LexisNexis Work Comp Community This Week In Review
The Workers Compensation Law Community Powered by Larsons on LexisNexis offers several great pieces this week:
First is this article by Roger Levy titled, “U.S. Supreme Court Issues Much Anticipated Decision in Roberts v. Sea-Land Services, Inc.” Levy explains the March U.S. Supreme Court decision answering the question of the meaning of LHWCA Sec. 6(c)'s "newly awarded compensation" clause in its decision in Roberts vs. Sea-Land Services, Inc. “Faced with two choices as to the meaning of the clause, the Court chose the one most favorable to employer/carriers and supported by the Director, Office of Workers Compensation Programs,” Levy writes.
[WCx]
In “Work Loss Data Institute Warns of Fox Guarding the Hen House in State Treatment Guidelines,” by John Stahl, found
here, Stahl explains that Phil LeFevre, a senior account executive at the Work Loss Data Institute,
recently compared official disability guidelines (ODG) with other workers’ compensation treatment guidelines. “The overall theme was that the ODG provides more objective guidance than individual state systems that often reflect the self-interests of medical providers in that jurisdiction,” he writes.
Larson’s Spotlight this week narrows in on a recent case in which an injured worker is entitled to additional TTD benefits despite derogatory conduct. The Supreme Court of Arkansas decided in a case where a worker sustained a work-related injury, was placed on light duty for a period of time, and then fired for calling his supervisor an "insulting, derogatory, and vulgar name." Read more about this case and others in the spotlight
here.
WCRI to Host Webinar April 10
The Workers Compensation Research Institute (WCRI) is hosting “Hospital outpatient Costs and the Impact of Fee Schedules” for those looking to control medical care costs for injured workers. The webinar will examine the WCRI study to help attendees make comparisons between “hospital outpatient costs across states, identify key cost drivers, and measure the impact of reforms over time.” The webinar will be from 1 to 2 p.m. EDT, Tuesday, April 10, 2012.
To learn more about the webinar or to register, go
here.
Managed Care Advisors Asks if FECA Regulations Will Change
In the recent issue of The Advisor, MCA notes that two proposed pieces of legislation would alter the Federal Employees Compensation Act (FECA). “The less controversial of the two, the Federal Workers Compensation Modernization and Improvement Act (HR. 2465), was introduced in the House of Representatives in July of 2011 and is currently pending in the Senate Homeland Security and Governmental Affairs Committee. It includes measures to allow the Department of Labor to cross-match claimants' reported income to Social Security data. It also includes provisions to authorize physician assistants and nurse practitioners to certify traumatic injury and related disability,” the article says.
Study Shows Workers’ Compensation Medical Prices Were Higher without Fee Schedules
A Workers Compensation Research Institute (WCRI) study shows that WC med prices were higher and grew more rapidly in states without medical fee schedules.
The study, found here, shows prices paid for medical professional services for injured workers were higher and rising faster in states without fee schedules compared with states that have them in place. The information was “designed to help public policymakers and system stakeholders understand how prices paid for medical professional services for injured workers in their states compare with other states and know if prices in their state are rising rapidly or relatively slowly,” according to WCRI.
[WCx]
Dr. Richard Victor, WCRI executive director, said, “In documenting the growing prices paid for the medical care received by injured workers, this unique study also shows the effectiveness of medical fee schedules in controlling those costs.”
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: 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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
If you leave the management of the workers compensation claims to chance, the chances are you will not have good results. To have good results in the control of the workers comp claims, it is important that everyone involved – the workers compensation claim coordinator, the floor or field supervisors, mid-management, medical personnel, legal, senior management and even the employees know what roles and responsibilities are in the management of the workers comp claims. My theme is: Take Control. Start by assigning roles and responsibilities to one or more parties in the process – it is a step that can be taken to get things on track. You do not need to assign ALL roles immediately, just take it one step at a time.
The duties of every person involved in the workers comp claim from the claim coordinator to the employee should be defined and written down for each participant. This includes both the pre-accident responsibilities, as well as, the post injury response. By knowing what is expected of them, each person will be able to take the appropriate action when an injury occurs. [WCx]
The workers comp claims coordinator, whether a full-time job at a medium-size or large employer, or a part-time job at a smaller employer, is the pivotal person in controlling the workers comp claims. The claims coordinator can be a part of the risk management department or a part of finance or human resources. The important thing is the claims coordinator has access to all information necessary to control the claim. [WCx]
Claims Coordinator Responsibilities
1- Establishing a transitional duty program prior to injuries occurring
2- Providing all new hires and providing annually to current employees the employee brochure on what to do in case of an accident
3- Arranging immediate medical care at the required medical provider or at the recommended medical provider
4- Providing the medical provider with a detailed job description prior to the employee arriving for the initial medical treatment
5- Interviewing the injured employee to obtain a detailed description of how the injury occurred.
6- Interviewing the employee’s supervisor to verify the description of the accident and what could have been done to prevent the accident from occurring.
