the adjuster requests the notes, and they consist of 1-2 sentences of barely visible hand written scribbles, this is not good. Not only is it worthless to the adjuster, it is worthless in general. There is no info about the patient, about the exam, or about the treatment plan. These doctors are out there. An example of their medical note could consist of the items below.
“Jack feels the same. Continue therapy for 4 weeks and return afterwards.”
As crazy as that seems, that sometimes is it. And the bill was probably $100-$150 for that “exam.” So beware of the doctor that does not dictate or does not have properly typed notes. It does not mean the doctor is necessarily bad, it just means that if the worker continues to treat with this physician, it is going to be a struggle to get information and clarification the longer the claim goes on. Those issues are very important, and if you struggle getting that much needed information, the rest of the claim will be a struggle as well.
Summary
There are good doctors, and bad doctors. There are doctors that care about their patients, and doctors that could care less. There are doctors that write up fantastic notes, and some that jot down a sentence or 2. Physicians are just like everyone else. They all have a unique style. They have good days and bad days. Some have successful practices, and some do not. (WCxKit)
But the bottom line is if a doctor is going to treat the injured worker, in a workers comp situation, then they have to abide by the rules. And if they choose not to do so, it is going to complicate the claim one way or another. Use the above warning signs to evaluate current claims for rough roads ahead.
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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
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
A Lorry, Great Britain, driver whose career was ended after he badly broke his wrist in a workplace accident recently received compensation from his employers.
According to a report from Hazards Magazine, Peter Stocks, 63, from Newton Alfreton in Derbyshire is now unable to drive HGVs after an accident meant he had to have a pair of operations on his right wrist. He was told he will never be able to lift with the arm and that he will need a third operation in the future.
While making a delivery for manufacturer Recricel, based in Alfreton he was injured as he went to move 150 kilos (330 pounds) of foam from his lorry. When he pulled on string holding the foam together it snapped and he fell backwards landing heavily on his wrist.
Stocks was forced to take three months off work and though he has returned he can only drive smaller vehicles.
Following the accident he contacted his trade union, Unite, which instructed its lawyers to pursue a claim for compensation.
Lawyers argued that the foam should have been secured in a safer fashion. Recricel admitted liability and settled the claim out of court for £23,000 ($35,700).
"All my life I've driven large vehicles like HGVs or JCBs. It was quite a shock to never be able to do that again; it makes me worried about my employability in the future,” Stocks commented.
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, contactInfo@ReduceYourWorkersComp.com.
Alberta labour groups are calling on the province to do more to prevent a growing number of workplace fatalities, according to a report from The Canadian Press.
The call for action comes shortly after an Edmonton worker was killed by a steel beam that collapsed at an Edmonton jobsite. (WCxKit)
The employee's death marks Alberta's 14th workplace fatality this year, which is four more than in all of 2010.
Construction worker Ali Fattah says nobody seems to be taking the situation seriously so it is becoming more dangerous.
He says a lot of the accidents are preventable.
Barrie Harrison, with the Occupational Health and Safety board, is among those at the provincial level working to prevent what he admits are too many injuries and fatalities in an inherently dangerous construction sector.
Harrison cites worker and employer safety education as a crucial part of the provincial safety strategy. He also points to the hiring of new OHS inspectors and targeted job site inspections that are intended to make jobsites safer.
While the Alberta Federation of Labour agrees education is part of the solution, it feels what the province is doing isn't enough.
The labour group's Gil McGowan says in Alberta the new inspectors only replace the inspectors who were laid-off during the Klein years, and employers receive advanced warnings about the targeted inspections, which defeats their purpose.
He believes those factors contribute to the province lagging behind all others when it comes to safety.
McGowan also blames the high workplace fatality numbers on the province ignoring warnings, and not taking advantage of a lull in development to adequately prepare for safety issues related to our province's returning growth. (WCxKit)
McGowan noted further tragedies could be averted if the government puts what he believes is just talk into action specifically more unannounced inspections, and a more aggressive approach to prosecuting employers who put their workers at risk.
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. He is co-author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. 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
The former owner of the country’s largest asbestos abatement training school has been sentenced to prison after having fled the United States after her trial in 2008.
