6 Steps to Take When Asking the Adjuster for a Physician Peer to Peer Review
You can request a peer-to-peer or a peer review from your adjuster when occasionally the information provided to you by the doctor treating your injured employee just doesn’t make sense.
What’s the difference between a peer-to-peer or peer review: Here are the definitions:
1-Peer-to-peer is a discussion between two doctors usually about the treatment or condition of the injured worker.
2-Peer Review is one doctor reviewing the treatment or work of another doctor, but not a discussion. It is more of a second opinion of the file.
When you need to ask for a peer review, remember, it’s business. No one is accusing anyone of not doing a proper job and the company is not suggesting the employee is manipulating the treating physician to stay out of work or to achieve a settlement.
What the injury coordinator is doing is trying to make sense of the gray areas of medicine. Very often two physicians can examine the same patient and come up with two different opinions. You may want someone to review your claim file.
An injury coordinator is familiar with some of the medical information involved in complex employee injuries and will be on the lookout for things not understood or not adding up. If this occurs, there is nothing wrong with asking for a peer review, a second opinion on the medical portion of the file.
An email to your adjuster requesting a review can include:
1. All contact information, claim number and copy to the supervisor.
2. Explanation stating the company’s medical director has found discrepancies between the treating physician’s documentation and the doctor’s evaluation – this could include, but is not limited, to previous injuries having nothing to do with the workplace event.
3. A detailed explanation of the discrepancy, using proper medical terminology.
4. A note stating the employee’s treating physician’s diagnosis is keeping the employee from resuming work.
5. Ask for the claim is sent for peer review. (workersxzcompxzkit)
6. A request for you to remain in the communication loop.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
We are accepting short articles* (200-300 words) on WC cost containment. Non-salesy, written from employer’s viewpoint. To: Info@ReduceYourWorkersComp.com. Send contact information. *Non-compensable.
Follow Us On Twitter: www.twitter.com/WorkersCompKit
Return to Work in Unionized Companies
http://reduceyourworkerscomp.com//Return-to-Work-Programs-Unionized-Companies.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
9 Telephone Questions for the Physician
Leaving no stone unturned is critical to managing your workers’ compensation costs. With the number of steps from injury to resolution; the number or people involved from physicians to adjusters; and the number of possible outcomes from a band-aid to a large insurance settlement you just cannot leave any single step to memory.
Certain questions must be asked. Certain forms must be filled out. Certain precautions must be made. Your form should include all the questions one should ask the physician on the telephone to be sure every “t” is crossed, so to speak. Formalize your questions in a checklist so these questions are asked uniformly; it’s not something that should be done on an ad hoc basis.
Your physician’s telephone checklist should include:
1. Introduce yourself and give the injured employee’s name, mentioning the employee has authorized you to speak with the doctor.
2. Get and give all contact information.
3. Offer to FAX authorization so the doctor may discuss the employee’s condition.
4. Ask for diagnosis and whether it is work related.
5. Ask how the employee is responding to treatment.
6. Ask if prescribed medications could interfere with the employee’s job.
7. Does the physician recommend any significant limitations?
8. Can the employee perform a transitional duty job? If yes, FAX a work ability form (WAF). (workersxzcompxzkit)
9. Is there anything else that I should know, that would help our employee recover more quickly?
This open-ended question gives the doctor an opportunity to provide information that is additional and helpful to the employer or the employee.
Keeping up with all these details assists your company in getting your employee healthy and back to work. Here’s an example of what your checklist can look like.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
We are accepting short articles* (200-300 words) on WC cost containment. Non-salesy, written from employer’s viewpoint. To: Info@ReduceYourWorkersComp.com. Subject Line: “Blog Submission.” Name/Title, Company, Phone/Cell, Short Bio. See http://www.reduceyourworkerscomp.com/. We will contact you. *Non-compensable.
WC IQ Test: http://www.workerscompkit.com/intro/
WC: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
Return to Work in Unionized Companies
http://reduceyourworkerscomp.com//Return-to-Work-Programs-Unionized-Companies.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
1. How long does an injured employee have to file a claim?
Prior to the filing of a claim, an injured employee must give notice of an accident or injury. Notice of an accident must be given to the employer “as soon as practicable after the happening thereof.” 342.185. A claim for benefits based on a traumatic injury must be filed within two years of the date of injury or death or the last voluntary temporary total disability benefits made by the Employer, whichever is later. KRS 342.185. When temporary total disability benefits have been paid, an IA-2 form must be filed electronically with the Office of Workers’ Claims in order to start the statute. The time limit for filing an occupational disease claim is typically three years. Other conditions require a careful review of the statute. KRS 342.316.