7- Completing the First Report of Injury and providing it to the claims office on the day of the injury
8- Contacting the employee immediately following the initial medical treatment for the diagnosis, prognosis and expected period of disability, if any
9- Arranging for light duty / transitional duty / modified duty for the injured employee
10- Sending the employee a get well card when the employee will be off work
11- Maintaining weekly telephone contact with the employee while the employee is treating weekly and telephone contact following each medical visit thereafter.
12- Facilitating on-going contact with the claims adjuster and the nurse case manager.
13- Coordinating and completing all necessary paper work related to the claim.
The employee’s supervisor has pre-accident responsibilities to ensure all employees work in a safe and prudent manner.
Post-accident responsibilities of the supervisor
1- Accompanying the injured employee to the required or recommended medical provider.
2- Providing the medical provider with the Work Ability Form and obtaining the completed form from the medical provider’s office
3- Submitting the Work Ability Form, the Supervisor’s Report of Accident, the Employee Report of Injury and the Witness Report Form to the workers compensation claims coordinator.
4- Enforcing compliance with the transitional duty program and verifying the work done by employees on modified duty is in accordance to the medical provider’s limitations.
5- Training all his/her employees on what to do in case of an injury.
The employee needs to be involved in the control of workers compensation claims.
The employee’s role and responsibilities
1- Participate in post-injury response training.
2- Participate in the return-to-work transitional duty program
3- Attend all employee weekly meetings/office meetings unless physically unable to get to the work-site
4- Provide the Work Ability Form to the supervisor or claims coordinator after each doctor’s visit.
The Best Practices for Injury Management also applies to middle and senior management. Management should have defined roles and responsibilities.
Management Roles and Responsibilities
1- Providing a strong safety program and implementing the necessary risk management practices to keep as many workers comp claims from occurring as possible.
2- Knowing the monthly and on-going cost of workers compensation.
3- Communicating to the employees how many additional sales or how much additional production is necessary to cover the cost of workers compensation claims.
4- Determining the medical providers that will be used
5- Determining the insurance carrier or the third party administrator.
6- Tracking and reporting lost work days.
In addition to the Best Practices for Injury Management noted above, there are best practices for risk managers, medical directors, in-house medical clinics and in-house legal. These sample best practices listed here are far from complete. There are many additional Best Practices for Injury Management covered in our 2012 Manage The Workers Compensation Program, Reduce Cost 20-50%. Contact us to learn more about how to control workers comp cost through Best Practices for Injury Management.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
California Fraud Case
Manuel Perales, 50, of Fontana, Calif., has been charged with two counts of workers compensation insurance fraud, according to the San Bernardino County District Attorney's Office.
Recently, members of the DA’s Office, Workers Compensation Fraud Prosecution Unit, began an investigation into allegations of possible insurance fraud involving Perales. (WCxKit)
Perales reportedly sustained an industrial injury, while working for a local company. During the workers comp process, Perales withdrew his claim after being confronted with evidence that supported the incident was not true.
Although Perales withdrew his claim; he subsequently filed a second workers comp claim alleging that he sustained the same injuries, along with other industrial injuries, over a specific period of time, not including his original date of injury.
During this investigation evidence revealed that the allegations of workers comp insurance fraud were substantiated. As a result, an arrest warrant showing a bail amount of $100,000.00 was issued, charging Perales with insurance fraud. (WCxKit)
Later, Perales was located and arrested pursuant to the arrest warrant. He was transported, booked and housed at the San Bernardino County Sheriff’s West Valley Detention Center to await trial in this matter. Perales is scheduled for arraignment some time in 2012.
Ohio Fraud Case
A Cleveland (Cuyahoga County) woman was sentenced recently for fraud after Ohio Bureau of Workers Compensation (BWC) investigators found she was working for a veterinary hospital and a local charity while receiving benefits for a workplace injury. Nancy Palmer pleaded guilty and must repay more than $8,000.
BWC's Special Investigations Department (SID) reports it received an allegation that Palmer had been working at a local veterinary hospital. Investigators found she had returned to work as a veterinary assistant while receiving Temporary Total Disability benefits.(WCxKit)
According to the report, Palmer was performing duties such as office work, assisting during surgeries, cleaning and taking care of animals. It was also found that Palmer was working as a telephone solicitor for a local charity.
Palmer entered a guilty plea recently to a felony count of workers comp fraud. The judge ordered Palmer to pay $7,457.72 in restitution and $1,000 for investigative costs. She was also sentenced to seven months in prison, suspended for 18 months of community control.(WCxKit)
Author Robert Elliott, executive vice president, Amaxx Risk 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. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: 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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
According to a new study from the Center for Construction Research and Training, construction workers in the United States have a large risk of work-related injuries and an increased risk of work-related illness and death.
