The wrong doctor treating the employee for a workers compensation injury is one of the biggest mistakes an employer can make. It is a very fast way to incur higher than necessary medical expenses and higher than necessary indemnity cost. The proper selection of the medical provider is crucial to the overall outcome and cost of the workers compensation claim.
While most employers are blissfully unaware of the importance of the medical provider selection, it is a fact very well known by the plaintiff’s bar association. When the concept of workers compensation was being adopted by the states nearly a hundred years ago, the employer always provided the medical provider. Over the years in approximately half of the states, the plaintiff’s bar has wrestled control of the medical provider selection away from employers and put it in the hands of the employee (who normally allows the attorney to make the medical provider selection). (WCxKit)
Why is the selection of the medical provider is so important to the plaintiff’s bar association? The answer is simple: money. The television attorney holding a fistful of money while soliciting the injured employee got most of that money by controlling the selection of the medical provider.
The plaintiff attorney representing the employee works for a percentage of the indemnity benefits paid to the employee. The more indemnity benefits paid to the employee, the more money the employee’s attorney makes. Hence it is in the best interest of the employee’s attorney to keep the employee off work as long as possible and for the employee to get the highest possible disability rating (regardless of whether or not it is accurate).
The large majority of medical providers is honest in the assessment of the employee’s ability to return to work light duty or full duty and are honest in the assessment of the employee’s permanent partial disability rating. Some of the doctors in this large majority are more liberal and some are more conservative, but even within those parameters they remain honest.
Unfortunately, there is a small minority of doctors, concentrating primarily in the chiropractic field and the orthopedic field, that sold off souls to the plaintiff’s bar. Whether it is by collusion with the plaintiff attorney or a silent agreement, the plaintiff attorney sends as many of his clients as possible to the “doctor” who in return keeps the employee off of work as long as possible. The employee remains off work until the employee wants to go back to work, or the doctor can no longer justify keeping him off work. The doctor then consults the disability rating guide used in that state, and gives the employee the highest possible disability rating out of the possible range of disability ratings.
This is a win-win situation for the attorney and the doctor. The doctor increases the attorney’s income, and the attorney increases the doctor’s income. The employer loses. The higher the amount paid to the employee in temporary total disability and permanent partial disability, the higher the eventual workers comp insurance premium will be for the employer.
What should the self-insured employer or insurance company do? The employer cannot conspire with a doctor to put the employee back to work before he is physically able to return to work and will not conspire with a doctor to falsify the disability rating. The answer is to consult with the workers compensation defense attorneys in the area where the employer is located. The defense counsels who have had extensive experience dealing with the various doctors in the areas can advise who are conservative, moderate or liberal in disability ratings. They can tell you which doctors get the employees back to work timely. They can also warn of doctors who work solely for the plaintiff’s bar.
We would recommend consulting with defense counsel and learn the precise requirements of the state. In some states, the employer only has to post one medical provider, while in other states the employer must post a list of medical providers (also referred to as a panel in some states). The list of medical providers should include both general practice doctors for the minor injuries, the orthopedic specialists, the emergency care facility and/or hospital and, any other specialties required by the state.
Not only should the employer ask defense counsel what the posting requirements are for the particular state but should also ask the names of conservative, reputable doctors. Employers need doctors who will provide the employee with all necessary medical care, but will also work to get the employee back to work on modified duty or full duty as soon as practical. Also doctors who will give the employee a fair, objective disability rating, if one is needed, are ideal.
Occasionally there will have a plaintiff attorney who will ignore the employer’s posted list of doctors and send the employee to a favorite doctor. The claims adjuster should immediately object and advise the attorney that any medical care the employee receives at the non-approved doctor will be at the employee’s own expense, plus if the employee does not attend the medical appointments with the employer selected doctor, the indemnity benefits will be suspended. WCxKit
In the states where the employee has the right to select the medical provider, we suggest for the employer to post the “recommended” (not required) doctors suggested by defense counsel. While this will not stop the plaintiff attorneys from sending the injured employee to their favorite doctor, it will eliminate some of the claims that end up in the hands of plaintiff attorneys as the employee will be receiving the medical care they need timely.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
In 1989 the federal law known as the Worker Adjustment and Retraining Notification Act (WARN Act) went into effect. The intent of the WARN Act was to provide employees with time to plan for their future employment with another company when the employer had to do a mass layoff. The WARN Act has in many ways morphed into the Workers Compensation Claims Preplanning Act (that is not a real title), which provides ample time for dishonest employees to plan and execute fraudulent workers comp claims.
The WARN Act requires employers with more than 100 workers to give a 60 day notice before laying off workers. Employers must issue a WARN Act notice if a facility closing or other Reduction in Force (RIF) will cause more than 50 employees to be without a job. The WARN Act also applies to companies that are staggering the layoffs if the employer is laying off more than 500 employees in any 30 day period, or more than one-third of the workforce if the company has less than 500 employees. If the employer does not provide the notice timely, the employer is required to continue the pay and benefits of the layoff workers for 60 days from the date the employees are notified of the layoff. Plus, in some cases the employer can be fined $500 per day per employee for not giving the layoff notice timely. Please consult your labor law attorney for additional information on WARN Act requirements. WCxKit
Statistics show that workers comp claims spike by an average of 50 percent after a plant closing or other mass layoff is announced. This jump in claims always results in a future jump in the employer’s workers compensation premiums, as claim frequency is the primary factor in the calculation of the employer’s workers comp premium.
