As an employer, you want your injured employees to get the best care available when they are hurt. You also want to find healthcare providers who understand your company’s specific goals, needs, and possibilities. And you want them focused on the bottom line as well. A very tricky balancing act – but a necessary one!
How can you locate and identify a good initial healthcare provider? Here are a couple of suggestions from a case management nurse who has been around the block a few (million!) times: (WCxKit)
1. For your initial evaluation and treatment, a great choice is an experienced Occupational and Environmental Health Physician (OEM). This is a specialty of physicians who evaluate the interaction between work and health. An Occupational Health doctor should be familiar with work operations, return to work procedures, workers compensation laws in your jurisdiction, and many other related topics. Please note: Just because the local clinic calls itself an “Occupational Health Clinic” don’t assume the doctors are Occupational and Environmental Medicine Physicians!
2. As you are selecting or reviewing your panel provider for occupational health, CALL the center and speak to the administrator. Set up a tour. Meet with the doctor(s). Ask about their specialty and experience. You are putting your employees’ health and your money into their hands, so go and check them out. Trust me — if the doctors won’t play nice with you, they certainly won’t play nice with your injured workers.
3. If you’re not sure where to find a qualified OEM doctor, check out the website for the American College of Occupational and Environmental Medicine,
www.acoem.org and click on “Find a Doctor.”
4. If you are in a location where there is no qualified OEM nearby, talk with your nearest occupational health center’s medical director and make sure he or she is familiar with your state workers compensation laws, your company’s policies regarding post-injury care and return-to-work, and that the doctor is willing to keep in close contact with you during treatment of your injured employee. Feel free to send over your own post-accident form for the doctor to complete, if you don’t like the form the center provides. You’re paying for this service – make it work for you!
5. PAs and NPs and DOs, oh my! Yes, there are too many initials in medicine. Let’s see try to clear up some you might encounter at your Occupational Health Center.
PA = Physician Assistant
A PA has completed an educational program lasting approximately 26 months; is state-licensed and certified by examination, and must complete continuing education regularly. A PA can prescribe medications, and must work under the supervision of a physician.
NP = Nurse Practitioner
An NP has completed graduate education as a Nurse Practitioner beyond the Registered Nurse program, either to the master or doctorate degree level; is state-licensed and nationally certified by examination, and must complete regular continuing education. A NP can prescribe medications and, depending on the regulations of their state may or may not function under a physician’s direction. Some states allow NPs to set up private practices
without physician supervision. Other states require some collaborative agreement
with a physician. (
State Requirements)
DO = Doctor of Osteopathy
Yes, they are “real doctors.” To generalize greatly, DOs have the same scope of practice as MDs, though there are differences in their training and treatment techniques. DOs are licensed to practice the full scope of medicine throughout the United States.
Overall, we recommend good old fashion COMMUNICATION! If you or a supervisor, adjuster, or case manager isn’t comfortable calling your healthcare provider to touch base about a tricky case, then you’re using the wrong facility. (WCxKit)
Remember, if you are in a Employer-Choice or Panel state, this is YOUR CHOICE. Make an informed decision. Be comfortable with your choice. If you’re in an Employee-Choice state, it’s still a good idea to have an Occupational Health center you are comfortable with and use. Often, you’ll end up sending your injured worker there, at least for an initial evaluation and quick treatment.
Starting with the best possible healthcare provider gets your claim off on the right foot (or shoulder, back, knee . . .). Do your homework and you’ll be ready!
Author: Kelly Haile, RN, CCM, WCCM is an experienced Nurse Case Manager who advocates working closely with each employer to refine their Workers Comp program to provide better post-injury care, excellent medical case management and timely communication. We provide services primarily in the PA, NJ, DE and MD areas. You can reach Kelly in her role as Director of Case Management at NursePartners, LLC, by phone at 610-323-9800, fax 610-323-8018, Email: khaile@nptrs.com.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
One of the more colorful phrases you will hear in the workers compensation claims office is the term “old dogs”. “Old dogs” is a term referring to the large, old paper files that have been around for years. There are two explanations where the term “old dogs” came from. The first explanation is: As the years went by, the corners of the paper file and some of the papers in the file got the corners bent over, the file became dog-eared. The second explanation is: the claim file is like a dog. During the early start of the claim, it can be very active and things happen quickly like a puppy jumping around. But after a few years, the file, like an old dog, just lays around with nothing happening. (And yes, electronic files can become an 'old dog' too, if they hang around long enough).
