Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 2

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 1

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 2

Top 5 Take Away Points 2016 National Work Comp & Disability Conf – Part 3

 

Hello, Michael Stack here with Amaxx. So I just got back from New Orleans, Louisiana… I want to talk to you about my top five take-away implementation points from the sessions that I attended. Continued from Part 1…

 

 

Take Away Point #2: Occupational Doctor Relationships

 

Take-away point number two is occupational doctor relationships, so occupational doctor relationships. This was a very dramatic point and dramatic example given by Laurie English from Excela Health, another Teddy Award-winning presentation. So obviously they’re a healthcare provider. The biggest challenge that they had was all their injured workers going to the emergency room to see non-occupational doctors. They had a relationship often times, they knew who the doctor was, the doctor would say, “Okay, Jane, you’ve got an injury. Here’s a script, you’ve got four days off work,” and then all the problems that start to come with that.

 

So a very dramatic example, and here’s what they did. they took those ER  doctors, those non-occupational doctors that weren’t trained in workers’ compensation, weren’t trained in occupational medicine, off their panel. They took them off the even possibility to go see them, and if an injured worker does go see them, it costs them $100 co-pay. So they had to do this very dramatically. Not necessarily an easy process to change that culture, but they have done it successfully and seen dramatic results. Now those injured workers go to occupationally medicine-trained nurses who will facilitate their care, and they’ve seen significant results, so very dramatic example in a healthcare situation.

 

Now fast-forward to the return to work presentation given by Anne-Marie Amiel, from the city of Columbus in Georgia, very different type of workforce, public workforce. They don’t have the internal doctors that the employers are going to, very different than a healthcare situation, but the statement she made that I thought was very telling of the success of their program, the success of their return to work program. She said the first six months on the job she went to go personally and visit every one of the providers that they work with. Doctors, physical therapists, etc., talk to them about their program, talk to them about the expectations, talked about how they can work together as a partner to return those injured employees back to work to heal rather than keeping them off to heal before they return to work, that dramatic mindset. That was done by those face-to-face individual meetings, she spent that first six months on the job and then they saw that dramatic success and those dramatic results.

 

 

Take Away Point #3: Weekly Claims Meetings

 

So now let’s talk about the third take-away point, and this is an interesting point, because this is one that was also mentioned when I did my top five take-away points last year. Caryl Russo from Barnabas Health, Jennifer Saddy from American Airlines, both mentioned this concept of weekly meetings, weekly claims meetings as a key to success in their programs, Teddy Award winners. Danielle Hill from Hampton Road Transit, Jennifer Massey from Harder Mechanical Contractors, and Laurie English from Excela Health all talked about this idea of regular claims meetings.

 

 

Here’s the take-away. If all these award-winning programs are using and leveraging this concept, to win these awards, probably something to think about implementing in your program or refining in your program if it’s something that you’re doing or maybe just not doing as well as you possibly could. Here’s the take-away here of really how to get this started. If weekly sounds way too often and that’s something that you could never possibly do, start with quarterly. Start to have some success. Move that then up to monthly, then move that up to weekly. You’re talking about in these meetings where these claims are, how to work together towards a positive outcome and a positive resolution in each one of these individual claims. As the great Zig Zigler said, you don’t have to be great to start, but you do have to start to be great.

 

Continued…

 

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/

 

10 Tips To Prepare For Workplace Catastrophe

Explosions, earthquakes, tornadoes, flash floods, sink holes, lightning strikes, hurricanes, terror attacks and acts of war are a few damage conditions that can strike the work place with little or no warning.

 

Regardless of which catastrophe might occur, the employer’s response will have a lasting impact on the employees and the organization.  Proper catastrophe plans, and programs with prompt response and corrective actions are necessary, and while the physical property damage is a paramount concern to get the organization back into business, it is the attention to employees that must come first.

 

Preparation:

 

If you fail to plan, you plan to fail.  Consider the following to properly prepare for a catastrophe:

 

  • Prepare physical requirements such as, fire-fighting equipment, fire walls, safety doors, wireless communication equipment, personnel safety ware, and first aid equipment.

 

  • Escape paths, properly placed emergency shut off buttons, valves, and wheels must be accessible.