Researchers peered over data from several national sources and discovered that a construction worker has a 75 percent chance of suffering a disabling injury over a 45-year career, and a 1-in-200 risk of being fatally injured at work. (WCxKit)
Meantime, Hispanic construction workers have a 20 percent greater risk of dying from a work-related injury than whites.
The authors of the study also discovered that people who begin construction work at age 20 have a 15 percent chance of developing chronic obstructive pulmonary disease over their lifetime and an 11 percent chance of developing dust-related changes to the lung tissue.
"While great strides have been made in reducing construction injuries and illnesses, the numbers are still stubbornly high," Pete Stafford, executive director of CPWR, commented in an APHA news release. (WCxKit)
"Workers and their families suffer the consequences of disabling injuries, and this research shows it's far too common. So we must continue to raise awareness of the problems and hope to see our research findings put to use to reduce construction fatalities, injuries and illnesses," Stafford added.
Nova Scotia Labor Department Charges Employer Following Death
Nova Scotia's Labor Department has laid charges following an 18 month investigation into the death of a 12-year-old boy who was run over by a truck in Cape Breton.
According to information from the NSLD, Dylan LeBlanc of Cheticamp was killed while riding his bicycle near a local inn that was being renovated in August 2010. The boy was hit and run over by a boom truck. (WCxKit)
Labor Department spokesman Brian Taylor reports charges were laid recently against 5823 NWT Ltd., the company that owns Maison Fiset House, and project manager Darren MacPhee.
Taylor says the company has been charged with failing to take every reasonable precaution to ensure the health and safety of people at the workplace and failing to take adequate precautions to ensure pedestrian safety.
He says MacPhee is charged with failing to take reasonable precautions to ensure health and safety at or near the project.
Taylor says a third person who has not been named by officials is also charged, but that person has not been served notice yet. (WCxKit)
Those charged are to appear in provincial court in the spring in Port Hood, N.S
Author Robert Elliott, executive vice president, Amaxx Risk 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. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: 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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
EVERY CLAIM HAS A FIRST WEEK. Right!
We all know that, it is obvious. What else would you call the seven days which follow an accident? And how, barring the end of the world, would you not have a first week? But that is not the message of this piece.
The first week following an accident is a one-time period for opportunity. A diligent employer can, in those first seven days, shape the outcome of a claim so that all (in this case, the employer and employee) will benefit. The “losers” will be those who stand to gain from inefficiency, which is to say, everyone else in the claims process. [WCx]
Why is the first week so important? The law requires some things to be done rather quickly (filing an employer’s report of injury) but most can surely wait until the carrier does them – can’t they? The technical answer is, “Yes.” The smart answer is, “No!”
Every claim does have a first week- but none have two of them. Once the first week passes without action it can never be regained – and the first week is exclusively the employer’s. A carrier cannot effectively get started defending a claim until several weeks passes from when it is notified.
What should the employer do in this period? Oversee the care of the employee and gather facts. The first is not optional – at least not in NY.
Most people who work in the comp field in NY are surprised to learn that the comp law places an affirmative responsibility on the part of the EMPLOYER (no one else is mentioned) to see that an injured employee receives proper medical care. That does not mean selecting a treating doctor (although that was actually done in the first decades of the comp law), but it does mean that the employer should not be passive if the employee is obviously not getting the treatment needed.
The other responsibility which should be attended to by the employer is gathering a forwarding (to the Board, the carrier, the treating doctor and the worker) information and documents which will be needed (payroll, details of accident) or which might be needed (prior injuries, claims, employers, medical plans, periods of significant absence, etc.).
The last, documents which might be needed, puzzles many employers. If the information is not requested, why would it ever be needed? The answer is that if others do not know the information exists – why would they request it? True, they should ask what other information exists – but in the real world they usually do not. Nothing will increase an x-mod faster than the useful information which remains silent and uninvited, sitting in a file cabinet drawer (or in cyberspace).
Finally, there is the therapeutic aspect of purposeful activity. A worker, and the worker’s family, is all too frequently struggling through a morass of silence and indifference during the first weeks. The person closest to them, the employer, seems to be uninvolved in the claim. Many employers are under the impression that they are REQUIRED to be out of the loop. “The carrier has to do that.” In truth, the comp law mentions the employer frequently and the carrier hardly at all – except as surety for payment of awards. [WCx]
In short, it is difficult for an employer to be over involved in a claim. Or over concerned about the welfare of an employee. And the best time to become involved and concerned is – the first week.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
medsearch7@optonline.net
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: 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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Whether your carrier/TPA is a small firm in your state, or a larger nationwide facility located on the opposite coast of the US, you will always have to have some sort of interaction with them.
Claims will never be avoided, and since you are the employer, risk manager, claims coordinator, whatever your title may be, you need to know who to reach out to with questions. If the only source of contact with your carrier/TPA is a 1-800 number to call with questions, you probably will not get very far. You may eventually get to the right person, but it could take you all morning.