According to the Environmental Protection Agency, U.S. District Judge Nathaniel Gorton sentenced Albania Deleon to 87 months in prison to be followed by 3 years of supervised release. She was ordered to pay more than $1.2 million in restitution to the Internal Revenue Service and several hundred thousand dollars to AIM Mutual Insurance Company. (WCxKit)
In 2008, Deleon was convicted of charges including selling training certificates to thousands of illegal aliens who had not taken the mandatory course. She allegedly placed these unqualified people in temporary positions as certified asbestos abatement workers in public buildings.
From approximately 2001 to 2006, Deleon owned and operated Environmental Compliance Training (ECT), a certified asbestos training school located in Methuen, Mass. ECT normally offered training courses on a weekly basis at its Methuen offices, however, many of the recipients of the certificates never took the required course.
Instead, with Deleon’s knowledge and approval, ECT’s office employees issued certificates of course completion to thousands of individuals who did not take the course. These individuals filed the certificates with the Massachusetts Division of Occupational Safety in order to be authorized to work in the asbestos removal industry. Many of the recipients were illegal aliens who wished to skip the four-daylong course so that they would not forego a week’s pay.
Since ECT’s training course records were subject to inspection, Deleon sought to cover up ECT’s practice of issuing certificates to untrained applicants by having the applicants sign final examination answer sheets that already had been completed and graded, which she maintained in ECT’s files. Based on the evidence at trial and information supplied by the Division of Occupation Safety, ECT issued training certificates to more than 2,000 untrained individuals.
Deleon is the fifth environmental criminal captured since the EPA fugitive website was launched in December 2008. (WCxKit)
“Today’s sentence marks the final chapter in bringing Albania Deleon to justice,” said EPA’s Cynthia Giles. “Committing environmental crimes to make a profit that put workers and our communities at risk [carries] serious consequences.”
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
A recent report looks at the dangers faced by both children living in close proximity to battery manufacturing units on the developing world and workers who work in such facilities.
A new study reported in the Journal of Occupational and Environmental Hygiene claims children living close to battery manufacturing units in the developing world were 13 times more apt to have lead traces in their blood than their U.S. counterparts.(WCxKit)
Health officials point out that lead poisoning damages the central nervous system, the kidneys, and the cardiovascular reproductive systems, along with leading to low hemoglobin percentages. In children, it can retard learning, make them hyperactive and even lead to violent behavior.
The researchers, using data from studies published between 1993 and 2010, also discovered that battery industry workers in the developing world had three times higher blood lead levels than their U.S. counterparts.
“Children and workers in developing countries face significant risks of lead poisoning, which can cause lifelong health problems,” commented Perry Gottesfeld, executive director of Occupational Knowledge International (OK International) and study author. “Without major improvements, we expect that lead poisoning cases will continue to increase as the industry grows.”
The battery industry uses approximately 80 percent of the global lead output. The demand is being led by huge demand for batteries in vehicles, solar power systems, cellular phones and for back-up to power supply.(WCxKit)
According to The World Health Organization (WHO), 120 million people are over-exposed to lead – approximately three times the number infected by HIV/AIDS – and 99 percent of the most severely affected live in the developing world.
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 killing of a convenience store employee in Saskatchewan in June has spurred the provincial labor federation to support a petition to change regulations for retail employees working alone, according to a report from the Canadian OH&S News.
Many delegates attending the Saskatchewan Federation of Labour's (SFL) annual Occupational Health and Safety Conference recently strongly supported and signed a petition calling for the introduction of "Jimmy's Law" into the provincial legislature, says Larry Hubich, president of the SFL. The proposed law is named after Jimmy Wiebe, who was murdered at a gas station convenience store on June 20 in Yorkton. (WCxKit)
It would require employers to schedule two employees to work together between the hours of 10 or 11 p.m. and 6 a.m. or provide protective barriers between lone workers and the public.
The incident that prompted the petition occurred in the early morning hours. Members of the Yorkton RCMP received a report of a man who had been found deceased in the Shell Canada convenience store by a customer, says Corporal Rob King, a spokesman for the Saskatchewan RCMP division. Four days after, King says, the Yorkton RCMP detachment charged Kyle Furness, 20, with first-degree murder in connection with the homicide of the 50-year-old worker, an employee of the store for more than 10 years.
Jimmy's Law is modeled after similar working alone regulations in British Columbia which were introduced in 2008, but have not yet come into effect because of the complexity of the issue, according to Megan Johnston, a spokeswoman for WorkSafeBC. That year, however, BC introduced a separate pay-then-pump requirement following the death of a young gas station attendant.
