How To Use Central Index Bureau To Stop Workers’ Comp Fraud

One of the best fraud fighting tools is provided by the Central Index Bureau report, a division of the Insurance Services Office. It is known as a Central Index Bureau report, a CIB report, an ISO, or as a claim index. The terminology varies from insurance company to insurance company. Regardless of the name, the CIB is a basic record of the insurance claims filed by an individual. What makes it effective is it is one of the very few areas where insurance companies share information.

 

Over 90 percent of all insurance companies are members of the ISO Central Index Bureau. Be sure your insurer is a member too. If not, the insurance company may be paying fraudulent claims which will have an adverse impact on workers compensation insurance premiums.

 

 

Information Reported to Central Database On Every Claim

 

When one of the employees files a workers compensation claim, the basic information about the claim and the claimant (employee) is obtained. The CIB report will contain the claimant’s name, social security number, maiden names, aliases or former names if known as well as address, former addresses if known, occupation, and date of birth. The CIB report will include the accident location, the date of the accident and the alleged injuries. It will identify the type of injury whether it is automobile bodily injury, general liability bodily injury, automobile medical payments or PIP, workers compensation, homeowner’s liability, medical malpractice, or a non-occupational disability claim.

 

The report will identify the medical provider by name and address as well as the lawyer’s name and address if the claimant is represented. The report will also contain the adjuster’s name, the name of the insurance company (or third party administrator), the insurance company’s address, and even the adjuster’s phone number. It identifies who the insured is for the insurance company and the insured’s address.

 

 

Protect Yourself From Paying For Prior Injuries

 

Why is all this information reported to the insurance services office on every insurance claim, including property claims? The reason is to protect the insurance company from paying for a prior injury. The claimant’s attorney is not going to tell the insurance adjuster that he has previously represented Mr. Bad Luck on his five previous injuries, two auto accidents, one slip and fall, and two workers compensation claims against five prior insurance companies.

 

 

Example: Employee Sustains Injury Every Deer Hunting Season

 

Take the example of Mr. Bad Luck. When the workers compensation adjuster interviewed Mr. Luck, he stated he was in excellent health, had never had a real injury before, but now he severely injures his back. The adjuster is alert. She electronically files the Central Index Bureau report and receives an electronic report that lists all the information on Mr. Bad Luck, even though his social security number was changed 3 times and his address four times. Suddenly the claimant has selective memory about previous injuries.

 

In one claim file audit of governmental pool‘s workers compensation claims, the auditor notices the adjuster has received 18 hits (prior injury claims) on one unfortunate employee. The employee was employed 17 years with the same city government during each of the 18 workers compensation injuries. Of the 18 injuries, 14 of the injuries occurred in the first two weeks of November in fourteen different years. It turns out the claimant is a deer hunter, and deer season is the last two weeks of November.

 

Fortunately the claimant always made a fairly quick recovery from various strains and sprains and was able to return to work on the first Monday of each December. The claimant is committing fraud by taking a two to four week leave of absence each year paid for by workers compensation. The employer knew this, and the adjuster knew it too. Why they did not prosecute the claimant for fraud is unknown.

 

 

Fraudulent Employees Often Switch Doctors

 

Please note that most adjusters reviewing a case like this will be aggressive about the claim when the claimant is alleging a new injury to a body part that was part of a prior injury claim.

 

Injured employees like Mr. Bad Luck above will often change doctors so that they can tell the doctor they have no previous injuries. The smart adjuster will share the information with the medical providers on the claimant’s prior injury by obtaining and providing the relevant medical records from the prior medical providers. Also, there is something about the claimant knowing the adjuster is aware of prior injury claims causing many claimants, even those represented by an attorney, to make a speedy recovery.

 

 

Central Index Bureau Submission as Standard Best Practice

 

Make sure the use of Central Index Bureau submissions is a standard part of best practices and is included in your account handling instructions.

 

 

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.