Unfortunately, there are times when a RIF is necessary due to a slow-down in business, a need to cut costs, a need to change the organizational structure, or a change in the company’s business strategy. However, the employer does not have to pay bogus work comp claims as a cost of doing business. There are numerous actions an employer who is planning a RIF should take prior to the announcement of the RIF. We recommend employers who must RIF employees to take the following actions.
1. Keep intentions to yourself and only communicate with those who need to know. The less time unethical employees have to plan their fraudulent claim or to think about doing so, the lower the number of bogus work comp claims.
2. If it is becoming obvious that the company needs a RIF, do not put it off. The longer you wait, the greater the distortion the rumor mill will create. The long wait provides ample time for unethical employees to not only plan their workers comp claim, but also to share their plans with other employees that would not be considering work comp fraud, until they learn others are going to file bogus workers comp claims.
3. When a RIF is announced, place a strong emphasis on the unemployment compensation benefits the employee will be receiving. Employees who are less anxious about their source of income are less likely to commit work comp fraud if they know they will have another source of income while they look for another job.
4. Learn how your state handles unemployment compensation in conjunction with workers compensation. Some states allow both at the same time, other states allow one or the other, and some states allow an offset (reduction) in workers comp benefits for employees drawing unemployment compensation.
Prepare for all workers compensation claims that may be received
5. Consult with the third party administrator (TPA) or insurer so the TPA can plan to handle the additional workers comp claims quickly so there is no waiting. If there is a delay in beginning claim investigations, the likelihood of properly defending the claim is reduced, evidence is lost and affirmative defenses are less likely. TPAs should handle these claims aggressively and early which requires sufficient staff.
6. If not already done, a "dedicated" or "designated" adjuster assigned to handle the claims for your company is needed. If you expect a large number of new workers comp claims, it is preferable to handle all of them in the same claims office. This way the claims adjusters are familiar with working conditions.
7. If you have been utilizing more than one defense firm, pick the best attorney and pre-arrange for one attorney (best) or one firm (acceptable) to handle all work comp litigation that occur after the announcement of the RIF.
8. If an employer is closing the facility or making a major remodeling, invite the defense attorney(s) to the facility so the defense attorney(s) can familiarize themselves with the facility.
9. Video record the areas/equipment/machinery that would most likely be included in any injury scenario, especially if the plant is to be renovated or demolished.
10. Video record job functions for the medical providers, especially those that would most likely be included in any injury scenario.
11. Make a list of all key personnel, managers and supervisors, including the home address, home phone number and cell phone number, who can testify if necessary.
12. Make sure all personnel records are up to date, especially health insurance records and sick time documentation (for example: the employee who took sick time for the back injury that occurred at home may now claim an aggravation of the pre-existing condition to continue the medical care and to draw indemnity benefits).
13. An exit physical should be considered especially if the employees work in a high decibel area or have been exposed to chemicals or other irritants while on the job. This action should be reviewed with your defense attorney and claims supervisor as to the benefits versus the risk.
14. An exit interview can identify potential future workers comp claims. Provide the employees with a form to complete to list any known medical condition.
15. Do not forget the employees who were already out of work and drawing indemnity benefits before the RIF announcement. Their incentive to return to work has been removed in situations where their department or plant is being closed. Every possible effort should be made to get these people back to work before the RIF.
16. Work with an offsite transitional duty vendor so that employees who are on transitional duty can be employed elsewhere until they are fully recovered and at MMI. Be prepared to place ALL employees who are on transitional duty in a paid position elsewhere. Charitable positions are also an option as is home-based employment.
It is essential that all workers comp claims reported after the announcement of a RIF be completely documented and thoroughly investigated promptly. Once the facility is closed and people and evidence is no longer available, it is much more difficult for the workers comp adjuster to handle the claim properly.
It should be noted that not all workers comp claims that occur after a RIF is announced are fraudulent. There will be legitimate injuries that occur. There also will be employees who have worked through other minor aches and strains who now feel they must report their work-related medical condition. (WCxKit)
When you are planning a large scale RIF, you will have a lot going on. The control and prevention of fraudulent work comp claims is necessary to not lose some or all of the financial benefits the company obtains from a RIF.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Sometimes, despite an employer's best efforts, some employees just do not want to come back to work (not having to work for a steady paycheck is a pretty good deal). The usual way employees block their return to work is by exaggerating the physical demands of their job. When asked by the orthopedic doctor how much lifting the job entails, the employee remembers the one time in his 20 years of employment where he picked up a 90-pound bag of concrete mix. What the doctor hears is the poor employee is lifting 90-pound bags all day long. The orthopedic in an effort to avoid a malpractice claim, tells the employee you cannot do that, and keeps the employee off work for another month.
