Workers Comp Kit Blog Workers

Claims Resolution and Settlements: Knowing When and How to Settle a Workers Compensation Claim

Negotiations
The effective adjuster has developed the talent, through practice and experience, to negotiate the claim by emphasizing the strengths of his/her case. Prior to starting the settlement negotiations, the adjuster outlines in the Action Plan the strengths and weaknesses of the claim, obtains settlement authority, and develops a strategy to stress the reasons the claim should be settled for the amount the adjuster recommends.

As part of any negotiation, the adjuster should establish a settlement range for the claim based upon the strengths and weaknesses. The initial offer starts at the bottom of the settlement range and is not increased until the employee or the employee's attorney has made a counter offer.

The adjuster negotiates in increments with counter offers until an agreement is reached within the settlement range.   The adjuster never increases the offer upward more than the employee's counter offer has decreased.   If the adjuster sees the claim is not going to settle within the settlement range established, the adjuster should cease negotiating; advising the employee or the attorney their demand is outside the justifiable settlement range and no further offers will be made until a more reasonable settlement demand is made.

Waivers and Releases

Each state has its own forms or documents to be executed when the claim is concluded. The adjuster should settle all aspects of the claim — current indemnity benefits, future indemnity benefits, current medical benefits, and future medical — to prevent future financial exposure to your company. This requirement should be specifically stated in your account handling instructions.

The method to close out future benefits is different in each state. For example, in California the employee must execute a Compromise and Release (C&R) to receive a lump sum for the payment of future medical expense and close out the exposure for the future medical care. The C&R must be approved by a workers' compensation judge.

If the employee will not be returning to work, the settlement release in addition to the standard language of "to be a complete, entire and final release and waiver of any and all rights to any and all past, present and future benefits" should also include language stating the separation from employment is voluntary.

Also, all other civil actions outside the realm of workers' compensation the employee might consider should be included. If the above California C&R was for an employee who filed a psych injury claim for sexual harassment, and the Release is not modified to include the civil matter of sexual harassment, the employee would be free to bring a sexual harassment lawsuit against your company even though you have paid and settled the work comp claim with the C&R.

Due to the complexity of making sure all financial exposures to your company are resolved at the time of settlement, it is recommended you have your in-house counsel prepare the Waivers and/or Releases in any complex or high value claim.

In those states mandating a particular release agreement form, be sure the adjuster utilizes the state mandated form. In the states not mandating a particular release format, a Workers' Compensation Release should be obtained.

If there is any possibility of the employee attempting to circumvent the workers' compensation settlement with an age discrimination claim, sex discrimination claim, Americans with Disabilities Act claim or other type of claim against the employer, a General Release should also be obtained from the employee in conjunction with the Workers' Compensation Release.

All settlement releases should contain language stating Medicare's interest was protected to the best of the parties' ability and Medicare's interest was considered at the time of the settlement (see section below on Medicare Set Asides). (workersxzcompxzkit)

In the states permitting subrogation, the release should also convey all rights of subrogation from the employee to the employer.

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Author Rebecca Shafer, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php

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.

Posted in Settling WC Claims, TPA and Claims Administration, WC 101 |

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Know the 6 Key Workers Compensation Responsibilities for Employers

We all know it is the employer's responsibility to purchase workers compensation insurance coverage and to report a claim to the claims office when an accident occurs. Unfortunately, in way too many cases this is where the employer's involvement in workers compensation ends. Being passive about workers compensation is an expensive approach to the subject. Here are some six responsibilities and suggestions on how your company can be an active participant in the workers comp claims process. The better the employer meets these responsibilities, the better the employer’s financial picture.

1. A Safe Workers Environment

It is your responsibility as an employer to provide a safe workers environment. By doing so, you eliminate many workers comp claims because the injuries never happen. A strong safety program in which the employees are actively involved in preventing accidents has a major impact on the financial cost of workers compensation. (WCxKitz)

2. Know the Law

Post in a place convenient for all employees the state required notices. This can include their rights under the workers comp laws, a posting of approved medical facilities (in the half of the states allow the employer to select the medical provider), post OSHA posters and anything else required in your state.