Claims Investigations 101: What Every Claim Handler Needs to Know

Investigating a workers’ compensation claim is an important step in claims management, however it can easily be overlooked or poorly done.  Now is the time to review how you investigate claims regardless of experience.  Doing so can save you time and ensure your program is effective and efficient.

 

 

First Things First: Determine Coverage

 

A workers’ compensation insurance carrier is responsible for a claim if they are contracted to provide coverage for an employer/insured.  This is something that should be verified from the onset of claim in order to avoid confusion later on in the process.

 

Verifying coverage is especially important in workers’ compensation cases that involve industrial exposure issues such as asbestos or repetitive trauma occurring over a period of time.  In other instances, insured falling into high-risk categories have multiple insurance carriers.  Conducting a diligent investigation on this matter may result in allowing a carrier to deny liability or identify other parties who may be responsible.

 

Important data points to consider as part of this review include:

 

  • Listed dates of injury on a claim petition;
  • Policy exclusions based on an employee’s different locations of employment; and
  • Dates when a policy was in force along with the requisite policy number(s).

 

 

Witness Identification 

 

All successful claim handlers need to be great sleuths.  They are given a limited set of facts found on the initial claim forms.  It is then their duty to ask questions and locate answers.  Part of this includes locating people who have information concerning the employee and the work injury.  Important people to consider include:

 

  • Employer: This includes not only the employee’s supervisor, but also other people who have contact with the injured party and understand their work activities.  It is especially important in claims subject to dispute such as unexplained injuries or those that take place over the course of time.

 

  • Other Fact Witnesses: These include a broad category of people.  It can include people who witnessed the accident in question, work directly with or have regular contact with the employee.  It is important to determine what information these persons have and also evaluate their credibility.

 

  • Employee: Contact with the employee is also important.  Not only will you be in contact with the employee as part of the injury report, but also following the injury as the claim handler manages the case.  Part of this contact may include a recorded statement.  When engaging in this activity, be sure to understand applicable rules and how to preserve it for use in litigation.

 

  • Expert Witnesses: The increasing sophistication and due process safeguards in workers’ compensation cases is leading to the growing us of experts.  This obviously includes medical doctors to address issues such as causation, the mechanism of injury and reasonableness/necessity of care.  Other experts include vocational rehabilitation counselors and others who can comment on design and safety matters.

 

 

Other Important Components of the Investigation

 

Members of the claims management team are responsible for investigating the claim at its onset.  This includes a number of other important considerations:

 

  • Determining issues of compensability. This goes beyond a determination of coverage and includes the threshold issue of all workers’ compensation claims—whether the injury “arose out of” and was “in the course of” employment;

 

  • Handling the injury triage and making sure the employee receives the medical care and treatment they are entitled to receive;

 

  • Obtain appropriate authorizations. This includes a number of different documents such as medical, insurance, workers’ compensation records and Social Security verification to name a few.

 

 

Organization is Key

 

A well-organized claim file can provide efficiency to internal processes, demonstrate competence to claim managers and assist legal counsel should the matter be referred for defense.

 

 

Conclusions

 

Members of the claims management team play an important role in investigating workers’ compensation claims.  It is important to be organized and work newly received file materials in an effective and efficient manner.  It can also result in a cost savings to your program, which pays dividends to all involved.

 

 

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.

3 Actions to Weed Out Marijuana-Related Workers’ Comp Challenges

The trend of legalizing marijuana for medical and/or recreational use is growing and may soon affect nearly all states. The recent election brought the number of ‘medical marijuana’ states to 28 plus the District of Columbia; while eight states now allow it for recreational use. Add to that the fact that several states have seen cases that allow injured workers to obtain the drug through their workers’ comp systems, and you’ve got a veritable nightmare for employers — especially those in multiple jurisdictions.

 

But employers don’t have to sit by and watch your workforce go up in smoke. You can — and should — take steps to keep your workers, property and the business itself safe.

 

 

Drug testing

 

The most effective way to prevent drug-related workplace injuries and illnesses is to avoid hiring drug users. While passing a drug test certainly doesn’t guarantee an employee won’t use marijuana or other drugs down the road, it is at least a way to eliminate habitual users from entering your workforce.