The primary reason a claim file becomes an old dog file is a lack of aggressive attention to the file by the work comp adjuster. This is not saying the adjuster did not do a good job on the file. The adjuster may have done a great investigation and made several efforts to move the file forward. What happens is the adjuster gets new claims in on a regular basis that need immediate attention, while the file that is becoming an old dog file has nothing happening at the moment. Therefore the adjuster's attention is on the new claims and not the claim she has for a couple of years or more. (WCxKit)
There is often a reason or even several reasons a claim file becomes an "old dog." Easy to handle files with minor injuries do not become old dog files. The old dog file is going to have either a medical treatment issue, a permanent partial disability issue or both. (While claim files where the employee is receiving permanent total disability payments for years or a widow is receiving life time death benefits are both types of old dog files, we are going to address the old dogs files where something can be done to move the files forward to resolution).
The employee's attorney will often steer the employee to a medical provider the attorney knows will keep the employee off work for as long as the employee wants to be off work or the attorney will take other actions to delay the file from being concluded. There are several things the work comp adjuster can do to stop the flow of disability benefits and excessive medical cost in these situations. This includes:
1. An independent medical examination (IME) by a medical provider who is a specialist in the area of medicine covering the employee's injury. The IME will either concur the employee should remain off work and provide recommendations for getting the employee back to work, or the IME will advise the employee is able to return to work either with restrictions or without restrictions, plus will give a disability rating that can be used to settle the indemnity portion of the claim.
2. If the state is a jurisdiction where the number of IMEs is limited, a peer review of the medical records can be requested from a medical specialist. The peer review doctor can advise the adjuster as to the appropriateness of the medical treatment and the expected time frame (if any) for the medical treatment to be completed.
3. Any claim more than a year old, or older, with on-going medical treatment, that does not have a Nurse Case Manager (NCM) assigned to the claim should have a NCM assigned. The NCM can assist the employee and the medical provider in coordinating the best possible medical care while expediting the medical treatment. [Note – If the employee is known to have a serious injury at the time the claim is reported to the claims office, medical management with a nurse case manager should be started at the time the claim is received. When medical management is started timely, the possibility of the claim every becoming an "old"dog" is significantly reduced].
4. If the issue on the claim becomes the ability of the employee to return to work, a vocational rehabilitation expert should be brought in to the claim as soon as it is mentioned that the employee might not be able to return to the previous job. The voc rehab expert will work with the employer and the medical provider on ways to place the employee with a permanent partial disability back at work. The vocational rehab expert can work out the details of what the employee will be able to do and the details of what the employer needs to do to be in compliance with the Americans with Disabilities Act (ADA).
5. A detailed review of the file by the claims supervisor or the claims manager should be completed to see if there are options available on the claim that the adjuster has missed. [Where this is a routine practice in the claims office, many claims that could become and old dog claim never get to be an old dog.] If the claims supervisor and claims manager are both too busy to give the old dog files this type of attention, an independent claims auditor should be brought in to review the files and make recommendations on how to move the old dog file forward to conclusion.
6. An old fashion round table discussion between the claims adjuster, the claims supervisor or the claims manager, and a couple of senior work comp adjusters is often a good way to identify steps that can be taken to move the old dog file. [The old adage: "Two heads (or more) are better than one."] By bringing other work comp experts into the discussion of the file, the claims adjuster may come up with new ideas to resolve the claim.
7. A source of information that the adjuster often does not think about if the work comp claim is not being contested is the defense attorney that normally handles the contested claims. The defense attorney is often willing to take an assignment to review an old dog claim and to make recommendations on how to bring the claim to a conclusion. (WCxKit)
Old dog claims can be difficult to resolve, but most of them can be concluded if a proactive and aggressive approach to doing so is taken. The individual recommendations above should be combined with as many of the other recommendations as needed to resolve the claim.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and Website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. www.LowerWC.com Contact: RShafer@ReduceYourWorkersComp.com .
©2010 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 new online risk assessment in Great Britain will reportedly help cut back the time it takes to weigh up the hazards in offices to just 20 minutes.