If an employee has an injury, allow the employee to seek medical care in a timely manner. Your company does not want to do anything appearing to interfere with the employee's right to medical assistance.

3. Report the Claim Immediately & Accurately

It is not enough just to report the injury claim to the claims office. The injury should be reported to the claims office immediately, not next week, not in a couple of days, but as soon as the employer becomes aware the employee is seeking medical treatment for a workers comp injury. All employees and all their supervisors must know it is a requirement for every workers comp claim to be reported to your workers comp claims coordinator as soon as medical treatment is needed. (WCxKitz)The claims coordinator then promptly completes the Employer's First Report of Injury and immediately transmits it electronically or by fax to the claims office.

All supervisors should be trained on the information needed to complete the Employer's First Report of Injury form so it is accurate when it is received in the claims office. It is well established in the claims field fast and accurate reporting of the claim has a positive impact on the outcome of the claim.

4. Cooperation with the Insurance Company

The employer who takes the hands-off approach to workers comp claims may expect to see a steady increase in the workers comp insurance premiums. The smart employer takes a very active approach to be involved in the workers comp claims process.

It is your responsibilities as an employer to assist the workers comp adjuster in the handling of the claim. As the adjuster investigates the claim, there will be a need for documentation from you as to the employee's payroll history. The adjuster may need to speak with the employee's supervisor or co-workers who may have witnessed the injury. In some situations the adjuster may need to see the employees personnel file or health benefits file. If you are contacted by an attorney for the employee, be sure to notify the adjuster immediately. By providing whatever assistance the adjuster needs on a timely basis you can help mitigate the cost of the workers comp claim.

5. Employee Contact

One of the most often over-looked responsibilities of the employer in workers comp claims is the human element. The employee's supervisor or the workers comp claims coordinator or both of them must stay in contact with the injured employee while he/she is off work. By letting the employee know your company is concerned about his/her well-being and by keeping the lines of communication open, the risk of the claim becoming adversarial or the employee employing an attorney, guaranteed to delay resolution of the claim, is diminished. (WCxKitz)

6. Return to Workers Program

Study after study shows the quicker the employee is returned to work, the lower the overall cost of the workers compensation claim. It is imperative the employer have a Modified Duty Program or a Light Duty Program available for all injured employees.

In most states you can contact the employee's medical provider and ask for the conditions under which the employee can return to work. You have the right to know the employee's medical condition and to have the worker return to work on a light duty program with the medical provider's agreement.

By getting the employee back to work in a modified duty program, the employee benefits and the employer saves money. (Remember the more the insurance company pays out, the higher your eventual workers comp premium becomes). When the employee is off work, the insurance company is paying benefits to the employee, but the employer is not receiving anything of value. When the employee returns to work, the benefits being paid by the insurance company stop. While an employee on modified duty may not be as productive as an employee on regular duty, the employee is still producing some benefit to the employer.

Summary

The more pro-active the employer is in the workers comp claim process, the lower the overall cost of workers compensation. The employer who provides a safe workers environment, knows the requirements of the workers comp laws in their state and who reports their workers comp claims quickly and accurately will lower their cost for workers comp coverage. The employer who cooperates with the insurance adjuster's investigation, keeps in contact with the employee and assists the employee in returning to work quickly has a positive effect on their workers comp costs.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.LowerWC.com/workers-comp-books-manuals.php
WC Calculator: http://www.LowerWC.com/calculator.php
TD Calculator: http://www.LowerWC.com/transitional-duty-cost-calculator.php

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.

Posted in WC 101 |

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Questions from Readers – My Employee is Injured HELLLLLLLLP

A Reader Writes…
I am just beginning to implement a workers' comp management program and I need help with controlling the events surrounding work related injuries. It seems when employees are injured, they leave work, go to their doctor and call in sick for a few days.

I need a tool to verify the extent of their injuries and keep me in the information loop. Can you suggest anything?