"Grant's Law" – named after Grant De Patie, who was dragged to his death while trying to prevent the theft of gas from a station in Maple Ridge, BC – requires mandatory pre-payment of fuel at all gas stations in BC, Johnston says.
Wayne Hoskins, president of the Western Convenience Stores Association (WCSA) in Surrey, BC, says it's important to note the distinction between mandatory pre-payment of gas and the requirement for multiple workers or barriers. "While Grant's Law was well-intended, it refers to outside, or ex-store, and not in-store coverage," Hoskins explains.
In British Columbia, the working alone regulations – known as the Late Night Retail Safety Procedures and Requirements – consist of an engineering control (barrier) or administrative control (extra staff), Johnston says. Hoskins says that a third option has also been proposed: additional training, testing and certification. This option, a combination of both engineering and administrative controls, will be presented to WorkSafeBC's board of directors in October. (WCxKit)
Ontario is another jurisdiction considering a mandatory pre-paid policy for gas stations following a recent gas-and-dash incident. A gas attendant Hashem Rad, 62, was struck by a vehicle that took off with unpaid gas at a Petro-Canada station in Mississauga, Ontario. Rad was taken to hospital, where he succumbed to his injuries the following day.
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.
Most workers' compensation managers do not think twice about the workers' comp claim for the employee stung by a bee or bitten by a flea. It is usually a first aid only claim or at worse, a medical only claim, right? Wrong! While the majority of claims for biting and stinging insects or spiders (spiders are not insects, they have 8 legs and are technically classified as arthropods) will be minor, there can be some nasty injury claims, especially from spider bites or multiple bees/wasp stings.
Employees that work outside like construction workers and landscapers are the most likely to encounter a bite or a sting, but warehouse workers and others who work around products or inventory where items sit stationary for a while can come into contact with insects and spiders. While office workers, retail employees, and other indoor occupations have less exposures to bites and stings, the risk manager needs to be sure the people in pest eradication do the job, or even office workers can encounter a bite or a sting. (WCxKit)
People often refer to insects and spiders as poisonous, but all insects and spiders are poisonous only if they are eaten. What they are is venomous. Insects and spiders normally inject a venom into the victims either through a bite or a sting. It is the venom that creates the work comp claim, not the actual bite or sting itself.
Rarely are bites or stings serious enough to require hospitalization or are deadly, but there are known cases where people with weak immune systems, elderly or very young children have died from bites or stings. Spider bites create the most work comp claims, especially bites from brown recluse, black widow, brown widow, and hobo spiders.
When a venomous spider bites an employee, the employee will immediately know they have been bitten (has been described as feeling like an unannounced flu shot). The symptoms usually start to develop within a few minutes, but can take hours or days depending on the amount and type of venom. Symptoms will often include pain, burning sensation, itching and swelling. Other symptoms can include vomiting, dizziness, cramps, diarrhea, rash and breathing problems. Anxiety can be a side effect.
An example of a spider bite claim is the truck driver at a warehouse in Washington State assisting in loading the trailer. A few hours later while driving through Idaho, he felt what he thought was a hornet sting on his leg, as he observed hornets in the warehouse. He pulls over at the first opportunity and checks his leg. He sees a small red spot. That evening he checks the spot and it has grown to the size of a quarter. The second evening the spot is the size of a golf ball. When he woke up in pain on the third night, he had a baseball size knot on his leg that was beginning to split open. He goes to a hospital emergency room where it is surgically necessary to remove the baseball size tissue. The trucker is treated for systemic toxicity. He is advised he has been bitten by a hobo spider (located in the northwestern USA). And if he waited another day for treatment he could have died. The tissue around the wound continued to die, requiring daily debridement and wound cleaning for the next couple of weeks, followed by less frequent debridement and wound cleaning. Once the wound stabilized, the trucker had to undergo a skin graft and the time necessary for healing and a total medical expense of $15,000 with 3 months of indemnity benefits.