A lot of savvy risk managers and workers compensation coordinators are furnishing the medical provider with a copy of the employees written job description as soon as they know who the medical provider is or is going to be. This often helps to get the employee back to work as soon as the employee is physically able to return to work. However even with a written job description, there are times the doctor does not have a clear understanding of the employee’s job.(WCxKit)
With YouTube and all the other video display sites on the internet, the use of video to show and describe things is quite common. Video job descriptions are now easy to create, simple to watch and they make it much easier to understand processes when the medical provider is not previously familiar with them. There are also videos and photos on Facebook that are now commonly used to dispute claims on inability to work.
Before you start making a video of the employee’s job, stop and plans what you want to show. Read through the written job description. Does it cover everything the employee does? Ask another conscientious employee who does the same job how the written job description can be improved (no need to mention the other employee’s work comp claim). Be sure to make note of everything the currently working employee states needs to be added to, or taken out of, the existing job description.
Obtain a copy of the injured employee’s medical restrictions. Identify the limitations the medical provider has placed that are preventing the employee from returning to work (this will be important when making the video record of the job description).
Ask the working employee to allow you to video record the work routine, the daily task and the most difficult parts of the job. Be sure to capture on the video the way the working employee has to move, bend, stretch, twist, walk, sit, stand, etc. Show all repetitive motions. Show all lifting whether it is a 40-pound box of materials, or a feather-light single piece of material.
Be sure to have the sound turned on during the video of the job and ask questions. Some of the questions you will want answered in your video include:
1. How much does that item weigh?
2. How often do you have to pick up the item?
3. Is it easier to do your job sitting down or standing up?
4. How far do you have to reach?
5. How many times a day to you repeat that motion?
6. What can be done to make the physical demands of the job easier?
7. Show me the most difficult part of your job.
8. Without mentioning the injured employee, ask about each limitation that has been placed on the injured employee, for example:
a. “If for safety reasons we said not to lift more than 20 pounds, could you still do your job?”
b. “If you were unable to stand for more than four hours at a time, would you be able to do the job sitting down?”
c. “Would it make the job easier if you alternated between standing and sitting?”
d. “Would you be able to do your job if we limited the repetitive motion to XX repetitions per hour?”
Keep in mind there is the possibility that the conscientious employee will state “you cannot do this job if you cannot lift 40 pounds” or something similar that will validate the fact the injured employee is not malingering and really cannot return to work, yet.
If necessary, edit your video job description to keep the length down to about five minutes. That is about as much time as you can expect the doctor to take away from his/her many other duties to watch the injured employee’s video job description.
When you are satisfied the video record will answer all the potential concerns of the medical provider and properly portray the injured employee’s job, ask the nurse case manager to view the video job description. See if she has any concerns about the injured employee’s capabilities to return to work. If she does, determine how the job might be modified for the injured employee to return to work.(WCxKit)
The nurse case manager is a good way to get the video record in front of the medical provider. The nurse case manager can explain your desire to get the employee back to work and also explain how any necessary job modification will be accomplished to meet the injured employee’s restrictions. If necessary, add to the video any job description changes needed to accompany the employee’s restrictions, showing the way the modified job will be done. When the medical provider sees the employee can do the regular job, or a modified duty job, the formerly injured employee will soon be back to work.
Author Rebecca Shafer
, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Workers’ Compensation Costs Can Be Reduced by Implementing Operational Best Practices: Learn How With This New Guidebook.
A company that wants to implement a new workers compensation program or revamp an existing system will find this book helpful. Maybe your company has recently expanded and you realize the need to train a workers compensation manager or regional coordinators how to hold down compensation costs. Whatever your need, here is the answer:
Workers Compensation Management Program: Reduce Workers’ Comp Costs 20%-50%.
Used by more than 150 firms across the country, this is THE book to help every employer develop a more effective workers compensation program to reduce workers compensation costs. It is based on field research and decades of experience in workers compensation from all aspects of the business. Best practices are described in detail for each person in the injury process.
This easy-to-read manual has been updated for 2012. It now includes:
An index for quick topic look-up so you can view a term or a procedure and see all relevant references.
NEW – Workers Compensation Basics
Purpose of Workers Compensation
Who Pays for Workers Compensation?
Parties Involved in Workers Compensation
Benefits for the Employer
Independent Contractors
Benefits for the Employee
Injuries Covered
Types of Workers Compensation
How Losses are Categorized
How Losses are Reported
Calculating Your Premium
How Mod Effects Your Premium
Good/Bad Mod Example
Five Ways to Reduce Your Mod
NEW – Fundamentals of Cost Containment
Reasons Workers Compensation Costs are High
Who is in Charge?
Work Ability Form Properties
Who is Responsible for Managing Workers Compensation Claims?
Who is Responsible for Managing Workers Compensation Process?