 

  • High Powered emergency battery lighting must be strategically placed. It needs to be set to go on at the immediate loss of regular power.  Everything will require clear egress and be highly visible at all times.

 

  • It will be necessary to train all employees in the use of all equipment. Run classes and actual drills on regular intervals.  Occasionally run drills without warning.   It is also suggested that some people be assigned as injury victims.

 

  • Designating employee partners, teams, and individuals that can help each other leave the premises and obtain medical care or other physical needs. Set up safe gathering areas to go to after the loss.

 

  • Keep the program current and constantly be ready to supply the latest in equipment and knowledge.

 

  • Management must be diligent at training, inspecting, monitoring, and enforcing for all equipment and procedures.

 

  • Employees’ compliance should be part of performance appraisals.

 

  • Arrange for handling of the press and electronic media. Designate one source to release verified information.  Instruct all employees to refrain from media interviews.

 

  • Make arrangements with local police, fire and medical facilities as to how they will respond. Prepare a program that defines what their functions are when a loss occurs.

 

Employees First Priority:

 

Regardless of all equipment, employee training and drills, there can still be some degree of confusion, fright, panic, and even forgetting by the employees on what to do.  If the devastation is horrific, instant shock might paralyze thought and action.

 

As a result, management’s response will have a huge impact on perception, efficiency, trustworthiness, and minimizing effects. If handled poorly, employee relations can be damaged for extended periods of time.  While there will be necessity to restore property and normal operation, it must be the employees that become the first priority.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

 

 

Supporting The CFO In Enterprise Risk Management

risk-innovationThe CFO is the most qualified to provide CEO and board operational insight. In most business environments, silos are pronounced and organizational noise is loud. Obtaining and providing a transparent perspective can be challenging.

 

In an ERM platform, process owners perform risk assessment in a standardized and repeatable method that aggregates up to the CFO. The Chief Risk Officer or Risk Manager is responsible to provide the framework and to ensure assessments are on-going, complete (strategic &  operational) and based on the root causes of the company’s business risk.

 

A centralized risk repository provides feedback on risk, across functions  and levels, and is qualified and quantified and easily prioritized so the CFO can provide one comprehensive picture to the board.

 

Operational insight is not something a CFO should be tracking. A structured process ensures current and emerging risk is being evaluated and assessed on a day- to- day basis.

 

 

Is there focus on the silos?

 

All organizations have silos. It is challenging to make connections across silos and difficult to effectively escalate even the most obvious concerns. Data is collected in different places; each area only has a piece of the problem and typically, activities and the conclusions are confined in  silos.

 

What efforts, resources and thoughts are put into breaking down silos? The core to ERM is addressing silos so that valuable resources are not wasted and cross-functional efficiencies are not lost.

 

 

Hazard vs. Business Risk

 

Traditional risk management deals with hazard-based risk. As hazards are negative, the goal is to avoid or eliminate risk.

 

There is a “seize the opportunity” component to business risk. All business decisions involve risk; they shift efforts and resources. The upside to these decisions is gain and the downside, loss.

 

ERM applies risk management logic to business decisions so that efforts and resources shift to an organization’s most important needs and key opportunities are not lost.

 

 

Is organizational noise good or bad?

 

It depends – random and unsubstantiated comments can undermine well thought-out plans.

 

Opportunity to voice opinions is what drives a healthy culture. Framework that encourages feedback through structure that requires thinking, processing and presenting like business owners sets the stage for a collaborative and innovative environment.

 

 

Author Mark Bennett, Founder of Risk Innovation Group (RIG), is dedicated to helping large employers face the complexities of risk through innovative Enterprise Risk Management (ERM) practices. ERM programs don’t just help large employers manage business risks more effectively; a well-developed ERM program can protect and create value as well as improve business performance and generate a strong competitive advantage.  Contact: m.bennett@riskinnovationgroup.com

 

September 11th Remembered – Tribute To Marsh And AON

Everyone remembers where they were the when they learned the World Trade Center crumbled to the ground. I was scooping ice cream at the Mansfield Center General Store. Having recently retired from the risk management and insurance industry, I had moved back to the area, built a house in Mansfield Center and worked from my home office. I was helping my family restore and run the General Store.

