4 Ways to Minimize Workers’ Comp Indemnity Exposure

When dealing with cost containment in workers’ compensation, focus is often given to the medical issues in claims management.  While medical expenses continue to drive costs in all programs, forgetting about the indemnity aspects of claims can lead unmanageable costs and reduce the effectiveness of overall cost containment measures.  Now is the time to examine the indemnity side of your claims practice to maximize the effectiveness of your workers’ compensation program.

 

           

Average Weekly Wage

 

As a general rule, a majority of indemnity benefits in any jurisdiction are driven by the average weekly wage (AWW).  The AWW is often described as the fair estimation of an employee’s weekly wage.  Knowing the law is the first step in correctly calculating this wage.  Other factors include:

 

  • Status of the employee—whether they are a full-time or part-time employee;

 

  • Other compensation such as bonuses tips, gratuities, employee benefits and other fringe benefits; and

 

  • The nature of one’s employment. Seasonal and construction workers often receive preferential treatment when calculating an AWW due to the fact weather impacts their ability to work.

 

 

Minimizing Your Indemnity Exposure

 

When an employee is off work or working at a reduced wage/number of hours, they are entitled to receive wage loss benefits.  While most jurisdictions limit the number of weeks benefits such as temporary total (TTD) and temporary partial disability (TPD) are paid, failing to return the employee to their same pre-injury status can have undesirable consequences.  These include:

 

  • Payment of permanent total disability (PTD) benefits; and

 

  • Retraining programs. During this time, insurance carriers are required to not only pay for educational instruction preparing the employee for a new career, but they can also be on the hook for costly miscellaneous expenses and additional periods of wage loss benefits.

 

 

Alternatives to Paying Wage Loss Benefits

 

When evaluating the indemnity aspects of your claims program, alternatives to costly benefit exposures should include:

 

  • Aggressive Return to Work: When an employee is injured on the job, the employer’s goal is to return the employee to work as soon as the worker is medically able to return. Transitional duty (TD) enables injured workers to stay in the work world while they recover from the injury.

 

  • Work Hardening: This interdisciplinary approach focuses on a number aspect of the employee.  It can include an assessment of their physical abilities, physical therapy and rehabilitation via simulated workplace activities.  The process involves taking a deconditioned employee who has been out of the workforce and redeveloping their neuromuscular and musculoskeletal functions, which includes one’s strength, power and endurance to return to work.  Professionals involved in this process can include physical therapists, other medical professionals and occupational counselors.

 

  • Vocational Rehabilitation: Employees suffering from the effects of a work injury are generally those who may be precluded from engaging in their “usual and customary” occupation.  This threshold question is typically a low standard and should encourage most defense-oriented stakeholders willing to provide these benefits versus engaging in costly litigation.  A vocational rehabilitation expert assists the injured employee with a number of issues.  This includes explaining medical procedures and options, counseling them on return to work issues, educating the employee on re-employment issues, including work restrictions, and providing guidance on job search matters.  A majority of state workers’ compensation acts preclude this expert from being an advocate or legal representative for the employee.

 

  • Independent Medical Examinations (IME) and Functional Capacity Evaluations (FCE): These procedures can be used separately or together to mitigate indemnity exposure.  While the defense is able to select their experts to perform an IME or FCE, it is wise to select someone who has a sound professional reputation and able to state their findings within a reasonable degree of medical or vocational certainty.  Timing is key and many jurisdictions limit the use of these events.

 

Conclusions

 

Proactive claims management teams and stakeholders need to be proactive in their approach to program cost management.  While a focus on the medical side of claims is important, failure to do the same regarding indemnity benefits can be harmful.  When controlling the indemnity portion of a workers’ compensation claim, there are many opportunities to implement effective and cost-efficient services to accomplish one’s goal.

 

 

 

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/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

How To Double Your Odds of Poor Workers’ Comp Outcome

What do these factors have in common: education level, fear of being fired, tenure on the job and English language proficiency? All help determine outcomes for injured workers.

 

While you may not be able to change all the factors that influence outcomes, you can vastly help improve them. Understanding how certain issues affect recoveries and emphasizing best practices can get your injured workers back on the job faster and save your company money.