2. What kinds of injuries qualify for workers’ compensation benefits?
In order to be compensable, an injury must be received in the course of and arising out of the employee’s employment. Generally, this does not include injuries sustained going to and coming from work, injuries or disabilities caused primarily by the natural deterioration of some part of the body, injuries that are entirely psychological in nature without some physical component, pre-existing conditions not aggravated by the injury, or injuries caused by the employee being under the influence of drugs or alcohol. However, there will be situations where exceptions do apply.
3. What types of benefits are available to an employee who files a worker’s compensation claim?
An employee is eligible to receive temporary total disability (TTD) benefits if the injury or disability prevents the employee from returning to his or her pre-injury position of employment. The amount of the TTD benefits is calculated as a percentage of the employee’s wages, with a maximum and a minimum amount. Prior approval does not have to be obtained from the Office of Workers’ Claims before terminating temporary total disability benefits. The employer must have reason to believe that the injured worker has (1) reached maximum medical improvement or (2) been released to return to work. KRS 342.0011 (11)(a). It is not reasonable to terminate TTD where an employee is released to perform minimal work but not the type of work customary or that the employee was performing at the time of injury.
If the employee’s injury or disability results in some type of permanent disability, the employee may be eligible for permanent partial disability (PPD) benefits. PPD benefits are calculated using a formula based, in part, upon the percentage of residual whole person impairment recommended by a physician. Weekly benefits are paid over a 420-week or 520-week period depending upon the extent of the disability.
An employee may also be entitled to vocational rehabilitation if unable to return to the type of work previously performed. These benefits usually do not extend past fifty-two weeks.
If the injury or disability renders the employee unable to engage in sustained remunerative employment utilizing the employment skills that he or she has or may reasonably be expected to develop, that employee may be eligible for permanent total disability benefits. These benefits, which are calculated in a manner similar to the TTD benefits, continue for the remainder of the claimant’s lifetime or until the employee qualifies for social security retirement benefits. (workersxzcompxzkit)
If an employee’s death is caused by his or her workplace injury or occupational disease, the spouse and/or dependants of that employee may also be entitled to death benefits. In the case of a dependant spouse, such death benefits are payable for life (or until social security retirement age) with a two-year dowry benefit upon remarriage.
Author: David D. Black, Partner. David Black is an attorney at Dinsmore & Shohl in Cincinnati, OH. He can be reached at David.Black@dinslaw.com or 513-977-8143.
We are accepting short articles* (200-300 words) on WC cost containment. Non-salesy, written from employer’s viewpoint. To: Info@ReduceYourWorkersComp.com. Subject Line: “Blog Submission.” Name/Title, Company, Phone/Cell, Short Bio. See http://www.reduceyourworkerscomp.com/. We will contact you. *Non-compensable.
WC IQ Test: http://www.workerscompkit.com/intro/
Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
New Article: Return to Work in Unionized Companies
http://reduceyourworkerscomp.com//Return-to-Work-Programs-Unionized-Companies.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
16 Steps for Implementing a Transitional Duty Checklist Transitional duty programs are put in place to get your injured employee back to work as soon as possible. This is good for both the company and the employee. Even in a limited capacity, the sooner you can get your injured employee back to work the better. It maintains a stable workforce and helps the employee recover more quickly. Workers' Comp Kit (http://www.workerscompkit.com/) provides a checklist form to indicate how to begin a transitional duty program. Important things a company should do to implement an effective transitional duty program include: 1. Knowing about your states' law in regard to returning an employee to work. 2. Making sure all employees receive the workers' comp policy. 3. Explaining employee rights, roles and responsibilities. 4. Informing treating physicians about your transitional duty policy. 5. Getting treating physicians to approve transitional duty jobs. 6. Hold weekly meetings with the injured employee returning to work for a transitional duty position. During this time therapy and treatment may still continue. As the employee heals, do the following: 1. Remind supervisors of the employee's physical limitations so they do not push him or her to exceed said limitations. 2. Identify transitional duty jobs creatively. Make a wish list of things you'd like to have done but don't have time to do. Consider off-site, work-hardening modified duty programs if you do not have any positions at your workplace. 3. Visit worksites to determine tasks similar to the employee's existing job. 4. Jobs should be meaningful and not demeaning, demoralizing or punitive for the injured employee. 5. Be sure to train the employee in the new position, if needed. 6. Send the transitional duty job offers first class, certified mail with confirmation receipt and enclose a stamped envelope. 7. Be sure not to violate union contracts; work with the unions. For more information, read this article aobut light duty and the unions: http://reduceyourworkerscomp.com//Return-to-Work-Programs-Unionized-Companies.php. 8. Get medical restrictions from the employee's doctor even if the employee isn't quite ready to return to the workforce. 9. Continue to pay the injured employee at their same rate. Consider doing so even if the employee works partial hours to avoid paying lost wage benefits; in many states (e.g. NY) this will reduce future settlements. Be sure to advise your third-party administrator of this. (workersxzcompxzkit) Consult with your insurance broker's claim analyst about this also. 10. Ask the employee for feedback on the transitional duty position – this should begin three to five days after you send the transitional duty offer letter. Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers' Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@ReduceYourWorkersComp.com or 860-786-8286.