Hidden (Indirect) Costs of Workers Compensation
Additional Costs
Calculating WC Costs
External Obstacles to Cost Control
Internal Obstacles to Cost Control
NEW – Working with Your Adjusters or TPA
Account Handling Instructions
MD Participation
NEW- Reporting a Claim
Critical Issues
Essential Intake Considerations
Nurse Triage
NEW- Directing Medical Care
Occupational Health Clinics
Remote Health Services
Directing Medical Care in California
NEW- Return to Work
What to Include in a Transitional Duty Policy
Non-Profit, Volunteer or Charitable Positions
Employees Who Never Return to Work
Coordinating WC with Federal and State Leave Statutes
NEW – Other Indemnity Cost Containment Services
Telephonic Disability Intervention
NEW – Medical Cost Containment
URAC Certification
Mental Health RNs
Chronic Pain Programs
An Aging Workforce
At Home Recovery Services
Medical Fee Schedules
Fee Schedule Coding
ICD-9 and CPT Codes
NEW- Physical Therapy and Physical Rehabilitation
Differences between Physical Rehabilitation Programs
Pharmacy Benefits Management Program
Authorized Drug Formulary
Toxicology Screening
NEW – Fighting Fraud and Abuse
Medical Terminology Used to Identify Malingering
Reviewing Investigation Reports and Videos
Avoid good Day/Bad Day Syndrome
NEW – Claims Resolution and Settlements
Conditional Payment and Final Demand
Pharmacy Component of MSA
California Settlement Process
A 183-page guide covering how to assess your workers compensation program, design program materials, roll out a program to the organization, and monitor and manage the program once implemented.
Written by a national expert on workers compensation cost containment with over 25 years experience helping companies reduce their losses 20% to 50%.
T. Ronca, a workers’ compensation defense attorney from Long Island, NY, said the
book is an invaluable desk reference. “It is one of the tools that should never be out of reach for a risk manager. Direct employer involvement with claims in the first weeks is the difference between success and failure. This manual will guide the conscientious employer through the pitfalls,” Ronca said.
What’s more, the book can be delivered with your company logo on the cover and a full-color ad for your company on the back cover.
Take it out to the field. Text tabs are available to put on each chapter and it is ready to go as your company training manual. All you will have to do is customize the Training Agenda that is in Part I of the book.
Included in the manual are topics such as: Return to work and transitional duty, claim reporting, employee communications, controlling fraud and abuse, directing medical care, medical cost containment solutions, post injury response procedures, reporting procedures, working with your carrier and third party administrator. There is information about physical therapy, pharmacy benefits management programs, training supervisors and gaining management commitment. It also contains concepts of claim settlement and resolution as well as safety and loss control. New areas are identified above.
There are 5 sample worksheets in the manual to help organize an efficient workers’ compensation program. These include: timetable for implementation, the injury coordinator job description, and several sample roll-out letters. We recently received a terrific phone call from a third-party administration firm saying how the manual provided an organized way to train clients at loss prevention and has helped their clients put "layers of better WC management" in place. Everyone benefited.
One large distribution firm wrote to us to say the chapter on safety and loss control led to a company-wide safety change that only cost a few hundred dollars but prevented a specific type of injury that had been draining its budget, says Rebecca Shafer, Esq., President of Amaxx Risk Solution, Inc. who authors the book. Shafer is a national expert on workers’ compensation cost containment with more than 25 years of industry experience helping many companies reduce their losses 20-50%.
When you order your copy of Manage your Workers’ Compensation Program from Advisen at
http://corner.advisen.com/wcbooks, the 183-page guidebook shows how to assess your program, design program materials, roll-out a program to the organization, and monitor and manage the program once implemented.
The workbook is also available with a customized front and back cover for bulk purchases. Discounted rates apply to bulk orders.
One company said, "After reading the manual, we took a look at past workers comp practices and saw that every department did things differently. Manage Your Workers’' Compensation Program 2012 gave us the guidance we needed to standardize our workers’ compensation programs across the country. It was like a pre-prepared lesson plan," according to the risk manager.
A regional hospital in North Dakota wrote that, "Our small company expanded rapidly and we actually didn’t have any official workers’ compensation program in place. This manual gave us step-by-step procedures from the first meetings with management to monitoring the final program. Buying and reading the book was almost like hiring another employee – one who was an expert in workers’ compensation."
Who Uses the Workers’ Compensation Book?
Risk Managers and Workers’ Comp Managers find it useful learning about the cost containment niche and use it for themselves and to bringing new team members up to speed very quickly. The book becomes a “lesson plan” tool.
Safety Directors use the book to train supervisors in workers’ compensation claims management. They learn more about their area of responsibility — post loss cost containment — adding to their overall knowledge. They also learn what to do after an injury and what steps are supposed to take place during the first 24 hours.
Brokers use it for prospects, as well as, to learn about specific aspects of cost containment, passing their knowledge on to their clients. For example, when discussing how to develop a return-to-work program and a client asks about, “off-site return-to-work programs,” the broker quickly finds the relevant section in the book, reviews it and passes the answer on to the client, along with a copy of the cost containment book with the broker’s logo.
Adjusters use the book to gain a better understanding of the employer’s perspective. Adjusters also want to learn more about cost containment to add to their overall workers’ compensation knowledge in order to grow their careers and stay abreast of new services.