 

 

Education, Fear of Being Fired, Language

 

According to recent research studies workers with less than a high school education had poorer return-to-work rates than high school graduates, and the gap was more pronounced compared to those with secondary degrees. Injured workers concerned about being fired had worse outcomes and were more likely to hire attorneys, than those without such concerns. Injured workers whose main language was not English were also more likely to have poorer outcomes than those whose primary language was English.

 

The latest research also shows a correlation between outcomes and the employer’s response to the worker’s initial report of injury. The following were associated with poor outcomes:

 

  • Not being supportive.
  • Blaming the worker for his injury.
  • Expressing anger toward the injured employee.
  • Not believing the person was injured.
  • Telling the injured worker not to file a workers’ compensation claim.

 

When more than one of these responses was present the duration of days out of work was 2 times more than for workers who did not get a negative response.

 

 

6 Steps to Improve Outcomes

 

A lower education level, shorter time on the job and difficulty understanding English all play a part in an injured worker’s concerns about being fired. That particular fear is a strong indicator of when and how well an injured worker will recover.

 

To combat that concern, employers need to adopt many of the practices associated with an advocacy based claims model. Simply put, it means treating the injured worker as you would treat a customer. In some cases that might mean changing the culture of an organization, while in other companies it may involve just tweaking and ensuring certain practices are followed. Building trust with the injured worker is key.

 

Here are steps to help:

 

  1. Early contact. Both the supervisor and claims handler should communicate with the injured worker as soon after the injury as possible. Multiple studies show the benefits of this to both the injured worker and the employer. Average claim costs, claim duration and medical costs are all significantly lower when efforts are made to reach out early to the injured worker. The contact should take into consideration the injured worker’s preference; older workers may appreciate a phone call and/or letter while younger employees may prefer text messaging. Those whose primary language is not English should be contacted by someone who understands and speaks his native tongue. The message should be positive and show concern and caring. The employer should express genuine interest in the employee’s well-being.

 

  1. Constant communication. Injured workers often feel isolated the longer they are away from the workplace. By maintaining regular contact, the employer can help ensure the claim is progressing, answer any questions, and keep the injured worker up to date on the latest workplace happenings. Injured workers need to feel they are still part of the organization and should know the employer looks forward to his return. If nothing else, the social interaction itself can help make the injured worker feel less isolated.

 

  1. Assign specific contacts. Where possible, a nurse or other medical person should interact with the injured worker to discuss any medical issues. A nurse or claims handler should stay in touch with the injured worker to discuss various aspects of the claims process, including return to work.

 

  1. Early access to medical care. Getting medical care to the injured worker as soon as possible not only helps speed his physical recovery, but can also help alleviate his frustrations. It lets him see the process is focused and moving along, rather than being stuck in bureaucracy. Many larger companies have clinics at the work site. Those that don’t may be able to take advantage of companies that send medical providers, such as physical therapists to the work site. Telemedicine is another option companies are increasingly looking to help their injured workers.

 

  1. Coordinate care. Injured workers who have risk factors such as lower educational levels, short-term tenure with the employer, or poor English skills should be targeted for coordinated interventions. The employer, claims handler, and any others involved should hold discussions with the injured worker to ensure they are all on the same page and kept up to date.

 

  1. Beyond the denied claim. A claim denial should not be the end of the communication, as that can result in litigation. Instead, someone should discuss the reasons for the denial with the injured worker. Also, the injured worker should be told about other options, such as general healthcare. A nurse or someone with understanding of the claim process and the healthcare system should contact the injured worker to discuss his options.

 

 

Summary

 

There are myriad reasons why workers’ compensation claims deteriorate and have poor outcomes. Research is increasingly uncovering many of them. One thing for certain is that injured workers who feel valued, supported and who understand and engage in the process are more likely to recover quicker and get back to work sooner. The system does not need to be adversarial. Employers willing to treat injured workers with respect and support will create a trusting atmosphere and have lower workers’ compensation costs.

 

 

 

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/

 

©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 Requirements For Employees Injured At Work

We tend to think of workers’ compensation cost containment programs as an endeavor best left to the employer, and while the employer must design the program, the employee has a role also.