Rebecca Shafer Replies: The tool we use is called a work ability form . Similar forms have other names like Work Capacity Form, etc. Keep in mind, one of the benefits of a workers' comp management program is the ability to structure processes by building forms not only designed to capture injury events, but to control process after the injury occurs. Your work ability form can be customized to reflect how your company wants things done. Keep in mind, you must comply with all state and federal laws applying to your business.

The point of a work ability form is to track the injured employee through the healing process, with return-to-work as quickly as possible being the final goal.

Include instructions to the treating physician with your fax number and request the completed, signed form be faxed to you within 24 hours following the injury.

Calendar all upcoming appointment dates and be sure the treating physician has additional copies of your form to complete and return to you following each subsequent medical appointment.

Seven Basic Sections of a Work Ability Form
1. Employee Information
Get the patient's full name, home, cell, business phone numbers. Date, time and place of the injury. If you are multi-sited, get the employer's name. Make sure the employee signs the release of medical records section, if at all possible so the treating physician can fax to you the part of the form with a diagnosis, prognosis. Once you have the information you can begin to build a modified duty job to offer to the injured employee as soon it's appropriate to do so.

2. Injury Information
Gather as much information about the injury as you can. Is it a new injury, a recurrence? What part of the body was injured? What is the diagnosis and prognosis? What type of physical exam was conducted subsequent to the injury?

3. Treatment
What kinds of medications are administered? Is further treatment necessary? Will treatment include physical therapy, hand therapy, etc.? Were tests administered (CT Scan, MRI, EMG, X-Ray)? Include dates, times.

4. Work Ability
What is this patient's prognosis for returning to work? Did the treating physician review the patient's job description (that you ensured the patient brought with him to the treatment facility)? Was the doctor able to view a job analysis video really see what the patient's job entails?

What is the return to work status? Can the patient return to full duty with full restrictions, and if so, when? You need a specific date. Is the patient returning to work with some restrictions? What are the restrictions and how can you work with the treating physician to accommodate a modified duty position. Regardless of type of modified duty, you must require a return to work date. Ask: Will the patient remain off duty? If so, until when?

5. Physical Restrictions
The treating physician completes a detailed report of the patient's ability in physical functions such as keyboarding, squatting, kneeling, sitting, driving, standing, walking, etc. The initial report is used as a base line to compare against future work ability reports the patient and treating physician complete as the patient recovers. Make a note if the patient requires an assistive device such as a wheel chair or a cane, in order to factor its use your modified duty plan. (workersxzcompxzkit)

6. Next Appointment
The treating physician assign a follow-up examination date and makes comments in this section.

7. Medical Provider Signature
The treating physician swears everything entered into the form is true. Insert instructions to have the doctor's name printed as well as signed and dated.

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Author Rebecca Shafer, Attorney, Consultant, Writer, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php

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.

Posted in Communication with Employees, Coordinating Medical Care, Medical Issues, WC 101 |

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Who’s Who in the Claims Office – Know The Players

If you never worked in a workers’ compensation claims office, but have dealt with one or more claim offices, you may have wondered who does what in the claims office. The following is a glossary of claim office positions and the type of work done by the people with these job titles. Every insurance carrier and every third party administrator (TPA) will structure their claim office a little differently. Not all workers’ comp claim offices will have all the claim positions listed here, as each claims organization will be structured to be suit their own business needs.

Claims Clerk

The clerical staff within the claims office is often the engine running the office. The clerical staff is normally responsible for the intake of new claims whether electronic, telephonic or mail, the case creation – “setting up the claim file,” the input of the data into the risk management information system and often, initial contact letters and acknowledgment forms to the state, the employer and the employee. (WCxKitz)

The clerical staff is also responsible for in-coming and out-going mail, matching correspondence to claim file folders (or scanning paper correspondence into the risk management information system) and opening & closing of files. Additionally, a clerical person is responsible for issuing payments, both automatic issues (like weekly indemnity checks) and one-time payments.

Depending on the size of the claims office the clerical staff may be broken down into various levels like Clerk 1, Clerk 2, Clerk 3, Secretary 1, Secretary 2, etc., with pay grade advancements to match their job title growth.