 

I had an exciting career in risk management and insurance working for two of the best insurance brokers in the industry. BOTH companies had sizeable offices located in the World Trade Center. So, when Bill called and asked me if I was watching TV, did I know a plane flew into the World Trade Center, I was alarmed. Initially I thought he meant it was a small plane, but when I turned on the TV, I could see it was a huge plane and the building was on fire. And then another plane had flown into the other tower.

 

 

We Never Knew How 9/11 Could Affect An Entire Industry

 

Everyone in the risk management field “plans”… we plan for every eventuality, thinking things through. That’s what we do. We help our clients, which are large companies such as The New York Times, Universal Orlando, and USAir, etc. plan how to provide safer workplaces, safer products and safer environments. But we never planned for Sept 11. We never knew how it could affect an entire industry.

 
AON and Marsh are the two largest insurance brokers in the world and I – with a loyal team of consultants – was responsible for development of the workers’ compensation practices at those companies. Workers’ comp insurance is the largest line of insurance coverage – a huge cost to most employers – and I had found the solution to reduce those costs significantly. Helping a wide-variety of types of organizations was gratifying, and there was a new challenge every day. I had written, published, traveled, and worked hard for 25 years, so I looked forward to scaling back.

 

When a retirement opportunity presented itself, I left the workforce to enjoy being a mom. My daughter was 17 and Glastonbury High School had not gone well. Against her will, we had moved her to a private school, and she and I were getting reacquainted during the long drive to and from school in Farmington, CT. Life was good.

 

 

Many Former Employees Went Back To Work

 

It wasn’t part of the plan to go back to work, but two weeks after Sept 11, I went back to AON, filling in for Lisa Ehrlich. Lisa was an outsourced risk manager who worked on-site at a company in Stamford, CT. On 9/11, she had gone into the NY office for a meeting and was killed that day. I was honored to be able to help in some small way. Many former employees went back to work in the intervening years to help the brokers rebuilt their practices. Here is a remembrance of my colleagues.

 
In the 15 years since Sept 11, a new generation has taken over. Some hardly know our industry lost so many that day, key leaders and pioneers in the field of workers’ compensation cost containment. In the intervening years, my niece and nephew, Kori and Michael Stack, have taken over a leadership role in my company and become industry leaders in their own right. I am very proud of them for carrying on the legacy and memory of our beloved colleagues lost on that fateful day.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the co-author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

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

 

 

Employee Course And Scope Can Change At Any Moment

Employees can be in and out of the course and scope of employment many times while on the job.  Most employers associate course and scope to apply to off premises operation which requires the employee to be in a direct time, place and position that furthers the employers business.

 

However, it may apply to on premises claims as well.  Horse play, sexual misconduct, intentional violation of duties, safety disregards, and self-inflicted injuries are just several such instances for deviation in course and scope of employment.

 

While jurisdictions vary greatly on waiting periods, benefit rates, exposures, disability rating methods and other wide ranging topics, they all agree that the injury or illness must arise out of the job scope and in the course of employment.

 

Tests to Determine Course and Scope:

 

There are three basic tests to prove a case compensable, questionable, or non- compensable.

 

  1. Course of Employment means the injury or illness, must occur on the employer premises, in a mandated location, or in a location where it is reasonable for the employee to further or conduct the employer’s business.  The employee must also be able to meet job performance standards and requirements. This does not include adherence to defined or regularly scheduled hours.  It also allows for different working environments, and relationships.

 

  1. Arising out of the employment means there must be a direct correlation for the employee to be furthering the business of the employer or the employer directly benefitted from the activity.

 

  1. Scope of employment has tests of its own:
    1. Analyze the employer’s direction and control of the employee at the time of loss.
    2. Analyze the employers ability to foresee the activities of the employee in completing the task or tasks at hand.
    3. Analyze the employee’s motivation.