 

Even in states where marijuana is legal — for medicinal or recreational purposes — private employers still have the right to test conditionally-hired job applicants. How you handle a positive test result, however, likely differs among states; so it behooves you to understand the laws in your jurisdiction.

 

Beyond pre-employment testing, employers may also do drug testing randomly, based on reasonable suspicion, for return-to-work screening and post-accident. OSHA’s new injury reporting rule has raised many questions about whether employers that conduct post-accident drug testing may run afoul of the agency.

 

OSHA has tried to clarify the confusion by saying drug testing policies should be limited to situations where drug use is “likely to have contributed” to the incident, and for which the test can “accurately identify impairment.” Injuries such as bee stings, repetitive strain injuries or one caused by a machine malfunction would not qualify for mandatory testing, under OSHA’s explanation. Federal drug testing has not changed.

 

There are generally three types of drug tests:

 

  • Urinalysis. The first and still most widely used, this is less expensive than some other test methods. It detects most drug use for the previous 2–3 days and is the only type allowed for federal testing. On the downside, it is easily manipulated and cannot measure the frequency of drug use.
  • Oral fluid. These are collected under supervision, making tampering impossible. It determines drug use for up to 48 hours and is generally inexpensive. It also does not measure frequency of use.
  • Hair. Perhaps the best for pre-employment tests, as its detection window is generally 3 months. However, it is the most expensive type of test. Also, it typically takes longer — up to 10 days versus 1 or 2 — for the results.

 

 

Create/Update Drug-Free Workplace Policy

 

Lower job performance, reduced productivity, absenteeism and higher workers’ comp costs are among the results of workers who abuse drugs. As an employer, you are obligated to provide a safe work environment for all employees. Those are among the biggest reasons to have a workplace drug and alcohol policy — and communicate it clearly to your workers. A policy can include the following:

 

  • Basic assumptions. The policy should spell out why the company is establishing it, what is expected of employees and the consequences for violations, including dismissal.
  • Broad statement. The policy should clarify that employees may not perform their job duties under the influence of alcohol, illegal drugs, or mind-altering prescription medications — including marijuana. In states where marijuana is legal you should include a section with clear guidelines devoted to that drug.
  • Drug testing. If your company conducts drug tests, that should be included with the specific procedures outlined. It should also say that workers with prescribed medical marijuana may not use the drug while at work. The policy should be similar to that for narcotic prescriptions.

 

Workers in states that have medical and/or recreational marijuana laws on the books are likely confused about their rights to the drug in the workplace. Therefore, you should train supervisors on it and ensure all employees understand it. Employee handbooks, posters, intranet messages and other technology-related approaches are ways to disseminate the policy.

 

 

Know the law

 

Before drafting or changing a policy you need to understand the specifics of all the jurisdictions in which you operate. Much like the workers’ comp system itself, marijuana laws vary by state. Statutes may have vastly different provisions, especially when it comes to the workplace.

 

In states where the drug is legal, courts have taken different actions as to whether marijuana is reimbursable through the workers’ comp system. Following several court rulings, New Mexico passed a reimbursement rule.

 

In other states, however, laws say workers’ comp payers are not compelled to pay for the drug. They include Arizona, Colorado, Michigan, Montana, New York, Oregon and Vermont.

In some states, employers that can prove the drug is the cause of a work-related injury are off the hook for reimbursement. In others, the injured worker may be entitled to payment even if the drug caused the accident.

 

Summary.

The laws surrounding marijuana are changing rapidly. Employers are well advised to stay abreast of this constantly changing situation through legislation and case law; review and update workplace substance abuse policies often; and consider drug testing — at least for pre-hiring.

 

 

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.

9 Steps to Foster a Mentally Healthy Workplace

Mental health, especially depression is one of the leading causes of workplace absenteeism and lost productivity.  Estimates are that around $12 billion in lost workdays annually are attributed to depression-related illnesses. Injured workers are often susceptible to depression, especially those who have been prone to it previously.