 

 

10 Requirements For Employees Injured At Work

 

  1. Know what to do if they are injured on the job
  2. Sign an acknowledgement of these responsibilities
  3. Seek medical care from the employers medical provider (or their own primary treating physician if allowed by law)
  4. Keep the employer informed and updated of their condition/status
  5. Complete forms required by the employer truthfully.
  6. Attend weekly meetings to keep the employer informed of their condition and any obstacles to return to work full duty
  7. Participate in transitional duty (this must be a condition of employment).
  8. Attend all medical and rehabilitation appointments.
  9. Return to work in either transitional duty or full duty as soon as medically able.
  10. Other tasks as required by the employer and allowable by law such. Each state is different.

 

Remember, communication is the most powerful to gain buy-in and bring employees on board with participation in your workers’ comp management program.

 

 

Main Communication Message

 

“Our employees are our greatest asset, we are sorry one of our employees was injured, and we need your help getting them back to work.”

 

 

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.

11 Simple Ways to Make Return to Work Part of Corporate Culture

It is critically important that management makes return-to-work programs part of the corporate culture. The employee’s expectations should be that if/when they go out on workers’ compensation, they will return to work immediately in some form of transitional work capacity. What are a few of the tools that can be used to make return to work part of the culture?

 

 

 

11 Simple Ways to Make Return to Work Part of Corporate Culture

 

  1. Talk about RTW in a positive way- never badmouth the jobs, the participants or the concept.
  2. Make RTW a positive experienceby finding productive tasks or jobs. Never have transitional duty jobs be punitive.
  3. Demonstrate the costof NOT doing it, and the savings OF doing it by showing it to employees in terms they understand and management in terms understood by executives.
  4. Incorporate RTW in all policies and procedures such asMedical Policy and/or Leave of Absence Policy, Wellness Policy. 
  5. Make it amandatory requirement of employment – so all employees expect to be treated in a similar fair manner.
  6. Holdweekly meetings to discuss obstacles to return to work – keeps employees “connected” and employers stay on top of the worker’s abilities.
  7. Send Get Well Cards for colleagues that are injured. Perhaps include a gift card to Papa Johns’s or a local restaurant or one that delivers with the card.
  8. Maintain the rules strictly and make them standardized.
  9. Show supervisors the cost savings and benefits (they have less retraining, for example).
  10. Don’t hesitate to use vendors that do on-site work hardening and RTW coaching.
  11. Include them in workplace activitieswhile they are recovering. Don’t forget to include them in meetings, events while they are injured. Once they are out of work they can easily become alienated and lose social contacts, so continue to include them in workplace activities even if they are doing a partial schedule while they work toward full duty.

 

These are just a few ways to make RTW part of your corporate culture. Start now, and take small steps. Stick with the program and gradually it will be accepted.

 

 

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.

 

5 Reasons Your Employee WANTS to Return to Work

There can often be a negative connotation for those that are injured at work.  After dealing with thousands of claims adjusters can get jaded that claimants are up to no good and are only looking for a free paycheck.

 

A handful of bad apples can ruin it for everyone, but for the most part people just want to get back to their normal routine.  When injured, workers are usually in pain, receiving less money than they are used to, and traveling back and forth to doctor offices for examinations and therapy.  A revolving statistic may state that up to 10% of claims filed are not necessarily legitimate.  That leaves 90% just looking to heal and get back to pre-injury status.  Some injured workers even heal or return to work quicker than expected.  But why?  It seems obvious, but let’s explore some of the reasons in more detail:

 

 

  1. Loss of income

 

The biggest factor for an injured worker wanting to go back to regular duty is the income they receive.  There aren’t many people out there than can get rich off of receiving work comp pay.  Typically they receive a percentage of the income they are used to receiving, ranging from 60% to 80% of their net income.

 

Even in dual income families, this loss of income can be substantial, especially those that are living from paycheck to paycheck.  Do not be surprised when your injured worker is in a rush to get back to normal.  As long as a qualified doctor releases them to work with no medical restrictions, then you should be all set.  Of course this will vary on the injury.  I have handled cases when the claimant is adamant about making the doctor return them to work, and the physician will indicate in the notes that they are just retuning the patient back to full duty because that is what the patient requests.  You have to be very careful in this situation to avoid further injury, so if this should happen review it on a case by case basis.