 

 

Investigating Claims to Acertain Course and Scope:

 

  • Start with the contract of hire or employment. Is the claimant a true employee with a contract of hire a job description?  Is the employee on the payroll?  Does the employee receive all corporate benefits?
  • For loaned employees, temporary employees or a contract employees review contracts and insurance endorsement that the injured person is covered under another workers compensation program?
  • Through statements and performance records determine compliance with these contracts. Excessive control by the employer or unusually extended periods of time with one employer have been used to establish employment
  • Volunteer people doing duties for an employer must meet strict standards in order to not accidently create an employer employee relationship. Explore these state rules and be certain the employer is in compliance.
  • When employment is verified, take very detailed statements from the employee, the employer and any witnesses. The statements must include what directions existed and how each party interpreted them.
  • Did the employer allow the employee to have discretion or leeway from the instructions? How much? How long? Did it comply with usual and customary standards?
  • What equipment was given to the employee? How, when and where was it to be used? Was the equipment in proper working order?
  • Occupational disease claims must explore if the public at large is exposed to the same conditions that the employee is claiming was due to the employment. They must determine medical connection to underlying pathologies, job conditions, environment, and products used by the employee.
  • What normal functions impact the task? What was the employee doing at the exact time of the injury? Was the employee in direct compliance with furthering the employer’s business?  Were there any violations of instruction or expected normal performance?  Was there substance impairment, criminal activity, the taking of unnecessary or dangerous risk?
  • Did the employer have any control of the premises where the injury occurred?
  • The claim technician must have specific guide lines for all questions and issues needed for clarification and proof. All questions need to be designed to obtain the information that will either prove or disprove the course, scope and arising out of the employment?
  • Investigate or have the scene of the loss investigate. Take photographs, make diagrams, and describe the scene in detail.

 

Summary:

 

Employees can leave the course and scope both on and off premises.  It can occur anytime during work operation.  Investigations must be through and meet the three tests covering course and scope.   The investigation must be documented by fact and performances by both employer and employee.

 

 

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 founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a monthly basis working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2015 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.

 

What is Impact of Claimant Age for Late-Term Medical Expenses?

How important is claimant age for late-term medical expenses and do employers and employees have the latest data?
Recent NCCI research found that for workers compensation medical payments made between 20 and 30 years after an injury, the average annual payments for claimants younger than age 60 at the time of treatment are greater than the average annual payments for claimants older than age 60.
This study examines this difference by looking at the claims characteristics for injured workers in these age groups:

 

• Number of medical services and overall average prices paid for medical services
• Injury mix
• Prescription drug use

 

For this study, late-term medical care consists of all medical services provided during 2011 and 2012, for claims that occurred 20 to 30 years ago.

 

 

Key Findings from Research

 

Among the key findings discovered by officials from the research:

 

• The average annual late-term medical cost per claim generally decreases gradually with increasing claimant age.
• The number of services per claim is a larger contributor to age-related annual late-term medical cost differences than is cost per service.
• Average annual late-term medical costs per claim are about 60% higher for claimants born after 1950 than for older claimants. About 80% of this difference is explained by:

 

o The mix of injuries being treated and, in particular, differences in the share of quadriplegic and paraplegic claims. This explains approximately 60% of the difference.
o Use of prescription drugs and, in particular, differences in the use of narcotics. This explains approximately 20% of the difference.

 

View the full report at: https://www.ncci.com/documents/Impact-Claimant-Age-Late-Term-Med-Costs.pdf

 

 

Author Michael Stack, Principal of Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  As the senior editor of Amaxx’s publishing division, Michael is on the cutting edge of innovation and thought leadership in workers compensation cost containment. http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

Thanksgiving, Volunteers, And Workers Comp

In 1705, a ship bringing cinnamon to Connecticut was frozen in ice offshore. Thanksgiving celebrations were held up until volunteers went across the ice to offload the cinnamon, which was necessary for – pumpkin pie (even then considered a standard Thanksgiving dessert).

 

 

Winter Holidays Often Marked By Volunteering

 

What does this have to do with work comp? Well, maybe not much in 1705 but quite a bit in 2014. Winter holidays are often marked by employees volunteering for chartiable activities centering around Thanksgiving and Christmas and – inevitably – a few get injured. Are those injuries compensable?

 

 

 

Nearly Always Volunteering Injuries Are Ruled Compensable

 

From the very beginning of work comp in the early 20th century courts were asked to deal with this question. Nearly always, the injuries were ruled compensable because the volunteer activities of an employer’s workers resulted in valuable good will for the employer, provided of course that the employer could somehow be identified as having a connection.

 

One of the first cases reported, in the early 1920s, involved a driver of a truck with the employer’s logo on it stopping to help a driver with a flat tire. The driver has been informally encouraged by the employer to lend reasonable assistance to people with disabled vehicles.