WC IQ Test: http://www.workerscompkit.com/intro/ WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php WC Calculator: www.reduceyourworkerscomp.com/calculator.php Follow Us On Twitter: www.twitter.com/WorkersCompKit Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers' comp issues. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
1. How long does an injured employee have to file a claim? An employee can file a claim for up to two years following the date of injury. However, in the case of an occupational disease, such as hearing loss or asbestosis, a disabled employee or the dependant of an employee whose death is caused by an occupational disease must file a claim: 1) within two years after the disability due to the disease began, 2) within six months after the diagnosis of an occupational disease, or 3) within two years after the employee's death; whichever comes later.
2. What kinds of injuries qualify for workers' compensation benefits? In order to be compensable, an injury must be received in the course of and arising out of the employee's employment. Generally, this does not include injuries sustained going to and coming from work, injuries or disabilities incurred in voluntary participation in an employer-sponsored recreation activity after the employee has signed a waiver, injuries or disabilities caused primarily by the natural deterioration of some part of the body, injuries that are entirely psychological in nature without some physical component, pre-existing conditions not substantially aggravated by the injury, or injuries caused by the employee being under the influence of drugs or alcohol. However, there will be situations where exceptions do apply.
3. What types of benefits are available to an employee who files a worker's compensation claim? An employee is eligible to receive temporary total disability (TTD) benefits if the injury or disability prevents the employee from returning to his or her pre-injury position of employment. The amount of the TTD benefits is calculated as a percentage of the employee's wages, with a maximum and a minimum amount. The Bureau of Workers' Compensation will schedule the claimant for an evaluation after 90 days of disability. TTD benefits will cease once a claimant has returned to work, the claimant's treating physician provides a written statement that the claimant is able to return to his or her former position of employment, or the claimant has reached maximum medical improvement.
If a claimant returns to the workforce but is unable to return to his or her former position of employment, that employee may be eligible to receive wage loss compensation for the difference between what he or she was making prior to the injury, and what he or she is currently making. This is known as working wage loss compensation. Payments for working wage loss may continue for up to a maximum of two hundred weeks. In some situations, an employee may also be eligible for wage loss compensation if he or she is unable to find employment consistent with his or her disability as a result of the injury or occupational disease. This is known as non-working wage loss compensation. Payments for non-working wage loss may continue for up to a maximum of 52 weeks, 26 of which will be offset by working wage loss. Both types of wage loss compensation are paid at two-thirds of the lost wages, up to the statewide maximum.
If the employee's injury or disability results in some type of permanent disability, that employee may be eligible for permanent partial disability (PPD) benefits. PPD benefits are also calculated as a percentage of the employee's wages, with a maximum and a minimum amount, and are awarded based on the percentage of residual whole person impairment recommended by a physician. The claimant must wait twenty-six weeks after the date of termination of the latest period of TTD payments to file an application for PPD benefits. In the absence of TTD payments, the claimant must wait twenty-six weeks after the date of the injury or the contraction of the occupational disease to file for PPD benefits.
If the injury or disability renders the employee unable to engage in sustained remunerative employment utilizing the employment skills that he or she has or may reasonably be expected to develop, that employee may be eligible for permanent total disability benefits. These benefits, which are calculated in a manner similar to the TTD and PPD benefits, continue for the remainder of the claimant's lifetime. (workersxzcompxzkit)
If an employee's death is caused by his or her workplace injury or occupational disease, the spouse and/or dependants of that employee may also be entitled to death benefits. In the case of a dependant spouse, such death benefits are payable for life with a two-year dowry benefit upon remarriage.