The Health and Safety Executive (HSE) has produced the web tool to help employers to consider relevant hazards in their office and think about how they control them to keep staff safe. The tool will help avoid unnecessary paperwork and bureaucracy for office-based businesses, which tend to be low risk. (WCxKit)
Safety officials will take account of the results of the assessments when they carry out inspections – evidence that businesses have taken appropriate steps to manage workplace risk.
Judith Hackitt, the HSE chair, noted "Many people assume that risk assessments need to be long, formal documents covering every hazard, no matter how minor or unlikely to occur. That's not the case and the new 20-minute risk assessments make it clear that this can be done for any office quickly and easily.
"We have previously provided example risk assessments to help people identify the sort of risks they should be considering, but this goes one step further in helping employers actually do the assessment for offices.
"Employers know their businesses better than anyone – and with a little helping hand they can easily consider what is necessary to protect workers. Complying with the law in a low risk business can be done with common sense by anyone."
The online tool works by prompting employers to answer a series of questions about their workplace and then generates a unique risk assessment with actions required.
HSE already provides example risk assessments for 34 workplaces, including charity shops, estate agents and hairdressers. They help businesses get to grips with the sort of risks they will need to manage. (WCxKit)
The new 20-minute risk assessments differ because the online tool prompts employers to answer a series of straightforward questions that generates their risk assessment and action plan. Simplified risk assessments for other low risk workplaces are currently being developed.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
1. Your lack of a safety program is job security for me.
My boss is very much like your boss. If there is not enough work for all of the adjusters, someone is going to get laid off. Fortunately for me (but unfortunately for your employees), you either do not have a safety program or you do not enforce it. Either way, I am guaranteed a lot of extra claims being assigned to our office and I will get my share of them. I know better than to criticize some of the dumb things employers do like not requiring hard hats on construction sites or removing safety guards from machinery. While I may think some of the employers we insure are morons for allowing accidents to happen, I will keep my mouth shut and enjoy the job security.
2. Burnout is a real problem.
This is really a stressful job. Not only am I under numerous time deadlines (the Best Practices guidelines we have impose time limits on almost every step of the claim), the phone is constantly ringing and often I cannot see over the stack of mail on my desk. I have to deal daily with people who are unhappy, whether it is the employer questioning a valid claim, an employee who wants to find a doctor with a better “bedside manner,” or the employee's attorney threatening to file a motion for sanctions because the clerical department sent out an indemnity check a day late. When you have never-ending pressure from many different sources, the stress becomes a motivational killer. We have some real zombie adjusters due to job burnout. (WCxKit)
3. We have a revolving door.
While we have some career claims people in our office, the turnover rate is often 25% to 35% a year in some of the claim offices. There are several reasons adjusters are coming and going constantly. The pay is relatively low for the demands of the job. The claims office often hires adjuster trainees fresh out of college who after a few months or even a couple of years, realize this is not the right field for them. If I can make 10% more money somewhere else, I'm gone. If the office is understaffed (and most are), I have more files than I can handle. If my spouse gets a better job and wants to move to a new city, I'm happy to leave.
4. I never tell you my mistakes.
My loyalties are to my employer, not to the employers we insure. If I do an overall lousy job on your claims, I won't tell you. Unless something really blows up bad, my boss won't tell you either when I goof up. If I fail to contact the employee after the accident, and the employee gets an attorney (which will eventually run up the overall cost of the claim), I won't tell you it is my fault. If I fail to investigate the claim and find out it is a fraudulent claim, while the employee will feel he got away with one, you as the employer will just have an uneasy feeling that something is not right, but we paid the claim anyway. (And yes, your premium will go up because I did not do my job).
5. I am overloaded.
If I work in a state that has few requirements for state form completion, if I am good at what I do, I can handle up to 150 work comp claims at a time. If I move to a state that has a different state mandated form to be completed for everything I do, 125 claims at anyone time is a heavy load. My boss in an effort to keep the cost of doing business down, will let my claim inventory drift up 175 or even 200 claims. There is no way I can properly handle that many claims, but I usually have no say in how many claims get dumped on my desk to handle. It is no wonder we have a revolving door and a lot of burned out adjusters.