 

Another case involved a portly salesman invited by a regular customer to play Santa Claus at the customer’s office Christmas party. The salesman bought a Santa costume with a one-piece hat and attached white beard. Driving to the party, in costume, the beard got caught in the belt, pulling the hat over his eyes causing a crash into a telephone pole. Ruling? Compensable! (The case was a favorite of Arthur Larson, author of the leading treatise on work comp.)

 

Employee participation in voluntary off-hours sports leagues which result in injury are also frequently compensable, especially if there are employee logos on the clothing.

 

 

Rulings Can Be The Grinch At The Holiday Celebration

 

The rulings in favor of compensability often turn out to be the grinch at the holiday celebration. This author watched, stunned, as a senior executive cancelled all company sports leagues after an employee collected $5,000 for a quickly healed fracture sustained at a July 4th  picnic and softball game.

 

Connecting recent rulings to the 1705 incident, suppose the volunteers were crossing the ice to bring the cinnamon back so the town could have its Thanksgiving pumpkin pie. If the volunteers were a group identifiably associated with an employer (or group of employers) the injuries might well be compensable, in much the same way that injuries to volunteer first responders have been since 9/11.

 

Happy Holidays!!

 

 

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

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

Lowering Workers Comp Best Practices – Follow Up Q&A

Lowering Workers’ Comp Costs – Best Practices webinar attracted over 750 industry professionals, including employers, risk managers, safety directors, brokers, consultants, or producers involved in claims management, specific aspects of cost containment, and/or, the latest workers’ comp strategy issues. The webinar was jointly hosted by Advisen and Amaxx Risk Solutions.

 

A panel of experts speakers, California Pizza Kitchen’s David Williams, Blackstone Consulting’s Mark Newman, Arthur Gallagher’s Bob Walker, Amaxx Risk Solutions’ Rebecca Shafer and Michael Stack, and Advisen’s Dave Bradford, discussed how organizations, big and small, can hone their injury procedures in order to significantly reduce their workers’ comp expenses by applying proven workers’ comp best practices.

 

It was a fast moving event that generated a number of questions.  Here are some of the questions and answers:

 

Q: What are some examples of red flags of fraud?

A: A couple are: claimant moves out of state, claimant is never home, claimant IS home but doesn’t answer phone, claimant’s recovery is longer than the duration guidelines indicate. This is just a few of many. Chapter 15 covers this in great detail and discusses ways to control fraud and abuse.

 

 

Q: How are ADA AA-related (American with Disabilities Act Amendment Act) concerns and activities managed from a Risk Management perspective? What are you advising clients about their legal obligations under the Act?

A: These can be tricky, and state laws can have more stringent requirements than the ADAAA which is federal. My initial response to this question was removed temporarily while we consult the EEOC regarding exactly when an employer’s duty to begin the interactive process to accomodate an injured employee with a transitional duty assignment attaches. Stay tuned. In the interim, the RM department needs to work with HR and Legal to ensure that they are compliant with ALL laws. Once the employee reaches MMI, and in some cases even before that while the employee is on transitional duty, there needs to be an interactive process between employee and employer to determine whether an accommodation is feasible if the employee requests one. Chapter 11 covers this topic.

 

 

Q: Are we suggesting that reporting can be done directly to a triage nurse instead of the traditional carrier input personnel?

A: Yes, in the injury triage program for California Pizza Kitchen, Medcor is the initial point of contact for all claims and everything funnels through them. In this way, all injuries get assessed and on the right track for treatment and reporting. Any information that is not initially available at the time of triage is obtained later by the TPA (as is the case with any reporting process).

 

 

Q: What are the two benchmarks that Becky was using?
A: I like my clients to reduce their incurred losses 50% of the National (or industry) Cost Per FTE ($754) and 90% -100% of injured workers returning to work within 1-4 days after the injury.

 

 

Q: You asked about “Direct to Specialist” Medical Programs.
A: The issue of better care versus cheaper care, is always a hot topic. I would whole-heartedly endorse such a program, even though it might take legislative changes in many states, but it is something I encourage employers to consider as part of their selection of medical providers. Direct to Specialist Programs work best when an employer has in onsite clinic or medical clinician, or an injury triage service for intake.

 

 

Q: Are saving based on incurred or paid losses?