Author George B. Wilkinson, Partner. Attorney Wilkinson is Workers Compensation Group Practice Leader at Dinsmore & Shohl in Cincinnati, OH. He can be reached at George.wilkinson@dinslaw.com or 513-977-8316. Many thanks to Attorney Wilkinson who has helped my clients and employers reduce workers' comp costs over the last 20 years.
Free WC IQ Test: http://www.workerscompkit.com/intro/ Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php Follow Us On Twitter: www.twitter.com/WorkersCompKit Do not use this information without independent verification. All state laws vary.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Workers Compensation 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.
Every state has it's own unique laws and rules covering workers' compensation and how its handled. Here are answers about West Virginia law from the law firm of Dinsmore & Shohl, authorities on workers' compensation. 1. How long does an injured employee have to file a claim? An employee can file a claim up to six months following the date of injury. However, if the injury is an occupational disease, such as hearing loss or black lung, the employee can file up to three years after the date he or she was last exposed to the condition causing the disease, or three years after he or she was diagnosed with the disease, whichever comes later. 2. What kinds of injuries qualify for workers' compensation benefits? In order to be compensable, an injury must be received in the course of and resulting from the employee's employment. Generally, this does not include injuries sustained going to and coming from work, injuries sustained before or after working hours, injuries that are entirely mental without some physical component, or injuries caused by the employee being under the influence of drugs or alcohol. 3. What types of benefits are available to an employee who files a workers' compensation claim? An employee is eligible to receive temporary total disability (TTD) benefits if the injury prevents him or her from returning to his or her pre-injury position of employment. The amount of the TTD benefits is calculated as a percentage of the employee's wages, with a maximum and a minimum amount. An employee can receive TTD benefits for up to 104 weeks. Otherwise, TTD benefits cease when a claimant reaches maximum medical improvement. (This means the employee's condition has improved as much as it can. The employee may not have returned to 100% of his or her pre-injury health status, but his or her condition is as good as it is going to get.) If the employee's injury results in some type of permanent disability, he or she may be eligible for permanent partial disability (PPD) benefits. PPD benefits are also calculated as a percentage of the employee's wages, with a maximum and a minimum amount, and are awarded based on the percentage of residual whole person impairment recommended by a physician. If the injury renders the employee unable to engage in substantial gainful activity, he or she may be eligible for permanent total disability benefits. These benefits, which are calculated in a manner similar to the TTD and PPD benefits, continue until the employee reaches age 70. (workersxzcompxzkit) Dependents of employees receiving PTD benefits are also eligible for benefits at the time of the employees' death, or who died as the result of a workplace injury or exposure. About the authors Denise D. Klug is a partner in the Litigation Department of Dinsmore & Shohl, LLP. Denise represents companies in the chemical, hospital, steel, trucking and numerous other industries in Ohio and W. Virginia. Denise counsels clients on violations of specific safety requirements, State Fund issues, premium discounts and establishing Drug Free Work Place Programs. She can be reached at denise.klug@dinslaw.com or 304-230-1700. Aimee M. Stern is a member of the Litigation Department of Dinsmore & Shohl, LLP with an emphasis on toxic torts, medical malpractice and workers' compensation. She can be reached at aimee.stern@dinslaw.com or 304-230-1603. Thank you to Dinsmore & Shohl, a law firm that has been helping me reduce claims for over 20 years.