Medical Only Adjuster

The medical only adjuster is often an experienced clerical person who has shown the aptitude and ability to do more than basic clerical work. The medical only adjuster will contact the medical providers to obtain the medical reports and medicals bill. Once the information is available, the medical only adjuster will review the medical bills to ascertain the relationship between the injury and the medical treatment. The medical only adjuster will request payment of the medical bills and verify there will be no further treatment prior to closing the medical only file. A standard workload, depending on the jurisdiction, for a medical only adjuster is to have 350 to 500 open medical only files at any one time.

Adjuster Trainee

Most new adjuster trainees are recent college graduates with a background in insurance, business or a related field. Occasionally, insurers or TPA's will recognize they have a bright clerical person who does not have a college degree but has shown the intellectual ability to take on the challenge of adjusting claims. (WCxKitz)

The new adjuster trainee will normally go to either an in-house training program or to a specialty school to learn the basics of workers’ comp insurance adjusting. Most states require the adjuster trainee to take a pre-determined number of hours of workers' compensation class training before they can take the state licensing test.

Once the new adjuster is licensed, the claim office will assign to the adjuster trainee the simple workers’ comp claims. The adjuster trainee is often asked to investigate thoroughly these claims for the experience of learning to contact employers and employees, take statements, investigate the details, etc. The adjuster trainee will have a claims supervisor who will be reviewing the work performed, providing directions and managing the process. A normal workload for an adjuster trainee is 75 to 100 open workers’ comp claims.

Adjuster

The adjuster is the workhorse of the claims office. The workers’ comp adjuster is responsible for the complete claim process including coverage verification, contacts, reserving, investigation, medical management/cost containment, disability management, litigation management, subrogation, subsequent injury fund recovery, disposition and settlement. Also, if the adjuster works for a TPA, the adjuster is responsible for reporting all information to the insurer or principal.

The adjuster is usually the primary contact of the employer with the insurer or TPA. In addition to working with the employees – “claimants” on each claim, the adjuster will build relationships with the various parties involved in the claim including the employers, the medical providers and the attorneys — both plaintiff and defense attorneys. (WCxKitz)

A supervisor will normally review the work of the adjuster on a regular basis, but will not be involved in the decision-making or claims handling process except on the more expensive files and the files with questionable compensability. It is normal for the workers’ comp adjuster to have 125 to 150 open files at any one time. Depending on the insurer or TPA, the adjuster level may be broken down into additional levels like Adjuster 1, Adjuster 2, etc.

Senior Adjuster

The designation senior adjuster is for highly experienced adjusters with many years on the job. These adjusters are masters of the workers’ comp world knowing how to investigate every type of claim, knowing the intricacies of their state workers’ comp laws, and knowing when to settle and when to fight a claim.

The senior adjusters often act as mentors to the adjuster trainees or younger/less-experienced adjusters. The senior adjusters are normally assigned the most difficult claims and the claims with the highest exposure. A normal workload, depending on the jurisdiction, for the senior adjuster is 125 to 150 open claims. (WCxKitz)

Supervisor

The workers’ comp supervisor is responsible for a team of adjusters and the work product produced by those adjusters. The supervisor will normally have three or four adjuster trainees on their team, or four or five adjusters, or five to eight senior adjusters. The supervisor is responsible for making sure the adjusters meet all best practices or service standards on each file.

The supervisor, in addition to day-to-day discussions and directions to the adjusters, will keep the inventory of all claims assigned to them on a diary (also known as a futurity at some companies). A diary is a calendar reminder system. All the files of the adjuster trainees will normally be reviewed by the supervisor every month while the claim files of the adjusters will be reviewed every 60 or 90 days.

Assistant Manager

If the claim office is large enough, it will have an assistant manager between the levels of workers’ comp supervisor and branch manager. The assistant manager is often responsible for assignment of claims to the adjusters, for compliance with regulatory requirements, and management of the workers’ comp supervisors. (WCxKitz)

Branch Manager

The branch manager of the claims office is responsible for everything that goes on in the claims office. The selection and hiring of employees, the workflow of the clerical staff, the prompt and proper resolution of claims, and the liaison between employers and insurers are the responsibility of the branch manager. Ultimately, the successful operation of the claims office lies with the skill level of the branch manager.