A: Savings are based on Total Incurred Losses as of the same date every policy year. It is an apples-to-apples comparison. We start measuring immediately when we start the program development. 2 months after we begin versus 2 month in prior policy year (or two policy years, etc.) then 3 months, then 4 months, etc. We measure as we go along so if we are not seeing a reduction (this has never happened), we can tweak at that point not wait until we are 12 months down the road to make adjustments. I hope this helps.

 

 

Q: Our Unions in California really push our employees to get attorneys. What can we do about that?

A: I am pretty familiar with problems in CA and have recently been speaking with an IW (injured worker) to find out more about the problems from the IW perspective. Cost of WC claims rises dramatically when IWs hire attorneys. In addition to the cost to the employer, the IWs are not necessarily better off working with attorneys in CA because many give inadequate service and prolong the claim. Also, I have not been impressed with level of care the Information & Assistance Officers provide to IWs.

 

The best way to keep the IW from getting legal representation is to remove all of their possible issues…including:  make sure they get rapid, excellent medical care and the doctors get paid. Stay in touch with IWs constantly — starting with a tight post injury procedure, get well card, transitional duty ASAP, weekly meetings, etc.

 

Being in an MPN is not enough as many MPNs have inadequate coverage. Don’t focus on medical cost control, focus on “how can we provide our IWs with better medical care” even if you pay more for it! For example, don’t allow all treatment requests to go to UR. Does a request for $5.00 Pepto-Bismol really need UR? Make sure in your Account Instructions, you let the TPA know to accept reasonable requests for care, not send everything to UR. You need to WRAP YOUR ARMS AROUND THE INJURED WORKERS, literally, and they will have no need to get legal advice.

 

 

Q: Rebecca talks about benchmarking by looking at the number of employees currently out of work. Does she look at entire history of company and # of employees out or does she take only a current employment census, looking at the current fiscal year.

A: I look at the number of employees OOW (out of work) right now. Of course if you look at it historically and your number of man-hours has gone done, but the number of employees OOW has gone up, that is indicative of a problem, but basically — how many employees OOW NOW tells how big a problem you have. Of all injured workers, 90-100% should be back to work within 1-4 days. Thus, most claims will be small medical-only claims.

 

 

Q: Your questions was about the Cost Per Employee, whether an employer with part-time and full-time employees can use that measurement.

A: The Cost Per FTE (full-time equivalent employee) is based on man hours, thus it equalizes full-time and part-time employees to “equivalent employees” that’s why it is a good measurement for employers with both full-time and part-time employees.

 

 

Q: Your second question was what measurement is best to figure out effectiveness of the RTW Program.

A: The Return to Work Ratio is the best way to measure your success in bringing people back to work. Some carriers RMIS will give you the RTW ratio in increments of days…. you want 90% -100% of injured employees back to work within 1-4 days. The Workers Comp Tool Kit has a calculator for the RTW Ratio if your carrier does not provide that measurement. More information about this is available from mbastone@advisen.com

 

 

Download and listen to the webinar

 

 

For more in-depth answers to these and other questions, reference “Your Ultimate Guide to Mastering Workers’ Comp Costs – Reduce Cost 20% to 50%”.

 

 

 

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.
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

Insurance Cost Shifting: Ethical Dilemmas in Claim Management

ethical dilemmaEveryday claims management teams are faced with many challenges and demands.  These pressures come in many forms and lead to ethical situations often in the form of cost shifting.

 

 

A Hypothetical: Cost Shifting At Its Worst

 

Sally McHurry has been working for Acme Widget Company as a laborer for the past 30 years.  Over the course of her employment, she had been required to stand on her feet and twist/turn a series of level and handles during her typical workdays.  As a result, she developed a number of conditions she suspected were work-related, which included plantar fasciitis, severe joint pain in her upper extremity joints and disc herniations in her cervical spine.

 

Sally was eventually placed on light duty work restrictions, which included a limitation on the number of hours she could work in a week.  ABC Insurance Company grudgingly accepted primary liability for the claimed injuries and started paying various workers’ compensation benefits.  After several months, her prognosis did not improve.  Around the same time, she was terminated from her employment without cause and forced into the state’s employment disability program.  Under the terms of this program’s lower reimbursement rates, Ms. McHurry received a reduced amount of disability benefits.