To avoid such a scenario, you need to know who is handling your claim, where they are located, and how they can help you. The more you personalize your relationship with them, the better they will work for you, and the quicker your questions will be responded to. Even if you only have a handful of claims per year, adjusters will respond to those employers they have a good interpersonal relationship with. Let’s discuss 5 ways to improve your relationship with your adjusting team: (WCxKit)
1. Know your adjuster and their team
If you do not have a lot of claims per year, or you are a smaller shop with limited exposure, you may not really know which carrier/TPA office location will be handling your claims. Maybe they start off in one city, such as Boston, then end up in Philly. Or maybe they start off and end in Milwaukee. Do you really know who has your claims, where they are, and who to contact with questions?
If you call your agent/broker, they may have the answer to this question. But with insurance carrier/TPA offices becoming more and more consolidated, even your Agent may not be 100% sure. So reach out to your carrier/TPA and find out if a dedicated local office will be handling your claims. Or, maybe they will start out at their Home Office in Boston, and then be transferred out to a local office in your state if it is a lost time claim, a claim that needs special investigation, or a claim that has issues with compensability. If you know who to call or email with questions, it will make filing claims and getting answers to your questions that much easier and quicker.
2. Communication is key
The main reason a claim derails from running smoothly is a lack of communication. Whether it is from the employee not talking to the adjuster, or a miscommunication between the employer and the adjuster, communication is extremely important when dealing with any aspect of claim handling. Be sure to check with your adjuster on all your open claims, and get an update on what is going on, and what their plan is to resolve the claim.
Even if you only have a handful of claims per year, your input is valued more than any other. After all, you as the employer are their client, and the carrier/TPA wants to make you happy. Adjusters will appreciate someone out there that cares about what they are doing to move these claims along. Scheduling regular claim updates is also a great way to prevent a claim from slipping through the cracks. Plus the more you as the employer are involved, the more the adjuster knows they have to keep an eye on your claims since you will be checking up on them. The more you are involved, and the more you communicate, the better your claim will be handled.
3. Answer all questions the adjuster asks
If an adjuster has a question about something, no matter how insignificant it may seem to you, it is probably really important to the adjuster. Several states require reporting to the State Bureaus of Work Comp, and missing information will hold an adjuster up from completing their filings. Even minor missing info such as a date of hire is important to the adjuster. They need complete info as part of their job for their state filings, so if they have questions about personal info, phone numbers, hire dates, wage history, etc. do what you can to get that info for them so they can move on with the claim.
Details such as the hire date could also key them in on certain aspects of the claim. If it is a new hire, maybe that explains why a worker cut their hand, or strained their back. Wage info is always needed when there is lost time. If the adjuster needs the wages, they probably can’t pay your worker until they get that info. A date of birth is needed for state filings, but it is another key to the claim, since an older worker may mean that this particular claim won’t resolve as easily as it would with a younger worker. The examples here are endless, and the bottom line is to get any requested info to your adjuster on a timely basis. You don’t have to stop what you are doing to look that info up, but try to get it for them within a few business days. The sooner you do, the quicker it is off your desk and the less chance you have of forgetting about it.
4. Bring your adjuster and their team out for a tour of your facility
If you are a large enough employer to churn out 50 claims per year, you probably will know who your adjuster is by name. You may even know who their manager is by name. But do you actually know who they are, other than just by name? Employers that have a lot of claims may know a little about their adjusters through casual conversation, such as if they are married and have kids, if they are sports fans, etc.
A way to strengthen the relationship is to have them come out to your facility for a tour. Not only can you put a face to a name, but it greatly helps your adjusters by seeing the premises. Adjusters can look at the machines, observe the workers doing their jobs, and get a better idea and understanding of what you guys do day in and day out. This helps them mentally process the claim by knowing what your injured workers are talking about when they are describing what they were doing when they were injured. If you describe a machine injury to 10 people, you could get 10 different ideas of what happened. But if you show your claims team the machines and how your operators run them, and then they know exactly what a worker is talking about when they were injured.
5. A “Thank you” goes a long way
As we have said time and time again, the work of a claims adjuster is often a very thankless job. Sure, it is the adjuster’s job to handle these claims, but often it is a stressful, high demand profession. Taking the time to thank your adjuster for their hard work will mean a lot to them, and they will take that compliment and use it to handle any of your issues right away. Your adjuster certainly will not forget your praise, and you can get them to work that much harder for you now and in the future. (WCxKit)
Summary:
Even if you only have a few claims per year, you will want those claims to be handled as if you are the only client that adjuster works for. Unfortunately, this is not the case. Adjusters usually have 150+ claims they are keeping an eye on, and a good way to get yours handled effectively is by implementing what we have described above. Get to know your team, take the time to meet them in person and show them around, and hand out praise when it is deserved. Your adjusting team will not forget it, and it will only make your life that much easier when it comes to getting claims resolved.