 

 

  1. The claimant is bored if they are totally out of work and sitting at home

 

Sitting at home in an empty house with nothing to do can be even worse than light duty.  There is only so much daytime TV one can stomach.  It is no coincidence that most plaintiff law firm commercials run during the morning and afternoon, when injured workers would be home while disabled from work.

The vast majority of workers like working, or at least need to work for income, and even though sitting at home for weeks sounds great it is indeed not so great after a while.  It’s not like they can do whatever they want.  In fact this is what will land most workers in trouble, because once boredom creeps in they start to get outside and do something to take their mind off of being at home, and if you have surveillance on that certain day this can land a person’s case in suspension or denial due to them breaking their medical restrictions, whether it be on purpose or not.  I have seen a lot of injured workers say they just cannot sit at home any longer, and want to return to work.

 

 

  1. The claimant hates being involved with the adjuster and the carrier/TPA

 

Most claimants are new to being on work comp.  They have no idea what they are supposed to do, they do not like treating with the occupational doctor, and they hate sitting around and waiting on a paycheck to come in the mail that may take weeks to come once the investigation is complete.  In fact, I have had some workers that have had a legitimate work injury decline filing a claim under work comp, and choose to cover the bills from their medical care another way.  This is especially true if they have had a messy comp case in their past.  They are so jaded about how the process works that they will avoid it at all cost.  This is not necessarily the right thing to do, but the overall choice is up to the worker.  Realistically the carrier is not going to try and talk the injured worker into filing the claim.

 

 

  1. They think that a work comp case is going to be a litigation nightmare

 

Taking this one step further, some workers have heard horror stories about being on work comp, and being embroiled in a years-long litigation battle, with mounting attorney fees and a life filled with misery.  Sure this could be true sometimes, but not as much as the general public thinks.  Despite what the adjuster may tell them, we can’t make the worker pull the trigger and file the claim.

 

 

  1. The worker just heals faster than expected

 

Some people just heal better and quicker than others.  This is due to conditioning, genetics, the type of injury, the location of the injury, the severity of the injury, and so on.  If the adjuster thinks that it can take 6-8 weeks to heal from a back strain, and the worker is released to full duty in 2 weeks, this doesn’t mean that they are just in a rush to get back to gainful employment.  If the medical checks out, and the treating doctor signs off on it, then so be it.  Full duty is full duty. Adjusters should not hold this against a person just because they heal better or quicker than we thought they would.

 

 

Summary

 

There are many more factors to add to this article, but in my opinion the 5 above are the most tangible. This should prove that all claims shouldn’t be placed in the “bad” category.  Put yourself in the shoes of your injured worker.  Their money is not the same, they are in some sort of pain, their job tasks have changed, they are dealing with the adjuster and the carrier/TPA, etc.  They are in uncertain waters.  The common response to that is to get back to whatever they think is their normal life as soon as possible, so they can put this all behind them.

 

 

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.

 

4 Communication Strategies to Lower Workers Comp Costs

Here’s a sobering reality: most of the world does not understand the workers’ compensation system. Unless they themselves or a family member has sustained an occupational injury, most people haven’t the foggiest idea how the whole process is supposed to work.

 

That means it’s up to us to make sure an injured worker gets a clear understanding. Why? Because confusion and misunderstandings about the system drive up claims costs. People are afraid and don’t know how or when they will receive medical care or another paycheck. The way the system has historically worked clearly does not help the situation.

 

Think about it. There may be notifications from the claims adjuster, claims administrator, third-party administrator, insurer, pharmacy benefit manager, employer, medical provider or the case manager; with questions or information about the DOI, future medicals, impairment ratings, TTD/TPD/PPD, MMI, or FCE. Add to that a few comorbidities and biopsychosocial risk factors and it’s no wonder some cases go south.

 

 

Effective Communication

 

Ideally, you want the injured worker engaged in the recovery process so he’s motivated to get back to function and work as quickly as possible. Building trust is key. Training supervisors and managers on communication skills can go a long way to preventing animosity; i.e., delayed recoveries, litigation, etc.