6. What supervision?
My supervisor is really a nice person. When I work late, which is often as I am overloaded, the light is still on in my supervisor's office. Ideally, depending on the experience level of the adjusters assigned to my supervisor, she would have four to six adjusters reporting to her. Like me, she is overloaded and often has eight to ten adjusters' work product that she is responsible for, in addition to all her other office responsibilities. Instead of her reviewing my work, she has been assigned an inventory of claims to handle in addition to the supervisory duties. In an ideal world, she would check each of my claims every month, but in reality the norm is she will see my file the first month it is open and again when I am ready to settle the claim.
7. Don't ask me for recommendations.
If you ask me for the name of a defense attorney, I will tell you the name of the defense attorney who takes over a claim from me and quietly does the investigation I failed to do. Or, I will tell you the name of the attorney who happens to be my golfing buddy (but I won't mention that fact), or I will tell you the name of the attorney who throws the best Christmas party. If you ask for the name of a nurse case manager, and we don't have our own, I will give you the name of the nurse case manager who showers the office with post-it notes, ink pens and calendars. If you ask for the name of a surveillance company, I will be glad to share the information on one that I know (as we often go out for drinks after work, but I won't mention that fact).
8. Communication is a two way street.
Yes, our Best Practice guidelines require me to call you within 24 hours of the time the claim is reported to my office, and yes I am required to stay in touch with you throughout the course of the claim (but I seldom do). It is easier for me to forget about keeping the employer in the loop. If you are unconcerned about the employee or about the status of the claim, and never call me, it is easy for me to drop you from the information loop. If you don't make any effort to get the employee back to work on modified duty – it's your money – I will put the disability checks on automatic pilot and they will keep going out until you call me to tell me the employee is back to work (which you may forget to do as we have not been communicating throughout the course of the claim).
9. You make my life miserable.
Between your lack of a safety program and your lack of a return to work program, you create a lot of unnecessary work for me. When you fail to report the claim timely, you alienate the employee and whether or not the employee gets an attorney, your failure to report the claim on time creates a lot of extra phone calls, and makes the claim cost more to resolve. When you have no drug testing policy, no fraud prevention policy, no medical management program and no organized approach to handling claims, I bear the brunt of your mistakes. (WcxKit)
10. I'm happy to let someone else do it.
Since I am overloaded with work to do, I have no qualms about letting the nurse case manager do all the contacts with all the medical providers. I have no qualms about letting the defense attorney do the investigation I never had time to get around to doing. When my mistakes and goof ups do come to light, I have no qualms about letting the broker deal with your irritation. It is not because I do not want to do a good job, I'm just have too much to deal with – see all of the above things I won't tell you.
This is a tongue in cheek parody; please take it with a grain of salt.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. www.LowerWC.com Contact: RShafer@ReduceYourWorkersComp.com
©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.
When employers hear the word ergonomics, they tend to think about teaching their employees proper lifting techniques to prevent back injuries and to prevent the resulting workers compensation claims. As back injuries for laborers account for a disproportionate share of the number of work comp claims and a disproportionate share of the cost of work comp that is understandable. However, there are a significant number of workers compensation claims to office workers that could be prevented through proper office ergonomics.
Sitting in an office chair that is incorrect for the employee is often the cause of back pain. Using a computer keyboard that is placed improperly often results in carpal tunnel syndrome and other repetitive motion injuries. These types of injuries can be prevented by applying ergonomic principles – the scientific study of individuals and their physical relationship to the work environment. (WCxKit)
An office ergonomics plan should have the goal of adapting the workplace to fit the individual needs of each specific employee. To accomplish this, three areas need to be considered. They are: (1) the physical shape and size of the employee; (2) an understanding of the employee's job description; (3) the tasks that the employee is required to do.
In an office environment, a comfortable workstation depends on how the workstation is set up. The location of the computer screen, where the keyboard is placed in relation to the hands, and the type of office chair. An ergonomically incorrect workstation is easy to identify by the employee who is sitting forward in his/her chair, hunched over looking at their computer. The correct workstation will have the employee looking straight ahead while sitting back in their office chair, which provides the employee with lumbar support to keep the back straight, and the neck and head erect. Another quick tip-off that the office is not ergonomically friendly is when all the cubicles have the same height for the work surface and all the cubicles have the same style office chair.