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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact: Info@ReduceYourWorkersComp.com
The wrong doctor treating the employee for a workers compensation injury is one of the biggest mistakes an employer can make. It is a very fast way to incur higher than necessary medical expenses and higher than necessary indemnity cost. The proper selection of the medical provider is crucial to the overall outcome and cost of the workers compensation claim.
While most employers are blissfully unaware of the importance of the medical provider selection, it is a fact very well known by the plaintiff’s bar association. When the concept of workers compensation was being adopted by the states nearly a hundred years ago, the employer always provided the medical provider. Over the years in approximately half of the states, the plaintiff’s bar has wrestled control of the medical provider selection away from employers and put it in the hands of the employee (who normally allows the attorney to make the medical provider selection). (WCxKit)
Why is the selection of the medical provider is important to the plaintiff’s bar association? The answer is simple: money. The television attorney holding a fistful of money while soliciting the injured employee got most of that money by controlling the selection of the medical provider.
The plaintiff attorney representing the employee works for a percentage of the indemnity benefits paid to the employee. The more indemnity benefits paid to the employee, the more money the employee’s attorney makes. Hence it is in the best interest of the employee’s attorney to keep the employee off work as long as possible and for the employee to get the highest possible disability rating (regardless of whether or not it is accurate).
The large majority of medical providers are honest in the assessment of the employee’s ability to return to work light duty or full duty and are honest in the assessment of the employee’s permanent partial disability rating. Some of the doctors in this large majority are more liberal and some are more conservative, but even within those parameters they remain honest.
Unfortunately, there is a small minority of doctors, concentrating primarily in the chiropractic field and the orthopedic field, that sold off souls to the plaintiff’s bar. Whether it is by collusion with the plaintiff attorney or a silent agreement, the plaintiff attorney sends as many of his clients as possible to the “doctor” who in return keeps the employee off of work as long as possible. The employee remains off work until the employee wants to go back to work, or the doctor can no longer justify keeping him off work. The doctor then consults the disability rating guide used in that state, and gives the employee the highest possible disability rating out of the possible range of disability ratings.
This is a win-win situation for the attorney and the doctor. The doctor increases the attorney’s income, and the attorney increases the doctor’s income. The employer loses. The higher the amount paid to the employee in temporary total disability and permanent partial disability, the higher the eventual workers comp insurance premium will be for the employer.
What should the self-insured employer or insurance company do? The employer cannot conspire with a doctor to put the employee back to work before he is physically able to return to work and will not conspire with a doctor to falsify the disability rating. The answer is to consult with the workers compensation defense attorneys in the area where the employer is located. The defense counsels who have had extensive experience dealing with the various doctors in the areas can advise who are conservative, moderate or liberal in disability ratings. They can tell you which doctors get the employees back to work timely. They can also warn of doctors who work solely for the plaintiff’s bar.
We would recommend consulting with defense counsel and learn the precise requirements of the state. In some states, the employer only has to post one medical provider, while in other states the employer must post a list of medical providers (also referred to as a panel in some states). The list of medical providers should include both general practice doctors for the minor injuries, the orthopedic specialists, the emergency care facility and/or hospital and, any other specialties required by the state.
Not only should the employer ask defense counsel what the posting requirements are for the particular state but should also ask the names of conservative, reputable doctors. Employers need doctors who will provide the employee with all necessary medical care, but will also work to get the employee back to work on modified duty or full duty as soon as practical. Also doctors who will give the employee a fair, objective disability rating, if one is needed, are ideal.
Occasionally there will be a plaintiff attorney who will ignore the employer’s posted list of doctors and send the employee to a favorite doctor. The claims adjuster should immediately object and advise the attorney that any medical care the employee receives at the non-approved doctor will be at the employee’s own expense, plus if the employee does not attend the medical appointments with the employer selected doctor, the indemnity benefits will be suspended. WCxKit
In the states where the employee has the right to select the medical provider, we suggest for the employer to post the “recommended” (not required) doctors suggested by defense counsel. While this will not stop the plaintiff attorneys from sending the injured employee to their favorite doctor, it will eliminate some of the claims that end up in the hands of plaintiff attorneys as the employee will be receiving the medical care they need timely.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Workers’ Compensation Costs Can Be Reduced by Implementing Operational Best Practices: Learn How With This New Guidebook.
A company that wants to implement a new workers compensation program or revamp an existing system will find this book helpful. Maybe your company has recently expanded and you realize the need to train a workers compensation manager or regional coordinators how to hold down compensation costs. Whatever your need, here is the answer:
Workers Compensation Management Program: Reduce Workers’ Comp Costs 20%-50%.
Used by more than 150 firms across the country, this is THE book to help every employer develop a more effective workers compensation program to reduce workers compensation costs. It is based on field research and decades of experience in workers compensation from all aspects of the business. Best practices are described in detail for each person in the injury process.
This easy-to-read manual has been updated for 2012. It now includes:
An index for quick topic look-up so you can view a term or a procedure and see all relevant references.
NEW – Workers Compensation Basics
Purpose of Workers Compensation
Who Pays for Workers Compensation?