 

 

Words

 

What you say has a big impact on how an injured worker responds to the workers’ comp process. You want to avoid creating animosity. Some tips on what to say (or not) include:

 

  • Don’t start sentences with ‘you.’ You don’t want to make accusations against the injured worker. Even if that is not the intention, sentences that start with ‘you’ may be perceived that way.
  • Avoid ‘never’ and ‘always.’ You want to be honest with the injured worker and show you are willing to work with him. Such definitive words may prematurely end a discussion, or provide false hope — neither of which will help.
  • Be positive. Use words that exude optimism. Let the worker know her job is not in danger and you are expecting and looking forward to her returning to work as soon as possible.
  • Use clear and concise language. The person speaking with the injured worker should have his message set and know what and how he plans to say before the conversation starts.

 

 

Tone/Attitude

 

It’s not only important what you say, but how you say it that matters. As the old adage goes, you catch more flies with honey than vinegar.

 

  • Be supportive. Ask the injured worker how he is doing, not only with his injury but overall. Find out if he’s experiencing any particular hardships with which you might be able to help, such as speaking with family members about the workers’ compensation process. Indicate you are interested in him as a person. Also, talk about what the person can do, rather than what he can’t due because of the injury.

 

  • Be friendly. Be polite and nice. Smiling when you speak is a trick used by radio announcers, as it affects how you come across to others.

 

 

Listen

 

Injured workers are often confused about their injuries and how the workers’ compensation process works. Give them a chance to say and ask what they want. Be open to hearing the injured worker’s point of view. Be an active listener by asking clarifying questions and paraphrasing what the person has said to make sure you understand.

 

 

Frequency

 

It’s imperative to keep the injured worker engaged throughout the claims process. That means maintaining regular communication in whatever forms best meet the injured worker’s needs, whether it be via phone, text, email, letter, etc.

 

The first contact should be made immediately following an injury, to show the person you care and are there for them. A phone call is typically best at this stage, as it provides for interpersonal communication. It’s also important to let the injured worker know what to expect throughout the claims process. Some organizations have developed brochures that clearly and concisely explain the workers’ compensation process. At the least, you can verbally tell the worker what he can expect.

 

Ongoing communications should focus on informing the injured worker about the status of his claim, in addition to continuing to show your support and concern. Also, convey the message that the person is still a valued employee. Update him on work-related goings on and send him any newsletters or other communications so he feels he is still part of the workplace. A get-well card signed by coworkers also helps them feel a part of the company.

 

It’s important that all communication with the injured worker is consistent. You should work with the claims handling team, providers, and others to ensure you are all on the same page.

 

 

Summary

 

Fear, misunderstandings and hurt feelings are prime drivers of adversarial relations between injured workers and employers. By working on communication skills and training all who play a part in the claims process, organizations can ensure their injured workers are on board with their recoveries and return-to-work processes.

 

 

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.

Examine 3 Common Disincentives to Return to Work

Understanding the psychology of human nature is an important component to reducing workers’ compensation program costs.  While most employees are genuinely interested in gainful employment, various collateral sources of benefits in the form of workplace perks can promote higher workers’ compensation costs.  In order to run an effective program, it is important for interested stakeholder and employers to evaluate the financial incentives they provide employees to determine possible detriments to return-to-work and reducing costs associated with workers’ compensation matters.

 

 

Common Examples of Collateral Disincentives

 

Employers offer a variety of different benefits to employees to boost morale and encourage employment.  Some common incentives that can drive higher workers’ compensation costs include:

 

  • Salary Continuation Programs: Under these programs, an employer may offer employees suffering any disability, including one resulting from a work-injury, 100% salary or partial wage replacement greater than what they would receive under a workers’ compensation wage loss rate.  In a majority of these instances, benefits are capped at after period.  Studies demonstrate these replacement programs result in longer disability periods for employees suffering work-related disabilities and injuries.

 

  • Disability Benefits: Many employers offer employees short- and long-term disability benefits.  These benefits are paid instead of salary for disability.  While some employers require employees to subsidize the cost of these benefits, others are willing to pay the price.  Depending on the policy language, an employee suffering a workers’ compensation claim can receive a “windfall” recovery by receiving disability benefits under a private program, plus wage loss benefits under workers’ compensation.

 

  • Supplemental Wage Replacement: Some employers offer supplemental pay for employees when they are off of work.  While this is often used in the correct manner, it can be common for employees off work due to a workplace disability to game the system and prolong their recovery.