Account Producers give the book to prospects during formal presentations to illustrate their company is on top of the workers’ compensation industry. The book makes an excellent client gift.
Vendors such as doctors, physical therapy networks, occupational clinics and medical management firms learn how their service might fit into the workers’ compensation marketplace, what is important to employers, and what they look for in medical services to enable the vendors to enter the workers’ compensation marketplace.
The manual is a cost-cutting tool to learn more about systematic and operational techniques for reducing workers compensation costs.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Posted in
Claim Audits & File Review,
Communication with Employees,
Coordinating Medical Care,
Federal Workers Compensation,
Fraud and Abuse,
Insurance Issues, Rates, Premiums,
Lowering Premiums & Experience Mod,
Management Commitment,
Medical Cost Containment & Managed Care,
Medicare Set Asides (MSAs),
Professional Development Issues,
Return to Work and Transitional Duty,
Risk Management,
Safety and Loss Control,
Settling WC Claims,
TPA and Claims Administration,
WC 101,
WC in Other Countries (International) |
“Return to Work” (RTW) will achieve unprecedented attention in the coming year, largely due to a series of recent decisions and an upcoming argument in the state’s highest court, the Court of Appeals. The issue will be defining better the standards for “voluntary withdrawal” from the labor force. Such withdrawals can result in halting of future payments.
If an employer makes a job offer a return to work is far more likely to result in success than if a worker tries to find a job. To help employers implement a RTW program, the Board has on its website an outline of an RTW program. One of the sections deals with “partners” in the return to work process. Nine people and entities are listed, but the most important is not present on the list. Who might that be? The SPOUSE!
In order to appreciate the role and importance of the spouse in managing disability it helps to have been as close to the problem as possible, but with professional expertise. That means being the treating doctor or the lawyer representing the worker. Only in that way are you likely to witness first hand the role that is played by the spouse.
People who have become cynical and jaded by the administrative handling of comp claims would be surprised to learn that the spouse is the person least likely to favor extended disability, no matter what the final settlement figure might be. The spouse, above all others, knows, and lives with, the consequences of extended absence from work. Even the children, who share the consequences, can only guess at the downside nature of disability though they quickly learn what it is like to have an additional parent commenting on their every move.
Why would the Board outline omit all references to a spouse? Perhaps because the very nature of the relationship is private and beyond the Board’s comment or control. But that is no reason for others to fail to involve that most important person.
In any enlightened RTW program by the employer a face to face discussion with the employee should be had as quickly as possible. The spouse should be present and participating in the discussion with, of course, the permission of the worker.
There is a good chance that the employer already knows the spouse, which makes the efforts far more effective. Leaving the efforts to a carrier or administrative board makes for a poor communication network which usually omits family members from the process. But the employer has an excellent functioning, and supportive, network when the family is directly involved.
A RTW discussion should not focus on the claim. The effort is part of the employer/employee relationship and such discussions can, and often are, had even in the absence of any kind of claim. Having such discussions when no claim has been filed will often result in lowering claims in the future. (Many disability claims – comp, LTD, Social Security disability – are triggered by uncertainty about future earnings or medical payments. A sooner, rather than later, meeting with the employer will greatly reduce that uncertainty.)
In short, the employer participates not as a surrogate for the carrier but as the other major player in the family’s security. (WCxKit)
The first rule of disaster management and control is to maximize the immediate use of all available tools. Do not wait for a third-party to appear with another tool, which is seldom as effective as those already in place and not nearly as timely.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
medsearch7@optonline.net
One of our readers, Tom Gassaway of Arthur J. Gallagher, found this article of particular interest and offered this example.
I received your newsletter this morning and found one article that I felt was long overdue. The article was “The Spouse Might Be the most Important Partner in NY Workers Comp.” I spent 17 years working at Liberty Mutual and remember hearing this mentioned, for the very severe cases, as far back as 1978. I was told they need to be involved in the psychological and emotional recovery from an accident, no matter in what state the accident occurred. I even saw it used for a claim involving one of my insureds.
The claim involved a worker who lost both hands in a punch press accident. He was due to be married within a few months of the accident and the obvious questions arose:
Would the wedding even take place?
Would the future spouse still want him?
Would the future spouse be able to assist with all of his needs?
What about income and medical bills?
Liberty immediately got him to their rehabilitation center in Boston and started to work on this whole process. Somewhere along the way the fiancé was asked to take part. The good news was she was agreeable and it went well. She was there through the fitting of the “hooks” for hands and other key milestones. The good news was they were able to be married on time and the they returned to Boston after the wedding to finish the rehabilitation. Overall, it was a good outcome and I heard later they even had two children.
Thanks for the article.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Two recent decisions, and an outline posted on the WCB website, indicate that there is a shift in New York workers comp towards employer return to work offers.
The court decisions “Browne v Medford Multicare” and “Smith v TWA, Inc” dealt with workers who refused return to modified work. (WCxKit)
The refusal of the offers was treated in both cases as voluntary withdrawal from the labor market – a conclusion that would have been unthinkable years ago. In addition, the Board has posted a return-to-work guide for employers on its website, another departure from past practices.