 

There are a variety of factors that can lead to depression; life events, physical conditions, medication, stress and lack of sleep. The workplace itself can by a source of, or exacerbate depression — unless employers take a proactive approach to the issue.

 

Employers can help their employees and their own bottom lines by promoting a culture of overall well-being, encouraging personal growth and empowerment among workers, and ensuring benefits adequately address mental health needs.

 

 

Workplace Environment

 

A culture of wellness that includes emotional and mental health can go a long way toward reducing the stigma attached, leading workers to get the help they need sooner.

 

  1. Inclusive language. Mention of depression, anxiety, post-traumatic stress disorder and other mental health-related conditions should be as common as diabetes, hypertension and heart disease. The environment should be one that supports and encourages people to seek help. People suffering are more likely do so when they feel supported rather than embarrassed.

 

  1. Engage leaders. Managers and other supervisors should be trained to use language that does not project negative attitudes about mental health issues. They should also understand how to identify emotional distress and respond promptly and constructively to behavioral performance issues.

 

  1. Provide information. The entire workforce should be educated about mental health issues. Your workers’ comp insurer and/or third-party administrator can help with various programs.

 

  1. Work/life balance. Time off for rest and relaxation is essential to a balanced life. Employers should provide adequate vacation time and consider a policy that encourages, if not mandates it be taken. Also, companies should make sure the workload is not continuously extreme, as a large workload without adequate time to complete tasks is viewed as a big stressor among many workers..

 

 

Personal Development

 

  1. Encouragement and support. Employees should have access to a variety of opportunities to improve their competencies, as it helps them with their current positions and can prepare them for promotional opportunities, and acquiring new skills and career development has been shown to enhance well-being. Learning new personal and interpersonal skills also contributes to a person’s overall psyche.

 

  1. Recognition. Everyone likes to be appreciated for a job well done. Employers should acknowledge such employees, whether through financial rewards, time off, or just celebrations during the workday. Such actions help build self-esteem and motivate workers to exceed expectations.

 

  1. Inclusion. Where possible, include workers in decisions about how work is done, whether their own or the organization as a whole. Encouraging workers to ask questions, suggest new ideas and provide feedback gives them a sense of pride in the workplace. Employees who have input into their work lives feel more empowered and have improved morale, along with psychological wellbeing.

 

 

Benefits

 

Individuals with depression and other emotional challenges can be valued employees — if they get the help they need. As an employer, you can make sure workers know where and how to seek help.

 

  1. Employee Assistance Programs. While many larger companies have Employee Assistance Programs, few employees actually use the services. Many don’t know they exist or understand how to access them. If your company has an EAP, make sure your employees are well informed about what is included and how to access the offerings.

 

  1. Health insurance. If your company offers health insurance, review it to see if and to what extent mental health programs and services are included. Where possible, make any necessary changes to foster engagement by workers, especially for early intervention. Educate workers about your health insurer’s mental health services through an intranet, pamphlets, and meetings from an insurer representative. If there are no mental health benefits included for workers, learn about community resources and inform workers about them.

 

Mental illnesses cost employers through direct and indirect costs and can be significant. Make sure your company does everything possible to encourage workers with depression or other mental health challenges to seek help early.

 

 

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.

13 Indicators You Might Get Burned By Workers’ Comp Fraud

On November 18, 2015 the US Department of Justice in Eastern PA published a partial sentencing of Barbara Stanley who fraudulently obtained approximately $199,000 between July 2006 and December 2010.  After committing a crime for over 4 years, why did it take 5 more years until she would be tried for her crime and then another 3 months for sentencing?  Would the $199,000 ever be recovered?

 

Another case in California involving former San Quentin prison worker Hosea Morgan came to a head in September 2015 when he was convicted of making 2 fraudulent workers comp claims back in 2009.  The trial lasted almost a month and sentencing took place about a month after in November.  Adding the 2-month gap between conviction and sentencing to the 6-year gap between commission and trial is worrisome.  Morgan was sentenced to six months’ jail time, 500 hours community service, and 5 years’ felony probation.  Collecting the over $160,000 in restitution may never occur.