Parties Involved in Workers Compensation
Benefits for the Employer
Independent Contractors
Benefits for the Employee
Injuries Covered
Types of Workers Compensation
How Losses are Categorized
How Losses are Reported
Calculating Your Premium
How Mod Effects Your Premium
Good/Bad Mod Example
Five Ways to Reduce Your Mod
NEW – Fundamentals of Cost Containment
Reasons Workers Compensation Costs are High
Who is in Charge?
Work Ability Form Properties
Who is Responsible for Managing Workers Compensation Claims?
Who is Responsible for Managing Workers Compensation Process?
Hidden (Indirect) Costs of Workers Compensation
Additional Costs
Calculating WC Costs
External Obstacles to Cost Control
Internal Obstacles to Cost Control
NEW – Working with Your Adjusters or TPA
Account Handling Instructions
MD Participation
NEW- Reporting a Claim
Critical Issues
Essential Intake Considerations
Nurse Triage
NEW- Directing Medical Care
Occupational Health Clinics
Remote Health Services
Directing Medical Care in California
NEW- Return to Work
What to Include in a Transitional Duty Policy
Non-Profit, Volunteer or Charitable Positions
Employees Who Never Return to Work
Coordinating WC with Federal and State Leave Statutes
NEW – Other Indemnity Cost Containment Services
Telephonic Disability Intervention
NEW – Medical Cost Containment
URAC Certification
Mental Health RNs
Chronic Pain Programs
An Aging Workforce
At Home Recovery Services
Medical Fee Schedules
Fee Schedule Coding
ICD-9 and CPT Codes
NEW- Physical Therapy and Physical Rehabilitation
Differences between Physical Rehabilitation Programs
Pharmacy Benefits Management Program
Authorized Drug Formulary
Toxicology Screening
NEW – Fighting Fraud and Abuse
Medical Terminology Used to Identify Malingering
Reviewing Investigation Reports and Videos
Avoid good Day/Bad Day Syndrome
NEW – Claims Resolution and Settlements
Conditional Payment and Final Demand
Pharmacy Component of MSA
California Settlement Process
A 183-page guide covering how to assess your workers compensation program, design program materials, roll out a program to the organization, and monitor and manage the program once implemented.
Written by a national expert on workers compensation cost containment with over 25 years experience helping companies reduce their losses 20% to 50%.
T. Ronca, a workers’ compensation defense attorney from Long Island, NY, said the
book is an invaluable desk reference. “It is one of the tools that should never be out of reach for a risk manager. Direct employer involvement with claims in the first weeks is the difference between success and failure. This manual will guide the conscientious employer through the pitfalls,” Ronca said.
What’s more, the book can be delivered with your company logo on the cover and a full-color ad for your company on the back cover.
Take it out to the field. Text tabs are available to put on each chapter and it is ready to go as your company training manual. All you will have to do is customize the Training Agenda that is in Part I of the book.
Included in the manual are topics such as: Return to work and transitional duty, claim reporting, employee communications, controlling fraud and abuse, directing medical care, medical cost containment solutions, post injury response procedures, reporting procedures, working with your carrier and third party administrator. There is information about physical therapy, pharmacy benefits management programs, training supervisors and gaining management commitment. It also contains concepts of claim settlement and resolution as well as safety and loss control. New areas are identified above.
There are 5 sample worksheets in the manual to help organize an efficient workers’ compensation program. These include: timetable for implementation, the injury coordinator job description, and several sample roll-out letters. We recently received a terrific phone call from a third-party administration firm saying how the manual provided an organized way to train clients at loss prevention and has helped their clients put "layers of better WC management" in place. Everyone benefited.
One large distribution firm wrote to us to say the chapter on safety and loss control led to a company-wide safety change that only cost a few hundred dollars but prevented a specific type of injury that had been draining its budget, says Rebecca Shafer, Esq., President of Amaxx Risk Solution, Inc. who authors the book. Shafer is a national expert on workers’ compensation cost containment with more than 25 years of industry experience helping many companies reduce their losses 20-50%.
When you order your copy of Manage your Workers’ Compensation Program from Advisen at
http://corner.advisen.com/wcbooks, the 183-page guidebook shows how to assess your program, design program materials, roll-out a program to the organization, and monitor and manage the program once implemented.
The workbook is also available with a customized front and back cover for bulk purchases. Discounted rates apply to bulk orders.
One company said, "After reading the manual, we took a look at past workers comp practices and saw that every department did things differently. Manage Your Workers’' Compensation Program 2012 gave us the guidance we needed to standardize our workers’ compensation programs across the country. It was like a pre-prepared lesson plan," according to the risk manager.
A regional hospital in North Dakota wrote that, "Our small company expanded rapidly and we actually didn’t have any official workers’ compensation program in place. This manual gave us step-by-step procedures from the first meetings with management to monitoring the final program. Buying and reading the book was almost like hiring another employee – one who was an expert in workers’ compensation."