 

In many instances, these well-intended incentives can have perverse outcomes.  This is why all parties interested in reducing costs in their workers’ compensation program should evaluate the effectiveness of rewards and fringe benefits on a regular basis.

 

 

Reducing Work Comp Costs and Promoting Efficiency

 

Employers offering generous rewards and other forms of financial compensation to employees should be prepared to expect the worse.  Human nature dictates a certain percentage of the employee population will “game the system,” other otherwise delay recovery.  Concerns regarding a slow recovery should be monitored closely.

 

Employer representatives and other interested stakeholders should pay close attention to employee benefit programs and workers’ compensation costs.  Action should be quick and decisive if it is suspected an injured worker is delaying their return to work.  If this is the case, the following tools can be used to correctly ascertain the true medical status and workability of an employee:

 

  • Independent Medical Examination (IME): There are limitations on when and how an IME can be used.  In many jurisdictions, this type of examination can only be used once.  Other jurisdictions allow for additional visits by a defense medical expert if there is a documented change in condition, or need to properly assess restrictions or maximum medical improvement (MMI) following surgery.

 

  • Independent Vocational Evaluations (IVE): IVE’s are conducted by a trained vocational or rehabilitation expert.  It involves a number of different tests, which can require the employee to undergo physical activities to determine mobility and function.  Other testing can be educational in nature to measure cognitive function and mental abilities.  The timing of the IVE typically coincides with the placement of the employee at MMI.

 

  • Surveillance: This tool can also be used to determine the true physical ability of an injured worker.  It should be performed in a manner consistent with state law and rules governing workers’ compensation proceedings.  Failure to do so can result in adverse consequences to the defense of a workers’ compensation claim, admissions against interest and/or sanctions.

 

 

Conclusions

 

All employees deserve dignity and respect.  However, sometimes attempts to extend courtesy can lead to perverse consequences.  Interested stakeholders in workers’ compensation programs should be mindful of unintended consequences and monitor matters to ensure the true intent of generosity is extended in return.

 

 

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.

Get Serious About Developing Your Return-To-Work Policy

Imagine the following conversation:

 

Q: What is your policy on “Return to Work?”

A:  Ahh, we are all for returning injured workers back to work?

 

Sadly, this is the typical response of most employer representatives when it comes to an important topic.  A topic so important it can save your workers’ compensation program countless dollars and reduced litigation costs.  If you are one of the many employers or employer representatives who is serious about return-to-work, now is the time to develop a policy that meets the needs of your workforce and keeps the best interests of everyone in mind.

 

 

The Role of Return-To-Work

 

The role of return-to-work in workers’ compensation is multi-faceted.  It involves an employer seeking to do what is best for their employees.  It also includes people ready to seek creative solutions to complex problems.  Time spent on return-to-work is valuable in a number of ways.  These include benefits to the employee and employer:

 

  • Benefits for Employees: Most injured workers would rather be in the workforce than stay at home.  The seclusion of home has many negative psychological consequences and prolongs recovery times.  Additional benefits to the employee include increased earning capacity, a consistent and regular schedule, positive and productive mindset, a strong sense of self-worth and increased security.

 

  • Benefits for Employers: There are numerous considerations beyond increased workers’ compensation premiums that should compel proactive employers to invest in these programs.  Other considerations include controlling the hidden costs of prolonged injury, reducing future exposures (including claims for retraining or permanent total disability) maintaining productive work operations and containing costs.

 

 

Developing a Proactive Return-To-Work Policy

 

Here are some important considerations to developing an effective and proactive return-to-work policy.

 

  • Purpose: The policy should outline the general philosophy of the company. It should include how it views all employees regardless of ability.  It should also inform workers of their rights and responsibilities following a work injury.  It should note that policies covering workers’ compensation issues do not impact or supersede other legal obligations the employer may have under the Americans with Disabilities Act (ADA) or disability/leave programs such as the Family and Medical Leave Act (FMLA).

 

  • Eligibility: This part of the policy will outline the rights and responsibilities of the employer and employee.  It should cover important aspects of being out of work or returning to duty with restrictions or a modified position.  Important elements to cover include time off to attend doctor appointments and restriction requirements, if applicable.