The decisions point to the emergence of a very different comp system. In the past, a claimant could refuse all offers of work without jeopardizing further compensation, which led to the final settlements which accounted for 60% of all attorney fees. The new model will substantially reduce comp costs and xmods for proactive employers.
The Board outline of return-to-work proposals makes it clear that, in the future, the worker’s attorney is expected to support prompt return to work even if a settlement fee is lost in the process. Hopefully, the Board will find a way to award fees for cooperating with a return-to-work program. Such cooperation, in the past, has been viewed as worth less than service which led to protracted disability.
Tellingly, the Board sites statistics in its RTW outline which claim that successful work rehabilitation has only a 1% chance of success for an injury which has resulted in two years of lost time. In the past, only disabilities resulting in two years lost time were considered for lump sum settlement. The Board construed years of lost time as a perversely positive result.
But all this is a potential reform. It is only as inevitable as the willingness of employers to become involved and do it right. All the decisions will mean nothing to an employer who imagines that, somehow, a carrier or the Board will do the heavy lifting for it. (WCxKit)
Will all, or even most, employers become “return to work” conscious? No. Certainly not. The chances that a claimant, chosen at random, will work for an employer diligently pursuing ways to reduce employee lost time will be substantially less than 50%, perhaps much less. Even so, the playing field is different. The employer making the effort will achieve the savings. And its workers will share in those savings in a wide variety of ways.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
As members of a management team, around the winter season, reevaluate for the upcoming year. Set goals, benchmarks, implement new techniques, purchase new materials, etc. But there is one area that seems to be focused on more than others: And that is ‘how can we use what we have to be better?’.
Chances are in a medium to large shop, there is plenty of talent, in more than one form. The workers can be your most important capital. So why not focus on how to better use that talent? (WCxKit)
1. Provide the best tools so employees can perform efficiently
As an example, if you drive cars, this does not mean that all all drive a top of the line Cadillac. But this is meant more to show how to provide the best output for workers. Make workstations adjustable so workers can perform at the levels they need to. This will increase output and performance, not to mention that it will make workers less prone to injury, especially in repetitive-motion workstations. Extra lighting can provide clarity and precision. Hand trucks and dollies can make moving heavy materials easier and quicker, and so on and so on.
2. Don't run it like a prison
The workplace does not have to run hard-nosed and rigid. As an employer allows some flexibility such as flex work hours, rotating job tasks, allowing hourly breaks, then you can best utilize workers time at work for production. A rested workforce is your best workforce. Sometimes having job rotation can provide breaks for those that do heavy duty work day in and day out. Also this can reduce injury since those workers that just do heavy lifting or moving of materials can get a much needed break from time to time throughout the day. You could also discover that one of your workers may be better suited for another type of job task, versus the one they are currently in now. This could lead to increased production, and better efficiency.
3. Keep an open mind
Time and time again we recommend listening to employees and their suggestions as to how changes can be made to make production better. Discuss alternative job tasks and how things could be done quicker and easier. Remember these are the people that do these jobs all day, sometimes for years. They have ideas and suggestions and you have to make management become approachable. If someone knows that you will take the time to listen to them, you may get an idea that you can implement. Not everyone will hit the ball out of the park every time, but you could stumble upon something that can really make a difference, and it could change the way things are done on a daily basis.
4. Encourage healthy lifestyles and reward those that make a change
A healthy body is one that comes ready and able to work, and able to take on the challenges of the day. Healthier employees also have less sick time away from work, and have fewer injuries. A lot of companies now offer discounts to local gyms, reduced medical premiums for wellness exams, smoking cessation programs for free, etc. The HR department probably has a lot of ideas and plans that are already in place to promote a healthier lifestyle, and the incentive programs to go with it, so check in to some of them and try to implement some over the course of a year. Provide some incentives for the workers to participate, and see what happens. I bet that more will participate than you thought.
5. Launch a return to work program
It has been well documented that the longer a person is out of work, the harder it is to get them back to productive employment and there is a strong correlation between a high return to work ratio and a low mod. Older employees also take longer to heal than younger ones, so consider home-based employment. If you provide some light duty work, employees know that even though they have an injury, they can still work and make a decent wage. This will help them transition back into full time work once they are released from medical care, and will reduce claims dollars that are spent on lost wages while injured. It will also free up full duty employees to do something more productive, while those with medical restrictions can take care of the lighter tasks you need done day in and day out. Make a "wish list" of tasks you wish you had someone to help perform, then use the wish list to create transitional duty tasks. For instance, I wish I had someone to proofread my writing.
6. Set up a mentoring program
It is always hard to start a new job. Nobody wants to be the new person, so set up a mentoring program to help those new or less-experienced employees. Shadowing programs work well also. The new employee can gain some great knowledge from the veteran worker, including how to do things quicker, properly, and more efficiently. A good mentoring program will improve productivity of the newer, younger employees while making veteran workers feel like they can contribute more to the company other than just cranking out their job tasks day after day. The more you make workers feel like they are involved, the better, harder, and more dedicated they will work for you.