Author Rebecca Shafer, Consultant & Attorney, 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: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.LowerWC.com/workers-comp-books-manuals.php
WC Calculator: http://www.LowerWC.com/calculator.php
TD Calculator: http://www.LowerWC.com/transitional-duty-cost-calculator.php

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.

Posted in Risk Management, TPA and Claims Administration, WC 101, Workers Comp Kit |

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Your Workers Comp Employee Brochure Should Answer These 7 Questions

When an injury happens at the workplace it’s only natural people are stressed out and may not be thinking clearly. Preparing your employees and supervisors before an injury occurs is an excellent communication technique.

A brochure stating clearly what do when an employee is hurt at work is an important step in managing your workers’ compensation cases. Whether your design and write your own brochure or ask your third-party administrator or carrier to provide the material, brochures must meet certain goals.

According to the 2009 RIMS survey, only 54% of companies have such a brochure or communication piece. So, 46% of employers have an easy opportunity to fill this important communication gap.

A Good Brochure begins with these basics:

Written at a 6^th grade level.
Written in several languages.
Visually inviting; i.e., simple, clear style and formatting.

And answers these 7 employee questions:

What to do to receive care.
Will they lose their job if they are injured?
Who pays the medical bills?
What the employer wants the employee to know:
Temporary duty available.
How they participate in TAD.
There are other obligations such as weekly meetings.
What happens to those who abuse the system?

By removing the “mystery” from the process, your employees know you are their first point of contact. (workersxzcompxzkit) And, you will see your litigation rate will drop because plaintiff’s attorneys say the number one reason injured employees come to them is because they’ve been unable to get information from their employer.

Author Rebecca Shafer, J.D.. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php

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.

Posted in Communication with Employees, Coordinating Medical Care, WC 101 |

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Knowing When and How to Settle A Workers Compensation Claim

Jurisdictional Issues

There are as many names as there are states for the legal entity overseeing the workers' compensation system. Whether the name is "Industrial Commission," "Workers' Compensation Court," "Bureau of Workers' compensation" or some other name, they each have their own way of doing things in their state, with no two states being alike. It is imperative the workers' compensation adjuster knows both the procedures at the local level and the procedures on the state level for closing a claim.

Some states require the filing of numerous forms throughout the course of the open claim and at the conclusion of the claim. You do not want a settlement of the workers' compensation claim to be ruled invalid because the proper forms were not submitted at the required times either during the course of handling the claim or at the time of the claim settlement.

The adjuster needs to state the jurisdictional issues and/or legal steps necessary in their Action Plan. Your company's workers' compensation coordinator needs to review and understand the jurisdictional procedures before approving any monetary settlement of the claim.

Local Influences

In order to make an appropriate evaluation of the workers' compensation claim, the adjuster must be familiar with the nuances of the local workers' compensation board. Does the local practice include a negotiated value for the disability? Does the local board increase the disability rating by a percentage amount or some other identifiable factor? Is the local work comp board plaintiff oriented? What is the reputation of the treating physician(s)? What is the reputation of the employee's attorney for settling claims or pushing them as far as they can in the legal system? (workersxzcompxzkit)

All these factors come into play when the adjuster is calculating the value of the disability rating. The Risk Management Department's workers' compensation coordinator who will approve the settlement amount needs to know the answers to these questions in order to verify the accuracy of the adjuster's disability settlement calculations

Author Rebecca Shafer, J.D. President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php

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.

©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com

Posted in Settling WC Claims, WC 101 |

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Eight Focus Areas for Best Practice Cost Containment of Workers Compensation

To maximize your company’s potential for workers’ comp cost containment we recommend focusing on these eight areas.

But, you say, this is just another checklist. Yes, it is. However, checklists are very useful tools to help those involved in the complex process of managing workers’ compensation claims, implementing best practices, and controlling costs, to very quickly triage those areas where they need to improve. Workers’ Comp Kit Blog, in over 1,300 blogs, provides suggestions and answers on how to implement all of the areas listed here, as faithful readers know.