 

 

Exposure:

 

While these two cases made headlines and give a very clear picture of how much workers comp insurance fraud costs, there are countless other cases that do not make headlines nor are even reported or prosecuted.  In some cases, prosecuting costs more than the fraudulent claim itself, so those cases fall to the wayside and are dismissed with no retribution.  With the time it takes for fraud cases to come to conclusion, statutes of limitation may apply anyway making restitution collection impossible.

 

Unfortunately, even with reporting requirements in place, Special Investigative Units have no measure of keeping records for the results on how much workers comp fraud costs across the board.  The examples above give the illusion that authorities are tough on workers comp fraud, however they fall short of keeping within laws that provide incarceration, fines, penalties, and restitution.  Fraud cases are often handled poorly, and leniency tends to prevail in favor of the perpetrators who are either excused, plea bargained, or given light punishments.

 

There are, however, many reports online for restitution recoveries which reveal a very sad picture.  Per the California Department of Insurance statement on Workers’ Compensation Fraud:

“In fiscal year 2014-15, the district attorneys reported a total of 740 arrests, which also included the majority of Fraud Division arrests. During the same time frame, district attorneys prosecuted 1,409 cases with 1,654 suspects, resulting in 650 convictions. Restitution of $32,065,830 was ordered in connection with these convictions and $8,647,532 was collected during fiscal year 2014-15. The total chargeable fraud was $646,186,555 representing only a small portion of actual fraud since so many fraudulent activities remain to be identified or investigated.”

With 1409 prosecutions, only 650 convictions were made.  Over $32 million in restitution was ordered, but less than $7 million collected.  In relation to the amount stolen (over $646 million) the amount collected is just over 1% of the total.  That means $639 million could go uncollected.

 

 

 Properly Investigate Every Claim

 

Every claim should pass through a “bulletproof investigation procedure”.  This is designed to give you the proper information to make an accurate decision on the claim.  Further subrosa investigation should be used as an information gathering tool.  It is better to investigate EVERY claim, than to investigate no claims.

 

Here are 13 claimant behaviors that raise red flags:

 

  1. Injury takes longer to heal than medical guidelines specify.
  2. Injury is reported late, reported to a lawyer or the state commission before reported to the employer.
  3. Fails to attend weekly meetings.
  4. Is uncooperative; will not try a transitional duty job.
  5. Is not home during the workday when you phone.
  6. Only has a postal box, not a home address.
  7. Misses doctor appointments.
  8. Performs seasonal activities, hobbies, or work.
  9. Has moved out of town or out of state.
  10. Disputes average weekly wage due to additional income.
  11. Files for benefits in state other than principle location.
  12. Disputes information supplied by the employer.
  13. Submits repetitive medical reports indicating continuing, constant pain with conservative medical treatment.

 

 

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.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.

Freeze Out Workers Comp Costs By Preventing Cold Stress Claims

Serious and even fatal conditions can result from cold stress. Any worker can be affected by cold stress, even those in near- freezing temperatures if they are not used to cold weather. New workers and those returning after time away are also at a high risk of cold stress.

 

Among those most at risk are construction workers, recreational workers, snow cleanup crews, emergency responders, transit workers, baggage handlers, and workers in water transportation, landscaping and support activities for oil and gas operations.

 

Cold stress happens when skin temperature and ultimately the body’s internal temperature are reduced to the point that the body cannot warm itself. Both the air temperature and wind speed can play a part. Permanent tissue damage and death can occur.

 

The factors that put workers at an increased risk for cold stress include:

  • Wetness, improper clothing, exhaustion.
  • Comorbid health conditions such as hypertension, hypothyroidism and diabetes.
  • Poor physical shape.

 

Employers should train workers to understand the types of cold stress, recognize the symptoms and know what to do to prevent it and help those affected. Frequent, short breaks in warm, dry areas go a long way to ensuring workers are not exposed too long. Warm beverages should be provided to outdoor workers, such as coffee or tea. And employees should be instructed to work in pairs rather than alone.