Who Uses the Workers’ Compensation Book?
Risk Managers and Workers’ Comp Managers find it useful learning about the cost containment niche and use it for themselves and to bringing new team members up to speed very quickly. The book becomes a “lesson plan” tool.
Safety Directors use the book to train supervisors in workers’ compensation claims management. They learn more about their area of responsibility — post loss cost containment — adding to their overall knowledge. They also learn what to do after an injury and what steps are supposed to take place during the first 24 hours.
Brokers use it for prospects, as well as, to learn about specific aspects of cost containment, passing their knowledge on to their clients. For example, when discussing how to develop a return-to-work program and a client asks about, “off-site return-to-work programs,” the broker quickly finds the relevant section in the book, reviews it and passes the answer on to the client, along with a copy of the cost containment book with the broker’s logo.
Adjusters use the book to gain a better understanding of the employer’s perspective. Adjusters also want to learn more about cost containment to add to their overall workers’ compensation knowledge in order to grow their careers and stay abreast of new services.
Account Producers give the book to prospects during formal presentations to illustrate their company is on top of the workers’ compensation industry. The book makes an excellent client gift.
Vendors such as doctors, physical therapy networks, occupational clinics and medical management firms learn how their service might fit into the workers’ compensation marketplace, what is important to employers, and what they look for in medical services to enable the vendors to enter the workers’ compensation marketplace.
The manual is a cost-cutting tool to learn more about systematic and operational techniques for reducing workers compensation costs.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Posted in
Claim Audits & File Review,
Communication with Employees,
Coordinating Medical Care,
Federal Workers Compensation,
Fraud and Abuse,
Insurance Issues, Rates, Premiums,
Lowering Premiums & Experience Mod,
Management Commitment,
Medical Cost Containment & Managed Care,
Medicare Set Asides (MSAs),
Professional Development Issues,
Return to Work and Transitional Duty,
Risk Management,
Safety and Loss Control,
Settling WC Claims,
TPA and Claims Administration,
WC 101,
WC in Other Countries (International) |
Workers Compensation Laws change frequently. This is only a summary; a complete copy of the most up-to-date version can be found at: www.WorkCompResearch.com , an excellent service.
In Kansas workers compensation coverage is compulsory as to all employment, including corporate executives and employees of charitable organizations. Coverage is elective for individuals, partners or the self-employed. There are some exceptions. Real estate brokers and real estate salespeople on commission are excluded from the compulsory requirements. Also, farm labor and employees of any employer whose gross annual payroll is $20,000 or less are excluded from compulsory coverage.
Obtaining Coverage
To obtain workers compensation coverage in Kansas, the employer has three options which are
- purchasing a workers compensation insurance policy from a state approved insurance company
- applying to and being approved for self-insurance status with the Kansas Department of Labor.
- being a part of a group-funded self-insurance plan that has been approved by the Kansas Department of Labor
Claim Reporting
The employee must provide notice of the injury to the employer with 10 days and up to 75 days with just cause. The actual claim of the employee must be served on the employer within 200 days after the accident, or last payment, or within 1 year of the employee’s death with death occurring within 5 years after the date of the accident. WCxKit
Medical Benefits
In Kansas, the employer selects the medical provider for workers compensation claims. The employer is required to provide all reasonable and necessary medical care free of any charges to the employee. The employer is also liable for up to $500 of employee incurred medical bills at a non-authorized doctor. The employee can also apply to the Director of Workers Compensation for a change of doctors. The employee is entitled to all medical treatment needed to cure or relieve the effects of the injury. Prayer or spiritual treatment is permitted by agreement.
Temporary Total Disability Benefits
The temporary total disability (TTD) benefits are calculated as two-thirds of the employee's average weekly. The maximum amount of TTD benefits that can be paid is $555.00 per week. The state maximum is subject to annual increase/decrease each July 1st, based on the state’s average weekly wage. The state minimum weekly benefit is $25.
The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days. TTD benefits can be paid until a cap of $100,000 has been reached.
Temporary Partial Disability Benefits
In Kansas if the employee is able to return to any type of work, but at a lesser rate of pay then the amount the employee was earning prior to the injury, the employee is entitled to temporary partial disability (TPD) benefits. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage. The TPD benefits are paid for up to a maximum of $100,000. The TPD benefits plus the post-injury pay rate cannot exceed the state's maximum indemnity benefits rate.
Permanent Partial Scheduled Disability
Kansas uses a Schedule to establish the value of an injury to all extremities, the shoulders, eyes and hearing. Each body part has a set number of weeks it is worth with a shoulder being worth 225 weeks of compensation and the number of weeks decreasing with other extremity body parts having lesser value down to a toe, other than a big toe, being worth 10 weeks of compensation. A 20% loss of use of the arm, which is scheduled at 210 weeks, would result in a permanent partial scheduled disability award of 42 weeks (210 weeks X 20%).