Incorrect computer usage and computer placement results in musculoskeletal problems, eye strain, blurred vision, and headaches. Using a computer involves sitting at the same place for an extended period of time, while involved in small repetitive motions of the hands and fingers, and repetitive movement of the eyes. These activities will cause the employee to develop various strains and fatigue. The office employees should be encouraged to:
1. To shift positions, stretch, walk or take a short break every hour.
2. To vary their work in order to utilize different muscles.
3. To have annual eye exams.
4. To be sure their workstation or work space is set up ergonomically correct to fit their physical needs and requirements.
There are four steps to setting up an office work space to be ergonomically correct. The four steps are:
1. The work surface height is designed for the employees specific job.
2. The office chair is adjustable for the employee.
3. The height of the computer screen is adjustable for the height of the employee.
4. The computer keyboard is properly placed.
The work surface height, whether the employee is sitting or standing should be designed to fit the job being done taking into consideration the tools used or equipment used. For example, the height of the work surface of an artist would be higher than the work surface of a writer. The work surface height also needs to be adjustable to the height of the specific employee who will be working at that location.
An adjustable office chair should be provided for employees seated at a desk. The chair should be raised or lowered so that the employees work surface is elbow high – the employee when sitting straight up in the office chair, with his arms at his side, can rest his elbows on the desk without slouching. The chair should provide lumbar support, neck and head support with the back rest pushing the low back slightly forward. There should be three to four inches from the front edge of the seat to the employee's leg calf. To avoid pressure on the back of the legs, the height of the chair should cause the thighs to be slightly above the front edge of the chair. If necessary, a foot rest should be provided to raise the knees slightly eliminate pressure on the back of the thighs.
When the height of the work surface has been adjusted to fit the employee and the chair has been adjusted, the employee should sit in the chair with proper posture and look straight ahead without tilting the head downward or upward or to the side. The center of the employees gaze is where the center of the employees computer monitor should be placed. The computer monitors support stand should be adjustable to place the computer screen at this height.
The computer keyboard should be placed so that the employee does not have to twist to either side to use the keyboard. The keyboard should be directly in front of the employee and placed at a level where the employee does not have to bend the wrist either downward or upward to use the keyboard. (The main cause of carpal tunnel syndrome for office workers is the incorrect placement of the keyboard causing the employee to bend their wrist while typing). (WCxKit)
A proper setup of the workstation will eliminate most back strains and repetitive motions strains incurred by employees. The proper height of the work surface, the proper adjustment of the chair, the proper placement of the computer monitor and the proper placement of the computer keyboard are all important. By preventing the causes of office related strains, the employer will eliminate most office related workers' compensation claims
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. 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.
It’s easy to become trapped in assumptions. One such assumption is that predictive modeling is exclusively achieved by scouring data using advanced mathematical computations. While that is the generally accepted method, and a valid one, it need not be the only method. Extraordinary outcomes and substantial savings can also result from simpler initiatives.
While more commonly used in other industries, predictive modeling is gathering interest in workers compensation. Predictive modeling is a process used to create a statistical model of future behavior. It is the area of data mining and business intelligence concerned with forecasting probable outcomes or trends.Multiple methods of testing assumptions and uncertainty are involved while looking for patterns in the data. Statistical modeling uses advanced mathematics to find correlations, look for consistent causation, develop a theory — apply it, validate it, adjust the theory and continually retest it. (WCxKit)
Answers are sought for basic questions using predictive modeling. If X is true, then what is the probability Y will occur? Or when Y occurs, what are the factors that could have predicted it?
A familiar example of how predictive modeling is used is auto insurance companies taking into account potential driving safety predictors in the data such as age, gender, and driving record. The predictions are not guesses. Instead, indicators are found using huge amounts of data and are based on the idea that consistent historic behavior found in costly claims is a predictor of future claims with similar conditions. Auto insurance premium costs are rated by this actuarial intelligence applied to the data.
Similarly, when predictive modeling is applied to workers compensation, the objective is to identify claims likely to be complex and costly based on historical data. The goal is also to identify those claims early so damage control can be implemented such as focused claim and medical management or early settlement. Regression analysis and other advanced methods of statistical mathematics are applied to the data to find key indicator data in those claims.