 

Here’s a look at the most common types of cold stress.

 

 

Frostbite.

 

Caused by the freezing of the skin and tissues, this can cause permanent damage and even lead to amputation. Symptoms include reddened skin that develops gray-white patches, especially in the fingers, toes, nose or ear lobes. The person may feel tingling, aching or a loss of feeling, and may develop blisters. People with reduced blood circulation and/or those not dressed adequately for cold temperatures are more susceptible to frostbite.

 

The affected area should be wrapped loosely in a dry cloth until medical help arrives, and the worker should be given warm, sweetened drinks. Anyone helping a worker with frostbite should be instructed not to rub the affected area, apply snow or water, or try to rewarm the area. A frostbitten area that is rewarmed and becomes frozen again can cause additional tissue damage.

 

 

Immersion/Trench Foot.

 

Prolonged exposure to wet and cold conditions can lead to trench foot, even in temperatures as high as 60 degrees. Wet feet lose heat 25 times faster than dry feet. Symptoms include reddening skin, tingling, pain, swelling, leg cramps, numbness and blisters.

 

The worker’s wet shoes and socks should be removed, and the feet should be dried and elevated until medical help is available.

 

 

Hypothermia.

 

Also called abnormally low body temperature, this occurs when the body temperature drops to less than 95 degrees. It generally occurs at very cold temperatures, but can affect someone in temperatures above 40 degrees if the worker is chilled from rain, sweat or immersion in cold water.

 

Uncontrollable shivering is one of the more mild symptoms. More severe ones are loss of coordination, confusion, slurred speech, slow heart rate and breathing, and unconsciousness. A body temperature that is too low affects the brain and the person may be unaware that anything is wrong.

 

First aid remedies call for alerting medical emergency workers immediately. Until help arrives, coworkers are advised to move the worker to a warm, dry area; remove and replace wet clothing; and wrap the entire body in layers of blankets. Warm bottles or hot packs can be placed in the armpits, sides of the chest and groin.

 

 

Conclusion

 

Employers can help keep these workers safe and healthy by providing heaters at worksites, allowing employees to take breaks to warm up, and offering warm beverages. Simple steps such as these can greatly reduce winter-related workers’ comp 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, 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.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 Ways To Prevent Workers’ Comp Fraud

More and more cases are being publicized for successful prosecution of workers compensation fraud.  The more prominent cases are usually publicized due to their large monetary values.  However, fraud can occur at any level with it all adding up to a significant loss in dollar amounts.  Additionally, there appear to be more findings against employers than employees which means success rates may be woefully low in actual employee values.

 

It’s almost impossible to find accurate records of defrauded amounts, cases reported, prosecutions, or convictions.  Few organizations actually keep record and there is no federal central bureau or governmental entity compiling data.  Restitution recovery amounts (when reported) are dismal.  Most recovery amounts are less than 1% of the amounts ordered.  Many employees are unable to repay and others simply ignore the order considering recovery punishment is seldom enforced.

 

 

Workers’ Comp Fraud Drives Up Premiums

 

Since recovery dollar amounts are low, insurance premiums are increased.  The lack of restitution translates into claims impact by increasing experience and retro modifications.  The employer always ends up paying more.  Self-insured parties must retain more money for claims.  State guaranty funds lose out and pass this on to employers left in the system.

 

It is in every employer’s best interest to prevent workers comp claims to help stop the whole potential fraud spiral from starting in the first place.  There are several things an employer should do in order to keep claims at bay and protect their business from fraud:

 