7. Do not be afraid to hire experienced workers
There are many benefits to hiring experienced workers. These workers already have sound work habits, years of experience in the field, and the skills the company needs to take you to the next level of competition. These workers also have less out of work distractions, such as needing more time off for child care or more time off for school commitments. Experienced workers will also add some diversity in workforce, contributing their ideas and experience to the team projects and ideas. If you utilize their assets, the workplace will benefit. (WCxKit)
Summary
A New Year means it is time to reflect on the year to date, and focus on what you can do better for the upcoming New Year. But you should also think about what the veteran workers can bring to the table for the company. Experienced workers are a great untapped resource, and their ideas and work ethics can be beneficial in more ways than one, especially in fields other than just being at their workstation. Tap the greatest free resource- the employees. Listen to their ideas, and make the management team approachable when someone has an idea about how something may be able to be done better. If you make this one of several things to focus on, accomplishing the rest of the goals could just be that much easier.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
A just-published NY decision, Browne v. Medford Multicare (2011 NY Slip Op 07764), gives employers greater than ever incentives for return to work offers in NY comp claims.
The Board conceded that the worker had a partial disability. However, the employer had made an offer of lighter work, which at least one medical exam said was within her limits. The worker turned down the offer for lighter work. (WCxKit)
Even though the treating doctor advised that she not take the offer, the Board said that the evidence supported her ability to do lighter work and halted further payments of compensation.
The decision demonstrates the value of offers of modified work by the employer. Settlement awards for ongoing partial disability can be reduced to a fraction with offers of lighter, modified work.
The offer, and meetings leading to an offer, are part of the employer-employee relationship, not the comp claim, and are not controlled by the Board, carrier/TPA or the attorneys. Such meetings, often with spouse present, permit flexibility and an atmosphere of trust, as the parties have already been in contact many times before.
A little recognized feature of RTW meetings is that they can be part of ADA compliance. It is a fallacy that ADA applies only to hiring. Retention is covered as well.
The NY decision, coupled with expanded ADA compliance, can substantially reduce comp costs. A 20% reduction is quite feasible. It should be remembered that family members generally support all efforts to return a member to work as soon as possible.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
The Americans with Disabilities Act extends the ability of workers with disabilities to be employed with reasonable accommodation. Medical examinations and review of prior medical records are frequently necessary for a vocational expert to comment on what jobs can be done by an individual with a disability and what the earning capacity would be. The vast number of ADA examinations are for pre-employment purposes. The use of ADA for examinations of workers in serious comp claims has received little attention.
In serious workers comp claims, precisely the same issues relevant to a pre-employment ADA exam appear about a year after date of accident, a time at which a permanent rate of disability and amount of wage loss in NY claims will be considered. Settlements will also be discussed. (WCxKit)
Using New York as an example (settlement procedures vary widely from state to state), an ADA examination and conference can be an effective RTW strategy and greatly reduce post-injury loss of earnings. In addition, ADA compliance is not subject to oversight and regulation by state workers comp agencies. Nor does an ADA medical exam count as a workers comp IME.
The ADA compliance exam must be done by the employer as part of a good faith effort to return a worker to employment. The worker, however, must indicate an interest in return to work for the employer; the exam cannot be forced.
A typical procedure might be as follows, subject to many modifications under collective bargaining agreements.
1. After a reasonable period, the employer may ask the worker if there is interest in returning to work, on a trial basis and with reasonable accommodations.
2. A face-to-face conference may be scheduled, with spouse present, to discuss the possibilities and the wages which would be paid.
3. A medical exam may be necessary to determine what accommodations might be necessary.
4. A vocational expert should compose a report and comment on wage earning capacity.
5. An effort to place the worker into a suitable job must be made.
In NY, settlement figures for comp PPD claims cluster at 50% disability, resulting in many claims with over $400/wk. rates. With a proper ADA program, many of these can be held to $100/wk., less, or even no wage loss.
A fact known to nearly every Social Security disability attorney is that the spouse is usually highly supportive of RTW, not extended disability. Involving the spouse in RTW discussions will produce far better results. (WCxKit)
The ADA exam and conference are part of the employer/employee relationship, not the workers comp claim, and are therefore outside the control of a comp board.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
medsearch7@optonline.net
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
So you have decided to provide some light duty or transitional work for injured workers to decrease wage loss expense. First of all, congratulations! This is the first step in decreasing claims costs. The wage expense in a comp claim is most usually the biggest cost, and any chance you have of decreasing that cost should be taken. But what should the workers do? What if they do not follow the rules and get hurt again? What if this light duty work hinders the rehab and recovery?