Nevertheless, advanced statistical modeling is not for everyone. Studying the data in this way requires huge amounts of data to achieve statistically significant results. Experts must be contracted and financial investments made. Such efforts are well founded, encouraged and ultimately lead to refined intelligence in workers comp. Still, there are lesser, yet valid, achievements to be made.
Notably, most payer organizations have an untapped predictive resource: internal wisdom. Claims adjusters, nurse case managers, and medical directors all know their claimant population and instinctively know what claims are likely to be problematic. Moreover, many organizations utilize the three-point contact methodology where vital data are collected about the claim that can be predictive. All this information should be collected in data form and structured procedurally to strengthen claim management functions.
Another way to find predictors in data is to leverage workers comp medical research as a guide. Edward Bernacki, MD and his team at Johns Hopkins published a study in the Journal of Occupational and Environmental Medicine in January of this year describing Cost Intensive Physicians. (Bernacki, et.al. “Impact of Cost Intensive Physicians on Workers Compensation” JOEM. Vol. 52. No. 1. January, 2010) Using five years’ closed claim data from the Louisiana Workers Compensation Corporation, they studied claims that began with reserves less than $15,000, but migrated to reserves of +/-$50,000. Of those claims, 3.8% of physicians involved were responsible for 72% of the costs. Their information about cost intensive physicians can be applied to identify predictors.
Cost intensive physicians, as labeled in the study, were those who had higher medical costs, longer medical treatment duration, longer claim durations, and higher indemnity costs. Therefore, one can conclude that identifying, avoiding or managing the cost intensive physicians is one way to contain costs. Look for those features associated with specific physicians in the data along with other characteristics highlighted in the study.
The Bernacki study also named certain injury types and procedures high cost predictors. Those injury types or diagnoses that do not have clearly defined treatment pathways are often problematic. Whereas a fractured tibia has a predictable treatment path, injuries of joints and back strains do not, leaving a wide berth of treatment options and opportunities for abuse. Monitor the data proactively to isolate injury types and procedures identified in the study and manage them aggressively.
Another study, “Long-term Outcomes of Lumbar Fusion Among Workers Compensation Subjects: An Historical Cohort Study”, found at
http://www.ncbi.nlm.nih.gov/pubmed/20736894. This study concluded, “Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a workers comp setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor RTW status.” Clearly, these conditions, when spinal fusion is the selected option, are predictors of complexity and cost. (WC
xKit)
Identifying and naming predictors using the knowledge from professionals and from research is a simple, yet valid approach to cost control through predictive methods. Call it “predictive modeling-light.” Monitor the data concurrently and continually to identify claims containing combinations of data that portend risk and focus on those. While the process is not sophisticated or complex, it will structure claims and medical management procedures, making them more proactive, effective, and replicable.
Author Karen Wolfe, BSN, MA, MBA, President/CEO, MedMetrics®, LLC. Karen is founder and president of MedMetrics® LLC, an Internet-based Workers Compensation medical analytics company. She applies her medical knowledge to gathering, understanding and applying Workers Compensation data to the operational process. MedMetrics imports, integrates, and analyzes its clients’ medical billing and claims level data. MedMetrics uses several tools such as Predictive Intelligence Profiling and Medical Provider Performance Assessment to gather and analyze data. Contact: Phone: 541-390-1680;
Karenwolfe@medmetrics.org; www.medmetrics.org.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
We are pleased to announce some changes to the Workers’ Compensation Roundtable, run by Rebecca Shafer and the Workers Comp Kit Blog Team, that will make it an even more effective tool for employers and the workers’ compensation community. Effective immediately, Bob Wilson, Kathy Lella and other key staff from www.WorkersCompensation.com will be sharing the responsibilities of managing this group with Rebecca Shafer of www.LowerWC.com. Rebecca started this group in 2009, and has done an excellent job in laying a strong foundation and establishing clear objectives for its purpose. With the addition of the WorkersCompensation.com team, we will continue to lead discussions on cost containment issues for both employers and WC professionals, but will also be taking a stronger focus on legislative discussion and review.
We believe this new team management approach will provide a very strong ability to meet the information needs of the workers’ compensation community. Rebecca’s experience and expertise in targeting and reducing workers comp cost burdens for employers across the nation is unmatched by anyone. For over 11 years WorkersCompensation.com has been widely recognized as a definitive source of news, information and valuable legal data for the entire nation. Together they will provide an excellent resource for the members of the Roundtable.