1. Management Commitment and Resources

Is there a lack of awareness of resources such as books, conferences?
Do you need additional personnel e.g., workers’ comp coordinator(s) for large multi-division company?
Is your cost allocation immediate and cost sensitive?

2. Work Closely with Third-Party Administrator(s)

Proactively use account instructions.
Examine the TPA's internal quality control; ask – do they give “grades” and bonuses to adjusters for superior performance.

3. Intake Procedures are Key

Be sure you have tight post injury response procedures.
Be involved – don’t leave this to your insurance company or TPA.
Immediate reporting is very important.

4. Nurse Triage

Start management at tiime of injury. Have the triage nurse identify type of treatment that is needed.
Coordinate medical care early.

5. High Standards for Medical Provider Quality

Rank your medical providers.
Lower duration means better outcomes, less litigation, and lower medical costs! Ask for specialized networks with better outcomes.

6. Peer-to-Peer Physicians

Get your medical doctors to discuss each claim with the treating doctor.
Get pharmacy benefits management proactively when MDs at TPA review the claim while it is just beginning.

7. Return-to-Work Policies: Clear and Organized

Start transitional duty immediately after the incident; inform the injured employee of your return-to-work policies.
Let injured employee know you expect a return to work as soon as the worker is medically able. (workersxzcompxzkit)
Consider off-site RTW programs such as charitable, home-based, cross-divisional, and alternate employers.

8. Improved Communication is a Simple Way to Improve WC Programs

Target communication to your employees.
Target additional communication specific to supervisors, management, TPAs, and medical providers.
Communicate, communicate, communite
First day phone calls, weekly meetings (that's er …. every week)…

Author Rebecca Shafer, Consultant, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact her: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php

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.

Posted in Risk Management, TPA and Claims Administration, WC 101 |

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Injury Duration Guidelines and Transitional Duty Cost Calculator Work Together

An injury duration guideline is a tool employers use to get an idea of how long an injured employee should be out of work for a particular injury. Often, even though carriers know about injury duration guide, employers may not, especially employers with someone new handling workers’ compensation claims. AMA, Dr. Presley Reed are the two most note-worthy sources of this type of guideline. Workers Comp Kit has a one-page that is laminated that's a good quick reference, especially good for training or to show senior management to show the type of tools that enpower the employer.

An injury duration quidelines do not replace a physician’s advice, but it gives the employer a sense of whether the time injured employees are actually out of work or say they need to be out of work matches up with the time the guideline’s gives for a particular injury.

A Scenario
1. An employee has a fractured knee.

2. By replacing heavy work with light work (in your return-to-work program), the employer “saves” six weeks of lost wage indemnity payments.

3. The employee says s/he will be out of work for six months. Because you know this time frame is disproportionate to a normal injury of that type you can dig more deeply into why the employee thinks six months off is needed.

The Transitional Duty Cost Calculator

Using a transitional duty cost calculator allows an employer to calculate the dollar amount (cost of an employee being out of work (OOW)) by multiplying the estimated number of days saved by the estimated average indemnity cost per day. Add this figure to your cost of replacement labor and your grand total cost of an out-of-work employee is quite daunting. (See link below for this FREE tool.)

To make the figure more frightening, divide your dollar amount by the company’s profit margin and you will see the amount of money it takes to “replace” lost expenses from an out-of-work employee.

A Scenario

1. An employee with a fractured knee returning to work in six weeks on transitional duty saves 42 days of indemnity.

2. If the average cost per day is $200, and you pay a replacement worker $3,000, the transitional duty saves your company $190,000.00 if your profit margin is 6%.

Knowing what your true costs are when a worker is out on comp is a huge incentive to return injured employees to work as soon as they are medically able. (workersxzcompxzkit) (See ink below to try this handy tool.) It’s also a good reason to have a solid transitional duty or return-to-work program in place.

Showing the dollar value of the savings of six weeks helps to gain management commitment for a transitional duty program.

Author Rebecca Shafer, J.D. President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact her: RShafer@ReduceYourWorkersComp.com or 860-553-6604.

FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php

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.