  1. Hire the right employees. Contact previous employers. Check the references listed on their application.  Complete a through pre-employment background investigation.
  2. Report all claims immediately. Make sure the injured employee is receiving proper treatment, benefits, and is compliant.
  3. Keep in contact with both the employee and the adjuster during the duration of the claim and push for a speedy recovery and return to work. Intercede if the injured employee has problems, and conversely cooperate with the adjuster if any suspicions arise.
  4. Investigate the claim. Visit the employee’s work environment/accident site.  Talk with witnesses.  Check all equipment involved.  Address and correct any and all safety issues in the workplace to prevent further injuries.
  5. Train all managers and supervisors in proper policy and procedure for handling injuries.
  6. Be alert for common fraudulent claim filing: Monday morning, pre-layoff, pre-vacation, pre-holiday, unwitnessed claims should all send up red flags.
  7. Be sure all employees fully understand the workings of the compensation act. Explain their rights, benefits, and obligations as well as your own as an employer.
  8. Gain knowledge of traumatic injury and occupational disease. Learn normal recovery times, medical treatments, and average fees.
  9. Pull loss runs and review periodically for accuracy, proper payment, disability compliance, and injuries casually related to the current claim. Contact the adjuster for clarification of any discrepancies or issues.
  10. Obtain interface with unions or employee organizations for input and cooperation in preparing policy and procedure.

 

Preventing workers comp fraud starts with preventing claims.  Gain more insight from insurance agents, loss control experts, lawyers, and adjusters.

 

 

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.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.

 

Photo credit: CA Dept of Insurance via VisualHunt.com / CC BY-NC-ND

 

Eliminate Most Frequent Cause of Seasonal Workers Comp Claims

Winter weather is upon us (at the time of this writing it’s 8 degrees in Kennebunkport, ME), and that often means an increase in claims. However, many winter weather claims are preventable. Whether it’s a slip/trip/fall, electrocution from using unfamiliar snow-removal equipment, or a temperature-related ailment such as trench foot, simple precautions can often protect workers — and your bottom line.

 

While you might not have control over the weather, you can at least control the risks faced by your employees. And you don’t necessarily have to spend a lot to reduce or even eliminate many weather-related workers’ comp claims.

 

Here’s a look at how to prevent the most frequent — and preventable — cause of seasonal claims.

 

Slippery Slopes

 

Icy, wet pavement and floors can wreak havoc for workers. Whether inside or outside, employers should seek to have the driest, safest surfaces for their employees.

 

Clear Snow & Ice

The most obvious solution for preventing slip and fall injuries in winter is to make sure snow and ice are cleared from all walkable surfaces and salt or other deicing material is laid down.

 

This includes sidewalks, entryways and parking lots. While state laws vary on whether injuries in outdoor areas are compensable through workers’ comp, making them safer can protect your employees as well as vendors and other visitors to your facility.

 

Place Signage Warning of Slippery Floors

In areas such as doorways, it’s also smart to place signage warning of slippery floors. Absorbent mats are another method to help keep inside walkways dry.  Good lighting should also be considered for areas where floors and pavements can be slippery.

 

Instruct Workers To Wear Footwear With Good Traction

Workers who are more likely to be outside should be given, or instructed to wear footwear with good traction, such as slip resistant shoes or boots. They should also be informed that taking shorter steps and walking slower will help them react better to sudden slippery spots.

 

Place Ladders Only On Cleared Surfaces

Workers who have to be on elevated surfaces, such as roof tops need to take extra precautions. They should be provided and trained on fall protection methods. Ladders should be placed only on surfaces that have been cleared of snow and ice. Where possible, outside vendors should be employed to remove snow from roofs and other areas.

 

Conclusion

Employers should try to avoid sending workers outside in frigid temperatures and where snow or ice is problematic. Scheduling work for the warmest part of the day is advisable. For employees who must work outside, they should be trained about the injuries and illnesses that can affect them and understand the hazards of any equipment they may use, such as snow blowers.

 

 

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.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.

4 More Keys To A Healthier Workforce Through Wellness

As reported in yesterday’s blog “4 Keys to a Healthier Workforce”, comorbidities in your workforce add significant costs in workers’ compensation claims.  While our New Year’s resolutions are still alive, take action today to consider these 4 more keys to a healthier workforce:

 

Lifestyle Management Programs

 

Employers can do a variety of things to get people moving. In addition to such things as workshops on various wellness issues, companies can allow breaks for workers to engage in physical activities. Or set up walking or other exercise programs. Smoking cessation programs can be done either onsite, or at a local hospital or other community facility.