Permanent Partial General Disability
When the employee sustains a permanent partial general disability of a body part not listed on the Kansas Scheduled Injuries list and the employee is not permanent totally disabled, the employee receives permanent partial general disability. If the employee is able to return to work and is earning at least 90% of the average weekly wage, the employee is given a percentage of the whole body impairment based on the AMA Guidelines, Fourth Edition. The maximum in weeks is 415 weeks. An employee with a 10% rating would get an award of 41.5 weeks of compensation. The maximum an employee can collect for permanent partial disability is $100,000.
Permanent total disability
Kansas permits the employee to collect a maximum of 415 weeks of indemnity benefits for all types of indemnity combined, but the total amount of benefits collected for permanent total disability is $125,000 instead of $100,000 (the amount of TTD benefits paid to the employee is included in the $125,000 indemnity benefit cap).
Death Benefits
The burial expenses in Kansas are covered for a work-related death up to $5,000. The death benefits for a dependent spouse and children follow the same guidelines as TTD benefits – two-thirds of the average weekly wage – currently a maximum of $555 week, and a minimum survivor’s benefit of $370 per week, except there is a dollar maximum for death benefits in the amount of $250,000 with children, or $200,000 without children. If there is no spouse and no dependents, the death benefit is reduced to $25,000. WCxKit
Vocational Benefits
Vocational Rehabilitation is on a voluntary basis in Kansas. However, once it is started, it cannot be terminated without the agreement of the employee. The vendor of the vocational rehabilitation may be changed for good cause supported by substantial evidence. If so, the employee may select the replacement vendor from a list of three qualified vendors provided by the employer.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
As any employer with locations in more than one state knows, the workers compensation policy is written specifically for the states where the employer has physical facilities. On the Information Page that comes with each new policy or policy renewal, is Item 3.A (for most insurance carriers) which designates the states where the workers compensation policy is applicable. Workers compensation coverage does not apply to claims filed in other states.
While the insurance carriers attempt to limit the exposure to claims occurring where they may not have claims offices, or knowledge of the workers compensation statutes, the states take a much broader approach. The workers comp statutes of most states specify when and how the workers comp act applies out of state. Normally, the state statute will indicate that if the contract to hire was negotiated within the state, the workers comp laws apply regardless where the injury occurs. (WCxKit)
Most state workers comp statutes will have extraterritorial provisions that state if the principal place of employment is within the jurisdictional boundaries, a workers comp injury occurring outside of the state boundaries is still covered by the state law. The workers comp statutes also normally specify that any work related injury occurring within the borders is subject to the workers compensation statutes, even for employers and employees whose place of business is not within the state line boundaries.
When the employee is injured in another state where the employer does not normally do business, the extraterritorial provisions of the state workers comp act work great, as long as the employee elects to utilize the benefits of the home state workers compensation act. The problems occur when the employee elects to file the claim in a state where the employer does not have a physical location and the employer does not have workers compensation coverage.
The usual reason an employee files for benefits in a state other than the home state is the amount of temporary total disability (TTD) benefits that will be paid. Consider the highly successful salesman from Georgia earning $1,500 per week. If he is injured in Iowa with its high maximum weekly TTD rate, he will receive $1,000 per week while he is unable to work, if he elects Iowa for workers comp benefits. If he elects Georgia benefits, the TTD rate is capped at $500 per week.
This creates a coverage issue for the employer. When the workers comp policy is purchased, the employer should have the insurance agent or broker specify in Item 3.C of the Information Page the other states for which coverage is requested. Some agents will approach this by listing every state and territory except North Dakota, Ohio, Washington, Wyoming, Puerto Rico and the US Virgin Islands (the four monopolistic states and two monopolistic territories where the state/territorial governments provide the workers comp coverage). This can result in an accidental oversight where the agent leaves out a state.
A better approach is to insert the following on the Information Page in Item 3.C: “All states and US territories except North Dakota, Ohio, Washington, Wyoming, Puerto Rico and the U.S. Virgin Islands and those states listed in Item 3.A of the Information Page.” While this is the best approach to out of state coverage, some insurers, especially single state insurers or small regional insurers, will object to providing workers comp coverage in other states where they are not licensed to do business.
Most employers think of the workers compensation policy and the workers compensation coverage as one and the same. Actually, the workers comp policy is divided into several sections with Part 1 being the actual workers comp coverage. Part 2 is employer’s liability insurance which covers injuries to employees when workers comp coverage does not apply. Part 3 is Other States Insurance. With this coverage, workers compensation and employers liability insurance is provided for incidental exposure in states not listed in Item 3.A of the Information Page.
It should be noted that Other States Insurance covers only incidental exposures. When the employer starts to have employees in a state on a regular basis, the states needs to be included in those listed in Item 3.A of the Information Page. If your business has employees who occasionally travel out of state, it is a good idea to routinely review your coverage with your insurance agent to confirm that your policy provides for incidental out of state exposures.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