 

  • Availability of Positions: It should be the goal of every return-to-work program to move a worker back to his or her pre-injury position and wage.  In many instances, this is not practical given physical limitations following the work-related incident.  In this case, notifying the employee of other job opportunities within the pre-injury employer and other positions is important.

 

  • Transitional Work/Assignments: Many state workers’ compensation laws govern the employee’s eligibility for ongoing wage loss benefits should he or she decide not to accept transitional or modified positions.  It is important to spell out the rights and responsibilities of the parties in these situations.  Other elements include legal requirements on how the employee is going to receive the offer of modified work and what procedures are required if they dispute the physical requirements of the position.

 

There is no set template for a return-to-work policy.  Other elements may include information on position expectations, termination of assignments, the number of hours open for a position (part-time or full-time) and rate of pay.  Interested stakeholders should also consult legal counsel given the employment issues that come into play in these complex matters.

 

 

Conclusions

 

Return-to-work is a complex issue that requires more than a mere moment of consideration by employers serious about reducing workers’ compensation costs.  When reviewing your best practices, it is important to consider the development of a policy regarding this issue.  Doing so can substantially reduce your workers’ compensation program costs.

 

 

For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.

 

Author Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

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

Live Stream WC Training: http://workerscompclub.com/livestreamtraining

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

How To Know When To Expect Your Employee Back To Work

Employers want to know how long an employee will be off work following a workers compensation injury. There are a lot of factors that go into the answer including the nature and extent of the injury, the employee’s age, the employee’s physical conditioning, and the overall state of the employee’s health.

 

The most common types of injuries are sprains and fractures. There are several factors that determine the disability period for sprains and fractures. The first factor to consider is the nature and extent of the injury. A moderate sprained ankle heals much quicker than a compound femur fracture. To get an idea of how extensive the medical provider considers a sprain, look for the adjective before the word sprain or strain.

 

The adjectives most commonly used with sprain and strains are: 

 

  • Slight – it happened, but there is not much to it.
  • Moderate – more extensive than slight – middle range
  • Severe – more extensive than moderate – really hurting

 

To understand how extensive a fracture is, again look for the adjectives the medical provider uses to describe.

 

Fractures are normally described as:

 

  • Simple: it has cracked, but has not done anything more than a little bit of damage to the surrounding tissue
  • Closed: basically the same as a simple fracture
  • Compound: the bone has broken in more than one spot, or the fracture has created significant tissue damage
  • Open compound: the broken bone is exposed through a wound in the skin
  • Compression: in the vertebrae where a brittle bone, due to age or osteoporosis, has cracked

 

 

Other adjectives to describe fractures include (per Wikipedia):

 

  • Complete fracture: A fracture in which bone fragments separate completely.
  • Incomplete fracture: A fracture in which the bone fragments are still partially joined. In such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone.[1]
  • Linear fracture: A fracture that is parallel to the bone’s long axis.
  • Transverse fracture: A fracture that is at a right angle to the bone’s long axis.
  • Oblique fracture: A fracture that is diagonal to a bone’s long axis.
  • Spiral fracture: A fracture where at least one part of the bone has been twisted.
  • Comminuted fracture: A fracture in which the bone has broken into a number of pieces.
  • Impacted fracture: A fracture caused when bone fragments are driven into each other.

 

 

Consider Age & Conditioning

 

In addition to the nature and extent of the injury, the employee’s age is a factor. A 25 year old employee with a simple fracture will heal more quickly than a 55 year old employee with the same injury.

 

 

The employee’s physical conditioning before the injury will play a significant factor in the employee’s disability recovery time. The 50 year old employee who runs in the Boston Marathon will recover from an injury faster than a 20 year old employee who spends all his free time in front of a video game monitor.

 

 

The overall state of an employee’s health will also impact the disability time. An employee with truncal obesity, diabetes, or other comorbidity issues will recover from an injury much slower than an employee who has the same injury, but no other on-going medical issues. Additionally, the non-smoker will recover from an injury faster than a smoker, all other factors being equal.