Effective immediately, the Workers Compensation Roundtable is designated as the official Employers and Professionals Forum for WorkersCompensation.com. It will also be linked from its members’ subscription area, WorkCompResearch. We wish to welcome those professionals to this new service.
If you know an employer or professional that could benefit from membership to the Workers’ Compensation Roundtable, please invite them today. The group link is: http://www.linkedin.com/groups?mostPopular=&gid=1922050
Please let us know how we can better serve your needs. You may contact Rebecca, Bob or Kathy through the LinkedIn system.
Thank you for your continued support of the Workers’ Compensation Roundtable.
The Workers’ Compensation Roundtable Team
Robert Elliott
Rebecca Shafer
Robert
Wilson
Kathy Lella
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
One of the easiest ways for an employer to control the cost of workers compensation is to hire employees who are unlikely to have a job related injury. To identify and hire employees who take safety seriously takes some efforts but makes great economic sense. To find the best people to hire is easier if you have a hiring plan that includes identifying the requirements of the position you are trying to fill and the capabilities (both physical and mental) of the person you are considering for the position. By creating a standardized hiring plan and using it, you identify the best job applicant for your company. Risk Management starts with hiring the right employee.
1- Job Analysis
The hiring of the best applicant for the job is a lot more than reading a resume and having an interview. With all the self-help books and internet websites on how to write a great resume and shine in the interview, a job applicant may make a good impression but be a poor choice for your company. A job analysis will assist you in determining if the job applicant is a good fit for your company. (WCxKit)
A job analysis breaks the specific position being filled down into its component parts. Each part of the job is separated into its essential features including skills, abilities, knowledge and attitudes needed to perform the job. By identifying the task and responsibilities of the position, the employer will be able to compare job applicants against the criteria of the job. Each job applicant can be tested (see Testing below) to measure their capabilities in each of the essential features of the job.
A job analysis for a manual labor position could include the applicant's ability to lift weights, carry weights and the strength to push or pull a weight. The frequency of performing these tasks – never, occasionally, frequently or constantly – is determined when the employer creates the job analysis. The applicant's ability to do each can be measured and tested prior to making a job offer.
In addition to strength testing for the manual labor position, the applicant's ability to bend, turn, twist, squat, crawl, climb, reach out, reach up, grasp and pinch can be tested. Again, the frequency of these activities should be established when the employer creates the job analysis. By establishing the applicant's ability to perform the physical demands of the job before hiring the job applicant, the probability of an on-the-job injury is greatly reduced.
The job analysis for a clerical position could include the applicant's ability to use a keyboard, operate word processing programs and perform other computer skills. The frequency of these activities and the speed in which they need to be accomplished should be established by the employer prior to the start of the hiring process.
2- Job Descriptions & Specifications
Each job position should have a written job description that specifies what the employee will be doing on an everyday basis. It should identify the task to be completed, the equipment or machinery that will be used, whether he/she will be working as a part of a group or have individual responsibilities and whether or not the employee will be supervising either processes or people.
The skills, abilities and knowledge needed for the job should be established. This includes any requirements for prior experience or specific education. For instance, the job description can include the requirement to operate a forklift safely, or the requirement to close a difficult sale successfully, or the requirement to have a law degree.
3- Testing
To compare the job applicants capabilities against the job description and specifications of the job, screening and testing is needed. The employer who has the expertise in testing job applicants can perform the necessary testing, but most employers elect to hire a vendor who specializes in performing pre-hire testing. The testing can include:
1. attitude and integrity assessment profiles
2. functional capabilities testing
3. pre-offer agility and strength testing
4. post offer comprehensive medical screen to identify pre-existing medical limitations and cumulative trauma
4- Screening and Background Checks
All pre-employment screening and background checks must comply with federal law and the state law where the employee is being hired. Pre-employment drug testing (as well as post-employment drug testing) should be a condition of any job offer. Thirty-eight to fifty percent of all workers' compensation claims are related to substance abuse according to the Tennessee Department of Labor. The employers who actively manage their drug-free workplace program benefit from higher productivity, fewer work related accidents, lower absenteeism and lower medical cost (both from medical insurance claims and workers compensation claims). At least a dozen states require the workers compensation insurers to offer your company a premium discount if your company has a drug-free workplace program.