These are all common issues and concerns. But there are ways to work around them with jobs that already in the workplace for these workers to do. Jobs that are no more or less strenuous than
anything else they do in a daily basis while out of work. If stumped for ideas as to where to start, use this information , and then further customize your jobs based on the building blocks we list below. These will not apply to all areas of every employer, but at least it offers possible job ideas. (WCxKit)
Although not glamorous, janitorial tasks are a much needed function of the workplace. A broom is not heavy so sweeping the floor and back storage areas is not only sanitary but can also reduce risks for slips and falls due to debris. Maybe wiping down machines and making sure they are in proper working order is a job the injured party can do based on level of experience. With winter looming, salting entryways and making sure rugs and mats are in good shape and in good working order is a must to prevent falls. Mopping could also be done, but it can involve lifting and twisting with a wet, heavy mop, so make sure your worker is capable of that before you assign that task to them. The goal is to have them working with light materials and prevent exertion that can cause further injury.
There may be a lot of jobs around the shop that are not done on a regular basis. Oiling machinery will increase the performance of the machine, as will changing belts, cleaning guards, checking saw blades, or cutting surfaces.
The tasks are not limited to only machinery. Light painting can freshen and improve the look of the work floor. Replacing broken faucets, light bulbs, cracked mirrors, or repairing/caulking windows that may be not closing properly can also help. Checking outlets for proper power wattage is another one. Go out on the floor and ask workers what needs to be done or what is not working properly and make the injured worker a “to-do” list. There
may not be enough work for them to last weeks, but at least it gets them back to work and doing something while in recovery mode.
These jobs can include answering the phone, taking sales orders from clients, copying materials for files, or scanning paperwork for example. Ask the office staff about any upcoming
projects and what needs to be done they have been putting off for a while. Chances are there are some sedentary work tasks available and needed, and this is a perfect task for your injured worker to do. That way a fully functional worker without work restrictions can focus on more important tasks, or jobs that are more strenuous in nature.
A lot of employers carry a certain level of inventory for workplace needs. Obviously the amount of inventory being carried depends on the type of workplace. But if you have the need, this is another light task the injured worker can do. Taking proper inventory and ordering more supplies is also another task to cross off your own to-do list. Have the injured worker tally up what is currently in stock, what needs to be ordered, and when it should arrive before supply runs low. This is also a good time to have the worker shop and price supplies. You might be able to find another vendor that can provide a better supply for a lower price. This way not only gets the injured worker back to work, but the employee is also saving you money in the long-term.
5. Job supervision and reporting
If the injured worker is unable to do the normal job, maybe the employee can still go out on job sites and help the other workers. Not only supervise the overall job, but the worker could also assist in gathering light materials needed for the job. If the work involves ladders and scaffolding, have someone on the ground to help the other workers, so they do not have to go up and down the ladders repeatedly to fetch materials or tools.
The injured worker also can report back like how the job is going so far, and recommend any changes or needed materials for the jobsite. This will keep the job running on time for completion, and it is just another task that nobody thinks of until the issue arises. You stay on top of the job status, and if certain recommendations are suggested and implemented, maybe that job is completed sooner than expected, resulting in a happier client.
If there is a management member out of work due to a claim, maybe now is a good time to bring them in to do annual performance reviews. This way they can pull all the personnel files on the workforce, review them, get updated feedback from other supervisors on what the current performance is like, and then sit down with the employee to conduct a review and suggest improvements. Again this may not supply the injured workers with weeks and weeks of work, but at least it is something that needed to be done. And if you have the right candidate to do it then it makes sense to have that person complete the task.
A lot of larger employers, such as grocery stores and retail businesses, have in-house surveillance cameras. The injured worker can monitor the day to day surveillance, clean up messes or spills, rotate product, place shelf signs, or any other light task that may need to be done. Theft prevention can also be addressed; however, you do not want the injured worker trying to apprehend anyone and get injured again.
8. Accounts payable/receivable
Another sedentary job is shifting the injured worker over to helping with accounts receivable/payable. Your business probably has vendors to pay, and you also may have clients that have outstanding invoices. Have the worker take over the books, and see if they can collect payment on some of the invoices that have not been paid. Sometimes a faxed invoice to a client followed up by a phone call is all it takes to get the invoice paid. This task will clean the books up, and make the company current with payments that are coming in and going out all the time.
If the injured party has restrictions but can still do most of the job, assign an entry-level helper to go along and do the tasks that they cannot do. This provides the newer employee a chance to learn more about the business and job duties, and it allows the injured worker to keep doing the normal job, now with the assistance of a helper
10. Reach out to the injured party for ideas
When you just cannot think of anything for the injured worker to do, reach out to them and see what ideas the employee has. The incentive for the worker is the chance to return to work, and maybe make the normal pay instead of collecting reduced wages on workers comp. Sometimes great ideas are suggested. So keep an open mind, solicit some ideas from them, and try to do what you can to implement those job ideas. (WCxKit)
Trying to create jobs for the injured workers is no easy task. But with an open mind and some creativity, get injured workers back to work. Not only does this cut down on the workers comp expense but it also can complete some overdue tasks. Put some thought in to it, and ask others around the workplace for ideas. Together you should be able to come up with a list of tasks that need to be done. Every dollar saved on wage loss will count in the end. Keep track of the cost of having these workers come back to light duty work, and weigh it against the cost of keeping them out of work, only returning at full duty. You will be surprised at the cost savings a implementing a light duty work program.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