While a venomous spider can create a serious wound, a single hornet does not. The only trouble is when an employee gets stung by a hornet, it is usually not just one hornet. The whole hive can become agitated resulting in the poor employee getting multiple stings. A Florida landscaper was trimming an overgrown hedge when the hedge trimmers went right through the center of a hornet hive. The landscaper received multiple hornet stings. Having been previously stung by a hornet, the landscaper had an almost immediate allergic reaction including difficulty breathing, difficulty swallowing, dizziness, and fainting. He was rushed to the local hospital where a tube was placed down his throat to allow him to breathe, and he received an antihistamine and a corticosteroid.
For the risk manager, there are steps that can be incorporated into the overall safety program to reduce (but not eliminate) the risk of bites and stings. All buildings, whether an office, a factory or a warehouse, should be regularly treated by trained pest control personnel. Any openings or crevices in older buildings should be plugged, caulked or sealed to prevent insects and spiders from coming in from the outdoors. Employees working in warehouses or other storage facilities where spiders might live should be provided gloves when handling of merchandise is required. (WCxKit)
Many bites and stings can be avoided by teaching the employees to be vigilant. Also, the employees should never place a hand where it can not be seen (underneath an item to be picked up for instance) without checking for insects and spiders. If the employee is going to be often exposed to insects and spiders, for example like the landscaper, proper clothing and gloves should be provided to protect them from exposure to bites and stings. When an employee is bitten, the best thing to do is call Nurse Triage immediately to determine what type of care is needed – emergency care or occupational clinic. Of course, for those employers with an on-site clinic, the employee will immediately be taken to the clinic for assessment and care.
Author Rebecca Shafer, JD, President of Amaxx Risks 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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
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.
Often overlooked in the on-going battle to control workers compensation cost is the cost of prescriptions. Pharmacy Benefits Managers (PBM) offer the self-insured employer, insurer or third party administrator a way to manage and control the cost of drugs. While PBM provide a cost savings by obtaining a discount on the cost of drugs, the good PBM goes a lot further.
The PBM that will provide the best results is the one that keeps track of not only the cost savings provided, but also the utilization of prescriptions, especially narcotics. The better PBMs will alert the medical provider and adjuster when there is over-utilization of drugs. (WCxKit)
The PBM you select should have a national network covering most of the 70,000+ drug stores in the United States. The PBM should have a working relationship with the three major drug store chains which include CVS, Walgreens and Rite-Aid, as well as the local independent drug stores.
The effectiveness of the PBM can be judged by three different criteria which are the rate of use by the employees, the ease of use for the adjuster, and their technology interface ability.
The penetration rate is a measure of how extensively the employees use the pharmacy program. The PBM will often mail the employee a pharmacy benefit card with a cover letter on the pharmacy benefit card use. Most employees will opt to use the PBM card rather than out of pocket and then having to seek reimbursement. The adjuster should have the ability to suspend the use of pharmacy benefit card when the claim is denied or concluded.
The PBM should coordinate the prescription with the employee, the pharmacy and the medical provider without involvement of the adjuster. The easier the process is to use, the less the involvement of the adjuster. The better PBM will make the process totally seamless resulting in no involvement for the adjuster, while the adjuster can be assured the cost of the prescriptions and the utilization of the prescriptions is being properly controlled.
The PBM should provide the user of the service with the ability to review on-line all transactions and to obtain all necessary management reports. The technology interface should allow you to quickly know and understand the prescription drug usage of any employee. This will allow you to identify both the high cost employees and the doctors who prescribe the medications.
There are numerous ways the PBM can control cost. Some of the techniques used by PBMs include: (WCxKit)
-The use of generic drugs wherever substitution for patent drugs is permitted.
-A comprehensive, standard formulary specific to workers compensation injuries.
-A pre-negotiated price for each drug in the formulary.
-The ability to provide home delivery for employees who are unable to pick-up the prescribed drugs.
-Mail order services for maintenance drugs.
-The ability to approve or deny the “off-label” use of a drug.
-The ability to prevent consumption of drugs faster than manufacturer recommendations.
-The prevention of multiple, overlapping prescriptions from multiple doctors.
-The prevention of multiple pharmacies filling the same prescription.
-The prevention of filling non-injury related prescriptions.
The use of a PBM is a great way to reduce the cost of prescriptions and to lower their cost impact on your workers compensation program. To learn more about PBMs and how you can utilize their services to reduce your workers compensation cost, read the chapter on Implementing a Pharmacy Benefits Management Program in our new 2012 edition of Manage Your Workers Compensation Program, Reduce Costs 20-50%. To obtain your copy, please contact us.
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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
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.
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