The job applicant should agree to a background check which includes checking the applicant's background for hidden criminal records, drug arrest, prior employment history, prior academic achievements and credit history {a good reason to use an outside vendor is to let the vendor comply with the Fair Credit Reporting Act.} The pre-hire job screening and testing vendor should be a Designated Agent approved by the Department of Homeland Security so they can do the E-Verify Legal Right to Work check.
5- Psychological Testing
Psychological testing can be used to screen potential employees. There are three primary types of psychological testing. They are:
5. Personality testing that provides insights into the values, ethics and behavioral characteristics of the potential employee.
6. Aptitude testing that evaluates job candidates reasoning skills. The test measure verbal, numerical and abstract thinking.
7. Motivational testing that identifies the areas of interest and importance to the job candidate and identifies what motivates the person.
Personality testing and behavioral testing adds an element of objectivity to the pre-employment screening process. The pre-employment assessment testing will provide the employer with information on the aptitudes and behavioral traits of the potential employee. The pre-employment assessment can provide the employer with information on the ethics, values, honesty and integrity of the job applicant. Often the behaviors identified in the personality testing can be confirmed through reference checks and background screening.
6- Without Discrimination
Nothing will mess up your hiring plans more than a lawsuit brought by a job applicant who believes there was discrimination in the hiring process. Be fully up to speed on the requirements of the Americans with Disabilities Act (ADA), the Civil Rights Act, the Equal Pay Act and the Age Discrimination in Employment Act. Any job applicant can file a lawsuit with the Equal Employment Opportunity Commission (EEOC).
All hiring decisions should be based on the job applicant's ability to do the job as measured in the testing you have done. If you let a job applicant's disability, ethnic background, gender or age influence your hiring decision, and the job applicant proves it, the legal remedies include the lost wages, compensatory damages, legal fees, and in severe cases of discrimination, punitive damages. (WCxKit)
Safe Hiring
By establishing the criteria of the job through the job analysis, including the physical requirements and the job specifications, the employer can eliminate most of the job applicants who do not have the physical capabilities to perform the job safely. This prevents many work comp claims from ever occurring. The pre-offer and post-offer job testing can identify job applicants who have medical limitations, while the workers compensation background check can verify the veracity of the job application in regards to prior workers compensation claims.
Author Rebecca Shafer, President of Amaxx Risks Solutions, Inc. is an attorney and 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. Contact: RShafer@ReduceYourWorkersComp.com.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Even companies with the strongest safety programs experience some workers compensation claims. When an injury occurs, the immediate action taken by the employee’s supervisor or co-workers has an impact on the outcome of the claim.
Implementing the next two phases of employment involvement helps to manage claims efficiently and get workers back to work sooner.
The Injury Occurrence
The employer must require a tight post-injury process by following these five principles:
1. Obtain immediate medical assistance for the employee – send the employee to designated doctor or medical facility if statute permits.
2. Do not permit employee's with minor injuries or soft-tissue strains to wait to obtain medical assistance – most will end up going to the unapproved hospital emergency room or their own doctor.
3. While the employee is in-route to the treating physician, advise the treating physician of any temporary jobs you can offer during recovery.
4. Advise the treating physician of modifications you can make to the existing job to accommodate the work restrictions the physician gives the employee.
5. Have a goal of returning all employees to work within 1 to 3 days after the injury unless they are medically unable to perform any role for the employer.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
©2010 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 Comp Kit Blog is very proud to be awarded a listing in the
"Top 50 Health Insurance Blogs," in the category of “By and For Health Insurance Industry Blogs by The Health Express.
The Health Express provides health and medical information covering fitness, nutrition and medical knowledge attractions on their website, and has selected top blogs contributing to that knowledge. Our MD's contribute important information about health and wellness.
Alba Collazo, The Health Express co-founder said of WCK when announcing our award, “I found Workers' Comp Kit Blog to be very interesting and relevant.”
We thank our many fine writers, contributors, editors and staff – we cannot achieve what we have without them. Our management and staff offer sincere appreciation and thanks for this honor and are encouraged to continue providing employers with tools to contain their workers compensation costs.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
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