Try Our FREE Tools WC Best Practices Quick Check: http://www.workerscompkit.com/intro/ WC Calculator: www.reduceyourworkerscomp.com/calculator.php TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php Do not use this information without independent verification. All state laws vary.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
A Story in Several Parts – 2 2) Corporate Structure The systemic way a company handles their work injuries is the most critical aspect of a solid workers' compensation control process. The same process can, of course, be used for all absences in the workplace including short and long term disability. Who is responsible for work-related injury reporting and procedures at your company? Is that person familiar with risk management and workers' compensation cost control? If not, they should attend conferences such as RIMS and the National Disability Conferences. They will need management support while they learn the ropes. The person responsible should have adequate resources to become familiar with the types of services available to companies to tightly control the injury process; this type of knowledge is gained through attendance at industry conferences where they attend seminars on point and also browse through the exhibit hall to see the range of services available to them. The person responsible for workplace injuries should receive at least one monthly newsletter or magazine to gain a broad understanding of the subject area. I've worked with several clients where the legal department was responsible for handling workers' compensation claims yet counsel had not had the opportunity to learn risk management techniques. Having started in the risk management field as in-house counsel for a large international company, I learned about risk management by accident. Law schools do not normally teach risk management although the two fields are closely related and most lawyers do not know the field of risk management is a specialized occupation. Corporate personnel often do not ask to attend conferences or subscribe to publications because they do not know these tools exist – they don't know what they don't know! Your structure should fuse different departments into a workers' comp team with one captain. The team leader should be a ‘get it done' person who has a strong workers' comp background. Determine which departments in your company deal with employee injury and absence. All relevant departments should report to the same executive, usually the CFO. There must be communication with all departments handling areas as safety, personnel/human resources, labor relations and the medical department. A good starting place for inter-departmental communication is a brainstorming session to discuss worker safety and injuries. Each department brings any written materials and forms they use for employee injuries and absences. The people responsible for WC must understand the operational side of their business. If they haven't been out into the ‘field' to see the actual operations, that is the first step – head out to see what your company does. While it sounds almost too simplistic to say this, it is an often overlooked step. (workersxzcompxzkit) It is important to have union buy-in so include the director of labor relations; important contract provisions may need to be changed during the next negotiation. Labor relations much coordinate closely with the risk management and medical departments, yet they may be unaware of the important role they play. Author: Rebecca Shafer, J.D. Rebecca is a cost containment consultant with over 20 years experience working with even the most challenged employers helping them implement workers' compensation cost containment solutions. Whether the problem is unions, decentralized workforce or lack of management commitment, our team can help you overcome the challenges. We can be reached at RShafer@ReduceYourWorkersComp.com or 860-786-8286.
Reduce Your Workers Comp: www.ReduceYourWorkersComp.com/ WC Best Practices Quick Check: http://www.workerscompkit.com/intro/ (free quick score) WC Calculator: www.reduceyourworkerscomp.com/calculator.php Do not use this information without independent verification. All state laws vary.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
We all love stories. Stories are entertaining, interesting and informative. So, I am going to tell you a story – all about how to reduce your workers’ compensations from 30% to 60%. Yes, that’s right. It’s been proven over and over and over . . .
A well designed workers’ compensation programs can cut your costs 305 to 60%. Too often however, those in charge rush to buy the latest new product before they understand the problem. Make sure you understand why your costs are high, then develop a comprehensive solution, A PLAN! If you want to reduce your losses quickly, don’t take a ‘dart-board’ approach. To reduce your losses, concentrate sufficient resources in the following areas.
The Data Tells a Story – Review Your Data
The first step is understanding how bad your workers’ compensation losses really are, if in fact they are bad. We know 80% of the cost of WC is losses and 20% is from premium and administrative costs. You must know your loss costs and if you have a problem.
One large entertainment company I worked with recently thought workers’ compensation costs were too high. When we compared their costs to national averages we found their costs actually were half the national average. The company failed to develop benchmarks to take into consideration an increase in the number of employees following a recent acquisition.
I recommend analyzing data to equalize the number of employees. Cost Per Full-time (Equivalent) Employee (FTE) offers a comparison of your company’s divisions regardless of how many full vs. part-time employees each has. The cost as percentage of payroll and cost as percentage of revenue allow you to compare your company to industry averages and establish baseline averages to use for future determination of progress. The return-to-work ratio tells what percentage of employees return to work quickly after the accident. Ideally, 90% of injured employees should return to work within the first four days after an accident. This is perhaps the most important measurement because it is indicative of the length of absence in each claim. (workersxzcompxzkit)
After reviewing data to determine you starting benchmark, select one or two measurements to convey success and progress to upper management and to employees. No one wants to receive 200 pages of data so make it concise – one page is preferable – with corporate then each business unit’s numbers shown individually. The senior management might prefer the Cost per FTE while the employees may relate better to number of lost workdays in their department. When employees understand workers’ comp costs are consuming their potential raises, they will cooperate.
Author: Rebecca Shafer, J.D. Rebecca helps companies reduce workers’ comp costs 20-50%. She has over 20 years of experience and an excellent track record of success. Contact her at RShafer@ReduceYourWorkersComp.com or 860-786-8286
WC Best Practices Quick Check: http://www.workerscompkit.com/intro/
Workers’ Comp Kit Books & Guides: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
Follow Us On Twitter: www.twitter.com/WorkersCompKit
Do not use this information without independent verification.