 

 

Industry Reflections on Cost-Shifting

 

Cost shifting occurs in insurance when one carrier seeks to reduce their expected losses by moving a claim or claimant onto another insurance plan.  This other form of insurance often pays benefits at a lower rate.  The result is the claimant receives fewer benefits.

 

While we do not want to believe that cost shifting occurs in the workers’ compensation system, it does happen more often than we expect.  It also raises questions about practices carriers engage in to move risk off their books and onto another form of insurance, which can result in added burdens to government programs and ultimately the taxpayers.  Some of these practices may include:

 

  • A carrier seeking to terminate workers’ compensation claimants without cause or legal grounds, done in a manner that leaves that person in a position where they receive reduced wage loss benefits.

 

  • Shifting the cost of wage loss and medical benefits onto another form of government assistance or medical programs. The result is taxpayers picking up the bill for these services, which leads to added pressures on safety net programs.  While reimbursements may take place at some point, the insurance carrier initially responsible will only be paying a discounted amount.

 

  • The added expense of legal fees associated with the use of defense attorneys in unnecessary and vexatious litigation.

 

  • Insurance defense attorneys padding legal bills on behalf of the insurance carrier for proceedings that are unwarranted or unnecessary.

 

 

Avoiding Ethical Pitfalls

 

All members of the claims management team encounter ethical issues daily.  It is important to be aware of this and make decisions that conform to high standards of professionalism.  Failing to act in this manner can result in loss of job, reputation and other sanctions.  It is also important to think about other issues beyond the financial bottom line.

 

  • Be proactive on all of your files. Know the deadlines for all activities in the course of your daily work.  Communicate with your team members and ask questions.
  • Be honest in all of your dealings. This goes beyond co-workers and includes vendors you work with and all claimants.
  • Never over promise. Keep all your promises as well.
  • When in doubt, seek an ethics opinion. If you do not have an “ethics hotline,” suggest immediate implementation within your organization.

 

Most of all follow the Platinum Rule: Treat others the way they want to be treated!

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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

 

How Would An Ebola Pandemic Affect Work Comp?

What does 1918 have to do with Ebola and work comp in 2014? Unfortunately a great deal. In 1918, the final year of World War I, the world saw a pandemic of influenza with the most deaths of any single event in world history – estimated to be 50,000,000 world wide, with 800,000+ in the United States in one year.

 

The pandemic came in two waves six months apart. The first was mild but the second was the killer. The virus had quickly mutated.

 

Work comp in NY was four years old in 1918 but the influenza event doesn’t seem to have received a single mention in the NY work comp cases. Perhaps that is due to the fact that communicable diseases were not yet covered under a law that was intended for heavy, dangerous work and covered only accidents, not diseases.

 

 

How Would An Ebola Pandemic Affect Work Comp?

 

What would be the effects of a pandemic be on work comp in the US? Certainly they will not be the same as they were in 1918. If we use the response to 9/11 as a guide, as many Ebola incidents as possible will be covered under work comp laws. The deaths on 9/11 were about 3000. The final number of occupational disease claims for first responders will surely be many multiples of the first day deaths.

 

It is difficult to imagine that work comp could resist expansion to cover Ebola when the largest available insurance program, in terms of percentage of workers covered, is work comp.

 

The effects of a pandemic are difficult to imagine in a nation that has not experienced one in more than three generations. Just one statistic shows what a pandemic can do. In 1919 the average life expectancy in the US had been lowered by 12 YEARS, largely due to infants under 1 year of age being the hardest hit.

 

The effects of the pandemic hit the most remote populations on earth, even in the high arctic. The death rates were the lowest in nations that had imposed the strictest barriers to influx of possibly infected persons (Japan had imposed a virtual ban on incoming ships).

 

 

Liberal Interpretation of Causal Relationship to Work Comp Claims

 

This would be an event unlike any other ever faced by a comp system, even though it has little to do with health risks created by hazards of a workplace. The impact will be enhanced by the liberal interpretation of causal relationship given to comp claims, a tradition started in the early years when only workplace trauma was covered.

 

With any great disaster, hindsight clearly locates the deficiences in responses to it. Unfortunately, for a system as litigation driven as work comp that can only mean a degradation of efficiency in the system overall.

 

 

 

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

 

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

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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