 

 

For more information, please see:

 

 

Please note that all disability times are normal ranges, and the medical facts will determine the disability period. Hospitalization times vary greatly depending on the severity of the injury. The total disability time range is the expected length of time before the medical provider will allow the employee to return to light duty work. The partial disability time ranges is the approximate amount of time the employee should be in a light duty job.

 

 

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.

WCRI Recap: 3 Factors That Most Impact Worker Outcomes

WCRI Recap – 3 Part Series

  1. WCRI Recap – Impact of Donald Trump and 2016 Election
  2. WCRI Recap: 3 Factors That Most Impact Worker Outcomes
  3. WCRI Recap: Single Biggest Factor To Turn-Around Opioid Crisis

It’s been two weeks since the WCRI Conference recently held in Boston. I’m Michael Stack with Amaxx and today I want to give you some highlights and recap from that recent conference, from the notes that I took and the perspective that I had on it. The second session was about worker outcomes and what impacts, based on studies and research to define the best outcome.

 

 

What are those factors that we can address? For me, this was the most interesting and impactful session for what I do, which is work with employers, insurance brokers and educating best in class programs. This session is one that I found extraordinarily valuable to get an understanding of, what are those things that impact the outcomes that we can address at the beginning a claim and make sure our success is that much more likely.

 

 

Single Biggest Factor That Impacts Claim Outcome

 

This is a study I’ve quoted a number of times. It was published by WCRI a few years back and they came out with a study and said, “The biggest single factor based on their research that impacts the outcome of that claim is trust.” The biggest single factor that outcome impacts the outcome of a claim, is the amount of trust between an employee and an employer. Hugely important point. Hugely important factor to understand. Now, we’ve seen that one before.

 

 

 

How Does Supervisor Respond to Injury?

 

Glen Pransky from Liberty Mutual gave a presentation about some of their research and their studies. I found it extraordinarily interesting and valuable. Here’s what they came up with. Two different things that impact their outcomes, one of the biggest factors, all things being equal, if how does the supervisor respond to the injured worker at the moment that claim is reported. I’m going to say that again. How does the supervisor respond to the injured worker at the moment that that claim is reported. Do they respond with blame and anger and frustration? There’s that lack of trust there. They’re not trusting that the employee maybe said they get injured and they say, “Yeah, right. You didn’t get injured. Get back to work.”  Or, “How could you do that wrong? You are now in trouble.” That lack of trust there. So, how does that supervisor respond to that injured worker at the time of injury? All things being equal, if they respond positively, it’s going to have a significantly better claim outcome. If they respond negatively, a significantly worse claim outcome. That was number one, “How does a supervisor respond to the injured worker at the time that claim is reported?”

 

 

 

How Does Insurance Adjuster Respond to Injured Worker?

 

Number two, how’s the insurance adjuster respond or how is that first interaction with the injured worker go? Are they using big insurance words that the injured worker doesn’t understand? Things like adjudication and calling him the claimant and all these different things that really foster this lack of trust that they’re going to be taken care of. So, if there’s all these things that they don’t understand and they don’t know what’s going to happen, what are they going to do? They’re going to make sure their rights are protected. They’re going to call an attorney and they’re going to be going down this path which makes the claim that much more complicated, because they had a poor interaction with a supervisor and their adjuster’s causing him all this adjudication. They say, “I don’t know what’s going on. I better look out for myself.” So, how you responding to the injured worker, how do those communication interactions, things to train on, things to work on.

 

 

 

Do You Think…

 

Here’s the next piece, which I thought was extremely interesting and something you need to input, impact into your program today. Starting today, do this on every single claim. Here’s what it was, they asked this question, it’s a highly predictive question of the outcome of that claim, “Is do you think, you’ll be back to work within four weeks without any restrictions?” Do you think, you will be back to work within four weeks without any restrictions? Do you think you’ll be back to work in four weeks without any restrictions? Highly, highly predictive question to ask of what that outcome of the claim is. If they say, “no” then you get to ask them why. “Why don’t you think you’ll be back to work?” You can bring in additional resources and support to drive that. If they say, “yes” then they’re setting that expectation in their own mind and it’s only going to drive that success to get them back to work. Highly predictive question and response to that claim’s outcome, “Do you think you’ll be back to work within four weeks without any restrictions?” Start asking that question, every single one of your claims today.

 

 

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.

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