All state laws vary.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
"All Employers Need to Know and Are UNAFRAID to Ask" Everyone agrees to attain effective cost management in workers' compensation employers need to develop and implement a workers' compensation program, covering EVERY aspect of this very complicated issue. Common sense also tells employers it is not necessary to figure it all out themselves. Rather, astute employers look for plans and programs designed and tested by trustworthy and knowledgeable individuals and tailor a plan fitting their particular industry, workplace environment, and employee culture. Sounds good. Sounds easy! — a little like putting a recipe together? But, as is known, just leave one essential element out of the recipe and the resulting food dish goes south. An effective cost management workers' compensation program needs, at minimum these TWELVE (12) KEYS 1. Management Basics: knowing best practices, involving management at all levels. 2. Knowledge of Adjusters (TPA)* who and what they are and how they function. 3. Management of Injuries: best practices, roles and responsibilities. 4. Employee Communication so they know what policy is, what to do, where to go when injury occurs and after. 5. Procedure for Reporting Injury at the time the injury occurs. 6. Procedure for Post Injury Follow Up: keeping track of the injured worker, healing progress, RTW* status. 7. Medical Care Direction: working with medical providers; looking at injuries from diagnosis to RTW* recommendations; learn medical terms. 8. Return-to-Work Procedure: transitional duty; state and federal leave laws. 9. Indemnity Cost Containment Services such as independent medical evaluations and work hardening. 10. Medical Cost Containment: using nurse case managers; peer and utilization review. 11. Plan to Fight Fraud and Abuse: knowing when to investigate and what type of investigation to use. 12. Training and Building Commitment involving both management and employees. Learn more at: Workers Compensation ToolKit Author: Robert Elliott, J.D.
Our links are now updated. Try them out. Visit Our Websites: ReduceYourWorkersComp and WorkersCompKit Try Our FREE Workers' Comp Best Practices Quick Check
You can still find and use WC Calculator, TD Calculator and WC101 at ReduceYourWorkersComp. Click on the link above. Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
It Isn’t “US” Against “THEM”
Look around. Are there horror stories of how employers, insurance companies and government agencies stick spokes into what should be a smooth-running workers’ compensation process? Oh yes!
Recently the city of Atlanta spent more than $171,000 over a five-year period fighting the claim of five gravely injured city workers – we are talking about one being brain damaged and the other four in wheelchairs. So, what’s the point? The workers have serious, life-altering injuries. Are they likely to return to their jobs? No. It would be better to settle the claims and move them onto permanent disability status thus giving them and their families peace of mind.
Every employer needs to ask: “What is the bottom-line GOAL in resolving injured employees workers’ compensation claims? Reducing the COST & LENGTH of claims and returning the employee to work. While it may be all about the money, it’s also very much about the employee.
Create a Positive, Effective Response When Employees Are Injured
Proactive Communication: Inform employees of the policies, programs and procedures expected of them in the event of a work-related injury.
Be interested in the injured worker’s concerns such as: Who will pay my medical bills? How long will I be out? Will I lose my job? How will I support my family; Do I have a workers’ comp claim? If I can’t do my regular job, is there another one for me?
Have a Plan
1. Know what to do when the injury occurs.
2. Make sure the worker receives prompt, adequate medical care.
3. Send a company representative with them to the medical facility.
4. Complete all relevant paperwork.
5. Arrange for personal items and car to be taken home.
6. Answer questions, be reassuring and convey interest in their well being.
Reactive Communication: Following the injury establish and maintain communications with the injured employee so s/he remains psychologically connected during recuperation and focuses on the final objective of returning to work as soon a medically able as a healthy, productive employee.
1. Remain in weekly telephone contact.
2. Send a get-well card.
3. Set-up weekly meetings at the workplace.
4. Make sure the injured worker keeps all medical appointments, even if you arrange transportation.
5. Arrange for a transitional duty assignment when the worker is medically able.
Employers with a plan can answer questions when they arise (and they will) and allow the parties to resolve them without resorting to lawsuits or other harsh methods. ( workersxzcompxzkit).
Engaging injured workers in an adversarial battle of wit and wills is a death knell to reducing costs and does nothing for the workplace environment, the employee’s attitude or the employer’s reputation. And, sends people running for their lawyers.
Author: Robert Elliott, J.D.
Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
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Coordinating Medical Care, Medical Cost Containment & Managed Care, Medical Issues, WC 101, Workers Comp Kit |