Posted in Medical Cost Containment & Managed Care, Medical Issues, WC 101 |

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Know the #1 Top Reason Workers Comp Costs Are High

According to a 2009 RIMS Benchmark Survey, only twenty-one% of employers get work restrictions on the FIRST medical visit. This "waiting" puts the employee in charge.

The problem usually almost always starts with a “lack of control,” something like this example…

In June, “Joe” brings in a disability note, a pre-printed form saying “totally incapacitated.”

There is no diagnosis, no prognosis, no treatment plan, no estimated RTW date, no indication of what the employee CAN do, not even a phone number to contact the doctor.

In December, “Joe” brings in another slip when he comes to the plant to pick up his Christmas bonus (a turkey) saying he will be out of work for another four months.

Too many claims that last too long are, in general, are the reason workers’ comp costs are high. THIS IS THE TOP REASON WORKERS COMP COSTS TOO MUCH. The root cause of this is that the employer is not in charge allowing the employee to be "in control" of the situation which has allowed the length of time out of work to become "disproportionate."

An employee is injured June 1, and healed by July 1, but doesn’t come back to work until Dec. 1.

Obviously, the time out of work is disproportionate to the duration of the disability. Do you use disability guidelines — learn what those are! We have some in Workers Comp Kit. www.WorkersCompKit.com

Most employers do not know how many employees are out of work, but they DO know how many vehicles are off the road, how many production lines are down, and how many flights are delayed. But, no one has focused on how many employees are out of work.

If you are a carrier, provide this information in a clear way to policyholders. If you are an employer, ask for this information. Require your carrier to track lost days accurately – days for which you pay lost wages. Make sure the lost days fields are mandatory. (workersxzcompxzkit)

Ask yourself: If someone came in your office tomorrow, could you tell him or her how many employees are out of work right now?

Author Rebecca Shafer, J.D. Consultant, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. She can be contacted at: RShafer@ ReduceYourWorkersComp.com or 860-553-6604.

Podcast: KNOW the New OSHA Recordkeeping Rules — OR Risk Fines and Criminal Penalties. Click Here: http://www.workerscompkit.com/gallagher/podcast/Non_Compliance_with_Recordkeeping_Standards/

WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php

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.

Posted in Return to Work and Transitional Duty, WC 101, Workers Comp Kit |

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How to Make Changes to Improve Workers Compensation Across Your Organization

Making changes to improve workers' compensation performance across your organization is hard. Maintaining your improvement might prove to be even more challenging! That’s why it’s important to make sure your processes are repeatable.

Conduct your assessments in a manner that is easily repeated and results over time can be compared. This means limiting open-ended questions and, preferably, using technology to make the trending of results easy.

Providing training for workers’ comp coordinators in the field is important, but how much will they remember six months later if you don’t give them easy access materials to use in the heat of the moment? Ideally, your organization will maintain an on-line instruction manual providing straightforward directions for each stage of handling an employee injury.

For that matter, you want to make sure it is easy to access the forms and tools needed throughout the life cycle of an employee injury. (workersxzcompxzkit)

This might include:

1. Call scripts.

2. Work availability forms.

3. Employee brochures.

4. Injury duration guidelines.

5. And more.

Invest in repeatable processes and tools:

1. Reassess and monitor compliance.

2. Ongoing training.

3. Easily accessible forms, manuals, and instructions.

4. Formal trainings.

5. Manuals and standardized processes.

6. Standardized tools and forms such as an on-line WC manual, supervisor guides, wallet cards and duration guidelines.

7. Examine the need to standardize communications to employees, doctors, claims managers, etc.

Author Rebecca Shafer, Attorney/Consultant, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. She can be contacted at: RShafer@ ReduceYourWorkersComp.com or 860-553-6604.

Podcast: KNOW the New OSHA Recordkeeping Rules — OR Risk Fines and Criminal Penalties.
Click Here: http://www.workerscompkit.com/gallagher/podcast/Non_Compliance_with_Recordkeeping_Standards/

WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php

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.

Posted in Assessment & Diagnostics, Implementation and Rolling Out Your Program, WC 101 |

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How to Make Changes to Improve Workers Compensation Across Your Organization

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