 

Convenience

 

Getting employees to participate in wellness programs is nearly impossible if it’s not easy for them to be involved. Third shift workers, for example, might feel left out of group activities that take place during the day. Using technology such as internal websites and mobile apps, can help these workers feel more involved. Encouraging workers to eat better can be made easier by providing healthy snacks onsite, such as in vending machines and during meetings.

 

Fun

 

Employees are much more inclined to participate in wellness activities if they enjoy them. Competitive teams can be established to challenge one another to walk X number of miles, or to lose the most weight in a given time period.

 

Confidentiality / Privacy

 

Many employees are concerned their health information may get into the wrong hands, causing them embarrassment or even to lose their jobs. Any health related information provided to the employer needs to be in the aggregate, with no indication a health issue is related to a specific individual.

 

Research shows for every $1 spent on wellness programs, the cost of medical care is reduced overall by $3 to $4 – an excellent return on investment an employer cannot ignore. Ref. Workplace Wellness Programs Can Generate Savings

 

 

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.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.

4 Keys To A Healthier Workforce Through Wellness

Comorbidities may be costing you a bundle. There’s overwhelming research that shows employees with certain health conditions are more likely to get injured on the job, and then take longer to heal and return to work. Consider the following effect on workers’ compensation:

 

  • Diabetes average workers’ comp medical costs 5x higher
  • Smokers are 40% more likely to have a work injury
  • Obesity is associated with 2x likelihood of a workplace injury, 7x higher workers’ comp medical costs, and 13x more days away from work

 

Employers can take a multitude of actions to help workers become healthier. And now’s a good time, as many people put ‘a healthier lifestyle’ atop their New Year’s resolution lists.

 

 

Wellness Programs

 

An effective wellness program can not only save money, but it can expand the bottom line through increased productivity from healthier workers. However, employers need to understand it is a long-term investment and the return might not be seen for several years.

 

Companies of any size can implement some type of wellness program. In fact, a recent survey showed more than half of employers with at least 50 employees have adopted a program. Most important is to make sure the program is specific to the company’s culture and needs. That said, there are several elements that can help result in a successful wellness program.

 

 

4 Keys To A Healthier Workforce Through Wellness

 

Executive Buy-In

 

Getting employees to participate in a wellness program has to start at the top. C-suite executives need to be engaged or the effort will have little chance of success.

 

Senior managers need to understand the business case that prevention can reduce injuries and mean more money for the organization. Larger companies may have the advantage of being able to use claims data and health plan utilization showing healthier workers have fewer claims and shorter recoveries. For smaller companies, information from organizations such as NCCI or WCRI can help make the case. There is also publicly available evidence from OSHA and NIOSH.

 

 

Goals

 

A look at various company records and reports — absenteeism, productivity, health insurance costs and biometric screening, for example, can help determine what types of things are needed for a company. Goals should be SMART: specific, measurable, agreed upon, realistic and relevant, and time based. Goals can be set by a group of workers representing many or all departments and at all levels to help ensure employee buy-in to the program. The group can be a formalized wellness team, in which each participant has various roles and responsibilities.

 

 

Integration With Safety

 

Reducing workplace injuries and improving overall employee health should go hand-in-hand with safety programs. Breaking down silos can expedite the effectiveness of both programs. Departments should be instructed to share information and resources. In larger companies, that means departments involved in any aspect of health benefits and health protection should communicate.

 

 

Communication and Education

 

Newsletters, emails, and posters are among the ways employers can let employees know about all the various components of the wellness program. They can also be used to help instruct workers on healthy lifestyle changes they can make. For example, low-calorie does not necessarily equal healthier foods, such as fruits, vegetables and whole grain products. People who understand how to read food labels are more inclined to buy food that offers good nutrition. Various health recipes can also be included, along with information on the importance of, and how to get a good night’s sleep.

 

When effective, wellness programs can reap significant financial benefits for companies, such as reduced injury rates and the number of lost work days. The key is to get buy-in by working with employees throughout the organization.

 

 

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.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.

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